1
|
Asano A, Xavier SP, Silva ER, Morinaga K, Botticelli D, Nakajima Y, Baba S. Critical-sized marginal defects around implants treated with xenografts in rabbits. Oral Maxillofac Surg 2024; 28:827-838. [PMID: 38285089 DOI: 10.1007/s10006-024-01216-3] [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: 11/19/2023] [Accepted: 01/19/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Healing of critical-size defects is a well-known problem that has been challenged in several studies. The aim of the experiment was to evaluate bone formation and osseointegration of implants installed in critical defects of the mandibular body simultaneously grafted with Bio-Oss® or Cerabone®. MATERIAL AND METHODS Defects, 10 mm wide and 3 mm deep, were prepared at both lateral aspects of the mandible in 12 rabbits. One implant was installed in the center of the defect, and bovine xenografts produced either at low (Bio-Oss®; Low-T) or high (Cerabone®; High-T) temperatures were used to fill the defects. A collagen membrane was placed to cover the sites. Healing was evaluated 10 weeks after surgery. RESULTS In both groups, most sites showed optimal healing with closure of the coronal entrance of the defects. However, residual defects occupied by soft tissues and biomaterial particles were observed, even though generally limited to some regions of the defect. Osseointegration of the implant surface in the region of the defect was poor in both groups. CONCLUSIONS Circumferential marginal critical-size defects around implants filled with bovine xenografts presented regions with a complete healing in both groups. However, the healing was not complete at all regions in most defects; therefore, a complete optimal healing of critical-size marginal defects cannot be predicted.
Collapse
Affiliation(s)
- Akihisa Asano
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka, 573-1121, Japan
| | - Samuel Porfirio Xavier
- Department of Oral and Maxillofacial Surgery and Periodontology, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Av. Do Café - Subsetor Oeste - 11 (N-11), Ribeirão Preto, SP, 14040-904, Brazil
| | - Erick Ricardo Silva
- Department of Oral and Maxillofacial Surgery and Periodontology, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Av. Do Café - Subsetor Oeste - 11 (N-11), Ribeirão Preto, SP, 14040-904, Brazil
| | - Kenzo Morinaga
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka, 573-1121, Japan
| | - Daniele Botticelli
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka, 573-1121, Japan.
- ARDEC Academy, 47923, Rimini, Italy.
| | - Yasushi Nakajima
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka, 573-1121, Japan
| | - Shunsuke Baba
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka, 573-1121, Japan
| |
Collapse
|
2
|
Kaenploy J, Li R, Makowka S, Sadid-Zadeh R. Fracture resistance of cement-retained lithium disilicate implant-supported crowns: Effect of material used for two-piece abutments. J Prosthodont 2024. [PMID: 38807201 DOI: 10.1111/jopr.13871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 03/14/2024] [Accepted: 05/13/2024] [Indexed: 05/30/2024] Open
Abstract
PURPOSE This study compared the fracture strength of single lithium disilicate implant-supported crowns fabricated on two-piece abutments with various materials: ceramic-reinforced PEEK, zirconia, and lithium disilicate. MATERIALS AND METHODS Thirty-six implants were embedded in acrylic cylinders. A two-piece abutment and a crown were designed following a pre-operation scan for a maxillary left central incisor. The designed crown was used to fabricate 36 lithium disilicate crowns. The designed abutment was used to manufacture 36 abutments from 3 materials, 12 each: (A) zirconia; (B) lithium disilicate; and (C) ceramic-reinforced PEEK. Abutments were surface treated and bonded on the titanium base abutments with resin cement. Then, lithium disilicate crowns were bonded on the assigned abutments. Specimens were then subjected to dynamic loading for 1,200,000 cycles. The fracture strength (N) of the assembly was assessed using a universal testing machine. One-way ANOVA followed by multiple comparison tests was used to evaluate the effect of abutment material on the fracture strength of single implant-supported restorations at a significance of .05. RESULTS The average fracture strength for the groups with zirconia, PEEK, and lithium disilicate two-piece abutments were 1362N ± 218N, 1235N ± 115N, and 1472N ± 171N, respectively. There was a significant (p < 0.05) difference in fracture strength among the groups. The lithium disilicate group had significantly higher fracture strength (p = 0.0058) than the group with PEEK; however, there was no significant (p > 0.05) difference between the other groups. CONCLUSIONS Two-piece abutments restored with lithium disilicate crowns investigated in the study have the potential to withstand the average physiological occlusal forces in the anterior region.
Collapse
Affiliation(s)
- Jekita Kaenploy
- Department of Restorative Sciences, College of Dentistry, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Rui Li
- Department of Restorative Dentistry, School of Dental Medicine, University at Buffalo, Buffalo, New York, USA
| | - Steven Makowka
- School of Dental Medicine, University at Buffalo, Buffalo, New York, USA
| | - Ramtin Sadid-Zadeh
- Department of Restorative Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
3
|
Verbist M, Vandevelde AL, Geusens J, Sun Y, Shaheen E, Willaert R. Reconstruction of Craniomaxillofacial Bone Defects with 3D-Printed Bioceramic Implants: Scoping Review and Clinical Case Series. J Clin Med 2024; 13:2805. [PMID: 38792347 PMCID: PMC11122134 DOI: 10.3390/jcm13102805] [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: 03/19/2024] [Revised: 04/27/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Reconstruction of craniomaxillofacial bone defects using 3D-printed hydroxyapatite (HA) bioceramic patient-specific implants (PSIs) is a new technique with great potential. This study aimed to investigate the advantages, disadvantages, and clinical outcomes of these implants in craniomaxillofacial surgeries. The PubMed and Embase databases were searched for patients with craniomaxillofacial bone defects treated with bioceramic PSIs. Clinical outcomes such as biocompatibility, biomechanical properties, and aesthetics were evaluated and compared to those of commonly used titanium or poly-ether-ether-ketone (PEEK) implants and autologous bone grafts. Two clinical cases are presented to illustrate the surgical procedure and clinical outcomes of HA bioceramic PSIs. Literature review showed better a biocompatibility of HA PSIs than titanium and PEEK. The initial biomechanical properties were inferior to those of autologous bone grafts, PEEK, and titanium but improved when integrated. Satisfactory aesthetic results were found in our two clinical cases with good stability and absence of bone resorption or infection. Radiological signs of osteogenesis were observed in the two clinical cases six months postoperatively. HA bioceramic PSIs have excellent biocompatible properties and imitate natural bone biomechanically and radiologically. They are a well-suited alternative for conventional biomaterials in the reconstruction of load-sharing bone defects in the craniomaxillofacial region.
Collapse
Affiliation(s)
- Maarten Verbist
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- OMFS IMPATH Research Group: Department of Oral and Maxillofacial Surgery, Imaging and Pathology, Leuven University Hospitals, 3000 Leuven, Belgium
| | - Anne-Laure Vandevelde
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- OMFS IMPATH Research Group: Department of Oral and Maxillofacial Surgery, Imaging and Pathology, Leuven University Hospitals, 3000 Leuven, Belgium
| | - Joris Geusens
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- OMFS IMPATH Research Group: Department of Oral and Maxillofacial Surgery, Imaging and Pathology, Leuven University Hospitals, 3000 Leuven, Belgium
| | - Yi Sun
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- OMFS IMPATH Research Group: Department of Oral and Maxillofacial Surgery, Imaging and Pathology, Leuven University Hospitals, 3000 Leuven, Belgium
| | - Eman Shaheen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- OMFS IMPATH Research Group: Department of Oral and Maxillofacial Surgery, Imaging and Pathology, Leuven University Hospitals, 3000 Leuven, Belgium
| | - Robin Willaert
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- OMFS IMPATH Research Group: Department of Oral and Maxillofacial Surgery, Imaging and Pathology, Leuven University Hospitals, 3000 Leuven, Belgium
| |
Collapse
|
4
|
Llorente JJ, Junquera L, Gallego L, Pérez-Basterrechea M, Suárez LI, Llorente S. Design, In Vitro Evaluation and In Vivo Biocompatibility of Additive Manufacturing Three-Dimensional Printing of β beta-Tricalcium Phosphate Scaffolds for Bone Regeneration. Biomedicines 2024; 12:1049. [PMID: 38791011 PMCID: PMC11118782 DOI: 10.3390/biomedicines12051049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
The reconstruction of bone deficiencies remains a challenge due to the limitations of autologous bone grafting. The objective of this study is to evaluate the bone regeneration efficacy of additive manufacturing of tricalcium phosphate (TCP) implants using lithography-based ceramic manufacturing (LCM). LCM uses LithaBone TCP 300 slurry for 3D printing, producing cylindrical scaffolds. Four models of internal scaffold geometry were developed and compared. The in vitro studies included cell culture, differentiation, seeding, morphological studies and detection of early osteogenesis. The in vivo studies involved 42 Wistar rats divided into four groups (control, membrane, scaffold (TCP) and membrane with TCP). In each animal, unilateral right mandibular defects with a total thickness of 5 mm were surgically performed. The animals were sacrificed 3 and 6 months after surgery. Bone neoformation was evaluated by conventional histology, radiology, and micro-CT. Model A (spheres with intersecting and aligned arrays) showed higher penetration and interconnection. Histological and radiological analysis by micro-CT revealed increased bone formation in the grafted groups, especially when combined with a membrane. Our innovative 3D printing technology, combined with precise scaffold design and efficient cleaning, shows potential for bone regeneration. However, further refinement of the technique and long-term clinical studies are crucial to establish the safety and efficacy of these advanced 3D printed scaffolds in human patients.
Collapse
Affiliation(s)
| | - Luis Junquera
- Department of Surgery, University of Oviedo, 33006 Oviedo, Spain;
- Department of Oral and Maxillofacial Surgery, Central University Hospital, 33011 Oviedo, Spain
| | - Lorena Gallego
- Department of Surgery, University of Oviedo, 33006 Oviedo, Spain;
- Department of Oral and Maxillofacial Surgery, Cabueñes University Hospital, 33394 Gijón, Spain
| | | | | | | |
Collapse
|
5
|
Morimoto A, Porfirio Xavier S, Ricardo Silva E, Morinaga K, Botticelli D, Nakajima Y, Baba S. Critical-sized marginal defects around implants in the rabbit mandible. Oral Maxillofac Surg 2024:10.1007/s10006-024-01233-2. [PMID: 38605114 DOI: 10.1007/s10006-024-01233-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/03/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND The mandible of the rabbit is considered a reliable model to be used to study bone regeneration in defects. The aim of the present study was to evaluate the formation of new bone around implants installed in defects of either 5 or 10 mm in the mandible of rabbits. MATERIALS AND METHODS In 12 rabbits, 3 mm deep circumferential defect, either 5 or 10 mm in diameter, were prepared bilaterally and an implant was placed in the center. A collagen membrane was placed to close the entrance. After 10 weeks, biopsies were taken, histological slides were prepared, and different regions of the defects were analyzed. RESULTS Similar amounts of new bone were found in both defects. However, most of the 5 mm defects were filled with new bone. New bone was observed closing the entrance of the defect and laid onto the implant surface. Only in a few cases the healing was incomplete. Despite a similar percentage of new bone found within the 10 mm defects, the healing was incomplete in most of the cases, presenting a low rate of bone formation onto the implant surface within the defect. Only one case presented the closure of the entrance. CONCLUSIONS The dimensions of the defect strongly influenced the healing so that a circumferential marginal defect of 10 mm around an implant in the mandible body should be considered a critical-sized defect. The presence of the implant and of residues of teeth might have strongly influenced the healing.
Collapse
Affiliation(s)
- Akihiro Morimoto
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka, 573-1121, Japan
| | - Samuel Porfirio Xavier
- Department of Oral and Maxillofacial Surgery and Periodontology, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Av. do Café - Subsetor Oeste - 11 (N-11), Ribeirão Preto, SP, 14040-904, Brazil
| | - Erick Ricardo Silva
- Department of Oral and Maxillofacial Surgery and Periodontology, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Av. do Café - Subsetor Oeste - 11 (N-11), Ribeirão Preto, SP, 14040-904, Brazil
| | - Kenzo Morinaga
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka, 573-1121, Japan
| | - Daniele Botticelli
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka, 573-1121, Japan.
- ARDEC Academy, Rimini, 47923, Italy.
| | - Yasushi Nakajima
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka, 573-1121, Japan
| | - Shunsuke Baba
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka, 573-1121, Japan
| |
Collapse
|
6
|
Kujur MS, Venkatraman Krishnan A, Manakari V, Parande G, Dieringa H, Mallick A, Gupta M. Scope of magnesium ceria nanocomposites for mandibular reconstruction: Degradation and biomechanical evaluation using a 3-dimensional finite element analysis approach. J Mech Behav Biomed Mater 2024; 152:106424. [PMID: 38290392 DOI: 10.1016/j.jmbbm.2024.106424] [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: 11/13/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/01/2024]
Abstract
Magnesium/Ceria nanocomposites (Mg/xCeO2 NCs (x = 0.5 %, 1 % and 1.5 %)) prepared by using powder metallurgy and microwave sintering method are assessed for their corrosion rate for a period of 28 days. As per the immersion tests results, the addition of ceria nanoparticles to pure Mg, brought about a noteworthy improvement to corrosion resistance. A corrosion rate of approximately 0.84 mm/year for Mg/0.5CeO2 and 0.99 mm/year for Mg/1.0CeO2 nanocomposites were observed. Another aspect of the study involves employing the simulation method i.e. finite element analysis (FEA) to compare the stress distribution in magnesium-ceria nanocomposite based screws and circular bars especially for Mg/0.5CeO2 and Mg/1.0CeO2. Further, the simulation also gives a perception of the impact of masticatory forces, the biting force and shear stress exerted on the Mg/0.5CeO2 and Mg/1.0CeO2 based screws. The simulations results show that the screws showed an acceptable level of stresses for a biting force up to 300 N. The circular bar as well kept its stresses at acceptable levels for the same load of 300N. The shear stress results indicated that a biting force up to 602 N can be safely absorbed by Mg/0.5CeO2 screw. The comprehensive approach allows for a better understanding of the corrosion behavior, stress distribution, and mechanical properties of the Mg/CeO2 nanocomposites, enabling the development of effective temporary implants for craniofacial trauma fixation that can withstand normal physiological forces during mastication. The study reported in this paper aims to target Mg/xCeO2 NCs for temporary implants for craniofacial trauma fixation.
