Effect of the prosthetic index on stress distribution in Morse taper connection implant system and peri-implant bone: a 3D finite element analysis.

BACKGROUND: The combination of a prosthetic index with Morse taper connection was developed, with the purpose of making prosthetic procedures more precise. However, the presence of the index may compromise the mechanical performance of the abutment. The aim of this study is to evaluate the effect of prosthetic index on stress distribution in implant-abutment-screw system and peri-implant bone by using the 3D finite element methodology. METHODS: Two commercial dental implant systems with different implant-abutment connections were used: the Morse taper connection with platform switching (MT-PS) implant system and the internal hex connection with platform matching (IH-PM) implant system. Meanwhile, there are two different designs of Morse taper connection abutment, namely, abutments with or without index. Consequently, three different models were developed and evaluated: (1) MT-PS indexed, (2) MT-PS non-indexed, and (3) IH-PM. These models were inserted into a bone block. Vertical and oblique forces of 100 N were applied to each abutment to simulate occlusal loadings. RESULTS: For the MT-PS implant system, the maximum stress was always concentrated in the abutment neck under both vertical and oblique loading. Moreover, the maximum von Mises stress in the neck of the MT-PS abutment with index even exceed the yield strength of titanium alloy under the oblique loading. For the IH-PM implant system, however, the maximum stress was always located at the implant. Additionally, the MT-PS implant system has a significantly higher stress level in the abutment neck and a lower stress level around the peri-implant bone compared to the IH-PM implant system. The combined average maximum stress from vertical and oblique loads is 2.04 times higher in the MT-PS indexed model, and 1.82 times for the MT-PS non-indexed model than that of the IH-PM model. CONCLUSIONS: MT-PS with index will cause higher stress concentration on the abutment neck than that of without index, which is more prone to mechanical complications. Nevertheless, MT-PS decreases stress within cancellous bone and may contribute to limiting crestal bone resorption.

Experimental validation of finite element simulation of a new custom-designed fixation plate to treat mandibular angle fracture.

BACKGROUND: The objective of the study was to validate biomechanical characteristics of a 3D-printed, novel-designated fixation plate for treating mandibular angle fracture, and compare it with two commonly used fixation plates by finite element (FE) simulations and experimental testing. METHODS: A 3D virtual mandible was created from a patient's CT images as the master model. A custom-designed plate and two commonly used fixation plates were reconstructed onto the master model for FE simulations. Modeling of angle fracture, simulation of muscles of mastication, and defining of boundary conditions were integrated into the theoretical model. Strain levels during different loading conditions were analyzed using a finite element method (FEM). For mechanical test design, samples of the virtual mandible with angle fracture and the custom-designed fixation plates were printed using selective laser sintering (SLS) and selective laser melting (SLM) printing methods. Experimental data were collected from a testing platform with attached strain gauges to the mandible and the plates at different 10 locations during mechanical tests. Simulation of muscle forces and temporomandibular joint conditions were built into the physical models to improve the accuracy of clinical conditions. The experimental vs the theoretical data collected at the 10 locations were compared, and the correlation coefficient was calculated. RESULTS: The results show that use of the novel-designated fixation plate has significant mechanical advantages compared to the two commonly used fixation plates. The results of measured strains at each location show a very high correlation between the physical model and the virtual mandible of their biomechanical behaviors under simulated occlusal loading conditions when treating angle fracture of the mandible. CONCLUSIONS: Based on the results from our study, we validate the accuracy of our computational model which allows us to use it for future clinical applications under more sophisticated biomechanical simulations and testing.

Thermo-Mechanical Properties of Glass Fiber Reinforced Shape Memory Polyurethane for Orthodontic Application.

