The Effect of Stem Surface Treatment and Substrate Material on Joint Replacement Stability: An In-Vitro Investigation into the Stem-Cement Interface Mechanics under Various Loading Modes

Mechanical loosening is a common mode of joint replacement failure. For cemented implants, loosening at the implant-cement interface may be affected by stem surface design. Altering the surface topography facilitates the infiltration of bone cement onto the stem, creating a mechanical interlock, improving interface stability. However, few in-vitro studies have investigated this. Therefore, the purpose of this thesis was to investigate the effect of stem surface treatments and substrate materials on stem-cement interface stability in-vitro. Four separate studies were performed to assess the stability of various stem surface treatments, with two substrate materials, under three loading modes. Titanium and cobalt chrome implant stems were custom machined and treated with one of four surfaces: smooth, sintered beads, plasma spray, and circumferential grooves. Sintered bead and plasma sprayed stems were tested in independent torsion, compression and bending; circumferential groove designs were compared in torsion and then compression. All stems were potted in aluminum tubes using PMMA, and loaded cyclically using a materials testing machine. A custom optical tracking system (resolution under 5 μm) was validated for use, and subsequently employed to measure stem-cement interface motion during loading. Overall, results showed surface treatments improved stability, but this was affected by substrate material. Across all loading modes, beaded treatments applied to titanium stems, and plasma spray treatments applied to cobalt chrome stems, improved interface stability and strength when large surface treatment areas were employed. Additionally, the machining of circumferential grooves onto the stem surface improved interface strength in compression, with no influence in torsion. A final study was performed using μ-CT imaging to observe stem and cement motion under bending loads. A custom-built loading device applied static loads to smooth titanium stems, while acquiring CT images of the stem-cement interface. Interface motion was quantified by comparing scans before and after the stem underwent cyclic loading. Results indicated the stem and the surrounding cement had displaced following loading, yet the stems remained relatively stable. These studies offer valuable information regarding the effect of stem surface treatments on stem-cement interface mechanics under various loading modes and will be used in the development of future implant systems

A novel technique for measurement of orthodontic mini-implant stability using the Osstell ISQ device

© 2019 by The EH Angle Education and Research Foundation, Inc. Objectives: To develop and validate a method for application of the Osstell ISQ device in the assessment of mini-implant stability. Materials and Methods: An adaptor was developed for attachment of Osstell\u27s SmartPeg onto a variety of orthodontic mini-implants. For validation of the adaptor, Benefit mini-implants were inserted into bone blocks that mimicked different stability conditions. The Osstell device was used to assess mini-implant stability with the adaptor (test measurement) and conventional SmartPeg attachment (gold-standard measurement). Implant stability quotient (ISQ) values were assessed for agreement, repeatability, and reproducibility. Results: Strong positive correlations were found between ISQ values obtained using the novel adaptor and the conventional attachment. Repeatability and reproducibility of ISQ values with the adaptor were similar to those obtained with the conventional attachment. Conclusions: A method was developed and validated to assess the stability of orthodontic mini-implants using the Osstell system. The novel mini-implant adaptor provided repeatable and reproducible measurements of mini-implant stability, which agreed with those obtained using a conventional SmartPeg attachment. This adaptor permits noninvasive stability assessment of various designs of mini-implants, most of which are incompatible with the conventional SmartPeg attachment

Transcription of toll-like receptors 2, 3, 4 and 9, FoxP3 and Th17 cytokines in a susceptible experimental model of canine Leishmania infantum infection

Canine leishmaniosis (CanL) due to Leishmania infantum is a chronic zoonotic systemic disease resulting from complex interactions between protozoa and the canine immune system. Toll-like receptors (TLRs) are essential components of the innate immune system and facilitate the early detection of many infections. However, the role of TLRs in CanL remains unknown and information describing TLR transcription during infection is extremely scarce. The aim of this research project was to investigate the impact of L. infantum infection on canine TLR transcription using a susceptible model. The objectives of this study were to evaluate transcription of TLRs 2, 3, 4 and 9 by means of quantitative reverse transcription polymerase chain reaction (qRT-PCR) in skin, spleen, lymph node and liver in the presence or absence of experimental L. infantum infection in Beagle dogs. These findings were compared with clinical and serological data, parasite densities in infected tissues and transcription of IL-17, IL-22 and FoxP3 in different tissues in non-infected dogs (n = 10), and at six months (n = 24) and 15 months (n = 7) post infection. Results revealed significant down regulation of transcription with disease progression in lymph node samples for TLR3, TLR4, TLR9, IL-17, IL-22 and FoxP3. In spleen samples, significant down regulation of transcription was seen in TLR4 and IL-22 when both infected groups were compared with controls. In liver samples, down regulation of transcription was evident with disease progression for IL-22. In the skin, upregulation was seen only for TLR9 and FoxP3 in the early stages of infection. Subtle changes or down regulation in TLR transcription, Th17 cytokines and FoxP3 are indicative of the silent establishment of infection that Leishmania is renowned for. These observations provide new insights about TLR transcription, Th17 cytokines and Foxp3 in the liver, spleen, lymph node and skin in CanL and highlight possible markers of disease susceptibility in this model

