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dos Santos CPC, Cruel PTE, Buchaim DV, da Cunha MR, Ervolino E, Issa JPM, Miglino MA, Buchaim RL. Calcium Hydroxyapatite Combined with Photobiomodulation for Bone Tissue Repair: A Systematic Review. MATERIALS (BASEL, SWITZERLAND) 2025; 18:1120. [PMID: 40077345 PMCID: PMC11902113 DOI: 10.3390/ma18051120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Revised: 12/11/2024] [Accepted: 02/26/2025] [Indexed: 03/14/2025]
Abstract
Repairing hard tissues, such as bones, remains a significant challenge, especially in adverse clinical conditions. Calcium hydroxyapatite (CaHA), a calcium phosphate (CaP), has structural and chemical characteristics similar to the mineral structure of human bones and teeth, offering bioactivity and biocompatibility properties. Photobiomodulation (PBM) uses light to reduce inflammation and accelerate tissue healing. This systematic review analyzes the combination of CaHA and PBM from 25 studies extracted from the PubMed, Web of Science, and ScienceDirect databases, using the keywords "hydroxyapatite AND photobiomodulation", "calcium hydroxyapatite AND photobiomodulation", and "low-level laser therapy AND calcium phosphate." All studies focused on bone regeneration, with no mention of soft tissue applications. The most commonly used calcium-based material was biphasic calcium phosphate (76%), a combination of CaHA and β-tricalcium phosphate, while 16% of the studies did not specify the brand or product used. With regard to PBM, the most commonly used wavelengths (48% of cases, with a tie of 24% for each) were infrared lasers at 808 nm and 780 nm, with 20% of studies not mentioning the brand or manufacturer. The results underscore the predominant focus on bone regeneration, highlighting the need for further investigations into soft tissue applications and the establishment of standardized protocols. The combination of CaHA and PBM shows promise in regenerative medicine and dentistry, although more research is needed to expand its experimental and clinical use.
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Affiliation(s)
- Camila Pascoal Correia dos Santos
- Graduate Program in Applied Dental Sciences, Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-901, Brazil; (C.P.C.d.S.); (P.T.E.C.)
| | - Paola Tatiana Espinosa Cruel
- Graduate Program in Applied Dental Sciences, Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-901, Brazil; (C.P.C.d.S.); (P.T.E.C.)
| | - Daniela Vieira Buchaim
- Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of Veterinary Medicine and Animal Science, University of Sao Paulo (FMVZ/USP), Sao Paulo 05508-270, Brazil;
- Medical School, University Center of Adamantina (FAI), Adamantina 17800-000, Brazil
| | - Marcelo Rodrigues da Cunha
- Postgraduate Program in Health Sciences, Faculty of Medicine of Jundiaí (FMJ), Jundiaí 13202-550, Brazil;
| | - Edilson Ervolino
- Department of Basic Sciences, School of Dentistry, São Paulo State University (UNESP), Araçatuba 16015-050, Brazil;
| | - João Paulo Mardegan Issa
- Department of Basic and Oral Biology, Ribeirao Preto School of Dentistry, University of Sao Paulo, Ribeirao Preto 14040-904, Brazil;
| | - Maria Angelica Miglino
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, Postgraduate Department, University of Marilia (UNIMAR), Marilia 17525-902, Brazil;
- Postgraduate Program in Animal Health, Production and Environment, University of Marilia (UNIMAR), Marilia 17525-902, Brazil
| | - Rogerio Leone Buchaim
- Graduate Program in Applied Dental Sciences, Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-901, Brazil; (C.P.C.d.S.); (P.T.E.C.)
- Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of Veterinary Medicine and Animal Science, University of Sao Paulo (FMVZ/USP), Sao Paulo 05508-270, Brazil;
- Department of Biological Sciences, Bauru School of Dentistry (FOB/USP), University of Sao Paulo, Bauru 17012-901, Brazil
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Wysokińska-Miszczuk J, Piotrowska K, Paulo M, Madej M. Composite Materials Used for Dental Fillings. MATERIALS (BASEL, SWITZERLAND) 2024; 17:4936. [PMID: 39410505 PMCID: PMC11477701 DOI: 10.3390/ma17194936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 10/03/2024] [Accepted: 10/08/2024] [Indexed: 10/20/2024]
Abstract
This article explores the properties of composite materials employed in dental fillings. A traditional nano-hybrid composite containing nanofiller particles exceeding 82% by weight served as a benchmark. The remaining samples were fabricated from ormocer resin, maintaining an identical nanofiller content of 84%. In all specimens, the nanoparticles were dispersed randomly within the matrix. This study presents findings from investigations into surface geometry, hardness, wettability, and tribological behavior. The microscopic observations revealed that ormocer-based samples exhibited greater surface roughness than those composed of the traditional composite. Hardness testing indicated that both ceramic addition and sample preparation significantly influenced mechanical properties. Ceramic-enhanced samples demonstrated superior hardness, surpassing the reference composite by 30% and 43%, respectively. Contact angle measurements revealed hydrophilic characteristics in the classic composite, contrasting with the hydrophobic nature of ceramic-containing samples. Tribological evaluations revealed the superiority of the classic composite in terms of friction coefficients and volumetric wear compared to ormocer-based materials.
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Affiliation(s)
- Joanna Wysokińska-Miszczuk
- Faculty of Medical Dentistry, Medical University of Lublin, ul. Chodźki 6 Ave, 20-093 Lublin, Poland; (J.W.-M.); (M.P.)
| | - Katarzyna Piotrowska
- Faculty of Mechatronics and Mechanical Engineering, Kielce University of Technology, al. Tysiąclecia Państwa Polskiego 7, 25-314 Kielce, Poland;
| | - Michał Paulo
- Faculty of Medical Dentistry, Medical University of Lublin, ul. Chodźki 6 Ave, 20-093 Lublin, Poland; (J.W.-M.); (M.P.)
| | - Monika Madej
- Faculty of Mechatronics and Mechanical Engineering, Kielce University of Technology, al. Tysiąclecia Państwa Polskiego 7, 25-314 Kielce, Poland;
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Saini RS, Binduhayyim RIH, Gurumurthy V, Alshadidi AAF, Aldosari LIN, Okshah A, Kuruniyan MS, Dermawan D, Avetisyan A, Mosaddad SA, Heboyan A. Dental biomaterials redefined: molecular docking and dynamics-driven dental resin composite optimization. BMC Oral Health 2024; 24:557. [PMID: 38735940 PMCID: PMC11089745 DOI: 10.1186/s12903-024-04343-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 05/07/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Dental resin-based composites are widely recognized for their aesthetic appeal and adhesive properties, which make them integral to modern restorative dentistry. Despite their advantages, adhesion and biomechanical performance challenges persist, necessitating innovative strategies for improvement. This study addressed the challenges associated with adhesion and biomechanical properties in dental resin-based composites by employing molecular docking and dynamics simulation. METHODS Molecular docking assesses the binding energies and provides valuable insights into the interactions between monomers, fillers, and coupling agents. This investigation prioritizes SiO2 and TRIS, considering their consistent influence. Molecular dynamics simulations, executed with the Forcite module and COMPASS II force field, extend the analysis to the mechanical properties of dental composite complexes. The simulations encompassed energy minimization, controlled NVT and NPT ensemble simulations, and equilibration stages. Notably, the molecular dynamics simulations spanned a duration of 50 ns. RESULTS SiO2 and TRIS consistently emerged as influential components, showcasing their versatility in promoting solid interactions. A correlation matrix underscores the significant roles of van der Waals and desolvation energies in determining the overall binding energy. Molecular dynamics simulations provide in-depth insights into the mechanical properties of dental composite complexes. HEMA-SiO2-TRIS excelled in stiffness, BisGMA-SiO2-TRIS prevailed in terms of flexural strength, and EBPADMA-SiO2-TRIS offered a balanced combination of mechanical properties. CONCLUSION These findings provide valuable insights into optimizing dental composites tailored to diverse clinical requirements. While EBPADMA-SiO2-TRIS demonstrates distinct strengths, this study emphasizes the need for further research. Future investigations should validate the computational findings experimentally and assess the material's response to dynamic environmental factors.
