Mineral heterogeneity affects predictions of intratrabecular stress and strain.

Knowledge of the influence of mineral variations (i.e., mineral heterogeneity) on biomechanical bone behavior at the trabecular level is limited. The aim of this study is to investigate how this material property affects the intratrabecular distributions of stress and strain in human adult trabecular bone. Two different sets of finite element (FE) models of trabecular samples were constructed; tissue stiffness was either scaled to the local degree of mineralization of bone as measured with microCT (heterogeneous) or tissue stiffness was assumed to be homogeneous. The influence of intratrabecular mineral heterogeneity was analyzed by comparing both models. Interesting effects were seen regarding intratrabecular stress and strain distributions. In the homogeneous model, the highest stresses were found at the surface with a significant decrease towards the core. Higher superficial stresses could indicate a higher predicted fracture risk in the trabeculae. In the heterogeneous model this pattern was different. A significant increase in stress with increasing distance from the trabecular surface was found followed by a significant decrease towards the core. This suggests trabecular bending during a compression. In both models a decrease in strain values from surface to core was predicted, which is consistent with trabecular bending. When mineral heterogeneity was taken into account, the predicted intratrabecular patterns of stress and strain are more consistent with the expected biomechanical behavior as based on mineral variations in trabeculae. Our findings indicate that mineral heterogeneity should not be neglected when performing biomechanical studies on topics such as the (long-term or dose dependent) effects of antiresorptive treatments.

Postnatal development of fiber type composition in rabbit jaw and leg muscles.

We examined the difference in fiber type composition and cross-sectional areas during postnatal development in male rabbit jaw muscles and compared these with changes in leg muscles. The myosin heavy chain (MyHC) content of the fibers was determined by immunohistochemistry. No fiber type difference was found between the jaw muscles in 20-week-old rabbits. However, the way this adult fiber type composition was reached differed between the muscles. The deep temporalis, medial pterygoid, and superficial masseter displayed an increase in alpha fibers during early and a decrease during late postnatal development. Other jaw muscles displayed an increase in alpha fibers during early development only. In contrast, alpha fibers were not found in the soleus, in which fiber type changes were completed at week 4. The gastrocnemius muscle did not change its fiber type composition. Initially, fibers in jaw-opening muscles had larger cross-sectional areas than in other muscles, but they increased less during development. Although there were no large differences in the fiber type composition of muscles in young adult rabbits, large differences were found in the jaw muscles, but not in the leg muscles, during development. In part, these developmental changes in fiber percentages within the jaw muscles can be explained by functional modifications in this muscle group. In the present study, the deep temporalis, medial pterygoid, and superficial masseter showed the most dramatic percent changes in fibers during postnatal development.

Biomechanical effect of mineral heterogeneity in trabecular bone.

Due to daily loading, trabecular bone is subjected to deformations (i.e., strain), which lead to stress in the bone tissue. When stress and/or strain deviate from the normal range, the remodeling process leads to adaptation of the bone architecture and its degree of mineralization to effectively withstand the sustained altered loading. As the apparent mechanical properties of bone are assumed to depend on the degree and distribution of mineralization, the goal of the present study was examine the influences of mineral heterogeneity on the biomechanical properties of trabecular bone in the human mandibular condyle. For this purpose nine right condyles from human dentate mandibles were scanned and evaluated with a microCT system. Cubic regional volumes of interest were defined, and each was transformed into two different types of finite element (FE) models, one homogeneous and one heterogeneous. In the heterogeneous models the element tissue moduli were scaled to the local degree of mineralization, which was determined using microCT. Compression and shear tests were simulated to determine the apparent elastic moduli in both model types. The incorporation of mineralization variation decreased the apparent Young's and shear moduli by maximally 21% in comparison to the homogeneous models. The heterogeneous model apparent moduli correlated significantly with bone volume fraction and degree of mineralization. It was concluded that disregarding mineral heterogeneity may lead to considerable overestimation of apparent elastic moduli in FE models.

Spatial orientation in bone samples and Young's modulus.

