Comparative analysis of the effect of nano- and microosteoperforations on the bone tissue of the lower jaw using the finite element method

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Introduction: 
    Orthodontic correction of the cramped position of the lower incisors is often difficult due to the thinned cortical plate of the bone and the lack of space in the dental arch. All this leads to a decrease in the speed of tooth movement, perforations and fenestration of the compact plate. [1]. Traditional methods of orthodontic treatment are not effective enough, especially in the mature age of patients, when tooth movement is slower and the duration of orthodontic treatment increases [2].
           One of the innovative approaches to the treatment of cramped teeth is the use of microosteoperforations, which weaken the bone tissue of the jaw and aim to stimulate local biochemical processes that improve tooth movement [3]. Microosteoperforations stimulate the restructuring of bone tissue.
               Our proposed method of nanosteoperforations using a special osteoperforator is less traumatic [4]. It consists in creating minimal bone injury in order to initiate local metabolic and inflammatory processes that stimulate the formation of new bone tissue and accelerate the movement of teeth.
               Microosteoperforations are performed by applying small perforations in the bone tissue in order to accelerate the processes of orthodontic tooth movement [5]. This technique can be performed in two ways:
1. Using a boron tip. In this variant, thin drills with a diameter of 1.5 to 2.5 mm are used to create holes in the compact plate of the alveolar part [6]. 
2. Using an orthodontic microimplant. The size of microimplants varies. The most popular sizes range from 1.6 to 2.5 mm in diameter [7].
      Nanosteoperforations are performed using an osteoperforator with a diameter ranging from 1.1 mm to 1.5 mm [8]. 
      Such manipulations promote the activation of osteoblast and osteoclast progenitor cells, accelerating the process of resorption of old bone tissue and the formation of new bone, which significantly avoids bone resorption during orthodontic treatment and shortens the duration of orthodontic treatment.
       The purpose of our study is to compare the effects of nano- and microosteoperforations on bone tissue.
         Materials and methods 
         During the study, a three-dimensional model of the lower jaw was created with a close position of the incisors of the first degree, a bracket system and an orthodontic arch (Bio Edge 16*16, form A), which orthodontists often use at the leveling stage to align the position of the teeth (Fig.1). Based on the available data, a three-dimensional model of the lower jaw was built. The model was a set of homogeneous elements with specified physical properties (Young's modulus, ultimate strength, etc.) [9]. The modeling of osteoperforations was carried out. Various types of osteoperforations were reproduced within the framework of the models:
o Nanosteoperforations: point-shaped, small in diameter - from 1.1 to 1.5 mm.
o Microosteoperforations: classic osteoperforations with a larger diameter - from 1.6 to 2.5 mm.
       A system of linear algebraic equations was constructed, which made it possible to determine the levels of stress and deformations in bone tissue in various types of osteoperforations [10]. Stresses within the limits of permissible loads characteristic of bone tissue were calculated.
        A comparative analysis of stress levels, deformability, and intensity of bone tissue damage at the sites of nano- and microosteoperations was performed. Special attention was paid to determining the maximum load perceived by the bone tissue and the structural resistance to fracture [11].
         The data obtained allowed us to formulate a conclusion about the advantages and disadvantages of each method of osteoperforation, identify preferred methods and propose rational approaches to the choice of techniques depending on the clinical situation.
 
Figure 1. Three-dimensional models of the lower jaw with a close position of the central incisors, a bracket system and an installed square arc with a force of 80g.
 
Figure 2. Three-dimensional model of the lower jaw with six nano-osteoperations between teeth 4.1 and 4.2; 4.2 and 4.3. 

 
Figure 3. Three-dimensional model of the lower jaw with microosteoperations a-between teeth 4.1 and 4.2; 4.2 and 4.3 (a)

          Research results:
Figure 4 shows the result of modeling orthodontic treatment using the finite element method (FEM). 
              The model shows that the stresses in the bone tissue are unevenly distributed. In the area where the orthodontic tooth movement occurs, there are areas with a high level of stress, colored red and yellow. This indicates that the maximum impact on bone tissue occurs in these areas. In other areas of the jaw, the tension is much lower, as can be seen from the blue and green hues. This indicates that the main load is concentrated in the area of tooth movement, and the rest of the jaw is experiencing less stress.
              According to the stress scale, the maximum value is 47.178 MPa, which corresponds to the red and yellow areas on the model. This indicates significant mechanical stress in these areas. The minimum voltage value is 0.00012722 MPa, which corresponds to the blue areas on the model. This shows that the load on the bone tissue is minimal in these areas.
 
