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Vautrin A, Thierrin R, Wili P, Voumard B, Klingler S, Chappuis V, Varga P, Zysset P. Homogenized finite element simulations can predict the primary stability of dental implants in human jawbone. J Mech Behav Biomed Mater 2024; 158:106688. [PMID: 39153410 DOI: 10.1016/j.jmbbm.2024.106688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 07/25/2024] [Accepted: 08/11/2024] [Indexed: 08/19/2024]
Abstract
Adequate primary stability is a pre-requisite for the osseointegration and long-term success of dental implants. Primary stability depends essentially on the bone mechanical integrity at the implantation site. Clinically, a qualitative evaluation can be made on medical images, but finite element (FE) simulations can assess the primary stability of a bone-implant construct quantitatively based on high-resolution CT images. However, FE models lack experimental validation on clinically relevant bone anatomy. The aim of this study is to validate such an FE model on human jawbones. Forty-seven bone biopsies were extracted from human cadaveric jawbones. Dental implants of two sizes (Ø3.5 mm and Ø4.0 mm) were inserted and the constructs were subjected to a quasi-static bending-compression loading protocol. Those mechanical tests were replicated with sample-specific non-linear homogenized FE models. Bone was modeled with an elastoplastic constitutive law that included damage. Density-based material properties were mapped based on μCT images of the bone samples. The experimental ultimate load was better predicted by FE (R2 = 0.83) than by peri-implant bone density (R2 = 0.54). Unlike bone density, the simulations were also able to capture the effect of implant diameter. The primary stability of a dental implant in human jawbones can be predicted quantitatively with FE simulations. This method may be used for improving the design and insertion protocols of dental implants.
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Affiliation(s)
- Antoine Vautrin
- AO Research Institute Davos, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Raphaël Thierrin
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Patrik Wili
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Benjamin Voumard
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Samuel Klingler
- School of Dental Medicine, Department of Oral Surgery and Stomatology, University of Bern, Bern, Switzerland
| | - Vivianne Chappuis
- School of Dental Medicine, Department of Oral Surgery and Stomatology, University of Bern, Bern, Switzerland
| | | | - Philippe Zysset
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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Qiu P, Cao R, Li Z, Fan Z. A comprehensive biomechanical evaluation of length and diameter of dental implants using finite element analyses: A systematic review. Heliyon 2024; 10:e26876. [PMID: 38434362 PMCID: PMC10907775 DOI: 10.1016/j.heliyon.2024.e26876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
Background With a wide range of dental implants currently used in clinical scenarios, evidence is limited on selecting the type of dental implant best suited to endure the biting force of missing teeth. Finite Element Analysis (FEA) is a reliable technology which has been applied in dental implantology to study the distribution of biomechanical stress within the bone and dental implants. Purpose This study aimed to perform a systematic review to evaluate the biomechanical properties of dental implants regarding their length and diameter using FEA. Material and methods A comprehensive search was performed in PubMed/MEDLINE, Scopus, Embase, and Web of Science for peer-reviewed studies published in English from October 2003 to October 2023. Data were organized based on the following topics: area, bone layers, type of bone, design of implant, implant material, diameter of implant, length of implant, stress units, type of loading, experimental validation, convergence analysis, boundary conditions, parts of Finite Element Model, stability factor, study variables, and main findings. The present study is registered in PROSPERO under number CRD42022382211. Results The query yielded 852 results, of which 40 studies met the inclusion criteria and were selected in this study. The diameter and length of the dental implants were found to significantly influence the stress distribution in cortical and cancellous bone, respectively. Implant diameter was identified as a key factor in minimizing peri-implant stress concentrations and avoiding crestal overloading. In terms of stress reduction, implant length becomes increasingly important as bone density decreases. Conclusions The diameter of dental implants is more important than implant length in reducing bone stress distribution and improving implant stability under both static and immediate loading conditions. Short implants with a larger diameter were found to generate lower stresses than longer implants with a smaller diameter. Other potential influential design factors including implant system, cantilever length, thread features, and abutment collar height should also be considered in future implant design as they may also have an impact on implant performance.
