Article

DOi: 10.2478/v10133-010-0048-9

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A THREE DIMENSIONAL ANALYSIS OF RECONSTRUCTION PLATES USED IN DIFFERENT MANDIBULAR DEFECTS

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S. Atilgan1, B. erol1, A. Yardimeden2, F. Yaman1, M.c. Ucan1, n. Gunes1, Y. Atalay1, i. Kose1 Dicle University, Faculty of Dentistry, Department of Oral & Maxillofacial Surgery, Diyarbakir, Turkey 2 Dicle University, Faculty of Engineering And Architecture, Department Of Mechanical Engineering, Diyarbakir, Turkey correspondence to: Ferhan Yaman e-mail: dtferhan@hotmail.com

ABSTRACT

In this study, the reasons of breaking of the reconstruction plates used in mandibular continuity or mandibular defects were investigated. The study was conducted on 3 cases in which reconstruction plates were used for tumor resection or invasive wound. The objective was to evaluate the mechanical stress in reconstruction plates by means of the finite element method. Three dimensional model of reconstruction plate was exposed to chewing force. A commercial finite element solver (ANSYS) was then applied to this plate to compute the stresses generated in chewing situation. Stress analyses have been carried out by applying Von Mises Yielding Criteria. In the standard reconstruction plate, the results of the finite element analysis revealed that stress resulting from the simulated functional loadings which far exceeded the strengths of the components. The main application of this study was the prediction of fractures as a consequence of known forces. If it was assumed that the patient executes several thousand masticatory movements within a week, a dynamic strain would be present due to the large number of changes in loading, so that there was a danger of a fatigue fracture at the point of the stress concentration (as seen in the analysis), as is also confirmed by clinical practice. Biotechnol. & Biotechnol. eq. 2010, 24(2), 1893-1896 Keywords: Finite element method, reconstruction plate, mandibula of the reconstruction plates reported in the literature vary between 2.8% and 9.8% (9, 15), indicating that mechanical weakness may be present in the reconstruction system itself. Furthermore, the rates of failure of up to 45% in alloplastic mandibular reconstruction, irrespective of what plate system was used, underscores the potential for improving this kind of reconstruction (8). The objective of the present study was to investigate the mechanical stresses on a commercially available reconstruction plate in bridging a mandibular defect using the finite element method (FeM).

Introduction

the mandible has a central functional and an aesthetic role. A loss of mandibular continuity occurring as a result of trauma, tumour or inflammation may lead to airways reduction, poor swallowing, failure to retain saliva, impairment of speech and aesthetic disfigurement (1, 14). Reconstruction may be carried out either with an osteoplasty combined with appropriate osteosynthesis or merely by alloplastic bridging of the defect using a reconstruction system without bone. An alloplastic procedure is often chosen following resection of malignant tumours with a poor prognosis (15). This alloplastic replacement of the mandible may be temporary or definitive (19). Besides the mechanical stabilization, reconstruction plates are also used to avoid dislocation of the mandibular stumps due to scars, which would be a major obstacle to later restoration of mastication (9). the systems employed should ensure both functional/mechanical and morphological rehabilitation (11). Many years of clinical experience and a review of the literature have shown that titanium reconstruction plates currently used for mandibular defects are often subject to excessive stress. This may lead to fatigue fractures of the plate. The cortical bones can also be overstrained as consequence of such fatigue. This results in enlargement of the screw holes which then loosen (8, 18). The figures for fractures Biotechnol. & Biotechnol. eq. 24/2010/2

Materiala and Methods

It is therefore presumed that avoiding stress concentrated on specific parts of the plates is essential for plate stability, and that adequate plate fixation should differ with regard to size and location of the defects. Until now, few reports have been published on the locations or numbers of screws needed to avoid stress concentrations. Therefore, a simulation study was performed using a three-dimensional (3D) FeM to determine the most appropriate locations and numbers of screws required. FEM is a numerical method allowing modeling of structures that approximates reality. the spatial geometry model is broken down into a large number of finite elements which are interconnected by nodes. This technique is termed discretization. When factors such as clamping conditions and loading stress are known, the deformations and tensions of these simple elements (1, 2) can be calculated at each node. Due to their mutual interlinking (the same displacement and rotation 1893

of the nodes in all dimensions of space), the same applies to the deformation of the overall structure. In turn, derived parameters (stresses, expansions, etc.) can be calculated from this (2). The vertical chewing force chosen was 135 N. This corresponds with the maximum value measured with alloplastic defect reconstruction in patients with mandibular resection (12). The behavior of the materials involved was characterized as isotropic, homogeneous and linearly elastic. Titanium was taken as material for the reconstruction plates. The parameters of the used material are shown in Table 1. TABLE 1 Material Properties of Reconstruction Plate (luhr, 1976; Goldstein, 1987; Schneider, 1988; Arendts et al, 1989) Youngs modulus (Nmm-2) 105 000 Poissons ratio 0.3 Tensile strength (Nmm-2) 290-740

