Three-Dimensional Prediction of the Nose for Facial Approximation in a Thai Population.

Most of the previous studies about nose prediction were concentrated only some landmarks of the nose. This study aimed to generate prediction equations for ten landmarks of the nose in the midline and alar regions for forensic facial approximation. The six midline landmarks were the sellion, nasion-pronasale posterior, nasion-pronasale anterior, pronasale, nasal drop, and subnasale. The four landmarks of the alar region were the alare, superior alar groove, posterior alar groove, and inferior alar groove. We used the skull landmarks in the nasal, zygomatic, and maxillary bone to predict the landmarks of the nose. Cone-beam computed tomography scans of 108 Thai subjects with normal BMI and age ranging from 21.0 to 50.9 years were obtained in a sitting position. The data were converted into three-dimensional (3-D) images of the skull and face. The Cartesian coordinates of the landmarks of the skull and nose were used to formulate the multiple regression equations. The formulated equations were tested in 24 new subjects. The mean differences in the predicted midline landmarks varied between -0.4 mm and 0.5 mm, whereas those for bilateral landmarks varied between -1.0 mm and 1.4 mm. In conclusion, the prediction equations formulated here will be beneficial for facial approximation of the nose in a Thai population.

Preoperative planning of medial opening wedge high tibial osteotomy using 3D computer-aided design weight-bearing simulated guidance: Technique and preliminary result.

BACKGROUND: High tibial osteotomy (HTO) is an established treatment for uni-compartmental osteoarthritis with varus deformity in relatively active young patients with good knee mobility. The most important factor for success and low complications of HTO is the precise correction of osteotomy. The objective of this study was to evaluate the accuracy of pre-operative planning of open-wedge HTO using t3D computer-aided design (CAD) weight-bearing simulated guidance technique for the succession of surgery. MATERIALS AND METHODS: Nineteen patients who met the inclusion criteria were recruited between July 2013 and June 2014. 3D CAD weight-bearing simulated guidance technique was obtained from standard anterior-posterior, lateral of hip-to-ankle full leg standing radiographs, and computed tomography (CT) scan provided the weight-bearing corrective axis of preoperative planning and predictive corrective mechanical axis value. Post-operative mechanical axis value was obtained after surgery. RESULTS: This comparative study between the predictive corrective, using 3D CAD weight-bearing simulated guidance technique, and post-operative mechanical axis value, analysed with t-test statistical analysis, showed the insignificant difference ( p > 0.05). CONCLUSION: We conclude that the 3D CAD weight-bearing simulated guidance technique has good accuracy as preoperative planning of open-wedge HTO for succession surgery.

PCL/PHBV blended three dimensional scaffolds fabricated by fused deposition modeling and responses of chondrocytes to the scaffolds.

In this study, poly(ε-caprolactone)/poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PCL/PHBV) blended porous scaffolds were fabricated by fused deposition modeling (FDM). PCL/PHBV filaments, initially prepared at different weight ratios, that is, 100/0, 75/25, 50/50, and 25/75, were fabricated by the lay-down pattern of 0/90/45/135° to obtain scaffolds with dimension of 6.0 × 6.0 × 2.5 mm3 and average filament diameters and channel sizes in the ranges of 370-390 µm and 190-210 µm, respectively. To enhance the surface hydrophilicity of the materials, the scaffolds were subsequently subjected to a low pressure oxygen plasma treatment. The untreated and plasma-treated scaffolds were comparatively characterized, in terms of surface properties, mechanical strength, and biological properties. From SEM, AFM, water contact angle, and XPS results, the surface roughness, wettability, and hydrophilicity of the blended scaffolds were found to be enhanced after plasma treatment, while the compressive strength of the scaffolds was scarcely changed. It was, however, found to increase with an increasing content of PHBV incorporated. The porcine chondrocytes exhibited higher proliferative capacity and chondrogenic potential when being cultured on the scaffolds with greater PHBV contents, especially when they were plasma-treated. The PCL/PHBV scaffolds were proven to possess good physical, mechanical, and biological properties that could be appropriately used in articular cartilage regeneration. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1141-1150, 2017.

Porous 45S5 Bioglass®-based scaffolds using stereolithography: Effect of partial pre-sintering on structural and mechanical properties of scaffolds.

