Research Papers

Prosthesis Loading After Temporomandibular Joint Replacement Surgery: A Musculoskeletal Modeling Study

[+] Author and Article Information
David C. Ackland

Department of Mechanical Engineering,
University of Melbourne,
Building 170,
Victoria 3010, Australia
e-mail: dackland@unimelb.edu.au

Adrian Moskaljuk

Department of Mechanical Engineering,
University of Melbourne,
Building 170,
Victoria 3010, Australia
e-mail: moskaljuka@gmail.com

Chris Hart

St Vincent's Hospital,
Suite 3, Level 10,
20 Collins Street, Victoria 3000, Australia
e-mail: cnhart@mac.com

Peter Vee Sin Lee

Department of Mechanical Engineering,
University of Melbourne,
Building 170,
Victoria 3010, Australia
e-mail: pvlee@unimelb.edu.au

George Dimitroulis

St Vincent's Hospital,
Suite 5, Level 10,
20 Collins Street,
Victoria 3000, Australia
e-mail: geodim25@gmail.com

1Corresponding author.

Manuscript received April 7, 2014; final manuscript received December 10, 2014; published online February 5, 2015. Assoc. Editor: Brian D. Stemper.

J Biomech Eng 137(4), 041001 (Apr 01, 2015) (9 pages) Paper No: BIO-14-1152; doi: 10.1115/1.4029503 History: Received April 07, 2014; Revised December 10, 2014; Online February 05, 2015

One of the most widely reported complications associated with temporomandibular joint (TMJ) prosthetic total joint replacement (TJR) surgery is condylar component screw loosening and instability. The objective of this study was to develop a musculoskeletal model of the human jaw to assess the influence of prosthetic condylar component orientation and screw placement on condylar component loading during mastication. A three-dimensional model of the jaw comprising the maxilla, mandible, masticatory muscles, articular cartilage, and articular disks was developed. Simulations of mastication and a maximum force bite were performed for the natural TMJ and the TMJ after prosthetic TJR surgery, including cases for mastication where the condylar component was rotated anteriorly by 0 deg, 5 deg, 10 deg, and 15 deg. Three clinically significant screw configurations were investigated: a complete, posterior, and minimal-posterior screw (MPS) configuration. Increases in condylar anterior rotation led to an increase in prosthetic condylar component contact stresses and substantial increases in condylar component screw stresses. The use of more screws in condylar fixation reduced screw stress magnitudes and maximum condylar component stresses. Screws placed superiorly experienced higher stresses than those of all other condylar fixation screws. The results of the present study have important implication for the way in which prosthetic components are placed during TMJ prosthetic TJR surgery.

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Grahic Jump Location
Fig. 1

Anatomical reference frame used in the present study. The coordinate system was defined with the positive x-direction directed laterally, the positive y-direction directed posteriorly, and the positive z-direction directed superiorly. The plane defined by the x- and y-axes was aligned with the Frankfurt plane. The coordinate system origin was centered halfway along a straight line formed between the two condylar heads.

Grahic Jump Location
Fig. 2

Location of screw holes in prosthetic condylar component (a) and position of the prosthetic condylar component in 0 deg of anterior rotation and 15 deg of anterior rotation (b)

Grahic Jump Location
Fig. 3

Muscle volumes (top) and muscle lines of action (bottom) of selected masticatory muscles in lateral view (a), front view (b), and top view (c). Masticatory muscle colors are as follows: masseter (blue), temporalis (red), medial pterygoid (aqua), lateral pterygoid (green).

Grahic Jump Location
Fig. 4

TMJ force direction (black arrow) and finite element model results for the prosthetic condylar component. Top, middle, and bottom rows represent MPS configuration, PS configuration, and CS configuration, respectively. Columns from left to right represent 0 deg, 5 deg, 10 deg, and 15 deg of anterior rotation of the prosthetic condylar component.



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