Zhiguo Zhang, Ruizhi Tao, Fan Zhou, Wenchao Sun, Maoning Wei
College of Mechanical and Electronic Engineering, Hohai University, Changzhou, Jiangsu, China; Institute of Intelligent Medical Devices, Suzhou Research Institute of Hohai University, Suzhou, Jiangsu, China.
College of Mechanical and Electronic Engineering, Hohai University, Changzhou, Jiangsu, China; Institute of Intelligent Medical Devices, Suzhou Research Institute of Hohai University, Suzhou, Jiangsu, China.
J Mech Behav Biomed Mater. 2023 Aug;144:105914. doi: 10.1016/j.jmbbm.2023.105914. Epub 2023 May 27.
Obstructive sleep apnea syndrome (OSAS) is recurrent apnoea caused by upper airway obstruction during sleep. In severe cases, OSAS might lead to sudden death. Currently, the mandibular advancement device (MAD) is the preferred product for the treatment of mild to moderate OSAS because of its compliance, portability and low cost. However, many clinical studies have suggested that long-term use of MAD might cause occlusal changes, periodontitis, muscle soreness, and joint damage. In view of the difficulties in the measurement of relevant mechanical factors in vivo, the present work aimed to quantitatively analyze biomechanical mechanisms that might lead to these side effects through computer numerical simulations and a nonhomogeneous alveolar bone model was established to approximate the actual bony features of the jaw in the simulations model. First, a 3D digital model of the teeth, periodontal ligament(PDL), and alveolar bone was created on the basis of computed tomography images and assembled with a 3D model of the MAD. A nonhomogeneous alveolar bone model was created based on computed tomographic images, and the stresses acting on the PDL were computed using the finite element method. The results showed that the nonhomogeneous model could more realistically reflect the mechanical properties of the alveolar bone and obtain the true stresses compared with the homogeneous model, which underestimated the adverse effects of PDL therapy. The numerical simulations in this paper can help doctors make more accurate judgements about MAD treatment from an oral health protection perspective.
阻塞性睡眠呼吸暂停综合征（OSAS）是睡眠期间上呼吸道阻塞引起的反复呼吸暂停。在严重情况下，OSAS可能导致猝死。目前，下颌前移装置（MAD）因其顺应性、便携性和低成本，是治疗轻至中度OSAS的首选产品。然而，许多临床研究表明，长期使用MAD可能会导致咬合变化、牙周炎、肌肉酸痛和关节损伤。鉴于体内相关力学因素测量的困难，本研究旨在通过计算机数值模拟定量分析可能导致这些副作用的生物力学机制，并建立了非均匀牙槽骨模型以在模拟模型中近似颌骨的实际骨质特征。首先，基于计算机断层扫描图像创建牙齿、牙周韧带（PDL）和牙槽骨的三维数字模型，并与MAD的三维模型组装。基于计算机断层扫描图像创建非均匀牙槽骨模型，并使用有限元方法计算作用于PDL的应力。结果表明，与均匀模型相比，非均匀模型能够更真实地反映牙槽骨的力学性能，并获得真实应力，均匀模型低估了PDL治疗的不良影响。本文的数值模拟可以帮助医生从口腔健康保护的角度对MAD治疗做出更准确的判断。
