Proposal for an Ultrasonic Tool to Monitor the Osseointegration of Dental Implants

Mechanics Predicts Effective Critical-Size Bone Regeneration Using 3D-Printed Bioceramic Scaffolds

BACKGROUND

3D-printed bioceramic scaffolds have gained popularity due to their controlled microarchitecture and their proven biocompatibility. However, their high brittleness makes their surgical implementation complex for weight-bearing bone treatments. Thus, they would require difficult-to-instrument rigid internal fixations that limit a rigorous evaluation of the regeneration progress through the analysis of mechanic-structural parameters.

METHODS

We investigated the compatibility of flexible fixations with fragile ceramic implants, and if mechanical monitoring techniques are applicable to bone tissue engineering applications. Tissue engineering experiments were performed on 8 ovine metatarsi. A 15 mm bone segment was directly replaced with a hydroxyapatite scaffold and stabilized by an instrumented Ilizarov-type external fixator. Several in vivo monitoring techniques were employed to assess the mechanical and structural progress of the tissue.

RESULTS

The applied surgical protocol succeeded in combining external fixators and subject-specific bioceramic scaffolds without causing fatal fractures of the implant due to stress concentrator. The bearing capacity of the treated limb was initially altered, quantifying a 28-56% reduction of the ground reaction force, which gradually normalized during the consolidation phase. A faster recovery was reported in the bearing capacity, stiffening and bone mineral density of the callus. It acquired a predominant mechanical role over the fixator in the distribution of internal forces after one post-surgical month.

CONCLUSION

The bioceramic scaffold significantly accelerated in vivo the bone formation compared to other traditional alternatives in the literature (e.g., distraction osteogenesis). In addition, the implemented assessment techniques allowed an accurate quantitative evaluation of the bone regeneration through mechanical and imaging parameters.

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

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

Assessment of dental implant stability using resonance frequency analysis and quantitative ultrasound methods

Purpose Quantitative ultrasound (QUS) and resonance frequency analyses (RFA) are promising methods to assess the stability of dental implants. The aim of this in vivo preclinical study is to compare the results obtained with these two techniques with the bone-implant contact (BIC) ratio, which is the gold standard to assess dental implant stability.Methods Twenty-two identical dental implants were inserted in the tibia and femur of 12 rabbits, which were sacrificed after different healing durations (0, 4, 8 and 13 weeks). For each implant, the ultrasonic indicator (UI) and the implant stability quotient (ISQ) were retrieved just before the animal sacrifice using the QUS and RFA techniques, respectively. Histomorphometric analyses were carried out to estimate the bone-implant contact ratio.Results UI values were found to be better correlated to BIC values (R²=0.47) compared to ISQ values (R²=0.39 for measurements in one direction and R²=0.18 for the other direction), which were shown to be dependent on the direction of measurements. Errors realized on the UI were around 3.3 times lower to the ones realized on the ISQ.Conclusions QUS provide a better estimation of dental implant stability compared to RFA. This study paves the way for the future clinical development of a medical device aiming at assessing dental implant stability in a patient-specific manner. Clinical studies should confirm these results in the future.

Analytical modeling of the interaction of an ultrasonic wave with a rough bone-implant interface

Quantitative ultrasound can be used to characterize the evolution of the bone-implant interface (BII), which is a complex system due to the implant surface roughness and to partial contact between bone and the implant. The determination of the constitutive law of the BII would be of interest in the context of implant acoustical modeling in order to take into account the imperfect characteristics of the BII. The aim of the present study is to propose an analytical effective model describing the interaction between an ultrasonic wave and a rough BII. To do so, a spring model was considered to determine the equivalent stiffness K of the BII. The stiffness contributions related (i) to the partial contact between the bone and the implant and (ii) to the presence of soft tissues at the BII during the process of osseointegration were assessed independently. K was found to be comprised between 10¹³ and 10¹⁷ N/m³ depending on the roughness and osseointegration of the BII. Analytical values of the reflection and transmission coefficients at the BII were derived from values of K. A good agreement with numerical results obtained through finite element simulation was obtained. This model may be used for future finite element bone-implant models to replace the BII conditions.