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Affiliation(s)
- Piaopiao Qiu
- Department of Implantology, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China
| | - Rongkai Cao
- Department of Implantology, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China
| | - Zhaoyang Li
- Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China
| | - Zhen Fan
- Department of Implantology, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China
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Chen S, Li R, Wu Z, Wang J, Xie G, Xie H, Pei X. An implant-supported overdenture for a mandibular defect after tumor resection guided by 3-dimensional finite element analysis: A clinical report. J Prosthet Dent 2024; 131:531-536. [PMID: 35764449 DOI: 10.1016/j.prosdent.2022.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 02/05/2023]
Abstract
This clinical report describes the rehabilitation of a mandibular defect after tumor resection with an implant-supported overdenture and the attachment selection as guided by 3-dimensional finite element analysis. Autologous bone grafting was declined by the patient who demanded the restoration of lateral appearance and mastication function. Three implants were placed based on the condition of the bone, and a satisfactory definitive prosthesis was provided that corresponded with the results of the finite element analysis.
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Affiliation(s)
- Song Chen
- Graduate student, State Key Laboratory of Oral Diseases, Department of Prosthodontics, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China; Resident, Stomaological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, PR China
| | - Ruyi Li
- Graduate student, State Key Laboratory of Oral Diseases, Department of Prosthodontics, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Zhanglin Wu
- Graduate student, State Key Laboratory of Hydraulics and Mountain River Engineering, College of Water Resource & Hydropower, Sichuan University, Chengdu, PR China
| | - Jian Wang
- Professor, State Key Laboratory of Oral Diseases, Department of Prosthodontics, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Guo Xie
- Associate Professor, State Key Laboratory of Hydraulics and Mountain River Engineering, College of Water Resource & Hydropower, Sichuan University, Chengdu, PR China
| | - Huixu Xie
- Associate Professor, State Key Laboratory of Oral Diseases, Department of Head and Neck Oncology Surgery, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Xibo Pei
- Associate Professor, State Key Laboratory of Oral Diseases, Department of Prosthodontics, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China.
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Abdoli Z, Mohammadi B, Karimi HR. On the fatigue life of dental implants: Numerical and experimental investigation on configuration effect. Med Eng Phys 2024; 123:104078. [PMID: 38365331 DOI: 10.1016/j.medengphy.2023.104078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 11/10/2023] [Accepted: 12/03/2023] [Indexed: 02/18/2024]
Abstract
Dental implants have seen widespread and successful use in recent years. Given their long-term application and the critical role of geometry in determining fracture and fatigue characteristics, fatigue assessments are of utmost importance for implant systems. In this study, nine dental implant system samples were subjected to testing in accordance with ISO 14801 standards. The tests included static evaluations to assess ultimate loads and fatigue tests conducted under loads of 270 N and 230 N at a frequency of 15 Hz, aimed at identifying fatigue failure locations and fatigue life. Fatigue life predictions and related calculations were carried out using Fe-safe software. The initial model featured a 22° angle for both the fixture and abutment. Subsequently, variations in abutment angles at 21° and 23° were considered while keeping the fixture angle at 22°. In the next phase, the fixture and abutment angles were set as identical, at 21° and 23°. The results unveiled that when the angles of the abutment and fixture matched, stress values decreased, and fatigue life increased. Conversely, models featuring abutment angles of 21° and 23°, with a 22° angle for the fixture, led to a 49.1 % increase in stress and a 36.9 % decrease in fatigue life compared to the primary model. Notably, in the case of the implant with a 23° angle for both abutment and fixture, the fatigue life reached its highest value at 10 million cycles. Conversely, the worst-case scenario was observed in the implant with a 21° abutment angle and a 23° fixture angle, with a fatigue life of 5.49 million cycles.
