Search results for: mechanical behavior of bone
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 9834

Search results for: mechanical behavior of bone

9534 Analysis of Flexural Behavior of Wood-Concrete Beams

Authors: M. Li, V. D. Thi, M. Khelifa, M. El Ganaoui

Abstract:

This study presents an overview of the work carried out by the use of wood waste as coarse aggregate in mortar. The paper describes experimental and numerical investigations carried on pervious concrete made of wood chips and also sheds lights on the mechanical properties of this new product. The properties of pervious wood-concrete such as strength, elastic modulus, and failure modes are compared and evaluated. The characterization procedure of the mechanical properties of wood waste ash are presented and discussed. The numerical and tested load–deflection response results are compared. It was observed that the numerical results are in good agreement with the experimental results.

Keywords: wood waste ash, characterization, mechanical properties, bending tests

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9533 Evaluation of Geomechanical and Geometrical Parameters’ Effects on Hydro-Mechanical Estimation of Water Inflow into Underground Excavations

Authors: M. Mazraehli, F. Mehrabani, S. Zare

Abstract:

In general, mechanical and hydraulic processes are not independent of each other in jointed rock masses. Therefore, the study on hydro-mechanical coupling of geomaterials should be a center of attention in rock mechanics. Rocks in their nature contain discontinuities whose presence extremely influences mechanical and hydraulic characteristics of the medium. Assuming this effect, experimental investigations on intact rock cannot help to identify jointed rock mass behavior. Hence, numerical methods are being used for this purpose. In this paper, water inflow into a tunnel under significant water table has been estimated using hydro-mechanical discrete element method (HM-DEM). Besides, effects of geomechanical and geometrical parameters including constitutive model, friction angle, joint spacing, dip of joint sets, and stress factor on the estimated inflow rate have been studied. Results demonstrate that inflow rates are not identical for different constitutive models. Also, inflow rate reduces with increased spacing and stress factor.

Keywords: distinct element method, fluid flow, hydro-mechanical coupling, jointed rock mass, underground excavations

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9532 Association of Clostridium difficile Infection and Bone Cancer

Authors: Daniela Prado, Lexi Frankel, Amalia Ardeljan, Lokesh Manjani, Matthew Cardeiro, Omar Rashid

Abstract:

Background: Clostridium difficile (C. diff) is a gram-positive bacterium that is known to cause life-threatening diarrhea and severe inflammation of the colon. It originates as an alteration of the gut microbiome and can be transmitted through spores. Recent studies have shown a high association between the development of C. diff in cancer patients due to extensive hospitalization. However, research is lacking regarding C. diff’s association in the causation or prevention of cancer. The objective of this study was to therefore assess the correlation between Clostridium difficile infection (CDI) and the incidence of bone cancer. Methods: This retrospective analysis used data provided by a Health Insurance Portability and Accountability Act (HIPAA) compliant national database to evaluate the patients infected versus patients not infected with C. diff using ICD-10 and ICD-9 codes. Access to the database was granted by the Holy Cross Health, Fort Lauderdale, for the purpose of academic research. Standard statistical methods were used. Results: Between January 2010 and December 2019, the query was analyzed and resulted in 78863 patients in both the infected and control group, respectively. The two groups were matched by age range and CCI score. The incidence of bone cancer was 659 patients (0.835%) in the C. diff group compared to 1941 patients (2.461%) in the control group. The difference was statistically significant by a P-value < 2.2x10^-16 with an odds ratio (OR)= 0.33 (0.31-0.37) with a 95% confidence interval (CI). Treatment for CDI was analyzed for both C. diff infected and noninfected populations. 91 out of 16,676 (0.55%) patients with a prior C. diff infection and treated with antibiotics were compared to the control group were 275 out of 16,676 (1.65%) patients with no history of CDI and received antibiotic treatment. Results remained statistically significant by P-value <2.2x10-16 with an OR= 0.42 (0.37, 0.48). and a 95% CI. Conclusion: The study shows a statistically significant correlation between C. diff and a reduced incidence of bone cancer. Further evaluation is recommended to assess the potential of C. difficile in reducing bone cancer incidence.

Keywords: bone cancer, colitis, clostridium difficile, microbiome

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9531 Development of 3D Printed Natural Fiber Reinforced Composite Scaffolds for Maxillofacial Reconstruction

Authors: Sri Sai Ramya Bojedla, Falguni Pati

Abstract:

Nature provides the best of solutions to humans. One such incredible gift to regenerative medicine is silk. The literature has publicized a long appreciation for silk owing to its incredible physical and biological assets. Its bioactive nature, unique mechanical strength, and processing flexibility make us curious to explore further to apply it in the clinics for the welfare of mankind. In this study, Antheraea mylitta and Bombyx mori silk fibroin microfibers are developed by two economical and straightforward steps via degumming and hydrolysis for the first time, and a bioactive composite is manufactured by mixing silk fibroin microfibers at various concentrations with polycaprolactone (PCL), a biocompatible, aliphatic semi-crystalline synthetic polymer. Reconstructive surgery in any part of the body except for the maxillofacial region deals with replacing its function. But answering both the aesthetics and function is of utmost importance when it comes to facial reconstruction as it plays a critical role in the psychological and social well-being of the patient. The main concern in developing adequate bone graft substitutes or a scaffold is the noteworthy variation in each patient's bone anatomy. Additionally, the anatomical shape and size will vary based on the type of defect. The advent of additive manufacturing (AM) or 3D printing techniques to bone tissue engineering has facilitated overcoming many of the restraints of conventional fabrication techniques. The acquired patient's CT data is converted into a stereolithographic (STL)-file which is further utilized by the 3D printer to create a 3D scaffold structure in an interconnected layer-by-layer fashion. This study aims to address the limitations of currently available materials and fabrication technologies and develop a customized biomaterial implant via 3D printing technology to reconstruct complex form, function, and aesthetics of the facial anatomy. These composite scaffolds underwent structural and mechanical characterization. Atomic force microscopic (AFM) and field emission scanning electron microscopic (FESEM) images showed the uniform dispersion of the silk fibroin microfibers in the PCL matrix. With the addition of silk, there is improvement in the compressive strength of the hybrid scaffolds. The scaffolds with Antheraea mylitta silk revealed higher compressive modulus than that of Bombyx mori silk. The above results of PCL-silk scaffolds strongly recommend their utilization in bone regenerative applications. Successful completion of this research will provide a great weapon in the maxillofacial reconstructive armamentarium.

