Search Results (22)

(1) Background: The present study was carried out to provide a state-of-the-art review of the prosthodontic factors related to customized subperiosteal implants (CSIs), and to offer clinical guidelines in this regard. (2) Methods: An expert consensus meeting was held in July 2024 in Santpedor (Manresa, Spain) to establish the most relevant clinical guidelines. (3) Results and (4) Conclusions: An interdisciplinary approach including surgeons, prosthodontists, bio-medical engineers and dental technicians, integrating both biological and mechanical considerations when designing CSI rehabilitations, is very important. While the reported survival rate of CSIs appears promising, their long-term performance beyond 5 years remains insufficiently documented. Thus, CSIs are a viable treatment option for patients with insufficient bone to place conventional implants, but there is a clear need to identify and analyze delayed-onset complications associated with these devices. The findings and their broader implications should be thoroughly examined, and potential future research directions should be highlighted. Full article

Total hip arthroplasty is one of the most common and rapidly growing surgical procedures, with over one million cases performed annually in the United States. Despite high success rates, revision surgeries remain a significant concern due to complications such as aseptic loosening, often resulting from inadequate primary implant stability. This study presents an automated computational framework that integrates three-dimensional preoperative planning and finite element modeling to predict the primary stability of hip implants. Data obtained from the virtual surgery phase are used to generate subject-specific finite element models, which are executed on high-performance computing systems. The simulation evaluates implant stability by analyzing the contact interaction between the bone and the implant. The pipeline is demonstrated using data from the open-source HFValid collection and a commercial implant. Automation substantially reduced the time required to set up simulations, improving the efficiency on high-performance infrastructure. This integrated computational approach bridges the gap between biomechanical modeling and clinical decision-making and can serve as a preclinical tool for identifying personalized implant strategies and for conducting large-scale virtual cohort studies. Full article

Background: Sinus-lift (SL) is a pre-prosthetic procedure with the objective of increasing bone height to achieve implant insertion primary stability in implant-supported prostheses. The biomechanical properties of SL augmentation materials are influenced by their origin, manufacture, bioactive substances addition, receiver, and surgical procedure. This systematic review provides insights into state-of-the-art SL biomaterials, focusing on autologous bone grafting as the gold standard. Methods: The study followed the PRISMA flow diagram, searching WoS (Web of Science), Embase, Cochrane, and PubMed databases using the search terms «sinus lift» OR «sinus augmentation» OR «bone graft» OR «bovine» OR «porcine» OR «autologous» OR «allogenic» OR «xenogeneic» OR «alloplastic» OR «hydroxyapatite» OR «β-tricalcium phosphate (β-TCP)» OR «equine» OR «PRF». Results: The highest bone gain was provided by Bioglass at 42%. Articles written between 2014 and 2024 in English or French, containing human studies and with full text available, were included. Participants were required to be in good general health, without acute, chronic, or congenital diseases, or substance abuse (drugs, alcohol, or nicotine). SL surgery was performed using the lateral approach, with no Schneiderian membrane perforation or postoperative complications. The network meta-analysis was conducted using the R statistical computing environment. To assess the inconsistency between direct and indirect evidence, we used a net heat plot. To evaluate heterogeneity across studies, we used the chi-squared-based Q-test and I² statistic. A significance level of 0.05 was applied throughout all analyses. Results: Allogeneic bovine bone and hydrox yapatite demonstrated the lowest resorption rates. Significant differences were found for residual graft and connective tissue between allogenous bovine bone (ABB) + AlB vs. β-TCP + PRF (p = 0.028); ABB + AlB vs. β-TCP (p = 0.034); ABB + AlB vs. BCP (p = 0.037). Meta-analysis showed that the overall heterogeneity was 51.8% (6.9–75%; p = 0.019), with significant heterogeneity within designs (p = 0.007) and no significant heterogeneity between designs (p = 0.39). AB had a better bone regeneration ratio compared to many of the other interventions, but only two passed the threshold of significance: A1B and B-TCP + AB. Conclusions: A grafting material’s superiority is determined by its new bone formation ratio, connective tissue integration, residual graft content, and bone resorptionratio. Although autologous bone grafting has exhibited superior bone regeneration compared to other biomaterials, it was not favored due to its unpredictable connective tissue concentration and bone resorption ratio. Additionally, autologous bone exhibited the fastest metabolic turnover among all grafting materials. Full article

