Biomechanical effect after Coflex and Coflex rivet implantation for segmental instability at surgical and adjacent segments: a finite element analysis

The Coflex device may provide stability to the surgical segment in extension but does not restore stability in other motion. Recently, a modified version called the Coflex rivet has been developed. The effects of Coflex and Coflex rivet implantation on the adjacent segments are still not clear; therefore, the purpose of this study was to investigate the biomechanical differences between Coflex and Coflex rivet implantation by using finite element analyses. The results show that the Coflex implantation can provide stability in extension, lateral bending, and axial rotation at the surgical segment, and it had no influence at adjacent segments except for extension. The Coflex rivet implantation can provide stability in all motions and reduce disc annulus stress at the surgical segment. Therefore, the higher range of motion and stress induced by the Coflex rivet at both adjacent discs may result in adjacent segment degeneration in flexion and extension.     

The influence of different magnitudes and methods of applying preload on fusion and disc replacement constructs in the lumbar spine: a finite element analysis

In a finite element (FE) analysis of the lumbar spine, different preload application methods that are used in biomechanical studies may yield diverging results. To investigate how the biomechanical behaviour of a spinal implant is affected by the method of applying the preload, hybrid-controlled FE analysis was used to evaluate the biomechanical behaviour of the lumbar spine under different preload application methods. The FE models of anterior lumbar interbody fusion (ALIF) and artificial disc replacement (ADR) were tested under three different loading conditions: a 150 N pressure preload (PP) and 150 and 400 N follower loads (FLs). This study analysed the resulting range of motion (ROM), facet contact force (FCF), inlay contact pressure (ICP) and stress distribution of adjacent discs. The FE results indicated that the ROM of both surgical constructs was related to the preload application method and magnitude; differences in the ROM were within 7% for the ALIF model and 32% for the ADR model. Following the application of the FL and after increasing the FL magnitude, the FCF of the ADR model gradually increased, reaching 45% at the implanted level in torsion. The maximum ICP gradually decreased by 34.1% in torsion and 28.4% in lateral bending. This study concluded that the preload magnitude and application method affect the biomechanical behaviour of the lumbar spine. For the ADR, remarkable alteration was observed while increasing the FL magnitude, particularly in the ROM, FCF and ICP. However, for the ALIF, PP and FL methods had no remarkable alteration in terms of ROM and adjacent disc stress.     

Effects of several temporomandibular disorders on the stress distributions of temporomandibular joint: a finite element analysis

The aim of this study was to evaluate stress distributions in the temporomandibular joints (TMJs) with temporomandibular disorders (TMDs) for comparison with healthy TMJs. A model of mandible and normal TMJs was developed according to CT images. The interfaces between the discs and the articular cartilages were treated as contact elements. Nonlinear cable elements were used to simulate disc attachments. Based on this model, seven models of various TMDs were established. The maximum stresses of the discs with anterior, posterior, medial and lateral disc displacement (ADD, PDD, MDD and LDD) were 12.09, 9.33, 10.71 and 6.07 times magnitude of the identically normal disc, respectively. The maximum stresses of the posterior articular eminences in ADD, PDD, MDD, LDD, relaxation of posterior attachments and disc perforation models were 21, 59, 46, 21, 13 and 15 times greater than the normal model, respectively. TMDs could cause increased stresses in the discs and posterior articular eminences.     

The effect of meniscal tears and resultant partial meniscectomies on the knee contact stresses: a finite element analysis

Knee osteoarthritis (OA) is believed to result from high levels of contact stresses on the articular cartilage and meniscus after meniscal damage. This study investigated the effect of meniscal tears and partial meniscectomies on the peak compressive and shear stresses in the human knee joint. An elaborate three-dimensional finite element model of knee joint including bones, articular cartilages, menisci and main ligaments was developed from computed tomography and magnetic resonance imaging images. This model was used to model four types of meniscal tears and their resultant partial meniscectomies and analysed under an axial 1150 N load at 0° flexion. Three different conditions were compared: a healthy knee joint, a knee joint with medial meniscal tears and a knee joint following partial meniscectomies. The numerical results showed that each meniscal tear and its resultant partial meniscectomy led to an increase in the peak compressive and shear stresses on the articular cartilages and meniscus in the medial knee compartment, especially for partial meniscectomy. Among the four types of meniscal tears, the oblique tear resulted in the highest values of the peak compressive and shear stresses. For the four partial meniscectomies, longitudinal meniscectomy led to the largest increase in these two stresses. The lateral compartment was minimally affected by all the simulations. The results of this study demonstrate meniscal tear and its resultant partial meniscectomy has a positive impact on the maintenance of high levels of contact stresses, which may improve the progression of knee OA, especially for partial meniscectomy. Surgeons should adopt a prudent strategy to preserve the greatest amount of meniscus possible.     