Keywords: compressive modulus, 3d printing, maxillofacial reconstruction, natural fiber reinforced composites, silk fibroin microfibers

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9530 Production of Metal Matrix Composites with Diamond for Abrasive Cutting Resistance by Gas Infiltration Casting

Authors: Haydar S. Al Shabbani, M. Marshall, R. Goodall

Abstract:

Metal matrix composites (MMCs) have been explored for many applications for many decades. Recently, this includes investigations for thermal applications associated with electronics, such as in heat sinks. Here, to promote thermal conductivity, composites of a metal matrix with diamond particles are used. However, this class of composites has not yet been extensively examined for mechanical and tribological behavior, especially for applications that require extreme mechanical and tribological strength, such as the resistance to abrasive cutting. Therefore, this research seeks to develop a composite material with metal matrix and diamond particles which resist abrasive and cutting forces. The development progresses through a series of steps, exploring methods to process the material, understanding the mechanics of abrasive behavior and optimizing the composite structure to resist abrasive cutting. In processing, infiltration casting under gas pressure has been applied to molten aluminum to obtain a significant penetration of the metal into a preform of diamond particles. Different diamond particle sizes were used with different surface modifications (coated/uncoated), and to compare resulting composites with the same particle sizes. Al-1 wt.% Mg as a matrix alloy was utilised to investigate the possible effect of Mg on bonding phases during the infiltration process. The mechanical behavior and microstructure of the materials produced have been characterised. These tests showed that the surface modification of the diamond particles with a reactive material (Ti-coating) has an important role for enhancing the bonding between the aluminium matrix and diamond reinforcement as apparent under SEM observation. The effect of this improved bond is seen in the cutting resistance of the material.

Keywords: aluminium, composites, diamond, Ti-coated, tribology

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9529 Piled Critical Size Bone-Biomimetic and Biominerizable Nanocomposites: Formation of Bioreactor-Induced Stem Cell Gradients under Perfusion and Compression

Authors: W. Baumgartner, M. Welti, N. Hild, S. C. Hess, W. J. Stark, G. Meier Bürgisser, P. Giovanoli, J. Buschmann

Abstract:

Perfusion bioreactors are used to solve problems in tissue engineering in terms of sufficient nutrient and oxygen supply. Such problems especially occur in critical size grafts because vascularization is often too slow after implantation ending up in necrotic cores. Biominerizable and biocompatible nanocomposite materials are attractive and suitable scaffold materials for bone tissue engineering because they offer mineral components in organic carriers – mimicking natural bone tissue. In addition, human adipose derived stem cells (ASCs) can potentially be used to increase bone healing as they are capable of differentiating towards osteoblasts or endothelial cells among others. In the present study, electrospun nanocomposite disks of poly-lactic-co-glycolic acid and amorphous calcium phosphate nanoparticles (PLGA/a-CaP) were seeded with human ASCs and eight disks were stacked in a bioreactor running with normal culture medium (no differentiation supplements). Under continuous perfusion and uniaxial cyclic compression, load-displacement curves as a function of time were assessed. Stiffness and energy dissipation were recorded. Moreover, stem cell densities in the layers of the piled scaffold were determined as well as their morphologies and differentiation status (endothelial cell differentiation, chondrogenesis and osteogenesis). While the stiffness of the cell free constructs increased over time caused by the transformation of the a-CaP nanoparticles into flake-like apatite, ASC-seeded constructs showed a constant stiffness. Stem cell density gradients were histologically determined with a linear increase in the flow direction from the bottom to the top of the 3.5 mm high pile (r2 > 0.95). Cell morphology was influenced by the flow rate, with stem cells getting more roundish at higher flow rates. Less than 1 % osteogenesis was found upon osteopontin immunostaining at the end of the experiment (9 days), while no endothelial cell differentiation and no chondrogenesis was triggered under these conditions. All ASCs had mainly remained in their original pluripotent status within this time frame. In summary, we have fabricated a critical size bone graft based on a biominerizable bone-biomimetic nanocomposite with preserved stiffness when seeded with human ASCs. The special feature of this bone graft was that ASC densities inside the piled construct varied with a linear gradient, which is a good starting point for tissue engineering interfaces such as bone-cartilage where the bone tissue is cell rich while the cartilage exhibits low cell densities. As such, this tissue-engineered graft may act as a bone-cartilage interface after the corresponding differentiation of the ASCs.

Keywords: bioreactor, bone, cartilage, nanocomposite, stem cell gradient

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9528 Bone Mineral Density in Long-Living Patients with Coronary Artery Disease

Authors: Svetlana V. Topolyanskaya, Tatyana A. Eliseeva, Olga N. Vakulenko, Leonid I. Dvoretski

Abstract:

Introduction: Limited data are available on osteoporosis in centenarians. Therefore, we evaluated bone mineral density in long-living patients with coronary artery disease (CAD). Methods: 202 patients hospitalized with CAD were enrolled in this cross-sectional study. The patients' age ranged from 90 to 101 years. The majority of study participants (64.4%) were women. The main exclusion criteria were any disease or medication that can lead to secondary osteoporosis. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. Results: Normal lumbar spine BMD was observed in 40.9%, osteoporosis – in 26.9%, osteopenia – in 32.2% of patients. Normal proximal femur BMD values were observed in 21.3%, osteoporosis – in 39.9%, and osteopenia – in 38.8% of patients. Normal femoral neck BMD was registered only in 10.4% of patients, osteoporosis was observed in 60.4%, osteopenia in 29.2%. Significant positive correlation was found between all BMD values and body mass index of patients (p < 0.001). Positive correlation was registered between BMD values and serum uric acid (p=0.0005). The likelihood of normal BMD values with hyperuricemia increased 3.8 times, compared to patients with normal uric acid, who often have osteoporosis (Odds Ratio=3.84; p = 0.009). Positive correlation was registered between all BMD values and body mass index (p < 0.001). Positive correlation between triglycerides levels and T-score (p=0.02), but negative correlation between BMD and HDL-cholesterol (p=0.02) were revealed. Negative correlation between frailty severity and BMD values (p=0.01) was found. Positive correlation between BMD values and functional abilities of patients assessed using Barthel index (r=0,44; p=0,000002) and IADL scale (r=0,36; p=0,00008) was registered. Fractures in history were observed in 27.6% of patients. Conclusions: The study results indicate some features of BMD in long-livers. In the study group, significant relationships were found between bone mineral density on the one hand, and patients' functional abilities on the other. It is advisable to further study the state of bone tissue in long-livers involving a large sample of patients.