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Affiliation(s)
- Zahrae Abdoli
- School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Bijan Mohammadi
- School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran.
| | - Hamid Reza Karimi
- School of Civil Engineering, Iran University of Science and Technology, Tehran, Iran
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Manekar VS, Datarkar AN, Ghormode A, Daware S, Pandilwar P, Sapkal P. Comparison of Two Types of Patient Specific Implants (PSI) and Quad Zygoma Implant (QZI) for Rehabilitation of Post-COVID Maxillary Mucormycosis Defect (PCMMD): Finite Element Analysis. J Maxillofac Oral Surg 2023; 22:688-694. [PMID: 37534346 PMCID: PMC10390377 DOI: 10.1007/s12663-023-01950-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/29/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction The residual post-COVID maxillary mucormycosis defect (PCMMD) were extensive, due to unilateral or bilateral maxillectomies. The Goal of rehabilitation of PCMMD is to deliver a prosthetically driven reconstruction. FEA was to evaluate the biomechanical response of PSI struts (PSI 1), PSI Screw retained (PSI 2) and QZI to masticatory load on virtual simulation to improve accuracy and enhance the design. Aim To validate and compare the Biomechanical benefit of the PSI struts, PSI Screw retained, QZI in a case of rehabilitation of post-COVID maxillary mucormycosis defect (PCMMD) by FEA study. Methodology The result of stress to masticatory load on virtual simulation for (1) Maximum and minimum stress (Von Mises stress); (2) the Displacement (in three positions) and (3) the Deformation (Plastic strain) was compared on virtual simulation for PSI 1 and PSI 2 and QZI. Conclusion The FEA and comparative evaluation of PSI 1, PSI 2 and QZI showed a good resistance to displacement. The stress and strain values are low and acceptable. In comparison QZI shows more stress in the anterior region.
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Affiliation(s)
- Varsha Sunil Manekar
- Oral and Maxillofacial Surgery, Government Dental College & Hospital, Nagpur, Maharashtra 444003 India
| | - Abhay N. Datarkar
- Oral and Maxillofacial Surgery, Government Dental College & Hospital, Nagpur, Maharashtra 444003 India
| | - Ashlesha Ghormode
- Oral and Maxillofacial Surgery, Government Dental College & Hospital, Nagpur, Maharashtra 444003 India
| | - Surendra Daware
- Oral and Maxillofacial Surgery, Government Dental College & Hospital, Nagpur, Maharashtra 444003 India
| | - Prashant Pandilwar
- Oral and Maxillofacial Surgery, Government Dental College & Hospital, Nagpur, Maharashtra 444003 India
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Castrillo G, Carnicero A, Perera R. Submodelling approach to screw-to-bone interaction in additively manufactured subperiosteal implant structures. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3672. [PMID: 36541118 DOI: 10.1002/cnm.3672] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/01/2022] [Accepted: 12/17/2022] [Indexed: 06/17/2023]
Abstract
Thanks to new digital technologies, complex cases of severe maxillary atrophy may now be treated with additively manufactured subperiosteal implant structures (AMSISs). However, there are few studies addressing this topic and most of them focus on the mechanical behaviour of the AMSIS itself without considering its interaction with the maxilla bone. The aim of this study is to provide a methodology based on finite element analysis (FEA) to evaluate the effect of interaction between the maxilla bone and the screws fixing the AMSIS. The mechanical performance of an AMSIS was examined via a FEA based on submodelling. Significant differences were encountered in displacements and reaction forces when bone-screw interaction was considered. Stress in the cortical layer was found to be close to the maximum strength while the trabecular layer seems to have no effect on the results; stresses in the AMSIS are lower than the fatigue stress limit. Finally, the comparison of stresses between models with and without osseointegration shows how stresses drop once osseointegration is complete. The proposed submodelling approach considerably reduces the computational effort and enables both a detailed model of the interaction between the thread of the screws and the bone and an accurate evaluation of displacement and stress fields on the interface. The results have shown that stresses in the cortical bone are highly affected by the initial geometry of the thread inside the bone, which demonstrates the importance of modelling the effect of the thread.