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Affiliation(s)
- Ravinder S Saini
- Department of Dental Technology, COAMS, King Khalid University, Abha, Saudi Arabia
| | | | | | | | | | - Abdulmajeed Okshah
- Department of Dental Technology, COAMS, King Khalid University, Abha, Saudi Arabia
| | | | - Doni Dermawan
- Applied Biotechnology, Faculty of Chemistry, Warsaw University of Technology, Warsaw, Poland
| | - Anna Avetisyan
- Department of Therapeutic Stomatology, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Seyed Ali Mosaddad
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Qasr-E-Dasht Street, Shiraz, Iran.
| | - Artak Heboyan
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Str. Koryun 2, 0025, Yerevan, Armenia.
- Department of Prosthodontics, School of Dentistry, Tehran University of Medical Sciences, North Karegar St, Tehran, Iran.
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Sivakumar PM, Yetisgin AA, Demir E, Sahin SB, Cetinel S. Polysaccharide-bioceramic composites for bone tissue engineering: A review. Int J Biol Macromol 2023; 250:126237. [PMID: 37567538 DOI: 10.1016/j.ijbiomac.2023.126237] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/05/2023] [Accepted: 08/07/2023] [Indexed: 08/13/2023]
Abstract
Limitations associated with conventional bone substitutes such as autografts, increasing demand for bone grafts, and growing elderly population worldwide necessitate development of unique materials as bone graft substitutes. Bone tissue engineering (BTE) would ensure therapy advancement, efficiency, and cost-effective treatment modalities of bone defects. One way of engineering bone tissue scaffolds by mimicking natural bone tissue composed of organic and inorganic phases is to utilize polysaccharide-bioceramic hybrid composites. Polysaccharides are abundant in nature, and present in human body. Biominerals, like hydroxyapatite are present in natural bone and some of them possess osteoconductive and osteoinductive properties. Ion doped bioceramics could substitute protein-based biosignal molecules to achieve osteogenesis, vasculogenesis, angiogenesis, and stress shielding. This review is a systemic summary on properties, advantages, and limitations of polysaccharide-bioceramic/ion doped bioceramic composites along with their recent advancements in BTE.
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Affiliation(s)
- Ponnurengam Malliappan Sivakumar
- Nanotechnology Research and Application Center (SUNUM), Sabanci University, Istanbul 34956, Turkey; Institute of Research and Development, Duy Tan University, Da Nang 550000, Viet Nam; School of Medicine and Pharmacy, Duy Tan University, Da Nang 550000, Viet Nam.
| | - Abuzer Alp Yetisgin
- Nanotechnology Research and Application Center (SUNUM), Sabanci University, Istanbul 34956, Turkey; Sabanci University, Faculty of Engineering and Natural Sciences, Materials Science and Nano-Engineering Program, Istanbul 34956, Turkey
| | - Ebru Demir
- Nanotechnology Research and Application Center (SUNUM), Sabanci University, Istanbul 34956, Turkey; Sabanci University, Faculty of Engineering and Natural Sciences, Molecular Biology, Genetics and Bioengineering Program, Istanbul 34956, Turkey
| | - Sevilay Burcu Sahin
- Nanotechnology Research and Application Center (SUNUM), Sabanci University, Istanbul 34956, Turkey; Sabanci University, Faculty of Engineering and Natural Sciences, Molecular Biology, Genetics and Bioengineering Program, Istanbul 34956, Turkey
| | - Sibel Cetinel
- Nanotechnology Research and Application Center (SUNUM), Sabanci University, Istanbul 34956, Turkey; Sabanci University, Faculty of Engineering and Natural Sciences, Molecular Biology, Genetics and Bioengineering Program, Istanbul 34956, Turkey.
