Oral & Maxillofacial Surgery, Taipei Veterans General Hospital, School of Dentistry, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan.
Department of Biomedical Engineering, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan.
J Craniomaxillofac Surg. 2017 Oct;45(10):1671-1680. doi: 10.1016/j.jcms.2017.07.010. Epub 2017 Jul 27.
This study develops a novel hybrid (NH) reconstruction plate that can provide load-bearing strength, secure the bone transplant at the prosthesis favored position, and also maintain the facial contour in a mandibular segmental defect. A new patient-match bending technique which uses a three-dimensional printing (3DP) stamping process is developed to increase the interfacial fit between the reconstruction plate and mandibular bone.
The NH reconstruction plate was designed to produce a continuous profile with non-uniform thickness and triangular cross-screw patterns with a locking-screw feature at the plate base. Two mandible segmental defect finite element models including the NH reconstruction plate to secure a bone flap for occlusal requirement and the commercial straight (CS) reconstruction plate to secure a bone flap along the lower mandible border were generated for biomechanical fatigue testing.
The simulated results showed that the maximum von Mises stresses of the reconstruction plate for CS secured model are about 4.5 times more than the NH secured model. The bone strains around the fixation screws showed that the CS secured model was meaningfully higher than that of the NH secured model and exceeded the bone limit value. No fracture of any component was found in any sample in the fatigue testing.
In conclusion, the newly developed NH reconstruction plate can secure the transplant position in accordance to the individual occlusal requirements without sacrificing the maintenance of facial contour. Finite element-based biomechanical evaluation demonstrates superior mechanical strength compared to commercial standard plates.
本研究开发了一种新型混合(NH)重建板,它可以提供承重强度,将假体固定在移植骨的理想位置,并在下颌骨节段性缺损中保持面部轮廓。开发了一种新的患者匹配弯曲技术,该技术使用三维打印(3DP)冲压工艺,以增加重建板和下颌骨之间的界面贴合度。
NH 重建板的设计旨在产生具有非均匀厚度的连续轮廓和三角形交叉螺丝图案,并在板底部具有锁定螺丝特征。针对生物力学疲劳测试,生成了两个下颌骨节段性缺损有限元模型,包括用于固定咬合要求的骨瓣的 NH 重建板和用于固定下颌骨下缘骨瓣的商用直(CS)重建板。
模拟结果表明,CS 固定模型的重建板的最大 von Mises 应力是 NH 固定模型的约 4.5 倍。固定螺钉周围的骨应变表明,CS 固定模型明显高于 NH 固定模型,并且超过了骨极限值。在疲劳测试中,没有发现任何样本的任何部件发生断裂。
总之,新开发的 NH 重建板可以根据个体咬合要求固定移植位置,同时不牺牲面部轮廓的维持。基于有限元的生物力学评估表明,与商用标准板相比,其具有更高的机械强度。