Biomechanics of craniofacial sutures: orthopedic implications.

Sutures are soft connective tissue articulations between craniofacial bones. Suture mechanics deals with patterns of mechanical stress experienced in sutures resulting from natural activities such as mastication and exogenous forces such as orthopedic loading. Patterns of sutural mechanical stress can be delineated readily as sutural strain using strain gages attached over the suture. In mastication, complex sutural strain patterns have been elucidated in a few species. Mechanical stresses are not transmitted in the skull as a continuing gradient, for different sutures are capable of redefining a propagating mechanical force as predominately tensile or compressive strain. Exogenous mechanical forces with engineering waveforms such as static and sine wave at different frequencies induce corresponding waveforms and rates of sutural strain, providing the basis for applying novel mechanical stimuli to engineer sutural growth. The available data on suture mechanics converge to a hypothetical theme that mechanical forces regulate sutural growth by inducing sutural mechanical strain. Various orthopedic therapies, including headgear, facemask, and functional appliances may induce sutural strain, leading to modification of otherwise natural suture growth.