OBJECTIVES: Glass fiber reinforced shape memory polyurethane (GFRSMPU) has great potential to be an alternative kind of material for orthodontic archwires for overcoming the disadvantages of metal wires in terms of esthetic and allergy and deficiency of pure shape memory polyurethane (SMPU) wires in mechanical properties. The objective of this study was to investigate the thermo-mechanical properties and shape recovery functions of GFRSMPU and evaluate the feasibility of using this composite for orthodontic archwires. MATERIAL AND METHODS: GFRSMPU were made from short cut glass fibers and SMPU by mixing extrusion. Scanning electron microscope (SEM) and differential scanning calorimetry (DSC) were performed to investigate the distribution of glass fibers in the mixture and glass transition temperature (Tg). Then the thermo-mechanical properties, including tensile modulus, flexural modulus and stress relaxation effects, were measured. Furthermore, shape recovery functions of GFRSMPU characterized by the shape recovery ratio and force were investigated through shape recovery tests, typodont models and finite element analysis (FEA). RESULTS: SEM images indicated that an excellent dispersity of glass fibers was obtained after double-extrusion. DSC experiments showed Tg was not enormously affected with the existence of glass fibers, but the mechanical properties of GFRSMPU were greatly improved. Shape recovery tests showed reduction of shape recovery ratio of the GFRSMPU material with the addition of glass fibers, but dentition aligning time was reduced by 50% in the simulation performed on identical typodont models with GFRSMPU archwires filled with 30 wt.% glass fibers. The FEA results illustrated that the reacting forces of GFRSMPU archwires with 30 wt.% glass fiber was increased by 96.36% compared with pure SMPU archwires. CONCLUSIONS: The mechanical properties of GFRSMPU can be considerably improved by adding glass fibers, and the shape memory function would be well preserved too. Enhanced SMPU owns a good application prospect in orthodontics for dentation aligning on the preliminary stage, as well as other medical fields.

Numerical and Experimental Analyses on the Temperature Distribution in the Dental Implant Preparation Area when Using a Surgical Guide.

PURPOSE: During dental implantation, if the temperature within the bone tissue exceeds a critical value, the thermal necrosis of bone cells may take place, inhibiting osseointegration. In contrast to conventional dental implant surgery, a surgery guided by a surgical template is a safer and more efficient technique; however, the temperature within the implant field is more difficult to control, because the surgical guide blocks irrigation water. The purpose of this study was to investigate the temperature distribution in the drilling site when preparing for dental implant placement with a surgical guide, and to derive suggestions for clinical operation. MATERIALS AND METHODS: Initially, the sources of heat during drilling were investigated, and theoretical equations were listed. Subsequently, a measurement system using thermocouples was constructed, with which the temperature increments at specific points in the simulated bone samples were recorded during guided drilling with different cooling methods. Based on the equations and data assessed, a thermal simulation model with a finite element method (FEM) was created, and the temperature change of the whole surgical field was calculated on the basis of the numerical simulation results. Consequently, the point experiencing the highest temperature within the bone was determined. RESULTS: From the experimental measurements, the highest temperature increment was located at a depth of 6 mm without irrigation and at 8 mm with cooling, rather than at the deepest point of the prepared hole. Because the surgical guide blocks the cooling water from entering the drilling site, the biggest increment of temperature using conventional irrigation with the surgical guide was 1.95 times that recorded when using a surgical guide consisting of cooling channels, and 3.6 times that recorded using a drill with an internal cooling hole. And from numerical analysis, during drilling for implant placement site with conventional irrigation, the highest temperature (45.6°C) was close to the critical point at which bone necrosis occurs. CONCLUSIONS: Based on theoretical analysis, experimentation, and FEM simulation, the temperature distribution of the drilling area in the placement of dental implants under surgical guide was determined. For clinical operation, improved cooling methods, such as using a drill with an internal cooling channel, should be used, and the drill should be regularly withdrawn during drilling.

A customized fixation plate with novel structure designed by topological optimization for mandibular angle fracture based on finite element analysis.

