.: ORİJİNAL ARAŞTIRMA
Investigation of the Stability of Maxillary Posterior Downward and Forward Movement by Using Finite Element Analysis: Methodological Study
Maksiller İlerletmeyle Beraber Posterior Sarkıtmanın Stabilitesinin Sonlu Elemanlar Analizi ile İncelenmesi: Metodolojik Çalışma
Turkiye Klinikleri J Dental Sci. 2023;29(3):393-400
doi: 10.5336/dentalsci.2022-95019
Makale Dili: EN
Tam Metin
Ücretsiz Erişim
ABSTRACT
Objective: The maxillomandibular complex's counterclockwise movement with maxillary advancement and posterior downward repositioning was considered as one of the most unstable movements in orthognathic surgery. This study examines the reliability of fixation of different plate-screw systems in grafted and nongrafted models in the counterclockwise rotation where the maxilla is positioned anteriorly with posterior downward movement. Material and Methods: Stress distribution has been examined in four maxilla models. The transportable segment was moved 5 mm forward and posteriorly 4 mm downward in all models. Two scenarios with and without graft applied to the posterior region were created. These two scenarios were fixed with 2.0- and 1.5-mm diameter osteosynthesis systems. Four forces were applied separately to these models (45 and 125 N to the incisive tooth, 110 and 250 N to the molar tooth). Stress distribution on the bone and osteosynthesis screw plate system were examined in all models. Results: The application of graft decreased the load distribution on the bone and osteosynthesis systems. The stress distribution of both plate systems in the grafted models was similar in bone and osteosynthesis systems. The highest stress was measured in the non-grafted model using the 1.5 osteosynthesis system (Screw-F, 249.81 N/mm2 ), while the lowest stress was measured in the 2.0 system (Screw-G, 0.49 N/mm2 ) with the graft-applied model. Conclusion: The study results support the view that it is predicted that the necessity of graft application in surgeries where the maxilla is downward posteriorly with advancement. The 1.5 mm diameter system can be used safely if a graft-applied to the posterior gap.
Keywords: Orthognathic surgery; Le Fort I; finite element analysis; counterclockwise rotation; maxillary downward movement
Objective: The maxillomandibular complex's counterclockwise movement with maxillary advancement and posterior downward repositioning was considered as one of the most unstable movements in orthognathic surgery. This study examines the reliability of fixation of different plate-screw systems in grafted and nongrafted models in the counterclockwise rotation where the maxilla is positioned anteriorly with posterior downward movement. Material and Methods: Stress distribution has been examined in four maxilla models. The transportable segment was moved 5 mm forward and posteriorly 4 mm downward in all models. Two scenarios with and without graft applied to the posterior region were created. These two scenarios were fixed with 2.0- and 1.5-mm diameter osteosynthesis systems. Four forces were applied separately to these models (45 and 125 N to the incisive tooth, 110 and 250 N to the molar tooth). Stress distribution on the bone and osteosynthesis screw plate system were examined in all models. Results: The application of graft decreased the load distribution on the bone and osteosynthesis systems. The stress distribution of both plate systems in the grafted models was similar in bone and osteosynthesis systems. The highest stress was measured in the non-grafted model using the 1.5 osteosynthesis system (Screw-F, 249.81 N/mm2 ), while the lowest stress was measured in the 2.0 system (Screw-G, 0.49 N/mm2 ) with the graft-applied model. Conclusion: The study results support the view that it is predicted that the necessity of graft application in surgeries where the maxilla is downward posteriorly with advancement. The 1.5 mm diameter system can be used safely if a graft-applied to the posterior gap.
