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Novel Design and Optimization of Porous Titanium Structure for Mandibular Reconstruction. Appl Bionics Biomech 2022; 2022:8686670. [PMID: 35782881 PMCID: PMC9249542 DOI: 10.1155/2022/8686670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 05/13/2022] [Accepted: 05/30/2022] [Indexed: 12/25/2022] Open
Abstract
A porous material is considered to be a potential material that can be used to repair bone defects. However, the methods of designing of a highly porous structure within the allowable stress range remain to be researched. Therefore, this study was aimed at presenting a method for generating a three-dimensional tetrahedral porous structure characterized by low peak stress and high porosity for the reconstruction of mandibular defects. Firstly, the initial tetrahedral porous structure was fabricated with the strut diameters set to 0.4 mm and a mean cell size of 2.4 mm in the design model space. Following this, the simulation analysis was carried out. Further, a homogenization algorithm was used for homogenizing the stress distribution, increasing porosity, and controlling peak stress of the porous structure by adjusting the strut diameters. The results showed that compared with the initial porous structure, the position of the large stress regions remained unchanged, and the peak stress fluctuated slightly in the mandible and fixation system with the optimized porous structure under two occlusions. The optimized porous structure had a higher porosity and more uniform stress distribution, and the maximum stress was lower than the target stress value. The design and optimization technique of the porous structure presented in this paper can be used to control peak stress, improve porosity, and fabricate a lightweight scaffold, which provides a potential solution for mandibular reconstruction.
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van Kootwijk A, Moosabeiki V, Saldivar MC, Pahlavani H, Leeflang MA, Kazemivand Niar S, Pellikaan P, Jonker BP, Ahmadi SM, Wolvius EB, Tümer N, Mirzaali MJ, Zhou J, Zadpoor AA. Semi-automated digital workflow to design and evaluate patient-specific mandibular reconstruction implants. J Mech Behav Biomed Mater 2022; 132:105291. [PMID: 35660552 DOI: 10.1016/j.jmbbm.2022.105291] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 12/31/2022]
Abstract
The reconstruction of large mandibular defects with optimal aesthetic and functional outcomes remains a major challenge for maxillofacial surgeons. The aim of this study was to design patient-specific mandibular reconstruction implants through a semi-automated digital workflow and to assess the effects of topology optimization on the biomechanical performance of the designed implants. By using the proposed workflow, a fully porous implant (LA-implant) and a topology-optimized implant (TO-implant) both made of Ti-6Al-4V ELI were designed and additively manufactured using selective laser melting. The mechanical performance of the implants was predicted by performing finite element analysis (FEA) and was experimentally assessed by conducting quasi-static and cyclic biomechanical tests. Digital image correlation (DIC) was used to validate the FE model by comparing the principal strains predicted by the FEM model with the measured distribution of the same type of strain. The numerical predictions were in good agreement with the DIC measurements and the predicted locations of specimen failure matched the actual ones. No statistically significant differences (p < 0.05) in the mean stiffness, mean ultimate load, or mean ultimate displacement were detected between the LA- and TO-implant groups. No implant failures were observed during quasi-static or cyclic testing under masticatory loads that were substantially higher (>1000 N) than the average maximum biting force of healthy individuals. Given its relatively lower weight (16.5%), higher porosity (17.4%), and much shorter design time (633.3%), the LA-implant is preferred for clinical application. This study clearly demonstrates the capability of the proposed workflow to develop patient-specific implants with high precision and superior mechanical performance, which will greatly facilitate cost- and time-effective pre-surgical planning and is expected to improve the surgical outcome.
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Affiliation(s)
- A van Kootwijk
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - V Moosabeiki
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands.