Keywords: osteoporosis, bone mineral density, centenarians, coronary artery disease

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9527 Electrospinning and Characterization of Silk Fibroin/Gelatin Nanofibre Mats

Authors: S. Mohammadzadehmoghadam, Y. Dong

Abstract:

In this study, Bombyx mori silk fibroin/gelatin (SF/GT) nanocomposite with different GT ratio (SF/GT 100/0, 90/10 and 70/30) were prepared by electrospinning process and crosslinked with glutaraldehyde (GA) vapor. Properties of crosslinked SF/GT nanocomposites were investigated by scanning electron microscopy (SEM), mechanical test, water uptake capacity (WUC) and porosity. From SEM images, it was found that fiber diameter increased as GT content increased. The results of mechanical test indicated that the SF/GT 70/30 nanocomposites had both the highest Young’s modulus of 342 MPa and the highest tensile strength of about 14 MPa. However, porosity and WUC decreased from 62% and 405% for pristine SF to 47% and 232% for SF/GT 70/30, respectively. This behavior can be related to higher degree of crosslinking as GT ratio increased which altered the structure and physical properties of scaffolds. This study showed that incorporation of GT into SF nanofibers can enhance mechanical properties of resultant nanocomposite, but the GA treatment should be optimized to control and fine-tune other properties to warrant their biomedical application.

Keywords: electrospinning, gelatin, silk fibroin, mechanical properties, nanocomposites

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9526 Analysis of the Influence of Fiber Volume and Fiber Orientation on Post-Cracking Behavior of Steel Fiber Reinforced Concrete

Authors: Marilia M. Camargo, Luisa A. Gachet-Barbosa, Rosa C. C. Lintz

Abstract:

The addition of fibers into concrete matrix can enhance some properties of the composite, such as tensile, flexural and impact strengths, toughness, deformation capacity and post-cracking ductility. Many factors affect the mechanical behavior of fiber reinforced concrete, such as concrete matrix (concrete strength, additions, aggregate diameter, etc.), characteristics of the fiber (geometry, type, aspect ratio, volume, orientation, distribution, strength, stiffness, etc.), specimen (size, geometry, method of preparation and loading rate). This research investigates the effects of fiber volume and orientation on the post-cracking behavior of steel fiber reinforced concrete (SFRC). Hooked-end steel fibers with aspect ratios of 45 were added into concrete with volume of 0,32%, 0,64%, 0,94%. The post-cracking behaviour was assessed by double punch test of cubic specimens and the actual volume and orientation of the fibers were determined by non-destructive tests by means of electromagnetic induction. The results showed that the actual volume of fibers in each sample differs in a small amount from the dosed volume of fibers and that the deformation and toughness of the concrete increase with the increase in the actual volume of fibers. In determining the orientation of the fibers, it was found that they tend to distribute more in the X and Y axes due to the influence of the walls of the mold. In addition, it was concluded that the orientation of the fibers is important in the post-cracking behaviour of FRC when analyzed together with the actual volume of fibers, since the greater the volume of fibers, the greater the number of fibers oriented orthogonally to the application of loadings and, consequently, there is a better mechanical behavior of the composite. These results provide a better understanding of the influence of volume and fiber orientation on the post-cracking behavior of the FRC.

Keywords: fiber reinforced concrete, steel fibers, volume of fibers, orientation of fibers, post-cracking behaviour

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9525 The Gap of Green Consumption Behavior: Driving from Attitude to Behavior

Authors: Yu Du, Jian-Guo Wang

Abstract:

Green consumption is a key link to develop the ecological economy, and consumers are vital to carry out green consumption. With environmental awareness gradually being aroused, consumers often fail to turn their positive attitude into actual green consumption behavior. According to behavior reasoning theory, reasons for adoption have a direct (positive) influence on consumers’ attitude while reasons against adoption have a direct (negative) influence on consumers’ adoption intentions, the incongruous coexistence of which leads to the attitude-behavior gap of green consumption. Based on behavior reasoning theory, this research integrates reasons for adoption and reasons against adoption into a proposed model, in which reasons both for and against green consumption mediate the relationship between consumer’ values, attitudes, and behavioral intentions. It not only extends the conventional theory of reasoned action but also provides a reference for the government and enterprises to design the repairing strategy of green consumption attitude-behavior gap.

Keywords: green product, attitude-behavior gap, behavior reasoning theory, green consumption, SEM

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9524 Tuberculous Osteomyelitis Mimicking Tumours and Tumour-Like Lesions of Bone: Clinico-Radiologic Study of 22 Patients

Authors: Parveen Kundu, Zile Singh, Kunika Kundu, Swaran Kaur

Abstract:

Context: Tuberculous osteomyelitis is a relatively uncommon condition that can present with various clinical and radiological features, often mimicking bone tumors or tumor-like lesions. In endemic countries like India, tuberculosis should be considered as a potential differential diagnosis for lytic bone lesions. This study aimed to highlight the different presentations of tuberculosis that can mimic tumors or tumor-like lesions in bone and emphasize the successful outcome of antitubercular therapy (ATT) in treating these cases. Research Aim: The main objective of this research was to explore the varied presentations of tuberculosis that mimic bone tumors or tumor-like lesions both clinically and radiologically, focusing on different bones. The study aimed to raise awareness among clinicians about this possibility and highlight the importance of histopathological confirmation before initiating treatment for lytic bone lesions. Methodology: This study utilized a retrospective review of 22 patients with suspected lytic bone lesions, who were subsequently diagnosed with tuberculous osteomyelitis through histopathological examination. The cases were collected over a period of ten years. Eleven cases required curettage for extensive lesions with sequestrations, while all 22 patients received 12 months of antitubercular therapy. Findings: The study included 14 male and 8 female patients, ranging in age from 3 to 61 years, with an average age of 22.05. The clinical and radiological presentations varied, with examples including bone cysts in the metaphyseal area of long bones, lesions resembling chondroblastomas, giant cell tumors, and osteoid osteoma, as well as multifocal lytic lesions resembling metastasis or multiple myeloma. One patient had lesions in both the clavicle and hand. Lesions mimicking chondromas were also observed in the phalanges of the hand and foot metatarsal. All patients showed resolution of the lesions and no residual disability following ATT. Theoretical Importance: This study highlights the importance of considering tuberculosis as a potential differential diagnosis for lytic bone lesions, particularly in endemic regions. It emphasizes the need for histopathological confirmation to accurately diagnose tuberculous osteomyelitis, as this is considered the gold standard. Data Collection and Analysis Procedures: Data for this study were collected retrospectively from medical records and radiological images of the 22 patients. The cases were analyzed based on clinical presentation, radiological findings, and histopathological confirmation. The outcomes of antitubercular therapy were also assessed. The data were summarized and presented descriptively. Question Addressed: This study aimed to address the question of how tuberculosis can mimic different bone tumors and tumor-like lesions clinically and radiologically. It also aimed to assess the successful outcome of antitubercular therapy in treating these cases. Conclusion: Tuberculous osteomyelitis can present with varied clinical and radiological features, often mimicking bone tumors or tumor-like lesions. Clinicians should consider tuberculosis as a potential diagnosis for lytic bone lesions, especially in endemic areas. Histopathological confirmation is essential for accurate diagnosis. Antitubercular therapy is an effective treatment for tuberculous osteomyelitis, leading to the resolution of the lesions with no residual disability.

