3D-FEM and histomorphology of mandibular reconstruction with the titanium functionally dynamic bridging plate.

Biomechanical investigation of the mandible is difficult due to the complex geometrical structure. A three-dimensional finite element model of the mandible and masticatory muscles was produced with approximately 23,000 hexahedral elements. On this model, mesial and distal portions of the jaw were resected and bridged with a buccal and/or caudally positioned bridging plate. The plate was fixed caudal or buccal to the mandible. The defect was left as it was or reconstructed with an exactly fitting transplant defined as bone. The jaw was loaded at a predefined point. The changes in stresses and deformations of bone, the transplant and the bridging plate were analysed. In the caudally positioned bridging plate, finite element analysis showed lesser stresses around the fixation screws of the bridging plate. During reconstruction of the lateral defect, the buccal (ramus)-caudal (corpus) position of the bridging plate showed fewer stresses and deformations than purely buccal positioning. The caudal position of the bridging plate has biomechanical advantages and facilitates fixation of the plate, and fixation of a bone graft on the jaw stumps. Histomorphological investigations, 12 weeks and 7 years after reconstruction, show partial osseous integration or transformation of autologous iliac crest transplants.