Optimization of Fixations for Additively Manufactured Cranial Implants: Insights from Finite Element Analysis.

With the emergence of additive manufacturing technology, patient-specific cranial implants using 3D printing have massively influenced the field. These implants offer improved surgical outcomes and aesthetic preservation. However, as additive manufacturing in cranial implants is still emerging, ongoing research is investigating their reliability and sustainability. The long-term biomechanical performance of these implants is critically influenced by factors such as implant material, anticipated loads, implant-skull interface geometry, and structural constraints, among others. The efficacy of cranial implants involves an intricate interplay of these factors, with fixation playing a pivotal role. This study addresses two critical concerns: determining the ideal number of fixation points for cranial implants and the optimal curvilinear distance between those points, thereby establishing a minimum threshold. Employing finite element analysis, the research incorporates variables such as implant shapes, sizes, materials, the number of fixation points, and their relative positions. The study reveals that the optimal number of fixation points ranges from four to five, accounting for defect size and shape. Moreover, the optimal curvilinear distance between two screws is approximately 40 mm for smaller implants and 60 mm for larger implants. Optimal fixation placement away from the center mitigates higher deflection due to overhangs. Notably, a symmetric screw orientation reduces deflection, enhancing implant stability. The findings offer crucial insights into optimizing fixation strategies for cranial implants, thereby aiding surgical decision-making guidelines.

Design of Hierarchical Architected Lattices for Enhanced Energy Absorption.

Hierarchical lattices are structures composed of self-similar or dissimilar architected metamaterials that span multiple length scales. Hierarchical lattices have superior and tunable properties when compared to conventional lattices, and thus, open the door for a wide range of material property manipulation and optimization. Using finite element analysis, we investigate the energy absorption capabilities of 3D hierarchical lattices for various unit cells under low strain rates and loads. In this study, we use fused deposition modeling (FDM) 3D printing to fabricate a dog bone specimen and extract the mechanical properties of thermoplastic polyurethane (TPU) 85A with a hundred percent infill printed along the direction of tensile loading. With the numerical results, we observed that the energy absorption performance of the octet lattice can be enhanced four to five times by introducing a hierarchy in the structure. Conventional energy absorption structures such as foams and lattices have demonstrated their effectiveness and strengths; this research aims at expanding the design domain of energy absorption structures by exploiting 3D hierarchical lattices. The result of introducing a hierarchy to a lattice on the energy absorption performance is investigated by varying the hierarchical order from a first-order octet to a second-order octet. In addition, the effect of relative density on the energy absorption is isolated by creating a comparison between a first-order octet lattice with an equivalent relative density as a second-order octet lattice. The compression behaviors for the second order octet, dodecahedron, and truncated octahedron are studied. The effect of changing the cross-sectional geometry of the lattice members with respect to the energy absorption performance is investigated. Changing the orientation of the second-order cells from 0 to 45 degrees has a considerable impact on the force-displacement curve, providing a 20% increase in energy absorption for the second-order octet. Analytical solutions of the effective elasticity modulus for the first- and second-order octet lattices are compared to validate the simulations. The findings of this paper and the provided understanding will aid future works in lattice design optimization for energy absorption.

Modeling the effect of tumor compression on airflow dynamics in trachea using contact simulation and CFD analysis.

Malignant central airway obstruction can cause severe breathing difficulty in a patient that requires surgical intervention or stent implantation to alleviate it. A predictive model to identify the onset of this event as the central airway is progressively compressed by tumor growth will be helpful for clinicians to plan for medical intervention. We present such a model to simulate tumor compression of the trachea and the resulting change in airflow dynamics to estimate the level of stenosis that will cause severe breathing difficulties. A patient-specific model of trachea was generated from acquired Computed Tomography (CT) scans for the simulations. The compression of this trachea due to tumor growth is modeled using nonlinear contact simulations of ellipsoidal tumors with the trachea. Computational fluid dynamics (CFD) is employed to simulate the turbulent airflow during inhalation in the stenosed trachea. From the CFD simulated flow fields, the power loss due to airflow through the domain is calculated. The results show that when the obstruction in the trachea reaches 50%, compared to the undeformed model, the power loss can rise to more than 66%. A measure of breathing difficulty can be derived by correlating it with the power loss. Thus, medical intervention can be predicted based on the degree of stenosis if the induced power loss exceeds a threshold that causes severe breathing discomfort.

A Two-Scale Multi-Resolution Topologically Optimized Multi-Material Design of 3D Printed Craniofacial Bone Implants.

