Search

Background: In clinical practice, specific customization is needed to address foot pathology, which must be disease and patient-specific. To date, the traditional methods for manufacturing custom functional Foot Orthoses (FO) are based on plaster casting and manual manufacturing, hence orthotic therapy depends entirely on the skills and expertise of individual practitioners. This makes the procedures difficult to standardize and replicate, as well as expensive, time-consuming and material-wasting, as well as difficult to standardize and replicate. 3D printing offers new perspectives in the development of patient-specific orthoses, as it permits addressing all the limitations of currently available technologies, but has been so far scarcely explored for the podiatric field, so many aspects remain unmet, especially for what regards customization, which requires the definition of a protocol that entails all stages from patient scanning to manufacturing. Methods: A feasibility study was carried out involving interdisciplinary cooperation between industrial engineers and podiatrists. To that end: (i) For patient-specific data acquisition, 3D scanning of the foot is compared to traditional casting. (ii) a modelling GD workflow is first created to design a process permitting easy creations of customized shapes, enabling the end user (the podiatrist) to interactively customize the orthoses. Then, (iii) a comparison is made between different printing materials, in order to reproduce the same mechanical behavior shown by standard orthoses. To do this, the mechanical properties of standard materials (Polycarbonate sheets), cut and hand-shaped, are compared with four groups of 3D printed samples: poly(ethylene glycol) (PETG), poly(acrylonitrile-butadiene.styrene) (ABS), polycarbonate (PC) and poly(lactic acid) (PLA) obtained by Fused Filament Fabrication (FFF). Results: Differences found between the foot plaster model obtained with the plaster slipper cast in a neutral position and the model of the real foot obtained with 3D scanning in the same position can be ascribed to the non-stationarity of the patient during the acquisition process, and were limited by a locking system with which no substantial differences in the almost entire sole of the foot scan were observed. Conclusions: Using the designed GD workflow, podiatrists with limited CAD skills can easily design and interactively customize foot orthoses to adapt them to the patients’ clinical needs. 3D printing enables the complex shape of the orthoses to be reproduced easily and quickly. Compared to Polycarbonate sheets (gold standard), all the printed materials were less deformable and reached lower yield stress for comparable deformation. No modifications in any of the materials as a result of printing process were observed.

In this work, a flexible and extensive digital platform for Smart Homes is presented, exploiting the most advanced technologies of the Internet of Things, such as Radio Frequency Identification, wearable electronics, Wireless Sensor Networks, and Artificial Intelligence. Thus, the main novelty of the paper is the system-level description of the platform flexibility allowing the interoperability of different smart devices. This research was developed within the framework of the operative project HABITAT (Home Assistance Based on the Internet of Things for the Autonomy of Everybody), aiming at developing smart devices to support elderly people both in their own houses and in retirement homes, and embedding them in everyday life objects, thus reducing the expenses for healthcare due to the lower need for personal assistance, and providing a better life quality to the elderly users.

The purpose of this work is the morphological.11 characterization of a Voronoi-based biomimetic bone scaffold, developed through an interactive generative design process and obtained by an additive manufacturing system. In particular, the assessment of its characteristics was carried out according to the main indices of trabecular bone structures. Therefore, a biomimetic cubic bone scaffold ( $$10\times 10\times 10$$ mm) with controlled porosity (P% = 80%) and mean pores size ( $$D_{p}=0.800\,\hbox { mm}$$ ) was first designed and then manufactured with Ti6Al4V by means of EOSINT M270, a direct metal laser sintering system. The surface morphology of the scaffold was analyzed by a Scanning Electron Microscopy, equipped with an Energy Dispersive X-ray Spectrometry, while the internal morphology was examined through a high-resolution micro-CT SkyScan 1172. Finally, the morphometric assessment of the scaffold was carried out using ImageJ with BoneJ, a tool for image bone analysis, by measuring the main indices for the characterization of trabecular bone structure. The Ti6Al4V scaffold, even though with smaller porosity (P% = 73%) and mean pores size ( $$D_{p}=0.695 \hbox { mm}$$ ) with respect to the expected values, was successfully fabricated with fully interconnected porous architecture and intact trabecular skeleton. Moreover, the main indices for the characterization of trabecular bone structure were well congruent with the actual natural bone. A viable and reproducible method to fabricate Ti6Al4V biomimetic bone scaffolds, with controlled porosity and mean pores size, was presented. These kind of scaffolds allowed reproducing the actual architecture of the trabecular bone and could be suitable for Bone Tissue Engineering, according to specific surgical requirements.

In regenerative medicine, 3D scaffolds are used to sustain the regeneration of tissues in removed or damaged parts of the human body. As such practices are being widely experimented in clinical applications, the design, the materials and the manufacturing process to obtain efficient 3D biocompatible lattices are being significantly investigated. Nevertheless, most of the proposed designs are based on regular 3D shapes obtained from the repetition of unit cells disposed in a three-dimensional array. This approach does not exploit the whole potential of computer-aided design tools coupled with manufacturing capabilities for freeform shapes. In this paper, we propose a method to model biomimetic lattices controlling the porosity and the pores size of scaffolds to be integrated with the anatomical shape of the defect. The method has been implemented in bone tissue case study and implements a generative design approach based on Voronoi diagrams.

The aim of regenerative medicine is replacing missing or damaged bone tissues with synthetic grafts based on porous interconnected scaffolds, which allow adhesion, growth, and proliferation of the human cells. The optimal design of such scaffolds, in the Bone Tissue Engineering field, should meet several geometrical requirements. First, they have to be customized to replicate the skeletal anatomy of the patient, and then they have to provide the proper trabecular structure to be successfully populated by the cells. Therefore, for modelling such scaffolds, specific design methods are needed to conceive extremely complex structures by controlling both macro and micro shapes. For this purpose, in the last years, the Computer Aided Design of Triply Periodic Minimal Surfaces has received considerable attention, since their presence in natural shapes and structures. In this work, we propose a method that exploit Triply Periodic Minimal Surfaces as unit cell for the development of customized trabecular scaffolds. The aim is to identify the mathematical parameters of these surfaces in order to obtain the target requirements of the bone grafts. For that reason, the method is implemented through a Generative Design tool that allow to interactively controlling both the porosity and the pores size of the scaffolds.

