3D Finite Element Study on: Bar Splinted Implants Supporting Partial Denture in the Reconstructed Mandible
Keywords:Finite element method, Stress Distribution, Bar splinted implants, Reconstructed Mandible, Partial Denture
AIM: This study aimed to estimate the stress patterns induced by the masticatory loads on a removable prosthesis supported and retained by bar splinted implants placed in the reconstructed mandible with two different clip materials and without clip, in the fibula-jaw bone and prosthesis using finite element analysis.
METHODS: Two 3D finite element models were constructed, that models components were modeled on commercial CAD/CAM software then assembled into finite element package. Vertical loads were applied simulating the masticatory forces unilaterally in the resected site and bilaterally in the central fossa of the lower first molar as 100N (tension and compression). Analysis was based on the assumption full osseointegration between different types of bones, and between implants and fibula while fixing the top surface of the TMJ in place.
RESULTS: The metallic bar connecting the three implants is insensitive to the clips material. Its supporting implants showed typical behavior with maximum stress values at the neck region. Fibula and jaw bone showed stresses within physiologic, while clips material effect seems to be very small due to its relatively small size.CONCLUSION: Switching loading force direction from tensile to compression did-not change the stresses and deformations distribution, but reversed their sign from positive to negative.
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Hoffman GR, Islam S, Eisenberg RL. Microvascular reconstruction of the mouth, face and jaws. Oromandibular reconstruction - free fibula flap. Aust Dent J. 2012;57(3):379-87.
Dalkiz M, Beydemir B, GÃ¼naydin Y. Treatment of a microvascular reconstructed mandible using an implant-supported fixed partial denture: case report. Implant Dent. 2001;10(2):121-5.
Schrag C, Chang YM, Tsai CY, Wei FC. Complete rehabilitation of the mandible following segmental resection. J Surg Oncol. 2006;94(6):538-45.
Lizuka T, Hafliger J, Seto I, Rahal A. Oral rehabilitation after mandibular reconstruction using an osteocutaneous fibula free flap with endosseous implant, Factors affecting functional outcome in patients with oral cancer. Clinical Oral Implant Research. 2005;16(1):69-79.
Parbo N, Murra NT, Andersen K, Buhl J, Kiil B, NÃ¸rholt SE. Outcome of partial mandibular reconstruction with fibula grafts and implant-supported prostheses. Int J Oral Maxillofac Surg. 2013;42(11):1403- 8.
Converse JM, Kawamoto HK, Wood-Smith D, Coccaro PJ, McCarthy JG. Deformities of the Jaws. In Converse JM. (Ed.), Reconstructive Plastic Surgery, Second Edition, W.B. Saunders Co., Philadelphia, 1977.
Yagihara K, Okabe S, Ishii J, Amagasa T, Yamashiro M, Yamaguchi S, et al. Mandibular reconstruction using a poly (L-lactide) mesh combined with autogenous particulate cancellous bone and marrow: a prospective clinical study. Int J Oral Maxillofac Surg. 2013;42(8):962-9.
Riediger D. Restoration of masticatory function by microsurgically revascularized bone grafts using endosseous implants. Plastic reconstruction surgery. 1988;81(6):861-77.
Helman JI, Blanchaert RH. Microvascular free tissue transfer. Peterson's principles of oral and maxillofacial surgery, London, Decker 2004:803-19.
Myoung H., KimYy, Heo Ms, Lee Ss. Comparative radiologic study of bone density and cortical thickness of donor bone. Oralsurgery, oralmedicine, Oral Radiology, 2001; 92(1): 23-9.
Teoh Kh, Hcryn Jm, Patel S, Halpern J, Tunick S, Wong HB, et al. Implant prosthodontic rehabilitation of fibula free flap reconstructed mandible. Int J of Oral Maxillofac Implants. 2005;20(1):738-46.
Urken ML, Buchbinder D, Weinberg H, Vickery C, Sheiner A, Biller HF. Primary placement of osseointegrated implants in microvascular mandibular reconstruction. Otolaryngol Head Neck Surg. 1989;101(1):56-73.
Bahr W, Stoll P, Wachter R. Use of the "double barrel" free vascularized fibula in mandibular reconstruction. J Oral Maxillofac Surg. 1998;56(1):38-44.
Garrett N, Roumanas ED, Blackwell KE, Freymiller E, Abemayor E, Wong WK, et al. Efficacy of conventional and implant supported mandibular resection prostheses: Study overview and treatment outcomes. Journal of prosthetic dentistry. 2006;96(1):13-24.
Roumanas ED, Garrett NR, Blackwell KE. Masticatory swallowing threshold performances with conventional and implant supported prostheses after mandibular fibula free flap reconstruction. J Prosthet Dent. 2006;96:289-97.
Chana JS, Chang YM, Wei FC. Segmental mandibulectomy and immediate free fibula osteoseptocutaneous flap reconstruction with endosteal implants. An ideal treatment method for mandibular ameloblastoma. J Plast Reconstr Surg. 2004;1:80-7.
