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Timme M, Steffens L, Viktorov J, Streeter A, Karch A, Schmeling A. Radiological assessment of periodontal ligament space visibility on third molars for forensic age assessment - a comparison study of three different staging scales. Int J Legal Med 2024; 138:1523-1531. [PMID: 38367027 PMCID: PMC11164763 DOI: 10.1007/s00414-024-03184-5] [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: 12/27/2023] [Accepted: 02/02/2024] [Indexed: 02/19/2024]
Abstract
Various staging scales have been proposed for the assessment of the visibility of the periodontal ligament space of mandibular third molars on dental panoramic radiographs (PANs) for forensic age assessment in living individuals. However, up to now, there has been no systematic comparison between these staging scales available. We directly compared the 2010 staging scale proposed by Olze et al. with the 2017 staging by Lucas et al. and the 2020 staging by Guo et al. in a German study population. We evaluated 233 PANs from 115 females and 118 males aged 20.0 to 40.9 years using three independent examiners, with one examiner conducting two assessments. We examined the correlation between age and stage, as well as the inter- and intra-rater reliabilities. While the point estimates for the correlation coefficient and the reliability measures were lowest for the Guo scale and highest for the Olze scale, confidence intervals showed a large overlap, particularly for the scales of Olze et al. and Lucas et al. The correlation coefficients between stage and age were consistently lower in females than in males across all methods. In summary, we showed that the staging scales of Olze et al. and Lucas et al. were very similar. The Olze method showed higher point estimates across all analyses, and because there are more reference data available for this method, we argue that it should be preferred as the method of choice for further studies in the field. However, Guo method could be considered for instances, in which the inter-radicular periodontal ligament is not evaluable.
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Affiliation(s)
- Maximilian Timme
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Munster, Germany.
| | - Laurin Steffens
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Munster, Germany
| | - Jan Viktorov
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Munster, Germany
| | - Adam Streeter
- Institute of Epidemiology and Social Medicine, University of Münster, Domagkstraße 3, 48149, Munster, Germany
| | - André Karch
- Institute of Epidemiology and Social Medicine, University of Münster, Domagkstraße 3, 48149, Munster, Germany
| | - Andreas Schmeling
- Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Munster, Germany
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Cui J, Yao C, Zhang Z, Zhang T, Cao Y, Liu T, Li B, Wu X. Maxillary molar distalization treated with clear aligners combined with mini-implants and angel button using different traction force: a finite element study. Comput Methods Biomech Biomed Engin 2024; 27:296-305. [PMID: 36939836 DOI: 10.1080/10255842.2023.2183735] [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: 05/19/2022] [Revised: 02/11/2023] [Accepted: 02/16/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVES To evaluate the biomechanical system of molar distalization with clear aligner therapy (CAT) combined with angel button using interradicular mini-implants (IRMIs) with varying elastic forces. MATERIALS AND METHODS FE models including maxilla, complete maxillary dentition, periodontal ligaments (PDL), composite attachments, mini-implants (MI), and dedicated orthodontic aligner, were constructed. Three groups were created in accordance with the sagittal position of MI. Elastic forces (0 N,1 N,1.5 N,2 N) were applied. RESULTS CAT without elastics caused labial tipping and intrusion of the anterior teeth. Initial labial tipping and the von Mises stress of the maxillary anterior teeth decreased as the elastic forces increased.
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Affiliation(s)
- Jiayu Cui
- Department of Orthodontics, School of Stomatology, Stomatological Hospital, Shanxi Medical University, Shanxi, China
| | - Chengliang Yao
- Department of Orthodontics, School of Stomatology, Stomatological Hospital, Shanxi Medical University, Shanxi, China
| | - Zheyuan Zhang
- Department of Orthodontics, School of Stomatology, Stomatological Hospital, Shanxi Medical University, Shanxi, China
| | - Tong Zhang
- Department of Orthodontics, School of Stomatology, Stomatological Hospital, Shanxi Medical University, Shanxi, China
| | - Yuxin Cao
- Department of Orthodontics, School of Stomatology, Stomatological Hospital, Shanxi Medical University, Shanxi, China
| | - Ting Liu
- Department of Orthodontics, School of Stomatology, Stomatological Hospital, Shanxi Medical University, Shanxi, China
| | - Bing Li
- Department of Orthodontics, School of Stomatology, Stomatological Hospital, Shanxi Medical University, Shanxi, China
| | - Xiuping Wu
- Department of Orthodontics, School of Stomatology, Stomatological Hospital, Shanxi Medical University, Shanxi, China
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3
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Najafidoust M, Hashemi A, Oskui IZ. Effect of temperature on dynamic compressive behavior of periodontal ligament. Med Eng Phys 2023; 116:103986. [PMID: 37230701 DOI: 10.1016/j.medengphy.2023.103986] [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: 06/13/2022] [Revised: 04/04/2023] [Accepted: 04/30/2023] [Indexed: 05/27/2023]
Abstract
Periodontal ligament (PDL) attaches tooth root to the surrounding bone. Its existence between tooth and jaw bone is of utmost importance due to its significant role in absorbing and distributing physiological and para-physiological loading. According to the previous studies, various mechanical tests have been performed to characterize the mechanical properties of the PDL; however, all of them have been done at room temperature. To the best of our knowledge, this is the first study in which the testing was performed at body temperature. The present research was planned to measure the dependency of PDL's viscoelastic behavior on temperature and frequency. Three different temperatures, including body and room temperature, were opted to perform the dynamic compressive tests of the bovine PDL. In addition, a Generalized Maxwell model (GMM) was presented based on empirical outcomes. At 37 °C, amounts of loss factor were found to be greater than those in 25 °C, which demonstrates that the viscous phase of the PDL in higher temperatures plays a critical role. Likewise, by raising the temperature from 25 °C to 37 °C, the model parameters show an enlargement in the viscous part and lessening in the elastic part. It was concluded that the PDL's viscosity in body temperature is much higher than that in room temperature. This model would be functional for a more accurate computational analysis of the PDL at the body temperature (37 °C) in various loading conditions such as orthodontic simulations, mastication, and impact.