Purpose. This study evaluated the efficacy of a regenerative approach using mesenchymal stem cells (MSCs) and CAD-CAM customized pure and porous hydroxyapatite (HA) scaffolds to replace the temporomandibular joint (TMJ) condyle.Methods. Pure HA scaffolds with a 70% total porosity volume were prototyped using CAD-CAM technology to replace the two temporomandibular condyles (left and right) of the same animal. MSCs were derived from the aspirated iliac crest bone marrow, and platelets were obtained from the venous blood of the sheep. Custom-made surgical guides were created by direct metal laser sintering and were used to export the virtual planning of the bone cut lines into the surgical environment. Sheep were sacrificed 4 months postoperatively. The HA scaffolds were explanted, histological specimens were prepared, and histomorphometric analysis was performed.Results. Analysis of the porosity reduction for apposition of newly formed bone showed a statistically significant difference in bone formation between condyles loaded with MSC and condyles without (P<0.05). The bone ingrowth (BI) relative values of split-mouth comparison (right versus left side) showed a significant difference between condyles with and without MSCs (P<0.05). Analysis of the test and control sides in the same animal using a split-mouth study design was performed; the condyle with MSCs showed greater bone formation.Conclusion. The split-mouth design confirmed an increment of bone regeneration into the HA scaffold of up to 797% upon application of MSCs.

The implant-supported fixed rehabilitation of patients with an atrophic edentulous crest remains a challenge if bone augmentation is not planned. A minimal intervention approach for bone regeneration is necessary to minimize the flap overextension needed to close the defect over the augmented bone. Prosthetically guided bone regeneration can determine the amount of bone augmentation necessary for definitive prosthetic fixed rehabilitation. The positions of the implants and prosthetic restoration were planned; a 0.3 mm thick titanium mesh was customized for bone augmentation by using computer-aided design and computer-aided manufacturing and rapid prototyped by laser sintering, and the definitive prosthetic rehabilitation was carried out according to the initial treatment plan. This resulted in minimal bone augmentation relative to the functional needs of the definitive prosthetic rehabilitation.

A feasibility study was performed in order to demonstrate the benefits of designing and manufacturing a customized foot orthosis by means of digital technologies, such as Reverse Engineering (RE), Generative Design (GD) and Additive Manufacturing (AM). The aim of this work was to define the complete design-manufacturing process, starting from the 3D scanning of the human foot anatomy to the direct fabricating of the customized foot orthosis. Moreover, this first methodological study tries to combine a user-friendly semi-automatic modelling approach with the use of low-cost devices for the 3D laser scanning and the 3D printing processes. Finally, the result of this approach, based on digital technologies, was also compared with that achieved by means of conventional manual techniques.

In this paper we report the application of CAD/CAM based technologies for the innovative development of customized surgical devices to assist the mandibular rehabilitation in both primary surgery (resection and reconstruction) and secondary surgery (only reconstruction). Design and manufacturing of such customized surgical device are conducted according to the virtual pre-operative planning of the surgeon and with the aim to transferring this planning into the operating theatre. In the case of primary surgery, a cutting guide is developed to assist the resection step while a bone plate is developed to assist the reconstruction step. Instead, in the case of secondary surgery, in addition to the bone plate to support the reconstruction, also a repositioning guide is designed to bring back to the original position the resected stumps according to the original shape of the mandible. Finally, the components of the surgical devices are manufactured by DMLS in alloys suitable for biomedical applications.

This paper describes a new protocol for mandibular reconstruction. Computer-aided design/computer-aided manufacturing (CAD/CAM) technology was used to manufacture custom-made cutting guides for tumor ablation and reconstructive plates to support fibula free flaps. CT scan data from a patient with an odontogenic keratocyst on the left mandibular ramus were elaborated to produce a virtual surgical plan of mandibular osteotomy in safe tissue for complete ramus resection. The CAD/CAM procedure was used to construct a customized surgical device composed of a cutting guide and a titanium reconstructive bone plate. The cutting guide allowed the surgeon to precisely transfer the virtual planned osteotomy into the surgical environment. The bone plate, including a custom-made anatomical condylar prosthesis, was designed using the outer surface of the healthy side of the mandible to obtain an ideal contour and avoid the bone deformities present on the side affected by the tumor. Operation time was reduced in the demolition and reconstruction phases. Functional and aesthetic outcomes allowed patients to immediately recover their usual appearance and functionality. This new protocol for mandibular reconstruction using CAD/CAM to construct custom-made guides and plates may represent a viable way to reproduce the patient’s anatomical contour, give the surgeon better procedural control, and reduce operation time.

Heel fat pad cushioning efficiency is the result of its structure, shape and thickness. However, while a number of studies have investigated heel fat pad (HFP) anatomy, structural behavior and material properties, no previous study has described its three-dimensional morphology in situ. The assessment of the healthy, unloaded, three-dimensional morphology of heel pad may contribute to deepen the understanding of its role and behavior during locomotion. It is the basis for the assessment of possible HFP morphological modifications due to changes in the amount or distribution of the loads normally sustained by the foot. It may also help in guiding the surgical reconstruction of the pad and in improving footwear design, as well as in developing a correct heel pad geometry for finite element models of the foot. Therefore the purpose of this study was to obtain a complete analysis of HFP three-dimensional morphology in situ. The right foot of nine healthy volunteers was scanned with computed tomography. A methodological approach that maximizes reliability and repeatability of the data was developed by building a device to lock the foot in a neutral position with respect to the scan planes during image acquisition. Scan data were used to reconstruct virtual three-dimensional models for both the calcaneus and HFP. A set of virtual coronal and axial sections were extracted from the three-dimensional model of each HFP and processed to extract a set of one- and two-dimensional morphometrical measurements for a detailed description of heel pad morphology. The tissue exhibited a consistent and sophisticated morphology that may reflect the biomechanics of the foot support. HFP was found to be have a crest on its anterior dorsal surface, flanges on the sides and posteriorly, and a thick portion that reached and covered the posterior surface of the calcaneus and the achilles tendon insertion. Its anterior internal portion was thinner and a lump of fat was consistently present in this region. Finally, HFP was found to be thicker in males than in females.