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Klimek L, Kopacz K, Śmielak B, Kula Z. An Evaluation of the Mechanical Properties of a Hybrid Composite Containing Hydroxyapatite. MATERIALS (BASEL, SWITZERLAND) 2023; 16:4548. [PMID: 37444862 DOI: 10.3390/ma16134548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023]
Abstract
There is currently a lack of scientific reports on the use of composites based on UDMA resin containing HAp in conservative dentistry. The aim of this study was therefore to determine the effect of hydroxyapatite content on the properties of a hybrid composite used in conservative dentistry. This paper compares a commercial hybrid composite with experimental composites treated with 2% by weight (b/w), 5% b/w, and 8% b/w hydroxyapatite. The composites were subjected to bending strength, compression, and diametrical compression tests, as well as those for impact strength, hardness, and tribological wear. The obtained results were subjected to statistical analysis. Increased hydroxyapatite was found to weaken the mechanical properties; however, 2% b/w and 5% b/w hydroxyapatite powder was found to achieve acceptable results. The statistical analysis showed no significant differences. HAp is an effective treatment for composites when applied at a low concentration. Further research is needed to identify an appropriate size of HAp particles that can be introduced into a composite to adequately activate the surface and modification its composition.
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Affiliation(s)
- Leszek Klimek
- Institute of Materials Science and Engineering, Faculty of Mechanical Engineering, Lodz University of Technology, ul. B. Stefanowskiego 1/15, 90-924 Lodz, Poland
| | - Karolina Kopacz
- "Dynamo Lab" Academic Laboratory of Movement and Human Physical Performance, Medical University of Lodz, ul. Pomorska 251, 92-213 Lodz, Poland
| | - Beata Śmielak
- Department of Dental Prosthodontics, Medical University of Lodz, ul. Pomorska 251, 92-213 Lodz, Poland
| | - Zofia Kula
- Department of Dental Technology, Medical University of Lodz, ul. Pomorska 251, 92-213 Lodz, Poland
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Kula Z, Klimek L, Kopacz K, Śmielak B. Evaluation of the Effect of the Addition of Hydroxyapatite on Selected Mechanical and Tribological Properties of a Flow-Type Composite. MATERIALS (BASEL, SWITZERLAND) 2022; 15:9016. [PMID: 36556822 PMCID: PMC9787188 DOI: 10.3390/ma15249016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: The aim of the study was to determine the effect of modification with sintered hydroxyapatite (HAp) on selected mechanical and tribological properties of a flow-type composite. (2) Methods: Samples in the shapes of cuboidal beams (n = 120) and cylinders (n = 120) with the proper dimensions were prepared from a standard flow-type composite and others with the addition of 2% wt., 5% wt., and 8% wt. sintered hydroxyapatite. The bending strength, compression strength, diametral compression strength, impact resistance, hardness, and tribological properties were compared. (3) Results: In all cases, it was established that an increase in the amount of HAp caused a reduction in the bending, compression, and diametral compression strength. Increasing the amount of added HAp also reduced the impact strength, hardness, and wear resistance. However, the differences were statistically insignificant. (4) Conclusions: The addition of hydroxyapatite to a flow-type composite material worsened its mechanical and tribological properties; however, the obtained values were acceptable with 2% wt. and 5% wt. HAp.
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Affiliation(s)
- Zofia Kula
- Department of Dental Technology, Medical University of Lodz, Pomorska Str. 251, 92-213 Lodz, Poland
| | - Leszek Klimek
- Institute of Materials Science and Engineering, Lodz University of Technology, Stefanowskiego Str. 1/15, 90-924 Lodz, Poland
| | - Karolina Kopacz
- “Dynamo Lab” Academic Laboratory of Movement and Human Physical Performance, Medical University of Lodz, Pomorska Str. 251, 92-215 Lodz, Poland
| | - Beata Śmielak
- Department of Prosthodontics, Medical University of Lodz, Pomorska Str. 251, 92-213 Lodz, Poland
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La Rosa GRM, Generali L, Bugea C, Ounsi HF, Benyőcs G, Neelakantan P, Pedullà E. Application of Tribology Concept in Dental Composites Field: A Scoping Review. J Funct Biomater 2022; 13:287. [PMID: 36547546 PMCID: PMC9781192 DOI: 10.3390/jfb13040287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/07/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Tribology is the discipline concerning the application of friction, lubrication, and wear concepts of interacting surfaces in relative motion. A growing interest has developed in tribology application in medical biomaterials, such as resin composites used in restorative dentistry. Yet, the keywords "tribology" and "biotribology" are little applied in the pertinent publications. The aim of this scoping review was to offer an overview of tribology application in dental composites research and to identify knowledge gaps and address future research. A literature search was conducted on Pubmed and Scopus databases and the studies investigating the tribological behavior of resin composites were included for qualitative synthesis. The majority of studies on dental tribology were published in the research areas of mechanical engineering/nanotechnology and differed in several methodological aspects. The preponderant engineering approach and the lack of standardized testing make the laboratory findings poorly informative for clinicians. Future research should focus on the tribological behavior of dental materials composites by means of an integrated approach, i.e., engineering and clinical, for improving development and advancement in this field of research.
