Simulating backspatter of blood from cranial gunshot wounds using pig models.

Few studies have examined the biomechanical basis for backspatter from cranial gunshot wounds. Backspatter is material which travels against the direction of fire following ejection from a gunshot entrance wound. Our paper focuses on the use of animals for reconstructing this phenomenon. Five live pigs and several slaughtered pigs were shot using either 9 × 19 mm, 115 grain, full metal jacketed ammunition or .22 long rifle, 40 grain, lead, round-nose ammunition. A high-speed camera was used to record the entrance wound formation and backspatter. A small amount of backspattered material was produced with all targets, and blood backspatter was seen in a few cases. However, we conclude that our model provides an understanding of the phenomenon of backspatter and the physical mechanisms associated with it. The various components of the mechanism of backspatter formation are complex and overlap. The principle mechanism observed in pig cranial gunshots was the high-speed impact response of the skin overlying the skull bone. This study has also produced evidence supporting the view that backspatter can result from the splashing of superficial blood if it is already present on the skin. Subcutaneous gas effects have been demonstrated for backspatter from contact shots. There has been no clear evidence of the role of the collapse of a temporary cavity within the brain.

Effect of occlusal vertical dimension on swallowing patterns and perioral electromyographic activity.

Abnormal swallow patterns have been associated with specific dentofacial traits, such as an anterior open bite, but the cause-effect relationship between swallowing and malocclusion remains highly controversial. The aim of this research was to determine the effects of acute change in occlusal vertical dimension (OVD) on intraoral pressure swallow patterns and perioral electromyographic activity (EMG) during swallowing. Ten volunteers (five female, five male; 27-32 years) repeated standardised swallowing tasks as the OVD was progressively increased using mandibular trays of different heights. Standardised swallowing tasks were performed repetitively with each tray in place. Individual swallowing waveforms were quantitatively and qualitatively analysed. Peak pressure, swallow duration, time to peak pressure and lip EMG peak activity were assessed for each swallow. Data were analysed using mixed-model analysis. As OVD increased, lip peak pressure during swallowing increased almost threefold (+2·1 kPa; P ≤ 0·001), whereas swallow duration increased by 12·7 per cent (+160 ms; P = 0·01) at lip level and by 26·4 per cent (+270 ms; P < 0·001) at tongue level. Perioral muscle activity during swallows increased by 43·7 per cent (P ≤ 0·01) up to the OVD where resting lip seal was not attainable. Swallowing waveforms varied markedly between individuals, but interindividual waveforms were only minimally affected. The adaptive response and the waveform similarities associated with OVD variation supports the existence of a central control mechanism for swallowing, which may be modified by peripheral inputs.

Intraoral pH and temperature during sleep with and without mouth breathing.

To measure and compare the intraoral pH and temperature of individuals during sleep with and without mouth breathing. Ten healthy participants [mean age = 25·8 (± 4·3)] wore a custom-made appliance fitted with a pH probe and thermocouple for two sets of 48 h. Continuous pH and temperature measurements were taken from the palatal aspect of the upper central incisors. To simulate mouth breathing during sleep, participants wore a nose clip for two nights of the four, with the first group (n = 5) wearing the nose clip during the first night and the rest (n = 5) wearing the nose clip during the second night of sleep to balance any potential bias from the wearing sequence. Both qualitative and quantitative analyses were conducted. The mean intraoral pH during daytime was 7·3 (± 0·4) and during sleep was 7·0 (± 0·5). The mean intraoral pH during sleep with mouth breathing was 6·6 (± 0·5), which was statistically significant compared with the normal sleep condition (P < 0·01). The intraoral pH decreased slowly over the hours of sleep in all participants. When sleeping with forced mouth breathing, intraoral pH showed a greater fall over a longer period of time. The mean intraoral temperature was 33·1 °C (± 5·2) during daytime and 33·3 °C (± 6·1) during sleep, with no statistical significance between sleep with and without mouth breathing (P > 0·05). The results suggest that mouth breathing during sleep is related to a decrease in intraoral pH compared with normal breathing during sleep, and this has been proposed as a causal factor for dental erosion and caries.

