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Population-Based Design of Mandibular Fixation Plates with Bone Quality and Morphology Considerations

Abstract

In this paper we present a new population-based implant design methodology, which advances the state-of-the-art approaches by combining shape and bone quality information into the design strategy. The method may enhance the mechanical stability of the fixation and reduces the intra-operative in-plane bending which might impede the functionality of the locking mechanism. The computational method is presented for the case of mandibular locking fixation plates, where the mandibular angle and the bone quality at screw locations are taken into account. The method automatically derives the mandibular angle and the bone thickness and intensity values at the path of every screw from a set of computed tomography images. An optimization strategy is then used to optimize the two parameters of plate angle and screw position. The method was applied to two populations of different genders. Results for the new design are presented along with a comparison with a commercially available mandibular locking fixation plate (MODUS® TriLock® 2.0/2.3/2.5, Medartis AG, Basel, Switzerland). The proposed designs resulted in a statistically significant improvement in the available bone thickness when compared to the standard plate. There is a higher probability that the proposed implants cover areas of thicker cortical bone without compromising the bone mineral density around the screws. The obtained results allowed us to conclude that an angle and screw separation of 129° and 9 mm for females and 121° and 10 mm for males are more suitable designs than the commercially available 120° and 9 mm.

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Abbreviations

CT:

Computed tomography

d :

Distance between adjacent screw holes

DVF:

Deformation vector field

f :

Objective functuion

H :

Local voxel intensity

I :

Intensity value

n :

Number of sampled voxels along one screw path

N r :

Number of screws in one region

p :

Number of image datasets

r :

Specific anatomical region

R :

Set of anatomical regions

T :

Local bone thickness

Α :

Plate angle–mandibular or gonial angle

θ:

Bone thickness

ω θ , ωI :

Weighting factors

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Acknowledgment

This work was carried out within the frame of the National Center of Competence in Research, Computer-Aided and Image-Guided Medical Interventions (NCCR Co-Me), supported by the funds of the Swiss National Science Foundation (SNSF).

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Correspondence to Habib Bousleiman.

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Associate Editor Mona Kamal Marei oversaw the review of this article.

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Bousleiman, H., Iizuka, T., Nolte, LP. et al. Population-Based Design of Mandibular Fixation Plates with Bone Quality and Morphology Considerations. Ann Biomed Eng 41, 377–384 (2013). https://doi.org/10.1007/s10439-012-0671-8

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  • DOI: https://doi.org/10.1007/s10439-012-0671-8

Keywords

  • Orthopedic implant design
  • Population-based analysis
  • Computational anatomy
  • Mandibular locking fixation plate