Osseointegration Research Articles

Analysis of osseointegration of implants with macrogeometries with healing chambers: a randomized clinical trial

BackgroundTo verify the influence of macrogeometry with healing chambers on the osseointegration of dental implants by analyzing implant stability quotient (ISQ) and evaluate the correlation between insertion torque and ISQ insertion with different macrogeometries.MethodsIn total, 26 implants were installed in the posterior mandible of eight patients with sufficient bone height for the installation of implants measuring 3.5 mm in diameter and 9.0 mm in length. The implants were categorized according to two types of macrogeometry: a test group (GT) with 13 conical implants with healing chambers and a control group (GC) with 13 conical implants with conventional threads. To insert the implants, a bone drilling protocol was used up to a diameter of 3 mm with the last helical bur. The insertion torque of the implants was evaluated, followed by the measurement of ISQ at 0 (T-0), 7 (T-7), 14 (T-14), 21 (T-21), 28 (T-28), and 42 (T-42) days.ResultsThe mean insertion torque was 43 Ncm in both groups, without a significant difference. Moreover, no significant difference in the ISQ values was found between the groups at different time points (p > 0.05), except at T-7 (GT = 69.87±1.89 and GC = 66.48±4.49; p = 0.01). Although there was no significant difference, ISQ median values were higher in the GT group than GC group at 28 days (GT = 67.98 and GC = 63.46; p = 0.05) and 42 days (GT = 66.12 and GC = 60.33; p = 0.09). No correlation was found between the insertion torque and ISQ insertion (p > 0.05).ConclusionFurthermore, implants with a 3.5 mm diameter macrogeometry, with or without healing chambers, inserted with a drilling protocol up to 3 mm in diameter of the last helical bur, led to a similar secondary stability, with no difference in ISQ values. Although, implants with healing chamber demonstrates ascending values in the graph of ISQ, having a trend of faster osseointegration than implants without healing chambers. Both macrogeometries provide a similar primary stability to implants.Trial registrationThis study was registered retrospectively in ReBec (brazilian registry of clinical trials) under the number RBR-96n5×69, on the date of 19/06/2023.

Performance of channel shear connectors in steel frame with reinforced concrete infill walls

To examine the mechanical properties of channel shear connectors employed in steel frame with reinforced concrete infill wall (SRCW) structures, the improved push-out tests were performed on three specimens of channel shear connectors subjected to the monotonic and cyclic loading. This study investigated the influences of loading protocol and concrete strength on the mechanical behavior of channel shear connectors. After the refined finite element (EF) models of channel shear connectors were validated based on the push-out tests, a systematical parametric analysis was conducted to evaluate the effects of RC infill wall thickness, concrete strength, and channel dimensions on its shear strength of the channel shear connectors. In addition, this study also compared the accuracy of the CSA S16, AISC 360 and GB50017 design code in predicting the shear capacity of channel shear connectors in SRCW structures. The experimental results and parametric studies indicated that the current design equations inaccurately evaluate the shear capacity of channel shear connectors used in SRCW structures. Consequently, an alternative equation was developed to estimate the shear-resistant capacity of channel shear connectors in SRCW structures, which provided the desirable calculation precision for engineering design.

Fabrication of a macro-micro porous structure on PEEK surface by ultrasound-assisted sulfonation

A multiscale porous surface can significantly improve the osseointegration of biomedical implants, but it cannot be facilely achieved on the Poly-ether-ether-ketone (PEEK) surface. In this work, a macro-micro porous structure was prepared on the PEEK surface by ultrasound-assisted sulfonation. The surface morphologies, chemical compositions, functional groups, surface roughness, and wettability of the porous structures at different sulfonation times were characterized by scanning electron microscope (SEM), energy dispersive spectroscopy (EDS), Fourier transform infrared spectrometer (FTIR), laser scanning confocal microscope (LSCM), and contact angle measurement, respectively. The results demonstrate that a macro-micro porous structure is formed on the PEEK surface, with macropore sizes ranging from 50 to 250 μm and micro-sized pore sizes ranging from 0.2 to 1.5 μm. Moreover, the results of in vitro cellular experiments demonstrate that the macro-micro porous structure can promote cell adhesion and proliferation of BMCSc. The formation mechanism of the multiscale porous structures has also been discussed. This novel approach may provide a simple and effective strategy for surface modification of PEEK to improve its mechanical and biological response.

