A model study on flapless implant placement by clinicians with a different experience level in implant surgery

Introduction: Some implant companies advocate that flapless surgery is easy to perform and beneficial for aesthetics and patients morbidity. However, studies objectively analyzing the position in the bone of implants installed with this approach are lacking. This in vitro model study was performed to analyse deviations in position and inclination of implants placed with flapless surgery compared with the ideally planned position and to examine whether the outcome is affected by experience level. Methods: Identical radio-opaque resin models were developed with a silicon lining mimicking the soft tissues and six edentulous single tooth spaces. Eighteen clinicians (six periodontists, six general dentists and six students) drilled four implant sites each (Straumann AG, Basel, Switzerland) with a flapless approach. Corresponding CT-scan images of the models were available. A virtual implant program (Simplant, Materialise NV, Leuven, Belgium) was used to plan the ideal position and to compare this with the implant angulation and position of the test implants. Results: There were no significant differences between the experience groups for all parameters except for global deviations between dentist and students, angle deviations between dentists and students and horizontal deviations between specialists and students. In incisor sites, specialists and students deviated significantly more in global deviation and depth than dentists. In premolar and molar sites, there were no significant differences except for horizontal deviations between specialists and dentists in molar sites. As a consequence of the malpositioning, perforations were seen in 59.7% (43/72) of the implant occasions when the artificial mucosa was removed from the model. Conclusions:The three-dimensional location of implants installed with flapless approach differs significantly from the ideal, although neighbouring teeth were present and maximal radiographical information was available. Within the limitations of this in vitro model study it seems necessary to point out that these deviations would in a clinical situation lead to complications such as loss of implant stability, aesthetical and phonetical consequences. The outcome is not influenced by the level of experience with implant surgery. This points out that more precise measurements of soft tissue in situ or additional use of guiding systems are recommendable

Validation of the coupling of magnetic resonance imaging velocity measurements with computational fluid dynamics in a U bend.

Magnetic resonance imaging (MRI) can be used in vivo in combination with computational fluid dynamics (CFD) to derive velocity profiles in space and time and accordingly, pressure drop and wall shear stress distribution in natural or artificial vessel segments. These hemodynamic data are difficult or impossible to acquire directly in vivo. Therefore, research has been performed combining MRI and CFD for flow simulations in flow phantoms, such as bends or anastomoses, and even in human vessels such as the aorta, the carotid, and the abdominal bifurcation. There is, however, no unanimity concerning the use of MRI velocity measurements as input for the inflow boundary condition of a CFD simulation. In this study, different input possibilities for the inflow boundary conditions are compared. MRI measurements of steady and pulsatile flow were performed on a U bend phantom, representing the aorta geometry. PAMFLOW (ESI Software, Krimpen aan den Ussel, The Netherlands), an industrial CFD software package, was used to solve the Navier-Stokes equations for incompressible flow. Three main parameters were found to influence the choice of an inflow boundary condition type. First, the flow rate through a vessel should be exact, since it proves to be a determining factor for the accuracy of the velocity profile. The other decisive parameters are the physiology of the flow profile and the required computer processing unit time. Our comparative study indicates that the best way to handle an inflow boundary condition is to use the velocities measured by MRI at the inflow plane as being fixed velocities. However, before using these MRI velocity data, they first should be corrected for the partial volume effect by filtering and second scaled in order to obtain the correct flow rate. This implies that a reliable flow rate measurement absolutely is needed for CFD calculations based on MRI velocity measurements

Ultrasound-based CFD for hemodynamics: a reproducibility study

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Accuracy and reproducibility of CFD predicted wall shear stress using 3D ultrasound images

Computational fluid dynamics (CFD) flow simulation techniques have the potential to enhance our understanding of how haemodynamic factors are involved in atherosclerosis. Recently, 3D ultrasound has emerged as an alternative to other 3D imaging techniques, such as magnetic resonance angiography (MRA). The method can be used to generate realistic vascular geometry suitable for CFD simulations. In order to assess accuracy and reproducibility of the procedure from image acquisition to reconstruction to CFD simulation, a human carotid artery bifurcation phantom was scanned three times using 3D ultrasound. The geometry was reconstructed and flow simulations were carried out on the three sets as well as on a model generated using computer aided design (CAD) from the geometric information given by the manufacturer It was found that the three reconstructed sets showed good reproducibility as well as satisfactory quantitative agreement with the CAD model. Analyzing two selected locations probably representing the 'worst cases,' accuracy comparing ultrasound and CAD reconstructed models was estimated to be between 7.2% and 7.7% of the maximum instantaneous WSS and reproducibility comparing the three scans to be between 8.2% and 10.7% of their average maximum