Mandibular Simfiz Fraktürlerinde Kullanılan İki Farklı Kompresyon Vidasının Biyomekanik Özelliklerinin Sonlu Elemanlar Analizi ve Servohidrolik Test Ünitesi ile Değerlendirilmesi ve Karşılaştırması: ex vitro bir çalışma.

Yıl 2024, Cilt: 8 Sayı: 1, 8 - 13, 30.04.2024

Alanur Çiftçi Şişman Altan Varol

Öz

Amaç: Kırık parçaları orijinal pozisyonlarında sabitlemek için çeşitli fiksasyon sistemleri geliştirilmiştir. Bu ex vitro çalışmanın amacı, bir servohidrolik test ünitesi (STU) ve sonlu elemanlar analizi (SEA) kullanılarak 2 farklı tasarıma sahip ikinci nesil başsız kanüllü kompresyon vidaları kullanılarak oluşturulan fiksasyonun biyomekanik özelliklerini karşılaştırmaktı.
Gereç ve Yöntemler: 14 adet taze dondurulmuş koyun kadavra alt çenesi rastgele 2 gruba ayrıldı (n=7). Mandibular simfiste orta hatta vertikal osteotomi ile kırık hattı oluşturuldu. Oluşturulan kırık fragmanların fiksasyonu için Grup 1'de 3,0 mm çapında, 20 mm uzunluğunda kısmen yivli Herbert vidaları, Grup 2'de ise 2,8 mm çapında, 20 mm uzunluğunda tam yivli HCCS vidaları kullanıldı. Her modele birbirine paralel ancak zıt yönlerde 2 adet vida yerleştirildi. Tüm modeller, STU ve SEA kullanılarak fiksasyonun stabilitesi açısından biyomekanik olarak incelendi.
Bulgular: Hem SEA hem de STU analizleri, HCCS kullanılarak oluşturulan fiksasyonun bozulması için gereken kuvvetlerin Herbert vidalarından istatistiksel olarak anlamlı derecede yüksek olduğu gözlemlendi.
Sonuç: Bu deneysel çalışmanın sınırları dahilinde, bulgular, ikinci nesil kompresyon vidalarının sağladığı biyomekanik yeterliliğin, bölgenin uygun anatomisinin de yardımıyla mandibular simfiz kırıklarının tedavisinde umut verici bir alternatif olabileceğini düşündürmektedir. Çalışma ayrıca SEA kullanılarak sanal ortamlarda farklı sabitleme sistemlerinin değerlendirilmesi ve karşılaştırılması açısından ileriki araştırmalara da faydalı olabilir.

Anahtar Kelimeler

Çene kırıkları, kırık sabitlenmesi, mandibula, sonlu eleman analizi

Biomechanical Comparison of Two Types of Compression Screws Using Finite Element Analysis and Servo-Hydraulic Testing Unit: an ex vitro study.

Öz

Objectives: Various types of fixation systems have been developed to stabilize the fractured fragments in their original position. The purpose of this ex vitro study was to compare the biomechanical properties of 2 fixation units provided by different types of second-generation headless cannulated compression screws (SG-HCCS) using a servo-hydraulic testing unit (STU) and finite element analysis (FEA).
Materials and Methods: 14 fresh frozen sheep cadaveric mandibles were divided into 2 groups randomly(n=7). 3.0 milimeters (mm) diameter, 20mm length partially threaded Herbert screws were used in Group 1 and 2.8mm diameter, 20mm length fully threaded HCCS were used in Group 2 for the fixation of the fragments that was made by a vertical osteotomy at the midline. 2 screws were placed in each model, parallel to each other but in opposite directions. All models were examined biomechanically for the stability of fixation by using STU and FEA.
Results: Both FEA and STU analysis revealed that the forces required to fail the fixation system provided by HCCS were significantly higher than Herbert screws.
Conclusions: Within the limits of this experimental study, the findings suggest that the biomechanical adequacy provided by second-generation compression screws may be a promising alternative in the treatment of mandibular symphysis fractures, aided by the favorable anatomy of the region. The study may also be useful for further studies in terms of evaluating and comparing different fixation systems in virtual environments using FEA.