The Push-Out Bond Strength, Surface Roughness, and Antimicrobial Properties of Endodontic Bioceramic Sealers Supplemented with Silver Nanoparticles.

This study evaluated push-out bond test (POBT), surface roughness, and antimicrobial properties against Enterococcus faecalis of bioceramic sealers supplemented with silver nanoparticles (AgNPs). The sealers tested were CeraSeal®, EndoSequence® BC SealerTM, and Bio-C® Sealer. The POBT was measured with a Universal Testing Machine, and the type of failure was evaluated with a stereomicroscope. The roughness average (Sa) and peak-valley height (Sy) values were evaluated by atomic force microscopy. The bacterial growth inhibition was evaluated using a disk diffusion test, and antimicrobial activity was determined with the plate microdilution method. The POBT showed no significant difference between sealers with and those without NPs in cervical and apical thirds (p > 0.05). In the middle third, the adhesion force was significant for Endosequence BC Sealer® (p < 0.05). The results showed that the Sa and Sy parameters, when AgNPs were added, did not show a statistically significant difference compared to the groups without nanoparticles (p > 0.05). All tested sealers showed bacterial growth inhibition, but no significant difference was found. Their efficacy, in descending order of antibacterial activity when AgNPs were added, is as follows: EndoSequence® BC SealerTM > Bio-C® Sealer > CeraSeal®. The incorporation of AgNPs into bioceramics improves antimicrobial activity without affecting mechanical properties.

Can Vitamin D Levels Influence Bone Metabolism and Osseointegration of Dental Implants? An Umbrella Review.

Due to the large amount of scientific evidence on the subject and the limitations and incongruities in previous reviews, the primary aim of this umbrella review is to gather all the information regarding the importance of vitamin D levels in the osseointegration of dental implants. The literature search was performed in PubMed, Web of Science, CINAHL Plus, Cochrane Library, and Academic Search Complete throughout the search expression ["vitamin D" AND ("dental implant" OR "dental implants")]. The initial search yielded 351 results, but at the end of the process, only five systematic reviews were selected. Vitamin D seems to have a positive effect on the osseointegration of dental implants and on the reduction of dental implant failures; however, it is recommended that future studies take into account the limitations mentioned in this study in order to increase the validity and quality of scientific evidence on the subject.

Factors affecting osseointegration of dental implants (literature review)

The article’s material based on sources from peer-reviewed scientific journals on the issues of osseointegration of dental implants. The main factors influencing the process of osseointegration: composition and surface of the implant, bone density, general health of the patient, primary stability of the implant, hygiene, and the impact of physiotherapeutic methods. The last factor requires special attention due to how insufficiently it’s been studied.

Comparative evaluation of stability and osseointegration of dental implants placed with and without platelet-rich fibrin (PRF): A systematic review

Comparative evaluation of stability and osseointegration of dental implants placed with and without platelet-rich fibrin (PRF): A systematic review

Experimental investigation on shear behavior of double-row perforated GFRP rib connectors in FRP-concrete hybrid beams

Perforated GFRP rib (PFR) connectors have been used in FRP-concrete hybrid beams due to durability and ease of construction. PFR connectors are parallel FRP plates with predrilled holes positioned in the flange of FRP beams. The optimal plate spacing needs to be determined because it affects the shear performance of PFR connectors. 18 push-out tests were conducted to investigate the effect of plate spacing ( Sl), penetrating GFRP bar diameter ( d), and concrete strength ( fc) on the failure mode, capacity, and shear load-slip (P-S) curves of double-row PFR connectors. Results showed that PFR connectors suffered plate shear failure with the concrete dowel undamaged. Typical P-S curves consisted of micro-slipping and significant-slipping phases. The shear capacity and stiffness of PFR connectors were improved by 33.3% and 45.1%, respectively, by increasing the plate spacing from 1.2 h (where h denotes the plate height) to 3.2 h. The effect of plate spacing on shear capacity and stiffness could be neglected if the ratio ( Sl/ h) was more than 3.2. Specimens with a larger diameter of penetrating bar and higher concrete strength demonstrated higher capacity and stiffness. An empirical equation based on the maximum stress failure criterion was proposed to estimate the capacity of PFR connectors, considering the plate spacing effect, and verified by available data. Additionally, a description of the P-S curve was developed and calibrated by the experimental results.

