Search Results (115)

Background: Calvarial defects in NF1 are rare and lack standardized management guidelines. This study seeks to shed light on calvarial defects in NF1 patients with extensive skull erosion. Methods: This case report focuses on clinical and radiological presentations and surgical interventions during six years of follow-up, comparing the results with those in the literature. Results: A five-year-old female with NF1 disease was diagnosed with a spontaneous calvarial defect in the occipital region and an arachnoid cyst underneath. The lesion enlarged progressively over the years and at the age of nine, she underwent her first surgery. Our surgery team performed a cranioplasty using a split-thickness bone graft harvested from the parietal bone after cyst decompression. Two years later, she underwent revision surgery with a titanium mesh plate due to total resorption of the initial bone graft and unsuccessful closure of the large defect. Conclusions: Calvaria defects are a relatively unknown aspect of NF1, and no standard treatment exists. Their management requires a personalized approach, considering factors like lesion size, and the potential for multiple interventions throughout the patient’s lifetime. Due to their progressive nature and the possibility of additional lesions, long-term follow-up is crucial for effective monitoring and intervention planning. Full article

Background and Clinical Significance: Currently, maxillary sinus floor elevation is one of the most common procedures used in implantology practice. Despite its predictability, the technique is not without complications, such as graft material dispersion in the sinus cavity, wound dehiscence, hematoma, fenestrations, oroantral fistulas, epistaxis, acute sinusitis, and Schneider membrane perforations. The treatment of the latter can be complex, and depending on its extent, surgery deferral may be necessary, leading to increased patient morbidity. Case Presentation: A patient with apical surgery underwent sinus floor elevation with a significant Schneider membrane perforation using a new approach involving titanium mesh, resorbable membrane, and xenograft. This allowed the continuation of surgery, reducing the number of interventions and patient morbidity. Conclusions: Despite limitations due to a small sample size, this case report demonstrates that addressing large Schneider membrane perforations and placing implants is effective and predictable using the technology and approach of mesh formwork with titanium. Full article

Reconstructing the orbit following complex craniofacial fractures presents significant challenges. Throughout the years, several materials have been used for orbital reconstruction, taking into account factors such as their durability, compatibility with living tissue, cost efficiency, safety, and capacity to be adjusted during surgery. Nevertheless, a consensus has not yet been reached on the optimal material for orbital restoration. This study investigates the potential of a hybrid hydroxyapatite–collagen (HAp-COL) material 3D-printed on Ti mesh to be used as an implant for orbital wall reconstruction. HAp-COL powder was synthesized using a high-pressure hydrothermal technique. The powder was further used to 3D-print HAp-COL structures on titanium mesh, with the latter having potential uses in orbital wall reconstruction. Biocompatibility was assessed by evaluating the effects of the HAp-COL material on the adhesion and proliferation of fibroblasts (3T3) and mesenchymal stem cells (MSCs) in culture. In vitro and in vivo results showed that HAp-COL is highly biocompatible and has a good integration of the implant in the bone. The findings reported in this study offer convincing evidence to support the use of our designed HAp-COL for the restoration of orbital wall fractures, with a high level of safety. Full article

Background/Objectives: The rising incidence of breast cancer has led to more mastectomies and increased demand for reconstruction. While retropectoral reconstruction with expanders is common, it has complications like postoperative pain and animation deformity. Prepectoral reconstruction, aided by advancements in biological and synthetic meshes, offers a promising alternative. Methods: This study prospectively evaluated the “Prepectoral Breast Reconstruction Assessment Score” on 20 patients undergoing mastectomy at Policlinico Umberto I, Rome, from July 2022 to February 2024. Patients with scores between 5 and 8 were included. The procedure involved the use of ADM (Acellular Dermal Matrix) or titanium-coated polypropylene mesh, followed by postoperative expansions and final implant placement after six months. Results: The mean age of patients was 51.85 years, with a mean BMI of 24.145 kg/m². ADM was used in 15 cases and synthetic mesh in 5. Complications were one exposure of the expander, one superficial skin necrosis and one seroma. Statistical analysis showed a trend toward fewer complications with higher scores, though this was not statistically significant (p-value = 0.139). Conclusions: Prepectoral reconstruction with expanders is a viable option, offering benefits such as reduced operating time, better volume control, and a more natural breast contour compared to the retropectoral approach. Although the trend suggests fewer complications with higher assessment scores, further studies with larger samples are needed for confirmation. Full article

