Methods and applications of finite element analysis in dental trauma research: A scoping review.

Finite Element Analysis (FEA) is vital for understanding dental traumatology (DT) biomechanics, aiding diagnosis, treatment planning, and outcome prediction. This review explores FEA applications in DT research, evaluates their quality and outcomes, and assesses methodological aspects. Accordingly, recommendations for future researchers are provided. The study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews and registered in Open Science framework. A comprehensive search using relevant text-words and MeSH terms was performed in established databases. The inclusion criteria encompassed all Finite element analysis (FEA)-based Dental traumatology (DT) studies without language or publication year restrictions. Risk of bias was assessed with the Risk of bias tool for the use of finite element analysis in dentistry (ROBFEAD) tool. Forty-six studies published from 2001 to 2023 were included in the qualitative synthesis. The studies were categorized into five domains and six subdomains based on objectives. Maxillary central incisors and surrounding structures were commonly modelled (n = 27). Most studies utilized Computed tomography (CT), Cone Beam CT, or micro CT. Traumatic injury forces ranged from 100 N to 2000 N, and occlusal forces ranged from 150 N to 350 N. All studies were rated as high risk of bias. Fory-six studies were categorized, with most focusing on stress distribution and fracture patterns in dento-alveolar structures under various conditions, while few assessed displacements. Methodological quality lacked robustness in model development and substructure properties. Future studies should address these limitations and enhance reporting practices.

COVID-19 in India: transmission dynamics, epidemiological characteristics, testing, recovery and effect of weather.

The spread of COVID-19 is recent in India, which has within 4 months caused over 190 000 infections, as of 1 June 2020, despite four stringent lockdowns. With the current rate of the disease transmission in India, which is home to over 1.35 billion people, the infection spread is predicted to be worse than the USA in the upcoming months. To date, there is a major lack of understanding of the transmission dynamics and epidemiological characteristics of the disease in India, inhibiting effective measures to control the pandemic. We collected all the available data of the individual patients, cases and a range of parameters such as population distribution, testing and healthcare facilities, and weather, across all Indian states till May 2020. Numerical analysis was conducted to determine the effect of each parameter on the COVID-19 situation in India. A significant amount of local transmission in India initiated with travellers returning from abroad. Maharashtra, Tamil Nadu and Delhi are currently the top three infected states in India with doubling time of 14.5 days. The average recovery rate across Indian states is 42%, with a mortality rate below 3%. The rest 55% are currently active cases. In total, 88% of the patients experienced symptoms of high fever, 68% suffered from dry cough and 7.1% patients were asymptomatic. In total, 66.8% patients were males, 73% were in the age group of 20-59 years and over 83% recovered in 11-25 days. Approximately 3.4 million people were tested between 1 April and 25 May 2020, out of which 4% were detected COVID-19-positive. Given the current doubling time of infections, several states may face a major shortage of public beds and healthcare facilities soon. Weather has minimal effect on the infection spread in most Indian states. The study results will help policymakers to predict the trends of the disease spread in the upcoming months and devise better control measures.

Vaginal Changes Due to Varying Degrees of Rectocele Prolapse: A Computational Study.

Pelvic organ prolapse (POP), downward descent of the pelvic organs resulting in a protrusion of the vagina, is a highly prevalent condition, responsible for 300,000 surgeries in the U.S. annually. Rectocele, a posterior vaginal wall (PVW) prolapse of the rectum, is the second most common type of POP after cystocele. A rectocele usually manifests itself along with other types of prolapse with multicompartment pelvic floor defects. To date, the specific mechanics of rectocele formation are poorly understood, which does not allow its early stage detection and progression prediction over time. Recently, with the advancement of imaging and computational modeling techniques, a plethora of finite element (FE) models have been developed to study vaginal prolapse from different perspectives and allow a better understanding of dynamic interactions of pelvic organs and their supporting structures. So far, most studies have focused on anterior vaginal prolapse (AVP) (or cystocele) and limited data exist on the role of pelvic muscles and ligaments on the development and progression of rectocele. In this work, a full-scale magnetic resonance imaging (MRI) based three-dimensional (3D) computational model of the female pelvic anatomy, comprising the vaginal canal, uterus, and rectum, was developed to study the effect of varying degrees (or sizes) of rectocele prolapse on the vaginal canal for the first time. Vaginal wall displacements and stresses generated due to the varying rectocele size and average abdominal pressures were estimated. Considering the direction pointing from anterior to posterior side of the pelvic system as the positive Y-direction, it was found that rectocele leads to negative Y-direction displacements, causing the vaginal cross section to shrink significantly at the lower half of the vaginal canal. Besides the negative Y displacements, the rectocele bulging was observed to push the PVW downward toward the vaginal hiatus, exhibiting the well-known "kneeling effect." Also, the stress field on the PVW was found to localize at the upper half of the vaginal canal and shift eventually to the lower half with increase in rectocele size. Additionally, clinical relevance and implications of the results were discussed.

