Methods for medical applications

The biomechanics of the abdominal wall depends on muscular activation, tissue mechanical behavior and Intra-Abdominal Pressure (IAP). In this work, a numerical model of a human abdomen is presented, based on abdominal wall geometry from medical images. Specific constitutive formulations describe tissues mechanical behavior. Connective tissues are modelled as hyperelastic fiber-reinforced materials, while muscular tissues are described by means of a three-element Hill's model. The abdominal cavity is represented by a volume region interacting with the abdominal wall. Numerical analyses are developed by applying a muscular contraction, inducing a volume reduction of the abdominal cavity and a simultaneous IAP increase. Numerical results of abdomen displacement at IAP corresponding to an abdominal crunch are compared with experimental results acquired via 3D laser scanning on a healthy subject. Numerical and experimental results are mutually consistent and show that muscular activation induces a raising in the region adjacent to linea alba along the posterior-anterior direction and a lowering along lateral-medial direction of the abdominal wall sides. The numerical model developed in this work allows a coherent representation of the abdominal wall mechanics.

Keywords: 3D laser scanning , Finite element modeling , Muscle activation , Numerical analysis , Tissue constitutive modeling

XR is an acronym used to refer to the spectrum of hardware, software applications, and techniques used for virtual reality or immersive environments, augmented or mixed reality and other related technologies. The special thematic session on ‘XR Accessibility' explores current research and development as well as presenting diverse approaches to meeting real user needs in immersive environments. The contributed research papers range from using spatial sound for object location and interaction for blind users, to alternative symbolic representation of information, Augmented Reality (AR) used in rehabilitation for stroke patients and vocational skills training for students with intellectual disabilities. The session also explores what we can learn from previous research into immersive environments – looks at opportunities for future research and collectively explores how we can together iterate accessibility standards.

Keywords: Accessibility , Augmented Reality , Immersive web , Inclusive design , Rehabilitation , Serious games , Usability , Virtual reality

Background: Lumbrical muscles originate in the palm from the 4 tendons of the flexor digitorum profundus and course distally along the radial side of the corresponding metacarpophalangeal joints, in front of the deep transverse metacarpal ligament. The first and second lumbrical muscles are typically innervated by the median nerve, and third and fourth by the ulnar nerve. A plethora of lumbrical muscle variants has been described, ranging from muscles' absence to reduction in their number or presence of accessory slips. The current cadaveric study highlights typical and variable neural supply of lumbrical muscles. Materials: Eight (3 right and 5 left) fresh frozen cadaveric hands of 3 males and 5 females of unknown age were dissected. From the palmar wrist crease, the median and ulnar nerve followed distally to their terminal branches. The ulnar nerve deep branch was dissected and lumbrical muscle innervation patterns were noted. Results: The frequency of typical innervations of lumbrical muscles is confirmed. The second lumbrical nerve had a double composition from both the median and ulnar nerves, in 12.5% of the hands. The thickest branch (1.38 mm) originated from the ulnar nerve and supplied the third lumbrical muscle, and the thinnest one (0.67 mm) from the ulnar nerve and supplied the fourth lumbrical muscle. In 54.5%, lumbrical nerve bifurcation was identified. Conclusion: The complex innervation pattern and the peculiar anatomy of branching to different thirds of the muscle bellies are pointed out. These findings are important in dealing with complex and deep injuries in the palmar region, including transmetacarpal amputations.

Keywords: anomaly , clinical implication , lumbrical muscle , lumbrical nerve , variation

The development of additive manufacturing allows the transformation of technological processes and the redesign of products. Among the most used methods to support additive manufacturing, the design can be optimised through the integration of topology optimisation techniques, allowing for creating complex shapes. However, there are critical issues (i.e., definition of product and process parameters, selection of redesign variants, optimised designs interpretation, file exchange and data management, etc.) in identifying the most appropriate process and set-ups, as well as in selecting the best variant on a functional and morphological level. Therefore, to fully exploit the technological potentials and overcome the drawbacks, this paper proposes a systematic redesign approach based on additive manufacturing technologies that integrate topology optimisation and a tool for selecting design variants based on the optimisation of both product and process features. The method leads to the objective selection of the best redesigned configuration in accordance with the key performance indicators (KPIs) (i.e., functional and production requirements). As a case study, the redesign of a medical assistive device is proposed, previously developed in fused filament fabrication and now optimised for being 3D printed with selective laser melting.