Keywords: Orthognathic surgery; Le Fort I; finite element analysis; counterclockwise rotation; maxillary downward movement
ÖZET
Amaç: Ortognatik cerrahi stabilizasyonunda maksillomandibular kompleksin hem saat yönü tersine hareketi hem de maksillanın inferiorda repoze edilmesi en güvensiz kabul edilen hareketlerden biridir. Çalışmanın amacı, maksillanın posterior sarkıtma ile anteriorda konumlandırıldığı saat yönü tersi hareketinde greftli, greftsiz ve farklı plak-vida sistemlerinin fiksasyonda güvenilirliğini incelemektir. Gereç ve Yöntemler: Çalışmada oluşturulan 4 maksilla model üzerinde stres dağılımı incelendi. Bütün modellerde hareketli segment 5 mm ilerletilerek posterior bölgeden 4 mm sarkıtıldı. Posterior bölgeye greft uygulanan ve uygulanmayan 2 senaryo oluşturuldu. Bu 2 senaryo hem 2,0 hem de 1,5 mm çaptaki osteosentez sistemleri ile fikse edildi. Oluşturulan bu modellere 4 farklı kuvvet ayrı ayrı uygulandı (insiziv dişe 45 N ve 125 N, molar dişe 110 N ve 250 N). Modellerde hem osteosentez vida plak sistemi hem de kemik üzerindeki stres dağılımı incelendi. Bulgular: Çalışmada greft uygulanmasının kemikte ve osteosentez sistemleri üzerinde yük dağılımını azalttığı bulundu. Greft uygulanan modellerde tüm plak sistemlerinin kemikte ve osteosentez sistemlerinde stres dağılımının birbirine yakın olduğu bulundu. En yüksek stres 1,5'lik osteosentez sisteminin kullanıldığı ve greft uygulanmayan modelde (Vida-F, 249,81 N/mm2 ), en düşük stres ise 2,0 sistemin kullanıldığı ve greft uygulanan modelde ölçüldü (Vida-G, 0,49 N/mm2 ). Sonuç: Maksillanın posteriordan sarkıtıldığı ameliyatlarda greft uygulanmasının gerekliliği, eğer greft uygulanmış ise 1,5'luk sistemin de güvenle kullanılabileceği öngörülmektedir.
Anahtar Kelimeler: Ortognatik cerrahi; Le Fort I; sonlu elemanlar analizi; saat yönü tersi rotasyon; maksiller sarkıtma
Amaç: Ortognatik cerrahi stabilizasyonunda maksillomandibular kompleksin hem saat yönü tersine hareketi hem de maksillanın inferiorda repoze edilmesi en güvensiz kabul edilen hareketlerden biridir. Çalışmanın amacı, maksillanın posterior sarkıtma ile anteriorda konumlandırıldığı saat yönü tersi hareketinde greftli, greftsiz ve farklı plak-vida sistemlerinin fiksasyonda güvenilirliğini incelemektir. Gereç ve Yöntemler: Çalışmada oluşturulan 4 maksilla model üzerinde stres dağılımı incelendi. Bütün modellerde hareketli segment 5 mm ilerletilerek posterior bölgeden 4 mm sarkıtıldı. Posterior bölgeye greft uygulanan ve uygulanmayan 2 senaryo oluşturuldu. Bu 2 senaryo hem 2,0 hem de 1,5 mm çaptaki osteosentez sistemleri ile fikse edildi. Oluşturulan bu modellere 4 farklı kuvvet ayrı ayrı uygulandı (insiziv dişe 45 N ve 125 N, molar dişe 110 N ve 250 N). Modellerde hem osteosentez vida plak sistemi hem de kemik üzerindeki stres dağılımı incelendi. Bulgular: Çalışmada greft uygulanmasının kemikte ve osteosentez sistemleri üzerinde yük dağılımını azalttığı bulundu. Greft uygulanan modellerde tüm plak sistemlerinin kemikte ve osteosentez sistemlerinde stres dağılımının birbirine yakın olduğu bulundu. En yüksek stres 1,5'lik osteosentez sisteminin kullanıldığı ve greft uygulanmayan modelde (Vida-F, 249,81 N/mm2 ), en düşük stres ise 2,0 sistemin kullanıldığı ve greft uygulanan modelde ölçüldü (Vida-G, 0,49 N/mm2 ). Sonuç: Maksillanın posteriordan sarkıtıldığı ameliyatlarda greft uygulanmasının gerekliliği, eğer greft uygulanmış ise 1,5'luk sistemin de güvenle kullanılabileceği öngörülmektedir.
Anahtar Kelimeler: Ortognatik cerrahi; Le Fort I; sonlu elemanlar analizi; saat yönü tersi rotasyon; maksiller sarkıtma
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