Collapse
Affiliation(s)
- Milli Suchita Kujur
- Department of Mechanical Engineering, Indian Institute of Technology (Indian School of Mines), Dhanbad, India; Department of Mechanical Engineering, National University of Singapore, Singapore; Institute of Material and Process Design, Helmholtz-Zentrum Hereon, Max-Planck-Str. 1, 21502 Geesthacht, Germany.
| | | | - Vyasaraj Manakari
- Department of Mechanical Engineering, National University of Singapore, Singapore; Magloy Tech Pte. Ltd., Singapore.
| | - Gururaj Parande
- Department of Mechanical Engineering, National University of Singapore, Singapore; Magloy Tech Pte. Ltd., Singapore.
| | - Hajo Dieringa
- Institute of Material and Process Design, Helmholtz-Zentrum Hereon, Max-Planck-Str. 1, 21502 Geesthacht, Germany.
| | - Ashis Mallick
- Department of Mechanical Engineering, Indian Institute of Technology (Indian School of Mines), Dhanbad, India.
| | - Manoj Gupta
- Department of Mechanical Engineering, National University of Singapore, Singapore.
| |
Collapse
|
7
|
Rungsiyakull P, Rungsiyakull C, Monstaporn M, Sae-Lee D, Elsaka S. Effects of bone type and occlusal loading pattern on bone remodeling in implant-supported single crown: A finite element study. J Prosthodont 2024; 33:288-296. [PMID: 36918484 DOI: 10.1111/jopr.13679] [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: 04/04/2022] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
PURPOSE To assess the influence of bone types and loading patterns on the remodeling process over 12 months according to the variations in stress, strain, strain energy density (SED), and density allocation in the bone of implant-supported single crown. MATERIALS AND METHODS A three-dimensional finite element of a single crown implant was modeled in five different bone types (D1-D4, and grafted bone). A 200 N load was applied on an implant crown with three occlusal loading patterns (nonfunctional contact, functional contact at center, and at 2-mm offset loading). During the first 12 months after implant placement, the SED was employed as a mechanical stimulus to simulate cortical and cancellous bone remodeling. RESULTS Functional contact at 2-mm offset loading led to a higher bone remodeling rate and stress compared to functional contact at center and nonfunctional contact. Under 2-mm offset loading, the greatest remodeling rate after 12 months was achieved with D3 and D4, D2, grafted, and D1 cortical bone with an average peri-implant density of 1.95, 1.77, 1.56, and 1.50 g/cm3 , respectively. Meanwhile, the highest von Mises stresses were found in D4 (22.2 MPa) and D3 (21.9 MPa) bones. CONCLUSIONS A greater stress concentration and remodeling rate were found when an off-axial load was applied on an implant placed in low bone density. Although the fastest remodeling processes resulting in increased bone density and strength were found in D3 and D4 bone types with greater off-axial loading that may provide greater bone engagement, it could increase stress concentrations that are susceptible to inducing implant failure.
Collapse
Affiliation(s)
- Pimduen Rungsiyakull
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Chaiy Rungsiyakull
- Department of Mechanical Engineering, Faculty of Engineering, Chiang Mai University, Chiang Mai, Thailand
| | - Montip Monstaporn
- Sena Hospital, Dental Department, Phra Nakhon Si Ayutthaya, Thailand
| | - Daraporn Sae-Lee
- Department of Prosthodontics, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Shaymaa Elsaka
- Department of Dental Biomaterials, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
- Department of Restorative Science, Vision Colleges, Jeddah, Saudi Arabia
| |
Collapse
|
8
|
Huang X, Lou Y, Duan Y, Liu H, Tian J, Shen Y, Wei X. Biomaterial scaffolds in maxillofacial bone tissue engineering: A review of recent advances. Bioact Mater 2024; 33:129-156. [PMID: 38024227 PMCID: PMC10665588 DOI: 10.1016/j.bioactmat.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Maxillofacial bone defects caused by congenital malformations, trauma, tumors, and inflammation can severely affect functions and aesthetics of maxillofacial region. Despite certain successful clinical applications of biomaterial scaffolds, ideal bone regeneration remains a challenge in maxillofacial region due to its irregular shape, complex structure, and unique biological functions. Scaffolds that address multiple needs of maxillofacial bone regeneration are under development to optimize bone regeneration capacity, costs, operational convenience. etc. In this review, we first highlight the special considerations of bone regeneration in maxillofacial region and provide an overview of the biomaterial scaffolds for maxillofacial bone regeneration under clinical examination and their efficacy, which provide basis and directions for future scaffold design. Latest advances of these scaffolds are then discussed, as well as future perspectives and challenges. Deepening our understanding of these scaffolds will help foster better innovations to improve the outcome of maxillofacial bone tissue engineering.
Collapse
Affiliation(s)
- Xiangya Huang
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Yaxin Lou
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Yihong Duan
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - He Liu
- Division of Endodontics, Department of Oral Biological and Medical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jun Tian
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Ya Shen
- Division of Endodontics, Department of Oral Biological and Medical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Xi Wei
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| |
Collapse
|
9
|
Wang L, Meloro C, Fagan MJ, Kissane RWP, Bates KT, Askew GN, Watson PJ. Regional variation of the cortical and trabecular bone material properties in the rabbit skull. PLoS One 2024; 19:e0298621. [PMID: 38412158 PMCID: PMC10898762 DOI: 10.1371/journal.pone.0298621] [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: 09/15/2023] [Accepted: 01/27/2024] [Indexed: 02/29/2024] Open
Abstract
The material properties of some bones are known to vary with anatomical location, orientation and position within the bone (e.g., cortical and trabecular bone). Details of the heterogeneity and anisotropy of bone is an important consideration for biomechanical studies that apply techniques such as finite element analysis, as the outcomes will be influenced by the choice of material properties used. Datasets detailing the regional variation of material properties in the bones of the skull are sparse, leaving many finite element analyses of skulls no choice but to employ homogeneous, isotropic material properties, often using data from a different species to the one under investigation. Due to the growing significance of investigating the cranial biomechanics of the rabbit in basic science and clinical research, this study used nanoindentation to measure the elastic modulus of cortical and trabecular bone throughout the skull. The elastic moduli of cortical bone measured in the mediolateral and ventrodorsal direction were found to decrease posteriorly through the skull, while it was evenly distributed when measured in the anteroposterior direction. Furthermore, statistical tests showed that the variation of elastic moduli between separate regions (anterior, middle and posterior) of the skull were significantly different in cortical bone, but was not in trabecular bone. Elastic moduli measured in different orthotropic planes were also significantly different, with the moduli measured in the mediolateral direction consistently lower than that measured in either the anteroposterior or ventrodorsal direction. These findings demonstrate the significance of regional and directional variation in cortical bone elastic modulus, and therefore material properties in finite element models of the skull, particularly those of the rabbit, should consider the heterogeneous and orthotropic properties of skull bone when possible.
Collapse
Affiliation(s)
- Linje Wang
- Structural Biomechanics, Department of Civil and Environmental Engineering, Imperial College London, London, United Kingdom
- School of Engineering, University of Hull, Hull, United Kingdom
| | - Carlo Meloro
- Research Centre in Evolutionary Anthropology and Palaeoecology, School of Biological and Environmental Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Michael J Fagan
- School of Engineering, University of Hull, Hull, United Kingdom
| | - Roger W P Kissane
- Department of Musculoskeletal & Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Karl T Bates
- Department of Musculoskeletal & Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Graham N Askew
- School of Biomedical Sciences, University of Leeds, Leeds, United Kingdom
| | - Peter J Watson
- School of Engineering, University of Hull, Hull, United Kingdom
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
| |
Collapse
|
10
|
Papaioannou A, Vasilaki E, Loukelis K, Papadogianni D, Chatzinikolaidou M, Vamvakaki M. Bioactive and biomimetic 3D scaffolds for bone tissue engineering using graphitic carbon nitride as a sustainable visible light photoinitiator. BIOMATERIALS ADVANCES 2024; 157:213737. [PMID: 38211506 DOI: 10.1016/j.bioadv.2023.213737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/03/2023] [Accepted: 12/16/2023] [Indexed: 01/13/2024]
Abstract
Graphitic carbon nitride (g-C3N4) is explored as a novel sustainable visible light photoinitiator for the preparation of biomimetic 3D hydrogel scaffolds comprising gelatin methacrylamide (GelMA) and dopamine methacrylamide for use in tissue engineering. The initiator efficiency was assessed by comparing the swelling behavior and the stability of photopolymerized hydrogels prepared with GelMA of different degrees of functionalization and different comonomer compositions. Bioactive composite hydrogels with a 50 wt% nanohydroxyapatite (nHAp) content, to closely mimic the actual bone composition, were successfully obtained by the introduction of nHAp in the prepolymer solutions followed by photopolymerization. The composite hydrogels demonstrated enhanced mechanical properties and excellent stability in PBS verifying the preparation of robust 3D scaffolds for use in cancellous or pre-calcified bone tissue engineering applications. The in vitro cell response of the composite scaffolds exhibited high cell viability and enhanced differentiation of pre-osteoblasts to mature osteoblasts, demonstrating their osteogenic potential. This work establishes, for the first time, the excellent properties of g-C3N4 as a sustainable, visible light initiator, fully satisfying the principles of green chemistry, for the preparation of robust and biologically relevant hydrogels, and proposes a new approach to overcome the main challenges of conventional photoinitiators in cell scaffold fabrication, such as photobleaching, high cost and non-scalable synthesis employing toxic organic precursors and solvents.
Collapse
Affiliation(s)
- Anna Papaioannou
- School of Medicine, University of Crete, 700 13 Heraklion, Greece
| | - Evangelia Vasilaki
- Department of Materials Science and Technology, University of Crete, 700 13 Heraklion, Greece; Institute of Electronic Structure and Laser, Foundation for Research and Technology - Hellas, 700 13 Heraklion, Crete, Greece.
| | - Konstantinos Loukelis
- Department of Materials Science and Technology, University of Crete, 700 13 Heraklion, Greece
| | - Danai Papadogianni
- Department of Materials Science and Technology, University of Crete, 700 13 Heraklion, Greece
| | - Maria Chatzinikolaidou
- Department of Materials Science and Technology, University of Crete, 700 13 Heraklion, Greece; Institute of Electronic Structure and Laser, Foundation for Research and Technology - Hellas, 700 13 Heraklion, Crete, Greece
| | - Maria Vamvakaki
- Department of Materials Science and Technology, University of Crete, 700 13 Heraklion, Greece; Institute of Electronic Structure and Laser, Foundation for Research and Technology - Hellas, 700 13 Heraklion, Crete, Greece.
| |
Collapse
|
11
|
Ceddia M, Lamberti L, Trentadue B. FEA Comparison of the Mechanical Behavior of Three Dental Crown Materials: Enamel, Ceramic, and Zirconia. MATERIALS (BASEL, SWITZERLAND) 2024; 17:673. [PMID: 38591528 PMCID: PMC10856216 DOI: 10.3390/ma17030673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/24/2024] [Accepted: 01/27/2024] [Indexed: 04/10/2024]
Abstract
The restoration of endodontically treated teeth is one of the main challenges of restorative dentistry. The structure of the tooth is a complex assembly in which the materials that make it up, enamel and dentin, have very different mechanical behaviors. Therefore, finding alternative replacement materials for dental crowns in the area of restorative care isa highly significant challenge, since materials such as ceramic and zirconia have very different stress load resistance values. The aim of this study is to assess which material, either ceramic or zirconia, optimizes the behavior of a restored tooth under various typical clinical conditions and the masticatory load. A finite element analysis (FEA) framework is developed for this purpose. The 3D model of the restored tooth is input into the FEA software (Ansys Workbench R23)and meshed into tetrahedral elements. The presence of masticatory forces is considered: in particular, vertical, 45° inclined, and horizontal resultant forces of 280 N are applied on five contact points of the occlusal surface. The numerical results show that the maximum stress developed in the restored tooth including a ceramic crown and subject to axial load is about 39.381 MPa, which is rather close to the 62.32 MPa stress computed for the natural tooth; stresses of about 18 MPa are localized at the roots of both crown materials. In the case of the zirconia crown, the stresses are much higher than those in the ceramic crown, except for the 45° load direction, while, for the horizontal loads, the stress peak in the zirconia crown is almost three times as large as its counterpart in the ceramic crown (i.e., 163.24 MPa vs. 56.114 MPa, respectively). Therefore, the zirconia crown exhibits higher stresses than enamel and ceramic that could increase in the case of parafunctions, such as bruxism. The clinician's choice between the two materials should be evaluated based on the patient's medical condition.
Collapse
Affiliation(s)
| | - Luciano Lamberti
- Dipartimento di Meccanica, Matematica e Management, Politecnico di Bari, 70125 Bari, Italy; (M.C.); (B.T.)
| | | |
Collapse
|
12
|
Romasco T, Pignatelli P, Tumedei M, Hossein HHS, Cipollina A, Piattelli A, Inchingolo F, Di Pietro N. The influence of truncated-conical implant length on primary stability in maxillary and mandibular regions: an in vitro study using polyurethane blocks. Clin Oral Investig 2023; 28:28. [PMID: 38147179 DOI: 10.1007/s00784-023-05444-x] [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: 09/07/2023] [Accepted: 12/17/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES This in vitro study is aimed at assessing whether implant primary stability is influenced by implant length in artificial bone with varying densities. MATERIALS AND METHODS A total of 120 truncated-conical implants (60 long-length: 3p L, 3.8 × 14 mm; 60 short-length: 3p S, 3.8 × 8 mm) were inserted into 20, 30, and 40 pounds per cubic foot (PCF) density polyurethane blocks. The insertion torque (IT), removal torque (RT), and resonance frequency analysis (RFA) values were recorded for each experimental condition. RESULTS In 30 and 40 PCF blocks, 3p S implants exhibited significantly higher IT values (90 and 80 Ncm, respectively) than 3p L (85 and 50 Ncm, respectively). Similarly, RT was significantly higher for 3p S implants in 30 and 40 PCF blocks (57 and 90 Ncm, respectively). However, there were no significant differences in RFA values, except for the 20 PCF block, where 3pS implants showed significantly lower values (63 ISQ) than 3p L implants (67 ISQ) in both the distal and mesial directions. CONCLUSIONS These results demonstrated that the implant's length mainly influences the IT and RT values in the polyurethane blocks that mimic the mandibular region of the bone, resulting in higher values for the 3p S implants, while the RFA values remained unaffected. However, in the lowest density block simulating the maxillary bone, 3p L implants exhibited significantly higher ISQ values. CLINICAL RELEVANCE Therefore, our data offer valuable insights into the biomechanical behavior of these implants, which could be clinically beneficial for enhancing surgical planning.
Collapse
Affiliation(s)
- Tea Romasco
- Center for Advanced Studies and Technology-CAST, "G. D'Annunzio, University of Chieti-Pescara, Via Luigi Polacchi 11, 66100, Chieti, Italy
- Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, 66100, Chieti, Italy
| | - Pamela Pignatelli
- Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, 66100, Chieti, Italy
| | - Margherita Tumedei
- Department of Medical, Surgical, and Dental Sciences, University of Milan, Via della Commenda 10, 20122, Milan, Italy
| | - Hamid Heydari Sheikh Hossein
- Center for Advanced Studies and Technology-CAST, "G. D'Annunzio, University of Chieti-Pescara, Via Luigi Polacchi 11, 66100, Chieti, Italy
- Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, 66100, Chieti, Italy
- Villa Serena Foundation for Research, Via Leonardo Petruzzi 42, 65013, Città Sant'Angelo, Italy
| | | | - Adriano Piattelli
- School of Dentistry, Saint Camillus International, University of Health and Medical Sciences, Via di Sant'Alessandro 8, 00131, Rome, Italy
- Facultad de Medicina, UCAM Universidad Católica San Antonio de Murcia, Av. de los Jerónimos 135, 30107, Guadalupe de Maciascoque, Spain
| | - Francesco Inchingolo
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Piazza Umberto I, 70121, Bari, Italy
| | - Natalia Di Pietro
- Center for Advanced Studies and Technology-CAST, "G. D'Annunzio, University of Chieti-Pescara, Via Luigi Polacchi 11, 66100, Chieti, Italy.
- Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, 66100, Chieti, Italy.
| |
Collapse
|
13
|
Demir O, Uslan I, Buyuk M, Salamci MU. Development and validation of a digital twin of the human lower jaw under impact loading by using non-linear finite element analyses. J Mech Behav Biomed Mater 2023; 148:106207. [PMID: 37922761 DOI: 10.1016/j.jmbbm.2023.106207] [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: 07/09/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
Mandibular fractures are one of the most frequently observed injuries within craniofacial region mostly due to tumor-related problems and traumatic events, often related to non-linear effects like impact loading. Therefore, a validated digital twin of the mandible is required to develop the best possible patient-specific treatment. However, there is a need to obtain a fully compatible numerical model that can reflect the patients' characteristics, be available and accessible quickly, require an acceptable level of modeling efforts and knowledge to provide accurate, robust and fast results at the same time under highly non-linear effects. In this study, a validated simulation methodology is suggested to develop a digital twin of mandible, capable of predicting the non-linear response of the biomechanical system under impact loading, which then can be utilized to design treatment strategies even for multiple fractures of the mandibular system. Using Computed Tomography data containing cranial (skull) images of a patient, a 3-dimensional mandibular model, which consists cortical and cancellous bones, disks and fossa is obtained with high accuracy that is compatible with anatomical boundaries. A Finite Element Model (FEM) of the biomechanical system is then developed for a three-level validation procedure including (A) modal analysis, (B) dynamic loading and (C) impact loading. For the modal analysis stage: Free-free vibration modes and frequencies of the system are validated against cadaver test results. For the dynamic loading stage: Two different regions of the mandible are loaded, and maximum stress levels of the system are validated against finite element analyses (FEA) results, where the first loading condition (i) transfers a 2000 N force acting on the symphysis region and, the second loading condition (ii) transfers a 2000 N force acting on the left body region. In both cases, equivalent muscle forces dependent on time are applied. For the impact loading stage: Thirteen different human mandibular models with various tooth deficiencies are used under the effects of traumatic impact forces that are generated by using an impact hammer with different initial velocities to transfer the impulse and momentum, where contact forces and fracture patterns are validated against cadaver tests. Five different anatomical regions are selected as the impact site. The results of the analyzes (modal, dynamic and impact) performed to validate the digital twin model are compared with the similar FEA and cadaver test results published in the literature and the results are found to be compatible. It has been evaluated that the digital twin model and numerical models are quite realistic and perform well in terms of predicting the biomechanical behavior of the mandible. The three-level validation methodology that is suggested in this research by utilizing non-linear FEA has provided a reliable road map to develop a digital twin of a biomechanical system with enough confidence that it can be utilized for similar structures to offer patient-specific treatments and can help develop custom or tailor-made implants or prosthesis for best compliance with the patient even considering the most catastrophic effects of impact related trauma.
Collapse
Affiliation(s)
- Osman Demir
- Gulhane Medical Design and Manufacturing Application and Research Center-SBU-METUM, University of Health Sciences, 06010, Ankara, Turkey; Department of Mechanical Engineering, Gazi University, 06570, Ankara, Turkey.
| | | | - Murat Buyuk
- Department of Engineering Sciences, Middle East Technical University, 06800, Ankara, Turkey.
| | - Metin Uymaz Salamci
- Department of Mechanical Engineering, Gazi University, 06570, Ankara, Turkey; Additive Manufacturing Technologies Research and Application Center-EKTAM, Gazi University, 06980, Ankara, Turkey.
| |
Collapse
|
14
|
Szabó ÁL, Matusovits D, Slyteen H, Lakatos ÉI, Baráth Z. Biomechanical Effects of Different Load Cases with an Implant-Supported Full Bridge on Four Implants in an Edentulous Mandible: A Three-Dimensional Finite Element Analysis (3D-FEA). Dent J (Basel) 2023; 11:261. [PMID: 37999025 PMCID: PMC10670282 DOI: 10.3390/dj11110261] [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: 09/13/2023] [Revised: 10/29/2023] [Accepted: 11/03/2023] [Indexed: 11/25/2023] Open
Abstract
The long-term success and predictability of implant-supported restorations largely depends on the biomechanical forces (stresses) acting on implants and the surrounding alveolar bone in the mandible. The aim of our study was to investigate the biomechanical behavior of an edentulous mandible with an implant-supported full bridge on four implants under simulated masticatory forces, in the context of different loading schemes, using a three-dimensional finite element analysis (3D-FEA). A patient-specific 3D finite element model was constructed using pre- and post-implantation computer tomography (CT) images of a patient undergoing implant treatment. Simplified masticatory forces set at 300 N were exerted vertically on the denture in four different simulated load cases (LC1-LC4). Two sets of simulations for different implants and denture materials (S1: titanium and titanium; S2: titanium and cobalt-chromium, respectively) were made. Stress outputs were taken as maximum (Pmax) and minimum principal stress (Pmin) and equivalent stress (Peqv) values. The highest peak Pmax values were observed for LC2 (where the modelled masticatory force excluded the cantilevers of the denture extending behind the terminal implants), both regarding the cortical bone (S1 Pmax: 89.57 MPa, S2 Pmax: 102.98 MPa) and trabecular bone (S1 Pmax: 3.03 MPa, S2 Pmax: 2.62 MPa). Overall, LC1-where masticatory forces covered the entire mesio-distal surface of the denture, including the cantilever-was the most advantageous. Peak Pmax values in the cortical bone and the trabecular bone were 14.97-15.87% and 87.96-94.54% higher in the case of S2, respectively. To ensure the long-term maintenance and longevity of treatment for implant-supported restorations in the mandible, efforts to establish the stresses of the surrounding bone in the physiological range, with the most even stress distribution possible, have paramount importance.
Collapse
Affiliation(s)
- Árpád László Szabó
- Department of Prosthodontics, Faculty of Dentistry, University of Szeged, Tisza Lajos krt. 64-66., 6720 Szeged, Hungary; (Á.L.S.); (D.M.)
| | - Danica Matusovits
- Department of Prosthodontics, Faculty of Dentistry, University of Szeged, Tisza Lajos krt. 64-66., 6720 Szeged, Hungary; (Á.L.S.); (D.M.)
| | - Haydar Slyteen
- Department of Structural Mechanics, Faculty of Civil Engineering, University of Technology and Economics, Budapest, Műegyetem rkp. 3., 1111 Budapest, Hungary; (H.S.); (É.I.L.)
| | - Éva Ilona Lakatos
- Department of Structural Mechanics, Faculty of Civil Engineering, University of Technology and Economics, Budapest, Műegyetem rkp. 3., 1111 Budapest, Hungary; (H.S.); (É.I.L.)
| | - Zoltán Baráth
- Department of Prosthodontics, Faculty of Dentistry, University of Szeged, Tisza Lajos krt. 64-66., 6720 Szeged, Hungary; (Á.L.S.); (D.M.)
| |
Collapse
|
15
|
Su Q, Qiao Y, Xiao Y, Yang S, Wu H, Li J, He X, Hu X, Yang H, Yong X. Research progress of 3D printed poly (ether ether ketone) in the reconstruction of craniomaxillofacial bone defects. Front Bioeng Biotechnol 2023; 11:1259696. [PMID: 37662437 PMCID: PMC10469012 DOI: 10.3389/fbioe.2023.1259696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023] Open
Abstract
The clinical challenge of bone defects in the craniomaxillofacial region, which can lead to significant physiological dysfunction and psychological distress, persists due to the complex and unique anatomy of craniomaxillofacial bones. These critical-sized defects require the use of bone grafts or substitutes for effective reconstruction. However, current biomaterials and methods have specific limitations in meeting the clinical demands for structural reinforcement, mechanical support, exceptional biological performance, and aesthetically pleasing reconstruction of the facial structure. These drawbacks have led to a growing need for novel materials and technologies. The growing development of 3D printing can offer significant advantages to address these issues, as demonstrated by the fabrication of patient-specific bioactive constructs with controlled structural design for complex bone defects in medical applications using this technology. Poly (ether ether ketone) (PEEK), among a number of materials used, is gaining recognition as a feasible substitute for a customized structure that closely resembles natural bone. It has proven to be an excellent, conformable, and 3D-printable material with the potential to replace traditional autografts and titanium implants. However, its biological inertness poses certain limitations. Therefore, this review summarizes the distinctive features of craniomaxillofacial bones and current methods for bone reconstruction, and then focuses on the increasingly applied 3D printed PEEK constructs in this field and an update on the advanced modifications for improved mechanical properties, biological performance, and antibacterial capacity. Exploring the potential of 3D printed PEEK is expected to lead to more cost-effective, biocompatible, and personalized treatment of craniomaxillofacial bone defects in clinical applications.
Collapse
Affiliation(s)
- Qiao Su
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Department of Paediatrics, West China Second University Hospital, State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, Sichuan University, Chengdu, Sichuan, China
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yixin Qiao
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yile Xiao
- Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Shuhao Yang
- Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Haoming Wu
- Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Jianan Li
- State Key Laboratory of Biotherapy, State Key Laboratory and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinlong He
- State Key Laboratory of Biotherapy, State Key Laboratory and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xulin Hu
- Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
- State Key Laboratory of Biotherapy, State Key Laboratory and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hui Yang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xin Yong
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Department of Paediatrics, West China Second University Hospital, State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
16
|
Ghaly M, Tarrazzi D, Xia V, Tharrington S, Schoenbaum TR. Changes in Peri-implant Marginal Bone Level by Jaw Location: A Systematic Review and Meta-Analysis of 4970 Implants. J ORAL IMPLANTOL 2023; 49:444-455. [PMID: 37527152 DOI: 10.1563/aaid-joi-d-22-00252] [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: 12/15/2022] [Revised: 05/03/2023] [Accepted: 05/29/2023] [Indexed: 08/03/2023]
Abstract
The purpose of this study was to evaluate the current evidence on marginal bone-level changes (ΔMBL) around internal connection implants with fixed prostheses by jaw location over time. An electronic literature search for ΔMBL (change in marginal bone level) was conducted in 6 databases. The data from the included manuscripts were categorized by jaw sextant of the implants and duration of follow-up (<2 years, 2-5 years, and >5 years). Meta-analyses were performed on groups with at least 5 studies. A total of 1270 records were screened. Full-text review of 413 papers resulted in a total of 46 studies (representing 2259 patients with 4970 implants) included for quantitative synthesis and analysis. The ΔMBL was summarized at 2 time intervals with the following results: <2 years (anterior maxilla = 0.393 mm [95% confidence interval {CI}, 0.172, 0.613], posterior maxilla = 0.468 mm [95% CI, 0.288, 0.648], and posterior mandible 0.559 mm [95% CI, 0.397, 0.72]), 2 to 5 years (anterior maxilla = 0.683 mm [95% CI, 0.224, 1.142], posterior maxilla = 0.645 mm [95% CI, 0.42, 0.87], and posterior mandible 0.563 mm [95% CI, 0.278, 0.849]). There were insufficient studies in the anterior mandible and with follow-up data over 5 years for quantitative synthesis. Within the limitations of this study, location within the maxillary and mandibular jaws does not seem to influence ΔMBL around internal connection bone level implants with fixed restorations. Although there may be a tendency for greater initial remodeling in the posterior mandible followed by long-term stability, additional studies are needed to evaluate this further.
Collapse
Affiliation(s)
- Mira Ghaly
- Department of Periodontics, Dental College of Georgia, Augusta University, Augusta GA, USA
| | - Daler Tarrazzi
- Department of Restorative Sciences, Dental College of Georgia, Augusta University, Augusta GA, USA
| | - Veronica Xia
- Dental College of Georgia, Augusta University, Augusta GA, USA
| | | | - Todd R Schoenbaum
- Department of Restorative Sciences, Dental College of Georgia, Augusta University, Augusta GA, USA
| |
Collapse
|
17
|
Alevizakos V, Mosch R, von See C. Influence of Multiple Used Implant Drills on Their Cutting Performance and Fracture Resistance. MATERIALS (BASEL, SWITZERLAND) 2023; 16:5271. [PMID: 37569975 PMCID: PMC10420324 DOI: 10.3390/ma16155271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023]
Abstract
This study aimed to analyze the influence of multiple uses of zirconia implant drills on their cutting performance and bending strength. The hypothesis was that drill usage and sterilization cycles would not affect drilling time or flexural strength. Sixty zirconia twist drills from Z-Systems were used to drill in the angulus mandibulae region of fresh porcine jaws. The drills were divided into four groups based on the cycle count, and the drilling time was measured. Bending strength tests were conducted using a universal testing machine, and statistical analysis was performed using ANOVA tests. The results showed that drilling times followed a normal distribution, and significant differences were observed in drilling times between group 1 and the other groups for the pilot drill. However, no significant differences were found for ø3.75 mm and ø4.25 mm drills, and drilling times also varied significantly among different drill diameters, regardless of the cycle count. Flexural strength did not significantly differ among drill diameters or sterilization cycles. Overall, using and sterilizing zirconia implant drills had no significant impact on drilling time or flexural strength. Nevertheless, drilling times did vary depending on the diameter of the drill. These findings provide valuable insights into the performance and durability of zirconia implant drills, contributing to the optimization of dental implant procedures.
Collapse
Affiliation(s)
- Vasilios Alevizakos
- Research Center for Digital Technologies in Dentistry and CAD/CAM, Danube Private University, Steiner Landstrasse 124, 3500 Krems an der Donau, Austria; (R.M.); (C.v.S.)
| | | | | |
Collapse
|
18
|
Park CS, Kang SR, Kim JE, Huh KH, Lee SS, Heo MS, Han JJ, Yi WJ. Validation of bone mineral density measurement using quantitative CBCT image based on deep learning. Sci Rep 2023; 13:11921. [PMID: 37488135 PMCID: PMC10366160 DOI: 10.1038/s41598-023-38943-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/17/2023] [Indexed: 07/26/2023] Open
Abstract
The bone mineral density (BMD) measurement is a direct method of estimating human bone mass for diagnosing osteoporosis, and performed to objectively evaluate bone quality before implant surgery in dental clinics. The objective of this study was to validate the accuracy and reliability of BMD measurements made using quantitative cone-beam CT (CBCT) image based on deep learning by applying the method to clinical data from actual patients. Datasets containing 7500 pairs of CT and CBCT axial slice images from 30 patients were used to train a previously developed deep-learning model (QCBCT-NET). We selected 36 volumes of interest in the CBCT images for each patient in the bone regions of potential implants sites on the maxilla and mandible. We compared the BMDs shown in the quantitative CBCT (QCBCT) images with those in the conventional CBCT (CAL_CBCT) images at the various bone sites of interest across the entire field of view (FOV) using the performance metrics of the MAE, RMSE, MAPE (mean absolute percentage error), R2 (coefficient of determination), and SEE (standard error of estimation). Compared with the ground truth (QCT) images, the accuracy of the BMD measurements from the QCBCT images showed an RMSE of 83.41 mg/cm3, MAE of 67.94 mg/cm3, and MAPE of 8.32% across all the bone sites of interest, whereas for the CAL_CBCT images, those values were 491.15 mg/cm3, 460.52 mg/cm3, and 54.29%, respectively. The linear regression between the QCBCT and QCT images showed a slope of 1.00 and a R2 of 0.85, whereas for the CAL_CBCT images, those values were 0.32 and 0.24, respectively. The overall SEE between the QCBCT images and QCT images was 81.06 mg/cm3, whereas the SEE for the CAL_CBCT images was 109.32 mg/cm3. The QCBCT images thus showed better accuracy, linearity, and uniformity than the CAL_CBCT images across the entire FOV. The BMD measurements from the quantitative CBCT images showed high accuracy, linearity, and uniformity regardless of the relative geometric positions of the bone in the potential implant site. When applied to actual patient CBCT images, the CBCT-based quantitative BMD measurement based on deep learning demonstrated high accuracy and reliability across the entire FOV.
