Research Papers

In Vitro Mechanical Evaluation of Mandibular Bone Transport Devices

[+] Author and Article Information
Uriel Zapata

Mechanical Engineering Department,
EAFIT University,
Medellin 050022, Colombia
e-mail: uzapata@eafit.edu.co

Ikuya Watanabe

Department of Dental and Biomedical
Materials Science,
Nagasaki University Graduate School of
Biomedical Science,
Nagasaki 852-8588, Japan

Lynne A. Opperman, Paul C. Dechow

Baylor College of Dentistry,
Texas A&M University,
Dallas, TX 75246

Timothy Mulone

Craniotech ACR Devices,
Dallas, TX 75214

Mohammed E. Elsalanty

College of Dental Medicine,
Georgia Regents University,
Augusta, GA 30912

1Corresponding author.

Manuscript received September 11, 2013; final manuscript received January 20, 2014; published online March 7, 2014. Assoc. Editor: Rita M. Patterson.

J. Med. Devices 8(2), 021004 (Mar 07, 2014) (8 pages) Paper No: MED-13-1208; doi: 10.1115/1.4026561 History: Received September 11, 2013; Revised January 20, 2014

Bone transport distraction osteogenesis (BTDO) is a surgical procedure that has been used over the last 30 years for the correction of segmental defects produced mainly by trauma and oncological resections. Application of BTDO has several clinical advantages over traditional surgical techniques. Over the past few years, several BTDO devices have been introduced to reconstruct mandibular bone defects. Based on the location and outline of the defect, each device requires a uniquely shaped reconstruction plate. To date, no biomechanical evaluations of mandibular BTDO devices have been reported in the literature. The present study evaluated the mechanical behavior of three different shaped prototypes of a novel mandibular bone transport reconstruction plate and its transport unit for the reconstruction of segmental bone defects of the mandible by using numerical models complemented with mechanical laboratory tests to characterize strength, fatigue, and stability. The strength test evaluated device failures under extreme loads and was complemented with optimization procedures to improve the biomechanical behavior of the devices. The responses of the prototypes were characterized to improve their design and identify weak and strong regions in order to avoid posterior device failure in clinical applications. Combinations of the numerical and mechanical laboratory results were used to compare and validate the models. In addition, the results remark the importance of reducing the number of animals used in experimental tests by increasing computational and in vitro trials.

Copyright © 2014 by ASME
Your Session has timed out. Please sign back in to continue.


