{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:29:19Z","timestamp":1787761759114,"version":"build-2784847793"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T00:00:00Z","timestamp":1766016000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T00:00:00Z","timestamp":1766016000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002839","name":"Charit\u00e9 - Universit\u00e4tsmedizin Berlin","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002839","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Oral Invest"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Mandibular reconstruction remains a clinical challenge due to a high rate of osseous non-unions. Mechanical factors are known to influence the bone regeneration process. Therefore, bite force levels, both immediately after surgery and during the bone healing process, are believed to play a critical role in the healing outcome. The aim of this study was to evaluate bite force and mandibular mobility measurements over time following mandibular reconstruction and to relate these measurements to the bone healing outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>In this prospective study, 28 patients were included and underwent functional measurements pre-operatively and at two weeks, four weeks, eight weeks, three months, and six months post-reconstruction. Additionally, the healing outcome was assessed using post-operative imaging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After surgery, the functional parameters - including bite force, mouth opening, protrusion, and laterotrusion - significantly decreased. However, between the initial post-operative measurement and the final follow-up six months after surgery, all parameters showed a significant increase.\u00a0Two weeks post-operatively, only 9 of the 28 patients were able to participate in the bite force measurement. However, 6 of these patients exhibited incomplete osseous union, which was associated with a mean bite force of 166\u00a0N at two weeks (mean over the whole cohort after six months of 154\u00a0N).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study demonstrated the trends in functional measurements over time following mandibular reconstruction and identified a significant trend in association between excessive post-operative bite force and incomplete osseous union.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical relevance<\/jats:title>\n                    <jats:p>In consequence, clinical strategies to reduce mechanical over-stimulation could be evaluated in future studies, such as soft food intake for 3 months after mandibular reconstruction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00784-025-06698-3","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T05:37:23Z","timestamp":1766036243000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prospective functional assessment after mandible reconstruction and bone healing assessment"],"prefix":"10.1007","volume":"30","author":[{"given":"Philipp","family":"Ruf","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Duda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakob","family":"Fenske","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Orassi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Lampert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henri","family":"Kreiker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Checa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Heiland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Rendenbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudius","family":"Steffen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,18]]},"reference":[{"key":"6698_CR1","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1016\/j.bjoms.2016.12.010","volume":"55","author":"JS Brown","year":"2017","unstructured":"Brown JS, Lowe D, Kanatas A, Schache A (2017) Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years. Br J Oral Maxillofac Surg 55:113\u2013126","journal-title":"Br J Oral Maxillofac Surg"},{"key":"6698_CR2","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1016\/j.ijom.2017.11.013","volume":"47","author":"C