The Evolution of Custom Subperiosteal Implants for Treatment of Partial or Complete Edentulism in Patients with Severe Alveolar Ridge Atrophy.

Dental implants have always played an important role in dentistry and have been used to replace missing teeth since around 600 AD. They can be classified into three groups: endosteal, subperiosteal, and transosteal. Over time, different materials have been used to manufacture dental implants and these, in turn, can be divided into three groups: metals, ceramics, and polymers. Today, the most commonly used treatment for edentulism is the use of endosteal implants. However, such an approach cannot be used in patients with severe alveolar ridge atrophy and, in such cases, custom subperiosteal implants are an alternative. This review article focuses on historical developments and improvements that have been made over recent years in treatment options for patients suffering from edentulism and significant resorption of the alveolar ridge. These treatment options involve the utilization of custom subperiosteal implants. This paper looks at the historical evolution of these implants, the significance of diagnostic imaging, and the application of the contemporary methods of production, such as CAD-CAM and additive manufacturing. The research emphasizes the importance of accuracy and personalization provided by these emerging technologies that have rendered subperiosteal implants a more feasible and less intrusive alternative for patients suffering from significant bone loss.

Optimization of Revision Hip Arthroplasty Workflow by Means of Detailed Pre-Surgical Planning Using Computed Tomography Data, Open-Source Software and Three-Dimensional-Printed Models.

BACKGROUND: In revision hip arthroplasty (RHA), establishing the center of rotation (COR) can be technically challenging due to the acetabular bone destruction that is usually present, particularly in severe cases such as Paprosky type II and III defects. The aim of this study was to demonstrate the use of open-source medical image reconstruction software and low-cost 3D anatomical models in pre-surgical planning of RHA. METHODS: A total of 10 patients, underwent RHA and were included in the study. Computed tomography (CT) scans were performed for all cases, before surgery and approximately 1 week after the procedure. The reconstruction of CT data, 3D virtual planning of the COR and positioning of acetabular cups, including their inclination and anteversion angles, was carried out using the free open source software platform 3D Slicer. In addition, anatomical models of the pelvis were built on a desktop 3D printer from polylactic acid (PLA). Preoperative and postoperative reconstructed imaging data were compared for each patient, and the position of the acetabular cups as well as the COR were evaluated for each case. RESULTS: Analysis of the pre- and post-op center of rotation position data indicated statistically insignificant differences for the location of the COR on the X-axis (1.5 mm, t = 0.5741, p = 0.5868) with a fairly strong correlation of the results (r = -0.672, p = 0.0982), whilst for the location of the COR in the Y and Z-axes, there was statistical dependence (Y axis, 4.7 mm, t = 3.168 and p = 0.0194; Z axis, 1.9 mm, t = 1.887 and p = 0.1081). A strong correlation for both axes was also observed (Y and Z) (Y-axis, r = 0.9438 and p = 0.0014; Z-axis, r = 0.8829 and p = 0.0084). Analysis of inclination angle values showed a statistically insignificant difference between mean values (3.9 degrees, t = 1.111, p = 0.3092) and a moderate correlation was found between mean values (r = -0.4042, p = 0.3685). Analysis of the anteversion angle showed a statistically insignificant difference between mean values (1.9 degrees, t = 0.8671, p = 0.4192), while a moderate correlation between mean values was found (r = -0.4782, p = 0.2777). CONCLUSIONS: Three-dimensional reconstruction software, together with low-cost anatomical models, are very effective tools for pre-surgical planning, which have great potential use in orthopedic surgery, particularly RHA. In up and in- and up and out-type defects, it is essential to establish a new COR and to identify three support points within the revision acetabulum in order to correctly position acetabular cups.

Comprehensive Biological Evaluation of Biomaterials Used in Spinal and Orthopedic Surgery.