Shear behavior of multi-row perforated GFRP rib shear connectors in GFRP-concrete hybrid beams/desks

Perforated GFRP ribs (PFRs) and epoxy bonding are commonly used shear connections ensuring a full composite action in FRP-concrete hybrid beam/deck. This study demonstrates test results of 27 push-out specimens to compare the failure modes, shear load-slip (P-S) curves, and shear performance of PFRs and epoxy bonding. The variables included the sanding depth on GFRP profiles (0.5 mm/1.0 mm) and the rows of PFRs (1/2/3/5). The push-out tests highlighted that the PFR specimens with 0.5 mm or 1.0 mm sanding depth experienced interface debonding failure and shearing failure of PFR, respectively. The epoxy bonding specimens with 0.5 mm or 1.0 mm sanding depth suffered adhesive failure and cohesive failure, respectively. Increasing the sanding depth from 0.5 mm to 1.0 mm is an effective approach to prevent the debonding failure. The typical shear load-slip (P-S) curves for PFRs exhibit the micro-slipping stage (slip≤0.2 mm) and the slipping stage (slip>0.2 mm). The P-S curves of epoxy bonding showed only the elastic stage. The shear capacity of the double-row PFR connector was close to epoxy bonding. The shear capacity and stiffness of the PFRs increased 37.2∼47.3 % and 99.7∼119.7 % with the sanding depth improved from 0.5 mm to 1.0 mm, respectively. Increasing the sanding depth would improve the shear stiffness of epoxy bonding. The shear capacity and stiffness of PFRs decreased with the rows of PFRs increased. Calculation equations for the shear capacity of epoxy bonding and PFRs were evaluated by comparing the test results collected from the literature and calculated results. Based on the elastic foundation beam theory, a calculation equation for the shear stiffness of PFRs was proposed and a theoretical bi-linear model was suggested to predict the load-slip curves.

Data-driven shear capacity analysis of headed stud in steel-UHPC composite structures

This study employs machine learning (ML) techniques for shear capacity analysis of headed stud in steel-UHPC composite structure. 194 experimental and numerical results of push-out tests are collected and serve as the dataset for ML models training and testing. Six ML algorithms are implemented to train ML models. Comparison analysis is conducted to compare the performance of three empirical formulae and ML models. The results demonstrate that both the Random Forest and eXtreme Gradient Boosting Trees (XGBoost) models exhibit excellent performance, surpassing an R2 value of 97 % on both training and testing datasets. In contrast, the empirical formulae perform less effectively. Besides, the study incorporates the Shapley additive explanations algorithm to ranking the importance of each feature, and carried out parametric analysis to investigate the correlation between each feature and shear capacity using all samples in the collected dataset. Notably, the most influential variables include diameter and ultimate strength of the headed studs, followed by stud height and thickness of UHPC slab. Cover thickness of UHPC layer and steel fiber volume fractions shows little influence on the shear capacity. Furthermore, based on findings of parametric analysis, design recommendations are provided to avoid shear capacity reduction caused by group effect of studs and UHPC damage. Finally, a user-friendly interactive software is developed and provided to facilitate the shear capacity prediction and design of headed studs in steel-UHPC composite structures.

Bond–Slip Performance between Steel Tube and Self-Compacting Fly Ash Concrete

To reduce the amount of ordinary concrete and then reduce carbon dioxide emission, improving the engineering application range of self-compacting fly ash concrete (FASCC), this study explored the bond–slip traits between FASCC and a steel tube. Six samples were created, and bond–slip push-out tests were performed with varying concrete strength grades and steel tube internal setups. Digital image correlation (DIC) technology was applied to track the surface strain of four samples throughout the experiment. The results show that the outer surface of the steel tube stays mostly undistorted after the concrete is pushed out. Prior to reaching peak load, the load–slip curves of each specimen exhibit a primarily linear load–displacement relationship. Post-peak, the curves diverge into two distinct patterns, namely a sudden drop and a gradual decline. As the strength grade of the inner concrete increases, the interfacial bond between the steel tube and FASCC improves. Additionally, under the same conditions, the internal structure of the steel tube significantly enhances bonding strength. The FA40-Z specimen shows a maximum load that is 25.6% and 53.7% higher than the FA40-G and FA40-C specimens, respectively. The strain evolution patterns of steel tubes within FASCC and regular self-compacting concrete demonstrate similar characteristics. These observations provide valuable insights for the application of FASCC in engineering projects.

