Personalized lattice-structured prosthesis as a graftless solution for mandible reconstruction and prosthetic restoration: A finite element analysis.

Oral cavity tumors are a prevalent cause of mandible reconstruction surgeries. The mandible is vital for functions like oralization, respiration, mastication, and deglutition. Current mandible reconstruction methods have low success rates due to complications like plate fracture or exposure, infections, and screw loosening. Autogenous bone grafts are commonly used but carry the risk of donor region morbidity. Despite technological advances, an ideal solution for mandible reconstruction remains elusive. Additive manufacturing in medicine offers personalized prosthetics from patient-specific medical images, allowing for the creation of porous structures with tailored mechanical properties that mimic bone properties. This study compared a commercial reconstruction plate with a lattice-structured personalized prosthesis under different biting and osseointegration conditions using Finite Element Analysis. Patient-specific images were obtained from an individual who underwent mandible reconstruction with a commercial plate and suffered from plate fracture by fatigue after 26 months. Compared to the commercial plate, the maximum von Mises equivalent stress was significantly lowered for the personalized prosthesis, hindering a possible fatigue fracture. The equivalent von Mises strains found in bone were within bone maintenance and remodeling intervals. This work introduces a design that doesn't require grafts for large bone defects and allows for dental prosthesis addition without the need for implants.

Multiscale stiffness characterisation of both healthy and osteoporotic bone tissue using subject-specific data.

Severe bone fractures are often treated by appending internal fixations. In unhealthy or osteoporotic patients, post-implantation bone fractures can occur due to external impact (e.g. from a fall), day-to-day activities in highly-osteoporotic cases and mismatches in the stiffness of bone and the implant's biomaterial, since this causes stress concentrations. One approach to alleviating this problem is to use biomaterials that closely mimic the effective stiffness of real bone, thereby more seamlessly integrating the fixation. This requires to know the properties target (bone properties) and therefore, it highlights the relevance of the evaluation of the bone's mechanical properties which is impractical via direct measurement. This work presents a methodology (multistage homogenisation) for predicting the anisotropic stiffness of bone given the porosity and mineral fraction, both of which are more readily obtained than the mechanical properties themselves. Unlike previous work we: (i) account for finger-like morphology of the mineral phase at the nanoscale; (ii) use microscopy data to model the osteon geometry and its curvilinear anisotropy at the microscale, and (iii) use data to define the trabecular (microCT) and cortical (microscopy) bone geometries at the mesoscale. The predicts have been shown to agree favourably with experimental data in the literature as well as previous modelling works. The results are summarised in a database containing anisotropic stiffness tensors applicable to a broad range of degrees of bone health (e.g. mineral fractions and mesoscale porosities); thus, this work is a contribution towards being able to design more robust patient-specific bone implants in practice.

Comportamiento y gravedad del trauma maxilofacial en urgencia en el Hospital Universitario "General Calixto García" / Characteristics and Severity of Maxillofacial Trauma in the Emergency Room at General Calixto García University Hospital

Introducción: La región maxilofacial es vulnerable al trauma. Se utilizan herramientas para evaluar la gravedad del trauma maxilofacial. Objetivo: Caracterizar el comportamiento y gravedad del trauma maxilofacial en los pacientes atendidos en el servicio de urgencias de cirugía maxilofacial del Hospital Universitario "General Calixto García". Métodos: Se realizó un estudio observacional descriptivo transversal en pacientes que acudieron al servicio de urgencias de cirugía maxilofacial del Hospital Universitario "General Calixto García", desde septiembre de 2018 hasta marzo de 2021. El universo fue de 57 pacientes. Se aplicó la escala de severidad de lesiones faciales. Variables analizadas: edad, sexo, etiología, diagnósticos, exámenes complementarios, gravedad del trauma maxilofacial, procederes terapéuticos inmediatos. Resultados: Prevaleció la fractura mandibular como diagnóstico (66,7 por ciento). La etiología más frecuente fue la violencia interpersonal (29,8 por ciento). Predominó la gravedad leve del trauma maxilofacial (71,9 por ciento). La extracción de cuerpos extraños de la vía aérea, tracción lingual, inserción de cánula orofaríngea, intubación orotraqueal (5,3 por ciento), y sutura (64,9 por ciento), fueron los procederes terapéuticos inmediatos más utilizados. Conclusiones: Prevalecen los pacientes del sexo masculino y del grupo de edad de 19 a 30 años. Predomina la fractura mandibular como diagnóstico. Los exámenes complementarios más utilizados son, la tomografía computarizada, el hemograma completo y el coagulograma. Impera la violencia interpersonal como etiología. Prevalece la gravedad leve del trauma maxilofacial. Los procederes terapéuticos inmediatos más empleados son, extracción de cuerpos extraños de la vía aérea, tracción lingual, inserción de cánula orofaríngea, intubación orotraqueal y sutura(AU)