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Affiliation(s)
- Mohammad Najafidoust
- Biomedical Engineering Group, Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran; Neuroscience Research Australia and Prince of Wales Clinical School, University of New South Wales, Randwick, NSW, Australia
| | - Ata Hashemi
- Biomedical Engineering Group, Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran.
| | - Iman Z Oskui
- Biomedical Engineering Group, Faculty of Biomedical Engineering, Sahand University of Technology, Tabriz, Iran.
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Li Q, Zhang X, Wang C, Hu H, Tang Z, Fan Y. Biomechanical evaluation of customized root implants in alveolar bone: A comparative study with traditional implants and natural teeth. J Prosthodont 2023; 32:e30-e40. [PMID: 35950785 DOI: 10.1111/jopr.13590] [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: 02/10/2022] [Accepted: 08/02/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To compare and evaluate density changes in alveolar bones and biomechanical responses including stress/strain distributions around customized root implants (CRIs), traditional implants, and natural teeth. MATERIALS AND METHODS A three-dimensional finite element model of the maxillary dentition defect, CRI models, traditional restored implant models, and natural teeth with periodontal tissue models were established. The chewing load of the central incisor, the traditional implant, and the CRI was 100N, and the load direction was inclined by 11° in the sagittal plane. According to the bone remodeling numerical algorithm, the bone mineral density and distribution were calculated and predicted. In addition, animal experiments were performed to verify the feasibility of the implant design. The results of the simulation calculations were compared with animal experimental data in vivo to verify their validity. RESULTS No significant differences in bone mineral density and stress/strain distribution were found between the CRI and traditional implant models. The animal experimental results (X-ray images and histological staining) were consistent with the numerical simulated results. CONCLUSIONS CRIs were more similar to traditional implants than to natural teeth in terms of biomechanical and biological evaluation. Considering the convenience of clinical application, this biomechanical evaluation provides basic theoretical support for further applications of CRI.
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Affiliation(s)
- Qing Li
- Center of Digital Dentistry, Peking University School and Hospital of Stomatology, Beijing, China.,Second Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China.,National Center of Stomatology and National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Xinyue Zhang
- Center of Digital Dentistry, Peking University School and Hospital of Stomatology, Beijing, China.,National Center of Stomatology and National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Chao Wang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, Beijing, China
| | - Hongcheng Hu
- Second Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China.,National Center of Stomatology and National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Zhihui Tang
- Second Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China.,National Center of Stomatology and National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Yubo Fan
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, Beijing, China
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Orthodontic Loads in Teeth after Regenerative Endodontics: A Finite Element Analysis of the Biomechanical Performance of the Periodontal Ligament. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12147063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to analyse the stress distribution in the periodontal ligament and tooth structure of a cementum-reinforced tooth, a dentine-reinforced tooth and an immature tooth during orthodontic loads using a finite element analysis. A finite element model of a maxillary incisor and its supporting tissues was developed. The root was segmented into two parts: a part that represented a root in an immature state and an apical part that represented the tissue formed after regenerative endodontics. The apical part was given the mechanical properties of dentine or cementum. The three models underwent simulation of mesial load, palatal inclination and rotation. The mean stress values and stress distribution patterns of the periodontal ligament of the dentine- and cementum-reinforced teeth were similar in all scenarios. The maturation of the root, with either dentine or cementum, was beneficial for all scenarios, since the periodontal ligament of the immature tooth showed the highest mean stress values. Under the condition of this computational study, orthodontic loads can be applied in teeth previously treated with regenerative endodontics, since the distribution of stress is similar to those of physiologically mature teeth. In vivo studies should be performed to validate these results.
