Influence of exposure protocol, voxel size, and artifact removal algorithm on the trueness of segmentation utilizing an artificial-intelligence-based system

PURPOSE

To evaluate the effects of exposure protocol, voxel sizes, and artifact removal algorithms on the trueness of segmentation in various mandible regions using an artificial intelligence (AI)-based system.

MATERIALS AND METHODS

Eleven dry human mandibles were scanned using a cone beam computed tomography (CBCT) scanner under differing exposure protocols (standard and ultra-low), voxel sizes (0.15 mm, 0.3 mm, and 0.45 mm), and with or without artifact removal algorithm. The resulting datasets were segmented using an AI-based system, exported as 3D models, and compared to reference files derived from a white-light laboratory scanner. Deviation measurement was performed using a computer-aided design (CAD) program and recorded as root mean square (RMS). The RMS values were used as a representation of the trueness of the AI-segmented 3D models. A 4-way ANOVA was used to assess the impact of voxel size, exposure protocol, artifact removal algorithm, and location on RMS values (α = 0.05).

RESULTS

Significant effects were found with voxel size (p < 0.001) and location (p < 0.001), but not with exposure protocol (p = 0.259) or artifact removal algorithm (p = 0.752). Standard exposure groups had significantly lower RMS values than the ultra-low exposure groups in the mandible body with 0.3 mm (p = 0.014) or 0.45 mm (p < 0.001) voxel sizes, the symphysis with a 0.45 mm voxel size (p = 0.011), and the whole mandible with a 0.45 mm voxel size (p = 0.001). Exposure protocol did not affect RMS values at teeth and alveolar bone (p = 0.544), mandible angles (p = 0.380), condyles (p = 0.114), and coronoids (p = 0.806) locations.

CONCLUSION

This study informs optimal exposure protocol and voxel size choices in CBCT imaging for true AI-based automatic segmentation with minimal radiation. The artifact removal algorithm did not influence the trueness of AI segmentation. When using an ultra-low exposure protocol to minimize patient radiation exposure in AI segmentations, a voxel size of 0.15 mm is recommended, while a voxel size of 0.45 mm should be avoided.

Accuracy of digital duplication scanning methods for complete dentures

PURPOSE

To compare the accuracy of four digital scanning methods in duplicating a complete denture.

MATERIAL AND METHODS

Four scanning methods were used: cone beam computed tomography (CBCT), Straumann desktop scanner (DS), Trios intraoral scanner (TIO), and Virtuo Vivo intraoral scanner (VVIO). Each method was used to duplicate all the surfaces of a printed complete denture. The denture was scanned 10 times in each group. The trueness (in root mean square, RMS) and precision (in standard deviation, SD) were calculated by comparing the combined dentition, denture extension, and intaglio surfaces with the reference file. One-way analysis of variance and F-tests were used to test statistical differences (α = 0.05).

RESULTS

For the scanning accuracy of the whole denture, CBCT showed the highest RMS (0.249 ± 0.020 mm) and lowest trueness than DS (0.124 ± 0.014 mm p < 0.001), TIO (0.131 ± 0.006 mm p < 0.001), and VVIO (0.227 ± 0.020 mm p = 0.017), while DS and TIO showed smaller RMS than VVIO (p < 0.001). For the trueness of dentition, denture extension, and intaglio surfaces, CBCT also showed the highest mean RMS and lowest trueness among all groups (p < 0.001). DS and TIO had smaller mean RMS and higher trueness among all groups in all surfaces (p < 0.001, except VVIO in intaglio surface, p > 0.05). TIO had significantly lower within-group variability of RMS and highest precision compared to DS (p = 0.013), CBCT (p = 0.001), and VVIO (p < 0.001) in the combined surface. For dentition and denture extension surfaces, TIO showed similar within-group variability of RMS with the DS group (p > 0.05) and lower than CBCT and VVIO (p < 0.001).

CONCLUSION

The 7 Series desktop scanner and Trios 4 intraoral scanner can duplicate dentures in higher trueness than CBCT and the Virtuo Vivo intraoral scanner. The Trios 4 intraoral scanner was more precise in the combined surfaces than other scanning methods, while the 7 Series desktop scanner and Trios 4 intraoral scanner were more precise in the denture extension surface.