Introduction: The maxillofacial region is vulnerable to trauma. Tools are used to assess the severity of maxillofacial trauma. Objective: To characterize maxillofacial trauma and its severity in patients cared for at the maxillofacial surgery emergency department of General Calixto García University Hospital. Methods: A cross-sectional, descriptive and observational study was carried out in patients attending the maxillofacial surgery emergency department at General Calixto García University Hospital, from September 2018 to March 2021. The study universe was 57 patients. The facial injury severity scale was applied. The analyzed variables were age, sex, etiology, diagnoses, complementary examinations, severity of maxillofacial trauma, immediate therapeutic procedures. Results: Mandibular fracture prevailed as a diagnosis (66.7 percent). The most frequent etiology was interpersonal violence (29.8 percent). Mild severity of maxillofacial trauma predominated (71.9 percent). Extraction of foreign bodies from the airway, tongue traction, insertion of oropharyngeal cannula, orotracheal intubation (5.3 percent) and suturing (64.9 percent) were the most frequently used immediate therapeutic procedures. Conclusions: There is a prevalence of male patients and the age group 19 to 30 years. Mandibular fracture predominates as a diagnosis. The most frequently used complementary tests are computed tomography, complete blood count and coagulogram. Interpersonal violence prevails as an etiology. Mild severity of maxillofacial trauma prevails. The most commonly used immediate therapeutic procedures are extraction of foreign bodies from the airway, tongue traction, insertion of oropharyngeal cannula, orotracheal intubation and suturing(AU)

Herramientas pronósticas de la gravedad del trauma maxilofacial en la atención de urgencia / Prognostic Tools for Maxillofacial Trauma Severity in Emergency Care

RESUMEN Introducción: La utilización de herramientas pronósticas que permitan valorar la gravedad del trauma, la supervivencia y mortalidad de los lesionados, permite la estratificación de los pacientes y la toma de decisiones acertadas para el tratamiento más efectivo en el área hospitalaria. Objetivo: Realizar una revisión bibliográfica sobre las herramientas pronósticas más utilizadas en la atención de urgencia para detectar la gravedad del trauma maxilofacial. Métodos: Se realizó una revisión bibliográfica desde octubre de 2018 hasta enero de 2019. Fueron examinados libros y artículos publicados en revistas de impacto, en idioma español, inglés y portugués, con atención prioritaria a aquellos que tuvieran cinco años o menos. Se consultaron las bases de datos MEDLINE, EBSCO, PubMed, SciELO, ClinicalKey, utilizando los descriptores: "Trauma Severity Indices", "Maxillofacial Injuries", "Traumatology", "Indexes". Se recuperaron dos libros y 50 artículos, aunque la revisión se circunscribió solamente a los 33 que mejor describían los elementos estudiados. Análisis e integración de la información: El puntaje Cooter David, el de gravedad de lesiones maxilofaciales, la escala de severidad de lesiones faciales, la de severidad de fracturas faciales y el modelo ZS, son los principales instrumentos utilizados en el pronóstico de gravedad existentes de la región facial. Conclusiones: Constan en la literatura escalas, índices y puntajes para pronosticar la gravedad del trauma maxilofacial en la urgencia, cada una exhibe ventajas que las convierte en una herramienta coadyuvante de la atención del trauma; sin embargo, poseen también desventajas que complejizan su aplicación en el medio hospitalario. Entre las herramientas más utilizadas está la escala de severidad de lesiones faciales; fácil de aplicar en los servicios de urgencia, pero con deficiencias a la hora de tratar los componentes de tejido blando y óseo. En Cuba hay escasas evidencias de la utilización de estos instrumentos en la especialidad de cirugía maxilofacial(AU)