Collapse
Grants
- Project Number: 1711174552, KMDF_PR_20200901_0147 Korea Medical Device Development Fund Grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety)
- Project Number: 1711174543, KMDF_PR_20200901_0011 Korea Medical Device Development Fund Grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety)
Collapse
Affiliation(s)
- Chan-Soo Park
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Se-Ryong Kang
- Department of Biomedical Radiation Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
| | - Jo-Eun Kim
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Jeong-Joon Han
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Won-Jin Yi
- Department of Biomedical Radiation Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea.
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea.
| |
Collapse
|
19
|
Gatto ML, Furlani M, Giuliani A, Cabibbo M, Bloise N, Fassina L, Petruczuk M, Visai L, Mengucci P. Combined Effects of HA Concentration and Unit Cell Geometry on the Biomechanical Behavior of PCL/HA Scaffold for Tissue Engineering Applications Produced by LPBF. MATERIALS (BASEL, SWITZERLAND) 2023; 16:4950. [PMID: 37512225 PMCID: PMC10381722 DOI: 10.3390/ma16144950] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/26/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023]
Abstract
This experimental study aims at filling the gap in the literature concerning the combined effects of hydroxyapatite (HA) concentration and elementary unit cell geometry on the biomechanical performances of additively manufactured polycaprolactone/hydroxyapatite (PCL/HA) scaffolds for tissue engineering applications. Scaffolds produced by laser powder bed fusion (LPBF) with diamond (DO) and rhombic dodecahedron (RD) elementary unit cells and HA concentrations of 5, 30 and 50 wt.% were subjected to structural, mechanical and biological characterization to investigate the biomechanical and degradative behavior from the perspective of bone tissue regeneration. Haralick's features describing surface pattern, correlation between micro- and macro-structural properties and human mesenchymal stem cell (hMSC) viability and proliferation have been considered. Experimental results showed that HA has negative influence on scaffold compaction under compression, while on the contrary it has a positive effect on hMSC adhesion. The unit cell geometry influences the mechanical response in the plastic regime and also has an effect on the cell proliferation. Finally, both HA concentration and elementary unit cell geometry affect the scaffold elastic deformation behavior as well as the amount of micro-porosity which, in turn, influences the scaffold degradation rate.
Collapse
Affiliation(s)
- Maria Laura Gatto
- Department of Industrial Engineering and Mathematical Sciences, Polytechnic University of Marche, Via Brecce Bianche 12, 60131 Ancona, Italy
| | - Michele Furlani
- Department of Clinical Science, Polytechnic University of Marche, Via Brecce Bianche 12, 60131 Ancona, Italy
| | - Alessandra Giuliani
- Department of Clinical Science, Polytechnic University of Marche, Via Brecce Bianche 12, 60131 Ancona, Italy
| | - Marcello Cabibbo
- Department of Industrial Engineering and Mathematical Sciences, Polytechnic University of Marche, Via Brecce Bianche 12, 60131 Ancona, Italy
| | - Nora Bloise
- Department of Molecular Medicine, Centre for Health Technologies (CHT), INSTM UdR of Pavia, University of Pavia, Viale Taramelli 3/b, 27100 Pavia, Italy
- Medicina Clinica-Specialistica, UOR5 Laboratorio di Nanotecnologie, ICS Maugeri, IRCCS, Via Salvatore Maugeri 4, 27100 Pavia, Italy
| | - Lorenzo Fassina
- Department of Electrical, Computer and Biomedical Engineering, Centre for Health Technologies (CHT), University of Pavia, Via Ferrata 5, 27100 Pavia, Italy
| | - Marlena Petruczuk
- Faculty of Materials Science and Engineering, Warsaw University of Technology, 141 Woloska Str., 02-507 Warsaw, Poland
| | - Livia Visai
- Department of Molecular Medicine, Centre for Health Technologies (CHT), INSTM UdR of Pavia, University of Pavia, Viale Taramelli 3/b, 27100 Pavia, Italy
- Medicina Clinica-Specialistica, UOR5 Laboratorio di Nanotecnologie, ICS Maugeri, IRCCS, Via Salvatore Maugeri 4, 27100 Pavia, Italy
| | - Paolo Mengucci
- Department of Materials, Environmental Sciences and Urban Planning, INSTM UdR of Ancona, Polytechnic University of Marche, Via Brecce Bianche 12, 60131 Ancona, Italy
| |
Collapse
|
20
|
Kuleshov AA, Aganesov NA, Vetrile MS, Dol AV, Lisyansky IN, Makarov SN. Biomechanical analysis of variants of spinopelvic fixation of longitudinal sacral fractures by the finite element method. HIRURGIÂ POZVONOČNIKA (SPINE SURGERY) 2023. [DOI: 10.14531/ss2023.1.28-35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Objective. To analyze the strength of three types of spinopelvic fixation system configurations in longitudinal fracture of the sacrum by the finite element method.Material and Methods. Biomechanical analysis was carried out by the finite element method. A three-dimensional model of a segment of the spinopelvic complex (SPC), including the pelvic bones, sacrum and L4 and L5 vertebrae, was created on the basis of the CT scan results of a healthy patient. Then, a longitudinal fracture of the sacrum was simulated on the developed model of the sacrum on the left side in zone 1 according to the Denis classification. Further, a comparative assessment of three variants of spinopelvic fixation systems with the help of biomechanical computer modeling was carried out: bilateral spinopelvic system L4–S2Alar, bilateral spinopelvic system L4–S2Alar with transverse connector installation, and bilateral spinopelvic system L4–S2Alar with L-shaped rod installation. The stability of fixation, as well as the amount of loads acting on the fixation elements and bone tissues were determined.Results. As the rigidity of the structure increases by means of a transverse connector or an L-shaped rod, the load is redistributed between the screws located to the left and right of the fracture. The rigidity of the L4–S2Alar system with parallel, unconnected rods is much lower, which leads to a critical increase in loads on instrumentation and vertebrae.Conclusion. Analysis of three variants of spinopelvic fixation of longitudinal fractures of the sacrum by finite element method revealed that bilateral spinopelvic system with pedicle screws installed in the L4 and L5 vertebrae and pelvic screws installed in the iliac bones through the lateral masses of S2, two on each side (L4–S2 Alar) and connected by two parallel rods (variant 1) is the least strong in comparison with the other variants. The strength of the fixation increases when the structure is supplemented with a transverse connector between the rods (variant 2). The L4–S2 Alar design with an L-shaped rod on the side of the longitudinal fracture of the sacrum (variant 3) proved to be the most strong.
Collapse
Affiliation(s)
- A. A. Kuleshov
- National Medical Research Center for Traumatology and Orthopedics n.a. N.N. Priorov
10 Priorova str., Moscow, 127299, Russia
| | - N. A. Aganesov
- National Medical Research Center for Traumatology and Orthopedics n.a. N.N. Priorov
10 Priorova str., Moscow, 127299, Russia
| | - M. S. Vetrile
- National Medical Research Center for Traumatology and Orthopedics n.a. N.N Priorov
10 Priorova str., Moscow, 127299, Russia
| | - A. V. Dol
- Saratov National Research State University n.a. N.G. Chernyshevsky
80 Astrakhanskaya str., Saratov, 410012, Russia
| | - I. N. Lisyansky
- National Medical Research Center for Traumatology and Orthopedics n.a. N.N. Priorov
10 Priorova str., Moscow, 127299, Russia
| | - S. N. Makarov
- National Medical Research Center for Traumatology and Orthopedics n.a. N.N. Priorov
10 Priorova str., Moscow, 127299, Russia
| |
Collapse
|
21
|
Gatto ML, Cerqueni G, Furlani M, Riberti N, Tognoli E, Denti L, Leonardi F, Giuliani A, Mattioli-Belmonte M, Mengucci P. Influence of Trabecular Geometry on Scaffold Mechanical Behavior and MG-63 Cell Viability. MATERIALS (BASEL, SWITZERLAND) 2023; 16:2342. [PMID: 36984222 PMCID: PMC10056383 DOI: 10.3390/ma16062342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
In a scaffold-based approach for bone tissue regeneration, the control over morphometry allows for balancing scaffold biomechanical performances. In this experimental work, trabecular geometry was obtained by a generative design process, and scaffolds were manufactured by vat photopolymerization with 60% (P60), 70% (P70) and 80% (P80) total porosity. The mechanical and biological performances of the produced scaffolds were investigated, and the results were correlated with morphometric parameters, aiming to investigate the influence of trabecular geometry on the elastic modulus, the ultimate compressive strength of scaffolds and MG-63 human osteosarcoma cell viability. The results showed that P60 trabecular geometry allows for matching the mechanical requirements of human mandibular trabecular bone. From the statistical analysis, a general trend can be inferred, suggesting strut thickness, the degree of anisotropy, connectivity density and specific surface as the main morphometric parameters influencing the biomechanical behavior of trabecular scaffolds, in the perspective of tissue engineering applications.
Collapse
Affiliation(s)
- Maria Laura Gatto
- Department DIISM, Università Politecnica Delle Marche, Via Brecce Bianche 12, 60131 Ancona, Italy;
| | - Giorgia Cerqueni
- Department DISCLIMO & UdR INSTM, Università Politecnica Delle Marche, Via Tronto 10/a, 60126 Ancona, Italy; (G.C.); (M.M.-B.)
| | - Michele Furlani
- Department DISCO, Università Politecnica Delle Marche, Via Brecce Bianche 12, 60131 Ancona, Italy; (M.F.); (A.G.)
| | - Nicole Riberti
- Neurosciences Imaging and Clinical Sciences Department, University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Emanuele Tognoli
- Department of Engineering “Enzo Ferrari”, Università di Modena e Reggio Emilia, Via Vivarelli 10, 41125 Modena, Italy; (E.T.); (L.D.)
| | - Lucia Denti
- Department of Engineering “Enzo Ferrari”, Università di Modena e Reggio Emilia, Via Vivarelli 10, 41125 Modena, Italy; (E.T.); (L.D.)
| | | | - Alessandra Giuliani
- Department DISCO, Università Politecnica Delle Marche, Via Brecce Bianche 12, 60131 Ancona, Italy; (M.F.); (A.G.)
| | - Monica Mattioli-Belmonte
- Department DISCLIMO & UdR INSTM, Università Politecnica Delle Marche, Via Tronto 10/a, 60126 Ancona, Italy; (G.C.); (M.M.-B.)
| | - Paolo Mengucci
- Department SIMAU & UdR INSTM, Università Politecnica Delle Marche, Via Brecce Bianche 12, 60131 Ancona, Italy
| |
Collapse
|
22
|
Facts to Consider in Developing Materials That Emulate the Upper Jawbone: A Microarchitecture Study Showing Unique Characteristics at Four Different Sites. Biomimetics (Basel) 2023; 8:biomimetics8010115. [PMID: 36975345 PMCID: PMC10046344 DOI: 10.3390/biomimetics8010115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023] Open
Abstract
The maxilla is generally acknowledged as being more trabecular than the mandible. Allograft currently available for use in the maxillofacial region is harvested from the hip and long bones, irrespective of their local characteristics, and grafted onto the jawbones. Other alternative are autograft or commercially available bone substitutes. Due to their inherent differences, an in-depth understanding of the bone microarchitecture is important to develop the most compatible graft for use at the maxilla. This cross-sectional study aimed to determine the microstructures of bone harvested from different sites of the maxilla, to be used for standard setting. Forty-nine specimens from seven human cadavers were harvested from the zygomatic buttress, anterior maxillary sinus wall, anterior nasal spine and anterior palate. Each bone block, measuring of 10 mm × 5 mm, was harvested using rotary instruments. Bone analysis was performed following micro-computed tomography to obtain trabecular number (Tb.N), trabecular separation (Tb.Sp), trabecular thickness (Tb.Th), and bone volume fraction (BV/TV). There were site-related differences, with BV/TV that ranged between 37.38% and 85.83%. The Tb.N was the lowest at the palate (1.12 (mm−1)) and highest at the anterior maxillary sinus wall (1.41 (mm−1)) region. The palate, however, had the highest trabecular separation value (Tb.Sp) at 0.47 mm. The TB.Th was the lowest at the anterior nasal spine (0.34 mm) but both the zygoma and anterior maxillary sinus regions shared the highest Tb.Th (0.44 mm). Except for having the lowest Th.Sp (0.35 mm), the anterior maxillary sinus wall consistently showed higher values together with the zygomatic buttress in all other parameters. Concurring with current clinical practice of harvesting autograft from the zygomatic buttress and anterior maxillary sinus wall, their bony characteristic serve as the microarchitecture standard to adopt when developing new bone graft materials for use in the maxilla.
Collapse
|
23
|
Karanth D, Puleo D, Dawson D, Holliday LS, Sharab L. Characterization of 3D printed biodegradable piezoelectric scaffolds for bone regeneration. Clin Exp Dent Res 2023; 9:398-408. [PMID: 36779270 PMCID: PMC10098282 DOI: 10.1002/cre2.712] [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: 06/15/2022] [Revised: 12/17/2022] [Accepted: 01/10/2023] [Indexed: 02/14/2023] Open
Abstract
OBJECTIVE The primary objective of this research was to develop a poly(l-lactic acid) (PLLA) scaffold and evaluate critical characteristics essential for its biologic use as a craniofacial implant. MATERIALS AND METHODS PLLA scaffolds were designed and fabricated using fused deposition modeling technology. The surface morphology and microarchitecture were analyzed using scanning electron microscopy (SEM) and microCT, respectively. Crystallography, compressive modulus, and the piezoelectric potential generated upon mechanical distortion were characterized. Hydrolytic degradation was studied. MG63 osteoblast-like cell proliferation and morphology were assessed. RESULTS The porosity of the scaffolds was 73%, with an average pore size of 450 µm and an average scaffold fiber thickness of 130 µm. The average compressive modulus was 244 MPa, and the scaffolds generated an electric potential of 25 mV upon cyclic/repeated loading. The crystallinity reduced from 27.5% to 13.9% during the 3D printing process. The hydrolytic degradation was minimal during a 12-week period. Osteoblast-like cells did not attach to the uncoated scaffold but attached well after coating the scaffold with fibrinogen. They then proliferated to cover the complete scaffold by Day 14. CONCLUSION The PLLA scaffolds were designed and printed, proving the feasibility of 3D printing as a method of fabricating PLLA scaffolds. The elastic modulus was comparable to that of trabecular bone, and the piezoelectric properties of the PLLA were retained after 3D printing. The scaffolds were cytocompatible. These 3D-printed PLLA scaffolds showed promising properties akin to the natural bone, and they warrant further investigation for bone regeneration.
