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Objectives: To evaluate and compare an experimental surgical navigation system (ESNS) in implant placement accuracy to static planning and transfer systems. Material and Methods: Partially edentulous, surgical typodonts were used to simulate prosthetically-driven osteotomies in preclinical setting. After cbCT acquisition the DICOM files were used to reverse plan and fabricate surgical guides. Manual placement, three static guiding systems and ESNS were compared. Eight osteotomies per jaw were transferred to 10 typodonts in five series, resulting in 400 osteotomies by 3 operators, each modality. Lateral, vertical, total and angular deviations were measured and compared. Results: Computer-assisted systems were comparable and provided superior precision laterally and in angulation, but not vertically; implants placed in free-end positions were less accurate. Conclusions: All computer-aided methods showed less than 2 mm or 5 degrees error on average, which needs to be considered in clinical practice.

Objectives: To evaluate and compare an experimental surgical navigation system (ESNS) in implant placement accuracy to static planning and transfer systems. Material and Methods: Partially edentulous, surgical typodonts were used to simulate prosthetically-driven osteotomies in preclinical setting. After cbCT acquisition the DICOM files were used to reverse plan and fabricate surgical guides. Manual placement, three static guiding systems and ESNS were compared. Eight osteotomies per jaw were transferred to 10 typodonts in five series, resulting in 400 osteotomies by 3 operators, each modality. Lateral, vertical, total and angular deviations were measured and compared. Results: Computer-assisted systems were comparable and provided superior precision laterally and in angulation, but not vertically; implants placed in free-end positions were less accurate. Conclusions: All computer-aided methods showed less than 2 mm or 5 degrees error on average, which needs to be considered in clinical practice.

Uranium-zirconium alloy nuclear fuels have many advantages as compared with ceramic fuels, especially for fast reactor systems. However, metallic fuels aren’t currently used in commercial power production due in part to issues with fuel swelling during irradiation. A major contributor to this expansion issue, the formation of fission gasses into bubbles, is examined here. Methods to evaluate evolution of fission gas bubbles within a U-Zr alloy are discussed and refined. Specifically, transmission electron microscopy (TEM) for viewing bubbles within the interior of the alloy is investigated. One constraint on the use of the TEM is the lack of literature pertaining to what thinning techniques are successful for U-10Zr alloy. Both initial and final thinning techniques were investigated. After thinning was complete, the specimens were viewed via TEM to determine their suitability. In addition, samples of U-Zr alloy were irradiated with gas atoms in an accelerator to simulate bubble initiation and formation and viewed via TEM. Only preliminary investigations were completed. Evaluated electrolyte solutions included one part phosphoric acid to two parts sulfuric acid and two parts water (A), one part phosphoric acid to one part ethanol and one part glycerol (B), one part hydrochloric acid to one part water (C), two parts methanol to 13 parts phosphoric acid (D), and one part perchloric acid to nine parts acetic acid (G). Positive responses were received from the solutions A, C, and G which generated electron transparent areas with few to no process induced artifacts. TEM trials with each electrolyte were performed on un-irradiated U-10Zr alloy. These trials indicated that the polishing methods would work but are not yet optimal. In addition, U-10Zr alloy was irradiated and viewed in the TEM where those polished with electrolyte A consistently included the presence of large circular features that could indicate bubbles or voids. The foundation was laid for further study to be done on this topic through the use of electropolishing solutions as final thinning techniques. Additional work that is recommended includes: electropolishing parameter refinement; implantation of heavier gas atoms or at elevated temperatures; annealing of the implanted alloy; and computer modeling of resulting first principles phenomena.