Real-Time Wireless Platform for In Vivo Monitoring of Bone Regeneration

For the monitoring of bone regeneration processes, the instrumentation of the fixation is an increasingly common technique to indirectly measure the evolution of bone formation instead of ex vivo measurements or traditional in vivo techniques, such as X-ray or visual review. A versatile instrumented external fixator capable of adapting to multiple bone regeneration processes was designed, as well as a wireless acquisition system for the data collection. The design and implementation of the overall architecture of such a system is described in this work, including the hardware, firmware, and mechanical components. The measurements are conditioned and subsequently sent to a PC via wireless communication to be in vivo displayed and analyzed using a developed real-time monitoring application. Moreover, a model for the in vivo estimation of the bone callus stiffness from collected data was defined. This model was validated in vitro using elastic springs, reporting promising results with respect to previous equipment, with average errors and uncertainties below 6.7% and 14.04%. The devices were also validated in vivo performing a bone lengthening treatment on a sheep metatarsus. The resulting system allowed the in vivo mechanical characterization of the bone callus during experimentation, providing a low-cost, simple, and highly reliable solution.

Ultrasonic Propagation in a Dental Implant

Ultrasound techniques can be used to characterize and stimulate dental implant osseointegration. However, the interaction between an ultrasonic wave and the implant-bone interface (IBI) remains unclear. This study-combining experimental and numerical approaches-investigates the propagation of an ultrasonic wave in a dental implant by assessing the amplitude of the displacements along the implant axis. An ultrasonic transducer was excited in a transient regime at 10 MHz. Laser interferometric techniques were employed to measure the amplitude of the displacements, which varied 3.2-8.9 nm along the implant axis. The results demonstrated the propagation of a guided wave mode along the implant axis. The velocity of the first arriving signal was equal to 2110 m.s^-1, with frequency components lower than 1 MHz, in agreement with numerical results. Investigating guided wave propagation in dental implants should contribute to improved methods for the characterization and stimulation of the IBI.

Modeling ultrasonic wave propagation in a dental implant - Bone system

The evolution of the bone-implant interface reflects the implant osseointegration and bond strength, thereby determining the overall implant stability in the jawbone. Quantitative ultrasound represents a promising alternative technique to characterize the interfacial integrity, precisely due to the fact that those waves propagate essentially along the bone-implant interface, and are therefore influenced by its state. This study reports a numerical investigation of ultrasonic wave propagation for a commercial implant-jawbone system in which the thickness and mechanical properties of the interfacial layer (corresponding to the interphase) are systematically varied through the application of a rule of mixtures, in order to mimic the evolution from a dominantly soft tissue - like medium up to a fully healed bone. A simple figure of merit is devised in terms of an RMS-like (root mean square) factor based on the implant displacements, that evolves continuously and significantly with the bone "healing" process, thereby providing unequivocal information on the nature of the investigated bone-implant interface. The results show that the wave propagation pattern is primarily dictated by the impedance mismatch rather than by the interface thickness. This study validates the concept of quantitative ultrasonic testing as a sensitive alternative to the widespread resonant frequency analysis, thereby opening the way for future sensitivity analyses that will address more refined bone-implant interface pathologies such as those observed in the clinical realm.

Elastography of the bone-implant interface

The stress distribution around endosseous implants is an important determinant of the surgical success. However, no method developed so far to determine the implant stability is sensitive to the loading conditions of the bone-implant interface (BII). The objective of this study is to investigate whether a quantitative ultrasound (QUS) technique may be used to retrieve information on compressive stresses applied to the BII. An acousto-mechanical device was conceived to compress 18 trabecular bovine bone samples onto coin-shaped implants and to measure the ultrasonic response of the BII during compression. The biomechanical behavior of the trabecular bone samples was modeled as Neo-Hookean. The reflection coefficient of the BII was shown to decrease as a function of the stress during the elastic compression of the trabecular bone samples and during the collapse of the trabecular network, with an average slope of −4.82 GPa⁻¹. The results may be explained by an increase of the bone-implant contact ratio and by changes of bone structure occurring during compression. The sensitivity of the QUS response of the BII to compressive stresses opens new paths in the elaboration of patient specific decision support systems allowing surgeons to assess implant stability that should be developed in the future.

