Editor’s Choice Articles

This in vitro investigation aimed to compare the trueness, precision, internal fit, and marginal adaptation of Varseo Smile Crown Plus (VSCP), CROWNTEC (C), and milled Enamic crowns (E) using a 5-axis dental milling machine (prograMill PM7). 39 crowns (VSCP, E, C; n = 13) were designed and fabricated. Internal/marginal adaptation, precision, and trueness were assessed via die scans with/without a fit checker. Dimensional discrepancies were determined by superimposing the scans. One-way ANOVA (α = 0.05) analyzed the results. No significant differences were found in internal fit or marginal adaptation between groups. However, group E exhibited the best fit (axial: 82.9 µm). Trueness differed significantly (p < 0.05) across all groups and areas. Group E had the highest trueness (intaglio: 25.8 µm), while VSCP had the lowest (marginal: 31.9 µm). Precision varied significantly within the occlusal area of printed groups (highest for C: 17.8 µm) and the marginal area between printed/milled (VSCP vs. E) and C vs. E (lowest for E: 20.5 µm, highest for VSCP: 27.9 µm). In conclusion, both milled and 3D-printed crowns achieved comparable internal fit and marginal adaptation. However, group E displayed superior fit and trueness. While C exhibited higher occlusal precision, E had higher marginal precision. These findings suggest the potential for 3D-printed hybrid polymer crowns, warranting further investigation. Full article

Purpose: This in vitro study aimed to evaluate and compare the physical and antimicrobial properties of provisional resin modified with two different nanoparticles, namely, silicon dioxide (nano-SiO₂) and titanium dioxide (nano-TiO₂). Methods: A commonly used commercially available polymethyl methacrylate (PMMA) provisional resin (Unifast III; GC Corp) was modified with nano-SiO₂ and nano-TiO₂ at different concentrations (1% wt. and 2.5% wt. respectively), while one unmodified group was used as a control. Rectangular specimens (60 × 10 × 3.3 mm) for strength (MPa) and elastic modulus, and square specimens (10 × 10 × 3.4 mm) for surface roughness (Ra, µm), hardness (VHN), and Candida albicans adhesion (colony forming unit, CFU/mL) were prepared and grouped into five groups (n = 10) according to (nanoparticles) NPs type and concentration. After polymerization, the specimens were finished and polished and then subjected to thermal cycling (5000 cycles). Analysis of variance and post-hoc Tukey test were used for data analysis (α = 0.05). The scanning electron microscope (SEM) was used for fracture surface analysis and C. albicans count. Results: The addition of 1% nano-SiO₂ significantly increased the flexural strength, and 1% nano-SiO₂ contributed to the highest flexural strength value, while 2.5% nano-SiO₂ and nano-TiO₂ showed non-significant increases (p > 0.05). The elastic modulus increased significantly for both NPs. Among the NP-modified groups, the nano-SiO₂ groups showed an increased elastic modulus compared to the nano-TiO₂ groups. The hardness significantly increased with NPs addition with no significant differences between NPs-modified groups. Surface roughness increased with 2.5% nano-TiO₂ addition, while 1% nano-TiO₂ and nano-SiO₂ showed non-significant differences. Nano-SiO₂ and nano-TiO₂ significantly decreased C. albicans adhesion, and nano-TiO₂ groups were significantly superior in their antimicrobial effect compared with nano-SiO₂. Conclusions: Low nano-SiO₂ addition increased the flexural strength of provisional resin. The addition of NPs increased elastic modulus and hardness and decreased the C. albicans adhesion to provisional resin. Nano-SiO₂ did not alter the surface roughness, while 2.5% of nano-TiO₂ increased the surface roughness. Full article

