A STUDY OF VON-MISES YIELD STRENGTH AFTER MANDIBULAR SAGITTAL SPLIT RAMUS OSTEOTOMY

하악지시상분할골절단술 시행 후 von-Miese 항복강도에 대한 유한요소법적 연구

  • Yoon, Ok-Byung (Dept. of Oral & Maxillafacial Surgery, Pohang Christianity Hospital) ;
  • Kim, Yeo-Gab (Dept. of Oral & Maxillafacial Surgery, College of Dentistry, Kyung Hee University)
  • 윤옥병 (포항기독병원 치과 구강악안면외과) ;
  • 김여갑 (경희대학교 치과대학 구강악안면외과학 교실)
  • Published : 2002.06.30

Abstract

For the study of its stability when the screw has been fixed after sagittal split ramus osteotomy(SSRO) of the mandible, the methods of screw arrangement are classified into two types, triangular and straight. The angles of screws to the bone surface are classified as perpendicular arrangements, the $60^{\circ}$ anterioinferior screw, known as triangular, and the most posterior screw, called straight arrangement, thus there are four types. The finite element method model has been made by using a three dimensional calculator and a supercomputer. The load directions are to the anterior teeth, premolar region, and molar region, and the bite force is 1 Kgf to each region. The distribution of stress, the von-Mises yield strength, and safety of margin refer to the total sum of transformed energy have been studied by comparison with each other. The following conclusion has been researched : 1. When shear stress is compared, in the triangular arrangement in the form of "ㄱ", the anterosuperior screw is seen at contributing to the support of the bone fragment. In the straight arrangement, substantial stress is seen to be concentrated on the most posterior angled screw. 2. When the von-Mises yield strength is compared, it seemed that the stress concentration on the angled anteroinferior screw is higher, it shows a higher possibility of fracture than any other screw. In the straight arrangement, stress appeared to be concentrated on the most posteriorly angled screw. 3. When the safety margins of the transfomed energy are compared, the energy conduction is much greater in the case of the angled screw than in the case of the perpendicular screw. The triangular arrangement in the form of "ㄱ" shows a superior clinical sign to that of the straight arrangement. Judging from the above results, when the screw fixation is made after SSRO in practical clinical cases, two screws should be inserted in the superior border of mandibular ramus and a third screw of mandibular inferior border should be inserted in the form of triangular. All screws on the bony surface should be placed perpendicularly-$90^{\circ}$ angles apparently best promote bony support and stability.