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

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

Reflection of an ultrasonic wave on the bone-implant interface: Effect of the roughness parameters

Quantitative ultrasound can be used to characterize the evolution of the bone-implant interface (BII), which is a complex system due to the implant surface roughness and to partial contact between bone and the implant. The aim of this study is to derive the main determinants of the ultrasonic response of the BII during osseointegration phenomena. The influence of (i) the surface roughness parameters and (ii) the thickness W of a soft tissue layer on the reflection coefficient r of the BII was investigated using a two-dimensional finite element model. When W increases from 0 to 150 μm, r increases from values in the range [0.45; 0.55] to values in the range [0.75; 0.88] according to the roughness parameters. An optimization method was developed to determine the sinusoidal roughness profile leading to the most similar ultrasonic response for all values of W compared to the original profile. The results show that the difference between the ultrasonic responses of the optimal sinusoidal profile and of the original profile was lower to typical experimental errors. This approach provides a better understanding of the ultrasonic response of the BII, which may be used in future numerical simulation realized at the scale of an implant.

Resonant frequency analysis of dental implants

Dental implant stability influences the decision on the determination of the duration between implant insertion and loading. This work investigates the resonant frequency analysis by means of a numerical model. The investigation is done numerically through the determination of the eigenfrequencies and performing steady state response analyses using a commercial finite element package. A peri-implant interface, of simultaneously varying stiffness, density and layer thickness is introduced in the numerical 3D model in order to probe the sensitivity of the eigenfrequencies and steady state response to an evolving weakened layer, in an attempt to identify the bone reconstruction around the implant. For the first two modes, the resonant frequency is somewhat insensitive to the healing process, unless the weakened layer is rather large and compliant, like in the very early stages of the implantation. A "Normalized Healing Factor" is devised in the spirit of the Implant Stability Quotient, which can identify the healing process especially at the early stages after implantation. The sensitivity of the resonant frequency analysis to changes of mechanical properties of periprosthetic bone tissue seems relatively weak. Another indicator considering the amplitude as well as the resonance frequency might be more adapted to bone healing estimations. However, these results need to be verified experimentally as well as clinically.

A Quantitative Approach for the Bone-implant Osseointegration Assessment Based on Ultrasonic Elastic Guided Waves

Quantitative and reliable monitoring of osseointegration will help further evaluate the integrity of the orthopaedic construct to promote novel prosthesis design and allow early mobilisation. Quantitative assessment of the degree or the lack of osseointegration is important for the clinical management with the introduction of prosthetic implants to amputees. Acousto-ultrasonic wave propagation has been used in structural health monitoring as well as human health monitoring but so far has not extended to osseointegrated implants or prostheses. This paper presents an ultrasonic guided wave approach to assess the osseointegration of a novel implant. This study explores the potential of integrating structural health monitoring concepts into a new osseointegrated implant. The aim is to demonstrate the extension of acousto-ultrasonic techniques, which have been widely reported for the structural health monitoring of engineering structures, to assess the state of osseointegration of a bone and implant. To illustrate this potential, this paper will report on the experimental findings which investigated the unification of an aluminium implant and bone-like geometry surrogate. The core of the test specimen is filled with silicone and wrapped with plasticine to simulate the highly damped cancellous bone and soft tissue, respectively. To simulate the osseointegration process, a 2-h adhesive epoxy is used to bond the surrogate implant and a bone-like structure. A series of piezoelectric elements are bonded onto the surrogate implant to serve as actuators and sensors. The actuating piezoelectric element on an extramedullary strut is excited with a 1 MHz pulse signal. The reception of the ultrasonic wave by the sensing elements located on the adjacent and furthest struts is used to assess the integration of this implant to the parent bone structure. The study shows an Osseointegration Index can be formulated by using engineering and acousto-ultrasonic methods to measure the unification of a bone and implant. This also highlights a potential quantitative evaluation technique regardless of bone-implant geometry and soft tissue damping.

