Finite element analysis of the human mandible at 3 different

stages of life
Pter Bujtr, MD, DMD, MSc,a
George K. B. Sndor, MD, DDS, PhD, FRCDC, FRCSC, FACS,b Attila Bojtos, MSc,c
Attila Szucs, DMD,d and Jzsef Barabs, MD, PhD,e Budapest, Hungary, Toronto, Canada, and
Tampere and Oulu, Finland
SEMMELWEIS UNIVERSITY, UNIVERSITY OF TORONTO, THE HOSPITAL FOR SICK CHILDREN AND
BLOORVIEW KIDS REHAB, UNIVERSITY OF TAMPERE, UNIVERSITY OF OULU, AND UNIVERSITY OF
TECHNOLOGY AND ECONOMICS

Objective. This study analyzed detailed models of human mandibles at 3 different stages of life with simulation of
supra normal chewing forces at static conditions.
Methods and materials. Finite element analysis (FEA) was used to generate models from cone-beam computerized
tomograms (CBCT) of 3 patients aged 12, 20, and 67 years, using numerically calculated material parameters.
Estimated chewing forces were then applied to the simulations.
Results. The results reflect higher elasticity in younger models in all regions of the mandible. The experimental models
show that physiologic load stress and strain distributional changes of the mandible vary according to age.
Conclusion. The CBCT-based model generation used in this study provided high-quality model definition of the 3
individual patients of different ages. FEA has great potential to predict bone responses to paradigms of mechanical
activity. Future applications of FEA will include surgical planning, surgical hardware testing, and the design of
scaffolds and tissue-engineered constructs. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:301-309)

Digital imaging in dentistry and medicine has opened
new possibilities to predict the behavior of components
of the facial skeleton when subjected to loading or
trauma. Diagnostic tools can be developed that allow
deeper understanding of the structure and responses of
the human skeleton to loading. As in engineering, the
initial work with Finite element analysis (FEA) in med-
icine was for the analysis of the macroscopic solid
a
Resident, Department of Oral and Maxillofacial Surgery and Den-
tistry, Faculty of Dentistry, Semmelweis University, Budapest, Hun-
gary.
b
Professor and Head of Oral and Maxillofacial Surgery, University of
Toronto, Coordinator of Pediatric Oral and Maxillofacial Surgery,
The Hospital for Sick Children and Bloorview Kids Rehab, Toronto,
Canada; Professor of Tissue Engineering, Regea Institute for Regen-
erative Medicine, University of Tampere, Tampere; Docent, Univer-
sity of Oulu, Oulu, Finland.
c reflecting differences between the various regions or
PhD candidate, Department of Mechatronics, Optics and Engineer-
ing Informatics, Faculty of Mechanical Engineering, University of
Technology and Economics, Budapest, Hungary.
d
Assistant Professor, Department of Oral and Maxillofacial Surgery
and Dentistry, Faculty of Dentistry, Semmelweis University, Budap-
est, Hungary.
e
Professor and Head, Department of Oral and Maxillofacial Surgery
and Dentistry, Faculty of Dentistry, Semmelweis University, Budap-
est, Hungary.
Received for publication Sep 4, 2009; returned for revision Jan 4,
2010; accepted for publication Jan 26, 2010.
1079-2104/$ - see front matter
2010 Mosby, Inc. All rights reserved.
doi:10.1016/j.tripleo.2010.01.025
structures.1-9 FEA was also used some years ago to
predict dental implant loading10,11 and for microstruc-
tural analysis.7,12
The literature regarding the generation of mandib-
ular models using FEA lacks consistency.1-12 There
are various strategies for finite element mesh gener-
ation from geometric models.13-16 Although there are
some automatic finite element model-generating pro-
tocols,17-24 human interaction is still required in most
cases. There are differences in application of various
element types such as different kinds of shells, tetrahe-
dra, or octahedra6-7 that need simplification to generate
a mesh. The mechanical parameters of elements result-
ing from the meshed geometry also need to be deter-
mined for FEA.
Material parameters were usually assigned without
structures of the mandible. Although several relation-
ships were established between the apparent bone den-
sity (app ) derived from CT scans and the mechanical
parameters of bone such as the Youngs modulus (E) of
linear elasticity,25-29 the visco-elastic and anisotropic
features of the mandible were rarely taken into ac-
count.30-32 The main components of the mandible such
as the cancellous and cortical bone also have their own
unique relationship to function and bone density that
must be considered in model generation.33,34 The cur-
rent authors goal in model simplification was to gen-

