İlerletme Genioplastisinde Kullanılan 5 Farklı Fiksasyon Sisteminin Stabilite ve Stres Dağılımlarının Sonlu Elemanlar Analizi ile Değerlendirilmesi

Yıl 2020, Cilt: 7 Sayı: 3, 364 - 372, 27.12.2020

Ahmet Aktı Abdullah Kalaycı

https://doi.org/10.15311/selcukdentj.735291

Öz

Amaç: Bu genioplasti çalışmasının amacı; segmentlerinin fiksasyonunda kullanılan titanyum monokortikal miniplak ve bikortikal vida sistemlerinin deplasman miktarı, kemikte oluşturduğu asal stresler ile plak ve vidalarda oluşan von-mises stres dağılımlarının sonlu elemanlar analizi ile karşılaştırılmasıdır. Gereç ve Yöntemler: Çalışmamızda alt çene ucunda genioplasti osteotomisi yapılarak distal fragman anteriora doğru 5 mm ilerletilmiştir. Fiksasyon olarak tek genioplasti plağı, 2 adet düz plak, 3 adet düz plak, 2 adet bikortikal vida ve 3 adet bikortikal vida fiksasyon modellerinin kullanıldığı 5 farklı modelde, alt segmente linguale doğru horizontal yönde 80 N’ luk kuvvet uygulanarak ortaya çıkan deplasman ve stres değerleri sonlu elemanlar analizi ile değerlendirilmiştir. Bulgular: En az deplasman üç adet titanyum bikortikal vida ile yapılan fiksasyon modelinde izlenirken, en fazla deplasman tek genioplasti plağı fiksasyon modelinde izlenmiştir. Materyallerde en az von-mises stres üç adet titanyum bikortikal vida ile yapılan fiksasyon modelinde, en fazla von-mises stres tek genioplasti plağı fiksasyon modelinde izlenmiştir. Kemikte en fazla gerilme stresi (Pmax) üç adet düz plak fiksasyon modelinde izlenirken en az gerilme stresi plak fiksasyon modellerinde izlenmiştir. Kemikte en fazla sıkışma stresi (Pmin) iki adet bikortikal vida fiksasyon modelinde izlenirken en az sıkışma stresi iki ve üç adet düz plak fiksasyon modellerinde izlenmiştir. Sonuç: Bikortikal vida grupları, deplasman ve von-mises gerilme stresleri açısından daha iyi sonuç vermekle birlikte, plak grupları gerilme ve sıkışma stresleri açısından daha elverişli bulunmuştur. Tüm bunlarla birlikte sonuçlar tüm gruplar için fizyolojik sınırlar içerisindedir.

