Use of a modified expander during rapid maxillary expansion in adults: an in vitro and finite element study.

PURPOSE: This preliminary study was performed to evaluate a proposed maxillary expansion treatment method for adults with fused intermaxillary sutures. MATERIALS AND METHODS: This study was performed in three Thiel-fixed skulls from older female cadavers with a microimplant-supported expansion screw. This modified expansion screw was mounted on the palatine process with microimplants and activated every 15 to 20 seconds with an activation key until the intermaxillary suture ruptured. A strain gauge was bonded to the expansion screw and calibrated so it could be used as a force sensor device. Rupture of the intermaxillary suture was indicated by a sudden drop in the registered force, through visible opening of the suture, and via computed tomographic data. Finite element simulations were performed, which led to the experimental testing. RESULTS: Rupture of the intermaxillary suture was achieved in all three experiments with the microimplant-supported screw. The strain measurement on one of the expansion screws resulted in an expansion force of 86 N. Finite element simulations showed a high tensile stress concentration exerted by the microimplant-supported expansion screw on the intermaxillary suture. CONCLUSION: The applied expansion force led to high tensile stress concentrations, mainly on the intermaxillary sutures, resulting in the opening of fused intermaxillary sutures. This method may help adults to be treated by an orthodontist, thereby avoiding surgical intervention.

Influence of different modeling strategies for the periodontal ligament on finite element simulation results.

INTRODUCTION: The finite element method is a promising tool to investigate the material properties and the structural response of the periodontal ligament (PDL). To obtain realistic and reproducible results during finite element simulations of the PDL, suitable bio-fidelic finite element meshes of the geometry are essential. METHODS: In this study, 4 independent coworkers generated altogether 17 volume meshes (3-dimensional) based on the same high-resolution computed-tomography image data set of a tooth obtained in vivo to compare the influence of the different model generation techniques on the predicted response to loading for low orthodontic forces. RESULTS: It was shown that the thickness of the PDL has a significant effect on initial tooth mobility but only a remarkably moderate effect on the observed stress distribution in the PDL. Both the tooth and the bone can be considered effectively rigid when exploring the response of the PDL under low loads. The effect of geometric nonlinearities could be neglected for the applied force system. CONCLUSIONS: Most importantly, this study highlights the sensitivity of the finite element simulation results for accurate geometric reconstruction of the PDL.

Soft-tissue changes after maxillomandibular advancement surgery assessed with cone-beam computed tomography.

INTRODUCTION: The purpose of this study was to quantify anteroposterior and transverse facial soft-tissue changes with respect to underlying skeletal movements after maxillomandibular advancements by using cone-beam computed tomography. METHODS: Thirty white patients were treated by maxillomandibular advancements after LeFort I osteotomies and bilateral sagittal split osteotomies. The patients were scanned by using cone-beam computed tomography within 1 week before the surgery, within 1 week after the surgery, and a minimum of 8 weeks postsurgery. We measured the differences between the first and last images and calculated ratios for anteroposterior and transverse soft-to-hard tissue movements. Changes in the greatest interalar width were also measured. RESULTS: There was a statistically significant difference in the greatest interalar width change between patients receiving maxillary advancements greater than 4 mm and those having advancements less than or equal to 4 mm (P <0.023). Mean ratios of anteroposterior soft-to-hard tissue movements were 84.9% +/- 38.0% in the malar region, 96.1% +/- 15.5% in the chin, and 101.1% +/- 27.3% in the subcommissural region. Mean ratios of transverse soft-to-hard tissue movements were 39.4% +/- 19.7% in the malar region and 82.5% +/- 56.7% in the subcommissural region. CONCLUSIONS: The amount of maxillary advancement most likely plays a role in the postsurgical increase in interalar width. In addition, facial soft tissues appear to respond more to anterior movement of the jaws than to an increase in transverse dimensions after maxillomandibular advancements.

In-vitro results of rapid maxillary expansion on adults compared with finite element simulations.

This study was mainly performed to investigate the effects of high maxillary expansion forces on the skull with fresh and thiel-fixed human skulls. The maxillary suture was not weakened except in one experiment. This study compares the strain measured on the zygomatic process of the skull with the results of a finite element model generated for this purpose. An increasing transversal force was applied on the alveolar process (teeth) until rupture. Strain on the zygomatic process, maxilla displacement and the expanding forces were registered. The results of this study show linear material behaviour of the skull before rupture. The highest stress during the experiments and FE simulation was observed on the alveolar process. Conclusions of this study are the necessity of the existence of appropriate models and that female specimens seem to rupture at a lower force than male ones. Both male and female specimens show a similar linear behaviour in the force/strain curve within each gender group. The probability of maxillary suture opening in adults during ultra-rapid maxillary expansion with tooth anchorage is very low. Complications and unwanted rupture could occur.