Bone replacement implants for craniofacial reconstruction require to provide an adequate structural foundation to withstand the physiological loading. With recent advances in 3D printing technology in place of bone grafts using autologous tissues, patient-specific additively manufactured implants are being established as suitable alternates. Since the stress distribution of these structures is complicated, efficient design techniques, such as topology optimization, can deliver optimized designs with enhanced functionality. In this work, a two-scale topology optimization approach is proposed that provides multi-material designs for both macrostructures and microstructures. In the first stage, a multi-resolution topology optimization approach is used to produce multi-material designs with maximum stiffness. Then, a microstructure with a desired property supplants the solid domain. This is beneficial for bone implant design since, in addition to imparting the desired functional property to the design, it also introduces porosity. To show the efficacy of the technique, four different large craniofacial defects due to maxillectomy are considered, and their respective implant designs with multi-materials are shown. These designs show good potential in developing patient-specific optimized designs suitable for additive manufacturing.

Topology optimization of fixed complete denture framework.

The functionality of a denture is directly related to the quality of life of the edentulous patients because treatment failure results in demoralizing consequences including difficulties in oral activities. Framework for fixed complete dentures plays a crucial role by transferring loads from the denture to the implants, which are integrated into the remaining bones and gingiva, thereby providing stability to the denture. Current techniques utilize 3D scan data of the implant site to capture the locations and soft tissue contours to design customized framework using computer-aided design (CAD) and computer-aided manufacturing (CAM) technology to properly support the denture teeth in their position. The performance and efficiency of these frameworks may be enhanced by incorporating a design optimization in the design process. We tested the feasibility of using the topology optimization to design patient-specific dental frameworks. The shapes of the optimized frameworks may be significantly different from the traditional designs, but better structural integrity is likely to be achieved with potentially less material. The numerical study reveals that commercially available dental framework would experience 16% less maximum stress when topology optimized even with a compliance minimization formulation with 50% volume fraction constraint. Topology optimization for designing dental frameworks might improve current clinical methods and provide better long-term patient satisfaction.

Large Animal Models of an In Vivo Bioreactor for Engineering Vascularized Bone.

Reconstruction of large skeletal defects is challenging due to the requirement for large volumes of donor tissue and the often complex surgical procedures. Tissue engineering has the potential to serve as a new source of tissue for bone reconstruction, but current techniques are often limited in regards to the size and complexity of tissue that can be formed. Building tissue using an in vivo bioreactor approach may enable the production of appropriate amounts of specialized tissue, while reducing issues of donor site morbidity and infection. Large animals are required to screen and optimize new strategies for growing clinically appropriate volumes of tissues in vivo. In this article, we review both ovine and porcine models that serve as models of the technique proposed for clinical engineering of bone tissue in vivo. Recent findings are discussed with these systems, as well as description of next steps required for using these models, to develop clinically applicable tissue engineering applications.

Design of complex bone internal structure using topology optimization with perimeter control.

Large facial bone loss usually requires patient-specific bone implants to restore the structural integrity and functionality that also affects the appearance of each patient. Titanium alloys (e.g., Ti-6Al-4V) are typically used in the interfacial porous coatings between the implant and the surrounding bone to promote stability. There exists a property mismatch between the two that in general leads to complications such as stress-shielding. This biomechanical discrepancy is a hurdle in the design of bone replacements. To alleviate the mismatch, the internal structure of the bone replacements should match that of the bone. Topology optimization has proven to be a good technique for designing bone replacements. However, the complex internal structure of the bone is difficult to mimic using conventional topology optimization methods without additional restrictions. In this work, the complex bone internal structure is recovered using a perimeter control based topology optimization approach. By restricting the solution space by means of the perimeter, the intricate design complexity of bones can be achieved. Three different bone regions with well-known physiological loadings are selected to illustrate the method. Additionally, we found that the target perimeter value and the pattern of the initial distribution play a vital role in obtaining the natural curvatures in the bone internal structures as well as avoiding excessive island patterns.

Designing patient-specific 3D printed craniofacial implants using a novel topology optimization method.

Large craniofacial defects require efficient bone replacements which should not only provide good aesthetics but also possess stable structural function. The proposed work uses a novel multiresolution topology optimization method to achieve the task. Using a compliance minimization objective, patient-specific bone replacement shapes can be designed for different clinical cases that ensure revival of efficient load transfer mechanisms in the mid-face. In this work, four clinical cases are introduced and their respective patient-specific designs are obtained using the proposed method. The optimized designs are then virtually inserted into the defect to visually inspect the viability of the design . Further, once the design is verified by the reconstructive surgeon, prototypes are fabricated using a 3D printer for validation. The robustness of the designs are mechanically tested by subjecting them to a physiological loading condition which mimics the masticatory activity. The full-field strain result through 3D image correlation and the finite element analysis implies that the solution can survive the maximum mastication of 120 lb. Also, the designs have the potential to restore the buttress system and provide the structural integrity. Using the topology optimization framework in designing the bone replacement shapes would deliver surgeons new alternatives for rather complicated mid-face reconstruction.