Keywords: Assistive device , Design for additive manufacturing , Design method , Design optimisation , Design variants selection , Redesign , Selective laser melting , Topology optimisation

Additive Manufacturing is a widespread technology that may enhance product customization based on specific users' needs, as in the case of assistive devices. Many chronic physical progressively disabling diseases, but also ageing, may cause severe limitations in daily life, which can be overcome by highly customized aids. Literature shows that the active involvement of the patient in the development of assistive devices through co-design allows for their greater therapeutic effectiveness and acceptance. Therefore, this paper proposes a methodological approach for the development of inclusive assistive devices to support daily activities in persons with disabling diseases of the upper-limb. The approach integrates co-design, standardized tools, and low- and high-tech prototyping techniques and tools, which lead to significant feedbacks from patients. The patients are encouraged to interact with conceptual prototypes through direct 3D CAD modelling and touch screen devices. Assessment tests highlight the suitability of the method to achieve the expected goals.

Keywords: Additive Manufacturing , Assistive device , Co-design , Hand pathologies , Inclusive method , Occupational therapy , Parametric modelling

The present work shows how 3D models extracted from a computerised tomography (CT) scan can be processed to be 3D printed into 1:1 orthopedic scale models, which find unquestionable utility in pre-operative surgical planning. Relying on the CAT-CAD methodology, which produces a 3D surface called “mesh” from diagnostic images of body parts, the CAD-AM process elaborates a volumetric bone model which a cost-efficient FDM printer can work with. The suitable materials for these applications are PLA polymers, due to their thermo-mechanical properties, affordability and ecological sustainability; these anatomic 3D printed models allows surgeons to accurately see bones injuries and trauma, resulting in a minimisation of risk and a much more flowing doctor-patient communication. Furthermore these 3D printed objects can be manufactured with specific density in order to simulate bone tissues, resulting in a useful tool through which experienced surgeons can pass on their knowledge to medical students at a very reasonable cost, overcoming the glaring limitations of two-dimensional images provided by CT scans. Here represented is a 3D printed 1:1 scale model of a femur donated to the Bone Bank of IOR-Rizzoli Orthopaedic Institute in Bologna.

Keywords: CT scan , FDM printer , Orthopaedic Reproduction Model , PLA polymer

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

Pectus Excavatum (PE) is a congenital anomaly of the ribcage, at the level of the sterno-costal plane, which consists of an inward angle of the sternum, in the direction of the spine. PE is the most common of all thoracic malformations, with an incidence of 1 in 300-400 people. To monitor the progress of the pathology, severity indices, or thoracic indices, have been used over the years. Among these indices, recent studies focus on the calculation of optical measures, calculated on the optical scan of the patient's chest, which can be very accurate without exposing the patient to invasive treatments such as CT scans. In this work, data from a sample of PE patients and corresponding doctors' severity assessments have been collected and used to create a decision tool to automatically assign a severity value to the patient. The idea is to provide the physician with an objective and easy to use measuring instrument that can be exploited in an outpatient clinic context. Among several classification tools, a Probabilistic Neural Network was chosen for this task for its simple structure and learning mode.

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

Pectus Excavatum (PE) is a congenital anomaly of the thoracic cage, at the level of the sternal-costal plane, which consists of an inward angle of the sternum, in the direction of the spine. Its incidence, equal to 1 in 300–400 people, makes it the most frequent among thoracic malformations. For a proper care of patients suffering from PE, it is essential to monitor the progression of the disease and estimate its severity, in order to follow the course of the pathology over time and define the correct treatment. To this end, over the years, severity indexes, or chest indexes, have been introduced. Among them, in recent years, the so-called optical indices, calculated on optical scans of the patient's chest, are gaining ground. In fact, the optical scan is faster to apply and prevents the patient from being exposed to radiation. In this work the peculiar morphological features of PE have been examined by extracting various geometric parameters, in order to develop an outpatient support tool for the evaluation of the severity of the pathology and the monitoring of its progression over time. The extracted values have been compared against a ground truth obtained through five independent surveys collected from paediatric specialists. A Linear Discriminant Analysis was performed to determine the accuracy of the classification using the proposed geometric parameters, obtaining positive results.