Materials

Chewing forces, 135 N, were distributed to the nodes perpendicularly to their main action interfaces. the Von Mises stresses were calculated and their points were determined for each model. All stress values were recorded in MPa (Mega Pascal; Newtons per square millimeter). Whole processes were conducted using finite element analysis software (ANSYS Ver.11, ANSYS Inc. Swanson, Houston, USA). Auto mesh is applied to the reconstruction plates after modeling of them. Element properties of the reconstruction plates were analyzed in ANSYS, shown in Table 2. After determining the loads and boundary conditions on the model, the solutions have carried out. TABLE 2 element Properties of the Plates analyzed in AnSYS Case 1 2 3 Node Number 7266 8211 9507 Element Size 3286 3607 4084 Element Type SoliD92 SoliD92 SoliD92 Screw No 8 7 8 Hole No 14 17 18

Results and Discussion

According to Von Mises yielding criteria it is observed that stress intensifies (it is shown by red colour zone on reconstruction plate) at the fifth hole of the all reconstruction plates (Fig. 1a, 2a, 3a). After this analysis we compared breaking point and stresses intensify points. The biggest stress intensifies were detected at the breaking point in the tensile strength analysis of all the reconstruction plates (Fig. 1b, 2b, 3b). 1894

Vascularized autogenous bones have been used for reconstruction of hard tissue in mandibular defects and they have proved to be more successful than metallic plates. However, under some conditions, metallic plates are preferred, e.g. in case of poor general health of the patient or advanced cancer (9, 22). One problem associated with conventional plate systems is the frequent incidence of complications such as screw loosening, plate exposure and plate fractures once masticator function is recovered (7). Although some retrospective clinical studies recommended the use of a modified plate system (4, 10, 16, 20), the rate of plate-related complications is still high (3, 10, 13, 20, 22). the greatest causes for complications are size and location of the defects (5, 7). In addition, masticator loads on plates contribute to vertical discrepancies and lead to bone resorption around the screw and to screw loosening. This local stress peak normally will not lead to spontaneous damage to the plate. If it was assumed that the patient executes several thousand masticator movements within a week, a dynamic strain would be present due to the large number of changes in loading, so that there was a danger of a fatigue fracture at these points, as is also confirmed by clinical practice. Reconstruction plates are often used to support fractured bones. the reconstruction plates are affixed using screws on to the bone over the fracture so that Biotechnol. & Biotechnol. eq. 24/2010/2

load is transferred via this reconstruction plate while the bone is healing after which the plate is removed from the body. The reconstruction plate should be biocompatible but should also have the appropriate mechanical properties.

Clinical research by Hastings (6) has shown that this is not desirable, as bone does not strain. Scwyzer and Tonino (17, 21) have established that callus formation, ossification and bone union are hampered by the lack of strain in bone. This result in not only the fractured part but also the whole bone structure becomes osteoporosis. Bone plate should be just strong enough to promote the healing of fracture yet not so stiff as to hinder the bone union. Therefore, new types of bone plates are required which will have stiffness close to that of bone, yet biocompatible. Bone plates made of composites are possible candidates as they can be manufactured to stiffness similar to that of bone; they have high strength (or stiffness) to weight ratio, and are non-corrosive. Further, the resulting composite behaviour can be tailored to nearly any requirement by choosing suitable matrix and reinforcement materials. Zimmerman (24) has also shown that composite design possesses good static and fatigue resistance as against laminated or random design (23).

Conclusions

In conclusion, the findings of the present study confirm the results of earlier clinical observations and previously published biomechanical studies. therefore, in the future, this analysis may be useful in evaluating new reconstruction plate geometry, length and diameter, as well as shape or design 1895

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and material properties of the reconstruction plates. in other words individual reconstruction plate for each patient will be prepared by using this method.

Acknowledgments

We thank to Gaziantep University for their kind help in providing the ANSYS program used in the finite element analysis.

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