Experimental validation of 3D printed patient-specific implants using digital image correlation and finite element analysis.

With the dawn of 3D printing technology, patient-specific implant designs are set to have a paradigm shift. A topology optimization method in designing patient-specific craniofacial implants has been developed to ensure adequate load transfer mechanism and restore the form and function of the mid-face. Patient-specific finite element models are used to design these implants and to validate whether they are viable for physiological loading such as mastication. Validation of these topology optimized finite element models using mechanical testing is a critical step. Instead of inserting the implants into a cadaver or patient, we embed the implants into the computer-aided skull model of a patient and, fuse them together to 3D print the complete skull model with the implant. Masticatory forces are applied in the molar region to simulate chewing and measure the stress-strain trajectory. Until recently, strain gages have been used to measure strains for validation. Digital Image Correlation (DIC) method is a relatively new technique for full-field strain measurement which provides a continuous deformation field data. The main objective of this study is to validate the finite element model of patient-specific craniofacial implants against the strain data from the DIC obtained during the mastication simulation and show that the optimized shapes provide adequate load-transfer mechanism. Patient-specific models are obtained from CT scans. The principal maximum and minimum strains are compared. The computational and experimental approach to designing patient-specific implants proved to be a viable technique for mid-face craniofacial reconstruction.

In vivo measurement of breast skin elasticity and breast skin thickness.

BACKGROUND: The mechanical properties of the breast skin play an important role in explaining the changes associated with radiotherapy, tissue expansion, and breast reconstruction surgery. Quantitative measurement of mechanical properties of breast skin is essential for surgical preplanning and outcome prediction. We have measured the skin elasticity properties and skin thickness of the breast using noninvasive methods. METHODS: The DermaLab suction cup and the DermaScanC ultrasound were used to measure the modulus of elasticity and the skin thickness, respectively. Measurements were taken in 16 different locations on the breast in 23 female patients, also with patients in supine and upright position. Different analytical models (plate, membrane, large deformation) that can represent the experiment were studied to extract the elasticity modulus. RESULTS: The average modulus of breast skin elasticity found was 344 ± 88 kPa (Mean ± SD) with 95% confidence interval being 306-382 kPa. The range of the modulus was 195-480 kPa. The average thickness of breast skin was 1.55 ± 0.25 mm with a range of 0.83-2.4 mm. CONCLUSIONS: Regional variations of breast skin elasticity properties and breast skin thickness were observed. No direct correlations of biomechanical properties with age or breast thickness were observed. No significant difference was observed in the elasticity modulus between the supine and upright patient positions.

Topological optimization for designing patient-specific large craniofacial segmental bone replacements.

Restoring normal function and appearance after massive facial injuries with bone loss is an important unsolved problem in surgery. An important limitation of the current methods is heuristic ad hoc design of bone replacements by the operating surgeon at the time of surgery. This problem might be addressed by incorporating a computational method known as topological optimization into routine surgical planning. We tested the feasibility of using a multiresolution three-dimensional topological optimization to design replacements for massive midface injuries with bone loss. The final solution to meet functional requirements may be shaped differently than the natural human bone but be optimized for functional needs sufficient to support full restoration using a combination of soft tissue repair and synthetic prosthetics. Topological optimization for designing facial bone tissue replacements might improve current clinical methods and provide essential enabling technology to translate generic bone tissue engineering methods into specific solutions for individual patients.

Modeling oxygen transport in surgical tissue transfer.

Reconstructive microsurgery is a clinical technique used to transfer large amounts of a patient's tissue from one location used to another in order to restore physical deformities caused by trauma, tumors, or congenital abnormalities. The trend in this field is to transfer tissue using increasingly smaller blood vessels, which decreases problems associated with tissue harvest but increases the possibility that blood supply to the transferred tissue may not be adequate for healing. It would thus be helpful to surgeons to understand the relationship between the tissue volume and blood vessel diameter to ensure success in these operations. As a first step towards addressing this question, we present a simple mathematical model that might be used to predict successful tissue transfer based on blood vessel diameter, tissue volume, and oxygen delivery.