Surgical correction of scoliosis is a complicated mechanical process. Understanding the loads applied to the spine and providing immediate feedback to surgeons during scoliosis surgery will prevent overloading, improve surgical outcome and patient safety. Long-term development of residual forces in the spinal instrument after surgery with the continual curvature changes over time has been unknown. The goal of this research work was to develop a wireless implantable sensor platform to investigate the loads during and after surgery. This thesis describes research leading to the design of a sensor platform that uses both 403 MHz and 2.45 GHz for wireless communication, and reports the resolution and accuracy of the built-in temperature sensor, the A/D accuracy of the sensing platform, the power consumption at different operation modes, the range of the wireless communication and the discharge characteristics of a potential capacitive power module. / Biomedical Engineering

Afirmação do problema. Estudos experimentais em animais são utilizados para avaliar previamente o resultado de pesquisas e sua necessidade de serem realizadas em humanos. Estudos em animais são fundamentais na implantodontia para que haja uma melhor compreensão da osseointegração. Durante o processo de execução de pesquisas nesse tipo de estudo, algumas dificuldades relacionadas ao manuseio, custos de manutenção e bem-estar dos animais tendem a dificultar o seu desenvolvimento. Finalidade. Esse estudo tem como objetivo, testar um novo dispositivo acoplado sobre o implante, para que possa atuar como uma extensão do mesmo, facilitando a realização da Análise de Frequência de Ressonância durante o processo de osseointegração permitindo que implantes instalados em ovelhas em diferentes períodos, possam ser reabertos sem que haja a necessidade de etapas cirúrgicas para a reabertura durante a realização de testes. Material e métodos. Foram utilizadas 4 ovelhas, sendo uma do Grupo Controle (GC) e 3 do Grupo Teste (GT). Cada animal recebeu oito implantes localizados próximos ao ângulo da mandíbula, sendo quatro do lado esquerdo e quatro do lado direito, totalizando, 32 implantes cone-morse Acqua® de 3,5 de diâmetro por 8,5mm de comprimento da empresa Neodent® que foram avaliados pela análise de frequência de ressonância com a medição do ISQ (Quociente de Estabilidade do Implante) utilizando um transdutor (SmartPeg) expressos numa escala de 0 a 100. Para o Grupo Controle (GC) as medições de ISQ foram realizadas pelo método convencional, onde o SmartPeg foi acoplado diretamente sobre a plataforma do implante. Já no Grupo Teste (GT) o dispositivo estudado, foi acoplado ao implante para que pudesse ser realizada a medição. Os períodos estudados foram: imediatamente após a cirurgia e com quatro semanas de osseointegração. Para a análise estatística foram empregados os testes de Wilcoxon e Man-Whitney com a probabilidade de 5% (p<0.05). Resultados. As médias obtidas no GC foram 50,47 imediatamente após cirurgia e 65,68 após 4 semana, enquanto que no GT foram 34,74 e 34,81, respectivamente. Comparando a diferença entre os grupos nas médias de ISQ imediatas e após quatro semanas, houve diferença significativa com p= 0.0321 e p= 0.0027, respectivamente, demonstrando que os resultados no GT nos dois períodos não foram equivalentes quando comparados ao GC. Conclusão. Os resultados demonstraram que o grupo teste, apesar de trazer benefícios em relação ao manuseio dos animais, não apresentou benefícios com relação à eficiência na leitura do ISQ, quando comparado ao método convencional. / Statement of the problem. Experimental studies in animals are used to pre-evaluate the results of research and their need to be performed in humans. Animal studies are fundamental in implantology so that there is a better understanding of osseointegration. During the execution of research in this type of study, some difficulties related to handling, maintenance costs and animal welfare tend to hinder its development. Purpose. This study aims to test a new device coupled on the implant, so that it can act as an extension of the same, facilitating the performance of the Resonance Frequency Analysis during the osseointegration process allowing implants installed in different periods of time, can be reopened without the need for surgical steps for reopening during testing. Material and methods. Four sheep were used, one being from the Control Group (GC) and 3 from the Test Group (GT). Each animal received eight implants located near the angle of the mandible, four on the left side and four on the right side, totaling 32 Acqua® 3.5 mm diameter 8.5 mm long implants of the company Neodent® that were evaluated by the resonance frequency analysis with the ISQ (Implant Stability Ratio) measurement using a transducer (SmartPeg) expressed on a scale of 0 to 100. For the Control Group (GC) the ISQ measurements were performed by the conventional method, where the SmartPeg was attached directly onto the implant platform. In the Test Group (GT) the studied device was attached to the implant so that the measurement could be performed. The periods studied were: immediately after surgery and four weeks of osseointegration. For the statistical analysis Wilcoxon and Man-Whitney tests were used, with a probability of 5% (p <0.05). Results. The averages obtained in the CG were 50.47 immediately after surgery and 65.68 after 4 weeks, while in the GT were 34.74 and 34.81, respectively. Comparing the difference between the groups in the means of immediate SAI and after four weeks, there was a significant difference with p = 0.0321 and p = 0.0027, respectively, demonstrating that the results in the WG in the two periods were not equivalent when compared to the CG. Conclusion. The results showed that the test group, despite having benefits in relation to the handling of the animals, did not present benefits in relation to the efficiency of the ISQ reading when compared to the conventional method.

