Proximal cementation of a collarless polished tapered hip stem: biomechanical analysis using a validated finite element model.

Total hip replacement (THR) with cemented stem is a common procedure for patients with hip osteoarthritis. When primary THR fails, removal of the cement is problematic and poses challenges during revision surgeries. The possibility of proximal partial cementing of the hip stem was explored to mitigate the problem. 3D finite element analysis was performed to investigate the feasibility of reduced cement length for effective implant fixation and load transmission. Three levels of cement reduction (40 mm, 80 mm, and 100 mm) in the femoral stem were evaluated. All models were assigned loadings of peak forces acting on the femur during walking and stair climbing. The experimental and predicted max/min principal bone strains were fitted into regression models and showed good correlations. FE results indicated stress increment in the femoral bone, stem, and cement due to cement reduction. A notable increase of bone stress was observed with large cement reduction of 80-100 mm, particularly in Gruen zones 3 and 5 during walking and Gruen zones 3 and 6 during stair climbing. The increase of cement stresses could be limited to 11% with a cement reduction of 40 mm. The findings suggested that a 40-mm cement reduction in hip stem fixation was desirable to avoid unwanted complications after cemented THR.

Adjacent vertebral fractures in the lumbar and thoracic spine after balloon kyphoplasty: A finite element analysis.

The purpose of the present study was to mechanically verify after vertebral augmentation (AVA) scores using a finite element method (FEM) with accurate material constants of balloon kyphoplasty (BKP) cement. Representative cases with AVA scores of 1 (case 1), 3 (case 2), and 5 (case 3) among patients with vertebral body fractures who underwent BKP were analyzed. A FEM model consisting of 5 vertebral bodies was created, including the injured vertebral body in each case. The amount of displacement for each load (up to 4000 N) between the upper and lower vertebral bodies of each model was measured. Young modulus of the BKP cement was calculated from actual measurements using the EZ-Test EZ-S (Shimadzu Corporation, Kyoto, Japan). In all cases, the number of shell elements (209,296-299,876), solid elements (1913,029-2417,671), and nodes (387,848-487,756) were similar, indicating that FEM modeling was comparable among the cases. Young modulus of BKP cement, calculated using EZ-Test EZ-S, was 572 MPa. Fractures were detected by compressive forces of 3300 N (upper) and 3300 N (lower), 3000 N (upper) and 3100 N (lower), and 1200 N (upper) and 1200 N (lower) in cases 1, 2, and 3, respectively. The AVA scoring system was mechanically verified using the accurate material constants of BKP cement. A multicenter survey and external validation are therefore required for the clinical implementation of the AVA score.

Mechanical evaluation of revision surgery for femoral shaft nonunion initially treated with intramedullary nailing: Exchange nailing versus augmentation plating.

INTRODUCTION: Exchange nailing (EN) or augmentation plating (AP) has been employed to treat nonunions after intramedullary nailing for femoral shaft fractures. Although instability is a factor in hypertrophic nonunion, mechanical evaluations have been limited because the contribution of the callus to fracture site stability varies with healing. Our previous study illustrated the potential for evaluation using a finite element analysis (FEA) that incorporates callus material properties. This study aimed to mechanically evaluate revision surgery for nonunions using FEA. MATERIALS AND METHODS: A quantitative computed tomography-based FEA was performed on virtual revision models of a patient with suspected nonunion after intramedullary nailing. In addition to the initial nailing model (IN) with an 11-mm diameter (D) and 360-mm length (L), four EN models with D12mm (EN1), D13mm (EN2), D12mm-L400mm (EN3), and D13mm-L400mm (EN4) nails and three AP models with 5- (AP1), 6- (AP2), and 7-hole (AP3) plates were created. As with bone, callus was assigned inhomogeneous material properties derived from density based on an empirical formula. The hip joint reaction force and muscle forces at maximum load during the gait cycle were applied. The volume ratio of the callus at the fracture site with a tensile failure risk of ≥1 (tensile failure ratio) and bone fragment movement were evaluated. RESULTS: The tensile failure ratio was 11.6 % (IN), 10.1 % (EN1), 6.3 % (EN2), 10.9 % (EN3), 6.2 % (EN4), 6.4 % (AP1), 7.2 % (AP2), and 7.7 % (AP3), respectively. The bone fragment movement showed an opening on the lateral side with the initial intramedullary nailing. However, both revision surgeries reduced the opening, leading to compression except in the EN1 model. The proximal bone fragments were internally rotated relative to the distal fragments, and the rotational instability was more suppressed in models with lower tensile failure ratio. CONCLUSIONS: For EN, the increase in diameter, not length, is important to suppress instability. AP reduces instability, comparable to a 2 mm increase in nail diameter, and screw fixation closer to the fracture site reduces instability. This study suggest that AP is mechanically equivalent to EN and could be an option for revision surgery for femoral shaft nonunions.