Bone mass is the most important determinant of the mechanical strength of bones, and spatial structure is the second. In general, the spatial structure and mechanical properties of bones such as the breaking strength are direction dependent. The mean intercept length (MIL) and line frequency deviation (LFD) are two methods for quantifying directional aspects of the spatial structure of bone. Young's modulus is commonly used to describe the stiffness of bone, which is also a direction-dependent mechanical property. The aim of this article is to investigate the relation between MIL and LFD on one hand and Young's modulus on the other. From 11 human mandibular condyles, 44 samples were taken and scanned with high-resolution computer tomography equipment (micro-CT). For each sample the MIL and LFD were determined in 72602 directions distributed evenly in 3D space. In the same directions Young's modulus was determined by means of the stiffness tensor that had been determined for each sample by finite element analysis. To investigate the relation between the MIL and LFD on one hand and Young's modulus on the other, multiple regression was used. On average the MIL accounted for 69% of the variance in Young's modulus in the 44 samples and the LFD accounted for 72%. The average percentage of variance accounted for increased to 80% when the MIL was combined with the LFD to predict Young's modulus. Obviously MIL and LFD to some extent are complementary with respect to predicting Young's modulus. It is known that directional plots of the MIL tend to be ellipses or ellipsoids. It is speculated that ellipsoids are not always sufficient to describe Young's modulus of a bone sample and that the LFD partly compensates for this.

Is fiber-type composition related to daily jaw muscle activity during postnatal development?

AIM: Muscles containing large numbers of slow-contracting fibers are generally more active than muscles largely composed of fast fibers. This relationship between muscle activity and phenotype suggests that (1) changes in fiber-type composition during postnatal development are accompanied by changes in daily activity and (2) individual variations in fiber-type composition are related to similar variations in daily muscle activity. METHODS: The masseter and digastric muscles of 23 New Zealand White rabbits (young, juvenile and adult) were examined for their phenotype (myosin heavy chain content) and their daily activity (total daily number of activity bursts). RESULTS: During development, the masseter showed a strong increase in the number of fast-type fibers compared to the number of slow-type fibers. During development, also the number of powerful bursts in the masseter increased. The digastric showed no significant changes in fiber types or burst numbers. Within each muscle, across individual animals, no significant correlations (R < 0.70) were found between any of the fiber types and daily burst numbers in any of the age groups. CONCLUSIONS: The results suggest that activity-related influences are of relatively minor importance during development and that other factors are dominant in determining fiber-type composition.

Consequences of viscoelastic behavior in the human temporomandibular joint disc.

The consequences of the viscoelastic behavior of the temporomandibular joint disc were analyzed in simulated jaw open-close cycles. It was hypothesized that viscoelasticity helps protect the underlying bone, while augmenting the smoothness of articular movements. Simulations were performed with a dynamic model of the masticatory system, incorporating the joints' cartilaginous structures as Finite Element Models. A non-linear viscoelastic material model was applied for the disc. The apparent stiffness of the disc to principal stress was largest when the jaw was closed, whereas, with the Von Mises' stress, it appeared largest when the jaw was open. The apparent stiffnesses appeared to be dependent on both the speed of the movements and the presence of a resistance between the teeth. It was concluded that the disc becomes stiffer when load concentrations can be expected. During continued cyclic motion, it softens, which favors smoothness of joint movement at the cost of damage prevention.

Regional variations in mineralization and strain distributions in the cortex of the human mandibular condyle.