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Affiliation(s)
- Giusy Rita Maria La Rosa
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Luigi Generali
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | | | - Hani F. Ounsi
- Department of Endodontics, Faculty of Dental Medicine, Lebanese University, Beirut 1533, Lebanon
| | - Gergely Benyőcs
- Private Practitioner, Precedent Dental Office, 1088 Budapest, Hungary
| | - Prasanna Neelakantan
- Discipline of Endodontology, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Eugenio Pedullà
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
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Qin L, Yao S, Meng W, Zhang J, Shi R, Zhou C, Wu J. Novel antibacterial dental resin containing silanized hydroxyapatite nanofibers with remineralization capability. Dent Mater 2022; 38:1989-2002. [DOI: 10.1016/j.dental.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/23/2022]
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Toong DWY, Ng JCK, Cui F, Leo HL, Zhong L, Lian SS, Venkatraman S, Tan LP, Huang YY, Ang HY. Nanoparticles-reinforced poly-l-lactic acid composite materials as bioresorbable scaffold candidates for coronary stents: Insights from mechanical and finite element analysis. J Mech Behav Biomed Mater 2021; 125:104977. [PMID: 34814078 DOI: 10.1016/j.jmbbm.2021.104977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/29/2021] [Accepted: 11/12/2021] [Indexed: 12/22/2022]
Abstract
Current generation of bioresorbable coronary scaffolds (BRS) posed thrombogenicity and deployment issues owing to its thick struts and overall profile. To this end, we hypothesize that the use of nanocomposite materials is able to provide improved material properties and sufficient radial strength for the intended application even at reduced strut thickness. The nanocomposite formulations of tantalum dioxide (Ta2O5), L-lactide functionalized (LA)-Ta2O5, hydroxyapatite (HA) and LA-HA with poly-l-lactic acid (PLLA) were evaluated in this study. Results showed that tensile modulus and strength were enhanced with non-functionalized nanofillers up until 15 wt% loading, whereas ductility was compromised. On the other hand, functionalized nanofillers/PLLA exhibited improved nanofiller dispersion which resulted higher tensile modulus, strength, and ductility. Selected nanocomposite formulations were evaluated using finite element analysis (FEA) of a stent with varying strut thickness (80, 100 and 150 μm). FEA data has shown that nanocomposite BRS with thinner struts (80-100 μm) made with 15 wt% LA-Ta2O5/PLLA and 10 wt% LA-HA/PLLA have increased radial strength, stiffness and reduced recoil compared to PLLA BRS at 150 μm. The reduced strut thickness can potentially mitigate issues such as scaffold thrombosis and promote re-endothelialisation of the vessel.
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Affiliation(s)
- Daniel Wee Yee Toong
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, 639798, Singapore
| | - Jaryl Chen Koon Ng
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore; Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, 117583, Singapore
| | - Fangsen Cui
- Institute of High Performance Computing, A*STAR, 1 Fusionopolis way, 138632, Singapore
| | - Hwa Liang Leo
- Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, 117583, Singapore
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore; Duke-NUS Medical School, 8 College Road, 169857, Singapore
| | - Shaoliang Shawn Lian
- Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, 117583, Singapore
| | - Subbu Venkatraman
- Department of Material Science Engineering, National University of Singapore, 9 Engineering Drive 1, 117575, Singapore
| | - Lay Poh Tan
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, 639798, Singapore
| | - Ying Ying Huang
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, 639798, Singapore.
| | - Hui Ying Ang
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore; Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, 117583, Singapore; Duke-NUS Medical School, 8 College Road, 169857, Singapore.
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