AISI 316L est un acier inoxydable couramment utilisé comme biomatériau grâce à des propriétés telles qu'une résistance à la corrosion élevée. Cependant, en cas d'attaque corrosive, ils sont susceptibles de libérer des ions métalliques qui peuvent provoquer des allergies. En outre, plusieurs défaillances d'implants ont été rapportées et reliées au fait que leur résistance à la corrosion localisée est néanmoins limitée. Dans ce sens, cette thèse vise à évaluer différentes approches visant à améliorer la résistance à la corrosion de l'acier inoxydable 316L pour des applications biomédicales à l'aide de deux stratégies: (1) la modification de la composition au sein de l'alliage et (2) la modification de la surface.La composition globale de l'acier inoxydable 316L a été modifiée avec l'addition d'azote. Des coulées ‘laboratoire' avec des compositions contrôlées ont été testées dans des milieux chloruré ainsi que dans des solutions physiologiques. L'effet de la combinaison de Mo et N sur le potentiel de piqûre s'est avéré supérieur à la somme de leurs effets individuels, ce qui indique une synergie. Cet effet, cependant, s'est montré dépendent du pH, étant fortement présent pour des milieux acides et neutres, tout en diminuant de façon importante avec l'augmentation du pH. Lors des essais dans des conditions physiologiques, cet effet était encore plus bénéfique avec le vieillissement. L'azote semble avoir amélioré la tendance à la répassivation de l'acier inoxydable avec Mo, déplaçant ainsi le potentiel de rupture du film passif vers des valeurs plus élevées.La surface de AISI 316L a aussi été revêtue avec de verres métalliques à basede fer à l'aide de laser cladding. Les revêtements ont donné des résultats différents en fonction de l'alliage. Les revêtements de Fe43.2Co28.8B19.2Si4.8Nb4 et Fe60Cr8Nb8B24 ont montré une matrice avec des ségrégations, en particulier de Nb, ce qui réduit leur résistance à la corrosion. D'autre part, le revêtement de Fe48.6Mo13.9Cr15.2C14.4Y1.8B6 s'est avéré être effectivement amorphe mais avec une résistance à la corrosion inférieure à celle du substrat, en raison de la présence de défauts.Ti et TiN ont également été revêtus sur les fils AISI 316L en utilisant un prototype de pulvérisation magnétron en mode défilé. Dans cette étude, les modesstatiques et semi-continus ont été utilisés. Globalement, la résistance à la corrosion des revêtements étaient plus faibles que celle du substrat, ce surtout avec l'augmentation de l'épaisseur du revêtement. La présence d'hétérogénéités de revêtement a permis l'interaction substrat-électrolyte, diminuant la résistance à la corrosion la corrosion et entrainant la délamination des revêtements avec le vieillissement. Des dépôts de phosphate de calcium ont été trouvés sur la surface du revêtement après 14 jours d'immersion, ce qui semble indiquer la possibilité de la croissance favorable de la matière osseuse. / AISI 316L stainless steel is commonly used as biomaterial because of its desirable properties such as high corrosion resistance. They have, however, the problem of releasing metal ions upon corrosion that may cause allergies to both humans and animals. In addition, implant failures have been reported due to their limited resistance to localised corrosion. There is thus a need to find ways to improve their corrosion resistance. This thesis aims to evaluate different approaches intending to improve the corrosion resistance of AISI 316L stainless steel for biomedical applications using two strategies: (1) modification of the bulk composition and (2) surface modification.The bulk composition of 316L-type stainless steel was modified by adding nitrogen. Laboratory grades with controlled compositions were tested in chloride conditions at a wide range of pH and in simulated physiological conditions. The combination of Mo and N on the pitting potential was found to be beyond the sum of their individual effects, indicating synergy. The effect, however, was found to be pH-dependent, being largely present in acid to neutral chloride conditions and in physiological solutions, while diminishing in high pH. When tested in physiological conditions, this effect was even more beneficial with ageing. Nitrogen was found to enhance the repassivation of the Mo-containing stainless steel grade, driving the potential for passive film breakdown to higher values.The surface of AISI 316L was coated with Fe-based metallic glasses using laser cladding. The resulting