| | - M Cruz Saldivar
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - H Pahlavani
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - M A Leeflang
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - S Kazemivand Niar
- Department of Mechanical Engineering, Tarbiat Modares University, Tehran, Iran
| | - P Pellikaan
- Amber Implants BV, Prinses Margrietplantsoen 33, 2595 AM, The Hague, the Netherlands
| | - B P Jonker
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GE, Rotterdam, the Netherlands
| | - S M Ahmadi
- Amber Implants BV, Prinses Margrietplantsoen 33, 2595 AM, The Hague, the Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GE, Rotterdam, the Netherlands
| | - N Tümer
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - M J Mirzaali
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - J Zhou
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - A A Zadpoor
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
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Peng WM, Cheng KJ, Liu YF, Nizza M, Baur DA, Jiang XF, Dong XT. Biomechanical and Mechanostat analysis of a titanium layered porous implant for mandibular reconstruction: The effect of the topology optimization design. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 124:112056. [PMID: 33947550 DOI: 10.1016/j.msec.2021.112056] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/12/2021] [Accepted: 03/20/2021] [Indexed: 11/18/2022]
Abstract
A porous scaffold/implant is considered a potential method to repair bone defects, but its mechanical stability and biomechanics during the repair process are not yet clear. A mandibular titanium implant was proposed and designed with layered porous structures similar to that of the bone tissue, both in structure and mechanical properties. Topology was used to optimize the design of the porous implant and fixed structure. The finite element analysis was combined with bone "Mechanostat" theory to evaluate the stress and osteogenic property of the layered porous implant with 3 different fixation layouts (Model I with 4 screws, Model II with 5 screws and Model III with 6 screws) for mandibular reconstruction. The results showed that Model III could effectively reduce the stress shielding effect, stress within the optimized implant, defective mandible, and screws were respectively dropped 48.18%, 44.23%, and 57.27% compared to Model I, and the porous implant had a significant stress transmission effect and maintained the same stress distribution as the intact mandible after the mandibular defect was repaired. The porous implant also showed a significant mechanical stimulation effect on the growth and healing of the bone tissue according to the bone "Mechanostat" theory. The combination of porous structure with the topology technique is a promising option to improve the mechanical stability and osteogenesis of the implant, and could provide a new solution for mandibular reconstruction.
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Affiliation(s)
- Wen-Ming Peng
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, China; Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou 310023, China; National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou 310023, China
| | - Kang-Jie Cheng
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, China; Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou 310023, China; National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou 310023, China
| | - Yun-Feng Liu
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, China; Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou 310023, China; National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou 310023, China.
| | - Mark Nizza
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Dale A Baur
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Xian-Feng Jiang
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, China; Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou 310023, China; National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou 310023, China
| | - Xing-Tao Dong
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, China; Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou 310023, China; National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou 310023, China
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Luo D, Rong Q, Chen Q. Finite-element design and optimization of a three-dimensional tetrahedral porous titanium scaffold for the reconstruction of mandibular defects. Med Eng Phys 2017; 47:176-183. [PMID: 28655500 DOI: 10.1016/j.medengphy.2017.06.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 04/25/2017] [Accepted: 06/03/2017] [Indexed: 10/19/2022]
Abstract
Reconstruction of segmental defects in the mandible remains a challenge for maxillofacial surgery. The use of porous scaffolds is a potential method for repairing these defects. Now, additive manufacturing techniques provide a solution for the fabrication of porous scaffolds with specific geometrical shapes and complex structures. The goal of this study was to design and optimize a three-dimensional tetrahedral titanium scaffold for the reconstruction of mandibular defects. With a fixed strut diameter of 0.45mm and a mean cell size of 2.2mm, a tetrahedral structural porous scaffold was designed for a simulated anatomical defect derived from computed tomography (CT) data of a human mandible. An optimization method based on the concept of uniform stress was performed on the initial scaffold to realize a minimal-weight design. Geometric and mechanical comparisons between the initial and optimized scaffold show that the optimized scaffold exhibits a larger porosity, 81.90%, as well as a more homogeneous stress distribution. These results demonstrate that tetrahedral structural titanium scaffolds are feasible structures for repairing mandibular defects, and that the proposed optimization scheme has the ability to produce superior scaffolds for mandibular reconstruction with better stability, higher porosity, and less weight.