Rendenbach","year":"2018","unstructured":"Rendenbach C, H\u00f6lterhoff N, Hischke S, Kreutzer K, Smeets R, Assaf AT, Heiland M, Wikner J (2018) Free flap surgery in europe: an interdisciplinary survey. Int J Oral Maxillofac Surg 47:676\u2013682","journal-title":"Int J Oral Maxillofac Surg"},{"key":"6698_CR3","doi-asserted-by":"publisher","first-page":"3375","DOI":"10.3390\/curroncol29050274","volume":"29","author":"M Knitschke","year":"2022","unstructured":"Knitschke M, Sonnabend S, Roller FC, Pons-K\u00fchnemann J, Schmermund D, Attia S, Streckbein P, Howaldt H-P, B\u00f6ttger S (2022) Osseous union after mandible reconstruction with fibula free flap using manually bent plates vs. patient-specific implants: a retrospective analysis of 89 patients. Curr Oncol (Toronto Ont) 29:3375\u20133392","journal-title":"Curr Oncol (Toronto Ont)"},{"key":"6698_CR4","doi-asserted-by":"crossref","unstructured":"Knitschke M, Yonan M, Roller FC, Pons-K\u00fchnemann J, Attia S, Howaldt H-P, Streckbein P, B\u00f6ttger S (2022) Osseous union after jaw reconstruction with Fibula-Free flap: conventional vs. CAD\/CAM Patient-Specific implants. Cancers 14","DOI":"10.3390\/cancers14235774"},{"key":"6698_CR5","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1016\/j.ijom.2021.04.003","volume":"51","author":"K Kreutzer","year":"2022","unstructured":"Kreutzer K, Steffen C, Nahles S, Koerdt S, Heiland M, Rendenbach C, Beck-Broichsitter B (2022) Removal of patient-specific reconstruction plates after mandible reconstruction with a fibula free flap: is the plate the problem? Int J Oral Maxillofac Surg 51:182\u2013190","journal-title":"Int J Oral Maxillofac Surg"},{"key":"6698_CR6","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1007\/s00113-016-0281-2","volume":"120","author":"L Claes","year":"2017","unstructured":"Claes L (2017) [Mechanobiology of fracture healing part 2\u202f: Relevance for internal fixation of fractures]. Unfallchirurg 120:23\u201331","journal-title":"Unfallchirurg"},{"key":"6698_CR7","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1007\/s00113-016-0280-3","volume":"120","author":"L Claes","year":"2017","unstructured":"Claes L (2017) [Mechanobiology of fracture healing part 1\u202f: Principles]. Unfallchirurg 120:14\u201322","journal-title":"Unfallchirurg"},{"key":"6698_CR8","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1016\/S0021-9290(98)00153-5","volume":"32","author":"LE Claes","year":"1999","unstructured":"Claes LE, Heigele CA (1999) Magnitudes of local stress and strain along bony surfaces predict the course and type of fracture healing. J Biomech 32:255\u2013266","journal-title":"J Biomech"},{"key":"6698_CR9","doi-asserted-by":"crossref","unstructured":"Duda GN, Geissler S, Checa S, Tsitsilonis S, Petersen A (2023) and K. Schmidt-Bleek, the decisive early phase of bone regeneration. Nat Rev Rheumatol","DOI":"10.1038\/s41584-022-00887-0"},{"key":"6698_CR10","doi-asserted-by":"publisher","first-page":"20220131","DOI":"10.1259\/dmfr.20220131","volume":"51","author":"C Steffen","year":"2022","unstructured":"Steffen C, Fischer H, Sauerbrey M, Heintzelmann T, Voss JO, Koerdt S, Checa S, Kreutzer K, Heiland M, Rendenbach C (2022) Increased rate of pseudarthrosis in the anterior intersegmental gap after mandibular reconstruction with fibula free flaps: a volumetric analysis. Dento Maxillo Fac Radiol 51:20220131","journal-title":"Dento Maxillo Fac Radiol"},{"key":"6698_CR11","doi-asserted-by":"publisher","first-page":"1156","DOI":"10.1016\/j.ijom.2019.01.029","volume":"48","author":"C Rendenbach","year":"2019","unstructured":"Rendenbach C, Steffen C, Hanken H, Schluermann K, Henningsen A, Beck-Broichsitter B, Kreutzer K, Heiland M, Precht C (2019) Complication rates and clinical outcomes of osseous free flaps: a retrospective comparison of CAD\/CAM versus conventional fixation in 128 patients. Int J Oral Maxillofac Surg 48:1156\u20131162","journal-title":"Int J Oral Maxillofac Surg"},{"key":"6698_CR12","doi-asserted-by":"crossref","unstructured":"Ruf P, Orassi V, Fischer H, Steffen