Mechanical Behavior and Failure Analysis of Prosthetic Retaining Screws after Long‐Term Use In Vivo. Part 2: Metallurgical and Microhardness Analysis

Abstract Purpose: This study involved testing and analyzing multiple retrieved prosthetic retaining screws after long‐term use in vivo to: (1) detect manufacturing defects that could affect in‐service behavior; (2) characterize the microstructure and alloy composition; and (3) further characterize the wear mechanism of the screw threads. Materials and Methods: Two new (control) screws from Nobel Biocare (NB) and 18 used (in service 18–120 months) retaining screws [12 from NB and 6 from Sterngold (SG)] were: (1) metallographically examined by light microscopy and scanning electron microscopy (SEM) to determine the microstructure; (2) analyzed by energy dispersive X‐ray (EDX) microanalysis to determine the qualitative and semiquantitative average alloy and individual phase compositions; and (3) tested for Vickers microhardness. Results: Examination of polished longitudinal sections of the screws using light microscopy revealed a significant defect in only one Group 4 screw. No significant defects in any other screws were observed. The defect was considered a “seam” originating as a “hot tear” during original casting solidification of the alloy. Additionally, the examination of longitudinal sections of the screws revealed a uniform homogeneous microstructure in some groups, while in other groups the sections exhibited rows of second phase particles. The screws for some groups demonstrated severe deformation of the lower threads and the bottom part of the screw leading to the formation of crevices and grooves. Some NB screws were comprised of Au‐based alloy with Pt, Cu, and Ag as alloy elements, while others (Groups 4 and 19) were Pd‐based with Ga, Cu, and Au alloy elements. The microstructure was homogeneous with fine or equiaxed grains for all groups except Group 4, which appeared inhomogeneous with anomalous grains. SG screws demonstrated a typical dendritic structure and were Au‐based alloy with Cu and Ag alloy elements. There were differences in the microhardness of gold alloy screws from NB and SG as well as palladium alloy screws from NB. Conclusions: Significant differences within NB retaining screws and between NB and SG screws were found for microstructure, major alloy constituents, and microhardness

Mechanical Behavior and Failure Analysis of Prosthetic Retaining Screws after Long‐term Use in vivo. Part 4: Failure Analysis of 10 Fractured Retaining Screws Retrieved from Three Patients

Purpose: The aim of this study was to perform a failure analysis on fractured prosthetic retaining screws after long‐term use in vivo. Additionally, the study addresses the commonly asked question regarding whether complex repeated functional occlusal forces initiate fatigue‐type cracks in prosthetic retaining screws. Materials and Methods: Ten fractured prosthetic retaining screws retrieved from three patients treated with fixed detachable hybrid prostheses were subjected to a failure analysis. In patients 1 and 2, the middle three retaining screws of the prostheses were found fractured at retrieval time after they had been in service for 20 and 19 months, respectively. In patient 3, the middle three and one of the posterior retaining screws were found to be fractured at retrieval after they had been in service for 18 months. Low power stereomicroscopy and high‐power scanning electron microscopy (SEM) were performed to analyze the fractured surfaces of the retaining screws examining fatigue cracks in greater detail. Results: Typical fatigue failure characterized by ratchet mark formation was revealed by light microscopy and SEM for all examined screws. Using low magnification light microscopy, ratchet marks were visible on the fracture surfaces of only two screws. SEM examination revealed all three classical stages of fatigue failure, and it was possible to see the ratchet marks on the fracture surfaces of all specimens, indicating a fatigue zone. The final catastrophic overload fracture appeared fibrous, indicating ductile fracture. The final overload ductile fracture surfaces showed equiaxed dimples, suggesting tensile overload in all examined screws except in two specimens that showed an elongated dimple pattern indicating shear/tearing overload forces. Conclusions: Fracture of prosthetic retaining screws in hybrid prostheses occurs mainly through a typical fatigue mode involving mostly the middle anterior three screws. Fatigue cracks can grow in more than one prosthetic retaining screw, leading to fracture before the patient or clinician determines that any problem exists

Mechanical Behavior and Failure Analysis of Prosthetic Retaining Screws after Long‐term Use In Vivo. Part 3: Preload and Tensile Fracture Load Testing