Clinical Assessment of Dental Implant Stability During Follow-Up: What Is Actually Measured, and Perspectives

The optimization of loading protocols following dental implant insertion requires setting up patient-specific protocols, customized according to the actual implant osseointegration, measured through quantitative, objective methods. Various devices for the assessment of implant stability as an indirect measure of implant osseointegration have been developed. They are analyzed here, introducing the respective physical models, outlining major advantages and critical aspects, and reporting their clinical performance. A careful discussion of underlying hypotheses is finally reported, as is a suggestion for further development of instrumentation and signal analysis.

Reflection of an ultrasonic wave on the bone-implant interface: A numerical study of the effect of the multiscale roughness

Quantitative ultrasound is used to characterize and stimulate osseointegration processes at the bone-implant interface (BII). However, the interaction between an ultrasonic wave and the implant remains poorly understood. This study aims at investigating the sensitivity of the ultrasonic response to the microscopic and macroscopic properties of the BII and to osseointegration processes. The reflection coefficient R of the BII was modeled for different frequencies using a two-dimensional finite element model. The implant surface roughness was modeled by a sinusoidal function with varying amplitude h and spatial frequency L. A soft tissue layer of thickness W was considered between bone tissue and the implant in order to model non-mineralized fibrous tissue. For microscopic roughness, R is shown to increase from around 0.55 until 0.9 when kW increases from 0 to 1 and to be constant for kW > 1, where k is the wavenumber in the implant. These results allow us to show that R depends on the properties of bone tissue located at a distance comprised between 1 and 25 μm from the implant surface. For macroscopic roughness, R is highly dependent on h and this dependence may be explained by phase cancellation and multiple scattering effects for high roughness parameters.

Evaluation of dental implant stability in bone phantoms: Comparison between a quantitative ultrasound technique and resonance frequency analysis

BACKGROUND

Resonance frequency analyses and quantitative ultrasound methods have been suggested to assess dental implant primary stability.

PURPOSE

The purpose of this study was to compare the results obtained using these two techniques applied to the same dental implants inserted in various bone phantoms.

MATERIALS AND METHODS

Different values of trabecular bone density and cortical thickness were considered to assess the effect of bone quality on the respective indicators (UI and ISQ). The effect of the implant insertion depth and of the final drill diameter was also investigated.

RESULTS

ISQ values increase and UI values decrease as a function of trabecular density, cortical thickness and the screwing of the implant. When the implant diameter varies, the UI values are significantly different for all final drill diameters (except for two), while the ISQ values are similar for all final drill diameters lower than 3.2 mm and higher than 3.3 mm. The error on the estimation of parameters with the QUS device is between 4 and 8 times lower compared to that made with the RFA technique.

CONCLUSIONS

The results show that ultrasound technique provides a better estimation of different parameters related to the implant stability compared to the RFA technique.

Comparison of Resonance Frequency Analysis and of Quantitative Ultrasound to Assess Dental Implant Osseointegration

Dental implants are widely used in the clinic. However, there remain risks of failure, which depend on the implant stability. The aim of this paper is to compare two methods based on resonance frequency analysis (RFA) and on quantitative ultrasound (QUS) and that aim at assessing implant stability. Eighty-one identical dental implants were inserted in the iliac crests of 11 sheep. The QUS and RFA measurements were realized after different healing times (0, 5, 7, and 15 weeks). The results obtained with the QUS (respectively RFA) method were significantly different when comparing two consecutive healing time for 97% (respectively, 18%) of the implants. The error made on the estimation of the healing time when analyzing the results obtained with the QUS technique was around 10 times lower than that made when using the RFA technique. The results corresponding to the dependence of the ISQ versus healing time were significantly different when comparing two directions of RFA measurement. The results show that the QUS method allows a more accurate determination of the evolution of dental implant stability when compared to the RFA method. This study paves the way towards the development of a medical device, thus providing a decision support system to dental surgeons.

