Finite Element Analysis of Two Panthera MADs: Implications for Biomechanical Stress on Teeth and Periodontal Ligaments

Aim: This study compares the biomechanical effects of 2 mandibular advancement devices (MADs), Panthera D-SAD Classic (ID1) and Panthera D-SAD X3 (ID2), on dental and periodontal structures using finite element analysis (FEA). The objective is to assess differences in stress distribution, displacement patterns, and mechanical interactions with teeth and periodontal ligaments (PDLs). This study provides insights to improve MAD design and clinical outcomes in the treatment of obstructive sleep apnea syndrome (OSAS). Methods: 3D anatomical models, including teeth and PDLs, were reconstructed from cone beam computed tomography (CBCT) scans of an OSA patient. Two Panthera MADs were digitally modeled, processed in CAD software, and integrated with the anatomical models. Finite element simulations were performed in ANSYS, applying uniform boundary conditions, material properties (including a hyperelastic Ogden model for PDLs), and simulated mandibular advancement forces. Stress and displacement distributions in dental structures and MADs were evaluated and compared between the 2 devices. Results: The Panthera D-SAD X3 (ID2) showed a more uniform distribution of stresses across dental and periodontal structures, attributable to a 23% increase in device volume, despite potential patient discomfort. In contrast, the Panthera D-SAD Classic (ID1) generated higher stress peaks, particularly in the mandibular molars and PDLs (eg, up to 135.85 kPa on tooth 37 and 1.44 kPa on the corresponding PDL). ID2 exhibited lower peak stresses but a more pronounced load on premolars and canines. Overall, the X3 device led to a more balanced mechanical response across the dentition. Conclusion: The MAD design influences biomechanical interactions with dental and periodontal tissues. The Panthera D-SAD X3 demonstrated superior stress uniformity and mechanical efficiency performance, suggesting its potential to reduce localized overloading. Future research should focus on simulating the effects across a larger number of patients by considering multiple anatomical geometries. Moreover, long-term effects must be assessed using an appropriate FEM model.