Figure 4. Three-dimensional model of the lower jaw with a bracket system and an orthodontic arch that develops a force of 80 g.
Figure 5 shows the result of modeling orthodontic treatment using the finite element method (FEM) using multiple nanosteoperforations.
               The model shows that the stresses in the bone tissue are distributed more evenly compared to microosteoperations. In the area where the orthodontic tooth movement occurs, there are areas with a moderate level of stress, colored yellow and green. This indicates that there is a moderate effect on bone tissue in these areas.
                 In other areas of the jaw, the tension is much lower, as can be seen from the blue shades. This indicates that the main load is concentrated in the area of tooth movement, and the rest of the jaw is experiencing less stress. According to the stress scale, the maximum value is 43.845 MPa, which corresponds to the yellow and green areas on the model. This indicates moderate mechanical stress in these areas. The minimum voltage value is 0.0001349 MPa, which corresponds to the blue areas on the model. This shows that the load on the bone tissue is minimal in these areas.
 
 Figure 5. A three-dimensional model of the lower jaw with a bracket system and six nanosteoperations between teeth 4.1 and 4.2; 4.2 and 4.3.
Figure 6 shows a three-dimensional model showing the stress distribution in the bone tissue of the lower jaw during orthodontic movement of teeth with microosteoperations. 
               According to the stress scale, the maximum value is 46.81 MPa, which corresponds to the red and yellow areas on the model. This indicates significant mechanical stress in these areas. The minimum voltage value is 0.00013798 MPa, which corresponds to the blue areas on the model. This shows that the load on the bone tissue is minimal in these areas. A slight stress distribution in the area of microosteoperations was revealed, equal to 5,2013 Mpa.

 
Figure 6. Three-dimensional model of the lower jaw with a bracket system and micro-osteopforations between teeth 4.1 and 4.2; 4.2 and 4.3.
          
          Conclusions:
1. Orthodontic treatment with multiple nano-osteoperforations causes moderate tension in the bone tissue, especially in the area of tooth movement. The minimum voltage value is 0.0001349 MPa, the maximum value is 43.845 Mpa.
2. Orthodontic treatment using microosteoperforations causes significant stress in the bone tissue, especially in the area of tooth movement. The minimum voltage value is 0.00013798 Mpa, the maximum value is 46.81 MPa.
3. The data obtained indicate a decrease in stresses in bone tissue with the use of nanosteoperforations, compared with microosteoperforations, thereby creating optimal conditions for bone remodeling.

About the authors

Tatyana Andreevna Shchedrina

MC "Romanovsky"; Federal State Budgetary Educational Institution of Higher Education named after
Yaroslav the Wise, Ministry
of Science and Higher Education of Russia;
I.I.Mechnikov NWSMU
Ministry of Health of Russia

Author for correspondence.
Email: tshedrina14@mail.ru

 dentist-orthodontist,
MC "Romanovsky"; postgraduate student at the Department
of Dentistry, NovSU
. Yaroslav the Wise, Ministry
of Science and Higher Education of Russia;
Senior Laboratory Assistant at the Department of Orthopedic
Dentistry, Orthodontics and Gnathology,
I.I.Mechnikov NWSMU
Ministry of Health of Russia

Russian Federation, St. Petersburg, 41 Kirochnaya Street

Roman Aleksandrovich Fadeev

I.I. Mechnikov North-Western State Medical University of the Ministry of Health of the Russian Federation;
Yaroslav the Wise Novgorod State University, Institute of Medical Education of the Ministry of Science and Higher Education of Russia.
Private educational institution of additional professional education "St. Petersburg Institute of Postgraduate Dentistry" (PIE "SPb INSTOM").
MC "Romanovsky"

Email: tshedrina14@mail.ru
ORCID iD: 0000-0003-3467-4479

Doctor of Medical Sciences, Professor, Head of the Department
of Orthopedic Dentistry, Orthodontics
and Gnatology,
I.I.Mechnikov Northwestern State Medical University of the Ministry of Health of the Russian Federation;
Head of the Department of Orthodontics,
Private educational institution of Higher Professional education "SPb INSTOM";
Professor of the Department of Dentistry,
Federal State Budgetary Educational Institution of Higher Education named after Yaroslav the Wise
Ministry of Science
and Higher Education of Russia;
Chief specialist of MC "Romanovsky"

Russian Federation, 1/82 Zanevsky Prospekt, Saint Petersburg

Natalya Vladimirovna Prozorova

Federal State Budgetary Educational Institution of Higher Education named after Yaroslav the Wise
Ministry of Science and Higher
Education of Russia

Email: prozorovanv@yandex.ru

 Candidate of Medical Sciences, Associate Professor, Head of the Department of Dentistry,
Federal State Budgetary Educational Institution of Higher Education named after Yaroslav the Wise
Ministry of Science and Higher
Education of Russia

Russian Federation, Veliky Novgorod, Derzhavina Street, 6

Marya Romanovna Fadeeva

Federal State Budgetary Educational Institution of Higher Education named after Yaroslav the Wise
Ministries of Science and Higher Education
Russian Federation; orthodontist of St. Petersburg State Medical University
Dental Clinic No. 9

Email: DocFad27@mail.ru

 Candidate of Medical Sciences, Associate Professor of the Department of Dentistry,
Federal State Budgetary Educational Institution of Higher Education named after Yaroslav the Wise
Ministries of Science and Higher Education
Of Russia

Russian Federation, Veliky Novgorod, Derzhavina Street, 6

References

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