Aim: To design a surgical template to guide the insertion of craniofacial implants for nasal prosthesis retention. Materials and methods: The planning of the implant position was obtained using software for virtual surgery; the positions were transferred to a free-form computer-aided design modeling software and used to design the surgical guides. A rapid prototyping system was used to 3D-print a three-part template: a helmet to support the others, a starting guide to mark the skin before flap elevation, and a surgical guide for bone drilling. An accuracy evaluation between the planned and the placed final position of each implant was carried out by measuring the inclination of the axis of the implant (angular deviation) and the position of the apex of the implant (deviation at apex). Results: The implant in the glabella differed in angulation by 7.78°, while the two implants in the premaxilla differed by 1.86 and 4.55°, respectively. The deviation values at the apex of the implants with respect to the planned position were 1.17 mm for the implant in the glabella and 2.81 and 3.39 mm, respectively, for those implanted in the maxilla. Conclusions: The protocol presented in this article may represent a viable way to position craniofacial implants for supporting nasal prostheses. To cite this article: Ciocca L, Fantini M, De Crescenzio F, Persiani F, Scotti R. Computer-aided design and manufacturing construction of a surgical template for craniofacial implant positioning to support a definitive nasal prosthesis. Clin. Oral Impl. Res. 22, 2011; 850–856 doi: 10.1111/j.1600-0501.2010.02066.x

Ear defects in patients affected by Treacher Collins syndrome necessitate the replacement of the existing anatomic residuals of the ears with custom-made prostheses. This paper describes a multidisciplinary protocol involving both medicine and computer-aided design/computer-aided manufacturing for manufacturing ear prostheses. Using innovative prototyping technologies together with conventional silicone processing procedures, a step-by-step procedure is presented. The complete workflow includes laser scanning of the defective regions of a patient's face, the use of 3D anatomic models from an ear digital library and rapid prototyping of both substructures for bar anchoring and moulds for silicone processing.

In this work a novel design and manufacturing procedure have been experimented in order to improve the production of implant-supported nasal prosthesis. The complete workflow was divided into three main steps: data capture, prosthesis design and prosthesis manufacturing. First, the data capturing of the patient’s face was obtained by means of 3D laser scanning. Then, design and manufacturing phases were carried out through CAD–CAM procedures and Rapid Prototyping technologies to obtain the mold for the silicone processing and the substructure for the retention of the prosthesis. Moreover, to design the customized prosthesis based on real anatomic shapes, a novel “Ear&Nose Digital Library” was developed in the framework of a multidisciplinary project with the involvement of students from medicine and engineering faculties. Advantages in terms of improvement of retention and cost reduction are presented.

Purpose– The purpose of this paper is to describe two different approaches for manufacturing pre-formed titanium meshes to assist prosthetically guided bone regeneration of atrophic maxillary arches. Both methods are based on the use of additive manufacturing (AM) technologies and aim to limit at the minimal intervention the bone reconstructive surgery by virtual planning the surgical intervention for dental implants placement.Design/methodology/approach– Two patients with atrophic maxillary arches were scheduled for bone augmentation using pre-formed titanium mesh with particulate autogenous bone graft and alloplastic material. The complete workflow consists of four steps: three-dimensional (3D) acquisition of medical images and virtual planning, 3D modelling and design of the bone augmentation volume, manufacturing of biomodels and pre-formed meshes, clinical procedure and follow up. For what concerns the AM, fused deposition modelling (FDM) and direct metal laser sintering (DMLS) were used.Findings– For both patients, a post-operative control CT examination was scheduled to evaluate the progression of the regenerative process and verify the availability of an adequate amount of bone before the surgical intervention for dental implants placement. In both cases, the regenerated bone was sufficient to fix the implants in the planned position, improving the intervention quality and reducing the intervention time during surgery.Originality/value– A comparison between two novel methods, involving AM technologies are presented as viable and reproducible methods to assist the correct bone augmentation of atrophic patients, prior to implant placement for the final implant supported prosthetic rehabilitation.