Osteoconductivity and neurotoxicity of silver-containing hydroxyapatite coating cage for spinal interbody fusion in rats.

Background: The use of spinal instrumentation is an established risk factor for postoperative infection. To address this problem, we prepared silver-containing hydroxyapatite coating, consisting of highly osteoconductive hydroxyapatite interfused with silver. The technology has been adopted for total hip arthroplasty. Silver-containing hydroxyapatite coating has been reported to have good biocompatibility and low toxicity. However, no studies about applying this coating in spinal surgery have addressed the osteoconductivity and direct neurotoxicity to the spinal cord of silver-containing hydroxyapatite cages in spinal interbody fusion. Aim: In this study, we evaluated the osteoconductivity and neurotoxicity of silver-containing hydroxyapatite-coated implants in rats. Materials & Methods: Titanium (non-coated, hydroxyapatite-coated, and silver-containing hydroxyapatite-coated) interbody cages were inserted into the spine for anterior lumbar fusion. At 8 weeks postoperatively, micro-computed tomography and histology were performed to evaluate the osteoconductivity of the cage. Inclined plane test and toe pinch test were performed postoperatively to assess neurotoxicity. Results: Micro-computed tomography data indicated no significant difference in bone volume/total volume among the three groups. Histologically, the hydroxyapatite-coated and silver-containing hydroxyapatite-coated groups showed significantly higher bone contact rate than that of the titanium group. In contrast, there was no significant difference in bone formation rate among the three groups. Data of inclined plane and toe pinch test showed no significant loss of motor and sensory function in the three groups. Furthermore, there was no degeneration, necrosis, or accumulation of silver in the spinal cord on histology. Conclusions: This study suggests that silver-hydroxyapatite-coated interbody cages produce good osteoconductivity and are not associated with direct neurotoxicity.

Analysis for Predictors of Failure of Orthodontic Mini-implant Using Patient-Specific Finite Element Models.

In this study, we analyzed the clinical factors and mechanical parameters for predicting orthodontic mini-implant (OMI) failure in the mandible, which has different properties from the maxilla. A patient-specific finite element analysis was applied to 32 OMIs (6 failures and 26 successes) implanted between the mandibular second premolars and first molars used for anchorage. The peak stress and strain parameters were calculated for each sample. A logistic regression of the failure (vs. success) of OMIs on the mechanical parameters in the models was conducted. In addition, the influence of clinical factors on the mechanical parameters considered to be related to OMI failure was examined by a regression analysis. The mechanical parameter which best predicts OMI failure in the mandible was found to be a minimum principal strain of between 0.5 to 1.0 mm from the OMI surface (R2 = 0.8033). The results indicate the patient's bone density, distance between the OMIs and adjacent root, and vertical implantation angle of the OMIs are potential clinical predictors of OMI failure in the mandible.