Keywords: tuberculosis, tumor, curettage, bone

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9523 Temperature-Responsive Shape Memory Polymer Filament Integrated Smart Polyester Knitted Fabric Featuring Memory Behavior

Authors: Priyanka Gupta, Bipin Kumar

Abstract:

Recent developments in smart materials motivate researchers to create novel textile products for innovative and functional applications, which have several potential uses beyond the conventional. This study investigates the memory behavior of shape memory filaments integrated into a knitted textile structure. The research advances the knowledge of how these intelligent materials respond within textile structures. This integration may also open new avenues for developing smart fabrics with unique sensing and actuation capabilities. A shape memory filament and polyester yarn were knitted to produce a shape memory knitted fabric (SMF). Thermo-mechanical tensile test was carried out to quantify the memory behavior of SMF under different conditions. The experimental findings demonstrate excellent shape recovery (100%) and shape fixity up to 88% at different strains (20% and 60%) and temperatures (30 ℃ and 50 ℃). Experimental results reveal that memory filament behaves differently in a fabric structure than in its pristine condition at various temperatures and strains. The cycle test of SMF under different thermo-mechanical conditions indicated complete shape recovery with an increase in shape fixity. So, the utterly recoverable textile structure was achieved after a few initial cycles. These intelligent textiles are beneficial for the development of novel, innovative, and functional fabrics like elegant curtains, pressure garments, compression stockings, etc. In addition to fashion and medical uses, this unique feature may also be leveraged to build textile-based sensors and actuators.

Keywords: knitting, memory filament, shape memory, smart textiles, thermo-mechanical cycle

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9522 Synthesis of Tricalcium Phosphate Substituted with Magnesium Ions for Bone Regeneration

Authors: Andreia Cucuruz, Cristina Daniela Ghitulica, Georgeta Voicu, Cristina Busuioc

Abstract:

Ceramics based on calcium phosphates have lately increased attention for tissue engineering because they can be used as substitute bones or for bone regeneration since they mimic very well the nanostructure of tough bone tissue, but also because of other advantages such as a very good biocompatibility and osseointegration. This study aims the preparation and characterization of ceramic materials on the basis of TCP (Ca₃(PO₄)₂), within which calcium ions are substituted by magnesium ions (Mg²⁺) in order to improve the regenerative properties of these materials. TCP-Mg material was synthesized by chemical precipitation method using calcium oxide (CaO) and phosphoric acid (H₃PO₄) as precursors. The objective was to obtain powders with different concentrations of Mg in order to analyze the effect of magnesium ions on the physicochemical properties of phosphate ceramics and in vitro degradation in simulated biological fluid (SBF). Ceramic powders were characterized in vitro but also from the compositional and microstructural point of view. TCP_Mg powders were prepared through wet chemical method from calcium oxide (CaO), magnesium oxide nanopowder (MgO < 50 nm particle size (BET) Sigma Aldrich), phosphoric acid (H₃PO₄ - 85 wt.% in H₂O, 99.99% trace metals basis - Sigma Aldrich). In order to determine the quantities of raw materials, calculations were performed to obtain HAp with Ca/P ratio of 1.5.

Keywords: bone regeneration, magnesium substitution, tricalcium phosphate, tissue engineering

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9521 The Role of Bone Marrow Stem Cells Transplantation in the Repair of Damaged Inner Ear in Albino Rats

Authors: Ahmed Gaber Abdel Raheem, Nashwa Ahmed Mohamed

Abstract:

Introduction: Sensorineural hearing loss (SNHL) is largely caused by the degeneration of the cochlea. Therapeutic options for SNHL are limited to hearing aids and cochlear implants. The cell transplantation approach to the regeneration of hair cells has gained considerable attention because stem cells are believed to accumulate in the damaged sites and have the potential for the repair of damaged tissues. The aim of the work: was to assess the use of bone marrow transplantation in repair of damaged inner ear hair cells in rats after the damage had been inflicted by Amikacin injection. Material and Methods: Thirty albino rats were used in this study. They were divided into three groups. Each group ten rats. Group I: used as control. Group II: Were given Amikacin- intratympanic injection till complete loss of hearing function. This could be assessed by Distortion product Otoacoustic Emission (DPOAEs) and / or auditory brain stem evoked potential (ABR). GroupIII: were given intra-peritoneal injection of bone marrow stem cell after complete loss of hearing caused by Amikacin. Clinical assessment was done using DPOAEs and / or auditory brain stem evoked potential (ABR), before and after bone marrow injection. Histological assessment of the inner ear was done by light and electron microscope. Also, Detection of stem cells in the inner ear by immunohistochemistry. Results: Histological examination of the specimens showed promising improvement in the structure of cochlea that may be responsible for the improvement of hearing function in rats detected by DPOAEs and / or ABR. Conclusion: Bone marrow stem cells transplantation might be useful for the treatment of SNHL.