Beumer J, Curtis TA, Marunick MT. Maxillofacial rehabilitation: prosthodontic and surgical management of cancer related, acquired and congenital defects of the head and neck. Third Edition. Quintessence publishing co., 2011.
Naert I, Al saadi G, Van steenberghe D. A 10- year randomized clinical trial on the influence of splinted and un-splinted oral implants retaining mandibular overdentures: peri implant outcome. Int J of Oral Maxillofac Implants. 2004;19(1):695-702.
Tie Y, Wang DM, Ji T, Wang CT, Zhang CP. Three-dimensional finite-element analysis investigating the biomechanical effects of human mandibular reconstruction with autogenous bone grafts. J of Cranio Maxillofac Surgery. 2006;34(1):290-8.
Nagasao T, Kobayashi M, Tsuchiya Y, Kaneko T, Nakajima T. Finite element analysis of the stresses around endosseous implants in various reconstructed mandibular models. J of Cranio Maxillofac Surgery. 2002;30(1):170-7.
Nagasao T, Miyamoto J, Kawana H. Biomechanical evaluation of implant placement in the reconstructed mandible. Int J of Oral Maxillofac Implants. 2009;24(1):999-1005.
Strackee SD, Kroon FHM, Bos KE. Fixation methods in mandibular reconstruction using fibula grafts. J Head Neck Surg. 2000;23:1-7.
Kohnke P. ANSYS Theory Reference Manual, Ansys Inc., Canonsburg, PA, USA, 2013.
Ken Y, Noriko T, Shohei K. Three-dimensional finite elemental analysis of bone stress near an implant placed at the border between mandible and fibular graft in mandibular reconstruction. Open Journal of Regenerative Medicine (OJRM). 2015;4:35-45.
El-Anwar MI, El-Mofty MS, Fawzy UM. The influence of different gingival thickness on stress to implant-supported overdenture and bone. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS). 2014;13(3):17-23.
Valentim A, Wirley C, Lucas F. Effect of mucosa thickness on stress distribution of implant retained overdenture. J Comp Meth Prog Biomed. 2008;92:213-23.
Ree JS. An investigation into the importance of the periodontal ligament and alveolar bone as supporting structures in finite element studies. J Oral Rehabil. 2001;5:425-32.
Militsakh ON, Werle A. Comparison of radial forearm with fibula and scapula osteocutaneous free flaps for oromandibular reconstruction. J Otolaryng Head Neck Surg. 2005;131:571-5.
Gaggl AJ, Burger HK, Chiari FM. The microvascular osteocutaneous femur transplant for covering combined alveolar ridge and floor of mouth defects: preliminary report. J Reconstr Microsurg. 2008;24:169-75.
Hundepool AC, Dumans AG, Hafer S. Rehabilitation after mandibular reconstruction with fibula free flap: clinical outcome and quality of life assessment. Int J Oral Maxillofac Surg. 2008;11:1009-13.
Balouri A, Zatman RR. Fabrication of custom clips for bar and clip attachments for implant supported overdentures. J prosthet Dent. 2006;96:379-80.
Krennmair G, Krainhofer M, Piehslinger E. The influence of bar design on prosthodontic maintenance of mandibular overdentures supported by four implants. Int J Prosthodont. 2008;21:514-20.
Trakas T, Michalakis K, Kang K. Attachment systems for implant retained overdentures. J Impl Dent. 2006;15:24-34.
Sugivra T, Horiuchi K, Kusano M. Stress analysis of mandibular reconstruction using fibular grafts by the three dimensional finite element method. J Distract Osteogen and Reconstr Surg. 2000;2:165-70.
Menicucci G, Lorenzetti M, Pera P. Mandibular implant retained overdenture: finite element analysis of two anchorage systems. Int J Oral Maxillofac Impl. 1998;13:369-75.
Kawasaki T, Takayama Y, Yamada T. Relationship between the stress distribution and the shape of the alveolar residual ridge: Three dimensional behaviour of a lower complete denture. J Oral Rehabil. 2001;28:950-4.
Almeida EO, Rocha EP, Freitas JÃºnior AC, Anchieta RB, Poveda R, Gupta N, et al. Tilted and short implants supporting fixed prosthesis in an atrophic maxilla: A 3D-FEA biomechanical evaluation. Clinical Implant Dentistry and Related Research. 2015;17(1):e332-42.
Nagaso T, Miyamoto J, Kawana H. Biomechanical evaluation of implant placement in the reconstructed mandible. Int J Oral Maxillofac Impl. 2009;24:999-1005.
Wong R, Tideman H, Merkx M. Finite element analysis of ednoprosthesis reconstruction of the mandible. J Cranio Maxillofac Surg. 2012;40:487-97.
Enlow DH. Wolff's law and the problem of muscle attachment on resorptive surfaces of bone. Am J Phys Anthropol. 1966;24:205-13.
JÄ™drusik-PawÅ‚owskam, Kromka-Szydek M, Katram, Niedzielska I. Mandibular reconstruction biomechanical strength analysis (FEM) based on a retrospective clinical analysis of selected patient. Acta of Bioengineering and Biomechanics. 2013;15(2):32-31.
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