Scaffolds made from 45S5 Bioglass® ceramic (BG) show clinical potential in bone regeneration due to their excellent bioactivity and ability to bond to natural bone tissue. However, porous BG scaffolds are limited by their mechanical integrity and by the substantial volume contractions occurring upon sintering. This study examines stereolithographic (SLA) methods to fabricate mechanically robust and porous Bioglass®-based ceramic scaffolds, with regular and interconnected pore networks and using various computer-aided design architectures. It was found that a diamond-like (DM) architecture gave scaffolds the most controllable results without any observable closed porosity in the fired scaffolds. When the pore dimensions of the DM scaffolds of the same porosity (~60vol%) were decreased from 700 to 400µm, the compressive strength values increased from 3.5 to 6.7MPa. In addition, smaller dimensional shrinkage could be obtained by employing partially pre-sintered bioglass, compared to standard 45S5 Bioglass®. Scaffolds derived from pre-sintered bioglass also showed marginally improved compressive strength.

3D CAD/reverse engineering technique for assessment of Thai morphology: Proximal femur and acetabulum.

PURPOSE: To assess morphological parameters of proximal femur and acetabulum in Thai population with three-dimensional measurement technique, and to analysis of collateral side symmetric, gender difference, and correlation between morphometric parameters. METHODS: Investigation was performed in 240 femurs. All three-dimensional femur models were acquitted from 64-slice spiral CT scanner. Morphometric parameters under consideration included acetabular diameter, femoral head diameter, shaft isthmus location, intramedullary canal diameter, diaphyseal diameter, femoral head height, femoral neck isthmus, femoral neck length, neck shaft angle, bow angle, and anteversion angle. All parameters were measured based on functions and least-square regression function in CAD software. Obtained measured data were then used for analysis of collateral side symmetric, gender difference, correlation between morphometric parameters, and compared with other populations. RESULTS: Female had a smaller dimension compared with male in most of the parameters. No significant difference was observed between left and right femurs. High correlation pairs of morphometric parameters included femoral head diameter-acetabular diameter, femoral head diameter-neck isthmus diameter, femoral head diameter-diaphyseal diameter at shaft isthmus level, acetabular diameter-neck isthmus diameter, neck isthmus diameter-diaphyseal diameter at shaft isthmus level, and acetabular diameter-diaphyseal diameter at shaft isthmus level. Some morphometric parameters of Thai are smaller than other Caucasian, and some Asian nation, i.e. femoral head diameter, femoral neck length, and femoral head height. CONCLUSIONS: This study provides essential morphometric data for various orthopedic implant designs relating to proximal femur region.

Stress relieving behaviour of flowable composite liners: A finite element analysis.

The purpose of this study was to investigate the consequences of using flowable composite as a liner beneath class I resin composite restorations on polymerization shrinkage stress and occlusal force. Models of class I resin composite restorations were generated. A control model received no flowable composite liner. Thirteen test models received different flowable composite liners with varying elastic modulus. Finite element analysis was used. The polymerization shrinkage of the resin composite and an occlusal force were simulated in the models. The stress and strain energy density in each model were investigated. The results demonstrated that all flowable composite linings were able to reduce polymerization shrinkage stress and occlusal force in enamel, dentin, the hybrid layer, and the adhesive layer to various degrees in tooth-restoration systems. Therefore, additional techniques may be applied to reduce the remaining stress and to ensure the long-term success of restorations.

Biomechanical performance of retrograde nail for supracondylar fractures stabilization.

The study compared the biomechanical performance of retrograde nail used to stabilize supracondylar fracture (three different levels) by means of finite element analysis. Three different nail lengths (200, 260, and 300 mm) of stainless steel and titanium nails were under consideration. Intact femur model was reconstructed from Digital Imaging and Communications in Medicine images of Thai cadaveric femur scanned by computed tomography spiral scanner, whereas geometry of retrograde nail was reconstructed with the data obtained from three-dimensional laser scanner. The retrograde nail was virtually attached to the femur before nodes and elements were generated for finite element model. The finite element models were analyzed in two stages, the early stage of fracture healing and the stage after fracture healing. The finding indicated that purchasing proximal locking screw in the bowing region of the femur may be at risk due to the high stresses at the implant and bone. There were no differences in stress level, elastic strain at a fracture gap, and bone stress between stainless steel and titanium implant. Since the intramedullary canal requires reaming to accommodate the retrograde nail, the length of retrograde nail should be as long as necessary. However, in case that the retrograde nail can be accommodated into the intramedullary canal without reaming, the longer retrograde nail can be used.