This report describes a novel protocol for the construction of surgical cutting guides and reconstructive titanium bone plates to guide osteotomies according to the preoperative plan and to position and fix an osseous free flap in mandibular reconstruction after cancer removal. Computed tomographic data of a mandible affected by an ameloblastoma were elaborated to produce a virtual surgical plan that included the osteotomy cuts, area of bone resection, and reconstruction. STLfiles were elaborated for use with direct metal laser sintering, and a cutting guide and custom-made bone fixation plate were rapidly prototyped. The operating time was reduced in both the demolition and reconstruction phases. The patient's usual appearance and functionality were restored immediately. The new protocol for mandibular reconstruction is a viable way of reproducing the patient's anatomical contour while giving the surgeon better procedural control and reducing operating time. The innovative technique presented here involves three steps: (1) surgery planning, (2) computer-aided design/computer-aided manufacture and rapid prototyping, and (3) the surgery. High-resolution computed tomographic images of the patient's craniofacial skeleton and soft tissues were acquired using a multidetector computed tomography scanner (HiSpeed CT scanning station; General Electric Company, Fairfield, Conn.). The Digital Imaging and Communications in Medicine–format data were processed by the surgeons using CMF 6.0 software (Materialise, Leuven, Belgium). Three projections of the bone cuts were made in the three spatial axes and imported in Rhino 4.0 software (Robert McNeel & Associates, Seattle, Wash.) to allow the perfect transfer of the surgical plan. The computer-aided design of the surgical device was obtained using Rhino 4.0 software. The first component was a customized cutting guide for use in mandibular resection and to maintain free space after tumor ablation (Fig. 1, above). The second component was a customized reconstructive bone plate to support the iliac free flap (Fig. 1, below). The plate was designed by thickening the outer surface of the mirrored healthy side of the mandible to obtain an ideal mandibular contour and to avoid bone deformities on the side affected by the tumor. Reference notches were also added to delimit the part that would support the free flap. The two components (cutting guide and bone plate) were projected so that the same holes for the screws to fix the guide were used to secure the bone plate that supported the free flap. The cutting guide and bone plate were manufactured directly using the EOSINT M270 system (Electro Optical Systems, Munich, Germany). EOS CobaltChrome MP1 (Electro Optical Systems) was used to produce the cutting guide. The bone plate was produced with EOS Titanium Ti64 (Electro Optical Systems). A man with an ameloblastoma of the left mandibular body underwent mandibular resection and reconstruction using an iliac free flap. The mandibular cutting guide was fixed to the mandible to reproduce the demolition plan (Fig. 2, above). After mandibular resection, the cutting guide was removed and the reconstructive plate was introduced and fixed using the same holes as for the cutting guide. The reconstructive bone plate supported the iliac free flap in the correct position to restore the patient's original mandibulofacial contour exactly (Fig. 2, below). The protocol presented here offers several benefits. First, the virtual environment permitted optimal preoperative planning for tumor ablation: the resection boundaries were chosen accurately in safe tissues. No operating time was consumed by modeling a plate to the native mandible.1–5 Second, the morphology of the opposite hemimandible was mirrored and the reconstruction bone plate was designed using the external healthy cortical bone as a template, reproducing the patient's ideal mandibular contour and avoiding potential bone deformities. Co...

This paper describes the multi-disciplinary approach to reconstruct the face of Dante Alighieri (1265–1321). Since Dante's sepulchre will be opened in 2021, the reconstructive process is based on morphological and metric data collected on the poet's cranium during the formal identification of his remains in 1921 by the anthropologist Fabio Frassetto, as well as on the resulting plaster model. Starting from this plaster model and a morphologically compatible reference mandible, since the original mandible was never found, a 3D digital model of the complete skull was obtained by reverse engineering and virtual modelling techniques. The most important aspect in this work was the method of virtual modelling proposed for the ex novo generation of the mandible. The physical model of the skull (cranium + mandible) was then produced by means of a rapid prototyping system. This model was finally used to recreate Dante's face via traditional facial reconstruction techniques currently used in forensic anthropology.

Recent statistics on causes of aviation accidents and incidents demonstrate that to increase air-transportation safety, we must reduce human errors' impact on operations. So, the industry should first address human factors related to people in stressful roles to significantly minimize such errors. In particular, aviation maintenance employees work under high-pressure conditions- that is, they're under strict time constraints and must adhere to stringent guidelines. Because of such constraints, they might be prone to making errors. Unfortunately, many of these errors might not become apparent until an accident occurs. Although maintenance errors are a recognized threat to aviation safety, there are few simulation and computer-based tools for managing human factor issues in this field. The main advantages in using computer-based systems to train or support technicians are that computers don't forget and that they can help humans clearly understand facts. Such features can help reduce errors due to procedure violations, misinterpretation of facts, or insufficient training. Toward that end, augmented reality (AR) is a promising technology to build advanced interfaces using interactive and wearable visualization systems to implement new methods to display documentation as digital data and graphical databases. Nevertheless, many factors-such as cumbersome hardware, the need to put markers on the aircraft, and the need to quickly create digital content-seem to hinder its effective implementation in industry.

PurposeThe purpose of this paper is to describe the method of virtually and physically reconstructing the missing part of a badly damaged medieval skull by means of reverse engineering, computer‐aided design (CAD) and rapid prototyping (RP) techniques.Design/methodology/approachLaser scanning data were used to create the 3D model of the damaged skull. Starting from this digital model, a virtual reconstruction of the missing part of the skull, based on the ideal symmetry with respect to the mid‐sagittal plane, was achieved in a CAD environment. Finally, the custom‐designed model was directly fabricated by means of the RP process.FindingsThe result shows that the designed missing part of the skull fits very well with the existing skeletal remains. The final physical assembly of the prototyped element on the damaged skull was tested, restoring it to its whole original shape.Research limitations/implicationsThe entire process was time‐consuming and may be applied just to the most representative skeletal remains.Practical implicationsThe method allows accurate fabrication of the missing part of the skull to be joined with the original skeletal remains. The advantage of using this technique is that the joining operation can be carried out without any need of supplementary connecting material, such as glue or plaster, to fix together the two parts.Originality/valueThe reversible and non‐invasive method improves the restoration process, reduces the risk of damage to the skeletal structure and allows reversion to the original repair as it was before.

The protocol presented here is intended to minimise the intervention in bone reconstruction surgery when severe atrophy or deformity is present in the maxillary arches. A patient underwent augmentation of an atrophic maxillary arch using titanium mesh and particulate autogenous plus bovine demineralised bone. After computed tomography data elaboration, computer-aided design and computer-aided machining were used to plan the augmentation of bone volume to improve the implant position needed to support the final dental prosthesis. The augmented maxilla was rapidly prototyped in plastic, and the titanium mesh was tested on this model before the surgical intervention. Then, the preformed titanium mesh was implanted in the maxillary arch with bone grafting. The bone was augmented relative to the position of the implants for the definitive fixed implant-supported rehabilitation. The protocol presented here is a viable, reproducible way to determine the correct bone augmentation for the final implant-supported prosthetic rehabilitation.

