Abstract: The spinal column is the load-bearing structure of the human being along with its components, which together build a strong, resistant, and stable structure, but there are a few different pathologies from which it can suffer, such as herniated discs. The intervertebral disc acts as a shock absorber and ensures the spine’s great capacity to support high loads and different states of stress, thanks to its viscoelastic properties. Some studies have attempted to describe the viscoelastic behaviour of the intervertebral disc using classical rheological models, such as the Kelvin-Voigt, or multi-parameter models. Even if these models partially describe the viscoelastic response of disc, all viscoelastic characteristics are not fully captured. This article aims to present the current studies on the biomechanics of intervertebral disc and to introduce a new approach using the powerful mathematical tool of fractional calculus. With fractional rheological models, it could be possible to formulate a fractional law that can fully describe the viscoelastic behaviour of the intervertebral disc. This new approach could lead to a breakthrough in the study of herniated pathologies by understanding how the intervertebral disc is damaged and identifying strategies to deal with these pathological problems.

Keywords: Biomechanics | Fractional calculus | Fractional rheological model | Intervertebral disc | Spinal column | Viscoelastic behaviour

Abstract: Over the past years, a wide range of dental implants has been proposed. In general, the dentists may find the best solutions according to the specific needs of the patients. A variety of factors influences the level of osseointegration and, consequently, the anchorage of the implant to the bone. The stress transfer mechanism along the bone-implant interface depends upon the surface area of the bone-implant contact. Great efforts have been devoted to the design of 3D porous lattice structures with tailored architectural features in order to reduce the implant stiffness as well as to favour bone ingrowth, thus stabilizing the device. Accordingly, the aim of the current study was to provide further insight into the design criteria for dental implants. In particular, starting from a screw implant (Implant A), different concepts of dental implants were developed: i) Implants B1–B5, with lattice shell surrounding a solid core, without thread; ii) Implant C, with lattice structure; iii) Implant D as topography optimized implant. Finite element analysis on the several models of bone-implant provided interesting information in terms of stress distributions in cortical and trabecular bone. Some differences among the implants may be ascribed to the different design criteria.

Keywords: Dental implants | Design criteria | Finite element analysis | Lattice structure | Topography optimization | Topology optimization

Abstract: Objective and reliable assessment of motor functions, such as dexterity, is a key point for evaluating worker’s abilities. In this context, the proposed work presents a tool for objective automatic assessment of the Minnesota Dexterity Test using cameras with depth sensors. Typical performance measurements (i.e., total time and associated percentiles) were estimated using custom algorithms. In addition, the possibility to identify the qualifiers for the code d440 of the International Classification of Functioning, Disability and Health was implemented in the developed algorithms. The proposed tool can also identify the mistakes most frequently committed by the subjects. To prove the capabilities of the proposed method, a series of experimental trials was conducted with 10 healthy young volunteers. Results showed that the developed tool helps clinicians to obtain performance feedback and evaluate patients’ dexterity quickly without bias.

Keywords: Automatic assessment | Biomechanics | Depth cameras | Manual dexterity | Motion capture

Abstract: The study of predictive models describing the biological processes relating extra-cellular mechanical stimuli to structural responses of living cells, or even a differentiation, as in the case of mesenchymal stem cells (MSCs), is a relevant aspect in mechanobiology. A preliminary phase for these studies is the assessment of the mechanical behavior of whole living cells or their subcellular components, often performed by means of Atomic Force Microscopy (AFM). In this study we developed a numerical optimization framework aiming at matching the computed results obtained from a sequence of FEM simulations to an experimental AFM report curve associated to a MSC under investigation, in order to extract the elastic parameters of subcellular components and to assess how the mechanical response changes if the stress fibers network present in the interior of the cell is activated or not. By means of the proposed study, we extracted a set of Young’s moduli for the main subcellular components, which resulted comparable to the values computed by means of the Hertzian contact theory, and was also in good agreement with the related literature. By neglecting the effect of the tensioning pre-stress field induced by the stress fibers network, an underestimation of the Young’s moduli of subcellular components, up to a 15% in magnitude, was obtained.

Keywords: Finite element method | Mechanical simulation | Mechanobiology | Stem cells | Stress fibers

Abstract: When dealing with craniofacial impairments, restoring the morphological condition is as crucial as restoring the functional ones to avoid psychosocial disabilities for the patient. For this aim, the accurate location of the midsagittal plane is essential for performing reliable symmetry analyses and guiding effective surgery planning. To provide a fully automatic and landmark-independent approach, capable of providing a midsagittal plane for craniofacial skeleton even from anatomical models with high asymmetries, an innovative method, called MaWR-method, was developed by the authors in a previous work. This paper further investigates the MaWR-method by evaluating its capacity to produce a successful outcome even in the worst-case scenario that may be considered in maxillofacial surgery, namely panfacial fractures. In all the test cases considered in this work, the method proved robust and reliable in its original design. It provided a consistent result requiring no user involvement, even when dealing with extreme asymmetries because of extensive and complex fractures.

Keywords: Feature recognition | Mid-sagittal plane | Symmetry analysis | Symmetry plane detection

Abstract: These authors presented an automatic computer-based method for morphological feature segmentation and recognition for thoracic and lumbar human vertebrae in a previous paper. The method analyses high-density discretized models by segmentation and recognition rules codifying the vertebra morphology information, which does not change between different subjects. The methodology has been demonstrated to be valid and repeatable in segmenting and recognizing morphological features of vertebrae. The proposed one gives repeatable and reproducible results concerning the traditional manual methods. Nonetheless, the method has been tested only on human lumbar and thoracic vertebrae without distinctive pathologies. This paper aims to extend this methodology for much wider use by analyzing single vertebrae affected by common defectiveness in archaeological and medical fields. The results of the experimentations, analyzed by a skilled anthropologist and radiologist, show that the method correctly segments the analyzed morphological features, also for thoracic and lumbar vertebrae with defectiveness: in particular, defects that alter the shape of features or the symmetry of the vertebra, determine the absence of a feature, or heavily change the spatial distribution of the anterior part respect to the posterior one, have been analyzed.

Keywords: 3D medical image analysis | Feature recognition | Thoracic and lumbar vertebrae analysis | Vertebrae analysis computer-based methods

Abstract: In the field of optical 3D scanning for healthcare applications, low-cost depth cameras can be efficiently used to capture geometry at video frame rates. However, the complete reconstruction of anatomical geometries remains challenging since different scans, collected from multiple viewpoints, must be aligned into a common reference frame. This paper proposes a fully automatic procedure to align scans of the upper limb patient’s anatomy. A 3D optical scanner, obtained by assembling three depth cameras, is used to collect upper limb acquisitions. A relevant dataset of key points on the hand and the forearm geometry is then determined and used to automatically obtain a rough 3D alignment of the different scans. Hand key points are identified through a neural network, which works on RGB images captured by the depth cameras; forearm key points are recognized by directly processing the point clouds through a specifically designed algorithm that evaluates the skeleton line of the forearm. The approach was tested on forearm acquisitions, and the results were compared to alternative alignment methodologies.

Keywords: 3D optical scanning | automatic point clouds alignment | depth cameras | upper limb anatomy

Abstract: This study evaluated the influence of distal implants angulation and framework material in the stress concentration of an All-on-4 full-arch prosthesis. A full-arch implant-supported prosthesis 3D model was created with different distal implant angulations and cantilever arms (30° with 10-mm cantilever; 45° with 10-mm cantilever and 45° with 6-mm cantilever) and framework materials (Cobalt–chrome [CoCr alloy], Yttria-stabilized tetragonal zirconia polycrystal [Y-TZP] and polyetheretherketone [PEEK]). Each solid was imported to computer-aided engineering software, and tetrahedral elements formed the mesh. Material properties were assigned to each solid with isotropic and homogeneous behavior. The contacts were considered bonded. A vertical load of 200 N was applied in the distal region of the cantilever arm, and stress was evaluated in Von Misses (σVM) for prosthesis components and the Maximum (σMAX) and Minimum (σMIN) Principal Stresses for the bone. Distal implants angled in 45° with a 10-mm cantilever arm showed the highest stress concentration for all structures with higher stress magnitudes when the PEEK framework was considered. However, distal implants angled in 45° with a 6-mm cantilever arm showed promising mechanical responses with the lowest stress peaks. For the All-on-4 concept, a 45° distal implants angulation is only beneficial if it is possible to reduce the cantilever’s length; otherwise, the use of 30° should be considered. Comparing with PEEK, the YTZP and CoCr concentrated stress in the framework structure, reducing the stress in the prosthetic screw.

Keywords: Dental implants | Finite element analysis | Polymers | Prosthodontics

Abstract: In this paper, we present a biomechanical analysis of the upper body, which includes upper-limb, neck and trunk, during the execution of overhead industrial tasks. The analysis is based on multiple performance metrics obtained from a biomechanical analysis of the worker during the execution of a specific task, i.e. an overhead drilling task, performed at different working heights. The analysis enables a full description of human movement and internal load state during the execution of the task, thought the evaluation of joint angles, joint torques and muscle activations. A digital human model is used to simulate and replicate the worker’s task in a virtual environment. The experiments were conduced in laboratory setting, where four subjects, with different anthropometric characteristics, have performed 48 drilling tasks in two different working heights defined as low configuration and middle configuration. The results of analysis have impact on providing the best configuration of the worker within the industrial workplace and/or providing guidelines for developing assistance devices which can reduce the physical overloading acting on the worker’s body.

Keywords: Biomechanics | Digital human models | Electromyography | Ergonomics | Industry | Overhead tasks

Abstract: In this work we derive the requirements of a soft upper-limb exoskeletons starting from the biomechanical analysis of human workers while performing three different industrial overhead tasks in laboratory settings. The results of the work allow to define the degrees of freedom which need to be supported to reduce the biomechanical overloads, as well the dimensional characteristics, in terms of required lengths and forces, of the soft actuators of the wearable robot.

Keywords: Biomechanics | Design | Industrial tasks | Soft exoskeleton | Soft robotics | Wearable robotics

Abstract: Indeterminate lung nodules detected on CT scans are common findings in clinical practice. Their correct assessment is critical, as early diagnosis of malignancy is crucial to maximise the treatment outcome. In this work, we evaluated the role of form factors as imaging biomarkers to differentiate benign vs. malignant lung lesions on CT scans. We tested a total of three conventional imaging features, six form factors, and two shape features for significant differences between benign and malignant lung lesions on CT scans. The study population consisted of 192 lung nodules from two independent datasets, containing 109 (38 benign, 71 malignant) and 83 (42 benign, 41 malignant) lung lesions, respectively. The standard of reference was either histological evaluation or stability on radiological followup. The statistical significance was determined via the Mann–Whitney U nonparametric test, and the ability of the form factors to discriminate a benign vs. a malignant lesion was assessed through multivariate prediction models based on Support Vector Machines. The univariate analysis returned four form factors (Angelidakis compactness and flatness, Kong flatness, and maximum projection sphericity) that were significantly different between the benign and malignant group in both datasets. In particular, we found that the benign lesions were on average flatter than the malignant ones; conversely, the malignant ones were on average more compact (isotropic) than the benign ones. The multivariate prediction models showed that adding form factors to conventional imaging features improved the prediction accuracy by up to 14.5 pp. We conclude that form factors evaluated on lung nodules on CT scans can improve the differential diagnosis between benign and malignant lesions.

Keywords: computed tomography | form factors | lung cancer | radiomics

Abstract: In hip arthroplasty, preoperative planning is fundamental to reaching a successful surgery. Nowadays, several software tools for computed tomography (CT) image processing are available. However, research studies comparing segmentation tools for hip surgery planning for patients affected by osteoarthritic diseases or osteoporotic fractures are still lacking. The present work compares three different software from the geometric, dimensional, and usability perspectives to identify the best three-dimensional (3D) modelling tool for the reconstruction of pathological femoral heads. Syngo.via Frontier (by Siemens Healthcare) is a medical image reading and post-processing software that allows low-skilled operators to produce prototypes. Materialise (by Mimics) is a commercial medical modelling software. 3D Slicer (by slicer.org) is an open-source development platform used in medical and biomedical fields. The 3D models reconstructed starting from the in vivo CT images of the pathological femoral head are compared with the geometries obtained from the laser scan of the in vitro bony specimens. The results show that Mimics and 3D Slicer are better for dimensional and geometric accuracy in the 3D reconstruction, while syngo.via Frontier is the easiest to use in the hospital setting.

Keywords: bio-imaging | CT image segmentation | hip surgery | orthopaedics | reverse engineering | software comparison | surgical planning

Abstract: Tissue engineering or tissue reconstruction/repair/regeneration may be considered as a guiding strategy in oral and maxillofacial surgery, as well as in endodontics, orthodontics, peri-odontics, and daily clinical practice. A wide range of techniques has been developed over the past years, from tissue grafts to the more recent and innovative regenerative procedures. Continuous research in the field of natural and artificial materials and biomaterials, as well as in advanced scaffold design strategies has been carried out. The focus has also been on various growth factors involved in dental tissue repair or reconstruction. Benefiting from the recent literature, this review paper illustrates current innovative strategies and technological approaches in oral and maxillofacial tissue engineering, trying to offer some information regarding the available scientific data and practical applications. After introducing tissue engineering aspects, an overview on additive manufacturing technologies will be provided, with a focus on the applications of superparamagnetic iron oxide nanoparticles in the biomedical field. The potential applications of magnetic fields and magnetic devices on the acceleration of orthodontic tooth movement will be analysed.

Keywords: 3D/4D printing | Dentistry | Design for additive manufacturing | Magnetism | SPIONs | Tissue engineering

Abstract: The aim of this study was to evaluate the effect of a time‐dependent magnetic field on the biological performance of periodontal ligament stem cells (PDLSCs). A Western blot analysis and Alamar Blue assay were performed to investigate the proliferative capacity of magnetically stimulated PDLSCs (PDLSCs MAG) through the study of the MAPK cascade (p‐ERK1/2). The observation of ALP levels allowed the evaluation of the effect of the magnetic field on osteogenic differentiation. Metabolomics data, such as oxygen consumption rate (OCR), extracellular acidification rate (ECAR) and ATP production provided an overview of the PDLSCs MAG metabolic state. Moreover, the mitochondrial state was investigated through confocal laser scanning microscopy. Results showed a good viability for PDLSCs MAG. Magnetic stimulation can activate the ERK phosphorylation more than the FGF factor alone by promoting a better cell proliferation. Osteogenic differentiation was more effectively induced by magnetic stimulation. The metabolic panel indicated significant changes in the mitochondrial cellular respiration of PDLSCs MAG. The results suggested that periodontal ligament stem cells (PDLSCs) can respond to biophysical stimuli such as a time‐dependent magnetic field, which is able to induce changes in cell proliferation and differentiation. Moreover, the magnetic stimulation also produced an effect on the cell metabolic profile. Therefore, the current study demonstrated that a time‐dependent magnetic stimulation may improve the regenerative properties of PDLSCs.

Keywords: Cellular respiration | Magnetic stimulation design | Metabolomics | Osteogenesis | Stem cells | Tissue engineering

Abstract: Emotion recognition through machine learning techniques is a widely investigated research field, however the recent obligation to wear a face mask, following the COVID19 health emergency, precludes the application of systems developed so far. Humans naturally communicate their emotions through the mouth; therefore, the intelligent systems developed to date for identifying emotions of a subject primarily rely on this area in addition to other anatomical features (eyes, forehead, etc.). However, if the subject is wearing a face mask this region is no longer visible. For this reason, the goal of this work is to develop a tool able to compensate for this shortfall. The proposed tool uses the AffectNet dataset which is composed of eight class of emotions. The iterative training strategy relies on well-known convolutional neural network architectures to identify five sub-classes of emotions: following a pre-processing phase the architecture is trained to perform the task on the eight-class dataset, which is then recategorized into five classes allowing to obtain 96.92% of accuracy on the testing set. This strategy is compared to the most frequently used learning strategies and finally integrated within a real time application that allows to detect faces within a frame, determine if the subjects are wearing a face mask and recognize for each one the current emotion.

Keywords: Artificial intelligence | COVID19 | Emotion recognition | Facial Expression Recognition | Grad-CAM | Non-verbal communication

Abstract: Torsional deformities of the lower limb are common in children with cerebral palsy (CP)-determining gait problems. The mechanisms underlying transverse plane gait deviations arise from a combination of dynamic and static factors. The dynamic elements may be due to spasticity, contractures and muscle imbalances, while the static ones may result from excessive femoral anteversion, which decreases the efficiency of the hip abductors by reducing the muscular lever arms. A therapeutic approach has been identified in multi-level functional surgery for the lower limb. Treating the malalignments of the lower limb with femoral or tibial derotation provides optimal results, especially when supported by adequate biomechanical planning. This planning requires an integrated static-dynamic approach of morphological and functional evaluation, based on radiological measurements, physical examination and gait analysis. Instrumented gait analysis has been confirmed as essential in the evaluation and surgical decision making process for children affected by CP with transverse plane deformities. Computational simulations based on musculoskeletal models that integrate patient-specific CT morphological data into gait analysis can be used for the implementation of a surgical simulation system in pre-operative planning to test the possible effects of the different surgical treatment options on the torsional defects of the lower limbs. Recently, a computer-aided simulation process has been implemented in the preoperative planning of complex osteotomies for limb deformities in children. Three-dimensional (3D) digital models were generated from Computed Tomography (CT) scans, using free open-source software. The aim of this study is to integrate the patient-specific CT musculoskeletal model with morphological data and gait analysis data, with the personalized calculation of kinematic and kinetic parameters, which allow us to generate an “avatar” of the patient for a more in-depth evaluation of the gait abnormalities. The computational simulation platform proposed provides a realistic movable musculoskeletal model in a virtual environment, with the possibility of planning and monitoring the effects of virtual three-dimensional surgical corrections.

Keywords: avatar | cerebral palsy | computed tomography | derotation | gait analysis | musculoskeletal modeling | torsional deformities | virtual surgical planning

Abstract: The present paper describes a procedure for the development and production of a physical model for surgical planning of a Left Ventricular Aneurysm. The method is based on the general approach provided in Otton et al. (2017) and was customized to seek a reliable and fast procedure for the production of a specific type of cardiac model – i.e. chambers of the left side of the heart. The paper covers all the steps: processing of the data, segmentation, modelling and 3D printing; details are provided for all the phases, in order to allow the reproduction of the achieved results. The procedure relies on Computed Tomography - CT imaging as data source for the identification and modelling of the anatomy. Materialise Mimics was used as segmentation software to process the CT data. While its usefulness for the surgical needs was verified on a single clinical case (provided by the Careggi Hospital of Florence, Italy), the modelling procedure was tested twice, to produce a physical replica both ex-ante and ex-post surgical intervention. • The tools used for segmentation and generation of the printable model were customized to reduce modelling time for the specific type of desired model. • Detailed information on the use of modeling tools, not available in the literature, will be provided. • The procedure allows fabrication of a physical model representing the heart chambers in a short time.

Keywords: 3D printing | Left Ventricular Aneurysm | Method for the production of an anatomical replica of a human heart for surgical planning | Surgical planning

Abstract: The spine is the load-bearing structure of human beings and may present several disorders, with low back pain the most frequent problem during human life. Signs of a spine disorder or disease vary depending on the location and type of the spine condition. Therefore, we aim to develop a probabilistic atlas of the lumbar spine segment using statistical shape modeling (SSM) and then explore the variability of spine geometry using principal component analysis (PCA). Using computed tomography (CT), the human spine was reconstructed for 24 patients with spine disorders and then the mean shape was deformed upon specific boundaries (e.g., by (Formula presented.) or (Formula presented.) standard deviation). Results demonstrated that principal shape modes are associated with specific morphological features of the spine segment such as Cobb’s angle, lordosis degree, spine width and height. The lumbar spine atlas here developed has evinced the potential of SSM to investigate the association between shape and morphological parameters, with the goal of developing new treatments for the management of patients with spine disorders.

Keywords: biomechanics | pathological lumbar spine segment | PCA | spinal column | SSM

Abstract: The study of the spine range of motion under given external load has been the object of many studies in literature, finalised to a better understanding of the spine biomechanics, its physiology, eventual pathologic conditions and possible rehabilitation strategies. However, the huge amount of experimental work performed so far cannot be straightforwardly analysed due to significant differences among loading set-ups. This work performs a meta-analysis of various boundary conditions in literature, focusing on the flexion/extension behaviour of the lumbar spine. The comparison among range of motions is performed virtually through a validated multibody model. Results clearly illustrated the effect of various boundary conditions which can be met in literature, so justifying differences of biomechanical behaviours reported by authors implementing different set-up: for example, a higher value of the follower load can indeed result in a stiffer behaviour; the application of force producing spurious moments results in an apparently more deformable behaviour, however the respective effects change at various segments along the spine due to its natural curvature. These outcomes are reported not only in qualitative, but also in quantitative terms. The numerical approach here followed to perform the meta-analysis is original and it proved to be effective thanks to the bypass of the natural variability among specimens which might completely or partially hinder the effect of some boundary conditions. In addition, it can provide very complete information since the behaviour of each functional spinal unit can be recorded. On the whole, the work provided an extensive review of lumbar spine loading in flexion/extension.

Keywords: Biomechanics | Follower load | Lumbar spine | Mechanical tests | Multibody | ROM

Abstract: Titanium and its alloys are widely employed in commercial dental devices. Because the surface morphology and chemical composition of Ti-based dental implants play a relevant role in osseointegration, three different commercial threaded implants have been investigated by scanning electron microscopy and X-ray photoelectron spectroscopy (XPS). The Implants A and C were made of pure Ti whereas the Implant B was made of Ti6Al4V alloy. Obtained results evidenced the common features and differences due to specific process parameters used in the treatments of mordanting and sandblasting for surface roughening. Implant A exhibits a uniform surface covered by very small dimples of about 1–2 μm. The surface of Implant B is not homogeneous: The thread tops present an irregular morphology (dimples size >10 μm) while finer dimples (about 1 μm) are observed along the thread flanks and valleys. Implant C shows an irregular morphology with dimples of different sizes and shapes distributed on thread tops, flanks, and valleys. XPS analyses revealed the presence of metal oxides: TiO2 in all the implants; Al2O3 and V2O5 only in the implant B. Moreover, these results demonstrated that Mg2SiO4 is present on the surface of Implant A, probably due to a specific preparation process. Obtained results have been discussed on the basis of the factors promoting the osseointegration.

Keywords: dental implants | SEM | surface morphology | Ti6Al4V | titanium | XPS

Abstract: Objective: The aim of this study was to evaluate the influence of three different dental implant neck geometries, under a combined compressive/shear load using finite element analysis (FEA). The implant neck was positioned in D2 quality bone at the crestal level or 2 mm below. Methods: One dental implant (4.2 × 9 mm) was digitized by reverse engineering techniques using micro CT and imported into Computer Aided Design (CAD) software. Non-uniform rational B-spline surfaces were reconstructed, generating a 3D volumetric model similar to the digitized implant. Three different models were generated with different implant neck configurations, namely 0°, 10° and 20°. D2 quality bone, composed of cortical and trabecular structure, was modeled using data from CT scans. The implants were included in the bone model using a Boolean operation. Two different fixture insertion depths were simulated for each implant: 2 mm below the crestal bone and exactly at the level of the crestal bone. The obtained models were imported to FEA software in STEP format. Von Mises equivalent strains were analyzed for the peri-implant D2 bone type, considering the magnitude and volume of the affected surrounding cortical and trabecular bone. The highest strain values in both cortical and trabecular tissue at the peri-implant bone interface were extracted and compared. Results: All implant models were able to distribute the load at the bone-implant contact (BIC) with a similar strain pattern between the models. At the cervical region, however, differences were observed: the models with 10° and 20° implant neck configurations (Model B and C), showed a lower strain magnitude when compared to the straight neck (Model A). These values were significantly lower when the implants were situated at crestal bone levels. In the apical area, no differences in strain values were observed. Significance: The implant neck configuration influenced the strain distribution and magnitude in the cortical bone and cancellous bone tissues. To reduce the strain values and improve the load dissipation in the bone tissue, implants with 10° and 20 neck configuration should be preferred instead of straight implant platforms.

Keywords: Dental implants | Finite element analysis | Implant design | Strain distribution

Abstract: Background and objective: Because of the three-dimensional distribution of morphological features of human vertebrae and the whole spine, in recent years, to make more precise diagnoses and to design optimized surgical procedures, new protocols have been proposed based on analysing their three-dimensional (3D) models. In the related literature, processes of segmentation and morphological features recognition are essentially performed by a skilled operator that selects the interesting areas. So, being affected by the preparation and experience of the operator, this produces an evaluation that is poorly reproducible and repeatable for the uncertainties of a typical manual measurement process. Methods: To overcome this limitation, in this paper a new automatic method is proposed for feature segmentation and recognition of human vertebrae. The proposed computer-based method, starting from 3D high density discretized models of thoracic and lumbar vertebrae, automatically performs both the semantic and geometric segmentation of their morphological features. The segmentation and recognition rules codify some important definitions used in the traditional manual method, considering all the vertebra morphology information that is invariant inter-subject. Results: The automatic method proposed here is verified by analysing many real vertebrae, both acquired using a 3D scanner and coming from Computerized Tomography (CT) scans. The obtained results are critically discussed and compared with the traditional manual methods for vertebra analysis. The method has proven to be robust and reliable in the segmentation and recognition of morphological features of vertebrae. Furthermore, the proposed automatic method avoids the blurring of quantitative parameters get from vertebrae, resulting from poor repeatability and reproducibility of manual methods used in the state-of-the-art. Conclusions: Starting from the automatic segmentation and recognition here proposed, it is possible to automatically calculate the parameters of thoracic or lumbar vertebrae used in archaeology, medicine, or biomechanics or define their new ones.

