Finite Element Simulation and Additive Manufacturing of Stiffness-Matched NiTi Fixation Hardware for Mandibular Reconstruction Surgery

Process parameters and post-processing heat treatment techniques have been developed to produce both shape memory and superelastic NiTi using Additive Manufacturing. By introducing engineered porosity, the stiffness of NiTi can be tuned to the level closely matching cortical bone. Using additively manufactured porous superelastic NiTi, we have proposed the use of patient-specific, stiffness-matched fixation hardware, for mandible skeletal reconstructive surgery. Currently, Ti-6Al-4V is the most commonly used material for skeletal fixation devices. Although this material offers more than sufficient strength for immobilization during the bone healing process, the high stiffness of Ti-6Al-4V implants can cause stress shielding. In this paper, we present a study of mandibular reconstruction that uses a dry cadaver mandible to validate our geometric and biomechanical design and fabrication (i.e., 3D printing) of NiTi skeletal fixation hardware. Based on the reference-dried mandible, we have developed a Finite Element model to evaluate the performance of the proposed fixation. Our results show a closer-to-normal stress distribution and an enhanced contact pressure at the bone graft interface than would be in the case with Ti-6Al-4V off-the-shelf fixation hardware. The porous fixation plates used in this study were fabricated by selective laser melting

Selective Laser Melting of Ni-Rich NiTi: Selection of Process Parameters and the Superelastic Response

Material and mechanical properties of NiTi shape memory alloys strongly depend on the fabrication process parameters and the resulting microstructure. In selective laser melting, the combination of parameters such as laser power, scanning speed, and hatch spacing determine the microstructural defects, grain size and texture. Therefore, processing parameters can be adjusted to tailor the microstructure and mechanical response of the alloy. In this work, NiTi samples were fabricated using Ni50.8Ti (at.%) powder via SLM PXM by Phenix/3D Systems and the effects of processing parameters were systematically studied. The relationship between the processing parameters and superelastic properties were investigated thoroughly. It will be shown that energy density is not the only parameter that governs the material response. It will be shown that hatch spacing is the dominant factor to tailor the superelastic response. It will be revealed that with the selection of right process parameters, perfect superelasticity with recoverable strains of up to 5.6% can be observed in the as-fabricated condition

Influence of SLM on Compressive Response of NiTi Scaffolds

Porous Nickel-Titanium shape memory alloys (NiTi-SMAs) have attracted much attention in biomedical applications due to their high range of pure elastic deformability (i.e., superelasticity) as well as their bone-level modulus of elasticity (E≈12-20 GPa). In recent years, Selective Laser Melting (SLM) has been used to produce complex NiTi components. The focus of this study is to investigate the superelasticity and compressive properties of SLM NiTi-SMAs. To this aim, several NiTi components with different level of porosities (32- 58%) were fabricated from Ni50.8Ti (at. %) powder via SLM PXM by Phenix/3D Systems, using optimum processing parameter (Laser power-P=250 W, scanning speed-v=1250mm/s, hatch spacing-h=120μm, layer thickness-t=30μm). To tailor the superelasticity behavior at body temperature, the samples were solution annealed and aged for 15 min at 350°C. Then, transformation temperatures (TTs), superelastic response, and cyclic behavior of NiTi samples were studied. As the porosity was increased, the irrecoverable strain was observed to be higher in the samples. At the first superelastic cycle, 3.5%, 3.5%, and 2.7% strain recovery were observed for the porosity levels of 32%, 45%, and 58%, respectively. However, after 10 cycles, the superelastic response of the samples was stabilized and full strain recovery was observed. Finally, the modulus of elasticity of dense SLM NiTi was decreased from 47 GPa to 9 GPa in the first cycle by adding 58% porosity

Additive Manufacturing of NiTiHf High Temperature Shape Memory Alloy

Additive manufacturing of a NiTi-20Hf high temperature shape memory alloy (HTSMA) was investigated. A selective laser melting (SLM) process by Phenix3D Systems was used to develop components from NiTiHf powder (of approximately 25-75 m particle fractions), and the thermomechanical response was compared to the conventionally vacuum induction skull melted counterpart. Transformation temperatures of the SLM material were found to be slightly lower due to the additional oxygen pick up from the gas atomization and melting process. The shape memory response in compression was measured for stresses up to 500 MPa, and transformation strains were found to be very comparable (Up to 1.26 for the as-extruded; up to 1.52 for SLM)

