Maxillofacial Implants Research Articles

Investigation of Patient-Specific Maxillofacial Implant Prototype Development by Metal Fused Filament Fabrication (MF3) of Ti-6Al-4V.

Additive manufacturing (AM) and related digital technologies have enabled several advanced solutions in medicine and dentistry, in particular, the design and fabrication of patient-specific implants. In this study, the feasibility of metal fused filament fabrication (MF3) to manufacture patient-specific maxillofacial implants is investigated. Here, the design and fabrication of a maxillofacial implant prototype in Ti-6Al-4V using MF3 is reported for the first time. The cone-beam computed tomography (CBCT) image data of the patient’s oral anatomy was digitally processed to design a 3D CAD model of the hard tissue and fabricate a physical model by stereolithography (SLA). Using the digital and physical models, bone loss condition was analyzed, and a maxillofacial implant initial design was identified. Three-dimensional (3D) CAD models of the implant prototypes were designed that match the patient’s anatomy and dental implant requirement. In this preliminary stage, the CAD models of the prototypes were designed in a simplified form. MF3 printing of the prototypes was simulated to investigate potential deformation and residual stresses. The patient-specific implant prototypes were fabricated by MF3 printing followed by debinding and sintering using a support structure for the first time. MF3 printed green part dimensions fairly matched with simulation prediction. Sintered parts were characterized for surface integrity after cutting the support structures off. An overall 18 ± 2% shrinkage was observed in the sintered parts relative to the green parts. A relative density of 81 ± 4% indicated 19% total porosity including 11% open interconnected porosity in the sintered parts, which would favor bone healing and high osteointegration in the metallic implants. The surface roughness of Ra: 18 ± 5 µm and a Rockwell hardness of 6.5 ± 0.8 HRC were observed. The outcome of the work can be leveraged to further investigate the potential of MF3 to manufacture patient-specific custom implants out of Ti-6Al-4V.

Editorial: Choosing the Right Implant

Steven E. Eckert, DDS, MS: Dental implants provide support for dental prostheses. It seems so easy, but we know that there are many pathways toward therapeutic misadventures. By contrast, however, one might suggest that the more complicated the path, the easier it is for a dentist to choose it. To validate this statement, one might only need to visit the trade booths at a dental meeting. The implant companies have the largest floor plan and the most traffic. Once there, you can count the number of manufacturers/distributors representing all these different companies. Beyond the amount of floor space, the numbers of companies, and the busyness at the booths, the scientific programs seem to present more implant discussions than any other form of presentation. It makes you wonder what all the discussion is about. Well, sometimes it’s discussions of the intended use for a specific implant. Some implants have a tapered form that is designed to fully seat in the osteotomy with a minimum number of rotations. Other implants are designed with a narrow coronal aspect to reduce bone loss. Implants are made from different materials: titanium or zirconia, and alloys of titanium, aluminum, vanadium, or titanium and zirconium. There have also been aluminum implants. The coronal aspect of the implants has garnered a great deal of attention. Some flare, some are parallel, and some are tapered, making the coronal aspect of the implant narrower than a point that is more apical. Of course, there are many different brands of bone graft material and many different types of membranes. There are graft materials that are autogenous, homogenous, heterogenous, xenografts, heterografts, homografts, alloplasts, and allografts. You’d be shocked if you heard me say that there are many synonyms that could be included, but this might be confusing. We have different membranes that can be placed over the tooth socket to allow the socket to recontour beneath the membrane, or we could use the membrane over the top of an implant that was placed the same day as the natural tooth was removed. Some of the sales representatives will promote the use of resorbable membrane in areas that are not esthetic, but there are folks who will promote the use of a membrane in an immediate placement after tooth extraction. This is a very noncomprehensive list of implant designs. (Remember that there are well over a thousand different implant designs, and by the time you add in the number of different manufacturers, there are many thousands of implants, implant designs, implant materials, graft materials, membrane materials, etc). You name it, if you can put it in the tooth socket, it may work well or may not, or you might not be able to tell how one works in comparison to another. I sure hope I haven’t lost anybody yet. It is virtually impossible to create a comprehensive list of all these different materials. Of course, then you need someone to help you through the morass of different products that are available in the marketplace. For me, I think it’s valuable to obtain a subscription to one of the dental implant journals. The journals give you something you can hold in your hand and look at again once you realize that the industry has become confusing. This editorial may or may not have been intended to be a little confusing, but confusing it has become. Personally, I like The International Journal of Oral & Maxillofacial Implants . I like that the articles look like they were put together in much the same way, so I know where the materials and methods will be, I know that the conclusion will relate to the introduction, I know how to find results, and I guess I know these things because I edit the journal. Personally, however, I think that other people can figure it out from this journal. There are other journals out there, and these are also good journals. Of course, I’m still partial to JOMI. Steven E. Eckert, DDS, MS Editor-in-Chief

Additive Manufacturing (3D PRINTING) Methods and Applications in Dentistry

Computer Aided Design-Computer Aided Manufacturing technologies (CAD-CAM) are often used in dentistry. Along with technological developments, techniques of additive manufacturing (3D) which has a lot of advantages have been improved and found a field of practice. Today, metals and metal alloys, polymer and composite, ceramic materials are produced and used through additive manufacturing techniques. With additive manufacturing in dentistry, dental implants, prosthetic restorations, maxillofacial implants and prostheses, dental models, custom trays, occlusal splints, orthodontic models and devices can be produced and used in tissue engineering. The aim of this study is to profile and evaluate the additive manufacturing methods, materials, and application fields in dentistry.

Editorial: How Does Science Affect Practice?

Editorial: How Does Science Affect Practice?

Development of nanostructured titanium implants for biomedical implants – A short review

Implants for bio medical applications have undergone rapid and dramatic developments in the past two decades. From the point of bio-compatibility, titanium (Ti) is superior to other metallic materials due to the formation of a stable passive layer of TiO2 on its surface. Another favorable properties of Ti are the low elastic modulus, light-weight than other surgical metals, and produce fewer artifacts on computer tomography (CT) and magnetic resonance imaging (MRI).Ti–6Al–4 V (Ti64) is the most widely used surgical Ti alloy. Despite the excellent passivity and corrosion resistance of Ti64, elevated concentrations of metal ions were detected in the tissues around the implants, questions the long-term safety of Ti64 alloy implants. An alternative approach to overcome the problem of harmful ion release is to use pure titanium. However, the mechanical properties of commercially pure (CP) Ti are not as good as Ti64.Severe Plastic Deformation processing provides an opportunity for refining the grains of conventional bulk solids to produce grain sizes within the sub-micrometer or even the nanometer range with higher strength, bioactivity and antibacterial properties. Equal channel angular pressing (ECAP) is a promising and efficient method for the production of bulk ultrafine-grained or nanostructured material with excellent biocompatibility and extraordinary mechanical properties. There have been reports of dental implant fractures in clinical practice, but the success rate of restoration is limited since for the dental and maxillofacial implants, nanostructured CPTi should have, in addition to high strength, and increased fatigue life, even at the locations with stress concentrators. Therefore, the mechanical properties especially fatigue strength of CPTi in clinical practice need to be improved. This short review briefly focuses on the suitability of ECAPed CPTi for medical implants.

Analysis of Wettability and Surface-Roughness of Titanium Grade 2 in Milling Process

Titanium Grade 2 is a material that is widely applied in biomedical implant materials. Titanium Grade 2 has a good corrosion resistance and good biocompatibility in the body. However, due to the low thermal conductivity, it is necessary to select the appropriate machining parameter in order to produce a good surface roughness value. The purpose of this study was to determine the surface characteristics of Titanium Grade 2 which include wettability and surface roughness on milling process. The research design used the full factorial L9 method, with 2 factors and 3 levels. The spindle speed variable has a p-value of 0.039 and the feeding speed variable has a p-value of 0.025. This shows that the two independent variables have a significant effect on the surface roughness response. The lowest surface roughness can be achieved by setting the spindle rotation at 700 rpm and the feed speed at 25 mm/min. All specimens showed contact angle measurement results below 90ᵒ, which means hydrophilic. Titanium Grade 2 material with this milling machining process can be used as an alternative to semi-permanent implant fabrication methods such as maxillofacial bone implants, bones of the fingers and toes, and others.