Evaluation of bone healing process after intramedullary nailing for femoral shaft fracture by quantitative computed tomography-based finite element analysis.

BACKGROUND: There is no proven method for quantitative evaluation of bone healing progress or decision to remove the nail after intramedullary nailing for femoral shaft fractures. Finite element analysis has become commonly utilized in bone analysis, but it may also be used to evaluate callus. The goal of this study was to use quantitative CT-based finite element analysis to assess the bone healing process and predict bone strength with the nail removed. METHODS: Quantitative CT-based finite element analysis was conducted on CT images from patients who had intramedullary nailing after a femoral shaft fracture at 6, 12, and 15 months postoperatively. The failure risk of the callus was evaluated with maximal load throughout the gait cycle. The tensile failure ratio was calculated using the volume ratio of the callus element with a tensile failure risk ≥100%. A virtual model with the nail removed was built for bone strength study, and the strength was calculated using the displacement-load curve. FINDINGS: The tensile failure ratio reduced with time, reaching 11.6%, 2.6%, and 0.5% at 6, 12, and 15 months postoperatively, respectively, consistent with bone healing inferred from imaging results. At 15 months, the bone strength at nail removal grew to 212, 2670, and 3385 N, surpassing the healthy side's 2766 N. INTERPRETATION: Quantitative CT-based finite element analysis enables mechanical assessment during the bone healing process and is expected to be applied to the selection of revision surgery. It is also applicable to the nail removal decision.

Prediction of Bone Mineral Density (BMD) Adaptation in Pelvis-Femur Model with Hip Arthroplasties.

The prediction of bone remodeling behaviour is a challenging factor in encouraging the long-term stability of hip arthroplasties. The presence of femoral components modifies the biomechanical environment of the bone and alters the bone growth process. Issues of bone loss and gait instability on both limbs are associated with the remodeling process. In this study, finite element analysis with an adaptive bone remodeling algorithm was used to predict the changes in bone mineral density following total hip and resurfacing hip arthroplasty. A three-dimensional model of the pelvis-femur was constructed from computed tomography (CT-based) images of a 79-year-old female patient with hip osteoarthritis. The prosthesis stem of the total hip arthroplasty was modelled with a titanium alloy material, while the femoral head had alumina properties. Meanwhile, resurfacing of the hip implant was completed with a cobalt-chromium material. Contact between the components and bone was designed to be perfectly bonded at the interface. Results indicate that the bone mineral density was modified over five years on all models, including hip osteoarthritis. The changes of BMD were predicted as being high between year zero and year one, especially in the proximal region. Changes were observed to be minimal in the following years. The bone remodeling process was also predicted for the non-operated femur. However, the adaptation was lower compared to the operated limbs. The reduction in bone mineral density suggested the bone loss phenomenon after a few years.

Improvement of Mechanical Strength of Tissue Engineering Scaffold Due to the Temperature Control of Polymer Blend Solution.

Polymeric scaffolds made of PCL/PLCL (ratio 1:3, respectively) blends have been developed by using the Thermally Induced Phase Separation (TIPS) process. A new additional technique has been introduced in this study by applying pre-heat treatment to the blend solution before the TIPS process. The main objective of this study is to evaluate the influence of the pre-heat treatment on mechanical properties. The mechanical evaluation showed that the mechanical strength of the scaffolds (including tensile strength, elastic modulus, and strain) improved as the temperature of the polymer blend solution increased. The effects on the microstructure features were also observed, such as increasing strut size and differences in phase separation morphology. Those microstructure changes due to temperature control contributed to the increasing of mechanical strength. The in vitro cell study showed that the PCL/PLCL blend scaffold exhibited better cytocompatibility than the neat PCL scaffold, indicated by a higher proliferation at 4 and 7 days in culture. This study highlighted that the improvement of the mechanical strength of polymer blends scaffolds can be achieved using a very versatile way by controlling the temperature of the polymer blend solution before the TIPS process.

