Three-dimensional finite element analysis of stress distribution and influence of stainless steel preformed crown on temporomandibular joint in children

doi:10.19439/j.sjos.2025.03.003

Abstract

Abstract: PURPOSE: To study the stress effect and distribution pattern of the first and second primary molars on temporomandibular joint in the restoration of upper and lower teeth with stainless steel precrown using three-dimensional finite element method, in order to provide theoretical basis for clinical diagnosis and treatment. METHODS: CBCT data from one male and one female aged 3, 6, and 8 years old were collected, and the first and second maxillary molar teeth, upper and lower mandible, dentition and temporomandibular joint(TMJ) data were obtained respectively. Three-dimensional finite element method was used to create the finite element models of the first and second maxillary molar teeth, upper and lower mandible, dentition and TMJ, respectively. The stress distribution of the TMJ with the stainless steel prefabricated crown raised at different heights was analyzed by applying the load force. RESULT: After stainless steel crown repair, different loads were applied to the TMJ, and the maximum stress values generated by the condyle were analyzed and compared. The stress difference analysis results of the condyle in children aged 3, 6, and 8 under different genders, ages, and load angles were statistically significant(P<0.01), while the stress difference analysis results of different groups were not statistically significant(P>0.05). CONCLUSIONS: After restoring primary molars with stainless steel preformed crowns, applying three angle loads results in a more uniform distribution of stress in the TMJ at normal occlusal height. Therefore, using stainless steel crowns to restore normal occlusal height in clinical restorative treatment is beneficial for reducing stress concentration in TMJ and improving the efficacy and long-term prognosis of primary molars restoration.

Key words: Finite element method, Deciduous teeth, Stainless steel preformed crown, Temporomandibular joint, Stress analysis

CLC Number:

R783

Zhang Yulu, Liu Jia. Three-dimensional finite element analysis of stress distribution and influence of stainless steel preformed crown on temporomandibular joint in children[J]. Shanghai Journal of Stomatology, 2025, 34(3): 237-243.