Biocompatibility of hydroxyapatite scaffolds processed by lithography-based additive manufacturing.

The fabrication of hydroxyapatite scaffolds for bone tissue engineering applications by using lithography-based additive manufacturing techniques has been introduced due to the abilities to control porous structures with suitable resolutions. In this research, the use of hydroxyapatite cellular structures, which are processed by lithography-based additive manufacturing machine, as a bone tissue engineering scaffold was investigated. The utilization of digital light processing system for additive manufacturing machine in laboratory scale was performed in order to fabricate the hydroxyapatite scaffold, of which biocompatibilities were eventually evaluated by direct contact and cell-culturing tests. In addition, the density and compressive strength of the scaffolds were also characterized. The results show that the hydroxyapatite scaffold at 77% of porosity with 91% of theoretical density and 0.36 MPa of the compressive strength are able to be processed. In comparison with a conventionally sintered hydroxyapatite, the scaffold did not present any cytotoxic signs while the viability of cells at 95.1% was reported. After 14 days of cell-culturing tests, the scaffold was able to be attached by pre-osteoblasts (MC3T3-E1) leading to cell proliferation and differentiation. The hydroxyapatite scaffold for bone tissue engineering was able to be processed by the lithography-based additive manufacturing machine while the biocompatibilities were also confirmed.

Rapid-prototype endoprosthesis for palliative reconstruction of an upper extremity after resection of bone metastasis.

PURPOSE: To present a rapid-prototype (RP) endoprosthesis replacement after tumor resection in patients with bone metastasis of the upper extremity. The short-term complications and functional outcomes were evaluated as well as the survival of patients and endoprosthesis. METHODS: Bone metastasis patients who required bone resection and endoprosthesis replacement were enrolled and consented before operation. Custom-made endoprosthesis was fabricated from polymethyl methacrylate assisted by RP technology. After surgery was performed, patients were followed up daily until discharge and monthly until 6 months postoperatively for immediate post-operative complications and for signs of endoprosthesis failure. The functional outcome was evaluated 6 months postoperatively by the Musculoskeletal Tumor Society score (MTSS) and the Mankin score. Thereafter, patients' survival and arm condition were monitored every 3 months. RESULTS: Sixteen cases participated on this study. There were nine proximal-, four total- and two distal humerus, and one proximal ulna replacement. The median follow-up period was 486 days. The mean MTSS was 55 % and the Mankin score was good in 64 % and fair in 36 % of the patients. Glenohumeral subluxation was observed in 23 % of the patients; however, a stable shoulder was achieved in all cases. There were no prosthesis failure or systemic breakage. CONCLUSIONS: An RP endoprosthesis may have significant advantages when the entire humerus needs to be replaced, or periarticular sites are involved. This technique offers custom-made endoprosthesis with enough durability, and in a relatively short production time at reasonable costs which are suitable for palliative reconstruction.

Optional entry point for retrograde femoral nailing: an anatomical study using the reverse engineering method.

OBJECTIVE: To investigate the optimal entry point for retrograde femoral nailing using medical imaging and reverse engineering technologies. MATERIAL AND METHOD: One hundred and eight adult cadaveric femurs were scanned using a computed tomography (CT) scanner. To obtain three-dimensional models, medical imaging and reverse engineering technologies were used. The insertion assessment was performed using computer aided design (CAD) software. The curve representing the mid-line in the intramedullary canal in the mid-shaft region was approximated using regression analysis. The curve was extended tangentially toward the femoral condyle, where the intersection between the curve and the condylar surface is the insertion site. The location of the insertion site was determined using the center of the anterior most of the intercodylar notch as a reference point. The measured distances were presented in medial-lateral and anterior-posterior perspectives from the reference point. RESULTS: Average insertion site for Thai population was 0.56 mm lateral to and 12.67 mm medial to the anterior most of the intercondylar notch. The distance measured from intercondylar notch to the insertion site in the anterior-posterior direction was not significantly different between males and females; however a significant difference in the insertion site was found in medial-lateral directions. CONCLUSION: The insertion site can be clinically approximated lying on the anterior-posterior axis, since the distance from the anterior-posterior axis to the insertion site is relatively small. The insertion site for the Thai population was found to be 12 mm anterior to the center of the anterior most of the intercondylar notch.