In this study, rapid CAD-CAM prototyping of pure hydroxyapatite to replace temporomandibular joint condyles was tested in sheep. Three adult animals were implanted with CAD-CAM-designed porous hydroxyapatite scaffolds as condyle substitutes. The desired scaffold shape was achieved by subtractive automated milling machining (block reduction). Custom-made surgical guides were created by direct metal laser sintering and were used to export the virtual planning of the bone cut lines into the surgical environment. Using the same technique, fixation plates were created and applied to the scaffold pre-operatively to firmly secure the condyles to the bone and to assure primary stability of the hydroxyapatite scaffolds during masticatory function. Four months post-surgery, the sheep were sacrificed. The hydroxyapatite scaffolds were explanted, and histological specimens were prepared. Different histological tissues penetrating the scaffold macropores, the sequence of bone remodeling, new apposition of bone and/or cartilage as a consequence of the different functional anatomic role, and osseointegration at the interface between the scaffold and bone were documented. This animal model was found to be appropriate for testing CAD-CAM customization and the biomechanical properties of porous, pure hydroxyapatite scaffolds used as joint prostheses.

A surgical guide is projected to aid the repositioning of the mandibular segments in their original locations, and a reconstruction bone plate is provided to support the fibula free flap. Computer-aided mandibular reconstruction involves three steps: virtual surgical planning, CAD/CAM and rapid-prototyping procedures for the design and manufacture of the customised surgical device and surgery. The duration of the reconstructive phase (

This study describes a protocol for the direct manufacturing of a customized titanium mesh using CAD-CAM procedures and rapid prototyping to augment maxillary bone and minimize surgery when severe atrophy or post-oncological deformities are present. Titanium mesh and particulate autogenous plus bovine demineralised bone were planned for patient rehabilitation. Bone augmentation planning was performed using the pre-op CT data set in relation to the prosthetic demands, minimizing the bone volume to augment at the minimum necessary for implants. The containment mesh design was used to prototype the 0.6 mm thickness customized titanium mesh, by direct metal laser sintering. The levels of regenerated bone were calculated using the post-op CT data set, through comparison with the pre-op CT data set. The mean vertical height difference of the crestal bone was 2.57 mm, while the mean buccal-palatal dimension of thickness difference was 3.41 mm. All planned implants were positioned after an 8 month healing period using two-step implant surgery, and finally restored with a partial fixed prosthesis. We present a viable and reproducible method to determine the correct bone augmentation prior to implant placement and CAD-CAM to produce a customized direct laser-sintered titanium mesh that can be used for bone regeneration.

Restoration of a nasal defect after ablative surgery for squamous cell carcinoma necessitates replacing the missing volume and anchoring a prosthesis to the patient's face. This report describes the failure of plastic reconstructive surgery after ablation of a squamous cell cancer of the nose and the esthetic and functional restoration of the patient with a nasal prosthesis. The process of making an implant-supported prosthesis using digital technology, including digitized anatomic models from a "nose library," and the rapid prototyping of the mesiostructure for bar anchorage and of the mold for silicone processing are presented.

PURPOSE: This study describes the workflow in a procedure to create a provisional facial prosthesis for cancer patients using digital and rapid prototyping technologies without the need for supporting craniofacial implants. MATERIALS AND METHODS: An integrated workflow procedure aimed at the construction of provisional silicone prosthesis was used to rehabilitate a facial disfigurement in a patient who had undergone ablative surgery of the midface. A laser scan of the defect was obtained, and a digital model of the patient's face was constructed using virtual mirroring of the healthy side and referencing the "Nose Digital Library." RESULTS: The missing volume of the face was reconstructed, and a rapid-prototyped mold was devised to process the silicone prosthesis. A provisional eyeglasses-supported prosthesis designed with a CAD/CAM-projected titanium substructure was connected using the micro-components of implant prosthetic devices. CONCLUSIONS: The workflow described herein offers a viable procedure for quickly restoring facial defects by means of provisional prosthetic rehabilitation.

We developed a model to test new bone constructs to replace spare skeletal segments originating from new generation scaffolds for bone marrow-derived mesenchymal stem cells. Using computed tomography (CT) data, scaffolds were defined using computer-aided design/computer-aided manufacturing (CAD/CAM) for rapid prototyping by three-dimensional (3D) printing. A bone defect was created in pig mandible ramus by condyle resection for CT and CAD/CAM elaboration of bone volume for cutting and scaffold restoration. The protocol produced a perfect-fitting bone substitute model for rapid prototyped hydroxyapatite (HA) scaffolds. A surgical guide system was developed to accurately reproduce virtually planned bone sectioning procedures in animal models to obtain a perfect fit during surgery.

Since teeth are resistant to decomposition processes, they provide important and at times unique sources of information about fossil humans. Fortunately, dental remains reflect significant evolutionary changes. These changes make a very important and often exclusive contribution to the definition of new taxa or the attribution of fossil specimens to existing taxa. The traditional approach to dental morphometric analyses usually focuses on the recording of several measures of the tooth with calipers, especially the two basic crown diameters (buccolingual and mesiodistal). However, since these measures do not adequately represent the complex morphology of the tooth, 2D images and 3D digital models of dental morphology have been used. For both types of analysis, the possibility of correctly comparing homologous teeth depends on the adoption of a common orientation system. The lack of such a system makes it difficult to compare the results of different studies. Here we describe a new method for orienting teeth specifically devised for the upper and lower first molar (M1). Samples of unworn maxillary (n=15) and mandibular (n=15) first molars of modern humans were scanned with a Roland Picza 3D digitizer. The 3D virtual models were used to compare our new orientation method with those proposed in the literature. The new orientation system, which meets a geometric criterion, is based on three points identified on the cervical line and ensures acceptable repeatability of the spatial positioning and orientation independent of the shape and wear of the first molar under investigation. This orientation system is a first step toward the creation of a virtual set of hominid and fossil human first molars, which will allow us to make comparisons via a sophisticated and noninvasive approach. This pilot study also provides guidelines to extend the new methodology to the other types of teeth.