BACKGROUND: The purpose of this study was to design a customized fixation plate for mandibular angle fracture using topological optimization based on the biomechanical properties of the two conventional fixation systems, and compare the results of stress, strain and displacement distributions calculated by finite element analysis (FEA). METHODS: A three-dimensional (3D) virtual mandible was reconstructed from CT images with a mimic angle fracture and a 1 mm gap between two bone segments, and then a FEA model, including volume mesh with inhomogeneous bone material properties, three loading conditions and constraints (muscles and condyles), was created to design a customized plate using topological optimization method, then the shape of the plate was referenced from the stress concentrated area on an initial part created from thickened bone surface for optimal calculation, and then the plate was formulated as "V" pattern according to dimensions of standard mini-plate finally. To compare the biomechanical behavior of the "V" plate and other conventional mini-plates for angle fracture fixation, two conventional fixation systems were used: type A, one standard mini-plate, and type B, two standard mini-plates, and the stress, strain and displacement distributions within the three fixation systems were compared and discussed. RESULTS: The stress, strain and displacement distributions to the angle fractured mandible with three different fixation modalities were collected, respectively, and the maximum stress for each model emerged at the mandibular ramus or screw holes. Under the same loading conditions, the maximum stress on the customized fixation system decreased 74.3, 75.6 and 70.6% compared to type A, and 34.9, 34.1, and 39.6% compared to type B. All maximum von Mises stresses of mandible were well below the allowable stress of human bone, as well as maximum principal strain. And the displacement diagram of bony segments indicated the effect of treatment with different fixation systems. CONCLUSIONS: The customized fixation system with topological optimized structure has good biomechanical behavior for mandibular angle fracture because the stress, strain and displacement within the plate could be reduced significantly comparing to conventional "one mini-plate" or "two mini-plates" systems. The design methodology for customized fixation system could be used for other fractures in mandible or other bones to acquire better mechanical behavior of the system and improve stable environment for bone healing. And together with SLM, the customized plate with optimal structure could be designed and fabricated rapidly to satisfy the urgent time requirements for treatment.

An Investigation of Two Finite Element Modeling Solutions for Biomechanical Simulation Using a Case Study of a Mandibular Bone.

The method used in biomechanical modeling for finite element method (FEM) analysis needs to deliver accurate results. There are currently two solutions used in FEM modeling for biomedical model of human bone from computerized tomography (CT) images: one is based on a triangular mesh and the other is based on the parametric surface model and is more popular in practice. The outline and modeling procedures for the two solutions are compared and analyzed. Using a mandibular bone as an example, several key modeling steps are then discussed in detail, and the FEM calculation was conducted. Numerical calculation results based on the models derived from the two methods, including stress, strain, and displacement, are compared and evaluated in relation to accuracy and validity. Moreover, a comprehensive comparison of the two solutions is listed. The parametric surface based method is more helpful when using powerful design tools in computer-aided design (CAD) software, but the triangular mesh based method is more robust and efficient.

Impact of Surgical Template on the Accuracy of Implant Placement.

PURPOSE: To achieve functional and esthetic results, implants must be placed accurately; however, little information is available regarding the effect of surgical templates on the accuracy of implant placement. Thus, the aim of this study was to measure the deviation between actual and planned implant positions, and determine the deviation caused by the surgical template. MATERIALS AND METHODS: Jaws from 16 patients were scanned using cone beam computed tomography (CBCT). For our study, 53 implants were planned in a virtual 3D environment, of which 35 were inserted in the mandible and 18 in the maxilla. A stereolithographic (SLA) surgical template was created. A CBCT scan of the surgical template fitted on a plaster model was performed, and the images obtained were matched to virtual implant plan images that contained the planned implant position. The actual implant position was acquired from the registration position of the surgical template. Deviation between actual and planned implant positions was analyzed. RESULTS: Mean central deviation at the hex and apex was 0.456 mm and 0.515 mm, respectively. Mean value of horizontal deviation at the hex was 0.193 mm, horizontal deviation at the apex was 0.277 mm, vertical deviation at the hex was 0.388 mm, vertical deviation at the apex was 0.390 mm, and angular deviation was 0.621°. CONCLUSION: Our study results revealed a significant deviation between actual and planned implant positions caused by the surgical template.

Technical procedures for template-guided surgery for mandibular reconstruction based on digital design and manufacturing.