301
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302 Bujtr et al. September 2010

Fig. 1. Orthopantomogram of patient 1, a 12-year-old male.

Fig. 2. Orthopantomogram of patient 2, a fully dentate 20-
year-old female.

erate a precise model that tried to reduce the model size

to an acceptable but still reasonable size. Previous
models were overly sophisticated and the authors of the
current FEA approach aimed to optimize boundary
conditions, thus simplifying the analysis.35-38 Such
simplification would minimize the simulation and nu-
meric calculation times producing a more user-friendly
analysis.
This experiment focused on the structural analysis of
3 different human mandibles at various stages of life
with the aim to produce 3 patient-specific, custom- Fig. 3. Orthopantomogram of patient 3, a 67-year-old eden-
made, high-resolution yet simplified models when com- tulous female.
pared with previous protocols. The study used an iden-
tical protocol for model formation and simulation in
each of the 3 patients to produce an acceptable and yet
still reasonable model size. The models emphasize a
3. An elderly 67-year-old completely edentulous fe-
stage-of-lifespecific response of mandibular bone to a
male requesting dental implant treatment (Fig. 3).
particular loading stimulus within the mechanical limits
of the bone resulting in simple yielding or acute frac-
Data acquisition
ture during long-term fatigue.39-42
All data were acquired from CBCTs taken on the 3
patients using the same CBCT scanner (i-CAT, Xoran
METHOD AND MATERIALS
Technologies, Ann Arbor, MI) designed specifically for
The already existing cone-beam computerized tomo-
dental and medical imaging with a 0.3-mm voxel res-
grams (CBCTs) of 3 patients were selected from the
olution with capability to export to DICOM format.
database of our clinic to study the potential of the
The scans of all 3 patients were ordered independently
current model generation method with ethical approval
by 3 different dentists for specific clinical indications.
of Semmelweis University and the informed consent of
None of the patients received additional dosages of
the patients. All 3 cases were of otherwise healthy
radiation for the purposes of this experiment. The cases
persons of different ages, representing 3 different
were also selected so that the 3 patients had no metallic
stages of life. The patients were not taking any medi-
dental restorations so as to minimize radiographic arti-
cations, had a normal diet, ambulated normally, had no
facts.
history of bone diseases such as osteoporosis, and in-
cluded
Modeling
1. A 12-year-old boy with no deciduous teeth and most Two meshes, an outer surface mesh and an inner
of the permanent teeth erupted with partially erupted volumetric mesh, were necessary to produce the FEA
maxillary canine teeth and partially developed third model. All data from the CBCTs were imported to a
molars (Fig. 1). visualization module using a graphics program called
2. A fully dentate adult 20-year-old female with im- Mimics (Materialise, Leuven, Belgium) to filter out and
pacted third molars (Fig. 2). manually remove any artifacts and outline the struc-
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Volume 110, Number 3 Bujtr et al. 303

Fig. 4. Primary CT mesh (brown color) and remeshed (green color) surfaces were produced for the 3 mandibles in this study.