Assessment of the biomechanical stability of a dental implant with quantitative ultrasound: A three-dimensional finite element study

Dental implant stability is an important determinant of the surgical success. Quantitative ultrasound (QUS) techniques can be used to assess such properties using the implant acting as a waveguide. However, the interaction between an ultrasonic wave and the implant remains poorly understood. The aim of this study is to investigate the sensitivity of the ultrasonic response to the quality and quantity of bone tissue in contact with the implant surface. The 10 MHz ultrasonic response of an implant used in clinical practice was simulated using an axisymmetric three-dimensional finite element model, which was validated experimentally. The amplitude of the echographic response of the implant increases when the depth of a liquid layer located at the implant interface increases. The results show the sensitivity of the QUS technique to the amount of bone in contact with the implant. The quality of bone tissue around the implant is varied by modifying the bone biomechanical properties by 20%. The amplitude of the implant echographic response decreases when bone quality increases, which corresponds to bone healing. In all cases, the amplitude of the implant response decreased when the dental implant stability increased, which is consistent with the experimental results.

Finite element simulation of ultrasonic wave propagation in a dental implant for biomechanical stability assessment

Dental implant stability, which is an important parameter for the surgical outcome, can now be assessed using quantitative ultrasound. However, the acoustical propagation in dental implants remains poorly understood. The objective of this numerical study was to understand the propagation phenomena of ultrasonic waves in cylindrically shaped prototype dental implants and to investigate the sensitivity of the ultrasonic response to the surrounding bone quantity and quality. The 10-MHz ultrasonic response of the implant was calculated using an axisymetric 3D finite element model, which was validated by comparison with results obtained experimentally and using a 2D finite difference numerical model. The results show that the implant ultrasonic response changes significantly when a liquid layer is located at the implant interface compared to the case of an interface fully bounded with bone tissue. A dedicated model based on experimental measurements was developed in order to account for the evolution of the bone biomechanical properties at the implant interface. The effect of a gradient of material properties on the implant ultrasonic response is determined. Based on the reproducibility of the measurement, the results indicate that the device should be sensitive to the effects of a healing duration of less than one week. In all cases, the amplitude of the implant response is shown to decrease when the dental implant primary and secondary stability increase, which is consistent with the experimental results. This study paves the way for the development of a quantitative ultrasound method to evaluate dental implant stability.

Assessment of in vitro dental implant primary stability using an ultrasonic method

Dental implants are used for oral rehabilitation. However, there remain risks of failure that depend on the implant stability. The objective of this study is to investigate whether quantitative ultrasound technique can be used to assess the amount of bone in contact with dental implants. Ten implants are first inserted in the bone samples. The 10 MHz ultrasonic response of each implant is measured using a dedicated device and an indicator I is derived based on the amplitude of the signal. Then, the implant is unscrewed by 2 π radians and the measurement is realized again. A statistical analysis of variance was carried out and revealed a significant effect of the amount of bone in contact with the implant on the values of I (p value < 10⁻⁵). The results indicates the feasibility of quantitative ultrasound techniques to assess implant primary stability in vitro.

Wave dispersion and attenuation on human femur tissue

Cortical bone is a highly heterogeneous material at the microscale and has one of the most complex structures among materials. Application of elastic wave techniques to this material is thus very challenging. In such media the initial excitation energy goes into the formation of elastic waves of different modes. Due to “dispersion”, these modes tend to separate according to the velocities of the frequency components. This work demonstrates elastic wave measurements on human femur specimens. The aim of the study is to measure parameters like wave velocity, dispersion and attenuation by using broadband acoustic emission sensors. First, four sensors were placed at small intervals on the surface of the bone to record the response after pencil lead break excitations. Next, the results were compared to measurements on a bulk steel block which does not exhibit heterogeneity at the same wave lengths. It can be concluded that the microstructure of the tissue imposes a dispersive behavior for frequencies below 1 MHz and care should be taken for interpretation of the signals. Of particular interest are waveform parameters like the duration, rise time and average frequency, since in the next stage of research the bone specimens will be fractured with concurrent monitoring of acoustic emission.