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Affiliation(s)
- Danmei Luo
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing 100871, China
| | - Qiguo Rong
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing 100871, China.
| | - Quan Chen
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
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Ostrowska B, Di Luca A, Szlazak K, Moroni L, Swieszkowski W. Influence of internal pore architecture on biological and mechanical properties of three-dimensional fiber deposited scaffolds for bone regeneration. J Biomed Mater Res A 2016; 104:991-1001. [PMID: 26749200 DOI: 10.1002/jbm.a.35637] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 12/12/2015] [Accepted: 12/21/2015] [Indexed: 11/08/2022]
Abstract
Fused deposition modeling has been used to fabricate three-dimensional (3D) scaffolds for tissue engineering applications, because it allows to tailor their pore network. Despite the proven flexibility in doing so, a limited amount of studies have been performed to evaluate whether specific pore shapes have an influence on cell activity and tissue formation. Our study aimed at investigating the influence of internal pore architecture on the biological and mechanical properties of 3D scaffolds seeded with mesenchymal stromal cells. Polycaprolactone scaffolds with six different geometries were fabricated. The 3D samples were manufactured with different lay-down pattern of the fibers by varying the layer deposition angle from 0°/15°/30°, to 0°/30°/60°, 0°/45°/90°, 0°/60°/120°, 0°/75°/150°, and 0°/90°/180°. The scaffolds were investigated by scanning electron microscopy and micro computed tomographical analysis and displayed a fully interconnected pore network. Cell proliferation and differentiation toward the osteogenic lineage were evaluated by DNA, alkaline phosphatase activity, and polymerase chain reaction. The obtained scaffolds had structures with open porosity (50%-60%) and interconnected pores ranging from 380 to 400 µm. Changing the angle deposition affected significantly the mechanical properties of the scaffolds. With increasing the angle deposition between successive layers, the elastic modulus increased as well. Cellular studies also showed influence of the internal architecture on cell adhesion and proliferation within the 3D construct, yet limited influence on cell differentiation was observed.
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Affiliation(s)
- Barbara Ostrowska
- Materials Design Division, Faculty of Material Science and Engineering, Warsaw University of Technology, 141 Woloska Street, Warsaw, 02-507, Poland.,Tissue Regeneration Department, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands
| | - Andrea Di Luca
- Tissue Regeneration Department, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands
| | | | - Lorenzo Moroni
- Tissue Regeneration Department, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands.,Complex Tissue Regeneration Department, MERLN Institute for Technology Inspired Regenerative Medicine, Maastricht University, Universiteitsingel 40, 6229, ER Maastricht, The Netherlands
| | - Wojciech Swieszkowski
- Materials Design Division, Faculty of Material Science and Engineering, Warsaw University of Technology, 141 Woloska Street, Warsaw, 02-507, Poland
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Feng P, Gao C, Shuai C, Peng S. Toughening and strengthening mechanisms of porous akermanite scaffolds reinforced with nano-titania. RSC Adv 2015. [DOI: 10.1039/c4ra12095g] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Akermanite possesses excellent biocompatibility and biodegradability, while low fracture toughness and brittleness have limited its use in load bearing sites of bone tissue.
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Affiliation(s)
- Pei Feng
- State Key Laboratory of High Performance Complex Manufacturing
- Central South University
- Changsha
- China
| | - Chengde Gao
- State Key Laboratory of High Performance Complex Manufacturing
- Central South University
- Changsha
- China
| | - Cijun Shuai
- State Key Laboratory of High Performance Complex Manufacturing
- Central South University
- Changsha
- China
- Orthopedic Biomedical Materials Institute
| | - Shuping Peng
- Hunan Provincial Tumor Hospital and the Affiliated Tumor Hospital of Xiangya School of Medicine
- Central South University
- Changsha
- China
- School of Basic Medical Science
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Hazer DB, Bal E, Nurlu G, Benli K, Balci S, Öztürk F, Hazer B. In vivo application of poly-3-hydroxyoctanoate as peripheral nerve graft. J Zhejiang Univ Sci B 2014; 14:993-1003. [PMID: 24190445 DOI: 10.1631/jzus.b1300016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study aims to investigate the degree of biocompatibility and neuroregeneration of a polymer tube, poly-3-hydroxyoctanoate (PHO) in nerve gap repair. METHODS Forty Wistar Albino male rats were randomized into two groups: autologous nerve gap repair group and PHO tube repair group. In each group, a 10-mm right sciatic nerve defect was created and reconstructed accordingly. Neuroregeneration was studied by sciatic function index (SFI), electromyography, and immunohistochemical studies on Days 7, 21, 45 and 60 of implantation. Biocompatibility was analyzed by the capsule formation around the conduit. Biodegradation was analyzed by the molecular weight loss in vivo. RESULTS Electrophysiological and histomorphometric assessments demonstrated neuroregeneration in both groups over time. In the experimental group, a straight alignment of the Schwann cells parallel to the axons was detected. However, autologous nerve graft seems to have a superior neuroregeneration compared to PHO grafts. Minor biodegradation was observed in PHO conduit at the end of 60 d. CONCLUSIONS Although neuroregeneration is detected in PHO grafts with minor degradation in 60 d, autologous nerve graft is found to be superior in axonal regeneration compared to PHO nerve tube grafts. PHO conduits were found to create minor inflammatory reaction in vivo, resulting in good soft tissue response.