Limb amputation remains a significant global health issue, affecting millions of individuals annually. A substantial proportion of these patients struggle with the inadequate fit and discomfort of conventional prosthetic sockets, leading to diminished quality of life. Osseointegration surgery, a promising alternative, offers the direct skeletal attachment of bone, implant, and prosthetic, providing a more stable and functional interface. Osseointegration remains an emerging procedure, and while exact global figures are difficult to pinpoint, estimates suggest that over 10,000 patients worldwide have received osseointegration implants since the technique was first introduced. This perspective article analyzes recent advancements in the field of limb osseointegration, highlighting key achievements such as improved implant materials, surgical techniques, and comprehensive prosthetic integration strategies. Additionally, it explores future directions for development and discusses the latest research trends shaping the evolution of this field. Despite these developments, the widespread adoption of osseointegration faces significant barriers, including complications, limited access to multidisciplinary care, economic constraints, and the need for further long-term clinical evidence. In this paper, we present an extensive perspective on the current state of osseointegration, discuss the challenges impeding its broader implementation, and offer recommendations to address these obstacles, with the goal of enhancing patient outcomes and facilitating the integration of osseointegration into mainstream clinical practice. Full article

The global increase in osteomuscular diseases, particularly bone defects and fractures, has driven the growing demand for metallic implants. Additive manufacturing (AM) has emerged as a transformative technology for producing high-precision metallic biomaterials with customized properties, offering significant advantages over traditional manufacturing methods. The integration of machine learning (ML) with AM has shown great promise in optimizing the fabrication process, enhancing material performance, and predicting long-term behavior, particularly in the development of orthopedic implants and vascular stents. This review explores the application of ML in AM of metallic biomaterials, focusing on four key areas: (1) component design, where ML guides the optimization of multi-component alloys for improved mechanical and biological properties; (2) structural design, enabling the creation of intricate porous architectures tailored to specific functional requirements; (3) process control, facilitating real-time monitoring and adjustment of manufacturing parameters; and (4) parameter optimization, which reduces costs and enhances production efficiency. This review offers a comprehensive overview of four key aspects, presenting relevant research and providing an in-depth analysis of the current state of ML-guided AM techniques for metallic biomaterials. It enables readers to gain a thorough understanding of the latest advancements in this field. Additionally, the this review addresses the challenges in predicting in vivo performance, particularly degradation behavior, and how ML models can assist in bridging the gap between in vitro tests and clinical outcomes. The integration of ML in AM holds great potential to accelerate the design and production of advanced metallic biomaterials. Full article

Background/Objectives: Computational models are increasingly used in orthopedic research, such as in the context of total knee arthroplasty (TKA). However, the models’ actual integration in clinical practice is far from routine. Major limitations include the amount of input data, effort, and time required for personalization and simulation. In this paper, we present and validate a patient-specific multi-body musculoskeletal TKA model based on sparse input data to address these limitations. Methods: The simulation model was individualized based on the patients’ bone and knee implant 3D geometries, predicted bony landmarks, and soft tissue attachments using annotated statistical shape models, a statistical squat motion pattern, and a statistically based load case. For the validation, we used publicly accessible in vivo knee contact forces during squatting from four patients of the Grand Challenge Competitions (GCCs). Results: The prediction accuracy was quantified using several error metrics, including the root mean square error (RSME). For GCC3 and GCC5, both the range and trend of the mean in vivo contact forces were well matched by the simulation (RMSE lateral: 8.2–26.1% of body weight (BW); RMSE medial: 15.9–42.7 %BW). In contrast, there were relevant deviations between the experiment and simulation in the trend of contact forces for patient GCC2, as well as in the range of medial contact forces for patient GCC6 (RMSE medial: 52.6 %BW). The model setup time was at the magnitude of 15 min per patient, and the simulation was completed in less than 4 min. Conclusions: When comparing our results with the literature, we found similar accuracy to state-of-the-art models in predicting knee contact forces. While remaining deviations between in vivo and simulation data still warrant investigation and evaluation for clinical significance, the model has already successfully addressed important limitations of these previous models, which represent significant barriers to clinical application. Full article