The effects of manufacturing technologies on the surface accuracy of CAD-CAM occlusal splints

PURPOSE

To investigate the effects of the manufacturing technologies on the surface (cameo and intaglio) accuracy (trueness and precision) of computer-aided design and computer-aided manufacturing (CAD-CAM) occlusal splints.

MATERIALS AND METHODS

The digital design of the master occlusal splint was designed in a CAD software program. Six groups (n = 10) were tested in this study, including Group 1 - Milling (Wax), Group 2 - Heat-polymerizing, Group 3 - Milling (M series), Group 4 - Milling (DWX-51/52D), Group 5 - 3D-printing (Cares P30), and Group 6 - 3D-printing (M2). The study samples were placed in a scanning jig fabricated from putty silicone and Type III dental stone. The study samples were then scanned with a laboratory scanner at the intaglio and cameo surfaces, and the scanned files were exported in standard tessellation language (STL) file format. The master occlusal splint STL file, was used as a reference to compare with all scanned samples at the intaglio and cameo surfaces in a surface matching software program. Root mean square (RMS, measured in mm, absolute value) values were calculated by the software for accuracy comparisons. Group means were used as the representation of trueness, and the standard deviation for each group was calculated as a measure of precision. Color maps were recorded to visualize the areas of deviation between study samples and the master occlusal splint file. The data were normalized and transformed to rank scores, and one-way ANOVA was used to test for the differences between the groups. Pairwise comparisons were made between different groups. Fishers least square differences were used to account for the family-wise error rate. A 5% significance level was used for all the tests.

RESULTS

The null hypotheses were rejected. The manufacturing technologies significantly affected the trueness of occlusal splints at both intaglio and cameo surfaces (p < 0.001). At the cameo surfaces, Group 1 - Milling (Wax) (0.03 ± 0.02 mm), Group 3 - Milling (M series) (0.04 ± 0.01 mm), and Group 4 - Milling (DWX-51/52D) (0.04 ± 0.01 mm) had the smallest mean RMS values and highest trueness. Group 3 had the smallest standard deviation and highest precision among all groups (p < 0.001, except p = 0.005 when compared with Group 2). Group 5 had the largest standard deviation and lowest precision among all groups (p < 0.001). At the intaglio surfaces, Group 1 - Milling (Wax) (0.06 ± 0.01 mm) had the smallest RMS values and highest trueness among all groups (p < 0.001), and Group 2 - Heat-polymerizing (0.20 ± 0.03 mm) and Group 5 - 3D-printing (Cares P30) (0.15 ± 0.05 mm) had significantly larger mean RMS and standard deviation values than all other groups (p < 0.001), with lowest trueness and precision. In the color maps, Group 2 - Heat-polymerizing and Group 5 - 3D-printing (Cares P30) showed the most discrepancies with yellow and red (positive discrepancies) in most areas, and Group 1 - Milling (Wax) showed the best and most uniform surface matching with the most area in green.

CONCLUSION

The manufacturing technologies significantly affected the trueness and precision of occlusal splints at both intaglio and cameo surfaces. The 5-axis milling units and industrial-level CLIP 3D-printer could be considered to achieve surface accuracy of occlusal splints.

Soft Tissue Manipulation Alters RANTES/CCL5 and IL-4 Cytokine Levels in a Rat Model of Chronic Low Back Pain