Development of patient-specific finite element model for study of composite dental implants.

Traumatic dental injuries can occur due to various reasons such as accidents, sports injuries, fights, falls, and others. These injuries can affect the teeth, gums, and surrounding tissues, and can range from minor chips and cracks to severe fractures, dislocations, and avulsions (when the tooth is completely knocked out of the socket). The most common way to address this is by replacing affected teeth with dental implants. The purpose of this research is to evaluate the use of composite materials in dental implants and compare them with the traditionally used materials using a patient specific cone beam computed tomography (CBCT) based finite element model (FEM). To conduct this research, two different implant groups i.e., traditional implant and composite implant were designed using Titanium grade 4, zirconium oxide-reinforced lithium silicate (ZLS), and Zirconia (ZrO2). Six dental implants were designed namely Ti implant, ZLS implant, ZrO2implant, Ti-ZrO2composite, Ti-ZLS composite, and ZLS-ZrO2composite using 3D modelling software. Detailed full-scale 3D models of patient specific dental implant were developed and traumatic loading conditions were applied to the enamel of central incisor teeth or crown of dental implant, and maxilla was constrained in all directions. It was found that the use of composite materials for dental implants can reduce the stresses over the surface of abutment and implant as compared to traditional implants. The detailed models developed as a part of this study can advance the research on dental implants, and with further experimental validation allow the use of composite materials for fabrication of more stable dental implants.

Biomechanical modeling of footwear-fluid-floor interaction during slips.

Slips and falls are among the major concerns for public safety. Slipping risks can be reduced by ensuring adequate traction at the shoe-floor interface. The outsole design of footwear is a critical factor to maintain sufficient shoe-floor traction in the presence of slippery contaminants such as water or oil. While the role of floorings and contaminants on footwear traction has been studied widely, limited works have investigated the role of footwear outsole geometry and tread patterns on shoe-floor traction. In this work, eight footwear outsole designs and their traction performance were tested on a common flooring with water contamination, through the development of a novel fluid-structure interaction based computational framework. Induced fluid pressure, mass flow rates, and contact areas were quantified across the outsole patterns, and their effect on footwear friction was investigated. The study results were validated using mechanical slip testing experiments. The results indicated that the outsoles which had horizontal treads or untreaded heel regions can lead to drastic reduction of footwear friction. Also, contact area alone was quantified to be a poor choice in estimating the traction performance of footwear on water contaminated floorings. Such novel study results have not been reported to date, and are anticipated to provide important guidelines to footwear manufacturers to evaluate and optimize footwear tread parameters which would help in reducing the risk of slips.

Modeling of metamaterial based incision patterns for generating high expansions in skin grafts.

BACKGROUND: Split-thickness skin grafting is a widely used treatment for burn patients. It requires removing a small portion of healthy skin, making parallel incisions on it, stretching it, and surgically implanting it into the burn site. Although skin graft mesher companies claim to significantly expand the size of the skin graft, in reality, the amount of expansion achieved is much smaller. METHODS: This study aimed to improve the expansion potential of skin grafts by designing new incision patterns with auxetic properties, using a skin simulant material and additive manufacturing. The mechanical properties and digital image correlation was used to analyze the strain, effective Poisson's ratio, local strains, void area, and meshing ratio of the auxetic skin graft simulants. FINDINGS: The results showed that the Y-shaped skin graft simulant had the highest effective negative Poisson's ratio, largest areal expansions, lowest maximum induced stresses and strains, and uniform strain distribution properties, making it the best choice for generating high expansions in skin grafts. INTREPRETATION: The study found that the expansions were highly strain sensitive, with higher auxeticity observed at lower strains. The novel findings with auxetic skin graft simulants are expected to provide valuable insights for developing skin grafts with higher expansion potential in the future.

