Femtosecond lasers for high-precision orthopedic surgery

High-Precision Implant Cavity Fabrication Using Femtosecond Lasers

Objective: This study aims to enhance the precision of implant cavity preparation, addressing a notable challenge in the current state of the field by utilizing femtosecond lasers. Background: The application of femtosecond lasers in implant cavity preparation heralds a noninvasive and efficient technique, characterized by diminished thermal damage and high biocompatibility. Despite these promising attributes, the realization of precise cavity preparation remains a significant challenge in the contemporary domain. Materials and Methods: Our research group devised a specialized femtosecond laser microsurgery robotic system tailored for sophisticated implant cavity preparation. This system facilitated the meticulous analysis of sheep shank bone samples, enabling precise three-dimensional cutting. The analysis included an extensive examination of ablation effects, using a laser scanning microscope and VK Analyzer software. This investigation spanned the phases of laser flux calibration and experimental validation, offering a critical evaluation of the automated preparation process. Results: The study delineated that at the focus position of our custom-made oral clinical femtosecond laser microsurgery robotic system, the laser spot diameter is 75.69 μm, and ascertained the ablation threshold for sheep shank cortical bone to be 1.47 J/cm2. Utilizing low laser flux with minimal ablation craters overlap compromised the sidewall precision of the implant cavity, whereas employing high laser flux with extensive ablation craters overlap resulted in an enlarged ablation angle. At a laser energy setting of 2.2362 J/cm2 and a 50% ablation crater overlap, an implant cavity was successfully crafted featuring a top diameter of 4.41 mm, a bottom diameter of 3.98 mm, and a depth of 3 mm, devoid of any adverse thermal effects such as cracking or carbonization. Conclusions: The oral clinical femtosecond laser microsurgery robotic system can achieve automated and precise implant cavity preparation. This advancement promotes the broader application of femtosecond lasers in the field of orthopedics.

Automation in Dentistry with Mechanical Drills and Lasers for Implant Osteotomy: A Narrative-Scoping Review

The popularity of implants is increasing with the aging population requiring oral-dental rehabilitation. There are several critical steps in the implant workflow, including case selection, implant design, surgical procedure, biological tissue responses, and functional restoration. Among these steps, surgical osteotomy procedures are a crucial determinant of clinical success. This brief review was aimed at outlining the current state of the field in automation-assisted implant surgical osteotomy technologies. A broad search of the literature was performed to identify current literature. The results are outlined in three broad categories: semi-automated static (image-guided) or dynamic (navigation-assisted) systems, and fully-automated robotic systems. As well as the current mechanical rotary approaches, the literature supporting the use of lasers in further refinement of these approaches is reviewed. The advantages and limitations of adopting autonomous technologies in practical clinical dental practices are discussed. In summary, advances in clinical technologies enable improved precision and efficacious clinical outcomes with implant dentistry. Hard-tissue lasers offer further advancements in precision, improved biological responses, and favorable clinical outcomes that require further investigation.

Femtosecond laser lithotripsy: a novel alternative for kidney stone treatment? Evaluating the safety and effectiveness in an ex vivo study

The Holmium (Ho:YAG) laser is presently the most extensively employed in laser lithotripsy for the management of kidney stones. Despite its adoption as the gold standard for laser lithotripsy, Ho:YAG laser lithotripsy poses three significant challenges, namely thermal effect, insufficient stone fragmentation, and stone displacement, which have garnered increased attention from urologic surgeons. Nowadays, the femtosecond laser is regarded as a potential alternative to the Ho:YAG laser due to its capacity to ablate diverse materials with minimal thermal effect. In our ex vivo investigation, we assessed the dimensions of ablation pits, the efficacy of ablation, the degree of stone fragmentation, the alterations in water temperature surrounding stones, and the degree of tissue damage associated with Femtosecond laser lithotripsy utilizing adjustable power settings (1-50 W). Our findings indicate that the ablation pits generated by the Femtosecond laser exhibited uniform geometries, and the effectiveness of ablation and fragmentation for Femtosecond laser lithotripsy were significantly and positively correlated with laser power. When the laser power remained constant, the Femtosecond laser with higher pulse energy demonstrated superior efficiency in stone ablation, but inferior performance in stone fragmentation. Conversely, the Femtosecond laser with higher pulse frequency exhibited the opposite behavior. Furthermore, the thermal effect increased proportionally with laser power, leading to a tentative recommendation of 10W laser power for future investigations. Our in vitro findings suggest that the Femtosecond laser holds promise as a safe and effective alternative to holmium lasers.

