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Application of combined three-dimensional bone and soft tissue model. A case report.

This article describes a new application in three-dimensional modelling. By adding the contours of important soft tissue structures to the bone contours, it is possible to produce a combined bone and soft tissue model. The advantages of this technique are shown in a patient suffering from a parapharyngeal tumour. The model not only enabled the precise localisation of the tumour in relation to the surrounding bone, but also identified important structures like the internal carotid artery in relation to the tumour.

Adult↗

In vivo measurement of total knee replacement wear.

Polyethylene wear is one of the most important causes of failure of total knee replacements (TKRs). Currently, wear can only be accurately measured by retrieval studies. There is a need for a method to measure wear accurately in vivo. We have developed a Roentgen stereophotogrammetric analysis (RSA) system that can measure penetration of the metallic femoral component into the polyethylene of the tibia. We have used this system to study six AGC TKRs at 6 years postoperatively and six control AGC TKRs at 2 weeks postoperatively. The mean difference between the RSA measured bearing thickness and the manufacturer's quoted values for the control group was -0.03 mm (S.D. 0.17). The average linear penetration in the study group was 0.8 mm (S.D. 0.46). This was significantly (P<0.0001) different from the control group. The average linear penetration rate was 0.13 mm per year (S.D. 0.08). We would expect the penetration to deepen with time. In young active patients, this could be a cause for concern, particularly with a thin bearing. The current system is accurate enough to measure wear at 5 years post TKR. It has the potential for predicting long-term wear problems with new designs of TKR and new materials within 2 years.

Aged↗

All-poly tibial component better than metal-backed: a randomized RSA study.

The quality of the fixation of the tibial component in 21 patients (23 knees) undergoing a cemented total-knee arthroplasty of the Profix design was investigated using radiostereometric analysis during 24 months. The patients were randomized to either an all-polyethylene (AP) or a metal-backed (MB) tibial component. The articulating geometry and the stem design of the implants were identical, as were the operative technique and the postoperative regimen. The results showed no negative consequences as regards fixation using AP tibial components. In all aspects, the AP components displayed magnitudes of migration on par with, or sometimes even lower than their MB counterparts. Five of 11 MB components displayed continuous migration between 1 and 2 years, compared to none of the AP implants, a finding known to be of positive prognostic significance when predicting future aseptic loosening.

Aged↗

Calvarial growth after linear craniectomy in scaphocephaly as evaluated by X-ray stereophotogrammetry.

An roentgen stereophotogrammetric system for the evaluation of skeletal adjustments following corrective surgery in craniosynostosis is described. Four illustrative cases of scaphocephaly, all treated with midline linear craniectomy, with uneventful postoperative follow-up periods of more than 4 years, are reported. The postoperative development, as evaluated by volumetric and kinematic analyses, was uniform but still rich in individual and local growth variations. This study confirms that roentgen stereometry ( = exact measurements from stereoradiographs), being an accurate and objective method, adds greatly to previous methods of postoperative assessment in craniofacial skeletal disorders.

Biomechanical Phenomena↗

Stability of the osteotomy site after oblique sliding osteotomy of the mandibular rami. A stereometric and plain radiographic study.

Displacement of the mandible 2-2 1/2 years after oblique sliding osteotomy of the mandibular rami is reported. Stability of the osteotomy site has been assumed to be complete much earlier, however. In the present stereo radiographic study mobility at the osteotomy site was recorded as late as 2 years after surgery. No sign of delayed healing was recorded in the plain radiographic examination. It seems possible that relapse after oblique sliding osteotomy continues as long as the functional matrix can influence an unstable osteotomy site. As plain radiography does not give full information on the quality of bone, the stability of the osteotomy site can not be assessed by this method.

Adolescent↗

Three dimensional analysis of the face in respect of zygomatic fractures and evaluation of the surgery with the aid of Moiré topography.

In this study, the author analyzed the facial deformity of patients with zygomatic fractures, using Moiré topography, which is a method of three dimensional morphometry. Facial Moiré photographs of patients were taken at 45 degree angles before and after operation and were quantitatively analyzed for degree of deformity by computer data processing. Each data was compared in the interval between injury and operation and in respect of the surgical procedures. Radiographic findings and normal individuals were also studied for comparison.

Cephalometry↗

Templates of the cartilage layers of the patellofemoral joint and their use in the assessment of osteoarthritic cartilage damage.