Anahtar Kelimeler

Bone screws, compression, finite element analysis, fracture fixation, mandible

Kaynakça

• REFERENCES:
• Reference1 Adla DN, Kitsis C, Miles AW. Compression forces generated by Mini bone screws--a comparative study done on bone model. Injury. 2005;36(1):65–70.
• Reference2 Atali O, Varol A, Basa S, Ergun C, Hartomacıoğlu S. Comparison and validation of finite element analysis with a servo-hydraulic testing unit for a biodegradable fixation system in a rabbit model. Int. J. Oral Maxillofac. Surg. 2014;43(1):32–9.
• Reference3 Bayram B, Araz K, Uçkan S, Balcik C. Comparison of fixation stability of resorbable versus titanium plate and screws in mandibular angle fractures. J. Oral Maxillofac. Surg. 2009;67(8):1644–8.
• Reference4 Booth P, Eppley B, Schmelzeisen R. Maxillofacial Trauma and Esthetic Facial Reconstruction. London: Churchill Livingstone; 2003.
• Reference5 Brasileiro BF, Grempel RG. Ambrosano GM, Passeri LA. An in vitro evaluation of rigid internal fixation techniques for sagittal split ramus osteotomies: advancement surgery. J Oral Maxillofac. Surg. 2009;67(4):809–17.
• Reference6 Budhraja NJ, Shenoi RS, Badjate SJ, Bang KO, Ingole PD, Kolte VS. Three-dimensional Locking Plate and Conventional Miniplates in the Treatment of Mandibular Anterior Fractures. Ann. Maxillofac. Surg. 2018;8(1):73–7.
• Reference7 Castaño MC, Zapata U, Pedroza A, Jaramillo JD, Roldán S. Creation of a three-dimensional model of the mandible and the TMJ in vivo by means of the finite element method. Int. J. Comput. Dent. 2002;5(2-3):87–99.
• Reference8 El-Mahallawy Y, Al-Mahalawy H. Herbert Cannulated Bone Screw Osteosynthesis in Anterior Mandibular Fracture Treatment: A Comparative Study With Lag Screw and Miniplate. J. Oral Maxillofac. Surg. 2018;76(6):1281.e1–8.
• Reference9 Faran KJ, Ichioka N, Trzeciak MA, Han S, Medige J, Moy OJ. Effect of bone quality on the forces generated by compression screws. J. Biomech. 1999;32(8):861–4.
• Reference10 Franz H, Maxime C, Bill T. Atlas of craniomaxillofacial osteosynthesis: Thieme; 2009.
• Reference11 Galuppo LD, Stover SM, Jensen DG. A biomechanical comparison of equine third metacarpal condylar bone fragment compression and screw pushout strength between headless tapered variable pitch and AO cortical bone screws. Vet. Surg. 2002;31(3):201–10.
• Reference12 Haug RH, Peterson GP, Goltz M. A biomechanical evaluation of mandibular condyle fracture plating techniques.J. Oral Maxillofac. Surg. 2002;60(1):73–81.
• Reference13 Korkmaz HH. Evaluation of different miniplates in fixation of fractured human mandible with the finite element method. Oral Surg-Oral Med-Oral Pathol-Oral Radiol Endod. 2007;103: e1-13.
• Reference14 Kozakiewicz M, Sołtysiak P. Pullout force comparison of selected screws for rigid fixation in maxillofacial surgery. Dent. Med. Probl. 2017;(54):129–33.
• Reference15 Kozakiewicz M. Small-diameter compression screws completely embedded in bone for rigid internal fixation of the condylar head of the mandible. Br. J. Oral Maxillofac. Surg. 2018;56(1):74–6.
• Reference16 Peterson GP, Haug RH, Van Sickels J. A biomechanical evaluation of bilateral sagittal ramus osteotomy fixation techniques. J. Oral Maxillofac. Surg. 2005;63(9):1317–24.
• Reference17 Rahpeyma A, Khajehahmadi S, Abdollahpour S. Mandibular Symphyseal/Parasymphyseal Fracture with Incisor Tooth Loss: Preventing Lower Arch Constriction. Craniomaxillofacial trauma & recons. 2016;9(1):15–9.
• Reference18 Ram R, Ahsan R, Bhardwaj Y, Ghezta N, Kumar S. Assessment of Fixation of Mandibular Interforaminal Fractures by Using a Single Second-Generation Headless Compression Screw: A Pilot Study. Craniomaxillofacial trauma & recons. 2017;10(2):138–44.
• Reference19 Shyam Sundar S, Nandlal B, Saikrishna D, Mallesh G. Finite Element Analysis: A Maxillofacial Surgeon's Perspective. J. Maxillofac. Oral Surg. 2012;11(2):206–11.
• Reference20 van Haaren EH, van der Zwaard BC, van der Veen AJ, Heyliger IC, Wuisman PI, Smit TH. Effect of long-term preservation on the mechanical properties of cortical bone in goats. Acta orthop. 2008;79(5):708–16.