Comparison of screw and plate osteosynthesis in advancement genioplasty: a finite element analysis study

Year 2025, Volume: 59 Issue: 1, 40 - 45, 29.01.2025

Serap Gülsever , Sümer Münevveroğlu , Selim Hartomacıoğlu , İpek Necla Güldiken , Sina Uçkan

https://doi.org/10.26650/eor.20241371296

Abstract

Purpose: The purpose of this study was to evaluate the distribution of stresses in screw and plate fixation systems during simulated advancement genioplasty using finite element analysis.

Materials and Methods: A cone-beam computed tomography image of a patient was used to create three dimensional virtual models of mandibular bone. Chin advancement of 8 mm was simulated following a horizontal osteotomy of the chin in a computer-aided design program. The distal segment was stabilized with two titanium mini-screws placed bilaterally in the first model and a single 4-hole titanium pre-bent chin plate placed centrally in the second model. The plate was fixed with four mini-screws, two in the proximal and two in the distal segment. All fixative appliances were submitted to 15 N force applied backwards to the lingual surface of the chin parallel to the occlusal plane and 7 N force applied upwards to the buccal surface of the chin perpendicular to the occlusal plane. The distributions of von Mises stresses and deformations in bone and titanium materials were evaluated.

Results: In the screw fixation system (22.52 MPa) higher stress values were observed compared to the plate fixation system (13.71 MPa). The deformation value was higher for the screw fixation system (0.021 mm) than the plate fixation system (0.0007 mm).

Conclusion: In advancement genioplasty, fixation with a single pre-bent centrally placed chin plate showed slightly better stabilization than fixation with two bilaterally placed bicortical screws. The stress values were within the physical strength limits of bone and titanium for both systems.

Keywords

Genioplasty, bone plate, bone screw, finite element analysis, stress distribution