OBJECTIVE: To develop a methodology for generating templates that represent the normal human patellofemoral joint (PFJ) topography and cartilage thickness, based on a statistical average of healthy joints. Also, to determine the cartilage thickness in the PFJs of patients with osteoarthritis (OA) and develop a methodology for comparing an individual patient's thickness maps to the normal templates in order to identify regions that are most likely to represent loss of cartilage thickness. DESIGN: The patella and femur surfaces of 14 non-arthritic human knee joints were quantified using either stereophotogrammetry or magnetic resonance imaging. The surfaces were aligned, scaled, and averaged to create articular topography templates. Cartilage thicknesses were measured across the surfaces and averaged to create maps of normal cartilage thickness distribution. In vivo thickness maps of articular layers from 33 joints with OA were also generated, and difference maps were created depicting discrepancies between the patients' cartilage thickness maps and the normative template. RESULTS: In the normative template, the surface-wide mean+/-SD (maximum) of the cartilage thickness was 2.2+/-0.4mm (3.7mm) and 3.3+/-0.6mm (4.6mm) for the femur and patella, respectively. It was demonstrated that difference maps could be used to identify regions of thinner-than-normal cartilage in patients with OA. Patients were shown to have statistically greater regions of thin cartilage over their articular layers than the normal joints. On average, patients showed deficits in cartilage thickness in the lateral facet of the patella, in the anterior medial and lateral condyles, and in the lateral trochlea of the femur. CONCLUSIONS: This technique can be useful for in vivo clinical evaluation of cartilage thinning in the osteoarthritic patellofemoral joint.

Adult↗

Precision and accuracy of joint space width measurements of the medial compartment of the knee using standardized MTP semi-flexed radiographs.

OBJECTIVE: To quantify the precision and accuracy of measurements of joint space width (JSW) and joint space narrowing (JSN) from the medial tibiofemoral compartment of knee radiographs using a simple and easily adaptable protocol. METHODS: Radiographs of a caliper (a surrogate for JSW) were obtained to determine the precision limits of the system under ideal conditions. Bilateral knee radiographs from 10 healthy volunteers were obtained at three different times using the metatarsophalangeal (MTP) semi-flexed view posterior-anterior position without fluoroscopy. A backlit digitizing tablet and three manual methods were used to measure JSW and analyses of precision were performed. The accuracy of measuring change in JSW (a measure of JSN) was estimated from radiographs of cadaver knees that were placed in a servo-hydraulic device that moved the femur relative to the tibia through known intervals. RESULTS: Radiographic measurements of the caliper inter-blade distance were comparable to the resolution limits of the backlit digitizing tablet (0.025 mm). Repeated radiography of healthy subject knees produced JSW standard deviation (SD) measurements of 0.08 mm by the median SD method, and 0.11 mm by repeated measures analysis. The accuracy of JSN measurements in the cadaver knees as a mean difference from the known reference value was 0.09 mm. CONCLUSION: The results indicate a high level of precision in measurements of JSW from MTP semi-flexed view knee radiographs of normal volunteers. Reproducibility was attained through careful subject positioning without fluoroscopy and the use of a backlit digitizing tablet. From the cadaver study we can predict that greater than 0.13 mm of measured JSN represents actual or true change in JSN. This radiographic technique can be used as a primary measure for early knee osteoarthritis (OA) when cartilage thickness is decreasing and limited bony remodeling has occurred.

Arthrography↗

Handling missing marker coordinates in 3D analysis.

The use of mathematical formulations to retrieve missing data is not usually implemented as an automated computer procedure. The purpose of this paper is to present a simple mathematical formulation that can be used to retrieve the coordinates of markers hidden during a task. A strategy based on the smoothness of the variation of distance between points is devised, which leads to an automated computer procedure for retrieving hidden skin markers or missing joint coordinates (missing 3D points). This approach has the advantage of not being restricted to the usual rigid-body assumption.

Algorithms↗

Femoral anatomical frame: assessment of various definitions.

The reliability of the estimate of joint kinematic variables and the relevant functional interpretation are affected by the uncertainty with which bony anatomical landmarks and underlying bony segment anatomical frames are determined. When a stereo-photogrammetric system is used for in vivo studies, minimising and compensating for this uncertainty is crucial. This paper deals with the propagation of the errors associated with the location of both internal and palpable femoral anatomical landmarks to the estimation of the orientation of the femoral anatomical frame and to the knee joint angles during movement. Given eight anatomical landmarks, and the precision with which they can be identified experimentally, 12 different rules were defined for the construction of the anatomical frame and submitted to comparative assessment. Results showed that using more than three landmarks allows for more repeatable anatomical frame orientation and knee joint kinematics estimation. Novel rules are proposed that use optimization algorithms. On the average, the femoral frame orientation dispersion had a standard deviation of 2, 2.5 and 1.5 degrees for the frontal, transverse, and sagittal plane, respectively. However, a proper choice of the relevant construction rule allowed for a reduction of these inaccuracies in selected planes to 1 degrees rms. The dispersion of the knee adduction-abduction and internal-external rotation angles could also be limited to 1 degrees rms irrespective of the flexion angle value.