Collapse
Affiliation(s)
- Divakar Karanth
- Department of Orthodontics, University of Florida College of Dentistry, Gainesville, Florida, USA
| | - David Puleo
- Department of Biomedical Engineering, University of Mississippi, University Park, Mississippi, USA
| | - Dolph Dawson
- Department of Periodontics, University of Kentucky College of Dentistry, Lexington, Kentucky, USA
| | - L S Holliday
- Department of Orthodontics, University of Florida College of Dentistry, Gainesville, Florida, USA
| | - Lina Sharab
- Department of Orthodontics, University of Kentucky College of Dentistry, Lexington, Kentucky, USA
| |
Collapse
|
24
|
Tilton M, Jacobs E, Overdorff R, Astudillo Potes M, Lu L, Manogharan G. Biomechanical behavior of PMMA 3D printed biomimetic scaffolds: Effects of physiologically relevant environment. J Mech Behav Biomed Mater 2023; 138:105612. [PMID: 36509012 PMCID: PMC9845185 DOI: 10.1016/j.jmbbm.2022.105612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 11/22/2022] [Accepted: 12/06/2022] [Indexed: 12/12/2022]
Abstract
Functional cellular structures with controllable mechanical and morphological properties are of great interest for applications including tissue engineering, energy storage, and aerospace. Additive manufacturing (AM), also referred to as 3D printing, has enabled the potential for fabrication of functional porous scaffolds (i.e., meta-biomaterials) with controlled geometrical, morphological, and mechanical properties. Understanding the biomechanical behavior of 3D printed porous scaffolds under physiologically relevant loading and environmental conditions is crucial in accurately predicting the in vivo performance. This study was aimed to investigate the environmental dependency of the mechanical responses of 3D printed porous scaffolds of poly(methyl methacrylate) (PMMA) Class IIa biomaterial that was based on triply periodic minimal surfaces - TPMS (i.e., Primitive and Schoen-IWP). The 3D printed scaffolds (n = 5/study group) were tested under compressive loading in both ambient and fluidic (distilled water with pH = 7.4) environments according to ASTM D1621 standards. Outcomes of this study showed that compressive properties of the developed scaffolds are significantly lower in the fluidic condition than the ambient environment for the same topological and morphological group (p≤0.023). Additionally, compressive properties and flexural stiffness of the studied scaffolds were within the range of trabecular bone's properties, for both topological classes. Relationships between predicted mechanical responses and morphological properties (i.e., porosity) were evaluated for each topological class. Quantitative correlation analysis indicated that mechanical behavior of the developed 3D printed scaffolds can be controlled based on both topology and morphology.
Collapse
Affiliation(s)
- Maryam Tilton
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Erik Jacobs
- Additive Manufacturing and Design Program, Pennsylvania State University, University Park, PA, USA
| | | | - Maria Astudillo Potes
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Lichun Lu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Guha Manogharan
- Additive Manufacturing and Design Program, Pennsylvania State University, University Park, PA, USA; Department of Mechanical Engineering, Pennsylvania State University, University Park, PA, USA.
| |
Collapse
|
25
|
Irandoust S, Müftü S. On computational predictions of fluid flow and its effects on bone healing in dental implant treatments: an investigation of spatiotemporal fluid flow in cyclic loading. Biomech Model Mechanobiol 2023; 22:85-104. [PMID: 36329356 DOI: 10.1007/s10237-022-01633-x] [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: 03/21/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022]
Abstract
Fluid flow in (porous) bone plays an important role in its maintenance, adaptation, and healing after an injury. Experimental and computational studies apply mechanical loading on bone to predict fluid flow development and/or to find its material properties. In most cases, mechanical loading is applied as a linear function in time. Multiple loading functions-with identical peak load and loading frequency-were used to investigate load-induced fluid flow and predict bone healing surrounding a dental implant. Implementing an instantaneous healing stimulus led to major differences in healing predictions for slightly different loading functions. Load-induced fluid flow was found to be displacement-rate dependent with complex spatial-temporal variations and not necessarily symmetrical during loading and unloading phases. Haversine loading resulted in more numerical stability compared to ramped/triangular loading, providing the opportunity for further investigation of the effects of various physiological masticatory loadings. It was concluded that using the average healing stimulus during cyclic loading gives the most robust bone healing predictions.
Collapse
Affiliation(s)
- Soroush Irandoust
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, 02115, USA.
| | - Sinan Müftü
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, 02115, USA
| |
Collapse
|
26
|
Zheng F, Zhu Y, Gong Y, Yin D, Liu Y. Variation in stress distribution modified by mandibular material property: a 3D finite element analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 229:107310. [PMID: 36565665 DOI: 10.1016/j.cmpb.2022.107310] [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: 07/13/2022] [Revised: 10/08/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Temporomandibular joint disorder (TMD) is a common oral and maxillary facial disease. Finite element method (FEM) has been widely used in TMD studies. Material assignment significantly affects FEM results. The differences in the methods of material assignment used in previous studies have not been comprehensively assessed for further calculations. METHODS The mandible material modelling approaches were of four types, namely: uniform modelling with (A) cortical bone; and (B) cancellous bone; (C) semi-uniform modelling with division of cortical and cancellous bone; and (D) non-uniform modelling with Computed tomography (CT) gray value related modulus. Meanwhile, the Young's modulus of values ranging from 20 to 300 GPa were considered for the teeth. Ten modellings were used to analyze and discuss the differences in contact pressure and contact force. RESULTS (1) The increase in teeth elastic modulus increased the maximum contact pressure on the alveolar bone and contact force on teeth, but induced insignificant stress variation on the temporomandibular joint; (2) The location of the maximum contact pressure was steady for all four modelling approaches of the mandibular material. However, the maximum contact pressure and contact force exhibited an insignificant difference. CONCLUSIONS Teeth with a higher elastic modulus significantly enhanced the stress concentration in the alveolar bone; in contrast, it induced minor variations in the temporomandibular joint stress states. The extreme stress regions predicted by the four mandibular models were consistent with the actual damaged regions. However, non-uniform modellings based on CT values could better describe the mechanical properties of the human bone, which should be primarily considered.
Collapse
Affiliation(s)
- Fangjie Zheng
- College of Aerospace Engineering, Chongqing University, Chongqing, China
| | - Yunfan Zhu
- College of Aerospace Engineering, Chongqing University, Chongqing, China
| | - Yanji Gong
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section, Renmin South Road, Chengdu 610041, China
| | - Deqiang Yin
- College of Aerospace Engineering, Chongqing University, Chongqing, China.
| | - Yang Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section, Renmin South Road, Chengdu 610041, China.
| |
Collapse
|
27
|
Kudoh K, Fukuda N, Akita K, Kudoh T, Takamaru N, Kurio N, Hayashi K, Ishikawa K, Miyamoto Y. Reconstruction of rabbit mandibular bone defects using carbonate apatite honeycomb blocks with an interconnected porous structure. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2022; 34:2. [PMID: 36586041 PMCID: PMC9805415 DOI: 10.1007/s10856-022-06710-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
Carbonate apatite (CO3Ap) granules are useful as a bone substitute because they can be remodeled to new natural bone in a manner that conforms to the bone remodeling process. However, reconstructing large bone defects using CO3Ap granules is difficult because of their granular shape. Therefore, we fabricated CO3Ap honeycomb blocks (HCBs) with continuous unidirectional pores. We aimed to elucidate the tissue response and availability of CO3Ap HCBs in the reconstruction of rabbit mandibular bone defects after marginal mandibulectomy. The percentages of the remaining CO3Ap area and calcified bone area (newly formed bone) were estimated from the histological images. CO3Ap area was 49.1 ± 4.9%, 30.3 ± 3.5%, and 25.5 ± 8.8%, whereas newly formed bone area was 3.0 ± 0.6%, 24.3 ± 3.3%, and 34.7 ± 4.8% at 4, 8, and 12 weeks, respectively, after implantation. Thus, CO3Ap HCBs were gradually resorbed and replaced by new bone. The newly formed bone penetrated most of the pores in the CO3Ap HCBs at 12 weeks after implantation. By contrast, the granulation tissue scarcely invaded the CO3Ap HCBs. Some osteoclasts invaded the wall of CO3Ap HCBs, making resorption pits. Furthermore, many osteoblasts were found on the newly formed bone, indicating ongoing bone remodeling. Blood vessels were also formed inside most of the pores in the CO3Ap HCBs. These findings suggest that CO3Ap HCBs have good osteoconductivity and can be used for the reconstruction of large mandibular bone defects. The CO3Ap HCB were gradually resorbed and replaced by newly formed bone.
Collapse
Affiliation(s)
- Keiko Kudoh
- Department of Oral Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.
| | - Naoyuki Fukuda
- Department of Oral Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Kazuya Akita
- Department of Oral Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Takaharu Kudoh
- Department of Oral Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Natsumi Takamaru
- Department of Oral Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Naito Kurio
- Department of Oral Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Koichiro Hayashi
- Department of Oral Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Kunio Ishikawa
- Department of Biomaterials, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Youji Miyamoto
- Department of Biomaterials, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| |
Collapse
|
28
|
Saha S, Roy S. Metallic Dental Implants Wear Mechanisms, Materials, and Manufacturing Processes: A Literature Review. MATERIALS (BASEL, SWITZERLAND) 2022; 16:ma16010161. [PMID: 36614500 PMCID: PMC9821388 DOI: 10.3390/ma16010161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/29/2022] [Accepted: 12/13/2022] [Indexed: 06/12/2023]
Abstract
OBJECTIVES From the treatment of damaged teeth to replacing missing teeth, dental biomaterials cover the scientific interest of many fields. Dental biomaterials are one of the implants whose effective life depends vastly on their material and manufacturing techniques. The purpose of this review is to summarize the important aspects for metallic dental implants from biomedical, mechanical and materials science perspectives. The review article will focus on five major aspects as mentioned below. Tooth anatomy: Maximizing the implant performance depends on proper understanding of human tooth anatomy and the failure behavior of the implants. Major parts from tooth anatomy including saliva characteristics are explored in this section. Wear mechanisms: The prominent wear mechanisms having a high impact on dental wear are abrasive, adhesive, fatigue and corrosion wear. To imitate the physiological working condition of dental implants, reports on the broad range of mastication force and various composition of artificial saliva have been included in this section, which can affect the tribo-corrosion behavior of dental implants. Dental implants classifications: The review paper includes a dedicated discussion on major dental implants types and their details for better understanding their applicability and characteristics. Implant materials: As of today, the most established dental implant materials are SS316L, cobalt chrome alloy and titanium. Detailed discussion on their material properties, microstructures, phase transformations and chemical compositions have been discussed here. Manufacturing techniques: In terms of different production methods, the lost wax casting method as traditional manufacturing is considered. Selective Laser Melting (SLM) and Directed Energy Deposition (DED) as additive manufacturing techniques (AM) have been discussed. For AM, the relationships between process-property-performance details have been explored briefly. The effectiveness of different manufacturing techniques was compared based on porosity distribution, mechanical and biomechanical properties. SUMMARY Despite having substantial research available on dental implants, there is a lack of systematic reviews to present a holistic viewpoint combining state-of-the-art from biomedical, mechanical, materials science and manufacturing perspectives. This review article attempts to combine a wide variety of analyzing approaches from those interdisciplinary fields to deliver deeper insights to researchers both in academia and industry to develop next-generation dental implants.
Collapse
|
29
|
Gershov S, Xie J, Shah FA, Shemtov-Yona K, Rittel D. Modelling the resonant frequency associated with the spatio-temporal evolution of the bone-dental implant interface. Acta Biomater 2022; 154:302-311. [PMID: 36306984 DOI: 10.1016/j.actbio.2022.10.042] [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: 08/18/2022] [Revised: 09/21/2022] [Accepted: 10/19/2022] [Indexed: 01/24/2023]
Abstract
Dental implant stability is greatly affected by the mechanical properties of the bone-implant interface (BII), and it is key to long-term successful osseointegration. Implant stability is often evaluated using the Resonant Frequency Analysis (RFA) method, and also by the quality of this interface, namely the bone-implant contact (BIC). True to this day, there is a scarcity of models tying BIC, RFA and a spatially and mechanically evolving BII. In this paper, based on the contact/distance osteogenesis concept, a novel numerical spatio-temporal model of the implant, surrounding bone and evolving interface, was developed to assess the evolution of the interfacial stresses on the one hand and the corresponding resonant frequencies on the other. We postulate that, since the BIC percentage reaches saturation over a very short time, long before densification of the interface, it becomes irrelevant as to load transmission between the implant and the bone due to the existence of an open gap. Gap closure is the factor that provides continuity between the implant and the surrounding bone. The results of the calculated RFA evolution match and provide an explanation for the multiple clinical observations of a sharp initial decline in RFA, followed by a gradual increase and plateau formation. STATEMENT OF SIGNIFICANCE: A novel three-dimensional numerical model of an evolving bone-dental implant interface (BII) is presented. The spatio-temporal evolution of the bone-implant contact (BIC) and the BII, based on contact/distance (CO/DO) osteogenesis, is modeled. A central outcome is that, until BII maturation into a solid continuous bone (no open gap between CO-DO fronts), the bone-implant load transfer is hampered, irrespective of the BIC. The resonant frequencies' evolution of the jawbone-BII-implant is calculated to reproduce the well-established implant stability analysis based on the Resonant Frequency Analysis. The results resemble those reported clinically, and here too, the determinant transition occurs only after interfacial gap closure. Those results should motivate clinicians to re-consider structural continuity of the BII rather than the BIC only.