Purpose: The aim of this study was to determine the preload and tensile fracture load values of prosthetic retaining screws after long‐term use in vivo compared to unused screws (controls). Additionally, the investigation addressed whether the preload and fracture load values of prosthetic retaining screws reported by the manufacturer become altered after long‐term use in vivo. Materials and Methods: For preload testing, 10 new screws (controls) from Nobel Biocare (NB) and 73 used retaining screws [58 from NB and 15 from Sterngold (SG)] were subjected to preload testing. For tensile testing, eight controls from NB and 58 used retaining screws (46 from NB and 12 from SG) were subjected to tensile testing. Used screws for both tests were in service for 18–120 months. A custom load frame, load cell, and torque wrench setup were used for preload testing. All 83 prosthetic screws were torqued once to 10 Ncm, and the produced preload value was recorded (N) using an X–Y plotter. Tensile testing was performed on a universal testing machine and the resulting tensile fracture load value was recorded (N). Preload and tensile fracture load values were analyzed with 2‐way ANOVA and Tukey post‐hoc tests. Results: There was a significant difference between preload values for screws from NB and screws from SG (p \u3c 0.001). The preload values for gold alloy screws from NB decreased as the number of years in service increased. There was a significant difference between tensile fracture values for the three groups (gold alloy screws from NB and SG and palladium alloy screws from NB) at p \u3c 0.001. The tensile fracture values for gold alloy screws from NB and SG decreased as the number of years in service increased. Conclusions: In fixed detachable hybrid prostheses, perhaps as a result of galling, the intended preload values of prosthetic retaining screws may decrease with increased in‐service time. The reduction of the fracture load value may be related to the increase of in‐service time; however, the actual determination of this relationship is not possible from this study alone

Mechanical Behavior and Failure Analysis of Prosthetic Retaining Screws after Long‐term Use In Vivo. Part 1: Characterization of Adhesive Wear and Structure of Retaining Screws

Purpose: The general aim of this study and those presented in Parts 2–4 of this series was to characterize the structure, properties, wear, and fracture of prosthetic retaining screws in fixed detachable hybrid prostheses after long‐term use in vivo. This part of the overall investigation addresses whether there are differences in thread wear between the screws closest to the fulcrum and those that are farthest from the fulcrum in fixed detachable hybrid prostheses. Materials and Methods: The total number of prosthetic retaining screws used in this study was 100 (10 new and 90 used). New screws (controls) from Nobel Biocare (NB) were divided into Group 1 (slotted) and Group 2 (hexed). Ninety used screws (in service 18–120 months) were retrieved from fixed detachable hybrid prostheses in 18 patients (5 screws from each patient, 60 from NB and 30 from Sterngold). The used screws were divided into 18 groups. Additionally, each group was subdivided into A and B categories. Category A contained the middle three prosthetic screws, which were considered the farthest screws from the fulcrum line. Category B contained the most posterior two screws, which were considered the screws closest to the fulcrum line. All 100 screws were subjected to thorough, nondestructive testing. Results: Light and scanning electron microscopic examination of all used screws for each group revealed surface deterioration of the active profile of the screw threads consistent with adhesive wear. The observed thread profile deterioration ranged from mild to severe. The wear was aggressive enough to cause galling, which led to thinning of the threads and, in severe cases, to knife‐edges at thread crests. In ten groups, the most anterior three screws exhibited more wear than the most posterior two screws. In addition to thread wear, severe plastic deformation was detected on the bottom part of each screw for three groups, and a long external longitudinal crack was detected in one screw of Group 2. Conclusions: The findings of this study and those presented in Parts 2–4 demonstrate that different retaining screws from the same manufacturer and/or from different manufacturers have different geometrical design, microstructures, major alloy constituents, and microhardness, and that these differences influence their preload and fractured load values. In this part of the overall investigation, the occurrence of galling as a result of wear involving prosthetic retaining screws appears to be an inevitable and unavoidable consequence of long‐term use in vivo in fixed detachable hybrid prostheses regardless of the intended/original preload value. The galling rate is greater on the middle three screws compared to the most posterior two screws in fixed detachable hybrid prostheses. The wear pattern is consistent with an adhesive wear mechanism; however, this study does not provide enough data to support a definitive analysis