Keywords: 3D medical image analysis | Computer methods for vertebra analysis | Shape segmentation | Thoracic and lumbar vertebrae | Three-dimensional measurement

Abstract: Evidence regarding the effect of the onlay preparation design for different CAD/CAM restorative materials considering the preservation of cusps is lacking. Molars were 3D-modeled in four preparation designs for onlay restoration: Traditional design with functional cusp coverage (TFC), non-retentive design with functional cusp coverage (NFC), traditional design with non-functional cusp coverage (TNFC) and non-retentive design with non-functional cusp coverage (NNFC). The restorations were simulated with two CAD/CAM restorative materials: LD—lithium disilicate (IPS e.max CAD) and RC—resin composite (GrandioBloc). A 100 N axial load was applied to the occlusal surface, simulating the centric contact point. Von Mises (VM) and maximum principal (Pmax) stress were evaluated for restorations, cement layer and dental substrate. The non-retentive preparation design reduced the stress concentration in the tooth structure in comparison to the conventional retentive design. For LD onlays, the stress distribution on the restoration intaglio surface showed that the preparation design, as well as the prepared cusp, influenced the stress magnitude. The non-retentive preparation design provided better load distribution in both restorative materials and more advantageous for molar structure. The resin composite restoration on thenon-functional cusp is recommended when the functional cusp is preserved in order to associate conservative dentistry and low-stress magnitude.

Keywords: Biomechanics | Dental materials | Finite element analysis | Prosthodontics

Abstract: The aim of the present study was to investigate the effect of shrinking and no shrinking dental filling materials combination in posterior restorations under the combined effects of polymerization shrinkage and occlusal load by means of 3D Finite Elements Analysis. Six computer-generated and restored class I or class II cavities models of a lower molar were designed in the CAD software and evaluated according to the cavity and restorative procedure. Different shrinking and no shrinking adhesive materials combination with diverse Young’s modulus were considered. A food bolus was modeled on the occlusal surface replicating the chewing load using static linear analyses Polymerization shrinkage was simulated for the shrinking different restorative materials. The maximum principal stress was selected as analysis criteria. All models exhibited higher stresses along the dentine restoration interfaces with different magnitude and a similar stress trend along enamel restoration interface. Stress values up to 22 MPa and 19 MPa were recorded in the enamel and restoration, respectively. The use of elastic not shrinking material layer in combination with bulk fill composite reduced the stress magnitude in dentine and enamel to replace dental tissues. Class I and class II posterior cavities adhesively restored with shrinking filling material’s combination showed the most unfavorable stress concentrations and the multilayer technique is a promising restorative alternative in posterior adhesive restorations when deep dentin and enamel volumes are missing.

Keywords: Dental materials | Dental restoration failure | Finite element analysis | Shrinkage polymerization

Abstract: Autologous ear reconstruction is the preferred treatment in case of partial or total absence of the external ear. The surgery can be very challenging to perform and the aesthetic result highly dependent on the surgeon’s “artistic skills”. In this context a preoperative planning and simulation phase based on the patient’s specific anatomy may result crucial for the surgical outcome. In this work, starting from a case study, the elements necessary for an effective simulation are identified and a strategy for their interactive design and customization is devised with a perspective of a semi-automatization of the procedure.

Keywords: Additive manufacturing | Autologous ear reconstruction | Microtia | Preoperative planning | Reverse engineering

Abstract: Computer-assisted analysis of three-dimensional imaging data (radiomics) has received a lot of research attention as a possible means to improve the management of patients with lung cancer. Building robust predictive models for clinical decision making requires the imaging features to be stable enough to changes in the acquisition and extraction settings. Experimenting on 517 lung lesions from a cohort of 207 patients, we assessed the stability of 88 texture features from the following classes: first-order (13 features), Grey-level Co-Occurrence Matrix (24), Grey-level Difference Matrix (14), Grey-level Run-length Matrix (16), Grey-level Size Zone Matrix (16) and Neighbouring Grey-tone Difference Matrix (five). The analysis was based on a public dataset of lung nodules and open-access routines for feature extraction, which makes the study fully reproducible. Our results identified 30 features that had good or excellent stability relative to lesion delineation, 28 to intensity quantisation and 18 to both. We conclude that selecting the right set of imaging features is critical for building clinical predictive models, particularly when changes in lesion delineation and/or intensity quantisation are involved.

Keywords: Computed tomography | Intensity quantisation | Lesion delineation | Lung nodules | Radiomics | Stability | Texture features

Abstract: The strong impulse recently experienced by the manufacturing technologies as well as the development of innovative biocompatible materials has allowed the fabrication of high-performing scaffolds for bone tissue engineering. The design process of materials for bone tissue scaffolds represents, nowadays, an issue of crucial importance and the object of study of many researchers throughout the world. A number of studies have been conducted, aimed at identifying the optimal material, geometry, and surface that the scaffold must possess to stimulate the formation of the largest amounts of bone in the shortest time possible. This book presents a collection of 10 research articles and 2 review papers describing numerical and experimental design techniques definitively aimed at improving the scaffold performance, shortening the healing time, and increasing the success rate of the scaffold implantation process.

Keywords: Bone regeneration | Bone tissue engineering | Porous materials

Abstract: Improvements in software for image analysis have enabled advances in both medical and engineering industries, including the use of medical analysis tools to recreate internal parts of the human body accurately. A research analysis found that FDM-sourced elements have shown viability for a customized and reliable approach in the orthopedics field. Three-dimensional printing has allowed enhanced accuracy of preoperative planning, leading to reduced surgery times, fewer unnecessary tissue perforations, and fewer healing complications. Furthermore, using custom tools chosen for each procedure has shown the best results. Bone correction-related surgeries require customized cutting guides for a greater outcome. This study aims to assess the biopolymer-based tools for surgical operations and their ability to sustain a regular heat-sterilization cycle without compromising the geometry and fit characteristics for a proper procedure. To achieve this, a DICOM and FDM methodology is proposed for fast prototyping of the cutting guide by means of 3D engineering. A sterilization test was performed on HTPLA, PLA, and nylon polymers. As a result, the unique characteristics within the regular autoclave sterilization process allowed regular supplied PLA to show there were no significant deformations, whilst annealed HTPLA proved this material’s capability of sustaining repeated heat cycles due to its crystallization properties. Both of these proved that the sterilization procedures do not compromise the reliability of the part, nor the safety of the procedure. Therefore, prototypes made with a similar process as this proposal could be safely used in actual surgery practices, while nylon performed poorly because of its hygroscopic properties.

Keywords: 3D engineering | Cutting guide | FDM | HTPLA | Nylon FDM | Preoperative planning | Sterilization

Abstract: This experimental study defines the usage of a computer-aided surgical simulation process that is effective, safe, user-friendly, and low-cost, that achieves a detailed and realistic representation of the anatomical region of interest. The chosen tools for this purpose are state-of-the-art Computer Aided Design (CAD) software for mechanical design, and are the fundamental application dedicated to parametric modeling. These tools support different work environments, each one is for a specific type of modeling, and they allow the simulation of surgery. The result will be a faithful representation of the anatomical part both before and after the surgical procedure, screening all the intermediate phases. The doctor will assess different lines of action according to the results, then he will communicate them to the engineer who, consequently, will correct the antisymmetric issue and regenerate the model. Exact measurements of the mutual positions of the various components, skeletal and synthetic, can be achieved; all the osteosynthesis tools, necessary for the surgeon, can be included in the project according to different types of fracture to perfectly match the morphology of the bone to be treated. The method has been tested on seven clinical cases of different complexity and nature and the results of the simulations have been found to be of great effectiveness in the phase of diagnosis and of preoperative planning for the doctors and surgeons; therefore, allowing a lower risk medical operation with a better outcome. This work delivers experimental results in line with theoretical research findings in detail; moreover, full experimental and/or methodical details are provided, so that outcomes could be obtained.

Keywords: 3D processing | CAD-aided | Customized surgery | Pediatric orthopedics | Preoperative planning | Surgical simulation

Abstract: This work aims to present the application of mechanical modeling software in three dimensions in the medical field, analyzing the procedures used by the engineer to support the orthopedic surgeon in preoperative planning. The first step of the procedure involves CT examinations in patients selected for surgery: DICOM images are managed in post-processing to obtain multiplanar reconstructions of the bone lesion to be treated. The files are then optimized, made shareable and imported into CREO's work platform; this is part of a family of CAD software products for mechanical design, developed by PTC, and is the fundamental application dedicated to parametric modeling. The result will be a faithful representation of the anatomical part both before and after surgical procedure, screening all the intermediate phases. The doctor will assess different lines of action according to the results, than he will communicate them to the engineer who, consequently, will correct and regenerate the model. The method finds its power in the dialogue between engineer and doctor: In complex cases closer collaboration is needed while, for the evaluation of less demanding injuries, the exam could be assigned as a remote project which, once completed, is returned to the medical facility of competence.

Keywords: 3D modeling | Computer aided | Parametric software | Preoperative planning | Surgical simulation

Abstract: Artificial Intelligence (AI) algorithms, together with a general increased computational performance, allow nowadays exploring the use of Facial Expression Recognition (FER) as a method of recognizing human emotion through the use of neural networks. The interest in facial emotion and expression recognition in real-life situations is one of the current cutting-edge research challenges. In this context, the creation of an ecologically valid facial expression database is crucial. To this aim, a controlled experiment has been designed, in which thirty-five subjects aged 18–35 were asked to react spontaneously to a set of 48 validated images from two affective databases, IAPS and GAPED. According to the Self-Assessment Manikin, participants were asked to rate images on a 9-points visual scale on valence and arousal. Furthermore, they were asked to select one of the six Ekman’s basic emotions. During the experiment, an RGB-D camera was also used to record spontaneous facial expressions aroused in participants storing both the color and the depth frames to feed a Convolutional Neural Network (CNN) to perform FER. In every case, the prevalent emotion pointed out in the questionnaires matched with the expected emotion. CNN obtained a recognition rate of 75.02%, computed comparing the neural network results with the evaluations given by a human observer. These preliminary results have confirmed that this experimental setting is an effective starting point for building an ecologically valid database.

Keywords: 3D facial database | Affective database | Basic emotions | Ecologically-valid data | Facial expression recognition | Human-robot interaction

Abstract: This work shows a preoperative simulation procedure with Computer Aided Design (CAD) 3D software for a patient suffering from Ollier's disease. This pathology is very rare and occurs in extremely different ways depending on the case. Consequently, it is difficult to establish a correct surgical strategy that can be applied in a similar way to all patients. Computer Aided Surgical Simulation (CASS) process uses advanced modeling technologies to reproduce bony anatomy and simulate the surgery. The starting point is represented by the 3D digital model of the bone obtained from tomographic images. Through CAD modeling software such as Creo Parametric and following surgeons directives, engineers can provide doctors with orthopedic simulation and expectation of achievable surgical outcome. If virtual surgical prediction doesn’t meet doctors requirements, model is regenerated and it is possible to seek for a better solution. CASS process allow for extensive surgical planning, enhancing accuracy in theatre and enriching the amount of medical information that is needed to perform complex orthopedic procedures. In conclusion, the possibility to recognize in advance the overall orthopedic situation and outcoming expectancy represent an extraordinary upgrade of current surgical state of the art, leading to minimally invasive surgeries and patient-specific solutions.

Keywords: 3D modeling | CAD | CASS | Parametric software | Preoperative planning

Abstract: Autologous ear reconstruction is the preferred treatment in case of partial or total absence of the patient external ear. This kind of surgery can be really challenging since precise replication of complex three-dimensional structure of the ear is crucial to provide the patients with aesthetically consistent reconstructed anatomy. Therefore, the results strongly depends on the “artistic skills” of the surgeon who is in charge to carry out a three-dimensional sculpture, which resembles the shape of a normal ear. In this context, the definition of a preoperative planning and simulation process based on the patient's specific anatomy may help the surgeon in speeding up the ear reconstruction process and, at the same time, to obtain better results, thus allowing a superior surgical outcome. In the present work the main required features for performing an effective simulation of the ear reconstruction are identified and a strategy for their interactive design and customization is devised with the perspective of a semi-automatization of the procedure. In detail, the paper provides a framework which start from the acquisition of 3D data from both a healthy ear of the patient (or, if not available e.g. due to bilateral microtia of the ear of one of his parents or from a template) and of costal cartilage. Acquired 3D data are properly processed to define the anatomical elements of the ear and to find, using nesting-based algorithms, the costal cartilage portions to be used for carving the ear itself. Finally, 3D printing is used to create a mockup of the ear elements and a prototype of the ear to be reconstructed is created. Validated on a test case, the devised procedure demonstrate its effectiveness.

Keywords: Additive manufacturing | Autologous ear reconstruction | Microtia | Preoperative planning | Reverse engineering

Abstract: Driver behaviour recognition is of paramount importance for in-car automation assistance. It is widely recognized that not only attentional states, but also emotional ones have an impact on the safety of the driving behaviour. This research work proposes an emotion-aware in-car architecture where it is possible to adapt driver’s emotions to the vehicle dynamics, investigating the correlations between negative emotional states and driving performances, and suggesting a system to regulate the driver’s engagement through a unique user experience (e.g. using music, LED lighting) in the car cabin. The relationship between altered emotional states induced through auditory stimuli and vehicle dynamics is investigated in a driving simulator. The results confirm the need for both types of information to improve the robustness of the driver state recognition function and open up the possibility that auditory stimuli can modify driving performance somehow.

Keywords: Driver monitoring system | Emotion recognition | Facial expression recognition

Abstract: The advantages of additive manufactured scaffolds, as custom-shaped structures with a completely interconnected and accessible pore network from the micro- to the macroscale, are nowadays well established in tissue engineering. Pore volume and architecture can be designed in a controlled fashion, resulting in a modulation of scaffold’s mechanical properties and in an optimal nutrient perfusion determinant for cell survival. However, the success of an engineered tissue architecture is often linked to its surface properties as well. The aim of this study was to create a family of polymeric pastes comprised of poly(ethylene oxide therephthalate)/poly(butylene terephthalate) (PEOT/PBT) microspheres and of a second biocompatible polymeric phase acting as a binder. By combining microspheres with additive manufacturing technologies, we produced 3D scaffolds possessing a tailorable surface roughness, which resulted in improved cell adhesion and increased metabolic activity. Furthermore, these scaffolds may offer the potential to act as drug delivery systems to steer tissue regeneration.

Keywords: additive manufacturing | mechanical analysis | mesenchymal stem cells | microparticles | polymers | tissue engineering

Abstract: The concept of magnetic guidance has opened a wide range of perspectives in the field of tissue regeneration. Accordingly, the aim of the current research is to design magnetic responsive scaffolds for enhanced bone tissue regeneration. Specifically, magnetic nanocomposite scaffolds are additively manufactured using 3D fibre deposition technique. The mechanical and magnetic properties of the fabricated scaffolds are first assessed. The role of magnetic features on the biological performances is properly analyzed.

Keywords: bone tissue engineering | design for additive manufacturing | magnetic nanocomposite scaffolds | mechanical and functional properties

Abstract: This paper introduces a new recommendation system for museums able to profile the visitors and propose them the most suitable exhibition path accordingly, to improve visitors’ satisfaction. It consists of an interactive touch screen totem, which implements a USB camera and exploits Convolutional Neural Network to perform facial coding to measure visitors’ emotions and estimate their age and gender. Based on the detected level of emotional valence, the system associates visitors with a profile and suggests them to visit a selection of five works of art, following a specific itinerary. An extensive experimentation lasting 2 months has been carried out at the Modern Art Museum “Palazzo Buonaccorsi” of Macerata. Results evidence that the proposed system can create an interactive and emotional link with the visitors, influencing their mood in the Pre-Experience phase and in the subsequent Post-Experience phase. In particular, they highlight that the proposed system, which aims at acting as emotional leverage, has been able to improve the positiveness of the emotions experienced by the visitors.

Keywords: Affective computing | Cultural heritage | Emotion recognition | Facial expression recognition

Abstract: The cooling of a melt corresponding to the eutectic between wollastonite (CaSiO3) and diopside (CaMgSi2O6) determines the synthesis of an interesting example of alkali-free bioactive glass, easily converted into glass-ceramics featuring two silicate phases, coupled also with åkermanite (Ca2MgSi2O7), by sinter-crystallization of fine glass powders at 1000°C. The fabrication of scaffolds by digital light processing of glass powders suspended in a photo-curable, sacrificial binder, is a well-established technique; the present paper aims at disclosing novel approaches, concerning the topology of scaffolds, offering components with remarkable strength, especially in bending conditions. As an alternative, glass-ceramic foams were fabricated by the firing of porous precursors derived from the gelation of suspensions of glass powders in alkali-free basic aqueous solution.

Keywords: additive manufacturing | alkali-free bioactive glasses | bioactive glass-ceramics | gel casting | scaffolds | sinter-crystallization

Abstract: Additive manufacturing technologies, compared to conventional shaping methods, offer great opportunities in design versatility, for the manufacturing of highly porous ceramic components. However, the application to glass powders, later subjected to viscous flow sintering, involves significant challenges, especially in shape retention and in the achievement of a substantial degree of translucency in the final products. The present paper disclosed the potential of glass recovered from liquid crystal displays (LCD) for the manufacturing of highly porous scaffolds by direct ink writing and masked stereolithography of fine powders mixed with suitable organic additives, and sintered at 950◦C, for 1–1.5 h, in air. The specific glass, featuring a relatively high transition temperature (Tg~700◦C), allowed for the complete burn-out of organics before viscous flow sintering could take place; in addition, translucency was favored by the successful removal of porosity in the struts and by the resistance of the used glass to crystallization.

Keywords: Additive manufacturing | Direct ink writing | Glass recycling | LCD glass | Scaffolds

Abstract: Short bowel syndrome is a pathological condition resulting from extensive resection of the intestine, generally performed due to congenital abnormalities, Crohn’s disease, mesenteric ischemia, or neoplasms. The main consequence of this syndrome is a reduction of intestinal absorp-tion, which causes malnutrition and dehydration. In the most severe cases, specific and complex surgical procedures are requested to manage the syndrome. Such procedures consist of the intestinal lengthening, with lead to an increase of absorptive mucosal surface and intestinal transit time and an overall enhancement of intestinal absorption. One of the most promising surgical procedures is spiral intestinal lengthening and tailoring, which consists of a spiral incision of the intestinal wall and in the elongation longitudinally of the intestine by sliding one flap over the other. The final intestinal lengthening is strictly dependent on a series of parameters, some of which are defined by the surgeon. The present paper proposes a mathematical model, based on patient specific anatomical data, which aims to help the surgeon in defining the optimal parameters for the intervention and in foreseeing its outcomes from the preoperative planning phase. Such a tool can assist the physician in the surgery room by improving the procedure and reducing surgical times.

Keywords: Intestinal failure | Intestinal lengthening | Pediatric | Preoperative planning | Short bowel syndrome | Surgical simulation

Abstract: Liver cells cultured in 3D bioreactors is an interesting option for temporary extracorporeal liver support in the treatment of acute liver failure and for animal models for preclinical drug screening. Bioreactor capacity to eliminate drugs is generally used for assessing cell metabolic competence in different bioreactors or to scale-up bioreactor design and performance for clinical or preclinical applications. However, drug adsorption and physical transport often disguise the intrinsic drug biotransformation kinetics and cell metabolic state. In this study, we characterized the intrinsic kinetics of lidocaine elimination and adsorption by porcine liver cells cultured in 3D four-compartment hollow fiber membrane network perfusion bioreactors. Models of lidocaine transport and biotransformation were used to extract intrinsic kinetic information from response to lidocaine bolus of bioreactor versus adhesion cultures. Different from 2D adhesion cultures, cells in the bioreactors are organized in liver-like aggregates. Adsorption on bioreactor constituents significantly affected lidocaine elimination and was effectively accounted for in kinetic analysis. Lidocaine elimination and cellular monoethylglicinexylidide biotransformation featured first-order kinetics with near-to-in vivo cell-specific capacity that was retained for times suitable for clinical assist and drug screening. Different from 2D cultures, cells in the 3D bioreactors challenged with lidocaine were exposed to close-to-physiological lidocaine and monoethylglicinexylidide concentration profiles. Kinetic analysis suggests bioreactor technology feasibility for preclinical drug screening and patient assist and that drug adsorption should be accounted for to assess cell state in different cultures and when laboratory bioreactor design and performance is scaled-up to clinical use or toxicological drug screening.

Keywords: Adsorption | Bioreactor | Elimination | Kinetics | Lidocaine | Liver cells | Tissue engineering

Abstract: In the current research, an optimization design strategy for additive manufacturing processes based on extrusion/injection methods was extended to the fabrication of poly(ε-caprolactone) (PCL)/iron oxide (Fe3O4) scaffolds for tissue engineering. The attention was focused on four parameters: process temperature (PT), deposition velocity (DV), screw rotation velocity (SRV), slice thickness (ST). Specifically, PCL/Fe3O4 scaffolds were manufactured varying iteratively one parameter, while maintaining constant the other three parameters. A further insight into the influence of process parameters on the morphological features and mechanical properties of PCL/Fe3O4 scaffolds was provided.

Keywords: Design for additive manufacturing | Magnetic nanocomposite scaffolds | Mechanical and morphological properties | Tissue engineering

Abstract: Nowadays, technology in sport plays an important role to help training and judgement processes. This study proposes the use of a wearable inertial system to derive novel biomechanical indices for the assessment of performance and infringements in race-walking. These indices are built from five inertial-based parameters: loss of ground contact time, loss of ground contact step classification, step length ratio, step cadence and smoothness. The biomechanical indices are customized for elite race-walkers, and represented on a radar chart for an intuitive analysis of performance and infringements. From the radar chart, a synthetic index regarding the athlete’s overall gesture is derived. The validation of the biomechanical indices is carried out in field tests, involving nine elite race-walkers wearing an inertial sensor located at the end of the column vertebra (L5–S1). A statistical analysis is used to determinate the quality and reliability of the proposed indices and of their representation. The results show that these biomechanical indices can be implemented on a wearable inertial system for assistance in training and judgement in race-walking.

Keywords: Biomechanics | Field tests | Graphical data analysis | Infringements | Performance | Race-walking | Wearable sensors

Abstract: In this paper we present novel biomechanical indices for site-specific assessment of injury risk in cycling. The indices are built from a multifactorial analysis based on the kinematics and kinetics of the cyclist from the biomechanical side, and muscle excitations and muscle synergies from the neurophysiological side. The indices are specifics for three body regions (back, knee, ankle) which are strongly affected by overuse injuries in cycling. We use these indices for injury risks analysis of a recreational cyclist, who offered to participate in the experiments. The preliminary results are promising towards the use of such indices for planning and/or evaluating training schedule with the final goal of reducing non-traumatic injuries in cycling.

Keywords: biomechanics | cycling | electromyography | injury risk | laboratory test

Abstract: This paper shows how studies on the biomechanics and neuroscience of human movements might be used for the design of wearable systems customized for humans. Such design is driven by key biomechanical and neuromuscular parameters extracted from accurate measurements made on the human body motion, as well as by subjective data collected from the end-users of the products through questionnaires. We present three case studies developed at ERGOS Lab: a wearable system for sports performance analysis; a synergy-based approach for industrial wearable robots; a soft wearable robotic glove for hand rehabilitation.

Keywords: Biomechanics | Design methods | Neuromuscular activity | Wearable technology

Abstract: Despite the wide use of scaffolds with spherical pores in the clinical context, no studies are reported in the literature that optimize the micro-architecture dimensions of such scaffolds to maximize the amounts of neo-formed bone. In this study, a mechanobiology-based optimization algorithm was implemented to determine the optimal geometry of scaffolds with spherical pores subjected to both compression and shear loading. We found that these scaffolds are particularly suited to bear shear loads; the amounts of bone predicted to form for this load type are, in fact, larger than those predicted in other scaffold geometries. Knowing the anthropometric characteristics of the patient, one can hypothesize the possible value of load acting on the scaffold that will be implanted and, through the proposed algorithm, determine the optimal dimensions of the scaffold that favor the formation of the largest amounts of bone. The proposed algorithm can guide and support the surgeon in the choice of a "personalized" scaffold that better suits the anthropometric characteristics of the patient, thus allowing to achieve a successful follow-up in the shortest possible time.

Keywords: Bone tissue engineering | Computational mechanobiology | Geometry optimization | Parametric CAD (Computer aided design) model | Python code

Abstract: In spite of the rather large use of the fused deposition modeling (FDM) technique for the fabrication of scaffolds, no studies are reported in the literature that optimize the geometry of such scaffold types based on mechanobiological criteria. We implemented a mechanobiology-based optimization algorithm to determine the optimal distance between the strands in cylindrical scaffolds subjected to compression. The optimized scaffolds were then 3D printed with the FDM technique and successively measured. We found that the difference between the optimized distances and the average measured ones never exceeded 8.27% of the optimized distance. However, we found that large fabrication errors are made on the filament diameter when the filament diameter to be realized differs significantly with respect to the diameter of the nozzle utilized for the extrusion. This feasibility study demonstrated that the FDM technique is suitable to build accurate scaffold samples only in the cases where the strand diameter is close to the nozzle diameter. Conversely, when a large difference exists, large fabrication errors can be committed on the diameter of the filaments. In general, the scaffolds realized with the FDM technique were predicted to stimulate the formation of amounts of bone smaller than those that can be obtained with other regular beam-based scaffolds.