Background: Dental implant rehabilitation has significantly advanced prosthodontics by providing a reliable, long-lasting solution for missing teeth. This systematic review compares the clinical, technical, and biological outcomes of cemented versus screw-retained single dental implant restorations based on randomized clinical trials (RCTs). Materials and Methods: This review included recent human and in vitro studies focusing on the keywords “cemented vs. screw-retained” and “dental implant”. Eight studies met the inclusion criteria, which investigated parameters, including implant survival rate, bleeding on probing (BOP), probing depth, plaque index, marginal bone loss (MBL), cytokine concentrations, mechanical complications, esthetic outcomes, patient satisfaction, treatment time, and technical failures. Results: The primary outcomes, BOP and MBL, did not statistically differ between cemented and screw-retained implants (p-values for MBL and BOP are 0.5813 and 0.8093, respectively). The reviewed studies, including RCTs, split-mouth studies, and clinical evaluations, demonstrated comparable clinical, technical, and biological outcomes between the two restoration methods. Conclusions: Screw-retained and cemented dental implant restorations exhibit similar clinical, technical, and biological outcomes. Screw-retained restorations offer advantages such as retrievability, ease of repair, and predictable passive fit, while cemented restorations provide superior esthetics. The risk of peri-implant complications due to residual cement in cemented restorations must be considered. Future research should explore long-term stability and the impact of different prosthetic protocols on peri-implant health. Full article

This retrospective cohort study assesses the effectiveness of straight-stem cementless versus cemented prostheses in hip replacement surgeries for elderly patients with femoral neck fractures. We analyzed 80 patients aged 70 and over who underwent surgery between 2018 and 2021. Clinical outcomes were evaluated using the Harris Hip Score, WOMAC Score, and Visual Analogue Scale, alongside radiological assessments through Brooker’s classification. Preoperative Dorr classification and five postoperative criteria (subsidence, cortical hypertrophy, pedestal sign, radiolucent lines, and stress shielding) were used to assess implant efficacy. The results demonstrated satisfactory mid-term outcomes for both groups, with slightly higher clinical scores observed in the cementless stem group. The Harris Hip Score (HHS) averaged 74.4 ± 6.7 in the cemented group and 79.2 ± 10.4 in the cementless group, with a statistically significant difference (p = 0.0146). The WOMAC Score showed an average of 30.1 ± 4.6 in the cemented group compared to 27.1 ± 6.9 in the cementless group, also indicating a statistically significant improvement (p = 0.0231). However, radiographic findings call for a re-evaluation of long-term stability. Our statistical analysis, which included power calculation and multivariate analysis to adjust for confounding variables, offers a comprehensive assessment of implant effectiveness. The findings contribute to the ongoing debate on the choice between cemented and cementless prostheses, indicating that both are viable options catering to different patient needs. Further research overcoming this study’s limitations is crucial for a deeper understanding of optimal treatment strategies in hip replacement surgery for the elderly. Full article

Considering the rapid evolution of lithium silicate-based glass ceramics (LSCs) in dentistry, this review paper aims to present an updated overview of the recently introduced commercial novel LSCs. The clinical and in vitro English-language literature relating to the microstructure, manufacturing, strengthening, properties, surface treatments and clinical performance of LSC materials was obtained through an electronic search. Findings from relevant articles were extracted and summarised for this manuscript. There is considerable evidence supporting the mechanical and aesthetic competency of LSC variants, namely zirconia-reinforced lithium silicates and lithium–aluminium disilicates. Nonetheless, the literature assessing the biocompatibility and cytotoxicity of novel LSCs is scarce. An exploration of the chemical, mechanical and chemo-mechanical intaglio surface treatments—alternative to hydrofluoric acid etching—revealed promising adhesion performance for acid neutralisation and plasma treatment. The subtractive manufacturing methods of partially crystallised and fully crystallised LSC blocks and the additive manufacturing modalities pertaining to the fabrication of LSC dental restorations are addressed, wherein that challenges that could be encountered upon implementing novel additive manufacturing approaches using LSC print materials are highlighted. Furthermore, the short-term clinical performance of zirconia-reinforced lithium silicates and lithium–aluminium disilicates is demonstrated to be comparable to that of lithium disilicate ceramics and reveals promising potential for their long-term clinical performance. Full article