Keywords

References

  1. Trauner R. Obwegeser H : The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. Oral Surg Oral Med Oral Pathol 1957,10:677-689
  2. Dal Pont G: Retromolar osteotomy for the correction of prognathism. J Oral Surg 1961,19:42-47
  3. 김여갑 :하악골전돌증의 악교정수술 후 재발에 관한 연구. 경희의학 1985;1:1:85-95
  4. 김여갑 : 상하악 동시 악교정술시 안정성에 관한 연구 [1] 강선고정에 의한 방법. 대한악안면성형재건외과학회지 1990;12:2:9-20
  5. 주성채, 민병일 :악교정 수술시 견고 및 비견고 고정에 따른 위치적 안정성에 대한 비교 연구. 대한악안면성형재건외과학회지 1991; 13:4:412-420
  6. 조병욱, 이용찬, 양용석, 유하식 : 하악골 시상골절단술시 miniplate에의한 rigid fixation. 대한악안면성형재건외과학회지 1990;12:2:48-53
  7. Kim HC, Essaki S, Kameyama T, Yamamoto K : Photoelatic analysis of internal screw fixation after sagittal split ramus osteotomy. J Cranio-Maxillofac Surg 1993;21:266-270 https://doi.org/10.1016/S1010-5182(05)80045-9
  8. Spiessl B : Osteosynthese bei sagittaler osteotomie nach Obwegesser-Dal Pont. Schuschardt For-tschritte der Kiefer and Gesichtschirurgie 1974;18:145-148
  9. Turvey TA, Hall DJ : Intra-oral self-threading screw fixation for sagittal osteotomies-early experience. Int J Adult Orthod Orthognath Surg 1986;4:243-250
  10. Kempf KK : Transoral technique for rigid fixation of sagittal ramus osteotomies. J Oral Maxillofac Surg 1987;45:1077-1079 https://doi.org/10.1016/0278-2391(87)90170-4
  11. Lindorf HH : Sagittal ramus osteotomy with tandem screw fixation : technique and results. J Maxillofac Surg 1986;14:311-316 https://doi.org/10.1016/S0301-0503(86)80314-9
  12. Niederdellman H, Shetty V, Collins FJV : Controlled osteosynthesis utilizing the position screw. lnt J Adult Ortho Orthoganth Surg 1987;2:159-162
  13. Foley WL, Frost DE, Paulin WB, Tucker MR : Internal screw fixation: Comparison of placement pattern and rigidity. J Oral Maxillofac Surg 1989;47:720-723 https://doi.org/10.1016/S0278-2391(89)80013-8
  14. Leonard M: The use of lag screws in mandibular fractures. Otolaryngol Clin North Am 1987;20:479-493
  15. Schpimmer A, Greenberg AM, Kummer F, Kaynal A : The effect of screw size and insertion technique on the stability of the mandibular sagittal split osteotomy. J Oral Maxillofac Surg 1994;52:45-48 https://doi.org/10.1016/0278-2391(94)90013-2
  16. Oeid G, Lindquist CC : Optimal placement of bicortical screws in sagittal split-ramus osteotomy of mandible. Oral Surg Oral Med Oral Pathol 1991;71:665-669 https://doi.org/10.1016/0030-4220(91)90270-M
  17. Shepherd, JP, Nohvoma CN, Harradine NWT : Screw fixation after mandibular sagittal osteotomy : an intraoral approach. Br J Oral Maxillofac Surg 1991;29:325-329 https://doi.org/10.1016/0266-4356(91)90119-P
  18. Farole A : An intraoral technique for transoral rigid fixation of the sagittal split ramus osteotomy. J Oral Maxillofac Surg 50:422-423, 1992
  19. Jeter T, Van Sickels JE, Dolwick MF : Modified techniques for internal fixatioin of sagittal ramus osteotomies. J Oral Maxillofac Surg 1984;42:270-272 https://doi.org/10.1016/0278-2391(84)90463-4
  20. Steinh?user EW: Bone screw and plates in orthognathic surgery. Int J Oral Surg 1982;11:209-216 https://doi.org/10.1016/S0300-9785(82)80069-0
  21. Ardary WC, Tracy DJ, Brownridge GW, Urata MM : Comparative evaluation of screw configuration on the stability of the sagittal split osteotomy. Oral Surg Oral Med Oral Pathol 1989;68:125-129 https://doi.org/10.1016/0030-4220(89)90179-5
  22. Shufford EL, Kraut RA : Passive rigid fixation of sagittal split osteotomy. Oral Surg Oral Med Oral Pathol 1989;68:150-153 https://doi.org/10.1016/0030-4220(89)90182-5
  23. Schlike L, Panjabi P, : Optimal orientation of transfixation screws across oblique fracture lines. Clin Orthop 1979;143:271-277
  24. 염영하, 오세욱, 송임홍, 송지호 : 고체 역학의 기초와 응력. 동명사 p 215
  25. 엄기원 : 고체 역학. 회중당 p 283-289
  26. 오승환, 김여갑 : 충격하중과 하악골 골절발생 기전의 유한요소법적 연구. 경희 치대논문집 1995;17:2:439-458
  27. 박노길, 박성태, 손권, 이건명, 이시복, 정의봉, 한상보 : 기계진동학. 반도출판사 1992;p 68-77
  28. 이병해 : 기초유한요소법, 경문사 1992;p 107-117
  29. Farah JW, Craig RG, Meroueh KA : Finite element analysis of a mandibular model. J Oral Rehab 1988;15:615-624 https://doi.org/10.1111/j.1365-2842.1988.tb00199.x
  30. Ralph JP, Caputo AA : Analysis of stress patterns in the human mandible. J Dent Res 1975;54:4:814-821 https://doi.org/10.1177/00220345750540042001
  31. Martis CS : Complications after mandibular sagittal split osteotomy. J Oral Maxillofac Surg 1984;42:101-107 https://doi.org/10.1016/0278-2391(84)90320-3
  32. Skoczylas LJ, Ellis Ⅲ E, Fonseca RJ, Gallo WJ : Stability of simultaneous maxillary intrusion and mandibular advancement : A comparison of rigid and nonrigid fixation techniques. J Oral Maxillofac Surg 1988;46:1056-1064 https://doi.org/10.1016/0278-2391(88)90451-X
  33. Ellis Ⅲ E, Carlson DS, Billups J : Osseous healing of the sagittal ramus osteotomy : A histologic comparison of rigid and nonrigid fixation in macaca mulatta. J Oral Maxillofac Surg 1992;50:718-723 https://doi.org/10.1016/0278-2391(92)90106-A
  34. Ayoub AF, Stirrups DR, Moos KF : A comparison of wire osteosynthesis and screw fixation in the stability of bimaxillary osteotomies lnt J Adult Orthod Orthognath Surg 1994;9:257-272
  35. Stroster TG, Pangrazio-Kulbersh V : Assessment of condylar position following bilateral ramus osteotomy with wire fixation or rigid fixation. lnt J Adult Orthod Orthognath Surg 1994;9:1:55-63
  36. 한훈, 김여갑 : 시상분할골절단술 후 나사고정방법에 따른 응력분포에 관한 유한요소법적 연구. 경희치대 논문집 1995;17:2:547-560
  37. MSC/NASTRAN theoretical manual. 1995;Ver.68
  38. MSC/NASTRAN application. 1995;Ver.68