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Houg KP, Camarillo AM, Doschak MR, Major PW, Popowics T, Dennison CR, Romanyk DL. Strain Measurement within an Intact Swine Periodontal Ligament. J Dent Res 2022; 101:1474-1480. [PMID: 35689395 PMCID: PMC9605999 DOI: 10.1177/00220345221100234] [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] [Indexed: 11/17/2022] Open
Abstract
The periodontal ligament (PDL) provides support, proprioception, nutrition, and protection within the tooth–PDL–bone complex (TPBC). While understanding the mechanical behavior of the PDL is critical, current research has inferred PDL mechanics from finite element models, from experimental measures on complete TPBCs, or through direct measurement of isolated PDL sections. Here, transducers are used in an attempt to quantify ex vivo PDL strain. In-fiber Bragg grating (FBG) sensors are small flexible sensors that can be placed within an intact TPBC and yield repeatable strain measurements from within the PDL space. The objective of this study was to determine: 1) if the FBG strain measured from the PDL space of intact swine premolars ex vivo was equivalent to physical PDL strains estimated through finite element analysis and 2) if a change in FBG strain could be linearly related to a change in finite element strain under variable tooth displacement, applied to an intact swine TPBC. Experimentally, individual TPBCs were subjected to 2 displacements (n = 14). The location of the FBG was determined from representative micro–computed tomography images. From a linear elastic finite element model of a TPBC, the strain magnitudes at the sensor locations were recorded. An experimental ratio (i.e., FBG strain at the first displacement divided by the FBG strain at the second displacement) and a finite element ratio (i.e., finite element strain at the first displacement divided by the finite element strain at the second displacement) were calculated. A linear regression model indicated a statistically significant relationship between the experimental and finite element ratio (P = 0.017) with a correlation coefficient (R2) of 0.448. It was concluded that the FBG sensor could be used as a measure for a change in strain and thus could be implemented in applications where the mechanical properties of an intact PDL are monitored over time.
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Affiliation(s)
- K P Houg
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
| | - A M Camarillo
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
| | - M R Doschak
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - P W Major
- School of Dentistry, University of Alberta, Edmonton, AB, Canada
| | - T Popowics
- Department of Oral Health Science, University of Washington, Seattle, WA, USA
| | - C R Dennison
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
| | - D L Romanyk
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada.,School of Dentistry, University of Alberta, Edmonton, AB, Canada
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Finite element analysis of stress distribution in autotransplanted molars. J Dent 2022; 119:104082. [PMID: 35247471 DOI: 10.1016/j.jdent.2022.104082] [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: 06/07/2021] [Revised: 02/22/2022] [Accepted: 02/28/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The biomechanical response of an autotransplanted tooth and surrounding bone to occlusal loads is not well-known. The aim of the present study was to investigate the effect of root form and occlusal morphology on stress distribution in autotransplanted teeth and surrounding bone by using finite element analysis (FEA). METHODS Seven FEA models representing different autotransplanted tooth situations were generated: (a) first molar, (b) third molar, (c) root canal-treated third molar, (d) root canal-treated, ankylosed, third molar, (e) crowned third molar, (f) crowned and root canal-treated third molar, (g) root canal-treated, ankylosed, and crowned third molar. Load (200 N) was applied on the occlusal surface, parallel to the long axis of the tooth. Maximum von Mises stress values on dentin and surrounding bone were calculated for each situation. RESULTS Differences in stress distribution were observed among models. In ankylosed model, stress was primarily observed at the coronal region of the tooth. The stress was observed more at the coronal region of the tooth in crowned models compared with the non-crowned models. The stress distribution was homogeneous with root canal-treated and crowned autotransplanted tooth. CONCLUSIONS The occlusal morphology and root form of the autotransplanted tooth affected the stress in surrounding bone at the transfer site and the biomechanical response of the tooth. The stress was more homogeneous in crowned tooth and primarily observed at the coronal region, which may decrease the risk for root resorption. CLINICAL SIGNIFICANCE Root configuration, occlusal form and root canal treatment induce significant changes on the stress distribution on teeth and bone, including characteristic stress concentration and increased stress values. Clinicians can consider crowning autotransplanted teeth for improved stress distribution within the tooth structure.