BACKGROUND: The occurrence of mandibular defects caused by tumors has been continuously increasing in China in recent years. Conversely, results of the repair of mandibular defects affect the recovery of oral function and patient appearance, and the requirements for accuracy and high surgical quality must be more stringent. Digital techniques--including model reconstruction based on medical images, computer-aided design, and additive manufacturing--have been widely used in modern medicine to improve the accuracy and quality of diagnosis and surgery. However, some special software platforms and services from international companies are not always available for most of researchers and surgeons because they are expensive and time-consuming. METHODS: Here, a new technical solution for guided surgery for the repair of mandibular defects is proposed, based on general popular tools in medical image processing, 3D (3 dimension) model reconstruction, digital design, and fabrication via 3D printing. First, CT (computerized tomography) images are processed to reconstruct the 3D model of the mandible and fibular bone. The defect area is then replaced by healthy contralateral bone to create the repair model. With the repair model as reference, the graft shape and cutline are designed on fibular bone, as is the guide for cutting and shaping. The physical model, fabricated via 3D printing, including surgical guide, the original model, and the repair model, can be used to preform a titanium locking plate, as well as to design and verify the surgical plan and guide. In clinics, surgeons can operate with the help of the surgical guide and preformed plate to realize the predesigned surgical plan. RESULTS: With sufficient communication between engineers and surgeons, an optimal surgical plan can be designed via some common software platforms but needs to be translated to the clinic. Based on customized models and tools, including three surgical guides, preformed titanium plate for fixation, and physical models of the mandible, grafts for defect repair can be cut from fibular bone, shaped with high accuracy during surgery, and fixed with a well-fitting preformed locking plate, so that the predesigned plan can be performed in the clinic and the oral function and appearance of the patient are recovered. This method requires 20% less operating time compared with conventional surgery, and the advantages in cost and convenience are significant compared with those of existing commercial services in China. CONCLUSIONS: This comparison between two groups of cases illustrates that, with the proposed method, the accuracy of mandibular defect repair surgery is increased significantly and is less time-consuming, and patients are satisfied with both the recovery of oral function and their appearance. Until now, more than 15 cases have been treated with the proposed methods, so their feasibility and validity have been verified.

Biomechanical behavior of temporomandibular joint movements driven by mastication muscles.

Surgery of jawbones has a high potential risk of causing complications associated with temporomandibular joint disorder (TMD). The objective of this study was to investigate the effects of two drive modeling methods on the biomechanical behavior of the temporomandibular joint (TMJ) including articular disc during mandibular movements. A finite element (FE) model from a healthy human computed tomography was used to evaluate TMJ dynamic using two methods, namely, a conventional spatial-oriented method (displacement-driven) and a compliant muscle-initiated method (masticatory muscle-driven). The same virtual FE model was 3D printed and a custom designed experimental platform was established to validate the accuracy of experimental and theoretical results of the TMJ biomechanics during mandibular movements. The results show that stress distributed to TMJ and articular disc from mandibular movements provided better representation from the muscle-driving approach than those of the displacement-driven modeling. The simulation and experimental data exhibited significant strong correlations during opening, protrusion, and laterotrusion (with canonical correlation coefficients of 0.994, 0.993, and 0.932, respectively). The use of muscle-driven modeling holds promise for more accurate forecasting of stress analysis of TMJ and articular disc during mandibular movements. The compliant approach to analyze TMJ dynamics would potentially contribute to clinic diagnosis and prediction of TMD resulting from occlusal disease and jawbone surgery such as orthognathic surgery or tumor resection.

Gradient gyroid Ti6Al4V scaffolds with TiO2 surface modification: Promising approach for large bone defect repair.