Keywords: amikacin, hair cells, sensorineural hearing loss, stem cells

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9520 Influence of Ligature Tightening on Bone Fracture Risk in Interspinous Process Surgery

Authors: Dae Kyung Choi, Won Man Park, Kyungsoo Kim, Yoon Hyuk Kim

Abstract:

The interspinous process devices have been recently used due to its advantages such as minimal invasiveness and less subsidence of the implant to the osteoporotic bone. In this paper, we have analyzed the influences of ligature tightening of several interspinous process devices using finite element analysis. Four types of interspinous process implants were inserted to the L3-4 spinal motion segment based on their surgical protocols. Inferior plane of L4 vertebra was fixed and 7.5 Nm of extension moment were applied on superior plane of L3 vertebra with 400N of compressive load along follower load direction and pretension of the ligature. The stability of the spinal unit was high enough than that of intact model. The higher value of pretension in the ligature led the decrease of dynamic stabilization effect in cases of the WallisTM, DiamTM, Viking, and Spear®. The results of present study could be used to evaluate surgical option and validate the biomechanical characteristics of the spinal implants.

Keywords: interspinous process device, bone fracture risk, lumbar spine, finite element analysis

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9519 Stability of a Self-Excited Machine Due to the Mechanical Coupling

Authors: M. Soltan Rezaee, M. R. Ghazavi, A. Najafi, W.-H. Liao

Abstract:

Generally, different rods in shaft systems can be misaligned based on the mechanical system usages. These rods can be linked together via U-coupling easily. The system is self-stimulated and may cause instabilities due to the inherent behavior of the coupling. In this study, each rod includes an elastic shaft with an angular stiffness and structural damping. Moreover, the mass of shafts is considered via attached solid disks. The impact of the system architecture and shaft mass on the instability of such mechanism are studied. Stability charts are plotted via a method based on Floquet theory. Eventually, the unstable points have been found and analyzed in detail. The results show that stabilizing the driveline is feasible by changing the system characteristics which include shaft mass and architecture.

Keywords: coupling, mechanical systems, oscillations, rotating shafts

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9518 Hydro-Mechanical Characterization of PolyChlorinated Biphenyls Polluted Sediments in Interaction with Geomaterials for Landfilling

Authors: Hadi Chahal, Irini Djeran-Maigre

Abstract:

This paper focuses on the hydro-mechanical behavior of polychlorinated biphenyl (PCB) polluted sediments when stored in landfills and the interaction between PCBs and geosynthetic clay liners (GCL) with respect to hydraulic performance of the liner and the overall performance and stability of landfills. A European decree, adopted in the French regulation forbids the reintroducing of contaminated dredged sediments containing more than 0,64mg/kg Σ 7 PCBs to rivers. At these concentrations, sediments are considered hazardous and a remediation process must be adopted to prevent the release of PCBs into the environment. Dredging and landfilling polluted sediments is considered an eco-environmental remediation solution. French regulations authorize the storage of PCBs contaminated components with less than 50mg/kg in municipal solid waste facilities. Contaminant migration via leachate may be possible. The interactions between PCBs contaminated sediments and the GCL barrier present in the bottom of a landfill for security confinement are not known. Moreover, the hydro-mechanical behavior of stored sediments may affect the performance and the stability of the landfill. In this article, hydro-mechanical characterization of the polluted sediment is presented. This characterization led to predict the behavior of the sediment at the storage site. Chemical testing showed that the concentration of PCBs in sediment samples is between 1.7 and 2,0 mg/kg. Physical characterization showed that the sediment is organic silty sand soil (%Silt=65, %Sand=27, %OM=8) characterized by a high plasticity index (Ip=37%). Permeability tests using permeameter and filter press showed that sediment permeability is in the order of 10-9 m/s. Compressibility tests showed that the sediment is a very compressible soil with Cc=0,53 and Cα =0,0086. In addition, effects of PCB on the swelling behavior of bentonite were studied and the hydraulic performance of the GCL in interaction with PCBs was examined. Swelling tests showed that PCBs don’t affect the swelling behavior of bentonite. Permeability tests were conducted on a 1.0 m pilot scale experiment, simulating a storage facility. PCBs contaminated sediments were directly placed over a passive barrier containing GCL to study the influence of the direct contact of polluted sediment leachate with the GCL. An automatic water system has been designed to simulate precipitation. Effluent quantity and quality have been examined. The sediment settlements and the water level in the sediment have been monitored. The results showed that desiccation affected the behavior of the sediment in the pilot test and that laboratory tests alone are not sufficient to predict the behavior of the sediment in landfill facility. Furthermore, the concentration of PCB in the sediment leachate was very low ( < 0,013 µg/l) and that the permeability of the GCL was affected by other components present in the sediment leachate. Desiccation and cracks were the main parameters that affected the hydro-mechanical behavior of the sediment in the pilot test. In order to reduce these infects, the polluted sediment should be stored at a water content inferior to its shrinkage limit (w=39%). We also propose to conduct other pilot tests with the maximum concentration of PCBs allowed in municipal solid waste facility of 50 mg/kg.

Keywords: geosynthetic clay liners, landfill, polychlorinated biphenyl, polluted dredged materials

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9517 Osteitis in the Diabetic Foot in Algeria

Authors: Mohamed Amine Adaour, Mohamed Sadek Bachene, Mosaab Fortassi, Wafaa Siouda

Abstract:

— Foot infections are responsible for a significant number of hospitalizations and amputations in diabetic patients. The objective of our study is to analyze and evaluate the management of diabetic foot in a surgical setting. A retrospective study was conducted based on a selected case of suspected diabetic foot infections of osteitis treated at the Mohamed Boudiaf hospital in Medea.The case was reiterated as a therapeutic charge, consisting of treating first the infection of the soft tissues, then the osteitis: biopsy after at least 15 days of cessation of antibiotic therapy. Successful treatment of osteitis was defined at the end of a follow-up period of complete wound healing, lack of bone resection/amputation surgery at the initial bone site during follow-up , Instead, biopsies are prescribed in the treatment of soft tissue infection. The mean duration of treatment for soft tissue infection was 2-3 weeks, the duration of the antibiotic-free window of therapy prior to bone biopsy was 2-4 weeks. This patient received medical management without surgical resection. The success rate for treating osteitis at one year was 73%, and healing at one year was 88%.It is often limited to a sausage of the foot at the cost of repeated amputations. The best management remains prevention, which necessarily involves setting up a specialized and adapted centre.