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Zhou J, Song Y, Shi X, Zhang C. Tensile creep mechanical behavior of periodontal ligament: A hyper-viscoelastic constitutive model. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 207:106224. [PMID: 34146838 DOI: 10.1016/j.cmpb.2021.106224] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 05/30/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE In orthodontic treatment, the biomechanical response of periodontal ligament (PDL) induces tooth movement. Coupling modeling of PDL can effectively reflect its biomechanical response. The nonlinear creep mechanical behavior of PDL was studied by uniaxial tensile creep test and a new hyper-viscoelastic constitutive model. Two coupling modeling methods with limitations were excluded. METHODS PDL specimens were prepared from the central incisors of pig mandible. The theoretical step function was replaced by static loading with a total loading time of 1 s. The creep loading with the constant stresses of 0.05, 0.1, and 0.15 MPa was selected and kept unchanged for 1000 s. The instantaneous hyperelastic mechanical behavior and time-dependent nonlinear viscoelastic mechanical behavior of PDL were characterized by coupled instantaneous third-order Ogden hyperelastic and time-dependent nonlinear creep models. RESULTS The results showed that the instantaneous elastic curve of PDL increases in the form of hyperelastic index. The creep strain and creep compliance curves increase rapidly before 200s, and then increase slowly in steady state. The creep strain increased with an increase in the constant stress; conversely, the creep compliance decreased with an increase in the constant stress. The results showed that the experimental data were highly consistent with the hyper-viscoelastic constitutive model (R2>0.97). SIGNIFICANCE We normalize the framework of hyper-viscoelastic coupling modeling (Instantaneous hyperelastic model + time-dependent nonlinear viscoelastic model). Which can be extended to other nonlinear viscoelastic biomaterials.
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Affiliation(s)
- Jinlai Zhou
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, School of Mechanical Engineering, Tianjin University of Technology, Tianjin 300384, China
| | - Yang Song
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, School of Mechanical Engineering, Tianjin University of Technology, Tianjin 300384, China.
| | - Xue Shi
- Periodontitis Department, Tianjin Stomatological Hospital, Tianjin 300041, China
| | - Chunqiu Zhang
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, School of Mechanical Engineering, Tianjin University of Technology, Tianjin 300384, China
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Houg KP, Armijo L, Doschak MR, Major PW, Popowics T, Dennison CR, Romanyk DL. Experimental repeatability, sensitivity, and reproducibility of force and strain measurements from within the periodontal ligament space during ex vivo swine tooth loading. J Mech Behav Biomed Mater 2021; 120:104562. [PMID: 33971497 DOI: 10.1016/j.jmbbm.2021.104562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
The Periodontal Ligament (PDL) is a complex connective tissue that anchors a tooth to the surrounding alveolar bone. The small size and complex geometry of the PDL space within an intact tooth-PDL-bone complex (TPBC) limits strain measurements. An in-fiber Bragg grating (FBG) sensor offers potential for such measurements due to its small size. This work defines an experimental procedure where strain and force were measured during quasi-static, apically directed, displacement-controlled tests on swine premolar crowns. Specifically, the: inter-TPBC, intra-TPBC, and long-term repeatability after a preconditioned state was objectively identified; sensitivity to preload magnitude, TPBC alignment, and sensor depth; and reproducibility within a TPBC was determined. Data clustering was used to determine the appropriate number of preconditioning trials, ranging from one to seven. Strain and force measurements showed intra-TPBC repeatability with average adjusted root mean square from the median of 28.9% of the peak strain and 4.5% of the peak force measurement. A Mann-Whitney U test generally found statistically significant differences in peak strain and force measurements between the left and right sides, suggesting a lack of inter-TPBC repeatability. Using a Friedman test, it was shown that peak strain measures were sensitive to the TPBC alignment and sensor depth, while peak force measures were sensitive to the preload and TPBC alignment. A Friedman test suggested reproducible strain and force measurements when the FBG was replaced within the same TPBC and the preload, alignment, and sensor depth were controlled.
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Affiliation(s)
- Kathryn P Houg
- Department of Mechanical Engineering, University of Alberta, 4-17 Mechanical Engineering Building, North Campus, Edmonton, T6G 2G8, AB, Canada.
| | - Leigh Armijo
- Department of Orthodontics, University of Washington School of Dentistry, 1959 NE Pacific St B307, Seattle, 98195, WA, USA.
| | - Michael R Doschak
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, 2-020J Katz Centre for Pharmacy & Health Research, 11361 - 87 Avenue NW, Edmonton, T6G 2E1, AB, Canada.
| | - Paul W Major
- School of Dentistry, University of Alberta, 5-478 Edmonton Clinic Health Academy, 1405 - 87 Avenue NW, T6G 1C0, Edmonton, AB, Canada.
| | - Tracy Popowics
- Dept. of Oral Health Sciences, University of Washington School of Dentistry, Box 357475, Seattle, WA, 98195, USA.
| | - Christopher R Dennison
- Department of Mechanical Engineering, University of Alberta, 10-372 Donadeo Innovation Centre for Engineering, 9211 - 116 Street NW, Edmonton, AB, T6G 2H5, Canada.
| | - Dan L Romanyk
- Department of Mechanical Engineering and School of Dentistry, University of Alberta, 10-354 Donadeo Innovation Centre for Engineering, 9211 - 116 Street NW, Edmonton, AB, T6G 2H5, Canada.