Introduction: The choice of prosthesis for vertebral body reconstruction (VBR) remains a controversial issue due to the lack of a reliable solution. The subsidence rate of the most commonly used titanium mesh cages (TMC) ranges from 42.5% to 79.7%. This problem is primarily caused by the differences in the elastic modulus between the TMC and bone. This review aims to summarize the clinical and radiological outcomes of new 3D-printed artificial vertebral bodies (3DP AVB). Methods: A literature search of PubMed, Scopus and Google Scholar was conducted to extract relevant studies. After screening the titles and abstracts, a total of 50 articles were selected for full-text analysis. Results: Preliminary data suggest fewer implant-related complications with 3DP AVB. Most comparative studies indicate significantly lower subsidence rates, reduced operation times and decreased intraoperative blood loss. However, the scarcity of randomized clinical trials and the high variability of the results warrant caution. Conclusion: Most literature data show an advantage of 3DP AVB in terms of the operation time, intraoperative blood loss and subsidence rate. However, long manufacturing times, high costs and regulatory issues are this technology’s main drawbacks. Full article

Background: The new frontiers of computer-based surgery, technology, and material advances, have allowed for customized 3D printed manufacturing to become widespread in guided bone regeneration (GBR) in oral implantology. The shape, structural, mechanical, and biological manufacturing characteristics achieved through 3D printing technologies allow for the customization of implant-prosthetic rehabilitations and GBR procedures according to patient-specific needs, reducing complications and surgery time. Therefore, the present narrative review aims to elucidate the 3D-printing digital radiographic process, materials, indications, 3D printed manufacturing-controlled characteristics, histological findings, complications, patient-reported outcomes, and short- and long-term clinical considerations of customized 3D printed mesh, membranes, bone substitutes, and dental implants applied to GBR in oral implantology. Methods: An electronic search was performed through MEDLINE/PubMed, Scopus, BioMed Central, and Web of Science until 30 June 2024. Results: Three-dimensionally printed titanium meshes and bone substitutes registered successful outcomes in vertical/horizontal bone defect regeneration. Three-dimensionally printed polymeric membranes could link the advantages of conventional resorbable and non-resorbable membranes. Few data on customized 3D printed dental implants and abutments are available, but in vitro and animal studies have shown new promising designs that could improve their mechanical properties and tribocorrosion-associated complications. Conclusions: While 3D printing technology has demonstrated potential in GBR, additional human studies are needed to evaluate the short- and long-term follow-up of peri-implant bone levels and volumes following prosthetic functional loading. Full article

This study investigated the effect of abrasive water jet (AWJ) kinematic parameters, such as jet traverse speed and water pressure, abrasive mass flow rate, and standoff distance on the surface of BK7. Nozzle A reinforced with a 100 nm particle-sized coating of titanium alloy has more wear resistance compared to Nozzle B coated with nothing. Through analysis of variance and measurement of BK7 surface quality, it is concluded that the grooving and plowing caused by abrasive particles and irregularities in the abrasive water jet machined surface with respect to traverse speed (3, 7.2, 7.8, and 9 mm/min), abrasive flow rate (7 L/min and 10 L/min, 80 mesh) and water pressure (2 and 3 MPa) were investigated using surface topography measurements. The surface roughness (15.734 nm) of BK7 results show that a nozzle coated with titanium alloy has more hardness, which protects BK7 undamaged and super-smooth. The values of selected surface roughness profile parameters—average roughness (Ra) and maximum height of PV (maximum depth of peak and valleys)—reveal a comparatively smooth BK7 surface in composites reinforced with 2% titanium alloy in the nozzle weight at a traverse speed of 7.8 mm/min. Moreover, abrasive water jet machining at high water pressure (3 MPa) produced better surface quality due to material removal and effective cleaning of lens fragmentation and abrasive particles from the polishing zone compared to a lower water pressure (2 MPa), low traverse speed (5 mm/min), and low abrasive mass flow rate (200 g/min). Full article