Dental implant utilization has emerged as a contemporary strategy for rectifying dental arch anomalies. However, the effective management of potential complications is paramount. Peri-implantitis, characterized by inflammation and bone resorption around dental implants, resembles periodontitis but specifically affects implant sites. Restoring lost peri-implant tissues poses a multifaceted challenge, with bioprinting methods showing promise as a viable solution. Three-dimensional bioprinting represents a forefront advancement in tissue engineering, traditionally focusing on scaffolds, cells, and signaling pathways. This systematic review aims to aggregate and synthesize data concerning bioprinting’s application in peri-implantitis treatment. Adhering to PRISMA guidelines, the review conducted an extensive literature search across PubMed, Scopus, Google Scholar, and ScienceDirect. Importantly, the search timeframe was not limited, reflecting the scarcity of available information on the subject. Bioprinting advancements offer auspicious avenues for refining treatment modalities, prompting clinicians to explore optimal solutions for establishing ideal anatomical conditions. In essence, this systematic review underscores 3D bioprinting’s potential in peri-implantitis management, highlighting its pivotal role in contemporary dental medicine and its capacity to reshape clinical approaches toward achieving optimal outcomes. Full article

This review article aims to provide an updated and comprehensive overview of the latest trends in adult upper limb prostheses, specifically targeting various amputation levels such as transradial, transmetacarpal, transcarpal, and transhumeral. A systematic search was conducted across multiple databases, including IEEE Xplore, MDPI, Scopus, Frontiers, and Espacenet, covering from 2018 to 2023. After applying exclusion criteria, 49 scientific articles (33 patents and 16 commercial prostheses) were meticulously selected for review. The article offers an in-depth analysis of several critical aspects of upper limb prostheses. It discusses the evolution and current state of input control mechanisms, the number of degrees of freedom, and the variety of grips available in prostheses, all tailored according to the level of amputation. Additionally, the review delves into the selection of materials used in developing these prostheses and examines the progression of technology readiness levels. A significant focus is also placed on the evolution of prosthesis weight over the years for different amputation levels. Moreover, the review identifies and explores critical technological challenges and prospects in upper limb prostheses. Finally, the article culminates with a conclusion that encapsulates the key findings and insights on the advancements and ongoing developments in this field. Full article

Achieving a comfortable socket residual limb interface is crucial for effective prosthetic rehabilitation, depending on the precise characterisation and fluctuations in the shape and volume of residual limbs. Clinicians rely on subjective and iterative methods for shaping sockets, often involving a trial-and-error approach. This study introduces a framework for measuring, analysing, and comparing residual limb shape and volume using scanned data to facilitate more informed clinical decision-making. Surface scans of 44 transtibial residual limb casts of various sizes and lengths were examined. All scans were spatially aligned to a mid-patella and subjected to analysis using a shape analysis toolbox. Geometric measurements were extracted, with particular attention to significant rectified regions during the cast rectification process. Following PTB guidelines, our analysis revealed substantial alterations, primarily in the mid-patella region, followed by the patellar tendon area. Notably, there was a significant volume change of 6.02% in the region spanning from mid-patella to 25% of the cast length. Beyond this point, linear cast modifications were observed for most amputees up to 60% of the cast length, followed by individual-specific deviations beyond this region. Regardless of residual limb size and length, the modifications applied to positive casts suggested categorising patients into five major groups. This study employs the AmpScan shape analysis tool, to comprehend the cast rectification process used for capturing and assessing the extent of rectification on patients’ residual limb casts. The clinical implications of our research are threefold: (a) the comparison data can serve as training resources for junior prosthetists; (b) this will aid prosthetists in identifying specific regions for rectification and assessing socket fit; (c) it will help in determining optimal timing for prosthetic fitting or replacement. Full article

Due to their lack of periodontal ligaments (PLs) and the differences between dental implants and natural teeth, it is necessary to improve and generate a new occlusal scheme to prolong the life of implants and prostheses. The age and the sex of patients must be considered because of their effects on the stomatognathic system’s physiology. Operators must manage all the changes to obtain good sensations during mastication and a better occlusal scheme for implanting fixed partial prostheses. Dentists should try to protect this type of prosthesis using adjacent teeth and the PL. This is why new digital systems were created. The combination of T-Scan^® (digital software for occlusal analysis) and electromyography (EMG) could allow doctors to find areas where it is necessary to act and to find suitable solutions for the problems generated by using conventional methods of occlusal analysis (such as articulating paper). In this study, a new method for establishing occlusion on fixed partial implant prostheses has been created, combining digital systems with conventional articulating paper. This method consists of asking the patient to bite down with different forces and situations in an attempt to achieve Implant-Protected Occlusion (IPO). The use of digital systems has been shown to be more effective than using only conventional systems. This new method allows a safer mode of occlusion which protects implants and prostheses, saving all the differences between them and natural teeth, and increasing the satisfaction of patients. This method also helps to overcome the changes in the stomatognathic system as age increases, adjusting the occlusion to changes in PLs with age. Full article

