Prediction of the articular eminence shape in a patient with unilateral hypoplasia of the right mandibular ramus before and after distraction osteogenesis—A simulation study

The aim of this work was to predict the shape of the articular eminence in a patient with unilateral hypoplasia of the right mandibular ramus before and after distraction osteogenesis (DO). Using a patient-specific musculoskeletal model of the mandible the hypothesis that the observed differences in this patient in the left and right articular eminence inclinations were consistent with minimisation of joint loads was tested. Moreover, a prediction was made of the final shape of the articular eminence after DO when the expected remodelling has reached a steady state. The individual muscle forces and the average TMJ loading were computed for each combination of articular eminence angles both before and after DO. This exhaustive parameter study provides a full overview of average TMJ loading depending on the angles of the articular eminences. Before DO the parameter study resulted in different articular eminence inclinations between left and right sides consistent with patient data obtained from CT scans, indicating that in this patient the articular eminence shapes result from minimisation of joint loads. The simulation model predicts development of almost equal articular eminence shapes after DO. The same tendency was observed in cone beam CT scans (NewTom) of the patient taken 6.5 years after surgery.     

Effect of hyperactivity of the lateral pterygoid muscle on the temporomandibular joint disk

In this study, the effect of hyperactivity of the lateral pterygoid muscle (LPM) on the temporomandibular joint (TMJ) disk during prolonged clenching was examined with a mathematical model. Finite element models of the TMJ were constructed based on magnetic resonance images from two subjects with or without internal derangement of the TMJ. For each model, muscle forces were used as a loading condition for stress analysis for 10 min clenching. Furthermore, an intermittent increase of the LPM force with intervals of 1 min was applied. In the asymptomatic model, large stresses were found in the central and lateral part of the disk at the onset of clenching. In the retrodiscal tissue, stress relaxation occurred during the first 2 min of clenching. When the force of the LPM increased temporarily, the disk moved anteriorly and returned to its original position afterward. In the symptomatic model, large stresses were observed in both the posterior region of the disk and the retrodiscal tissue throughout clenching. Upon temporary increase of the LPM force, the disk was elongated anteriorly, which appeared to be irreversible. These results indicate that hyperactivity of the LPM may be involved in the progression of disk displacement.     

Modeling the biomechanics of swine mastication – An inverse dynamics approach

A novel reconstructive alternative for patients with severe facial structural deformity is Le Fort-based, face-jaw-teeth transplantation (FJTT). To date, however, only ten surgeries have included underlying skeletal and jaw-teeth components, all yielding sub-optimal results and a need for a subsequent revision surgery, due to size mismatch and lack of precise planning. Numerous studies have proven swine to be appropriate candidates for translational studies including pre-operative planning of transplantation. An important aspect of planning FJTT is determining the optimal muscle attachment sites on the recipient?s jaw, which requires a clear understanding of mastication and bite mechanics in relation to the new donated upper and/or lower jaw. A segmented CT scan coupled with data taken from literature defined a biomechanical model of mandible and jaw muscles of a swine. The model was driven using tracked motion and external force data of one cycle of chewing published earlier, and predicted the muscle activation patterns as well as temporomandibular joint (TMJ) reaction forces and condylar motions. Two methods, polynomial and min/max optimization, were used for solving the muscle recruitment problem. Similar performances were observed between the two methods. On average, there was a mean absolute error (MAE) of <0.08 between the predicted and measured activation levels of all muscles, and an MAE of <7 N for TMJ reaction forces. Simulated activations qualitatively followed the same patterns as the reference data and there was very good agreement for simulated TMJ forces. The polynomial optimization produced a smoother output, suggesting that it is more suitable for studying such motions. Average MAE for condylar motion was 1.2 mm, which reduced to 0.37 mm when the input incisor motion was scaled to reflect the possible size mismatch between the current and original swine models. Results support the hypothesis that the model can be used for planning of facial transplantation.     

Volumetric change of the medial pterygoid following distraction osteogenesis of the mandible: an example of the associated soft-tissue changes

Mandibular distraction osteogenesis lengthens not only the affected skeleton but also the associated muscles of mastication. The purpose of this study was to determine medial pterygoid volume before and after distraction by using computed tomography. Using computed tomographic scans, the volume of the medial pterygoid muscle was determined before and after mandibular distraction in six pediatric patients. In four unilateral distraction patients (average age, 65 months), the average increase of the medial pterygoid muscle on the distracted side of the mandible was 29 percent, and on the contralateral nondistracted side, 10 percent. The average increase in medial pterygoid muscle volume in two bilateral distraction patients (each aged 8 months) was 75 percent. Results of this study demonstrate that distraction osteogenesis of the human mandible not only lengthens deficient bone, but it also increases the volume of the attached musculature.     