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Kaiser AH, Keilig L, Klein R, Bourauel C. Parameter identification for the simulation of the periodontal ligament during the initial phase of orthodontic tooth movement. Comput Methods Biomech Biomed Engin 2020; 24:333-348. [PMID: 33136452 DOI: 10.1080/10255842.2020.1830275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The paper is concerned with simulation of the periodontal ligament response to force in the initial phase of orthodontic tooth movement. This is based on two previous investigations, a in vitro experiment with specimens of porcine mandibular premolars and a in vivo experiment on human upper first incisors. For the curve fit of the in vitro experiment a model function, assuming viscoelasticity, was introduced. The viscoelastic model function was augmented by a ramp rise time term, to account for observed dependence of the response on actuator velocity, and a previous load history term, to account for the effect of the previous tests on the current test. The correlation coefficient of a curve fit for all tests grouped together was R2=0.98. Next, a curve fit of the in vivo experiment was done. Good correlation was found for a simplified model function, without viscoelastic term (R2=0.96). For both tests, in vitro and in vivo, the ramp rise time term improved correlation. A finite element model of the specimen of the in vitro experiment was created. For the PDL a hyperelastic constitutive model for compressible material was used and model parameters were identified. The present work indicates that the macroscopic response of the periodontal ligament to an external load can be simulated with a poro-visco-hyperelastic model. The simulation showed that poroelastic behaviour will gradually cease when viscoelastic relaxation progresses. This followed also from dimensionless analysis. As a consequence, for slow loading, or if initial response to fast loading is not of interest, a visco-hyperelastic model may suffice. To identify parameters of the finite element model several optimisation problems were solved. A model function, which can be regarded as a reduced order model, allowed a full factorial experiment (analysis) at low cost, to identify initial parameters. The thus found parameters were further refined with an optimum interpolation meta-model. That is, for limited number of parameter combinations the response was simulated with the finite element model and a refined parameter study was conducted by means of optimal interpolation. The thus found optimal parameters were verified by simulation with the finite element model. Optimal interpolation is computationally cheap, which allowed full factorial experiments at low cost.
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Affiliation(s)
| | - Ludger Keilig
- Oral Technology, University Hospital Bonn, Bonn, Germany
| | - Reinhard Klein
- Institute of Computer Science II, University of Bonn, Bonn, Germany
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Wu B, Pu P, Zhao S, Izadikhah I, Shi H, Liu M, Lu R, Yan B, Ma S, Markert B. Frequency-related viscoelastic properties of the human incisor periodontal ligament under dynamic compressive loading. PLoS One 2020; 15:e0235822. [PMID: 32658896 PMCID: PMC7357742 DOI: 10.1371/journal.pone.0235822] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 06/22/2020] [Indexed: 12/19/2022] Open
Abstract
Studies concerning the mechanical properties of the human periodontal ligament under dynamic compression are rare. This study aimed to determine the viscoelastic properties of the human periodontal ligament under dynamic compressive loading. Ten human incisor specimens containing 5 maxillary central incisors and 5 maxillary lateral incisors were used in a dynamic mechanical analysis. Frequency sweep tests were performed under the selected frequencies between 0.05 Hz and 5 Hz with a compression amplitude that was 2% of the PDL's initial width. The compressive strain varied over a range of 4%-8% of the PDL's initial width. The storage modulus, ranging from 28.61 MPa to 250.21 MPa, increased with the increase in frequency. The loss modulus (from 6.00 MPa to 49.28 MPa) also increased with frequency from 0.05 Hz- 0.5 Hz but remained constant when the frequency was higher than 0.5 Hz. The tanδ showed a negative logarithmic correlation with frequency. The dynamic moduli and the loss tangent of the central incisor were higher than those of the lateral incisor. This study concluded that the human PDL exhibits viscoelastic behavior under compressive loadings within the range of the used frequency, 0.05 Hz- 5 Hz. The tooth position and testing frequency may have effects on the viscoelastic properties of PDL.
