Development of a 3D printable maxillofacial silicone: Part II. Optimization of moderator and thixotropic agent.

STATEMENT OF PROBLEM: Conventionally, maxillofacial prostheses are fabricated by hand carving the missing anatomic defect in wax and creating a mold into which pigmented silicone elastomer is placed. Digital technologies such as computer numerical control milling and 3-dimensional (3D) printing have been used to prepare molds, directly or indirectly, into which a biocompatible pigmented silicone elastomer can be placed. PURPOSE: The purpose of this in vitro study was to develop a silicone elastomer that could be 3D printed directly without a mold to create facial or body prostheses by varying its composition. MATERIAL AND METHODS: The room temperature vulcanizing silicone composition was divided into 2 components which were mixed 1:1 to initiate polymerization in the printer before printing began. Different types of moderators and thixotropic agents were used, and the base composition was varied to obtain 11 formulations. The specimens were printed and polymerized from these formulations and tested for tear and tensile strength and hardness. Ten readings of the specimens were recorded for tear and tensile strength and 6 for hardness. Results were analyzed using ANOVA (α=.05). Visual assessment of uncured printed specimens was undertaken for 5 formulations to assess any differences in their ability to hold their shape after printing. RESULTS: The tear and tensile strength of the 11 formulations with varying moderators, thixotropic agents, and base compositions were statistically similar to each other (P>.05). Five of 11 formulations were chosen for the visual assessment as they had sufficient thixotropic agent to avoid slumping while printing. The specimens showed varied slumping behavior until they polymerized. The filler content was increased in the selected formulation, and the tear and tensile strength of the formulation was increased to 6.138 kNm-1 and 3.836 MPa; these increases were comparable to those of commercial silicones currently used for the fabrication of facial prostheses. CONCLUSIONS: The optimum combination of mechanical properties implies the use of one of the formulations as a suitable material for the 3D printing of facial prostheses.

Development of a 3D printable maxillofacial silicone: Part I. Optimization of polydimethylsiloxane chains and cross-linker concentration.

STATEMENT OF PROBLEM: Conventionally, maxillofacial prostheses are fabricated by hand carving the missing anatomic defect in wax and creating a mold into which pigmented silicone elastomer is placed. Digital technologies such as computer numerical control (CNC) milling and 3-dimensional (3D) printing have been used to prepare molds directly or indirectly into which a biocompatible pigmented silicone elastomer is placed. PURPOSE: The purpose of this in vitro study was to develop a silicone elastomer by varying composition that could eventually be 3D printed directly without a mold to create facial/body prostheses. MATERIAL AND METHODS: The silicone was composed of polydimethylsiloxane (PDMS), filler, catalyst, and cross-linker. Four types of base silicone polymers were prepared with different PDMS molecular weight combinations with long, medium, and short chain length PDMS. The effect of the cross-linker (2.5% to 12.5%) content in these bases was assessed for the effect upon the mechanical properties of the elastomer. Ten readings were made for each formulation, and differences in the means were evaluated with a 2-way ANOVA (α=.05). RESULTS: Variations in silicone composition resulted in hardness from 6.8 to 28.5 durometer, tensile strength from 0.720 to 3.524 kNm-1 and tear strength from 0.954 to 8.484 MPa. Significant differences were observed among all formulations (P<.05). These formulations have mechanical properties comparable with the commercial silicones currently used for the fabrication of facial prostheses. The formulation with 5% cross-linker content and high content of long-chain PDMS chains with optimum mechanical properties was chosen for further development. CONCLUSIONS: The optimum combination of mechanical properties implies the use of one of these formulations for further evaluation in a 3D printer capable of actively mixing and extruding 2-component, room temperature vulcanization silicone.

Biocide activity against urinary catheter pathogens.

Antimicrobial effects of essential oils against bacteria associated with urinary catheter infection was assessed. Tests were performed on 14 different bacterial species cultured either planktonically or as biofilms. Biofilms were found to be up to 8-fold more tolerant of the test agents. Higher antimicrobial tolerance was also evident in tests conducted in artificial urine. Eugenol exhibited higher antimicrobial effects against both planktonic cells and biofilms than did terpinen, tea tree oil, and cineole.

Development of an "early warning" sensor for encrustation of urinary catheters following Proteus infection.