Keywords: Biomaterials | Geometry optimization | Mechanobiology | Scaffold design | Tissue engineering

Abstract: This paper presents IART, a novel inertial wearable system for automatic detection of infringements and analysis of sports performance in race walking. IART algorithms are developed from raw inertial measurements collected by a single sensor located at the bottom of the vertebral column (L5–S1). Two novel parameters are developed to estimate infringements: loss of ground contact time and loss of ground contact step classification; three classic parameters are indeed used to estimate performance: step length ratio, step cadence, and smoothness. From these parameters, five biomechanical indices customized for elite athletes are derived. The experimental protocol consists of four repetitions of a straight path of 300 m on a long-paved road, performed by nine elite athletes. Over a total of 1620 steps (54 sequences of 30 steps each), the average accuracy of correct detection of loss of ground contact events is equal to 99%, whereas the correct classification of the infringement is equal to 87% for each step sequence, with a 92% of acceptable classifications. A great emphasis is dedicated on the user-centered development of IART: an intuitive radar chart representation is indeed developed to provide practical usability and interpretation of IART indices from the athletes, coaches, and referees perspectives. The results of IART, in terms of accuracy of its indices and usability from end-users, are encouraging for its usage as tool to support athletes and coaches in training and referees in real competitions.

Keywords: Biomechanics | Inertial sensor | Judgment | Race walking | Step classification | Training improvement | User-centered design

Abstract: Purpose: The purpose of this study is the evaluation of advantages and criticalities related to the application of addtive manufacturing (AM) to the production of parts for musical instruments. A comparison between traditional manufacturing and AM based on different aspects is carried out. Design/methodology/approach: A set of mouthpieces produced through different AM techniques has been designed, manufactured and evaluated using an end-user satisfaction-oriented approach. A musician has been tasked to play the same classical music piece with different mouthpieces, and the sound has been recorded in a recording studio. The mouthpiece and sound characteristics have been evaluated in a structured methodology. Findings: The quality of the sound and comfort of 3D printed mouthpieces can be similar to the traditional ones provided that an accurate design and proper materials and technologies are adopted. When personalization and economic issues are considered, AM is superior to mouthpieces produced by traditional techniques. Research limitations/implications: In this research, a mouthpiece for trombone has been investigated. However, a wider analysis where several musical instruments and related parts are evaluated could provide more data. Practical implications: The production of mouthpieces with AM techniques is suggested owing to the advantages which can be tackled in terms of customization, manufacturing cost and time reduction. Originality/value: This research is carried out using a multidisciplinary approach where several data have been considered to evaluate the end user satisfaction of 3D printed mouthpieces.

Keywords: Additive manufacturing | Dental materials | Fused deposition modelling | Musical instruments | Stereolithography

Abstract: This work aims to present an in-house low-cost computer-aided simulation (CASS) process that was recently implemented in the preoperative planning of complex osteotomies for limb deformities in children. Five patients admitted to the Unit of Paediatric Orthopaedics and Traumatology from April 2018 to December 2019, for correcting congenital or post-traumatic limb deformities were included in the study. Three-dimensional (3D) digital models were generated from Computed Tomography (CT) scans, using free open-source software, and the surgery was planned and simulated starting from the 3D digital model. 3D printed sterilizable models were fabricated using a low-cost 3D printer, and animations of the operation were generated with the aim to accurately explain the operation to parents. All procedures were successfully planned using our CASS method and the 3D printed models were used during the operation, improving the understanding of the severely abnormal bony anatomy. The surgery was precisely reproduced according to CASS and the deformities were successfully corrected in four cases, while in one case, the intraoperative intentional undersizing of the bone osteotomy produced an incomplete correction of a congenital forearm deformity. Our study describes the application of a safe, effective, user-friendly, and low-cost CASS process in paediatric orthopaedics (PO) surgery. We are convinced that our study will stimulate the widespread adoption of this technological innovation in routine clinical practice for the treatment of rare congenital and post-traumatic limb deformities during childhood.

Keywords: 3D modeling | Computer aided | Osteotomy | Paediatric orthopaedics | Preoperative planning | Surgery | Surgical simulation

Abstract: In brain tumor surgery, an appropriate and careful surgical planning process is crucial for surgeons and can determine the success or failure of the surgery. A deep comprehension of spatial relationships between tumor borders and surrounding healthy tissues enables accurate surgical planning that leads to the identification of the optimal and patient-specific surgical strategy. A physical replica of the region of interest is a valuable aid for preoperative planning and simulation, allowing the physician to directly handle the patient’s anatomy and easily study the volumes involved in the surgery. In the literature, different anatomical models, produced with 3D technologies, are reported and several methodologies were proposed. Many of them share the idea that the employment of 3D printing technologies to produce anatomical models can be introduced into standard clinical practice since 3D printing is now considered to be a mature technology. Therefore, the main aim of the paper is to take into account the literature best practices and to describe the current workflow and methodology used to standardize the pre-operative virtual and physical simulation in neurosurgery. The main aim is also to introduce these practices and standards to neurosurgeons and clinical engineers interested in learning and implementing cost-effective in-house preoperative surgical planning processes. To assess the validity of the proposed scheme, four clinical cases of preoperative planning of brain cancer surgery are reported and discussed. Our preliminary results showed that the proposed methodology can be applied effectively in the neurosurgical clinical practice both in terms of affordability and in terms of simulation realism and efficacy.

Keywords: 3D casting | 3D printing | Additive manufacturing | Brain | Cancer | Computer aided design | Neurosurgery | Physical simulation | Preoperative planning | Virtual planning

Abstract: The paper describes the conceptual model of an emotion-aware car interface able to: map both the driver’s cognitive and emotional states with the vehicle dynamics; adapt the level of automation or support the decision-making process if emotions negatively affecting the driving performance are detected; ensure emotion regulation and provide a unique user experience creating a more engaging atmosphere (e.g. music, LED lighting) in the car cabin. To enable emotion detection, it implements a low-cost emotion recognition able to recognize Ekman’s universal emotions by analyzing the driver’s facial expression from stream video. A preliminary test was conducted in order to determine the effectiveness of the proposed emotion recognition system in a driving context. Results evidenced that the proposed system is capable to correctly qualify the drivers’ emotion in a driving simulation context.

Keywords: Driver Monitoring System | Emotion recognition | Facial expression recognition

Abstract: Degeneration of articular cartilage (AC) is a common healthcare issue that can result in significantly impaired function and mobility for affected patients. The avascular nature of the tissue strongly burdens its regenerative capacity contributing to the development of more serious conditions such as osteoarthritis. Recent advances in bioprinting have prompted the development of alternative tissue engineering therapies for the generation of AC. Particular interest has been dedicated to scaffold-based strategies where 3D substrates are used to guide cellular function and tissue ingrowth. Despite its extensive use in bioprinting, the application of polycaprolactone (PCL) in AC is, however, restricted by properties that inhibit pro-chondrogenic cell phenotypes. This study proposes the use of a new bioprintable poly(ester urea) (PEU) material as an alternative to PCL for the generation of an in vitro model of early chondrogenesis. The polymer was successfully printed into 3D constructs displaying adequate substrate stiffness and increased hydrophilicity compared to PCL. Human chondrocytes cultured on the scaffolds exhibited higher cell viability and improved chondrogenic phenotype with upregulation of genes associated with type II collagen and aggrecan synthesis. Bioprinted PEU scaffolds could, therefore, provide a potential platform for the fabrication of bespoke, pro-chondrogenic tissue engineering constructs.

Keywords: 3D bioprinting | Cartilage repair | Poly(ester urea) | Scaffold design | Tissue engineering

Abstract: Background: In the case of a degenerated intervertebral disc (IVD), even though spinal fusion has provided good short-term clinical results, an alteration of the spine stability has been demonstrated by long-term studies. In this context, different designs of IVD prostheses have been proposed as alternative to spinal fusion. However, over the past few years, much of the recent research has been devoted to IVD tissue engineering, even if several limitations related to the complex structure of IVD are still presented.Purpose/Aim: Accordingly, the aim of the current paper was to develop a strategy in designing customised multiphasic nucleus/annulus scaffolds for IVD tissue engineering, benefiting from the great potential of reverse engineering, additive manufacturing and gels technology.Materials and Methods: The device consisted of a customised additive-manufactured poly(ε-caprolactone) scaffold with tailored architectural features as annulus and a cell-laden collagen-low molecular weight hyaluronic acid-based material as nucleus with specific rheological and functional properties. To this aim, injectability and viscoelastic properties of the hydrogel were analyzed. Furthermore, a mechanical and biological characterization of cell-laden multiphasic nucleus/annulus scaffold was performed.Results and Conclusions: Analyses on the developed devices demonstrated appropriate viscoelastic and mechanical properties. As evidenced by rheological tests, the hydrogel showed a shear-thinning behaviour, supporting the possibility to inject the material. The mechanical characterization highlighted a compressive modulus which falls in the range of lumbar discs, with the typical initial J-shaped stress–strain curve of natural IVDs. Furthermore, preliminary biological tests showed that human mesenchymal stem cells were viable over the culture period.

Keywords: additive manufacturing | gels | intervertebral disc | Polymers | reverse engineering | tissue engineering

Abstract: The concept of magnetic guidance is still challenging and has opened a wide range of perspectives in the field of tissue engineering. In this context, magnetic nanocomposites consisting of a poly(ε-caprolactone) (PCL) matrix and iron oxide (Fe3 O4) nanoparticles were designed and manufactured for bone tissue engineering. The mechanical properties of PCL/Fe3 O4 (80/20 w/w) nanocomposites were first assessed through small punch tests. The inclusion of Fe3 O4 nanoparticles improved the punching properties as the values of peak load were higher than those obtained for the neat PCL without significantly affecting the work to failure. The effect of a time-dependent magnetic field on the adhesion, proliferation, and differentiation of human mesenchymal stem cells (hMSCs) was analyzed. The Alamar Blue assay, confocal laser scanning microscopy, and image analysis (i.e., shape factor) provided information on cell adhesion and viability over time, whereas the normalized alkaline phosphatase activity (ALP/DNA) demonstrated that the combination of a time-dependent field with magnetic nanocomposites (PCL/Fe3 O4 Mag) influenced cell differentiation. Furthermore, in terms of extracellular signal-regulated kinase (ERK)1/2 phosphorylation, an insight into the role of the magnetic stimulation was reported, also demonstrating a strong effect due the combination of the magnetic field with PCL/Fe3 O4 nanocomposites (PCL/Fe3 O4 Mag).

Keywords: Bone tissue engineering | Design of magnetic nanocomposite substrates | Magnetic stimulation | Material interaction | Mechanical properties and cell | Reverse engineering/image analysis

Abstract: AIM: The purpose of this study is to compare the stress effects developed on the periodontal ligaments and teeth by three different types of mandibular advancement devices (MADs) using a finite element method (FEM) analysis. Introduction: Obstructive sleep apnea (OSA) is a disease with a high prevalence and, in recent years, the use of MADs as an alternative or support treatment to the continuous positive airway pressure (CPAP) has spread. Their use finds relative contraindications in the case of partial edentulism and severe periodontal disease. Given the widespread of periodontal problems, it is essential to know the effects that these devices cause on the periodontal ligament of the teeth. Materials and methods: Starting from the computed tomography (CT) scan of a patient’s skull, 3D reconstructions of the maxilla and mandible were implemented. Three different MADs were prepared for the patient, then 3D scanned, and lastly, coupled with the 3D models of the jaws. The devices have two different mechanics: One has a front reverse connecting rod (Orthoapnea™), and two have lateral propulsion (Somnodent™ and Herbst™). A FEM analysis was performed to calculate the stress applied on periodontal ligaments, on every single tooth and the displacement vectors that are generated by applying an advancement force on the mandible. Results: Herbst™ and Somnodent™ devices present very similar stress values, mainly concentrated on lateral teeth, but in general, the forces are very mild and distributed. The maximum stresses values are 3.27 kPa on periodontal ligaments and 287 kPa on teeth for Somnodent™ and 3.56 kPa on periodontal ligaments and 302 kPa on teeth for Herbst™. Orthoapnea™ has, instead, higher and concentrated stress values, especially in the anterior maxillary and mandibular area with 4.26 kPa and 600 kPa as maximum stress values, respectively, on periodontal ligaments and teeth. Conclusions: From the results, it is concluded that devices with a bilateral mechanism generate less and more distributed stress than an anterior connecting rod mechanism. Therefore, they may be advisable to patients with compromised periodontal conditions in the anterior area.

Keywords: Dental materials | Finite element method | Mandibular advancement device | Obstructive sleep apnea | Orthodontics

Abstract: This work proposes an innovative method for evaluating usersâ™ engagement, combining the User Engagement Scale (UES) questionnaire and a facial expression recognition (FER) system, active research topics of increasing interest in the humanâ"computer interaction domain (HCI). The subject of the study is a 3D simulator that reproduces a virtual FabLab in which users can approach and learn 3D modeling software and 3D printing. During the interaction with the virtual environment, a structured-light camera acquires the face of the participant in real-time, to catch its spontaneous reactions and compare them with the answers to the UES closed-ended questions. FER methods allow overcoming some intrinsic limits in the adoption of questioning methods, such as the non-sincerity of the interviewees and the lack of correspondence with facial expressions and body language. A convolutional neural network (CNN) has been trained on the Bosphorus database (DB) to perform expression recognition and the classification of the video frames in three classes of engagement (deactivation, average activation, and activation) according to the model of emotion developed by Russell. The results show that the two methodologies can be integrated to evaluate user engagement, to combine weighted answers and spontaneous reactions and to increase knowledge for the design of the new product or service.

Keywords: 3D simulator | CNN | Deep learning | Facial expression recognition | Human-computer interaction | User engagement scale | User-centered design

Abstract: The ovary is a dynamic mechanoresponsive organ. In vitro, tissue biomechanics was reported to affect follicle activation mainly through the Hippo pathway. Only recently, ovary responsiveness to mechanical signals was exploited for reproductive purposes. Unfortunately, poor characterization of ovarian cortex biomechanics and of the mechanical challenge hampers reproducible and effective treatments, and prevention of tissue damages. In this study the biomechanical response of ovarian cortical tissue from abattoir bovines was characterized for the first time. Ovarian cortical tissue fragments were subjected to uniaxial dynamic testing at frequencies up to 30 Hz, and at increasing average stresses. Tissue structure prior to and after testing was characterized by histology, with established fixation and staining protocols, to assess follicle quality and stage. Tissue properties largely varied with the donor. Bovine ovarian cortical tissue consistently exhibited a nonlinear viscoelastic behavior, with dominant elastic characteristics, in the low range of other reproductive tissues, and significant creep. Strain rate was independent of the applied stress. Histological analysis prior to and after mechanical tests showed that the short-term dynamic mechanical test used for the study did not cause significant tissue tear, nor follicle expulsion or cell damage.

Keywords: Biomechanics | Creep | Elastic modulus | Ovarian tissue | Tensile test | Viscous behavior

Abstract: Cement-retained implant-supported prosthetics are gaining popularity compared to the alternative screw-retained type, a rise that serves to highlight the importance of retrievability. The aim of the present investigation is to determine the influence of luting agent, abutment height and taper angle on the retrievability of abutment-coping cementations. Abutments with different heights and tapers were screwed onto an implant and their cobalt-chrome copings were cemented on the abutments using three different luting agents. The removals were performed by means of Coronaflex®. The number of impulses and the forces were recorded and analyzed with a Kruskal-Wallis test. Harvard cement needed the highest number of impulses for retrieval, followed by Telio CS and Temp Bond. However, abutment height and taper showed a greater influence on the cap's retrievability (p < 0.05). Long and tapered abutments provided the highest percentage of good retrievability. The influence of the luting agent and the abutment geometry on the cap's retrieval performed by Coronaflex® reflects data from literature about the influence of the same factor on the maximum force reached during uniaxial tensile tests. The impulse force was slightly affected by the same factors.

Keywords: Abutments geometry | Coronaflex | Dental cements | Dental implants | Retrievability

Abstract: A number of studies have recently demonstrated that the geometry of scaffolds for bone tissue engineering significantly affects the tissue differentiation process and the rate of bone tissue regeneration. These findings and the possibility of fabricating any kind of sophisticated geometries by additive manufacturing techniques led many researchers throughout the world to investigate strategies for the design of scaffolds and for the optimization of their geometry. In this chapter, after revising the numerical optimization algorithms recently implemented to determine the best scaffold geometry we will investigate, in particular, those that are mechanobiology-driven. These algorithms perturb the scaffold microarchitecture until the optimal scaffold geometry, i.e., the geometry that allows maximizing the amounts of bone forming within the scaffold pores, is computed. Different applications of these algorithms to different regular and irregular scaffold geometries will be shown.

Keywords: Beam-based scaffold | Irregular scaffold | Mechanobiology | Mechanoregulation algorithm | Regular scaffold

Abstract: Light activated composites are the most popular choice in the field of dental restoration. They generally show internal stress even after a prolonged time period. The knowledge of mechanical properties and residual stress should provide interesting information on the clinical performance of such materials. Accordingly, in the current research experimental analyses were carried out to assess the effect of the curing process on the properties of one of the most commonly employed light activated dental composites (Gradia Direct—GC Corporation, Japan). At 10 min, 1 h and 24 h after light curing, the bending modulus (4.7–6.2 GPa) as well as the punching performance (peak load of 12.1–17.5 N) were evaluated for the micro-hybrid composite. Scanning electron microscopy also allowed to analyze the fracture surface. Residual stresses ranging from 0.67 ± 0.15 MPa to 1.12 ± 0.17 MPa were measured by means of the thin-ring-slitting approach reported in the literature, according to measurement time and cutting time.

Keywords: CAD/CAM system | Dental materials | Mechanical and morphological properties | Residual stress

Abstract: The control of the process–structure–property relationship of a material plays an important role in the design of biomedical metal devices featuring desired properties. In the field of endodontics, several post-core systems have been considered, which include a wide range of industrially developed posts. Endodontists generally use posts characterized by different materials, sizes, and shapes. Computer-aided design (CAD) and finite element (FE) analysis were taken into account to provide further insight into the effect of the material–shape combination of metal posts on the mechanical behavior of endodontically treated anterior teeth. In particular, theoretical designs of metal posts with two different shapes (conical-tapered and conical-cylindrical) and consisting of materials with Young’s moduli of 110 GPa and 200 GPa were proposed. A load of 100 N was applied on the palatal surface of the crown at 45◦ to the longitudinal axis of the tooth. Linear static analyses were performed with a non-failure condition. The results suggested the possibility to tailor the stress distribution along the metal posts and at the interface between the post and the surrounding structures, benefiting from an appropriate combination of a CAD-based approach and material selection. The obtained results could help to design metal posts that minimize stress concentrations.

Keywords: Computer-aided design (CAD) | Dental materials | Finite element analysis | Image analysis | Mechanical properties | Metal posts

Abstract: The musculoskeletal disorders represent one of the most common problems in industrial environment; they impact the health of workers and employees. In this work we present a preliminary study towards the use of biomechanical models for improving classic methods for ergonomic assessment in industry. To this end, we use OpenSim, a software for biomechanical simulation and analysis. With OpenSim, we reconstruct the human motion corresponding to the execution of industrial tasks, performed in laboratory settings. In particular, we compute the evolution over time of the joint angles that, according to a classic observation method for ergonomic assessment, are needed to evaluate the risks associated to the musculoskeletal disorders for the upper limb.

Keywords: biomechanics | digital human model | ergonomics | industry

Abstract: In this work we present a study for the experimental reconstruction of the human shoulder torque in the sagittal plane, since this is usually overloaded in industrial overhead tasks. To this end, we measure the three-dimensional motion of the human upper limb while performing selected movements using an optical motion capture system. Then, using a skeleton model implemented in one of the most common software for industrial ergonomic assessment, we reconstruct the shoulder angle and torque in the sagittal plane. A possible exploitation of this reconstruction strategy is presented for active compensation of this torque. The implementation of this simple strategy in a custom developed assistive device could augment human workers in performing repetitive jobs.

Keywords: biomechanics | digital human models | human motion analysis | industrial assistive devices

Abstract: This scientific work aims at developing an innovative virtual platform to design lower limb prosthesis centered on the virtual model of the patient and based on a computer-aided and knowledge-guided approach. The main idea is to develop a digital human model of the amputee to be used by the prosthetist in a full virtual environment in which a platform provides a set of interactive tools to design, configure, and test the prosthesis. This virtual platform permits to design and configure the whole prosthesis, in particular, the 3D model of the assembled prosthesis, crucial to define the prosthesis setup and patient’s walking performance. An ad-hoc computer-aided design system has been developed in house to design the 3D model of the socket according to traditional operations made by technicians during traditional manufacturing process. Moreover, a finite element model has been defined to study the contact between residual limb and socket. The resulting 3D model of the socket can be realized by exploiting multimaterial additive manufacturing technology. Finally, the developed platform also permits to handle contact pressures and patient’s gait data in a unique application through the use of a low-cost motion capture (MOCAP) system. The whole platform has been tested with the help of an Italian orthopedic laboratory. The developed platform is a promising solution to develop the check socket, and the application may be used also for training purpose for junior orthopedic technicians.

Keywords: Low-cost MOCAP system | Lower limb prosthesis | Pressure analysis | Socket design and 3D modeling

Abstract: Scaffolds are porous biomaterials that serve to replace missing portions of bone. Scaffolds must possess a proper geometry and hence have to be adequately designed to correctly undergo to the load and to favor the differentiation of the mesenchymal stem cells invading it, into osteoblasts. It is commonly known that scaffold geometry affects the quality of the regenerated bone creating within the scaffold pores. Scaffold properly designed trigger favorable values of biophysical stimuli that are responsible for the reactions cascade leading to the bone formation. In this paper an optimization algorithm is proposed that, based on mechano-regulation criteria, identifies the optimal geometry of scaffolds, i.e. the geometry that favors the formation of the largest amounts of bone in the shortest time. In detail, the algorithm, written in the Matlab environment, incorporates parametric finite element models of different scaffold types, a computational mechanobiological model and structural optimization routines. The scaffold geometry is iteratively perturbed by the algorithm until the optimal geometry is computed, i.e. the geometry that triggers the most favorable values of the biophysical stimulus which lead to the formation of mature bone. Mesenchymal stem cells were hypothesized to spread within the fracture domain and uniformly occupy the scaffold pores.

Keywords: Hexahedron unit cell | Mechanobiology | Rhombicuboctahedron unit cell | Unit cell geometry

Abstract: The final subject position is often the only evidence in the case of the fall of a human being from a given height. Foreseeing the body trajectory and the respective driving force may not be trivial due to the possibility of rotations and to an unknown initial position and momentum of the subject. This article illustrates how multibody models can be used for this aim, with specific reference to an actual case, where a worker fell into a stair well, prior to stair mounting, and he was found in an unexpected posture. The aim of the analysis was establishing if this worker was dead in that same place, if he had been pushed, and which was his initial position. A multibody model of the subject has been built (“numerical android”), given his stature and his known mass. Multiple simulations have been performed, following a design of experiments where various initial positions and velocity as well as pushing forces have been considered, while the objective function to be minimized was the deviation of the numerical android position from the actual worker position. At the end of the analysis, it was possible to point how a very limited set of conditions, all including the application of an external pushing force (or initial speed), could produce the given final posture with an error on the distance function equal to 0.39 m. The full analysis gives a demonstration of the potentiality of multibody models as a tool for the analysis of falls in forensic inquiries.

Keywords: accident | android | biomechanics | crime | doe | fall | forensic | multibody

Abstract: This paper presents the application of a low-cost 3D printing technology in pre-operative planning and intra-operative decision-making. Starting from Computed Tomography (CT) scans, we were able to reconstruct a 3D model of the area of interest with a very simple and rapid workflow, using open-source software and an entry level 3D printer. The use of High Temperature Poly-Lactic Acid (HTPLA) by ProtoPasta allowed fabricating sterilizable models, which could be used within the surgical field. We believe that our method is an appealing alternative to high-end commercial products, being superior for cost and speed of production. It could be advantageous especially for small and less affluent hospitals that could produce customized sterilizable tools with little investment and high versatility.

Keywords: 3D printing | Computed tomography | Diagnostic imaging | Mesh reconstruction | Rapid prototyping | Surgical planning

Abstract: 3D reconstruction of human anatomy from cross-sectional imaging has recently gained increasing importance in several medical fields thus designating the 3D bones reconstruction accuracy, critical for the success of the whole surgical intervention. The 3D anatomic model quality depends on the quality of the reconstructed image, on the quality of the images segmentation step and on the error introduced by the iso-surface triangulation algorithm. The influence of image processing procedures and relative parametrization has been largely studied in the scientific literature; however, the analysis of the direct impact of the quality of the reconstructed medical images is still lacking. In this paper, a comparative study on the influence of both image reconstruction algorithm (standard and iterative) and applied kernel is reported. Research was performed on the 3D reconstruction of a pig tibia, by using Philips Brilliance 64 CT scanner. At the stage of scanning and at the stage of 3D reconstruction, the same procedures were followed, while only image reconstruction algorithm and kernel were changed. The influence of such selection on the accuracy of bone geometry was assessed by comparing it against the 3D model obtained with a professional 3D scanner. Results show an average error in reconstructing the geometry of around 0.1 mm with a variance of 0.08 mm. The presented study highlights new opportunities to control the deviations on the geometry accuracy of the bones structures at the stage of cross sectional imaging generation.