C, Duda GN, Heiland M, Kreutzer K, Checa S, Rendenbach C (2022) Towards mechanobiologically optimized mandible reconstruction: CAD\/CAM miniplates vs. reconstruction plates for fibula free flap fixation: A finite element study. Front Bioeng Biotechnol 10","DOI":"10.3389\/fbioe.2022.1005022"},{"key":"6698_CR13","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/S0901-5027(89)80101-8","volume":"18","author":"MC Kennady","year":"1989","unstructured":"Kennady MC, Tucker MR, Lester GE, Buckley MJ (1989) Stress shielding effect of rigid internal fixation plates on mandibular bone grafts. A photon absorption densitometry and quantitative computerized tomographic evaluation. Int J Oral Maxillofac Surg 18:307\u2013310","journal-title":"Int J Oral Maxillofac Surg"},{"key":"6698_CR14","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1016\/j.joms.2006.06.306","volume":"65","author":"W Schupp","year":"2007","unstructured":"Schupp W, Arzdorf M, Linke B, Gutwald R (2007) Biomechanical testing of different osteosynthesis systems for segmental resection of the mandible. J Oral Maxillofac Surg 65:924\u2013930","journal-title":"J Oral Maxillofac Surg"},{"key":"6698_CR15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.medengphy.2018.03.008","volume":"56","author":"N Yoda","year":"2018","unstructured":"Yoda N, Zheng K, Chen J, Liao Z, Koyama S, Peck C, Swain M, Sasaki K, Li Q (2018) Biomechanical analysis of bone remodeling following mandibular reconstruction using fibula free flap. Med Eng Phys 56:1\u20138","journal-title":"Med Eng Phys"},{"key":"6698_CR16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2022.110968","volume":"133","author":"K Zheng","year":"2022","unstructured":"Zheng K, Yoda N, Chen J, Liao Z, Zhong J, Wu C, Wan B, Koyama S, Sasaki K, Peck C, Swain M, Li Q (2022) Bone remodeling following mandibular reconstruction using fibula free flap. J Biomech 133:110968","journal-title":"J Biomech"},{"key":"6698_CR17","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1002\/(SICI)1097-0347(199707)19:4<287::AID-HED7>3.0.CO;2-X","volume":"19","author":"DA Curtis","year":"1997","unstructured":"Curtis DA, Plesh O, Miller AJ, Curtis TA, Sharma A, Schweitzer R, Hilsinger RL, Schour L, Singer M (1997) A comparison of masticatory function in patients with or without reconstruction of the mandible. Head Neck 19:287\u2013296","journal-title":"Head Neck"},{"key":"6698_CR18","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1002\/micr.22433","volume":"37","author":"M Sakuraba","year":"2017","unstructured":"Sakuraba M, Miyamoto S, Fujiki M, Higashino T, Oshima A, Hayashi R (2017) Analysis of functional outcomes in patients with mandible reconstruction using vascularized fibular grafts. Microsurgery 37:101\u2013104","journal-title":"Microsurgery"},{"key":"6698_CR19","doi-asserted-by":"publisher","DOI":"10.1016\/j.compbiomed.2023.107887","volume":"169","author":"H Aftabi","year":"2024","unstructured":"Aftabi H, Zaraska K, Eghbal A, McGregor S, Prisman E, Hodgson A, Fels S (2024) Computational models and their applications in biomechanical analysis of mandibular reconstruction surgery. Comput Biol Med 169:107887","journal-title":"Comput Biol Med"},{"key":"6698_CR20","doi-asserted-by":"crossref","unstructured":"Steffen C, Duda K, Wulsten D, Voss JO, Koerdt S, Nahles S, Heiland M, Checa S, Rendenbach C (2023) Clinical and technical validation of novel bite force measuring device for functional analysis after mandibular reconstruction. Diagnostics (Basel Switzerland) 13","DOI":"10.3390\/diagnostics13040586"},{"key":"6698_CR21","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1438269","volume":"14","author":"P Lampert","year":"2024","unstructured":"Lampert P, Fenske J, Wuster J, Koerdt S, Kreutzer K, Ruf P, Checa S, Heiland M, Steffen C, Rendenbach C (2024) Comparative study of CAD\/CAM reconstruction and miniplates for patient-specific fixation in LCL-type mandibular reconstruction. Front Oncol 14:1438269","journal-title":"Front Oncol"},{"key":"6698_CR22","first-page":"1266","volume":"92","author":"JB Boyd","year":"1993","unstructured":"Boyd JB, Gullane