Risk assessment of vertebral compressive fracture using bone mass index and strength predicted by computed tomography image based finite element analysis.

BACKGROUND: A main purpose of osteoporosis diagnosis is to evaluate the bone fracture risk. Some bone mass indices evaluated using bone mineral density has been utilized clinically to assess the degree of osteoporosis. On the other hand, Computed tomography image based finite element analysis has been developed to evaluate bone strength of vertebral bodies. The strength of a vertebra is defined as the load at the onset of compressive fracture. The objective of this study was therefore to propose a new feasible method to combine the advantages of the two osteoporotic indices such as the bone mass index and the bone strength. METHODS: Three-dimensional finite element models of 246 vertebral bodies from 88 patients were constructed using the computed tomography images. Finite element analysis was then conducted to evaluate their strength values. The Pearson's correlation analysis was also conducted between the vertebral strength and bone mass indices. FINDINGS: It was found that relatively weak positive correlations existed between the strength and the bone mass indices. A new assessment method was then proposed by combining the strength and the bone mass index. "high risk zone" corresponding to low strength with normal bone mass was found from the assessment method. INTERPRETATION: Singe bone mass index cannot predict the fracture risk with high standard. The results of fracture risk assessment conducted by the new method clearly indicated the necessity and effectiveness to take both the strength and the bone mass index into account.

Engineered chitosan for improved 3D tissue growth through Paxillin-FAK-ERK activation.

Scaffold engineering has attracted significant attention for three-dimensional (3D) growth, proliferation and differentiation of stem cells in vitro. Currently available scaffolds suffer from issues such as poor ability for cell adhesion, migration and proliferation. This paper addresses these issues with 3D porous chitosan scaffold, fabricated and functionalized with cysteine-terminated Arg-Gly-Asp (Cys-RGD) tri-peptide on their walls. The study reveals that the compressive moduli of the scaffold is independent to RGD functionalization but shows dependence on the applied freezing temperature (TM) during the fabrication process. The low freezing TM (-80°C) produces scaffold with high compressive moduli (14.64 ± 1.38 kPa) and high TM (-30°C) produces scaffold with low compressive moduli (5.6 ± 0.38 kPa). The Cys-RGD functionalized scaffolds lead to significant improvements in adhesion (150%) and proliferation (300%) of human mesenchymal stem cell (hMSC). The RGD-integrin coupling activates the focal adhesion signaling (Paxillin-FAK-ERK) pathways, as confirmed by the expression of p-Paxillin, p-FAK and p-ERK protein, and results in the observed improvement of cell adhesion and proliferation. The proliferation of hMSC on RGD functionalized surface was evaluated with scanning electron microscopy imaging and distribution though pore was confirmed by histochemistry of transversely sectioned scaffold. The hMSC adhesion and proliferation in scaffold with high compressive moduli showed a constant enhancement (with a slope value 9.97) of compressive strength throughout the experimental period of 28 days. The improved cell adhesion and proliferation with RGD functionalized chitosan scaffold, together with their mechanical stability, will enable new interesting avenues for 3D cell growth and differentiation in numerous applications including regenerative tissue implants.

Effect of sagittal pelvic tilt on joint stress distribution in hip dysplasia: A finite element analysis.