Citation Characteristics of H-Classics Articles in Implant Dentistry: A Citation Analysis Using H-Classics Method.

Citation-based metrics, such as the H-classics method, have been used as an indicator to assess academic performance in the scientific community. However, information addressing issues regarding self-citation, citation half-life, and subject area of origin in implant dentistry is lacking. The purpose of this study was to investigate the citation characteristics of H-classics articles in implant dentistry throughout different time periods. H-classics implant dentistry articles were searched and selected by applying the H-classics method from the Scopus database. Bibliometric analysis was conducted to evaluate the citation characteristics, including institutional and journal self-citation, citation half-life, and subject area of origin of identified H-classics articles. The International Journal of Oral & Maxillofacial Implants and Clinical Oral Implants Research are the leading journals contributing the majority of citations to the retrieved H-classics articles. Articles published in the United States cited the most H-classics articles. Journal self-citation was 12.41% on average, while institutional self-citation was approximately 7.81%. Citation half-life decreased significantly across time periods, with an average decreasing ratio of 43.95%. Research on Scope III, bioengineering interventions, had the most prominent distribution citation frequency in the subject area "Others." This study provides insightful views regarding citation characteristics of H-classics articles in implant dentistry (eg, interdisciplinary publications on bioengineering interventions) during the investigation periods, which may foster the translation of preclinical research into clinical applications in the future.

Polydopamine (PDA) mediated nanogranular-structured titanium dioxide (TiO2) coating on polyetheretherketone (PEEK) for oral and maxillofacial implants application

Polyetheretherketone (PEEK) is being used in various biomedical devices thanks to its bio-inertness, nontoxicity, and an elastic modulus near to that of human cortical bone. However, its oral and maxillofacial applications remain challenging owing to is hydrophobicity, lack of biocompatibility, and infectious complications. To address this problem, a biocompatible nanogranular-structured TiO2 coating assisted by a mediating layer of pre-grafted polydopamine (PDA) was deposited onto PEEK to modify its surface. The PDA-mediated TiO2 coated PEEK showed a unique surface layer of single anatase phase. The surface tended to become more hydrophilic with increased TiO2 deposition, and even turned super-hydrophilic with a sufficient amount of deposited TiO2. In vitro cell culture tests verified that such prepared PEEK improved adhesion and proliferation of both fibroblast and osteoblast cells, decreased the inflammatory reaction by suppressing TNF-α expression for macrophages, as well as enhanced the antibacterial activity against Staphylococcus aureus and Streptococcus mutans bacteria attachment when compared to only PDA coated and uncoated PEEK. Such a superior bio-performance is apparently correlated with anatase TiO2, as well as its improved physiochemical surface states, including altered surface energy. The PDA-mediated TiO2 nanostructured coating may bode well for oral and maxillofacial implants applications of PEEK.

Biofunctional Glycol-Modified Polyethylene Terephthalate and Thermoplastic Polyurethane Implants by Extrusion-Based Additive Manufacturing for Medical 3D Maxillofacial Defect Reconstruction.

This work addresses the topic of extrusion-based additive manufacturing (filament-based material extrusion) of patient-specific biofunctional maxillofacial implants. The technical approach was chosen to overcome the shortcomings of medically established fabrication processes such as a limited availability of materials or long manufacturing times. The goal of the work was a successful fabrication of basic implants for defect reconstruction. The underlying vision is the implants’ clinic-internal and operation-accompanying application. Following a literature search, a material selection was conducted. Digitally prepared three-dimensional (3D) models dealing with two representative mandible bone defects were printed based on the material selection. An ex-vivo model of the implant environment evaluated dimensional and fitting traits of the implants. Glycol-modified PET (PETG) and thermoplastic polyurethane (TPU) were finally selected. These plastics had high cell acceptance, good mechanical properties, and optimal printability. The subsequent fabrication process yielded two different implant strategies: the standard implant made of PETG with a build-up rate of approximately 10 g/h, and the biofunctional performance implant with a TPU shell and a PETG core with a build-up rate of approximately 4 g/h. The standard implant is meant to be intraoperatively applied, as the print time is below three hours even for larger skull defects. Standard implants proved to be well fitting, mechanically stable and cleanly printed. In addition, the hybrid implant showed particularly cell-friendly behavior due to the chemical constitution of the TPU shell and great impact stability because of the crack-absorbing TPU/PETG combination. This biofunctional constellation could be used in specific reconstructive patient cases and is suitable for pre-operative manufacturing based on radiological image scans of the defect. In summary, filament-based material extrusion has been identified as a suitable manufacturing method for personalized implants in the maxillofacial area. A further clinical and mechanical study is recommended.