American Cancer Society, 2012, “Cancer Facts and Figures,” http://www.cancer.org
Bell, R. B., 2007, “The Role of Oral and Maxillofacial Surgery in the Trauma Care Center,” J. Oral Maxillofac. Surg., 65(12), pp. 2544–2553. [CrossRef]
Klotch, D. W., Gal, T. J., and Gal, R. L., 1999, “Assessment of Plate Use for Mandibular Reconstruction: Has Changing Technology Made a Difference?,” Otolaryngol. Head Neck Surg., 121(4), pp. 388–392. [CrossRef]
Herford, A. S., 2004, “Use of a Plate-Guided Distraction Device for Transport Distraction Osteogenesis of the Mandible,” J. Oral Maxillofac. Surg., 62(4), pp. 412–420. [CrossRef]
Castaño, F. J., Troulis, M. J., Glowacki, J., Kaban, L. B., and Yates, K. E., 2001, “Proliferation of Masseter Myocytes After Distraction Osteogenesis of the Porcine Mandible,” J. Oral Maxillofac. Surg., 59(3), pp. 302–307. [CrossRef]
Cope, J. B., Samchukov, M. L., and Cherkashin, A. M., 1999, “Mandibular Distraction Osteogenesis: A Historic Perspective and Future Directions,” Am. J. Orthod. Dentofacial Orthop., 115(4), pp. 448–460. [CrossRef]
Costantino, P. D., Shybut, G., Friedman, C. D., Pelzer, H. J., Masini, M., Shindo, M. L., and Sisson, G. A., Sr., 1990, “Segmental Mandibular Regeneration by Distraction Osteogenesis. An Experimental Study,” Arch. Otolaryngol. Head Neck Surg., 116(5), pp. 535–545. [CrossRef]
van Sickels, J. E., and Reddy, L. V., 2008, “Distractor Design and Options,” Atlas Oral Maxillofac. Surg. Clin. North Am., 16(2), pp. 159–167. [CrossRef]
Zapata, U., Elsalanty, M. E., Dechow, P. C., and Opperman, L. A., 2010, “Biomechanical Configurations of Mandibular Transport Distraction Osteogenesis Devices,” Tissue Eng. Part B: Rev., 16(3), pp. 273–283. [CrossRef]
Uckan, S., Veziroglu, F., and Arman, A., 2006, “Unexpected Breakage of Mandibular Midline Distraction Device: Case Report,” Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod., 102(6), pp. e21–e25. [CrossRef]
Panjabi, M. M., 1988, “Biomechanical Evaluation of Spinal Fixation Devices: I. A Conceptual Framework,” Spine, 13(10), pp. 1129–1134. [CrossRef]
Alkan, A., Ozer, M., Bas, B., Bayram, M., Celebi, N., Inal, S., and Ozden, B., 2007, “Mandibular Symphyseal Distraction Osteogenesis: Review of Three Techniques,” Int. J. Oral Maxillofac. Surg., 36(2), pp. 111–117. [CrossRef]
Djasim, U. M., Wolvius, E. B., van Neck, J. W., van Wamel, A., Weinans, H., and van der Wal, K. G. H., 2008, “Single Versus Triple Daily Activation of the Distractor: No Significant Effects of Frequency of Distraction on Bone Regenerate Quantity and Architecture,” J. Craniomaxillofac. Surg., 36(3), pp. 143–151. [CrossRef]
Wu, Z., Liu, Y., Singare, S., and Li, D., 2007, “Animal Model for Evaluation of Strain Gauge in Mandibular Distraction Osteogenesis in Rabbits,” Br. J. Oral Maxillofac. Surg., 45(8), pp. 633–636. [CrossRef]
Djasim, U. M., Wolvius, E. B., van Neck, J. W., Weinans, H., and van der Wal, K. G. H., 2007, “Recommendations for Optimal Distraction Protocols for Various Animal Models on the Basis of a Systematic Review of the Literature,” Int. J. Oral Maxillofac. Surg., 36(10), pp. 877–883. [CrossRef]
Haug, R. H., Nuveen, E. J., Barber, J. E., and Storoe, W., 1998, “An In Vitro Evaluation of Distractors Used for Osteogenesis,” Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod., 86(6), pp. 648–659. [CrossRef]
Burstein, F. D., Lukas, S., and Forsthoffer, D., 2008, “Measurement of Torque During Mandibular Distraction,” J. Craniofac. Surg., 19(3), pp. 644–647. [CrossRef]
Cheung, L. K., Zhang, Q., Wong, M. C. M., and Wong, L. L. S., 2003, “Stability Consideration for Internal Maxillary Distractors,” J. Craniomaxillofac. Surg., 31(3), pp. 142–148. [CrossRef]
Meyer, C., Martin, E., Kahn, J. L., and Zink, S., 2007, “Development and Biomechanical Testing of a New Osteosynthesis Plate (TCP®) Designed to Stabilize Mandibular Condyle Fractures,” J. Craniomaxillofac. Surg., 35(2), pp. 84–90. [CrossRef]
