Evaluation of Stability and Stress Distribution on Plate and Bone for Correction of Anterior Open Bite with Le Fort I Osteotomy: New Plate Design

Abstract

Aim: Many different fixation methods have been proposed in the literature for the treatment of open bite. Beginning with the use of plates and screws, rigid fixation methods have become commonplace, however, open bite is a disorder prone to relapse despite rigid fixation. In our study, we aimed to eliminate the need for guided split usage during surgery and to increase postoperative stabilization in open bite patients with a new personalized plate design. Material and Method: For this purpose, a three-dimensional (3D) head model was created in the virtual environment. After the Le Fort I osteotomy on the model, the inferior segment of the maxilla was placed 1 cm forward and positioned to leave a space between the inferior and superior part of the maxilla. Different fixation methods were applied to fix the bone segments. In the first group, four plates with a thickness of 0.8 mm were fixed. In the other groups, we used three different thicknesses (0.4 mm, 0.6 mm, 0.8 mm) of the continuous plate we designed. The amount of movement and tension that occurred on the bone segments, plates, and screws were evaluated. Results: The maximum movement in the study was observed with the standard 4-plate fixation method, and the minimum movement was observed with the custom plate system with 11-screw type with a thickness of 0.8 mm. As a result, it has been found that the custom-made continuous plates provide a more rigid fixation than the standard plates. Conclusion: It may be possible to reduce the likelihood of a relapse problem by designing a plate with the appropriate thickness and form to spread the stress on the bone over a wider area.

Keywords

• Orthognathic surgery
• bone fixation
• Le Fort I osteotomy

References

1. Proffit WR, Fields HW, Sarver DM. Contemporary Orthodontics. 4th edition. Elsevier Health Sciences; 2006:193-208.
2. Ng CST, Wong WKR, Hagg U. Orthodontic treatment of anterior open bite. Int J Paediatr Dent. 2008;18:78-83.
3. Greenlee GM, Huang GJ, Chen SS, et al. Stability of treatment for anterior open-bite malocclusion: a meta-analysis. Am J Orthod Dentofacial Orthop. 2011;139:154-69.
4. Denison TF, Kokich VG, Shapiro PA. Stability of maxillary surgery in openbite versus nonopenbite malocclusions. Angle Orthod. 1989;59:5-10.
5. Buchanan EP, Hyman CH. LeFort I osteotomy. Semin Plast Surg. 2013:149-54.
6. Baek MS, Choi YJ, Yu HS, et al. Long-term stability of anterior open-bite treatment by intrusion of maxillary posterior teeth. Am J Orthod Dentofacial Orthop. 2010;138:396.e1-9.
7. Dowling PA, Espeland L, Sandvik L, et al. LeFort I maxillary advancement: 3-year stability and risk factors for relapse. Am J Orthod Dentofacial Orthop. 2005;128:560-9.
8. Proffit W, Phillips C, Turvey T. Stability after surgical-orthodontic corrective of skeletal Class III malocclusion. 3. Combined maxillary and mandibular procedures. Int J Adult Orthodon Orthognath Surg. 1991;6:211-25.