Fracture resistance of commonly used self-drilling orthodontic mini-implants

© 2015 by The EH Angle Education and Research Foundation, Inc. Objective: To investigate the fracture resistance of six commonly used self-drilling orthodontic mini-implants by comparing their respective fracture torques during insertion. Materials and Methods: Ninety self-drilling mini-implants from six manufacturers (Aarhus, Dual Top, OrthoEasy, Tomas-pin, Unitek, and VectorTAS), with diameters ranging from 1.4 to 1.8 mm, were inserted into acrylic blocks using a custom-made insertion device. Insertion torques were measured using a 6-degree-of-freedom load cell fixed to the base of the acrylic blocks, and peak torques experienced at the time of fracture for each of the mini-implants were recorded. One-way analysis of variance (a 5 .05) was used to compare the fracture torques among the six different groups. Results: Statistical analysis revealed significant differences (P \u3c .05) in the peak fracture torques among mini-implant groups. Mean fracture torques ranked as follows: Unitek (72 Ncm) . Tomaspin (36 Ncm) . Dual-Top (32 Ncm) \u3c VectorTAS (31 Ncm) . OrthoEasy (28 Ncm) . Aarhus (25 Ncm), with significant differences found between all manufacturers, except for Dual-Top and VectorTAS. Conclusions: Mini-implants tested showed a wide range of torque at fracture depending on the manufacturer, with only a weak correlation between mini-implant diameter and fracture resistance. This torque should be considered at the time of mini-implant insertion to minimize the risk of implant fracture, especially in areas of high-density bone without predrilling

Insertion torques of self-drilling mini-implants in simulated mandibular bone: Assessment of potential for implant fracture

© 2016 by Quintessence Publishing Co Inc. Purpose: Fracture of orthodontic mini-implants during insertion is a limiting factor for their clinical success. The purpose of this study was to determine the fracture potential of commonly used self-drilling orthodontic mini-implants when placed into simulated thick, dense mandibular bone. Materials and Methods: Six mini-implant systems were assessed for the potential for fracture (Aarhus, Medicon; Dual-Top, Jeil Medical; OrthoEasy, Forestadent; tomas-pin, Dentaurum; Unitek, 3M; and VectorTAS, Ormco). First, mini-implants were inserted manually, without predrilling, into bone substitutes (Sawbones) with a 3-mm-thick, dense (1.64 g/cm3) cortical layer. A custom-made insertion device was used for placement of mini-implants. A sixaxis force/torque transducer was secured at the base of the bone blocks to measure the maximum torque experienced during insertion. Measured insertion torques were compared with previously reported fracture torques, yielding a torque ratio (insertion torque as a percentage of fracture torque), which was used as an indicator of the potential for mini-implant fracture. Mini-implants that experienced torque ratios ≥ 75% upon insertion underwent further testing, following the manufacturer\u27s recommendations for predrilling in thick, dense bone conditions. Results: Significant differences in torque ratios were found among all mini-implants, except between OrthoEasy and Dual-Top, and OrthoEasy and VectorTAS. Overall, Aarhus had the highest torque ratio (91% ± 3%), with Unitek showing the lowest ratio (37% ± 3%). Aarhus and tomas-pin mini-implants displayed torque ratios ≥ 75% and experienced fracture upon insertion. When the manufacturer\u27s specific predrilling recommendations were followed, no changes in torque ratio were found for Aarhus and tomas-pin. However, while Aarhus continued to fracture upon insertion, all tomas-pin mini-implants were inserted fully without fracture following predrilling. Conclusion: These findings support the safe use of Unitek, VectorTAS, Dual-Top, and OrthoEasy self-drilling mini-implants in areas of 3-mm-thick, 1.64 g/cm3 dense cortical bone without predrilling. Following predrilling, fractures did not occur with tomas-pin. For implants that continued to fracture after predrilling, other strategies may be required, such as the use of larger-diameter mini-implants in thick, dense bone conditions