Keywords: diabetic foot, bone biopsy, osteitis, algeria

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9516 The Mechanical Behavior of a Cement-Fiber Composite Material

Authors: K. Harrat, M. Hidjeb, M. T’kint

Abstract:

The aim of the present research work is to characterize a cement palm date fiber composite in order to be used in isolation and in the manufacture of new structural materials. This technique may possibly participate seriously in the preservation of the environment and develop a growing need for plant products. On one hand, It has been shown that the presence of natural fiber in the composite materials manufacture, based on hydraulic binder, has improved the mechanical behaviour of the material. On the Other hand, It has been proven that the durability of composite materials reinforced with untreated fibers was largely affected by the presence of organic matter. In order to extract the organic material, the fibers were treated with boiling water and then coated with different types of products. A considerable improvement in the sensitivity to water of the fibers, as well as in the mechanical strength and in the ductility of the composite material was observed. The fiber being sensitive to water, the study put the emphasis on its dimensional stability.

Keywords: cement composite, durability, heat treatment, mechanical behaviour, vegetal fiber

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9515 Tc-99m MIBI Scintigraphy to Differentiate Malignant from Benign Lesions, Detected on Planar Bone Scan

Authors: Aniqa Jabeen

Abstract:

The aim of this study was to evaluate the effectiveness of Tc-99m MIBI (Technetium 99-methoxy-iso-butyl-isonitrile) scintigraphy to differentiate malignancies from benign lesions, which were detected on planar bone scans. Materials and Methods: 59 patients with bone lesions were enrolled in the study. The scintigraphic findings were compared with the clinical, radiological and the histological findings. Each patient initially underwent a three-phase bone scan with Tc-99m MDP (Methylene Diphosphonate) and if evidence of lesion found, the patient then underwent a dynamic and static MIBI scintigraphy after three to four days. The MDP and MIBI scans were evaluated visually and quantitatively. For quantitative analysis count ratios of lesions and contralateral normal side (L/C) were taken by region of interests drawn on scans. The Student T test was applied to assess the significant difference between benign and malignant lesions p-value < 0.05 was considered significant. Result: The MDP scans showed the increase tracer uptake, but there was no significant difference between benign and malignant uptake of the radiotracer. However significant difference (p-value 0.015), in uptake was seen in malignant (L/C = 3.51 ± 1.02) and benign lesion (L/C = 2.50±0.42) on MIBI scan. Three of thirty benign lesions did not show significant MIBI uptake. Seven malignant appeared as false negatives. Specificity of the scan was 86.66%, and its Negative Predictive Value (NPV) was 81.25% whereas the sensitivity of scan was 79.31%. In excluding the axial metastasis from the lesions, the sensitivity of MIBI scan increased to 91.66% and the NPV also increased to 92.85%. Conclusion: MIBI scintigraphy provides its usefulness by distinguishing malignant from benign lesions. MIBI also correctly identifies metastatic lesions. The negative predictive value of the scan points towards its ability to accurately diagnose the normal (benign) cases. However, biopsy remains the gold standard and a definitive diagnostic modality in musculoskeletal tumors. MIBI scan provides useful information in preoperative assessment and in distinguishing between malignant and benign lesions.

Keywords: benign, malignancies, MDP bone scan, MIBI scintigraphy

Procedia PDF Downloads 378
9514 Physiopathology of Osteitis in the Diabetic Foot

Authors: Mohamed Amine Adaour, Mohamed Sadek Bachene, Mosaab Fortassi, Wafaa Siouda

Abstract:

Foot infections are responsible for a significant number of hospitalizations and amputations in diabetic patients. The objective of our study is to analyze and evaluate the management of diabetic foot in a surgical setting. A retrospective study was conducted based on a selected case of suspected diabetic foot infections of osteitis treated at the Mohamed Boudiaf hospital in Medea. The case was reiterated as a therapeutic charge, consisting of treating first the infection of the soft tissues, then the osteitis: biopsy after at least 15 days of cessation of antibiotic therapy. Successful treatment of osteitis was defined at the end of a follow-up period of complete wound healing, lack of bone resection/amputation surgery at the initial bone site during follow-up , Instead, biopsies are prescribed in the treatment of soft tissue infection. The mean duration of treatment for soft tissue infection was 2-3 weeks, the duration of the antibiotic-free window of therapy prior to bone biopsy was 2-4 weeks. This patient received medical management without surgical resection. The success rate for treating osteitis at one year was 73%, and healing at one year was 88%.It is often limited to a sausage of the foot at the cost of repeated amputations. The best management remains prevention, which necessarily involves setting up a specialized and adapted centre.

Keywords: osteitis, antibiotic therapy, bone biopsy, diabetic foot

Procedia PDF Downloads 60
9513 Thermomechanical Damage Modeling of F114 Carbon Steel

Authors: A. El Amri, M. El Yakhloufi Haddou, A. Khamlichi

Abstract:

The numerical simulation based on the Finite Element Method (FEM) is widely used in academic institutes and in the industry. It is a useful tool to predict many phenomena present in the classical manufacturing forming processes such as fracture. But, the results of such numerical model depend strongly on the parameters of the constitutive behavior model. The influences of thermal and mechanical loads cause damage. The temperature and strain rate dependent materials’ properties and their modelling are discussed. A Johnson-Cook Model of damage has been selected for the numerical simulations. Virtual software called the ABAQUS 6.11 is used for finite element analysis. This model was introduced in order to give information concerning crack initiation during thermal and mechanical loads.

Keywords: thermo-mechanical fatigue, failure, numerical simulation, fracture, damage

Procedia PDF Downloads 371
9512 Experimental and Theoretical Study on Hygrothermal Aging Effect on Mechanical Behavior of Fiber Reinforced Plastic Laminates

Authors: S. Larbi, R. Bensaada, S. Djebali, A. Bilek

Abstract:

The manufacture of composite parts is a major issue in many industrial domains. Polymer composite materials are ideal for structural applications where high strength-to-weight and stiffness-to-weight ratios are required. However, exposition to extreme environment conditions (temperature, humidity) affects mechanical properties of organic composite materials and lead to an undesirable degradation. Aging mechanisms in organic matrix are very diverse and vary according to the polymer and the aging conditions such as temperature, humidity etc. This paper studies the hygrothermal aging effect on the mechanical properties of fiber reinforced plastics laminates at 40 °C in different environment exposure. Two composite materials are used to conduct the study (carbon fiber/epoxy and glass fiber/vinyl ester with two stratifications for both the materials [904/04] and [454/04]). The experimental procedure includes a mechanical characterization of the materials in a virgin state and exposition of specimens to two environments (seawater and demineralized water). Absorption kinetics for the two materials and both the stratifications are determined. Three-point bending test is performed on the aged materials in order to determine the hygrothermal effect on the mechanical properties of the materials.

