| 1. |
- Lewin, Susanne, et al.
(författare)
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Additively manufactured mesh-type titanium structures for cranial implants : E-PBF vs. L-PBF
- 2021
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Ingår i: Materials & design. - : Elsevier. - 0264-1275 .- 1873-4197. ; 197
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Tidskriftsartikel (refereegranskat)abstract
- A patient-specific titanium-reinforced calcium phosphate (CaP–Ti) cranial implant has recently shown promising clinical results. Currently, its mesh-type titanium structure is additively manufactured using laser beam powder bed fusion (L-PBF). Nevertheless, an electron-beam (E-PBF) process could potentially be more time efficient. This study aimed to compare the geometrical accuracy and mechanical response of thin titanium structures manufactured by L-PBF (HIPed) and E-PBF (as-printed). Tensile test (ø = 1.2 mm) and implant specimens were manufactured. Measurements by μCT revealed a deviation in cross-sectional area as compared to the designed geometry: 13–35% for E-PBF and below 2% for L-PBF. A superior mechanical strength was obtained for the L-PBF specimens, both in the tensile test and the implant compression tests. The global peak load in the implant test was 457 ± 9 N and 846 ± 40 N for E-PBF and L-PBF, respectively. Numerical simulations demonstrated that geometrical deviation was the main factor in implant performance and enabled quantification of this effect: 34–39% reduction in initial peak force based on geometry, and only 11–16% reduction based on the material input. In summary, the study reveals an uncertainty in accuracy when structures of sizes relevant to mesh-type cranial implants are printed by the E-PBF method.
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| 2. |
- Lewin, Susanne, et al.
(författare)
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Mechanical behaviour of composite calcium phosphate-titanium cranial implants : Effects of loading rate and design
- 2020
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Ingår i: Journal of The Mechanical Behavior of Biomedical Materials. - : Elsevier BV. - 1751-6161 .- 1878-0180. ; 104
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Tidskriftsartikel (refereegranskat)abstract
- Cranial implants are used to repair bone defects following neurosurgery or trauma. At present, there is a lack of data on their mechanical response, particularly in impact loading. The aim of the present study was to assess the mechanical response of a recently developed composite calcium phosphate-titanium (CaP-Ti) implant at quasi-static and impact loading rates. Two different designs were tested, referred to as Design 1 (D1) and Design 2 (D2). The titanium structures in the implant specimens were additively manufactured by a powder-bed fusion process and subsequently embedded in a self-setting CaP material. D1 was conceptually representative of the clinically used implants. In D2, the titanium structure was simplified in terms of geometry in order to facilitate the manufacturing. The mechanical response of the implants was evaluated in quasi-static compression, and in impact using a drop-tower. Similar peak loads were obtained for the two designs, at the two loading rates: 808 ± 29 N and 852 ± 34 for D1, and 840 ± 40 N and 814 ± 13 for D2. A strain rate dependency was demonstrated for both designs, with a higher stiffness in the impact test. Furthermore, the titanium in the implant fractured in the quasi-static test (to failure) but not in the impact test (to 5.75 J) for D1. For D2, the displacement at peak load was significantly lower in the impact test than in the quasi-static test. The main difference between the designs was seen in the quasi-static test results where the deformation zones, i.e. notches in the titanium structure between the CaP tiles, in D1 likely resulted in a localization of the deformation, compared to in D2 (which did not have deformation zones). In the impact test, the only significant difference between the designs was a higher maximum displacement of D2 than of D1. In comparison with other reported mechanical tests on osteoconductive ceramic-based cranial implants, the CaP-Ti implant demonstrates the highest reported strength in quasi-static compression. In conclusion, the titanium structure seems to make the CaP-Ti implant capable of cerebral protection in impact situations like the one tested in this study.
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| 3. |
- Lewin, Susanne, et al.
(författare)
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Monetite-based composite cranial implants demonstrate long-term clinical volumetric balance by concomitant bone formation and degradation
- 2021
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Ingår i: Acta Biomaterialia. - : Elsevier. - 1742-7061 .- 1878-7568. ; 128, s. 502-513
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Tidskriftsartikel (refereegranskat)abstract
- The use of calcium phosphates (CaPs) as synthetic bone substitutes should ideally result in a volumetric balance with concomitant bone formation and degradation. Clinical data on such properties is nevertheless lacking, especially for monetite-based CaPs. However, a monetite-based composite implant has recently shown promising cranial reconstructions, with both CaP degradation and bone formation. In this study, the volumetric change at the implant site was quantified longitudinally by clinical computed tomography (CT). The retrospective CT datasets had been acquired postoperatively ( n = 10), in 1-year ( n = 9) and 3-year ( n = 5) follow-ups. In the 1-year follow-up, the total volumetric change at the implant site was-8 +/- 8%. A volumetric increase (bone formation) was found in the implant-bone interface, and a volumetric decrease was observed in the central region (CaP degradation). In the subjects with 2-or 3-year follow-ups, the rate of volumetric decrease slowed down or plateaued. The reported degradation rate is lower than previous clinical studies on monetite, likely due to the presence of pyrophosphate in the monetite-based CaP-formulation. A 31-months retrieval specimen analysis demonstrated that parts of the CaP had been remodeled into bone. The CaP phase composition remained stable, with 6% transformation into hydroxyapatite. In conclusion, this study demonstrates successful bone-bonding between the CaP-material and the recipient bone, as well as a long-term volumetric balance in cranial defects repaired with the monetitebased composite implant, which motivates further clinical use. The developed methods could be used in future studies for correlating spatiotemporal information regarding bone regeneration and CaP degradation to e.g. patient demographics. Statement of significance In bone defect reconstructions, the use of calcium phosphate (CaP) bioceramics ideally results in a volumetric balance between bone formation and CaP degradation. Clinical data on the volumetric balance is nevertheless lacking, especially for monetite-based CaPs. Here, this concept is investigated for a composite cranial implant. The implant volumes were quantified from clinical CT-data: postoperatively, one year and three years postoperatively. In total,-8 +/- 8% ( n = 9) volumetric change was observed after one year. But the change plateaued, with only 2% additional decrease at the 3-year follow-up ( n = 5), indicating a lower CaP degradation rate. Osseointegration was seen at the bone-implant interface, with a 9 +/- 7% volumetric change after one year. This study presented the first quantitative spatiotemporal CT analysis of monetite-based CaPs.
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