Achieving Superelasticity in Additively Manufactured NiTi in Compression Without Post-Process Heat Treatment

Shape memory alloys (SMAs), such as Nitinol (i.e., NiTi), are of great importance in biomedical and engineering applications due to their unique superelasticity and shape memory properties. In recent years, additive manufacturing (AM) processes have been used to produce complex NiTi components, which provide the ability to tailor microstructure and thus the critical properties of the alloys, such as the superelastic behavior and transformation temperatures (TTs), by selection of processing parameters. In biomedical applications, superelasticity in implants play a critical role since it gives the implants bone-like behavior. In this study, a methodology of improving superelasticity in Ni-rich NiTi components without the need for any kind of post-process heat treatments will be revealed. It will be shown that superelasticity with 5.62% strain recovery and 98% recovery ratio can be observed in Ni-rich NiTi after the sample is processed with 250 W laser power, 1250 mm/s scanning speed, and 80 µm hatch spacing without, any post-process heat treatments. This superelasticity in as-fabricated Ni-rich SLM NiTi was not previously possible in the absence of post-process heat treatments. The findings of this study promise the fast, reliable and inexpensive fabrication of complex shaped superelastic NiTi components for many envisioned applications such as patient-specific biomedical implants

Global variations in diabetes mellitus based on fasting glucose and haemogloblin A1c

Fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) are both used to diagnose diabetes, but may identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening had elevated FPG, HbA1c, or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardised proportion of diabetes that was previously undiagnosed, and detected in survey screening, ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the agestandardised proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global gap in diabetes diagnosis and surveillance.peer-reviewe

Fixation Release and the Bone Bandaid: A New Bone Fixation Device Paradigm

The current gold standard of care for mandibular segmental defeat reconstruction is the use of Ti-6Al-4V immobilization hardware and fibular double barrel graft. This method is often successful immediately at restoring mandible function, however the highly stiff fixation hardware causes stress shielding of the grafted bone and stress concentration in the fixation device over time which can lead to fixation device failure and revision surgery. The purpose of reconstructive surgery could be to create normal stress trajectories in the mandible following engraftment. We investigate the use of a two stage mechanism which separates the immobilization/healing and regenerative phases of mandibular segmental defect treatment. The device includes the use of a very stiff, Ti-6Al-4V, releasable mechanism which assures bone healing. Therefore it could be released once the reconstructed boney tissue and any of its ligamentous attachments have completely healed. Underneath the released Ti-6Al-4V plate would be a pre-loaded nitinol (NiTi) wire-frame apparatus that facilitates the normal stress-strain trajectory through the engrafted bone after the graft is healed in place and the Ti-6Al-4V fixation device has been released. Due to the use of NiTi wires forming a netting that connects vascularized bone and possibly bone chips, bone grafts are also more likely to be incorporate rather than to resorb. We first evaluated a healthy adult mandible during normal mastication to obtain the normal stress-strain distribution. Then, we developed the finite element (FE) model of the mandibular reconstruction (in the M1-3 region) with the proposed fixation device during the healing (locked state) and post-healing (released state) periods. To recreate normal stress trajectory in the reconstructed mandible, we applied the Response Surface Methodology (RMS) to optimize the Bone Bandaid geometry (i.e., wire diameters and location). The results demonstrate that the proposed mechanism immobilizes the grafted bone in the locked state properly since the maximum resultant gap (21.54 micron) between the graft and host mandible surfaces are in the safe region (less than 300 micron). By considering the von Mises criteria for failure, FE analysis together with experimental studies (i.e., compressive and tensile testing on the inferior and superior fixation devices, respectively) confirm that the proposed fixation devices do not fail, showing safety factor of at least 10.3. Based on the Response Surface Methodology (RSM) technique, the optimal parameter values for the wires are achieved (0.65 mm and 1 mm for the superior and inferior wires, respectively) and the required level of preload on each wire are calculated (369.8 N and 229 N for the inferior and superior wires, respectively). The FE results for stress distribution on the reconstructed mandible during the released state closely match that of a healthy mandible

Application of the Superelastic NiTi Spring in Ankle Foot Orthosis (AFO) to Create Normal Ankle Joint Behavior