Orthopedics-Related Applications of Ultrafast Laser and Its Recent Advances

The potential of ultrafast lasers (pico- to femtosecond) in orthopedics-related procedures has been studied extensively for clinical adoption. As compared to conventional laser systems with continuous wave or longer wave pulse, ultrafast lasers provide advantages such as higher precision and minimal collateral thermal damages. Translation to surgical applications in the clinic has been restrained by limitations of material removal rate and pulse average power, whereas the use in surface texturing of implants has become more refined to greatly improve bioactivation and osteointegration within bone matrices. With recent advances, we review the advantages and limitations of ultrafast lasers, specifically in orthopedic bone ablation as well as bone implant laser texturing, and consider the difficulties encountered within orthopedic surgical applications where ultrafast lasers could provide a benefit. We conclude by proposing our perspectives on applications where ultrafast lasers could be of advantage, specifically due to the non-thermal nature of ablation and control of cutting.

Prediction of the irradiation doses from ultrashort laser-solid interactions using different temperature scalings at moderate laser intensities

The ionising radiation created by high intensity and high repetition rate lasers can cause significant radiological hazard. Earlier defined electron temperature scalings are used for dose characterisation and prediction using Monte Carlo modelling. Dosimetric implications of different electron temperature scalings are investigated and the resulting equivalent doses are compared. It was found that scaling defined by Beget al(1997Phys. Plasmas4447-57) predicts the highest electron temperatures for given intensities, and subsequently the highest doses. The atomic number of the target, x-ray generation efficiency and interaction volume are the other parameters necessary for the dose evaluation. The set of these operational parameters should be sufficient to characterise radiological characteristics of ultrashort laser pulse based x-ray generators and evaluate radiological hazards of the laser processing facilities.

Nursing degree students' clinical placement experiences in Australia: A survey design

AIM

This study aimed to evaluate Australian nursing students' views of placements at seven tertiary education institutions with the use of the Placement Evaluation Tool (PET).

BACKGROUND

Clinical placements are a core element of healthcare education programs around the world (Chuan and Barnett, 2012) with undergraduate nursing students required to complete a prescribed number of hours as part of their degree. The quality of nursing clinical placements varies with a range of positive and negative learning experiences.

DESIGN

A survey design was used with a contemporary survey tool- the Placement Evaluation Tool (PET). Using Qualtrics software (Qualtrics, 2005) the on-line survey was distributed to approximately 6265 undergraduate nursing students at six Australian universities and one Technical and Further Education (TAFE) college where Bachelor of Nursing degree students were enrolled. Three Australian States were covered. Sites were selected where a project team member was employed.

METHODS

A total of 1263 nursing students completed the Placement Evaluation Tool (PET) - 19 items (rated 1-5), one global rating (rated 1-10) - following placement in three Australian States (July 2019-February 2020). Most - 618 (48.9%) completed a placement in acute care with placements positively rated overall.

RESULTS

The total PET mean score was 78.3% with 29.8% being 'extremely satisfied' (10 out of 10 - Item 20). However, 11.0% were dissatisfied with global ratings of four or less, whilst ratings between States differed significantly (p = <0.001). One third of respondents answered a free text statement relating to placement experiences, with significantly more comments from older students (p = <0.001) and from those with ratings in the lower range (p = <0.001). Three core themes emerged: 1. Staff Attitudes to Students, 2. Environment and 3. Lifestyle.

CONCLUSIONS

Whilst students' clinical experiences in Australia tend to be positive a minority reported exposure to negative staff attitudes, in unsafe environments, with lifestyle detriments. Further work is required to understand and enhance student experiences.