Development of an ultra-low-cost planar biaxial tester for soft tissue characterization.

Nowadays, the research in the arena of biomedical engineering or specifically soft tissue characterization is rapidly increasing. Due to the complex properties of soft tissues such as, anisotropy and viscoelasticity, it is difficult to predict the deformation behaviour. Hence, soft tissue characterization is essential to analyze these metrics. Soft tissue characterization, specifically, can be done by implementing a planar biaxial tester. Currently, available biaxial testers are mostly developed with respect to other mechanical components such as metals, and not for the soft tissues. Also, these devices are very costly, which makes it difficult for the low and middle income countries to perform this characterization. To solve this problem, in this work, an extremely low-cost biaxial tester was designed and developed. The design of the biaxial tester was simple and modular to allow device modifications according to the applications. The device has a force capability of less than 0.4 kN and a variable speed of 18 mm min-1to 300 mm min-1. The biaxial tester was validated using a standard test material with mechanical testing machine and was further tested on several wound geometries including circular, square, diamond shaped, L-Plasty, and elliptical. The developed fully automated device exhibited high accuracy with real-time monitoring. Furthermore, test results on the wounds showed the device's capability to differentiate amongst the considered wound geometries. This device can be helpful to medical students and doctors in understanding the mechanical behaviour of soft tissues during injury induced damage, disease, wounds healing and also for plethora of applications such as expansion testing of skin grafts.

Development of novel hierarchical designs for skin graft simulants with high expansion potential.

Skin graft designs play an essential role in healing severe burn injuries. Split-thickness skin grafting (STSG) is one of the commonly used techniques for treating large burn injuries. In STSG, parallel cuts are projected onto a small portion of excised healthy skin for expansion and covering a larger burn area. To date, expansions reported for STSG are very low and insufficient to cover large burn areas. In this work, novel traditional and auxetic hierarchical cuts were designed on skin graft simulants, which were mechanically tested to study their expansion potential. Additive manufacturing and a two-part polymeric material were employed to fabricate the skin graft simulants. The nonlinear mechanical behavior of the hierarchical skin graft simulants was characterized using hyperelastic models. The effective Poisson's ratio, meshing ratios, and induced stresses in first and second-order hierarchical cut patterns were estimated across all skin graft simulants for up to 300% strain. Also, Statistical analysis was performed to calculate the significance among the groups. From the analysis, the skin graft simulants with second-order auxetic incision patterns were found to exhibit the lowest induced stresses and maximum expansion of approximately four times, at 300% strain. To date, traditional skin grafts have only been able to achieve up to three times expansion. Therefore, the expansions realized with the novel hierarchical skin graft simulants is unprecedented, with the potential to generate ground-breaking advances in burn injury treatment.

A high-fidelity biomechanical modeling framework for injury prediction during frontal car crash.

Injuries arising from car crashes are ubiquitous across the globe and account for over 1.3 million fatalities annually. 93% of mortalities are observed in middle- and low-income countries owing to the lack of infrastructure in the safety assessment of car designs. It is therefore imperative to predict the extent of injuries to the occupants during car crashes, which would lead to safer vehicle design. To date, conventional computational testing methods use Hybrid III dummies, which fail to reproduce fracture and tear injuries. In this work, a full-frontal collision of a vehicle against a rigid wall with a highly biofidelic human body model of an occupant was simulated for the first time to investigate fractures and tears using a novel fracture modeling technique. Fractures were observed in ribs (5-7), which occurred at stresses of 120 MPa at the left lateral vertebrosternal region. In the lower extremity, tears in the ligaments at 70.80 MPa, and fractures in the tibia and femur at 236 MPa were quantified. Stresses in the skull were limited to 11 MPa, indicating a possibility of concussion rather than fractures. The developed computational model would be indispensable for car manufacturers to test the crash impact on the human body at all possible accident scenarios accurately, which will help design better solutions for automotive injury mitigation.