Using the finite element method to model the biomechanics of the asymmetric mandible before, during and after skeletal correction by distraction osteogenesis

An approach was developed to evaluate the load transfer mechanism in the temporomandibular joint (TMJ) area before, during and after mandibular ramus elongation by distraction osteogenesis (DO). In a concerted approach using computer tomography, magnetic resonance imaging (MRI), and finite element analysis, three-dimensional numerical models based on a young male patient, with a dento-facial deformity were generated. The magnitude and direction of the muscle forces acting on the mandible were assessed using both values derived from the muscles volume and cross-section as retrieved from the MRI-scan data-sets and taken from the literature. The resistance of the soft tissue envelope towards elongation during the DO-phase was also included. The finite element analyses showed that before skeletal correction by DO the load transfer was asymmetrical with high peak stresses in the affected joint. Following ramus elongation a more symmetrical loading in TMJs was predicted. The reaction forces in the TMJs during DO were low.     

Using the finite element method to model the biomechanics of the asymmetric mandible before,during and after skeletal correction by distraction osteogenesis

An approach was developed to evaluate the load transfer mechanism in the temporomandibular joint (TMJ) area before, during and after mandibular ramus elongation by distraction osteogenesis (DO). In a concerted approach using computer tomography, magnetic resonance imaging (MRI), and finite element analysis, three-dimensional numerical models based on a young male patient, with a dento-facial deformity were generated. The magnitude and direction of the muscle forces acting on the mandible were assessed using both values derived from the muscles volume and cross-section as retrieved from the MRI-scan data-sets and taken from the literature. The resistance of the soft tissue envelope towards elongation during the DO-phase was also included. The finite element analyses showed that before skeletal correction by DO the load transfer was asymmetrical with high peak stresses in the affected joint. Following ramus elongation a more symmetrical loading in TMJs was predicted. The reaction forces in the TMJs during DO were low.     

Computer planning for distraction osteogenesis

Distraction osteogenesis of the mandible has found an application in the treatment of patients with a variety of different mandibular deformities. Compared with the relatively simple unidirectional distraction of long bones as described by Ilizarov, the three-dimensional distraction of the mandible is extremely complex. Whereas experience with orthognathic surgery clearly demonstrates that careful presurgical planning is necessary to achieve predictable outcomes, there are few reported methods for the planning of mandibular distraction. The authors have developed a method for planning distraction osteogenesis of the mandible that involves the use of three-dimensional modeling and animation to simulate distraction osteogenesis in virtual reality. The first step in the authors' treatment planning process is to obtain a three-dimensional computerized scan of the facial skeleton. From this scan, a three-dimensional wire-mesh model is built using animation software. With the same software, a virtual distractor is built and installed on the wire-mesh model. The osteotomies and the distraction process are then simulated. Finally, a recipe for sequencing the linear and angular changes of the distractor is calculated. The authors have used this planning process in seven patients (age range, 4 to 10 years): four with unilateral mandibular deformities and three with bilateral. The planning process has yielded predictable and reproducible results.     

A three-dimensional mathematical model of the human masticatory system predicting maximum possible bite forces

A three-dimensional mathematical model of the human masticatory system, containing 16 muscle forces and two joint reaction forces, is described. The model allows simulation of static bite forces and concomitant joint reaction forces for various bite point locations and mandibular positions. The system parameters for the model were obtained from a cadaver head. Maximum possible bite forces were computed using optimization techniques; the optimization criterion we used was the minimizing of the relative activity of the most active muscle. The model predicts that at each specific bite point, bite forces can be generated in a wide range of directions, and that the magnitude of the maximum bite force depends on its direction. The relationship between bite force direction and its maximum magnitude depends on bite point location and mandibular position. In general, the direction of the largest possible bite force does not coincide with the direction perpendicular to the occlusal plane.     

Manipulation of callus after linear distraction: a "lifeboat" or an alternative to multivectorial distraction osteogenesis of the mandible?

