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Numerical simulation and biomechanical analysis of an orthodontically treated periodontally damaged dentition. 2013

A Kettenbeil, and S Reimann, and C Reichert, and L Keilig, and A Jäger, and C Bourauel
Endowed Chair of Oral Technology, Rheinische Friedrich-Wilhelms-Universität Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany.

OBJECTIVE Once periodontitis has been completely resolved, one common follow-up method is to carry out orthodontic treatment to take advantage of the residual bone, i.e., via tooth intrusion. In this study, the biomechanical behavior of teeth in a reduced periodontium was studied by numerically simulating upper-incisor intrusion accomplished with various orthodontic mechanics. METHODS Using the finite element method, a patient-customized 3D model of a periodontally reduced dentition was generated in order to simulate tooth movement. The morphology of this upper-jaw model was derived from cone-beam computed tomography (CBCT) datasets of four patients. Material parameters were adopted from previous investigations, including teeth (E=20 GPa), periodontal ligament (PDL) (bilinear elastic; E1=0.05 MPa; E2=0.20 MPa; ε12=7%), and bone (homogeneous, isotropic; E=2 GPa). Two intrusion scenarios were used, the first drawing from Burstone's segmented-arch technique to intrude four splinted incisors at a time, and the second one using cantilevers to intrude single incisors. The aforementioned PDL material parameters were varied in several ways to simulate different biological and biomechanical states of PDL. All simulations were recalculated with an idealized, periodontally intact model to assess the effect of bone loss by way of comparison. RESULTS Single-tooth intrusion via cantilever mechanics was accompanied by less rotation than the segmented-arch approach. Both intrusion systems involved significantly greater degrees of tooth displacement and PDL load in the periodontally reduced model. CONCLUSIONS Periodontally reduced dentitions are associated with an increased load on periodontal tissue. This can be counteracted by reducing orthodontic force levels and by selecting mechanics that do not harm the tissue. In so doing, the use of numerical methods may greatly facilitate individualized computer-aided treatment-planning strategies.

UI MeSH Term Description Entries
D007180 Incisor Any of the eight frontal teeth (four maxillary and four mandibular) having a sharp incisal edge for cutting food and a single root, which occurs in man both as a deciduous and a permanent tooth. (Jablonski, Dictionary of Dentistry, 1992, p820) Incisors
D008437 Maxilla One of a pair of irregularly shaped bones that form the upper jaw. A maxillary bone provides tooth sockets for the superior teeth, forms part of the ORBIT, and contains the MAXILLARY SINUS. Maxillae,Maxillary Bone,Bone, Maxillary,Bones, Maxillary,Maxillary Bones,Maxillas
D008954 Models, Biological Theoretical representations that simulate the behavior or activity of biological processes or diseases. For disease models in living animals, DISEASE MODELS, ANIMAL is available. Biological models include the use of mathematical equations, computers, and other electronic equipment. Biological Model,Biological Models,Model, Biological,Models, Biologic,Biologic Model,Biologic Models,Model, Biologic
D010513 Periodontal Ligament The fibrous CONNECTIVE TISSUE surrounding the TOOTH ROOT, separating it from and attaching it to the alveolar bone (ALVEOLAR PROCESS). Alveolodental Ligament,Alveolodental Membrane,Gomphosis,Alveolodental Ligaments,Alveolodental Membranes,Gomphoses,Ligament, Alveolodental,Ligament, Periodontal,Membrane, Alveolodental,Periodontal Ligaments
D010518 Periodontitis Inflammation and loss of connective tissues supporting or surrounding the teeth. This may involve any part of the PERIODONTIUM. Periodontitis is currently classified by disease progression (CHRONIC PERIODONTITIS; AGGRESSIVE PERIODONTITIS) instead of age of onset. (From 1999 International Workshop for a Classification of Periodontal Diseases and Conditions, American Academy of Periodontology) Pericementitis,Pericementitides,Periodontitides
D003198 Computer Simulation Computer-based representation of physical systems and phenomena such as chemical processes. Computational Modeling,Computational Modelling,Computer Models,In silico Modeling,In silico Models,In silico Simulation,Models, Computer,Computerized Models,Computer Model,Computer Simulations,Computerized Model,In silico Model,Model, Computer,Model, Computerized,Model, In silico,Modeling, Computational,Modeling, In silico,Modelling, Computational,Simulation, Computer,Simulation, In silico,Simulations, Computer
D003799 Dental Stress Analysis The description and measurement of the various factors that produce physical stress upon dental restorations, prostheses, or appliances, materials associated with them, or the natural oral structures. Analyses, Dental Stress,Analysis, Dental Stress,Stress Analyses, Dental,Stress Analysis, Dental,Dental Stress Analyses
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014086 Tooth Mobility Horizontal and, to a lesser degree, axial movement of a tooth in response to normal forces, as in occlusion. It refers also to the movability of a tooth resulting from loss of all or a portion of its attachment and supportive apparatus, as seen in periodontitis, occlusal trauma, and periodontosis. (From Jablonski, Dictionary of Dentistry, 1992, p507 & Boucher's Clinical Dental Terminology, 4th ed, p313) Mobilities, Tooth,Mobility, Tooth,Tooth Mobilities
D014087 Tooth Movement Techniques Orthodontic techniques used to correct the malposition of a tooth or teeth. Tooth Depression,Tooth Intrusion,Tooth Movement, Minor,Tooth Uprighting,Orthodontic Tooth Movement,Depression, Tooth,Depressions, Tooth,Intrusion, Tooth,Intrusions, Tooth,Minor Tooth Movement,Minor Tooth Movements,Movement Technique, Tooth,Movement Techniques, Tooth,Movement, Orthodontic Tooth,Movements, Orthodontic Tooth,Orthodontic Tooth Movements,Technique, Tooth Movement,Techniques, Tooth Movement,Tooth Depressions,Tooth Intrusions,Tooth Movement Technique,Tooth Movement, Orthodontic,Tooth Movements, Minor,Tooth Movements, Orthodontic,Tooth Uprightings,Uprighting, Tooth,Uprightings, Tooth

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