Biofilm formation in long-term urinary catheterized patients can lead to encrustation and blockage of urinary catheters with serious clinical complication. Catheter encrustation stems from infection with urease-producing bacteria, particularly Proteus mirabilis. Urease generates ammonia from urea, and the elevated pH of the urine results in crystallization of calcium and magnesium phosphates, which block the flow of urine. The aim of this research is to develop an "early warning" silicone sensor for catheter encrustation following bacterial infection of an in vitro bladder model system. The in vitro bladder model was infected with a range of urease positive and negative bacterial strains. Developed sensors enabled catheter blockage to be predicted ~17-24 h in advance of its occurrence. Signaling only occurred following infection with urease positive bacteria and only when catheter blockage followed. In summary, sensors were developed that could predict urinary catheter blockage in in vitro infection models. Translation of these sensors to a clinical environment will allow the timely and appropriate management of catheter blockage in long-term catheterized patients.

Titanium surface modification and its effect on the adherence of Porphyromonas gingivalis: an in vitro study.

AIM: Titanium dental implants are an important treatment option in the replacement of missing teeth. Implant failures can, however, occur and may be promoted by the loss of tissue as a result of local bacterial infection (peri-implantitis). OBJECTIVES: Bacterial adherence to implant surfaces is believed to be influenced by material surface roughness and surface-free energy parameters. Consequently, the aim of this study was to modify these properties of titanium and identify what effect these modifications had on subsequent bacterial adherence. MATERIALS AND METHODS: In this study, 16 titanium samples of different roughness (R(a) 34.57-449.42 nm) were prepared using specific polishing procedures. A further six samples were chemically altered by argon plasma discharge treatment and immersion in silane solutions to produce different surface hydrophobicities. An in vitro adhesion assay using Porphyromonas gingivalis was used to assess the effect of modification on bacterial adherence. RESULTS: A significant reduction in adhesion to materials categorised as being 'very smooth' (R(a) 34.57+/-5.79 nm) was evident. This reduction did not occur with 'smooth' (R(a) 155.00+/-33.36 nm), 'rough' (R(a) 223.24+/-9.86 nm) or 'very rough' (R(a) 449.42+/-32.97 nm) surfaces. Changing material surface hydrophobicity was also not found to effect bacterial adhesion. CONCLUSIONS: Adhesion of P. gingivalis to titanium was inhibited at surface roughness levels below those generally encountered for implant collars/abutments (R(a) 350 nm). Considerations of these findings may be beneficial in the production of titanium implants in order to reduce bacterial colonisation.

A clinical assessment of the performance of a sensor to detect crystalline biofilm formation on indwelling bladder catheters.

OBJECTIVES: To test the ability of a sensor developed to signal infection by the organisms that generate the crystalline biofilms that encrust catheters, to give an early warning that encrustation was occurring on patients' catheters, as the care of many patients undergoing long-term bladder catheterization is complicated by the encrustation and blockage of their catheters. PATIENTS AND METHODS: Twenty patients were followed prospectively for the lifetime of one of their catheters. Sensors based on cellulose acetate/bromothymol blue were placed in the urine-collection bags, which were changed as usual at weekly intervals. The bacteriology was assessed and pH determined weekly on urine samples. Photographic records were made of the sensors twice weekly. On removal, each catheter was examined for encrustation and blockage. RESULTS: Proteus mirabilis was not isolated from five patients and in these cases the sensor colour remained golden-yellow to brown. The catheters drained for the scheduled period and showed no signs of encrustation. By contrast, the sensors turned dark blue/black in the urine of all 15 patients infected with P. mirabilis. All these patients' catheters were encrusted and in 12 the catheters blocked. The mean interval between the sensor signalling and the catheter blocking was 12 days. CONCLUSION: The cellulose acetate/bromothymol blue sensors placed in the urine collection bags are capable of signalling infection by P. mirabilis. They also signal the early stages of catheter encrustation and allow catheter replacement in ample time to avoid the clinical crises and emergency referrals caused by catheter blockage.

An elastomeric material for facial prostheses: synthesis, experimental and numerical testing aspects.

Current materials used for maxillofacial prostheses are far from ideal and there is a need for new improved materials which better simulate the tissues they are replacing. This study was based on a mixed experimental/analytical/numerical approach. A new polymeric material was developed to provide a better alternative to the materials currently used in maxillofacial prosthetics. A series of experimental tensile tests were performed in order to characterise the tensile properties of the material. A Mooney-Rivlin type hyperelastic formulation was chosen to describe the constitutive behaviour of the polymer which operates at the finite strain regime. The material parameters (two) of the constitutive law were identified with the experimental data. The Mooney-Rivlin material was found to be suitable to represent accurately the mechanical behaviour of the polymer up to 50% strain as shown by the excellent agreement between analytical and experimental results. An FE model reproducing all the characteristics of the experimental tensile tests was built and a series of three FE analyses were conducted and has proven the proper finite element implementation of the material model. This preliminary study will serve as a basis to introduce more complex features such as viscoelasticity and wrinkling of the soft polymeric structure in order to optimise the performances of the final prosthetic material.