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Affiliation(s)
- D Burcu Hazer
- Department of Neurosurgery, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla 48000, Turkey; Atatürk Research and Medical Center, Neurosurgery Clinic, Ministry of Health of the Republic of Turkey, Ankara 06110, Turkey; Department of Neurology, Faculty of Medicine, School of Medicine, Hacettepe University, Ankara 06100, Turkey; Department of Neurosurgery, Faculty of Medicine, School of Medicine, Hacettepe University, Ankara 06100, Turkey; Atatürk Research and Medical Center, Department of Pathology, Yıldırım Beyazıt University, Ankara 06110, Turkey; Department of Histology and Embryology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla 48000, Turkey; Department of Chemistry, Bülent Ecevit University, Zonguldak 67100, Turkey
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Liu YF, Xu LW, Zhu HY, Liu SSY. Technical procedures for template-guided surgery for mandibular reconstruction based on digital design and manufacturing. Biomed Eng Online 2014; 13:63. [PMID: 24886431 PMCID: PMC4049493 DOI: 10.1186/1475-925x-13-63] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 05/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The occurrence of mandibular defects caused by tumors has been continuously increasing in China in recent years. Conversely, results of the repair of mandibular defects affect the recovery of oral function and patient appearance, and the requirements for accuracy and high surgical quality must be more stringent. Digital techniques--including model reconstruction based on medical images, computer-aided design, and additive manufacturing--have been widely used in modern medicine to improve the accuracy and quality of diagnosis and surgery. However, some special software platforms and services from international companies are not always available for most of researchers and surgeons because they are expensive and time-consuming. METHODS Here, a new technical solution for guided surgery for the repair of mandibular defects is proposed, based on general popular tools in medical image processing, 3D (3 dimension) model reconstruction, digital design, and fabrication via 3D printing. First, CT (computerized tomography) images are processed to reconstruct the 3D model of the mandible and fibular bone. The defect area is then replaced by healthy contralateral bone to create the repair model. With the repair model as reference, the graft shape and cutline are designed on fibular bone, as is the guide for cutting and shaping. The physical model, fabricated via 3D printing, including surgical guide, the original model, and the repair model, can be used to preform a titanium locking plate, as well as to design and verify the surgical plan and guide. In clinics, surgeons can operate with the help of the surgical guide and preformed plate to realize the predesigned surgical plan. RESULTS With sufficient communication between engineers and surgeons, an optimal surgical plan can be designed via some common software platforms but needs to be translated to the clinic. Based on customized models and tools, including three surgical guides, preformed titanium plate for fixation, and physical models of the mandible, grafts for defect repair can be cut from fibular bone, shaped with high accuracy during surgery, and fixed with a well-fitting preformed locking plate, so that the predesigned plan can be performed in the clinic and the oral function and appearance of the patient are recovered. This method requires 20% less operating time compared with conventional surgery, and the advantages in cost and convenience are significant compared with those of existing commercial services in China. CONCLUSIONS This comparison between two groups of cases illustrates that, with the proposed method, the accuracy of mandibular defect repair surgery is increased significantly and is less time-consuming, and patients are satisfied with both the recovery of oral function and their appearance. Until now, more than 15 cases have been treated with the proposed methods, so their feasibility and validity have been verified.
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Affiliation(s)
- Yun-feng Liu
- Key Laboratory of E&M (Zhejiang University of Technology), Ministry of Education & Zhejiang Province, Hangzhou 310014, China.
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Payne KF, Balasundaram I, Deb S, Di Silvio L, Fan KF. Tissue engineering technology and its possible applications in oral and maxillofacial surgery. Br J Oral Maxillofac Surg 2014; 52:7-15. [DOI: 10.1016/j.bjoms.2013.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 03/09/2013] [Indexed: 12/27/2022]
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