Large bone defects, particularly those exceeding the critical size, present a clinical challenge due to the limited regenerative capacity of bone tissue. Traditional treatments like autografts and allografts are constrained by donor availability, immune rejection, and mechanical performance. This study aimed to develop an effective solution by designing gradient gyroid scaffolds with titania (TiO2) surface modification for the repair of large segmental bone defects. The scaffolds were engineered to balance mechanical strength with the necessary internal space to promote new bone formation and nutrient exchange. A gradient design of the scaffold was optimized through Finite Element Analysis (FEA) and Computational Fluid Dynamics (CFD) simulations to enhance fluid flow and cell adhesion. In vivo studies in rabbits demonstrated that the G@TiO2 scaffold, featuring a gradient structure and TiO2 surface modification, exhibited superior healing capabilities compared to the homogeneous structure and TiO2 surface modification (H@TiO2) and gradient structure (G) scaffolds. At 12 weeks post-operation, in a bone defect representing nearly 30 % of the total length of the radius, the implantation of the G@TiO2 scaffold achieved a 27 % bone volume to tissue volume (BV/TV) ratio, demonstrating excellent osseointegration. The TiO2 surface modification provided photothermal antibacterial effects, enhancing the scaffold's biocompatibility and potential for infection prevention. These findings suggest that the gradient gyroid scaffold with TiO2 surface modification is a promising candidate for treating large segmental bone defects, offering a combination of mechanical strength, bioactivity, and infection resistance.

Experimental validation of a new model for mandibular motions.

Long-term excessive forces loading from muscles of mastication during mandibular motions may result in disorders of temporomandibular joint (TMJ), myofascial pain, and restriction of jaw opening and closing. Current analysis of mandibular movements is generally conducted with a single opening, protrusive and lateral movements rather than composite motions that the three can be combined arbitrarily. The objective of this study was to construct theoretical equations reflecting the correlation between composite motions and muscle forces, and consequently to analyze the mandibular composite motions and the tensions of muscles of mastication in multiple dimensions. The muscle performances such as strength, power, and endurance of mandibular motions were analyzed and the effective motion range of each muscle was derived. The mandibular composite motion model was simplified by calculating muscle forces. An orthogonal rotation matrix based on muscle forces was established. A 3D printed mandible was used for in vitro simulation of mandibular motions on a robot and measurements of force were conducted. The theoretical model and forces were verified through a trajectory tracing experiment of mandibular motions driven by a 6-axis robot with force/torque sensors. Through the analysis of the mandibular composite motion model, the motion form was obtained and transferred to guide the motions of the robot. The error between the experimental data obtained by the 6-axis force/torque sensors and the theoretical data was within 0.6 N. Our system provides excellent visualization for analyzing the changes of muscle forces and locations during various mandibular movements. It is useful for clinicians to diagnose and formulate treatment for patients who suffer from (temporomandibular joint disorders) TMDs and restrict jaw movements. The system can potentially offer the comparison before and after treatment of TMDs or jaw surgery.

3D printed PEKK bone analogs with internal porosity and surface modification for mandibular reconstruction: An in vivo rabbit model study.

Polyetheretherketone (PEEK) and its derivative polyetherketoneketone (PEKK) have been used as implant materials for spinal fusing and enjoyed their success for many years because of their mechanical properties similar to bone and their chemical inertness. The osseointegration of PEEKs is datable. Our strategy was to use custom-designed and 3D printed bone analogs with an optimized structure design and a modified PEKK surface to augment bone regeneration for mandibular reconstruction. Those bone analogs had internal porosities and a bioactive titanium oxide surface coating to promote osseointegration between native bone and PEKK analogs. Our workflow was 3D modeling, bone analog designing, structural optimization, mechanical analysis via finite element modeling, 3D printing of bone analogs and subsequently, an in vivo rabbit model study on mandibular reconstruction and histology evaluation. Our results showed the finite element analysis validated that the porous PEKK analogs provided a mechanical-sound structure for functional loadings. The bone analogs offered a perfect replacement for segmented bones in the terms of shape, form and volume for surgical reconstruction. The in vivo results showed that bioactive titanium oxide coating enhanced new bone in-growth into the porous PEKK analogs. We have validated our new approach in surgical mandibular reconstruction and we believe our strategy has a significant potential to improve mechanical and biological outcomes for patients who require mandibular reconstruction procedures.

Lever arm on bracket vs. lever arm on archwire: A 3D finite element method study of mechanics of miniscrew-supported lingual en-masse retraction of maxillary anterior teeth.