In the last thirty years, tissue engineering (TI) has emerged as an alternative method to regenerate tissues and organs and restore their function by implanting specific lineage cells, growth factors, or biomolecules functionalizing a matrix scaffold. Recently, several pathologies have led to bone loss or damage, such as malformations, bone resorption associated with benign or malignant tumors, periodontal disease, traumas, and others in which a discontinuity in tissue integrity is observed. Bone tissue is characterized by different stiffness, mechanical traction, and compression resistance as a function of the different compartments, which can influence susceptibility to injury or destruction. For this reason, research into repairing bone defects began several years ago to find a scaffold to improve bone regeneration. Different techniques can be used to manufacture 3D scaffolds for bone tissue regeneration based on optimizing reproducible scaffolds with a controlled hierarchical porous structure like the extracellular matrix of bone. Additionally, the scaffolds synthesized can facilitate the inclusion of bone or mesenchymal stem cells with growth factors that improve bone osteogenesis, recruiting new cells for the neighborhood to generate an optimal environment for tissue regeneration. In this review, current state-of-the-art scaffold manufacturing based on the use of polycaprolactone (PCL) as a biomaterial for bone tissue regeneration will be described by reporting relevant studies focusing on processing techniques, from traditional—i.e., freeze casting, thermally induced phase separation, gas foaming, solvent casting, and particle leaching—to more recent approaches, such as 3D additive manufacturing (i.e., 3D printing/bioprinting, electrofluid dynamics/electrospinning), as well as integrated techniques. As a function of the used technique, this work aims to offer a comprehensive overview of the benefits/limitations of PCL-based scaffolds in order to establish a relationship between scaffold composition, namely integration of other biomaterial phases’ structural properties (i.e., pore morphology and mechanical properties) and in vivo response. Full article

Introduction: With the advancements in chemotherapy for malignant bone tumors, the number of patients eligible for limb salvage surgery has increased. Surgeons face a subsequent challenge in limb-sparing resection due to the need for reconstructing soft tissue coverage. The aim of this review is to focus on the present state of the field in these areas, highlighting recent advancements. Methods: A literature research was conducted using keywords such as “soft tissue”, “integration”, “reconstruction”, “megaprosthesis”, and “soft tissue coverage”, on different databases, and following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria, a total of 35 studies were selected. Results: In recent times, there has been a growing emphasis on different techniques such mesh application, allograft-prosthesis composites, allograft reconstruction, a polyethylene terephthalate (PET) tube, prosthesis itself and certain metals utilized for implant coatings are used in soft tissue reconstruction. Conclusion: While tissue-engineered constructs and advancements in biological and cellular approaches have shown potential for enhancing osseointegration and interactions with soft tissues and implants, the actual clinical outcomes have frequently fallen short of expectations. The success of soft tissue integration is crucial for achieving functional outcomes, minimizing complications, and ensuring the long-term stability of orthopedic implants. Full article

Accurate detection of implant loosening is crucial for early intervention in total hip replacements, but current imaging methods lack sensitivity and specificity. Vibration methods, already successful in dentistry, represent a promising approach. In order to detect loosening of the total hip replacement, excitation and measurement should be performed intracorporeally to minimize the influence of soft tissue on damping of the signals. However, only implants with a single sensor intracorporeally integrated into the implant for detecting vibrations have been presented in the literature. Considering different mode shapes, the sensor’s position on the implant is assumed to influence the signals. In the work at hand, the influence of the position of the sensor on the recording of the vibrations on the implant was investigated. For this purpose, a simplified test setup was created with a titanium rod implanted in a cylinder of artificial cancellous bone. Mechanical stimulation via an exciter attached to the rod was recorded by three accelerometers at varying positions along the titanium rod. Three states of peri-implant loosening within the bone stock were simulated by extracting the bone material around the titanium rod, and different markers were analyzed to distinguish between these states of loosening. In addition, a modal analysis was performed using the finite element method to analyze the mode shapes. Distinct differences in the signals recorded by the acceleration sensors within defects highlight the influence of sensor position on mode detection and natural frequencies. Thus, using multiple sensors could be advantageous in accurately detecting all modes and determining the implant loosening state more precisely. Full article