A 6-year-old castrated male mixed dog presented with a rapidly growing mass at the right chest wall two weeks after initial detection. A mesenchymal origin of the malignancy was suspected based on fine-needle aspiration. Computed tomography (CT) revealed that the mass originated from the right chest wall and protruded externally (6.74 × 5.51 × 4.13 cm³) and internally (1.82 × 1.69 × 1.50 cm³). The patient revisited the hospital because of breathing difficulties. Radiography confirmed pleural effusion, and ultrasonography-guided thoracocentesis was performed. The effusion was hemorrhagic, and microscopic evaluation showed no malignant cells. Before surgery, CT without anesthesia was performed to evaluate the status of the patient. The 7–10th ribs were en bloc resected at a 3-cm margin dorsally and ventrally, and two ribs cranially and caudally from the mass. After recovering the collapsed right middle lobe of the lung due to compression from the internal mass with positive-pressure ventilation, a 3D-printed bone model contoured titanium mesh was tied to each covering rib and surrounding muscles using 2-0 blue nylon and closed routinely. The thoracic cavity was successfully reconstructed, and no flail chest was observed. The patient was histo-pathologically diagnosed with extraskeletal osteosarcoma. A CT scan performed 8 months after surgery showed no evident recurrence, metastasis, or implant failure. This is the first case report of chest wall reconstruction using titanium mesh in a dog. The use of a titanium mesh allows for the reconstruction of extensive chest wall defects, regardless of location, without major postoperative complications. Full article

The newest technology allows the medical industry to manufacture innovative products such as milled titanium prosthodontic parts in an implant for a screw-retained suprastructure. In the literature, there are some articles on the clinical usage of subperiosteal implants, but none of these publications, either in PubMed or Google Scholar, thoroughly describe the workflow for the design and manufacture of individual implants for maxillofacial surgery with milled threads for a screw-retained prosthodontic bridge. The aim of the article is to present a step-by-step method of producing personalized implants, from the first steps of production to the implantation of the final product. The article includes information on patient qualification for surgery, computational preparation and skull printing, planning of Mai Implants^®, meshing, 3D printing and milling, cleaning, rinsing, anodizing, and laser marking, as well as the cleaning and sterilization process in a hospital or dental clinic. A detailed description of implant production allows for the analysis of each step and the development of technology. The production of implants is an expensive procedure, but considering all the advantages of the Mai Implants^® treatment and the disadvantages of alternatives, the product is worth the price. Full article

In this paper, the degradation of nitric oxide (NO) in an annular laboratory reactor is presented. Preliminary experiments were performed in an annular reactor (AR) under simulated solar irradiation. Titanium dioxide (TiO₂ P25) was used as a photocatalyst and immobilized on glass fibers mesh (GM) by the sol–gel method prepared from commercially available materials. The aim of the experiments was to remove NO from the air stream. The initial rate constant of the NO photocatalytic degradation was recognized to follow mass-transfer-controlled first-order kinetics. The results confirmed the photocatalytic reduction of NO to molecular nitrogen (N₂) and oxidation to nitrate. Therefore, the preliminary results obtained in this work are used for the development of a computational fluid dynamics (CFD) model (COMSOL Multiphysics v6.2). CFD calculations provide a good basis for sizing reactors at the semi-pilot and pilot levels for both indoor and outdoor air purification systems. Full article

