Modeling the electromechanical impedance technique for the assessment of dental implant stability

[Possibilities and prospects for experimental and clinical instrumentation techniques for determining the primary stability of dental implants in comparative analysis]

The high primary stability of dental implants provides a favorable prognosis for orthopedic treatment with implant-supported structures. The importance of assessing the stability and the bone tissue surrounding the implant as a whole is due to the fact that the process of osseointegration is a structural and functional connection between the bone and the loaded surface of the implant. Determination of the dynamics of the stability of dental implants allows timely monitoring of unpredictable changes at the stages of osseointegration and remodeling of bone tissue around the implant. Currently, in addition to clinical and radiation diagnostic methods, there are generally recognized by clinicians frequency resonance analysis and periotestometry. However, there are some scientific discrepancies indicating the lack of objectivity of these methods and the impossibility of their full-fledged application without the support of radiation and clinical diagnostic methods. In addition to these methods, there are many experimental and less common methods in clinical practice for assessing the primary stability of implants, but with reasonable objectivity. Thus, the reasons are given that for a full assessment of the relationship between the efforts exerted on implants and their movements in the space of bone tissue, devices are needed that reflect the stability and density of the contact of the implant with bone tissue in physical quantities. In particular, methods based on lasers, sound, quantitative ultrasound, and others have found experimental practical application. The ultrasound method of assessing the primary stability of the implant is estimated as the most promising, since it allows you to demonstrate the results of studies in certain physical quantities, as well as to compare these results with histomorphological indicators of osseointegration of dental implants.

Identification of Bone Density Changes Applying Impedance Spectroscopy with a Piezo-Device Coupled to a Human Tooth

Bone tissue is a calcium deposit and supporting structure of the human body, it is exposed to several pathologies that modify its mineral content. To determine these changes, different diagnostic procedures are performed with techniques using invasive ionizing radiation, which are limited by the negative effects in the long term on human health. A methodology is explored that could be applicable in the diagnosis of pathologic variations in bone mineral density, using structural monitoring tools. The proposed technique estimates changes in bone conditions by applying impedance spectroscopy with a tooth-borne piezo-device. Bone-tooth samples were prepared to simulate a section of maxillary bone and subsequently treated with chemical agents, simulating pathologic decalcification. The piezo-device is inserted in the slot of an orthodontic bracket, previously bonded to the crown of the tooth, in order to transmit vibration to surrounding bone. The variations in bone micro-architecture were computed by image processing analyzed with samples prepared in transparent resin, allowing the measurement of morphometry before and after the induced changes in mineral content. Using vibrational bone response, impedance measurements allowed to observe the variations in bone mass as the samples were progressively decalcified. In the 5-50kHz spectrum, it was demonstrated the sensitivity of the electro-mechanical impedance during the bone alteration procedure since the electrical resistance signals of the piezo-device consistently changed in the frequency spectrum (5-50kHz). The piezo-device shows to be sensitive to the changes produced by the bone alterations, which were caused by the stiffness variations made in the sample during the decalcifying. These changes were statistically correlated to demonstrate that in a less invasive way, bone alterations could be monitored from the teeth. This result opens the door to search for a new way to diagnose bone density changes in real applications.

A finite element model for evaluating the effectiveness of the Advanced System for Implant Stability Testing (ASIST)

The Advanced system for Implant Stability Testing (ASIST) was developed to evaluate the stability of osseointegrated implants. ASIST matches the physical response with an analytical model's prediction to determine the stiffness of the bone implant interface (BII) which is then used to calculate the ASIST Stability Coefficient (ASC). In this investigation, a 3D dynamic finite element (FE) model of the ASIST experimental impact technique for bone anchored hearing aids was created. The objectives were to evaluate the analytical model's ability to capture the behavior of the implant system and to assess its effectiveness in minimising the effects of the system's geometry on the ASC scores. The models were developed on ABAQUS®, they consisted of the implant, abutment, screw, base support and impact rod. The models relied on frictional contact definitions between the system's components. The simplified "three-part" model had the implant, abutment and screw merged as one part while the "five-part" model treated them as separate components. Different interface conditions were simulated (friction coefficient range: 0-0.9) for three abutment lengths (6, 9 and 12 mm). The simulation output was the average nodal acceleration response of the rod, which was imported to the custom ASIST program in Mathematica® to obtain the ASC scores. The overall quality of the curve fits indicate that the analytical model is capable of representing the system's behavior. Moreover,ASC scores provide a reliable assessment of implant stability as they are sensitive to interface conditions and are minimally influenced by the system's geometry.