Keywords: 3D model reconstruction | Accuracy | Computed tomography | Kernel reconstruction

Abstract: This study proposes a novel occlusions detection and restoration strategy. The aim is to success with 3D face recognition even when faces are partially occluded by external objects. The method, which relies on geometrical facial properties, is designed for managing two types of facial occlusions (eye and mouth occlusions due to hands). First occlusions are detected and (if present) classified, by considering their effects on the 3D points cloud. Then, the occluded regions are progressively removed, and finally, the non-occluded symmetrical regions are used to restore the missing information. After the restoration process, face recognition is performed relying on the restored facial information and on the localized landmarks. The landmarking methodology relies on derivatives and on 12 differential geometry descriptors. The discriminating features adopted for facial comparison include shape index histograms, Euclidean and geodetical distances between landmarks, facial curves, and nose volume. Obtained recognition rates, evaluated on the whole Bosphorus database and on our private dataset, ranging from 92.55 to 97.20% depending on the completeness of data.

Keywords: 3D face | Differential geometry | Face analysis | Face recognition | Feature extraction

Abstract: Three-dimensional technologies have had a wide diffusion in several fields of application throughout the last decades; medicine is no exception and the interest in their introduction in clinical applications has grown with the refinement of such technologies. We focus on the application of 3D methodologies in maxillofacial surgery, where they can give concrete support in surgical planning and in the prediction of involuntary facial soft-tissue changes after planned bony repositioning. The purpose of this literature review is to offer a panorama of the existing prediction methods and software with a comparison of their reliability and to propose a series of still pending issues. Various software are available for surgical planning and for the prediction of tissue displacements, but their reliability is still an unknown variable in respect of the accuracy needed by surgeons. Maxilim, Dolphin and other common planning software provide a realistic result, but with some inaccuracies in specific areas of the face; it also is not totally clear how the prediction is obtained by the software and what is the theoretical model they are based on.

Keywords: 3D face analysis | Orthognathic surgery | Prediction methods | Soft tissue prediction | Surgical planning

Abstract: In recent years, facial expression analysis and recognition (FER) have emerged as an active research topic with applications in several different areas, including the human-computer interaction domain. Solutions based on 2D models are not entirely satisfactory for real-world applications, as they present some problems of pose variations and illumination related to the nature of the data. Thanks to technological development, 3D facial data, both still images and video sequences, have become increasingly used to improve the accuracy of FER systems. Despite the advance in 3D algorithms, these solutions still have some drawbacks that make pure three-dimensional techniques convenient only for a set of specific applications; a viable solution to overcome such limitations is adopting a multimodal 2D+3D analysis. In this paper, we analyze the limits and strengths of traditional and deep-learning FER techniques, intending to provide the research community an overview of the results obtained looking to the next future. Furthermore, we describe in detail the most used databases to address the problem of facial expressions and emotions, highlighting the results obtained by the various authors. The different techniques used are compared, and some conclusions are drawn concerning the best recognition rates achieved.

Keywords: 2D/3Dcomparison | 3Dface analysis | Action units | Deep learning-based FER | Facial action coding system | Facial expression recognition

Abstract: Nowadays, facial mimicry studies have acquired a great importance in the clinical domain and 3D motion capture systems are becoming valid tools for analysing facial muscles movements, thanks to the remarkable developments achieved in the 1990s. However, the face analysis domain suffers from a lack of valid motion capture protocol, due to the complexity of the human face. Indeed, a framework for defining the optimal marker set layout does not exist yet and, up to date, researchers still use their traditional facial point sets with manually allocated markers. Therefore, the study proposes an automatic approach to compute a minimum optimized marker layout to be exploited in facial motion capture, able to simplify the marker allocation without decreasing the significance level. Specifically, the algorithm identifies the optimal facial marker layouts selecting the subsets of linear distances among markers that allow to automatically recognizing with the highest performances, through a k-nearest neighbours classification technique, the acted facial movements. The marker layouts are extracted from them. Various validation and testing phases have demonstrated the accuracy, robustness and usefulness of the custom approach.

Keywords: 3D face | Face analysis | Feature extraction | Marker optimization | Motion capture

Abstract: As the potentials of technology grow, the embedding of IT advances in different fields and applications increases. A recent example is virtual reality and in particular the virtual product. The possibility of having a product in a virtual form allows creators and designers to efficiently manage the cycle of a product generation and evolution. The key advantage of the “virtual” is to have the product in advance, even in the conceptualization phase, with clear benefits in terms of consumptions of resources and, hence, sustainability. A potential customer could thus interact with a product-to-be and provide feedback about its look and feel, its usability, and, most of all, give an emotional response. In this context, the interaction between the virtual product and the future customer becomes a core point for the new approaches related to user-centred and user experience design, giving birth to a design methodology called “emotional design”. In particular, the study of facial expressions seems to be the more reliable and attractive aspect of it.

Keywords: 3D | Concept design | Emotional design | Facial expression recognition | PLM | Virtual reality

Abstract: In recent years the science of dental materials and implantology have taken many steps forward. In particular, it has tended to optimize the implant design, the implant surface, or the connection between implant and abutment. All these features have been improved or modified to obtain a better response from the body, better biomechanics, increased bone implant contact surface, and better immunological response. The purpose of this article, carried out by a multidisciplinary team, is to evaluate and understand, through the use also of bioengineering tests, the biomechanical aspects, and those induced on the patient’s tissues, by dental implants. A comparative analysis on different dental implants of the same manufacturer was carried out to evaluate biomechanical and molecular features. Von Mises analysis has given results regarding the biomechanical behavior of these implants and above all the repercussions on the patient’s tissues. Knowing and understanding the biomechanical characteristics with studies of this type could help improve their characteristics in order to have more predictable oral rehabilitations

Keywords: biomechanical phenomena | bone tissue | dental implants | dental occlusion | dental prosthesis design | finite element analysis | immunological | osseointegrated implants | osseointegration | wound healing

Abstract: Objective: To investigate the influence of implant design on the change in the natural frequency of bone-implant system during osseointegration by means of a modal 3D finite element analysis. Methods: Six implants were considered. Solid models were obtained by means of reverse engineering techniques. The mandibular bone geometry was built-up from a CT scan dataset through image segmentation. Each implant was virtually implanted in the mandibular bone. Two different models have been considered, differing in the free length of the mandibular branch (‘long branch’ and ‘short branch’) in order to simulate the variability of boundary conditions when performing vibrometric analyses. Modal analyses were carried out for each model, and the first three resonance frequencies were assessed with the respective vibration modes. Results: With reference to the ‘long branch’ model, the first three modes of vibration are whole bone vibration with minimum displacement of the implant relative to bone, with the exception of the initial condition (1% bone maturation) where the implant is not osseointegrated. By contrast, implant displacements become relevant in the ‘short branch’ model, unless osseointegration level is beyond 20%. The difference between resonance frequency at whole bone maturation and resonance frequency at 1% bone maturation remained lower than 6.5% for all modes, with the exception of the third mode of vibration in the ‘D’ implant where this difference reached 9.7%. With reference to the ‘short branch’ considering the first mode of vibration, 61–68% of the frequency increase was achieved at 10% osseointegration; 72–79% was achieved at 20%; 89–93% was achieved at 50% osseointegration. The pattern of the natural frequency versus the osseointegration level is similar among different modes of vibration. Significance: Resonance frequencies and their trends towards osseointegration level may differ between implant designs, and in different boundary conditions that are related to implant position inside the mandible; tapered implants are the most sensitive to bone maturation levels, small implants have very little sensitivity. Resonance frequencies are less sensitive to bone maturation level beyond 50%.

Keywords: Bone properties | CAD | Dental materials | Endosteal implants | Finite element analysis | Implant stability | Material properties | Osseointegration | Reverse engineering

Abstract: Objectives: To assess conceptual designs of dental posts consisting of polyetherimide (PEI) reinforced with carbon (C) and glass (G) glass fibers in endodontically treated anterior teeth. Methods: 3D tessellated CAD and geometric models of endodontically treated anterior teeth were generated from Micro-CT scan images. Model C-G/PEI composite posts with different Young's moduli were analyzed by Finite Element (FE) methods post A (57.7 GPa), post B (31.6 GPa), post C (from 57.7 to 9.0 GPa in the coronal–apical direction). A load of 50 N was applied at 45° to the longitudinal axis of the tooth, acting on the palatal surface of the crown. The maximum principal stress distribution was determined along the post and at the interface between the post and the surrounding structure. Results: Post C, with Young's modulus decreasing from 57.7 to 9.0 GPa in the coronal–apical direction, reduced the maximum principal stress distribution in the restored tooth. Post C gave reduced stress and the most uniform stress distribution with no stress concentration, compared to the other C-G/PEI composite posts. Significance: The FE analysis confirmed the ability of the functionally graded post to dissipate stress from the coronal to the apical end. Hence actual (physical) C-G/PEI posts could permit optimization of stress distributions in endodontically treated anterior teeth.

Keywords: CAD | Dental materials | Design | Endodontic treatment | Finite Element analysis | Image analysis

Abstract: Over the last three decades, it has been frequently reported that the properties of dental restorative composites cured with argon laser are similar or superior to those achieved with conventional halogen and light emitting diode (LED) curing units. Whereas laser curing is not dependent on the distance between the curing unit and the material, such distance represents a drawback for conventional curing units. However, a widespread clinical application of this kind of laser remains difficult due to cost, heavy weight, and bulky size. Recently, with regard to the radiation in the blue region of the spectrum, powerful solid-state lasers have been commercialized. In the current research, CAD (computer-aided design)/CAM (computer-aided manufacturing) assisted solid-state lasers were employed for curing of different dental restorative composites consisting of micro- and nanoparticle-reinforced materials based on acrylic resins. Commercial LED curing units were used as a control. Temperature rise during the photopolymerisation process and bending properties were measured. By providing similar light energy dose, no significant difference in temperature rise was observed when the two light sources provided similar intensity. In addition, after 7 days since curing, bending properties of composites cured with laser and LED were similar. The results suggested that this kind of laser would be suitable for curing dental composites, and the curing process does not suffer from the tip-to-tooth distance.

Keywords: Composites | Computer-aided design/computer-aided systems | Dental materials | Laser | Mechanical properties | Thermal properties

Abstract: Objective: To assess the influence of implant thread shape and inclination on the mechanical behaviour of bone-implant systems. The study assesses which factors influence the initial and full osseointegration stages. Methods: Point clouds of the original implant were created using a non-contact reverse engineering technique. A 3D tessellated surface was created using Geomagic Studio® software. From cross-section curves, generated by intersecting the tessellated model and cutting-planes, a 3D parametric CAD model was created using SolidWorks® 2017. By the permutation of three thread shapes (rectangular, 30° trapezoidal, 45° trapezoidal) and three thread inclinations (0°, 3° or 6°), nine geometric configurations were obtained. Two different osseointegration stages were analysed: the initial osseointegration and a full osseointegration. In total, 18 different FE models were analysed and two load conditions were applied to each model. The mechanical behaviour of the models was analysed by Finite Element (FE) Analysis using ANSYS® v. 17.0. Static linear analyses were also carried out. Results: ANOVA was used to assess the influence of each factor. Models with a rectangular thread and 6° inclination provided the best results and reduced displacement in the initial osseointegration stages up to 4.58%. This configuration also reduced equivalent VM stress peaks up to 54%. The same effect was confirmed for the full osseointegration stage, where 6° inclination reduced stress peaks by up to 62%. Significance: The FE analysis confirmed the beneficial effect of thread inclination, reducing the displacement in immediate post-operative conditions and equivalent VM stress peaks. Thread shape does not significantly influence the mechanical behaviour of bone-implant systems but contributes to reducing stress peaks in the trabecular bone in both the initial and full osseointegration stages.

Keywords: Bone properties | CAD | Dental materials | Endosteal implants | Finite element analysis | Material properties | Osseointegration | Plateau implants

Abstract: Additive Manufacturing technologies allow for the direct fabrication of lightweight structures with improved properties. In this context, Fused Deposition Modelling (FDM) has also been considered to design 3D multifunctional scaffolds with complex morphology, tailored biological, mechanical and mass transport properties. As an example, poly(ε-caprolactone) (PCL), surface-modified PCL and PCL-based nanocomposite scaffolds were fabricated and analysed. The effects of structural and morphological features (i.e., sequence of stacking, fiber spacing distance, pore size and geometry), surface modification and nanoparticles on the in vitro biological and mechanical performances were investigated.

Keywords: Additive Manufacturing | Design | Mechanical and Functional Analyses | Scaffolds

Abstract: In this chapter, authors provide a description of boundary element method (BEM) applications in biomechanics, with a focus on advantages and limitations of BEM versus other numerical methods such as finite element method, finite difference method, and meshless methods. In addition to a general overview, the chapter focus on how the BEM approach can be advantageous in those biomechanical problems involving fracture mechanics and contact modeling. To this aim, its preprocessing flexibility to tackle sharp geometric changes and complex remeshing is highlighted. The comparison among BEM and other numerical approaches proceeds through the evaluation of inherent accuracy, preprocessing and postprocessing efforts, and run times. Bio-CAD models with complex shapes are usually created from medical images acquisition, computer tomography or magnetic resonance scan, with different modeling techniques, which result in different accuracy and usability of the generated tessellated or surface computer-aided design (CAD) geometry. Special attention must be drawn to the mathematical reconstruction of bio-CAD model to facilitate the meshing process in the BEM environment and reduce the geometrical imperfections generated during the CAD to computer-aided engineering translation phase. BEM is best suited to reproduce accurately high surface stress gradients that are generally a modeling issue (e.g., in bone-implant contact simulations). Working with 3D models, the mesh refinement in the neighboring areas where high stress gradients are expected is much facilitated when using BEM, also because it is possible to use discontinuous elements and circumvent the constraint of a continuous mesh. BEM approach is certainly more accurate for linear analysis but, on the other hand, less versatile in some areas like those of highly nonlinear material behavior. A short description of some case studies showing the described advantages of BEM approach is reported.

Keywords: Bio-CAD | Biomechanics | Boundary element method | Dual boundary element method | Fracture

Abstract: The percutaneous interventions in the treatment of structural heart diseases represent nowadays a viable option for patients at high risk for surgery. However, unlike during the traditional open heart surgery, the heart structures to be corrected are not directly visualized by the physician during the interventions. The interpretation of the available medical images is often a demanding task and needs specific skills i.e. clinical experience and complex radiological and echocardiographic analysis. The new trend for cardiovascular diagnosis, surgical planning and intervention is, today, mutually connected with most recent developments in the field of 3D acquisition, interactive modelling and rapid prototyping techniques. This is particularly true when dealing with complex heart diseases since 3D-based techniques can really help in providing an accurate planning of the intervention and to support surgical intervention. To help the research community in confronting with this new trend in medical science, the present work provides an overview on most recent approaches and methodologies for creating physical prototypes of patient-specific cardiac structures, with particular reference to most critical phases such as: 3D image acquisition, interactive image segmentation and restoration, interactive 3D model reconstruction, physical prototyping through additive manufacturing. To this purpose, first, recent techniques for image enhancement to highlight anatomical structures of interest are presented together with the current state of the art of interactive image segmentation. Finally, most suitable techniques for prototyping the retrieved 3D model are investigated so as to derive a number of criteria for manufacturing prototypes useful for planning the medical intervention.

Keywords: 3D modelling | Cardiovascular diseases | Heart | Medical imagery | Rapid prototyping | Surgical planning

Abstract: In tissue engineering, biocompatible porous scaffolds that try to mimic the features and function of the bone are of great relevance. In this paper, an effective method for the design of 3D porous scaffolds is applied to the modelling of structures with variable architectures. These structures are of interest since they are more similar to the stochastic configuration of real bone with respect to architectures made of a unit cell replicated in three orthogonal directions, which are usually considered for this kind of applications. This property configures them as, potentially, more suitable to satisfy simultaneously the biological requirements and those relative to the mechanical strength. The procedure implemented is based on the implicit surface modelling method and the use of a triply periodic minimal surface (TPMS), specifically, the Schwarz's Primitive (P) minimal surface, whose geometry was considered for the development of scaffolds with different configurations. The representative structures modelled were numerically analysed by means of finite element analysis (FEA), considering them made of a biocompatible titanium alloy. The architectures considered were thus assessed in terms of the relationship between the geometrical configuration and the mechanical response to compression loading.

Keywords: Design | FEA | Scaffold | Tissue engineering | TPMS

Abstract: Background/Aim. We retrospectively investigated the prognostic potential (correlation with overall survival) of 9 shape and 21 textural features from non-contrast-enhanced computed tomography (CT) in patients with non-small-cell lung cancer. Materials and Methods. We considered a public dataset of 203 individuals with inoperable, histologically- or cytologically-confirmed NSCLC. Three-dimensional shape and textural features from CT were computed using proprietary code and their prognostic potential evaluated through four different statistical protocols. Results. Volume and grey-level run length matrix (GLRLM) run length non-uniformity were the only two features to pass all four protocols. Both features correlated negatively with overall survival. The results also showed a strong dependence on the evaluation protocol used. Conclusion: Tumour volume and GLRLM run-length non-uniformity from CT were the best predictor of survival in patients with non-small-cell lung cancer. We did not find enough evidence to claim a relationship with survival for the other features.

Keywords: Computed tomography | Non-small-cell lung cancer | Radiomics. | Shape | Texture

Abstract: Enhancing the performance of scaffolds for bone regeneration requires a multidisciplinary approach involving competences in the fields of Biology, Medicine and Engineering. A number of studies have been conducted to investigate the influence of scaffolds design parameters on their mechanical and biological response. The possibilities offered by the additive manufacturing techniques to fabricate sophisticated and very complex microgeometries that until few years ago were just a geometrical abstraction, led many researchers to design scaffolds made from different unit cell geometries. The aim of this work is to find, based on mechanobiological criteria and for different load regimes, the optimal geometrical parameters of scaffolds made from beam-based repeating unit cells, namely, truncated cuboctahedron, truncated cube, rhombic dodecahedron and diamond. The performance, -expressed in terms of percentage of the scaffold volume occupied by bone-, of the scaffolds based on these unit cells was compared with that of scaffolds based on other unit cell geometries such as: hexahedron and rhombicuboctahedron. A very intriguing behavior was predicted for the truncated cube unit cell that allows the formation of large amounts of bone for low load values and of very small amounts for the medium-high ones. For high values of load, scaffolds made from hexahedron unit cells were predicted to favor the formation of the largest amounts of bone. In a clinical context where medical solutions become more and more customized, this study offers a support to the surgeon in the choice of the best scaffold to be implanted in a patient-specific anatomic region.

Keywords: Beam-based scaffolds | Bone tissue engineering | Diamond | Mechanobiology | Rhombic dodecahedron | Truncated cube | Truncated cuboctahedron | Unit cell

Abstract: Background: New sources of stem cells in adult organisms are constantly emerging. Postnatal Mesenchymal Stem Cells (MSCs), are the most promising support to perform an effective regenerative medicine: such cells have the ability to differentiate into several lineages, such as osteoblasts and chondroblasts, providing novel strategies to improve different complex treatments, during bone regeneration. 3D-printed biomaterials can be designed with geometry aimed to induce stem cells to differentiate towards specific lineage. Objective: The interaction between stem cells easy to isolate and engineered 3D-printed scaffolds can translate the tissue bio-engineering into bone regenerative surgery. For those reasons, to better identify the complexity represented by the activities and responses of MSCs requires the advance of new target therapies which are not current in endocrine, metabolic and immune disorders and yet to be developed. Method: This topical review briefly focuses on the new approaches of translational medicine with the use of MSCs and scaffolds engineered with the aid of 3D-printing technology, highlights the osteogenic functions and addresses their applications across the breadth of regenerative medicine. Results: The application of bone constructs consisting of the engineered scaffold and MSCs as well as the aspects related to the optimal scaffold geometry that favours the best MSCs differentiation and the improvement of concepts as “sensing surface” were also discussed. Conclusion: Regenerative surgery is largely growing in the field of translational medicine. The use of new sources of MSCs and the improvement of new concepts of bio-engineered scaffolds will certainly be the next step of customized medicine.

Keywords: 3D-printed scaffolds | Customized medicine | Mesenchymal stem cells | Regenerative medicine | Tissue engineering | Translational medicine

Abstract: The aim of this ex vivo study was to test a novel three-dimensional (3D) automated computer-aided design (CAD) method (aCAD) for the computation of femoral angles in dogs from 3D reconstructions of computed tomography (CT) images. The repeatability and reproducibility of three manual radiography, manual CT reconstructions and the aCAD method for the measurement of three femoral angles were evaluated: (1) anatomical lateral distal femoral angle (aLDFA); (2) femoral neck angle (FNA); and (3) femoral torsion angle (FTA). Femoral angles of 22 femurs obtained from 16 cadavers were measured by three blinded observers. Measurements were repeated three times by each observer for each diagnostic technique. Femoral angle measurements were analysed using a mixed effects linear model for repeated measures to determine the levels of intra-observer agreement (repeatability) and inter-observer agreement (reproducibility). Repeatability and reproducibility of measurements using the aCAD method were excellent (intra-class coefficients, ICCs ≥ 0.98) for all three angles assessed. Manual radiography and CT exhibited excellent agreement for the aLDFA measurement (ICCs ≥ 0.90). However, FNA repeatability and reproducibility were poor (ICCs < 0.8), whereas FTA measurement showed slightly higher ICCs values, except for the radiographic reproducibility, which was poor (ICCs < 0.8). The computation of the 3D aCAD method provided the highest repeatability and reproducibility among the tested methodologies.

Keywords: Canine | Computed tomography | Femur | Repeatability | Reproducibility | Three-dimensional constructions

Abstract: Meniscectomy significantly change the kinematics of the knee joint by reducing the contact area between femoral condyles and the tibial plateau, but the shift in the contact area has been poorly described. The aim of our investigation was to measure the shift of the tibiofemoral contact area occurring after meniscectomy. We used laser scans combined to surface texturing for measuring the 3D position and area of the femoral and tibial surfaces involved in the joint. In particular, natural condyles (porcine model) were analysed and the reverse engineering approach was used for the interpretation of the results from compression tests and local force measurements in conjunction with staining techniques. The results suggested that laser scans combined to surface texturing may be considered as a powerful tool to investigate the stained contours of the contact area. Beside the largely documented reduction of contact area and local pressure increase, a shift of the centroid of the contact area toward the intercondylar notch was measured after meniscectomy. As a consequence of the contact area shift and pressure increase, cartilage degeneration close to the intercondylar notch may occur.

Keywords: Biomechanics | Centroid | Image analysis | Laser scanning | Surface texturing | Tibiofemoral contact area

Abstract: Material structure-property relationship is strongly related to the employed process technology. Over the past years, laser processing of engineering materials has been proposed in many fields and different uses for diode lasers have been found in dentistry. In this contest, the potential of GaN- and InGaN-based laser diodes to cure dental materials was analysed. Two wavelengths of 405 nm and 445 nm were used as heat or light sources for warm condensation of gutta-percha, light transmission in dental posts and brackets or light curing of dental composites. Additive manufacturing approach was considered to fabricate 3D root analogues, suitable supports, positioning systems and moulds for optical measurements. A three-axis CAD/CAM system was implemented for positioning and aligning the laser beam. The ability of diode-pumped solid-state lasers to cure dental materials or to transmit light was compared to that of a traditional instrument. Temperature profile at the apex of an additive manufactured root canal sealed with gutta-percha, light transmission through translucent quartz fiber post or through aesthetic ceramic bracket, bending properties and morphological features of light cured dental composites (Gradia Direct - GC Corporation and Venus Diamond - Heraeus Kulzer) were measured. Results showed a very high potential of diode-pumped solid-state lasers to be used in endodontics, orthodontics and restorative dentistry.

Keywords: CAD/CAM system | Ceramic bracket | Dental materials | Laser diode | Mechanical analysis

Abstract: The ability to engineer scaffolds that resemble the transition between tissues would be beneficial to improve repair of complex organs, but has yet to be achieved. In order to mimic tissue organization, such constructs should present continuous gradients of geometry, stiffness and biochemical composition. Although the introduction of rapid prototyping or additive manufacturing techniques allows deposition of heterogeneous layers and shape control, the creation of surface chemical gradients has not been explored on three-dimensional (3D) scaffolds obtained through fused deposition modelling technique. Thus, the goal of this study was to introduce a gradient functionalization method in which a poly(ε-caprolactone) surface was first aminolysed and subsequently covered with collagen via carbodiimide reaction. The 2D constructs were characterized for their amine and collagen contents, wettability, surface topography and biofunctionality. Finally, chemical gradients were created in 3D printed scaffolds with controlled geometry and porosity. The combination of additive manufacturing and surface modification is a viable tool for the fabrication of 3D constructs with controlled structural and chemical gradients. These constructs can be employed for mimicking continuous tissue gradients for interface tissue engineering.

Keywords: collagen | functionalization | interface tissue engineering | poly(ε-caprolactone) | scaffold

Abstract: This study proposes a novel automatic method for facial landmark localization relying on geometrical properties of 3D facial surface working both on complete faces displaying different emotions and in presence of occlusions. In particular, 12 descriptors coming from Differential Geometry including the coefficients of the fundamental forms, Gaussian, mean, principal curvatures, shape index and curvedness are extracted as facial features and their local geometric properties are exploited to localize 13 soft-tissue landmarks from eye and nose areas. The method is deterministic and is backboned by a thresholding technique designed by studying the behaviour of each geometrical descriptor in correspondence to the locus of each landmark. Occlusions are managed by a detection algorithm based on geometrical properties which allows to proceed with the landmark localization avoiding the covered areas. Experimentations were carried out on 3132 faces of the Bosphorus database and of a 230-sized internal database, including expressive and occluded ones (mouth, eye, and eyeglasses occlusions), obtaining 4.75 mm mean localization error.