Ryoyama, D., Sawaki, Y., and Ueda, M., 2004, “Experimental Study of Mechanical Analysis in Mandibular Lengthening: Application of Strain Gauge Measurement,” Int. J. Oral Maxillofac. Surg., 33(3), pp. 294–300. [CrossRef]
Cope, J. B., Yamashita, J., Healy, S., Dechow, P. C., and Harper, R. P., 2000, “Force Level and Strain Patterns During Bilateral Mandibular Osteodistraction,” J. Oral Maxillofac. Surg., 58(2), pp. 171–178. [CrossRef]
Campos, T. N., Adachi, L. K., Chorres, J. E., Campos, A. C., Muramatsu, M., and Gioso, M. A., 2006, “Holographic Interferometry Method for Assessment of Static Load Stress Distribution in Dog Mandible,” Braz. Dent. J., 17(4), pp. 279–284. [CrossRef]
Meyer, C., Kahn, J. L., Boutemi, P., and Wilk, A., 2002, “Photoelastic Analysis of Bone Deformation in the Region of the Mandibular Condyle During Mastication,” J. Craniomaxillofac. Surg., 30(3), pp. 160–169. [CrossRef]
Osborn, J. W., and Baragar, F. A., 1985, “Predicted Pattern of Human Muscle Activity During Clenching Derived From a Computer Assisted Model: Symmetric Vertical Bite Forces,” J. Biomech., 18(8), pp. 599–612. [CrossRef]
Barbenel, J. C., 1972, “Biomechanics of the Temporomandibular Joint: A Theoretical Study,” J. Biomech., 5(3), pp. 251–256. [CrossRef]
Nickel, J. C., Yao, P., Spalding, P. M., and Iwasaki, L. R., 2002, “Validated Numerical Modeling of the Effects of Combined Orthodontic and Orthognathic Surgical Treatment on TMJ Loads and Muscle Forces,” Am. J. Orthod. Dentofacial Orthop., 121(1), pp. 73–83. [CrossRef]
Lovald, S. T., Wagner, J. D., and Baack, B., 2009, “Biomechanical Optimization of Bone Plates Used in Rigid Fixation of Mandibular Fractures,” J. Oral Maxillofac. Surg., 67(5), pp. 973–985. [CrossRef]
Korioth, T. W. P., and Versluis, A., 1997, “Modeling the Mechanical Behavior of the Jaws and Their Related Structures by Finite Element (FE) Analysis,” Crit. Rev. Oral Biol. Med., 8(1), pp. 90–104. [CrossRef]
Rohrle, O., and Pullan, A. J., 2007, “Three-Dimensional Finite Element Modelling of Muscle Forces During Mastication,” J. Biomech., 40(15), pp. 3363–3372. [CrossRef]
Cattaneo, P. M., Kofod, T., Dalstra, M., and Melsen, B., 2005, “Using the Finite Element Method to Model the Biomechanics of the Asymmetric Mandible Before, During and After Skeletal Correction by Distraction Osteogenesis,” Comput. Methods Biomech. Biomed. Eng., 8(3), pp. 157–165. [CrossRef]
Boccaccio, A., Pappalettere, C., and Kelly, D. J., 2007, “The Influence of Expansion Rates on Mandibular Distraction Osteogenesis: A Computational Analysis,” Ann. Biomed. Eng., 35(11), pp. 1940–1960. [CrossRef]
Kofod, T., Cattaneo, P. M., Dalstra, M., and Melsen, B., 2005, “Three-Dimensional Finite Element Analysis of the Mandible and Temporomandibular Joint During Vertical Ramus Elongation by Distraction Osteogenesis,” J. Craniofac. Surg., 16(4), pp. 586–593. [CrossRef]
Savoldelli, C., Bouchard, P. O., Manière-Ezvan, A., Bettega, G., and Tillier, Y., 2012, “Comparison of Stress Distribution in the Temporomandibular Joint During Jaw Closing Before and After Symphyseal Distraction: A Finite Element Study,” Int. J. Oral Maxillofac. Surg., 41(12), pp. 1474–1482. [CrossRef]
Reina-Romo, E., Gómez-Benito, M., Sampietro-Fuentes, A., Domínguez, J., and García-Aznar, J., 2011, “Three-Dimensional Simulation of Mandibular Distraction Osteogenesis: Mechanobiological Analysis,” Ann. Biomed. Eng., 39(1), pp. 35–43. [CrossRef]
Cordey, J., and Gautier, E., 1999, “Strain Gauges Used in the Mechanical Testing of Bones. Part I: Theoretical and Technical Aspects,” Injury, 30(Suppl. 1), pp. 7–13. [CrossRef]
Rubio-Bueno, P., Padrón, A., Villa, E., and Díaz-González, F. J., 2000, “Distraction Osteogenesis of the Ascending Ramus for Mandibular Hypoplasia Using Extraoral or Intraoral Devices: A Report of 8 Cases,” J. Oral Maxillofac. Surg., 58(6), pp. 593–599. [CrossRef]
