Composite Prosthesis Research Articles

Comparison of Maintenance in Different Materials for Implant Dental Prostheses

ABSTRACT Context: In contemporary prosthodontics, implant-supported dental prostheses are frequently utilized to restore function and esthetics for individuals who are edentulous. The prosthetic material selection has a big impact on long-term performance and maintenance needs. Methods: A retrospective review of patient files from the dental implant clinic of a tertiary care facility was done. Included were patients who had dental prosthesis supported by implants between January 2018 and December 2022. Data were gathered and examined on the prosthesis material, follow-up visits, and maintenance interventions (adjustments, repairs, and replacements). Results: Materials for 50 prostheses made of porcelain, 45 prostheses made of acrylic, 35 prostheses made of metal, and 40 prostheses made of composite were assessed. When it came to modifications and repairs, porcelain prosthesis needed less work than acrylic prostheses. Composite prostheses required the least amount of maintenance overall, whereas metal prostheses indicated a considerable demand for maintenance. Conclusion: Superior durability is provided by porcelain, frequent repairs are needed for acrylic, structural strength is provided by metal, and composite material gives promising esthetics with low maintenance requirements. These results highlight how crucial it is to take material properties into account when choosing a prosthesis to maximize long-term results and patient happiness.

Pressure redistribution in additively manufactured composite prosthesis by architecture control

Pressure redistribution in additively manufactured composite prosthesis by architecture control

Laparoscopic Treatment of Morgagni-Larrey Diaphragmatic Hernia with Reposition of the Transverse Colon in Patients with Cardiac Comorbidity. Clinical Observation

Morgagni-Larrey hernia is a rare form of diaphragmatic hernia (2-5% of cases) usually diagnosed in children; in adults, it is often detected in emergency cases or accidentally, during examinations or during surgery. The symptoms of the disease are non-specific, so the diagnosis is made using imaging methods (computed tomography is the gold standard). Currently, there is no single method of treating Morgagni-Larrey hernias. Closure of the defect is performed with or without the use of various mesh prostheses through the abdominal or thoracic route; open or minimally invasive access.
 The aim. To conduct a retrospective analysis of the treatment of adult patients with a Morgagni-Larrey diaphragmatic hernia, including those with cardiovascular comorbidity, with a comparison of symptoms, contents of the hernial sac, with the use of laparoscopic techniques and composite mesh prostheses.
 Materials and methods. The results of the treatment of three patients with a Morgagni-Larrey hernia in the period from 2020 to 2022 at the Shalimov National Institute of Surgery and Transplantation are shown. In two patients, the content of the hernial sac was a loop of the transverse colon, in one, the content of the hernial sac was a greater omentum. Taking into account the accompanying cardiovascular pathology, an interdisciplinary council consisting of a surgeon, anesthesiologist, and cardiologist recommended laparoscopic surgical intervention. Laparoscopic allogeneoplasty with composite prosthesis implantation was performed in three patients.
 Conclusions. The laparoscopic method of treating diaphragmatic hernias is safe and effective. The use of composite prostheses in combination with tension closure of the defect allows to reduce the risk of recurrence of the disease in the distant postoperative period.

A modified Rives–Stoppa technique with composite mesh (FLaPp) in large incisional hernia: a multicentric retrospective cohort study

Summary Background Large incisional hernias (LIH) are challenging conditions, often necessitating complex surgical procedures such as transversus abdominis muscle release (TAR). We evaluated the feasibility and effectiveness of tension-free abdominal wall repair of LIH with an innovative modified Rives–Stoppa procedure employing a composite free lateral polypropylene (FLaPp) prosthesis. Methods Symptomatic patients affected by LIH and treated with FLaPp composite prosthesis between April 2010 and December 2016 were retrospectively analyzed. The FLaPp prosthesis is made up of two layers: an internal layer based on a polypropylene film that can be used in contact with the intestinal loops to address the posterior peritoneal defect, and an external layer based on a macroporous lightweight mesh, with which a classic repair according to Rives–Stoppa is carried out. Results Forty-three patients were enrolled in the study. All hernias were W3. Early complications were seroma (16.3%), hematoma (11.6%), wound infection (7.0%), and bowel injury (2.3%). Late complications were sinus tract (4.7%), occasional pain (2.3%), and stiff abdomen (9.3%). The median operative time was 126 min and median hospitalization was 8 days. At the median follow-up of 40 months (range 37.5–117), the recurrence rate was 9.3% (4/43). Conclusion Use of FLaPp mesh with a tension-free surgical approach is an effective strategy for managing LIH in selected cases with the presence of a posterior defect, with low rates of complications and recurrences.