Despite impressive results, distraction osteogenesis of the mandible is still compromised by difficulties with vector control. Because of the action of the masticatory muscles, the gonion angle has the tendency to open, resulting in an open bite. We report two patients, aged 10 and 12 years, who developed a severe open bite during mandibular distraction. As a salvage procedure, manual shaping of the soft regenerate was done immediately after distraction. Uneventful bony consolidation was observed, which resulted in anatomically shaped gonion angles. The fact that a regenerate created by distraction osteogenesis can be molded to virtually any shape offers interesting perspectives for the correction of complex mandibular deformities.     

Quantitative calculations of temporomandibular joint reaction forces--I. The importance of the magnitude of the jaw muscle forces

The effect of measurement errors on quantitative calculation of temporomandibular joint reaction force was investigated in a two-dimensional, two-muscle model. A computer program using the model incremented the magnitude of the bite force and muscle forces and the lengths of their moment arms, and calculated the joint reaction force at each increment. Computation of the joint reaction force is most sensitive to the relative lengths of the bite force and muscle forces moment arms. Absolute values for each muscle force are not required and errors in the magnitudes of the muscle forces have only a minor effect on calculation of the total joint reaction force.     

Biomechanics of the masticatory apparatus of Pteropus giganteus (Megachiroptera)

Jaw mechanics in Pteropus were studied by means of a three-dimensional model. The model included several parameters of muscle architecture, combined with quantified movement and electromyographical data. Estimates of the nature of the applied forces that act upon the mandible during a chewing cycle, and subsequent estimates of reaction forces at the bite point and joints during the powerstroke, were thus obtained for different food consistencies. The resultant muscle force (relative to the palate) shifts from upward and slightly backward at large gapes to upward and markedly backward at the end of closing. The resultant simultaneously moves anteriorly. During the powerstroke it retains a constant position and orientation along the thickened anterior edge of the coronoid process. The early stages of opening are guided by the slope of the teeth and mandibular fossa; during the remaining part of opening the working line of the resultant crosses the skull behind the joint and thus acquires an opening moment. The bite force has downward and forward components, and a slight transverse component. For a given applied muscular force its magnitude is larger in more posteriorly positioned bite points. Both joints are loaded, the contralateral one more than the ipsilateral. Food consistency affects magnitude and orientation of the applied force, and hence, magnitude and orientation of the bite force and magnitude of the joint reaction forces. The magnitude of masseter activity relative to temporalis activity appears to be the key factor for the orientation of the bite force, and hence for the mechanical optimal position of the food. The adaptive value of the general topography of the masticatory muscles in Pteropus is discussed.     

Application and validation of a three-dimensional mathematical model of the human masticatory system in vivo.

A previously described three-dimensional mathematical model of the human masticatory system, predicting maximum possible bite forces in all directions and the recruitment patterns of the masticatory muscles necessary to generate these forces, was validated in in vivo experiments. The morphological input parameters to the model for individual subjects were collected using MRI scanning of the jaw system. Experimental measurements included recording of maximum voluntary bite force (magnitude and direction) and surface EMG from the temporalis and masseter muscles. For bite forces with an angle of 0, 10 and 20 degrees relative to the normal to the occlusal plane the predicted maximum possible bite forces were between 0.9 and 1.2 times the measured ones and the average ratio of measured to predicted maximum bite force was close to unity. The average measured and predicted muscle recruitment patterns showed no striking differences. Nevertheless, some systematic differences, dependent on the bite force direction, were found between the predicted and the measured maximum possible bite forces. In a second series of simulations the influence of the direction of the joint reaction forces on these errors was studied. The results suggest that they were caused primarily by an improper determination of the joint force directions.     

The human mandible: Lever or link?

The mammalian mandible, and in particular the human mandible, is generally thought to function as a lever during biting. This notion, however, has not gone unchallenged. Various workers have suggested that the mandible does not function as a lever, and they base this proposition on essentially two assertions: (1) the resultant of the forces produced by the masticatory muscles always passes through the bite point; (2) the condylar neck and/or the temporomandibular joint is unsuited to withstand reaction forces during biting. A review of the electromyographic data and of the properties of the tissues of the temporomandibular joint do not support the non-lever hypothesis of mandibular function. In addition, an analysis of the strength of the condylar neck demonstrates that this structure is strong enough to withstand the expected reaction force during lever action. Ordinarily the human mandible and the forces that act upon it are analyzed solely in the lateral projection. Moments are then usually analyzed about the mandibular condyle; however, some workers have advocated taking moments about other points, e.g., the instantaneous center of rotation. Obviously it makes no difference as to what point is chosen since the moments about any point during equilibrium conditions are equal to zero. It is also useful to analyze the forces acting on the mandible in the frontal projection, particularly during unilateral biting. The electromyographic data suggest that during powerful unilateral molar biting the resultant adductor muscle force is passing between the bite point and the balancing (non-biting side) condyle. Therefore, in order for this system to be in equilibrium there must be a reaction force acting on the balancing condyle. This suggests that reaction forces are larger on the balancing side than on the working side, and possibly explains why individuals with a painful temporomandibular joint usually prefer to bite on the side of the diseased joint.     

