Methods for medical applications

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

Nowadays, upper-limb injury or impairment represent a widespread problem, related to sport accidents or traumas, surgery operations, stroke and so on. The typical approach to the rehabilitation is one or more physiotherapy sessions, to restore muscular mass and strength. Despite this, over the years, several works proposed innovative solutions, including electromechanical orthoses, which work in relation to the muscular activity, measured by techniques such as superficial electromyography (sEMG). Yet, these systems are still far from commercialization because of their cost, complexity and difficulties in using. A currently unmet need regards the ability of the therapist to control and manage data through a remote interface, by exploiting some of the latest technological resources on the market (smartphones, tablets). The present works aims at designing an upper-limb rehabilitation system, based on an orthosis, sEMG wireless sensors and a dedicated software architecture to overcome these limitations. This will lead to an important change of perspective in physiotherapy procedures since data collection and correlation will produce innovative medical protocols, addressed to people affected by several types of injury or impairment. Copyright © 2013 by ASME.

Keywords: Orthoses , SEMG sensors , Upper-limb rehabilitation

In the context of a research program aiming at defining a framework to acquire patient data and support the whole shoe design and manufacturing process, this paper presents new CAD tools to design and validate lasts for shoes designed specifically for people with diabetes. Shoe last customising systems have already been proposed in the literature. However, tools for designing shoes for people with diabetes do not currently have the capacity to modify the last in order to reduce the risk of foot ulceration, whilst at the same time preserving the style of the shoe. The main contributions of the work are given by a method to identify the required design features to guarantee the footwear preventive function, the determination of a systematic protocol for orienting and measuring the virtual models of the feet and the lasts, and the definition of geometrical operators to modify the last shape according to its original aesthetic and the required footwear parameters. Such variables are computed by a knowledge based system on the basis of the patient's pathology. The paper presents the implementation of two CAD tools and describes the procedures and the geometrical algorithms to handle the last geometry. Finally a case study is reported to show the advantages provided by the proposed approach in terms of achieved quality of the design process and expected footwear performance. © 2013 Elsevier Ltd. All rights reserved.

Keywords: Diabetic foot , Foot-last fitting , Last design , Last measurement

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

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

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

Poly(ε-caprolactone), PCL, has been functionalized with a biologically relevant monosaccharide, i.e. glucosamine, in a single step process after material fabrication. Glucosamine-functionalised PCL showed enhanced cell density and spreading over the non-functionalised samples. © 2013 The Royal Society of Chemistry.

The inability of the avascular region of the meniscus to regenerate has led to the use of tissue engineering to treat meniscal injuries. The aim of this study was to evaluate the ability of fibrochondrocytes preseeded on PLDLA/PCL-T [poly(L-co-D,L-lactic acid)/poly(caprolactone-triol)] scaffolds to stimulate regeneration of the whole meniscus. Porous PLDLA/PCL-T (90/10) scaffolds were obtained by solvent casting and particulate leaching. Compressive modulus of 9.5±1.0 MPa and maximum stress of 4.7±0.9 MPa were evaluated. Fibrochondrocytes from rabbit menisci were isolated, seeded directly on the scaffolds, and cultured for 21 days. New Zealand rabbits underwent total meniscectomy, after which implants consisting of cell-free scaffolds or cell-seeded scaffolds were introduced into the medial knee meniscus; the negative control group consisted of rabbits that received no implant. Macroscopic and histological evaluations of the neomeniscus were performed 12 and 24 weeks after implantation. The polymer scaffold implants adapted well to surrounding tissues, without apparent rejection, infection, or chronic inflammatory response. Fibrocartilaginous tissue with mature collagen fibers was observed predominantly in implants with seeded scaffolds compared to cell-free implants after 24 weeks. Similar results were not observed in the control group. Articular cartilage was preserved in the polymeric implants and showed higher chondrocyte cell number than the control group. These findings show that the PLDLA/PCL-T 90/10 scaffold has potential for orthopedic applications since this material allowed the formation of fibrocartilaginous tissue, a structure of crucial importance for repairing injuries to joints, including replacement of the meniscus and the protection of articular cartilage from degeneration. © 2013, Mary Ann Liebert, Inc. 2013.