Continuous measurement of intra-oral pH and temperature: development, validation of an appliance and a pilot study.

To describe a novel approach for continuous measurement of intra-oral pH and temperature in individuals carrying out normal daily activities over 24 h. We designed, validated and constructed a custom-made appliance fitted with a pH probe and a thermocouple. Six subjects wore the appliance over a 24-h period for two non-consecutive days, while the intra-oral pH and temperature were measured continuously and recorded. Intra-oral pH and temperature were very similar across different recording days, the difference being not statistically significant (P ≥ 0.14). There was a noticeable difference in the pattern of variation of pH between day and night. During the day, the mean pH was 7.3 (±0.4) and dropped markedly only after consumption of acidic food and drinks. The intra-oral pH decreased slowly during sleep with an average pH of 6.6 (±0.4) being recorded. The difference between day and night was statistically significant (P = 0.002). The mean intra-oral temperature was 33.9 °C (±0.9) during daytime and 35·9 °C (±0·5) during sleep (P = 0.013) with minor fluctuations occurring over 24 h. The continuous and simultaneous intra-oral pH and temperature measurement system described in this report is reliable, easy to construct, able to measure variables over a sustained period and may serve as a future diagnostic tool in a number of applications.

Factors associated with pain induced by orthodontic separators.

Pain resulting from the application of orthodontic forces varies markedly across individuals. The reasons of this variability are still largely unknown. To investigate factors that may be associated with orthodontic pain following the application of orthodontic separators. One hundred and seven participants were screened for pain response over 48 h following placement of orthodontic elastomeric separators. The highest (n = 10) and lowest (n = 10) pain responders were identified, and data collected on tooth pain sensitivity to electrical stimulation in conjunction with using the Pain Catastrophising Scale (PCS), Dental Anxiety Scale (DAS) and cold pressor test (CPT). There were statistically significant differences between high- and low-pain responders in catastrophising score (P ≤ 0.023). For every PCS magnification score of 1 unit higher, the relative risk of being a high-pain responder was 1.6 (P = 0.002); those scoring higher on helplessness had a lower risk of being so. DAS scores of high-pain responders were twice as high as those of low-pain responder (P = 0.043). During the first 2 min of CPT, the high-pain responders experienced more pain than the low-pain responders (P ≤ 0.029). Tooth pain thresholds did not differ between the two different pain responder groups. Pain catastrophising, dental anxiety and cold sensitivity appear to modify the pain experienced following placement of orthodontic separators. Further research is needed to determine the validity of screening questions to identify at-risk patients prior to commencing orthodontic treatment.

Identifying the source of bullet wipe: a randomised blind trial.

OBJECTIVE: To assess the usefulness of scanning electron microscopy and energy dispersive x-ray spectroscopy in matching bullet wipe to the bullet. HYPOTHESIS: Bullet wipe can be used to match a bullet type to a crime scene.

Patterns and trends in facial fractures in New Zealand between 1999 and 2009.

OBJECTIVES: To describe patterns and trends in facial fractures in New Zealand over a decade. METHOD: A secondary analysis of Ministry of Health data on facial fractures occurring between 30 June 1999 and 1 July 2009. Patient demographic characteristics and the details of injury were analysed and described. RESULTS: Over the study period, the incidence of injury was constant. A total of 26,637 facial fractures were recorded. Most (79%) occurred in males, giving a male-to-female ratio of 4:1. Peak injury rates for both males and females, coincide with the legal alcohol purchasing age. Interpersonal violence (IPV) was the leading cause of facial fractures, accounting for 38%; it increased steadily each year. The number of fractures attributed to sports/other, and road traffic accidents (RTA) had fallen. Maori still continue to experience a disproportionate rate of facial fractures, twice that of the NZ European population. CONCLUSIONS: Interpersonal violence is an increasing problem in NZ and contributes to a greater number of facial fractures each year. More measures are required to reduce the number of IPV-related injuries. Perhaps the most effective would be to return the legal alcohol purchasing age to 20 years. More is also required to reduce facial fractures in the high-risk injury groups of young adults, males, and Maori.

Gunshot induced indirect femoral fracture: mechanism of injury and fracture morphology.