Keywords: FRP laminates, hygrothermal aging, mechanical properties, theory of laminates

Procedia PDF Downloads 257
9511 Diagnostic Physiopathology of Osteitis in the Diabetic Foot

Authors: Adaour Mohamed Amine, Bachene Mohamed Sadek, Fortassi Mosaab, Siouda Wafaa

Abstract:

Foot infections are responsible for a significant number of hospitalizations and amputations in diabetic patients. The objective of our study is to analyze and evaluate the management of diabetic foot in a surgical setting. A retrospective study was conducted based on a selected case of suspected diabetic foot infections of osteitis treated at the Mohamed Boudiaf hospital in Medea. The case was reiterated as a therapeutic charge, consisting of treating first the infection of the soft tissues, then the osteitis: biopsy after at least 15 days of cessation of antibiotic therapy. Successful treatment of osteitis was defined at the end of a follow-up period of complete wound healing, lack of bone resection/amputation surgery at the initial bone site during follow-up , Instead, biopsies are prescribed in the treatment of soft tissue infection. The mean duration of treatment for soft tissue infection was 2-3 weeks, the duration of the antibiotic-free window of therapy prior to bone biopsy was 2-4 weeks. This patient received medical management without surgical resection. The success rate for treating osteitis at one year was 73% and healing at one year was 88%.It is often limited to a sausage of the foot at the cost of repeated amputations. The best management remains prevention, which necessarily involves setting up a specialized and adapted centre.

Keywords: osteitis, antibiotic therapy, bone biopsy, diabetic foot

Procedia PDF Downloads 75
9510 Advancement in Adhesion and Osteogenesis of Stem Cells with Histatin Coated 3D-Printed Bio-Ceramics

Authors: Haiyan Wang, Dongyun Wang, Yongyong Yan, Richard T. Jaspers, Gang Wu

Abstract:

Mesenchymal stem cell and 3D printing-based bone tissue engineering present a promising technique to repair large-volume bone defects. Its success is highly dependent on cell attachment, spreading, osteogenic differentiation, and in vivo survival of stem cells on 3D-printed scaffolds. In this study, human salivary histatin-1 (Hst1) was utilized to enhance the interactions between human adipose-derived stem cells (hASCs) and 3D-printed β-tricalcium phosphate (β-TCP) bioceramic scaffolds. Fluorescent images showed that Hst1 significantly enhanced the adhesion of hASCs to both bioinert glass and 3D-printed β-TCP scaffold. In addition, Hst1 was associated with significantly higher proliferation and osteogenic differentiation of hASCs on 3D-printed β-TCP scaffolds. Moreover, coating 3D-printed β-TCP scaffolds with histatin significantly promotes the survival of hASCs in vivo. The ERK and p38 but not JNK signaling was found to be involved in the superior adhesion of hASCs to β-TCP scaffolds with the aid of Hst1. In conclusion, Hst1 could significantly promote the adhesion, spreading, osteogenic differentiation, and in vivo survival of hASCs on 3D-printed β-TCP scaffolds, bearing a promising application in stem cell/3D printing-based constructs for bone tissue engineering.

Keywords: 3d printing, adipose-derived stem cells, bone tissue engineering, histatin-1, osteogenesis

Procedia PDF Downloads 32
9509 Oncological and Antiresorptive Treatment of Breast Cancer: Dental Assessment and Risk of MRONJ Development

Authors: Magdalena Korytowska, Gunnar Lengstrand, Cecilia Larsson Wexell

Abstract:

Background: Breast cancer (BC) is the most common cancer among women worldwide, and cases are continuing to increase in Sweden. Bone is the most common metastatic site in breast cancer patients, where > 65-75% of women with advanced breast cancer develop bone metastases during their disease. To prevent the skeletal-related events of metastases (e.g., pathological fractures, bone loss, cancer-induced bone pain, and hypercalcemia bone), two different classes of antiresorptive medications (AR), bisphosphonate and denosumab are typically administered every 3 to 4 weeks. Since 2015, adjuvant bisphosphonate treatment has been used every six months for three to five years in postmenopausal women for the prevention of skeletal metastases and improved survival. Methods: A case-control study was conducted to test the hypotheses that patients treated with high-dose AR are at higher risk of developing MRONJ than breast cancer patients with adjuvant bisphosphonate treatment at a lower dose. Medical and odontological data was collected between 2015-2020. Assessment of oral health and dental care before and during oncological treatment took place at the specialist clinic for Orofacial medicine linked to the specific hospital. Results: In total, 220 patients were included, 101 patients in the high-dose group and 119 patients in the adjuvant BP-treatment group. MRONJ was diagnosed in 13 patients (14%) in the high-dose group. The mandible was affected in most of the cases (84.6%), with a mean duration of high-dose treatment of 19.7 months. In 46.2% of cases, no dental cause of MRONJ could be identified. Overall, estrogen receptor-positive (ER+) BC was the most representative type in 172 patients (78.2%). However, this was 83.9% in the high-dose cases group. The most used drug was denosumab. Twenty-five patients (26.9%) switched their medication from ZOL to denosumab during their oncological treatment. Patients with ER+ breast cancer were reported in 88 patients (87.8%) in the adjuvant group that was treated with ZOL. Conclusions: MRONJ was diagnosed only in the high-dose AR group. Dental assessment and care of patients in the adjuvant group should be considered, with a recommendation to potentially prolong ZOL treatment from 3 to 5 years, with concomitant use of hormonal therapy in patients diagnosed with ER+ breast cancer to prevent bone loss induced by oncological treatment. A new referral for dental assessment is very important in the case of bone metastases when treatment with high dose AR will be required since it is associated with a higher risk of MRONJ.