References

[1] 中华口腔医学会.第四次全国口腔健康流行病学调查报告[M].北京: 人民卫生出版社, 2018:12-13.
[2] Beldüz Kara N, Yilmaz Y.Assessment of oral hygiene and periodontal health around posterior primary molars after their restoration with various crown types[J]. Int J Paediatr Dent, 2014, 24(4): 303-313.
[3] Santamaria RM, Innes NP, Machiulskiene V, et al.Caries management strategies for primary molars[J]. J Dent Res, 2014, 93(11): 1062-1069.
[4] Kindelan SA, Day P, Nichol R, et al.UK National clinical guidelines in paediatric dentistry: stainless steel preformed crowns for primary molars[J]. Int J Paediatr Dent, 2008, 18(Suppl 1): 20-28.
[5] Gallagher S, O'Connell BC, O'Connell AC. Assessment of occlusion after placement of stainless steel crowns in children-a pilot study[J]. J Oral Rehabil, 2014, 41(10): 730-736.
[6] Osborn JW.The disc of the human temporomandibular joint: design, function and failure[J]. J Oral Rehabil, 1985, 12(4): 279-293.
[7] Cervino G, Fiorillo L, Arzukanyan AV, et al.Application of bioengineering devices for stress evaluation in dentistry: the last 10 years FEM parametric analysis of outcomes and current trends[J]. Minerva Stomatol, 2020, 69(1): 55-62.
[8] Joseph RM, Rao AP, Srikant N, et al.Evaluation of changes in the occlusion and occlusal vertical dimension in children following the placement of preformed metal crowns using the hall technique[J]. J Clin Pediatr Dent, 2020, 44(2):130-134.
[9] Kaya MS, Kınay Taran P, Bakkal M.Temporomandibular dysfunction assessment in children treated with the hall technique:a pilot study[J]. Int J Paediatr Dent, 2020, 30(4): 429-435.
[10] Nair K, Chikkanarasaiah N, Poovani S, et al.Digital occlusal analysis of vertical dimension and maximum intercuspal position after placement of stainless steel crown using hall technique in children[J]. Int J Paediatr Dent, 2020, 30(6): 805-815.
[11] van der Zee V, van Amerongen WE. Short communication: influence of preformed metal crowns(hall technique)on the occlusal vertical dimension in the primary dentition[J]. Eur Arch Paediatr Dent, 2010, 11(5): 225-227.
[12] Guduk OF, Sivrikaya EC, Yilmaz N, et al.Is zirconium or stainless steel the most suitable crown material for less dentin stress in endodontically treated teeth?[J]. Technol Health Care, 2022, 30(5): 1199-1207.
[13] Owais AI, Shaweesh M, Abu Alhaija ES.Maximum occlusal bite force for children in different dentition stages[J]. Eur J Orthod, 2013, 35(4): 427-433.
[14] 胡凯, 张晔缨, 柳春明, 等. 模拟功能咬合时人颞下颌关节内的应力分布和位移特征[J].解放军医学杂志, 2003, 28(1): 63-65.
[15] Faulkner MG, Hatcher DC, Hay A.A three-dimensional investigation of temporomandibular joint loading[J]. J Biomech, 1987, 20(10): 997-1002.
[16] 刘路平, 由敬舜, 徐剑青, 等. 五种咬合情况下颞下颌关节负荷的三维有限元分析[J]. 中华口腔医学杂志, 1994, 29(6): 368-371.
[17] Savoldelli C, Bouchard PO, Loudad R, et al.Stress distribution in the temporo-mandibular joint discs during jaw closing: a high-resolution three-dimensional finite-element model analysis[J]. Surg Radiol Anat, 2012, 34(5): 405-413.
[18] dos Santos J Jr, Blackman RB, Nelson SJ. Vectorial analysis of the static equilibrium of forces generated in the mandible in centric occlusion, group function, and balanced occlusion relationships[J]. J Prosthet Dent, 1991, 65(4): 557-567.
[19] Verma L, Passi S.Glass fibre-reinforced composite post and core used in decayed primary anterior teeth: a case report[J].Case Rep Dent, 2011: 864254.
[20] Hegde KS, Suvarna RM, Bhat SS.Stress analysis in endodontically treated primary molar with and without stainless steel crown: a comparative finite element model study[J]. J Nat Sci Biol Med, 2019, 10(2): 202-208.
[21] Mongini F.Remodelling of the mandibular condyle in the adult and its relationship to the condition of the dental arches[J]. Acta Anat (Basel), 1972, 82(3): 437-453.
[22] Mongini F.Dental abrasion as a factor in remodeling of the mandibular condyle[J]. Acta Anat (Basel), 1975, 92(2): 292-300.
[23] Arnett GW, Milam SB, Gottesman L.Progressive mandibular retrusion-idiopathic condylar resorption. part Ⅱ[J]. Am J Orthod Dentofacial Orthop, 1996, 110(2): 117-127.
[24] 施宜君, 杨燃, 王艳, 等. 乳磨牙金属预成冠修复后咬合及颞下颌关节评估的临床研究[J].口腔疾病防治, 2022, 30(11): 785-791.
[25] Prabhakar AR, Chakraborty A, Nadig B, et al.Finite element stress analysis of restored primary teeth: a comparative evaluation between stainless steel crowns and preformed zirconia crowns[J]. Int J Oral Health Sci, 2017, 7(1): 10-10.
[26] American Academy of Pediatric Dentistry. Acquired temporomandibular disorders in infants, children, and adolescents[J]. Pediatr Dent, 2018, 40(6): 366-372.
[27] 石伟华, 王丹丹, 唐忠旺, 等. 乳牙列个别正常牙尖交错位咬合接触的研究[J]. 中华口腔医学杂志, 2021, 56(9): 873-879.
[28] Owais AI, Al-Battah AH, Abu Alhaija ES.Changes in occlusal bite force following placement of preformed metal crowns on primary molars in 4-6 years old children:a 6 months’follow-up pilot study[J]. Eur Arch Paediatr Dent, 2019, 20(1): 9-14.
[29] 张人杰, 周翊翛, 郑东翔, 等. 患者主观感受和T-Scan咬合分析在牙列重度磨耗修复功能性评价中的作用[J]. 北京口腔医学, 2019, 27(1): 37-41.
[30] Kamegai T, Tatsuki T, Nagano H, et al.A determination of bite force in northern Japanese children[J]. Eur J Orthod, 2005, 27(1): 53-57.
[31] Gavião MB, Raymundo VG, Rentes AM.Masticatory performance and bite force in children with primary dentition[J]. Braz Oral Res, 2007, 21(2): 146-152.
[32] Mountain G, Wood D, Toumba J.Bite force measurement in children with primary dentition[J]. Int J Paediatr Dent, 2011, 21(2): 112-118.
[33] Savoldelli C, Bouchard PO, Manière-Ezvan A, et al.Comparison of stress distribution in the temporomandibular joint during jaw closing before and after symphyseal distraction:a finite element study[J]. Int J Oral Maxillofac Surg, 2012, 41(12): 1474-1482.