Biomechanical evaluation of the natural abutment teeth in combined tooth-implant-supported telescopic prostheses: a three-dimensional finite element analysis

Telescopic overdentures supported by the combination of natural teeth and implants have been thought a valuable treatment for the severely compromised partially edentulous patients. But the combination of teeth and implants involves highly complex biomechanical problems. This study is to evaluate biomechanical behaviors of the natural abutment teeth with the treatment of combined tooth-implant supported telescopic crown prostheses in mandible through 3D FEA. According to this study, the prosthetic option supported by a combination of teeth and implants and retained by double crowns could protect teeth and their periodontal support tissues acting as a rigid splint, and may be a valuable treatment option for partially edentulous patients with severely reduced remaining teeth in mandible.     

Biomechanical analysis of lumbar interbody fusion cages with various lordotic angles: a finite element study

Inappropriate lordotic angle of lumbar fusion cage could be associated with cage damage or subsidence. The biomechanical influence of cage lordotic angle on lumbar spine has not been fully investigated. Four surgical finite element models were constructed by inserting cages with various lordotic angles at L3-L4 disc space. The four motion modes were simulated. The range of motion (ROM) decreased with increased lordotic angle of cage in flexion, extension, and rotation, whereas it was not substantially changed in bending. The maximum stress in cage decreased with increased lordotic angle of cage in all motion modes. The maximum stress in endplate at surgical level increased with increased lordotic angle of cage in flexion and rotation, whereas it was not substantially changed in extension and bending. The facet joint force (FJF) was much smaller than that for the intact conditions in extension, bending, and rotation, while it was not substantially changed in flexion. In conclusion, the ROM, stresses in the cage and endplate at surgical level are sensitive to the lordotic angle of cage. The increased cage lordotic angle may provide better stability and reduce the risk of cage damage, whereas it may increase the risk of subsidence in flexion and rotation.     

Biomechanical comparison of implant inclinations and load times with the all-on-4 treatment concept: a three-dimensional finite element analysis

The purpose of this study was to compare the effects of implant inclinations and load times on stress distributions in the peri-implant bone based on immediate- and delayed-loading models. Four 3D FEA models with different inclination angle of the posterior implants (0°, 15°, 30°, 45°) were constructed. A static load of 150?N in the multivectoral direction was applied unilaterally to the cantilever region. The stress distributions in the peri-implant bone were evaluated before and after osseointegration. The principal tensile stress (σ_max), mean principal tensile stress (σ_max), principal compressive stress (σ_min) and mean principal compressive stress (σ_min) of the bone and micromotion at the contact interface between the bone and implants were calculated. In all the models, peak principal stresses occurred in the bone surrounding the left tilted implant. The highest σ_max and σ_min were all observed in the 0° model for both immediate- and delayed-loading models. And the 0° and 15° models showed higher σ_max and σ_min values. The 0°models showed the largest micromotion. The observed stress distribution was better in the 30° and 45° models than in the 0° and 15° models.     

