Numerical Study of Mechanical Development of Patient-Specific Mandibular Reconstruction Implant
Abstract
Introduction: Patient-specific mandibular reconstruction implants are a new technique to deal with ameloblastoma tumors. Although they could solve the integration problem which is attributed to the graft reconstruction approach, they may increase the risk of infection due to poor blood supply around it. Using bone grafts besides customized plates with smaller geometries would be considered as an alternative. However, they would also have possible complications like poor graft integration and plate fracture. Considering weight reduction patterns on implants would efficiently help to solve the mentioned problems.Materials and Methods: In this study, two design concepts of mandibular reconstruction implants which were different in weight reduction pattern’s location were presented. Also, a finite element assessment was performed to evaluate the mechanical performance and functionality of the implants under chewing load.Results: Results revealed that designing patterns all over the implant geometry would lead to minimum jaw deviation and maximum Von Mises stress values around 120 MPa which is much less than Ti6Al4V yield stress.Conclusion: Compared to the solid design, the patterns would enhance the implant function by decreasing the deviation which would result in a function similar to the intact side. Although results showed the proper functionality of the implant clinical trials with multiyear follow-ups are still needed to investigate the detailed clinical results of this concept.Keywords: Biomechanics; Finite element analysis; Patient-specific implants; Customized implants; Reconstruction surgery; Ameloblastoma tumor.
1. Awad ME, Altman A, Elrefai R, Shipman P, Looney S, Elsalanty M. The use of vascularized fibula flap in mandibular reconstruction; A comprehensive systematic review and meta-analysis of the observational studies. J Cranio-Maxillofacial Surg. 2019;47(4):629–41.
2. Succo G, Berrone M, Battiston B, Tos P, Goia F, Appendino P, et al. Step-by-step surgical technique for mandibular reconstruction with fibular free flap: Application of digital technology in virtual surgical planning. Eur Arch Oto-Rhino-Laryngology. 2015;272(6):1491–501.
3. Correction of a mandibular asymmetry after fibula reconstruction using a custom-made polyetheretherketone (PEEK) onlay after implant supported occlusal rehabilitation.
4. Neagu D, Escuder-de la Torre O, Vázquez-Mahía I, Carral-Roura N, Rubín-Roger G, Penedo-Vázquez ángel, et al. Surgical management of ameloblastoma. Review of literature. J Clin Exp Dent. 2019;11(1):e70–5.
5. Darwich K, Ismail MB, Al-Mozaiek MYAS, Alhelwani A. Reconstruction of mandible using a computer-designed 3D-printed patient-specific titanium implant: a case report. Oral Maxillofac Surg. 2021;25(1):103–11.
6. Yao CM, Ziai H, Tsang G, Copeland A, Brown D, Irish JC, et al. Surgical site infections following oral cavity cancer resection and reconstruction is a risk factor for plate exposure. J Otolaryngol - Head Neck Surg. 2017;46(1):1–9.
7. Azuma M, Yanagawa T, Ishibashi-Kanno N, Uchida F, Ito T, Yamagata K, et al. Mandibular reconstruction using plates prebent to fit rapid prototyping 3-dimensional printing models ameliorates contour deformity. Head Face Med. 2014;10:45.
8. Maurer P, Eckert AW, Kriwalsky MS, Schubert J. Scope and limitations of methods of mandibular reconstruction: a long-term follow-up. Br J Oral Maxillofac Surg [Internet]. 2010;48(2):100–4. Available from: http://dx.doi.org/10.1016/j.bjoms.2009.07.005
9. Lopez R, Dekeister C, Sleiman Z, Paoli JR. Mandibular Reconstruction Using the Titanium Functionally Dynamic Bridging Plate System: A Retrospective Study of 34 Cases. J Oral Maxillofac Surg. 2004;62(4):421–6.
10. Shibahara T, Noma H, Furuya Y, Takaki R. Fracture of mandibular reconstruction plates used after tumor resection. J Oral Maxillofac Surg. 2002;60(2):182–5.
11. Arias-Gallo J, Maremonti P, González-Otero T, Gómez-García E, Burgueño-García M, Chamorro Pons M, et al. Long term results of reconstruction plates in lateral mandibular defects: Revision of nine cases. Auris Nasus Larynx. 2004;31(1):57–63.