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Affiliation(s)
- Bin Wu
- College of Mechanical and Electronic Engineering, Nanjing Forestry University, Nanjing, China
| | - Panjun Pu
- Jiangsu Key Laboratory of Oral Diseases, Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Siyu Zhao
- Jiangsu Key Laboratory of Oral Diseases, Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Iman Izadikhah
- Jiangsu Key Laboratory of Oral Diseases, Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Haotian Shi
- Jiangsu Key Laboratory of Oral Diseases, Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Mao Liu
- Jiangsu Key Laboratory of Oral Diseases, Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Ruxin Lu
- College of Mechanical Engineering, Southeast University, Nanjing, China
| | - Bin Yan
- Jiangsu Key Laboratory of Oral Diseases, Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
- * E-mail:
| | - Songyun Ma
- Institute of General Mechanics, RWTH-Aachen University, Aachen, Nordrhein-Westfalen, Germany
| | - Bernd Markert
- Institute of General Mechanics, RWTH-Aachen University, Aachen, Nordrhein-Westfalen, Germany
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12
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Koletsi D, Iliadi A, Papageorgiou SN, Konrad D, Eliades T. Evidence on the effect of uncontrolled diabetes mellitus on orthodontic tooth movement. A systematic review with meta-analyses in pre-clinical in- vivo research. Arch Oral Biol 2020; 115:104739. [PMID: 32422362 DOI: 10.1016/j.archoralbio.2020.104739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 12/09/2022]
Abstract
OBJECTIVE The aim of this review was to appraise the existing evidence from pre- clinical research on tooth movement under the condition of hyperglycemic status. DESIGN Electronic search was conducted in 8 databases in October 13, 2019, to identify related pre- clinical animal research with keywords being: "diabetes mellitus", "tooth movement". Eligibility criteria involved controlled animal studies, entailing tooth movement under diabetic status compared to control healthy animals. Primary endpoints involved all outcomes related to tooth movement. Risk of bias (RoB) was assessed through the SYstematic Review Centre for Laboratory animal Experimentation tool (SYRCLE), while quantitative synthesis was planned after exploration of heterogeneity, through random effects meta-analyses of standardized mean differences (SMDs) with 95 % confidence intervals (CIs). RESULTS Of an initial number of 290 articles retrieved, 14 papers were eligible for inclusion in the qualitative synthesis, while 9 contributed to meta-analyses. Heterogeneity of experimental conditions in individual studies was evident. The risk of bias overall was rated as unclear to high. There was no evidence of a significant effect of diabetes mellitus when tooth movement was assessed macroscopically (6 studies, SMD: 1.47; 95 % CI: -0.60, 3.53; p = 0.16). However, attenuation of osteoblastic differentiation within the periodontal ligament was detected, as there was evidence of reduction of osteopontin expression (2 studies, SMD: -3.77; 95 %CI: -4.89, -2.66; p < 0.001). CONCLUSIONS There is currently a paucity of solid evidence with regard to alterations of the equilibrium of the implicated structures under the status of diabetes mellitus, when mechanical stimulation of teeth is attempted, with sporadic inferences from animal research. Significant research insights in how the disease impacts on orthodontic tooth movement are invaluable, at present.
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Affiliation(s)
- Despina Koletsi
- Clinic of Orthodontics and Pediatric Dentistry, School of Dental Medicine, University of Zurich, Switzerland.
| | - Anna Iliadi
- Department of Biomaterials, School of Dentistry, National and Kapodistrian University of Athens, Greece
| | - Spyridon N Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, School of Dental Medicine, University of Zurich, Switzerland
| | - Daniel Konrad
- Division of Pediatric Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland; Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Theodore Eliades
- Clinic of Orthodontics and Pediatric Dentistry, School of Dental Medicine, University of Zurich, Switzerland
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13
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Najafidoust M, Hashemi A, Oskui IZ. Dynamic viscoelastic behavior of bovine periodontal ligament in compression. J Periodontal Res 2020; 55:651-659. [DOI: 10.1111/jre.12751] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 02/02/2020] [Accepted: 03/15/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Mohammad Najafidoust
- Biomechanical Engineering Group Faculty of Biomedical Engineering Amirkabir University of Technology Tehran Iran
| | - Ata Hashemi
- Biomechanical Engineering Group Faculty of Biomedical Engineering Amirkabir University of Technology Tehran Iran
| | - Iman Z. Oskui
- Biomechanical Engineering Group Faculty of Biomedical Engineering Sahand University of Technology Tabriz Iran
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14
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Mendes TA, Marques D, Lopes LP, Caramês J. Total digital workflow in the fabrication of a partial removable dental prostheses: A case report. SAGE Open Med Case Rep 2019; 7:2050313X19871131. [PMID: 31452892 PMCID: PMC6699011 DOI: 10.1177/2050313x19871131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/31/2019] [Indexed: 11/16/2022] Open
Abstract
This report describes a clinical and laboratory protocol used in the fabrication of a removable partial dental prosthesis with a digital workflow in a 73-year-old patient. The metal framework was produced with a selective laser melting technique. For quality assurance and discrepancy analysis, the framework was superimposed and compared to the respective digital design file, and the printed model was also compared to the digital impression and rendered as a 3D colour map. Differences were detected in the framework on the clasp of tooth 17 (upper right second molar) and on the printed model on the interproximal surfaces of the abutments, particularly on tooth 17 and palatine area. The use of this digital workflow allowed for the achievement of an removable partial dental prosthesis with a good fit and occlusion with minimal adjustments, with the reduction of both clinical and laboratory time. Further studies are needed to gain a better understanding of these techniques.
