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Table of Contents   
REVIEW ARTICLE  
Year : 2014  |  Volume : 25  |  Issue : 3  |  Page : 390-397
The application of finite element analysis in the skull biomechanics and dentistry


Department of Morphology, Anatomy Area, State University of Campinas, Av. Limeira, 901, P.O. Box 52 Piracicaba, SP, 13414-903, Brazil

Click here for correspondence address and email

Date of Submission06-Jul-2010
Date of Decision22-Jul-2010
Date of Acceptance27-Aug-2012
Date of Web Publication7-Aug-2014
 

   Abstract 

Empirical concepts describe the direction of the masticatory stress dissipation in the skull. The scientific evidence of the trajectories and the magnitude of stress dissipation can help in the diagnosis of the masticatory alterations and the planning of oral rehabilitation in the different areas of Dentistry. The Finite Element Analysis (FEA) is a tool that may reproduce complex structures with irregular geometries of natural and artificial tissues of the human body because it uses mathematical functions that enable the understanding of the craniofacial biomechanics. The aim of this study was to review the literature on the advantages and limitations of FEA in the skull biomechanics and Dentistry study. The keywords of the selected original research articles were: Finite element analysis, biomechanics, skull, Dentistry, teeth, and implant. The literature review was performed in the databases, PUBMED, MEDLINE and SCOPUS. The selected books and articles were between the years 1928 and 2010. The FEA is an assessment tool whose application in different areas of the Dentistry has gradually increased over the past 10 years, but its application in the analysis of the skull biomechanics is scarce. The main advantages of the FEA are the realistic mode of approach and the possibility of results being based on analysis of only one model. On the other hand, the main limitation of the FEA studies is the lack of anatomical details in the modeling phase of the craniofacial structures and the lack of information about the material properties.

Keywords: Biomechanics, dentistry, finite element analysis, implant, skull, teeth

How to cite this article:
Prado FB, Rossi AC, Freire AR, Ferreira Caria PH. The application of finite element analysis in the skull biomechanics and dentistry. Indian J Dent Res 2014;25:390-7

How to cite this URL:
Prado FB, Rossi AC, Freire AR, Ferreira Caria PH. The application of finite element analysis in the skull biomechanics and dentistry. Indian J Dent Res [serial online] 2014 [cited 2020 Sep 26];25:390-7. Available from: http://www.ijdr.in/text.asp?2014/25/3/390/138350
The Finite Element Analysis (FEA) is a technique that reconstructs and evaluates the stress, strain and deformation of structures. This methodology is a representation of a structure that is readily resolved by mathematical analysis as a series of subdivisions, i.e., a method that reduces a complex geometry into a finite number of elements with simple geometries, with the same properties of the origin model. All finite elements are described by differential equations and solved by mathematical models from which results are obtained.

The success of the applications of FEA depends on the processing power of computers. However, the great challenge of FEA is the difficulty to establish a model that respects, with reliability, the morphological characteristics of the cranial structures. The limited availability of information about the craniofacial tissues properties, as well as of dental materials, is another complicating factor in interpreting results. [1],[2],[3],[4],[5]

Currently, the FEA is used in the medical area to assess the human musculoskeletal system, [6],[7],[8] remodeling and ossification fields, [9],[10] the skeleton biomechanics, [11],[12] the functional morphology and the evolutionary anthropology. [13]

In Dentistry, the FEA has applications in various specialties; [14],[15],[16],[17] it allows to assess tooth movement on orthodontics area, [18] the action of orthopedic forces on the craniofacial complex, [4] the action of mechanical loads on implants [17] and the creation of models for forensic application. [19]

The aim of this study was to review the literature about the advantages and limitations of FEA in the study of the skull biomechanics and its application in different dental specialties. The selected original research articles with the keywords were: Finite element analysis, biomechanics, skull, dentistry, teeth, and implant. Literature review was performed in the databases, PUBMED, MEDLINE and SCOPUS. The selected books and articles were between years 1928 and 2010. This review was divided into five topics: (1) theories, concepts and fundamentals about the skull biomechanics; (2) the different methods used to assess the effects of mechanical loads on the skull; (3) the application of FEA in the skull biomechanics; (4) the use of FEA in the different specialties of Dentistry and (5) the main advantages, limitations and prospects of application of FEA in the skull biomechanics and in Dentistry.