Collapse
Affiliation(s)
- Sapir Gershov
- Technion Autonomous Systems Program, Technion - Israel Institute of Technology, Haifa 32000, Israel.
| | - Jing Xie
- State Key Laboratory of Explosion Science and Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Furqan A Shah
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Keren Shemtov-Yona
- Faculty of Mechanical Engineering, Technion - Israel Institute of Technology, Haifa 32000, Israel; The Maurice and Gabriela Goldschleger School of Dental Medicine, Department of Oral Biology, Tel Aviv University, Tel Aviv 39040, Israel
| | - Daniel Rittel
- Faculty of Mechanical Engineering, Technion - Israel Institute of Technology, Haifa 32000, Israel
| |
Collapse
|
30
|
Wearing Effect of Implant Steel Drills and Tappers for the Preparation of the Bone Osteotomies: An Infrared Thermal Analysis and Energy Dispersive Spectroscopy-Scanning Electron Microscopy (EDS-SEM) Study. PROSTHESIS 2022. [DOI: 10.3390/prosthesis4040054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: The thermal effect correlated with implant osteotomy could produce significant effects on the healing process and fixture osseointegration. The aim of the present investigation was to assess the heat generation and surface wearing of dental implant drills and manual tappers during simulated osteotomies on animal ribs. Methods: Steel drills (20 units per type) and tappers (20 units per type) were evaluated for a total of 30 osteotomies. The infrared thermal analysis was performed at the first and thirtieth osteotomy. The surface alteration and wearing was assessed by energy dispersive spectroscopy–scanning electron microscopy (EDS-SEM) prior to and after use. Conclusions: The drill material produced a non-significant temperature change during bone osteotomy. Lower heating was reported for manual tappers in favor of a manual osteotomy instead rotary instruments.
Collapse
|
31
|
Dorado S, Arias A, Jimenez-Octavio JR. Biomechanical Modelling for Tooth Survival Studies: Mechanical Properties, Loads and Boundary Conditions-A Narrative Review. MATERIALS (BASEL, SWITZERLAND) 2022; 15:7852. [PMID: 36363451 PMCID: PMC9657341 DOI: 10.3390/ma15217852] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
Recent biomechanical studies have focused on studying the response of teeth before and after different treatments under functional and parafunctional loads. These studies often involve experimental and/or finite element analysis (FEA). Current loading and boundary conditions may not entirely represent the real condition of the tooth in clinical situations. The importance of homogenizing both sample characterization and boundary conditions definition for future dental biomechanical studies is highlighted. The mechanical properties of dental structural tissues are presented, along with the effect of functional and parafunctional loads and other environmental and biological parameters that may influence tooth survival. A range of values for Young's modulus, Poisson ratio, compressive strength, threshold stress intensity factor and fracture toughness are provided for enamel and dentin; as well as Young's modulus and Poisson ratio for the PDL, trabecular and cortical bone. Angles, loading magnitude and frequency are provided for functional and parafunctional loads. The environmental and physiological conditions (age, gender, tooth, humidity, etc.), that may influence tooth survival are also discussed. Oversimplifications of biomechanical models could end up in results that divert from the natural behavior of teeth. Experimental validation models with close-to-reality boundary conditions should be developed to compare the validity of simplified models.
Collapse
Affiliation(s)
- Saúl Dorado
- Department of Mechanical Engineering, Escuela Técnica Superior de Ingeniería ICAI, Universidad Pontificia Comillas, 28015 Madrid, Spain
| | - Ana Arias
- Department of Conservative and Prosthetic Dentistry, School of Dentistry, Complutense University, 28040 Madrid, Spain
| | - Jesus R. Jimenez-Octavio
- Instituto de Investigación Tecnológica, Escuela Técnica Superior de Ingeniería ICAI, Universidad Pontificia Comillas, 28015 Madrid, Spain
| |
Collapse
|
32
|
Hasan J, Bright R, Hayles A, Palms D, Zilm P, Barker D, Vasilev K. Preventing Peri-implantitis: The Quest for a Next Generation of Titanium Dental Implants. ACS Biomater Sci Eng 2022; 8:4697-4737. [PMID: 36240391 DOI: 10.1021/acsbiomaterials.2c00540] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Titanium and its alloys are frequently the biomaterial of choice for dental implant applications. Although titanium dental implants have been utilized for decades, there are yet unresolved issues pertaining to implant failure. Dental implant failure can arise either through wear and fatigue of the implant itself or peri-implant disease and subsequent host inflammation. In the present report, we provide a comprehensive review of titanium and its alloys in the context of dental implant material, and how surface properties influence the rate of bacterial colonization and peri-implant disease. Details are provided on the various periodontal pathogens implicated in peri-implantitis, their adhesive behavior, and how this relationship is governed by the implant surface properties. Issues of osteointegration and immunomodulation are also discussed in relation to titanium dental implants. Some impediments in the commercial translation for a novel titanium-based dental implant from "bench to bedside" are discussed. Numerous in vitro studies on novel materials, processing techniques, and methodologies performed on dental implants have been highlighted. The present report review that comprehensively compares the in vitro, in vivo, and clinical studies of titanium and its alloys for dental implants.
Collapse
Affiliation(s)
- Jafar Hasan
- Academic Unit of STEM, University of South Australia, Mawson Lakes, SA 5095, Australia
| | - Richard Bright
- Academic Unit of STEM, University of South Australia, Mawson Lakes, SA 5095, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park 5042, South Australia, Australia
| | - Andrew Hayles
- Academic Unit of STEM, University of South Australia, Mawson Lakes, SA 5095, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park 5042, South Australia, Australia
| | - Dennis Palms
- Academic Unit of STEM, University of South Australia, Mawson Lakes, SA 5095, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park 5042, South Australia, Australia
| | - Peter Zilm
- Adelaide Dental School, University of Adelaide, Adelaide, 5005, South Australia, Australia
| | - Dan Barker
- ANISOP Holdings, Pty. Ltd., 101 Collins St, Melbourne VIC, 3000 Australia
| | - Krasimir Vasilev
- Academic Unit of STEM, University of South Australia, Mawson Lakes, SA 5095, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park 5042, South Australia, Australia
| |
Collapse
|
33
|
Park HI, Lee JH, Lee SJ. The comprehensive on-demand 3D bio-printing for composite reconstruction of mandibular defects. Maxillofac Plast Reconstr Surg 2022; 44:31. [PMID: 36195777 PMCID: PMC9532487 DOI: 10.1186/s40902-022-00361-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background The mandible is a functional bio-organ that supports facial structures and helps mastication and speaking. Large mandible defects, generally greater than 6-cm segment loss, may require composite tissue reconstruction such as osteocutaneous-vascularized free flap which has a limitation of additional surgery and a functional morbidity at the donor site. A 3D bio-printing technology is recently developed to overcome the limitation in the composite reconstruction of the mandible using osteocutaneous-vascularized free flap. Review Scaffold, cells, and bioactive molecules are essential for a 3D bio-printing. For mandibular reconstruction, materials in a 3D bio-printing require mechanical strength, resilience, and biocompatibility. Recently, an integrated tissue and organ printing system with multiple cartridges are designed and it is capable of printing polymers to reinforce the printed structure, such as hydrogel. Conclusion For successful composite tissue reconstruction of the mandible, biologic considerations and components should be presented with a comprehensive on-demand online platform model of customized approaches.
Collapse
Affiliation(s)
- Han Ick Park
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Jee-Ho Lee
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea.
| | - Sang Jin Lee
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, 27157, USA.
| |
Collapse
|
34
|
Soldatos N, Pham H, Fakhouri WD, Ngo B, Lampropoulos P, Tran T, Weltman R. Temperature Changes during Implant Osteotomy Preparations in Human Cadaver Tibiae Comparing MIS ® Straight Drills with Densah ® Burs. Genes (Basel) 2022; 13:1716. [PMID: 36292601 PMCID: PMC9601368 DOI: 10.3390/genes13101716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/17/2022] [Accepted: 09/21/2022] [Indexed: 07/29/2023] Open
Abstract
(1) Background: Several studies showed a sustained temperature of 47 °C or 50 °C for one minute resulted in vascular stasis and bone resorption with only limited bone regrowth over a 3-4-week healing period. The purpose of the present study was to evaluate the temperature changes (ΔΤ) that occur during the preparation of dental implant osteotomies using MIS® straight drills versus Densah® burs in a clockwise (cutting) drilling protocol. (2) Methods: Two hundred forty (240) osteotomies of two different systems' drills were prepared at 6 mm depth at 800, 1000, and 1200 revolutions per minute (RPM), in fresh, unembalmed tibiae, obtained by a female cadaver. ΔΤ was calculated by subtracting the baseline temperature on the tibial surface, from the maximum temperature-inside the osteotomy (ΔT = Tmax - Tbase). The variables were evaluated both for their individual and for their synergistic effect on ΔΤ with the use of one-, two-, three- and four-way interactions; (3) Results: An independent and a three-way interaction (drill design, drill width, and RPM) was found in all three RPM for the Densah® burs and at 1000 RPM for the MIS® straight drills. As Densah® burs diameter increased, ΔΤ decreased. The aforementioned pattern was seen only at 1000 RPM for the MIS® straight drills. The usage of drills 20 times more than the implant manufacturers' recommendation did not significantly affect the ΔΤ. A stereoscopic examination of the specimens confirmed the findings. (4) Conclusions: The independent and synergistic effect of drills' diameter, design and RPM had a significant effect on ΔΤ in human tibiae, which never exceeded the critical threshold of 47 °C.
Collapse
Affiliation(s)
- Nikolaos Soldatos
- Department of Periodontics, School of Dentistry, Oregon Health Science University (OHSU), 2730 SW Moody Ave, Portland, OR 97201, USA
- Department of Periodontics and Dental Hygiene, School of Dentistry, University of Texas, Health Science Center at Houston, 7500 Cambridge St., Houston, TX 77054, USA
| | - Huy Pham
- Department of Periodontics and Dental Hygiene, School of Dentistry, University of Texas, Health Science Center at Houston, 7500 Cambridge St., Houston, TX 77054, USA
| | - Walid D. Fakhouri
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, University of Texas, Health Science Center at Houston, 7500 Cambridge St., Houston, TX 77054, USA
| | - Binh Ngo
- School of Dentistry, University of Texas, Health Science Center at Houston, 7500 Cambridge St., Houston, TX 77054, USA
| | - Panagiotis Lampropoulos
- Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens (NKUA), 2 Thivon St., Goudi, 11527 Athens, Greece
| | - Tiffany Tran
- California School of Podiatric Medicine, Samuel Merritt University, Oakland, CA 94609, USA
| | - Robin Weltman
- Department of Periodontics and Dental Hygiene, School of Dentistry, University of Texas, Health Science Center at Houston, 7500 Cambridge St., Houston, TX 77054, USA
- Department of Clinical Sciences, School of Dental Medicine, University of Nevada Las Vegas (UNLV), Las Vegas, NV 89106, USA
| |
Collapse
|
35
|
Injectability, Processability, Drug Loading, and Antibacterial Activity of Gentamicin-Impregnated Mesoporous Bioactive Glass Composite Calcium Phosphate Bone Cement In Vitro. Biomimetics (Basel) 2022; 7:biomimetics7030121. [PMID: 36134925 PMCID: PMC9496498 DOI: 10.3390/biomimetics7030121] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Calcium phosphate cement (CPC) is similar to bone in composition and has plasticity, while mesoporous bioactive glass (MBG) has the advantage of releasing Si, which can promote osteogenic properties and drug loading capacity. A sol–gel-prepared MBG micro-powder (mMBG) and further impregnated antibiotic gentamicin sulfate (Genta@mMBG: 2, 3, and 4 mg/mL) antibiotic were added to CPC at different weight ratios (5, 10, and 15 wt.%) to study CPC’s potential clinical applications. Different ratios of mMBG/CPC composite bone cement showed good injectability and disintegration resistance, but with increasing mMBG addition, the working/setting time and compressive strength decreased. The maximum additive amount was 10 wt.% mMBG due to the working time of ~5 min, the setting time of ~10 min, and the compressive strength of ~51 MPa, indicating that it was more suitable for clinical surgical applications than the other groups. The 2Genta@mMBG group loaded with 2 mg/mL gentamicin had good antibacterial activity, and the 10 wt.% 2Genta@mMBG/CPC composite bone cement still had good antibacterial activity but reduced the initial release of Genta. 2Genta@mMBG was found to have slight cytotoxicity, so 2Genta@mMBG was composited into CPC to improve the biocompatibility and to endow CPC with more advantages for clinical application.
Collapse
|
36
|
Poovarodom P, Rungsiyakull C, Suriyawanakul J, Li Q, Sasaki K, Yoda N, Rungsiyakull P. Effect of implant placement depth on bone remodeling on implant-supported single zirconia abutment crown: A 3D finite element study. J Prosthodont Res 2022; 67:278-287. [PMID: 35934782 DOI: 10.2186/jpr.jpr_d_22_00054] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE This study aimed to evaluate the influence of subcrestal implant placement depth on bone remodeling using time-dependent finite element analysis (FEA) with a bone-remodeling algorithm over 12 months. METHODS Seven models of different subcrestal implant placement depths (0, 0.5, 1.0, 1.5, 2.0, 2.5, and 3.0 mm) were analyzed using FEA to evaluate the biomechanical responses in the bone and implant, including von Mises equivalent stress, strain energy density (SED), and overloading elements. SED was used as a mechanical stimulus to simulate cortical and cancellous bone remodeling over the first 12 months after final prosthesis delivery. RESULTS The highest increase in cortical bone density was observed at Depth 1.5, whereas the lowest increase was observed at Depth 3.0. In contrast, the highest increase in bone density was observed at Depth 3.0 in the cancellous bone, whereas the lowest increase was observed at Depth 0. The highest peak von Mises stress in the cortical bone occurred at Depth 2.5 (107.24 MPa), while that in the cancellous bone was at Depth 2.5 (34.55 MPa). Notably, the maximum von Mises stress values in the cancellous bone exceeded the natural limit of the bony material, as indicated by the overloading elements observed at the depths of 2.0, 2.5, and 3.0 mm. CONCLUSION Greater bone density apposition is observed with deeper implant placement. An implant depth of more than 1.5 mm exhibited a higher maximum von Mises stress and greater overloading elements.
Collapse
Affiliation(s)
- Pongsakorn Poovarodom
- PhD Student, Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Thailand
| | - Chaiy Rungsiyakull
- Department of Mechanical Engineering, Faculty of Engineering, Chiang Mai University, Thailand
| | - Jarupol Suriyawanakul
- Department of Mechanical Engineering, Faculty of Engineering, Khon Kaen University, Thailand
| | - Qing Li
- School of Aerospace, Mechanical and Mechatronic Engineering, Faculty of Engineering, The University of Sydney, Australia
| | - Keiichi Sasaki
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Japan
| | - Nobuhiro Yoda
- Graduate School of Dentistry, Division of Prosthetic Dentistry, Tohoku University, Japan
| | - Pimduen Rungsiyakull
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Thailand
| |
Collapse
|
37
|
Barium Oxide Doped Magnesium Silicate Nanopowders for Bone Fracture Healing: Preparation, Characterization, Antibacterial and In Vivo Animal Studies. Pharmaceutics 2022; 14:pharmaceutics14081582. [PMID: 36015208 PMCID: PMC9415424 DOI: 10.3390/pharmaceutics14081582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 02/01/2023] Open
Abstract
Magnesium silicate (MgS) nanopowders doped with barium oxide (BaO) were prepared by sol-gel technique, which were then implanted into a fracture of a tibia bone in rats for studying enhanced in vivo bone regeneration. The produced nanopowders were characterized using X-ray diffraction (XRD), Fourier transform infrared spectra (FTIR), scanning electron microscope with energy-dispersive X-ray spectrometry (SEM-EDX) and transmission electron microscope (TEM). Mechanical and bactericidal properties of the nanopowders were also determined. Increased crystallinity, particle diameter and surface area were found to decrease after the BaO doping without any notable alterations on their chemical integrities. Moreover, elevated mechanical and antibacterial characteristics were recognized for higher BaO doping concentrations. Our animal studies demonstrated that impressive new bone tissues were formed in the fractures while the prepared samples degraded, indicating that the osteogenesis and degradability of the BaO containing MgS samples were better than the control MgS. The results of the animal study indicated that the simultaneous bone formation on magnesium biomaterial silicate and barium MgS with completed bone healing after five weeks of implantations. The findings also demonstrated that the prepared samples with good biocompatibility and degradability could enhance vascularization and osteogenesis, and they have therapeutic potential to heal bone fractures.