Anahtar Kelimeler

Sonlu eleman analizi, Fiksasyon, Genioplasti

Destekleyen Kurum

Selçuk Üniversitesi BAP

Proje Numarası

19102041

Kaynakça

• Referans1. Chow B, Lau A. The planning of orthognathic surgery-the digital era. The Hong Kong Medical Diary 2009; 14(6): 11-4.
• Referans2. Precious DS, Cardoso AB, Cardoso MCA, Doucet JC. Cost comparison of genioplasty: when indicated, wire osteosynthesis is more cost effective than plate and screw fixation. Oral and maxillofacial surgery. 2014;18(4):439-44.
• Referans3. Proffit WR, White RP. and D.M. Sarver. Contemporary treatment of dentofacial deformity. Mosby, 2003.
• Referans4. Brons, R. Facial harmony: standards for orthognathic surgery and orthodontics. 1998: Quintessence Publishing Company Limited.
• Referans5. Reyneke, J. Essentials of orthognathic surgery, 2nd ed. Hanover: Quintessence Publishing Co, 2010.
• Referans6. Shaik M, Rao N, Kumar N, Prasanthi G. Comparison of rigid and semirigid fixation for advancement genioplasty. Journal of maxillofacial and oral surgery 2013; 12(3): 260-5.
• Referans7. Erkmen E, Şimşek 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. British Journal of Oral and Maxillofacial Surgery 2005; 43(2): 97-104.
• Referans8. Azevedo C, Hippert E. Failure analysis of surgical implants in Brazil. Engineering Failure Analysis 2002; 9(6): 621-33.
• Referans9. Azevedo C, Marques E. Three dimensional analysis of fracture, corrosion and wear surfaces. Engineering Failure Analysis 2010; 17(1): 286-300.
• Referans10. Azevedo C. Failure analysis of a commercially pure titanium plate for osteosynthesis. Engineering Failure Analysis 2003; 10(2): 153-64.
• Referans11. Magne P. Efficient 3D finite element analysis of dental restorative procedures using micro-CT data. Dental materials 2007; 23(5): 539-48.
• Referans12. Ramos, VF, Pinto L, Basting R. Force and deformation stresses in customized and non-customized plates during simulation of advancement genioplasty. Journal of Cranio-Maxillofacial Surgery 2017; 45(11): 1820-7.
• Referans13. Polido WD, Bell WH. Long-term osseous and soft tissue changes after large chin advancements. Journal of Cranio-Maxillofacial Surgery 1993; 21(2): 54-9.
• Referans14. Shaughnessy S, Mobarak KA, Høgevold HE, Espeland L.Long-term skeletal and soft-tissue responses after advancement genioplasty. American journal of orthodontics and dentofacial orthopedics 2006; 130(1): 8-17.
• Referans15. Lee GT, Jung HD, Kim SY, Park HS, Jung YS. The stability following advancement genioplasty with biodegradable screw fixation. British Journal of Oral and Maxillofacial Surgery 2014; 52(4): 363-8.
• Referans16. Reyneke J, Johnston T, Van der Linden WJ. Screw osteosynthesis compared with wire osteosynthesis in advancement genioplasty: a retrospective study of skeletal stability. British Journal of Oral and Maxillofacial Surgery 1997; 35(5): 352-6.
• Referans17. Yurtyapan H, Ayrancı F. İlerletme Genioplastisinde Kullanılan Farklı Vida Sistemlerinin Stabilite ve Stres Dağılımlarının Sonlu Elemanlar Analizi ile Karşılaştırılması. Turkiye Klinikleri Dishekimliği Bilimleri Dergisi 2019; 25(2): 124-32
• Referans18. Hannam AG, Stavness I, Lloyd JE, Fels S. A dynamic model of jaw and hyoid biomechanics during chewing. Journal of Biomechanics 2008; 41(5): 1069-76.
• Referans19. Celebi N, Rohner EC, Gateno J, Noble PC, Ismaily SK, Teichgraeber JF, Xia JH. Development of a mandibular motion simulator for total joint replacement. Journal of Oral and Maxillofacial Surgery 2011; 69(1): 66-79.
• Referans20. Huang HL, Huang JS, Ko CC, Hsu JT, Chang CH, Chen MYC. Effects of splinted prosthesis supported a wide implant or two implants: a three‐dimensional finite element analysis. Clinical oral implants research 2005; 16(4): 466-72.
• Referans21. Voo L, Kumaresan S, Pintar FA, Yoganandan N, Sances A. Finite-element models of the human head. Medical and Biological Engineering and Computing 1996; 34(5): 375-81.
• Referans22. Coskunses FM, Kan B, Mutlu I, Cilasun U, Celik T. Evaluation of prebent miniplates in fixation of Le Fort I advancement osteotomy with the finite element method. Journal of Cranio-Maxillofacial Surgery 2015; 43(8): 1505-10.
• Referans23. Kan B, Coskunses FM, Mutlu I, Ugur L, Meral DG. Effects of inter-implant distance and implant length on the response to frontal traumatic force of two anterior implants in an atrophic mandible: three-dimensional finite element analysis. International journal of oral and maxillofacial surgery 2015; 44(7): 908- 13.
• Referans24. Al-Moraissi E, Al-Hendi E. Are bicortical screw and plate osteosynthesis techniques equal in providing skeletal stability with the bilateral sagittal split osteotomy when used for mandibular advancement surgery? A systematic review and meta-analysis. International journal of oral and maxillofacial surgery 2016; 45(10): 1195-200.
• Referans25. Al-Moraissi E, Ellis E. Stability of bicortical screw versus plate fixation after mandibular setback with the bilateral sagittal split osteotomy: a systematic review and meta-analysis. International Journal of Oral and Maxillofacial Surgery 2016; 45(1): 1-7.
• Referans26. Choi BH, Min YS, Yi CK, Lee wy, Do K. A comparison of the stability of miniplate with bicortical screw fixation after sagittal split setback. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 2000; 90(4): 416-9.
• Referans27. Chung IH, Chung KY, Lee EK, Ihm JA, Park CJ, Lim JS, Hwang KG. Postoperative stability after sagittal split ramus osteotomies for a mandibular setback with monocortical plate fixation or bicortical screw fixation. J Oral Maxillofac Surg 2008; 66(3): 446-52.
• Referans28. Anucul B, Waite PD, Lemons JE. In vitro strength analysis of sagittal split osteotomy fixation: noncompression monocortical plates versus bicortical position screws. Journal of oral and maxillofacial surgery 1992; 50(12): 1295-9.
• Referans29. Sugiura T, Horiuchi K, Sugimura M, Tsutsumi S. Evaluation of threshold stress for bone resorption around screws based on in vivo strain measurement of miniplate. J Musculoskelet Neuronal Interact 2000; 1(2): 165-70.
• Referans30. Ganesh VK, Ramakrishna K, Ghista DN. Biomechanics of bone-fracture fixation by stiffness-graded plates in comparison with stainless-steel plates. Biomed Eng Online 2005; 4: 46.