title: A 3-dimensional finite-element analysis investigating the biomechanical behavior of the mandible and plate osteosynthesis in cases of fractures of the condylar process.
abstract: OBJECTIVE
  The condylar region is one of the most frequent sites for mandibular fractures, with direct application of miniplates being the most commonly used open-fixation technique today. Yet, anatomic and biomechanical limitations continue to make this application technically challenging with a considerable complication rate. We sought to analyze such incongruencies with respect to the complex biomechanical behavior of the mandible.
  
  
  METHODS
  Individual human mandible geometry, the specific bone density distribution, and the position and orientation of the masticatory muscles were evaluated by performing computed tomography scans and a sequential dissection of the cadaver mandible. Three-dimensional finite-element analysis was performed for different fracture sites, osteosynthesis plates, and loading conditions.
  
  
  RESULTS
  Osteosynthesis of fractures of the condylar neck with 1 or 2 miniplates of a diameter of 2.35 x 1.00 mm was found to be an insufficient fixation method. This also applies for plates (3.60 x 1.54 mm), according to Pape et al,(8) when used in singular fashion (high condylar neck fractures excepted). In cases of singular occlusal contacts in the molar region (particularly at the contralateral side of the fracture), the highest stress values inside the mandible and osteosynthetic devices could be observed. With even the static yield limit of titanium being exceeded in such cases, consecutive rapid failure of the miniplates becomes most likely when loading of the condylar region caused by bite forces cannot be prevented.
  
  
  CONCLUSIONS
  We strongly recommend the use, whenever possible, of 2 plates in the manner described by Pape et al(8) for osteosynthesis of fractures of the condylar neck in combination with bicortically placed screws. The stiffness of a singular osteosynthesis plate made of titanium in a diametrical dimension of approximately 5.0 x 1.75 mm was found to be equivalent to the physiological bone stiffness in the investigated fracture sites. The actual stiffness of such a fixation plate is approximately 3 times higher than the stiffness of devices commonly in use.
authors.affiliation: University Hospital of Cranio-Maxillofacial and Oral Surgery, Medical School, University of Vienna, Austria. arne.wagner@univie.ac.at
authors.forename: Arne
authors.initials: A
authors.lastname: Wagner
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Krach
authors.forename: Kurt
authors.initials: K
authors.lastname: Schicho
authors.forename: Gerhard
authors.initials: G
authors.lastname: Undt
authors.forename: Oliver
authors.initials: O
authors.lastname: Ploder
authors.forename: Rolf
authors.initials: R
authors.lastname: Ewers
mesh_terms: D001732:Bite Force; D001860:Bone Plates; D003799:Dental Stress Analysis / Q000379:methods*; D020342:Finite Element Analysis; D005593:Fracture Fixation, Internal / Q000295:instrumentation; D006801:Humans; D019248:Jaw Fixation Techniques / Q000295:instrumentation*; D008335:Mandibular Condyle / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D008337:Mandibular Fractures / Q000503:physiopathology* / Q000601:surgery*; D008410:Masticatory Muscles / Q000503:physiopathology; D013314:Stress, Mechanical; D014025:Titanium
chemical_list: D014025:Titanium