   Theories, Concepts And Fundamentals About The Biomechanics of Skull Top


The skull is a dynamical structure capable to suffer morphological changes in response to mechanical loads. The relation between functional load and bone morphology was described by Wolff J [20] whose law states that the bone is a optimized mechanical structure which resists maximum forces with minimum weight, respecting mathematical rules. [21]

Theoretical fundaments of biomechanics explain the skull architecture based on bone pillars in the maxilla and trajectories of stress dissipations in the mandible. However, there is no scientific evidence of how the occlusal tensions generated by masticatory activities are transferred to alveolar bone and from this to the skull. [22]

According to Sicher, [22] the masticatory forces are dissipated from alveolar process to the three enhanced bone pillars in the maxilla, located at each antimere and bypassed by nasal and orbital cavities. The canine and zygomatic pillars are horizontally connected along the supra and infraorbital edges, which act as beams that resist the mechanical stresses. The pterygoid pillar is an enhanced bone arched toward the skull base and hard palate, connecting the pillar systems on each side of the skull. [23] Following this concept, beyond dental occlusion, the traction of masticatory muscles also generates tension and compression forces which dissipate to mandible by three bone trajectories (marginal, temporal and alveolar) and posterior to the skull, given its bone structural arrangement. [22]

Models were used to describe the tension lines along the mandible and skull based on mechanical and architectonical characteristics, as well as on the functional bone adaptation. [22],[24],[25],[26],[27],[28],[29],[30],[31],[32]

If the Wolff's theory [33],[34],[35] and the concepts of skull biomechanics affirm that the masticatory stress is dissipated along the skull and interferes in its morphology through the bone remodeling, what are the kinds of experimental analysis that would be able to assess these conditions?


   The different methods used to assess the effects of mechanical loads on the skull Top


The process by which the mechanical forces influence the morphology or form and the craniofacial geometry is known as mechanical adaptation. Many classic experiments have shown the bone remodeling in response to mechanical functional loads. [36],[37],[38] Different methodologies are used to evaluate the effects of the mechanical functional loads on the teeth and craniofacial structures [14],[39],[40],[41],[42] among which are highlighted the conventional methods, photoelastic models, holographic lasers, mathematical analytical models, experimental analysis in human and animals and FEA.

The difficulty to reproduce in vitro models similar to craniofacial structures is due to the diversity of elements that compose them, and specially the anatomical irregularity of its shapes. Apart from these limitations, the necessity of sophisticated laboratories, equipments and instruments becomes indispensable and difficult for analysis, generating doubts on the efficiency of some conventional methods. [41],[43]

The photoelastic models provide wide, [43] but not quantified illustrations of main tension concentration along the skull with a single elasticity modulus. [44],[45] However, these models are considered limited once the two-dimensional results, featured by color fringes, not represent the results in entire geometry. [41] In affirmation, the photoelastic methods are complex and the numerical results found could be more easily obtained by other methods. [46]

The holographic laser is deficient for considering all materials characteristics and, moreover, its limitation is how the structure is simulated as not allow the creation of materials with same responses, such as the biological structures and not allow variations in the geometrical shapes. [41] In addition, the holographic laser requires complex equipments, which complicates their execution. [16],[47],[48]

Mathematical analysis may simulate biological situations and express results compatible with real function of model. [49] However, the results obtained disrespect the aspects such as width or area of the structure analyzed, simplifying and compromising the intended evaluation.

The experimental techniques in human/animals are limited by difficult access to parts of the skull through the use of devices and eventually invasive analysis. [50] As for animal models, the limitations are in the capability for reproduction of the same morphofunctional characteristics as that of humans, and also the ethical aspects for the use of animals in experiments which use complex force systems. [50]

Despite the advantages and disadvantages mentioned, the methodologies described above present limitations when applied for biomechanical purpose as they are not effective to describe how mechanical masticatory forces act on the craniofacial skeleton.


   The application of fea in the skull biomechanics Top


The FEA of skull made it possible to obtain information on displacement, the degree of tension caused during chewing [41],[50],[51],[52] and the distribution of mechanical forces on craniofacial structures.

In recent years, few studies have been conducted on computer models of human craniofacial skeleton reproducing in detail the anatomical structures to study the dissipation of mechanical stresses during functional masticatory activity on the FEA. [53],[54] The FEA is being employed in various forms at a microscopic level, [55],[56] aimed to characterize the mechanical receptor and the mechanical transduction in cancellous and cortical bone (Beauprxe et al. 1990), which have led to a significant improvement in the understanding of the fundamental factors that control the morphology and bone remodeling. [57]

Other uses of FEA are to evaluate the relationship between form and function in the musculoskeletal system of extinct species and to test the theory that deals with the influence of the action of hard and soft tissues on mechanical function as a determinant of the viability of the structure and ontogeny. [33],[34],[35],[58],[59],[60],[61],[62],[63],[64],[65]

The efficiency of the skeleton to perform specific mechanical functions and the understanding of whether the shape is an adaptation to the mechanical action or is associated with the space requirements of non-skeletal factors, such as sexual dimorphism, dentition, facial orientation and phylogenetic constraints can be evaluated by FEA. Similarly, it is possible to evaluate the adaptation of skeletal structures during evolution by comparative analysis between species of the same lineage to help understand why some features of the skeleton were kept and others disappeared during the evolution. [13],[35] It can be said that FEA is a promising tool to promote understanding of the relationship between form, function and evolution of vertebrates and extinct species.