Which is the best antibiotic prophylaxis protocol to prevent early implant failures?

Selection criteria The inclusion criteria of this systematic review were patients undergoing dental implant placement. Only randomised clinical trials (RCTs) that compared placebo, no antibiotic and/or any type of antibiotics, administered pre-operatively, intra-operatively, post-operatively or combinations of these, at any dose and for any duration were considered eligible. Included RCTs were required to have a follow up period of at least three months with at least 20 patients per treatment arm. No restrictions on date of publication or language were applied.Key study factor Four electronic databases (MEDLINE, SCOPUS, CENTRAL and Web of Knowledge) in addition to six related journals (Journal of Clinical Periodontology, Clinical Oral Implants Research, Clinical Implant Dentistry and Related Research, Journal of Periodontology, European Journal of Oral Implantology, International Journal of Oral & Maxillofacial Implants) were searched in duplicate for RCTs up to July 2017. Additional relevant literature was identified through hand-searching of reference lists, and through grey literature databases. Two independent reviewers screened the titles and abstracts . Data extraction and risk of bias assessment was performed simultaneously by two reviewers independently and in duplicate using the Cochrane tool for risk of bias assessment. A Network Meta-analysis (NMA) was conducted by integrating direct and indirect comparisons and the probability that each protocol was optimal was estimated. Subgroup and sensitivity analyses were planned to test the effect of risk of bias and of different variables on the results, but were not conducted due to the limited number of included studies.Main outcome measure Outcomes analysed were adverse events and early implant failures, defined as removal of mobile or stable implants with progressive marginal bone loss or infection in the first year after placement.Main results A total of 2248 RCTs were identified after removing duplicates, nine of which were finally included. Different protocols of antibiotic prophylaxis were compared with a total number of 1,693 participants. Seven of the included trials compared the use of one or more protocols of antibiotic prophylaxis with no prophylaxis or prophylaxis with a placebo, and two trials compared the use of different protocols, without the use of a no prophylaxis/placebo group. Amoxicillin was the only type used in all studies. Doses and timing varied among studies, although most of them used a single dose taken just before the implant placement. For the investigated outcomes, two trials were considered at low risk of bias and seven at high risk of bias.All protocols were more effective in reducing implant failures compared to placebo/no antibiotic (mean OR 0.08 to 0.45). Meta-analysis of direct comparison was only possible for the four trials comparing 2 g amoxicillin one hour preoperatively (B) to no antibiotic or placebo (A), indicating B as more effective (pulled OR = 0.40; 95% CI: 0.19-0.88; heterogeneity chi-squared 1.40, P = 0.706). These results were consistent with NMA effect estimates (mean OR = 0.45; 95% CI: 0.0210.93). A single dose of 3 g of amoxicillin administered one hour pre-operatively (C) was statistically more effective in reducing implant failures if compared to no prophylaxis/placebo (OR = 0.41, 95% CI = 0.180.91) and was considered as the most effective protocol. The single dose of 2 g of amoxicillin administered one hour pre-operatively was less effective than protocol C. Adverse events could not be studied in a meta-analysis due to an insufficient number of trials reporting it.Conlusions Implant patients are likely to benefit from antibiotis being administered one hour preoperatively in a dose of 3 g orally. The use of post-operative antibiotics does not seem, however, to be justified.

Opportunities and challenges of translational 3D bioprinting.