Oxygen-isotopic composition and high-resolution secondary ion mass spectrometry imaging of Martian carbonate in Lafayette meteorite

Carbonate from SNC meteorites gives insight into a variety of processes on and/or beneath the surface of Mars. In Lafayette, carbonate occurs in unusually intimate association with hydrous phases when compared with other carbonate-bearing SNCs [1]. We have measured the ^(18)O/^(16)O ratio of carbonate in the alteration veins of Lafayette using the magnetic sector ion microprobe. In addition, we obtained isotope images of major- and minor-element cations in veinlets with the focused ion beam (FIB) quadrupole SIMS. The spot size of the FIB probe used in this study (~0.03 µm) provides an opportunity for high spatial resolution chemical imaging, which is ideal for examining features in the fine-grained alteration assemblage

Click Chemistry for the Assembly of Gold Nanorods and Silver Nanoparticles

The synthesis of compact nanostructures with highly integratedfunctionalities through the controlled assembly ofnanoparticles (NPs) is potentially of broad interest in researchfields such as drug delivery, multimodal imaging, andelectronic devices. This concept seems to be particularlyimportant in view of the emerging concept of theranostic,according to which both therapeutic and diagnostic capabilitiescan be present in two nanostructures. A key step, however,is how to combine individual nanostructures withoutloosing the original properties

High performance wearable ultrasound as a human-machine interface for wrist and hand kinematic tracking

Objective: Non-invasive human machine interfaces (HMIs) have high potential in medical, entertainment, and industrial applications. Traditionally, surface electromyography (sEMG) has been used to track muscular activity and infer motor intention. Ultrasound (US) has received increasing attention as an alternative to sEMG-based HMIs. Here, we developed a portable US armband system with 24 channels and a multiple receiver approach, and compared it with existing sEMG- and US-based HMIs on movement intention decoding. Methods: US and motion capture data was recorded while participants performed wrist and hand movements of four degrees of freedom (DoFs) and their combinations. A linear regression model was used to offline predict hand kinematics from the US (or sEMG, for comparison) features. The method was further validated in real-time for a 3-DoF target reaching task. Results: In the offline analysis, the wearable US system achieved an average R2 of 0.94 in the prediction of four DoFs of the wrist and hand while sEMG reached a performance of R2=0.06 . In online control, the participants achieved an average 93% completion rate of the targets. Conclusion: When tailored for HMIs, the proposed US A-mode system and processing pipeline can successfully regress hand kinematics both in offline and online settings with performances comparable or superior to previously published interfaces. Significance: Wearable US technology may provide a new generation of HMIs that use muscular deformation to estimate limb movements. The wearable US system allowed for robust proportional and simultaneous control over multiple DoFs in both offline and online settings

Intra-Host Evolution Analyses in an Immunosuppressed Patient Supports SARS-CoV-2 Viral Reservoir Hypothesis.

Throughout the SARS-CoV-2 pandemic, several variants of concern (VOCs) have been identified, many of which share recurrent mutations in the spike glycoprotein's receptor-binding domain (RBD). This region coincides with known epitopes and can therefore have an impact on immune escape. Protracted infections in immunosuppressed patients have been hypothesized to lead to an enrichment of such mutations and therefore drive evolution towards VOCs. Here, we present the case of an immunosuppressed patient that developed distinct populations with immune escape mutations throughout the course of their infection. Notably, by investigating the co-occurrence of substitutions on individual sequencing reads in the RBD, we found quasispecies harboring mutations that confer resistance to known monoclonal antibodies (mAbs) such as S:E484K and S:E484A. These mutations were acquired without the patient being treated with mAbs nor convalescent sera and without them developing a detectable immune response to the virus. We also provide additional evidence for a viral reservoir based on intra-host phylogenetics, which led to a viral substrain that evolved elsewhere in the patient's body, colonizing their upper respiratory tract (URT). The presence of SARS-CoV-2 viral reservoirs can shed light on protracted infections interspersed with periods where the virus is undetectable, and potential explanations for long-COVID cases