Algorithms↗

A stereomorphologic study of bone matrix apposition in HA-implanted cavities observed with SEM, being prepared by a microvascular cast and freeze-fracture method.

In order to obtain further understanding of the relationship between hydroxyapatite (HA) with regard to its properties as an implantation bed, dense HA particles were implanted into the tibiae of dogs. Following the healing periods of 2 weeks, 1 month, 2 months, 3 months and 6 months, the specimens were prepared with a combination of a microvascular cast method and a freeze-fracture technique, allowing observations to be made with a scanning electron microscope (SEM). Under SEM, osteogenesis among the HA particles developed in a programmed sequence. The unfolding sequence revealed that the sinusoidal capillaries provided the initial evidence of vascularization preceding new bone formation, with microvessels creeping along the interparticular space among the HA particles. Having established an intimate contact existing between the microvessels, collagen fibres and the HA surface, the HA particles served as a supporting scaffold for the vessels to creep over and to connect with each other to form a vascular network. The way that the collagen fibres attached to the HA particles was either through globular depositions or via directly abutting themselves on to the HA surface. On closer inspection the osteoblasts with extracellular collagen fibrils were observed over the HA surface. By appositional growth, osteoblasts laid down a bone matrix in successive layers, forming a woven bone around the HA particles. As the implantation time increased, bony tissues gradually transformed into mature bone occupying all of the interparticular space. This study successfully revealed the spatial relationship between bone cells, collagen fibres and blood vessels in an osteogenetic sequence among HA particles, as revealed by a microvascular cast and the freeze-fracture method.

Animals↗

Variation of the spatial position computed by Roentgen Stereophotogrammetric Analysis (RSA) under non-standard conditions.

Roentgen Stereophotogrammetric Analysis (RSA) has been applied to different kinds of research in order to obtain important information in the biomechanics field. Operative requirements change according to the type of investigation and sometimes practical conditions do not always permit one to respect standard specifications. The aim of this paper is to verify the reliability of the system under non-standard conditions, studying the effects of the focus-to-film distance on the determination of 3D co-ordinates of markers. The application of statistical analysis, consisting of two and three way ANalysis Of VAriance (ANOVA), showed that focus-to-film distance is not a significant source of variation, i.e., the system can correctly compute the marker position inside the calibrated space under all conditions of magnification. Since we obtained a fluctuation due to focal distance change of 10(-5) mm (LSD for 95% confidence level), we can assert that this source causes a variation strictly within the limits required by clinical investigations. Thus, this study contributes to improving the flexibility of RSA in clinical applications, making the technical requirements of the radiographic set-up less constraining.

Analysis of Variance↗

Intrapair facial differences in twins.

Annual serial records in the form of facial contour maps were examined for 18 like-sexed twin pairs of near equal zygosity distribution. Zygosity diagnosis was based primarily on hematological reports for 26 of the 36 children and the remainder were diagnosed on a basis of the concordance or discordance of various physical characteristics: standing height, finger print ridge count, tooth size, and hair and eye colour. Thirteen facial parameters were measured on 274 maps. After age correcting and three-point smoothing, more than 1,150 intrapair differences of individual facial parameters were measured. In general, the dizygotic twin pairs had the larger mean intrapair differences in facial parameters and the monozygotic twin pairs had the smaller intrapair mean differences. The more important facial parameters for distinguishing the two groups were identified and used to calculate a "facial similarity index".

Adolescent↗

Metric analyses of the teeth and faces of South Australian twins.

Procedures are described for the acquisition and analysis of data in a study of the dental and facial characteristics of South Australian twins. Comparisons of the mesiodistal diameters of maxillary incisors in MZ and DZ twins revealed heterogeneity of total variances and evidence of inequality of mean values for some dimensions between MZ and DZ twins. Previous estimates of heritabilities for tooth size, relying on classical assumptions in twin research, may be exaggerated. A preliminary analysis of facial shape was undertaken using a procedure for shape matching based on a least squares fit of homologous coordinates. There was evidence of mirror-imaging in some MZ twin pairs and differences in facial asymmetry between male and female DZ twins. Future extensions of the study using methods for three-dimensional shape analysis are described.