BACKGROUND: Physiologic pelvic tilt can change acetabular orientation and coverage in patients with hip dysplasia. In this study, we aimed to clarify the impact of change in sagittal pelvic tilt on joint stress distribution in dysplastic hips. METHODS: We developed patient-specific finite element models of 21 dysplastic hips and 21 normal hips. The joint contact area, contact pressure, and equivalent stress of the acetabular cartilage were assessed at three pelvic tilt positions relative to the functional pelvic plane: 10° anterior tilt, no tilt, and 10° posterior tilt. FINDINGS: The mean contact area was 0.6-0.7 times smaller, the mean maximum contact pressure was 1.8-1.9 times higher, and the mean maximum equivalent stress was 1.3-2.8 times higher in dysplastic hips than in normal hips at all three pelvic positions. As the pelvis tilted from 10° anterior to 10° posterior, the mean contact area decreased, and the mean maximum contact pressure and median maximum equivalent stress increased. The latter two changes were more significant in dysplastic hips than in normal hips (total increment was 1.3 MPa vs. 0.4 MPa, P = 0.001, and 3.6 MPa vs. 0.4 MPa, P < 0.001, respectively). The mean equivalent stress increased in the anterosuperior acetabulum during posterior pelvic tilt in dysplastic and normal hips, while the change was not significant in the superior and posterosuperior acetabulum in both groups. INTERPRETATION: Sagittal pelvic tilt alters the loading environment and joint stress distribution of the hip joint and may impact the degeneration process in dysplastic hips.

Adhesion, proliferation and differentiation of human mesenchymal stem cell on chitosan/collagen composite scaffold.

In vitro tissue engineering requires a progenitor cell source and a porous scaffold providing three dimensional (3D) supports for growth and differentiation to attain tissue architectures. This research focused on fabrication and characterization of 3D porous scaffolds using chitosan (CS), collagen (CG) and chitosan-collagen (CS-CG) composite to investigate their influence on human mesenchymal stem cell (hMSC) adhesion, proliferation and differentiation. Material dependent variations in porous morphology and mechanical behavior of the fabricated CS, CG and CS-CG scaffold showed significant impact on hMSC adhesion, proliferation and differentiation. The maximum hMSC adhesion and proliferation was reported on CS-CG scaffold among all fabricated scaffold groups. Interconnectivity of pores structure in CS-CG scaffold was considered as preferable attribute for such enhanced growth and distribution throughout the scaffold. Besides, CS scaffold with well interconnected pores showed poor adhesion and proliferation because of inadequate adhesion motifs. In case of CG scaffold, optimum growth and distribution of hMSC occurs only at the surface because of the absence of interconnectivity in their pore structures. Likewise, osteogenic differentiation of hMSC occurs most preferably in CS-CG composite scaffold among all scaffold groups. Such enhanced hMSC proliferation and differentiation in CS-CG scaffold significantly influenced on mechanical behavior of scaffold which is essential for in vivo application of a bone tissue implant. Thus CS-CG composite scaffold holds promise to be a suitable platform for in vitro engineering of bone tissue implant.

Effects of culture conditions on the mechanical and biological properties of engineered cartilage constructed with collagen hybrid scaffold and human mesenchymal stem cells.

Mesenchymal stem cells (MSCs) has been used as one of the new cell sources in osteochondral tissue engineering. It has been well known that control of their differentiation into chondrocytes plays a key role in developing engineered cartilages. Therefore, this study aims to develop a fundamental protocol to control the differentiation and proliferation of MSCs to construct an engineered cartilage. We compared the effects of three different culture conditions on cell proliferation, extracellular matrix formation and the mechanical response of engineered cartilage constructed using a collagen-based hybrid scaffold and human MSCs. The experimental results clearly showed that the combined culture condition of the chondrogenic differentiation culture and the chondrocyte growth culture exhibited statistically significant cell proliferation, ECM formation and stiffness responses as compared to the other two combinations. It is thus concluded that the combination of the differentiation culture with the subsequent growth culture is recommended as the culture condition for chondrogenic tissue engineering using hMSCs.

Development and characterization of hybrid tubular structure of PLCL porous scaffold with hMSCs/ECs cell sheet.