Single point incremental forming (SPIF) is becoming more and more widely used in the metal industry due to its high production flexibility and the possibility of obtaining larger material deformations than during conventional sheet metal forming processes. This paper presents the results of the numerical modeling of friction stir rotation-assisted SPIF of commercially pure 0.4 mm-thick titanium sheets. The aim of this research was to build a reliable finite element-based thermo-mechanical model of the warm forming process of titanium sheets. Finite element-based simulations were conducted in Abaqus/Explicit software (version 2019). The formability of sheet metal when forming conical cones with a slope angle of 45° was analyzed. The numerical model assumes complex thermal interactions between the forming tool, the sheet metal and the surroundings. The heat generation capability was used to heat generation caused by frictional sliding. Mesh sensitivity analysis showed that a 1 mm mesh provides the best agreement with the experimental results of total forming force (prediction error 3%). It was observed that the higher the size of finite elements (2 mm and 4 mm), the greater the fluctuation of the total forming force. The maximum temperature recorded in the contact zone using the FLIR T400 infrared camera was 157 °C, while the FE-based model predicted this value with an error of 1.3%. The thinning detected by measuring the drawpiece with the ARGUS non-contact strain measuring system and predicted by the FEM model showed a uniform thickness in the drawpiece wall zone. The FE-based model overestimated the minimum and maximum wall thicknesses by 3.7 and 5.9%, respectively. Full article

Background: Orbital floor fractures (OFFs) represent an interesting chapter in maxillofacial surgery, and one of the main challenges in orbit reconstruction is shaping and cutting the precise contour of the implants due to its complex anatomy. Objective: The aim of the retrospective study was to demonstrate, through pre- and postoperative volumetric measurements of the orbit, how the use of a preformed titanium mesh based on the stereolithographic model produced with 3D printers (“In-House” reconstruction) provides a better reconstruction volumetric compared to the intraoperatively shaped titanium mesh. Materials and Methods: The patients with OFF enrolled in this study were divided into two groups according to the inclusion criteria. In Group 1 (G1), patients surgically treated for OFF were divided into two subgroups: G1a, patients undergoing orbital floor reconstruction with an intraoperatively shaped mesh, and G1b, patients undergoing orbital floor reconstruction with a preoperative mesh shaped on a 3D-printed stereolithographic model. Group 2 (G2) consisted of patients treated for other traumatic pathologies (mandible fractures and middle face fractures not involving orbit). Pre- and postoperative orbital volumetric measurements were performed on both G1 and G2. The patients of both groups were subjected to the measurement of orbital volume using Osirix software (Pixmeo SARL, CH-1233 Bernex, Switzerland) on the new CT examination. Both descriptive (using central tendency indices such as mean and range) and regressive (using the Bravais–Pearson index, calculated using the GraphPad program) statistical analyses were performed on the recorded data. Results: From 1 January 2017 to 31 December 2021, of the 176 patients treated for OFF at the “Magna Graecia” University Hospital of Catanzaro 10 fulfilled the study’s inclusion criteria: 5 were assigned to G1a and 5 to G1b, with a total of 30 volumetric measurements. In G2, we included 10 patients, with a total of 20 volumetric measurements. From the volumetric measurements and statistical analysis carried out, it emerged that the average of the volumetric differences of the healthy orbits was ±0.6351 cm³, the standard deviation of the volumetric differences was ±0.3383, and the relationship between the treated orbit and the healthy orbit was linear; therefore, the treated orbital volumes tend to approach the healthy ones after surgical treatment. Conclusion: This study demonstrates that if the volume is restored within the range of the standardized mean, the diplopia is completely recovered already after surgery or after one month. For orbital volumes that do not fall within this range, functional recovery could occur within 6 months or be lacking. The restoration of the orbital volume using pre-modeled networks on the patient’s anatomical model, printed internally in 3D, allows for more accurate reconstructions of the orbital floor in less time, with clinical advantages also in terms of surgical timing. Full article

