Development of a mandibular motion simulator for total joint replacement.
OBJECTIVE
The purpose of this study was to develop a motion simulator capable of recreating and recording the full range of mandibular motions in a cadaveric preparation for an intact temporomandibular joint (TMJ) and after total joint replacement.


METHODS
A human cadaver head was used. Two sets of tracking balls were attached to the forehead and mandible, respectively. Computed tomographic (CT) scan was performed and 3-dimensional CT models of the skull were generated. The cadaver head was then dissected to attach the muscle activation cables and mounted onto the TMJ simulator. Realistic jaw motions were generated through the application of the following muscle forces: lateral pterygoid muscle, suprahyoid depressors (geniohyoid, mylohyoid, and digastric muscles), and elevator muscles. To simulate muscle contraction, cables were inserted into the mandible at the center area of each muscle's attachment. To provide a minimum mouth closing force at the initial position, the elevator muscles were combined at the anterior mandible. During mandibular movement, each motion was recorded using a high-resolution laser scanner. The right TMJ of the same head was reconstructed with a total TMJ prosthesis. The same forces were applied and the jaw motions were recorded again. CT scan was performed and 3-dimensional CT models of the skull with TMJ prosthesis were generated.


RESULTS
Mandibular motions, before and after TMJ replacement, with and without lateral pterygoid muscle reattachment, were re-created in a cadaveric preparation. The laser-scanned data during the mandibular motion were used to drive 3-dimensional CT models. A movie for each mandibular motion was subsequently created for motion path analysis. Compared with mandibular motion before TMJ replacement, mandibular lateral and protrusive motions after TMJ replacement, with and without lateral pterygoid muscle reattachment, were greatly limited. The jaw motion recorded before total joint replacement was applied to the mandibular and prostheses models after total TMJ replacement. The condylar component was observed sinking into the fossa during jaw motion.


CONCLUSIONS
A motion simulator capable of re-creating and recording full range of mandibular motions in a cadaveric preparation has been developed. It can be used to simulate mandibular motions for the intact TMJ and total joint prosthesis, and to re-create and record their full range of mandibular motions. In addition, the full range of the recorded motion can be re-created as motion images in a computer. These images can be used for motion path analysis and to study the causation of limited range of motion after total joint replacement and strategies for improvement.
Department of Oral and Maxillofacial Surgery, The Methodist Hospital Research Institute, Houston, TX, USA.
Nukhet
N
Celebi
E Carlos
EC
Rohner
Jaime
J
Gateno
Philip C
PC
Noble
Sabir K
SK
Ismaily
John F
JF
Teichgraeber
James J
JJ
Xia
D019643:Arthroplasty, Replacement; D001696:Biomechanical Phenomena; D002102:Cadaver; D003198:Computer Simulation; D003768:Dental Occlusion, Centric; D005471:Fluoroscopy; D006696:Holography; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007595:Joint Prosthesis; D007834:Lasers; D008334:Mandible / Q000502:physiology*; D008335:Mandibular Condyle / Q000502:physiology; D008406:Masseter Muscle / Q000502:physiology; D008954:Models, Biological; D009040:Motion Pictures; D009119:Muscle Contraction / Q000502:physiology; D009334:Neck Muscles / Q000502:physiology; D011626:Pterygoid Muscles / Q000502:physiology; D016059:Range of Motion, Articular / Q000502:physiology*; D013701:Temporal Bone / Q000502:physiology; D013703:Temporal Muscle / Q000502:physiology; D013704:Temporomandibular Joint / Q000502:physiology* / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods