Hindawi

International Journal of Clinical Practice

Volume 2022, Article ID 2171049, 9 pages
https://doi.org/10.1155/2022/2171049

Research Article
Effects of Occlusal Plane Inclination on the Temporomandibular
Joint Stress Distribution: A Three-Dimensional Finite
Element Analysis

Ebru Demet Cifter

Istanbul University Faculty of Dentistry, Department of Prosthodontics, Istanbul, Turkey

Correspondence should be addressed to Ebru Demet Cifter; [email protected]

Received 14 June 2022; Accepted 8 August 2022; Published 2 September 2022

Academic Editor: André Luiz Ferreira Costa

Copyright © 2022 Ebru Demet Cifter. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background. Sudden changes in masticatory loads and occlusal conditions contribute to temporomandibular disorders. Clockwise
(CW) or counterclockwise (CCW) rotation of the occlusal plane is one of the factors that alter the direction of the occlusal forces
transmitted to the temporomandibular joint structures. Finite element analysis was used to identify possible regions of high stress
in the temporomandibular joint. Materials and Methods. A computer-aided design model of a symmetrical edentulous max-
illomandibular bony complex with a temporomandibular joint was manually generated using Rhinoceros 4.0 freeform modeling
software. Three-dimensional discrete mesh generation was performed using VRMesh Studio. The reference occlusal plane angle
was accepted as 8° in the sagittal plane, and by modifying 4° in the CW and CCW directions, CW and CCW models were obtained,
respectively. The present study aimed to evaluate the changes in stress distribution in the condylar cartilage and temporo-
mandibular disc using the von Mises and maximum-minimum principal stress evaluations of three different occlusal plane
inclinations. The null hypothesis of this three-dimensional finite element analysis was that “occlusal plane inclination does not
change the stress distribution on the temporomandibular joint structures.” Results. The compressive stress on the condyle
increased with CW rotation of the occlusal plane. The von Mises equivalent stress of the temporomandibular disc shifted to the
medial, posterior, and superior directions after CW and CCW rotations of the occlusal plane. The CW rotation of the occlusal
plane increased the von Mises equivalent.

1. Introduction OP is defined by The Glossary of Prosthodontic Terms as

follows: “The average plane established by the incisal and
The temporomandibular joint (TMJ) is one of the most occlusal surfaces of the teeth” [2]. The OP is at an angle of
complex joint systems in the body, connecting a single bone approximately 8 ± 4° relative to the Frankfort horizontal
to the skull with two separate joints. It performs gliding and plane when viewed in the sagittal plane [3]. The angle of the
hinging movements; therefore, it is called a ginglymoar- plane can be altered by full-arch prosthodontic rehabilita-
throdial joint, which provides special biomechanical fea- tion, tooth loss, orthodontic treatment, or during ortho-
tures. There is a significant relationship between the gnathic surgeries, correcting low or high occlusal facial types
dentition alignment and the distribution of masticatory [4]. The clockwise (CW) or counterclockwise (CCW) ro-
forces through the stomatognathic system. The harmony of tation of the OP inclination changes the direction of occlusal
condylar guidance with anterior guidance and occlusal plane forces transferred to the TMJ additional to noticeable es-
(OP) inclination maintains the structural health of the thetic outcomes [5, 6]. Changes in the direction of the
system. Sudden changes in masticatory loads and occlusal occlusal forces and the decrease of OP angle are assumed to
conditions are listed as contributing factors to temporo- be related to increased pressure in TMJ structures [7].
mandibular disorders [1]. Barientos et al. stated that the direction of the clenching
2 International Journal of Clinical Practice

forces affects the localization of stress distribution areas on Table 1: Roth prescriptions of maxillary and mandibular teeth.
TMJ structures [8]. In the TMJ, the disc and articular Roth prescriptions Torque Angulation
cartilage are the load-bearing structures. They are respon- Maxillary centrals +12° 5°
sible for stress absorption and dissipation of the energy Maxillary laterals +8° 9°
produced during function [9]. Excessive loads, orthopedic Maxillary cuspids −2° 9°
instability, and aging are the major reasons for the degen- Maxillary 1st/2nd bicuspids −7° 0°
eration of the TMJ components. Erosion and roughening of Maxillary 1st/2nd molars −14° 0°
the articular structures can lead to pain and dysfunction, Mandibular incisors 0° 0°
which can later be accompanied by inflammatory changes Mandibular cuspids −11° 7°
[10]. Mandibular 1st bicuspids −17° 0°
Finite element analysis (FEA) is an effective, noninva- Mandibular 2nd bicuspids −22° 0°
sive, and qualitative method used for identifying the possible Mandibular 1st molars −30° 1°
Mandibular 2nd molars −30° 0°
region of high stresses that are responsible for soft tissue and
bone degeneration in a complex structure such as the TMJ
[11]. To evaluate the possible relationship between OP in-
clination and TMJ biomechanics, a three-dimensional (3D) relationship was set according to the Angle Class I molar
finite element model was constructed. The present study relationship. The reference OP angle was accepted as 8° in
aimed to evaluate the changes in the stress distribution in the sagittal plane, and by changing 4° in the CW and CCW
condylar cartilage and temporomandibular disc by the von directions, CW and CCW models were obtained, respec-
Mises and maximum-minimum principal stress (MaxPs- tively (Figure 1).
MinPs) evaluations of three different OP inclinations. The After completing the modeling process, 3D discrete
null hypothesis of this 3D FEM analysis was that “occlusal mesh generation was performed using the VRMesh Studio
plane inclination does not change the stress distribution on (VirtualGrid Inc., Bellevue City, WA, USA) software. In the
the TMJ structures.” regions of interest, 8-node brick type hexahedral elements
were used as much as possible. Fewer knotted elements were
used in the regions close to the center of the structure. This
2. Materials and Methods modeling technique aims to create a high-quality network
A computer-aided design model of a symmetrical edentu- structure with the highest possible number of nodes to fa-
lous maxillomandibular bony complex with the TMJ was cilitate calculations. The total number of elements and nodes
manually generated using Rhinoceros 4.0 freeform modeling used in the mathematical model is listed in Table 2.
software (3670 Woodland Park Ave N, Seattle, WA 98103, After the mesh convergence analysis process, the model
USA). The anatomical data used for this process were was exported to Algor Fempro software (Algor Inc., USA) in
gathered from sagittal and coronal tracings and images of STL format to perform the FEA. Before the FEA, the material
the Sobotta Anatomy Atlas and the Visible Human Project properties were assigned to all structures composing the 3D
(US National Library of Medicine, Bethesda, MD, USA). model. The elastic moduli and Poisson’s ratios of the ele-
Cortical and trabecular bone layers were determined using ments are listed in Table 3.
Rhinoceros software. Cortical bone thickness was defined as All the materials in this study were assumed to be ho-
2 mm for the glenoid fossa, condylar head, and mandible. A mogeneous, isotropic, and linearly elastic. To limit the
0.2 mm uniform layer of articular cartilage was created at the displacement of the model in the loading simulations,
glenoid fossa and condyle to maximize the realism of the boundary conditions were assigned to the nodes on the
created model based on the anatomic findings [12, 13]. The posterior border of the temporal bone and the most superior
temporomandibular disc, retrodiscal tissue, and capsular part of the model as a zero displacement in all directions. The
ligament were modeled manually between the glenoid fossa model was designed symmetrically along the x axis. The
and condyle using the same software in accordance with the applied masticatory muscle loads are presented in Table 4.
surfaces of the glenoid fossa and condyle which were
modeled from the Sobotta Anatomy Atlas and the Visible 3. Results
Human Project (US National Library of Medicine, Bethesda,
MD, USA). Stress distribution on the condylar cartilage and TMJ disc
Modeling of the dentition was manually accomplished, was evaluated by maximum and minimum principal stress
as suggested by the Rhinoceros software. The 3D model parts (MaxPs and MinPs, respectively) and the von Mises stress
were created in STL (stereolithography) format, exported to calculations. The highest and lowest amounts of maximum
Rhinoceros software, and integrated using the Boolean and minimum principal stress and von Mises stress under
method. While integrating the denture into the alveolar the three different occlusal inclinations are presented in
bone, a periodontal membrane was formed with a thickness Table 5.
of 0.25 mm and was assumed to be even in all regions [14].
Each tooth was positioned in the maxilla and mandible
corresponding to the alveolar arch shape in accordance with 3.1. Condylar Cartilage. The MaxPs values indicating tensile
the Roth prescription (Table 1) [15]. While integrating the stresses in the mandibular structure were localized on the
denture into the alveolar process, the interocclusal frontal face of the condylar cartilage in all models. CCW and
International Journal of Clinical Practice 3

8° Ref –4° ccw

+4° cw

Figure 1: Reference model (8° ref ), counterclockwise (−4° CCW), and clockwise (+4° CW) models.