Collapse
|
38
|
Wattanaanek N, Suttapreyasri S, Samruajbenjakun B. 3D Printing of Calcium Phosphate/Calcium Sulfate with Alginate/Cellulose-Based Scaffolds for Bone Regeneration: Multilayer Fabrication and Characterization. J Funct Biomater 2022; 13:47. [PMID: 35645255 PMCID: PMC9149863 DOI: 10.3390/jfb13020047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/15/2022] [Accepted: 04/22/2022] [Indexed: 12/23/2022] Open
Abstract
Congenital abnormalities, trauma, and disease result in significant demands for bone replacement in the craniofacial region and across the body. Tetra-compositions of organic and inorganic scaffolds could provide advantages for bone regeneration. This research aimed to fabricate and characterize amorphous calcium phosphate (ACP)/calcium sulfate hemihydrate (CSH) with alginate/cellulose composite scaffolds using 3D printing. Alginate/cellulose gels were incorporated with 0%, 13%, 15%, 18%, 20%, and 23% ACP/CSH using the one-pot process to improve morphological, physiochemical, mechanical, and biological properties. SEM displayed multi-staggered filament layers with mean pore sizes from 298 to 377 μm. A profilometer revealed mean surface roughness values from 43 to 62 nm that were not statistically different. A universal test machine displayed the highest compressive strength and modulus with a statistical significance in the 20% CP/CS group. FTIR spectroscopy showed peaks in carbonate, phosphate, and sulfate groups that increased as more ACP/CSH was added. Zero percent of ACP/CSH showed the highest swelling and lowest remaining weight after degradation. The 23% ACP/CSH groups cracked after 60 days. In vitro biocompatibility testing used the mouse osteoblast-like cell line MC3T3-E1. The 18% and 20% ACP/CSH groups showed the highest cell proliferation on days five and seven. The 20% ACP/CSH was most suitable for bone cell regeneration.
Collapse
Affiliation(s)
- Nattanan Wattanaanek
- Orthodontic Section, Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hat Yai 90112, Songkhla, Thailand;
| | - Srisurang Suttapreyasri
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Prince of Songkla University, Hat Yai 90112, Songkhla, Thailand;
| | - Bancha Samruajbenjakun
- Orthodontic Section, Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hat Yai 90112, Songkhla, Thailand;
| |
Collapse
|
39
|
Liokatis P, Tzortzinis G, Gerasimidis S, Smolka W. Application of the lambda plate on condylar fractures: Finite element evaluation of the fixation rigidity for different fracture patterns and plate placements. Injury 2022; 53:1345-1352. [PMID: 35101256 DOI: 10.1016/j.injury.2022.01.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The treatment challenges of condylar fractures necessitated the production of several plate designs. Among the relatively new plate designs is the lambda plate, for which biomechanical and clinical data are lacking. The purpose of this study is to examine the rigidity of fixation achieved when the lambda plate is applied to different fractures of the condylar neck and base. METHODS Five fractures of the condylar area were designed on a virtual model of a healthy mandible obtained from a CT scan. The fractures were reduced using the lambda plate. For the same fractures, alternative placements of the plate were simulated. The generated models were analysed using the finite element analysis for a 500 N bite load. The displacement of the two condylar fragments along the fracture line was calculated as an indicator of the rigidity of the fixation. RESULTS The displacement along the fracture was less than 0.144 mm for the neck fractures and greater than 0.165 mm for the fractures of the condylar base. A more cranial placement of the plate for the neck fractures further reduced the displacement, while a more anterior placement of the plate for the base fractures resulted in displacements greater than 0.330 mm. CONCLUSION According to our study, the lambda plate offers better rigidity when applied as cranially as possible for condylar neck fractures. The lambda plate did not provide adequate fixation for base fractures. A second plate at the sigmoid notch should be considered to achieve better stabilization along the fracture if the lambda plate is eventually used.
Collapse
Affiliation(s)
- Paris Liokatis
- Senior Resident, Department of Oral & Maxillofacial Surgery, Ludwig-Maximilians-University of Munich, Germany.
| | - Georgios Tzortzinis
- Dresden Center for Intelligent Materials (DCIM), Technische Universität Dresden, Dresden, Germany
| | - Simos Gerasimidis
- Assistant Professor, Department of Civil and Environmental Engineering, University of Massachusetts, Amherst, MA, USA
| | - Wenko Smolka
- Senior Consultant, Department of Oral & Maxillofacial Surgery, Ludwig-Maximilians-University of Munich, Germany
| |
Collapse
|
40
|
Chen S, Rittel D, Shemtov-Yona K. Probing the sensitivity of the resonant frequency analysis to the dental implant-bone condition: A numerical study. J Mech Behav Biomed Mater 2022; 128:105128. [DOI: 10.1016/j.jmbbm.2022.105128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/29/2022]
|
41
|
Soldatos N, Nelson-Rabe L, Palanker N, Angelov N, Romanos G, Weltman R. Temperature Changes during Implant Osteotomy Preparations in Fresh Human Cadaver Tibiae, Comparing Straight with Tapered Drills. MATERIALS 2022; 15:ma15072369. [PMID: 35407704 PMCID: PMC8999768 DOI: 10.3390/ma15072369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/26/2022] [Accepted: 03/16/2022] [Indexed: 12/03/2022]
Abstract
The success of osseointegration depends on many factors. With temperatures beyond a 47 °C threshold over 1 min, bone survival may be impaired. The purpose of the study was to evaluate, in fresh human cadaver tibiae, the temperature changes during osteotomy preparations using two straight and two tapered implant systems’ drills, external irrigation, and varying revolutions per minute (RPM). The tibiae from a fresh female cadaver were harvested bilaterally. Two tapered and two straight design drills were assessed. Two-hundred and forty osteotomies were prepared at 6 mm depth following the drill sequence of the manufacturers’ protocol for each drilling speed. Difference in temperature (ΔΤ) was calculated by subtracting the baseline from the maximum temperature (ΔT = Tmax − Tbase). Drill design and drill diameter, as independent variables or synergistically, had a significant effect on ΔΤ. Tapered drills: As the drill diameter increased, ΔΤ increased at all RPM. Straight drills: As the drill diameter increased, ΔΤ remained constant or slightly decreased at all RPM. Drill diameter and design had a significant effect on ΔΤ in human tibiae, which never exceeded the critical threshold of 47 °C. Tapered drills caused significantly greater heat production compared to straight drills.
Collapse
Affiliation(s)
- Nikolaos Soldatos
- Department of Periodontics and Dental Hygiene, School of Dentistry, University of Texas, Health Science Center at Houston, 7500 Cambridge Str, Suite 6400, Houston, TX 77054, USA; (L.N.-R.); (N.P.); (N.A.); (R.W.)
- Correspondence:
| | - Laura Nelson-Rabe
- Department of Periodontics and Dental Hygiene, School of Dentistry, University of Texas, Health Science Center at Houston, 7500 Cambridge Str, Suite 6400, Houston, TX 77054, USA; (L.N.-R.); (N.P.); (N.A.); (R.W.)
| | - Nathan Palanker
- Department of Periodontics and Dental Hygiene, School of Dentistry, University of Texas, Health Science Center at Houston, 7500 Cambridge Str, Suite 6400, Houston, TX 77054, USA; (L.N.-R.); (N.P.); (N.A.); (R.W.)
| | - Nikola Angelov
- Department of Periodontics and Dental Hygiene, School of Dentistry, University of Texas, Health Science Center at Houston, 7500 Cambridge Str, Suite 6400, Houston, TX 77054, USA; (L.N.-R.); (N.P.); (N.A.); (R.W.)
| | - Georgios Romanos
- Department of Periodontology, LASER Education at SDM, School of Dental Medicine (SDM), Stony Brook University, South Dr, Stony Brook, Long Island, NY 11794, USA;
| | - Robin Weltman
- Department of Periodontics and Dental Hygiene, School of Dentistry, University of Texas, Health Science Center at Houston, 7500 Cambridge Str, Suite 6400, Houston, TX 77054, USA; (L.N.-R.); (N.P.); (N.A.); (R.W.)
- Department of Clinical Sciences, School of Dental Medicine, University of Nevada, Las Vegas, NV 89106, USA
| |
Collapse
|
42
|
Jani M, Gaur V, Doshi AG, Patel K, Pałka Ł. Clinically Based Classification and Positioning Indication for Single-Piece Compressive Implants Placement in Regard to Extraction Socket. Healthcare (Basel) 2022; 10:healthcare10040598. [PMID: 35455776 PMCID: PMC9024819 DOI: 10.3390/healthcare10040598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/11/2022] [Accepted: 03/18/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: Dental implantology has been rapidly developing over the last decades. The introduction of new materials, surface modifications and implant designs has brought the need to rethink and systematize our knowledge regarding dental implants. Thus, the aim of this paper is to introduce a new classification and implant positioning indications that can be used to maximize the survival rate and the aesthetic outcome of single-piece compressive screw implants. (2) Materials and methods: This classification was based on a multicenter clinical and radiological observation of 151 patients, in whom 1057 implants were placed with a success rate of 98.5% (1041). The follow-up period was up to 82 months with a mean of 22.34 months. (3) Results: it seems that, in the case of single-piece implants, diameter and length of the implant have influence on their survival rate, whereas smoking and hypertension do not. (4) Conclusions: this paper provides clinicians with comprehensive information about the rationale, criteria and implementation of the new classifications based on a large number of implants and long-term observations.
Collapse
Affiliation(s)
- Mmehul Jani
- Department of Oral and Maxillofacial Surgery, College of Dental Sciences, Ahmedabad 382115, India; (M.J.); (K.P.)
| | - Vivek Gaur
- Jaipur Dental College, Maharaj Vinayak Global University, Jaipur 302038, India;
| | | | - Kiran Patel
- Department of Oral and Maxillofacial Surgery, College of Dental Sciences, Ahmedabad 382115, India; (M.J.); (K.P.)
| | - Łukasz Pałka
- Private Dental Practice, 68200 Zary, Poland
- Correspondence:
| |
Collapse
|
43
|
Bojedla SSR, Chameettachal S, Yeleswarapu S, Nikzad M, Masood SH, Pati F. Silk fibroin microfiber-reinforced polycaprolactone composites with enhanced biodegradation and biological characteristics. J Biomed Mater Res A 2022; 110:1386-1400. [PMID: 35261161 DOI: 10.1002/jbm.a.37380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/13/2022] [Accepted: 03/01/2022] [Indexed: 01/18/2023]
Abstract
There is an enormous demand for bone graft biomaterials to treat developmental and acquired bony defects arising from infections, trauma, tumor, and other conditions. Polycaprolactone (PCL) has been extensively utilized for bone tissue engineering but limited cellular interaction and tissue integration are the primary concerns. PCL-based composites with different biomaterials have been attempted to improve the mechanical and biological response. Interestingly, a few studies have tried to blend PCL with aqueous silk fibroin solution, but the structures prepared with the blend were mechanically weak due to phase mismatch. As a result, silk microparticle-based PCL composites have been prepared, but the microfibers-reinforced composites could be superior to them due to significant fiber-matrix interaction. This study aims at developing a unique composite by incorporating 100-150 μm long (aspect ratio; 8:1-5:1) silk-fibroin microfibers into the PCL matrix for superior biological and mechanical properties. Two silk variants were used, that is, Bombyx mori and a wild variant, Antheraea mylitta, reported to have cell recognizable Arginine-Glycine-Aspartic acid (RGD) sequences. A. mylitta silk fibroin microfibers were produced, and composites were made with PCL for the first time. The morphological, tensile, thermal, biodegradation, and biological properties of the composites were evaluated. Importantly, we tried to optimize the silk concentration within the composite to strike a balance among the cellular response, biodegradation, and mechanical strength of the composites. The results indicate that the PCL-silk fibroin microfiber composite could be an efficient biomaterial for bone tissue engineering.
Collapse
Affiliation(s)
- Sri Sai Ramya Bojedla
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad, Kandi, Sangareddy, Telangana, India
| | - Shibu Chameettachal
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad, Kandi, Sangareddy, Telangana, India
| | - Sriya Yeleswarapu
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad, Kandi, Sangareddy, Telangana, India
| | - Mostafa Nikzad
- Department of Mechanical and Product Design Engineering, School of Engineering, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Syed H Masood
- Department of Mechanical and Product Design Engineering, School of Engineering, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Falguni Pati
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad, Kandi, Sangareddy, Telangana, India
| |
Collapse
|
44
|
Fixture Length and Primary Stability: An In Vitro Study on Polyurethane Foam. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12052683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
(1) Background: Recently, novel dental implants that are characterized by different levels of surface roughness in the distinct parts of the fixture’s body have been introduced in the market. These surface characteristics could affect the primary stability of the implants. The aim of this in vitro study was to compare the primary stability of short and long implants, characterized by multiscale surface roughness, inserted on polyurethane blocks. The secondary aim was to understand if the implant length could be a crucial factor in the decision-making in immediate or rather than delayed loading protocol in the different bone densities. (2) Methods: A total of 20 cylindrical dental implants with a diameter of 5.0 mm were tested for the lengths 6.0 mm (short implants) versus 13.0 mm (long implants) on two different solid rigid polyurethane blocks (20 and 30 PCF). The primary stability was evaluated by measuring the insertion torque value (ITV), the removal torque (RTV), and the resonance frequency analysis RFA. (3) Results: The values of ITV, RTV, and RFA showed the same trend in all measurements. Long implants showed a significantly higher primary stability on 30 PCF blocks that present mechanical properties similar to high-density bone. On the contrary, no relevant differences were found on 20 PCF blocks, which mimic trabecular bone density. (4) Conclusions: The impact of fixture length on the primary stability of implants with multiscale surface roughness is significant in 30 PCF polyurethane corresponding to higher bone density, but not in lower ones.