This study employs the finite element (FE) method to analyze the Incremental Sheet Forming (ISF) process of Ti-6Al-4V titanium alloy. The numerical modeling of pressure-assisted warm forming of Ti-6Al-4V sheets with combined oil-heating and friction stir rotation-assisted heating of the workpiece is presented in this article. The thermo-mechanical FE-based numerical model took into account the characteristics of the mechanical properties of the sheet along with the temperature. The experimental conditions were replicated in FEM simulations conducted in Abaqus/Explicit, which incorporated boundary conditions and evaluated various mesh sizes for enhanced accuracy and efficiency. The simulation outcomes were compared with actual experimental results to validate the FE-based model’s predictive capacity. The maximum temperature of the tool measured using infrared camera was approximately 326 °C. Different mesh sizes were considered. The results of FEM modeling were experimentally validated based on axial forming force and thickness distribution measured using the ARGUS optical measuring system for non-contact acquisition of deformations. The greatest agreement between FEM results and the experimental result of the axial component of forming force was obtained for finite elements with a size of 1 mm. The maximum values of the axial component of forming force determined experimentally and numerically differ by approximately 8%. The variations of the forming force components and thickness distribution predicted by FEM are in good agreement with experimental measurements. The numerical model overestimated the wall thickness with an error of approximately 5%. By focusing on the heating techniques applied to Ti-6Al-4V titanium alloy sheet, this comparative analysis underlines the adaptability and precision of numerical analysis applied in modeling advanced manufacturing processes. Full article

Enophthalmos is a severe complication of primary reconstruction following orbital floor fractures, oncological resections, or maxillo-facial syndromes. The goal of secondary orbital reconstruction is to regain a symmetrical globe position to restore function and aesthetics. In this article, we present a method of computer-assisted orbital floor reconstruction using a mirroring technique and a custom-made titanium or high-density polyethylene mesh printed using computer-aided manufacturing techniques. This reconstructive protocol involves four steps: mirroring of the healthy orbit computer tomography files at the contralateral affected site, virtual design of a customized implant, computer-assisted manufacturing (CAM) of the implant using Direct Metal Laser Sintering (DMLS) or Computer Numerical Control (CNC) methods, and surgical insertion of the device. Clinical outcomes were assessed using 3dMD photogrammetry and computed tomography measures in 13 treated patients and compared to a control group treated with stock implants. An improvement of 3.04 mm (range 0.3–6 mm) in globe protrusion was obtained for the patients treated with patient-specific implants (PSI), and no major complications have been registered. The technique described here appears to be a viable method for correcting complex orbital floor defects needing delayed reconstruction. Full article

Purpose: This pilot study aims to evaluate the feasibility and effectiveness of computer-assisted surgery protocol with 3D-preformed orbital titanium mesh (3D-POTM), using presurgical virtual planning and intraoperative navigation in primary inferomedial orbital fracture reconstruction. Methods: Between March 2021 and March 2023, perioperative data of patients undergoing surgery for unilateral inferomedial orbital fracture treated with 3D-POTM were analyzed. Presurgical virtual planning with a Standard Triangle Language file of preformed mesh was conducted using the mirrored unaffected contralateral side as a reference, and intraoperative navigation was used. The reconstruction accuracy was determined by: correspondence between postoperative reconstruction mesh position with presurgical virtual planning and difference among the reconstructed and the unaffected orbital volume. Pre- and postoperative diplopia and enophthalmos were assessed. Results: Twenty-six patients were included. Isolated orbital floor fracture was reported in 14 (53.8%) patients, meanwhile medial wall and floor one in 12 (46.1%) cases. The mean difference between final plate position and ideal digital plan was 0.692 mm (95% CI: 0.601–0.783). The mean volume difference between reconstructed and unaffected orbit was 1.02 mL (95% CI: 0.451–1.589). Preoperative diplopia was settled out in all cases and enophthalmos in 19 (76.2%) of 21 patients. Conclusion: The proposed protocol is an adaptable and reliable workflow for the early treatment of inferomedial orbital fractures. It enables precise preoperative planning and intraoperative procedures, mitigating pitfalls and complications, and delivering excellent reconstruction, all while maintaining reasonable costs and commitment times. Full article