Biomechanical Analyses of Porous Designs of 3D-Printed Titanium Implant for Mandibular Segmental Osteotomy Defects

Clinically, a reconstruction plate can be used for the facial repair of patients with mandibular segmental defects, but it cannot restore their chewing function. The main purpose of this research is to design a new three-dimensionally (3D) printed porous titanium mandibular implant with both facial restoration and oral chewing function reconstruction. Its biomechanical properties were examined using both finite element analysis (FEA) and in vitro experiments. Cone beam computed tomography images of the mandible of a patient with oral cancer were selected as a reference to create 3D computational models of the bone and of the 3D-printed porous implant. The pores of the porous implant were circles or hexagons of 1 or 2 mm in size. A nonporous implant was fabricated as a control model. For the FEA, two chewing modes, namely right unilateral molar clench and right group function, were set as loading conditions. Regarding the boundary condition, the displacement of both condyles was fixed in all directions. For the in vitro experiments, an occlusal force (100 N) was applied to the abutment of the 3D-printed mandibular implants with and without porous designs as the loading condition. The porous mandibular implants withstood higher stress and strain than the nonporous mandibular implant, but all stress values were lower than the yield strength of Ti-6Al-4V (800 MPa). The strain value of the bone surrounding the mandibular implant was affected not only by the shape and size of the pores but also by the chewing mode. According to Frost’s mechanostat theory of bone, higher bone strain under the porous implants might help maintain or improve bone quality and bone strength. The findings of this study serve as a biomechanical reference for the design of 3D-printed titanium mandibular implants and require confirmation through clinical investigations.

Polyester 5-0 Suture for Porous Implant Placement After Retinoblastoma Enucleation: Analysis of 120 Sockets

Background: Techniques used to suture the rectus muscle to the implant can influence the implant-related complications which is still a major problem following retinoblastoma enucleation. The goals of this work were to report the efficacy among patients with retinoblastoma who underwent enucleation followed by porous implant placement with the rectus muscles sutured with 5-0 polyester suture.Methods: This was a retrospective study of consecutive patients with retinoblastoma who underwent primary enucleation and porous implant placement with the rectus muscles tagged and sutured to the implant with polyester 5-0 suture. All the patients were followed up for a minimum of 2 years. The main outcome measure was implant exposure. The secondary efficacy measures were other implant-related complications.Results: A total of 120 patients (120 eyes) underwent primary enucleation and porous implant placement were included. Postoperatively, 10/120 (8.3%) eyes developed exposure and conjunctival granuloma. Exposure was the most common postoperative complication (7/10, 70.0%). There were no cases of implant extrusion, migration, or infection.Conclusions:Polyester 5-0 sutures are successful in patients with retinoblastoma who underwent enucleation followed by porous implant placement. Complications are minimal. Polyester 5-0 sutures were not associated with unacceptable complications in this pediatric population.

The Optimization of Ti Gradient Porous Structure Involves the Finite Element Simulation Analysis

Titanium (Ti) and its alloys are attracting special attention in the field of dentistry and orthopedic bioengineering because of their mechanical adaptability and biological compatibility with the natural bone. The dental implant is subjected to masticatory forces in the oral environment and transfers these forces to the surrounding bone tissue. Therefore, by simulating the mechanical behavior of implants and surrounding bone tissue we can assess the effects of implants on bone growth quite accurately. In this study, dental implants with different gradient pore structures that consisted of simple cubic (structure a), body centered cubic (structure b) and side centered cubic (structure c) were designed, respectively. The strength of the designed gradient porous implant in the oral environment was simulated by three-dimensional finite element simulation technique to assess the mechanical adaptation by the stress-strain distribution within the surrounding bone tissue and by examining the fretting of the implant-bone interface. The results show that the maximum equivalent stress and strain in the surrounding bone tissue increase with the increase of porosity. The stress distribution of the gradient implant with a smaller difference between outer and inner pore structure is more uniform. So, a-b type porous implant exhibited less stress concentration. For a-b structure, when the porosity is between 40 and 47%, the stress and strain of bone tissue are in the range of normal growth. When subject to lingual and buccal stresses, an implant with higher porosity can achieve more uniform stress distribution in the surrounding cancellous bone than that of low porosity implant. Based on the simulated results, to achieve an improved mechanical fixation of the implant, the optimum gradient porous structure parameters should be: average porosity 46% with an inner porosity of 13% (b structure) and outer porosity of 59% (a structure), and outer pore sized 500 μm. With this optimized structure, the bone can achieve optimal ingrowth into the gradient porous structure, thus provide stable mechanical fixation of the implant. The maximum equivalent stress achieved 99 MPa, which is far below the simulation yield strength of 299 MPa.

