Abstract
This study developed a zygomaticomaxillary complex (ZMC) patient-specific repairing thin (PSRT) implant based on the buttress theory by integrating topology optimization and finite element (FE) analysis. An intact facial skeletal (IFS) model was constructed to perform topology optimization to obtain a hollow skeleton (HS) model with the structure and volume optimized. The PSRT implant was designed based on the HS contour which represented similar trends as vertical buttress pillars. A biomechanical analysis was performed on a ZMC fracture fixation with the PSRT implant and two traditional mini-plates under uniform axial loads applied on posterior teeth with 250 N. Results indicated that the variation in maximum bone stress and model volume between the IFS and HS models was 15.4% and 75.1%, respectively. Small stress variations between the IFS model and repairing with a PSRT implant (2.75–26.78%) were found for compressive stress at frontal process and tensile stress at the zygomatic process. Comparatively, large stress variations (30.67–96.26%) with different distributions between the IFS model and mini-plate models were found at the corresponding areas. This study concluded that the main structure/contour design of the ZMC repair implant according to the buttress position and orientation can obtain a favorable mechanical behavior.
Highlights
The objectives of repairing zygomaticomaxillary complex (ZMC) fractures involve stabilization and rehabilitation for craniofacial diseases [1,2,3]
This study concluded that the main structure/contour design of the ZMC repair implant according to the buttress position and orientation can obtain a favorable mechanical behavior
intact facial skeletal (IFS) finite element (FE) model showed that and unnecessary screws the implant and of (b) the two traditional mini-plates at upper lower partselements between were removed under part a stress constrain condition a hollow skeleton (HS) model with jagged appearance the remaining of the infraorbital rim and and zygomatic processwas bonegenerated were constructed
Summary
The objectives of repairing zygomaticomaxillary complex (ZMC) fractures involve stabilization and rehabilitation for craniofacial diseases [1,2,3]. Titanium implants (mini-plates) that were usually used to obtain superior realignment is the clinical standard treatment procedure in surgical repair [4,5,6], but the traditional mini-plate provides a fixation function only to the resting bone, but the mid-face stability after surgery is not considered, which may lead to plate deformation or screw loosening, making an asymmetrical mid-face appearance. Understanding the stress/strain biomechanical behavior of the ZMC fracture, the repaired and healing facial skeleton is relevant to the design of fixation implants [7]. There is still no consensus on the optimization strategy for designing an internal fixation implant for ZMC fractures. The repair stability of ZMC fractures remains controversial, because the fixation of fractures may not require maximum rigidity or strength to achieve reliable bone healing [7,8]. Proponents of single plate implants believe that decreasing the number of
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