Prevention of excessive medialisation of trochanteric fracture by a buttress screw: a novel method and finite element analysis.

This paper proposes a novel method of using an antero-posterior buttress screw at the distal fragment just below the fracture site in conjunction with the sliding hip screw (SHS) to resist excessive femoral medialisation. A virtual assessment of the effectiveness of this new method was performed using the finite element analysis. The results indicate that the use ofa sliding hip screw (SHS) combined with a buttress screw can help resistfemoral medialisation better than using an SHS with no buttress screw. The von Mises equivalent stress (EQ ) was found to be in a safe range, which indicates increased integrity of the lateral wall with the addition of the buttress screw.

Bone tissue engineering scaffolding: computer-aided scaffolding techniques.

Tissue engineering is essentially a technique for imitating nature. Natural tissues consist of three components: cells, signalling systems (e.g. growth factors) and extracellular matrix (ECM). The ECM forms a scaffold for its cells. Hence, the engineered tissue construct is an artificial scaffold populated with living cells and signalling molecules. A huge effort has been invested in bone tissue engineering, in which a highly porous scaffold plays a critical role in guiding bone and vascular tissue growth and regeneration in three dimensions. In the last two decades, numerous scaffolding techniques have been developed to fabricate highly interconnective, porous scaffolds for bone tissue engineering applications. This review provides an update on the progress of foaming technology of biomaterials, with a special attention being focused on computer-aided manufacturing (Andrade et al. 2002) techniques. This article starts with a brief introduction of tissue engineering (Bone tissue engineering and scaffolds) and scaffolding materials (Biomaterials used in bone tissue engineering). After a brief reviews on conventional scaffolding techniques (Conventional scaffolding techniques), a number of CAM techniques are reviewed in great detail. For each technique, the structure and mechanical integrity of fabricated scaffolds are discussed in detail. Finally, the advantaged and disadvantage of these techniques are compared (Comparison of scaffolding techniques) and summarised (Summary).

Biomechanical evaluation of a novel porous-structure implant: finite element study.

PURPOSE: The biomechanical performance of a novel engineered porous-structure implant (EPSI) with various porosities and a conventional solid-structure implant (CSSI) was investigated and compared. MATERIALS AND METHODS: The three-dimensional finite element method was applied to titanium dental implant models placed in a block of bone that included both cortical and medullary bone. Five different pore sizes and porosities of the EPSI (58% porosity [PSI-58], 62% porosity [PSI-62], 71% porosity [PSI-71], 75% porosity [PSI-75], and 79% porosity [PSI-79]), were compared with the CSSI. Equivalent von Mises (EQV) stress, strain energy density, and displacement were examined for each implant design. RESULTS: The maximum EQV stresses exhibited in cortical bone of the EPSI models were lower than those of the CSSI model. Higher EPSI porosity tended to increase the EQV stress. The EPSI appeared to share the load with the cortical bone, as evidenced by lower strain energy density in the cortical bone of EPSI models. High values for displacement were observed at the coronal part of the implant in all models. Slight differences in maximum displacement values were seen between EPSI and CSSI models. CONCLUSION: The EPSI effectively reduced the maximum EQV stress in the cortical bone and enhanced the load-sharing capacity. A significant amount of energy was absorbed by the implant instead of being transferred to the surrounding cortical bone. Varying the porosity of an implant had less effect on implant displacement.

Scaffold library for tissue engineering: a geometric evaluation.