Keywords: 3D face | Differential geometry | Face analysis | Feature extraction | Landmark localization

Abstract: Objective To assess the effect of a ferrule design with specific post material-shape combinations on the mechanical behavior of post-restored canine teeth. Methods Micro-CT scan images of an intact canine were used to create a 3-D tessellated CAD model, from which the shapes of dentin, pulp and enamel were obtained and geometric models of post-endodontically restored teeth were created. Two types of 15 mm post were evaluated: a quartz fiber post with conical–tapered shape, and a carbon (C) fiber post with conical–cylindrical shape. The abutment was created around the coronal portion of the posts and 0.1 mm cement was added between prepared crown and abutment. Cement was also added between the post and root canal and a 0.25 mm periodontal ligament was modeled around the root. Four models were analysed by Finite Element (FE) Analysis: with/without a ferrule for both types of post material and shape. A load of 50 N was applied at 45° to the longitudinal axis of the tooth, acting on the palatal surface of the crown. The maximum normal stress criterion was adopted as a measure of potential damage. Results Models without a ferrule showed greater stresses (16.3 MPa) than those for models with a ferrule (9.2 MPa). With a ferrule, stress was uniformly distributed along the abutment and the root, with no critical stress concentration. In all models, the highest stresses were in the palatal wall of the root. Models with the C-fiber post had higher stress than models with the quartz fiber posts. The most uniform stress distribution was with the combination of ferrule and quartz fiber post. Significance The FE analysis confirmed a beneficial ferrule effect with the combination of ferrule and quartz fiber post, with tapered shape, affording no critical stress concentrations within the restored system.

Keywords: CAD | Dental materials | Endodontic treatment | Finite element analysis | Image analysis | Materials properties

Abstract: For the purpose of reducing uncertainties in the measurements of morphologically complex biological objects, the authors present a new automatic method, which takes advantage from the representation of the object in the form of the 3D geometric model obtained from CT-scans or 3D scanning. In this paper, the method is verified in real cases and compared with the traditional approaches.

Keywords: 3D biomedical image analysis | measurement accuracy | measurement protocols in biomedicine | shape segmentation

Abstract: This work explores the use of an industry-oriented digital human modelling tool for the estimation of the musculoskeletal loads corresponding to a simulated human activity. The error in using a static analysis tool for measuring articulations loads under not-static conditions is assessed with reference to an accurate dynamic model and data from real experiments. Results show that, for slow movements, static analysis tools provide good approximation of the actual loads affecting human musculoskeletal system during walking.

Keywords: Biomechanics | Dynamics | Gait analysis | Kinematics | Virtual simulation

Abstract: This paper concerns the design and manufacture of medical devices, such as lower limb prosthesis, integrating low cost industrial technologies. In particular, it focuses the attention on the custom-fit component of a lower limb prosthesis, i.e., the socket, that is the interface with the residual limb. The considered process starts from the 3D reconstruction of patients’ limb and ends with the manufacture of the socket with a 3D printer using a multi-material approach. The process counts three steps: 3D modeling, testing (both experimental and numer-ical) and manufacturing. For each step adopted solutions and tools are described. Finally, conclusions are drawn mainly concerning the challenge of multi-material 3D printing of the socket.

Keywords: 3D printing | Lower limb prosthesis | Socket Modelling Assistant

Abstract: Cardiovascular diagnosis, surgical planning and intervention are among the most interested in recent developments in the field of 3D acquisition, modelling and rapid prototyping techniques. In case of complex heart disease, to provide an accurate planning of the intervention and to support surgical planning and intervention, an increasing number of Hospitals make use of physical 3D models of the cardiac structure, including heart, obtained using additive manufacturing starting from the 3D model retrieved with medical imagery. The present work aims in providing an overview on most recent approaches and methodologies for creating physical prototypes of patient-specific heart and cardiac structures, with particular reference to most critical phases such as segmentation and aspects concerning converting digital models into physical replicas through rapid prototyping techniques. First, recent techniques for image enhancement to highlight anatomical structures of interest are presented together with the current state of the art of semi-automatic image segmentation. Then, most suitable techniques for prototyping the retrieved 3D model are investigated so as to draft some hints for creating prototypes useful for planning the medical intervention.

Keywords: 3D modelling | 3D printing | Cardiovascular diseases | Heart | Medical imagery | Rapid prototyping | Surgical planning

Abstract: In orthopaedics, cellular structures can be used as three-dimensional porous biomaterials that try to mimic the characteristics and function of the bone. The progress in manufacturing techniques, mainly in the field of additive manufacturing, can potentially allow the production of highly controlled pore architectures and customized implants that, however, need more sophisticated design methodologies. In this paper, the design of porous biocompatible structures based on mathematically defined surfaces (triply periodic minimal surfaces) has been considered in respect of the approach that considers unit cells entirely modelled in CAD environment. Two types of unit cell have been here considered: the cubic and the P-cell. The cubic cell is created by a 3D CAD s/w from solid features that are combined together. The P-cell is modelled using an implicit function to describe the outer surface of the cell. Two are the design parameters of the P-cell: thickness and radius. The variation of these parameters allows modifying the architecture of the basic unit of the scaffold. The modification of the radius is carried out by a procedure, based on scaling and truncation operations. The thickness of the cell is modified by thickening and closure operations on the P-isosurface. The effect of these variations on the mechanical behaviour of the scaffold has been numerically evaluated by the estimation of the stiffness of each structure considered. The results demonstrated the huge potentiality of the method and stiffness values compatible with those required for biomechanical applications.

Keywords: Bone implants | Design | Porous materials | Scaffolds

Abstract: The aim of regenerative medicine is replacing missing or damaged bone tissues with synthetic grafts based on porous interconnected scaffolds, which allow adhesion, growth, and proliferation of the human cells. The optimal design of such scaffolds, in the Bone Tissue Engineering field, should meet several geometrical requirements. First, they have to be customized to replicate the skeletal anatomy of the patient, and then they have to provide the proper trabecular structure to be successfully populated by the cells. Therefore, for modelling such scaffolds, specific design methods are needed to conceive extremely complex structures by controlling both macro and micro shapes. For this purpose, in the last years, the Computer Aided Design of Triply Periodic Minimal Surfaces has received considerable attention, since their presence in natural shapes and structures. In this work, we propose a method that exploit Triply Periodic Minimal Surfaces as unit cell for the development of customized trabecular scaffolds. The aim is to identify the mathematical parameters of these surfaces in order to obtain the target requirements of the bone grafts. For that reason, the method is implemented through a Generative Design tool that allow to interactively controlling both the porosity and the pores size of the scaffolds.

Keywords: Bone tissue engineering | Generative design | Scaffold design | Triple periodic minimal surfaces

Abstract: Over the past few years, the influence of static or dynamic magnetic fields on biological systems has become a topic of considerable interest. Magnetism has recently been implicated to play significant roles in the regulation of cell responses and, for this reason, it is revolutionizing many aspects of healthcare, also suggesting new opportunities in tissue engineering. The aim of the present study was to analyze the effect of the application mode of a time-dependent magnetic field on the behavior of human mesenchymal stem cells (hMSCs) seeded on 3D additive-manufactured poly(ɛ-caprolactone)/iron-doped hydroxyapatite (PCL/FeHA) nanocomposite scaffolds.

Keywords: Additive manufacturing | Cell-material interaction | Magnetic field | Scaffold

Abstract: Bone tissue engineering is strongly dependent on the use of three-dimensional scaffolds that can act as templates to accommodate cells and support tissue ingrowth. Despite its wide application in tissue engineering research, polycaprolactone presents a very limited ability to induce adhesion, proliferation and osteogenic cell differentiation. To overcome some of these limitations, different calcium phosphates, such as hydroxyapatite and tricalcium phosphate, have been employed with relative success. This work investigates the influence of nano-hydroxyapatite and micro-hydroxyapatite (nHA and mHA, respectively) particles on the in vitro biomechanical performance of polycaprolactone/hydroxyapatite scaffolds. Morphological analysis performed with scanning electron microscopy allowed us to confirm the production of polycaprolactone/hydroxyapatite constructs with square interconnected pores of approximately 350 μm and to assess the distribution of hydroxyapatite particles within the polymer matrix. Compression mechanical tests showed an increase in polycaprolactone compressive modulus (E) from 105.5 ± 11.2 to 138.8 ± 12.9 MPa (PCL-nHA) and 217.2 ± 21.8 MPa (PCL-mHA). In comparison to PCL-mHA scaffolds, the addition of nano-hydroxyapatite enhanced the adhesion and viability of human mesenchymal stem cells as confirmed by Alamar Blue assay. In addition, after 14 days of incubation, PCL-nHA scaffolds showed higher levels of alkaline phosphatase activity compared to polycaprolactone or PCL-mHA structures.

Keywords: bioactive materials | Biomanufacturing | bone tissue engineering | hydroxyapatite | mesenchymal stem cells | scaffold development

Abstract: The success of Tissue Engineering (TE) based approaches is strongly dependent on the development of novel biomaterials for the design of 3D matrices with tailored biomechanical properties to promote the regeneration of human tissues and organs. This review covers the critical aspects related with the preparation of new unsaturated polyester (UP) resin formulations with suitable biological, chemical, thermal and morphological properties for the additive manufacturing (AM) of TE constructs. In this context, the basic principles of available AM technologies, with a special focus on novel stereolithography processes such as microstereolithography (micro-SLA), stereo-thermal-lithography (STLA), two-photon polymerization (TPP) and nanostereolithography (nano-SLA), are also presented and discussed. Ultimately, the present review will provide a better insight into the limitations and potential of combining UP and AM towards the rationale design/fabrication of complex artificial tissue substitutes.

Keywords: Additive manufacturing | Stereolithography processes | Structure/properties relationships | Tissue engineering | Unsaturated polyesters

Abstract: Background: A variety of antiinflammatory therapies are employed to promote corneal wound healing. The effects of steroidal and nonsteroidal antiinflammatory drugs on the biomechanical properties of rabbit cornea were investigated over time using tensile tests. Methods: Full-thickness incisions were made and used to analyze the effects of dexamethasone sodium phosphate 0.1% and diclofenac sodium 0.1% on corneal biomechanical properties during wound healing at 7, 14 and 21 days after surgery. Results: The full-thickness incision deeply modified all of the mechanical properties. At 3 weeks after incision, regardless of the drug therapy, the tensile modulus was about 70% of the value for the intact cornea. Conclusions: Topical treatment with dexamethasone was particularly effective during the first week after surgery; the second week after surgery, a similar result was observed in the corneas treated with diclofenac. Low doses of steroidal and nonsteroidal antiinflammatory drugs would seem to have the potential to improve biomechanical properties only during the early stage of the healing process of the cornea.

Keywords: Biomechanics | Corneal wound healing | Nonsteroidal drugs | Steroidal drugs | Stress-strain

Abstract: Background: In recent years, the tissue engineering (TE) field has significantly benefited from advanced techniques such as additive manufacturing (AM), for the design of customized 3D scaffolds with the aim of guided tissue repair. Among the wide range of materials available to biomanufacture 3D scaffolds, poly(ε-caprolactone) (PCL) clearly arises as the synthetic polymer with the greatest potential, due to its unique properties – namely, biocompatibility, biodegradability, thermal and chemical stability and processability. This study aimed for the first time to investigate the effect of pore geometry on the in vitro enzymatic chain cleavage mechanism of PCL scaffolds manufactured by the AM extrusion process. Methods: Methods: Morphological properties of 3D printed PCL scaffolds before and after degradation were evaluated using Scanning Electron Microscopy (SEM) and micro-computed tomography (μ-CT). Differential Scanning Calorimetry (DSC) was employed to determine possible variations in the crystallinity of the scaffolds during the degradation period. The molecular weight was assessed using Size Exclusion Chromatography (SEC) while the mechanical properties were investigated under static compression conditions. Results: Morphological results suggested a uniform reduction of filament diameter, while increasing the scaffolds’ porosity. DSC analysis revealed and increment in the crystallinity degree while the molecular weight, evaluated through SEC, remained almost constant during the incubation period (25 days). Mechanical analysis highlighted a decrease in the compressive modulus and maximum stress over time, probably related to the significant weight loss of the scaffolds. Conclusions: All of these results suggest that PCL scaffolds undergo enzymatic degradation through a surface erosion mechanism, which leads to significant variations in mechanical, physical and chemical properties, but which has little influence on pore geometry.

Keywords: Biomanufacturing | Enzymatic degradation | Polycaprolactone | Scaffolds | Tissue engineering

Abstract: 3D face was recently investigated for various applications, including biometrics and diagnosis. Describing facial surface, i.e. how it bends and which kinds of patches is composed by, is the aim of studies of Face Analysis, whose ultimate goal is to identify which features could be extracted from three-dimensional faces depending on the application. In this study, we propose 105 novel geometrical descriptors for Face Analysis. They are generated by composing primary geometrical descriptors such as mean, Gaussian, principal curvatures, shape index, curvedness, and the coefficients of the fundamental forms, and by applying standard functions such as sine, cosine, and logarithm to them. The new descriptors were mapped on 217 facial depth maps and analysed in terms of descriptiveness of facial shape and exploitability for localizing landmark points. Automatic landmark extraction stands as the final aim of this analysis. Results showed that some newly generated descriptors were sounder than the primary ones, meaning that their local behaviours in correspondence to a landmark position is thoroughly specific and can be registered with high similarity on every face of our dataset.

Keywords: 3D face | Face analysis | Face expression recognition | Face recognition | Geometry | Landmarks

Abstract: As the interest in human face grows, facial landmarks become more and more important for a large variety of fields and applications. Multipurpose medical is evidently leading in this sense, but others such as skull study for crime scenes, sex estimation, and attractiveness quantification, morphological and cephalometric analyses are present. A cluster analysis of the examined papers is performed depending on scope, landmarking method, and facial database features. The purpose is to face these topics by providing the reader with a comprehensive view of what 3D facial landmarks are and what "they have been up to" in 2014 and 2015. The aim is to offer to users the very up-todate scenario, the best outcomes, i.e., the latest frontier of landmarks' talents and skills. The third dimension allowed to select the most prominent contributions, especially in terms of scientific advance innovativeness.

Keywords: 3D face | Cluster analysis | Fiducial point | Landmarks | Soft-tissue landmark, hard-tissue landmark

Abstract: 3D face was recently investigated for various applications, including biometrics and diagnosis. Describing facial surface, i.e. how it bends and which kinds of patches is composed by, is the aim of studies in Face Analysis, whose ultimate goal is to identify which features could be extracted from three-dimensional faces depending on the application. In this study, we propose 54 novel geometrical descriptors for Face Analysis. They are generated by composing primary geometrical descriptors such as mean, Gaussian, principal curvatures, shape index, curvedness, and the coefficients of the fundamental forms. The new descriptors were mapped on 217 facial depth maps and analysed in terms of descriptiveness of facial shape and exploitability for localizing landmark points. Automatic landmark extraction stands as the final aim of this analysis. Results showed that the newly generated descriptors are suitable to 3D face description and to support landmark localization procedures.

Keywords: 3D Face | Face Analysis | Face Recognition | Geometry | Landmarks

Abstract: Background: Double pelvic osteotomy (DPO) planning is usually performed by hip palpation, and on radiographic images which give a poor representation of the complex three-dimensional manoeuvre required during surgery. Furthermore, bone strains which play a crucial role cannot be foreseen. Objective: To support surgeons and designers with biomechanical guidelines through a virtual model that would provide bone stress and strain, required moments, and three-dimensional measurements. Methods: A multibody numerical model for kinematic analyses has been coupled to a finite element model for stress/strain analysis on deformable bodies. The model was parametrized by the fixation plate angle, the iliac osteotomy angle, and the plate offset in ventro-dorsal direction. Model outputs were: acetabular ventro-version (VV) and lateralization (L), Norberg (NA) and dorsal acetabular rim (DAR) angles, the percentage of acetabular coverage (PC), the peak bone stress, and moments required to deform the pelvis. Results: Over 150 combinations of cited parameters and their respective outcome were analysed. Curves reporting NA and PC versus VV were traced for the given patient. The optimal VV range in relation to NA and PC limits was established. The 25° DPO plate results were the most similar to 20° TPO. The output L grew for positive iliac osteotomy inclinations. The 15° DPO plate was critical in relation to DAR, while very large VV could lead to bone failure. Clinical significance: Structural models can be a support to the study and optimization of DPO as they allow for foreseeing geometrical and structural outcomes of surgical choices.

Keywords: Finite elements | Hip dysplasia | Multibody analysis | Pelvic osteotomies | Preoperative planning

Abstract: This paper proposes a new automatic approach to determine the accurate measure of human teeth. The aim of the proposed computer based method is to reduce inaccuracy of measurement with respect to traditional approaches. Starting from a 3D model of the teeth which is obtained from 3D scanning, the method algorithmically evaluates the most important dimensional features detectable in central incisors. For this purpose, specific rules are put forward and implemented in original software with a view to identifying repere points, from which to detect dimensional features both unambiguously and accurately. The automatic method which is proposed here is verified by means of the analysis of real teeth and is then compared with the current state-of-the-art methods for teeth measurement.

Keywords: 3D biomedical image analysis | Computer methods for tooth analysis | Dental dimensions | Measurement accuracy | Measurement protocols in biomedicine

Abstract: In this paper performance evaluation and experimental characterization of a new automatic method for measuring vertebrae are analysed. Starting to a discrete valid geometric model of the vertebra, obtained from CT-scans or 3D scanning, the method measures algorithmically vertebrae. The proposed study is performed by analysing the most used dimensional features of lumbar and thoracic real vertebrae in anthropological investigations. The results are compared with the state-of-the-art methods for vertebra measurement.

Abstract: This paper describes a new motion analysis protocol for race-walking. The protocol has been tested under laboratory conditions on a real athlete of the Italian national race-walking team. The experimental setup included a motion capture system and a force platform to record both kinematic and dynamic aspects of the athletic action. Thus, any infringement of the rules can be detected, based on the measure of knee flexion-extension and the loss of ground contact. The biomechanical efficiency can be determined from the joint angles and the temporal components of gait. The results of experiments show that the protocol can be a valuable tool to assist athletes and trainers in improving race-walking technique.

Keywords: Biomechanics | Dynamics | Experimental protocol | Gait Analysis | Kinematics | Motion Capturing | Race-walking

Abstract: Digital Human Modelling (DHM) is becoming a simple way to study the ergonomic behaviour of devices interacting with the human body. In particular, innovative technologies per- mit to manage big amount of data coming from several IT devices in order to better understand the correlation be- tween technical aspects and human factors. In the medical field DHM can be exploited to combine in a unique applica- tion many data types coming from several inputs (e.g. 3D scan, motion capture). In this research work, the attention is focused on the design of lower limb prosthesis around the digital human model of the patient. We present an appli- cation, which allows visualizing pressure on patient's limb while evaluating his/her gait in a unique virtual knowledge- guided environment. Such application is conceived to be usable by non IT experts, and all information are directly visualized on the digital human model of the amputee. The first part of the paper describes the platform to design lower limb prosthesis with particular attention on the use of low- cost technologies. Then, the virtual gait analysis tool is described. Finally, tests and conclusion are discussed.

Keywords: Digital human modelling | Gait analysis | Lower limb prosthesis | Pressure mapping

Abstract: In this work we present a preliminary study on a system able to design automatically sockets for lower-limb prosthesis. The socket is the most important part of the whole prosthesis and requires a custom design specific for the patient’s characteristics and her/his residuum morphology. The system takes in input the weight and the lifestyle of the patient, the tonicity level and the geometry file of the residuum, and creates a new model applying the correct geometric deformations needed to create a functional socket. In fact, in order to provide the right fit and prevent pain, we need to create on the socket load and off-load zones in correspondence of the critical anatomical areas. To identify the position of such critical areas, several neural networks have been trained using a dataset generated from real residuum models.

Keywords: CAD | Lower limb prosthesis | Neural network | Prosthetic socket

Abstract: The socket for lower limb prosthesis is the central element of artificial leg that needs to be optimize with the aim to increase comfort and reduce pain. Nowadays, the modeling of this part is completely manual and based on prosthetist skills. The key parameter determining if the socket is properly designed is the pressure distribution in the interface between the skin of residual limb and the internal surface of the socket. In this paper, we expose a method to measure this pressure thought resistive pressure sensors and we illustrate a case study of a transfemoral amputee patient. A visualization tool has been developed to dynamically show pressure data on the 3D model of the residual limb during topic moments of the gait by a color scale. Achieved results and future work will be discussed in the paper.

Keywords: Gait | Lower limb prosthesis | Pressure mapping

Abstract: Endocanalar posts are necessary to build up and retain coronal restorations but they do not reinforce dental roots. It was observed that the dislodgement of post-retained restorations commonly occurs after several years of function and long-term retention may be influenced by various factors such as temperature changes. Temperature changes, in fact, produce micrometric deformations of post and surrounding tissues/materials that may generate high stress concentrations at the interface thus leading to failure. In this study we present an optical system based on the projection moiré technique that has been utilized to monitor the displacement field of endocanalar glass-fibre posts subjected to temperature changes. Measurements were performed on forty samples and the average displacement values registered at the apical and middle region were determined for six different temperature levels. A total of 480 displacement measurements was hence performed. The values of the standard deviation computed for each of the tested temperatures over the forty samples appear reasonably small which proves the robustness and the reliability of the proposed optical technique. The possible implications for the use of the system in the applicative context were discussed.

Keywords: Dental materials | Endocanalar post | Projection moiré | Thermal deformation | Thermal stress

Abstract: Complexity of scaffold geometries and biological mechanisms involved in the bone generation process make the design of scaffolds a quite challenging task. The most common approaches utilized in bone tissue engineering require costly protocols and time-consuming experiments. In this study we present an algorithm that, combining parametric finite element models of scaffolds with numerical optimization methods and a computational mechano-regulation model, is able to predict the optimal scaffold microstructure. The scaffold geometrical parameters are perturbed until the best geometry that allows the largest amounts of bone to be generated, is reached. We study the effects of the following factors: (1) the shape of the pores; (2) their spatial distribution; (3) the number of pores per unit area. The optimal dimensions of the pores have been determined for different values of scaffold Young’s modulus and compression loading acting on the scaffold upper surface. Pores with rectangular section were predicted to lead to the formation of larger amounts of bone compared to square section pores; similarly, elliptic pores were predicted to allow the generation of greater amounts of bone compared to circular pores. The number of pores per unit area appears to have rather negligible effects on the bone regeneration process. Finally, the algorithm predicts that for increasing loads, increasing values of the scaffold Young’s modulus are preferable. The results shown in the article represent a proof-of-principle demonstration of the possibility to optimize the scaffold microstructure geometry based on mechanobiological criteria.

Keywords: Mechano-regulation algorithm | Mechanobiology | Numerical optimization | Scaffold microstructure

Abstract: Abstract: The aim of this work is to show a quick and simple procedure able to identify the geometrical parameters of the intervertebral disc that strongly affect the behavior of the FEM model. First, we allocated a selection criterion for the minimum number of geometrical parameters that describe, with a good degree of approximation, a healthy human vertebra. Next, we carried out a sensitivity analysis using the ‘Taguchi orthogonal array’ to arrive at a quick identification of the parameters that strongly affect the behavior of the Fem model.

Keywords: geometrical parameters | intervertebral disc | Spine | subject-specific finite element models | Taguchi method

Abstract: Recent Face Analysis advances have focused the attention on studying and formalizing 3D facial shape. Landmarks, i.e. typical points of the face, are perfectly suited to the purpose, as their position on visage shape allows to build up a map of each human being’s appearance. This turns to be extremely useful for a large variety of fields and related applications. In particular, the forensic context is taken into consideration in this study. This work is intended as a survey of current research advances in forensic science involving 3D facial landmarks. In particular, by selecting recent scientific contributions in this field, a literature review is proposed for in-depth analyzing which landmarks are adopted, and how, in this discipline. The main outcome concerns the identification of a leading research branch, which is landmark-based facial reconstruction from skull. The choice of selecting 3D contributions is driven by the idea that the most innovative Face Analysis research trends work on three-dimensional data, such as depth maps and meshes, with three-dimensional software and tools. The third dimension improves the accurateness and is robust to colour and lightning variations.

Keywords: 3D face | Fiducial point | Forensic | Landmarks | Reconstruction

Abstract: A 3D automatic facial expression recognition procedure is presented in this work. The method is based on point-by-point mapping of seventeen Differential Geometry descriptors onto the probe facial depth map, which is then partitioned into seventy-nine regions. Then, features such as mean, median, mode, volumes, histograms are computed for each region and for each descriptor, to reach a varied large set of parameters representing the query face. Each set of parameters, given by a geometrical descriptor, a region, and a feature, form a trio, whose featuring numerical values are compared with appropriate thresholds, set via experimentation in a previous phase by processing a limited portion of the public facial Bosphorus database. This allows the identification of the emotion-based expression of the query 3D face among the six basic ones (anger, disgust, fear, joy, sadness, surprise). The algorithm was tested on the Bosphorus database and is suitable for applications in security, marketing, medical. The three-dimensional context has been preferred due to its invariance to different lightening/make-up/camouflage conditions.