The strain (i.e. deformation) history influences the degree of mineralization of cortical bone (DMB) as well as its osteonal microstructure. This study aimed to examine the relationships of stress and strain distributions with the variations in DMB and the osteonal orientations in the cortical bone of the human mandibular condyle. It was hypothesized that strains are inversely proportional to local DMB and that the principal strains are oriented parallel to the osteons. To test this, ten human mandibular condyles were scanned in a microCT system. Finite element models were created in order to simulate static clenching. Within each condyle, 18 volumes of interest were selected to analyze regional differences in DMB, stress and strains. Subchondral bone showed a lower equivalent strain (2652+/-612 muepsilon) as compared to the anterior (p=0.030) and posterior cortex (p=0.007) and was less mineralized. Contrary to our hypothesis, the results show that strains correlated positively with regional variations in DMB (r=0.750, p<0.001). In the anterior and the posterior cortex, the first principal strain was parallel to the cortical surface and oriented supero-inferiorly with a fan-like shape. In subchondral bone, the first and the second principal strain were parallel to the surface and oriented antero-posteriorly and medio-laterally, respectively. It was concluded that the strain distributions, by themselves, cannot explain the regional differences found in DMB. In agreement with our second hypothesis, the orientation of the osteonal network of the mandibular condyle was closely related to the strain orientations. The results of this study suggest that the subchondral and the cortical bone are structured to ensure an optimal load distribution within the mandibular condyle and have a different mechanical behaviour. Subchondral bone plays a major role in the transmission of the strains to the anterior and posterior cortex, while these ensure an optimal transmission of the strains within the condylar neck and, eventually, to the mandibular ramus.

Heterogeneity of fiber characteristics in the rat masseter and digastric muscles.

The functional requirements in muscle use are related to the fiber type composition of the muscles and the cross-sectional area of the individual fibers. We investigated the heterogeneity in the fiber type composition and fiber cross-sectional area in two muscles with an opposing function, namely the digastric and masseter muscles (n = 5 for each muscle) of adult male rats, by means of immunohistochemical staining according to their myosin heavy chain (MyHC) content. The digastric and masseter muscles were taken from Wistar strain male rats 10 weeks old. In the masseter six predefined sample locations were examined; in the digastric four. Most regions showed dominant proportions of type IIA and IIX fibers. However, both muscles also revealed a regional heterogeneity in their fiber type distribution. In the digastric, type I fibers were detected only at the central and deep areas of the anterior and posterior belly, respectively. Meanwhile, the peripheral area of the anterior belly contained a higher proportion of type IIB fibers. In the masseter, the type I fibers were absent. In the superficial masseter the distribution of IIA and IIB fibers was significantly different between the superior and inferior regions. In the deep masseter, regional differences were observed among all four examined areas, of which the posterolateral region contained the highest proportion of type IIB fibers. The cross-sectional areas of type IIB fibers were always the largest, followed by the type IIX and IIA fibers. Only a few differences in cross-sectional area of corresponding fiber types were detected between the various sites. In conclusion, the masseter and digastric muscles showed an obvious heterogeneity of fiber type composition and fiber cross-sectional area. Their heterogeneity reflects the complex role of the both muscles during function. This detailed description of the fiber type composition can serve as a reference for future studies examining the muscular adaptations after the onset of various diseases in the masticatory system.

Porosity of human mandibular condylar bone.

Quantification of porosity and degree of mineralization of bone facilitates a better understanding of the possible effects of adaptive bone remodelling and the possible consequences for its mechanical properties. The present study set out first to give a three-dimensional description of the cortical canalicular network in the human mandibular condyle, in order to obtain more information about the principal directions of stresses and strains during loading. Our second aim was to determine whether the amount of remodelling was larger in the trabecular bone than in cortical bone of the condyle and to establish whether the variation in the amount of remodelling was related to the surface area of the cortical canals and trabeculae. We hypothesized that there were differences in porosity and orientation of cortical canals between various cortical regions. In addition, as greater cortical and trabecular porosities are likely to coincide with a greater surface area of cortical canals and trabeculae available for osteoblastic and osteoclastic activity, we hypothesized that this surface area would be inversely proportional to the degree of mineralization of cortical and trabecular bone, respectively. Micro-computed tomography was used to quantify porosity and mineralization in cortical and trabecular bone of ten human mandibular condyles. The cortical canals in the subchondral cortex of the condyle were orientated in the mediolateral direction, and in the anterior and posterior cortex in the superoinferior direction. Cortical porosity (average 3.5%) did not differ significantly between the cortical regions. It correlated significantly with the diameter and number of cortical canals, but not with cortical degree of mineralization. In trabecular bone (average porosity 79.3%) there was a significant negative correlation between surface area of the trabeculae and degree of mineralization; such a correlation was not found between the surface area of the cortical canals and the degree of mineralization of cortical bone. No relationship between trabecular and cortical porosity, nor between trabecular degree of mineralization and cortical degree of mineralization was found, suggesting that adaptive remodelling is independent and different between trabecular and cortical bone. We conclude (1) that the principal directions of stresses and strains are presumably directed mediolaterally in the subchondral cortex and superoinferiorly in the anterior and posterior cortex, (2) that the amount of remodelling is larger in the trabecular than in the cortical bone of the mandibular condyle; in trabecular bone variation in the amount of remodelling is related to the available surface area of the trabeculae.