12. Merema BBJ, Kraeima J, de Visscher SAHJ, van Minnen B, Spijkervet FKL, Schepman KP, et al. Novel finite element-based plate design for bridging mandibular defects: Reducing mechanical failure. Oral Dis. 2020;26(6):1265–74.
13. Narra N, Valášek J, Hannula M, Marcián P, Sándor GK, Hyttinen J, et al. Finite element analysis of customized reconstruction plates for mandibular continuity defect therapy. J Biomech. 2014;47(1):264–8.
14. Gutwald R, Jaeger R, Lambers FM. Customized mandibular reconstruction plates improve mechanical performance in a mandibular reconstruction model. Comput Methods Biomech Biomed Engin [Internet]. 2017;20(4):426–35. Available from: http://dx.doi.org/10.1080/10255842.2016.1240788
15. Schottey O, Huys SEF, van Lenthe GH, Mommaerts MY, Vander Sloten J. Development of a topologically optimized patient-specific mandibular reconstruction implant for a Brown class II defect. Ann 3D Print Med. 2023;10.
16. Ashby MF. Materials Selection in Mechanical Design [Internet]. Elsevier Science; 2016. Available from: https://books.google.com/books?id=K4h4CgAAQBAJ
17. Horita S, Sugiura T, Yamamoto K, Murakami K, Imai Y, Kirita T. Biomechanical analysis of immediately loaded implants according to the “All-on-Four” concept. J Prosthodont Res [Internet]. 2017;61(2):123–32. Available from: http://dx.doi.org/10.1016/j.jpor.2016.08.002
18. De Las Casas EB, De Almeida AF, Cimini CA, Gomes PDTV, Cornacchia TPM, Saffar JME. Determination of tangential and normal components of oral forces. J Appl Oral Sci. 2007;15(1):70–6.
19. van Eijden TMGJ. Three-dimensional analyses of human bite-force magnitude and moment. Arch Oral Biol. 1991;36(7):535–9.
20. Adebayo ET, Fomete B, Adekeye EO. Delayed soft tissue recurrence after treatment of ameloblastoma in a black African: Case report and review of the literature. J Cranio-Maxillofacial Surg [Internet]. 2011;39(8):615–8. Available from: http://dx.doi.org/10.1016/j.jcms.2010.05.010
21. Janeček M, Novy F, Harcuba P, Stráský J, Trško L, Mhaede M, et al. The Very High Cycle Fatigue Behaviour of Ti-6Al-4V Alloy. Acta Phys Pol A. 2015;128:497–503.
22. Zarb GA, Hobkirk J, Eckert S, Jacob R. Prosthodontic Treatment for Edentulous Patients: Complete Dentures and Implant-Supported Prostheses [Internet]. Elsevier Health Sciences; 2012. Available from: https://books.google.com/books?id=GbfwAwAAQBAJ
2. Succo G, Berrone M, Battiston B, Tos P, Goia F, Appendino P, et al. Step-by-step surgical technique for mandibular reconstruction with fibular free flap: Application of digital technology in virtual surgical planning. Eur Arch Oto-Rhino-Laryngology. 2015;272(6):1491–501.
3. Correction of a mandibular asymmetry after fibula reconstruction using a custom-made polyetheretherketone (PEEK) onlay after implant supported occlusal rehabilitation.
4. Neagu D, Escuder-de la Torre O, Vázquez-Mahía I, Carral-Roura N, Rubín-Roger G, Penedo-Vázquez ángel, et al. Surgical management of ameloblastoma. Review of literature. J Clin Exp Dent. 2019;11(1):e70–5.
5. Darwich K, Ismail MB, Al-Mozaiek MYAS, Alhelwani A. Reconstruction of mandible using a computer-designed 3D-printed patient-specific titanium implant: a case report. Oral Maxillofac Surg. 2021;25(1):103–11.
6. Yao CM, Ziai H, Tsang G, Copeland A, Brown D, Irish JC, et al. Surgical site infections following oral cavity cancer resection and reconstruction is a risk factor for plate exposure. J Otolaryngol - Head Neck Surg. 2017;46(1):1–9.
7. Azuma M, Yanagawa T, Ishibashi-Kanno N, Uchida F, Ito T, Yamagata K, et al. Mandibular reconstruction using plates prebent to fit rapid prototyping 3-dimensional printing models ameliorates contour deformity. Head Face Med. 2014;10:45.