ABSTRACT Introduction: The usage of prognostic tools that allow assessing trauma severity, as well as injury survival and mortality, allows patient stratification and making right decisions for the most effective treatment in the hospital area. Objective: To carry out a bibliographic review about the prognostic tools most widely used in emergency care to identify maxillofacial trauma severity. Methods: A bibliographic review was carried out from October 2018 to January 2019. We examined books and articles published in high-impact magazines, in Spanish, English and Portuguese, with priority attention on those five years old or less. We consulted the MEDLINE, EBSCO, PubMed, SciELO, Clinical Key databases using the descriptors Trauma Severity Indices, Maxillofacial Injuries, Traumatology, and Indexes. Two books and 50 articles were retrieved, although the review was limited to only 33 which described best the elements studied. Information analysis and integration: The Cooter-David scoring system, the maxillofacial injury severity score, the facial injury severity scale, the facial fracture severity scale, and the ZS model are the main instruments used for existing severity forecast in the facial region. Conclusions: There literature includes scales, indexes and scoring systems for predicting the maxillofacial trauma severity in the emergency department, each one showing advantages that make them an adjunct tool for trauma care; however, they also have disadvantages that complicate their application in the hospital setting. The facial injury severity scale is among the most widely used tools, as far as it is easy to apply in the emergency services, but with deficiencies for treating soft tissue and bone components. In Cuba, there is little evidence about the use of these instruments in the specialty of maxillofacial surgery(AU)

Patient-Specific Bone Multiscale Modelling, Fracture Simulation and Risk Analysis-A Survey.

This paper provides a starting point for researchers and practitioners from biology, medicine, physics and engineering who can benefit from an up-to-date literature survey on patient-specific bone fracture modelling, simulation and risk analysis. This survey hints at a framework for devising realistic patient-specific bone fracture simulations. This paper has 18 sections: Section 1 presents the main interested parties; Section 2 explains the organzation of the text; Section 3 motivates further work on patient-specific bone fracture simulation; Section 4 motivates this survey; Section 5 concerns the collection of bibliographical references; Section 6 motivates the physico-mathematical approach to bone fracture; Section 7 presents the modelling of bone as a continuum; Section 8 categorizes the surveyed literature into a continuum mechanics framework; Section 9 concerns the computational modelling of bone geometry; Section 10 concerns the estimation of bone mechanical properties; Section 11 concerns the selection of boundary conditions representative of bone trauma; Section 12 concerns bone fracture simulation; Section 13 presents the multiscale structure of bone; Section 14 concerns the multiscale mathematical modelling of bone; Section 15 concerns the experimental validation of bone fracture simulations; Section 16 concerns bone fracture risk assessment. Lastly, glossaries for symbols, acronyms, and physico-mathematical terms are provided.

Manifestaciones bucales de la diabetes mellitus tipo 2 en el adulto mayor / Oral manifestations of type 2 diabetes mellitus in the elderly

Introducción: La diabetes mellitus tipo 2 favorece la aparición de enfermedades bucales en el adulto mayor. Objetivos: Identificar las alteraciones bucales y factores de riesgo más frecuentes en pacientes con diabetes mellitus tipo 2. Métodos: Se realizó un estudio observacional, descriptivo y transversal. El universo lo conformaron 52 pacientes pertenecientes al consultorio # 13 del Policlínico Héroes del Corynthia, atendidos desde 2016 a 2017 en la Clínica Estomatológica Docente H y 21, municipio Plaza de la Revolución. Las variables analizadas fueron: edad, sexo, estado de salud bucal, factores de riesgo y manifestaciones bucales. Resultados: 55,7 por ciento de los adultos mayores pertenecieron al grupo de 60-69 años y el 59,4 por ciento del total de los pacientes involucrados en el estudio fueron mujeres. El 44,2 por ciento presentó un estado de salud bucal medianamente favorable. Por caries dental fueron afectados 34 pacientes, 31 por periodontitis y 25 por gingivitis. La obesidad se evidenció en el 59,6 por ciento de los pacientes. Conclusiones: El factor de riesgo predominante fue la obesidad. Las alteraciones bucales más observadas fueron la caries dental, la periodontitis y la gingivitis(AU)