The most common complaint among patients with vestibular schwannoma (VS) is hearing loss. This significantly affects the quality of life before, during, and after treatment for patients with VS. Untreated hearing loss in VS patients may even lead to depression and feelings of social isolation. A variety of devices are available for hearing rehabilitation for patients with vestibular schwannoma. These include contralateral routing of hearing signals (CROSs), bone-anchored hearing devices, auditory brainstem implants (ABI), and cochlear implants. In the United States, ABI is approved for patients 12 years of age and older with neurofibromatosis type 2. In the past few years, cochlear implantation has been offered simultaneously or sequentially with tumor resection or irradiation, or even to patients whose VS have been monitored with serial imaging. However, determining the functional integrity of the auditory nerve in patients with vestibular schwannoma is a challenge. This review article consists of (1) the pathophysiology of vestibular schwannoma (VS), (2) hearing loss in VS, (3) treatment of VS and associated hearing loss, (4) options for auditory rehabilitation in patients with VS with their individual benefits and limitations, and (5) challenges in hearing rehabilitation in this cohort of patients to determine auditory nerve functionality. (6) Future directions. Full article

Background and Objectives: Bone fractures contribute significantly to the global disease and disability burden and are associated with a high and escalating incidence and tremendous economic consequences. The increasingly challenging climate of orthopaedic training and practice re-echoes the established potential of leveraging computer-based reality technologies to support patient-specific simulations for procedural teaching and surgical precision. Unfortunately, despite the recognised potential of virtual reality technologies in orthopaedic surgery, its adoption and integration, particularly in fracture procedures, have lagged behind other surgical specialities. We aimed to review the available virtual reality systems adapted for orthopaedic trauma procedures. Materials and Methods: We performed an extensive literature search in Medline (PubMed), Science Direct, SpringerLink, and Google Scholar and presented a narrative synthesis of the state of the art on virtual reality systems for bone trauma procedures. Results: We categorised existing simulation modalities into those for fracture fixation techniques, drilling procedures, and prosthetic design and implantation and described the important technical features, as well as their clinical validity and applications. Conclusions: Over the past decade, an increasing number of high- and low-fidelity virtual reality systems for bone trauma procedures have been introduced, demonstrating important benefits with regard to improving procedural teaching and learning, preoperative planning and rehearsal, intraoperative precision and efficiency, and postoperative outcomes. However, further technical developments in line with industry benchmarks and metrics are needed in addition to more standardised and rigorous clinical validation. Full article

The reconstruction of craniomaxillofacial deformities, especially zygomatic bone repair, can be exigent due to the complex anatomical structure and the sensitivity of the crucial organs involved. The need to reconstruct the zygomatic bone in the most precise way is of crucial importance for enhancing the patient outcomes and health care-related quality of life (HRQL). Autogenous bone grafts, despite being the gold standard, do not match bone forms, have limited donor sites and bone volume, and can induce substantial surgical site morbidity, which may lead to adverse outcomes. The goal of this study is to provide an integrated approach that includes various processes, from patient scanning to implant manufacture, for the restoration of zygomatic bone abnormalities utilizing Polyetheretherketone (PEEK) material, while retaining adequate aesthetic and facial symmetry. This study takes an integrated approach, including computer-aided implant design using the mirror reconstruction technique, investigating the biomechanical behavior of the implant under loading conditions, and carrying out a fitting accuracy analysis of the PEEK implant fabricated using state-of-the-art additive manufacturing technology. The findings of the biomechanical analysis results reveal the largest stress of approximately 0.89 MPa, which is relatively low in contrast to the material’s yield strength and tensile strength. A high degree of sturdiness in the implant design is provided by the maximum value of strain and deformation, which is also relatively low at roughly 2.2 × 10⁻⁴ and 14 µm. This emphasizes the implant’s capability for load resistance and safety under heavy loading. The 3D-printed PEEK implant observed a maximum deviation of 0.4810 mm in the outside direction, suggesting that the aesthetic result or the fitting precision is adequate. The 3D-printed PEEK implant has the potential to supplant the zygoma bone in cases of severe zygomatic reconstructive deformities, while improving the fit, stability, and strength of the implant. Full article