Effect of different chelators on the push-out bond strength of hydraulic cements in retrograde obturation.

This study examined the effect of ethylenediaminetetraacetic acid (EDTA) and etidronic acid (HEDP) in retrograde cavities on the bond strength of MTA Angelus and NeoPutty. Sixty-six teeth with single roots and canals were decoronated and enlarged up to F3 using the ProTaper Universal file system. After removing the apical 3 mm within the scope of endodontic surgery procedures, retrograde cavities were prepared with ultrasonic tips. The teeth were divided into three main groups according to the irrigation solution used: saline, 17% EDTA, and 9% HEDP. Following the irrigation of retrograde cavities, each main group was further divided into two subgroups in terms of using MTA Angelus and NeoPutty as retrograde filling materials. Bond strength values of hydraulic cements were measured by the push-out test. Fracture modes were examined under a stereo microscope. Two dentin sections from each group were examined under scanning electron microscopy (SEM) to observe dentinal tubules. Two-way ANOVA and post hoc Tukey tests were used to analyze the data. Irrigation solutions similarly affected the bond strength values of hydraulic cements (P=0.115). MTA Angelus showed significantly higher values than NeoPutty in all the solution groups (P=0.34). Adhesive and cohesive fracture modes were mostly observed in the MTA Angelus and NeoPutty groups, respectively. EDTA, HEDP, and saline had a similar effect on the bond strength of hydraulic cements. The higher bond values of MTA Angelus compared to NeoPutty could support its safe use in endodontic surgery procedures.

Effect of calcium hydroxide and calcium hydroxide nanoparticles used as intracanal drugs after manual and ultrasonic removal on the bond strength of a new sealer with a pozzolan base (Endoseal mineral trioxide aggregate)

ABSTRACT Aim: The adhesion ability of filling materials to the root canal wall can be affected by the intracanal medicaments. The present study investigated the effect of pretreatment with nano-calcium hydroxide and calcium hydroxide on the bond strength of Endoseal mineral trioxide aggregate (MTA) to root canal dentin. Materials and Methods: Fifty maxillary incisor teeth were randomly divided into two experimental groups (n = 20) and a control group (n = 10) after decoronation near the cementoenamel junction and root canal instrumentation according to the type of intracanal medicament (calcium hydroxide and nano-calcium hydroxide). Each experimental group was divided into two subgroups based on manual and ultrasonic drug removal methods. After removing intracanal medicaments and irrigating them, all the groups were obturated with gutta-percha and Endoseal MTA sealer. Then, the samples were sectioned into cross-sections with a thickness of 2 mm using a diamond disc, and the push-out bond strength test was performed on them. Results: The results showed no significant difference in the mean Endoseal MTA bond strength in terms of the type of intracanal medicament and the method used to remove it from the canal (P &gt; 0.05). Conclusion: Using the ultrasonic method compared to the manual method in removing intracanal medicament resulted in no significant difference in the strength of the Endoseal MTA bond. Furthermore, the effect of nanoparticle calcium hydroxide on Endoseal MTA bond strength was not different compared to the conventional type of this medication.

Predicting the structural behaviour and failure mechanism of hybrid steel-grout connectors for cross-laminated timber panels using high-fidelity finite-elements modelling

In this paper, a symbiotic experimental and numerical approach is used to determine the structural performance parameters and analyse the failure behaviour of a novel high-performance hybrid steel-grout connector for cross-laminated timber (CLT) panels. The connector is composed of a steel rod, which is embedded into a 3-ply CLT panel with the aid of a thick layer of epoxy-based grout. Material tests on wood from the two lumber grades present in the CLT panels, and on the epoxy-based grout were conducted to provide an insight into their mechanical behaviour. Forty-two monotonic push-out shear tests were conducted on connectors, varying the grout layer diameter thrice and the loading direction twice. A finite-elements (F.E.) model for the connector was developed in the F.E. software ANSYS and calibrated based on experimental observations on materials and connectors. The tested connectors proved to be strong and stiff in both loading directions, with a maximum slip modulus of 111 kN/mm, yield resistance of 177 kN, and maximum resistance of 192 kN. The diameter of the grout was found to significantly influence all three performance parameters, and much so when the connector was loaded in the direction perpendicular to the CLT face layers. The developed F.E model was able to capture the slip modulus, yield resistance, and maximum resistance with an accuracy above 95 %. The F.E. model also sheds light on the structural performance, yield mechanism, and failure propagation for connectors.

