Finite element analysis and clinical application of 3D-printed Ti alloy implant for the reconstruction of mandibular defects.

BACKGROUND: The reconstruction of segmental defect of the mandible has always been a challenge. The customized reconstruction plate without a bone graft is also considered a transitional means of rehabilitation and reconstruction in some cases. METHODS: This study evaluated the biomechanical behaviors of customized plates with different structural designs comparing with commercial plates using the finite element method in reconstrution of the lateral mandible defect. RESULTS: Simulations revealed the stress state in the plate bodies, bone tissues and screws were associated with the width, height, thickness of the plates as well as the distribution of screws. In all of the groups, the system of 16 mm-high, 2.8 mm-thick customized reconstruction plate with 10 screws was considered to be the most ideal design because of the most harmonious biomechanical state. What's more, the stress shielding effects were not obvious in this experiment. Based on the above findings, we conducted a clinical case analysis to verify the mechanical properties of customized reconstruction and obtained a satisfactory operation result. CONCLUSIONS: The results show that by adjusting the contour parameters of the reconstruction plates, an ideal and reliable customized plate can be manufactured. And the customized 3D-printed Ti alloy implant will be a new way to achieve mandibular reconstruction in patients unable to perform autologous bone graft surgery. TRIAL REGISTRATION: The present trial has been registered with ChiCTR, the registration number is ChiCTR 2,000,038,973 on 11/10/2020.

Finite element analysis of 3D-printed personalized titanium plates for mandibular angle fracture.

This paper discussed the size of 3 D-printed personalized titanium plates that can gain maximum stability of mandibular fracture and minimize stress shielding through finite element analysis. A 3 D virtual model of mandible with mandibular angle fracture was created from the CT data of patient. 3 D-printed personalized titanium plates varying in length and thickness were designed, and finite element analysis was performed under different loading conditions and fracture healing periods. After that, the stress distribution and deformation of the mandible with gonial fracture could be observed, and the stress shielding rate could be obtained. Finally, SPSS21.0 was used for statistical analysis. The results of finite element analysis indicated that as the thickness of titanium plates and the healing time decreased, the maximum displacement increased, under a certain condition in which the pore size, the width, the hole distance and the bridge spacing were 2.0 mm, 4.0 mm, 6.0 mm, 12.0 mm, respectively. What's more, in this condition, the thicker the titanium plate and the shorter the healing time were, the higher the stress shielding was at central occlusion. When the thickness of the personalized 3 D-printed titanium plate was 1.0 mm, the maximum displacement tended to be stable and the stress shielding was minimized. It can not only improve the bone stability after tension band fixation, but also minimize the stress shielding, which is expected to expand the indications of tension band fixation.

Hard Tissue Preservation and Recovery in Minimally Invasive Alveolar Surgery Using Three-Dimensional Printing Guide Plate.

BACKGROUND: For completely impacted teeth, it is of great significance to locate teeth accurately, preserve hard tissue and recovering the height of alveolar ridge. This can be effectively solved by the digital three-dimensional printing guide technology. METHODS: Ten patients with completely impacted tooth were selected in this experiment. After cone-beam computed tomography scan, the dicom formal computed tomography data was analyzed for threedimensional reconstruction by mimics 17.0 software. Then determining the surgical plan and making surgical guide plate. Threedimensional printing guide plate assisted piezosurgery was used to remove bone and extract impacted teeth. After that, the removed bone cap was back to the original position. Cone-beam computed tomography was used for each operated patients after 1 week and 6 months. RESULT: The surgical guide plates can locate teeth accurately and the surgery time was reduced for all patients. A week later, all patients healed well and removed the stitches on time. Cone-beam computed tomography showed that the retention of bone caps was good and there was no displacement. All patients showed a normal parameter of pain. Six months later, cone-beam computed tomography showed good bone formation in the extraction area, which filled with new bones completely. The recovery of bone outline and height of alveolar crest at the surgical site were basically consistent with those before the operation. CONCLUSIONS: Three-dimensional printing guide plates combining with fenestration and bone-cap restoration can locate impacted teeth accurately, reduce the extraction volume of bone, shorten surgery time, and alleviate complications. This was conducive to preserve and restore hard tissue and had great prospective.