Validating the ability of a portable shoe-floor friction testing device, NextSTEPS, to predict human slips.

Measuring shoe-floor friction is critical for assessing the safety of footwear products. Portable devices for measuring coefficient of friction (COF) are needed. This study introduces such a device and evaluates its ability to predict human slip events across shoe designs. A portable device (18 kg) was utilized to measure 66 unique shoe-floor-fluid coefficients of friction (COF). Consistent with the shoes, flooring, and fluid contaminants from the COF tests, participants (n = 66) were unexpectedly exposed to the fluid while walking. Slip predictions were made based on a separate training data set. Slip predictions were made prospectively and using logistic regression analyses. The slip predictions were valid (p < 0.001), 91% sensitive, and 64% specific. The logistic regression fit also revealed that the COF values predicted slip outcomes (p = 0.006). This device is expected to expand the capacity of researchers, product developers, forensic engineers, and safety professionals to prevent slips and enhance human safety.

Finite element analysis of a hybrid corrugated hip implant for stability and loading during gait phases.

Implants used in total hip replacements (THR) exhibit high failure rates and up to a decade of operational life. These surgical failures could be mainly attributed to the improper positioning, post-surgical stability and loading, of the implants during different phases of the gait. Typically, revised surgeries are suggested within a few years of hip implantation, which requires multiple femoral drilling operations to remove an existing implant, and to install a new implant. The pain and trauma associated with such procedures are also challenging with the existing hip implants. In this work, we designed a novel corrugated hip implant with innovative dimensioning as per ASTM standards, and grooves for directed insertion and removal (using a single femoral drilling and positioning operation). Biocompatible titanium alloy (Ti6Al4V) was chosen as the implant material, and the novel implant was placed into a femur model through a virtual surgery to study its stability and loading during a dynamic gait cycle. A detailed mesh convergence study was conducted to select a computationally accurate finite element (FE) mesh. Tight fit and frictional fit attachment conditions were simulated, and the gait induced displacements and stresses on the implant, cortical and cancellous bone sections were characterized. During walking, the implant encountered the maximum von-Mises stress of 254.97 MPa at the femoral head. The analyses indicated low micro-motions (i.e., approximately 7µm) between the femur and implant, low stresses at the implant and bone within elastic limits, and uniform stress distribution, which unlike existing hip implants, would be indispensable for bone growth and implant stability enhancement, and also for reducing implant wear.

Biomechanical modeling of novel high expansion auxetic skin grafts.

Over 20 million burn injuries are reported every year, with severe cases requiring skin grafting. Traditionally, split thickness skin grafts are prepared by excising a small portion of healthy skin and its incision patterning using a suitable meshing device, which allows the graft to be expanded beyond its capacity. To date, the maximum expansion achieved through skin grafting has been reported to be less than three times, which is not sufficient for covering large burn sites with limited donor site skin. In this work, we have attempted to study skin graft expansion potential with novel auxetic patterns, which are known to exhibit negative Poisson's effect. Two-layer skin graft models were developed using eight different auxetic incision patterns, and subjected to uniaxial and biaxial tensile strains. The Poisson's ratio, meshing ratio, and induced stresses were characterized for all graft models. The numerical results indicated expansion potentials greater than that of traditional skin grafts across all loads. Extremely high expansions (i.e., >30 times) were estimated for the I-Shaped Re-entrant and Rotating Triangles shaped auxetic models without rupture. Such pioneering findings are anticipated to initiate ground-breaking advances towards skin graft research and improved outcomes in burn surgeries.

Expansion potential of skin grafts with novel I-shaped auxetic incisions.