Keywords: 3D face | Differential geometry | Emotions | Face expression recognition (FER) | Facial expression recognition | Shape index

Abstract: Bone tissue engineered 3-D constructs customized to patient-specific needs are emerging as attractive biomimetic scaffolds to enhance bone cell and tissue growth and differentiation. The article outlines the features of the most common additive manufacturing technologies (3D printing, stereolithography, fused deposition modeling, and selective laser sintering) used to fabricate bone tissue engineering scaffolds. It concentrates, in particular, on the current state of knowledge concerning powder-based 3D printing, including a description of the properties of powders and binder solutions, the critical phases of scaffold manufacturing, and its applications in bone tissue engineering. Clinical aspects and future applications are also discussed.

Keywords: 3D printing | Additive manufacturing technologies | Binder | Bone | Depowdering | Powder | Scaffold | Sintering

Abstract: In this paper a new automatic approach to determine the accurate measure of human vertebrae is proposed. The aim is to speed up the measurement process and to reduce the uncertainties that typically affect the measurement carried out by traditional approaches. The proposed method uses a 3D model of the vertebra obtained from CT-scans or 3D scanning, from which some characteristic dimensions are detected. For this purpose, specific rules to identify morphological features, from which to detect dimensional features unambiguously and accurately, are put forward and implemented in original software. The automatic method which is here proposed is verified by analysing real vertebrae and is then compared with the state-of-the-art methods for vertebra measurement.

Keywords: 3D medical-image analysis | Computer methods for vertebra analysis | Measurement accuracy | Measurement protocols in biomedicine | Shape segmentation | Vertebral dimensions

Abstract: The diffusion of depth sensors to sense people and objects constitutes an outstanding opportunity in those fields in which the benefits of optical marker-less solutions for scanning or tracking are requested. This paper shows how two different applications based on MS Kinect device can be accomplished in the domain of lower limb prosthesis design and test. The first one refers to the use of a depth camera as a three-dimensional scanner to acquire the geometry of residual limbs or of custom-fit components. The second application is related to the motion capture of patients' gait with the prosthesis. In both cases, the technology resulted to be better than many traditional ones mainly for its limited invasivity, interesting performance, portability and low cost.

Keywords: 3D scanner | Digital human modelling | Lower limb prosthesis | Motion capture | RGB-D cameras

Abstract: The diffusion of depth sensors to sense people and objects constitutes an outstanding opportunity in those fields in which the benefits of optical marker-less solutions for scanning or tracking are requested. This paper shows how two different applications based on MS Kinect device can be accomplished in the domain of lower limb prosthesis design and test. The first one refers to the use of a depth camera as a three-dimensional scanner to acquire the geometry of residual limbs or of custom-fit components. The second application is related to the motion capture of patients' gait with the prosthesis. In both cases, the technology resulted to be better than many traditional ones mainly for its limited invasivity, interesting performance, portability and low cost.

Keywords: 3D scanner | Digital human modelling | Lower limb prosthesis | Motion capture | RGB-D cameras

Abstract: The research work presented in this paper is part of an innovative framework that deals with the design process of lower limb prostheses. The quality of the whole prosthesis depends on the comfort of the socket, which realizes the interface between the patient body and the mechanical parts. We developed a CAD system, named Socket Modelling Assistant that guides the user during the design of the socket, exploiting domain knowledge and design rules. In this work we present a preliminary study that describes the implementation of a software module able to automatically identify the critical areas of the residuum to adequately modify the socket model and reach the optimal shape. Once the critical areas have been identified, the Socket Modelling Assistant can apply proper geometry modifications, in order to create the load and off-load zones for a good pressure distribution over the residual limb.

Keywords: CAD | Lower limb prosthesis | Neural network | Prostheses socket

Abstract: The paper concerns the use of integrated methodologies and tools to perform innovative human centered development of products. Digital simulation of ergonomics by means of DHM is shown together with advanced tools for design, taking into account Knowledge-based systems, Design Automation and design of highly customized goods. Two different applications of the proposed approach are described, the first refers to an industrial product, the second to the medical domain. Both applications, even if belonging to completely different fields benefit from putting the human at the center of the developing paradigm from the very first step of product development. Some results and discussion highlight benefits and limitation of the approach and of the adopted tools.

Keywords: Design Automation | Digital human modelling | Ergonomics | Human centered design | Knowledge-based systems | Lower limb prosthesis

Abstract: Purpose - The purpose of this paper is to describe two different approaches for manufacturing pre-formed titanium meshes to assist prosthetically guided bone regeneration of atrophic maxillary arches. Both methods are based on the use of additive manufacturing (AM) technologies and aim to limit at the minimal intervention the bone reconstructive surgery by virtual planning the surgical intervention for dental implants placement. Design/methodology/approach - Two patients with atrophic maxillary arches were scheduled for bone augmentation using pre-formed titanium mesh with particulate autogenous bone graft and alloplastic material. The complete workflow consists of four steps: three-dimensional (3D) acquisition of medical images and virtual planning, 3D modelling and design of the bone augmentation volume, manufacturing of biomodels and pre-formed meshes, clinical procedure and follow up. For what concerns the AM, fused deposition modelling (FDM) and direct metal laser sintering (DMLS) were used. Findings - For both patients, a post-operative control CT examination was scheduled to evaluate the progression of the regenerative process and verify the availability of an adequate amount of bone before the surgical intervention for dental implants placement. In both cases, the regenerated bone was sufficient to fix the implants in the planned position, improving the intervention quality and reducing the intervention time during surgery. Originality/value - A comparison between two novel methods, involving AM technologies are presented as viable and reproducible methods to assist the correct bone augmentation of atrophic patients, prior to implant placement for the final implant supported prosthetic rehabilitation.

Keywords: CAD/CAM | Computed tomography | Implant surgery | Rapid prototyping | Titanium mesh

Abstract: Intervertebral disc (IVD) degeneration is one of the main causes of low back pain. Current surgical treatments are complex and generally do not fully restore spine mobility. Development of injectable extracellular matrix-based hydrogels offers an opportunity for minimally invasive treatment of IVD degeneration. Here we analyze a specific formulation of collagen-low molecular weight hyaluronic acid (LMW HA) semi-interpenetrating network (semi-IPN) loaded with gelatin microspheres as a potential material for tissue engineering of the inner part of the IVD, the nucleus pulposus (NP). The material displayed a gel-like behavior, it was easily injectable as demonstrated by suitable tests and did not induce cytotoxicity or inflammation. Importantly, it supported the growth and chondrogenic differentiation potential of mesenchymal stem cells (MSC) and nasal chondrocytes (NC) in vitro and in vivo. These properties of the hydrogel were successfully combined with TGF-β3 delivery by gelatin microspheres, which promoted the chondrogenic phenotype. Altogether, collagen-LMW HA loaded with gelatin microspheres represents a good candidate material for NP tissue engineering as it combines important rheological, functional and biological features.

Keywords: Chondrocyte | Collagen | Hydrogel | Intervertebral disc | Mesenchymal stem cell

Abstract: In the past few years, researchers have focused on the design and development of three-dimensional (3D) advanced scaffolds, which offer significant advantages in terms of cell performance. The introduction of magnetic features into scaffold technology could offer innovative opportunities to control cell populations within 3D microenvironments, with the potential to enhance their use in tissue regeneration or in cell-based analysis. In the present study, 3D fully biodegradable and magnetic nanocomposite scaffolds for bone tissue engineering, consisting of a poly(ε-caprolactone) (PCL) matrix reinforced with iron-doped hydroxyapatite (FeHA) nanoparticles, were designed and manufactured using a rapid prototyping technique. The performances of these novel 3D PCL/FeHA scaffolds were assessed through a combination of theoretical evaluation, experimental in vitro analyses and in vivo testing in a rabbit animal model. The results from mechanical compression tests were consistent with FEM simulations. The in vitro results showed that the cell growth in the magnetized scaffolds was 2.2-fold greater than that in non-magnetized ones. In vivo experiments further suggested that, after only 4 weeks, the PCL/FeHA scaffolds were completely filled with newly formed bone, proving a good level of histocompatibility. All of the results suggest that the introduction of magnetic features into biocompatible materials may confer significant advantages in terms of 3D cell assembly.

Keywords: Bone tissue engineering | Experimental/theoretical analysis | Nanocomposite | Rapid prototyping | Scaffold

Abstract: Scaffolds have been produced by supercritical CO<inf>2</inf> drying of Poly-L-Lactid Acid (PLLA) gels loaded with micrometric fructose particles used as porogens. These structures show a microporous architecture generated by the voids left in the solid material by porogen leaching, while they maintain the nanostructure of the gel, consisting of a network of nanofilaments. These scaffolds have also been loaded with Hydroxyapatite (HA) nanoparticles, from 10 to 50% w/w with respect to the polymer, to improve the mechanical properties of the PLLA structure.Based on miscroscopic and mechanical considerations, we propose a parametric Finite Element Method (FEM) model of PLLA-HA composites that describes the microporous structure as a close-packing of equal spheres and the nanoscale structure as a space frame of isotropic curved fibers. The effect of HA on the mechanical properties of the scaffolds has been modeled on the basis of SEM images and by taking into consideration the formation of concentric cylinders of HA nanoparticles around PLLA nanofibers. Modeling analysis confirms that mechanical properties of these scaffolds depend on nanofibrous network connections and that bending is the major factor causing deformation of the network. The FEM model also takes into account the formation of HA multi-layer coating on some areas in the nanofiber network and its increase in thickness with HA percentage. The Young modulus tends to a plateau for HA percentages larger than 30% w/w and when the coverage of the nanofibers produced by HA nanoparticles reaches a loaded surface index of 0.14 in the FEM model.

Keywords: FEM modeling | Hydroxyapatite nanoparticles | Poly(L-Lactic Acid) nanofibers | Scaffold | Supercritical fluids

Abstract: Purpose: A suture passed along the part of the graft that will be inserted into the femoral tunnel is widely used by surgeons, because it could prevent the graft sliding on the femoral fixation device during pulling from the tibial side. The aim of this study was to evaluate the biomechanical effects of suturing the intratunnel femoral part of the graft during an anterior cruciate ligament (ACL) reconstruction. Methods: Bovine digital extensor tendons and tibias were harvested from 20 fresh-frozen mature bovine knees ranging in age from 18 to 24 months. Quadruple-strand bovine tendons were passed through the tibial tunnel and secured distally with a bioabsorbable interference screw. In one half of all grafts (N = 10), the looped-over part of the graft was sutured in a whipstitch technique over a distance of 30 mm (Group 1). In one half of all grafts (N = 10), the looped-over part was left free from any suture (Group 2). The grafts were preconditioned at 50 N for 10 min, followed by cyclic loading at 1 Hz between 50 N and 250 N for 1,000 cycles. Load-to-failure test was then carried out at a rate of 1 mm/s. Results: There was no statistically significant difference between mean stiffness at pullout and yield load between the two groups. In all specimens on Group 1, failure occurred following to partial breaking and then slipping of the tendons between the screw and the tunnel. Concerning Group 2, in six cases failure occurred as described for Group 1 specimens. In the remaining four cases, failure occurred entirely through the ligament mid-substance. Conclusions: Suturing in a whipstitch fashion the femoral portion of the graft doesn't affect the mechanical proprieties of the ACL graft. When suspension fixation device is used, suturing the looped-over part of the graft could be helpful in order to provide equal tension in all of the strands of the graft at time of tibial fixation. © 2013 Springer-Verlag Berlin Heidelberg.

Keywords: ACL graft | ACL reconstruction | Anterior cruciate ligament | Biomechanics | Graft properties

Abstract: This paper presents a new mirroring-and-registration method for the automatic symmetry plane detection of 3D asymmetrically scanned human faces. Once the mirroring of the original data is carried out with respect to the first-attempt symmetry plane, which is estimated by the PCA method, the source point cloud and the mirrored data are registered by the ICP algorithm that minimises a new weighted function. The final symmetry plane obtained approximates in the least-squares sense the midpoints of the lines connecting homologous points randomly chosen. This method is validated by analysing some specifically-designed test cases. The obtained results show that the method is quite insensitive to asymmetries of data resulting from the acquisition process. © 2013 © 2013 CAD Solutions, LLC.

Keywords: iterative closest points | mirroring | rasterstereography | registration | symmetry plane

Abstract: Nowadays, it is widely recognized that a large number of phenomenological degrees of freedom basically rule the functionality of bone tissue scaffolds. As a consequence of this, the design of scaffolds for tissue engineering involves multidisciplinary and multi-scale aspects, the latter being the subject of intensive investigation by the research community. In this chapter we present an overview on the computational aspects of bone tissue engineering, with particular emphasis on the recent mechanobiological based finite element models, as well as on novel aspects regarding the numerical characterization of the network of scaffold voids.

Keywords: Bone tissue engineering | Finite element modelling | Mechanobiology | Percolation analysis | Scaffold

Abstract: Minimally invasive percutaneous fixation techniques play a role of crucial relevance in the clinical practice. In spite of their consolidated use, little is reported in the literature to provide a mechanobiological explanation on how design of fixation devices can affect the healing process within fractured vertebrae. The aim of the study is to develop a multi-scale mechano-regulation model capable of predicting how the patterns of tissue differentiation within a vertebral fracture change in the presence or in the absence of fixation devices and how the dimensions of the device, and the materials it is made from, can affect the outcome of the healing process. To this purpose, a multi-scale mechano-regulation model is developed that combines a macro-scale model representing the spinal segment L3-L4-L5 including the fractured body of the L4 vertebra, and a micro-scale model of a fractured portion of cancellous bone. The macro-scale model includes also a minimally invasive percutaneous fixation device. The above mentioned model allows us to investigate how spatial and temporal patterns of tissue differentiation in the fracture gap change for different dimensions of the fixation device components and for different materials (Ti-6A1-4V alloy and Co-Cr alloy). Furthermore, the model provides information on the stress state in the fixation device and hence allows the risk of failure of the device itself to be estimated. The mechanical properties of the forming tissue change as the healing process progresses. In order to validate the mechano-regulation model, displacement fields will be measured with moiré and holography and compared with numerical computations. The model predicts that fixation devices significantly shorten healing times. Increasing values of the rod diameter D and decreasing values of its radius of curvature R lead to shorter durations of the healing period. Manufacturing the rods in Cobalt-Chrome alloy is predicted to reduce slightly the healing period by providing greater mechanical stability within the fracture callus. © The Society for Experimental Mechanics, Inc. 2014.

Keywords: Mechanobiology | Minimally invasive percutaneous fixation | Moiré | Tissue differentiation | Vertebral fracture

Abstract: The perception of haptic textures depends on the mechanical interaction between a surface and a biological sensor. A texture is apprehended by sliding one’s fingers over the surface of an object. We describe here an apparatus that makes it possible to record the mechanical fluctuations arising from the friction between a human fingertip and easily interchangeable samples. Using this apparatus, human participants tactually scanned material samples. The analysis of the results indicates that the biomechanical characteristics of individual fingertips clearly affected the mechanical fluctuations. Nevertheless, the signals generated for a single material sample under different conditions showed some invariant features. We propose that this apparatus can be a valuable tool for the analysis of natural haptic surfaces.

Keywords: Apparatus | Biomechanics | Biotribology | Humans | Texture

Abstract: In oral implantology, proper execution of the holes for the installation of dental implants is directly related to the correct functioning and durability of the system itself. For this reason, the procedure discussed here, which was once performed freehand in all its phases, is now being implemented through aids with more precision. Masks currently in use are created in resin ad hoc; surgical stents are inserted into the holes that will then be used as a guide. These aids are fixed into the jaw by means of micro bone screws in order to prevent movement during surgery. Despite this, we still use the guides as they are, centered properly with the help of drilling jigs. The same technique is also used in partially edentulous cases through smaller jig fixed on teeth near to the implant zone. In this article, we propose a guidance system for milling cutters used in partially edentulous cases involving from one to three adjacent installations. The purpose of the study was to realize a modular model adaptable to most dental implants, as well as efficient, quick, and low cost by pouring the resin into a plaster mold of the teeth, and then drilling the masks into position in the plants at the required angle.

Keywords: Dental implants | Drilling aid

Abstract: This study aimed at investigating the effects of titanium implants and different configurations of full-arch prostheses on the biomechanics of edentulous mandibles. Reverse engineered, composite, anisotropic, edentulous mandibles made of a poly(methylmethacrylate) core and a glass fibre reinforced outer shell were rapid prototyped and instrumented with strain gauges. Brånemark implants RP platforms in conjunction with titanium Procera one-piece or two-piece bridges were used to simulate oral rehabilitations. A lateral load through the gonion regions was used to test the biomechanical effects of the rehabilitations. In addition, strains due to misfit of the one-piece titanium bridge were compared to those produced by one-piece cast gold bridges. Milled titanium bridges had a better fit than cast gold bridges. The stress distribution in mandibular bone rehabilitated with a one-piece bridge was more perturbed than that observed with a two-piece bridge. In particular the former induced a stress concentration and stress shielding in the molar and symphysis regions, while for the latter design these stresses were strongly reduced. In conclusion, prosthetic frameworks changed the biomechanics of the mandible as a result of both their design and manufacturing technology.

Keywords: Composite | Dental implants | Mandible | Stress concentration | Stress shielding

Abstract: Purpose: The main purpose of this research work is to study the effect of poly lactic acid (PLA) addition into poly (e-caprolactone) (PCL) matrices, as well the influence of the mixing process on the morphological, thermal, chemical, mechanical and biological performance of the 3D constructs produced with a novel biomanufacturing device (BioCell Printing). Design/methodology/ approach: Two mixing processes are used to prepare PCL/PLA blends, namely melt blending and solvent casting. PCL and PCL/PLA scaffolds are produced via BioCell Printing using a 300-mm nozzle, 0/908 lay down pattern and 350-μm pore size. Several techniques such as scanning electron microscopy (SEM), simultaneous thermal analyzer (STA), nuclear magnetic resonance (NMR), static compression analysis and Alamar BlueTM are used to evaluate scaffold's morphological, thermal, chemical, mechanical and biological properties. Findings: Results show that the addition of PLA to PCL scaffolds strongly improves the biomechanical performance of the constructs. Additionally, polymer blends obtained by solvent casting present better mechanical and biological properties, compared to blends prepared by melt blending. Originality/value: This paper undertakes a detailed study on the effect of the mixing process on the biomechanical properties of PCL/PLA scaffolds. Results will enable to prepare customized PCL/PLA scaffolds for tissue engineering applications with improved biological and mechanical properties, compared to PCL scaffolds alone. Additionally, the accuracy and reproducibility of by the BioCell Printing enables to modulate the micro/macro architecture of the scaffolds enhancing tissue regeneration. © Emerald Group Publishing Limited.

Keywords: Biological analysis and testing | Fused deposition modelling | Polymers | Scaffolds

Abstract: The application of three-dimensional (3D) facial analysis and landmarking algorithms in the field of maxillofacial surgery and other medical applications, such as diagnosis of diseases by facial anomalies and dysmorphism, has gained a lot of attention. In a previous work, we used a geometric approach to automatically extract some 3D facial key points, called landmarks, working in the differential geometry domain, through the coefficients of fundamental forms, principal curvatures, mean and Gaussian curvatures, derivatives, shape and curvedness indexes, and tangent map. In this article we describe the extension of our previous landmarking algorithm, which is now able to extract eyebrows and mouth landmarks using both old and new meshes. The algorithm has been tested on our face database and on the public Bosphorus 3D database. We chose to work on the mouth and eyebrows as a separate study because of the role that these parts play in facial expressions. In fact, since the mouth is the part of the face that moves the most and affects mainly facial expressions, extracting mouth landmarks from various facial poses means that the newly developed algorithm is pose-independent.

Keywords: 3D face | 3D scanner | Differential geometry | Face morphology | Medical diagnosis | Soft-tissue landmarks

Abstract: In the last decade, three-dimensional landmarking has gained attention for different applications, such as face recognition for both identification of suspects and authentication, facial expression recognition, corrective and aesthetic surgery, syndrome study and diagnosis. This work focuses on the last one by proposing a geometrically-based landmark extraction algorithm aimed at diagnosing syndromes on babies before their birth. Pivotal role in this activity is the support provided by physicians and 3D ultrasound tools for working on real faces. In particular, the landmarking algorithm here proposed only relies on descriptors coming from Differential Geometry (Gaussian, mean, and principal curvatures, derivatives, coefficients of first and second fundamental forms, Shape and Curvedness indexes) and is tested on nine facial point clouds referred to nine babies taken by a three-dimensional ultrasound tool at different weeks' gestation. The results obtained, validated with the support of four practitioners, show that the localization is quite accurate. All errors lie in the range between 0 and 3.5 mm and the mean distance for each shell is in the range between 0.6 and 1.6 mm. The landmarks showing the highest errors are the ones belonging to the mouth region. Instead, the most precise landmark is the pronasal, on the nose tip, with a mean distance of 0.55 mm. Relying on current literature, this study is something missing in the state-of-the-art of the field, as present facial studies on 3D ultrasound do not work on automatic landmarking yet.

Keywords: 3D echography | 3D face | 3D ultrasound | Dysmorphisms | Landmarking | Syndrome diagnosis

Abstract: In the last decades, several three-dimensional face recognition algorithms have been thought, designed, and assessed. What they have in common can be hardly said, as they differ in theoretical background, tools, and method. Here we propose a new 3D face recognition algorithm, entirely developed in Matlab ® ,whose framework totally comes from differential geometry. First, 17 soft-tissue landmarks are automatically extracted relying on geometrical properties of facial shape. We made use of derivatives, coefficients of the fundamental forms, principal, mean, and Gaussian curvatures, and shape and curvedness indexes. Then, a set of geodesic and Euclidean distances, together with nose volume and ratios between geodesic and Euclidean distances, has been computed and summed in a final score, used to compare faces. The highest contribution of this work, we believe, is that its theoretical substratum is differential geometry with its various descriptors, which is something totally new in the field.

Keywords: 3D face | Face recognition | Geodesic distance | Geometry | Landmark | Shape index

Abstract: In this work, a new technique for symmetry line detection for non-erected postures, which can not be investigated with the other methods presented in the literature, is proposed. It evaluates the symmetry line by means an adaptive process in which a first attempt is modified step by step until the solution converges to the best estimation. The method here proposed is validated by analysing four different non-erected postures in which the spine does not lie onto sagittal plane, by the comparison with the traditional approach to symmetry line detection, having as reference the cutaneous marking. Results are analysed and critically discussed. © 2012 Springer-Verlag France.

Keywords: Anatomical landmarks | Back shape analysis | Posture prediction | Rasterstereography | Symmetry line

Abstract: This paper proposes a new method for the identification of the symmetry plane of the human face, working from 3D high-density scanned data. The method being proposed is an original variant of a typical mirroring and registration method. This method is validated by analysing some specifically designed test cases. The obtained results show that the method is quite insensitive to local asymmetries, whether they be near or far from the symmetry plane, and is also repeatable and slightly conditioned by the acquisition process. © 2012 Springer-Verlag France.

Keywords: Asymmetry | Mirroring | Rasterstereography | Registration | Symmetry plane

Abstract: The methods for symmetry line detection presented in the literature are typically suited to analyse symmetric upright postures, both standing and seated. The proposed method focuses on the symmetry line detection in subjects assuming asymmetric postures in which this line falls far outside the sagittal plane. The proposed approach evaluates the symmetry line by means of an autoregressive process in order to determine the set of planes suited to slice the back coherently with its geometric spatial configuration. The method is analysed assuming the cutaneous marking as reference and it is compared with a previous one, also developed by these authors. Results are analysed and critically discussed. © 2013 Taylor & Francis.

Keywords: anatomical landmarks | back shape analysis | posture prediction | rasterstereography | symmetry line

Abstract: This article concerns the design of lower limb prosthesis, both belowand above knee. It describes a newcomputer-based design framework and a digital model of the patient around which the prosthesis is designed and tested in a completely virtual environment. The virtual model of the patient is the backbone of the whole system, and it is based on a biomechanical generalpurpose model customized with the patient's characteristics (e.g. anthropometric measures). The software platform adopts computer-aided and knowledge-guided approaches with the goal of replacing the current development process, mainly hand made, with a virtual one. It provides the prosthetics with a set of tools to design, configure and test the prosthesis and comprehends two main environments: the prosthesis modelling laboratory and the virtual testing laboratory. The first permits the three-dimensional model of the prosthesis to be configured and generated, while the second allows the prosthetics to virtually set up the artificial leg and simulate the patient's postures and movements, validating its functionality and configuration. General architecture and modelling/simulation tools for the platform are described as well as main aspects and results of the experimentation. © 2013 The Author(s) Published by the Royal Society. All rights reserved.

Keywords: Digital patient | Human modelling | Lower limb prosthesis | Virtual prototyping

Abstract: This paper concerns a research project that aims at developing an innovative platform to design lower limb prosthesis. The platform is centered on the virtual model of the amputee and is based on a computer-aided and knowledge-guided approach. In particular, the paper focuses on the module, named Socket Modeling Assistant-SMA, conceived to design the socket, the most critical component of the whole prosthesis. The underlining idea is to experiment low-cost devices, such the Leap Motion, to manipulate the 3D virtual model of the socket using hands as traditional done by the prosthetist. The goal is to make available a modeling tool that permits to replicate/emulate manual operations usually performed by the prosthetist during the traditional development process. First, we first describe the traditional socket development process; then the SMA software architecture and the guidelines used to develop the interaction algorithms (integrated within SMA) that exploit the Leap Motion and Falcon devices. Finally preliminary tests and results will be illustrated. © 2013 ACM.