Keywords: fibrochondrocyte culture , meniscus regeneration , PLDLA/PCL-T scaffold

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

The basic principle of tissue engineering entails the guided application and the control of cells, materials, and the microenvironment into which they are delivered [1]. In a tissue engineering process, tissues or organs may be created in vivo, in vitro, or ex vivo and implanted into the patient [2]. In this direction, the selection of three elements rstly concurs to satisfy the basic tissue engineering principles on fabricating biological tissues: (i) viable, responsive cells; (ii) a scaffold to support tissue formation; and (iii) a growth-inducing stimulus.

Hydrogel-based materials are widely employed in the biomedical field. With regard to central nervous system (CNS) neurodegenerative disorders, the design of injectable nanocomposite hydrogels for in situ drug or cell release represents an interesting and minimally invasive solution that might play a key role in the development of successful treatments. In particular, biocompatible and biodegradable hydrogels can be designed as specific injectable tools and loaded with nanoparticles (NPs), to improve and to tailor their viscoelastic properties upon injection and release profile. An intriguing application is hydrogel loading with mesenchymal stem cells (MSCs) that are a very promising therapeutic tool for neurodegenerative or traumatic disorders of the CNS. This multidisciplinary review will focus on the basic concepts to design acellular and cell-loaded materials with specific and tunable rheological and functional properties. The use of hydrogel-based nanocomposites and mesenchymal stem cells as a synergistic strategy for nervous tissue applications will be then discussed. © 2013 Diego Albani et al.

Purpose: Our aim was to assess the use of injectable, biocompatible and resorbable, hydrogel-based tools for innovative therapies against brain-related neurodegenerative disorders like Alzheimer's (AD) and Parkinson's (PD) diseases. Methods: Two compositions of semi-interpenetrating polymer networks (semi-IPNs) based on collagen and poly(ethylene glycol) (PEG) were investigated. We examined their viscoelastic properties, flow behavior, functional injectability, as well as in vitro biocompatibility with SH-SY5Y human neuroblastoma cells and murine primary neurons. We also evaluated the in vivo biological performance after subcutaneous and brain injection in mice. Results: The selected semi-IPNs showed a gel-like behavior and were injectable through a 30 G needle, with the maximum load ranging from 3.0 to 3.9 N. In vitro results showed that immortalized cells kept their proliferative potential and neurons maintained their viability after embedding in both materials, with better performances for the gel with the higher collagen content. For both semi-IPNs, after subcutaneous injection, the inflammatory response was negligible; after brain injection, the tissue did not show any signs of damage or degeneration. Conclusions: The results suggest that the selected semi-IPNs not only represent a proper environment for cells, but also, once injected in vivo, do not induce damage/inflammation in the surrounding brain tissue. These findings represent a crucial starting point for the development of minimally invasive and injectable hydrogel-based tools for innovative drug/cell-based therapeutic strategies against AD, PD, or other severe brain-related neurodegenerative pathologies. © 2013 Wichtig Editore.

Keywords: Brain , Hydrogels , Neurodegenerative diseases , Semi-interpenetrating polymer networks

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

A new biomanufacturing system allowing to produce three-dimensional matrices (scaffolds) with well defined internal geometries, uniform pore distribution and good adhesion among different adjacent layers. Polymers selected are Poly ε-caprolactone (PCL) and Poly Lactic Acid (PLA), both these polymers are used in medical applications. These two polymers are interesting biomaterials because they are complementary on their physical properties and biodegradability. This work aims to assess the temperature evaluation during the extrusion process and the influences of the temperatures on the PCL and PCL/PLA scaffolds with lay down pattern 90° and pore size 350μm. The results demonstrated that extrusion process not modified the thermal properties of the scaffolds and these structures are able to sustain MG-63cells. Copyright © 2013, AIDIC Servizi S.r.l.

