Patient-specific mandibular reconstruction plates (PSMRPs) are being widely used to bridge segmental defects of the mandible after tumor resection or trauma as a result of their superior performance in mandibular reconstruction. Two structural optimized PSMRPs were created to boost the biomechanical behavior in patient-specific mandibular reconstruction by responding to the original design's unexpected in vivo fatigue fracture. Sequentially, through finite element analysis, the biomechanical benefit of the structural optimized PAMRPs was verified, and the biomechanical performances were compared between generally designed PSMRP1 with the customization and mandibular angle region optimized PSMRP2 with a tangent arc upper margin. Consequently, it was validated that the structural optimized PSMRPs reveal their better biomechanical performance, and the PSMRP1 presents better biomechanical performance to the patient-specific mandibular reconstruction than PSMRP2 as a result of its superior safety, preferable flexibility, and equivalent stability.
Background and Objective
: Owing to the unexpected in vivo fracture failure of the original design, structural optimized patient-specific mandibular reconstruction plates (PSMRPs) were created to boost the biomechanical performance of bridging segmental bony defect in the mandibular reconstruction after tumor resection. This work aimed to validate the biomechanical benefit of the structural optimized PAMRPs than the original design and compare the biomechanical performance between PSMRP1 with generic contour customization and PSMRP2 with a tangent arc upper margin in mandibular angle region.
Methods
: Finite Element Analysis (FEA) was used to evaluate the biomechanical behavior of mandibular reconstruction assemblies (MRAs) concerning these two structural optimized PSMRPs by simulating momentary left group clenching and incisal clenching tasks. Bonded contact was set between mandibular bone and fixation screws and between PSMRP and fixation screws in the MRA, while the frictionless connection was allocated between mandibular bone and PSMRP. The loads were applied on four principal muscles, including masseter, temporalis, lateral and medial pterygoid, whose magnitudes along the three orthogonal directions. The mandibular condyles were retrained in all three directions, and either the left molars or incisors area were restrained from moving vertically.
Results
: The peak von Mises stresses of structural optimized PSMRPs (264MPa, 296MPa) were way lower than that of the initial PSMRP design (393MPa), with 33% and 25% reduction during left group clenching. The peak magnitude of von Mises stress, minimum principal stress, and maximum principal strain of PSMRP1 (264MPa, 254MPa; -297MPa, -285MPa; 0.0020, 0.0020) was lower than that of PSMRP2 (296MPa, 286MPa; -319MPa, -306MPa; 0.0022, 0.0020), while the peak maximum principal stress of PSMRP1 (275MPa, 257MPa) was higher than that of PSMRP2 (254MPa, 235MPa) during both left group clenching and incisal clenching tasks.
Conclusions
: The structural optimized PSMRPs reveal their biomechanical advantage compared with the original design. The PSMRP1 presents better biomechanical performance to the patient-specific mandibular reconstruction than PSMRP2 as a result of its superior safety, preferable flexibility, and comparable stability. The PSMRP2 provides biomechanical benefit in reducing the maximum tension than PSMRP1, indicated by lower peak maximum principal stress, through tangent arc upper margin in mandibular angle region.