Tissue engineering scaffold is a biological substitute that aims to restore, to maintain, or to improve tissue functions. Currently available manufacturing technology, that is, additive manufacturing is essentially applied to fabricate the scaffold according to the predefined computer aided design (CAD) model. To develop scaffold CAD libraries, the polyhedrons could be used in the scaffold libraries development. In this present study, one hundred and nineteen polyhedron models were evaluated according to the established criteria. The proposed criteria included considerations on geometry, manufacturing feasibility, and mechanical strength of these polyhedrons. CAD and finite element (FE) method were employed as tools in evaluation. The result of evaluation revealed that the close-cellular scaffold included truncated octahedron, rhombicuboctahedron, and rhombitruncated cuboctahedron. In addition, the suitable polyhedrons for using as open-cellular scaffold libraries included hexahedron, truncated octahedron, truncated hexahedron, cuboctahedron, rhombicuboctahedron, and rhombitruncated cuboctahedron. However, not all pore size to beam thickness ratios (PO:BT) were good for making the open-cellular scaffold. The PO:BT ratio of each library, generating the enclosed pore inside the scaffold, was excluded to avoid the impossibility of material removal after the fabrication. The close-cellular libraries presented the constant porosity which is irrespective to the different pore sizes. The relationship between PO:BT ratio and porosity of open-cellular scaffold libraries was displayed in the form of Logistic Power function. The possibility of merging two different types of libraries to produce the composite structure was geometrically evaluated in terms of the intersection index and was mechanically evaluated by means of FE analysis to observe the stress level. The couples of polyhedrons presenting low intersection index and high stress level were excluded. Good couples for producing the reinforced scaffold were hexahedron-truncated hexahedron and cuboctahedron-rhombitruncated cuboctahedron.

Mismatch analysis of humeral nailing: antegrade versus retrograde insertion.

BACKGROUND: Closed humeral nailing is now considered an alternative treatment for humeral-shaft fracture. The nail can be inserted with either the antegrade or retrograde method. We investigated and compared the problem of geometric mismatch of the humeral nail to the humerus between the two methods of insertion. METHODS: The study was performed using virtual simulation based on computed tomography (CT) data of 76 Thai cadaveric humeri and the commonly used Russell-Taylor humeral nail 8 mm in diameter and 220 mm long. Mismatch of the nail to the intact humerus was analyzed and compared between the antegrade and retrograde nailing approaches. RESULTS: The results showed: (1) the diameter of the medullary canal averaged 7.9-13.8 mm; (2) the minimal reaming diameter to accommodate virtual nail insertion averaged 8.8-14.8 mm for the antegrade and 8.8-29.3 mm for the retrograde approach; (3) the minimal reaming thickness of the inner cortex averaged 0.1-1.5 mm for the antegrade and 0.1-9.9 mm for the retrograde approach; (4) the percentages of cortical bone removed prior to nail insertion were 3.8-107.1% and 3.8-1,287.6% for the antegrade and retrograde approaches, respectively; (5) the eccentricity of the nail-medullary canal center were 0.4-3.4 and 0.4-10.6 mm for the antegrade and retrograde approaches, respectively. CONCLUSIONS: Less mismatching occurred with antegrade nailing than with the retrograde approach. Retrograde nailing requires excessive reaming at the distal part of the humerus to accommodate nail insertion. This may create bone weakness and the risk of supracondylar fracture.

Geometric mismatch analysis of retrograde nail in the Asian femur.

The geometric mismatch analysis of the retrograde nail was performed in 108 Asian cadaveric adult femora. The insertion was done virtually based on a three-dimensional geometric model derived from computed tomographic images. The investigation was performed at eight levels located at 120, 140, 160, 180, 200, 220 and 240 mm above the condylar surface. The evaluation of each level included: (1) the diameter of the intramedullary canal, (2) the percentage of area filled by the nail in the unreamed intramedullary canal, (3) the minimal reamer diameter that required enlargement of the canal to accommodate retrograde nail insertion, (4) the minimal inner cortical reaming thickness that needed to be removed, (5) the percentage of the cortical bone area that needed to be removed prior to nail insertion and (6) the deviation of the nail center from the center of the intramedullary canal. The result showed significant mismatch of the nail to most of the study specimens (94 femora, 87%), which the intramedullary canal needed extensive reaming to accommodate the nail insertion. This may lead to a high possibility of clinical complications. Redesign for proper shape and size of retrograde nail should be considered for the use in Asian population.