OBJECTIVE: To compare the deformation of the main archwire and 3D movements of maxillary anterior teeth during miniscrew-supported en-masse retraction with the lever arm on the archwire and on the brackets in lingual orthodontic treatment in finite element analysis (FEM) simulation. MATERIAL AND METHODS: A 3D dental-alveolar model with bonded 0.018×0.025-inch slot lingual brackets and a 0.017×0.025-inch dimension stainless-steel archwire was created. Four FEM models were created based on a 3D dental-alveolar model: in Models A and C, the lever arms were attached to the lingual bracket, while in Models B and D, the lever arms were attached to the archwire. Meanwhile, in Models A and B, the miniscrews were placed in between the molars, while in Models C and D, the miniscrews were positioned on the palatal roof. After a 1.5N retraction force was applied from the miniscrew to the end of the lever arm, the initial movements in the sagittal, transversal, and vertical planes were recorded and analysed for maxillary anterior teeth. RESULTS: In Models B and D, smaller deformation of the main archwire and less prominent bowing effect were noticed in both sagittal and vertical directions compared to their counter groups. In Models C and D, the central incisors showed less torque loss in the sagittal direction and more canine intrusion vertically. CONCLUSIONS: For the same lever arm-miniscrew retraction configuration, the lever arm on the bracket showed less deformation of the main archwire and more body movement of the teeth than the lever arm on the archwire group. With the same level arm height, the transverse and vertical bowing effect is reduced when the lever arm was placed distal to the central incisor and the miniscrews placed next to the palatal suture.

Biomechanical behavior of mandible with posterior marginal resection using finite element analysis.

This study aims to characterize biomechanical behavior of various designs of posterior mandibular marginal resection under functional loadings using finite element method. The ultimate goal of this work is to provide clinically relevant information to prevent postoperative fracture and to stipulate prophylactic internal fixation for planning of marginal mandibulectomy. A 3D mandibular master model was reconstructed from cone beam computed tomography images. Different marginal resection models were created based on three design parameters, namely, defect curvilinear radius, anterior-posterior defect width and residual height of the mandibular body. Functional loadings from incisors (60 N) and contralateral first molar area (200 N) were applied to designed models and stress patterns were compared of five groups with curvilinear radius from 0 (conventional rectangular shape), 2.5, 3.5, 5, and 6 mm. Models with 25, 35 and 45 mm defect width mimic defects varied from canine to 3rd molar were tested. Residual height range from 10 to 4 mm was assessed. The results show high stresses predominated in the occlusal area and the posterior inferior border near the resection corner. The average maximum stress decreased by 29.8% (r = 2.5 mm), 51.9% (r = 3.5 mm), 54.4% (r = 5 mm), and 59.3% (r = 6 mm) compared to the baseline of r = 0 mm. The results from the combined defect width/residual height models demonstrate the increase of defect width and the decrease in residual height resulted in the increase of maximum stress. Our data also confirm that the factor of residual height supersedes defect width in terms of prevention of postoperative fracture when considering resection design.

Evaluation of a custom-designed human-robot collaboration control system for dental implant robot.

BACKGROUND: The purpose of this study is to develop a methodology to better control a human-robot collaboration for robotic dental implant placement. We have designed a human-robot collaborative implant system (HRCDIS) which is based on a zero-force hand-guiding concept and a operational task management workflow that can achieve highly accurate and stable osteotomy drilling based on a surgeon's decision and robotic arm movements during implant surgery. METHOD: The HRCDIS brings forth the robot arm positions, exact drilling location, direction and performs automatic drilling. The HRCDIS can also avoid complex programing in the robot. The purpose of the study is to evaluate the accuracy of drilling resulting from our developed operational task management method (OTMM). The OTMM can enable the robot to switch, pause, and resume drilling tasks. The force required for hand-guiding in a zero-force control mode of the robot was detected by a 6D force sensor. We compared our force data to those provided by the manufacturer's manual. The study was conducted on a phantom head with a 3D-printed jaw bone to verify the validity of our HRCDIS. We appraised the discrepancies between free-hand drillings and the HRCDIS controlled drillings at apical centre and head centre of the implant and implant angulation to the baseline data from a virtual surgical planning model. RESULTS: The average required force used by hand-guiding to operate the robot with HRCDIS was near 7 Newton which is much less than the manufacturer's specification (30 Newton). The results from our study showed that the average error at implant head was 1.04 ± 0.37 mm, 1.56 ± 0.52 mm at the implant apex, and deviation of implant angle was 3.74 ± 0.67°. CONCLUSIONS: The results from this study validate the merit of the human-robot collaboration control by the HRCDIS. Based on the improved navigation system using HRCDIS, a robotic implant placement can provide seamless drilling with ease, efficiency and accuracy.