This study aims to assess and compare the impact of Monolithic Zirconia (MZ) and In-Ceram Zirconia (ZP) superstructures on stress distribution within implants and D2/D4 bone densities under 200 N vertical and oblique occlusal loads using three-dimensional finite element analysis via ANSYS WORKBENCH R2. The analysis employed maximum and minimum von Mises stress values. Modeling an implant (4.2 mm diameter, 10 mm length) and abutment (0.47 mm diameter), with an 8 mm diameter and 6 mm length single crown, the research identified lower von Mises stresses in D2 cancellous bone with the MZ model under vertical loading. Conversely, under oblique loading, the ZP model exhibited maximum von Mises stresses in D4 bone around the implant. This underscores the critical need to consider physical and mechanical properties, beyond mere aesthetics, for sustained implant success. The findings highlight the effect of material composition and stress distribution, emphasizing the necessity of durable and effective implant treatments. Full article

Total knee arthroplasty (TKA) is a successful and highly effective procedure in most patients with tricompartmental knee arthritis. Despite the innovations in surgical techniques due to planning software and technological innovations, patients’ dissatisfaction after TKA is still high, at up to 20%. Robotic-assisted surgery (RAS) could be considered as a future option for improving outcomes due to its higher accuracy, precision, and reliability. Robotic systems can be classified as fully active, semi-active, or passive depending on the surgeon’s involvement during the procedure, and as imageless or image-based according to the necessity of radiological exams for the pre-operative planning. Three of the most well-known robotic systems for knee surgery are MAKO^® (Stryker Ltd., Kalamazoo, MI, USA), NAVIO^® (Smith & Nephew, Andover, TX, USA), and ROSA^® (Zimmer Inc., Warsaw, IN, USA). These systems show differences in terms of surgeon involvement, the use of CT scans or X-rays for pre-operative planning, the possibility to perform both unicompartmental knee arthroplasty (UKA) and TKA (or even total hip arthroplasty THA), and in the different kinds of knee prosthesis that can be implanted. This article aims to describe the features of the most used robotic systems for knee arthroplasty, to examine their outcomes and analyze their cost-effectiveness, and to evaluate future perspectives. Full article

A prosthetic rehabilitation, whether supported by implants, teeth, or mucous membranes, must be functionally and aesthetically adequate, so it is essential that the oral structures are reproduced as accurately as possible. The purpose of this overview is to evaluate the accuracy, time of digital impressions, and patient preference compared to those of conventional high-precision in vivo impressions. This umbrella review was developed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement and was registered in the PROSPERO systematic review registry. The search method and study selection were based on the PEO (Population–Exposure–Outcome) model, a modified version of the PICO model. Systematic reviews regarding the dental impression technique made using an intraoral scanner versus the analog impression technique made with high-precision impression materials were searched electronically up to 1 February 2023 among articles published in English, through numerous registries and databases, such as PROSPERO e, Scopus, MEDLINE/ PubMed, BioMed Central, and Cochrane Library. The records screened totaled 2942, but only 23 systematic reviews were included in this umbrella review. The Assessing the Methodological Quality of Systematic Reviews (AMSTAR) 2 tool was used to evaluate the quality assessment of the systematic reviews included in this umbrella review. Accuracy, time, and patient preference for digital impressions were compared with those of high-precision conventional impressions. A total of 23 systematic reviews were included in this umbrella review. From the analysis of this umbrella review, the data on the accuracy between the two methods of taking the impression are conflicting, especially as regards full-arch rehabilitations. However, the digital impression seems to be preferred over the analog one as regards time and patient preference. However, there is limited high-quality evidence available for studying conventional and digital implant impressions. The results obtained are limited to the type of review performed, and the type of studies included was limited by the settings and study designs. Furthermore, another important limitation highlighted was that the digital scanners analyzed in the various studies are not the same, and the number of missing teeth or implants inserted is not the same. More in vivo clinical studies and RCTs are needed to increase the level of evidence for impression procedures. Full article