References

• Brar RS, Gupta R, Gupta S, Chaudhary K, Singh P, Kaur M. Skeletal and Soft-Tissue Stability Following Advancement Genioplasty: A Comparative Analysis between Wire and Miniplate Osteosynthesis. J Pharm Bioallied Sci 2021;13:72-5. google scholar
• Janssens E, Shujaat S, Shaheen E, Politis C, Jacobs R. Long-term stability of isolated advancement genioplasty, and influence of associated risk factors: a systematic review. J Craniomaxillofac Surg 2021;49(4):269-76. google scholar
• Mortazavi H, Tabrizi R, Mohajerani H, Ozkan T. Evaluation of stability in advancement genioplasty: An 18-month follow-up. Shiraz Univ Dent J 2010;10:61-4. google scholar
• Hofer O. Operation der prognathie and mikrogenie. Dtsch Zahn-, Mund-, und Kieferheilkunde 1942;9:121-32. google scholar
• Trauner R, Obwegeser H. The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. Part I. Surgical procedures to correct mandibular prognathism and reshaping of the chin. Oral Surg Oral Med Oral Pathol 1957;10(7):677-89. google scholar
• Precious DS, Cardoso AB, Cardoso MCAC, Doucet JC. Cost comparison of genioplasty: when indicated, wire osteosynthesis is more cost effective than plate and screw fixation. Oral Maxillofac Surg 2014;18:439-44. google scholar
• Shaik M, Koteswar Rao N, Kiran Kumar N, Prasanthi G. Comparison of rigid and semirigid fixation for advancement genioplasty. J Maxillofac Oral Surg 2013;12:260-5. google scholar
• Talebzadeh N, Pogrel MA. Long-term hard and soft tissue relapse rate after genioplasty. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91(2):153-6. google scholar
• Ekram S, Arunkumar KV, Mowar A, Khera A. Evaluation of stability and esthetic outcome following rigid fixation of a new sagittal genioplasty technique - A clinical study. Natl J Maxillofac Surg 2021;12:17-24. google scholar
• Shaughnessy S, Mobarak KA, Hogevold HE, Espeland L. Long-term skeletal and soft-tissue responses after advancement genioplasty. Am J Orthod Dentofac Orthop 2006;130(1):8-17. google scholar
• Reyneke JP, Johnston T, Van der Linden WJ. Screw osteosynthesis compared with wire osteosynthesis in advancement genioplasty: a retrospective study of skeletal stability. Br J Oral Maxillofac Surg 1997;35(5):352-6. google scholar
• Polido WD, Regis LDC, Bell WH. Bone resorption, stability, and soft-tissue changes following large chin advancements. J Oral Maxillofac Surg 1991;49(3):251-6. google scholar
• Rawat MK, Ibrahim M, Kolli H, Nuthalapati SC, Khanna SS, Pendyala GS, Tiwari RVC. Comparison Of Two Different Osteosynthesis Technique To Evaluate Skeletal Stability In Advancement Genioplasty: A Retrospective Study. Eur J Molecul Clin Med 2020;7(3):5685-90. google scholar
• Lee GT, Jung HD, Kim SY, Park HS, Jung YS. The stability following advancement genioplasty with biodegradable screw fixation. Br J Oral Maxillofac Surg 2014;52(4):363-^8. google scholar
• Ueki K, Moroi A, Yoshizawa K. Stability of the chin after advancement genioplasty using absorbable plate and screws with template devices. J Craniomaxillofac Surg 2019;47(10):1498-503. google scholar
• Aktı A, Kalaycı A. İlerletme Genioplastisinde Kullanılan 5 Farklı Fiksasyon Sisteminin Stabilite ve Stres Dağılımlarının Sonlu Elemanlar Analizi ile Değerlendirilmesi. Selcuk Dent J 2020;7(3):364-72. google scholar
• Carneiro JA, Lima PRL, Leite MB, Toledo Filho RD. Compressive stress-strain behavior of steel fiber reinforced-recycled aggregate concrete. Cem Concr Compos 2014;46:65-72. google scholar
• DeFreitas CE, Ellis E III, Sinn DP. A retrospective study of advancement genioplasty using a special bone plate. J Oral Maxillofac Surg 1992;50(4):340-6. google scholar
• Van Sickels JE, Smith CV, Tiner BD, Jones DL. Hard and soft tissue predictability with advancement genioplasties. Oral Surg Oral Med Oral Pathol 1994;77(3):218-21. google scholar
• Payami A, Manji Z, Greenberg AM. Genioplasty Techniques. In: Greenberg AM, Schmelzeisen R (eds). Craniomaxillofacial Reconstructive and Corrective Bone Surgery. New York: Springer, 2019, p. 625-650. google scholar
• Precious DS, Armstrong JE, Morais D. Anatomic placement of fixation devices in genioplasty. Oral Surg Oral Med Oral Pathol 1992;73(1):2-8. google scholar
• Polido WD, Bell WH. Long-term osseous and soft tissue changes after large chin advancements. J Craniomaxillofac Surg 1993;21(2):54-9. google scholar
• Moragas JSM, Oth O, Büttner M, Mommaerts MY. A systematic review on soft-to-hard tissue ratios in orthognathic surgery part II: Chin procedures. J Craniomaxillofac Surg 2015;43(8):1530-40. google scholar
• Ward JL, Garri JI, Wolfe SA. The Osseous Genioplasty. Clin Plastic Surg 2007;34(3):485-500. google scholar
• Aquilina P, Chamoli U, Parr WCH, Clausen PD, Wroe S. Finite element analysis of three patterns of internal fixation of fractures of the mandibular condyle. Br J Oral Maxillofac Surg 2013;51(4):326-31. google scholar
• Erkmen E, Şimsek B, Yücel E, Kurt A. Three-dimensional finite element analysis used to compare methods of fixation after sagittal split ramus osteotomy: Setback surgery-posterior loading. Br J Oral Maxillofac Surg 2005;43(2):97-104. google scholar
• Atik F, Ataç MS, Özkan A, Kılınç Y, Arslan M. Biomechanical analysis of titanium fixation plates and screws in mandibular angle fractures. Niger J Clin Pract 2016;19(3):386-90. google scholar
• Ramos VF, Pinto LAPF, Basting RT. Force and deformation stresses in customized and non-customized plates during simulation of advancement genioplasty. J Craniomaxillofac Surg 2017;45(11):1820-7. google scholar
• Kayabaşı O, Yüzbasıoğlu E, Erzincanlı F. Static, dynamic and fatigue behaviors of dental implant using finite element method. Adv Eng Softw 2006;37(10):649-58. google scholar