coatings had different results depending on the alloy. The coatings of Fe43.2Co28.8B19.2Si4.8Nb4 and Fe60Cr8Nb8B24 showed a matrix with segregations, particularly of Nb, thereby lowering their corrosion resistance. On the other hand, the Fe48.6Mo13.9Cr15.2C14.4Y1.8B6 coating was found to be amorphous but with lower corrosion resistance than the substrate, due to the presence of defects.Ti and TiN were also coated on AISI 316L wires using a prototype for magnetron sputtering in moving deposition mode. In this study, static and semi-continuous modes of motion were used. Overall, the corrosion resistance of the coatings were lower than the substrate, increasing further with coating thickness. The presence of coating heterogeneity allowed for substrate-electrolyte interaction, driving forward corrosion and delamination with further immersion. Deposits of calcium phosphate were found on the coating surface after 14 days of immersion, indicating the possible favourability of bone material growth.

Objetivo: O objetivo do presente estudo foi avaliar a resistência de união da interface coping cerâmico-pilar de implante variando o agente cimentante antes e após ciclagem térmica. Material e métodos: Foram utilizados quarenta conjuntos de copings cerâmicos e.max - pilar sólido 5.5/ análogo regular, sendo estes divididos aleatoriamente de acordo com o agente cimentante (n=10): (OZ) óxido de zinco sem eugenol; (FZ) fosfato de zinco; (CIV) ionômero de vidro modificado por resina; (RES) resinoso autopolimerizável. O teste de resistência da união à tração foi executado em uma máquina de ensaios universal (Versat 2000-Panambra), com velocidade de 1,0mm/min, antes e após ensaio de envelhecimento por ciclagem térmica. Os resultados foram submetidos ao teste de normalidade e posteriormente a ANOVA (two-way) e teste de Tukey, com nível de significância de 5%. Resultados: Antes da ciclagem térmica, os valores variaram entre o mínimo de 50,77N (OZ) e o máximo de 240,21N (CIV). Não foi observada diferença entre OZ e FZ (60,16N), nem entre CIV e RES (230,36N). Após a ciclagem térmica, os valores foram de no mínimo 3,5N (OZ) e máximo de 330,66N (RES). OZ apresentou resultados estatísticamente inferiores se comparado aos demais, enquanto RES obteve resultados estatísticamente superiores em relação aos demais agentes cimentantes, FZ (90,58N) e CIV (280,43N) apresentaram resultados intermediários. Conclusões: O cimento de óxido de zinco sem eugenol foi associado ao pior desempenho comparado aos demais agentes avaliados antes e após a ciclagem. Antes da ciclagem térmica o maior valor médio obtido foi do ionômero de vidro, enquanto que após a ciclagem o maior valor médio foi do cimento resinoso. O envelhecimento das amostras promoveu inversão dos resultados do ionômero e resinoso, com melhor resultado mecânico para o cimento resinoso. / Objective: The aim of the present study was to evaluate the bond strength of the ceramic coping-abutment implant interface according to the luting agent, before and after thermal cycling. Methods: A total of forty sets of ceramic copings (IPS e.max) and solid pillar 5.5/ regular analogue were divided according to the luting agent (n=10): (OZ) zinc oxide with no eugenol; (ZP) zinc phosphate, (CIV) resin modified glass ionomer, (RES) adhesive resin cement. Tensile bond strength test was performed using a universal testing machine (2000-Versat Panambra) with a speed of 1.0mm/min, before and after thermal cycling. Results were submitted to normality test and then analyzed by ANOVA and Tukey test with significance level of 5%. Results: Prior to thermal cycling, values ranged from 50.77N (OZ) to 240.21N (CIV). No difference was observed between OZ and FZ (60.16N), nor between CIV and RES (230.36N). After thermal cycling, values ranged between 3.5N (OZ) and 330.66N (RES). OZ showed statistically lower mean values compared to the others. RES presented statistically higher mean values in comparison to the other luting agents. FZ (90.58N) and CIV (280.43N) showed intermediate results. Conclusions: Zinc oxide with no eugenol was associated with the worst performance compared to the other agents after thermal cycling. Before thermal cycling the highest mean value was obtained for the glass ionomer. However, after this step, adhesive resin cement showed the highest mean value of bond strength. The sample aging inverted results between ionomer and resin cement, with better mechanical performance for the resin cement.

