title: Sutural strain in orthopedic headgear therapy: a finite element analysis.
abstract: BACKGROUND
  The goal of this study was to analyze the strains induced in the sutures of the midface and the cranial base by headgear therapy involving orthopedic forces. Does the mechanical signal induced in the sutures sufficiently account for a growth-influencing effect?
  
  
  METHODS
  A finite element model of the viscerocranium and the neurocranium was used. It consisted of 53,555 tetrahedral elements and 97,550 nodes. The strain induced in the sutures of the cranial base and the midface when applying orthopedic headgear forces of 5 and 10 N was computed and recorded with an interactive measurement tool.
  
  
  RESULTS
  The magnitude and the distribution of the measured strains depended on the level and the direction of the acting force. Overall, the strain values measured at the sutures of the midface and the cranial base were moderate. The measured peak values at a load of 5 N per side were usually just below 20 microstrain irrespective of the force direction. A characteristic distribution of strain values appeared on the anatomical structures of the midface and the cranial base for each vector direction. The measurements based on the finite element method provided a good overview of the approximate magnitudes of sutural strains with orthopedic headgear therapy. The signal arriving in the sutures is apparently well below threshold, since the maximum measured strains in most sutures were about 100 fold lower than the minimal effective strain. A skeletal effect of the orthopedic headgear due to a mechanical effect on sutural growth cannot be confirmed from these results.
  
  
  CONCLUSIONS
  The good clinical efficacy of headgear therapy with orthopedic forces is apparently based mainly on dentoalveolar effects, whereas the skeletal effect due to inhibition of sutural growth is somewhat questionable.
authors.affiliation: Department of Orthodontics, University of Munich, Munich, Germany. christof.holberg@med.uni-muenchen.de
authors.forename: Christof
authors.initials: C
authors.lastname: Holberg
authors.forename: Nikola
authors.initials: N
authors.lastname: Holberg
authors.forename: Ingrid
authors.initials: I
authors.lastname: Rudzki-Janson
mesh_terms: D000293:Adolescent; D001696:Biomechanical Phenomena; D003198:Computer Simulation; D003393:Cranial Sutures / Q000503:physiopathology*; D004548:Elasticity; D005115:Extraoral Traction Appliances; D005147:Facial Bones / Q000503:physiopathology; D020342:Finite Element Analysis; D005624:Frontal Bone / Q000503:physiopathology; D006801:Humans; D008297:Male; D008437:Maxilla / Q000503:physiopathology; D008443:Maxillary Sinus / Q000503:physiopathology; D008445:Maxillofacial Development / Q000502:physiology; D008954:Models, Biological; D009295:Nasal Bone / Q000503:physiopathology; D009777:Occipital Bone / Q000503:physiopathology; D009915:Orbit / Q000503:physiopathology; D019291:Skull Base / Q000503:physiopathology; D013100:Sphenoid Bone / Q000503:physiopathology; D013314:Stress, Mechanical; D013701:Temporal Bone / Q000503:physiopathology; D015050:Zygoma / Q000503:physiopathology