Tissue engineering offers an alternate approach to providing vascular graft with potential to grow similar with native tissue by seeding autologous cells into biodegradable scaffold. In this study, we developed a combining technique by layering a sheet of cells onto a porous tubular scaffold. The cell sheet prepared from co-culturing human mesenchymal stem cells (hMSCs) and endothelial cells (ECs) were able to infiltrate through porous structure of the tubular poly (lactide-co-caprolactone) (PLCL) scaffold and further proliferated on luminal wall within a week of culture. Moreover, the co-culture cell sheet within the tubular scaffold has demonstrated a faster proliferation rate than the monoculture cell sheet composed of MSCs only. We also found that the co-culture cell sheet expressed a strong angiogenic marker, including vascular endothelial growth factor (VEGF) and its receptor (VEGFR), as compared with the monoculture cell sheet within 2 weeks of culture, indicating that the co-culture system could induce differentiation into endothelial cell lineage. This combined technique would provide cellularization and maturation of vascular construct in relatively short period with a strong expression of angiogenic properties.

Prediction of damage formation in hip arthroplasties by finite element analysis using computed tomography images.

Femoral bone fracture is one of the main causes for the failure of hip arthroplasties (HA). Being subjected to abrupt and high impact forces in daily activities may lead to complex loading configuration such as bending and sideway falls. The objective of this study is to predict the risk of femoral bone fractures in total hip arthroplasty (THA) and resurfacing hip arthroplasty (RHA). A computed tomography (CT) based on finite element analysis was conducted to demonstrate damage formation in a three dimensional model of HAs. The inhomogeneous model of femoral bone was constructed from a 79 year old female patient with hip osteoarthritis complication. Two different femoral components were modeled with titanium alloy and cobalt chromium and inserted into the femoral bones to present THA and RHA models respectively. The analysis included six configurations, which exhibited various loading and boundary conditions, including axial compression, torsion, lateral bending, stance and two types of falling configurations. The applied hip loadings were normalized to body weight (BW) and accumulated from 1 BW to 3 BW. Predictions of damage formation in the femoral models were discussed as the resulting tensile failure as well as the compressive yielding and failure elements. The results indicate that loading directions can forecast the pattern and location of fractures at varying magnitudes of loading. Lateral bending configuration experienced the highest damage formation in both THA and RHA models. Femoral neck and trochanteric regions were in a common location in the RHA model in most configurations, while the predicted fracture locations in THA differed as per the Vancouver classification.

Tissue Reaction to a Novel Bone Substitute Material Fabricated With Biodegradable Polymer-Calcium Phosphate Nanoparticle Composite.

PURPOSE: The aim of this study was to evaluate the effectiveness of a novel bone substitute material fabricated using a biodegradable polymer-calcium phosphate nanoparticle composite. METHODS: Porous structured poly-L-lactic acid (PLLA) and hydroxyapatite (HA) nanoparticle composite, which was fabricated using solid-liquid phase separation and freeze-drying methods, was grafted into bone defects created in rat calvarium or tibia. Rats were killed 4 weeks after surgery, and histological analyses were performed to evaluate new bone formation. RESULTS: Scanning electron microscopic observation showed the interconnecting pores within the material and the pore diameter was approximately 100 to 300 µm. HA nanoparticles were observed to be embedded into the PLLA beams. In the calvarial implantation model, abundant blood vessels and fibroblastic cells were observed penetrating into pores, and in the tibia model, newly formed bone was present around and within the composite. CONCLUSIONS: The PLLA-HA nanoparticle composite bone substitute developed in this study showed biocompatibility, elasticity, and operability and thus has potential as a novel bone substitute.

Characterization of Tensile Mechanical Behavior of MSCs/PLCL Hybrid Layered Sheet.