A comparative study of two trunk biomechanical models under symmetric and asymmetric loadings

Despite recent advances in modeling of the human spine, simplifying assumptions are still required to tackle complexities. Such assumptions need to be scrutinized to assess their likely impacts on predictions. A comprehensive comparison of muscle forces and spinal loads estimated by a single-joint (L5–S1) optimisation-assisted EMG-driven (EMGAO) and a multi-joint Kinematics-driven (KD) model of the spine under symmetric (symmetric trunk flexion from neutral upright to maximum forward flexion) and asymmetric (holding a load at various heights in the right hand) activities is carried out. Regardless of the task simulated, the KD model predicted greater activities in extensor muscles as compared to the EMGAO model. Such differences in the symmetric tasks was due mainly to the distinct approaches to resolve the redundancy while in the asymmetric tasks they were due also to the different methods used to estimate joint moments. Shear and compression forces were generally higher in the KD model. Differences in predictions between these modeling approaches varied depending on the task simulated and the joint considered in the single-joint EMGAO model. The EMGAO model should incorporate a multi-joint strategy to satisfy equilibrium at different levels while the KD model should benefit from recorded EMG activities of the antagonistic muscles to supplement input measured kinematics.     

Experimental analysis of temporomandibular joint reaction force in macaques

Mandibular bone strain in the region immediately below the temporomandibular ligament was analyzed in adult and sub-adult Macaca fascicularis and Macaca mulatta. Following recovery from the general anesthetic, the monkeys were presented food objects, a wooden rod, or a specially designed bite-force transducer. Bone strain was recorded during incisal biting and mastication of food, and also during isometric biting of the rod and/or the transducer. The bone strain data suggest the following: The macaque TMJ is loaded by a compressive reaction force during the power stroke of mastication and incision of food, and during isometric molar and incisor biting. TMJ reaction forces are larger on the contralateral side during both mastication and isometric molar biting. Patterns of ipsilateral TMJ reaction force in macaques during isometric biting vary markedly in response to the position of the bite point. During biting along the premolars or first two molars a compressive reaction force acts about the ipsilateral TMJ; however, when the bite point is positioned along the M3, the ipsilateral TMJ has either very little compressive stress, no stress, or it is loaded in tension.     

Three dimensional model of the human mandible

A new biomechanical three-dimensional (3D) model for the human mandible is proposed. A simple two-dimensional model cannot explain the biomechanics of the human mandible, where muscular forces through occlusion and condylar surfaces are in a state of dynamical 3D equilibrium. All forces are resolved into components according to a selected coordinate system. The muscular forces, which during clenching act on the jaw, along with the necessary force level for chewing, also act as some kind of stabilizers of the mandibular condyles preventing dislocation and loading of nonarticular tissues.     

Distraction osteogenesis of the porcine mandible: histomorphometric evaluation of bone

Distraction osteogenesis is a technique for skeletal lengthening that exploits the body's innate capacity for bone formation in response to tension forces on the repair callus. The authors developed a distraction osteogenesis model with a semiburied device in the Yucatan minipig mandible because of similarities between human and porcine mandibular anatomy, temporomandibular function, chewing patterns, and bone turnover rates. The purpose of this study was to measure histomorphometric bone fill after different latency periods, rates of distraction, and duration of neutral fixation in the minipig mandible. In addition, the relationship between histomorphometric bone fill and clinical stability was investigated. Mandibular osteotomies in 20 female Yucatan minipigs weighing 25 to 30 kg were distracted with modified semiburied distraction devices. Variables included 0-day or 4-day latency; 1-mm, 2-mm, or 4-mm daily distraction rates; gap size of 7 or 12 mm; and evaluation after neutral fixation for various lengths of time. Specimens were fixed in 2% paraformaldehyde, pH 7.4, before being embedded in methylmethacrylate. Sections were prepared from the region just below the inferior alveolar canal. The area of new bone formation within the gap was measured and expressed as a percentage of the total area of the distraction gap. Bone fill ranged from 0 to 100 percent. A pilot study with 7-mm advancements showed similar bone fill with 0-day or 4-day latency, but with poor reproducibility. Mandibles that were distracted to 12 mm at 1 mm per day exhibited nearly complete bone fill, either with 0-day latency (average, 93 percent) or 4-day latency (average, 100 percent). Mandibles that had been distracted for 3 days at 4 mm per day showed moderate osteogenesis and clinical stability with increasing time of neutral fixation. Bone fill was significantly correlated with clinical stability (Spearman r = 0.801, p = 0.001). Histological examination showed exuberant periosteal osteogenesis in distracted mandibles, even in those that showed poor bone fill and clinical stability. Thus, the periosteum appears to be a major source of new bone formation. These results show that osteogenesis was nearly complete with 1 mm per day and 0-day or 4-day latency. These results are consistent with the authors' previously reported clinical and radiographic observations that a latency period is not necessary for successful healing of the mandibular distraction osteogenesis wound.     