Severe burn injures lead to millions of fatalities every year due to lack of skin replacements. While skin is a very limited and expensive entity, split thickness skin grafting, which involves the projection of a parallel incision pattern on a small section of healthy excised skin, is typically employed to increase the expansion and cover a larger burn site. To date, the real expansion capacity of such grafts are low (<3 times) and insufficient for treatment of severe burn injuries. In this study, novel I-shaped auxetic incision patterns, which are known to exhibit high negative Poisson's ratios, have been tested on the skin to investigate their expansion potential. Fourteen two-layer skin graft models with varying incision pattern parameters (i.e., length, spacing, and orientation) were developed using finite element modelling and tested under uniaxial and biaxial tensile loads. The Poisson's ratio, meshing ratios, and induced stresses were quantified across all models. Graft models tested uniaxially along the orthogonal directions indicated opposite trends in generated Poisson's ratios, as the length of the I-shape incisions were increased. Biaxially, with a symmetric and closely spaced I-shape pattern, graft meshing ratios up to 15.65 were achieved without overstressing the skin. Overall, the findings from the study indicated that expansion potentials much higher than that of traditional skin grafts can be achieved with novel I-shaped auxetic skin grafts, which would be indispensable for covering large wounds in severe burn injuries.

Predicting Obesity Using Facial Pictures during COVID-19 Pandemic.

BACKGROUND: Sedentary lifestyle and work from home schedules due to the ongoing COVID-19 pandemic in 2020 have caused a significant rise in obesity across adults. With limited visits to the doctors during this period to avoid possible infections, there is currently no way to measure or track obesity. METHODS: We reviewed the literature on relationships between obesity and facial features, in white, black, hispanic-latino, and Korean populations and validated them against a cohort of Indian participants (n = 106). The body mass index (BMI) and waist-to-hip ratio (WHR) were obtained using anthropometric measurements, and body fat mass (BFM), percentage body fat (PBF), and visceral fat area (VFA) were measured using body composition analysis. Facial pictures were also collected and processed to characterize facial geometry. Regression analysis was conducted to determine correlations between body fat parameters and facial model parameters. RESULTS: Lower facial geometry was highly correlated with BMI (R 2 = 0.77) followed by PBF (R 2 = 0.72), VFA (R 2 = 0.65), WHR (R 2 = 0.60), BFM (R 2 = 0.59), and weight (R 2 = 0.54). CONCLUSIONS: The ability to predict obesity using facial images through mobile application or telemedicine can help with early diagnosis and timely medical intervention for people with obesity during the pandemic.

Mechanical properties of whole-body soft human tissues: a review.

The mechanical properties of soft tissues play a key role in studying human injuries and their mitigation strategies. While such properties are indispensable for computational modelling of biological systems, they serve as important references in loading and failure experiments, and also for the development of tissue simulants. To date, experimental studies have measured the mechanical properties of peripheral tissues (e.g. skin)in-vivoand limited internal tissuesex-vivoin cadavers (e.g. brain and the heart). The lack of knowledge on a majority of human tissues inhibit their study for applications ranging from surgical planning, ballistic testing, implantable medical device development, and the assessment of traumatic injuries. The purpose of this work is to overcome such challenges through an extensive review of the literature reporting the mechanical properties of whole-body soft tissues from head to toe. Specifically, the available linear mechanical properties of all human tissues were compiled. Non-linear biomechanical models were also introduced, and the soft human tissues characterized using such models were summarized. The literature gaps identified from this work will help future biomechanical studies on soft human tissue characterization and the development of accurate medical models for the study and mitigation of injuries.

Prediction of diabetic foot ulcer progression: a computational study.

The development of foot ulcers is a common consequence of severe diabetes. Due to vascular disorders and impeded healing caused by the disease, most foot ulcers have been reported to be affected by body weight and progress with time. Also, abnormal distribution of plantar pressures has been observed to cause the formation of additional ulcers, which may collectively lead to traumatic amputations. While a study of such pathophysiology is not possible through experiments, a few computational modelling works have investigated diabetic foot ulcers. To date, ulcers with a few sizes and locations have been studied, and their effect on the plantar stresses has been quantified. In this work, we have attempted to study the effect of all possible ulcer locations on the generated plantar peak stresses and peak stress locations where additional ulcers may form. Also, the effect of ulcer location on the possible ulcer growth was investigated. A full-scale foot model was developed and a total of 52 ulcer locations were simulated separately, with standing and walking loads. The generated stresses were normalised with the foot size and statistically analysed to develop novel formulations for predicting peak plantar stresses and their locations for any known ulcer location. The results from this study are anticipated to provide important guidelines to doctors and medical practitioners for predicting foot ulcer progression in diabetic patients with existing ulcers and allow the administration of timely preventive interventions.

Biomechanical modelling of diabetic foot ulcers: A computational study.