Development and implementation of new educational concepts in a dental curriculum.

The Academic Centre for Dentistry Amsterdam introduced a fully renewed 5-year dental curriculum in September 2003. In this article, the educational principles and didactic choices that form the basis of the curriculum development are presented and attention is given to the process of development and the implementation strategy that constitute such an important part of the success of introducing a new curriculum. Special characteristics of the new curriculum are the clinical training practice, professional conduct, the elective profiles and academic education. In clinical practice, groups of students from different levels run a group practice in which they learn to work together, delegate tasks, solve clinical problems and apply evidence-based dentistry. In the new curriculum students learn to conduct themselves as professionals. In the third and in the fifth year, students choose an elective profile oriented, respectively, on research and on clinical knowledge and skills. Academic education is an important spearhead in this curriculum in which students not only learn why research is important to dentistry but also how dentists can use research to their own benefit. In development and implementation, a stepwise approach was used in which as many people as logistically possible were involved.

Variations in mineralization affect the stress and strain distributions in cortical and trabecular bone.

The mechanical properties of bone depend largely on its degree and distribution of mineralization. The present study analyzes the effect of an inhomogeneous distribution of mineralization on the stress and strain distributions in the human mandibular condyle during static clenching. A condyle was scanned with a micro-CT scanner to create a finite element model. For every voxel the degree of mineralization (DMB) was determined from the micro-CT scan. The Young's moduli of the elements were calculated from the DMB using constant, linear, and cubic relations, respectively. Stresses, strains, and displacements in cortical and trabecular bone, as well as the condylar deformation (extension along the antero-posterion axis) and compliance were compared. Over 90% of the bone mineral was located in the cortical bone. The DMB showed large variations in both cortical bone (mean: 884, SD: 111 mg/cm(3)) and trabecular bone (mean: 738, SD: 101 mg/cm(3)). Variations of the stresses and the strains were small in cortical bone, but large in trabecular bone. In the cortical bone an inhomogeneous mineral distribution increased the stresses and the strains. In the trabecular bone, however, it decreased the stresses and increased the strains. Furthermore, the condylar compliance remained relatively constant, but the condylar deformation doubled. It was concluded that neglect of the inhomogeneity of the mineral distribution results in a large underestimation of the stresses and strains of possibly more than 50%. The stiffness of trabecular bone strongly influences the condylar deformation. Vice versa, the condylar deformation largely determines the magnitude of the strains in the trabecular bone.

Viscoelastic material model for the temporomandibular joint disc derived from dynamic shear tests or strain-relaxation tests.

Viscoelastic material models for the temporomandibular joint disc, based upon strain relaxation, were considered to underestimate energy absorption for loads with time constants beyond the relaxation time. Therefore, the applicability of a material model that takes the viscous behavior at a wide range of frequencies into account was assessed. To that purpose a non-linear multi-mode Maxwell model was tested in cyclic large-strain compression tests. Its material constants were approximated from dynamic small-strain shear deformation tests. The storage and loss moduli as obtained from a disc sample could be approximated with a four-mode Maxwell model. In simulated large-strain compression tests it behaved similarly as observed from the experimental tests. The underestimation of energy dissipation, as obtained from a single-mode Maxwell model was considerably reduced, especially for deformations with a higher strain rate. Furthermore, in contrast to the latter it was able to predict the increase of the stress amplitude with the compression frequency much better. In conclusion, the applied four-mode Maxwell model, based upon dynamic shear tests, was considered more suitable to predict higher frequency viscoelastic response, for instance during shock absorption, than a model based upon strain-relaxation.