Table 2: The number of nodes and elements of clockwise (CW) and Table 5: The highest and lowest amounts of maximum and
counterclockwise (CCW) models. minimum principal stress values on the condylar cartilage and von
Mises stress values for temporomandibular joint (TMJ) disc
Reference CW CCW (N/mm2).
Number of nodes 231678 520627 472516
Number of elements 1066340 2104547 2061979 Reference CCWa CWb
c
MaxPs highest 0.01 0.01 0.01
MaxPsc lowest −1,51 −1,74 −5,49
Table 3: The elastic moduli and Poisson ratios of the elements. MinPsd highest 3,03 2,78 4,72
MinPsd lowest −0.01 −0.01 −0.01
Elastic modulus (MPa) Poisson ratio vonMe highest 66.97 74,01 81.01
Cortical bone 13700 0.3 vonMe lowest 0.21 0.05 0.11
Enamel 84100 0.33 a: counterclockwise, b: clockwise, c: maximum principal stress d: minimum
Periodontal ligament 0.0689 0.45 principal stress, e: von Mises stress.
Cancellous bone 1370 0.3
Cartilage 7.4 0.4
TMJ disc 30.9 0.4 The distribution of MinPs values in the condylar car-
Retrodiscal tissues 1.5 0.4 tilage in the reference model, CCW rotation, and CW ro-
tation of the OP is presented in Figures 5–7, respectively.
The maximum values of the MinPs indicating the
Table 4: Masticatory muscle loads applied. compressive stresses in the structure were the highest on the
􏽢
medial face of the condylar cartilage for all models and
Force applied (N2)
increased after CW rotation of the OP. The minimum values
Superficial masseter 190.40 of the MinPs were on the lateral face of the condylar neck
Deep masseter 81.60
and did not change quantitatively following changes in the
Medial pterygoid 174.80
Anterior temporalis 158
OP inclination.
Middle temporalis 95.60
Posterior temporalis 75.60
Superficial masseter 190.40
3.2. Temporomandibular Joint Disc. The von Mises equiv-
alent stresses were the highest on the lateral/inferior/frontal
site of the TMJ disc in the reference model. The maximum
stress point shifted medially, posteriorly, and superiorly as
CW rotation of the OP did not change the quantity or lo- the OP inclined both CW and CCW. The greatest value for
cation of the highest MaxPs values. the maximum von Mises stress increased as the OP rotated
The CW rotation of the OP increased the lowest value of CW. The minimum von Mises stress value was observed at
MaxPs more than the CCW rotation without changing the the lateral-inferior/posterior site of the disc. The point
location where it remained on the posterior face of the moved medially, superiorly, and frontally as the OP inclined
condylar neck. CCW; however, it did not change in place with the CW
The MaxPs distribution on the condylar cartilage in the rotation of the OP.
reference model, CCW rotation, and CW rotation of the The maximum and minimum values and distribution of
occlusal plane is presented in Figures 2–4, respectively. the von Mises stress on the TMJ disc for the reference model,
4 International Journal of Clinical Practice

Stress
maximum principal
N/(mm–2)
0.01
0.009
0.008
0.007
0.006
0.005
0.004
0.003
0.002
0.001
0

Load case: 1 of 1 X
Maximum value: 0.0148517 N/(mm–2)
Minimum value: –1.51788e-17 N/(mm–2)
0.000 5.122 mm 10.245 15.383
1 < referans >

Figure 2: Maximum and minimum values and maximum principal stress distribution on condylar cartilage in the reference model.

Stress
maximum principal
N/(mm–2)
0.01
0.009
0.008
0.007
0.006
0.005
0.004
0.003
0.002
0.001
0

0.014160

–1.741951E-17

Load case: 1 of 1 X
Maximum value: 0.0141699 N/(mm–2)
Minimum value: –1.74195e-17 N/(mm–2)
0.000 8.133 mm 12.228 18.339
1 < sagittal4CCW >

Figure 3: Maximum principal stress distribution on condylar cartilage after counterclockwise rotation of the occlusal plane.