Biomechanical comparison of conventional and optimised locking plates for the fixation of intraarticular calcaneal fractures: a finite element analysis

Intraarticular calcaneal fractures can result in poor prognosis. Although operative fixation can improve the functional outcomes in most cases, surgical complications such as loss of reduction and wound healing problems may increase the risk of reoperation. Hence, this study aimed to design calcaneal locking plate with a lower profile and better biomechanical performance and to compare the redesigned plate with the traditional calcaneal plate via the finite element method. A Sanders’ type II-C intraarticular calcaneal fracture was simulated. Two fixation models utilising the branch-like calcaneal locking plate and the full plate were constructed. Topology optimisation was conducted to generate a new calcaneal plate design. A biomechanical comparison among the three groups of plates was performed using the finite element method. For the fracture simulated in this study, the optimised plate was superior to the traditional plate in terms of fixation stability and safety but was reduced in volume by approximately 12.34%. In addition, more rational stress distributions were observed in the redesigned plate, underscoring the superiority of this new design in terms of fatigue strength. These results demonstrate that the topology optimisation can be used to design a new implant with a minimised profile and no loss of fixation stability.     

The use of functionally graded dental crowns to improve biocompatibility: a finite element analysis

In post-core crown restorations, the significant mismatch between stiffness of artificial crowns and dental tissues leads to stress concentration at the interfaces. The aim of the present study was to reduce the destructive stresses by using a class of inhomogeneous materials called functionally graded materials (FGMs). For the purpose of the study, a 3-dimentional computer model of a premolar tooth and its surrounding tissues were generated. A post-core crown restoration with various crown materials, homogenous and FGM materials, were simulated and analyzed by finite element method. Finite element and statistical analysis showed that, in case of oblique loading, a significant difference (p < 0.05) was found at the maximum von Mises stresses of the crown margin between FGM and homogeneous crowns. The maximum von Mises stresses of the crown margin generated by FGM crowns were lower than those generated by homogenous crowns (70.8 vs. 46.3 MPa) and alumina crown resulted in the highest von Mises stress at the crown margin (77.7 MPa). Crown materials of high modulus of elasticity produced high stresses at the cervical region. FGM crowns may reduce the stress concentration at the cervical margins and consequently reduce the possibility of fracture.     

Biomechanical effects of posterior pedicle fixation techniques on the adjacent segment for the treatment of thoracolumbar burst fractures: a biomechanical analysis

Abstract

Posterior pedicle fixation technique is a common method for treating thoracolumbar burst fractures, but the effect of different fixation techniques on the postoperative spinal mechanical properties has not been clearly defined, especially on adjacent segments. A finite element model of T10-L2 with moderate T12 vertebra burst fracture was constructed to investigate biomechanical behavior of three posterior pedicle screw fixation techniques. Compared with traditional short-segment 4 pedicle screw fixation (TS-4) and intermediate long-segment 6 pedicle screw fixation (IL-6), mono-segment 4 pedicle screw fixation (MS-4) provides a safer surgical selection to prevent the secondary degeneration of adjacent segments in the long-term.     

Mechanical response comparison in an implant overdenture retained by ball attachments on conventional regular and mini dental implants: a finite element analysis

This study investigates the bone/implant mechanical responses in an implant overdenture retained by ball attachments on two conventional regular dental implants (RDI) and four mini dental implants (MDI) using finite element (FE) analysis. Two FE models of overdentures retained by RDIs and MDIs for a mandibular edentulous patient with validation within 6% variation errors were constructed by integrating CT images and CAD system. Bone grafting resulted in 2 mm thickness at the buccal side constructed for the RDIs-supported model to mimic the bone augmentation condition for the atrophic alveolar ridge. Nonlinear hyperelastic material and frictional contact element were used to simulate characteristic of the ball attachment-retained overdentures. The results showed that a denture supported by MDIs presented higher surrounding bone strains than those supported by RDIs under different load conditions. Maximum bone micro strains were up to 6437/2987 and 13323/5856 for MDIs/RDIs under single centric and lateral contacts, respectively. Corresponding values were 4429/2579 and 9557/5774 under multi- centric and lateral contacts, respectively. Bone micro strains increased 2.06 and 1.96-folds under single contact, 2.16 and 2.24-folds under multiple contacts for MDIs and RDIs when lateral to axial loads were compared. The maximum RDIs and MDIs implant stresses in all simulated cases were found by far lower than their yield strength. Overdentures retained using ball attachments on MDIs in poor edentulous bone structure increase the surrounding bone strain over the critical value, thereby damaging the bone when compared to the RDIs. Eliminating the occlusal single contact and oblique load of an implant-retained overdenture reduces the risk for failure.