Introduction: Type 2 diabetes mellitus fosters the appearance of oral diseases in the elderly. Objectives: Identify the most common oral alterations and risk factors among patients with type 2 diabetes mellitus. Methods: A cross-sectional observational descriptive study was conducted. The study universe was 52 patients from Consultation Office No. 13 of Héroes del Corynthia polyclinic cared for from 2016 to 2017 at H and 21st University Dental Clinic in the municipality of Plaza de la Revolución. The variables analyzed were age, sex, oral health status, risk factors and oral manifestations. Results: 55.7 percent of the elderly patients were in the 60-69 age group, and 59.4 percent of the total patients involved in the study were women. 44.2 percent had a fairly favorable oral health status. 34 had dental caries, 31 periodontitis and 25 gingivitis. 59.6 percent were obese. Conclusions: Obesity was the prevailing risk factor. The oral alterations most commonly found were dental caries, periodontitis and gingivitis(AU)

Manifestaciones bucales de la diabetes mellitus tipo 2 en el adulto mayor / Oral manifestations of type 2 diabetes mellitus in the elderly

Introducción: La diabetes mellitus tipo 2 favorece la aparición de enfermedades bucales en el adulto mayor. Objetivos: Identificar las alteraciones bucales y factores de riesgo más frecuentes en pacientes con diabetes mellitus tipo 2. Métodos: Se realizó un estudio observacional, descriptivo y transversal. El universo lo conformaron 52 pacientes pertenecientes al consultorio # 13 del Policlínico Héroes del Corynthia, atendidos desde 2016 a 2017 en la Clínica Estomatológica Docente H y 21, municipio Plaza de la Revolución. Las variables analizadas fueron: edad, sexo, estado de salud bucal, factores de riesgo y manifestaciones bucales. Resultados: 55,7 por ciento de los adultos mayores pertenecieron al grupo de 60-69 años y el 59,4 por ciento del total de los pacientes involucrados en el estudio fueron mujeres. El 44,2 por ciento presentó un estado de salud bucal medianamente favorable. Por caries dental fueron afectados 34 pacientes, 31 por periodontitis y 25 por gingivitis. La obesidad se evidenció en el 59,6 por ciento de los pacientes. Conclusiones: El factor de riesgo predominante fue la obesidad. Las alteraciones bucales más observadas fueron la caries dental, la periodontitis y la gingivitis(AU)

Introduction: Type 2 diabetes mellitus fosters the appearance of oral diseases in the elderly. Objectives: Identify the most common oral alterations and risk factors among patients with type 2 diabetes mellitus. Methods: A cross-sectional observational descriptive study was conducted. The study universe was 52 patients from Consultation Office No. 13 of Héroes del Corynthia polyclinic cared for from 2016 to 2017 at H and 21st University Dental Clinic in the municipality of Plaza de la Revolución. The variables analyzed were age, sex, oral health status, risk factors and oral manifestations. Results: 55.7 percent of the elderly patients were in the 60-69 age group, and 59.4 percent of the total patients involved in the study were women. 44.2 percent had a fairly favorable oral health status. 34 had dental caries, 31 periodontitis and 25 gingivitis. 59.6 percent were obese. Conclusions: Obesity was the prevailing risk factor. The oral alterations most commonly found were dental caries, periodontitis and gingivitis(AU)

Manifestaciones bucales de la diabetes mellitus en el adulto mayor / Oral manifestations of diabetes mellitus in elder people

RESUMEN A lo largo de la historia, el hombre siempre ha estado preocupado por el envejecimiento, siendo en la actualidad un fenómeno mundial sin precedentes en la historia de la humanidad. Entre las enfermedades crónicas características de la ancianidad se encuentra la diabetes mellitus, siendo esta una enfermedad compleja endocrino metabólica, de curso crónico, que puede favorecer la aparición de enfermedades bucales. El objetivo fue caracterizar a la población adulta mayor con diabetes mellitas e identificar las principales manifestaciones bucales provocadas por la enfermedad. Se reunió información a través de los buscadores de información y plataformas científicas: Pubmed, Scielo, Springer, ClinicalKey. Se consultaron un total de 36 artículos. Como resultados más relevantes se constató que el envejecimiento es un proceso que con el tiempo le ocurre a todo ser vivo a consecuencia de la interacción de la genética del individuo con su medio, y que la caries dental, la peridontitis y la gingivitis son las manifestaciones bucales más frecuentes de la diabetes mellitus. Existe una relación importante entre la diabetes mellitus y la aparición de las manifestaciones bucales (AU).