The objective of this study was to meticulously examine the diverse vocal rehabilitation techniques that are employed following total laryngectomy, with emphasis on their implications on patients’ quality of life and on the determinants influencing the selection of one technique over another. We embarked on a comprehensive literature review, which concentrated on three primary rehabilitation approaches: tracheoesophageal puncture (TEP) accompanied by a vocal prosthesis, esophageal speech acquisition, and electrolarynx utilization. The outcomes assessed included quality of life, functional performance, communication effectiveness, patient satisfaction, and factors governing the choice of technique, such as patient demographics, disease stage, and treatment history. Our findings demonstrated that TEP with vocal prosthesis yielded the most favorable overall quality of life and patient satisfaction. Individuals who underwent TEP exhibited superior speech intelligibility, voice quality, and communication ease compared with those who employed esophageal speech acquisition or electrolarynx utilization. While esophageal speech learning exhibited inferior speech quality and functional performance, it offered cost-effectiveness and diminished maintenance advantages. Electrolarynx utilization emerged as the least preferred approach due to suboptimal speech intelligibility and voice quality. The determinants influencing the choice of vocal rehabilitation technique included patient age, sex, disease stage, and previous treatment history. Patient preferences also substantially contributed to the selection of a specific technique. It is essential for clinicians to consider individual factors and patient inclinations when deliberating on an appropriate vocal rehabilitation method following total laryngectomy. Our investigation underscores the significance of collaborative decision making between clinicians and patients to pinpoint the most fitting rehabilitation technique. Future research endeavors should be directed towards enhancing existing approaches, devising innovative methods, and probing long-term outcomes and cost-effectiveness to optimize patient care in the aftermath of total laryngectomy. Full article

The prevalence of individuals with flat feet and high arches is very high (between 15% to 37%), which can often lead to other orthopedic complications. Three-dimensional-printed insoles are being studied and validated for their effects in correcting these highly prevalent foot disorders. Highly customizable parameters while printing the insole allows for precise correction of foot biomechanics. In this study, 200 patients suffering from various foot-related problems and joint pain were given 3d-printed insoles (designed using plantar pressure systems and clinical practitioner’s assessment) to use in their footwear. Tested activities included standing, walking, running, sports, and gym workout. Customization of insoles included custom density, heel cup, heel rise, medial arch height, and lateral wedge. Based on the patient history, additional podiatry elements were provided for patients with diabetes. Each insole was designed as per the insole profile of the shoe with a comfortable fit. These insoles were found to be effective in alleviating pain for more than 90% of the patients and provided a longer life cycle with effective orthotic correction (for >16 months of daily use). This paper presents the post-use effects (6–18 months) of custom 3D-printed insoles. Full article

Background: Effective debris and smear layer removal affects post-cementation and bond strength. Aim: The aim was to compare the effectiveness of debris and smear layer removal using standard irrigation and activated irrigation with heated EDTA. Moreover, an irrigant activation technique was chosen in the current research, employing the ultrasonic activation of an EDTA solution after being heated directly inside the post space preparation. Materials and Methods: 30 single-rooted human mandibular premolar teeth were used in the current study to test the proposed techniques. First, the teeth were cut to have standardised roots 18 mm in length and prepared endodontically, and then the post space was carried out on all the samples. Then the specimens were randomly distributed into three study groups according to the post space irrigation technique. In detail, the groups were group 1, where a 3D cleaning technique was used; group 2, where the traditional irrigation with EDTA was applied; and group 3, where only saline as an irrigant was used. The third group was considered the control group. Next, the teeth were segmented and analysed via scanning electron microscopy (SEM). The magnification was used to evaluate and score the smear layer and debris. Statistical analysis was undertaken using the classic statistical software package (SPSS, version 28.0; SPSS IBM, Armonk, NY, USA). Then, the data were interpreted with a non-parametric analysis of variance (Kruskal–Wallis ANOVA) among the experiment groups. The significance level was decided as p < 0.05. In addition, statistically significant (p < 0.05) lower mean smear layer and debris scores were found in both the examination groups compared to the control group. Results: group 1 demonstrated better results compared to group 2 in terms of cleaning the dentinal walls. Conclusions: The current research concluded that the EDTA 3D cleaning technique is an effective irrigation technique for clearing debris and smear layers in the post space. Future research, such as on push-out bond strength, should be used to verify this research’s conclusions. Key findings: The use of ultrasonically activated heated EDTA improved the smear layer removal. The use of the 3D cleaning technique resulted in better post space cleaning. Full article