V-057 INTRAPERITONEAL ONLAY MESH (IPOM) TECHNIQUE FOR THE LAPAROSCOPIC TREATMENT OF INGUINAL HERNIA

Abstract Laparoscopic treatment of inguinal hernia is a widely accepted technique, especially in the case of bilateral or recurrent inguinal hernias. The evolution of materials has led to the successful use of double layer prostheses for the intraperitoneal treatment of wall defects, significantly reducing the mesh-related complications. In this regard, the literature data and the availability of non-absorbable, transparent, light surgical prostheses in polypropylene, composed of a macroporous monofilament mesh and a transparent film, have led to the re-proposal of the IPOM technique also for the treatment of primary inguinal hernias. After the laparoscopic access in the abdomen using a 10 mm trocar in the umbilical region and two 5 mm trocars operating in the Iliac fossae, the hernia is reduced by returning the hernial contents to their original compartments and the hernial sac is closed with the possible lipoma using purse-string suture. Subsequently, a polypropylene composite prosthesis is then inserted into the abdomen, centered on the defect and fixed to the wall by tack and chemical glue. To date we have performed 10 procedures on 6 patients (4 with bilateral hernia). The longest follow-up is one year. The patients were all discharged the day after the surgery, reporting a mean postoperative pain score (assessed with EHS QoL scale) equal to 2 (range: 0–4), and the work resumption after a week in average. This technique, which is easy to perform and reproducible, can significantly reduce operating times and minimize complications related to the preparation of the peritoneal pocket.

P-120 LAPAROSCOPIC REPAIR OF INCISIONAL HERNIA USING A NON-ABSORBABLE TRANSPARENT COMPOSITE PROSTHESIS TOTALLY IN POLYPROPYLENE - OUR EXPERIENCE

Abstract Introduction Incisional ventral hernia is one of the most common surgical complications after laparotomy. The aim of this retrospective observational study is an evaluation of clinical outcomes after laparoscopic repair of incisional hernias with a non-absorbable and transparent composite prosthesis composed of a macro-porous monofilament polypropylene mesh and a transparent polypropylene film. Materials and Methods 63 patients, from January 2016 to December 2021, were treated for incisional hernia at Center of minimal invasive surgery Nis, Serbia. The mesh was always positioned intraperitoneally after closing the defects and fixed with absorbable tacks and non-absorbable suture. Results In the considered cohort (54% female and 46% male) the median age and BMI were 54 years (range: 39–68) and 25,1 kg/m2 (range: 21.5–30.3), respectively. Concerning hernia position, 93.7% of the hernias were medial, 4.8% lumbar and 1.6% medio-lumbar. According to EHS classification, 58.7% of the hernias were W1, 36.5% W2 and 12.7% W3. The average duration of hospitalization was 2 days. The rate of early post-operative complications was 6.3%, including 1 seroma (1.6%) and 3 patients reporting pain (4.8%). At a median follow up of 48 months (range: 6–60) we registered 2 cases of hernia recurrency (3.2%, both at 36 months follow-up) and 1 case of bowel obstruction (1.6%). All the considered variables did not result statistically significative in relation to post-operative complications. Conclusion Our clinical experience showed that intraperitoneal treatment of incisional hernia using a transparent composite prosthesis. The minimally invasive procedure allows a fast postoperative recovery and a consequent low economical cost.

Effects of composite intramedullary nail on cell phenotype-related activities and callus growth during the healing of tibial bone fractures

Flexible composite prostheses provide favorable conditions for bone healing. Simulation of the human body is a complicated process, and accurate techniques are needed as physiological behavior is chaotic. We propose appending the mechanoregulation (MR) algorithm with callus volume changes, implant-dependent growth, and cell phenotype-specific activities for use with composite prostheses. The MR algorithm and simulation technique were validated, and simulation results were compared with developed models and in vivo sheep data. Healing of transverse diaphyseal tibial fractures with a fixed conventional stainless steel intramedullary nail and the flexible glass/polypropylene composite was compared. The flexible implants promoted better callus growth and volume and healthy cell phenotype.