Collapse
|
45
|
Meneses J, van de Kemp T, Costa-Almeida R, Pereira R, Magalhães FD, Castilho M, Pinto AM. Fabrication of Polymer/Graphene Biocomposites for Tissue Engineering. Polymers (Basel) 2022; 14:polym14051038. [PMID: 35267861 PMCID: PMC8914623 DOI: 10.3390/polym14051038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 02/26/2022] [Accepted: 02/26/2022] [Indexed: 12/10/2022] Open
Abstract
Graphene-based materials (GBM) are considered one of the 21st century’s most promising materials, as they are incredibly light, strong, thin and have remarkable electrical and thermal properties. As a result, over the past decade, their combination with a diverse range of synthetic polymers has been explored in tissue engineering (TE) and regenerative medicine (RM). In addition, a wide range of methods for fabricating polymer/GBM scaffolds have been reported. This review provides an overview of the most recent advances in polymer/GBM composite development and fabrication, focusing on methods such as electrospinning and additive manufacturing (AM). As a future outlook, this work stresses the need for more in vivo studies to validate polymer/GBM composite scaffolds for TE applications, and gives insight on their fabrication by state-of-the-art processing technologies.
Collapse
Affiliation(s)
- João Meneses
- LEPABE, Faculdade de Engenharia, Universidade do Porto, Rua Roberto Frias, 4200-465 Porto, Portugal; (J.M.); (T.v.d.K.); (F.D.M.)
- International Iberian Nanotechnology Laboratory, 4715-330 Braga, Portugal
| | - Tom van de Kemp
- LEPABE, Faculdade de Engenharia, Universidade do Porto, Rua Roberto Frias, 4200-465 Porto, Portugal; (J.M.); (T.v.d.K.); (F.D.M.)
- i3S—Instituto de Investigação e Inovacão em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; (R.C.-A.); (R.P.)
- INEB—Instituto de Engenharia Biomédica, Universidade do Porto, 4200-135 Porto, Portugal
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Raquel Costa-Almeida
- i3S—Instituto de Investigação e Inovacão em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; (R.C.-A.); (R.P.)
- INEB—Instituto de Engenharia Biomédica, Universidade do Porto, 4200-135 Porto, Portugal
| | - Rúben Pereira
- i3S—Instituto de Investigação e Inovacão em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; (R.C.-A.); (R.P.)
- INEB—Instituto de Engenharia Biomédica, Universidade do Porto, 4200-135 Porto, Portugal
- ICBAS—Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
| | - Fernão D. Magalhães
- LEPABE, Faculdade de Engenharia, Universidade do Porto, Rua Roberto Frias, 4200-465 Porto, Portugal; (J.M.); (T.v.d.K.); (F.D.M.)
| | - Miguel Castilho
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands
| | - Artur M. Pinto
- LEPABE, Faculdade de Engenharia, Universidade do Porto, Rua Roberto Frias, 4200-465 Porto, Portugal; (J.M.); (T.v.d.K.); (F.D.M.)
- i3S—Instituto de Investigação e Inovacão em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; (R.C.-A.); (R.P.)
- INEB—Instituto de Engenharia Biomédica, Universidade do Porto, 4200-135 Porto, Portugal
- Correspondence:
| |
Collapse
|
46
|
Wang F, Tankus EB, Santarella F, Rohr N, Sharma N, Märtin S, Michalscheck M, Maintz M, Cao S, Thieringer FM. Fabrication and Characterization of PCL/HA Filament as a 3D Printing Material Using Thermal Extrusion Technology for Bone Tissue Engineering. Polymers (Basel) 2022; 14:polym14040669. [PMID: 35215595 PMCID: PMC8879030 DOI: 10.3390/polym14040669] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/28/2022] [Accepted: 02/06/2022] [Indexed: 12/19/2022] Open
Abstract
The most common three-dimensional (3D) printing method is material extrusion, where a pre-made filament is deposited layer-by-layer. In recent years, low-cost polycaprolactone (PCL) material has increasingly been used in 3D printing, exhibiting a sufficiently high quality for consideration in cranio-maxillofacial reconstructions. To increase osteoconductivity, prefabricated filaments for bone repair based on PCL can be supplemented with hydroxyapatite (HA). However, few reports on PCL/HA composite filaments for material extrusion applications have been documented. In this study, solvent-free fabrication for PCL/HA composite filaments (HA 0%, 5%, 10%, 15%, 20%, and 25% weight/weight PCL) was addressed, and parameters for scaffold fabrication in a desktop 3D printer were confirmed. Filaments and scaffold fabrication temperatures rose with increased HA content. The pore size and porosity of the six groups’ scaffolds were similar to each other, and all had highly interconnected structures. Six groups’ scaffolds were evaluated by measuring the compressive strength, elastic modulus, water contact angle, and morphology. A higher amount of HA increased surface roughness and hydrophilicity compared to PCL scaffolds. The increase in HA content improved the compressive strength and elastic modulus. The obtained data provide the basis for the biological evaluation and future clinical applications of PCL/HA material.
Collapse
Affiliation(s)
- Fengze Wang
- MIRACLE Smart Implants Group, Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland; (F.W.); (E.B.T.); (F.S.); (N.S.); (M.M.); (M.M.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Esma Bahar Tankus
- MIRACLE Smart Implants Group, Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland; (F.W.); (E.B.T.); (F.S.); (N.S.); (M.M.); (M.M.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Francesco Santarella
- MIRACLE Smart Implants Group, Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland; (F.W.); (E.B.T.); (F.S.); (N.S.); (M.M.); (M.M.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Nadja Rohr
- Biomaterials and Technology, Department of Reconstructive Dentistry, University Center for Dental Medicine Basel UZB, University of Basel, 4058 Basel, Switzerland;
| | - Neha Sharma
- MIRACLE Smart Implants Group, Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland; (F.W.); (E.B.T.); (F.S.); (N.S.); (M.M.); (M.M.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland
| | - Sabrina Märtin
- Biomaterials and Technology, Department of Research, University Center of Dental Medicine Basel UZB, University of Basel, 4058 Basel, Switzerland;
| | - Mirja Michalscheck
- MIRACLE Smart Implants Group, Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland; (F.W.); (E.B.T.); (F.S.); (N.S.); (M.M.); (M.M.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland
| | - Michaela Maintz
- MIRACLE Smart Implants Group, Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland; (F.W.); (E.B.T.); (F.S.); (N.S.); (M.M.); (M.M.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
- Institute for Medical Engineering and Medical Informatics, University of Applied Sciences and Arts of Northwestern Switzerland, 4132 Muttenz, Switzerland
| | - Shuaishuai Cao
- MIRACLE Smart Implants Group, Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland; (F.W.); (E.B.T.); (F.S.); (N.S.); (M.M.); (M.M.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
- Department of Stomatology, Shenzhen University General Hospital and Shenzhen University Clinical Medical Academy, Shenzhen University, Shenzhen 518071, China
- Correspondence: (S.C.); (F.M.T.)
| | - Florian M. Thieringer
- MIRACLE Smart Implants Group, Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland; (F.W.); (E.B.T.); (F.S.); (N.S.); (M.M.); (M.M.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Correspondence: (S.C.); (F.M.T.)
| |
Collapse
|
47
|
Nelluri V, Gedela R, Roseme K. A 3-year prospective clinical study to evaluate the outcome of single-piece implant-prosthetic complex after immediate nonfunctional loading in the maxillary anterior and mandibular posterior areas in varied bone densities. Contemp Clin Dent 2022; 13:140-149. [PMID: 35846581 PMCID: PMC9285836 DOI: 10.4103/ccd.ccd_698_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/26/2020] [Accepted: 01/22/2021] [Indexed: 11/24/2022] Open
Abstract
Context: There is limited evidence on the outcome of single-piece implant-prosthetic complex after immediate nonfunctional loading in varied bone densities. Aim: The aim of this study was to report the outcome of single-piece implant-prosthetic complex with a novel cervical platform design in the anterior and posterior jaws 3 years after loading. Setting and Design: Prospective clinical study. Materials and Methods: The present study included placement of 90 single-piece implants in the anterior and the posterior jaws in varied bone densities. After immediate loading, survival and marginal bone loss was recorded at regular intervals. Statistical Analysis: Independent sample t-test and paired t-test were done (P = 0.05). Results: Group I, annual marginal bone loss at the end of one, 2 and 3 years was 0.21, respectively, in both bone densities. Group II, annual marginal bone loss in D2 regions was 0.75,0.38 and 0.18; 0.64, 0.28 and 0.18 in D3 regions at the end of 1, 2, and 3 years, respectively. Group I showed no statistically significant difference in marginal bone loss between D2 and D3 bone annually in contrast to Group II. Intragroup comparisons of mean between baseline and various time intervals showed statistically significant bone loss in both bone densities. Conclusion: Three years after loading, single-piece implants with the novel cervical platform design provided survival rates of 93% in the maxillary anteriors and 91% in the mandibular posteriors. D3 bone showed more marginal bone loss than D2 bone.
Collapse
|
48
|
Senatov F, Zimina A, Chubrik A, Kolesnikov E, Permyakova E, Voronin A, Poponova M, Orlova P, Grunina T, Nikitin K, Krivozubov M, Strukova N, Generalova M, Ryazanova A, Manskikh V, Lunin V, Gromov A, Karyagina A. Effect of recombinant BMP-2 and erythropoietin on osteogenic properties of biomimetic PLA/PCL/HA and PHB/HA scaffolds in critical-size cranial defects model. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2022; 135:112680. [DOI: 10.1016/j.msec.2022.112680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/14/2022] [Accepted: 01/21/2022] [Indexed: 12/28/2022]
|
49
|
Huang YC, Ding SJ, Yuan C, Yan M. Biomechanical analysis of rigid and non-rigid connection with implant abutment designs for tooth-implant supported prosthesis: A finite element analysis. J Dent Sci 2022; 17:490-499. [PMID: 35028075 PMCID: PMC8739742 DOI: 10.1016/j.jds.2021.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/26/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND/PURPOSE The design of the connectors and implant abutments could affect the stress distribution of the tooth-implant supported prosthesis (TISP) entire system after loading. Therefore, the purpose of this study was to investigate the stress distribution of the TISP in different connectors and different implant abutments after loading. MATERIALS AND METHODS The TISP design used in this study was divided into six models. R1, R2 and R3 represented the tooth and the one-piece, two-piece and three-piece abutment implant system connected by a rigid connector, respectively, while NR1, NR2 and NR3 were the corresponding tooth-abutment implant systems connected by a non-rigid connector. A vertical occlusal load of 50 N was applied at a right angle on the 6 occlusal points of the occlusal surface. RESULTS As a result, regarding the maximum average stress distribution, R1 and NR1 appeared on the implant fixture, and the other four models were on the implant abutment. On the other hand, regardless of the abutment implant system, the maximum von Mises stress generated by the rigid connector was greater than the corresponding non-rigid connector in the cortical bone around implant. In addition, the three-piece abutment implant system had lower von Mises stress than the one-piece and two-piece implant systems in the cortical bone. CONCLUSION It is concluded that by adding a flexible non-rigid connector and three-piece abutment device design to TISP, the occlusal load of the implant was dispersed, and the stress could be gradually introduced into the relatively strong implant abutment.
Collapse
Affiliation(s)
- Yen-Chang Huang
- Institute of Oral Sciences, Chung Shan Medical University, Taichung, Taiwan
| | - Shinn-Jyh Ding
- Institute of Oral Sciences, Chung Shan Medical University, Taichung, Taiwan
- Department of Dentistry, Chung Shan Medical University Hospital, Chung Shan Medical University, Taichung, Taiwan
| | - Cadmus Yuan
- Department of Mechanical and Computer-aided Engineering, Feng Chia University, Taichung, Taiwan
| | - Min Yan
- Institute of Oral Sciences, Chung Shan Medical University, Taichung, Taiwan
- Department of Dentistry, Chung Shan Medical University Hospital, Chung Shan Medical University, Taichung, Taiwan
| |
Collapse
|
50
|
Cao SS, Li SY, Geng YM, Kapat K, Liu SB, Perera FH, Li Q, Terheyden H, Wu G, Che YJ, Miranda P, Zhou M. Prefabricated 3D-Printed Tissue-Engineered Bone for Mandibular Reconstruction: A Preclinical Translational Study in Primate. ACS Biomater Sci Eng 2021; 7:5727-5738. [PMID: 34808042 PMCID: PMC8672350 DOI: 10.1021/acsbiomaterials.1c00509] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
![]()
The
advent of three dimensionally (3D) printed customized bone
grafts using different biomaterials has enabled repairs of complex
bone defects in various in vivo models. However, studies related to
their clinical translations are truly limited. Herein, 3D printed
poly(lactic-co-glycolic acid)/β-tricalcium
phosphate (PLGA/TCP) and TCP scaffolds with or without recombinant
bone morphogenetic protein −2 (rhBMP-2) coating were utilized
to repair primate’s large-volume mandibular defects and compared
efficacy of prefabricated tissue-engineered bone (PTEB) over direct
implantation (without prefabrication). 18F-FDG PET/CT was
explored for real-time monitoring of bone regeneration and vascularization.
After 3-month’s prefabrication, the original 3D-architecture
of the PLGA/TCP-BMP scaffold was found to be completely lost, while
it was properly maintained in TCP-BMP scaffolds. Besides, there was
a remarkable decrease in the PLGA/TCP-BMP scaffold density and increase
in TCP-BMP scaffolds density during ectopic (within latissimus dorsi
muscle) and orthotopic (within mandibular defect) implantation, indicating
regular bone formation with TCP-BMP scaffolds. Notably, PTEB based
on TCP-BMP scaffold was successfully fabricated with pronounced effects
on bone regeneration and vascularization based on radiographic, 18F-FDG PET/CT, and histological evaluation, suggesting a promising
approach toward clinical translation.
Collapse
Affiliation(s)
- Shuai-Shuai Cao
- Department of Oral and Maxillofacial Surgery, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510182, China
| | - Shu-Yi Li
- Department of Oral and Maxillofacial Surgery, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510182, China.,Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam UMC and Academic Center for Dentistry Amsterdam (ACTA), Amsterdam Movement Science, de Boelelaan, Vrije Universiteit Amsterdam 1117, Amsterdam, The Netherlands
| | - Yuan-Ming Geng
- Department of Stomatology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Kausik Kapat
- Department of Oral and Maxillofacial Surgery, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510182, China
| | - Shang-Bin Liu
- Department of Oral and Maxillofacial Surgery, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510182, China
| | - Fidel Hugo Perera
- Department of Mechanical, Energy and Materials Engineering, University of Extremadura, Industrial Engineering School, Avda. de Elvas s/n, 06006 Badajoz, Spain
| | - Qian Li
- Hangzhou Jiuyuan Gene Engineering Co., Ltd., Hangzhou 3100018, China
| | - Hendrik Terheyden
- Department of Oral and Maxillofacial Surgery, Red Cross Hospital, Kassel 34117, Germany
| | - Gang Wu
- Department of Oral Implantology and Prosthetic Dentistry, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam 1117, The Netherlands
| | - Yue-Juan Che
- Department of Anesthesia, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
| | - Pedro Miranda
- Department of Mechanical, Energy and Materials Engineering, University of Extremadura, Industrial Engineering School, Avda. de Elvas s/n, 06006 Badajoz, Spain
| | - Miao Zhou
- Department of Oral and Maxillofacial Surgery, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510182, China
| |
Collapse
|