Evaluation of Tissue Tensions in Segmental Maxillary Osteotomies by Finite Element Analysis

Abstract

Maxillary segmentation associated with Le Fort I osteotomy is a surgical technique used to correct transverse maxillary discrepancies. Notwithstanding advances over the years, there are still complications arising from this surgical intervention, including the maintenance of sufficient blood supply and excessive tension of the palatal fibromucosa. Therefore, the aim of this study was to analyze the effect of the force applied during surgery on bone dislocation and fibromucosa tension in different maxillary segmentation designs by finite element analysis. A 3-dimensional skull was generated from tomographic images. We worked with 4 models. In 2 models, we divided the maxilla into 3 segments: one with osteotomy between the lateral incisor and canine and the other between the canine and first premolar. In the other 2 models, we divided the maxilla into 4 segments with the same osteotomies previously mentioned. A force of 100N was applied to the palatal surfaces of the right and left permanent maxillary first molars. When comparing the technique between 3 and 4 segments with the same interdental osteotomy, we evidenced greater bone dislocation and less fibromucosa tension in the 3-segment technique. When we contrast the same number of segments with different regions of interdental osteotomy, we noticed a lower fibromucosa tension and a greater bone dislocation in the lateral incisors and canine. The technique with 3 segments and with interdental osteotomy between the lateral incisor and canine presented less resistance, allowing greater dislocation and consequently generating less mucosa tension.