Diabetic foot problems are widespread globally, resulting in substantial medical, economic, and social challenges for patients and their families. Among diabetic complications, foot ulceration is the most frequent outcome and is more probable to be of neuropathic origin. To date, a plethora of studies has focused on diabetic foot and ulcer prevention. However, limited studies have investigated the biomechanics of diabetic foot post ulceration. In this work, extensive biomechanical modelling of diabetic foot ulcers was attempted. A full-scale foot model was developed using measurements from a human subject, and ulcers of differing sizes and depths were modelled at different plantar sites numerically. Also, the foot model was computationally modified to study the effect of flat foot conditions on the same diabetic ulcers. Standing condition was simulated, and the induced stresses were investigated at the plantar region. The maximum stresses were observed to be similar for all ulcer sizes and depths at the lateral midfoot region of the normal foot. However, the maximum stresses were reported in the lateral heel region for the flat foot, which varied significantly with size and depth. Such results present important information on the foot condition post ulceration and may help identify possibilities of further ulceration in the diabetic foot. These novel findings are anticipated to be indispensable for the development of suitable interventions (e.g., custom orthotics) for diabetic foot ulcer management.

Effect of weather on COVID-19 spread in the US: A prediction model for India in 2020.

The effect of weather on COVID-19 spread is poorly understood. Recently, few studies have claimed that warm weather can possibly slowdown the global pandemic, which has already affected over 1.6 million people worldwide. Clarification of such relationships in the worst affected country, the US, can be immensely beneficial to understand the role of weather in transmission of the disease in the highly populated countries, such as India. We collected the daily data of new cases in 50 US states between Jan 1-Apr 9, 2020 and also the corresponding weather information (i.e., temperature (T) and absolute humidity (AH)). Distribution modeling of new cases across AH and T, helped identify the narrow and vulnerable AH range. We validated the results for 10-day intervals against monthly observations, and also worldwide trends. The results were used to predict Indian regions which would be vulnerable to weather based spread in upcoming months of 2020. COVID-19 spread in the US is significant for states with 4 < AH < 6 g/m3 and number of new cases > 10,000, irrespective of the chosen time intervals for study parameters. These trends are consistent with worldwide observations, but do not correlate well with India so far possibly due the total cases reported per interval < 10,000. The results clarify the relationship between weather parameters and COVID-19 spread. The vulnerable weather parameters will help classify the risky geographic areas in different countries. Specifically, with further reporting of new cases in India, prediction of states with high risk of weather based spread will be apparent.

Differences in Friction Performance between New and Worn Shoes.

Occupational ApplicationsSlips and falls are among the most common reason for non-fatal work accidents. Preventing slips in the workplace can be achieved by ensuring sufficient friction between the shoe and floor. As shoes are worn down, there is a decrease in the coefficient of friction, which increases the risk of injury from a slip and fall for the wearer. We found that shoes worn in the workplace commonly had friction performance that is about 25% lower than their new condition and that this effect was largest for shoes with the highest initial friction performance. These results inform the magnitude of improvement in friction performance that can be achieved through footwear replacement programs.

TECHNICAL ABSTRACTBackground As slip-resistant shoes are naturally worn, the coefficient of friction (COF) decreases. Proper and timely shoe replacement is an important factor for preventing injuries related to slips. Knowledge of the change in COF for naturally worn shoes in the workplace, relative to the COF of their new counterparts, is needed for a better understanding in this area. Methods: Slip-resistant shoes worn in the workplace and their new counterparts were mechanically tested to assess their COF. Eighteen pairs of shoes (new and worn) were tested on a whole-shoe slip testing device that simulates under-shoe slipping conditions. The COF was calculated for each pair of shoes at a shoe-floor angle of 17 ± 1° relative to the ground surface, a speed of 0.5 m/s, and a mean normal force of 250 ± 10 N. Results: A mean decrease in COF of 0.055 (25%) was observed when comparing the naturally worn shoes with the new shoes. New shoes with an initial higher COF showed a larger loss in COF due to wear. Conclusions: Naturally worn, slip-resistant shoes have substantively reduced COF compared to their new counterparts. These findings demonstrate the potential for programs that monitor and replace slip-resistant shoes as a means to prevent slips.