Influence of graft quality and marginal bone loss on implants placed in maxillary grafted sinus: a finite element study.

The purpose of this study was to investigate the biomechanical effects of graft stiffness and progression of marginal bone loss (MBL) in the bone surrounding an implant placed in a maxillary grafted sinus based on the finite element method. The simulating model of graft stiffness as well as depth of MBL was varied to simulate nine different clinical scenarios. The results showed that the high-level strain distributions in peri-implant tissue increased with the increase in MBL depth when the stiffness of the graft was less than that of the cancellous bone (less stiffness graft models). The strain energy density (SED) value showed that a slight MBL depth (1.3 mm) with medium stiffness of grafted bone can reach the optimal load sharing due to the exhibited similar values of SED in the crestal cortical, cancellous, and grafted bone. With progression of MBL and the decrease in graft quality, maximal displacement of the implant increased considerably. Our results demonstrated that the effects of the two investigated factors (progression of MBL and graft stiffness) on the biomechanical adaptation are likely to be interrelated. The results also reveal that for clinical situations with poor grafted bone quality and progression of MBL, it is critical to consider implant stability.

Craniometric study of Thai skull based on three-dimensional computed tomography (CT) data.

The present study revealed an advanced method using data obtained from three-dimensional computed tomography (3D CT) to evaluate the craniometric data of the Thai population. Ninty-one Thai cadaveric dry skulls from the Faculty of Medicine, Khon Kaen University were investigated in the present study. It enabled the authors to assess the three-dimensional anatomical landmarks in digital format without physical measurements. The results have revealed that the craniometric data of Thai males were larger than Thai females with a statistical significant difference, especially, the maximum cranial length, basion-bregma height, nasion-basion length, nasion-bregma length and bizygomatic breadth parameters (p << 0.001). In addition, the craniometric data based on Thai skulls of the people in the northeast region was different from the people in the central region. Furthermore, the linear regression equations obtained from the pairwise parameter, it is useful to predict the craniometric parameters in forensic medicine.

Three-dimensional morphometric study of the Thai proximal humerus: cadaveric study.

Seventy-six cadaveric humeri were investigated to study the three-dimensional morphometric data based on CT data. The present study was an advanced method to determine the 3D proximal humeral parameters for both intra and extra geometries through the utilization of medical imaging and reverse engineering techniques. The following parameters were calculated for each humerus and then compared with the 3D Caucasian data such as diameter of humeral head, articular surface thickness, inclination angle, retroversion angle, medial offset, posterior offset, curve length, radius of curvature, and mediolateral angle. It was found that the Thai humeral parameters were smaller than Caucasian except the retroversion angle and posterior offset. This data could be further used to develop a proper design of shoulder arthroplasty for Thai patients.

A finite element study of stress distributions in normal and osteoarthritic knee joints.

OBJECTIVE: To study the stress distributions in normal and osteoarthritic knee joints using the finite element method (FEM). MATERIAL AND METHOD: Three normal and three varus knee joints are included in the study. Computed tomography (CT) images of the lower extremities are used to create 3D geometric models consisting of bones, articular cartilages, menisci, and knee ligaments. Each of the lower extremities includes the femur, tibia, fibula, and talus. Each 3D geometric model is adjusted to the normal standing configuration with the help of its corresponding 2D radiographic image. After that, 3D finite element (FE) models are created from the adjusted 3D geometric models. FEM is then used to obtain stress distributions on the articular cartilages. In the analysis, the displacements on the posterior calcaneal articular surface of the talus are fully fixed. A vertical concentrated force equal to the body weight is applied at the femoral head. RESULTS: In the normal knee joints, the maximum normal stresses on the articular cartilages in the lateral compartments are always higher than those in the medial compartments. In the varus knee joints, the opposite results are observed. However, in each normal knee joint, the stress distribution on the whole articular cartilage is moderately uniform. On the contrary, in each varus knee joint, comparatively high magnitudes of the normal stress are found on a large area of the articular cartilage in the medial compartment. CONCLUSION: Varus knee joints have higher stresses in the medial compartments while normal knee joints have higher stresses in the lateral compartments. This pilot study shows that FE studies are comparable to cadaveric studies. FEM can be used as an alternative method for studying and examining knee joints of patients.