Considering the FEA as a tool able to evaluate the action of mechanical forces on the skull, is it possible to apply this information to the various dental specialties?


   The fea in the different specialties of dentistry Top


Over the past 20 years, scientific articles have emphasized that knowledge of the process of dissipation of occlusal forces on the craniofacial skeleton can assist in the diagnosis of masticatory functional alterations which would help in planning oral rehabilitation, as well as in the understanding of mechanisms involved in the dissipation of tension by teeth and implants, and in the alveolar bone remodeling. [66],[67]

The mechanical behaviors of the maxillomandibular complex and supporting structures serve as important information for the achievement of restorative treatments, rehabilitation, surgical and forensic procedures. [5] They would consider and characterize the masticatory effort and the distribution of stress in different craniofacial structures, and the FEA can help carry out those tasks. [2],[52],[68],[69],[70]

Two-dimensional models were used to assess the patterns of mechanical stress in healthy teeth, restored teeth and in alveolar bone support and other oral structures. [71]

The FEA is useful in different areas of Dentistry because it allows to assess the mechanical behavior and the distribution of stress in dental elements, periodontal ligament and alveolar bone by applying force, [15],[16],[68] simulating clinical conditions that could hardly be evaluated by other methodologies.

Implantology, Dentistry, Prosthesis, Orthodontics, Oral and Maxillofacial Surgery and Forensic Dentistry are influenced by laws of skull biomechanics because the masticatory forces that act on soft and hard tissues also act directly on dental materials such as resins, porcelain, metal and others such as prosthetics, implants and braces.

Restorative dentistry

In Restorative Dentistry, the FEA has been applied to assess the patterns of mechanical stress in bonded restorations and retention pin, [72] the etiologies of abfraction, to investigate the stress distribution in the different systems of dental reconstruction or verify the fracture resistance of fixed prostheses. [46]

The evaluation of the biomechanical behavior and dissipation of tension in the teeth in different restorative techniques with various restorative materials such as ceramic and gold, composite resins, combined polyethylene fibers, glass fibers or others materials can be performed with the FEA. Simulation of clinical conditions of the oral cavity, such as alteration in the dental structure, inclination of cusps and comparison of the tensile strength between endodontically treated teeth and untreated one are all made possible by FEA. [72],[73] The mentioned analysis may favor the clinical treatments of restoration and rehabilitation.

Orthodontics

The bones and articulations of the craniofacial skeleton grow and function in an environment of mechanical forces. The craniofacial sutures, as well as the temporomandibular joints (TMJs), can be remodeled by externally applied mechanical force. The significance of these findings and the application of these biomechanical concepts can be utilized clinically in the correction of skeletal malocclusion. Furthermore, based on bioengineering principles, an understanding of the cellular and molecular mechanisms that enable bones and other connective tissues of the dentofacial skeleton to adapt to changes in their mechanical environment is fundamental to the practice of orthodontics and dentofacial orthopedics. [74]

The FEA has become useful in orthodontic research by presenting accurate results that allow the simulation of orthodontic treatment and its effects, which are unlikely to be clinically evaluated. [74],[75],[76]

The FEA allows evaluating the effect of orthodontic movement on the periodontal ligament and alveolar bone through simulation of different types of stress, [76],[77] repeatedly and comparatively, which would hardly be reproduced experimentally with the same accuracy in vivo. The relative facility of modeling complex geometric structures of biological tissues of different properties and the ability of the program to allow simulation of various magnitudes of force in different points of application are the advantages of this method. [14]

The FEA generates information about the behavior of craniofacial tissues, including sutures, the orthopedic action forces generated by extra or intraoral appliances, and alterations in size, shape and position of facial structures after orthodontic treatment. [77],[78],[79]

Furthermore, it is possible to evaluate the resistance of orthodontic brackets, simulating the displacements during the application of shear and torsional strength, as well as the causes of success or failure of treatments. [80] The FEA has been used successfully in orthodontic treatment to assist the planning and analysis of the final results.