3D-printed orthopaedic devices and surgical tools, printed maxillofacial implants and other printed acellular devices have been used in patients. By contrast, bioprinted living cellular constructs face considerable translational challenges. In this Perspective, we first summarize the most recent developments in 3D bioprinting for clinical applications, with a focus on how 3D-printed cartilage, bone and skin can be designed for individual patients and fabricated using the patient's own cells. We then discuss key translational considerations, such as the need to ensure close integration of the living device with the patient's vascular network, the development of biocompatible bioinks and the challenges in deriving a physiologically relevant number of cells. Lastly, we outline untested regulatory pathways, as well as logistical challenges in material sourcing, manufacturing, standardization and transportation.

3DP Materials and Methods for Orthopedic, Dental and Maxillofacial Implants: A Brief Comparative Report

The current approach of modifying standardized prosthetics for orthopedic, dental and maxillofacial implants made from conventional manufacturing techniques have been found inconvenient to customize for specific cases as the complex geometry of the skeletal tissue varies appreciably from patient to patient [ 1 , 2 ]. These standard procedures justly demand patient-specific, complex-shaped, custom-made implants be reliably delivered in minimal time. In this specific regard, 3DP implants are extensively researched [ 3 ]. A significant number of research outcomes sufficiently emphasize the desirable superior shape conformity and the short delivery time provided by the custom-made 3DP implants compared over conventional implants. These potential benefits facilitated by the novel 3DP technology can be adequately explained by the inherent ability of various modern 3DP disciplines to manufacture complex shaped implants by efficiently converting any patient-specific x-ray or CT scans into STL files. In this academic paper, we comparatively review the methods and materials utilized for specific 3DP implants.

CLINICAL AND RADIOGRAPHIC EVALUATION OF THE USE OF INTRAORAL IMPLANTS IN CONSTRUCTON OF SINGLE STAGE IMPLANT RETAINED AURICULAR PROSTHESES

INTRODUCTION: Although plastic surgery is capable of restoring missing tissues, it may not be the ideal choice of treatment because of the complex shape and structure. For restoration of complex organs such as ears, prosthetic restorations may be an alternative to surgical restorations due to their aesthetical success. Prosthetic rehabilitation to restore the facial disfigurements with custom made prosthetic devices may improve the level of function and patient’s self-esteem. Difficulties with facial prostheses may arise due to patient factors such as amount of soft tissue loss, location of the auricular defect, dynamic tissue beds, retentive quality of the area, and associated irritation of the tissue beds. Hence, the rehabilitation choice depends on meticulous restoration of physical dimensions, external contour, and surface landmarks to ensure satisfactory aesthetic outcomes for prosthodontists and their patients. OBJECTIVES: To use inrta-oral implant as an alternate of maxillofacial ones to retain auricular prostheses and evaluate autografted single stage implant placement surgery. MATERIALS AND METHODS: Ten patients complaining of congenitally missing ear either microtia or anotia or acquired missing ones were recruited from maxillofacial and prosthodontic departments’ outpatient clinics, Faculty of dentistry, Alexandria University. Patients were diagnosed clinically and radio-graphically using Cone Beam Computed tomography imaging (CBCT). The prosthetic ear was retained using three ball and socket attachments .They were evaluated upon radiographic and clinical level of osseointegration as well as patient acceptance and hygiene. RESULTS: None of the implants showed failure to osseointegration; providing a survival rate of 100% on both clinical and radiographic levels of evaluation. CONCLUSIONS: The use of 6 mm dental implants in the mastoid region succeeded to replace the maxillofacial implants. Single stage implant placement surgery minimized tissue traumatization and possessed higher patient satisfaction level.

The funding sources of implantology research in the period 2008-2017: A bibliometric analysis.