Biological acceptance is one of the most important aspects of a biomaterial and forms the basis for its clinical use. The aim of this study was a comprehensive biological evaluation (cytotoxicity test, bacterial colonization test, blood platelets adhesion test and transcriptome and proteome analysis of Saos-2 cells after contact with surface of the biomaterial) of biomaterials used in spinal and orthopedic surgery, namely, Ti6Al4V ELI (Extra Low Interstitials), its modified version obtained as a result of melting by electron beam technology (Ti6Al4V ELI-EBT), polyether ether ketone (PEEK) and polished medical steel American Iron and Steel Institute (AISI) 316L (the reference material). Biological tests were carried out using the osteoblasts-like cells (Saos-2, ATCC HTB-85) and bacteria Escherichia coli (DH5α). Results showed lack of cytotoxicity of all materials and the surfaces of both Ti6Al4V ELI and PEEK exhibit a significantly higher resistance to colonization with E. coli cells, while the more porous surface of the same titanium alloy produced by electron beam technology (EBT) is more susceptible to microbial colonization than the control surface of polished medical steel. None of the tested materials showed high toxicity in relation to E. coli cells. Susceptibility to platelet adhesion was very high for polished medical steel AISI 316L, whilst much lower for the other biomaterials and can be ranked from the lowest to the highest as follows: PEEK < Ti6Al4V ELI < Ti6Al4V ELI-EBT. The number of expressed genes in Saos-2 cells exposed to contact with the examined biomaterials reached 9463 genes in total (ranging from 8455 genes expressed in cells exposed to ELI to 9160 genes in cells exposed to PEEK). Whereas the number of differentially expressed proteins detected on two-dimensional electrophoresis gels in Saos-2 cells after contact with the examined biomaterials was 141 for PEEK, 223 for Ti6Al4V ELI and 133 for Ti6Al4V ELI-EBT. Finally, 14 proteins with altered expression were identified by mass spectrometry. In conclusion, none of the tested biomaterials showed unsatisfactory levels of cytotoxicity. The gene and protein expression analysis, that represents a completely new approach towards characterization of these biomaterials, showed that the polymer PEEK causes much more intense changes in gene and protein expression and thus influences cell metabolism.

Designing laser-modified surface structures on titanium alloy custom medical implants using a hybrid manufacturing technology.

The hybrid technology combines an efficient material-removal process and implant surface treatment by the laser reducing time of manufacture process compared to currently used machining technologies. It also permits precise structuring of the implant material surface. Six structures of the Ti6Al4V ELI surface were designed and studied how the structure topography prepared with the hybrid technology affected the Escherichia coli adhesion to the surface and viability, as well as the growth, adhesion, and viability of human osteogenic Saos-2 cells cultured on the investigated surfaces. Results have confirmed that the microtopography of medical titanium alloy plays a beneficial role in bacterial adhesion and viability (number of bacteria found on reference surface: [5.9 ± 0.44] × 106 CFU/ml, sample no. 3: [8.8 ± 0.93] × 104 CFU/ml, and sample no. 5: [1.2 ± 0.23] × 107 CFU/ml; CFU - Colony Forming Unit). All tested structured surfaces enabled good cell attachment and proliferation of Saos-2 cells (viability of Saos-2 cells [% of control] for reference surface: 81.93%; sample no. 3: 75% and sample no. 5: 100%). Transcriptome analysis of genes commonly expressed in the process of osseointegration demonstrated that the use of hybrid technology allows designing structures that enhance osseointegration but it should be coupled with other methods of preventing bacterial growth, or with a different strategy to limit microbial colonization with the satisfactory osseointegration potential.

Arterio-bronchial fistula as a complication of post-traumatic subclavian artery pseudoaneurysm - radiological findings and outcome.

Post-traumatic arterio-bronchial fistula is a rare cause of life-threatening hemorrhage. We present a case of a ten-year-old patient with a post-traumatic subclavian artery pseudoaneurysm complicated by an arterio-bronchial fistula and occlusion of the subclavian artery. The patient was treated with a stent-graft. We present radiological images of the fistula and the evolution of the changes in subsequent follow-up examinations.

Simultaneous transcriptome and proteome analysis of EA.hy926 cells under stress conditions induced by nanomaterials.

Today, the extensive and constantly growing number of applications in the field of nanotechnology poses a lot of questions about the potential toxicity of nanomaterials (NMs) toward cells of different origins. In our work we employed the tools of molecular biology to evaluate changes that occur in human endothelial cells at the transcriptomic and proteomic level, following 24 h of exposure to three different classes of NMs. Using microarray technology, we demonstrated that 24 h of exposure to silver nanoparticles (SNPs), multiwalled carbon nanotubes (MWCNTs) and polyamidoamine dendrimers (PAMAMs) leads to changes in 299, 1271, and 431 genes, respectively, influencing specific molecular pathways. The 2D-DIGE and mass spectrometry analysis revealed that differentially expressed proteins were involved in numerous cellular processes, for example, cytoskeletal reorganization, cell growth and proliferation, or response to stress. Both, transcriptome and proteome alterations indicate reorganization of mechanism regulating cell functioning. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1024-1034, 2019.