INTRODUCTION: Indirect ballistic fractures occur when a projectile passes close to, but not contacting, the bone. The mechanism of how these fractures occur is not yet proven, but recently the acoustic shockwave has been excluded as a cause. The objective of this study is to determine whether the expanding temporary cavity, the collapse of this cavity or its oscillation causes these fractures. In addition, we describe the fracture morphology and biomechanical causes of this injury. METHOD: 40 fresh deer femora were strain gauged and embedded in ballistic gelatin before being shot with four different projectiles with varying distances off the bone. Pressure recordings, chronographs and radar allowed assessment of local pressures and energy transfer. High-speed video allowed the temporal relationship between the temporary cavity and fracture formation to be analysed, while sample dissection allowed the fracture morphology to be described. RESULTS: The fractures produced were consistently wedge-shaped and caused by the expansion of the temporary cavity, flexing the bone beyond its yield point, causing tension failure on the cortex opposite the expanding temporary cavity and a compression wedge on the side of the cavity. Local pressure was not predictive of fracture formation but the energy transfer to the gelatin block was predictive. CONCLUSIONS: Indirect fractures are caused by the expansion of the temporary cavity and relate to the proximity of this cavity to the bone. Fractures occur from flexion of the bone and classically display wedge-shaped fracture patterns with the apex of the wedge pointing away from the expanding cavity.

Structure and compositional characteristics of caniniform dental enamel in the tuatara Sphenodon punctatus (Lepidosauria: Rhynchocephalia).

OBJECTIVE: The evolution of dental tissues in relation to tooth function is poorly understood in non-mammalian vertebrates. We studied the dentition of Sphenodon punctatus, the sole remaining member of the order Rhynchocephalia in this light. METHODS: We examined 6 anterior maxillary caniniform teeth from adult Sphenodon by scanning electron microscopy, nano-indentation and Raman spectroscopy. RESULTS: The elastic modulus (E) for tuatara enamel was 73.17 (sd, 3.25) GPa and 19.52 +/- 0.76 Gpa for dentine. Hardness (H) values for enamel and dentine were 4.00 (sd, 0.22) and 0.63 +/- 0.02 Gpa respectively. The enamel was thin (100 gm or less), prismless and consisted of grouped parallel crystallites. Incremental lines occurred at intervals of about 0.5 to 1 rm. There were tubular structures along the enamel dentine junction running from the dentine into the inner enamel, at different angles. These were widened at their base with a smooth, possibly inorganic lining. Enamel elastic modulus and hardness were lower than those for mammals. CONCLUSIONS: The presence of enamel tubules in the basal part of the enamel along the EDJ remains speculative, with possible functions being added enamel/dentinal adhesion or a role in mechanosensation.

Modelling of fracture behaviour in biomaterials.

One of the most frequent causes of degradation and failure of quasi-brittle biomaterials is fracture. Mechanical breakdown, even when not catastrophic, is of particular importance in the area of biomaterials, as there are many clinical situations where it opens the path for biologically mediated failures. Over the past few decades the materials/biomaterials community has developed a number of numerical models, but only with limited incorporation of brittle failure phenomena. This article investigates the ability of a non-linear elastic fracture mechanics (NLEFM) model to reliably predict failure of biomaterials with a specific focus on the clinical settings of restorative dentistry. The approach enables one to predict fracture initiation and propagation in a complex biomechanical status based on the intrinsic material properties of the components. In this paper, we consider five examples illustrating the versatility of the present approach, which range from the failure of natural biomaterials, namely dentine and enamel, to a restored tooth, a three unit all ceramic bridge structure and contact-induced damage in the restorative layered materials systems. It is anticipated that this approach will have ramifications not only to model fracture events but also for the design and optimisation of the mechanical properties of biomaterials for specific clinically determined requirements.

Functional significance of strain distribution in the human mandible under masticatory load: numerical predictions.

