Influence of the expansion screw height on the dental effects of the hyrax expander: a study with finite elements.

INTRODUCTION: Our objective was to evaluate the influence of the expansion screw height of a hyrax expander on the degree of dental inclination during rapid maxillary expansion by using the finite element method. METHODS: The hyrax expander and the maxillary arch were modeled by using Solidworks software (Dassault Systèmes, Paris, France). Three distinct finite element method models were created by simulating different screw heights relative to the plane that intersected the center of resistance of the maxillary first molars. These 3 relative positions were 10 mm below the maxillary first molars' center of resistance, at the same level as the maxillary first molars' center of resistance, and 10 mm above the maxillary first molars' center of resistance. The initial activation of the expanders was simulated, and tooth displacements for each finite element method model were registered in the buccolingual, corono-apical, and mesiodistal directions. RESULTS: The simulations tested showed that the 3 hyrax screw heights had different dental tipping tendencies. When the screw was simulated below the maxillary first molars' center of resistance, buccal tipping of the crowns and lingual tipping of the roots were registered. This tendency decreased when the screw was simulated at the same level as the maxillary first molars' center of resistance. However, when the screw was simulated above the maxillary first molars' center of resistance, the tipping tendency was inverted, with the crowns displaying lingual tipping and the roots displaying buccal tipping. CONCLUSIONS: These findings might explain the importance of carefully planning the height of the hyrax expander screw, since, depending on this position, different tooth movements can be achieved. From an orthopedic perspective, the ideal screw position might be slightly above the maxillary first molars' center of resistance; this would generate less dental tipping.

Stress patterns on implants in prostheses supported by four or six implants: a three-dimensional finite element analysis.

PURPOSE: Using the three-dimensional finite element method (FEM), this study compared the biomechanical behavior of the "All-on-Four" system with that of a six-implant-supported maxillary prosthesis with tilted distal implants. The von Mises stresses induced on the implants under different loading simulations were localized and quantified. MATERIALS AND METHODS: Three-dimensional models representing maxillae restored with an "All-on-Four" and with a six-implant-supported prosthesis were developed in three-dimensional design software and then transferred into FEM software. The models were subjected to four different loading simulations (full mouth biting, canine disclusion, load on a cantilever, load in the absence of a cantilever). The maximum von Mises stresses were localized and quantified for comparison. RESULTS: In both models, in all loading simulations, the peak stress points were always located on the neck of the distal tilted implant. The von Mises stress values were higher in the "All-on-Four" model (7% to 29%, higher, depending on the simulation). In the presence of a cantilever, the maximum von Mises stress values increased by about 100% in both models. CONCLUSIONS: The stress locations and distribution patterns were similar in the two models. The addition of implants resulted in a reduction of the maximum von Mises stress values. The cantilever greatly increased the stress.