The Biological Impact of Residual Aluminum Particles on Sand-Blasted Dental Implant Surfaces: A Systematic Review of Animal Studies

(1) Background: The use of alumina particles for surface treatment of dental implants is a common practice aimed at enhancing osseointegration. However, the biological effects of residual alumina particles on implant surfaces remain a subject of debate. This systematic review evaluates the impact of residual alumina particles on the osseointegration, biocompatibility, and bacterial adhesion of dental implants based on available in vivo experimental animal studies. (2) Methods: A comprehensive literature search was conducted across PubMed, Web of Science, and Scopus to identify relevant studies. The inclusion criteria focused on experimental animal studies that assessed the biological effects of alumina-blasted dental implants. Data extraction was carried out, and quality assessments were performed using the SYRCLE risk-of-bias tool. (3) Results: Ten studies met the inclusion criteria, involving various animal models, such as rabbits, pigs, dogs, and sheep. The findings demonstrated that residual alumina particles did not negatively impact osseointegration. Some studies reported accelerated bone growth and improved osseointegration with residual alumina. Additionally, residual alumina showed potential bactericidal properties, reducing bacterial adhesion. (4) Conclusions: The available evidence from animal studies suggests that residual alumina particles do not adversely affect the osseointegration and biocompatibility of dental implants. These particles may even enhance bone growth and reduce bacterial adhesion. However, due to the scarcity of human studies and the impracticality of histological assessments in humans, further research, including long-term clinical trials, is necessary to confirm these findings.

Effect of Low-Level Laser Therapy on Osseointegration of Immediate Dental Implants in Anterior and Premolar Region of the Mandible: A Pilot Clinical Study

Effect of Low-Level Laser Therapy on Osseointegration of Immediate Dental Implants in Anterior and Premolar Region of the Mandible: A Pilot Clinical Study

Shear strength and ductility of novel steel fibre-reinforced concrete dowel connections for composite beams

In this paper, a novel steel fibre-reinforced concrete (SFRC) dowel connection without traditional steel bar reinforcement is proposed for steel-concrete composite beams. Push-out tests on thirty-six specimens were conducted to investigate the shear strength and ductility of SFRC dowel connections with varying dowel sizes, concrete densities, fibre content and type. Even without the presence of reinforcing bars, the SFRC dowels were able to resist substantial loads and maintained a ductile load-slip behaviour. The shear strength of SFRC dowels increased with an increase in the fibre content, dowel size, and concrete density. Further, dowels with higher steel fibres content exhibited enhanced ductility, displaying a near elastic-plastic load-slip behaviour, with an ability to resist up to 80 % of the ultimate load even at 6 mm slip. A unique analytical model to predict the ultimate load and the load-slip curve is proposed in this study. The model was able to predict the ultimate load to within 6 % of test results, on average, while the mean load at 6 mm slip was predicted to within 3 % of the test results, with standard deviation of 17 % and 13 % respectively. The general shape of the load-slip curve was also well predicted. The study also proposes simplified equations, which predicted the shear strength of SFRC dowels to within 2 % of the test results with a standard deviation of 13 %.

Enhancing osseointegration and angiogenesis of Titanium implants through KMnO4-Modified Montmorillonite nano-clay coating

Titanium (Ti) is a widely used and favored material for dental implants, with research efforts focusing on enhancing its osseointegration capabilities. Montmorillonite (MMT), a nano-clay, has shown significant potential in drug delivery, wound healing, and other biomedical applications. Implant coatings based on MMT have demonstrated promising results; however, challenges remain in terms of surface bond strength, stability, and uniformity. Studies have indicated that manganese (Mn) can enhance cell viability, proliferation, and adhesion by activating integrin receptors. Here, a KMnO4-modified MMT (MAO-MMT-Mn) coating was developed on Ti through the micro-arc oxidation (MAO) technique. The MAO-MMT-Mn coating significantly strengthens its bond, enabling it to withstand greater loads. The incorporation of Mn, silicon (Si) and phosphorus (P) resulted in the formation of uniformly distributed lamellar MMT, facilitating the sustained release of these elements. In vitro experiments demonstrated that the MAO-MMT-Mn coating promoted osteoblast adhesion and endothelial cell migration, and led to a significant increase in the expression of osteogenic and angiogenic genes compared to uncoated Ti. Moreover, in vivo assessments using micro-CT scans and histological staining revealed improved local osseointegration and angiogenesis after 4 weeks of implantation. In conclusion, the MAO-MMT-Mn coating offers a safe, simple, and cost-effective method to enhance the surfaces of Ti implants, thereby potentially enhancing the clinical outcomes of dental implant procedures.

