Influence of Plate Design, Thickness, and Fixation Architecture on Mandibular Advancement Stability: A Finite Element Analysis.

Background

Mandibular advancement is a commonly performed surgical procedure for the treatment of mandibular retrognathia and Class II dentofacial deformities; however, large advancements impose increased mechanical demands on fixation systems. Despite the availability of various fixation strategies, standard straight plate systems remain widely used worldwide due to their availability, cost-effectiveness, and clinical familiarity. Continuous biomechanical evaluation of these systems is therefore required to optimize stability and performance under demanding conditions.

Objectives

The aim of this study was to evaluate the influence of plate design, plate thickness, and fixation architecture on the mechanical stability of mandibular advancement using finite element analysis.

Methods

A three-dimensional finite element model simulating a unilateral mandibular osteotomy with a 10 mm gap was generated as mandibular advancement was developed. Fifteen fixation configurations were analyzed, including variations in plate design (simple and reinforced plates with partial or total inferior mesh extension), plate thickness (0.8 mm and 1.0 mm), and fixation architecture using independent plate systems (LN) or integrated fixation systems (FM). A vertical load was applied to the lower central incisor to simulate functional loading. Outcome measures included global equivalent stress considering screws and plate, equivalent stress within the plate, and global deformation of the fixation system.

Results

The analyses demonstrated distinct mechanical behaviors among the evaluated configurations. Differences in stress distribution and deformation were observed according to plate design, thickness, and fixation architecture. Reinforced designs, increased plate thickness, and integrated fixation systems showed reduced deformation and more favorable stress distribution when compared with simple plate configurations.

Conclusions

Plate design, thickness, and fixation architecture influenced the mechanical stability of mandibular advancement, supporting the importance of biomechanical optimization of standard fixation systems, particularly in large mandibular advancements.