Implantology

Implantology is one of the specialties of Dentistry where FEA is found to be beneficial as this method allows to evaluate the concentration and distribution of masticatory stress on the implant and adjacent bone tissue. [81]

It is also possible to understand the events related to the osseointegration of implants, since the FEA allows assessing the biomechanical behavior of implants, simulating the clinical conditions which other analyses do not provide. [82]

The development of computers has allowed reproduction of biological structures in more detail. Another advantage of using this tool is to understand the actions of mechanical stresses along the surfaces of an implant and surrounding bone, favoring determination of the design of the implant and its anchorage in the bone. The FEA also makes possible the manufacture of prostheses to minimize the mechanical stress. [83]

The integration of dental implants in the maxilla is dependent on the resistance and dissipation of forces on the implant and the alveolar bone, and the FEA allows defining these elements, thus avoiding mechanisms that cause failures in the clinical performance of implants. [84]

Stress transmission and biomechanical implant design problems can be simulated by FEA. The interaction phenomena between implants and the surrounding tissues and the understanding of the craniofacial biomechanics can be used in the analysis of the functional adaptation process, since it is facilitated by the ability to investigate the various loading, implant, and surrounding tissue variables. [83],[84] The understanding of the craniofacial biomechanics concepts, load transmission and resultant stress distribution are significantly important in determining the success or failure of an implant. [83],[84]

Periodontics

There is controversy on whether the mechanical loads are absorbed and distributed throughout the periodontal ligament during mastication or if the occlusal contact affects its integrity. Understanding the biomechanical behavior of the periodontal ligament under functional and non-functional loads has become possible by means of FEA. Combining FEA with experimental research facilitates the understanding of biological reactions of the periodontal ligament, the factors that affect the integrity of the periodontal structures and the causes of destruction of its fibers and cells, and alveolar bone resorption under mechanical influences. [85]

The morphology of the periodontium and its structural support can be understood in relation to clinical functions such as load-bearing capability. Understanding the biomechanics' fundamentals and the stress distribution in the periodontium also predicts the potential pain and damage that occur under functional bite force. The FEA can be used to estimate the stress distribution within soft and hard tissues. Changes of stress distribution in the periodontium under simulated bite force can affect the alveolar bone support of a periodontally compromised tooth. [86] The FEA can be used to investigate and understand the association between changes in the periodontal tissues and pathologic processes and the action of external forces, [87] based on the biomechanical principle of the craniofacial structures.

Oral and maxillofacial surgery

There have been a few studies on biomechanics (stress distribution and strength) of oral and maxillofacial surgery, but knowledge of the craniofacial biomechanics is fundamental and allows the surgeon to understand the forces acting on the skull during function and the resulting deformation that can occur. [88]

Simulating different types of surgical treatments for craniofacial injuries and anomalies, calculating and analyzing the stability of fixation on maxillofacial fractures, [75] evaluating the stability of the osteotomies, predicting the influence of masticatory activity in the performance and efficiency of materials used for surgical fixation. [76] and allow to check the biomechanical behavior of bone tissue during mechanical compressions [76] are all possible by means of FEA.

With the development of FEA, the craniofacial anatomical structures of each individual may be evaluated biomechanically to predict changes of soft tissues after craniofacial surgery, since esthetics is a fundamental aspect to be considered in maxillofacial surgery. [89]

Forensic dentistry

The FEA is a tool that allows assessing the consequences of head impacts as in studies of ballistic materials or other artifacts. [19] This method favors the forensic investigations because it allows determining the effect of head injuries. It also enables to gauge the extent of an impact and report on the intensity of mechanical forces that act on the skull, showing the causes of the impact according to the distribution of mechanical stress. [90]

The FEA is developed according to the processing power of computers and software, but it is able to assist routine forensic practice. [19] However, knowledge of geometry and anatomy of the head during the modeling is essential to perform this type of analysis and to obtain precise information on the mechanical stresses of materials. [90],[91],[92]

The biomechanical approach also affects trauma classification, shifting category criteria from the inflicting tool to physical factors such as force and speed. The biomechanical properties of bone influence its ability to absorb energy, as well as its stiffness, density, and fatigue strength. Bone fractures are also decisively dependent on extrinsic factors including the rate, duration, magnitude, and direction of force. They may also involve the adoption of analytical techniques such as polynomial textural mapping and FEA. [93],[94]


   The Advantages, Limitations And Prospects of Application of Fea In The Skull Biomechanics And Dentistry Top