Does the type of renal artery anatomic variant determine the diameter of the main vessel supplying a kidney? A study based on CT data with a particular focus on the presence of multiple renal arteries.

BACKGROUND: An in-depth knowledge of renal vascular anatomy is essential when planning many surgical procedures; however, a few data exists regarding renal artery diameter. The aim of this study was to assess this morphological feature and to investigate whether a correlation exists between renal artery diameter and the type of arterial supply, with a particular emphasis on variant anatomy and the presence of multiple renal arteries. MATERIALS AND METHODS: Computed tomography angiography (CTA) studies of 248 patients, i.e., a total of 496 kidneys, were evaluated. The mean age of the patients was 66.4 ± 15.01 years. Renal artery diameter was measured based on the type of arterial blood supply. RESULTS: The frequency of occurrence of three anatomic variants of renal arterial supply was established: single renal artery (RA) 43.35%, single artery with prehilar branching (pRA) 37.30%, and multiple renal artery (mRA) 19.35%. The diameter of single renal arteries, with either prehilar or hilar branching, was significantly larger than when multiple arteries were present. A detailed analysis of just the mRA variant demonstrated that the diameter of the renal arteries in men was larger (p = 0.012) than those in women and that there was no difference in diameter with regard to the side of the body (p = 0.219). CONCLUSIONS: The classification described in our study containing a detailed description of renal artery diameter. It may be helpful in clinical practice, especially for transplantologists, surgeons, and vascular surgeons.

In vitro and in vivo imaging of ultra-high-molecular-weight polyethylene orbital implants.

The aim of this study is to compare magnetic resonance imaging (MRI) with computed tomography (CT) for visualization of an orbital alloplastic prosthesis made of ultra-high-molecular-weight polyethylene (UHMW-PE) both in vitro and in vivo. A study of 15 test implants from UHMW-PE visualized in vitro in CT and MRI and an in vivo visualization in a patient who suffered from orbital injury and underwent reconstructive surgery is presented. The postsurgery MRI showed the UHMW-PE material clearly, with no significant artifacts. The surrounding tissues could be satisfactorily evaluated. The CT scans did not present the graft material. Both techniques were sufficient tools for in vitro evaluation of the shape and measurement of the prosthesis.

Technical concept of patient-specific, ultrahigh molecular weight polyethylene orbital wall implant.

INTRODUCTION: The authors have been using patient-specific implants since 2006 and are constantly looking for new reconstructive materials, in order to create precise implants for orbital reconstruction. Such materials should be biocompatible and stable in the human body, as well as easy to machine and form into complex 3D shapes. Biocompatible ultrahigh molecular weight polyethylene (UHMW-PE) has several unique properties including high impact strength and a low friction coefficient that result in self-lubricating and thus non-sticking surfaces after processing. AIM: To present the concept of a patient-specific, UHMW-PE orbital wall implant. MATERIALS AND METHODS: The material used to manufacture the orbital implant was UHMW-PE converted into a solid block of medical polymer from a powder material. A delayed treatment unilateral orbital fracture case was chosen for reconstruction with patient-specific orbital wall implant. On the basis of computerized tomography, a virtual model of both orbits was prepared. The injured orbit was significantly enlarged due to dislocation of its walls. The 3D model of the facial skeleton was symmetrically divided into two parts. This resulted in two models - left and right orbit, then the uninjured orbit was superimposed onto the contralateral side. As a result two surfaces were created; the outer surface (taken from the injured orbit) was used to design the outer surface of the implant, and the inner (taken from the uninjured orbit) for the inner surface. By combining both these surfaces it was possible to determine the unique shape and thickness of the UHMW-PE implant that would allow for accurate reconstruction of the orbit. Following this, the CAD model was transferred to CAM software and a numerical code for a 5-axis milling machine was generated. The manufactured implant was sterilized in gas plasma and used to reconstruct three orbital walls. RESULTS: The thickness of the manufactured implant ranged from 0.2 mm to 1.5 mm and was successfully inserted via transconjunctival approach. The lower, medial and lateral walls were reconstructed. The correct position of the right eyeball was re-established by moving it upward and medially, which resulted in enophthalmos and diplopia correction. The described method features several advantages: accurate reconstruction of the original shape of the orbit, precise modification of local implant thickness during design of the CAD model, structural globe support combined with a thin implant, the possibility of repairing large orbital floor defects, corrections using scissor/scalpel during surgery are relatively uncomplicated, low level of morbidity, smooth edges and gradual, controlled variations in implant thickness between different regions. Disadvantages: changes to the curvature of the implant cannot be made during surgery, implant may require fixing with screws to be stabilized during the early phase of healing, long time required to design and manufacture implants (pre-op) and also UHMW-PE implants are radiolucent and cannot be imaged using X-rays. CONCLUSION: UHMW-PE appears to have numerous advantages as a material for precise reconstruction of the orbits. Such patient-specific implants are durable, can even be used to reconstruct very thin walls, do not exhibit the high degree of morbidity typical for autogenous bone grafts and result in restoration of vision function.

