Numerical simulation of bone remodelling around dental implants.

Crestal bone loss can result in the failure of dental implants and can be caused, by among other factors, the development of non-physiological mechanical conditions. Bone remodelling (BR) is the physiological process through which bone adapts itself to the mechanical environment. A previously published mathematical model of BR is used in this work to study the homogenized structural evolution of peri-implant bone. This model is used to study the influence of the diameter and length of a dental implant of pure titanium on its long-term stability. The temporal evolution of porosity and microstructural damage of the peri-implant bone are the variables analysed in this study. The results show that damage and porosity increase as the implant length decreases and, more pronouncedly, as its diameter decreases. The increase in damage and porosity levels is localized, as many other studies confirm, at the implant neck due to the stress concentration that is created in that area. The main conclusion of this study is that in implants with a diameter equal to or greater than 3 mm the damage is under control and there is no mechanical failure of the peri-implant bone in the long term.

Comparison of the viscoelastic properties of human abdominal and breast adipose tissue and its incidence on breast reconstruction surgery. A pilot study.

BACKGROUND: Breast cancer is the leading malignant tumor in women in the world. Reconstruction after mastectomy plays a key role in the physical and psychological recuperation, being the abdominal skin and adipose tissue the best current option for the DIEP surgery. The aim of the surgery is to obtain a reconstructed breast which looks and behaves naturally. Therefore, it would be useful to characterize the mechanical behaviour of the adipose tissue in the abdomen and breast to compare their mechanical properties, also investigating possible regional differences. METHODS: Experimental tests have been carried out in breast and abdominal adipose tissue samples, obtaining their viscoelastic properties. The specimens have been subjected to uniaxial compression relaxation tests and a mechanical behaviour model has been fitted to the experimental curves. Afterwards, statistical analyses have been used to detect differences between different individuals' abdominal fat tissue and finally between different areas of the same individual's breast and abdominal adipose tissue. FINDINGS: Several conclusions could be extracted from the results: 1) inter-individual differences may exist in the abdominal adipose tissue; 2) the breast fat could be regarded as a unique tissue from the mechanical point of view; 3) significant differences were detected between the superficial breast and all the locations of the abdomen, except for the superficial lateral one and 4) the mechanical properties of the abdominal adipose tissue seem to change with the depth. These conclusions can be of great value for DIEP surgeries and other surgeries in which the adipose tissue is involved.

Influence of musculotendon geometry variability in muscle forces and hip bone-on-bone forces during walking.

Inverse dynamics problems are usually solved in the analysis of human gait to obtain reaction forces and moments at the joints. However, these actions are not the actual forces and moments supported by the joint structure, because they do not consider the forces of the muscles acting across the joint. Therefore, to analyse bone-on bone forces it is necessary to estimate those muscle forces. Usually, this problem is addressed by means of optimization algorithms. One of the parameters required to solve this problem is the musculotendon geometry. These data are usually taken from cadavers or MRI data from several subjects, different from the analysed subject. Then, the model is scaled to the subject morphology. This procedure constitutes a source of error. The goals of this work were two. First, to perform a sensitivity analysis of the influence of muscle insertion locations on the muscle forces acting on the hip joint and on the hip joint bone-on-bone forces. Second, to compare the hip joint bone-on-bone forces during gait cycle obtained through muscle insertion locations taken from a musculoskeletal model template and a scaling procedure to those obtained from a subject-specific model using an MRI of the subject. The problem was solved using OpenSim. Results showed that anatomical variability should be analysed from two perspectives. One the one hand, throughout the gait cycle, in a global way. On the other hand, at a characteristic instant of the gait cycle. Variations of ±1 cm in the position of the attachment points of certain muscles caused variations of up to 14.21% in averaged deviation of the muscle forces and 58.96% in the peak force in the modified muscle and variations up to 57.23% in the averaged deviation of the muscle force and up to 117.23% in the peak force in the rest of muscles. Then, the influence of that variability on muscle activity patterns and hip bone-on-bone forces could be described more precisely. A biomechanical analysis of a subject-specific musculoskeletal model was carried out. Using MRI data, variations up to 5 cm in the location of the insertion points were introduced. These modifications showed significant differences between the baseline model and the customized model: within the range [-12%, 10%] for muscle forces and around 35% of body weight for hip bone-on-bone forces.