Ultrasonic evaluation of dental implant osseointegration

Dental implants are widely used for oral rehabilitation. However, there remain risks of failure which are difficult to anticipate and depend on the implant osseointegration. The objective of this in vivo study is to determine the variation of the echographic ultrasonic response of a dental implant to bone healing around the implant interface. Twenty one dental implants were inserted in the femur of seven New Zealand white rabbits. Two animals were sacrificed after a healing duration of two weeks, three animals after six weeks and six animals after eleven weeks. The 10 MHz ultrasonic response of the implant was measured just after the implantation using a dedicated device positioned at the emerging surface of each dental implant. The measurements were realized again before the sacrifice with the same device. An indicator I˜ was derived based on the amplitude of the rf signal obtained for each configuration. The bone-Implant Contact (BIC) ratio was determined by histological analyses. The average value of the relative variation of the indicator I˜ obtained after initial surgery and after the corresponding healing period varies between 7% and 40%. A Kruskal-Wallis test (p<0.01) revealed a significant decrease of the value of the indicator I˜ as function of healing time. The indicator I˜ was significantly correlated (R(2)=0.45) with the BIC ratio. The results show that the ultrasonic response of a dental implant varies significantly as a function of healing time, which paves the way for the development of a new quantitative ultrasound (QUS) method in oral implantology.

Effects of biomechanical properties of the bone-implant interface on dental implant stability: from in silico approaches to the patient's mouth

Dental implants have become a routinely used technique in dentistry for replacing teeth. However, risks of failure are still experienced and remain difficult to anticipate. Multiscale phenomena occurring around the implant interface determine the implant outcome. The aim of this review is to provide an understanding of the biomechanical behavior of the interface between a dental implant and the region of bone adjacent to it (the bone-implant interface) as a function of the interface's environment. First, we describe the determinants of implant stability in relation to the different multiscale simulation approaches used to model the evolution of the bone-implant interface. Then, we review the various aspects of osseointegration in relation to implant stability. Next, we describe the different approaches used in the literature to measure implant stability in vitro and in vivo. Last, we review various factors affecting the evolution of the bone-implant interface properties.

Biomechanical determinants of the stability of dental implants: influence of the bone-implant interface properties

Dental implants are now widely used for the replacement of missing teeth in fully or partially edentulous patients and for cranial reconstructions. However, risks of failure, which may have dramatic consequences, are still experienced and remain difficult to anticipate. The stability of biomaterials inserted in bone tissue depends on multiscale phenomena of biomechanical (bone-implant interlocking) and of biological (mechanotransduction) natures. The objective of this review is to provide an overview of the biomechanical behavior of the bone-dental implant interface as a function of its environment by considering in silico, ex vivo and in vivo studies including animal models as well as clinical studies. The biomechanical determinants of osseointegration phenomena are related to bone remodeling in the vicinity of the implants (adaptation of the bone structure to accommodate the presence of a biomaterial). Aspects related to the description of the interface and to its space-time multiscale nature will first be reviewed. Then, the various approaches used in the literature to measure implant stability and the bone-implant interface properties in vitro and in vivo will be described. Quantitative ultrasound methods are promising because they are cheap, non invasive and because of their lower spatial resolution around the implant compared to other biomechanical approaches.

Influence of healing time on the ultrasonic response of the bone-implant interface

The aim of the present study is to investigate the effect of bone healing on the ultrasonic response of coin-shaped titanium implants inserted in rabbit tibiae. The ultrasound response of the interface was measured in vitro at 15 MHz after 7 and 13 weeks of healing time. The average value of the ratio r between the amplitudes of the echo of the bone-implant interface and of the water-implant interface was determined. The bone-implant contact (BIC) was measured by histomorphometry and the degree of mineralisation of bone was estimated qualitatively by histologic staining. The significant decrease of the ultrasonic quantitative indicator r (p = 2.10⁻⁴) vs. healing time (from r = 0.53 to r = 0.49) is explained by (1) the increase of the BIC (from 27% to 69%) and (2) the increase of mineralization of newly formed bone tissue, both phenomena inducing a decrease of the gap of acoustical impedance.