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Affiliation(s)
- Teresa Almeida Mendes
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Implantologia, Lisboa, Portugal
| | - Duarte Marques
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Implantologia, Lisboa, Portugal
| | - Luis Pires Lopes
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
| | - João Caramês
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Implantologia, Lisboa, Portugal
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15
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Schmidt F, Lapatki BG. Effect of variable periodontal ligament thickness and its non-linear material properties on the location of a tooth's centre of resistance. J Biomech 2019; 94:211-218. [PMID: 31427090 DOI: 10.1016/j.jbiomech.2019.07.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/31/2019] [Accepted: 07/31/2019] [Indexed: 11/29/2022]
Abstract
In orthodontics, the 3D translational and rotational movement of a tooth is determined by the force-moment system applied and the location of the tooth's centre of resistance (CR). Because of the practical constraints of in-vivo experiments, the finite element (FE) method is commonly used to determine the CR. The objective of this study was to investigate the geometric model details required for accurate CR determination, and the effect of material non-linearity of the periodontal ligament (PDL). A FE model of a human lower canine derived from a high-resolution µCT scan (voxel size: 50 µm) was investigated by applying four different modelling approaches to the PDL. These comprised linear and non-linear material models, each with uniform and realistic PDL thickness. The CR locations determined for the four model configurations were in the range 37.2-45.3% (alveolar margin: 0%; root apex: 100%). We observed that a non-linear material model introduces load-dependent results that are dominated by the PDL regions under tension. Load variation within the range used in clinical orthodontic practice resulted in CR variations below 0.3%. Furthermore, the individualized realistic PDL geometry shifted the CR towards the alveolar margin by 2.3% and 2.8% on average for the linear and non-linear material models, respectively. We concluded that for conventional clinical therapy and the generation of representative reference data, the least sophisticated modelling approach with linear material behaviour and uniform PDL thickness appears sufficiently accurate. Research applications that require more precise treatment monitoring and planning may, however, benefit from the more accurate results obtained from the non-linear constitutive law and individualized realistic PDL geometry.
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Affiliation(s)
- Falko Schmidt
- Department of Orthodontics, Centre of Dentistry, University of Ulm, Albert-Einstein-Allee 11, 89081 Ulm, Germany.
| | - Bernd Georg Lapatki
- Department of Orthodontics, Centre of Dentistry, University of Ulm, Albert-Einstein-Allee 11, 89081 Ulm, Germany
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16
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Oskui IZ, Hashemi A, Jafarzadeh H, Kato A. Finite element investigation of human maxillary incisor under traumatic loading: Static vs dynamic analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 155:121-125. [PMID: 29512492 DOI: 10.1016/j.cmpb.2017.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 12/02/2017] [Accepted: 12/11/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Traumatic loading is the main form of injury sustained in dental injuries. In spite of the prevalence of dental trauma, little information is available on traumatic dental damage and the evaluation of tooth behavior under traumatic loading. Due to the short period of traumatic loading, at first sight, a dynamic analysis needs to be performed to investigate the dental trauma. However, it was hypothesized that dental traumatic loading could be regarded as quasi-static loading. Thus, the aim of the present study was to examine this hypothesis. METHODS Static and dynamic analyses of the human maxillary incisor were carried out under traumatic loading using a 3D finite element method. Also, modal analysis of the tooth model was performed in order to evaluate the assumption of the dental traumatic loading as a quasi-static one. RESULTS It was revealed that the static analysis of dental trauma is preferred to the dynamic analysis when investigating dental trauma, mainly due to its lower computational cost. In fact, it was shown that including the inertia of the tooth structure does not influence the results of the dental trauma simulation. Furthermore, according to the modal analysis of the tooth structure, it was found that the mechanical properties and geometry of the periodontal ligament play significant roles in the classification of dental traumatic loading as a quasi-static one, in addition to the time duration of the applied load. CONCLUSIONS This paper provides important biomechanical insights into the classification of dental loading as quasi-static, transient or impact loading in future dental studies.
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Affiliation(s)
- Iman Z Oskui
- Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Ata Hashemi
- Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran.
| | - Hamid Jafarzadeh
- Department of Endodontics, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Akiko Kato
- Department of Oral Anatomy, School of Dentistry, Aichi Gakuin University, Chikusa-ku, Nagoya, Japan
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17
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Knaup TJ, Dirk C, Reimann S, Keilig L, Eschbach M, Korbmacher-Steiner H, Bourauel C. Time-dependent behavior of porcine periodontal ligament: A combined experimental, numeric in-vitro study. Am J Orthod Dentofacial Orthop 2018; 153:97-107. [DOI: 10.1016/j.ajodo.2017.05.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 05/01/2017] [Accepted: 05/01/2017] [Indexed: 10/18/2022]
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18
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Hamanaka R, Yamaoka S, Anh TN, Tominaga JY, Koga Y, Yoshida N. Numeric simulation model for long-term orthodontic tooth movement with contact boundary conditions using the finite element method. Am J Orthod Dentofacial Orthop 2017; 152:601-612. [PMID: 29103438 DOI: 10.1016/j.ajodo.2017.03.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Although many attempts have been made to simulate orthodontic tooth movement using the finite element method, most were limited to analyses of the initial displacement in the periodontal ligament and were insufficient to evaluate the effect of orthodontic appliances on long-term tooth movement. Numeric simulation of long-term tooth movement was performed in some studies; however, neither the play between the brackets and archwire nor the interproximal contact forces were considered. The objectives of this study were to simulate long-term orthodontic tooth movement with the edgewise appliance by incorporating those contact conditions into the finite element model and to determine the force system when the space is closed with sliding mechanics. METHODS We constructed a 3-dimensional model of maxillary dentition with 0.022-in brackets and 0.019 × 0.025-in archwire. Forces of 100 cN simulating sliding mechanics were applied. The simulation was accomplished on the assumption that bone remodeling correlates with the initial tooth displacement. RESULTS This method could successfully represent the changes in the moment-to-force ratio: the tooth movement pattern during space closure. CONCLUSIONS We developed a novel method that could simulate the long-term orthodontic tooth movement and accurately determine the force system in the course of time by incorporating contact boundary conditions into finite element analysis. It was also suggested that friction is progressively increased during space closure in sliding mechanics.