This study investigated the immediate implant placement in the maxillary aesthetic zone without flap elevation or enhancement of the hard tissue component with filler or membrane material. The aim of this paper is to study treatment outcome for immediate implant placement in fresh extraction socket in the maxillary anterior region regarding marginal bone level. This retrospective cross-sectional study includes data on 41 patients, total of 54 implants (n = 54), treated for immediate placed implants without flap elevation. 30 patients, a total of 33 single immediate implants were placed in the anterior maxilla and immediately restored with a temporary crown. In another 11 patients, 21 implants were placed in fresh extraction sockets and temporalized with a provisional bridge engaging immediate implants and in some cases in combination with delayed implants. No implants were lost during the follow-up period, mean radiographic follow up was 32 months. Analysis of the radiographs presented mean bone level of all sites 1.47 mm (SD 1.63) immediately after the installation and 0.85 mm (SD 0.75) at the follow up evaluation, resulting in a mean bone gain of 0.62 mm. With careful patient selection immediate placement of implant in fresh extraction socket can be an attractive treatment modality in maxilla anterior region.

L'implantation cochléaire reste à ce jour le seul moyen capable de restaurer la perception auditive chez les personnes présentant une surdité sévère ou profonde en échec d'appareillage conventionnel. Son principe repose sur la stimulation électrique directe des neurones auditifs de la cochlée par un faisceau d'électrode inséré dans l'oreille interne. Malgré les progrès réalisés dans le manufacturage des électrodes et dans la technique chirurgicale, le geste d'insertion du faisceau d'électrode demeure traumatique. Ce traumatisme est souvent responsable de la perte de l'audition résiduelle sur les fréquences graves et d'une réaction inflammatoire conduisant à une cicatrisation fibreuse. Cette réaction fibreuse est délétère à la fois pour le fonctionnement de l'implant, car augmentant l'impédance des électrodes, mais aussi pour l'audition résiduelle lorsqu'elle est préservée, limitant ainsi les possibilités de stimulation hybride électro-acoustique. Aussi les recherches actuelles tendent à réduire cette fibrose par des moyens pharmacologiques limités, utilisant un corticoïde (dexaméthasone), sans pour autant que son efficacité n'ait été démontrée de manière formelle in vitro ou in vivo. En outre, les cibles moléculaires visées lors de la réaction inflammatoire et fibrotique dans la cochlée n'étant pas clairement identifiées, il est difficile de savoir si cette approche thérapeutique est la plus adaptée. Dans ce travail nous avons donc mis au point des modèles in vitro de culture de tranche de cochlée et d'explant cochléaire de rat pour tester l'efficacité antifibrotique et la toxicité de plusieurs drogues, dont la dexaméthasone, mais aussi l'aracytine, antimitotique non ototoxique et d'utilisation sûre au contact du système nerveux central. Entre nos mains, il apparaît que la stratégie antimitotique par application d'aracytine était plus efficace contre la fibrose et moins toxique pour les cellules sensorielles que la dexamethasone. Dans une seconde partie de ce travail, nous avons utilisé deux modèles in vivo de fibrose cochléaire, à savoir : l'induction d'une labyrinthite immune à Keyhole Limpet Hemocyanin et l'implantation chronique d'un corps étranger intra-cochléaire. A nouveau, l'aracytine délivrée par pompe osmotique intracochléaire permettait de réduire significativement la fibrose dans le modèle de labyrinthite alors que l'effet de la dexamethasone n'était pas significatif. De même la préservation de l'audition était statistiquement meilleure dans le groupe des animaux traités par antimitotiques. Aussi seule l'aracytine a été testée dans l'autre modèle de corps étranger intracochléaire. Elle permettait également de réduire la fibrose observée dans la cochlée, sans effet toxique sur les neurones auditifs. Si la préservation de l'audition était impossible dans le groupe contrôle, l'audition sur les basses fréquences était conservée chez les animaux traités par aracytine. Enfin, les