Implant dentistry is subject to major economic pressures as a result of the growth in the manufacturing and commercialization of dental implants. To examine research funding in implant dentistry by means of a bibliometric analysis of articles indexed in Web of Science (WoS) published during the period 2008-2017. The search was conducted applying the truncated term "implant*" in the WoS dentistry area. Only items labeled as "article" or "review" were selected. Records were manually refined and normalized to unify terms and to remove typographical, transcription, and/or indexing errors. A total of 14 255 records were identified for analysis. About 5002 of the 14 255 published works received funding. Of these, 85.9% of funded research articles received at least one citation. Of the 7733 funding entities mentioned, 29.8% were government entities, 25% NGOs and Foundations, 23.7% private companies, 19.6% academic entities, and 1.9% hospitals and research centers. Clinical Oral Implants Research and the International Journal of Oral & Maxillofacial Implants published the highest numbers of funded articles. This study revealed an overall increase in the funding of research in implant dentistry in recent years. Funded articles were cited more frequently and published in journals with higher impact factors.

Systemic Risk Factors for the Development of Periimplant Diseases.

Although periimplantitis results from the tissue destructive effects of a dysbiotic periimplant microbiome, several factors may either contribute to the dysbiosis or influence the host response to this bacterial challenge and thereby increase the risk of disease. The goal of this narrative review is examine extrinsic factors that might increase the risk at both subject and site levels. The PubMed (MEDLINE) database was searched for articles examining the influence of systemic conditions on periimplantitis or implant failure. Key search terms included "systemic," "medications," "periodontitis," "dental implant," "periimplantitis," "implant failure" and related terms. Manual searches were also performed for the following journals: Clinical Oral Implants Research, International Journal of Periodontics and Restorative Dentistry, Journal of Clinical Periodontology, International Journal of Oral and Maxillofacial Implants, Implant Dentistry, and Journal of Periodontology. The inclusion criteria were cohort studies and case-control studies with at least 10 participants per group and with at least 6 months of follow-up. Certain systemic diseases, medications, radiotherapy, and behavioral factors, such as oral hygiene and compliance with periodontal maintenance therapy, appear to significantly increase the risk of disease.

Reverse Engineering Approach for Customized Dental and Maxillofacial Implants of Alumina Fibre Reinforced Composite

Different customized implant fabrication processes are emerging with the advent of computer aided designing (CAD) and computer aided manufacturing (CAM) technologies to minimize bone removal during surgery and to facilitate faster recovery of the patients. In this direction, the present study offers an alternative reverse engineering approach towards development of customized oral and maxillofacial implants. Here, CAD model of dental crown and mandibular jaw were extracted directly from 3D scanned data and filtered using reverse engineering software. Using ‘.stl’ file of the 3D model, prototype was developed by rapid tooling that was used for fabrication of customized flexible mold. Several difficulties and shrinkage associated defects were encountered during fabrication of alumina-based implants via molding technique. Finally, ceramic fiber reinforced epoxy-resin composite based implants (like mandible and dental crown) were successfully fabricated. The density and compressive strength of the composite were measured to be 0.95 g/cc and 369 MPa, respectively. The dimensions of the fabricated mandible and crowns were close to the natural one. The wear analysis revealed the significant differences in the volume loss between the composite (6.30x10-5 cm3) and human tooth (0.29x10-5 cm3) against composite. Besides fabrication related issues, the alumina fiber-reinforced epoxy resin composite has several other benefits like density, modulus match, improved tribology and cyto-compatibility.

Short Dental Implants: A Review of Literature.

When anatomic structures and ridge resorption limit the placement of a standard implant, the clinician can apply augmentation techniques or use short implants. We conducted a literature review to evaluate the differences in survival rate and the rational use of short implants. Some of the parameters the clinician should consider are (1) area to rehabilitate as well as bone quality, (2) length of the implant, (3) implant diameter, and (4) type of implant and surface treatment. We conducted an electronic search of the PubMed and Google Scholar databases. We also thoroughly evaluated the articles published in the Journal of Periodontology (JOP) and the Journal of Maxillofacial Implants (JOMI) using the key words "implant," "short implant," "finite element analysis," "FEA," "stress-strain distribution," "long imp," and "standard imp." Of the obtained articles, English articles published between 1996 and 2018 were selected for further evaluation. Mechanical factors such as increasing the length and diameter of implants and decreasing the C/I ratio as well as splinting the implants decrease the level of stress in the implant supporting bone. Thus, one or a combination of the aforementioned mechanical factors must be considered in cases where the level of stress in the peri-implant bone needs to be decreased due to the poor quality of bone or use of short implants.