3D-printed porous condylar prosthesis for temporomandibular joint replacement: Design and biomechanical analysis.

BACKGROUND: Customized prosthetic joint replacements have crucial applications in severe temporomandibular joint problems, and the combined use of porous titanium scaffold is a potential method to rehabilitate the patients. OBJECTIVE: The objective of the study was to develop a design method to obtain a titanium alloy porous condylar prosthesis with good function and esthetic outcomes for mandibular reconstruction. METHODS: A 3D virtual mandibular model was created from CBCT data. A condylar defect model was subsequently created by virtual condylectomy on the initial mandibular model. The segmented condylar defect model was reconstructed by either solid or porous condyle with a fixation plate. The porous condyle was created by a density-driven modeling scheme with an inhomogeneous tetrahedral lattice structure. The porous condyle, supporting fixation plate, and screw locations were topologically optimized. Biomechanical behaviors of porous and solid condylar prostheses made of Ti-6Al-4V alloy were compared. Finite element analysis (FEA) was used to evaluate maximum stress distribution on both prostheses and the remaining mandibular ramus. RESULTS: The FEA results showed levels of maximum stresses were 6.6%, 36.4% and 47.8% less for the porous model compared to the solid model for LCI, LRM, and LBM loading conditions. Compared to the solid prosthesis, the porous prosthesis had a weight reduction of 57.7% and the volume of porosity of the porous condyle was 65% after the topological optimization process. CONCLUSIONS: A custom-made porous condylar prosthesis with fixation plate was designed in this study. The 3D printed Ti-6Al-4V porous condylar prosthesis had reduced weight and effective modulus of elasticity close to that of cortical bone. The.

[Cockayne syndrome].

Cockayne syndrome is a rare autosomal recessive disease. This paper reports a case of Cockayne syndrome confirmed by gene analysis. The baby (male, 7 years old) was referred to Peking University Third Hospital with recurrent desquamation, pigmentation and growth and development failure for 6 years, and recurrent dental caries and tooth loss for 2 years. Physical examination showed very low body weight, body length and head circumference, yellow hair, a lot of fawn spots on the face, skin dry and less elastic, and subcutaneous lipopenia. He had an unusual appearance with sunken eyes, sharp nose, sharp mandible, big auricle and dental caries and tooth loss. Crura spasticity and ataxia with excessive tendon reflexion, and ankle movement limitation while bending back were observed. He had slured speech. The level of serum insulin like growth factor I was low, and the results of blood and urinary amino acid analysis suggested malnutrition. The results of blood growth hormone, thyroxin, parathyroxin, liver function, renal function, lipoprotein profile and blood glucose and electrolytes were all within normal limit. An electronic hearing examination showed moderate neural hearing loss. The sonogram of eyes revealed small eye axis and vitreous body opacity of right side. MRI of brain revealed bilateral calcification of basal ganglia and generalized cerebral and cerebellar atrophy, and brainstem and callus were also atrophic. Genetic analysis confirmed with CSA gene mutation. So the boy was definitely diagnosed with Cockayne syndrome. He was discharged because of no effective treatment.

Biomechanical and Mechanostat analysis of a titanium layered porous implant for mandibular reconstruction: The effect of the topology optimization design.