tures being examined. This resulted in a highly defined Table I. Model modifications
surface mesh to allow further processing and exporting Patient 1* Patient 2 Patient 3
of images (Fig. 4). CT volume, mm 3
59.595 48.000 55.080
CT surface, mm2 20.039 18.130 17.672
Meshing Triangle number 233.532 194.102 247.576
Numerous possibilities exist for creating the outer or Remeshed volume, mm3 58.956 47.368 54.552
Remeshed surface, mm2 18.976 17.282 17.174
surface mesh of the mandible from raw data. One Triangle number 63.118 50.500 33.220
common way is the B-spline/NURBS (non-uniform Element number 1.004.347 792.412 515.272
rational B-spline) method, which creates small surface Node number 194.466 148.181 96.604
entities called facets using computer-aided design *Patient 1, 12 years old; patient 2, 20 years old; patient 3, 67 years
(CAD) engineering programs. The authors elected not old.
to use such rough simplifications but instead used the
3-Matic and Magic (Materialise, Leuven, Belgium) and
ANSYS (ANSYS Inc. Southpointe, PA) for surface
refining. pressure (STP); the radiodensity of air at STP was
The geometry and the unique shape of the mandible 1000 HU. The following settings were used. At the
required further refinement of the model. This was done 600-HU radiodensity the Youngs modulus (E) was set
by importing the data into ANSYS software (ANSYS to 2.6 GPa as the cancellous bone density region. Then
Inc.) to fill any holes in the mesh. Geometric shapes at 1300 HU the linear elastic modulus was set to 10
such as triangles or tetrahedra can be used in generating GPa as the cortical bone density region. At 1600 HU,
a mesh. The surface meshes were generated using tri- 15 GPa was used as the upper limit of the cortical bone
angles. The volumetric meshes were built up from density. These settings resulted in 2 equations that
linear tetrahedra as a structural solid element with 3 estimated the mechanical parameters of cortical bone
degrees of freedom at each node using the Octree using radiodensity (HU), the apparent bone density
automated meshing method of the ANSYS Advanced (app), and the relationship with Youngs modulus (E).
Meshing Module rather than using the Advanced Front
and Delanuay methods tried by others. This optimized app 200 1.2 HU [kg m3] (1)
mesh formation, reduced the number of surface trian-
E 0.024 1.762 [MPa] (2)
gles with minimal surface and volume alterations, and
kept the model size small (Table I). Minimum and a maximum limits were also used.
Based on this relationship, all calculated elements with
Material assignment values of less than 0.05 GPa were all set to 0.05 GPa to
Once the outer surface mesh was complete, the inner avoid high strains owing to a low elastic modulus. The
volume mesh elements required assignment of mechan- material assignment function was also modified setting
ical parameters. No other relevant CBCT-based mate- the 3071-HU X-ray absorption not to exceed 50 GPa. A
rial assumptions were found at the time this project color-coded HU density distribution on the surface of
started based on the i-CAT CBCT (Xoran Technolo- all models can be seen in Fig. 5, A. The range was
gies, Ann Arbor, MI). X-ray density was used to assign from light blue of 0 HU toward 3000 HU in red color
individual mechanical parameters to each element us- (Fig. 5, B).
ing Hounsfield units (HU). Zero HU defined the radio- During a preliminary phase of this experiment,
density of distilled water at standard temperature and scanned object volumes over 600 HU in patient 1 were
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304 Bujtr et al. September 2010

Fig. 5. A, Density map of the remeshed models. B, Radiodensity expressed in Hounsfield Units with the scale used to interpret
Fig. 5, A. Red color indicates increased radiodensity.

separated resulting in sharp geometry that was meshed

using the above method. The resulting model was built
up from more than 4 million tetrahedra (Fig. 6). All
teeth can be seen in this model within the U-shaped
bicortical lamella of the mandible without low-density
parts, which represent the soft tissues such as the peri-
odontal ligaments of each tooth. These initial models
reflected the high and low load-bearing parts of the
mandible in the early stages of macroscopic biome-
chanics (Fig. 6). No simulation was done with these
initial models. Instead, the next generation of models
was used for the assessments.