Adolescent↗

A calibration method used for volumetric measurement of orthodontically induced root resorption craters.

The aim of this study was to measure the accuracy and reproducibility of volumetric estimations obtained by a commercial software used to measure resorption craters induced by orthodontic forces. Twenty human first maxillary premolars were selected and divided into light and heavy force groups with 25 and 225 g of force applied to the upper-right first premolars, respectively. The contralateral teeth served as controls. Samples were extracted and prepared for SEM stereoimaging after 28 days of force application. Volumetric measurements of these resorption craters were generated by the software. Standardized pyramidal indentations by the Vickers microhardness tester on four solid metallic cylindrical rods (brass, copper, stainless steel, and aluminum) similar to the dimensions of human premolars were used for calibration. Mathematically calculated volumes of these indentations were compared to volumes estimated by the software. The software estimated the errors of volumes of pyramidal indentations of the harder and softer materials to within 11 and 19%, respectively. Non-uniform plastic deformation that occurred in softer materials during indentation distorts the calculated results. The estimates obtained by the software even for distorted indentations caused by non-uniform plastic deformation have high degrees of reproducibility and accuracy.

Bicuspid↗

Photogrammetric measurements of implant positions. Description of a technique to determine the fit between implants and superstructures.

A photogrammetric technique was designed to measure the position of dental implants in 3 dimensions to enable assessment of the fit of superstructures placed on the implants. A relatively simple camera set-up was developed and tested. Calibration of the camera was performed in a high-precision analytical plotter and revealed a film measurement accuracy of 0.005 mm. The achieved measuring accuracy for clear and well defined points on clinical components was found to be around 0.02 mm. To find the center points of the implants, points on the circumference were measured. These points are not well defined, which resulted in an estimation of the center point of the implant with a precision of 0.05 mm. Independent measurements of a prosthesis with 5 implants were also within the precision of 0.05 mm. The angular orientation of the top surface of the implant cylinder (abutment, brass replica of gold alloy cylinder of the framework) was measured with a precision of 0.01 radians, which corresponded to an error with a peripheral gap of about 0.03 mm. This value was about 5-10 times lower than the clinical fit between frameworks and abutments, measured in 3 randomly selected clinical cases.

Dental Implants↗

Mucosal topography around implants in edentulous upper jaws. Photogrammetric three-dimensional measurements of the effect of replacement of a removable prosthesis with a fixed prosthesis.

A photogrammetric technique was tested to measure the topography of the mucosa around implants, placed in edentulous upper jaws. Photographs were taken of casts from 6 patients, who all had used a removable overdenture for one year. Another series of photographs was taken on new casts after the use of a fixed prosthesis for a second year. The 6 pairs of photographs were measured and compared in an analytical stereo plotter for surface contour and implant positions. The results from the measurements indicated a trend of general recession of the mucosa after one year with fixed prosthesis, both on the buccal as well as on the palatal side. The mean volume of recession was 222.4 mm3, corresponding to an average of 0.4 mm3/mm2 of mucosa. More recession was generally observed on the palatal side, but obvious variations between the patients were present. In conclusion, the photogrammetric technique was considered to be well suited for analysing tissue contours in various dental situations.

Aged↗

Accuracy of implant-supported prostheses in the edentulous jaw: analysis of precision of fit between cast gold-alloy frameworks and master casts by means of a three-dimensional photogrammetric technique.

Distortions of 15 routine implant-supported prostheses were measured in relation to the master casts after completion by means of a 3-dimensional (3-D) photogrammetric technique. All prostheses were designed as one-piece gold-alloy castings with resin teeth. Five of the prostheses were placed in the edentulous maxilla, and the remaining were placed in the lower jaw. Distortion of the cylinders was mostly observed in the horizontal plane (x- and y-axis) while the vertical aspect seemed to be more stable. The mean 3-D center point distortion was 42 (SD 15) and 74 (SD 38) microns for the upper and lower jaws, respectively. The measurements revealed a range of 3-D center point distortion from 16 to 80 and 15 to 165 microns for the different jaws, respectively. The corresponding 3-D mean angular distortion of the cylinders was 51 (SD 35) microns in lower and 70 (SD 75) microns in the upper jaws. A correlation was found between 3-D center point distortion and the width as well as the curvature of the implant arch, indicating more displacement the wider and the more curved the arch was. The 3-D center point distortion was also significantly higher in the upper jaws which could possibly be explained by the curvature of the implant arch and higher numbers of implants in the upper jaws. Further problems with the fit of upper jaw castings could be related to more alloy in the castings and poor alignment of implants.

Dental Prosthesis Design↗