Keywords: 3D modeling | hand tracking | haptic interaction | lower limb prosthesis

Abstract: In this paper, we propose a knowledge-based approach to design lower limb prostheses; in particular, we focus on the 3D modelling of the socket, the most critical component. First, the architecture of a dedicated design framework is described, detailing features of the main design steps. Then, the paper discusses the acquisition and formalisation of the knowledge related both to the prosthesis manufacturing process and to the considered component. Finally, we present the computer-aided module, named socket modelling assistant-SMA, we specifically developed to design the socket. It is a virtual laboratory where the socket virtual prototype is generated directly on the digital model of patient's residual limb. It guides and supports the designer during each step in an automatic and/or semi-automatic way applying design rules and procedures. The modelling steps and available interactive tools that emulate orthopaedic technician's operations are described. Results of the experimentation phase are described. At current state of the prototype development, they are encouraging and have permitted to preliminarily validate the proposed approach and envisage future improvements. Copyright © 2013 Inderscience Enterprises Ltd.

Keywords: 3D socket modelling | Knowledge-based design | Lower limb prosthesis | Virtual prototyping

Abstract: In this paper we report the application of CAD/CAM based technologies for the innovative development of customized surgical devices to assist the mandibular rehabilitation in both primary surgery (resection and reconstruction) and secondary surgery (only reconstruction). Design and manufacturing of such customized surgical device are conducted according to the virtual pre-operative planning of the surgeon and with the aim to transferring this planning into the operating theatre. In the case of primary surgery, a cutting guide is developed to assist the resection step while a bone plate is developed to assist the reconstruction step. Instead, in the case of secondary surgery, in addition to the bone plate to support the reconstruction, also a repositioning guide is designed to bring back to the original position the resected stumps according to the original shape of the mandible. Finally, the components of the surgical devices are manufactured by DMLS in alloys suitable for biomedical applications. © 2012 Springer-Verlag France.

Keywords: 3D Reconstruction | Computed tomography | Computer aided design | Direct metal laser sintering | Rapid prototyping

Abstract: The protocol presented here is intended to minimise the intervention in bone reconstruction surgery when severe atrophy or deformity is present in the maxillary arches. A patient underwent augmentation of an atrophic maxillary arch using titanium mesh and particulate autogenous plus bovine demineralised bone. After computed tomography data elaboration, computer-aided design and computer-aided machining were used to plan the augmentation of bone volume to improve the implant position needed to support the final dental prosthesis. The augmented maxilla was rapidly prototyped in plastic, and the titanium mesh was tested on this model before the surgical intervention. Then, the preformed titanium mesh was implanted in the maxillary arch with bone grafting. The bone was augmented relative to the position of the implants for the definitive fixed implant-supported rehabilitation. The protocol presented here is a viable, reproducible way to determine the correct bone augmentation for the final implant-supported prosthetic rehabilitation. © 2013 Copyright Taylor and Francis Group, LLC.

Keywords: bone augmentation | bone graft | computed tomography | dental implants | rapid prototyping

Abstract: Ideal scaffolds for tissue engineering should mimic the complex characteristics of natural tissues and their mechanical performance. This work presents a new concept of hybrid scaffolds produced through the combination of electrospinning and an additive bioextruder system. The obtained results have shown that the hybrid structures present improved mechanical properties. © (2013) Trans Tech Publications, Switzerland.

Keywords: Bioextrusion | Electrospinning | Hybrid scaffolds | Polycaprolactone | Tissue engineering

Abstract: This paper investigates the use of PCL and PCL/PLA scaffolds, produced using a novel additive biomanufacturing system called BioCell Printing, for bone tissue engineering applications. Results show that the BioCell Printing system produces scaffolds with regular and reproducible architecture, presenting no toxicity and enhancing cell attachment and proliferation. It was also possible to observe that the addition of PLA to PCL scaffolds strongly improves the biomechanical performance of the constructs. © (2013) Trans Tech Publications, Switzerland.

Keywords: Additive biomanufacturing | Bone tissue regeneration | Cells | Polymers | Scaffolds

Abstract: Non-woven scaffolds, with fiber dimensions at a nanometer scale, can mimic the physical structure of natural extracellular matrices, being ideal construts for Tissue Engineering applications. This research work explores solution electrospinning to produce nanoscale meshes. Different Poly (ε-caprolactone) (PCL) solutions were considered and the influence of both polymer concentration and type of solvent studied regarding the fabrication of polymeric meshes and their mechanical and biological properties. PCL solutions were prepared using two different solvents: glacial acetic acid with triethylamine (AA/TEA)) and Acetone (DMK) at different concentrations. PCL/AA/TEA meshes present better mechanical properties and good cell viability and proliferation. © (2013) Trans Tech Publications, Switzerland.

Keywords: Electrospinning | Nanofibers | Polycaprolacone | Tissue engineering

Abstract: In biomedicine, magnetic nanoparticles provide some attractive possibilities because they possess peculiar physical properties that permit their use in a wide range of applications. The concept of magnetic guidance basically spans from drug delivery and hyperthermia treatment of tumours, to tissue engineering, such as magneto-mechanical stimulation/activation of cell constructs and mechanosensitive ion channels, magnetic cell-seeding procedures, and controlled cell proliferation and differentiation. Accordingly, the aim of this study was to develop fully biodegradable and magnetic nanocomposite substrates for bone tissue engineering by embedding irondoped hydroxyapatite (FeHA) nanoparticles in a poly(1-caprolactone) (PCL) matrix. X-ray diffraction analyses enabled the demonstration that the phase composition and crystallinity of the magnetic FeHA were not affected by the process used to develop the nanocomposite substrates. The mechanical characterization performed through small punch tests has evidenced that inclusion of 10 per cent by weight of FeHA would represent an effective reinforcement. The inclusion of nanoparticles also improves the hydrophilicity of the substrates as evidenced by the lower values of water contact angle in comparison with those of neat PCL. The results from magnetic measurements confirmed the superparamagnetic character of the nanocomposite substrates, indicated by a very low coercive field, a saturation magnetization strictly proportional to the FeHA content and a strong history dependence in temperature sweeps. Regarding the biological performances, confocal laser scanning microscopy and AlamarBlue assay have provided qualitative and quantitative information on human mesenchymal stem cell adhesion and viability/proliferation, respectively, whereas the obtained ALP/DNA values have shown the ability of the nanocomposite substrates to support osteogenic differentiation. © 2013 The Authors.

Keywords: Bone tissue regeneration | Magnetic hydroxyapatite | Nanocomposite | Poly(ε-caprolactone) | Scaffold

Abstract: This paper investigates the use of PCL and PCL/PLA scaffolds produced using a novel additive biomanufacturing system called BioCell Printing. PCL/PLA blends were prepared using melt blend and solvent casting techniques. Scaffolds with 0/90° architecture and 350 μm of pore size were morphologically evaluated using scanning electron microscopy and atomic force microscopy. Biological tests, using osteosarcoma cell line G-63, were performed using the Alamar Blue Assay and Alkaline Phosphatase Activity. Results show that the BioCell Printing system produces scaffolds with regular and reproducible architecture, presenting no toxicity and enhancing cell attachment and proliferation. It was also possible to observe that the addition of PLA to PCL scaffolds strongly improves the biomechanical performance of the constructs. © 2013 The Authors.

Keywords: Biomanufacturing | Polymer blends | Scaffolds | Tissue Engineering

Abstract: Cellular adhesion and proliferation inside three-dimensional synthetic scaffolds represent a major challenge in tissue engineering. Besides the surface chemistry of the polymers, it is well recognized that scaffold internal architecture, namely pore size/shape and interconnectivity, has a strong effect on the biological response of cells. This study reports for the first time how polycaprolactone (PCL) scaffolds with controlled micro-architecture can be effectively produced via bioextrusion and used to enhance the penetration of plasma deposited species. Low-pressure nitrogen-based coatings were employed to augment cell adhesion and proliferation without altering the mechanical properties of the structures. X-ray photoelectron spectroscopy carried out on different sections of the scaffolds indicates a uniform distribution of nitrogen-containing groups throughout the entire porous structure. In vitro biological assays confirm that plasma deposition sensitively promotes the activity of Saos-2 osteoblast cells, leading to a homogeneous colonization of the PCL scaffolds. © 2013 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Keywords: Biofabrication | Osteoblast cells | Scaffolds | Surface modification | Tissue engineering

Abstract: Face study and description through landmarks is a key activity in many fields, in particular the medical one for both corrective and esthetic surgery purposes. In a previous work, we used a geometric approach to automatically extract landmarks working in the Differential Geometry domain, through the coefficients of the Fundamental Forms, the Principal Curvatures, Mean and Gaussian Curvatures, derivatives, and Shape and Curvedness Indexes. In this paper we describe the improvements made to our previously developed algorithm by using a new parameterization of the mesh, new geometrical descriptors, and new conditions. © 2013 Elsevier B.V. All rights reserved.

Keywords: 3D face | 3D scanner | Differential Geometry | Face morphology | Soft-tissue landmark extraction

Abstract: Objective: In the paper laser scanning was used to evaluate, by indirect methods, the accuracy of computer-designed surgical guides in the oral implant supported rehabilitation of partially or completely edentulous patients. Materials and methods: Five implant supported rehabilitations for a total of twenty-three implants were carried out by computer-designed surgical guides, performed with the master model developed by muco-compressive and muco-static impressions. For all cases the surgical virtual planning, starting from 3D models obtained by dental scan DICOM data, was performed. The implants were inserted on the pre-surgical casts in the position defined in the virtual planning. These positions were acquired by three-dimensional optical laser scanning and compared with the laser scans of the intraoral impressions taken post-operatively. Results: The comparison between the post-surgical implant replica positions and the positions in the pre-operative cast, for the five patients, shows a maximum distance in the range 1.02-1.25 mm, an average distance in the range 0.21-0.41 mm and a standard deviation in the range 0.21-0.29 mm. Significance: The results of this research demonstrate accurate transfer of implant replica position by virtual implant insertion into a pre-operative cast and a post-operative cast obtained from impressioning. In previous studies the evaluation of the implant positions have required a post-surgical CT scan. With the indirect methods by laser scanning technique, proposed in the paper, this extra radiation exposure of the patient can be eliminated. © 2012 Academy of Dental Materials.

Keywords: Dental implants | Guided implant surgery | Impressions | Laser scan | Virtual modeling

Abstract: Objective: To investigate the influence of implant design factors in terms of bone integrity and implant stability. Materials and methods: A 3D parametric CAD model was developed. Then, once domain settings and boundary conditions were defined, a 3D FEM model was created. To simulate the physical interaction at the bone-implant interface, identity pairs were introduced. After generating different design scenarios with a DOE approach, the most significant design factors were obtained. Results: This study showed that the geometry of the screw thread highly influenced the implant stability. In particular the degree of bone damage became minimal when adopting 0.40 mm for the thread width and 0.05 mm for the thickness. Significance: Thread width and thickness play a crucial role to reduce induced stresses and damage in bone. Considering these preliminary results, future improvements should focus on investigating also two-factor and higher interactions to better understand the implant loading mechanism. © 2012 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Keywords: Bone-stress distribution | Dental implants | DOE design | FEM modeling | Osseo-integration | Thread parameterization | Titanium implants

Abstract: In this work, a new technique for symmetry line detection for asymmetric postures, which can not be investigated with the other methods presented in the literature, is proposed. It evaluates the symmetry line by means an adaptive process in which a first attempt is modified step by step until the solution converges to the best estimation. The method here proposed is validated by analysing four different asymmetric postures in which the spine lies far outside the sagittal plane, having as reference the cutaneous marking. Results are analysed and critically discussed. © 2012 Springer-Verlag.

Keywords: Anatomical landmarks | Back shape analysis | Posture prediction | Raster stereography | Symmetry line

Abstract: Computer-aided tools can help to realize custom-fit products characterized by a strict interaction with human body and definitely improve quality of life, in particular of people with disabilities. The paper refers to this context and to a specific custom-fit product, the lower limb prosthesis. It presents an innovative framework centred on virtual models of the patient's body, to design and configure lower limb prosthesis, both transfemoral and transtibial. The framework integrates virtual prototyping and knowledge-based tools to support the orthopaedic technician during all the steps of the lower limb prosthesis design, suggesting rules and procedures for each task. First, the considered product is introduced, and then, the new design framework is described as well as main steps and related tools, from socket modelling to standards component selection and final prosthesis assembly. Results of preliminary experimentation and final remarks conclude the paper. © 2012 Springer-Verlag.

Keywords: Custom-fit products | Knowledge-based systems | Lower limb prosthesis | Socket | Virtual prototyping

Abstract: In spite of the consolidated clinical use of minimally invasive percutaneous fixation techniques, little is reported in the literature providing a mechanobiological explanation for how the design of fixation devices can affect the healing process within fractured vertebrae. The aim of this study was to develop a multi-scale mechano-regulation model capable of predicting how the patterns of tissue differentiation within a vertebral fracture change in the presence or in the absence of fixation devices and how the dimensions of the device, and the materials it is made from (Ti-6Al-4V alloy and cobalt chrome alloy) can affect the outcome of the healing process. The macro-scale model simulates the spinal segment L3-L4-L5, including the fractured body of the L4 vertebra, while the micro-scale model represents a fractured portion of cancellous bone. The macro-scale model also includes a minimally invasive percutaneous fixation device. The model predicts that fixation devices significantly shorten healing times. Increasing values of the rod diameter D and decreasing values of its radius of curvature R lead to shorter durations of the healing period. Manufacturing the rods in cobalt chrome alloy is also predicted to reduce slightly the healing period by providing greater mechanical stability within the fracture callus. © International Federation for Medical and Biological Engineering 2012.

Keywords: Mechanobiology | Minimally invasive percutaneous fixation | Spine | Tissue differentiation | Vertebral fracture

Abstract: Hydrogels currently represent a powerful solution to promote the regeneration of soft and hard tissues. Primarily, they assure efficient bio-molecular interactions with cells, also regulating their basic functions, guiding the spatially and temporally complex multi-cellular processes of tissue formation, and ultimately facilitating the restoration of structure and function of damaged or dysfunctional tissues. In order to overcome basic drawbacks of traditional synthesized hydrogels, many recent strategies have been implemented to realize multi-component hydrogels based on natural and/or synthetic materials with tailored chemistries and different degradation kinetics. Here, a critical review of main strategies has been proposed based on the use of hydrogels-based devices for the regeneration of complex tissues, i.e., osteo-chondral tissues and intervertebral disc. © 2012 by the authors.

Keywords: Disc nucleus | Hydrogels | Osteochondral tissue | Scaffolds | Tissue regeneration

Abstract: An Additive Manufacturing technique for the fabrication of three-dimensional polymeric scaffolds, based on wet-spinning of poly(ε-caprolactone) (PCL) or PCL/hydroxyapatite (HA) solutions, was developed. The processing conditions to fabricate scaffolds with a layer-by-layer approach were optimized by studying their influence on fibres morphology and alignment. Two different scaffold architectures were designed and fabricated by tuning inter-fibre distance and fibres staggering. The developed scaffolds showed good reproducibility of the internal architecture characterized by highly porous, aligned fibres with an average diameter in the range 200-250 μm. Mechanical characterization showed that the architecture and HA loading influenced the scaffold compressive modulus and strength. Cell culture experiments employing MC3T3-E1 preosteoblast cell line showed good cell adhesion, proliferation, alkaline phosphatase activity and bone mineralization on the developed scaffolds. © 2012 Springer Science+Business Media, LLC.

Keywords: Additive manufacturing | Polycaprolactone | Scaffolds | Tissue engineering | Wet-spinning

Abstract: As reported in the literature, scaffolds for soft and hard tissue regeneration should satisfy several requirements. In the present work, the potential of 3D fiber deposition technique to design morphologically controlled scaffolds consisting of poly(ε-caprolactone) reinforced with sol-gel synthesized organic-inorganic hybrid fillers was demonstrated, also benefiting from a basic study carried out on 2D composite substrates. Finite element analysis, biological and mechanical tests were properly performed to assess the effects of the inclusion of the hybrid fillers on the performances of 2D substrates and 3D structures. © 2012 American Institute of Physics.

Keywords: Alamar Blue™ assay | Composite scaffolds | Finite element analysis | Mechanical properties | Organic-inorganic hybrid | Poly(e-caprolactone) | Tissue engineering

Abstract: Hydrogels are considered promising for disc regeneration strategies. However, it is currently unknown whether the destruction of the natural interface between nucleus and surrounding structures caused by nucleotomy and an inadequate annulus closure diminishes the mechanical competence of the disc. This in vitro study aimed to clarify these mechanisms and to evaluate whether hydrogels are able to restore the biomechanical behaviour of the disc.Nucleus pressure in an ovine intervertebral disc was measured in vivo during day and night and adapted to an in vitro axial compressive diurnal (15min) and night (30min) load. Effects of different defects on disc height and nucleus pressure were subsequently measured in vitro using 30 ovine motion segments. Following cases were considered: intact; annulus incision repaired by suture and glue; annulus incision with removal and re-implantation of nucleus tissue; and two different hydrogels repaired by suture and glue.The intradiscal pressure in vivo was 0.75. MPa during day and 0.5. MPa during night corresponding to an in vitro axial compressive force of 130 and 58. N, respectively. The compression test showed that neither the implantation of hydrogels nor the re-implantation of the natural nucleus, assumed as being the ideal implant, was able to restore the mechanical functionality of an intact disc.Results indicate the importance of the natural anchorage of the nucleus with its surrounding structures and the relevance of an appropriate annulus closure. Therefore, hydrogels that are able to mimic the mechanical behaviour of the native nucleus may fail in restoring the mechanical behaviour of the disc. © 2012 Elsevier Ltd.

Keywords: Compression test | Disc regeneration | Hydrogels | In vitro | In vivo | Intervertebral disc | Nucleus replacement

Abstract: Currently, numerous hydrogels are under examination as potential nucleus replacements. The clinical success, however, depends on how well the mechanical function of the host structure is restored. This study aimed to evaluate the extent to and mechanisms by which surgery for nucleus replacements influence the mechanical behaviour of the disc. The effects of an annulus defect with and without nucleus replacement on disc height and nucleus pressure were measured using 24 ovine motion segments. The following cases were considered: intact; annulus incision repaired by suture and glue; annulus incision with removal and re-implantation of nucleus tissue repaired by suture and glue or plug. To identify the likely mechanisms observed in vitro, a finite-element model of a human disc (L4-L5) was employed. Both studies were subjected to physiological cycles of compression and recovery. A repaired annulus defect did not influence the disc behaviour in vitro, whereas additional nucleus removal and replacement substantially decreased disc stiffness and nucleus pressure. Model predictions demonstrated the substantial effects of reductions in replaced nucleus water content, bulk modulus and osmotic potential on disc height loss and pressure, similar tomeasurements. In these events, the compression load transfer in the disc markedly altered by substantially increasing the load on the annulus when compared with the nucleus. The success of hydrogels for nucleus replacements is not only dependent on the implantmaterial itself but also on the restoration of the environment perturbed during surgery. The substantial effects on the disc response of disruptions owing to nucleus replacements can be simulated by reduced nucleus water content, elastic modulus and osmotic potential. © 2012 The Royal Society.

Keywords: Disruptions | Finite-element method | Hydrogels | In vitro | Interface | Intervertebral disc

Abstract: The intervertebral disc is a complex structure consisting of different tissues (nucleus pulposus, annulus fibrosus and cartilage endplate) that differ chemically, histologically and physiologically. Its degeneration represents a serious medical problem which affects many people worldwide. Discectomy and spinal fusion compromise the biomechanics of the spine, whilst current disc prostheses do not properly reproduce the static mechanical behaviour, as well as the viscoelastic, transport and biological properties of the natural structure. This clearly stresses the importance of biological approaches to disc repair. Considering the structure-function relationship, biomimetic structures able to mimic the multi-scale structural hierarchy of complex tissues are extremely important for tissue engineering applications. This chapter first describes the structure, anatomy and function of the intervertebral disc, then it briefly introduces the mechanics-biology interrelation. In particular, the chapter underlines the several approaches considered in the field of tissue engineering of annulus, nucleus and entire intervertebral disc, also trying to evidence key functional features. Injectable materials, polymers, electrospun scaffolds and several cell sources are also discussed alone or in combination. © 2012 Woodhead Publishing Limited. All rights reserved.

Keywords: Annulus fibrosus | Intervertebral disc | Nucleus pulposus | Polymers | Scaffolds | Tissue engineering

Abstract: Purpose - This paper aims to report a detailed study regarding the influence of process parameters on the morphological/mechanical properties of poly(1-caprolactone) (PCL) scaffolds manufactured by using a novel extrusion-based system that is called BioExtruder. Design/methodology/approach - In this study the authors focused investigations on four parameters, namely the liquefier temperature (LT), screw rotation velocity (SRV), deposition velocity (DV) and slice thickness (ST). Scaffolds were fabricated by employing three different values of each parameter. Through a series of trials, scaffolds were manufactured varying iteratively one parameter while maintaining constant the other ones. The morphology of the structures was investigated using a scanning electron microscope (SEM), whilst the mechanical performance was assessed though compression tests. Findings - Experimental results highlight a direct influence of the process parameters on the PCL scaffolds properties. In particular, DV and SRV have the highest influence in terms of road width (RW) and consequently on the porosity and mechanical behaviour of the structures. Research limitations/implications - The effect of process and design parameters on the biological response of scaffolds is currently under investigation. Originality/value - The output of this work provides a major insight into the effect of process parameters on the morphological/mechanical properties of PCL scaffolds. Moreover, the potential and feasibility of this novel extrusion-based system open a new opportunity to study how structural features may influence the characteristics and performances of the scaffolds, enabling the development of integrated biomechanical models that can be used in CAD systems to manufacture customized structures for tissue regeneration. © Emerald Group Publishing Limited.

Keywords: Biomanufacturing | Biotechnology | Mechanical properties of materials | Morphological properties | Process parameters | Scaffolds

Abstract: Recently, 3D landmark extraction has been widely researched and experimented in medical field, for both corrective and aesthetic purposes. Automation of these procedures on three-dimensional face renderings is something desirable for the specialists who work in this field. In this work we propose a new method for accurate landmark localization on facial scans. The method relies on geometrical descriptors, such as curvatures and Shape Index, for computing candidate and initial points, and on a statistical model based on Procrustes Analysis and Principal Component Analysis, which is fitted to candidate points, for extracting the final landmarks. The elaborated method is independent on face pose. © 2012 Elsevier Ireland Ltd.

Keywords: 3D face | Differential Geometry | Landmark extraction | PCA | Procrustes Analysis

Abstract: In this work a new method for symmetry line recognition, from 3D scanned data of a subject's back, is presented. The new method is validated by comparison with traditional techniques based on cutaneous marking. For this purpose, the upright standing and sitting postures of a sample of 75 subjects, who usually perform different sports activities, are analysed. Error in symmetry line detection is measured as the distance between the estimated symmetry line and the position of the markers. The proposed method is compared with another one described in literature which has been validated in clinical field. Results are analysed and critically discussed. © 2011 CAD Solutions, LLC.

Keywords: Back shape analysis | Posture prediction | Symmetry line

Abstract: This paper concerns the usage of virtual humans to validate lower limb prosthesis design. In particular, we are developing an innovative design framework centered on digital models of the whole patient or of his/her anatomical districts, which constitute the backbone of the design process. The framework integrates a set of virtual "assistants" to guide the technicians during each design task providing specific knowledge and design rules. In this paper, we focus the attention on the last step of the prosthesis deign process, i.e., the final set-up with the patient using a biomechanical model of the amputee. First, we describe the state of art on virtual humans and main features of the new design framework. Then, the application of virtual humans for the prosthesis set-up is presented as well as preliminary results. Copyright © 2011 by ASME.

Keywords: Lower limb prosthesis | Product development | Virtual humans | Virtual prototyping

Abstract: In this study a multi-scale mechano-regulation model was developed in order to investigate the mechanobiology of trabecular fracture healing in vertebral bodies. A macro-scale finite element model of the spinal segment L3-L4-L5, including a mild wedge fracture in the body of the L4 vertebra, was used to determine the boundary conditions acting on a micro-scale finite element model simulating a portion of fractured trabecular bone. The micro-scale model, in turn, was utilized to predict the local patterns of tissue differentiation within the fracture gap and then how the equivalent mechanical properties of the macro-scale model change with time. The patterns of tissue differentiation predicted by the model appeared consistent with those observed in vivo. Bone formation occurred primarily through endochondral ossification. New woven bone was predicted to occupy the majority of the space within the fracture site approximately 7-8 weeks after the fracture event. Remodeling of cancellous bone architecture was then predicted, with complete new trabeculae forming due to bridging of the microcallus between the remnant trabeculae. Copyright © 2010 Orthopaedic Research Society.

