Computer-aided optimization of choice and positioning of bone plates and screws used for internal fixation of mandibular fractures

doi:10.1016/S0901-5027(05)80766-0

International Journal of Oral and Maxillofacial Surgery

Volume 21, Issue 6, December 1992, Pages 373-377

https://doi.org/10.1016/S0901-5027(05)80766-0 Get rights and content

Abstract

The present study describes a biomechanical integrated model of the mandibular system in which the maxilla and mandible, the masticatory muscles, and the temporomandibular joints are regarded as one system. In this model, strains in plate-osteosynthesis devices for internal fixation of mandibular fractures can be minimized by optimizing their positions. The model evaluates maximal bite force strategies on all possible dental elements; it uses a linear programming technique and a muscle architecture model, resulting in muscle recruitment patterns. The shape of a “standard” lower jaw is digitized by means of a three-dimensional (3-D) coordinate retrieval device and drawn on a computer screen after its dimensions have been changed according to the clinical case at hand. The 3-D location of the fracture as well as the anatomic restrictions for screw placement can be indicated on the screen. Osteosynthesis devices can be indicated in terms of dimensions, number, and material properties.

References (34)

BarbenelJC
The biomechanics of the temporomandibular joint: a theoretical study
J Biomech
(1972)
BosRRM et al.
Resorbable poly(L-lactide) plates and screws for the fixation of zygomatic fractures
J Oral Maxillofac Surg
(1987)
BosRRM et al.
Bone plate and screws of bio-absorbable poly(L-actide). An animal pilot study
Br J Oral Maxillofac Surg
(1989)
BosRRM et al.
Bio-absorbable plates and screws for internal fixation of mandibular fractures. A study in 6 dogs
Int J Oral Maxillofac Surg
(1989)
KaraszI et al.
Photo-elastic stress analysis on mandibular osteosynthesis
Int J Oral Maxillofac Surg
(1986)
KoolstraJH et al.
A three-dimensional mathematical model of the human masticatory system predicting maximum possible bite forces
J Biomech
(1988)
LeenslagJW et al.
Resorbable materials of poly(L-lactide). VI. Plates and screws for internal fracture fixation
Biomaterials
(1987)
LeenslagJW et al.
Resorbable materials of poly(L-lactide). In vivo and in vitro degradation
Biomaterials
(1987)
OsbornJW et al.
Predicted pattern of human muscle activity during clenching derived from a computer assisted model: symmetric vertical bite forces
J Biomech
(1985)
OttenE
A myocybernetic model of the jaw system of the rat
J Neurosci Methods
(1987)

PruimGJ et al.

Forces acting on the mandible during bilateral static bite at different bite force levels

J Biomech

(1980)

ThrockmortonGS et al.

Quantitative calculation of temporomandibular joint forces. I. The importance of the magnitude of the muscle forces

J Biomech

(1985)

ThrockmortonGS

Quantitative calculations of temporomandibular joint reaction forces. II. The importance of the direction to the jaw muscle forces

J Biomech

(1985)

AshmanRB et al.

The elastic properties of the human mandible

Adv Dent Res

(1987)

BronsR

Stabiele interne fixatie bij corpus mandibulafrakturen

ChampyM et al.

Ostéosynthéses mandibulaires selon la technique de Michelet. I. Bases biomécaniques

Rev Stomatol

(1976)

ChampyM et al.

Mandibular fractures

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The study described a biomechanical integrated model of the mandibular system. Experiments with the software indicated that in all cases a complex load across the fracture site occurs.20 This results in a failure of predictions of optimal bone plate position based on the main load (ignoring the other load components), such as those used by Champy et al.
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Computer-aided optimization of choice and positioning of bone plates and screws used for internal fixation of mandibular fractures

Abstract

J Biomech

J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

J Biomech

Biomaterials

Biomaterials

J Biomech

J Neurosci Methods

J Biomech

J Biomech

J Biomech

The elastic properties of the human mandible

Adv Dent Res

Stabiele interne fixatie bij corpus mandibulafrakturen

Ostéosynthéses mandibulaires selon la technique de Michelet. I. Bases biomécaniques

Rev Stomatol

Mandibular fractures