A layered construct was developed by combining a porous polymer sheet and a cell sheet as a tissue engineered vascular patch. The primary objective of this study is to investigate the influence of mesenchymal stem cells (MSCs) sheet on the tensile mechanical properties of porous poly-(l-lactide-co-ε-caprolactone) (PLCL) sheet. The porous PLCL sheet was fabricated by the solid-liquid phase separation method and the following freeze-drying method. The MSCs sheet, prepared by the temperature-responsive dish, was then layered on the top of the PLCL sheet and cultured for 2 weeks. During the in vitro study, cellular properties such as cell infiltration, spreading and proliferation were evaluated. Tensile test of the layered construct was performed periodically to characterize the tensile mechanical behavior. The tensile properties were then correlated with the cellular properties to understand the effect of MSCs sheet on the variation of the mechanical behavior during the in vitro study. It was found that MSCs from the cell sheet were able to migrate into the PLCL sheet and actively proliferated into the porous structure then formed a new layer of MSCs on the opposite surface of the PLCL sheet. Mechanical evaluation revealed that the PLCL sheet with MSCs showed enhancement of tensile strength and strain energy density at the first week of culture which is characterized as the effect of MSCs proliferation and its infiltration into the porous structure of the PLCL sheet. New technique was presented to develop tissue engineered patch by combining MSCs sheet and porous PLCL sheet, and it is expected that the layered patch may prolong biomechanical stability when implanted in vivo.

A theoretical model to predict tensile deformation behavior of balloon catheter.

In this technical note, a simple theoretical model was proposed to express the tensile deformation and fracture of balloon catheter tested by the ISO standard using piece-wise linear force-displacement relations. The model was then validated by comparing with the tensile force-displacement behaviors of two types of typical balloon catheters clinically used worldwide. It was shown that the proposed model can effectively be used to express the tensile deformation behavior and easily be handled by physicians who are not familiar with mechanics of materials.

Variation of mechanical behavior of ß-TCP/collagen two phase composite scaffold with mesenchymal stem cell in vitro.

The primary aim of this study is to characterize the variational behavior of the compressive mechanical property of bioceramic-based scaffolds using stem cells during the cell culture period. ß-Tricalcium phosphate (TCP)/collagen two phase composites and ß-TCP scaffolds were fabricated using the polyurethane template technique and a subsequent freeze-drying method. Rat bone-marrow mesenchymal stem cells (rMSCs) were then cultured in these scaffolds for up to 28 days. Compression tests of the scaffolds with rMSCs were periodically conducted. Biological properties, such as the cell number, alkaline phosphatase (ALP) activity, and gene expressions of osteogenesis, were evaluated. The microstructural change due to cell growth and the formation of extracellular matrices was examined using a field-emission scanning electron microscope. The compressive property was then correlated with the biological properties and microstructures to understand the mechanism of the variational behavior of the macroscopic mechanical property. The porous collagen structure in the ß-TCP scaffold effectively improved the structural stability of the composite scaffold, whereas the ß-TCP scaffold exhibited structural instability with the collapse of the porous structure when immersed in a culture medium. The ß-TCP/collagen composite scaffold exhibited higher ALP activity and more active generation of osteoblastic markers than the ß-TCP scaffold.

Predisposing Factors for Orthodontic Mini-Implant Failure Defined by Bone Strains in Patient-Specific Finite Element Models.

Factors responsible for the success or failure of orthodontic mini-implants (OMIs) in clinical settings are unclear. Failure of OMIs was found to be associated with increased maximum principal strain (MaxPN) when assessed using the subject-specific finite element (FE) modeling technique. The purpose of the present study was to identify factors that increase MaxPN and thereby predispose the OMI to failure. Using the FE method, MaxPN was calculated around 28 OMIs placed in orthodontic patients, 6 of which failed during the first 5 months. Sixteen potential risk factors related to patients or to OMI position were measured on computerized tomographic images or calculated in FE models. The impact of these factors on MaxPN was verified using regression analysis. Three factors were found to have significant nonlinear relationships with MaxPN: cortical bone quality, vertical angulation of the OMI, and proximity of the OMI to the tooth in the direction of force. In conclusion, failure of an OMI is a multifactorial problem, and position and angulation of the implant are among the affecting factors. Slight apical inclination and positioning at least 1 mm off the root in the direction of force may significantly decrease failure probability.