Abstract
The purpose of this paper was to analyze the biomechanical performance of customized mandibular reconstruction plates with optimized strength. The best locations for increasing bar widths were determined with a sensitivity analysis. Standard and customized plates were mounted on mandible models and mechanically tested. Maximum stress in the plate could be reduced from 573 to 393 MPa (−31%) by increasing bar widths. The median fatigue limit was significantly greater (p < 0.001) for customized plates (650 ± 27 N) than for standard plates (475 ± 27 N). Increasing bar widths at case-specific locations was an effective strategy for increasing plate fatigue performance.
Highlights
Tumors of the mandible often require resection of the mandible and are associated with surgical morbidity and difficulties in mastication and speaking
The specific goals of this study were (1) to assess optimal locations for plate strengthening based on a sensitivity analysis which was performed for a standard mandibular reconstruction plate, (2) to determine the fatigue performance of standard plates bent by a surgeon and customized mandibular reconstruction plates by mechanical testing, and (3) to compare the location of plate failure induced by mechanical testing and the location of stress concentrations determined by finite element modeling
The fatigue performance determined by mechanical testing was significantly greater (p < 0.001, unpaired t-test) for customized mandibular reconstruction plates (MFL = 650 N ± 27 N) than for standard reconstruction plates (MFL = 475 N ± 27 N, Figure 4)
Summary
Tumors of the mandible often require resection of the mandible and are associated with surgical morbidity and difficulties in mastication and speaking. Complications related to the removal of a mandibular reconstruction plates occur in 5–47% of all cases and are mainly due to plate exposure, infection, and tissue necrosis (Shibahara et al 2002; Lopez et al 2004; Militsakh et al 2004; Ettl et al 2010; Maurer et al 2010; Ciocca et al 2013). Plate fractures most commonly occur on the inner curvature of a reconstruction plate where stress concentrations are located (Martola et al 2007), and in most cases involves a resection including the mandibular angle (Shibahara et al 2002; Sakakibara et al 2014). Plate fracture does not seem to depend on patient age or gender (Seol et al 2014)
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