Histomorphometric Comparison of Transmandibular Implant and Titanium Implant.

This study was a histomorphometric comparison of the transmandibular implant (TMI) system and titanium implant using a confocal laser scanning microscope (CLSM). Two dogs were used. In each dog, 16 implant holes were made in the bilateral mandibular angle. Four cortical screws in the TMI, four titanium plasma spray (TPS) implants, and four hydroxyapatite (HA) coating implants were inserted and four holes were left as a control. Two dogs were sacrificed at 3 and 6 months. The samples were cut longitudinally and examined under CLSM. The contact rate of trabecular bone was smaller than that of cortical bone in all implants. The contact rates in TMI at 3 and 6 months was significantly smaller than those of TPS and HA and there was no difference between TPS and HA. Although the contact rate of TMI was low, only a small contact area may be enough for TMI because of its box form structure.

A micromechanical elastic property study of trabecular bone in the human mandible.

Micromechanical properties of human mandibular trabecular bone, with particular interest to any site differences were investigated. A mandible was harvested from a 66 year-old female cadaver free from bone disease. It was embedded in PMMA, cut into 2mm sections and polished. Micromechanical property measurements were obtained using the UH3 Scanning Acoustic Microscope (SAM) (Olympus Co., Tokyo, Japan) at 400MHz in the burst mode. 6 vertical slices from the right and 6 horizontal slices from the left were chosen. In each of the 12 samples, 3 points were measured; first in the center, the other 2 from the margins. Data were analyzed statistically by SPSS (SPSS, Inc.) using Student's t-test. The average value of reflection coefficient r is 0.58+/-0.079 with the range from 0.46 to 0.64; E=25.0+/-5.64 GPa. There is no significant difference in properties in the osteonal direction of related cortical bone and those found between the marginal area and center areas. The average value of r from the right side, 0.60+/-0.07, is statistically higher than the average value of from the left side, 0.56+/-0.07. Micromechanical properties of both mandibular trabecular and cortical bone have almost the same values.

Finite element analysis of a transmandibular implant.

Finite element analysis (FEA) was used to study the influence of bony height and baseplate effect on the transmandibular implant (TMI). FEA was used to assess the stress distribution in the mandible, with and without a baseplate. Forces were applied to the center of a bar space. The von Mises stress (SEQV) was displayed in bone, and shear stress also was measured. Tensile stress was always seen at the so-called saddle area; compressive stress was seen at the inferior border. Tensile strain at the saddle area of a 6-mm height mandible is always 9.1 times greater (corresponding to more SEQV) than that of an 18-mm mandible. At same bone heights, saddle area stresses are similar with or without a baseplate. However, stress at the lateral transossseous post interface with bone was significantly different between different bone height groups. Shear stress around the lateral transossseous post was smaller than does the SEQV of the same site. Decreased bone height dramatically increases stress at the saddle area independent of the baseplate presence. These data suggest that bone apposition is found in the severely atrophic mandibles. Thus, there is no need for a baseplate in a slight to mild atrophic mandible.

A clinical case report: interface analysis of a successful well-functioning transmandibular implant from a cadaver mandible.

Transmandibular implants (TMI) are indicated both for functional reconstruction of the severely atrophic mandible and when routine augmentation is unpredictable. This study investigates the interface of bone around a TMI, retrieved from the cadaver. The TMI had successfully functioned for 7 years. The mandible was immersed in 10% formaldehyde and sectioned into nine appropriate pieces. Samples were embedded in polymethylmethacrylate, and cut around the transosseous posts and cortical screws in both vertical and horizontal sections. Samples were analyzed at 400 MHz (nominal lateral resolution, 2.5 microm) using a UH3 Scanning Acoustic Microscope (Olympus, Tokyo, Japan). The middle of implant specimens 1-4 were cut to 50 microm, and stained by toluidine blue for light microscopy. Dental X-rays showed no bone resorption around any implant. On a 2-mm lateral scan, almost uniform interface space was seen between bone and implant surface in cortical screws. There are wider spaces around the transmandibular posts in the superior area. Histology revealed the small area of direct contact. There is bone marrow space in the interface, with no significant fibrous tissue. We interpret these results at the interface to be because of adaptation for stress distribution.

Evaluation of the micromechanical elastic properties of potential bone-grafting materials.

The micromechanical elastic properties of potential bone-graft materials were compared with that of the human mandible. Six different potential bone-replacement materials were used: Bio-Oss (Osteohealth), OsteoGraf/N-700 (Ceramed), Pepgen P15 (Ceramed), Interpore200 (Interpore Cross International), Allogro (Ceramed), and Dynagraft (GenSci Dental). As a control, mandibular cortical bone was obtained from a 17-year-old woman. Micromechanical elastic property analysis was obtained with the use of a UH3 scanning acoustic microscope (Olympus Co., Tokyo, Japan) (SAM) at 400 MHz in the burst mode. Each sample was measured at three areas. The data were analyzed statistically by SPSS (SPSS, Inc.) with the use of the Student t test. In human bone, the reflection coefficients r of the x dimension (r = 0.75 +/- 0.01) was statistically higher than those of the y (0.72 +/- 0.05) and the z (0.72 +/- 0.01) directions. The order of stiffness magnitude was found to be Pepgen (r = 0.73 +/- 0.05) >/= OsteoGraf (0.72 +/- 0.03) > Bio-Oss (0.71 +/- 0.02) > Interpore (0.69 +/- 0.10) > Dynagraft (0.43 +/- 0.05) > Allogro (0.36 +/- 0.04). For these samples, Interpore alone showed a large deviation in properties in the same specimen. With regard to the elastic properties solely, bone-grafting materials made from bovine or processed marine coral appear to be reasonable choices as graft materials.

Micromechanics/structure relationships in the human mandible.

OBJECTIVES: A clear understanding of the relationship between the micromechanical properties and orientation of the osteons within the mandible is important to understand mandibular function, fracture repair, treatment of temporo-mandibular joint disorders, the materials and organization of dental implants. The objective of this research was to obtain the micromechanical properties of human mandibular cortical bone as a function of orientation from TMJ to TMJ. METHODS: A mandible obtained from a deceased 66 year-old female free of bone disease was used. The mandible was embedded in polymethylmethacrylate. The micromechanical properties analysis was obtained using the UH3 scanning acoustic microscope (SAM; Olympus Co., Tokyo, Japan). The coordinates system is defined such that the inferior border of mandibular is positioned on the x-y plane. x is along the anterior-posterior direction, y is in the horizontal direction and z is in superior-inferior direction. RESULTS: The osteonal orientations were almost parallel to the x axis and eventually branched into two directions towards the coronoid process and condylar head. The SAM revealed that almost the whole area of the mandible body was found to be transversely isotropic in the plane perpendicular to the x axis. In the parallel and oblique directions, all data were transversely isotropic with respect to the x axis. Data of the perpendicular osteons were transversely isotropic with respect to the z axis. SIGNIFICANCE: Having actual micromechanical properties as a function of orientation in the mandible could provide base line data for: fracture repair; choice of bone replacement materials.