PJ, Rotstein LE, Brown DH, Irish JC (1993) Classification of mandibular defects. Plast Reconstr Surg 92:1266\u20131275","journal-title":"Plast Reconstr Surg"},{"key":"6698_CR23","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1016\/j.jcms.2023.09.019","volume":"51","author":"K Kreutzer","year":"2023","unstructured":"Kreutzer K, Lampert P, Doll C, Voss JO, Koerdt S, Heiland M, Steffen C, Rendenbach C (2023) Patient-specific 3D-printed mini-versus reconstruction plates for free flap fixation at the mandible: retrospective study of clinical outcomes and complication rates. J Craniomaxillofac Surg 51:621\u2013628","journal-title":"J Craniomaxillofac Surg"},{"key":"6698_CR24","doi-asserted-by":"publisher","DOI":"10.1016\/j.compbiomed.2023.107817","volume":"168","author":"P Ruf","year":"2024","unstructured":"Ruf P, Orassi V, Fischer H, Steffen C, Kreutzer K, Duda GN, Heiland M, Checa S, Rendenbach C (2024) Biomechanical evaluation of CAD\/CAM magnesium miniplates as a fixation strategy for the treatment of segmental mandibular reconstruction with a fibula free flap. Comput Biol Med 168:107817","journal-title":"Comput Biol Med"},{"key":"6698_CR25","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2024.110652","volume":"202","author":"J Fenske","year":"2025","unstructured":"Fenske J, Steffen C, Mrosk F, Lampert P, Nikolaidou E, Beck M, Heiland M, Kreutzer K, Doll C, Koerdt S, Rendenbach C (2025) A critical reflection of radiotherapy on osseous free flaps in mandibular segmental resection and immediate reconstruction in locally advanced oral squamous cell carcinoma: a cohort study. Radiother Oncol 202:110652","journal-title":"Radiother Oncol"},{"key":"6698_CR26","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2025.1527149","volume":"15","author":"J Fenske","year":"2025","unstructured":"Fenske J, Lampert P, Nikolaidou E, Steffen C, Beck M, Neckel N, Nahles S, Heiland M, Mrosk F, Koerdt S, Rendenbach C (2025) Osteoradionecrosis in osseous free flaps after maxillofacial reconstruction: a single-center experience. Front Oncol 15:1527149","journal-title":"Front Oncol"},{"key":"6698_CR27","doi-asserted-by":"publisher","first-page":"2905","DOI":"10.1007\/s00784-020-03607-8","volume":"25","author":"LM Ritschl","year":"2021","unstructured":"Ritschl LM, Mucke T, Hart D, Unterhuber T, Kehl V, Wolff KD, Fichter AM (2021) Retrospective analysis of complications in 190 mandibular resections and simultaneous reconstructions with free fibula flap, Iliac crest flap or reconstruction plate: a comparative single centre study. Clin Oral Investig 25:2905\u20132914","journal-title":"Clin Oral Investig"},{"key":"6698_CR28","unstructured":"Gheibollahi H, Aliabadi E, Khaghaninejad MS, Mousavi S, Babaei A (2021) Evaluation of bite force recovery in patients with maxillofacial fracture. Journal of cranio-maxillo-facial surgery. official publication of the European Association for Cranio-Maxillo-Facial Surgery"}],"container-title":["Clinical Oral Investigations"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00784-025-06698-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00784-025-06698-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00784-025-06698-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T08:35:38Z","timestamp":1770626138000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00784-025-06698-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,18]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["6698"],"URL":"https:\/\/doi.org\/10.1007\/s00784-025-06698-3","relation":{},"ISSN":["1436-3771"],"issn-type":[{"value":"1436-3771","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,18]]},"assertion":[{"value":"28 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 December 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"MH received speaker remuneration and research funding for other projects by KLS Martin SE & Co. KG. CR received research funding for other projects by KLS Martin SE & Co. KG. CR received research funding for other projects and consultant fees by KLS Martin SE & Co. KG.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"14"}}