CCW rotation, and CW rotation of the OP are presented in of conducting studies that would never be possible to
Figures 8–10, respectively. conduct on human subjects. Testing the same hypothesis by
changing the variables under standardized conditions en-
4. Discussion sured the validity of the results.
The TMJ is one of the most complex joint systems in the
Computed simulations such as FEA have been successfully human body. The internal structure of the joint can be
used to reveal the internal stresses of body structures for a monitored to a limited extent using imaging methods, such
long while [16]. Mathematical models provide the advantage as magnetic resonance or computed tomography. The data
International Journal of Clinical Practice 5

Stress
maximum principal
N/(mm–2)
0.01
0.009
0.008
0.007
0.006
0.005
0.004
0.003
0.002
0.001
0

0.016207

–5.493291e-18

Load case: 1 of 1 X
Maximum value: 0.0162072 N/(mm–2)
Minimum value: –5.49329e-18 N/(mm–2)
0.000 8.488 mm 12.928 18.485
1 < sagittal4CCW >

Figure 4: Maximum principal stress distribution on condylar cartilage after clockwise rotation of the occlusal plane.

Stress
maximum principal
N/(mm–2)
0
–0.001
–0.009
–0.008
–0.007
–0.006
–0.005
–0.004
–0.003
–0.002
–0.01

3.035766e-16

–0.017773 Z

Load case: 1 of 1 X
Maximum value: 3.03577e-18 N/(mm–2)
Minimum value: –0.0177734 N/(mm–2)
0.000 5.199 mm 10.988 15.599
1 < referans >

Figure 5: Minimum principal stress distribution on condylar cartilage in the reference model.

obtained by imaging methods provide information about the Nevertheless, the relationship between TMJ disorders and
instant status of the articular surfaces; however, they are occlusal factors is still being comprehensively investigated
unable to demonstrate the effects of changing forces. Fur- [17].
thermore, the FEA of the TMJ is limited by several as- The results of the current study revealed the change in
sumptions. Adaptive changes in biological systems explain the magnitude and direction of the occlusal forces trans-
the reason for the variation in the occurrence of TMJ dis- mitted to the TMJ disc and condylar cartilage is due to OP
orders among people with occlusal disharmonies. rotation. The tensile stresses on the condylar cartilage
6 International Journal of Clinical Practice

Stress
maximum principal
N/(mm–2)
0
–0.001
–0.009
–0.008
–0.007
–0.006
–0.005
–0.004
–0.003
–0.002
–0.01

2.782786e-18

–0.015948
Z

Load case: 1 of 1 X
Maximum value: 2.78279e-18 N/(mm–2)
Minimum value: –0.0158479 N/(mm–2)
0.000 8.119 mm 12.228 18.239
1 < sagittal4CCW >

Figure 6: Minimum principal stress distribution on condylar cartilage after counterclockwise rotation of the occlusal plane.

Stress
maximum principal
N/(mm–2)
0
–0.001
–0.009
–0.008
–0.007
–0.006
–0.005
–0.004
–0.003
–0.002
–0.01

4.72712e-17

–0.014478
Z

Load case: 1 of 1 X
Maximum value: 4.72712e-17 N/(mm–2)
Minimum value: –0.0144787 N/(mm–2)
0.000 8.488 mm 12.978 19.485
1 < referans >

Figure 7: Minimum principal stress distribution on condylar cartilage after clockwise rotation of the occlusal plane.

(MaxPs highest values) and the least compressive forces value of the MinPs, indicating compressive stress in the
(MinPs lowest values) remained the same in magnitude and structure. CCW rotation slightly decreased the compressive
direction, suggesting that the condylar cartilage faces mostly stress on the condylar cartilage. Compressive stresses
compressive stresses in all models. remained on the medial face of the condylar cartilage, re-
OP inclination changed the differential pattern of force gardless of the OP inclination.
applied on the TMJ disc both in direction and magnitude. CW rotation of the OP increased the von Mises stresses
CW rotation of the OP caused an increase in the maximum observed in the disc more than CCW rotation. The von
International Journal of Clinical Practice 7

Stress
yon mises
N/(mm–2)
7
6.3
5.6
4.9
4.2
3.5
2.8
2.1
1.4
0.7
0

66.975248

0.211504

Load case: 1 of 1 X
Maximum value: 66.9782 N/(mm–2)
Minimum value: 0.211504 N/(mm–2)
0.000 4.038 mm 8.073 12.110 Y
1 < referans >

Figure 8: The maximum and minimum values and distribution of the von Mises stress on temporomandibular joint disc for the reference
model.