On the role of bone damage in calcium homeostasis.

Bone serves as the reservoir of some minerals including calcium. If calcium is needed anywhere in the body, it can be removed from the bone matrix by resorption and put back into the blood flow. During bone remodelling the resorbed tissue is replaced by osteoid which gets mineralized very slowly. Then, calcium homeostasis is controlled by bone remodelling, among other processes: the more intense is the remodelling activity, the lower is the mineral content of bone matrix. Bone remodelling is initiated by the presence of microstructural damage. Some experimental evidences show that the fatigue properties of bone are degraded and more microdamage is accumulated due to the external load as the mineral content increases. That damage initiates bone remodelling and the mineral content is so reduced. Therefore, this process prevents the mineral content of bone matrix to reach very high (non-physiological) values. A bone remodelling model has been used to simulate this regulatory process. In this model, damage is an initiation factor for bone remodelling and is estimated through a fatigue algorithm, depending on the macroscopic strain level. Mineral content depends on bone remodelling and mineralization rate. Finally, the bone fatigue properties are defined as dependent on the mineral content, closing the interconnection between damage and mineral content. The remodelling model was applied to a simplified example consisting of a bar under tension with an initially heterogeneous mineral distribution. Considering the fatigue properties as dependent on the mineral content, the mineral distribution tends to be homogeneous with an ash fraction within the physiological range. If such dependance is not considered and fatigue properties are assumed constant, the homogenization is not always achieved and the mineral content may rise up to high non-physiological values. Thus, the interconnection between mineral content and fatigue properties is essential for the maintenance of bone's structural integrity as well as for the calcium homeostasis.

Elastic properties of woven bone: effect of mineral content and collagen fibrils orientation.

Woven bone is a type of tissue that forms mainly during fracture healing or fetal bone development. Its microstructure can be modeled as a composite with a matrix of mineral (hydroxyapatite) and inclusions of collagen fibrils with a more or less random orientation. In the present study, its elastic properties were estimated as a function of composition (degree of mineralization) and fibril orientation. A self-consistent homogenization scheme considering randomness of inclusions' orientation was used for this purpose. Lacuno-canalicular porosity in the form of periodically distributed void inclusions was also considered. Assuming collagen fibrils to be uniformly oriented in all directions led to an isotropic tissue with a Young's modulus [Formula: see text] GPa, which is of the same order of magnitude as that of woven bone in fracture calluses. By contrast, assuming fibrils to have a preferential orientation resulted in a Young's modulus in the preferential direction of 9-16 GPa depending on the mineral content of the tissue. These results are consistent with experimental evidence for woven bone in foetuses, where collagen fibrils are aligned to a certain extent.

[Application of fluid mechanics and simulation: urinary tract and ureteral catheters.] / Aplicación de la mecánica de fluidos y la simulación: tracto urinario y catéteres ureterales.

The mechanics of urine during its transport from the renal pelvis to the bladder is of great interest for urologists. The knowledge of the different physical variables and their interrelationship, both in physiologic movements and pathologies, will help a better diagnosis and treatment. The objective of this chapter is to show the physics principles and their most relevant basic relations in urine transport, and to bring them over the clinical world. For that, we explain the movement of urine during peristalsis, ureteral obstruction and in a ureter with a stent. This explanation is based in two tools used in bioengineering: the theoretical analysis through the Theory of concontinuous media and Ffluid mechanics and computational simulation that offers a practical solution for each scenario. Moreover, we review other contributions of bioengineering to the field of Urology, such as physical simulation or additive and subtractive manufacturing techniques. Finally, we list the current limitations for these tools and the technological development lines with more future projection. CONCLUSIONS: In this chapter we aim to help urologists to understand some important concepts of bioengineering, promoting multidisciplinary cooperation to offer complementary tools that help in diagnosis and treatment of diseases.

A bone remodelling model including the effect of damage on the steering of BMUs.