A downloadable meshed human canine tooth model with PDL and bone for finite element simulations.

OBJECTIVE: The aim of this study is to relieve scientists from the complex and time-consuming task of model generation by providing a model of a canine tooth and its periradicular tissues for Finite Element Method (FEM) simulations. METHODS: This was achieved with diverse commercial software, based on a micro-computed tomography of the specimen. RESULTS: The Finite Element (FE) Model consists of enamel, dentin, nerve (innervation), periodontal ligament (PDL), and the surrounding cortical bone with trabecular structure. The area and volume meshes are of a very high quality in order to represent the model in a detailed form. Material properties are to be set individually by every user. The tooth model is provided for Abaqus, Ansys, HyperMesh, Nastran and as STL files, in an ASCII format for free download. SIGNIFICANCE: This can help reduce the cost and effort of generating a tooth model for some research institutions, and may encourage other research groups to provide their high quality models for other researchers. By providing FE models, research results, especially FEM simulations, could be easily verified by others.

Correspondences of hydrostatic pressure in periodontal ligament with regions of root resorption: a clinical and a finite element study of the same human teeth.

INTRODUCTION: The main objectives of this study were to generate individual finite element models of extracted human upper first premolars, and to simulate the distribution of the hydrostatic pressure in the periodontal ligament (PDL) of these models for evaluation of the risk of root resorption. METHODS: The individual extracted teeth were from a previous in vivo study that investigated root resorption after application of continuous intrusive forces. The results of experimental examination and simulations were compared on these identical tooth roots. The applied force system was 0.5N and 1.0N of intrusive force. RESULTS: The simulated results during intrusion of 0.5N showed regions near the apical thirds of the roots with hydrostatic pressure over the human capillary blood pressure. These regions correlated with the electron microscopies of previous studies performed in Brazil with the identical teeth. An increased force of 1.0N resulted in increased areas and magnitudes of the hydrostatic pressure. CONCLUSIONS: The key parameter indicating beginning root resorption used in this study was an increased value for hydrostatic pressure in the PDL.

Stress distribution and displacement analysis during an intermaxillary disjunction--a three-dimensional FEM study of a human skull.

The goal of this study was to contribute to an understanding of how much expansion force is needed during a maxillary expansion (ME) and where bony reaction takes place. A finite element (FE) model of a dry human male skull was generated from CT scans. The FE model, which consists of cortical and cancellous bone and teeth, was loaded with the same force magnitudes, directions and working points as in rapid maxillary expansion (RME). A three-dimensional finite element stress analysis (FESA) of the forces and displacement was performed. The highest stress was observed in the maxilla in the region where the forces were applied, and spreads more or less throughout almost the whole frontal skull structures. The displacement distribution which causes stress in the skull is highly dependant on the thickness of the bone and its structure. All areas with high compressive and tensile stress are exactly the regions which determine the maximal amount of force to be used during the maxillary expansion and should be examined in case of any complication during a patient's treatment. Regions with significant compressive and tensile stress are the regions observed to have an increase in cellular activity. Further simulations with a given displacement (0.5mm) showed that displacement simulations need extra caution otherwise they will lead to very high forces which are not realistic in an orthodontic treatment.

Periodontal ligament hydrostatic pressure with areas of root resorption after application of a continuous torque moment.

OBJECTIVE: To evaluate the risk of root resorption, individual finite element models (FEMs) of extracted human maxillary first premolars were created, and the distribution of the hydrostatic pressure in the periodontal ligament (PDL) of these models was simulated. MATERIALS AND METHODS: A continuous lingual torque of 3 Nmm and 6 Nmm respectively was applied in vivo to the aforementioned teeth. After extraction, FEMs of these double-rooted teeth were created based on high-resolution microcomputed tomographics (micro CT, voxel size: 35 microns). This high volumetric resolution made the recognition of very small resorption lacunae possible. Scanning electron micrographs of the root surfaces were created as well. This enabled the investigation of advantages and disadvantages of the different imaging techniques from the viewpoint of the examination of root resorption. Using the FEMs, the same loading conditions as applied in vivo were simulated. RESULTS: The results of clinical examination and simulations were compared using the identical roots of the teeth. The regions that showed increased hydrostatic pressure (>0.0047 MPa) correlated well with the locations of root resorption for each tooth. Increased torque resulted in increased high-pressure areas and increased magnitudes of hydrostatic pressure, correlating with the experiments. CONCLUSION: If hydrostatic pressure exceeds typical human capillary blood pressure in the PDL, the risk of root resorption increases.