Boundary conditions
Prior models calculated optimal muscle forces used
for FEA. In this simulation, a unilateral first molar bite
or loading was chosen for static simulation with the
load assumed to be in the normal range of human
loading (Table II). Exactly the same boundary condi-
tions were used in all 3 patients to compare the differ-
ent-aged mandible configurations (Fig. 7). Mechanical
parameters including reaction force, strain, total defor- Fig. 6. Cortical bone density map of the 12-year-old patent.
mation, von Mises stress, and 1st principal (maximal)
and 3rd (minimal) stress were evaluated in the models
(Figs. 8 to 10).
in all regions especially at the condyles. All of the teeth
RESULTS were more mineralized, and the mandible had denser
The model of the 20-year-old female required the cortical bone, shown with more yellow and red color,
least manual preparation because of increased densities when compared with the 12-year-old patient (Fig. 5, A).
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Volume 110, Number 3
Table II. Boundary conditions
Loads in different directions, N
X Y
Masseter 50* 50
Medial pterygoid 0 50
Temporalis 0 100
*The X component is directed away from the mid-sagittal plane.
Fig. 7. Boundary conditions.
In the model of the 67-year-old edentulous female,
higher HU elements were present mostly at basal cor-
tical regions of the body of the mandible.
The reaction force was calculated after each simula-
tion in the Z-axis or cranio-caudal direction (Table III).
The reaction forces on the left or contralateral condyle
were similar to forces on the first molar and ipsilateral
condyle. This was true in the 12-year-old, the 20-year-
old, and in the 67-year-old patients. With respect to
age, loads tended to be shared between the ipsilateral
condyle and the tooth biting or load bearing regions.
Biting forces normalized to 100 Newtons (N) biting
force reaction forces showed that the 3 groups had a
similar reaction to a 100-N bite especially at the ipsi-
lateral condyle but also at the contralateral condyle
under higher loading (Tables IV and V, Figs. 8 to 10).
Significant contralateral stress was found at the con-
tralateral subcondylar and articular surfaces in all 3 pa-
tients. Peak von Mises stresses were 21 to 50 Mega
Pascals (MPa) whereas 1st and 3rd principal stresses were
5 to 80 MPa, mostly below the threshold needed for
fatigue owing to tension or compressive stress. Strains
Bujtr et al. 305
were between 5300 and 100400 microstrain at the same
regions.
Z Articular surface stresses were similar on the contra
200
lateral (45-47 MPa) and the ipsilateral (12.0-15.4 MPa)
100 sides. However, strains in the 12-year-old patient were
200 10400 on the contralateral and 18600 microstain on the
ipsilateral side, in the 20-year-old these were 20000 and
9000, and in the 67-year-old they were 37000 and 14300
microstrain.
When considering the ipsilateral side of first molar
loading at the body and inferior border of the mandible
of the 67-year-old patient, the stress and strain were
higher compared with the 2 younger patients as 5900
microstrain and 41 MPa. The 12- and 20-year-old stress
values were only 28 and 30 MPa and strains were 3900
and 3500 microstrain.
At the symphiseal region, stress and strain were
similar to each other in the 3 different aged patients.
The stresses were 14, 19, and 19 MPa and strains were
3200, 3000, and 4100 microstrain in the 12-, 20-, and
67-year-old patients, respectively.
The maximal deformations of the contralateral coro-
noid process were 2.27, 1.003, and 1.11 mm for the 12-,
20- and 67-year-old samples, respectively.
DISCUSSION
This technique of model generation shows that a uni-
form method can be applied in these 3 patients of different
ages with a loading protocol consisting of muscle loading
with first molar biting to evaluate the models response.
The experimental models show that physiologic load
stress and strain distributional changes of the mandible
vary according to age with higher elasticity in younger
models in all regions of the mandible.
Bone has genetically determined set points, at which
it responds with resorption, remodeling with strength-
ening, or by fracture.39-42 These threshold ranges are
described by the following:
1. MESr: The genetically determined disuse threshold
range of bone, below which resorption occurs.39
2. MESm: The genetically determined modeling thresh-
old range of bone, above which strengthening re-
modeling occurs.39
3. MESp: The genetically determined operational mi-
crofracture (fatigue damage) threshold range of
bone, above which microfractures begin to accumu-
late eventually resulting in macrofracture.39
Haversian unit stress and strain function as load
orientation to the longitudinal axis of the particular
bone unit.39-42 Normalized stress and strain from a
100-N bite force can provide a physiologic stimulus to
help preserve the bony structure of the mandible as
strain is higher than MESr (100 microstrain and stress
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306 Bujtr et al. September 2010