Ortakoglu, K., Karacay, S., Sencimen, M., Akin, E., Ozyigit, A. H., and Bengi, O., 2007, “Distraction Osteogenesis in a Severe Mandibular Deficiency,” Head Face Med., 3(1), p. 7. [CrossRef] [CrossRef]
van der Bilt, A., Tekamp, A., van der Glas, H., and Abbink, J., 2008, “Bite Force and Electromyograpy During Maximum Unilateral and Bilateral Clenching,” Eur. J. Oral Sci., 116(3), pp. 217–222. [CrossRef]
Throckmorton, G. S., Buschang, P. H., and Ellis, E., III, 1996, “Improvement of Maximum Occlusal Forces After Orthognathic Surgery,” J. Oral Maxillofac. Surg., 54(9), pp. 1080–1086. [CrossRef]
Hylander, W. L., 1978, “Incisal Bite Force Direction in Humans and the Functional Significance of Mammalian Mandibular Translation,” Am. J. Phys. Anthropol., 48(1), pp. 1–7. [CrossRef]
Paphangkorakit, J., and Osborn, J. W., 1998, “Effects on Human Maximum Bite Force of Biting on a Softer or Harder Object,” Arch. Oral Biol., 43(11), pp. 833–839. [CrossRef]
Harada, K., Watanabe, M., Ohkura, K., and Enomoto, S., 2000, “Measure of Bite Force and Occlusal Contact Area Before and After Bilateral Sagittal Split Ramus Osteotomy of the Mandible Using a New Pressure-Sensitive Device: A Preliminary Report,” J. Oral Maxillofac. Surg., 58(4), pp. 370–373. [CrossRef]
Nagai, I., Tanaka, N., Noguchi, M., Suda, Y., Sonoda, T., and Kohama, G., 2001, “Changes in Occlusal State of Patients With Mandibular Prognathism After Orthognathic Surgery: A Pilot Study,” Br. J. Oral Maxillofac. Surg., 39(6), pp. 429–433. [CrossRef]
Boyer, R., Welsch, G., and Collings, E., 2007, Material Properies Handbook: Titanium Alloys, ASM International, Materials Park, OH.
Cordey, J., and Gautier, E., 1999, “Strain Gauges Used in the Mechanical Testing of Bones. Part II: ‘In Vitro’ and ‘In Vivo’ Technique,” Injury, 30(Suppl. 1), pp. 14–20. [CrossRef]
Robinson, R. C., O'Neal, P. J., and Robinson, G. H., 2001, “Mandibular Distraction Force: Laboratory Data and Clinical Correlation,” J. Oral Maxillofac. Surg., 59(5), pp. 539–544. [CrossRef]
de Las Casas, E. B., de Almeida, A. F., Cimini, C. A., Jr., Gomes, P. D. T. V., Cornacchia, T. P. M., and Saffar, J. M. E., 2007, “Determination of Tangential and Normal Components of Oral Forces,” J. Appl. Oral Sci., 15(1), pp. 70–76. [CrossRef]
Komuro, Y., Takato, T., Harii, K., and Yonemara, Y., 1994, “The Histologic Analysis of Distraction Osteogenesis of the Mandible in Rabbits,” Plast. Reconstr. Surg., 94(1), pp. 152–159. [CrossRef]
McCarthy, J. G., Stelnicki, E. J., Mehrara, B. J., and Longaker, M. T., 2001, “Distraction Osteogenesis of the Craniofacial Skeleton,” Plast. Reconstr. Surg., 107(7), pp. 1812–1827. [CrossRef]
Haug, R. H., Barber, J. E., and Punjabi, A. P., 1999, “An In Vitro Comparison of the Effect of Number and Pattern of Positional Screws on Load Resistance,” J. Oral Maxillofac. Surg., 57(3), pp. 300–308. [CrossRef]
Hibbeller, R. C., 2010, Mechanics of Materials, Prentice Hall, Englewood Cliffs, NJ.
Zeng, R. S., Zhang, P., and Wang, C., 2008, “Osteotomy With Titanium-Nickel Shape Memory Alloy Distracter for Repairing Mandibular Defects in Dogs,” J. Clin. Rehab. Tissue Eng. Res., 12(2), pp. 217–220.
Zhou, H. Z., Hu, M., Hu, K. J., Yao, J., and Liu, Y. P., 2006, “Transport Distraction Osteogenesis Using Nitinol Spring: An Exploration in Canine Mandible,” J. Craniofac. Surg., 17(5), pp. 943–949. [CrossRef]
Zheng, X. H., Tian, W. D., Long, J., Jing, W., and Li, S. W., 2005, “Mandibular Distraction Osteogenesis: An Experimental Study in Goats,” J. Sichuan Univ. (Med. Sci. Ed.), 36(3), pp. 386–389.
Eski, M., Nisanci, M., Cil, Y., Sengezer, M., and Ozcan, A., 2005, “A Custom-Made Distraction Device for Experimental Mandibular Distraction Osteogenesis,” J. Craniofac. Surg., 16(4), pp. 675–683. [CrossRef]


