Biomechanical evaluation of type p condylar head osteosynthesis using conventional small-fragment screws reinforced by a
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RESEARCH
Open Access
Biomechanical evaluation of type p condylar head osteosynthesis using conventional small-fragment screws reinforced by a patient specific twocomponent plate Tetiana Pavlychuk1*, Denis Chernogorskyi1, Yurii Chepurnyi1, Andreas Neff2 and Andrii Kopchak1
Abstract Background: The aim of this study was to evaluate via finite element analysis (FEA) the biomechanical behavior of conventional small-fragment screws reinforced by a patient-specific plate in type p condylar head. Methods: A finite element model of the mandible was created using Mimics 12.1 software. A type p condylar head fracture was simulated in the right condyle, and the left condyle was used as a control. Two patterns of fixation were investigated: conventional two-screw fixation and the same fixation system reinforced with a small, patientspecific plate. Surface models were imported into the software Ansys 5.7for further volume mesh generation. Results: The highest stress gradients were observed in the cortical layer of the lateral fragment, located near the screw. The conventional fixation method resulted in equivalent stresses 2 to 10 times greater than the reinforced method. Rigidity of fixation in the reinforced method increased up to 1.25–3 times compared to the conventional two-screw technique. Conclusion: This study’s findings suggest significant benefits in unfavorable biomechanical conditions from reinforcement of the standard two-screw fixation of condylar head fractures with a small, patient-specific plate acting as a washer. Keywords: Condylar head fracture, Reinforcement plate, Screw osteosynthesis, Biomechanics, FEA, Finite element analysis
Background Condylar head fracture management is still one of the most controversial issues in maxillofacial surgery [1–3]. A recent randomized multicentre study reported that open reduction and internal fixation (ORIF) resulted in better morphologic and functional outcomes compared with non-surgical treatment [1]; according to a recent * Correspondence: [email protected] 1 Department of Stomatology, O.O. Bogomolets National Medical University, Kyiv, Ukraine Full list of author information is available at the end of the article
long-term follow-up study, it also leads to a better quality of life [3]. ORIF facilitates anatomically accurate repositioning of the dislocated fragments and restoration of the ramus to its normal height, which is important to avoid mandibular movement restriction, malocclusion or temporomandibular joint (TMJ) internal derangement [2–5]. Several studies have shown that the main predictors of unfavorable functional prognosis at long term follow up are adequate reconstruction of the condylar head and minimally invasive revision of the surrounding soft tissues [2, 3, 6–8]. At the same time, stable ORIF of
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropria
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