Keywords: Clinical support , Depth camera , Pectus Excavatum , Severity index

In cranioplasty surgery, achieving an effective aesthetic shape restoration of the cranial vault is the most important issue to ensure a proper outcome in terms of social and psychological benefits for the patient. To date, the most advanced approach uses CT/MRI data to reconstruct, in a pre-operative stage, the 3D anatomy of the defective skull in order to design a patient-specific prosthesis. In the last years, several techniques have been proposed to improve the applicability of such approach in the clinical practice, but the analysis of the related literature shows still open issues, due to the wide anatomical variability and complexity of the craniofacial anatomy that needs to be retrieved. With the aim to overcome the State-of-the-Art drawbacks, a new semi-automatic hybrid procedure for repairing unilateral or quasi-unilateral (i.e. a single defect slightly passing the sagittal plane) cranial defects is presented. The novel approach is hybrid because a surface interpolation for filling the hole is used together with a template-based reconstruction guided by the healthy counterpart. The procedure, being landmark-independent and avoiding any patch adaptation, represents a valid alternative for the existing approaches also in terms of user's burden, requiring less time consuming and less cumbersome operations. In addition, a new evaluating technique able to measure the symmetry of the reconstruction as well as the continuity between patch and healthy bone is proposed to test the procedure performance. Several test cases have been then addressed to prove the effectiveness and repeatability of the proposed procedure in reconstructing large-size defects of the skull.

Keywords: CAD , Cranioplasty , Reverse Engineering , Skull Reconstruction

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

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

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

In the current study, Sr/Fe co-substituted hydroxyapatite (HAp) bioceramics were prepared by the sonication-assisted aqueous chemical precipitation method followed by sintering at 1100 °C for bone tissue regeneration applications. The sintered bioceramics were analyzed for various structural and chemical properties through X-ray diffraction, scanning electron microscopy, and Fourier transform infrared spectroscopy, which confirmed the phase purity of HAp and Sr/Fe co-substitution into its lattice. The Vickers hardness measurement, high blood compatibility (less than 5% hemolysis), and ability to support the adhesion, proliferation, and osteogenic differentiation of human mesenchymal stem cells suggest the suitability of Sr/Fe:HAp bioceramics for bone implant applications. The physicochemical analysis revealed that the developed Sr/Fe:HAp bioceramics exhibited a polyphasic nature (HAp and βTCP) with almost identical structural morphology having a particle size less than 0.8 μm. The dielectric constant (ϵ′) and dielectric loss (ϵ″) were potentially affected by the incorporated foreign ions together with the polyphasic nature of the material. The Sr/Fe co-substituted samples demonstrated extended drug (5-fluorouracil and amoxicillin) release profiles at the pH of physiological medium. The multifunctional properties of the developed HAp bioceramics enabled them to be an auspicious candidate for potential biomedical applications, including targeted drug-delivery applications, heating mediator in hyperthermia, and bone tissue repair implants.

Keywords: biocompatibility , biomechanical properties , drug release , osteogenic differentiation , polyphasic nature , Sr/Fe co-substitution

Cranioplasty represents the surgical repair of bone defects or deformities in the cranium arising from traumatic skull bone fracture, cranial bone deformities, bone cancer, and infections. The actual gold standard in surgery procedures for cranioplasty involves the use of biocompatible materials, and repair or regeneration of large cranial defects is particularly challenging from both a functional and aesthetic point of view. PMMA-based bone cement are the most widely biomaterials adopted in the field, with at least four different surgical approaches. Modifications for improving biological and mechanical functions of PMMA-based bone cement have been suggested. To this aim, the inclusion of antibiotics to prevent infection has been shown to provide a reduction of mechanical properties in bending. Therefore, the development of novel antibacterial active agents to overcome issues related to mechanical properties and bacterial resistance to antibiotics is still encouraged. In this context, mechanical, biological, and antibacterial feature against P. aeruginosa and S. aureus bacterial strains of surgical PMMA cement modified with BG and recently developed Cu-TCP bioactive particles have been highlighted.