Electromechanical impedance measurements for bone health monitoring through teeth used as probes of a Piezo-device

Bone is a dynamic biological tissue that acts as the primary rigid support of the body. Several systemic factors are responsible for pathologies that negatively affect its structural attributes. Although the bone is in continuous renewal by osteogenesis, metabolic diseases are the most common affectations that alter its natural equilibrium. Different techniques based on ionizing radiation are used for the bone diagnosis restrictively. However, if these are not used adequately, the application could present risks for human health. In this paper, it is proposed and explored a new technique to apply an early-stage diagnosis of bone variations. The technique evaluates bone structural conditions from the teeth (used as probes) by applying a structural health monitoring (SHM) methodology. An experimental procedure is described to identify the stiffness variations produced by mechanical drillings done in prepared bone samples. The identification is carried out applying the electromechanical impedance technique (EMI) through a piezo-actuated device in the frequency spectrum 5-20kHz. Three bone samples with incorporated teeth (three teeth, two teeth, and one tooth) were prepared to emulate a mandibular portion of alveolar bone-PDL (periodontal ligament)-tooth system. Piezo-device was attached to the crown of the tooth with an orthodontic bracket allowing the teeth to act as probes. The electrical resistance measurements were computed with an electrical decoupling approach that improved the detection of the drillings; it was due to the increment of the sensitivity of the signals. The results showed that the bone mass reduction is correlated with statistical indices obtained in specific frequency intervals of the electrical resistance. This work suggests the possibility of a future application addressed to a bone diagnosis in a non-invasive way.

Bio-structural monitoring of bone mineral alterations through electromechanical impedance measurements of a Piezo-device joined to a tooth

Bone presents different systemic functionalities as calcium phosphate reservoir, organ protection, among others. For that reason, the bone health conditions are essential to keep in equilibrium the metabolism of several body systems. Different technologies exist to diagnose bone conditions with invasive methods based on ionizing radiation. Therefore, there is a challenge to develop new ways to evaluate bone alterations in a noninvasive form. This study shows the assessment of a piezo-actuated device acting on a human tooth for the bio-monitoring of bone alterations. The bone diagnosis is performed by applying the electromechanical impedance technique (EMI), commonly used in structural health monitoring. For the experimental tests, five bone samples were prepared, and one was chosen as the monitoring. All samples were put in a decalcifying substance (TBD1 acid-base) at different times to emulate localized bone mineral alterations. Bone reductions were computed by using X-ray micro-computed tomography analyzing the morphometry. Electrical resistance measurements (piezo-device) were taken for the monitoring specimen meanwhile it was partially decalcified during 8520 seconds. In the frequency spectrum, several observation windows showed that the bone alterations gradually changed the electrical resistance signals which were quantified statistically. Results evidenced that the bone density changes are correlated with the electrical resistance measurements; these changes presented an exponential behavior as much as in the calculated index, and bone mineral reduction. The results demonstrated that bone alterations exhibit linear dependence with the computed statistical indexes. This result confirms that it is possible to observe the bone changes from the teeth as a future application.

Quantitative assessment of compress-type osseointegrated prosthetic implants in human bone using electromechanical impedance spectroscopic methods

Osseointegrated (OI) prostheses are a promising alternative to traditional socket prostheses. They can enhance the quality of life of amputees by avoiding fit and comfort issues commonly associated with sockets. The main structural element of the OI prosthesis is a biocompatible metallic implant that is surgically implanted into the bone of the residual limb. The implant is designed to provide a conducive surface for the host bone to osseointegrate with. The osseointegration process of the implant is difficult to clinically evaluate, leading to conservative postoperative rehabilitation approaches. Elastic stress waves generated in an OI prosthesis have been previously proposed to interrogate the implant-bone interface for quantitative assessment of the osseointegration process. This paper provides a detailed overview of the various elastic stress wave methods previously explored for in situ characterization of OI implants. Specifically, the paper explores the use of electromechanical impedance spectroscopy (EIS) to assess the OI process in compress-type OI prostheses. The EIS approach measures the electrical impedance spectrum of lead zirconate titanate elements bonded to the free end of the implant. The research utilizes both numerical simulation and experimental verification to establish that the electromechanical impedance spectrum is sensitive (between 400 and 460 kHz) to both the degree and location of osseointegration. A baseline-free OI index is proposed to quantify the degree of osseointegration at the implant-bone interface and to assess the stability of the OI implant for clinical decision making.

