Biomechanical effect of anteriorly directed extraoral forces on the craniofacial complex: a study using the finite element method.

This study was designed to investigate the biomechanical effect of protractive maxillary orthopedic forces on the craniofacial complex by use of the three-dimensional finite element method (FEM). The three-dimensional FEM model was developed on the basis of a dry skull of a young human being. The model consisted of 2918 nodes and 1776 solid elements. Eighteen cranial and facial sutural systems were integrated in the model. An anteriorly directed 1.0-kg force was applied on the buccal surfaces of the maxillary first molars in both a horizontal parallel direction and a 30 degree obliquely downward direction to the functional occlusal plane. The nasomaxillary complex showed a forward displacement with upward and forward rotation in a horizontal protraction case, whereas a downward force produced almost translatory repositioning of the complex in an anterior direction. High stress levels were observed in the nasomaxillary complex and its surrounding structures. However, the pattern of stress distributions within the complex was different in two force systems. A downward protraction force produced relatively uniform stress distributions, indicating the importance of the force direction in determining the stress distributions from various orthopedic forces.