The role of the fiber ply configurations on the biomechanics of the hip prosthesis

The total hip replacement is the only approved procedure for restoring a degenerated hip joint through operation. The life span of a prosthesis could depend on the geometry and material properties of the implant. This study aims to analyze the biomechanics of the carbon/polyetheretherketone (PEEK) composite prosthesis having three different fiber ply configurations compared to traditional stainless steel (SS) ones. The implant-bone system was established and subjected to a load from the head of the femur and abductor muscle sides. The stresses and strains in the implant-bone systems were calculated and compared. The results revealed lower stresses and strains in composite prostheses compared to SS ones. The fiber ply orientation of the carbon/PEEK composite prosthesis is shown to be a key asset in stress and strain distribution of the 13 implant-bone systems. The fiber plies which orientated multidirectionally with −45 and +45 degrees exhibited uniform stress and strain distributions. The results suggested the advantage of using composite prostheses in implant designs as they not only invoke lower stresses and strains in the implant-bone system but also amplify the life span of implants in the body.

Modern aspects of allohernioplasty of postoperative ventral hernias (a literature review)

The aim. Based on the data of the publications of herniologists for the last 5 years to examine the effectiveness and safety of prosthetic materials used in hernioplasty of postoperative ventral hernias. According to surgeons, the incidence of postoperative ventral hernia is up to 20 % of performed laparotomies, and if risk factors are present – up to 70 %. This problem was considered solved by the use of prosthetic mesh that became the standard of surgical approach in hernia repair since a recurrence rate was reduced to 20 %. However, the results of histological examination and body biological responses to an implant showed chronic inflammatory processes due to use of prosthetic material, especially polypropylene, causing purulent-inflammatory complications and intraperitoneal adhesion in 20.0–45.8 %. To prevent adhesion, a special barrier layer was applied on the polypropylene mesh, a process of mesothelial epithelialization (formation of the neoperitoneum) was supposed to occur, thereby reducing the risk of adhesions. A temporary nature of the barrier coating, where adhesion may develop at any time after implantation resulting in complications, has proven to be a potential problem of composite prostheses. There has been an attempt to address the challenge by using biological meshes made of decellularised pig and bovine dermis. However, recurrence rates after repair of hernia using the biological meshes was 6.3–61.0 %, wound infection – 16.0 %. Conclusions. Thus, world publications have proved today that it is impossible to perform adequate hernioplasty of postoperative hernias without the use of prosthetic material. However, complications and recurrences of the disease remain quite high. In order to improve these indicators, a sufficient number of studies were conducted, the effect of various prosthetic meshes on the patient body and on the postoperative wound itself was examined. Nevertheless, all the results are often contradictory, without specific conclusions about the indications for the use of method and type of prosthetic material.

Treatment of a Case of Subtotal Maxillary Edentulism by Composite Prosthesis

In the subtotally edentulous, facing the last remaining teeth, the practitioner may be faced with a dilemma: "Keep or extract". Of course the answer is not always obvious, it must take into consideration several parameters. When the practitioner decides to keep the residual teeth, he can consider, depending on the case, the implant solution, the supra-radicular prosthesis or the composite prosthesis.
 In this article we present a case of maxillary subtotal edentulism treated by the composite prosthesis. The choice of this therapy was based on a diagnostic approach leading to the manufacture of temporary prostheses that were re-evaluated over six months, then a definitive prosthesis made according to the rules of art, giving the patient a suitable smile and optimal comfort during mastication.

Workflow of a fiber-reinforced composite fixed dental prosthesis by using a 4-piece additive manufactured silicone index: A dental technique

A digital workflow for fabricating a fiber-reinforced composite prosthesis is described. A facial scanner and an intraoral scanner were used to gather records, and dental and open-source software programs were used to elaborate a diagnostic waxing and design a 4-piece additively manufactured clear silicone index. Advantages of the index design included precise translation of the diagnostic waxing, optimal composite resin stratification, and minimal clinical time.

MRI-guided segmental sternectomy, reconstruction by polypropylene mesh/methylmethacrylate composite prosthesis and double pectoralis major muscle flap

MRI-guided segmental sternectomy, reconstruction by polypropylene mesh/methylmethacrylate composite prosthesis and double pectoralis major muscle flap

Chest wall resection and reconstruction by composite prosthesis for locally recurrent breast carcinoma.

Primary or secondary chest wall neoplasms and contiguous infiltration of the chest wall from breast or lung cancer represent the most frequent indications for neoplastic chest wall resection (1,2). Chest wall reconstruction together with adequate soft tissue coverage are the main principles for managing major post resectional chest wall defects (3).