A porous scaffold/implant is considered a potential method to repair bone defects, but its mechanical stability and biomechanics during the repair process are not yet clear. A mandibular titanium implant was proposed and designed with layered porous structures similar to that of the bone tissue, both in structure and mechanical properties. Topology was used to optimize the design of the porous implant and fixed structure. The finite element analysis was combined with bone "Mechanostat" theory to evaluate the stress and osteogenic property of the layered porous implant with 3 different fixation layouts (Model I with 4 screws, Model II with 5 screws and Model III with 6 screws) for mandibular reconstruction. The results showed that Model III could effectively reduce the stress shielding effect, stress within the optimized implant, defective mandible, and screws were respectively dropped 48.18%, 44.23%, and 57.27% compared to Model I, and the porous implant had a significant stress transmission effect and maintained the same stress distribution as the intact mandible after the mandibular defect was repaired. The porous implant also showed a significant mechanical stimulation effect on the growth and healing of the bone tissue according to the bone "Mechanostat" theory. The combination of porous structure with the topology technique is a promising option to improve the mechanical stability and osteogenesis of the implant, and could provide a new solution for mandibular reconstruction.

Shear models and parametric analysis of the PVC geomembrane-cushion interface in a high rock-fill dam.

As a type of flexible impermeable material, a PVC geomembrane must be cooperatively used with cushion materials. The contact interface between a PVC geomembrane and cushion easily loses stability. In this present paper, we analyzed the shear models and parameters of the interface to study the stability. Two different cushion materials were used: the common extrusion sidewall and non-fines concrete. To simulate real working conditions, flexible silicone cushions were added under the loading plates to simulate hydraulic pressure loading, and the loading effect of flexible silicone cushions was demonstrated by measuring the actual contact areas under different normal pressures between the geomembrane and cushion using the thin-film pressure sensor. According to elastomer shear stress, there are two main types of shear stress between the PVC geomembrane and the cushion: viscous shear stress and hysteresis shear stress. The viscous shear stress between the geomembrane and the cement grout was measured using a dry, smooth concrete sample, then the precise formula parameters of the viscous shear stress and viscous friction coefficient were obtained. The hysteresis shear stress between the geomembrane and the cushion was calculated by subtracting the viscous shear stress from the total shear stress. The formula parameters of the hysteresis shear stress and hysteresis friction coefficient were calculated. The three-dimensional box-counting dimensions of the cushion surface were calculated, and the formula parameters of the hysteresis friction were positively correlated with the three-dimensional box dimensions.

Accuracy of dental implant surgery with robotic position feedback and registration algorithm: An in-vitro study.

BACKGROUND: The purpose of this study was to develop and validate a positioning method with hand-guiding and contact position feedback of robot based on a human-robot collaborative dental implant system (HRCDIS) for robotic guided dental implant surgery. METHODS: An HRCDIS was developed based on a light-weight cooperative robot arm, UR5. A three-dimensional (3D) virtual partially edentulous mandibular bone was reconstructed using the cone bone computed tomography images. After designing the preoperative virtual implant planning using the computer software, a fixation guide worn on teeth for linking and fixing positioning marker was fabricated by 3D printing. The fixation guide with the positioning marker and a resin model mimicking the oral tissues were assembled on a head phantom. The planned implant positions were derived by the coordinate information of the positioning marker. The drilling process using the HRCDIS was conducted after mimicking the experimental set-up and planning the drilling trajectory. Deviations between actual and planned implant positions were measured and analyzed. RESULTS: The head phantom experiments results showed that the error value of the central deviation at hex (refers to the center of the platform level of the implant) was 0.79 ± 0.17 mm, central deviation at the apex was 1.26 ± 0.27 mm, horizontal deviation at the hex was 0.61 ± 0.19 mm, horizontal deviation at the apex was 0.91 ± 0.55 mm, vertical deviation at the hex was 0.38 ± 0.17 mm, vertical deviation at the apex was 0.37 ± 0.20 mm, and angular deviation was 3.77 ± 1.57°. CONCLUSIONS: The results from this study preliminarily validate the feasibility of the accurate navigation method of the HRCDIS.