A Comparison of the Mechanical Measures Used for Assessing Orthodontic Mini-Implant Stability

© 2016 Wolters Kluwer Health, Inc. All rights reserved. Purpose: Mechanical loosening remains a common complication associated with mini-implant failure. The purpose of this study was to compare common mechanical measures of mini-implant stability to determine their association and reliability. Materials and Methods: Ninety self-drilling orthodontic mini-implants from 6 manufacturers were inserted into artificial bone blocks. Insertion torques (ITs) and Periotest values (PVs) were measured. Subsequently, mini-implants underwent pull-out testing for measures of pull-out load (POL) and screw displacement (ScrD). Stability measurements were compared using one-way ANOVA, associations among them were assessed using correlation analyses, and reliability was evaluated using coefficients of variation (COVs). Results: Variations in stability of mini-implants were found, specific to the mechanical measure used for assessment (P \u3c 0.05). The strongest correlations were found between IT and PV (r =-0.68) and between IT and POL (r = 0.66). Overall, PV showed the greatest variability (COV: 11%-100%) compared with IT (≤11%), POL (≤4%), and ScrD (≤19%). Conclusions: IT, PV, and POLs only agreed moderately in their assessment of mini-implant stability, and Periotest showed the least reliability in predicting mini-implant stability. As such, independent and interchangeable use of these stability measures should be avoided

In-vitro comparison of different palatal sites for orthodontic miniscrew insertion: Effect of bone quality and quantity on primary stability

Introduction: This experiment was undertaken to assess the primary stability of orthodontic miniscrews inserted at different sites in human cadaveric palatal bone for temporary skeletal anchorage, and to determine the effect of bone quality and quantity on their primary stability using microcomputed tomography imaging. Methods: A total of 10 cadaveric maxillary hard palates were used for insertion of 130 orthodontic miniscrews (VectorTAS; Ormco, Orange, Calif; length, 6 mm; diameter, 1.4 mm). Upon insertion, maximal insertion torque (IT) was recorded. Imaging (microcomputed tomography) was performed before and after insertion for assessment of bone quality and quantity parameters (bone mineral density [BMD], bone thickness [BT], and length of screw engagement [LSE]). Differences in each parameter were assessed at the various insertion sites. Correlations between IT and measurements of BMD, BT, and LSE were evaluated. Results: Significant differences (P \u3c 0.001) were found among insertion sites for IT, BT, and LSE, but not for BMD (P = 0.004). Correlations were found between IT and BMD (r(s) = 0.42; P \u3c 0.001), IT and BT (r(s) = 0.58; P \u3c 0.001), and IT and LSE (r(s) = 0.58; P \u3c 0.001). Most perforations of miniscrews into the nasal cavity occurred posterior to the permanent second premolars. Conclusion: The primary stability of orthodontic miniscrews in the palate is affected by bone quality and quantity, with higher primary stability obtained anterior to the second premolars and parasagittally at the level of the permanent first molars

In vitro corrosion and biocompatibility behavior of CoCrMo alloy manufactured by laser powder bed fusion parallel and perpendicular to the build direction

Biomedical cobalt-chromium-molybdenum alloys (CoCrMo) are frequently used for orthopedic implant and dental materials exposed to mechanical stressors, such as wear and cyclic load. Due to the high demand for customizable implant shapes, these alloys are increasingly manufactured by additive manufacturing methods such as laser powder bed fusion (LPBF). LPBF results in different microstructures and surface roughness as a function of the building direction. This study investigated the corrosion resistance, bioactivity, biocompatibility, and microstructure of LPBF CoCrMo (low carbon content, heat-treated) in the XY (perpendicular) and XZ (parallel) plane of the building direction for as-printed (as-received) and abraded surfaces. A distinct microstructure and different surface roughness were found for the XY and XZ planes. The as-received XY surface showed the lowest corrosion resistance but was still passive in phosphate-buffered saline (PBS, pH 7.4). As-received surfaces were less corrosion-resistant than abraded surfaces. All specimens exhibited lower corrosion resistance in PBS containing citric acid at pH 7.4 than in PBS and citric acid alone. As-received surfaces showed better hydroxyapatite precipitation and cell viability; however, all surfaces had satisfactory biocompatibility and bioactivity. This study showed that the building direction had a minor effect on the corrosion of LPBF CoCrMo