Bone remodelling in cortical bone is performed by the so-called basic multicellular units (BMUs), which produce osteons after completing the remodelling sequence. Burger et al. (2003) hypothesized that BMUs follow the direction of the prevalent local stress in the bone. More recently, Martin (2007) has shown that BMUs must be somehow guided by microstructural damage as well. The interaction of both variables, strain and damage, in the guidance of BMUs has been incorporated into a bone remodelling model for cortical bone. This model accounts for variations in porosity, anisotropy and damage level. The bone remodelling model has been applied to a finite element model of the diaphysis of a human femur. The trajectories of the BMUs have been analysed throughout the diaphysis and compared with the orientation of osteons measured experimentally. Some interesting observations, like the typical fan arrangement of osteons near the periosteum, can be explained with the proposed remodelling model. Moreover, the efficiency of BMUs in damage repairing has been shown to be greater if BMUs are guided by damage.

Biomechanical analysis of a new minimally invasive system for osteosynthesis of pubis symphysis disruption.

INTRODUCTION: We analysed the effectiveness of a new percutaneous osteosynthesis system for the treatment of pelvis fractures with rotational instability. METHODS: A pre-clinical cross-sectional experimental study wherein Tile type B1 injuries (open-book fractures) were produced in 10 specimens of fresh human cadavers, including the L4-5 vertebrae, pelvic ring, and proximal third of the femur, keeping intact the capsular and ligamentous structures, is presented in this paper. The physiological mobility of the intact pelvis in a standing position post-injury was compared to that following the performance of a minimally invasive osteosynthesis of the symphysis with two cannulated screws. A specially designed test rig capable of applying loads simulating different weights, coupled with a photogrammetry system, was employed to determine the 3D displacements and rotations in three test cases: intact, injured and fixed. RESULTS: After applying an axial load of 300 N, no differences were observed in the average displacement (mm) of the facet joints of the intact pubic symphysis in comparison to those treated with screws (p >0.7). A statistical difference was observed between the average displacements of the sacroiliac facet joints and pelvises with symphyseal fractures treated with screws after the application of a load (p <0.05). CONCLUSION: The symphyseal setting with two crossed screws appears to be an effective alternative to osteosynthesis in pelvic fractures with rotational instability.

Effect of porosity and mineral content on the elastic constants of cortical bone: a multiscale approach.

A micromechanical multiscale model which estimates the elastic properties of cortical bone as a function of porosity and mineral content is presented. The steps of the model are divided into two main phases. In the first one, the elastic properties of the collagen fibril, collagen fiber and lamella are given. In the second phase, porosity is included in the lamella in the form of canaliculi, lacunae and Haversian canals, to provide the elastic properties of the osteonal tissue. Then, a symmetrization technique is used to estimate the transversely isotropic elasticity tensor of the osteon. Osteons are superimposed using a self-consistent scheme, and finally, the fluid filling the pores is included to estimate the elastic constants of the undrained cortical tissue. The main novelty of the model presented here is the possibility of varying the mineral content of bone, considering that mineralization begins from the inner levels, initially intrafibrillar and then interfibrillar. Correlations of the elastic properties of cortical bone obtained with this model on the one hand, and porosity and ash fraction on the other hand, are estimated.

A bone remodelling model including the directional activity of BMUs.

Bone is able to adapt itself to the mechanical and biological environment by changing its porosity and/or orientation of its internal microstructure in a process known as bone remodelling. As a consequence, a change of bone mechanical properties is produced leading to an optimum structure, able to bear the external loads with the minimum weight. This adaptation is carried out by a temporal association of cells known as BMUs (basic multicellular units) that resorb old bone and sometimes produce new organic extracellular matrix (osteoid) that is later mineralized. This involves changes in porosity, damage level (density of microcracks accumulated by cyclic loads) and mineral content. All of these features were taken into account in a previous model, but the whole process and therefore the resulting bone constitutive behaviour was considered isotropic. The model proposed herein, recognizing that bone is actually anisotropic, tries to explain how BMUs modify the anisotropy by changing their progressing direction. We check the potential of the model to predict the alignment of the bone microstructure with the external loads in different situations. Then, the model is also applied to obtain the anisotropy and mechanical properties of the human proximal femur under physiological loads with initial conditions corresponding to a heterogeneous, but otherwise isotropic bone.