Keywords: Bacterial strains , Bending properties , Bioactive particles , Biocomposites , Compressive properties , Cranioplasty , MTT assay , PMMA

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 (Orthoapneaâ„¢), and two have lateral propulsion (Somnodentâ„¢ and Herbstâ„¢). 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: Herbstâ„¢ and Somnodentâ„¢ 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 Somnodentâ„¢ and 3.56 kPa on periodontal ligaments and 302 kPa on teeth for Herbstâ„¢. Orthoapneaâ„¢ 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

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

Statement of problem: The marginal gap and ceramic bond strength of metal-ceramic restorations are important for success. However, studies evaluating the marginal gap and ceramic bond strength of fixed partial dentures (FPDs) produced with 3D printing technologies such as selective laser melting (SLM) are scarce. Purpose: The purpose of this in vitro study was to investigate the marginal gap of cobalt-chromium (Co-Cr) alloy frameworks produced by SLM technology before and after ceramic firing. Additionally, the metal-ceramic bond strength was evaluated with the Schwickerath crack-initiation test according to the International Standards Organization (ISO) 9693-1:2012. Material and methods: Conventional impressions were made, and the definitive cast of a patient requiring a 4-unit FPD was scanned. After designing the FPD, the files were sent to a service center for the fabrication of a metal master model, 80 Co-Cr frameworks, and 80 flat specimens (25×3×0.5 mm) with SLM technology. The marginal gap between frameworks and the abutment tooth of the metal master model was nondestructively measured by using an optical coordinate-measuring machine. A total of 80 sets, consisting of 1 framework and 1 flat specimen, were sent to 80 dental laboratory technicians for ceramic firing. Detailed instructions for correct manipulation of the framework and flat specimen were provided. The marginal gap was remeasured, and the 3-point bend test was used to evaluate metal-ceramic bond strength. Results: Only 28 of the 80 dental technicians returned the specimens within a prespecified time and/or in adequate condition. The mean ±standard deviation marginal gap of the framework before ceramic firing was 25 ±9 μm and 34 ±12 μm after firing. The difference was statistically significant (P=.001). The mean ±standard deviation 3-point bend strength was 33 ±9 MPa. Conclusions: Ceramic firing affected the marginal gap; however, all Co-Cr frameworks had a marginal gap lower than 120 μm, which is reported to be a clinically acceptable limit. Most of the specimens (80%) had a metal-ceramic bond strength value higher than the 25-MPa ISO 9693 requirement. Five of 28 dental laboratory technicians were not able to comply with ceramic firing instructions.

background: resin-bonded fixed dental prosthesis (RBFDP) represents a highly aesthetic and conservative treatment option to replace a single tooth in a younger patient. The purpose of this in vitro study was to compare the fracture strength and the different types of failure on anterior cantilever RBFDPs fabricated using zirconia (ZR), lithium disilicate (LD), and PMMA-based material with ceramic fillers (PM) by the same standard tessellation language (STL) file. Methods: sixty extracted bovine mandibular incisives were embedded resin block; scanned to design one master model of RBFDP with a cantilevered single-retainer. Twenty cantilevered single-retainer RBFDPs were fabricated using ZR; LD; and PM. Static loading was performed using a universal testing machine. Results: the mean fracture strength for the RBFDPs was: 292.5 Newton (Standard Deviation (SD) 36.6) for ZR; 210 N (SD 37.6) for LD; and 133 N (SD 16.3) for PM. All the failures of RBFDPs in ZR were a fracture of the abutment tooth; instead; the 80% of failures of RBFDPs in LD and PM were a fracture of the connector. Conclusion: within the limitations of this in vitro study, we can conclude that the zirconia RBFDPs presented load resistance higher than the maximum anterior bite force reported in literature (270 N) and failure type analysis showed some trends among the groups.

Keywords: Adhesive restorations , CAD/CAM , Digital dentistry , Fracture , Lithium disilicate , PMMA , Resin bonded bridge , Zirconia