Fig. 8. Von Mises stress isosurfaces. Left aspect of the 12-year-old patient.

Fig. 9. Von Mises stress isosurfaces. Left aspect of the 20-year-old patient.

than 1-2 MPa). Strain response at each side at the
external oblique ridge in the 12- and 20-year-old pa-
tients were somewhat higher (2633-3197 microstrain)
than the MESp (3000 microstrain) whereas in the 67-
year old this was decreased (745-1196). Strain at the
ipsilateral side of the condylar neck in the case of the 12-
and 67-year-old patients was also higher than the MESp
(3228, 3498 microstrain), whereas in the 20-year-old it
was lower (1814 microstrain). On the opposite side at the
articular process the 12-year-old recorded the highest val-
ues (18800 microstain) close to fracturing. The 67- and the
20-year-old-patients also had high levels (8352 and 4031
microstain) over MESp. The subcondylar sites at each
side in the 12-year-old patient were near the MESp (2257
and 3949). All other sites and in each patient were below
the MESp.
The following have been noted in this study:
1. The models created by this technique illustrate the
higher degree of flexibility of the younger mandible in
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Volume 110, Number 3 Bujtr et al. 307

Fig. 10. Von Mises stress isosurfaces. Left aspect of the 67-year-old patient.

Table III. Reaction forces 6. The load-bearing function of the symphiseal region
12-year-old 20-year-old 67-year-old does not change with age, where there were no
Calculated reaction forces significant stress and strain deviations.
to Z-axis, N 7. The reduction of the cross section of the body of the
Left condyle 335.99 347.82 348.83 mandible with age results in increased ipsiilateral
Right condyle 125.04 148.00 204.44
stress and strain.
First molar load 531.78 496.14 443.03
Normalized reaction forces 8. The articular surface of the condyle exhibits extremely
to 100N to the Z-axis, N high strain values possibly because of soft tissuelike
Left condyle 63.18 70.11 78.74 behavior, possibly because the simulation was performed
Right condyle 23.51 29.83 46.15 without the buffering effect of the articular disc. This is
First molar load 100.00 100.00 100.00
100N/First molar reaction 0.1880 0.2016 0.2257 especially so on the contralateral side although stress
force remains within the normal working range.
Trends have been observed with the 3 patients in this
study. The experimental models highlight several phys-
iologic load stress and strain distributional changes of
the sense of maximal total deformation and strain the mandible that vary according to age. The weak
values. point of these simulations is the material assignments
2. In first molar biting high stresses are found at both the that are assumed and the lack of articulationlike contact
contralateral subcondylar and condylar neck regions. simulation. Reliable functional data regarding bone
3. The reaction forces of the mandible become maxi- density and linear elastic modulus with proper measure-
mal with aging. With the loading protocol, stress ments are lacking. Determination of the boundary con-
increases on loading of the ipsilateral condyle while ditions is also arbitrary.
loading at the first molar decreases. The simulations reflect the sites of potential stress-
4. Normalized reaction forces, which reflect the physiologic bearing areas as stresses accumulate in the cortical lamel-
situation, elicit the same 100-N biting force with more lae. Stress should be used as the predictor of fatigue,
condylar loading especially on the ipsilateral side. fracture, resorption, and bone remodeling. The use of
5. The stress and the strain peaks of the 67-year-old strain limits is not totally clear because the transition
patient at the anterior margin of the articular sur- between soft tissue and cortical bony parts is abrupt.
faces on both sides are significantly lower, reflecting Although trends have been observed with the 3 pa-
the hardening of the bone of this region with age. tients in this study, the results are not meant to be
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308 Bujtr et al. September 2010

