Additive manufacturing processes become more and more important in almost all areas, also for medical implant application. Medical implants made of ceramics are known for their excellent biological ...compatibility. For increasing the ingrowth of cells into an implant, a function-optimized structure with a defined porosity seems to be advantageous. Additive manufacturing is suited to realize defined and filigree structures. Lithography-based ceramic manufacturing (LCM), for example, has a high resolution, but still a limited material portfolio. Alumina toughened zirconia is a very interesting material for medical applications, but not commercially available for LCM. In this study, the development of an ATZ suspension usable in the LCM process with a bulk material density higher than 99% after sintering is presented. Furthermore, printing of lattice test structures for the evaluation of accuracy in dependence of printing dimension is demonstrated.
Abstract
In the context of additive manufacturing, the adjustment of process data to individual geometric features offers the potential to further increase manufacturing speed and quality, while ...being widely underestimated in recent research. Unfortunately, the current non-uniform data handling in the CAD-CAM-Link results in a downstream data loss, that prevents the availability of geometric knowledge from being present at any time to apply the more advanced approaches of adaptive slicing and tool path generation. Automatic detection of various geometric entities would be beneficial for classifying partial surfaces and volumetric ranges to gain customized informational insights of geometric parameterization. In this work, an enhanced approach of geometric deep learning for the analysis of voxelized engineering parts will be presented to align the inference representations to modeling paradigms for complex design models like architected materials. Although the baseline voxel representation offers distinct advantages in detection accuracy, it comes with an adversely large memory footprint. The geometry discretization leads to high resolutions needed to capture various detail levels that prevent the analysis of fine-grained objects. To achieve efficient usage of three-dimensional (3D) deep learning techniques, we propose a 3D-convolutional neural network-based feature recognition approach using signed distance field data to limit the needed resolution. These implicit geometric data leverage the advantages of volumetric convolution while alleviating their disadvantages through the use of the continuous signed distance function. When analyzing computer-aided design data for geometric primitive features, a common application task in surface reconstruction of reverse engineering the proposed methodology, achieves a detection accuracy that is in line with the accuracy values achieved by comparable algorithms. This enables the recognition of fine-grained surface instances. The unambiguous shape information extracted could be used in subsequent adaptive slicing algorithms to achieve individual geometry-based hatch generation.
Graphical Abstract
Graphical Abstract
The juxtaglomerular niche occupied by renin cells (RCN) plays an important role in glomerular repair but the precise temporal and spatial interrelations remain unclear. This study proposes the ...hypothesis of a local intra-extraglomerular regenerative feedback system and establishes a new quantifiable system for RCN responses in individual glomeruli
in vivo
. A strictly intraglomerular two-photon laser-induced injury model was established. Labeled renin cells (RC) in transgenic renin reporter mice were fate-traced in healthy and injured glomeruli over several days by intravital microscopy and quantified via new three-dimensional image processing algorithms based on ray tracing. RC in healthy glomeruli demonstrated dynamic extraglomerular protrusions. Upon intraglomerular injury the corresponding RCN first increased in volume and then increased in area of dynamic migration up to threefold compared to their RCN. RC started migration reaching the site of injury within 3 hours and acquired a mesangial cell phenotype without losing physical RCN-contact. During intraglomerular repair only the corresponding RCN responded via stimulated neogenesis, a process of
de novo
differentiation of RC to replenish the RCN. Repeated continuous intravital microscopy provides a state-of-the-art tool to prove and further study the local intraglomerular RCN repair feedback system in individual glomeruli
in vivo
in a quantifiable manner.
In current implantology, calcium phosphate cement (CPC) is increasingly used. A special focus is given to CPC scaffolds, as they are suitable for cell settlement and growth due to their positive ...osteoconductive properties. The design of the scaffolds is of decisive importance for this. The value ranges of the geometric parameters of these scaffolds (e.g. path distance, path diameter), which are positive for both cell settlement and cell growth, are very small. Manufacturing deviations therefore have a significant impact on cell settlement and growth. The pasty manufacturing consistency can cause sagging at the path interstices of a layer immediately below, resulting in significant manufacturing deviations. A larger path distance and thus a larger path interstitial space promotes cell settlement, but at the same time increases the risk of CPC path shape inconsistency. This in turn can have a negative effect on cell settlement. Therefore, the aim of this paper is to investigate the discrepancies between the nominal and actual state at a path distance favourable to cell settlement on the basis of manufactured CPC scaffolds. In this context, geometric and manufacturing parameters of the shape deviation are to be identified and constructive design adaptations are to be derived on the basis of these. In addition, the effects of the shape and position deviations on the flow behaviour will be investigated.
Porous ceramics can be realized by different methods and are used for various applications such as cross-flow membranes or wall-flow filters, porous burners, solar receivers, structural design ...elements, or catalytic supports. Within this paper, three different alternative process routes are presented, which can be used to manufacture porous ceramic components with different properties or even graded porosity. The first process route is based on additive manufacturing (AM) of macro porous ceramic components. The second route is based on AM of a polymeric template, which is used to realize porous ceramic components via replica technique. The third process route is based on an AM technology, which allows the manufacturing of multimaterial or multiproperty ceramic components, like components with dense and porous volumes in one complex-shaped component.
