Finite element study of fractured mandible in human and sheep

Osteosynthesis is one of the most discussed and investigated subjects in the orthopaedic literature. Mandible fractures are reported as one of the main causes of facial injury and their impact on patient life may bring serious consequences, compromising masticatory function, speech and facial aesthetics. Current treatments for mandibular simple fractures include the use of load-sharing devices such as titanium miniplates and screws, which have the role of fixing the fracture ends and restore the facial continuity. Fixation systems ultimately aim to generate the optimum mechanical strains within the fracture region, which will promote the bone healing process. However, there is not a clear understanding of the influence of fixation stability on the biomechanics of stabilized mandibular fractures, particularly when using biomaterials different from titanium. The aim of this study is to investigate the biomechanical response of fractured mandible using traditional titanium miniplates and alternative fixation systems made of magnesium alloys. With a view on future preclinical evaluation of these new devices, both human and sheep models are investigated

Novel finite element-based plate design for bridging mandibular defects:Reducing mechanical failure

Introduction: When the application of a free vascularised flap is not possible, a segmental mandibular defect is often reconstructed using a conventional reconstruction plate. Mechanical failure of such reconstructions is mostly caused by plate fracture and screw pull-out. This study aims to develop a reliable, mechanically superior, yet slender patient-specific reconstruction plate that reduces failure due to these causes. Patients and Methods: Eight patients were included in the study. Indications were as follows: fractured reconstruction plate (2), loosened screws (1) and primary reconstruction of a mandibular continuity defect (5). Failed conventional reconstructions were studied using finite element analysis (FEA). A 3D virtual surgical plan (3D-VSP) with a novel patient-specific (PS) titanium plate was developed for each patient. Postoperative CBCT scanning was performed to validate reconstruction accuracy. Results: All PS plates were placed accurately according to the 3D-VSP. Mean 3D screw entry point deviation was 1.54 mm (SD: 0.85, R: 0.10–3.19), and mean screw angular deviation was 5.76° (SD: 3.27, R: 1.26–16.62). FEA indicated decreased stress and screw pull-out inducing forces. No mechanical failures appeared (mean follow-up: 16 months, R: 7–29). Conclusion: Reconstructing mandibular continuity defects with bookshelf-reconstruction plates with FEA underpinning the design seems to reduce the risk of screw pull-out and plate fractures

Esthetic and functional reconstruction of large mandibular defects using free fibula flap and implant-retained prosthetics - a case series with long-term follow-up

The reconstructive and rehabilitative management of large mandibular defects with basal continuity is challenging in many respects, especially in the vertical dimension. The free fibula flap is an under-utilised but efficient approach in this indication. The aim of this case series is to demonstrate its use and long-term success.Three cases are presented, where the patient had a large bone defect (at least 5 cm in length and 1 cm in the vertical dimension), but the continuity of the mandible was maintained. Two cases were related to pathological fracture and one was a large defect due to oncological surgery. Vertical augmentation with free microvascularised fibula flap was carried out, followed by implant-retained prosthetic therapy. Clinical status has been followed up for 5 to 6 years, with special attention to the condition of the peri-implant tissues and any radiographically detectable alterations or complications. No complications occurred during the follow-up. Function and esthetics have remained unchanged throughout.Free microvascularised fibula flap reconstruction combined with implant-retained prosthetics allows a lasting functional and esthetic solution in the discussed indication

Biomechanics of North Atlantic right whale bone : mandibular fracture as a fatal endpoint for blunt vessel-whale collision modeling

Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at the Massachusetts Institute of Technology and the Woods Hole Oceanographic Institution September 2007The North Atlantic right whale, Eubalaena glacialis, one of the most critically endangered whales in the world, is subject to high anthropogenic mortality. Vessel-whale collisions and entanglement in fishing gear were indicated in 27 (67.5%) of the 40 right whales necropsied between 1970 and December 2006. Of those, at least 9 deaths (22.5%) resulted from blunt contact with a vessel. To reduce the likelihood of fatal collisions, speed restrictions are being considered for vessels traversing critical habitat, although the effects of speed on collision outcomes have not been specifically evaluated from a biomechanics perspective. The ultimate goal of a larger collaborative project is to evaluate the efficacy of speed restrictions for reducing blunt collision mortality using a multi-scale finite element model. Complete, transverse fracture of the right whale mandible, an injury seen only in right whales killed by vessels, is used as a proxy for mortality in the model. Vital for that model are the material properties and biomechanical behavior of the right whale mandible. Here, the internal structure and physical properties of right whale jawbone tissue are reported. The average apparent densities, 0.4258 g/cc ±0.0970 and 1.2370 g/cc ±0.0535 for trabecular and cortical bone respectively, indicate that the bone is of relatively low density. Average ash content for trabecular bone (64.38% ±1.1330) is comparable with values from other species, indicating that low density results from a reduction of bone mass, not mineralization. Mechanical properties of right whale bone (Young’s modulus of elasticity and Poisson’s ratio) were determined via uniaxial compression testing. These data are incorporated into the finite element model simulating different loading conditions (e.g. vessel speeds) that likely lead to mandibular failure and thereby mortality from blunt vessel collisions. Model results (e.g. risk of fracture) are used to determine the effect of speed restrictions on collision outcomes.Funding for this work was provided by the National Science Foundation (Graduate Research Fellowship Program, Campbell-Malone), the National Oceanic and Atmospheric Administration (Right Whale Grants Program, 2004, PI Campbell-Malone, Award number NA04NMF4720402), the Ocean Life Institute (PI Campbell-Malone and PI Moore), the Quebec Labrador Foundation (PI Campbell-Malone), WHOI SeaGrant (PI Campbell-Malone), and an MIT (Presidential Fellowship, Campbell-Malone)

Procedure for Creating Personalized Geometrical Models of the Human Mandible and Corresponding Implants

The greatest challenge in engineering of human mandible implants lies in its customization for each patient individually, by adapting them to the patient's anatomical, morphological and physiological characteristics. This customization maximizes the efficiency of the patient's health recovery process. The application of anatomically shaped and personalized bone endoprosthesis, fixation plate and scaffold models bring great improvement to the clinical practice in maxillofacial surgery. It ensures that implant meets the biomechanical and dentofacial aesthetic requirements and, ultimately, reduces complications during recovery. In order to create such implants, novel procedure based on personalized models of mandible and its parts, and also plates and scaffold implants is presented in this paper. Design procedures for the creation of the personalized models are based on the application of Method of Anatomical Features, which has been already applied for the creation of geometrical models of human bones. This procedure improves pre-surgical planning, enables better execution of surgical intervention, and as a consequence improves patient recovery processes

Digital design of medical replicas via desktop systems: shape evaluation of colon parts

In this paper, we aim at providing results concerning the application of desktop systems for rapid prototyping of medical replicas that involve complex shapes, as, for example, folds of a colon. Medical replicas may assist preoperative planning or tutoring in surgery to better understand the interaction among pathology and organs. Major goals of the paper concern with guiding the digital design workflow of the replicas and understanding their final performance, according to the requirements asked by the medics (shape accuracy, capability of seeing both inner and outer details, and support and possible interfacing with other organs). In particular, after the analysis of these requirements, we apply digital design for colon replicas, adopting two desktop systems. ,e experimental results confirm that the proposed preprocessing strategy is able to conduct to the manufacturing of colon replicas divided in self-supporting segments, minimizing the supports during printing. ,is allows also to reach an acceptable level of final quality, according to the request of having a 3D presurgery overview of the problems. ,ese replicas are compared through reverse engineering acquisitions made by a structured-light system, to assess the achieved shape and dimensional accuracy. Final results demonstrate that low-cost desktop systems, coupled with proper strategy of preprocessing, may have shape deviation in the range of ±1 mm, good for physical manipulations during medical diagnosis and explanation

Advanced Applications of Rapid Prototyping Technology in Modern Engineering

Rapid prototyping (RP) technology has been widely known and appreciated due to its flexible and customized manufacturing capabilities. The widely studied RP techniques include stereolithography apparatus (SLA), selective laser sintering (SLS), three-dimensional printing (3DP), fused deposition modeling (FDM), 3D plotting, solid ground curing (SGC), multiphase jet solidification (MJS), laminated object manufacturing (LOM). Different techniques are associated with different materials and/or processing principles and thus are devoted to specific applications. RP technology has no longer been only for prototype building rather has been extended for real industrial manufacturing solutions. Today, the RP technology has contributed to almost all engineering areas that include mechanical, materials, industrial, aerospace, electrical and most recently biomedical engineering. This book aims to present the advanced development of RP technologies in various engineering areas as the solutions to the real world engineering problems