A common feature of studies of mandibular morphology is the assumption that there is some functional relation between the form of the lower jaw and masticatory stress. It was noted that the local variation in cortical bone thickness in the mandibular corpus appears to be stereotypical among anthropoids. This occurs at sections under the molars, where the lingual cortical plate is thinner than buccal one. In this study we investigate and contrast the strain pattern along buccal and lingual surfaces of the mandibular corpus during mastication using a numerical model of a human mandible. We show that strain distribution differs in alveolar and mid-corpus segments of the mandible and that the latter develops an alternate pattern between the buccal and lingual aspects of the working and balancing sides of the jaw. We then relate the magnitude of these strains to Frost's mechanostat. Our results suggest that the cortical asymmetry of the human mandible is in fact not related to strain patterns generated during mastication.

Restoration of non-carious cervical lesions Part I. Modelling of restorative fracture.

OBJECTIVE: As a typical non-carious cervical lesion, abfraction is a common clinical occurrence which requires restorative treatment in most patients. Nonetheless, the relatively poor clinical longevity of cervical dental used for restoring abfraction lesions has been a major concern of dentists and patients. The continuing loss of hard tissue and, in turn, the low retention of the restorative materials in situ motivates an in-depth exploration of the failure mechanism of the biomaterials involved. Despite considerable biomechanical relevance, conventional application of linear static finite element analysis (FEA) does not consider the fracture failure process, nor does it provide a quantitative predictive analysis for restorative design. This paper adopts a novel Rankine and rotating crack model to trace the fracture failure process of the cervical restorations. METHODS: In contrast to the existing linear FEA, this study presents a nonlinear fracture analysis in an explicit finite element framework, which involves an automatic insertion of initial crack, mesh updating for crack propagation and self contact at the cracked interface. RESULTS: The results are in good agreement with published clinical data, in terms of the location of the fracture failure of the simulated restoration and the inadequacy of the dental restoratives for abfraction lesions. The success of the proposed model also demonstrates the potential for the monitoring and prediction of mechanical failure in other brittle biomaterials in a clinical situation.

Restoration of non-carious cervical lesions Part II. Restorative material selection to minimise fracture.

OBJECTIVE: It is still largely unknown as to what material parameter requirements would be most suitable to minimise the fracture and maximising the retention rate of the restoration of cervical non-carious lesions (NCCL). The present paper, as a first of its kind, proposes a radical approach to address the problems of material improvement, namely: numerical-based, fracture and damage mechanics materials optimisation engineering. It investigates the influence of the elastic modulus (E) on the failure of cervical restorative materials and aims to identify an E value that will minimise mechanical failure under clinically realistic loading conditions. METHOD: The present work relies on the principle that a more flexible restorative material would partially buffer the local stress concentration. We employ a "most favourable" parametric analysis of the restorative's elastic modulus using a fracture mechanics model embedded into finite element method. The advanced numerical modelling adopts a Rankine and rotating crack material fracture model coupled to a non-linear analysis in an explicit finite element framework. RESULTS: The present study shows that the restorative materials currently used in non-carious cervical lesions are largely unsuitable in terms of resistance to fracture of the restoration and we suggest that the elastic modulus of such a material should be in the range of 1GPa. We anticipate that the presented methodology would provide more informative guidelines for the development of dental restorative materials, which could be tailored to specific clinical applications cognisant of the underlying mechanical environment.

Mechanical evaluation of cervical glass-ionomer restorations: 3D finite element study.

OBJECTIVES: The aim of this paper was to investigate the influence of lesion shape and depth as well as the direction of occlusal loading on the mechanical response of cervical GIC restorations. METHODS: A finite element model of a lower first premolar was created. Both wedged and rounded lesions were then modelled with incremental depth after which the tooth was loaded at different angles. First principal stress (tension) was employed as an indicator of material failure, by contrasting our calculated stresses with the ultimate tensile strength of the GIC and known values of bond strength between material and tooth substrate. RESULTS: Obliquely loaded teeth exhibited significantly higher tensile stress in the cervical region of the restoration. For forces inclined at angles of 30 degrees and higher to the vertical tooth axis, the tensile stresses in the cervical margin of the restoration exceeded the ultimate material and bond strength. In contrast, lesion shape and depth have only a minor influence on tensile stress development. CONCLUSIONS: Lesion depth and shape are not of primary concern from a mechanical perspective for a restorative treatment decision. By contrast, occlusal diagnosis and subsequent re-adjustments of tooth contacts do form a critical part of the treatment of non-carious cervical lesions (NCCLs).

