Kasapoglu Metin Berk, Az Zeynep Afra Akbiyik
Istanbul University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul, Türkiye.
Int J Med Sci. 2025 Apr 22;22(10):2257-2268. doi: 10.7150/ijms.111111. eCollection 2025.
Orthognathic surgery is important for correcting craniofacial deformities and restoring occlusion. However, in edentulous patients with severe maxillary atrophy, traditional fixation methods, such as mini plates, may not provide sufficient stability and support for prosthetic rehabilitation. Advances in additive manufacturing have enabled the development of patient-specific subperiosteal implants, offering improved biomechanical performance and more favourable load distribution. This study utilized finite element analysis to compare the biomechanical performance of traditional mini plates and customized subperiosteal implants in maxillary orthognathic surgery. Computed tomography data were used to construct patient-specific models, and a Le Fort I osteotomy with a 9-mm maxillary advancement was simulated. Displacement and stress distribution were analysed under vertical and oblique loading conditions, focusing on critical regions such as osteotomy sites and screw interfaces. Subperiosteal implants exhibited superior biomechanical performance, with significantly lower displacement (0.58 mm) compared to mini plates (4.50 mm). Stress levels in mini plates frequently exceeded the yield strength of grade IV titanium, whereas subperiosteal implants remained within the elastic limit of Ti6Al4V. Additionally, screw stresses were reduced by 38-42% in the subperiosteal implant group, thereby reducing the risk of mechanical failure. Customized subperiosteal implants provided enhanced stability, reduced stress concentrations, and improved load distribution compared to traditional mini plates. These findings highlight their potential as a transformative solution in orthognathic surgery, particularly for edentulous patients with severe maxillary atrophy. Future research should focus on long-term clinical outcomes and cost-effectiveness to further establish their role in maxillofacial reconstruction.
正颌手术对于矫正颅面畸形和恢复咬合关系至关重要。然而，在患有严重上颌骨萎缩的无牙患者中，传统的固定方法，如微型钢板，可能无法为修复体康复提供足够的稳定性和支撑。增材制造技术的进步使得定制的骨膜下种植体得以开发，其生物力学性能得到改善，载荷分布更有利。本研究利用有限元分析比较了传统微型钢板和定制骨膜下种植体在上颌正颌手术中的生物力学性能。利用计算机断层扫描数据构建患者特异性模型，并模拟了9毫米上颌骨前移的Le Fort I截骨术。在垂直和斜向加载条件下分析位移和应力分布，重点关注截骨部位和螺钉界面等关键区域。骨膜下种植体表现出卓越的生物力学性能，与微型钢板（4.50毫米）相比，位移显著更低（0.58毫米）。微型钢板中的应力水平经常超过IV级钛的屈服强度，而骨膜下种植体仍处于Ti6Al4V的弹性极限范围内。此外，骨膜下种植体组的螺钉应力降低了38 - 42%，从而降低了机械故障风险。与传统微型钢板相比，定制骨膜下种植体提供了更高的稳定性、降低了应力集中并改善了载荷分布。这些发现凸显了它们作为正颌手术变革性解决方案的潜力，特别是对于患有严重上颌骨萎缩的无牙患者。未来的研究应关注长期临床结果和成本效益，以进一步确立它们在颌面重建中的作用。