Stress
yon mises
N/(mm–2)
7
6.3
5.6
4.9
4.2
3.5
2.8
2.1
1.4 0.053397
0.7
0

74.017706

Load case: 1 of 1 X
Maximum value: 74.0177 N/(mm–2)
Minimum value: 0.0533968 N/(mm–2)
0.000 2.947 mm 8.949 9.843 Y
1 < sagittal4CCW >

Figure 9: The maximum and minimum values and distribution of the von Mises stress on temporomandibular joint disc after coun-
terclockwise rotation of the occlusal plane.

Mises equivalent stresses were the highest on the lateral/ several studies that revealed the localization of stress pat-
inferior/frontal site of the TMJ disc in the reference model. terns on the lateral side of the disc. In addition, occlusal
This result is consistent with the findings of Mori et al. [9]. trauma-induced thinning and perforation of the TMJ disc
Maximum stress points shifted medially, posteriorly, and are found in the central and lateral areas in anatomical
superiorly as the OP inclined both CW and CCW. The studies [18]. Furthermore, Hansson et al. found arthritic
results of the current study are in line with the results of changes located mainly on the disc and in the lateral one-
8 International Journal of Clinical Practice

Stress
yon mises
N/(mm–2)
7
6.3
5.6
4.9
4.2
3.5
2.8
2.1
1.4
0.7
0
81.017648

0.113488

Load case: 1 of 1 X
Maximum value: 81.0176 N/(mm–2)
Minimum value: 0.113488 N/(mm–2)
0.000 4.151 mm 8.3432 12.483 Y
1 < sagittal4CW >

Figure 10: The maximum and minimum values and distribution of the von Mises stress on temporomandibular joint disc after clockwise
rotation of the occlusal plane.

third of the joint from the cadaver studies [19]. The cor- established, increased joint loads are reported to be a pos-
relation between studies shows us that the disc is the most sible reason for some temporomandibular disorders [22].
load-bearing element in the TMJ. Mori et al. conducted a However, the role of occlusion-related changes in tempo-
FEA of cartilaginous tissues in the TMJ and suggested that romandibular disorders remains controversial. To date,
the TMJ disc plays an important role in stress distribution there is no certain scientific evidence that can specifically
during prolonged clenching [9]. According to the result of judge the relation between force distribution and tempo-
the current study, the increasing magnitude of the von Mises romandibular disorders.
stress on the articular disc indicates that the major stress
distributing element of the TMJ is the articular disc.
The change in the OP inclination in both directions
5. Conclusion
(CCW and CW) shifted the maximum stress point of the (1) CW or CCW rotation of the occlusal plane did not
disc in the opposite direction with increasing magnitudes. change the tensile stresses on the condyle.
Nickel et al. stated that mediolateral translation due to (2) Compressive stresses on the condyle increased with
tractional forces in the joint could affect degenerative the CW rotation of the OP; however, they remained
changes in the cartilage structures [20]. Buranastidporn et al. on the medial side.
concluded that arthritic changes of the articular disc were
(3) The von Mises equivalent stress of the TMJ disc
related to the compressive stress patterns of the clenching
shifted to medial, posterior, and superior directions
loads. Recurrent loading of the TMJ structures with in-
after CW and CCW rotation of the OP.
compatible forces is also suggested as the reason for internal
derangement and disc displacement [21]. (4) In comparison to CCW, the CW rotation of the OP
The significant energy dissipation capacity and stress resulted in a greater increase of the von Mises
relaxation observed under sheer and tensile loads protect the equivalent stress.
TMJ disc from irreversible structural deformation [21]. The
adaptation capacity of the individual also plays an important Data Availability
role in the probability of developing temporomandibular
disorders [1]. Patients with temporomandibular disorders All data used to support the findings of the study will be
should be evaluated closely during dental treatments which made available upon reasonable request.
cause OP alteration. Unnecessary changes in the OP angle
should be avoided during full-arch restorations in indi-
viduals with a healthy stomatognathic system. Although the Conflicts of Interest
etiology of temporomandibular disorders has not yet been The authors declare that they have no conflicts of interest.
International Journal of Clinical Practice 9

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