Mandibular biomechanics and development of the human chin.

The development of the chin, a feature unique to humans, suggests a close functional linkage between jaw biomechanics and symphyseal architecture. The present study tests the hypothesis that the presence of a chin changes strain patterns in the loaded mandible. Using an anatomically correct 3-D model of a dentate mandible derived from a CT scan image, we analyzed strain patterns during incisal and molar biting. We then constructed a second mandible, without a chin, by 'defeaturing' the first model. Strain patterns of the second model were then compared and contrasted to the first. Our main finding was that chinned and non-chinned mandibles follow closely concordant patterns of strain distribution. The results suggest that the development of the human chin is unrelated to the demands placed on the mandible during function.

Mandibular stiffness in humans: numerical predictions.

The chin is a feature unique to humans. This study evaluates the effect of mandibular symphyseal design on biomechanical masticatory effectiveness as determined by structural stiffness and stress developed under flexural and torsional loading. A simple model of three symphyseal shapes (chin, flat symphysis and lingual buttress), was built to represent human, Neanderthal and higher primate symphyses and these were subjected to wishboning and torsional forces. Additionally, an anatomically detailed reconstruction was made of the CT scan of an actual human mandible, which was then also morphed into a chinless model. The results of a 3-D finite element analysis show firstly, that none of the three different symphyseal shapes is biomechanically more advantageous than the others for the given loading condition. Secondly, we show in a CT-derived model, that the presence of a chin does not confer significantly improved stiffness to torsional or flexural loading. These results indicate that the acquisition of a chin in modern humans is not related to the functional demands placed upon the mandible during mastication, but suggest that it may have developed in response to other biomechanical demands.

Unusual fatal dog attack in Dunedin, New Zealand.

A case of a fatal dog attack on a middle aged woman is presented. The offending dog was her own Bull-mastiff, which had previously shown signs of aggression towards her. Most of the injuries were found on the victim's face, neck and skull. A noteworthy feature of this attack was that the victim was known to suffer from Huntington disease. It is postulated that the involuntary movements, progressive dementia and increased moodiness characteristic of the disease may have had a significant role in triggering the attack.

Prevalence of Treponema denticola and Porphyromonas gingivalis in plaque from periodontally-healthy and periodontally-diseased sites.

Intracrevicular plaque from periodontally-healthy individuals who had refrained from oral hygiene measures for 24 h prior to sampling, and subgingival plaque from diseased sites of patients with chronic periodontitis were screened by ELISA for the presence of Porphyromonas gingivalis and Treponema denticola. The samples were also subjected to the PerioScan test to detect the presence of enzymes capable of degrading N-benzoyl-DL-arginine-2-naphthylamide (BANA). Of the 141 samples from periodontally-healthy sites, 73% contained T. denticola antigens and 78% P. gingivalis antigens, compared to 43% and 59%, respectively, in plaque samples from the 159 diseased sites. A positive reaction in the PerioScan test was obtained in 89% of plaque samples from diseased sites and in 60% of those from healthy sites. The correlation between the results of the two assays was poor in the case of intracrevicular plaque from healthy sites. However, with plaque samples from diseased sites, the results of the PerioScan test showed very strong correlation with those obtained with the ELISA, suggesting that the former may be a useful, rapid means of indicating the presence of T. denticola and P. gingivalis in such plaque samples.

Fluctuating odontometric asymmetry in an urban South African black population.

The magnitude of fluctuating odontometric asymmetry is reported for a group of 106 urban South African Blacks by use of re-scaled asymmetry values and Euclidean map analyses. When these results were contrasted with those reported for South African Caucasoids and Paraguayan Lengua Indians, Blacks were found to be significantly more asymmetric. It is suggested that the disproportionately high levels of dental asymmetry may be ascribed to the high disease and malnutrition burden of South African Blacks and to decreased individual buffering ability. The present study failed to support Garn's model of x-chromosomal odontogenetic buffering in females, and also failed to confirm significant arcadal differences in the magnitude of fluctuating odontometric asymmetry.