The major difficulty in construction of craniofacial models for tridimensional FEA is the anatomical complexity of these structures, such as face sinus, variations in the alveolar topography and bone thickness. [93]

Since 1977, finite element models of complex regions of craniofacial skeleton, such as two-dimensional (2D) [94],[95] as three-dimensional (3D) [96],[97],[98],[99] models, have been developed and applied in specific areas of Dentistry, without reproduction of anatomy of the skull with fidelity, especially the maxilla. [98] Some models are designed in an idealized way. [96]

3D models developed to assess the effects of orthopedic maxillary forces on the craniofacial complex may verify through FEA the different patterns of dissipation of tension; however, lack of anatomical details presents as a limiting factor, with the limited number of elements and nodes on which the model was built. [98]

Other studies that described the tension distribution of occlusal forces on the teeth and implants show the importance of characteristics of support structures, position, size of implants for longevity and stability and the need to evaluate the response of the human bone to mechanical tension. [96]

Importantly, the research employing the FEA results of a 3D analysis provides more accurate information of analysis than that performed in 2D, since a 3D model allows a more comprehensive spatial evaluation. [99]

Models that have been developed to assess the concentration and the dissipation of tension around implants, using several clinical parameters such as implant-bone interface, the elastic properties of bone, and the presence of lamina dura, are shown to be sensitive to these parameters, but there are limitations on the reproducibility of the anatomical structures modeled, where the bone was modeled as a simplified rectangular configuration. [82],[100]

The FEA is a realistic method to approach and the results are often based on analysis of only one model where there is not a natural variation. The reliability of analysis with the model is data dependent on the model incorporated the details of the geometric representation, and also the availability of data and materials on the reality of the load. [13]

A major challenge with regard to modeling is the limited availability of data from dental materials, since there are few physical data and patterns for them, such as their elastic modulus and strength. The lack of pattern is a complicating factor in interpreting the results of the analysis and the conclusions related, [13] requiring further studies to determine the patterns that may be used in all searches that use this tool.

Despite the simplification of parameters of material properties, method of verification, boundary conditions, and especially the geometry of the structures, these parameters are necessary to achieve confident results using 3D FEA. [1],[2],[3],[78] Therefore, the validity of this method and the necessity to define the effects of these parameters have been questioned by most researchers, [56] mainly with the progress in computer technology.

The exact incorporation of the structure and behavior of cortical bone, trabecular bone, dentoalveolar surface, and articular components in 3D models of the masticatory system with highly refined meshes is still one of the solutions to the research in FEA. [70] In this case, detailed models are more useful for the investigation of the mechanical behavior as the specific conditions of a given region of interest are reproduced with accuracy and detail. [13] The ideal analysis through the FEA includes systematic changes in geometry, material properties, boundary conditions, and attention, if some variables are changed. [70]

The nonlinear FEA has gained space as it is able to simulate conditions of tension in the orofacial structures in a more realistic fashion than could be accomplished by conventional linear analysis. However, its validity and reliability in dental research are not fully established. [95],[101]

With the development of digital imaging techniques, more efficient methods are available including the development of specialized software for the direct transformation of 2D or 3D information in image data from computed tomography (CT) or magnetic resonance imaging (MRI) into FEA meshes. [102],[103] The friction between contact surfaces can also be modeled with nonlinear frictional contact elements to provide an excellent simulation of the implant-bone interface with immediate load and the influence of the periodontal ligament during mastication.

With the continuous use of FEA in dental research and skull biomechanics, and the clarification of the advantages and limitations compared to the other available methods, the knowledge of this methodology becomes important for its correct use provides benefits for dental and scientific craniofacial biology as a whole, as researchers and clinicians will not only learn the basics of FEA but also interpret accurately the results of the studies.


   Conclusions Top


Though the use of FEA for evaluation in biomechanics of the skull is limited, it would be the solution for this kind of study.

In Dentistry, FEA has applications in several specialties, allows a series of evaluations to simulate conditions that would hardly be possible to be analyzed clinically or by other methodologies. Within Dentistry, Prosthesis, Implantology and Orthodontics are the areas that use the technique of FEA analysis the most.

The main limitations of studies by the FEA are the deficiency of anatomical details on the models reproduced due the complexity of certain craniofacial structures and the lack of information on the properties of materials due to the necessity of expanding the use of this tool.

 
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Correspondence Address:
Felippe Bevilacqua Prado
Department of Morphology, Anatomy Area, State University of Campinas, Av. Limeira, 901, P.O. Box 52 Piracicaba, SP, 13414-903
Brazil
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DOI: 10.4103/0970-9290.138350

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