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Item type:Publication, Access status: with files , Prospective functional assessment after mandible reconstruction and bone healing assessmentObjectives: Mandibular reconstruction remains a clinical challenge due to a high rate of osseous non-unions. Mechanical factors are known to influence the bone regeneration process. Therefore, bite force levels, both immediately after surgery and during the bone healing process, are believed to play a critical role in the healing outcome. The aim of this study was to evaluate bite force and mandibular mobility measurements over time following mandibular reconstruction and to relate these measurements to the bone healing outcome. Materials and methods: In this prospective study, 28 patients were included and underwent functional measurements pre-operatively and at two weeks, four weeks, eight weeks, three months, and six months post-reconstruction. Additionally, the healing outcome was assessed using post-operative imaging. Results: After surgery, the functional parameters - including bite force, mouth opening, protrusion, and laterotrusion - significantly decreased. However, between the initial post-operative measurement and the final follow-up six months after surgery, all parameters showed a significant increase. Two weeks post-operatively, only 9 of the 28 patients were able to participate in the bite force measurement. However, 6 of these patients exhibited incomplete osseous union, which was associated with a mean bite force of 166 N at two weeks (mean over the whole cohort after six months of 154 N). Conclusions: This study demonstrated the trends in functional measurements over time following mandibular reconstruction and identified a significant trend in association between excessive post-operative bite force and incomplete osseous union. Clinical relevance: In consequence, clinical strategies to reduce mechanical over-stimulation could be evaluated in future studies, such as soft food intake for 3 months after mandibular reconstruction.Publicationtype: Journal Article16 19 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Access status: without files , Local mechanical stresses can explain the mechanoregulation of bone healing after mandibular reconstruction: an in silico studyObjectives: Recent advancements in mandibular reconstruction, including virtual surgical planning and patient-specific 3D-printed reconstruction plates, have improved surgical precision but have not yet fully optimized the mechanical environment for bone healing. This study aimed to investigate the level of mechanical signals that may promote bone regeneration in mandibular reconstruction with patient-specific plates. Materials and methods: A coupled finite‑element and agent‑based mechanobiological model for mandibular bone healing was developed to predict bone formation after mandibular reconstruction. A finite element model (FEM) of a monosegmental mandibular reconstruction with a patient-specific 3D-printed plate during unilateral clenching was coupled with a 3D agent-based model to simulate cellular activities at the osteotomy sites. Using an established mechano-regulation theory, tissue formation and resorption were simulated based on mechanical signals. The latter were systematically varied to identify thresholds matching clinical observations. Results: Increasing the ossification threshold from 0.15 MPa to 0.30 MPa improved agreement with clinical data, leading to 39% and 69% of bone formation in the anterior and posterior gaps, respectively, after 90 days. Conclusions: The model was able to predict levels of newly-formed bone as per clinical observations. Adaptation of the mechano-regulation theory to the mandibular environment suggested that mandibular bone regeneration might occur at a higher level of mechanical stress than in long bones. Clinical relevance: This study presented a computational framework that could, in the future, be incorporated into the clinical workflow during virtual surgical planning to support the mechanical optimization of patient-specific fixation devices and ultimately enhance the healing outcome.Publicationtype: Journal Article15