Shear behavior of short stud in I-beam-ultra-high performance concrete (UHPC) composite structure

As the connecting component of I-beam and UHPC, the stud is the basis of the cooperative work of each component, and is crucial to the stability and safety of the structure. To further study the shear behavior of studs in I-beam-UHPC composite structures, the push-out test was carried out by numerical simulation. The numerical simulation is in line with the load-relative slip curve and failure mode obtained by the experiment, verifying the accuracy of the numerical model. On the basis of verifying the model, the influences of the diameter, height and ultimate tensile strength of the stud on the relative slip curve, shear strength, yield strength and shear stiffness of the stud are studied. The findings indicate that a stud with a diameter of 22 mm exhibits a shear strength 156% greater than that of a stud with a diameter of 10 mm. Additionally, the yield strength increases by 135%, and the shear stiffness by 160 kN, highlighting the significant impact of stud diameter on shear resistance. When the ratio of length to diameter is less than 2.7, the shear strength of the stud increases with the height of the stud. The shear strength of a stud with a length-to-diameter ratio of 2.7 is 35% higher than that of a stud with a ratio of 1.5. The ultimate tensile strength of the stud ranges from 360 to 510 MPa, with only an 11 kN increase in yield strength, indicating that the ultimate tensile strength has a limited influence on shear properties. As the height of the stud decreases, its ultimate tensile strength gradually increases, bringing the numerical model closer to the predicted values. For shorter studs with higher ultimate tensile strength, the finite element simulation results are closer to the predicted values.

Advantages of customization of osseointegrated implants in transfemoral amputees: a comparative analysis of surgical planning

BackgroundCommercially available osseointegrated devices for transfemoral amputees are limited in size and thus fail to meet the significant anatomical variability in the femoral medullary canal. This study aimed to develop a customized osseointegrated stem to better accommodate a variety of femoral anatomies in transfemoral amputees than off-the-shelf stems. Customization is expected to enhance cortical bone preservation and increase the stem-bone contact area, which are critical for the long-term stability and success of implants.MethodsA customized stem (OsteoCustom) was designed based on the statistical shape variability of the medullary canal. The implantability of the OsteoCustom stem was tested via 70 computed tomography (CT) images of human femurs and compared to that of a commercial device (OFI-C) for two different resection levels. The evaluations included the volume of cortical bone removed and the percentage of stem-bone contact area for both resection levels. Statistical significance was analyzed using paired and unpaired t tests.ResultsThe OsteoCustom stem could be virtually implanted in all 70 femurs, while the OFI-C was unsuitable in 19 cases due to insufficient cortical thickness after implantation, further emphasizing its adaptability to varying anatomical conditions. The OsteoCustom stem preserved a greater volume of cortical bone than did the OFI-C. In fact, 42% less bone was removed at the proximal resection level (3.15 cm³ vs. 5.42 cm³, p ≤ 0.0001), and 33% less at the distal resection level (2.25 cm³ vs. 3.39 cm³, p = 0.003). The stem-bone contact area was also greater for the OsteoCustom stem, particularly at the distal resection level, showing a 20% increase in contact area (52.3% vs. 32.2%, p = 0.002) compared to that of the OFI-C.ConclusionsThe OsteoCustom stem performed better than the commercial stem by preserving more cortical bone and achieving a greater stem–bone contact area, especially at distal resection levels where the shape of the medullary canal exhibits more inter-subject variability. Optimal fit in the distal region is of paramount importance for ensuring the stability of osseointegrated implants. This study highlights the potential benefits of customized osseointegrated stems in accommodating a broader range of femoral anatomies, with enhanced fit in the medullary canal.