A Regularization Homotopy Strategy for the Constrained Parameter Inversion of Partial Differential Equations.

The main difficulty posed by the parameter inversion of partial differential equations lies in the presence of numerous local minima in the cost function. Inversion fails to converge to the global minimum point unless the initial estimate is close to the exact solution. Constraints can improve the convergence of the method, but ordinary iterative methods will still become trapped in local minima if the initial guess is far away from the exact solution. In order to overcome this drawback fully, this paper designs a homotopy strategy that makes natural use of constraints. Furthermore, due to the ill-posedness of inverse problem, the standard Tikhonov regularization is incorporated. The efficiency of the method is illustrated by solving the coefficient inversion of the saturation equation in the two-phase porous media.

A study on biosafety of HAP ceramic prepared by SLA-3D printing technology directly.

Hydroxyapatite powder was mixed into photosensitive resin to form complex shape scaffold using SLA-3D printing technology, and then the final entity was obtained successively by debinding and sintering. It is crucial to confirm whether the prepared hydroxyapatite scaffold have the toxic effects after our designed printing, debinding, and sintering processes because the photosensitive resin in the starting printing paste is poisonous to cells. To investigate these issues in details, thermogravimetric analysis (TG), differential scanning calorimetry (DSC), in vitro cytotoxicity test, and implantation pre-experiment in the rabbit parietal were performed, aiming to develop the SLA-3D prepared hydroxyapatite scaffold. Through thermal analysis, it was proved that photosensitive resin would be completely pyrolyzed at temperature ranging from 350 °C to 580 °C, corresponding to a secondary chemical reaction mechanism. Combined with cytotoxicity test results, it is unquestionable that the toxic substances would be totally decomposed after debinding process and a good biocompatible HAP samples could be obtained. The finally prepared HAP samples with micro-holes showed good biosafety in pre-experiment of the rabbit parietal implantation.

Application of Three-Dimensional Printing Technology for Improved Orbital-Maxillary-Zygomatic Reconstruction.

The reconstruction of orbital-maxillary-zygomatic complex (OMZC) on patients suffering from trauma and space-occupying lesions is challenging due to the irregularity of craniomaxillofacial bones. To overcome the challenge in precise OMZC reconstruction, individual three-dimensional (3D) disease models and mirror-imaged 3D reconstruction models were printed on the basis of the computer tomography. Preoperative planning by rehearsing surgical procedures was made on the 3D disease models and the scaffolds including titanium and absorbable meshes or plates were anatomically premolded using the mirror-imaged 3D models as guide. Many benefits were achieved including more precise OMZC reconstruction, fluent and smooth procedures of surgeries, shorter operation time, less blood loss, and improved cosmetic outcomes of craniomaxillofacial shapes. There were no complications such as diplopia, infection, foreign body reaction, exophthalmos, enophthalmos, disordered occlusal relationship, and hematoma. And patients were satisfied with the functional and esthetic outcome during the following-up time. Therefore, OMZC reconstruction can be optimized and successful through preoperative planning and premolded scaffolds with 3D printing bone model by computer-aid design and manufacturing.

Endoscope-assisted resection of nonneoplastic space-occupying lesion in oral and maxillofacial areas.

Endoscope-assisted oral and maxillofacial surgeries have been applied to the resection of tumors with minimal invasion and good cosmetic outcomes. However, with regard to endoscope-assisted resection of nonneoplastic space-occupying lesion (NSOL) in oral and maxillofacial areas which differ from tumors in treatment, there are no systematic reports. Therefore the advantages and limitations of the endoscopy-assisted approach (EAA) in resection of NSOL remain unclear. In this novel study we describe endoscope technique for resection of NSOL in face and submandibular areas and compare the feasibility and effectiveness of EAA with external approach (EA). Eleven patients underwent EAA and 20 patients underwent EA procedures. The perioperative and postoperative outcomes of the patients were evaluated. The resection of NSOL with EAA was completed successfully with a shorter hospitalization duration, less bleeding, a smaller incison and better satisfaction with appearance than with the EA procedure (P < 0.01). Our study showed that endoscope-assisted resection of NSOL is technically safe, feasible and practicable. Good cosmetic results with minimal invasion can be achieved with this new technique and therefore this may be a promising new standard procedure in oral and maxillofacial areas.