INTRODUCTION After tumor removal or accidental injury, such as a gunshot or road accident, the plastic surgeon should do whatever possible using skin and cartilage to restore a defect involving the nose. Sometimes, however, the patient's condition does not allow plastic surgery rehabilitation, necessitating a silicone nasal prosthesis, which provides good aesthetics, respiratory function, and social relationship recovery. The methods most commonly used for retaining nasal prostheses include medical adhesives, mechanical support (e.g., eyeglasses), and osseointegrated craniofacial implants [1-6]. The medical adhesives used to retain prostheses may irritate soft tissues that contact the prosthesis and may damage the thin margins of the prosthesis when it is removed for maintenance and cleaning. An eyeglasses-supported nasal prosthesis system may result in displacement, with an opening at the margins of the prosthesis. For definitive rehabilitation, osseointegrated craniofacial implants (two positioned in the premaxilla in the nasal floor and one in the glabella, if necessary) and a metal support bar to stabilize the prosthesis are best for anchoring a nasal prosthesis to the skull. Because manufacturing a definitive implant-supported nasal prosthesis takes a long time and the patient needs to have an acceptable aesthetic appearance as soon as possible, a provisional eyeglasses-supported nasal prosthesis may be a temporary solution. Moreover, the use of eyeglasses to support the nasal prosthesis may be necessary when insufficient bone exists for implant placement. Recently, several authors have attempted to design facial prostheses (auricular and nasal) using computer-aided design/computer-aided manufacturing (CAD/CAM) technology to reduce time and costs and to increase the quality of the final product [7-13]. In 2007 and 2009, protocols for provisional eyeglasses-supported nasal prostheses were published [14-16]. These studies developed a simple transfer system requiring try-in on the patient's face for correct positioning of the eyeglasses and prosthesis with the use of a manual silicone-based approach. The investigators placed eyeglasses on the patient's face and used silicone to check the relationship with the nasal prosthesis wax-up to design the substructure framework used to connect the prosthesis to the eyeglasses. This article presents an update of this method in which the eyeglasses were digitized and the relative position of the nasal prosthesis was planned and evaluated in a virtual environment without any try-in appointment, further reducing the delivery time and patient discomfort. MATERIALS AND METHODS A 58-year-old man lost his entire nose after being shot (Figure 1). He was scheduled for a definitive nasal prosthesis anchored to osseointegrated craniofacial implants. His general medical condition, which did not allow surgical reconstruction, determined the schedule. In the meantime, to provide an immediate temporary solution and to enable the patient to recover socially, the maxillofacial prosthodontist constructed an eyeglasses-supported provisional prosthesis. [FIGURE 1 OMITTED] The flow chart of the process used to make the provisional prosthesis is shown in Figure 2. First, the patient's facial defect and surrounding anatomical structures, including both ears for later positioning of the digital model of the eyeglasses, were scanned with a three-dimensional (3-D) laser. We used a laser scanner (NextEngine Desktop 3-D Scanner; NextEngine, Inc; Santa Monica, California) to obtain a digital model of the entire face while the patient's eyes were covered with a protective anti-ultraviolet device, although the class 1M laser beam is classified as eye-safe scanning (Figure 3). The face was scanned from five (left, right, frontal, upper, and lower) different perspectives around the patient's head to detect all undercuts. …

The study of the morphological features of the foot is a fundamental component of footwear design, as it is the basis for the improvement of shoe properties such as fitting and cushioning. In this ...

Since teeth are resistant to decomposition processes, they provide important and at times unique sources of information about fossil humans. Fortunately, dental remains reflect significant evolutionary changes. These changes make a very important and often exclusive contribution to the definition of new taxa or the attribution of fossil specimens to existing taxa. The traditional approach to dental morphometric analyses usually focuses on the recording of several measures of the tooth with calipers, especially the two basic crown diameters (buccolingual and mesiodistal). However, since these measures do not adequately represent the complex morphology of the tooth, 2D images and 3D digital models of dental morphology have been used. For both types of analysis, the possibility of correctly comparing homologous teeth depends on the adoption of a common orientation system. The lack of such a system makes it difficult to compare the results of different studies. Here we describe a new method for orienting teeth specifically devised for the upper and lower first molar (M1). Samples of unworn maxillary (n = 15) and mandibular (n = 15) first molars of modern humans were scanned with a Roland Picza 3D digitizer. The 3D virtual models were used to compare our new orientation method with those proposed in the literature. The new orientation system, which meets a geometric criterion, is based on three points identified on the cervical line and ensures acceptable repeatability of the spatial positioning and orientation independent of the shape and wear of the first molar under investigation. This orientation system is a first step toward the creation of a virtual set of hominid and fossil human first molars, which will allow us to make comparisons via a sophisticated and noninvasive approach. This pilot study also provides guidelines to extend the new methodology to the other types of teeth.