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Affiliation(s)
- Ryo Hamanaka
- Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
| | - Satoshi Yamaoka
- Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Tuan Nguyen Anh
- Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Jun-Ya Tominaga
- Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yoshiyuki Koga
- Department of Orthodontics, Nagasaki University Hospital, Nagasaki, Japan.
| | - Noriaki Yoshida
- Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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19
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Kondo T, Hotokezaka H, Hamanaka R, Hashimoto M, Nakano-Tajima T, Arita K, Kurohama T, Ino A, Tominaga JY, Yoshida N. Types of tooth movement, bodily or tipping, do not affect the displacement of the tooth's center of resistance but do affect the alveolar bone resorption. Angle Orthod 2017; 87:563-569. [PMID: 28206811 DOI: 10.2319/110416-794.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate how types of tooth movement, bodily or tipping, influence the displacement of the center of resistance in teeth and alveolar bone resorption. MATERIALS AND METHODS Ten-week-old female Wistar rats were divided into eight groups of different factors, as follows: type of movement (bodily and tipping) and force magnitude (10, 25, 50, and 100 cN). The maxillary left first molars were moved mesially with nickel-titanium coil springs for 28 days. Micro-computed tomography (micro-CT) images were taken before and after tooth movement. The position of the center of resistance was determined by using finite element models constructed from the micro-CT image. The displacement of the center of resistance and the volume of alveolar bone resorption were measured. RESULTS The displacement of the center of resistance showed no significant difference between the bodily and tipping groups. The displacements of the center of resistance were increased with force magnitude at 10 and 25 cN, whereas they were not further increased at 50 and 100 cN. On the other hand, cervical alveolar bone resorption was significantly greater in the tipping group than in the bodily group. CONCLUSIONS Displacement of the center of resistance was not influenced by the types of tooth movement. However, volume of cervical alveolar bone resorption was greater in the tipping movement group than in the bodily movement group.
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20
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In vivo determination of tooth mobility after fixed orthodontic appliance therapy with a novel intraoral measurement device. Clin Oral Investig 2016; 21:1283-1289. [DOI: 10.1007/s00784-016-1881-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 06/09/2016] [Indexed: 12/20/2022]
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21
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Schmidt F, Geiger ME, Jäger R, Lapatki BG. Comparison of methods to determine the centre of resistance of teeth. Comput Methods Biomech Biomed Engin 2016; 19:1673-82. [DOI: 10.1080/10255842.2016.1177822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Falko Schmidt
- Department of Orthodontics, Centre of Dentistry, University of Ulm, Ulm, Germany
| | | | - Rudolf Jäger
- Department of Orthodontics, Centre of Dentistry, University of Ulm, Ulm, Germany
| | - Bernd Georg Lapatki
- Department of Orthodontics, Centre of Dentistry, University of Ulm, Ulm, Germany
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22
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Dynamic tensile properties of bovine periodontal ligament: A nonlinear viscoelastic model. J Biomech 2016; 49:756-764. [DOI: 10.1016/j.jbiomech.2016.02.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 12/16/2015] [Accepted: 02/05/2016] [Indexed: 11/20/2022]
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23
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Dalstra M, Cattaneo P, Laursen M, Beckmann F, Melsen B. Multi-level synchrotron radiation-based microtomography of the dental alveolus and its consequences for orthodontics. J Biomech 2015; 48:801-6. [DOI: 10.1016/j.jbiomech.2014.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
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24
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Huang H, Tang W, Yan B, Wu B, Cao D. Mechanical responses of the periodontal ligament based on an exponential hyperelastic model: a combined experimental and finite element method. Comput Methods Biomech Biomed Engin 2015; 19:188-98. [DOI: 10.1080/10255842.2015.1006207] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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25
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Tuna M, Sunbuloglu E, Bozdag E. Finite element simulation of the behavior of the periodontal ligament: A validated nonlinear contact model. J Biomech 2014; 47:2883-90. [DOI: 10.1016/j.jbiomech.2014.07.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/05/2014] [Accepted: 07/22/2014] [Indexed: 11/30/2022]
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