A new model for calculating muscle forces from electromyograms

A muscle model is described that uses electromyogram (EMG), muscle length and speed of contraction to predict muscle force. Physiological parameters are the Hill constants and the shape of the twitch response to a single stimulus. The model was incorporated in a jaw model of the rabbit and tested by predicting the bite force produced by the jaw muscles during mastication. The time course of the calculated force appeared to match the bite force, measured in vivo by a strain gauge, applied to the bone below the teeth. The variation in peak strain amplitude from cycle to cycle correlated with the variation predicted by the model. The peak amplitude of the integrated EMGs of individual jaw muscles showed an average correlation with peak strain of 0.41. Use of the sum of the available peak amplitudes, weighted according to their effect upon the bite force increased the correlation to 0.46; the model predicted bite forces showed a correlation of 0.57 with the strain. The increase in correlation was statistically significant. The muscle forces were calculated using a minimum number of easily obtainable constants.     

A biomechanical model for analysis of muscle force,power output and lower jaw motion in fishes

Fish skulls are complex kinetic systems with movable components that are powered by muscles. Cranial muscles for jaw closing pull the mandible around a point of rotation at the jaw joint using a third-order lever mechanism. The present study develops a lever model for the jaw of fishes that uses muscle design and the Hill equation for nonlinear length-tension properties of muscle to calculate dynamic power output. The model uses morphometric data on skeletal dimensions and muscle proportions in order to predict behavior and force transmission mediated by lever action. The computer model calculates a range of dynamic parameters of jaw function including muscle force, torque, effective mechanical advantage, jaw velocity, bite duration, bite force, work and power. A complete list of required morphometrics is presented and a software program (MandibLever 2.0) is available for implementing lever analysis. Results show that simulations yield kinematics and timing profiles similar to actual fish feeding events. Simulation of muscle properties shows that mandibles reach their peak velocity near the start of jaw closing, peak force at the end of jaw closing, and peak power output at about 25% of the closing cycle time. Adductor jaw muscles with different mechanical designs must have different contractile properties and/or different muscle activity patterns to coordinate jaw closing. The effective mechanical advantage calculated by the model is considerably lower than the mechanical advantage estimated from morphological lever ratios, suggesting that previous studies of morphological lever ratios have overestimated force and underestimated velocity transmission to the mandible. A biomechanical model of jaw closing can be used to interpret the mechanics of a wide range of jaw mechanisms and will enable studies of the functional results of developmental and evolutionary changes in skull morphology and physiology.     

The vector of jaw muscle force as determined by computer-generated three dimensional simulation: a test of Greaves' model

We present results from a detailed three-dimensional finite element analysis of the cranium and mandible of the Australian dingo (Canis lupus dingo) during a range of feeding activities and compare results with predictions based on two-dimensional methodology [Greaves, W.S., 2000. Location of the vector of jaw muscle force in mammals. Journal of Morphology 243, 293-299]. Greaves showed that the resultant muscle vector intersects the mandible line slightly posterior to the lower third molar (m3). Our work demonstrates that this is qualitatively correct, although the actual point is closer to the jaw joint. We show that it is theoretically possible for the biting side of the mandible to dislocate during unilateral biting; however, the bite point needs to be posterior to m3. Simulations show that reduced muscle activation on the non-biting side can considerably diminish the likelihood of dislocation with only a minor decrease in bite force during unilateral biting. By modulating muscle recruitment the animal may be able to maximise bite force whilst minimising the risk of dislocation.