Posterior wall capture and femoral artery stenosis following use of StarClose closing device: diagnosis and therapy.

A case of femoral artery obstruction following application of a StarClose type arterial puncture closing device (APCD) is presented. Ultrasonographic and angiographic imaging of this complication was obtained. The posterior wall of the vessel was accidentally caught in the anchoring element of the nitinol clip. This complication was successfully resolved by endovascular treatment and the implantation of a stent.

Infectious or noninfectious? Ruptured, thrombosed inflammatory aortic aneurysm with spondylolysis.

Osteolysis of vertebrae due to inflammatory aortic aneurysm is rarely observed. However, it is estimated that up to 10 % of infectious aneurysms coexist with bone tissue destruction, most commonly the vertebrae. Inflammatory aneurysms with no identified infection factor, along with infiltration of adjacent muscle and in particular extensive destruction of bone tissue have rarely been described in the literature. A case of inflammatory aneurysm with posterior wall rupture and inflammatory infiltration of the iliopsoas muscle and spine, together with extensive vertebral body destruction, is presented. The aneurysm was successfully treated with endovascular aneurysm repair EVAR.

Pancreatitis-related abdominal aortic pseudoaneurysms treated with stent-grafts.

Endovascular treatment of pseudoaneurysms that develop as a complication of pancreatitis is increasingly more common. A case of a pseudoaneurysm of the abdominal aorta initially treated by implantation of a straight aortic stent-graft is presented. In the 4 months after the procedure, chronic inflammation of the retroperitoneal space caused a further perforation on the posterior wall of the aorta in the area of the bifurcation, distal to the graft. Implantation of a bifurcated stent-graft was subsequently performed. The aneurysm was excluded, with the implant and peripheral arteries remaining patent.

The use of modern imaging techniques in the diagnosis and treatment planning of patients with orbital floor fractures.

BACKGROUND: Ocular motility impairment associated with orbital trauma may have several causes and manifest with various clinical symptoms. In some cases orbital reconstructive surgery can be very challenging and the results are often unsatisfactory. The use of modern imaging techniques aids proper diagnosis and surgical planning. CASE REPORT: The authors present the case of a 29-year-old male who sustained trauma to the left orbit. Orthoptic examination revealed limited supra- and infraduction of the left eye. The patient reported diplopia in upgaze and downgaze with primary position spared. Dynamic magnetic resonance imaging (dMRI) was performed, which revealed restriction of the left inferior rectus muscle in its central section. A patient-specific anatomical model was prepared on the basis of 3-dimensional computed tomography (CT) study of the intact orbit, which was used to prepare a custom pre-bent titanium mesh implant. The patient underwent reconstructive surgery of the orbital floor. CONCLUSIONS: Modern imaging techniques such as dMRI and 3-dimensional CT reconstruction allow us to better understand the pathophysiology of orbital floor fractures and to precisely plan surgical treatment.

A large posttraumatic subclavian artery aneurysm complicated by artery occlusion and arteriobronchial fistula successfully treated using a covered stent.

The treatment of posttraumatic aneurysms of peripheral arteries using covered stents is increasingly commonplace. We present the case of a 10-year-old girl with a pseudoaneurysm of the subclavian artery complicated by an arteriobronchial fistula with hemorrhaging into the bronchial tree and distal subclavian artery occlusion. Despite the lack of artery patency, endovascular stent graft implantation was successful. Pseudoaneurysm exclusion and involution was achieved, together with a patent implant and maintained collateral circulation patency.

Treatment with individual orbital wall implants in humans - 1-Year ophthalmologic evaluation.