Keywords: finite element analysis | fracture repair | mechanobiology | tissue differentiation | vertebral body

Abstract: Techniques of bone reconstructive surgery are largely based on conventional, non-cell-based therapies that rely on the use of durable materials from outside the patient's body. In contrast to conventional materials, bone tissue engineering is an interdisciplinary field that applies the principles of engineering and life sciences towards the development of biological substitutes that restore, maintain, or improve bone tissue function. Bone tissue engineering has led to great expectations for clinical surgery or various diseases that cannot be solved with traditional devices. For example, critical-sized defects in bone, whether induced by primary tumor resection, trauma, or selective surgery have in many cases presented insurmountable challenges to the current gold standard treatment for bone repair. The primary purpose of bone tissue engineering is to apply engineering principles to incite and promote the natural healing process of bone which does not occur in critical-sized defects. The total market for bone tissue regeneration and repair was valued at $1.1 billion in 2007 and is projected to increase to nearly $1.6 billion by 2014. Usually, temporary biomimetic scaffolds are utilized for accommodating cell growth and bone tissue genesis. The scaffold has to promote biological processes such as the production of extra-cellular matrix and vascularisation, furthermore the scaffold has to withstand the mechanical loads acting on it and to transfer them to the natural tissues located in the vicinity. The design of a scaffold for the guided regeneration of a bony tissue requires a multidisciplinary approach. Finite element method and mechanobiology can be used in an integrated approach to find the optimal parameters governing bone scaffold performance. In this paper, a review of the studies that through a combined use of finite element method and mechano-regulation algorithms described the possible patterns of tissue differentiation in biomimetic scaffolds for bone tissue engineering is given. Firstly, the generalities of the finite element method of structural analysis are outlined; second, the issues related to the generation of a finite element model of a given anatomical site or of a bone scaffold are discussed; thirdly, the principles on which mechanobiology is based, the principal theories as well as the main applications of mechano-regulation models in bone tissue engineering are described; finally, the limitations of the mechanobiological models and the future perspectives are indicated. © Ivyspring International Publisher.

Keywords: Bone tissue engineering | Finite element analysis | Mechano-regulation algorithms | Mechanobiology | Scaffold

Abstract: In order to mimic the behaviors of natural tissue, the optimal approach for designing novel biomaterials has to be inspired to nature guidelines. One of the major challenge consists in the development of well-organized structures or scaffolds with controlled porosity in terms of pore size, pore shape and interconnection degree able to guide new tissue formation during the in vivo degradation following the scaffold implantation. Scaffolds endowed with molecular cues together to a controlled degradation profile should contribute to cell proliferation and differentiation, controlled vascularization, promoting the remodeling of neo tissue through a gradual transmission of biochemicals and biophysical signals as performed by the extracellular matrix (ECM). Here, different polymers and composites have been investigated to design scaffolds with peculiar micro and/or nanometric morphological features in order to satisfy all these requirements: a) bioactive scaffolds, with tailored porosity and high pores interconnectivity were developed by integrating PLA fibres, Calcium Phosphates particles or Hyaff11 phases into a Poly(ε-caprolactone) (PCL) matrix by the combination of filament winding technology and phase inversion/salt leaching technique as mineralised ECM analogue for bone regeneration; b) custom made PCL/hydroxyapatite scaffolds were designed by imaging and rapid prototyping technologies for the osteochondral defect. c) Ester of Hyaluronic Acid reinforced with degradable fibres were processed by composite technology, phase inversion and salt leaching technique, to obtain scaffolds for meniscus regeneration. d) PCL and gelatin nanofibres were obtained by highly customized fibre deposition via electrospinning to guide the nerve outgrowth in nerve regeneration. All the proposed approaches offer the chance of realizing tailor-made platforms with micro/nanoscale architecture and chemical composition suitable for the regeneration of the extracellular matrix of a large variety of natural tissues (i.e, bone, menisci, osteochondral and peripheral nervous tissues). © (2011) Trans Tech Publications, Switzerland.

Keywords: Composite | Polycaprolactone | Scaffold | Tissue engineering

Abstract: The goal of this study was to produce and characterize the scaffolds by combining the advantages of both natural and synthetic polymers for engineering fibro-cartilaginous tissues. Porous three-dimensional composite scaffolds were produced based on glycosaminoglycans and hyaluronic acid (HYAFF11) reinforced with polycaprolactone. The mechanical properties of scaffolds were evaluated as a function of time and compared with those of scaffolds seeded with human chondrocytes (constructs) and cultured in vitro up to 6 weeks. The composite scaffolds had a porosity of 68% with interconnected macropores with average pore sizes of 200 μm, an equilibrium swelling of 350%, and a predominant elastic behavior, typical of a macromolecular gel. The composite constructs maintained chondrocyte phenotype and degraded with the deposition of macromolecules synthesized by the cells. The scaffold presented mechanical properties and the ability to dissipate energy similar to the fibro-cartilaginous tissue. © The Author(s) 2011.

Keywords: cartilage tissue engineering | hyaluronic acid derivatives | mechanical properties | PCL | scaffolds

Abstract: Spinal disease due to intervertebral disc degeneration represents a serious medical problem which affects many people worldwide. Disc arthroplasty may be considered the future "gold standard" of back pain treatment, even if problems related to available disc prostheses are considered. Hence, the aim of the present study was to improve the artificial disc technology by proposing the engineering of a pilot-scale device production process for a total multi-component intervertebral disc prosthesis. The device is made up of a poly(2-hydroxyethyl methacrylate)/poly(methyl methacrylate) (PHEMA/PMMA) (80/20 w/w) semi-interpenetrating polymer network (s-IPN) composite hydrogel reinforced with poly(ethylene terephthalate) (PET) fibers as annulus/nucleus substitute, and two hydroxyapatite-reinforced polyethylene composite (HAPEXTM) endplates in order to anchor the multi-component device to the vertebral bodies. Static and dynamic-mechanical characterization show appropriate mechanical behavior. An example of engineering of a suitable pilot-scale device production process is also proposed in order to manufacture custom made implants. © 2010 The Author(s).

Keywords: customized prosthesis | fiber-reinforced hydrogel | intervertebral disc | mechanical testing. | multi-component model | reverse engineering | technologies

Abstract: Low back pain, a common cause of disability in individuals - especially between 20 and 50 years old - with enormous socioeconomic consequences, may be strongly associated with the degeneration of the intervertebral disc (IVD). The traditional IVD treatments, such as spinal fusion, even though they provide amelioration of the pain, present different drawbacks; consequently there is a lot of research interest in replacing the damaged disc with an artificial one. In this chapter, after an introductory part on IVD and the pathologies and treatment related to it, an overview of the IVD traditional prostheses is given, followed by the presentation of new hydrogels-based prostheses designed according to a biomimetic approach. Finally, the hydrogels-based systems aimed to replace the nucleus pulposus (NP) and to act as scaffolds to carry cells to engineer the IVD tissues are described.

Keywords: Hydrogels | Intervertebral disc prostheses | Nucleus pulposus | Tissue engineering

Abstract: In this work a new method for symmetry line recognition, from 3D scanned data of a subject’s back, is presented. The new method is validated by comparison with traditional techniques based on cutaneous marking. For this purpose, the upright standing and sitting postures of a sample of 75 subjects, who usually perform different sports activities, are analysed. Error in symmetry line detection is measured as the distance between the estimated symmetry line and the position of the markers. The proposed method is compared with another one described in literature which has been validated in clinical field. Results are analysed and critically discussed. © 2010 Taylor & Francis Group, LLC.

Keywords: Back shape analysis | Posture prediction | Symmetry line

Abstract: In this paper, we propose a knowledge-based approach to design lower limb prostheses; in particular, we focus on the 3D modelling of the socket, the most critical component. First, the architecture of a dedicated knowledge based engineering framework is described, detailing features of the main design steps. Then, the paper discusses the acquisition and formalization of the knowledge related both to the prosthesis manufacturing process and to the considered component. Finally, we present a computer-aided module, named Socket Modelling Assistant-SMA, to design the socket; it is a virtual laboratory where the socket virtual prototype is generated directly on the digital model of patient's residual limb. It guides and supports the designer during each step in an automatic and/or semi-automatic way applying design rules and procedures. The guided modelling steps and available tools are described. Work in progress and future developments conclude the paper. © Organizing Committee of TMCE 2010 Symposium.

Keywords: 3d socket modelling | Knowledge-based design | Lower limb prosthesis | Virtual prototyping

Abstract: Scaffolds should possess suitable properties to play their specific role. In this work, the potential of 3D fiber deposition technique to develop multifunctional and well-defined magnetic poly(ε-caprolactone)/iron oxide scaffolds has been highlighted, and the effect of iron oxide nanoparticles on the biological and mechanical performances has been assessed. © 2010 American Institute of Physics.

Keywords: 3D fiber deposition | Iron oxide nanoparticles | Poly(ε-caprolactone) | Scaffolds | Tissue engineering

Abstract: Tissue engineering may be defined as the application of biological, chemical and engineering principles toward the repair, restoration or regeneration of living tissue using biomaterials, cells and biologically active molecules alone or in combinations. The rapid restoration of tissue biomechanical function represents a great challenge, highlighting the need to mimic tissue structure and mechanical behavior through scaffold designs. For this reason, several biodegradable and bioresorbable materials, as well as technologies and scaffold designs, have been widely investigated from an experimental and/or clinical point of view. Accordingly, this review aims at stressing the importance of polymer-based composite materials to make multifunctional scaffolds for tissue engineering, with a special focus on bone, ligaments, meniscus and cartilage. Moreover, polymer-based nanocomposites will also be briefly introduced as an interesting strategy to improve the biological and mechanical performances of polymer scaffolds, especially for bone tissue engineering. © 2010 Società Italiana Biomateriali.

Keywords: Bone | Cartilage | Composites | Ligaments | Meniscus | Polymers | Scaffolds

Abstract: The tissue engineering of tendon was studied using highly elastic poly(L-lactide-co-&epsi;-caprolactone) (PLCL) scaffolds and focusing on the effect of dynamic tensile stimulation. Tenocytes from rabbit Achilles tendon were seeded (1.0 × 106 cells/scaffold) onto porous PLCL scaffolds and cultured for periods of 2 weeks and 4 weeks. This was performed in a static system and also in a bioreactor equipped with tensile modulation which mimicked the environmental surroundings of tendons with respect to tensile extension. The degradation of the polymeric scaffolds during the culture was relatively slow. However, there was an indication that cells accelerated the degradation of PLCL scaffolds. The scaffold/cell adducts from the static culture exhibited inferior strength (at 2 weeks 350 kPa, 4 weeks 300 kPa) compared to the control without cells (at 2 weeks 460 kPa, 4 weeks 340 kPa), indicating that the cells contributed to the enhanced degradation. On the contrary, the corresponding values of the adducts from the dynamic culture (at 2 weeks 430 kPa, 4 weeks 370 kPa) were similar to, or higher than, those from the control. This could be explained by the increased quantity of cells and neo-tissues in the case of dynamic culture compensating for the loss in tensile strength. Compared with static and dynamic culture conditions, mechanical stimulation played a crucial role in the regeneration of tendon tissue. In the case of the dynamic culture system, cell proliferation was enhanced and secretion of collagen type I was increased, as evidenced by DNA assay and histological and immunofluorescence analysis. Thus, tendon regeneration, indicated by improved mechanical and biological properties, was demonstrated, confirming the effect of mechanical stimulation. It could be concluded that the dynamic tensile stimulation appeared to be an essential factor in tendon/ligament tissue engineering, and that elastic PLCL co-polymers could be very beneficial in this process. © 2010 Koninklijke Brill NV, Leiden.

Keywords: BIOREACTOR | MECHANICAL STIMULATION | PLCL | TENDON | TISSUE ENGINEERING

Abstract: We developed a model to test new bone constructs to replace spare skeletal segments originating from new generation scaffolds for bone marrow-derived mesenchymal stem cells. Using computed tomography (CT) data, scaffolds were defined using computer-aided design/computer-aided manufacturing (CAD/CAM) for rapid prototyping by three-dimensional (3D) printing. A bone defect was created in pig mandible ramus by condyle resection for CT and CAD/CAM elaboration of bone volume for cutting and scaffold restoration. The protocol produced a perfect-fitting bone substitute model for rapid prototyped hydroxyapatite (HA) scaffolds. A surgical guide system was developed to accurately reproduce virtually planned bone sectioning procedures in animal models to obtain a perfect fit during surgery. © 2008 Elsevier Ltd. All rights reserved.

Keywords: Bone regeneration | CAD-CAM | Maxillofacial prosthesis | Rapid prototyping | Scaffold

Abstract: At present, computer assisted surgery systems help orthopaedic surgeons both plan and perform surgical procedures. To enable these systems to function, it is crucial to have at one's disposal 3D models of anatomical structures, surgical tools and prostheses (if required). This paper analyses and compares three methods for generating 3D digital models of anatomical structures starting from X-ray images: parametric solid modelling/reconfiguration, global shape modelling and free-form deformation. Seven experiences involving the generation of a femur model were conducted by software developers and different skilled users. These experiences are described in detail and compared at different stages and from different points of view. © 2009 Taylor & Francis.

Keywords: 3D modelling of anatomical structures | CAS systems | Orthopaedic surgery | Surgical planning

Abstract: Tissue engineering represents an interesting approach which aims to create tissues and organs de novo. In designing scaffolds for tissue engineering applications, the principal goal is to mimic the function of the natural extracellular matrix, providing a temporary template for the growth of target tissues. For this reason, scaffolds should possess suitable mechanical properties and architecture to play their specific role. In this paper, limitations of conventional scaffold fabrication methods will be briefly introduced, and rapid prototyping techniques will be described as advanced processing methods to realize customized scaffolds with controlled internal microarchitecture. Among the rapid prototyping techniques, the potential and challenges of 3D fiber deposition to create multifunctional and tailor-made scaffolds will be reviewed. © Società Italiana Biomateriali.

Keywords: 3D fiber deposition | Bioplotter | Rapid prototyping | Scaffolds | Tissue engineering

Abstract: Mandibular symphyseal distraction osteogenesis is a common clinical procedure to modify the geometrical shape of the mandible for correcting problems of dental overcrowding and arch shrinkage. In spite of consolidated clinical use, questions remain concerning the optimal latency period and the influence of mastication loading on osteogenesis within the callus prior to the first distraction of the mandible. This work utilized a mechano-regulation model to assess bone regeneration within the callus of an osteotomized mandible. A 3D model of the mandible was reconstructed from CT scan data and meshed using poroelastic finite elements (FE). The stimulus regulating tissue differentiation within the callus was hypothesized to be a function of the strain and fluid flow computed by the FE model. This model was then used to analyse tissue differentiation during a 15-day latency period, defined as the time between the day of the osteotomy and the day when the first distraction is given to the device. The following predictions are made: (1) the mastication forces generated during the latency period support osteogenesis in certain regions of the callus, and that during the latency period the percentage of progenitor cells differentiating into osteoblasts increases; (2) reducing the mastication load by 70% during the latency period increases the number of progenitor cells differentiating into osteoblasts; (3) the stiffness of new tissue increases at a slower rate on the side of bone callus next to the occlusion of the mandibular ramus which could cause asymmetries in the bone tissue formation with respect to the middle sagittal plane. Although the model predicts that the mastication loading generates such asymmetries, their effects on the spatial distribution of callus mechanical properties are insignificant for typical latency periods used clinically. It is also predicted that a latency period of longer than a week will increase the risk of premature bone union across the callus. © International Federation for Medical and Biological Engineering 2007.

Keywords: Finite element modelling | Mandibular distraction osteogenesis | Mechanobiology | Orthodontic devices | Tissue differentiation

Abstract: Computed tomography is a medical instrument that can be useful not only for diagnostic purposes, but also for surgical planning, thanks to the fact that it offers volumetric information which can be translated in three dimensional models. These models can be visualized, but also exported to Rapid Prototyping (RP) systems, that can produce these structures thanks to the rapidity and versatility of the technologies involved. The literature reports various cases of stereolithographic models used in orthopedic, neurological, and maxillo-facial surgery. In these contexts, the availability of a copy of the real anatomy allows not only planning, but also the practical execution of surgical operations, within the limitations of the materials. Nevertheless, the Rapid Prototyping model also presents some disadvantages that can be reduced if practical simulation is accompanied by virtual simulation, performed on a digital model. The purpose of this work is to examine and present the use of Virtual Reality (VR) and Rapid Prototyping for surgical planning in Maxillo-Facial surgery. ©2008Muntaz B. Habal, MD.

Keywords: Osteogenesis distraction | Rapid prototyping | Reverse engineering | Surgical planning | Virtual reality

Abstract: Purpose: Low back pain related to intervertebral disc (IVD) degeneration represents a socio-economic problem which affects quality of life. In order to solve this problem the current gold standard techniques such as spinal arthroplasty and arthrodesis (or fusion) are considered. As for spinal arthroplasty, over the past 40 yrs, IVD prostheses have been designed to maintain the correct IVD spacing and to allow for motion, while providing stability. However, there are many difficulties in incorporating important features such as viscoelastic and shock absorber behavior of natural IVDs in a prosthetic disc design. Moreover, in some cases, the use of IVD prostheses does not represent the ideal solution. Consequently, the aim of this study was to improve the design of alternative devices for spinal fusion, which overcome the problems related to metal ones currently available on the market, such as stress shielding, stress concentration effects and eventual bone corrosive or inflammatory reaction. Methods: Accordingly, a novel polyetherimide (PEI)-based cage reinforced with carbon fibers through filament winding and compression molding technologies was realized. Results: The characterization through a porcine model has produced very interesting results. The small values obtained from local compression tests have suggested that a reduction in mobility occurred, whereas distributed compression tests on IVDs prosthesized by employing the PEI-based cage reinforced with carbon fibers have highlighted a compressive stiffness of 100 MPa. This stiffness is lower than that of the IVD prosthesized through the titanium cage (146 MPa), and closer to the stiffness of natural porcine IVDs (90 MPa). Conclusions: Through a suitable composite cage design it is possible to control stress-strain distributions and the mechanical signals to bone, thus avoiding the stress-shielding phenomena, but also corrosion and metal ions release which are typical of the metallic implants. © Società Italiana Biomateriali.

Keywords: Composite interbody fusion device | Intervertebral disc | Mechanical behavior | Porcine model | Prosthesized segments

Abstract: Tissue engineered scaffolds must have an organized and repeatable microstructure which enables cells to assemble in an ordered matrix that allows adequate nutriental perfusion. In this work, to evaluate the reciprocal cell interactions of endothelial and osteoblast-like cells, human osteoblast-like cells (MG63) and Human Umbilical Vein Endothelial Cells (HUVEC) were co-seeded onto 3D geometrically controlled porous poly(ε-caprolactone) (PCL) and cultured by means of a rotary cell culture system (RCCS-4DQ). In our dynamic co-culture system, the lack of significant enhancement of osteoblast ALP activity and ECM production indicated that the microgravity conditions of the rotary system affected the cells by favoring their proliferation and cellular cross-talk. These results emphasize how osteoblasts increase endothelial cell proliferate and endothelial cells amplify the growth of osteoblasts but decrease their differentiation. This dynamic seeding of osteoblasts and endothelial cells onto a 3D polymeric scaffold may represent a unique approach for studying the mechanisms of interaction of endothelial and osteoblast cells as well as achieve a functional hybrid in which angiogenesis, furnished by neo-vascular organization of endothelial cells may further support osteoblasts growth. Furthermore, this in vitro model may be useful in examining the applicability of novel material structures for tissue engineering. © SAGE Publications 2008.

Keywords: 3D scaffolds | Dynamic co-culture | Poly-ε- caprolactone | Rapid prototyping | Tissue engineering

Abstract: Mandibular distraction osteogenesis is a clinical procedure used for modifying the mandibular geometry when problems of dental overcrowding and arch shrinkage occur. The objective of this study is to use a computational model of tissue differentiation to examine the influence of the rate of distraction on bone re-growth within the fracture callus of a human mandible submitted to symphyseal distraction osteogenesis. A 3D model of the mandible is reconstructed from CT scan data and meshed into finite elements. Two different mastication loadings have been investigated: a 'full' mastication load and a 'reduced' mastication load where the action of each muscle was reduced by 70%. Four different distraction rates were analyzed: 0.6, 1.2, 2, and 3 mm/day, allowing a total displacement of 6 mm. In the early stages of the distraction process it is predicted that there is a decrease in the amount of bone tissue forming within the center of the fracture gap for all distraction rates. After the initial phases of expansion, the bone tissue within the callus increases for the slower rate of distraction or continues to decrease at the faster rates of distraction. At the end of the simulated maturation period, 47% of the distracted callus was predicted to consist of bone tissue for a distraction rate of 0.6 mm/day, decreasing to 22% for a distraction rate of 3 mm/day. Significantly higher amounts of bone formation were predicted for all distraction rates for the case of reduced mastication loading. Disparities between the model predictions and what is observed in vivo were found. For instance, during the latency period, the distraction period and beyond, the model is predicting larger than expected amounts of cartilage tissue formation within the callus. This and other limitations of the proposed model are discussed and possible specific explanations for these disparities are provided in the paper. The model predicts a distraction rate of around 1.2 mm/day to be optimal as higher rates produce less bone tissue while the risk of a premature bone union is greater at slower rates of distraction because in the latter stages of the distraction process bone tissue is predicted to form between the left and right side of the bone callus. © 2007 Biomedical Engineering Society.

Keywords: Finite element analysis | Mandibular distraction osteogenesis | Mechanobiology | Osteotomized human mandible | Tissue differentiation

Abstract: A review of recent literature revealed a very high success rate of implants used to support a mandibular overdenture as an alternative to the conventional removable dentistry. Today there are already several prosthetic solutions for the same clinical situations: in particular, the implant support can be different depending on the type of implants used and their layout. It is well known that the success or the failure of implants interfaced with bone depends, taking into account a favourable biological reaction, on the structural condition of the biomechanical system constituted by the bone structure and the implant. Knowledge of the strain/stress pattern can allow one to establish if bone maintenance, resorption or addition is more likely to take place. In this work two different kinds of implant supports for overdenture retention were compared by means of FEM: they differed in the number of implants, their dimension, their location inside the mandible and, finally, in the presence/absence of a beam connecting all implants and making them all linked. Clinical follow-up was assessed by means of technetium 99m-MDP scintigraphy. The obtained results agree with the clinical experience.

Keywords: Biomechanics | Bone remodelling | Bone scintigraphy | Dental implants | FEM | Nuclear medicine

Abstract: The paper presents an innovative approach totally based on digital data to optimize lower limb socket prosthesis design. This approach is based on a stump's detailed geometric model and provides a substitute to plaster cast obtained through the traditional manual methodology with a physical model, realized with Rapid Prototyping technologies; this physical model will be used for the socket lamination. The paper discusses a methodology to reconstruct a 3D geometric model of the stump able to describe with high accuracy and detail the complete structure subdivided into bones, soft tissues, muscular masses and dermis. Some different technologies are used for stump acquisition: non contact laser technique for external geometry, CT and MRI imaging technologies for the internal structure, the first one dedicated to bones geometrical model, the last for soft tissues and muscles. We discuss problems related to 3D geometric reconstruction: the patient and stump positioning for the different acquisitions, markers' definition on the stump to identify landmarks, alignment's strategies for the different digital models, in order to define a protocol procedure with a requested accuracy for socket's realization. Some case-studies illustrate the methodology and the results obtained. © 2006 SPIE-IS&T.

Keywords: 3D geometrical model | Human body scanning | Lower limb prosthesis | Medical imaging | Rapid prototyping | Reverse engineering

Abstract: The purpose of the present work was to develop a tool for preoperatively planning the Total Hip Replacement (THR). Starting from the MR images, the 3D surface model of both the pelvis and the femur was built and the surgical operation was virtually performed. Data coming from gait analysis were added to visualize the physiologic movement of the hip joint. The resulting triangular mesh was sufficiently accurate to allow the building of the stereolithographic model of the joint by means of rapid prototyping technique. The plastic bones allow the user to have an enhanced vision of the surgical procedure to be performed. © 2005 CARS and Elsevier B.V.

Keywords: Magnetic resonance imaging | Rapid prototyping | Surgical planning | Total hip replacement

Abstract: This article presents the use of stereolithography in oral implantology. Stereolithography is a new technology that can produce physical models by selectively solidifying an ultraviolet-sensitive liquid resin using a laser beam, reproducing the true maxillary and mandibular anatomic dimensions. With these models, it is possible to fabricate surgical guides that can place the implants in vivo in the same places and same directions as those in the planned computer simulation. A 70-year-old woman, in good health, with severe mandibular bone atrophy was rehabilitated with an overdenture supported by 2 Branemark implants. Two different surgical planning methods were considered: 1) the construction of a surgical guide evaluating clinical aspects, and 2) the surgical guide produced by stereolithographic study. The accuracy of surgical planning can reduce the problems related to bone density and dimensions. Furthermore, the stereolithographic study assured the clinicians of a superior location of fixtures in bone. Surgical planning based on stereolithographic technique is a safe procedure and has many advantages. This technologic advance has biologic and therapeutic benefits because it simplifies anatomic surgical management for improved implant placement. Copyright © 2004 by Lippincott Williams & Wilkins.

Keywords: Anatomic models | Jaw atrophy | Rapid prototyping | Surgical planning

Abstract: Hip joint simulators were developed for predicting, by attempting to duplicate in vitro physiological loads and motion, the wear rate that total hip replacements are likely to show in vivo. From a theoretical point of view, loading and motion cycles of hip joints could be closely reproduced by three rotation actuators and three force actuators. However existing devices have been designed assuming that some of these degrees of freedom are negligible, in order to reduce the complexity of the equipment. The present study singles out some preliminary indications on the design choices regarding the spatial configuration of loading and motion actuators. The aim is to define theoretically a simplified simulator but still able to apply the most physiologically realistic loading cycle to the specimen.

Keywords: Biomechanics | Hip joint simulator | Wear