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Affiliation(s)
- Gabriel Castrillo
- Department of Mechanical Engineering, Technical University of Madrid, Madrid, Spain
| | - Alberto Carnicero
- Institute for Research in Technology, ETSI-ICAI, Comillas Pontifical University of Madrid, Madrid, Spain
| | - Ricardo Perera
- Department of Mechanical Engineering, Technical University of Madrid, Madrid, Spain
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Al Qahtani WMS. Effect of Short Dental Implant Material on Bone Stress: An In Vitro Finite Element Analysis. J BIOMATER TISS ENG 2022. [DOI: 10.1166/jbt.2022.3107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aim: Using finite element analysis, determine the influence of short dental implant material on surrounding bone stresses. Material and Methods: One simplified model was created for a short implant of 4.8×4.8×4 mm placed vertically in simplified bone geometry
to support dummy crown fixed by 50micron resin cement layer. Three materials were tested as an implant material, Zirconia, Titanium, and 30% CFR-PEEK. Components of the 3D model were prepared on engineering CAD/CAM software accumulated under ANSYS modeling for finite element analysis. The
model was subjected to two loading cases as; 100 N compressive load and 50 N Oblique (45°), both at the central fossa. Results: Under the applied loads, all values of total deformations and Von Mises stresses that developed during the current investigation were within physiological
limits. Under both loading cases, changing the implant material from Zirconia to titanium to Polyether ether ketone (PEEK) decreased Von Mises stress values in the implant, cortical, and cancellous bone. The cement layer, abutment, and connecting screws all showed signs of growth. Conclusion:
Zirconia and Titanium can replace each other as short implant material. In addition, 30% CFR-PEEK can also be used as short implant material with minor acceptable stress differences.
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Affiliation(s)
- Waleed M. S. Al Qahtani
- Department of Prosthetic Dentistry, King Khalid University College of Dentistry Abha, 62529, Saudi Arabia
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Carnicero A, Peláez A, Restoy-Lozano A, Jacquott I, Perera R. Improvement of an additively manufactured subperiosteal implant structure design by finite elements based topological optimization. Sci Rep 2021; 11:15390. [PMID: 34321582 PMCID: PMC8319128 DOI: 10.1038/s41598-021-94980-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
To design a new subperiosteal implant structure for patients suffering from severe Maxillary Atrophy that lowers manufacturing cost, shortens surgical time and reduces patient trauma with regard to current implant structures. A 2-phase finite-element-based topology optimization process was employed with implants made from biocompatible materials via additive manufacturing. Five bite loading cases related to standard chewing, critical chewing force, and worst conditions of fastening were considered along with each specific result to establish the areas that needed to be subjected to fatigue strength optimization. The 2-phase topological optimization tested in this study performed better than the reference implant geometry in terms of both the structural integrity of the implant under tensile-compressive and fatigue strength conditions and the material constraints related to implant manufacturing conditions. It returns a nearly 28% lower volumetric geometry and avoids the need to use two upper fastening screws that are required with complex surgical procedures. The combination of topological optimization methods with the flexibility afforded by additively manufactured biocompatible materials, provides promising results in terms of cost reduction, minimizing the surgical trauma and implant installation impact on edentulous patients.
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Affiliation(s)
- Alberto Carnicero
- Institute for Research in Technology, ETSI-ICAI, Comillas Pontifical University of Madrid, C/ Alberto Aguilera 25, 28015, Madrid, Spain.
| | - Andrés Peláez
- Department of Mechanical Engineering, Technical University of Madrid, Madrid, Spain
| | - Andrés Restoy-Lozano
- Department of Oral and Maxillofacial Surgery, Principe de Asturias University Hospital, University of Alcala, Madrid, Spain
| | - Isaías Jacquott
- Department of Oral and Maxillofacial Surgery, Principe de Asturias University Hospital, University of Alcala, Madrid, Spain
| | - Ricardo Perera
- Department of Mechanical Engineering, Technical University of Madrid, Madrid, Spain
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Comparative analysis of stress distribution in one-piece and two-piece implants with narrow and extra-narrow diameters: A finite element study. PLoS One 2021; 16:e0245800. [PMID: 33539392 PMCID: PMC7861395 DOI: 10.1371/journal.pone.0245800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/07/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aim of this in vitro study was to evaluate the stress distribution on three implant models with narrow and extra-narrow diameters using the finite element method (FEA). MATERIALS AND METHODS Dental implants of extra-narrow diameter of 2.5 mm for a one-piece implant (group G1), a narrow diameter of 3.0 mm for a one-piece implant (group G2) and a narrow diameter of 3.5 mm for a two-piece implant with a Morse taper connection (group G3). A three-dimensional model was designed with cortical and cancellous bone, a crown and an implant/abutment set of each group. Axial and angled (30°) loads of 150 N was applied. The equivalent von Mises stress was used for the implants and peri-implant bone plus the Mohr-Coulomb analysis to confirm the data of the peri-implant bone. RESULTS In the axial load, the maximum stress value of the cortical bone for the group G1 was 22.35% higher than that the group G2 and 321.23% than the group G3. Whereas in angled load, the groups G1 and G2 showing a similar value (# 3.5%) and a highest difference for the group G3 (391.8%). In the implant structure, the group G1 showed a value of 2188MPa, 93.6% higher than the limit. CONCLUSIONS The results of this study show that the extra-narrow one-piece implant should be used with great caution, especially in areas of non-axial loads, whereas the one- and two-piece narrow-diameter implants show adequate behavior in both directions of the applied load.
