Assessment of bone ingrowth around beaded coated tibial implant for total ankle replacement using mechanoregulatory algorithm.

The long-term performance of porous coated tibial implants for total ankle replacement (TAR) primarily depends on the extent of bone ingrowth at the bone-implant interface. Although attempts were made for primary fixation for immediate post-operative stability, no investigation was conducted on secondary fixation. The aim of this study is to assess bone ingrowth around the porous beaded coated tibial implant for TAR using a mechanoregulatory algorithm. A realistic macroscale finite element (FE) model of the implanted tibia was developed based on computer tomography (CT) data to assess implant-bone micromotions and coupled with microscale FE models of the implant-bone interface to predict bone ingrowth around tibial implant for TAR. The macroscale FE model was subjected to three near physiological loading conditions to evaluate the site-specific implant-bone micromotion, which were then incorporated into the corresponding microscale model to mimic the near physiological loading conditions. Results of the study demonstrated that the implant experienced tangential micromotion ranged from 0 to 71 µm with a mean of 3.871 µm. Tissue differentiation results revealed that bone ingrowth across the implant ranged from 44 to 96 %, with a mean of around 70 %. The average Young's modulus of the inter-bead tissue layer varied from 1444 to 4180 MPa around the different regions of the implant. The analysis postulates that when peak micromotion touches 30 µm around different regions of the implant, it leads to pronounced fibrous tissues on the implant surface. The highest amount of bone ingrowth was observed in the central regions, and poor bone ingrowth was seen in the anterior parts of the implant, which indicate improper osseointegration around this region. This macro-micro mechanical FE framework can be extended to improve the implant design to enhance the bone ingrowth and in future to develop porous lattice-structured implants to predict and enhance osseointegration around the implant.

Radiographic parameter-driven decision tree reliably predicts aseptic mechanical failure of compressive osseointegration fixation.

Background and purpose - Compressive osseointegration fixation is an alternative to intramedullary fixation for endoprosthetic reconstruction. Mechanical failure of compressive osseointegration presents differently on radiographs than stemmed implants, therefore we aimed to develop a reliable radiographic method to determine stable integration.Patients and methods - 8 reviewers evaluated 11 radiographic parameters from 29 patients twice, 2 months apart. Interclass correlation coefficients (ICCs) were used to assess test-retest and inter-rater reliability. We constructed a fast and frugal decision tree using radiographic parameters with substantial test-retest agreement, and then tested using radiographs from a new cohort of 49 patients. The model's predictions were compared with clinical outcomes and a confusion matrix was generated.Results - 6 of 8 reviewers had non-significant intra-rater ICCs for ≥ one parameter; all inter-rater ICCs were highly reliable (p < 0.001). Change in length between the top of the spindle sleeve and bottom of the anchor plug (ICC 0.98), bone cortex hypertrophy (ICC 0.86), and bone pin hypertrophy (ICC 0.81) were used to create the decision tree. The sensitivity and specificity of the training cohort were 100% (95% CI 52-100) and 87% (CI 74-94) respectively. The decision tree demonstrated 100% (CI 40-100) sensitivity and 89% (CI 75-96) specificity with the test cohort.Interpretation - A stable spindle length and at least 3 cortices with bone hypertrophy at the implant interface predicts stable osseointegration; failure is predicted in the absence of bone hypertrophy at the implant interface if the pin sites show hypertrophy. Thus, our decision tree can guide clinicians as they follow patients with compressive osseo-integration implants.

Cone beam analysis of the buccal bone associated with a dental implant: A tridimensional assessment case report.

OBJECTIVE: This case report presents cone beam computed tomography (CBCT) three-dimensional (3D) assessment of the buccal bone associated with an implant. METHOD AND MATERIALS: A patient who had immediate implant replacement of a maxillary incisor received a CBCT examination after 6 months. The scanned volume was then subjected to segmentation of the buccal bone associated with the implant and to its three-dimensional rendering. RESULTS: Virtual reconstruction allowed volumetric assessment of the buccal plate, and of the buccal marginal bone level. CONCLUSION: Creating a 3D virtual volume permits a comprehensive evaluation of the anatomical information contained in the CBCT dataset.

Damping Factor as a Diagnostic Parameter for Assessment of Osseointegration during the Dental Implant Healing Process: An Experimental Study in Rabbits.

The purpose of this study was to evaluate the possibility of using damping factor (DF) analysis to provide additional information on osseointegration of dental implants during the healing period. A total of 30 dental implants were installed in the bilateral femoral condyles of 15 rabbits. A DF analyzer detected with an impulse-forced vibration method and a commercialized dental implant stability analyzer based on resonance frequency (RF) analysis were used to measure the implant stability immediately after implant placement and 1, 2, 4, and 8 weeks post-surgically. Results of DF and RF analyses at different time points were compared with the corresponding osseointegration performance of dental implants via micro-computed tomography (micro-CT), histological and histomorphometrical analysis. The DF values revealed a decrease with time and reached 0.062 ± 0.007 at 8 weeks after implantation, which is almost 50% lower than the initial value. Moreover, highly significant correlations between DF values and bone volume densities (R 2 = 0.9797) and percentages of bone-to-implant contact measured at trabecular bone area (R 2 = 0.9773) were also observed. These results suggested that DF analysis combined with RF analysis results in a more sensitive assessment of changes in the dental implant/bone complex during the healing period than RF analysis alone.

Comparison of radiographic and histological assessment of peri-implant bone around oral implants.

OBJECTIVES: The aim of this study was to compare the radiographic bone mineral density and the histological assessment of relative volume density of bone and bone-to-implant contact (BIC) of single implants placed in the posterior mandible of monkeys. MATERIALS AND METHODS: Five mature, male cynomolgus monkeys (Macaca fascicularis) with a total of 20 implants inserted 3-6 months previously were available for investigation. Digital intra-oral radiographs were obtained with two different sensors and one phosphor plate system. The marginal bone level was measured on both sides of the implant on digital radiographs. Furthermore, bone density was evaluated using histogram analysis of the grey shades in a distance of 1 mm from the implant surface. The radiographic assessments were compared to histomorphometric analyses. RESULTS: The marginal bone level, the distance from the margin of the implant to the most coronal bone in direct contact with the implant evaluated histologically, was on average 1.4 mm, whereas this distance was significantly shorter (0.3 mm) on the digital radiographs. Still, a statistical significant correlation between the two bone level measurements was observed. The average radiographic bone density evaluated with the three different systems varied considerably. The histologic bone density was statistically significantly lower than the radiographic bone density measured with all the three techniques for acquiring digital radiographic images. Furthermore, the histologic bone density was statistically significantly correlated with the radiographic bone density only when measured with one of the sensors. On the other hand, the histologic BIC was statistically significantly correlated with the radiographic bone density obtained with all three techniques for acquiring digital radiographic images. CONCLUSIONS: The distance from the margin of the implant to the most coronal bone in direct contact with the implant showed lower values on digital intra-oral radiographs than histologically. Furthermore, the bone density assessed on intra-oral radiographs reflected to some extend the amount of bone at or near the implant surfaces evaluated histologically.