Citation Network Analysis of Dental Implant Literature from 2007 to 2016

This bibliometric study analyzed English language dental implant literature from 2007 to 2016 to evaluate and identify the terms, authors, and journals concerning dental implant articles with high citation count and the structure of their bibliometric networks. The Web of Science database was searched to identify articles on the topic of dental implants published under the Web of Science category of Dentistry, Oral Surgery & Medicine from 2007 to 2016. The articles were first assessed using descriptive analysis concerning the authors, organizations, countries/territories, and journals. Afterward, VOSviewer was used to visualize the term map, author network, and journal network consisting of the most highly cited entities. CiteSpace II was used with default settings to identify keywords that experienced a large increase in citations received within the surveyed period of time. The citation analyses were based on 12,114 dental implant articles published during the survey period. The top five highly cited terms with > 500 publication counts were peri-implantitis (a mean of 20.17 citations per surveyed article [CPA]), survival rate (19.02 CPA), survival (18.74 CPA), implant failure (16.58 CPA), and success rate (16.53 CPA). The top five authors with highest average citations authored 80 papers (80/12,114 = 0.7%) that received 5,962 citations (5,962/151,404 = 3.9%) among the highly cited authors' network. Clinical Oral Implants Research had the largest total number of citation links (19,283), and hence, was in the center of the journal network, with a mean of 21.47 citations per surveyed article. The terms with high impact were related to implant success, survival, failure, and peri-implantitis. Clinical Oral Implants Research and The International Journal of Oral & Maxillofacial Implants were in the center of the journal citation network.

A novel computational method to determine subject-specific bite force and occlusal loading during mastication

The evaluation of three-dimensional occlusal loading during biting and chewing may assist in development of new dental materials, in designing effective and long-lasting restorations such as crowns and bridges, and for evaluating functional performance of prosthodontic components such as dental and/or maxillofacial implants. At present, little is known about the dynamic force and pressure distributions at the occlusal surface during mastication, as these quantities cannot be measured directly. The aim of this study was to evaluate subject-specific occlusal loading forces during mastication using accurate jaw motion measurements. Motion data was obtained from experiments in which an individual performed maximal effort dynamic chewing cycles on a rubber sample with known mechanical properties. A finite element model simulation of one recorded chewing cycle was then performed to evaluate the deformation of the rubber. This was achieved by imposing the measured jaw motions on a three-dimensional geometric surface model of the subject’s dental impressions. Based on the rubber’s deformation and its material behaviour, the simulation was used to compute the resulting stresses within the rubber as well as the contact pressures and forces on the occlusal surfaces. An advantage of this novel modelling approach is that dynamic occlusal pressure maps and biting forces may be predicted with high accuracy and resolution at each time step throughout the chewing cycle. Depending on the motion capture technique and the speed of simulation, the methodology may be automated in such a way that it can be performed chair-side. The present study demonstrates a novel modelling methodology for evaluating dynamic occlusal loading during biting or chewing.

Applications of additive manufacturing in dentistry: A review.

Additive manufacturing (AM) or 3D printing has been hailed as the third industrial revolution as it has caused a paradigm shift in the way objects have been manufactured. Conventionally, converting a raw material to a fully finished and assembled, usable product comprises several steps which can be eliminated by using this process as functional products can be created directly from the raw material at a fraction of the time originally consumed. Thus, AM has found applications in several sectors including automotive, aerospace, printed electronics, and healthcare. AM is increasingly being used in the healthcare sector, given its potential to fabricate patient-specific customized implants with required accuracy and precision. Implantable heart valves, rib cages, and bones are some of the examples where AM technologies are used. A vast variety of materials including ceramics, metals, polymers, and composites have been processed to fabricate intricate implants using 3D printing. The applications of AM in dentistry include maxillofacial implants, dentures, and other prosthetic aids. It may also be used in surgical training and planning, as anatomical models can be created at ease using AM. This article gives an overview of the AM process and reviews in detail the applications of 3D printing in dentistry. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2058-2064, 2018.