Keywords: antiresorptive therapy, breast cancer, dental care, MRONJ

Procedia PDF Downloads 56
9508 Traumatic Osteoarthritis Induces Mechanical Hyperalgesia through IL-1β/TNF-α-Mediated Upregulation of the Sema4D Gene Expression

Authors: Hsiao-Chien Tsai, Yu-Pin Chen, Ruei-Ming Chen

Abstract:

Introduction: Osteoarthritis (OA) is characterized by joint destruction and causes chronic disability. One of the prominent symptoms is pain. Alleviating the pain is necessary and urgent for the therapy of OA patients. However, currently, understanding the mechanisms that drive OA-induced pain remains challenging, which hampers the optimistic management of pain in OA patients. Semaphorin 4D (Sema4D) participates in axon guidance pathway and bone remodeling, thus, may play a role in the regulation of pain in OA. In this study, we have established a rat model of OA to find out the mechanisms of OA-induced pain and to deliberate the roles of Sema4D. Methods: Behavioral changes and the pro-inflammatory cytokines (IL-1β, TNF-α, and IL-17) associated with pain were measured during the development of OA. Sema4D expression in cartilage and synovial membrane at 1, 4, and 12 weeks after inducing OA was analyzed. To assess if Sema4D is related to the neurogenesis in OA as an axon repellant, we analyzed the expression of PGP9.5 as well. Results: Synovitis and cartilage degradation were evident histologically during the development of OA. Mechanical hyperalgesia was most severe at week 1, then persisted thereafter. It was associated with stress coping strategies. Similar to the pain behavioral results, levels of IL-1β and TNF-α in synovial lavage fluid were significantly elevated in the OA group at weeks 1 and 4, respectively. Sema4D expression in cartilage and the synovial membrane was also enhanced in the OA group and was correlated with pain and pro-inflammatory cytokines. The marker of neurogenesis, PGP9.5, was also enhanced during the development of OA. Discussion: OA induced mechanical hyperalgesia, which might be through upregulating IL-1β/TNF-α-mediated Sema4D expressions. If anti-Sema4D treatment could reduce OA-induced mechanical hyperalgesia and prevent the subsequent progression of OA needs to be further investigated. Significance: OA can induce mechanical hyperalgesia through upregulation of IL-1β/TNF-α-mediated Sema4D and PGP9.5 expressions. And the upregulation of Sema4D may indicate the severity or active status of OA and OA-induced pain.

Keywords: traumatic osteoarthritis, mechanical hyperalgesia, Sema4D, inflammatory cytokines

Procedia PDF Downloads 54
9507 Degradation of Mechanical Properties of Offshoring Polymer Composite Pipes in Thermal Environment

Authors: Hamza Benyahia, Mostapha Tarfaoui, Ahmed El-Moumen, Djamel Ouinas

Abstract:

Composite pipes are commonly used in the oil industry, and extreme flow of hot and cold gas fluid can cause degradation of their mechanical performance and properties. Therefore, it is necessary to consider thermomechanical behavior as an important parameter in designing these tubular structures. In this paper, an experimental study is conducted on composite glass/epoxy tubes, with a thickness of 6.2 mm and 86 mm internal diameter made by filament winding of (Փ = ± 55°), to investigate the effects of extreme thermal condition on their mechanical properties b over a temperature range from -40 to 80°C. The climatic chamber is used for the thermal aging and then, combine split disk system is used to perform tensile tests on these composite pies. Thermal aging is carried out for 8hr but each specimen was subjected to various temperature ranges and then, uniaxial tensile test is conducted to evaluate their mechanical performance. Experimental results show degradation in the mechanical properties of composite pipes with an increase in temperature. The rigidity of pipes increases progressively with a decrease in thermal load and results in a radical decrease in their elongation before fracture, thus, decreasing their ductility. However, with an increase in the temperature, there is a decrease in the yield strength and an increase in yield strain, which confirmed an increase in the plasticity of composite pipes.

Keywords: composite pipes, thermal-mechanical properties, filament winding, thermal degradation

Procedia PDF Downloads 115
9506 Development and Characterization of Ethiopian Bamboo Fiber Polypropylene Composite

Authors: Tigist Girma Kedane

Abstract:

The purpose of this paper is to evaluate the properties of Ethiopian bamboo fiber polymer composites for headliner materials in the automobile industry. Accurate evaluation of its mechanical properties is thus critical for predicting its behavior during a vehicle's interior impact assessment. Conventional headliner materials are higher in weight, nonbiodegradable, expensive in cost, and unecofriendly during processing compared to the current researched materials. Three representatives of bamboo plants are harvested in three regions of bamboo species, three groups of ages, and two harvesting months. The statistical analysis was performed to validate the significant difference between the mean strength of bamboo ages, harvesting seasons, and bamboo species. Two-year-old bamboo fibers have the highest mechanical properties in all ages and November has higher mechanical properties compared to February. Injibara and Kombolcha have the highest and the lowest mechanical properties of bamboo fibers, respectively. Bamboo fiber epoxy composites have higher mechanical properties compared to bamboo fiber polypropylene composites. The flexural strength of bamboo fibre polymer composites has higher properties compared to tensile strength. Ethiopian bamboo fibers and their polymer composites have the best mechanical properties for the composite industry, which is used for headliner materials in the automobile industry compared to conventional headliner materials.

Keywords: bampoo species, culm age, harvesting seasons, mechanical properties, polymer composite

Procedia PDF Downloads 37
9505 A Radiographic Superimposition in Orthognathic Surgery of Class III Skeletal Malocclusion

Authors: Albert Suryaprawira

Abstract:

Patients requiring correction of severe Class III skeletal discrepancy historically has been among the most challenging treatments for orthodontists. Correction of an aesthetic and functional problem is crucially important. This is a case report of an adult male aged 18 years who complained of difficulty in chewing and speaking. Patient has a prominent profile with mandibular excess. The pre-treatment cephalometric radiograph was taken to analyse the skeletal problem and to measure the amount of bone movement and the prediction soft tissue response. The panoramic radiograph was also taken to analyse bone quality, bone abnormality, third molar impaction, etc. Before the surgery, the pre-surgical cephalometric radiograph was taken to re-evaluate the plan and to settle the final amount of bone cut. After the surgery, the post-surgical cephalometric radiograph was taken to confirm the result with the plan. The superimposition between those radiographs was performed to analyse the outcome. It includes the superimposition of the cranial base, maxilla, and mandible. Superimposition is important to describe the amount of hard and soft tissue movement. It is also important to predict the possibility of relapse after the surgery. The patient needs to understand all the surgical plan, outcome and relapse prevention. The surgery included mandibular set back by bilateral sagittal split osteotomies. Although the discrepancy was severe using this combination of treatment and the use of radiographic superimposition, an aesthetically pleasing and stable result was achieved.

Keywords: cephalometric, mandibular set back, orthognathic, superimposition

Procedia PDF Downloads 238