The interface between a dental implant and an abutment is stabilized by two mechanical characteristics: a preload of an abutment screw and the friction between the contact surfaces of the implant and the abutment. These mechanical properties are quantitatively analyzed by using physical and mechanical formulas. The important thing is that such mechanical properties cause various biological phenomena when medical devices are inserted into human bodies. Some mechanical complications in dental implant prostheses are closely associated with biological complications. This literature review explores the mechanical complications of the implant–abutment connection and their biological effects in a titanium dental implant system, which is the system most widely used in dental clinics. Understanding the biomechanics of the implant–abutment connection helps to predict the merits and limits of zirconia dental implants, which have been recently introduced and clinically applied. Full article

Background: Immediate implant placement (IIP) or Type I implants have become more attractive than conventional implant placements as it reduces the number of surgical procedures and allows faster delivery of the final restoration compared to conventional implant placements. However, the survival of Type I implants varies depending on multiple factors. Purpose: To evaluate the survival rate of Type I implants, and to describe the factors influencing their failure. Materials and methods: A developed search strategy was applied to identify randomised controlled trials on single-unit immediate implants including at least six human participants with a minimum follow-up time of 12 months and published between 1 January 1999 and 1 January 2020 in several databases. The data were extracted independently using validated data extraction forms. Information on survival rates, number of implants placed, loading protocols, setting of the study, location of implants in the jaw, antibiotic protocol, grafting methods, and implant geometry were obtained and assessed. Results: Twenty-six randomised controlled trials with an average follow-up time of 24 months (range = 12–120 months) were included and analysed to give a survival rate ranging between 83.7 and 100%. Fifteen studies reported implant failures, of which twelve reported early losses (loss before definitive restoration). Nine early losses were due to lack of osseointegration, two did not report the reason for implant failure, and one was reported as iatrogenic. Of the eleven studies with 100% survival rates, the common trend observed was the use of titanium implants and an antibiotic regimen using amoxicillin. Conclusions: The survival rate for immediate single implant placement ranged from 83.7 to 100%. Implant failure was not consistently reported and when reported, failure due to lack of osseointegration prior to placement of the definitive restoration was the most common descriptor. Other attributed reasons included infection abscess, mobility after immediate loading, and iatrogenic complications. Full article

The prospect of repair, regeneration, and remineralisation of the tooth tissue is currently transitioning from the exploratory stages to successful clinical applications with materials such as dentine substitutes that offer bioactive stimulation. Glass-ionomer or polyalkenoate cements are widely used in oral healthcare, especially due to their ability to adhere to the tooth structure and fluoride-releasing capacity. Since glass-ionomer cements exhibit an inherent ability to adhere to tooth tissue, they have been the subject of modifications to enhance bioactivity, biomineralisation, and their physical properties. The scope of this review is to assess systematically the modifications of glass-ionomer cements towards bioactive stimulation such as remineralisation, integration with tissues, and enhancement of antibacterial properties. Full article

Rehabilitative dentistry has made enormous progress in recent years, not only due to the advent of new implant-prosthetic methods, but also thanks to new information technologies that support the doctor. This study aims to present a new implant protocol that involves the application of bioengineering methods. With the application of the finite element analysis, it is possible to evaluate the distribution of the forces of a fixture and possible implant rehabilitation on each patient, even before performing the surgery. This protocol provides for the combination of radiographic images and three-dimensional files to obtain predictable results on possible rehabilitation, guiding its planning in the best possible way. Surely, the evolution of machines and computers will enable the surgeon to carry out and maintain these protocols in a chair-side manner, and to carry out safe and predictable rehabilitations. Full article