The paper introduces a method for the automated generation of patient-specific instruments (PSI), here in particular templates, for the implantation of customized implants. The basis is the ...derivation of data from the morphology of the bony situation and the medical planning. A developed methodological approach based on an Active Shape Model (ASM) is used for the morphological measurement. Determined geometric dimensions are placed on this ASM and automatically adjusted in each case. In addition, specially developed software tools for the planning and design of medical devices will be presented. This includes, among other things, the intuitive control of template parameters by the user when manual adjustments are necessary. The determined data is bundled and applied to previously methodically thought-out and categorized master CAD (Computer Aided Design) models of surgical templates. These master models are fully configurable and designed to be adjusted within defined ranges of values. The templates are printed from the biocompatible material PA12 using selective laser sintering (SLS).
The Tactile Internet aims to advance human-human and human-machine interactions that also utilize hand movements in real, digitized, and remote environments. Attention to elderly generations is ...necessary to make the Tactile Internet age inclusive. We present the first age-representative kinematic database consisting of various hand gesturing and grasping movements at individualized paces, thus capturing naturalistic movements. We make this comprehensive database of kinematic hand movements across the adult lifespan (CeTI-Age-Kinematic-Hand) publicly available to facilitate a deeper understanding of intra-individual-focusing especially on age-related differences-and inter-individual variability in hand kinematics. The core of the database contains participants' hand kinematics recorded with wearable resistive bend sensors, individual static 3D hand models, and all instructional videos used during the data acquisition. Sixty-three participants ranging from age 20 to 80 years performed six repetitions of 40 different naturalistic hand movements at individual paces. This unique database with data recorded from an adult lifespan sample can be used to advance machine-learning approaches in hand kinematic modeling and movement prediction for age-inclusive applications.
Magnetic resonance imaging (MRI) is a common clinical practice to visualize defects and to distinguish different tissue types and pathologies in the human body. So far, MRI data have not been used to ...model and generate a patient-specific design of multilayered tissue substitutes in the case of interfacial defects. For orthopedic cases that require highly individual surgical treatment, implant fabrication by additive manufacturing holds great potential. Extrusion-based techniques like 3D plotting allow the spatially defined application of several materials, as well as implementation of bioprinting strategies. With the example of a typical multi-zonal osteochondral defect in an
osteochondritis dissecans
(OCD) patient, this study aimed to close the technological gap between MRI analysis and the additive manufacturing process of an implant based on different biomaterial inks. A workflow was developed which covers the processing steps of MRI-based defect identification, segmentation, modeling, implant design adjustment, and implant generation. A model implant was fabricated based on two biomaterial inks with clinically relevant properties that would allow for bioprinting, the direct embedding of a patient’s own cells in the printing process. As demonstrated by the geometric compatibility of the designed and fabricated model implant in a stereolithography (SLA) model of lesioned femoral condyles, a novel versatile CAD/CAM workflow was successfully established that opens up new perspectives for the treatment of multi-zonal (osteochondral) defects.
Graphic abstract
Three dimensional (3D) printing allows additive manufacturing of patient specific scaffolds with varying pore size and geometry. Such porous scaffolds, made of 3D-printable bone-like calcium ...phosphate cement (CPC), are suitable for bone augmentation due to their benefit for osteogenesis. Their pores allow blood-, bone- and stem cells to migrate, colonize and finally integrate into the adjacent tissue. Furthermore, the pore size affects the scaffold’s stability. Since scaffolds in maxillofacial surgery have to withstand high forces within the jaw, adequate mechanical properties are of high clinical importance. Although many studies have investigated CPC for bone augmentation, the ideal porosity for specific indications has not been defined yet. We investigated 3D printed CPC cubes with increasing pore sizes and different printing orientations regarding cell migration and mechanical properties in comparison to commercially available bone substitutes. Furthermore, by investigating clinical cases, the scaffolds’ designs were adapted to resemble the in vivo conditions as accurately as possible. Our findings suggest that the pore size of CPC scaffolds for bone augmentation in maxillofacial surgery necessarily needs to be adapted to the surgical site. Scaffolds for sites that are not exposed to high forces, such as the sinus floor, should be printed with a pore size of 750 µm to benefit from enhanced cell infiltration. In contrast, for areas exposed to high pressures, such as the lateral mandible, scaffolds should be manufactured with a pore size of 490 µm to guarantee adequate cell migration and in order to withstand the high forces during the chewing process.
For sinus grafting, different methods and materials are available. One possible shortcoming of particulate bone grafts is either overfilling or augmenting the planned implant area insufficiently. To ...overcome this risk and to determine the implant position prior augmentation, we present an approach using three-dimensional printed scaffolds. A patient with a remaining anterior dentition and bilateral severely atrophied posterior maxilla was seeking oral rehabilitation. The cone beam computed tomography (CBCT) showed residual bone heights between one and two millimeters. Following the three-dimensional reconstruction of the CBCT data, the positions of the implants were determined in areas 16 and 26. Three-dimensional scaffolds adapted to the topography of the sinus were virtually designed and printed using a calcium phosphate cement paste. Bilateral sinus floor augmentation applying the printed scaffolds with an interconnecting porosity followed. After nine months, a satisfying integration of the scaffolds was obvious. At the re-entry, vital bone with sufficient blood supply was found. One implant could be placed in positions 16 and 26, respectively. After five months, the implants could be uncovered and were provided with a temporary denture. The application of three-dimensionally printed scaffolds from calcium phosphate cement paste seems to be a promising technique to graft the severely atrophied posterior maxilla for the placement of dental implants.
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