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Witek L, Parra M, Tovar N, Alifarag A, Lopez CD, Torroni A, Bonfante EA, Coelho PG. Effect of Surgical Instrumentation Variables on the Osseointegration of Narrow- and Wide-Diameter Short Implants. J Oral Maxillofac Surg 2020; 79:346-355. [PMID: 33137302 DOI: 10.1016/j.joms.2020.09.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 09/23/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of the present study was to systematically analyze how a multifactorial surgical instrumentation approach affects osseointegration on both narrow-diameter and wide-diameter short implants. MATERIALS AND METHODS Twelve skeletally mature female sheep were used in the study along with 144 plateau-root-form healing chamber titanium (Ti-6Al-4V) implants (Bicon LLC, Boston, MA), evenly distributed between narrow (3.5 mm) and wide (6.0 mm) diameters. The presence or the absence of irrigation, different drilling speeds, and 2 time points quantifying bone-implant contact (BIC) and bone area fraction occupancy (BAFO) to evaluate the osteogenic parameters around the implants. RESULTS There were no signs of inflammation, infection, or failure of the implants observed at either healing period. The narrow 3.5-mm implant, at 6 weeks, yielded significant differences in terms of BIC at a drilling speed of 50 rotations per minute (RPM), with higher values of the samples using irrigation (30.6 ± 6.1%) compared with those without (19.7 ± 6.1%). No statistical differences were detected for 500 and 1,000 RPM with or without irrigation. The wide 6-mm diameter implant showed differences with respect to drilling speed, 500 and 1,000 RPM, with higher values associated with samples subjected to irrigation. BAFO results, for both diameters, only detected statistical differences between the 2 times (3 vs 6 weeks); no statistical differences were detected when evaluating as a function of time, drilling speed, and irrigation. CONCLUSIONS Surgical instrumentation variables (ie, drilling speed [RPM] and irrigation) yielded to be more of an effect for BIC at longer healing time (6 weeks) for the wider implants. Furthermore, deploying narrow or wide plateau-root-form implants, where conditions allow, has shown to be a safe alternative, considering the high BIC and BAFO values observed, independent of irrigation.
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Affiliation(s)
- Lukasz Witek
- Assistant Professor, Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY and Assistant Professor, Department of Biomedical Engineering, Tandon School of Engineering, New York University, Brooklyn, NY.
| | - Marcelo Parra
- Graduate Student, PhD Program in Morphological Sciences, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile; and Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
| | - Nick Tovar
- Research Fellow, Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY; and OMFS Resident, Department of Oral and Maxillofacial Surgery, New York University, Langone Medical Center and Bellevue Hospital Center, New York, NY
| | - Adham Alifarag
- Research Fellow, Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, USA; and Surgical Resident Fellow, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Christopher D Lopez
- Plastic Surgery Resident, Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Andrea Torroni
- Associate Professor, Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, NY
| | - Estevam A Bonfante
- Assistant Professor, Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru, SP, Brazil
| | - Paulo G Coelho
- Professor, Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, USA; Professor, Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, NY, USA; and Professor, Department of Mechanical Engineering, Tandon School of Engineering, New York University, Brooklyn, NY
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