seuils de stimulation électrique capables de provoquer une réponse électrophysiologique par le potentiel évoqué auditif étaient significativement inférieurs dans le groupe traité par aracytine. Ainsi, nous avons pu montrer qu'une stratégie antimitotique était capable d'inhiber efficacement la fibrose dans la cochlée in vitro et in vivo, et ce avec une efficacité supérieure à la dexaméthasone. Nous recommandons donc d'envisager en pratique clinique l'utilisation de l'aracytine pour prévenir la fibrose cochléaire. De plus, ce travail souligne l'intérêt de mieux décortiquer les voies cellulaires conduisant à l'inflammation et à la fibrose cochléaire, de sorte à déterminer les meilleures cibles et molécules candidates. Ces mêmes molécules pourront être testées sur les modèles que nous avons mis au point afin de proposer de nouvelles alternatives thérapeutiques à la prévention de la fibrose cochléaire. / Cochlear implantation is the only treatment capable of restoring the auditory pathways in patient suffering from severe to profound hearing loss with poor benefit from hearing aids. Its functioning relies on direct electric stimulation of primary auditory neurons through an electrode array inserted into the cochlea.Despite the advances in electrode design and surgical technique, the act of inserting the electrode array is still traumatic. These traumas result in the loss of residual hearing in low frequencies and provoke an inflammatory reaction leading to fibrous scarring. This fibrous reaction is deleterious to not only the implant performance by increasing the impedance of the electrodes, but also the preserved residual hearing which limit the possibilities of hybrid electro-acoustic stimulation.Current researches aim at limiting this fibrosis by drug application, such as corticosteroids. Therefore dexamethasone is frequently used, but its effectiveness has been only demonstrated formally in vitro or in vivo. Furthermore, the molecular targets set in the fibrotic and inflammatory reaction in the cochlea are not clearly identified, and it is unclear whether this therapeutic approach is best suited.In this study we have developed in vitro models of rat cochlear slice and cochlear explants culture to test the antifibrotic efficacy and toxicity of various drugs, including dexamethasone, but also aracytine, an antimitotic drug with very low ototoxicity which is safely used in contact with the central nervous system. In our hands, it appears that antimitotic aracytine is more effective against fibrosis and less toxic to the sensory cells than the anti-inflammatory drug dexamethasone.In the second part of this study, we used two in vivo models of cochlear fibrosis namely the KLH(keyhole limpet hemocyanin)-induced sterile labyrinthitis and the foreign-body-induced chronic labyrinthitis. Again, the intracochlear fibrosis in the model of KLH-induced labyrinthitis was signticantly reduced by the osmotic pump with aracytine, while the effect of dexamethasone was not significant. Also the preservation of the hearing was statistically better in the group of animals treated with this antimitotic drug. Consequently, aracytine was the only drug tested in the other model of foreign-body-induced labyrinthitis. Again, aracytine reduced fibrosis in the cochlea, without any toxic effects on auditory neurons. While the preservation of the hearing was not achieved in the control group, the low frequencies hearing was preserved in animals treated with aracytine. Finally, the thresholds of electrical stimulation eliciting auditory brainstem response recordings were significantly lower in the treated group by aracytine.Thus, we have shown that an antimitotic strategy was able to inhibit fibrosis effectively in the cochlea in vitro and in vivo, and this with a greater efficiency than dexamethasone. We therefore recommend considering in clinical practice the use of aracytine to prevent cochlear fibrosis. In addition, this study stresses the importance of analyzing the cellular pathways of cochlear inflammation and fibrosis, in order to determine the best targets and candidate molecules. These molecules could be tested on the models that we have developed in order to offer new therapeutic options to prevent cochlear fibrosis.