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TECHNICAL PAPERS: Bone/Orthopedics

Anterior Displacement of the TMJ Disk: Repositioning of the Disk Using a Mitek System. A 3D Finite Element Study

[+] Author and Article Information
A. Pérez del Palomar

Group of Structural Mechanics and Materials Modeling, Aragón Institute of Engineering Research (I3A),  University of Zaragoza, Spain

M. Doblaré

Group of Structural Mechanics and Materials Modeling, Aragón Institute of Engineering Research (I3A),  University of Zaragoza, Spainmdoblare@unizar.es

J Biomech Eng 128(5), 663-673 (Apr 19, 2006) (11 pages) doi:10.1115/1.2246238 History: Received September 09, 2005; Revised April 19, 2006

In this paper the behaviors of the temporomandibular joint (TMJ) with an anteriorly displaced disk without reduction and with a surgically repositioned one were compared with the response of a healthy disk during jaw opening. The movement of each joint was obtained imposing the same opening path between incisors and assuming that the movement of the condyle is determined by the passive action of the masticatory muscles and the restrictions imposed by the articulating surfaces and the ligaments. A fiber-reinforced porohyperelastic model was used to simulate the behavior of the articular disk. The influence of the friction coefficient in the diseased joint was also analyzed, finding that the final displacement of the complex condyle-disk was smaller as the friction coefficient increased. On the other hand, its displacement in the repositioned joint was different than in the healthy case because the artificial sutures used in the surgery do not fully stabilize the disk posteriorly as the retrodiscal tissue does. The stress response of the disk changed in both pathologic cases: in the displaced joint the highest stresses moved from the intermediate zone (healthy case) to the posterior band, and in the reconstructed one the most loaded zone moved posteriorly at total opening. Besides, local stress concentrations appeared in the neighborhood of the artificial sutures and therefore damage of the disk and releasing of the sutures might be possible postoperatively.

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Copyright © 2006 by American Society of Mechanical Engineers
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Figures

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Figure 1

A healthy joint with the disk located in its physiological position (a); anterior disk displacement without reduction (the disk is permanently displaced) (b); repositioning of the disk with a Mitek anchor to its physiological position (c).

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Figure 2

Finite element model of the TMJ with details of the three cases analyzed: a healthy TMJ, a displaced TMJ, and a repositioned disk. MED: medial; LAT: lateral. The details shown in the middle and right parts are marked with a circle in the left figure.

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Figure 3

Imposed displacement to the incisor of the lower jaw during the opening movement (51) and action lines of the medial pterygoid, anterior, and posterior portions of the temporal and deep and superficial portions of the masseter muscles (52-53)

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Figure 4

Displacement of the central point of the right condyle (point C in Fig. 3) in the anteriorly displaced disk without reduction (ADDWOR) (a) and in the repositioned joint (b) for different friction coefficients, compared to the displacement of the condyle in the healthy joint

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Figure 5

Position of the right disk and condyle at maximum opening in the three analyzed scenarios. In gray the initial configuration and in black the final configuration

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Figure 6

Healthy joint. Minimum principal (SMIN ), maximum principal (SMAX ), and tangential stresses (STANG ) (MPa) in the right disk. PB : Posterior Band; AB : Anterior band; IZ : Intermediate Zone; L: Lateral; M: Medial.

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Figure 7

Anteriorly displaced disk. Minimum principal (SMIN ), maximum principal (SMAX ), and tangential stresses (STANG ) (MPa) in the right disk. PB: Posterior band; AB: anterior band; L: lateral; M: medial.

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Figure 8

Repositioning surgery. Minimum principal (SMIN ), Maximum principal (SMAX ), and Tangential Stresses (STANG ) (MPa) in the right disk. PB: Posterior Band; AB: Anterior band; L: Lateral; M: Medial.

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Figure 9

Repositioning surgery. Stress concentrations around the artificial sutures in the posterior band of the repositioned disk.

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Figure 10

Mean stress values in the different zones of the disk in the three analyzed scenarios. Lat: Lateral Zone; IZ: Intermediate Zone; MED: Medial Zone; AB: Anterior Band; PB: Posterior Band.

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Figure 11

Directions of the maximum principal stresses at the top surface of the disk in the three cases. (a) Healthy, (b) Displaced, (c) Repositioned.

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