Duty time of rabbit jaw muscles varies with the number of activity bursts.

The relative duration of muscle activity during a specified period (duty time) varies depending on activity level and time of the day. Since both the number and the length of activity bursts contribute to the duty time, it was hypothesized that these variables would show intra-day variations similar to those of the duty time. To test this, we determined duty times, burst numbers, and burst lengths per hour, in relation to multiple activity levels, in a 24-hour period of concurrent radio-telemetric long-term electromyograms of various rabbit jaw muscles. The marked intra-day variation of the burst number resembled that of the duty time in all muscles, and was in contrast to the relatively invariable mean burst length. Furthermore, the duty times were more highly correlated with the number than with the length of bursts at all activity levels. Thus, the variation of the duty time in rabbit jaw muscles is caused mainly by changes in burst numbers.

[Transient paresis after mandibular block anaesthesia]. / Parese na mandibulaire blokanesthesie.

Mandibular block anaesthesia is frequently used in dentistry. The technique is more susceptible to failure than local anaesthesia by infiltration. Two cases of patients who were afflicted by transient paresis of (branches of) the facial and vagus nerves after mandibular block anaesthesia have been analysed. With reference to both these cases advice is given on how to react in case of a misdirected mandibular block anaesthesia.

Degree and distribution of mineralization in the human mandibular condyle.

The degree of mineralization of bone (DMB) in the mandibular condyle reflects the age and remodeling rate of the bone tissue. Quantification of DMB facilitates a better understanding of possible effects of adaptive remodeling on mineralization of the condyle and its possible consequences for its mechanical quality. We hypothesized differences in the degree and distribution of mineralization between trabecular and cortical bone and between various cortical regions. Microcomputed tomography was used to measure mineralization in 10 human mandibular condyles. Mean DMB was higher in cortical (1,045 mg hydroxyapatite/cm(3)) than in trabecular bone (857 mg/cm(3)) and differed significantly between cortical regions (anterior 987 mg/cm(3), posterior 1,028 mg/cm(3), subchondral 1,120 mg/cm(3)). The variation of DMB distribution was significantly larger in the anterior cortex than in the posterior and subchondral cortex, indicating a larger amount of heterogeneity of mineralization anteriorly. Within the cortical bone, DMB increased with the distance from the cortical canals to the periphery. Similarly, the DMB of trabecular bone increased with the distance from the surface of the trabeculae to their cores. It was concluded that the rate of remodeling differs between condylar trabecular and cortical bone and between cortical regions and that DMB is not randomly distributed across the bone. The difference in DMB between condylar cortical and trabecular bone suggests a large difference in Young's modulus.

Prediction of volumetric strain in the human temporomandibular joint cartilage during jaw movement.

Human temporomandibular joint loading causes pressurization and flow of interstitial fluid in its cartilaginous structures. This largely determines its load-bearing and maintenance capacity. It was hypothesized that during cyclical jaw movements normal pressure distribution dynamics would enable fluid to reach all necessary cartilage regions. This was tested qualitatively by analysis of local volumetric strain dynamics during jaw open-close movements predicted by a dynamic model of the human masticatory system. Finite-element analysis was performed in separate regions of the articular cartilage layers and articular disc. Heterogeneous patterns of dilatation and compression were predicted. Compression was found to be more dominant during jaw closing than opening. The pressure gradient in the superior layer of the articular disc was more mediolaterally orientated than in its inferior layer. The findings suggest that, where necessary, regionally the cartilage can imbibe fluid to protect the subchondral bone from impact loads effectively. In the disc itself presumably all areas receive regular refreshment of interstitial fluid.