8. Maurer P, Eckert AW, Kriwalsky MS, Schubert J. Scope and limitations of methods of mandibular reconstruction: a long-term follow-up. Br J Oral Maxillofac Surg [Internet]. 2010;48(2):100–4. Available from: http://dx.doi.org/10.1016/j.bjoms.2009.07.005
9. Lopez R, Dekeister C, Sleiman Z, Paoli JR. Mandibular Reconstruction Using the Titanium Functionally Dynamic Bridging Plate System: A Retrospective Study of 34 Cases. J Oral Maxillofac Surg. 2004;62(4):421–6.
10. Shibahara T, Noma H, Furuya Y, Takaki R. Fracture of mandibular reconstruction plates used after tumor resection. J Oral Maxillofac Surg. 2002;60(2):182–5.
11. Arias-Gallo J, Maremonti P, González-Otero T, Gómez-García E, Burgueño-García M, Chamorro Pons M, et al. Long term results of reconstruction plates in lateral mandibular defects: Revision of nine cases. Auris Nasus Larynx. 2004;31(1):57–63.
12. Merema BBJ, Kraeima J, de Visscher SAHJ, van Minnen B, Spijkervet FKL, Schepman KP, et al. Novel finite element-based plate design for bridging mandibular defects: Reducing mechanical failure. Oral Dis. 2020;26(6):1265–74.
13. Narra N, Valášek J, Hannula M, Marcián P, Sándor GK, Hyttinen J, et al. Finite element analysis of customized reconstruction plates for mandibular continuity defect therapy. J Biomech. 2014;47(1):264–8.
14. Gutwald R, Jaeger R, Lambers FM. Customized mandibular reconstruction plates improve mechanical performance in a mandibular reconstruction model. Comput Methods Biomech Biomed Engin [Internet]. 2017;20(4):426–35. Available from: http://dx.doi.org/10.1080/10255842.2016.1240788
15. Schottey O, Huys SEF, van Lenthe GH, Mommaerts MY, Vander Sloten J. Development of a topologically optimized patient-specific mandibular reconstruction implant for a Brown class II defect. Ann 3D Print Med. 2023;10.
16. Ashby MF. Materials Selection in Mechanical Design [Internet]. Elsevier Science; 2016. Available from: https://books.google.com/books?id=K4h4CgAAQBAJ
17. Horita S, Sugiura T, Yamamoto K, Murakami K, Imai Y, Kirita T. Biomechanical analysis of immediately loaded implants according to the “All-on-Four” concept. J Prosthodont Res [Internet]. 2017;61(2):123–32. Available from: http://dx.doi.org/10.1016/j.jpor.2016.08.002
18. De Las Casas EB, De Almeida AF, Cimini CA, Gomes PDTV, Cornacchia TPM, Saffar JME. Determination of tangential and normal components of oral forces. J Appl Oral Sci. 2007;15(1):70–6.
19. van Eijden TMGJ. Three-dimensional analyses of human bite-force magnitude and moment. Arch Oral Biol. 1991;36(7):535–9.
20. Adebayo ET, Fomete B, Adekeye EO. Delayed soft tissue recurrence after treatment of ameloblastoma in a black African: Case report and review of the literature. J Cranio-Maxillofacial Surg [Internet]. 2011;39(8):615–8. Available from: http://dx.doi.org/10.1016/j.jcms.2010.05.010
21. Janeček M, Novy F, Harcuba P, Stráský J, Trško L, Mhaede M, et al. The Very High Cycle Fatigue Behaviour of Ti-6Al-4V Alloy. Acta Phys Pol A. 2015;128:497–503.
22. Zarb GA, Hobkirk J, Eckert S, Jacob R. Prosthodontic Treatment for Edentulous Patients: Complete Dentures and Implant-Supported Prostheses [Internet]. Elsevier Health Sciences; 2012. Available from: https://books.google.com/books?id=GbfwAwAAQBAJ
| Files | ||
| Issue | Vol 10, No 4 (Autumn 2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jcr.v10i4.15313 | |
| Keywords | ||
| Biomechanics Finite element analysis Patient-specific implant Customized implant Reconstruction surger Ameloblastoma tumor | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Nourishirazi R, Karimpour M. Numerical Study of Mechanical Development of Patient-Specific Mandibular Reconstruction Implant. J Craniomaxillofac Res. 2024;10(4):201-207.