A review on the latest advancements in the non-invasive evaluation/monitoring of dental and trans-femoral implants

Dental implants and transcutaneous prostheses (trans-femoral implants) improve the quality of life of millions of people because they represent the optimal treatments to edentulism and amputation, respectively. The clinical procedures adopted by surgeons to insert these implants are well established. However, there is uncertainty on the outcomes of the post-operation recovery because of the uncertainty associated with the osseointegration process, which is defined as the direct, structural and functional contact between the living bone and the fixture. To guarantee the long-term survivability of dental or trans-femoral implants doctors sometimes implement non-invasive techniques to monitor and evaluate the progress of osseointegration. This may be done by measuring the stability of the fixture or by assessing the quality of the bone-fixture interface. In addition, care providers may need to quantify the structural integrity of the bone-implant system at various moments during the patients recovery. The accuracy of such non-invasive methods reduce recovery and rehabilitation time, and may increase the survival rate of the therapies with undisputable benefits for the patients. This paper provides a comprehensive review of clinically-approved and emerging non-invasive methods to evaluate/monitor the osseointegration of dental and orthopedic implants. A discussion about advantages and limitations of each method is provided based on the outcomes of the cases presented. The review on the emerging technologies covers the developments of the last decade, while the discussion about the clinically approved systems focuses mostly on the latest (2017-2018) findings. At last, the review also provides some suggestions for future researches and developments in the area of implant monitoring.

Ultrasound Bone Fracture Sensing and Data Communication: Experimental Results in a Pig Limb Sample

Approximately 6.3 million fractures occur each year in the United States alone. Accurately monitoring the progression of fracture healing is essential to be able to advise patients when it is safe to return to normal activity. The most common method used to confirm and monitor fracture healing is the acquisition of multiple radiographic images over the many months required for healing. This imaging method uses large expensive equipment and exposes patients to high levels of ionizing radiation. In the study described here, we tested another technology for monitoring fracture healing that could minimize the need for multiple radiographic images. We tested a piezoelectric transducer fixed to the surface of a bone that uses electromechanical impedance spectroscopy to measure simulated fractures and transmits the measurement data to an acoustic receiver located externally on the skin surface.

Numerical evaluation of nonbonded piezo sensor for biomedical diagnostics using electromechanical impedance technique

Directly bonded piezo sensor, conventionally employed in the electromechanical impedance (EMI) technique, although a proven candidate for structural health monitoring, is severely constrained in its application in the biomedical field due to its bonding requirement. In contrast, nonbonded piezo sensor (NBPS) provides a viable platform to assess the condition of human bones, tissues, and other biomedical subjects using the EMI technique without inflicting pain or irritation to the skin. The name NBPS was coined to emphasize that there was no direct bonding between the PZT patch and the live subject; instead, the PZT patch was bonded to a supporting medium, which maintains the mechanical interaction between the PZT patch and the subject. However, there are several aspects in the analysis of NBPS configuration that cannot be addressed completely through experimental study due to measurement constraints, cost, and time. For example, experimentally changing the density of bone continuously to study the osteoporosis effect is a tedious task warranting large number of specimens. This paper presents a detailed parametric study based on finite element method covering condition monitoring of human bones using the NBPS configuration. It is for the first time that 3D analysis for specimen identification and damage detection in bones using NBPS has been carried out. In addition to the validation of the numerical model against the previously established experimental studies involving bones, quantification of the extent of damage and its localization has been investigated. The density changes due to osteoporosis in bones are comprehensively investigated by the NBPS including the quantification aspect of osteoporosis/damage. Definite acquisition of bone signature and detection of physiological changes in bones are achieved even with the presence of skin, muscle, and fat layers on the bone.

Evaluation of a Piezo-Actuated Sensor for Monitoring Elastic Variations of Its Support with Impedance-Based Measurements

This study exposes the assessment of a piezo-actuated sensor for monitoring elastic variations (change in Young’s modulus) of a host structure in which it is attached. The host structure is monitored through a coupling interface connected to the piezo-actuated device. Two coupling interfaces were considered (an aluminum cone and a human tooth) for the experimental tests. Three different materials (aluminum, bronze and steel) were prepared to emulate the elastic changes in the support, keeping the geometry as a fixed parameter. The piezo device was characterized from velocity frequency response functions in pursuance to understand how vibration modes stimulate the electrical resistance through electrical resonance peaks of the sensor. An impedance-based analysis (1–20 kHz) was performed to correlate elastic variations with indexes based on root mean square deviation (RMSD) for two observation windows (9.3 to 9.7 kHz and 11.1 to 11.5 kHz). Results show that imposed elastic variations were detected and quantified with the electrical resistance measurements. Moreover, it was demonstrated that the sensitivity of the device was influenced by the type of coupling interface since the cone was more sensitive than the tooth in both observation windows. As a final consideration, results suggest that bio-structures (fruits and bone, among others) could be studied since these can modify naturally its elastic properties.