Table IV. Nodal solution overview

Microstrain Stress, MPa
Site of reaction Total mechanic von Mises 1st principal 3rd principal
Age, y 12 20 67 12 20 67 12 20 67 12 20 67
Mandibular condyle
Ipsilateral 18600 9000 14300 13 12 15.4 4 2 3 21 11 16
Contralateral 100400 20000 37000 45 47 46.2 14 7 9.4 80 49 49
Condylar neck
Ipsilateral 12000 4000 3800 13 18 12 6 6 6 17 18 11
Contralateral 21000 9100 8000 34 40 33 21 11 13 45 40 31
External oblique ridge
Ipsilateral 14000 15000 3300 33 45 18 34 44 18 18 13 10
Contralateral 17000 15000 5300 50 48 21 51 49 21 22 11 5
Basal bone of mandibular body
Ipsilateral 3900 3500 5900 28 30 41 27.5 30 40 16 12 22
Contralateral 4400 2500 3500 26 24 33 16 15 10 34 24 33
Symphysis 3200 3000 4100 14 19 19 15 20 20 22 18 16

Table V. Nodal solution overview normalized to a 100N unilateral 1st molar bite
Microstrain Stress, Mpa
Site of reaction Total mechanic (NORM) von Mises (NORM)
Age, y 12 20 67 12 20 67
Mandibular condyle
Ipsilateral 3498 1814 3228 2.4 2.4 3.5
Contralateral 18880 4031 8352 8.5 9.5 10.4
Condylar neck
Ipsilateral 2257 806 858 2.4 3.6 2.7
Contralateral 3949 1834 1806 6.4 8.1 7.4
External oblique ridge
Ipsilateral 2633 3023 745 6.2 9.1 4.1
Contralateral 3197 3023 1196 9.4 9.7 4.7
Basal bone of mandibular body
Ipsilateral 733 705 1332 5.3 6.0 9.3
Contralateral 827 504 790 4.9 4.8 7.4
Symphysis 602 605 925 2.6 3.8 4.3

extrapolated to an entire population. Future studies
involving larger patient numbers are needed. The ef-
fects of patient health, presence of bone diseases, med-
ication history, diet, exercise or ambulatory capabili-
ties, or even geographic variances require further study.
This method of model generation will be used for
future evaluation of questions relevant to loading of the
mandible or other bones of the cranio-maxillofacial
skeleton. FEA may be used to develop programs and
models that could make clinically relevant predictions
about mandibular loading. In cases of impacted teeth in
ectopic positions43 or with destructive lesions such as
cystlike lesions of the jaws, such a program could
predict the risk of pathologic fracture with loading.
Osteotomy designs and fixation devices could be tested
with FEA-generated models. In the case of tissue en-
gineering44 and reconstruction with bone grafting or
with bone substitutes,45 the load-bearing capacity of a
particular scaffold used to replace a major segment of
the mandible could be predicted before its clinical use.
This information may have important applications in
designing future loading protocols of the scaffolds,
in the selection of the appropriate scaffold material or in
designing the shape of the scaffold, balancing the load-
ing capacity of the particular biomaterial with the pre-
dicted clinical loading requirements of the mandibular
segment that it must replace. FEA provides a new
platform to make such clinically relevant predictions.
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Reprint requests:
George K. B. Sndor, MD, DDS
The Hospital for Sick Children
S-525, 555 University Avenue
Toronto, Ontario, Canada M5G 1X8,
george.sandor@utoronto.ca