BACKGROUND: In 2009 a method of creating individual, patient specific orbital wall implants using rapid prototyping (RP) was shown in a preliminary human study. That study showed that it is financially viable to produce anatomical models and that this technology could be used in the repair of orbital floor fractures. MATERIALS AND METHODS: In this study, 24 consecutive subjects who had sustained orbital fractures (14 males, 6 females) without any coexisting central nervous system or globe injury were assessed post-operatively. The first series of 12 patients, recruited during the period 2005-2006, were treated with classical method (CM) of forming titanium mesh by manual manipulation, based on individual subjective assessment of the extent and shape of damaged orbital walls. The following 12 cases, recruited between 2007 and 2008, were treated with patient specific titanium mesh implants designed with an RP method. Early (2 weeks) and late (12 months) follow-up was performed. Patients were evaluated by binocular single vision (BSV) test and an assessment of eye globe motility. RESULTS: The superiority of the RP treatment method over CM was shown on the basis of early results when BSV loss area and reduction of vertical visual disparity (VVD) in upgaze were considered. Better outcomes for the RP group were confirmed in the late follow-up results which showed a reduction of BSV loss area, correction of primary globe position and a very significant improvement in upgaze. CONCLUSIONS: One-year post-operatively, functional assessment of pre-bent individual implants of the orbital wall has shown the technique to be a predictable reconstruction method. Nevertheless longer follow-up and an increase in the number of cases treated are required for the full evaluation of the technique.

Comparison of tomographic coronary artery calcification index (calcium score) and ultrasonographic measurement of intima-media complex thickness in diabetic subjects.

BACKGROUND: At present, there is a number of diagnostic imaging procedures allowing for the evaluation of atherosclerosis. The earliest, subclinical stage of atherosclerosis can be visualized with the development of computed tomography (CT) and ultrasound (US) techniques. Therefore, the purpose of this study was to assess the degree of coronary artery calcification and carotid intima-media thickness in diabetic subjects divided into different age groups. MATERIAL/METHODS: Fifty-six men, aged from 18 to 72 were included in the study. Participants were divided into 4 groups according to age (18-30, 31-45, 46-60 and more than 60 years). Two tests were performed: coronary calcium score (CS) determination and intima-media thickness (IMT) in ultrasound. CS was performed using a multi-slice scanner. Images were analyzed using the Agatson method. Ultrasound examinations were performed using a 9-12-MHz linear transducer. RESULTS: The correlation coefficient between calcium score index (CSI) and age of patients was 0.52 (p<0.001). The correlation between duration of diabetes and CSI was significantly lower (r=0.3; p<0.05). The increase of IMT is associated with age to a much greater extent and the correlation coefficient was 0.63 (p<0.001). IMT depended on the duration of diabetes, but the correlation was also weak (r=0.35; p<0.01). CONCLUSIONS: Comparison of the findings obtained in the presented study and in the group of healthy subjects proves that influence of diabetes on vascular deterioration may be observed, even among young individuals. Obtained results allow to make the following conclusions: 1. Calcium score index remains low in the group of male patients with diabetes before the age of 45. 2. Intima-media thickness correlates well with age (r=0.6; p<0.05) and weaker with the duration of diabetes (r=0.35; p<0.05). 3. IMT assessment may be a useful tool to identify the increased predisposition to atherosclerosis, also before the age of 30.

Clinical application of 3D pre-bent titanium implants for orbital floor fractures.

INTRODUCTION: Orbital structures are affected in approximately 40% of all cases of craniofacial trauma. Changes in the bony orbital dimensions can alter the function of intraorbital contents and lead to serious complications. The unique anatomy of the orbit and the resulting surgical approaches make the process of fitting and aligning implants difficult, time consuming and operator dependent. It is now possible to make relatively inexpensive anatomical models on the basis of computed tomography images, using rapid prototyping. Such models can be used as templates to form titanium mesh implants, which are then used in the reconstruction of orbital floor defects. MATERIAL AND METHODS: Six patients with facial trauma were included in this study. First, 3D virtual models and then physical models were created. These were used as templates to shape the titanium mesh and then intraoperatively as guides to aid correct implant placement in the orbit. RESULTS: Significant improvement resulted in three cases and total recovery in three cases. CONCLUSION: It is financially viable to build anatomical models, on the basis of CT studies, that can be used in the repair of orbital floor fractures.