Effect of initial micro-movement of a fracture gap fastened by composite prosthesis on bone healing

Micro-movements are considered to have strong influence on the secondary healing process of fractured long bones, however, the translational shear movement is assumed to have a negative effect on the healing of such fractures. Numerical simulations were carried out with initially applied individual and combined, axial and shear displacements (ranging 0.1 mm to 1.0 mm for a 3 mm fracture at day 1) for a tibial fracture fastened by flexible composite prostheses. The best individual case of healing was seen with an initial axial displacement of 0.1 mm (86% reduced movement compared to the worst, 1.0 mm translational movement) while in combined cases, 0.1–0.1 mm (axial-shear combination) gave the best healing results (0.000157 mm) at day 56. Moreover, using composite intramedullary (IM) nail and bone plate as a superior implant resulted in 157.81% and 201% improved callus volumes with a promising bending stiffness of 20.62 and 19.03 Nm/θ, respectively, at day 154. But the excessive shear movement for the initial 4–6 weeks using an IM nail delayed fracture healing.

Review of the Effectiveness of Composite Barrier Mesh Used for Laparoscopic Ventral Hernia Repair

Background: The objective of this research is to provide an overview of the physical and biomechanical properties of composite barrier meshes frequently used in Laparoscopic Ventral Hernia Repair as well as reviewing the existing relevant literature assessing the characteristics and effectiveness of both procedures. Methods: A secondary research is used using existing literature review of the preclinical and clinical literature designed to compare the Composite prostheses with permanent barriers (COMPOSIX, VENTRIO, DUALMESH, DYNAMESH and TiMESH ) to composite prostheses with absorbable barriers ( PROCEED, C-QUR, PHYSIOMESH, PARIETEX and SEPRAMESH ). Results: Significant differences were observed between Composite prostheses with regard to its physical and biomechanical properties. Amongst the permanent barrier meshes, Dualmesh showed the highest suture retention strength. On the other hand, between the absorbable barrier meshes, Sepramesh proved to have the most significant suture retention and tears strength. Overall, all meshes established tensile strengths greater than 16-32 N/cm. Moreover, that composite meshes with absorbable barriers had less complications of adhesions, recurrences and wound infection compared with meshes with permanent barriers. Conclusion: Composite meshes with absorbable barriers proved to be superior to permanent ones. Other findings demonstrated there was no significant difference of effectiveness among absorbable barriers.

Review of the Effectiveness of Composite Barrier Mesh Used for Laparoscopic Ventral Hernia Repair

Background: The objective of this research is to provide an overview of the physical and biomechanical properties of composite barrier meshes frequently used in Laparoscopic Ventral Hernia Repair as well as reviewing the existing relevant literature assessing the characteristics and effectiveness of both procedures. Methods: A secondary research is used using existing literature review of the preclinical and clinical literature designed to compare the Composite prostheses with permanent barriers (COMPOSIX, VENTRIO, DUALMESH, DYNAMESH and TiMESH ) to composite prostheses with absorbable barriers ( PROCEED, C-QUR, PHYSIOMESH, PARIETEX and SEPRAMESH ). Results: Significant differences were observed between Composite prostheses with regard to its physical and biomechanical properties. Amongst the permanent barrier meshes, Dualmesh showed the highest suture retention strength. On the other hand, between the absorbable barrier meshes, Sepramesh proved to have the most significant suture retention and tears strength. Overall, all meshes established tensile strengths greater than 16-32 N/cm. Moreover, that composite meshes with absorbable barriers had less complications of adhesions, recurrences and wound infection compared with meshes with permanent barriers. Conclusion: Composite meshes with absorbable barriers proved to be superior to permanent ones. Other findings demonstrated there was no significant difference of effectiveness among absorbable barriers.

Umbilical hernia repair with composite prosthesis: a single-centre experience.

Since 2004, composite prosthesis repair is the preferred procedure for umbilical hernia repair in our centre, although long-term results of this technique are lacking. The aim of this study was to analyze the long-term results of a cohort of patients who underwent umbilical hernia repair with this procedure. A retrospective cohort study of patients who underwent umbilical hernia repair with composite prosthesis was conducted. Data were obtained from electronic medical records. Univariate and multivariate analyses were performed to analyze the factors associated with postoperative complications and hernia recurrence. Between March 2004 and December 2015, 2135 patients underwent umbilical hernia repair and composite prosthesis (Ventralex or Ventralex ST®) was used in 1538 patients. 179 patients were lost during the follow-up. Finally, 1359 patients were included in the study. The prosthesis was placed in the preperitoneal space in 93.4% of the patients. 86.3% of the patients underwent same-day surgery. Only 2.1% of the patients developed a complication during the follow-up, and 1.8% of the patients required a new surgery. After a mean follow-up of 4.1 years, hernia recurrence rate was 3.9%. Multivariate analysis showed that hernia recurrence was associated with female gender, recurrent hernia, and postoperative complication. Postoperative complications were related to follow-up time and smoking patients. Long-term results after umbilical hernia repair with composite prosthesis are satisfactory, with a low percentage of complications and recurrences.