The evolution of prosthetic limbs continues to develop, with novel manufacturing techniques being evaluated, including additive manufacturing. Additive manufacturing (AM), or 3D-printing, holds promise for enabling personalized and tailored medical device options. The requirements for personalized medicine, coupled with the limitations of small-batch manufacturing, have made the technique viable for exploration. In this manuscript, an approach is presented for incorporating additive manufacturing for prostheses, both as a final part and in applications as an intermediate manufacturing step. As a result, through the use of these methods a multi-gesture capable electromyographic prosthesis was designed and manufactured, currently being evaluated in clinical trials for pediatric patients. This paper explored the results of this unique method of applying additive manufacturing techniques, and assessed how the blend of different manufacturing techniques improved performance and reduced device weight. Creating unique and aesthetic cosmetic coverings for the device was achieved through using additive manufacturing as an intermediate manufacturing component and, then, applying thermoforming. Cosmesis components saw a 33% reduction in weight from this change in manufacturing. The approach is explored to blend multiple manufacturing techniques to create cosmesis components and structural components for the prosthesis. The techniques serve the design intent to reduce reported challenges with upper limb prosthesis devices and to encourage device retention. Recommendations for manufacturing strategies are discussed, including the limitations. Full article

Vascular graft or endograft infection (VGEI) is a complex disease that complicates vascular-surgery and endovascular-surgery procedures and determines high morbidity and mortality. This review article provides the most updated general evidence on the pathogenesis, prevention, diagnosis, and treatment of VGEI. Several microorganisms are involved in VGEI development, but the most frequent one, responsible for over 75% of infections, is Staphylococcus aureus. Specific clinical, surgical, radiologic, and laboratory criteria are pivotal for the diagnosis of VGEI. Surgery and antimicrobial therapy are cornerstones in treatment for most patients with VGEI. For patients unfit for surgery, alternative treatment is available to improve the clinical course of VGEI. Full article

Prosthetics are an extension of the human body and must provide functionality similar to that of a non-disabled individual to be effective. Sports prosthetics such as the Flex-Foot Cheetah from Össur have demonstrated the value of creating devices that both provide mechanical support and introduce passive energy return to mimic forces otherwise produced at joints. These energy return mechanisms have not yet been demonstrated for upper limb prosthetics but could improve their effectiveness and provide a greater range of motion and control. Using multi-material 3D printing technology, we extend energy return components to upper limb prosthetics by developing novel force-sensing springs and applying them to a basketball prosthetic. The 3D-printed springs compensate for the forces otherwise generated by wrist and finger flexion while measuring the mechanical deflection. We discuss design guidelines, methods for integrated 3D printed energy return within prosthetics, and broader applications in assistive technologies. Full article

Functional, comfortable prosthetic limbs depend on personalised sockets, currently designed using an iterative, expert-led process, which can be expensive and inconvenient. Computer-aided design and manufacturing (CAD/CAM) offers enhanced repeatability, but far more use could be made from clinicians’ extensive digital design records. Knowledge-based socket design using smart templates could collate successful design features and tailor them to a new patient. Based on 67 residual limb scans and corresponding sockets, this paper develops a method of objectively analysing personalised design approaches by expert prosthetists, using machine learning: principal component analysis (PCA) to extract key categories in anatomic and surgical variation, and k-means clustering to identify local ‘rectification’ design features. Rectification patterns representing Total Surface Bearing and Patella Tendon Bearing design philosophies are identified automatically by PCA, which reveals trends in socket design choice for different limb shapes that match clinical guidelines. Expert design practice is quantified by measuring the size of local rectifications identified by k-means clustering. Implementing smart templates based on these trends requires clinical assessment by prosthetists and does not substitute training. This study provides methods for population-based socket design analysis, and example data, which will support developments in CAD/CAM clinical practice and accuracy of biomechanics research. Full article