Development of a low-cost airborne ultrasound sensor for the detection of brick joints behind a wall painting

Non-destructive methods are of great interest for the analysis of cultural heritage. Among the different possible techniques, this paper presents a low cost prototype based on the emission and reception of airborne ultrasound without direct contact with the test specimen. We successfully performed a method test for the detection of brick joints under a XVth century Renaissance fresco of the Metropolitan Cathedral of the city of Valencia (Spain). Both laboratory and in situ results are in agreement. Using this prototype system, an early moisture detection system has been installed in the dome that supports the fresco. The result is encouraging and opens interesting prospects for future research.

Numerical simulation of ultrasonic wave propagation for the evaluation of dental implant biomechanical stability

Osseointegration of dental implants remains poorly understood. The objective of this numerical study is to understand the propagation phenomena of ultrasonic waves in prototypes cylindrically shaped implants and to investigate the sensitivity of their ultrasonic response to the surrounding bone biomechanical properties. The 10 MHz ultrasonic response of the implant was calculated using a finite difference numerical simulation tool and was compared to rf signals taken from a recent experimental study by Mathieu et al. [Ultrasound Med. Biol. 37, 262-270 (2011a)]. Reflection and mode conversion phenomena were analyzed to understand the origin of the different echoes and the importance of lateral wave propagation was evidenced. The sensitivity of the ultrasonic response of the implant to changes of (i) amount of bone in contact with the implant, (ii) cortical bone thickness, and (iii) surrounding bone material properties, was compared to the reproducibility of the measurements. The results show that, either a change of 1 mm of bone in contact with the implant, or 1.1 mm of cortical thickness or 12% of trabecular bone mass density should be detectable. This study paves the way for the investigation of the use of quantitative ultrasound techniques for the evaluation of bone-implant interface properties and implant stability.

Evaluation of the Effect of Ozonated Plant Oils on the Quality of Osseointegration of Dental Implants Under the Influence of Cyclosporin A: An In Vivo Study

Immunosuppressive agents have been recognized as factors that induce changes and modifications in bone metabolism. The purpose of this study was to evaluate the effect of ozonated plant extracts (herein termed ozonated oil) under the influence of Cyclosporin A (CsA) on osseointegration. A total of 20 dental implants were placed in 20 rabbit tibiae assigned to Group A or B. CsA was injected at an immunosuppressive dose in Groups A and B as a single-dose treatment. At the day of surgery, Group A received a single topical ozonated oil treatment (0.55 mL) around dental implants; Group B, the control group, received no ozonated oil. Animals were sacrificed after 8 weeks. Radiographs were obtained at implant surgery and on the day of sacrifice. Bone quality was compared between the 2 groups. Radiographically, osseointegration was microscopically evaluated using scanning electron and light microscopies. In ozonated Group A specimens, light microscopic examination demonstrated evidence of more organized mature bone compared with Group B. Within the limits of this study, the results suggest that short-term administration of CsA, when administered with topical ozonated oil, may influence bone density and the quality of dental implant osseointegration. Therefore, topically applied ozonated oil may influence bone density and the quality of osseointegration around dental implants.

Ultrasonic evaluation of dental implant biomechanical stability: an in vitro study

Dental implants are widely used for oral rehabilitation. However, there remain risks of failure that are difficult to anticipate. The objective of this ex vivo study is to investigate the potentiality of quantitative ultrasound (QUS) to assess the amount of bone in contact with titanium prototype cylindrical implants. Four groups of 10 rabbit femurs each are considered, corresponding to different amounts of bone in contact with the implant. The 10 MHz ultrasonic response of the implant is processed to derive a quantitative indicator I, based on the temporal variation of the signal amplitude. Analysis of variance (ANOVA) (p < 10(-5)) tests revealed a statistical distribution of I significantly correlated with the amount of bone in contact with the cylinders. An analytical model considering the propagation of lateral waves allows the understanding of the physical origin of the echoes. QUS technique may be used to investigate the amount of bone in contact with a cylinder implant.