Utilization of group 10 2D TMDs-PdSe2 as a nonlinear optical material for obtaining switchable laser pulse generation modes

In-plane anisotropic two-dimensional (2D) materials have gained considerable interest in the field of research, due to having the potential of being used in different device applications. Recently, among these 2D materials, group 10 transition metal dichalcogenides (TMDs) pentagonal Palladium diselenide (PdSe₂) is utilized in various sections of researches like nanoelectronics, thermoelectric, spintronics, optoelectronics, and ultrafast photonics, owing to its high air stability and broad absorption spectrum properties. In this paper, it is demonstrated that by utilizing this novel 2D layered PdSe₂ material as a saturable absorber (SA) in an EDF laser system, it is possible to obtain switchable laser pulse generation modes. At first, the Q-switching operation mode is attained at a threshold pump power of 56.8 mW at 1564 nm, where the modulation range of pulse duration and repetition rate is 18.5 μs-2.0 μs and 16.4 kHz-57.0 kHz, respectively. Afterward, the laser pulse generation mode is switched to the mode-locked state at a pump power of 63.1 mW (threshold value) by changing the polarization condition inside the laser cavity, and this phenomenon persists until the maximum pump power of 230.4 mW. For this mode-locking operation, the achieved pulse duration is 766 fs, corresponding to the central wavelength and 3 dB bandwidth of 1566 nm and 4.16 nm, respectively. Finally, it is illustrated that PdSe₂ exhibits a modulation depth of 7.01%, which substantiates the high nonlinearity of the material. To the best of the authors' knowledge, this is the first time of switchable modes for laser pulse generation are achieved by using this PdSe₂ SA. Therefore, this work will encourage the research community to carry out further studies with this PdSe₂ material in the future.

In vitro evaluation of ultrafast laser drilling large-size holes on sheepshank bone

Bone drilling has been widely used in medical surgeries such as repair and fixation in orthopedics. Traditional drilling method using drill-bits inevitably causes significant thermal and mechanical trauma in the adjacent bone tissues. This paper demonstrates the feasibility of femtosecond laser drilling in vitro large-size holes on the sheepshank bone with high efficiency and minimal collateral damage. A Yb:KGW femtosecond laser was utilized to drill millimeter-scale holes on the bone under different cooling conditions including gas- and water-assisted processes. Scanning electron microscopy, confocal laser scanning microscopy and infrared thermographic imaging system were used to investigate the residual debris, removal rate, bone temperature variation and hole morphology. Histological examination, Fourier transform infrared spectroscopy and Raman spectroscopy were employed to study thermal damage. Results show that a 4 mm hole with smooth and clean surface was successfully drilled on the bone, and the highest removal rate of 0.99 mm³/s was achieved, which was twenty times higher than the previous study of 0.05 mm³/s. Moreover, bone and bone marrow were distinguished by real-time monitoring system during laser drilling. This work demonstrates the potential for clinical applications using an ultrafast laser to produce crack-free large-size bone holes.

Micromachining of High Quality PMN-31%PT Single Crystals for High-Frequency (>20 MHz) Ultrasonic Array Transducer Applications

A decrease of piezoelectric properties in the fabrication of ultra-small Pb(Mg_1/3Nb_2/3)-x%PbTiO3 (PMN-x%PT) for high-frequency (>20 MHz) ultrasonic array transducers remains an urgent problem. Here, PMN-31%PT with micron-sized kerfs and high piezoelectric performance was micromachined using a 355 nm laser. We studied the kerf profile as a function of laser parameters, revealing that micron-sized kerfs with designated profiles and fewer micro-cracks can be obtained by optimizing the laser parameters. The domain morphology of micromachined PMN-31%PT was thoroughly analyzed to validate the superior piezoelectric performance maintained near the kerfs. A high piezoresponse of the samples after micromachining was also successfully demonstrated by determining the effective piezoelectric coefficient (d₃₃*~1200 pm/V). Our results are promising for fabricating superior PMN-31%PT and other piezoelectric high-frequency (>20 MHz) ultrasonic array transducers.