Biomechanical design of a composite femoral prosthesis to investigate the effects of stiffness, coating length, and interference press fit

Traditionally, high stiffness hip prostheses are associated with aseptic loosening. Hence, the effects of stiffness, coating length, and interference press fit on load sharing and micro-movements are investigated for a better understanding from a mechanical perspective. A simplified 3D model of the femur and prostheses composed of cobalt chrome (CoCr), titanium (Ti), and glass/polypropylene (Twintex [0]2nT) composite are constructed. Three interference fits corresponding to 5, 25, and 50 µm are used with half, three-quarter, and full lengths of coating that are used to assemble the prostheses with bones to investigate micro-movements at the bone-prosthesis interfaces, interfacial failure, and stress transfer to the bone. The reaction forces of body weight and muscular forces in the femur are used to simulate the FE model. The results indicate that the CoCr and Ti prostheses exhibit low micro-movements at the proximal end and high micro-movements at the distal end and vice versa for the Twintex [0]2nT composite prosthesis. Uniformity of stress transfer to the bone along the prosthesis efficiently increases with increases in the coating lengths and interference press fits for all the cases. A fully coated length of Twintex [0]2nT composite prosthesis with a 50-µm interference press fit provides the most efficient load sharing and stress transfer to the bone and micro-movements at the bone–prosthesis interface.

Hundred years development and future prospect of the material science for hernia

Inguinal hernia is a defect disease in the abdominal wall. Surgeons have tried various ways to repair the defect for more than 100 years. The traditional herniorrhaphy destroys the normal anatomical structure, and the recurrence rate is quite high. After that, surgeons began to repair the defects with prostheses, from the initial use of rough metal materials such as silver, tantalum, stainless steel, to nylon, fiberglass, silicone rubber and other non-metallic materials, and also from artificial synthetic polymer non-absorbable materials such as polypropylene, polyester, ePTFE, to synthetic absorbable materials such as polyglycolic acid and the acellular extracellular matrix derived from biological meshes. However, these prostheses still can not meet the diverse needs of patients. Thus, multifunctional composite prostheses consisting of two or more materials were born, and various types of composite prostheses, stem cell coating meshes, 3D meshes, microstructure meshes were developed. The repair method evolved from traditional hernia repair to tension-free hernia repair and laparoscopic hernia repair. Surgeons are dedicated to finding idealized meshes for the perfect repair of defects, while considering postoperative complications, patient's quality of life, long-term efficacy and other issues. In the face of a wide variety of repair materials, the choice of surgeons is blind, and there is no standard to determine which prostheses are suitable for patients. Therefore, we have combed the development of different types of prostheses, summarized the development process of hernia repair materials for the past 100 years, and put forward the prospects for future development of prostheses, in order to provide reference for the selection of prostheses.

The Conometric Concept: A 5-Year Follow-up of Fixed Partial Monolithic Zirconia Restorations Supported by Cone-in-Cone Abutments.

The use of the cone-in-cone connection to support definitive restorations was previously evaluated in cases involving full-acrylic resin or hybrid acrylic-resin composite prostheses. The aim of this study was to evaluate the performance of definitive fixed partial prostheses made with monolithic zirconia and supported by cone-in-cone abutments and integrated implants. Implants were placed into healed sites and fresh extraction sockets. The prostheses were placed in the posterior regions of partially edentulous patients after healing periods of 3 months. A total of 76 patients received fixed monolithic zirconia restorations splinted with cone-in-cone connections to two implants that were followed up yearly for 5 years. At each follow-up visit, peri-implant bone levels and pocket depths were recorded. Esthetic, functional, and biologic United States Public Health Services parameters modified by the World Dental Federation study design were assessed at the last follow-up appointments. The opposing dentition was categorized by type of restoration and supporting structure at the time of placement of the definitive zirconia partial restoration and at the 5-year follow-up. The treatment achieved an 88.2% success rate and a 97.4% survival rate at the 5-year follow-up. None of the prostheses became loose or detached. One fixed prosthesis (0.76%) fractured 41 months after placement. No significant difference involving peri-implant bone and probing levels between the experimental times was found. The results of this research indicated that abutment-prosthesis cone-in-cone connections were successful within the 5-year study period.