9. Bell WH, Buche WA, Kennedy JW, Ampil JP. Surgical correction of the atrophic alveolar ridge: a preliminary report on a new concept of treatment. Oral Surg Oral Med Oral Pathol. 1977;43:485-98.
10. Bishara SE, Chu GW, Jakobsen JR. Stability of the LeFort I one-piece maxillary osteotomy. Am J Orthod Dentofacial Orthop. 1988;94:184-200.
11. Bays RA, Bouloux GF. Complications of orthognathic surgery. Oral Maxillofac Surg Clin North Am. 2003;15:229-42.
12. Chua HDP, Hägg MB, Cheung LK. Cleft maxillary distraction versus orthognathic surgery—which one is more stable in 5 years?. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109:803-14.
13. Moldez MA, Sugawara J, Umemori M, et al, Long-term dentofacial stability after bimaxillary surgery in skeletal Class III open bite patients. Int J Adult Orthodon Orthognath Surg. 2000;15:309-19.
14. Espeland L, Dowling PA, Mobarak KA, Stenvik A. Three-year stability of open-bite correction by 1-piece maxillary osteotomy. Am J Orthod Dentofacial Orthop. 2008;134:60-6.
15. Proffit WR, Turvey TA, Phillips C. The hierarchy of stability and predictability in orthognathic surgery with rigid fixation: an update and extension. Head Face Med. 2007;3:21.
16. Kretschmer WB, Baciut G, Baciut M, et al. Stability of Le Fort I osteotomy in bimaxillary osteotomies: single-piece versus 3-piece maxilla. J Oral Maxillofac Surg. 2010;68:372-80.
17. Perez MMC, Sameshima GT, Sinclair PM. The long-term stability of LeFort I maxillary downgrafts with rigid fixation to correct vertical maxillary deficiency. Am J Orthod Dentofacial Orthop. 1997;112:104-8.
18. Convens J, Kiekens R, Kuijpers-Jagtman A, Fudalej P. Stability of Le Fort I maxillary inferior repositioning surgery with rigid internal fixation: a systematic review. Int J Oral Maxillofac Surg. 2015;44:609-14.
19. Ertem SY. Eğimli ve köşeli yapılan marjinal mandibulektominin kuvvet iletimine etkisinin üç boyutlu modelleme ve sonlu elemanlar analizi ile değerlendirilmesi. Doctoral thesis. Başkent University, Ankara, 2010;
20. Courant R. Variational methods for the solution of problems of equilibrium and vibrations. Bulletin of the American mathematical Society. 1943;49:1-23.
21. Clough RW. The finite element in plane stress analysis. 1960;
22. Aziz AK. The mathematical foundations of the finite element method with applications to partial differential equations. 1st edition. Academic Press; 2014:345-59.
23. Nagasao T, Miyamoto J, Hikosaka M, et al. Appropriate diameter for screws to fix the maxilla following Le Fort I osteotomy: an investigation utilizing finite element analysis. J Craniomaxillofac Surg. 2007;35:227-33.
24. Ataç M, Erkmen E, Yücel E, Kurt A. Comparison of biomechanical behaviour of maxilla following Le Fort I osteotomy with 2-versus 4-plate fixation using 3D-FEA. Part 1: advancement surgery. Int J Oral Maxillofac Surg. 2008;37:1117-24.
25. Ataç M, Erkmen E, Yücel E, Kurt A. Comparison of biomechanical behaviour of maxilla following Le Fort I osteotomy with 2-versus 4-plate fixation using 3D-FEA: Part 2: impaction surgery. Int J Oral Maxillofac Surg. 2009;38:58-63.
26. Erkmen E, Ataç M, Yücel E, Kurt A. Comparison of biomechanical behaviour of maxilla following Le Fort I osteotomy with 2-versus 4-plate fixation using 3D-FEA: part 3: inferior and anterior repositioning surgery. Int J Oral Maxillofac Surg. 2009;38:173-9.
27. Coskunses FM, Kan B, Mutlu I, et al. Evaluation of prebent miniplates in fixation of Le Fort I advancement osteotomy with the finite element method. J Craniomaxillofac Surg. 2015;43:1505-10.
28. Huang SF, Lo LJ, Lin CL. Biomechanical interactions of different mini-plate fixations and maxilla advancements in the Le Fort I Osteotomy: a finite element analysis. Comput Methods Biomech Biomed Engin. 2016;19:1704-13.
29. Centenero SA-H, Hernández-Alfaro F. 3D planning in orthognathic surgery: CAD/CAM surgical splints and prediction of the soft and hard tissues results–our experience in 16 cases. J Craniomaxillofac Surg. 2012;40:162-8.
30. Chin S-J, Wilde F, Neuhaus M, et al. Accuracy of virtual surgical planning of orthognathic surgery with aid of CAD/CAM fabricated surgical splint—A novel 3D analyzing algorithm. J Craniomaxillofac Surg. 2017;45:1962-70.
31. Ellis III E. Accuracy of model surgery: evaluation of an old technique and introduction of a new one. J Oral Maxillofac Surg. 1990;48:1161-7.
32. Sharifi A, Jones R, Ayoub A, et al. How accurate is model planning for orthognathic surgery?. Int J Oral Maxillofac Surg. 2008;37:1089-93.
33. Suojanen J, Leikola J, Stoor P. The use of patient-specific implants in orthognathic surgery: a series of 32 maxillary osteotomy patients. J Craniomaxillofac Surg. 2016;44:1913-6.
34. Huang SF, Lo LJ, Lin CL. Biomechanical optimization of a custom-made positioning and fixing bone plate for Le Fort I osteotomy by finite element analysis. Comput Biol Med. 2016;68:49-56.