ABSTRACT Through the history, the man has been always worried about ageing; currently it is worldwide phenomena without precedents in the history of the human kind. Diabetes mellitus is among the chronic diseases that are characteristic of the elder age, being this an endocrine-metabolic complex disease, of chronic curse, that may contribute to the emergence of oral diseases. The objective was characterizing elder population with Diabetes mellitus and to identify the main oral manifestations caused for that disease. The information was gathered using information searchers and scientific platforms: Pubmed, Scielo, Springer, ClinicalKey. 36 articles were consulted. As the most relevant results were stated that ageing is a process occurring to any living creature as a consequence of the interaction of the individual's genetic and his environment, and that dental caries, periodontitis and gingivitis are the most frequent oral manifestations of the Diabetes mellitus. There is an important relation between Diabetes mellitus and the emergence of oral manifestations (AU).

Manifestaciones bucales de la diabetes mellitus en el adulto mayor / Oral manifestations of diabetes mellitus in elder people

RESUMEN A lo largo de la historia, el hombre siempre ha estado preocupado por el envejecimiento, siendo en la actualidad un fenómeno mundial sin precedentes en la historia de la humanidad. Entre las enfermedades crónicas características de la ancianidad se encuentra la diabetes mellitus, siendo esta una enfermedad compleja endocrino metabólica, de curso crónico, que puede favorecer la aparición de enfermedades bucales. El objetivo fue caracterizar a la población adulta mayor con diabetes mellitas e identificar las principales manifestaciones bucales provocadas por la enfermedad. Se reunió información a través de los buscadores de información y plataformas científicas: Pubmed, Scielo, Springer, ClinicalKey. Se consultaron un total de 36 artículos. Como resultados más relevantes se constató que el envejecimiento es un proceso que con el tiempo le ocurre a todo ser vivo a consecuencia de la interacción de la genética del individuo con su medio, y que la caries dental, la peridontitis y la gingivitis son las manifestaciones bucales más frecuentes de la diabetes mellitus. Existe una relación importante entre la diabetes mellitus y la aparición de las manifestaciones bucales (AU).

ABSTRACT Through the history, the man has been always worried about ageing; currently it is worldwide phenomena without precedents in the history of the human kind. Diabetes mellitus is among the chronic diseases that are characteristic of the elder age, being this an endocrine-metabolic complex disease, of chronic curse, that may contribute to the emergence of oral diseases. The objective was characterizing elder population with Diabetes mellitus and to identify the main oral manifestations caused for that disease. The information was gathered using information searchers and scientific platforms: Pubmed, Scielo, Springer, ClinicalKey. 36 articles were consulted. As the most relevant results were stated that ageing is a process occurring to any living creature as a consequence of the interaction of the individual's genetic and his environment, and that dental caries, periodontitis and gingivitis are the most frequent oral manifestations of the Diabetes mellitus. There is an important relation between Diabetes mellitus and the emergence of oral manifestations (AU).

Design rationale and dimensional considerations for a femoral neck prosthesis.

Despite the high level of survivorship of cemented and uncemented stemmed components, there is a need for a joint prosthesis that does not invade the femoral canal. This type of prosthesis would be useful in treating younger and more active patients, in whom the use of such a design would usefully prolong the time before a conventional total joint replacement design was necessary. We present the rationale for a femoral neck prosthesis and show its feasibility as an off-the-shelf system based on a morphologic analysis of the proximal femur. The new design concept consists of a barrel with longitudinal flutes that enters the neck of the femur, loads on the calcar, and contacts the lateral cortex below the greater trochanter. Areas of porous ingrowth are placed so that the load transfer between the implant and the bone resembles that of the two main trabecular patterns in the proximal femur. A new method, cluster analysis, was used for defining a set of 12 sizes that could fit a population of femurs with acceptable dimensional discrepancies. We conclude that this type of device could be implanted reproducibly so that it was a close fit against the target areas of bone in the proximal neck area and against the lateral cortex.