Grahic Jump Location
Fig. 1

(a) Basic configuration of the BTRP device. (b) Finite element model of the BTRP device.

Grahic Jump Location
Fig. 2

Three bone transport reconstruction plate prototypes. (a) BTRP-01 straight device recommended for the mandibular ramus. (b) BTRP-02 L shaped device suggested for the mandibular body. (c) BTRP-03 curved device advised for the mandibular symphysis.

Grahic Jump Location
Fig. 3

Finite element models of the three BTRP devices series including von Mises stress distributions. (a) Straight BTRP-01 affected by 50 N load, (b) L shaped BTRP-02 affected by 50 N load, and (c) curve-shaped BTRP-03 affected by 200 N load. (d) Transport disk unit affected by a 200 N load effect.

Grahic Jump Location
Fig. 4

Mechanical evaluation of BTRP devices series. (a) Tension test of straight devices, (b) local stability test of shielded transport units, (c) bending test of L-shaped devices, and (d) bending test of a curved devices.

Grahic Jump Location
Fig. 5

Mechanical deformation of the BTRP devices series tested in the laboratory. (a) Deformation of straight MTRP devices and a standard titanium plate tested under tension load in N, (b) deformation of L-shaped BTRP-02 devices tested under vertical load in a bending test, and (c) deformation of a curved BTRP-03 device under vertical load in a bending test.

Grahic Jump Location
Fig. 6

Microstrain (με = m/m*(1/1,000,000)) measures recorded at the strain gauges positioned on the BTRP devices. (a) Microstrain recorded on three BTRP-02 L-shaped devices tested on a bending test with a 50 N load. (b) Microstrain recorded on three BTRP-03 curved devices during a bending test with maximum applied load of 200 N.

Grahic Jump Location
Fig. 7

Principal stress patterns after optimization process applied to BTRP-02 device and its transport unit case



Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging and repositioning the boxes below.

Related Journal Articles
Related eBook Content
Topic Collections

Sorry! You do not have access to this content. For assistance or to subscribe, please contact us:

  • TELEPHONE: 1-800-843-2763 (Toll-free in the USA)
  • EMAIL: asmedigitalcollection@asme.org
Sign In