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

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

Purpose: The purpose of this study was to investigate the marginal precision of computer numeric control- milled frameworks fabricated of grade 4 commercially pure titanium or cobalt-chrome alloy through digital technology and to compare them with conventional cast frameworks. Material and Methods: A titanium cast of a mandibular arch with six implant analogs was used as a master. The master cast was measured with a coordinate measuring machine. Fifteen rigid anatomic frameworks were created on the master cast in cast gold alloy and milled in titanium or cobalt-chrome material. The fifteen anatomic frameworks were measured in the same manner as the master cast. While the milled frameworks were measured once, at the end of the milling process, the cast anatomic frameworks were measured twice: immediately after the casting and divesting procedures and again after a technical adaptation procedure. Each anatomic framework was weighed. To compare the measurements obtained from each group of frameworks, descriptive statistics were calculated and one-way analysis of variance was performed, with values considered statistically significant at P < .05. Results: The mean weight of the cast frameworks was 33.41 g, the cobalt-chrome frameworks weighed 18.12 g on average, and the titanium frameworks averaged 8.7 g. The mean values for three-dimensional deviation of the center point position for each group of frameworks were 261 µm (cast frameworks before adaptation), 49 µm (cast frameworks after adaptation), 26 µm (milled frameworks in cobalt-chrome), and 26 µm (milled frameworks in titanium). Conclusions: Within the limitations of this in vitro study, absolute passive fit cannot be achieved, regardless of material and fabrication technique. Anatomic milled frameworks fabricated in titanium or cobalt-chrome presented reduced center point deviation compared to cast frameworks. Titanium frameworks weighed less than cobalt-chrome and cast gold alloy frameworks. © 2013 by Quintessence Publishing Co Inc.

Keywords: Cobalt-chrome , Computer-aided design/computer-assisted manufacture , Dental implant , Edentulous jaw , Passive fit , Prosthesis framework , Titanium

Objectives. To build a 3D parametric model to detect shape and volume of dental roots, from a panoramic radiograph (PAN) of the patient. Materials and Methods. A PAN and a cone beam computed tomography (CBCT) of a patient were acquired. For each tooth, various parameters were considered (coronal and root lengths and widths): these were measured from the CBCT and from the PAN. Measures were compared to evaluate the accuracy level of PAN measurements. By using a CAD software, parametric models of an incisor and of a molar were constructed employing B-spline curves and free-form surfaces. PAN measures of teeth 2.1 and 3.6 were assigned to the parametric models; the same two teeth were segmented from CBCT. The two models were superimposed to assess the accuracy of the parametric model. Results. PAN measures resulted to be accurate and comparable with all other measurements. From model superimposition the maximum error resulted was 1.1 mm on the incisor crown and 2 mm on the molar furcation. Conclusion. This study shows that it is possible to build a 3D parametric model starting from 2D information with a clinically valid accuracy level. This can ultimately lead to a crown-root movement simulation. © 2013 Laura Mazzotta et al.

Mini-invasive surgery deserves increasing attention to lower the post-operative stay in hospital and lessen falls-off complications. This leads to the trends in robots, as innovative integrated computer-aided implements. Out of front-end haptic effectors, the background support is turning to inclusive on-duty functions, e.g., surgical planners, operation assistants, etc., making possible the rethinking of protocols to progressively embed the innovations offered by the micro- and nano-technologies. The chapter brings in surgical robotics, with focus on technology and design issues of the remote-mode operation assistants. The investigation leads to define the technical characteristics of a CRHA, Co-Robotic Handling Appliance, to be purposely developed, to support the duty-split approach surgical planner. The expected features are outlined, including analysis of operation potential of special-purpose contrivances (i.e., automatic changing device of the surgical tools) and of scope-driven enhancers (i.e., exploration of the intervention theatre, IT).

We have developed an application based on binocular vision for amblyopia treatment. It is founded on stereo vision of objects with different contrast. Fellow eye occlusion does not allow a binocular vision but only a monocular one. This approach causes brain skills loss like the perception of depth. Our system increases visual acuity for amblyopic patients using binocular vision. Binocular vision shows an object to each eye with different contrast. In fact, if we apply a right contrast ratio between amblyopic eye and lazy eye, then amblyopic patient is able to perceive both. © 2013 IEEE.

Keywords: 3D technologies , Amblyopia , Binocular vision , Contrast-based measurement , Motion coherence threshold