7.1.1 Ear & Nose Digital Library Ciocca L, Fantini M, De Crescenzio F. Nel caso in cui non si disponga di modelli preoperatori prima di iniziare la costruzione di una epitesi auricolare o nasale, è necessario avere modelli virtuali di riferimento che possano essere correttamente adattati sulla superficie del difetto. A tale scopo da un imnsieme di modelli reali in gesso presi da pazienti sani, si è proceduto alla costruzione di una biblioteca virtuale di modelli nasali ed auricolari che possano essere utilizzati anche nei casi congeniti di agenesia auris bilaterale, come accade ad es. come nella sindrome di Treacher Collins. La realizzazione dei modelli digitali è avvenuta attraverso la scansione laser 3D dei modelli in gesso. Le differenti prese necessarie per la completa aqcuisizione di ogni calco sono state quindi registrate e fuse in un unico modello tridimensionale. Vengono descritti nel dettaglio due casi di studio. 7.2 Progettazione di scaffold per la rigenerazione ossea: impostazione del modello di studio animale Uno dei problemi più cogenti della Protesi Maxillo-Facciale è la morfologia ossea e mucogengivale residua dell’anatomia dei mascellari dopo l’intervento chirurgico maxillo-facciale. Molte variabili influiscono nel risultato post-operatorio a livello morfologico, fra cui principalmente la mancanza di una corretta progettazione protesica preventiva dell’intervento di exeresi maxillo-facciale. Infatti spesso il chirurgo si trova a dover affrontare il caso clinico da un punto di vista demolitivo e ricostruttivo, senza una base di progettazione protesica finale di come il caso dovrà successivamente essere riabilitato che serva da riferimento durante l’intervento. Tale problematica è alla base di un ampio protocollo di ricerca che gli autori conducono sulla possibilità di progettare scaffold in grado di ripristinare il corretto volume e di ospitare al loro interno cellule staminali che consentano la rigenerazione tissutale ossea. Per tale obiettivo attualmente si sta lavorando su un modello di studio animale di cui si forniscono alcuni dettagli a titolo di esempio degli sviluppi futuri della ricerca nel campo della Protesi Maxillo-Facciale.

Teeth play a fundamental role in human evolutionary systematics because each species has different morphological and morphometric characteristics of the dentition. In morphometric analyses the information available from the two basic diameters (bucco-lingual and mesio-distal) is limited. Therefore some authors have used 2D imaging analysis or 3D dental models. At present, however, there are no standard orientation procedures or analytical methods that are valid for worn teeth. In this paper we present a new method of 3D analysis of first molars with a standardized orientation system and a comparative dental analysis. The proposed geometric orientation system is based on three points identified on the cervical line. The morphometric analysis of the orientated teeth is based on virtual sections of the dental crown for the first 4 mm beginning from the cervical line. This method was tested by principal components analysis. It correctly separated Neanderthal and modern human teeth and allowed us to classify two specimens of uncertain attribution. In addition to being based on an objective criterion of comparison the method maintained its power of taxonomic discrimination even when the crown height was reduced to 3 mm by wear.

This paper describes the application of 3D techniques, such as Reverse Engineering (RE), Computer Aided Design (CAD) and Rapid Prototyping (RP), for studying the skeletal remains of the Upper Palaeolithic Romito 7. Laser Scanning data were used to create the 3D models of the bones on which traditional and innovative analyses were performed in a CAD environment. Moreover, starting from the digital models of the single bones a virtual reconstruction of the whole skeleton both in the anatomical connection and in the burial position discovered during the excavation was carried out. Finally, physical models of the bones were directly fabricated by means of RP process. This non-invasive approach increase the amount of data collected from a morphological and morphometric point of view, reduces the risk of damages of the skeletal remains and allows the enhancement of the skeleton of the Romito 7 giving it back to its original configuration.

Le mummie costituiscono un patrimonio storico, culturale e scientifico di estrema importanza ma, a causa della fragilità dei tessuti molli e della presenza di strutture di rivestimento (quali il fardo nelle mummie mesoamericane), il loro studio deve essere condotto mediante tecniche di analisi non invasive. Lo scopo del presente lavoro è la realizzazione di un insieme dettagliato ed innovativo di misure antropometriche, eseguite sul modello virtuale dello scheletro di una mummia precolombiana del Perù, conservata presso i Civici Musei di Reggio Emilia. Per limitare al massimo gli interventi diretti sulla mummia, che avrebbero compromesso il suo già precario stato di conservazione, essa è stata sottoposta a Tomografia Computerizzata (TC). I dati così ottenuti sono stati utilizzati per costruire modelli tridimensionali dei segmenti del corpo in cui la mummia risulta smembrata, estrapolando in particolare la sola componente ossea, sulla quale si sono effettuate operazioni di manipolazione virtuale e analisi morfologiche e metriche senza provocare danni ai reperti. Viene inoltre presentata, a scopo esemplificativo, una ipotesi preliminare di morfometria virtuale dell’omero resa possibile dalla creazione di modelli 3D dell’osso, che evidenzia le potenzialità dell’approccio virtuale e le prospettive di sviluppi innovativi che esso può offrire nel campo della morfologia e morfometria scheletrica.

Attualmente le diverse problematiche legate alla conservazione e valorizzazione dei Beni Culturali, coinvolgono uno spettro sempre più ampio di discipline, alcune specifiche, altre mutuate da altri settori scientifici di ricerca. In generale, tra le tecnologie applicate ai Beni Culturali, stanno assumendo un ruolo di crescente interesse le Time Compression Technologies, come Ingegneria Inversa e Prototipazione Rapida. L’impiego di queste tecnologie, già consolidate nell’ambito della progettazione industriale come strumenti di grande efficacia per sostenere l’innovazione di prodotto e migliorare la competitività aziendale, nasce principalmente dall’esigenza di ridurre il Time to Market, cioè l’intervallo di tempo che intercorre tra la progettazione di un nuovo prodotto o servizio e la sua commercializzazione. In particolare, con il termine di Ingegneria Inversa si individua la metodologia che consente, partendo da un oggetto reale, di risalire al suo modello digitale attraverso processi di acquisizione 3D, mentre, con il termine di Prototipazione Rapida si individua una serie di sistemi che, prescindendo dalla complessità costruttiva, sono in grado di realizzare un modello fisico per addizione di materiale layer by layer, a partire dal suo modello digitale. L’impiego di queste tecnologie, per la loro trasversalità e flessibilità, consente, ora, di progettare nuove modalità di intervento anche nel campo dei Beni Culturali. Uno degli obiettivi legati ad applicazioni in questo campo è quello di ottenere riproduzioni ad alta precisione (modelli digitali e fisici) che possono essere proficuamente impiegate a scopo divulgativo e scientifico. Da un lato possono essere progettati nuovi sistemi di fruizione da parte del pubblico e, di conseguenza, nuove modalità di musealizzazione dei reperti, dall’altro, si possono fornire ad archeologi e ricercatori nuovi strumenti finalizzati a semplificare lo studio dei Beni Culturali, a incrementare la quantità e la qualità delle informazioni ottenibili dall’analisi dei modelli e a progettare nuove ipotesi di restauro. In questo lavoro si descrive la procedura seguita per rilevare la forma, ricostruire il modello digitale e realizzare una copia fisica di due casi di studio, il volto di un busto muliebre e un reperto di mosaico, in occasione di una campagna di rilievi svoltasi a Pompei nell’ottobre del 2005. Per la digitalizzazione dei reperti in situ è stato utilizzato il digitalizzatore piezoelettrico Picza PIX-30 della Roland, mentre, per la realizzazione delle copie fisiche, avvenuta in laboratorio, è stata impiegata la stampante 3D Dimension SST della Stratasys.

