3D-FEM and histomorphology of mandibular reconstruction with the titanium functionally dynamic bridging plate.

Biomechanical investigation of the mandible is difficult due to the complex geometrical structure. A three-dimensional finite element model of the mandible and masticatory muscles was produced with approximately 23,000 hexahedral elements. On this model, mesial and distal portions of the jaw were resected and bridged with a buccal and/or caudally positioned bridging plate. The plate was fixed caudal or buccal to the mandible. The defect was left as it was or reconstructed with an exactly fitting transplant defined as bone. The jaw was loaded at a predefined point. The changes in stresses and deformations of bone, the transplant and the bridging plate were analysed. In the caudally positioned bridging plate, finite element analysis showed lesser stresses around the fixation screws of the bridging plate. During reconstruction of the lateral defect, the buccal (ramus)-caudal (corpus) position of the bridging plate showed fewer stresses and deformations than purely buccal positioning. The caudal position of the bridging plate has biomechanical advantages and facilitates fixation of the plate, and fixation of a bone graft on the jaw stumps. Histomorphological investigations, 12 weeks and 7 years after reconstruction, show partial osseous integration or transformation of autologous iliac crest transplants.

Forensic odontologists successfully identify tsunami victims in Phuket, Thailand.

More than a year has elapsed since the seaquake in South-East Asia in December 2004, and more than 92% of the non-Thai victims have been identified. About 80% of the non-Thai victims were identified by dental information. This high success rate of dental identification in Thailand was a matter of surprise for many forensic experts. Identification based on dental information is a highly efficient, reliable and rapid procedure. The conclusions drawn from the identification of tsunami victims in Thailand were recently discussed at the 17th Meeting of the Standing Committee on Disaster Victim Identification of Interpol in Lyon, and may be used to formulate new guidelines for the identification of victims.

2D-finite element analyses and histomorphology of lag screws with and without a biconcave washer.

For osteosynthesis and for bone transplant fixation in particular, a lag screw with a biconcave washer, the so called "Anchor Screw" (AS) has been introduced in maxillo-facial surgery. Using 2D-finite element analysis (FEA), the v. Mises and the circumferential stresses induced in underlying bone by this AS are analysed and compared to those under a conventional lag screw. The stress distributions below the biconcave washer of the AS were correlated with histomorphological bone reactions after AS osteosynthesis in two tumor patients, retrieved 12 weeks and 19 months after tumor surgery, respectively. Depending on the thickness of cortical bone, the v. Mises stress concentrations below the biconcave washer were lower than under the head of the conventional lag screw (CLS), but with a higher stress maximum concentrated around the rim of the washer. The circumferential stresses were only half as high around the AS, and thus the deformation of bone was reduced. As predicted by FEA, histology showed microcrack formation, but then after minimal resorption, remodelling of bone below the biconcave washer. Stable osteosynthesis could be demonstrated by bony union already after 12 weeks, and, while bone remodelling continued in the healed osteotomy, it had decreased around the screws after 19 months. It can be concluded from the biomechanical principles and the histomorphological findings that the AS appears superior to the CLS.

The caudal mandibular reconstruction plate: a radiographic and histologic study of an autopsy specimen.

During autopsy, a reconstructed partial mandibular resection was recovered and subjected to histological examination. The mandible had been reconstructed 12 weeks earlier with a caudal plate and autologous cancellous bone from the iliac crest. Undecalcified microsections showed that the plate was firmly anchored by screws on both sides and on one side there was bony union. However, most of the free transplant bone had undergone 'unreplaced resorption.' Nevertheless, this method offers advantages over the conventional method of seating the plate on the buccal aspect and has interesting potential for further development.