Three-dimensional-printed porous implant combined with autograft reconstruction for giant cell tumor in proximal tibia

Background This study is to describe the design and surgical techniques of three- dimensional-printed porous implants for proximal giant cell tumors of bone and evaluate the short-term clinical outcomes. Methods From December 2016 to April 2020, 8 patients with giant cell tumor of bone in the proximal tibia underwent intralesional curettage of the tumor and reconstruction with bone grafting and three-dimensional-printed porous implant. Detailed anatomy data were measured, including the size of lesion and thickness of the subchondral bone. Prostheses were custom-made for each patient by our team. All patients were evaluated regularly and short-term clinical outcomes were recorded. Results The mean follow-up period was 26 months. According to the different defect sizes, the mean size of the plate and mean length of strut were 35 × 35 mm and 20 mm, respectively. The mean affected subchondral bone percentage was 31.5%. The average preoperative and postoperative thickness of the subchondral bone was 2.1 mm and 11.1 mm, respectively. There was no wound infection, skin necrosis, peroneal nerve injury, or other surgical related complications. No degeneration of the knee joint was found. Osseointegration was observed in all patients. The MSTS improved from an average of 12 preoperatively to 28 postoperatively. Conclusion The application of three-dimensional-printed printed porous prosthesis combined autograft could supply enough mechanical support and enhance bone ingrowth. The design and operation management lead to satisfactory subchondral bone reconstruction.

MORPHOLOGICAL AND FUNCTIONAL CHARACTERISTICS OF LIVER REGENERATION WHEN USING THE IMPLANT MADE OF TITANIUM NICKELIDE (EXPERIMENTAL STUDY)

The development of medicine all over the world is currently mainly associated with regenerative medicine technologies. The study of regenerative processes in liver under the influence of various factors is relevant. Nickel-titanium implants with shape memory are widely used in surgery. Recently, porous alloys based on titanium nickelide have also been used as implantation materials in various fields of medicine. They are biologically compatible, exhibit hysteresis properties, and are permeable to biological tissues, which is essential for the development of cell and regenerative medicine techniques. In an experimental study, changes in the liver parenchyma were studied when using a clip for clamping parenchymal organs and when using a porous implant. The possibility of targeted liver regeneration using a porous implant was studied. The object of the study was laboratory rats with healthy livers. The animals were operated with these implants applied to the liver. Changes in the liver were studied for 30 days after surgery by histological examination of various parts of it with an assessment of dystrophic and proliferative processes in the liver parenchyma. The study found that implants of titanium nickelide possess the bioinert condition. The undulating structure of the branch clip provides a reduced specific pressure on the pinched tissue and, thus, its injury safety, and compression when pinching the marginal part of the organ is carried out gently, without injury, and leads to a smooth decrease in trophic and atrophy of the tissue of this area. More pronounced atrophy was accompanied by increased regeneration processes, which was accompanied by hypertrophy of hepatocytes, an increase in their nuclei and polyploidization of liver cells.

Nanotechnology Assisted Targeted Drug Delivery for Bone Disorders: Potentials and Clinical Perspectives

Nanotechnology and its allied modalities have brought revolution in tissue engineering and bone healing. The research on translating the findings of the basic and preclinical research into clinical practice is ongoing. Advances in the synthesis and design of nanomaterials along with advances in genomics and proteomics, and tissue engineering have opened a bright future for bone healing and orthopedic technology. Studies have shown promising outcomes in the design and fabrication of porous implant substrates that can be exploited as bone defect augmentation and drug-carrier devices. However, there are dozens of applications in orthopedic traumatology and bone healing for nanometer-sized entities, structures, surfaces, and devices with characteristic lengths ranging from tens 10s of nanometers to a few micrometers. Nanotechnology has made promising advances in the synthesis of scaffolds, delivery mechanisms, controlled modification of surface topography and composition, and biomicroelectromechanical systems. This study reviews the basic and translational sciences and clinical implications of the nanotechnology in tissue engineering and bone diseases. Recent advances in NPs assisted osteogenic agents, nanocomposites, and scaffolds for bone disorders are discussed.