Hinge-based Ankle Foot Orthosis (HAFO) is one of the most common non-surgical solutions for the foot drop. In conventional HAFOs, the ankle joint is almost locked, and plantar flexion is restricted due to the high stiffness of the hinge mechanism. This often leads to a rigid walking gate cycle, poor muscle activity, and muscle atrophy. Since the ankle torque-angle loop has a non-linear profile, the use of a superelastic NiTi spring within the hinge, due to its nonlinear behavior, could recreate a close-to-normal stiffness of the normal ankle joint, which, in turn, could create a more natural walk. The focus of this study is to evaluate the performance of a superelastic NiTi spring versus a conventional Stainless Steel spring in a hinge mechanism of a custom-fit HAFO. To this aim, a custom-fit HAFO was fabricated via the fast casting technique. Then, motion analysis was performed for two healthy subjects (Case I and Case II): (i) subjects with bare foot; (ii) subjects wearing a conventional HAFO with no spring; (iii) subjects wearing a conventional Stainless Steel-based HAFO; and (iv) subjects wearing a NiTi spring-based HAFO. The data related to the ankle angle and the amount of moment applied to the ankle during walking were recorded using Cortex software and used for the evaluations. Finally, Finite Element Analysis (FEA) was performed to evaluate the safety of the designed HAFO. The NiTi spring offers a higher range of motion (7.9 versus 4.14 degree) and an increased level of moment (0.55 versus 0.36 N·m/kg). Furthermore, a NiTi spring offers an ankle torque-angle loop closer to that of the healthy subjects

In Vitro Corrosion Assessment of Additively Manufactured Porous NiTi Structures for Bone Fixation Applications

NiTi alloys possess distinct functional properties (i.e., shape memory effect and superelasticity) and biocompatibility, making them appealing for bone fixation applications. Additive manufacturing offers an alternative method for fabricating NiTi parts, which are known to be very difficult to machine using conventional manufacturing methods. However, poor surface quality, and the presence of impurities and defects, are some of the major concerns associated with NiTi structures manufactured using additive manufacturing. The aim of this study is to assess the in vitro corrosion properties of additively manufactured NiTi structures. NiTi samples (bulk and porous) were produced using selective laser melting (SLM), and their electrochemical corrosion characteristics and Ni ion release levels were measured and compared with conventionally fabricated NiTi parts. The additively manufactured NiTi structures were found to have electrochemical corrosion characteristics similar to those found for the conventionally fabricated NiTi alloy samples. The highest Ni ion release level was found in the case of 50% porous structures, which can be attributed to their significantly higher exposed surface area. However, the Ni ion release levels reported in this work for all the fabricated structures remain within the range of most of values for conventionally fabricated NiTi alloys reported in the literature. The results of this study suggest that the proposed SLM fabrication process does not result in a significant deterioration in the corrosion resistance of NiTi parts, making them suitable for bone fixation applications

Predicting the Biodegradation of Magnesium Alloy Implants: Modeling, Parameter Identification, and Validation

Magnesium (Mg) and its alloys can degrade gradually up to complete dissolution in the physiological environment. This property makes these biomaterials appealing for different biomedical applications, such as bone implants. In order to qualify Mg and its alloys for bone implant applications, there is a need to precisely model their degradation (corrosion) behavior in the physiological environment. Therefore, the primary objective develop a model that can be used to predict the corrosion behavior of Mg-based alloys in vitro, while capturing the effect of pitting corrosion. To this end, a customized FORTRAN user material subroutine (or VUMAT) that is compatible with the finite element (FE) solver Abaqus/Explicit (Dassault Systèmes, Waltham, MA, USA) was developed. Using the developed subroutine, a continuum damage mechanism (CDM) FE model was developed to phenomenologically estimate the corrosion rate of a biocompatible Mg⁻Zn⁻Ca alloy. In addition, the mass loss immersion test was conducted to measure mass loss over time by submerging Mg⁻Zn⁻Ca coupons in a glass reactor filled with simulated body fluid (SBF) solution at pH 7.4 and 37 °C. Then, response surface methodology (RSM) was applied to calibrate the corrosion FE model parameters (i.e., Gamma (γ), Psi (ψ), Beta (β), and kinetic parameter (Ku)). The optimum values for γ, ψ, β and Ku were found to be 2.74898, 2.60477, 5.1, and 0.1005, respectively. Finally, given the good fit between FE predictions and experimental data, it was concluded that the numerical framework precisely captures the effect of corrosion on the mass loss over time