The work consists of the reconstruction of the face of the great poet called Dante Alighieri through a multidisciplinary approach that matches traditional techniques (manual ones), usually used in forensic anthropology, with digital methodologies that take advantage of technologies born in manufacturer- military fields but that are more and more often applied to the field of the cultural heritage. Unable to get the original skull of Dante, the work started from the data and the elements collected by Fabio Frassetto and Giuseppe Sergi, two important anthropologists, respectively at the University of Bologna and Rome, in an investigation carried out in 1921, sixth century anniversary of his death, on the remains of the poet collected in Ravenna. Thanks to this, we have a very accurate description of Dante’s bones, including 297 metric data inherent to the whole skeleton, some photographs in the scale of the skull, the various norms and many other bones, as well as a model of the skull subsequently realized by Frassetto. According to these information, a geometric reconstruction of Dante Alighieri skull including the jaw was carried out through the employment and integration of the instruments and technologies of the virtual reality, and from this the relative physical model through fast prototype was realized. An important aspect of the work regards in a particular manner the methodology of 3D modelling proposed for the new reconstruction of the jaw (not found in the course of the 1921 recognition), starting from a reference model. The model of the skull prototype is then useful as the basis for the successive stage of facial reconstruction through the traditional techniques of forensic art.

Il lavoro consiste nella ricostruzione del volto del sommo poeta Dante Alighieri attraverso un approccio multidisciplinare che combina tecniche tradizionali (manuali), solitamente utilizzate nell’ambito dell’antropologia forense, e metodologie digitali che sfruttano tecnologie nate in ambiente industriale-militare ma che vengono sempre più applicate anche al campo dei beni culturali. Non potendo disporre del cranio originale di Dante, il lavoro ha preso le mosse dai dati e dagli elementi raccolti da Fabio Frassetto e Giuseppe Sergi, antropologi rispettivamente presso le Università di Bologna e di Roma, nel corso della ricognizione effettuata nel 1921, sesto centenario della morte, sui resti del poeta conservati a Ravenna. Grazie a questa ricognizione disponiamo di una descrizione molto accurata delle ossa di Dante, corredata da ben 297 dati metrici inerenti tutto lo scheletro, di alcune fotografie in scala del cranio, nelle diverse norme, e di molte altre ossa, nonché di un modello del cranio successivamente realizzato dal Frassetto. Sulla base di queste informazioni è stata effettuata una ricostruzione geometrica del cranio di Dante Alighieri, completo di mandibola, attraverso l’impiego e l’integrazione degli strumenti e delle tecnologie della realtà virtuale, e la realizzazione del relativo modello fisico tramite prototipazione rapida. Un aspetto rilevante del lavoro riguarda, in particolare, la metodologia di modellazione 3D proposta per la generazione ex-novo della mandibola (non rinvenuta nel corso della ricognizione del 1921) partendo da un modello acquisito come riferimento. Il modello del cranio prototipato è servito poi da base per la fase successiva di ricostruzione facciale attraverso le tecniche tradizionali di arte forense.

Pre-Columbian civilizations in South America used to induce artificial cranial deformations. Researchers have studied modifications to skull morphology mainly by means of comparison of anthropometric indexes. The analysis of these indexes could be a valid approach for the evaluation of artificial cranial deformations, but anthropologists may be prevented from measuring the mummified skull at the traditional osteometric landmarks due to the soft tissues that cover the reference points on the bones. In this paper, the study of a set of human mummified remains is presented. 3D models of four skulls, coming from Peru, are generated via CT (Computed Tomography). Reference landmarks have been selected and outline profiles have been identified on the virtual skulls, in order to compute traditional anthropometric indexes. Finally, artificial cranial deformations have been evaluated using the 3D models and compared with the results of previous scientific works

In this work we present the results of innovative methods in the anthropological analysis of a preincaic mummy. This mummy is seriously damaged and dismembered in six fragments. Moreover, due to the mummified soft tissues which cover the bones of the real mummy, researchers are prevented from performing traditional morphometric analysis. Therefore CT acquisition and 3D surface reconstruction of the rare bones provide a unique and extensive data-set to enhance the results of scientific studies. Landmarks identification and detailed measurements have been carried out on the virtual skeleton of the whole mummy, whose original position had been previously identified. In order to perform repeatability and comparison of measures, especially on the limbs, a detailed orientation procedure has been applied. Moreover the integration of Virtual Reality and CAD (Computer Aided Design) tools lead to the computation of additional geometric features on selected single bones. Several considerations are provided by the computation of detailed indexes on the sections, distances and curvatures of the limbs. Furthermore the virtual skull has been analysed following a computer based approach for the evaluation of artificial cranial deformation. Silhouettes extraction, multivariate analysis and 3D visualization allow estimating the place of origin in accordance with previous scientific and recognised works on the classification of induced deformations. These are the results of a complex work that aims at a project based approach exploiting new computer based technologies in the analysis of ancient human remains. A modular and integrative approach shows how a multidisciplinary team, made of engineers and anthropologists, can really enhance the knowledge on the mummy and present it in a sustainable way.