A significant challenge in orthopedics is the design of biomaterial devices that are able to perform biological functions by substituting or repairing various tissues and controlling bone repair when required. This review presents an overview of the current state of our recent research into biomaterial modifications to reduce bacterial adhesive ability, compared with previous reviews and excellent research papers, but it is not intended to be exhaustive. In particular, we investigated biomaterials for replacement, such as metallic materials (titanium and titanium alloys) and polymers (ultra-high-molecular-weight polyethylene), and biomaterials for regeneration, such as poly(ε-caprolactone) and calcium phosphates as composites. Biomaterials have been designed, developed, and characterized to define surface/bulk features; they have also been subjected to bacterial adhesion assays to verify their potential capability to counteract infections. The addition of metal ions (e.g., silver), natural antimicrobial compounds (e.g., essential oils), or antioxidant agents (e.g., vitamin E) to different biomaterials conferred strong antibacterial properties and anti-adhesive features, improving their capability to counteract prosthetic joint infections and biofilm formation, which are important issues in orthopedic surgery. The complexity of biological materials is still far from being reached by materials science through the development of sophisticated biomaterials. However, close interdisciplinary work by materials scientists, engineers, microbiologists, chemists, physicists, and orthopedic surgeons is indeed necessary to modify the structures of biomaterials in order to achieve implant integration and tissue regeneration while avoiding microbial contamination. Full article

Bone tissue engineering strategies attempt to regenerate bone tissue lost due to injury or disease. Three-dimensional (3D) scaffolds maintain structural integrity and provide support, while improving tissue regeneration through amplified cellular responses between implanted materials and native tissues. Through this, scaffolds that show great osteoinductive abilities as well as desirable mechanical properties have been studied. Recently, scaffolding for engineered bone-like tissues have evolved with the use of conductive materials for increased scaffold bioactivity. These materials make use of several characteristics that have been shown to be useful in tissue engineering applications and combine them in the hope of improved cellular responses through stimulation (i.e., mechanical or electrical). With the addition of conductive materials, these bioactive synthetic bone substitutes could result in improved regeneration outcomes by reducing current factors limiting the effectiveness of existing scaffolding materials. This review seeks to overview the challenges associated with the current state of bone tissue engineering, the need to produce new grafting substitutes, and the promising future that conductive materials present towards alleviating the issues associated with bone repair and regeneration. Full article

Gingival recessions constitute serious limitations for effective interdisciplinary periodontal, orthodontic, and implant therapy. A proper bone morphology of the alveolar bone and soft tissues that cover it are interdependent. The regeneration procedures known to date are based on the use of autogenous bone, or its allogeneic, xenogeneic, or alloplastic substitutes. These substitutes are characterized by different osteogenesis potentials. No effective procedure for three-dimensional bone reconstruction for cases in which there is dentition with recessions has been described to date, especially in its vertical dimension. This article presents the patented method of the three-dimensional bone reconstruction of the anterior mandible with preserved dentition when using an allogeneic bone block, and also includes a case report with a 2-year follow-up as an example. Based on clinical observations, it was stated that the intended therapeutic effect was achieved. There was no recession, shallowing of the vestibule, signs of inflammation, or pathological mobility of the teeth in the area undergoing reconstruction. The radiographic images revealed the formation of a new layer of cortical bone on the vestibular side and a certain volume of cancellous bone. No radiological demarcation zone of brightening, which indicates an incomplete adaptation, integration, and reconstruction of the bone block, was found. Full article