A sensitive method for measuring spatial orientation in bone structures.

OBJECTIVES: This article introduces the newly developed line frequency deviation (LFD) method for measuring the orientation of the trabecular structure and shows that it is more sensitive than the mean intercept length (MIL) method that is commonly used. METHODS: The LFD method, which has been developed to measure the orientation of bone on two-dimensional X-ray images, was expanded to handle three-dimensional shapes. For the purpose of comparison, both the LFD and the MIL methods were applied to micro CT scans of 24 trabecular bone samples as well as to 24 simple synthetic samples. LFD and MIL values were calculated in various directions and collected in polar plots. Next, the anisotropy was quantified by calculating the coefficient of variation as well as by fitting ellipsoids through the plots. RESULTS: The MIL method yielded smooth rather spherical ellipsoidal polar plots with almost no sensitivity for changes in structure. The LFD method yielded more slender polar plots and more sensitivity for geometrical changes. The LFD method yielded significantly more anistropy and larger variation in anisotropy. CONCLUSIONS: The LFD method is a more sensitive descriptor of spatial orientation of bone structures than the MIL method.

Dynamic mechanics in the pig mandibular symphysis.

During mastication, various biomechanical events occur at the mammalian jaw symphysis. Previously, these events have been studied in the static environment, or by direct recording of surface bone strains. Thus far, however, it has not been possible to demonstrate directly the forces and torques passing through the symphysis in association with dynamically changing muscle tensions. Therefore, we modified a previously published dynamic pig jaw model to predict the forces and torques at the symphysis, and related these to simulated masticatory muscle tensions, and bite, joint and food bolus forces. An artificial rigid joint was modelled at the symphysis, allowing measurements of the tri-axial forces and torques passing through it. The model successfully confirmed three previously postulated loading patterns at the symphysis. Dorsoventral shear occurred when the lower teeth hit the artificial food bolus. It was associated with balancing-side jaw adductor forces, and reaction forces from the working-side bite point. Medial transverse bending occurred during jaw opening, and was associated with bilateral tensions in the lateral pterygoid. Lateral transverse bending (wishboning) occurred at the late stage of the power stroke, and was associated with the actions of the deep and superficial masseters. The largest predicted force was dorsoventral shear force, and the largest torque was a 'wishboning' torque about the superoinferior axis. We suggest that dynamic modelling offers a new and powerful method for studying jaw biomechanics, especially when the parameters involved are difficult or impossible to measure in vivo.

Postnatal transitions in myosin heavy chain isoforms of the rabbit superficial masseter and digastric muscle.

We investigated the early (< 8 weeks) and late (> 8 weeks) postnatal development of the fibre type composition and fibre cross-sectional area in the superficial masseter and digastric muscle of male rabbits. It was hypothesized, first, that due to the transition between suckling and chewing, during early postnatal development the increase in the proportion of slow fibre types and in fibre cross-sectional areas would be larger in the masseter than in the digastric; and second, that due to the supposed influence of testosterone during late postnatal development, the proportion of slow fibre types in both muscles would decrease. Fibre types were classified by immunostaining according to their myosin heavy chain (MyHC) content. The proportion of slow fibre types significantly increased in the masseter, from 7% at week 1 to 47% at week 8, and then decreased to 21% at week 20, while in the digastric it increased from 5% in week 1 to 19% at week 8 and remained the same thereafter. The changes in the proportion of fast fibre types were the opposite. The remarkable increase and decrease in the proportion of slow fibre types in the masseter was attributed predominantly to MyHC-cardiac alpha fibres. During early development, the cross-sectional area of all fibres in both muscles increased. However, only the fast fibre types in the masseter continued to grow further after week 8. Before weaning, the fast fibre types in the digastric were larger than those in the masseter, but after week 8, they became larger in the masseter than in the digastric. In adult animals, masseter and digastric had the same percentage of fast fibre types, but these fibres were almost twice as large in masseter as in digastric.