Low back pain (LBP) is a common musculoskeletal complaint that can impede physical function and mobility. Current management often involves pain medication, but there is a need for non-pharmacological and non-invasive interventions. Soft tissue manipulation (STM), such as massage, has been shown to be effective in human subjects, but the molecular mechanisms underlying these findings are not well understood. In this paper, we evaluated potential changes in the soft tissue levels of more than thirty pro- or anti-inflammatory cytokines following instrument-assisted STM (IASTM) in rats with chronic, induced LBP using Complete Freund's Adjuvant. Our results indicate that IASTM is associated with reduced soft tissue levels of Regulated on Activation, Normal T cell Expressed and Secreted (RANTES)/Chemokine (C-C motif) ligand 5 (CCL5) and increased soft tissue levels of Interleukin (IL)-4, which are pro-inflammatory and anti-inflammatory factors, respectively, by 120 min post-treatment. IASTM was not associated with tissue-level changes in C-X-C Motif Chemokine Ligand (CXCL)-5/Lipopolysaccharide-Induced CXC Chemokine (LIX)-which is the murine homologue of IL-8, CXCL-7, Granulocyte-Macrophage-Colony Simulating Factor (GM-CSF), Intercellular Adhesion Molecule (ICAM)-1, IL1-Receptor Antagonist (IL-1ra), IL-6, Interferon-Inducible Protein (IP)-10/CXCL-10, L-selectin, Tumor Necrosis Factor (TNF)-α, or Vascular Endothelial Growth Factor (VEGF) at either 30 or 120 min post-treatment. Combined, our findings raise the possibility that IASTM may exert tissue-level effects associated with improved clinical outcomes and potentially beneficial changes in pro-/anti-inflammatory cytokines in circulation and at the tissue level.

Tensile bond strength of auto-polymerizing and heat-polymerizing denture reliners on the conventional and CAD-CAM denture base materials

PURPOSE

The study aimed to compare the tensile bond strength (TBS) of auto-polymerizing and heat-polymerizing denture reliners on the conventional (compression-molding and injection-molding) and computer-aided design and computer-aided manufacturing (milled and 3D-printed) denture base materials.

MATERIALS AND METHODS

Eighty standard dogbone-shaped specimens were fabricated from four materials: compression-molding, injection-molding, milled, and 3D-printed denture base materials. A 3-mm cutoff was removed from each specimen at the midsection, and all specimens were reattached with either auto-polymerizing (n = 10) or heat-polymerizing (n = 10) reliner. The TBS was measured on the universal testing machine. A scanning electron microscope (SEM) was used to examine the fractured surfaces at cross sections to determine the dominant failure mode in each group. Two-way ANOVA was used to examine the effects of denture base material and reliner on the TBS (α = 0.05). Weibull survival analysis was also used to determine the survival probability curves.

RESULTS

Heat-polymerizing reliner led to a higher TBS than the auto-polymerizing reliner, except in the compression-molding (p = 0.573) groups. Compression-molding denture base material connected with a heat-polymerizing reliner showed the highest TBS (29.8 ± 6.9 MPa), whereas 3D-printed denture base material connected with an auto-polymerizing reliner showed the lowest TBS (7.2 ± 0.9 MPa). The survival probability based on the Weibull model demonstrated that the compression-molding denture base material connected with either auto-polymerizing or heat-polymerizing reliners had the longest survival time to failure, whereas 3D-printed denture base material relined with auto-polymerizing reline material showed the shortest survival time to failure. Under the SEM, the compression-molding groups demonstrated that the failure modes were mixed but predominantly cohesive. The injection-molding and milled groups showed predominantly adhesive failures at the denture base-reline material interfaces. The dominant mode of failure in the 3D-printed groups was cohesive failures within the bonding adhesive.

CONCLUSIONS

Although the heat-polymerizing reliner led to a higher TBS than the auto-polymerizing reliner in most denture base materials, the compression-molding denture base material can achieve high TBS with both reliners. When the auto-polymerizing reliner is used with 3D-printed denture base material, clinicians should be aware of lower TBS value and possible cohesive failures, and the detachment of the reliner from the denture base.

Effects of shade and thickness on the translucency parameter of anatomic-contour zirconia, transmitted light intensity, and degree of conversion of the resin cement

STATEMENT OF PROBLEM

Anatomic-contour zirconia prostheses are usually cemented with resin cement. However, information regarding the effects of the zirconia shade and thicknesses on the translucency of the prosthesis, the intensity of the transmitted light beneath the prosthesis, and the subsequent degree of conversion in the resin cement is sparse.

PURPOSE

The purpose of this in vitro study was to investigate the translucency parameter in 3 anatomic-contour zirconia specimens of 2 shades at 5 different thicknesses and to investigate the transmitted light intensity and degree of conversion of the resin cement beneath the ceramic specimens by using a traditional zirconia and a lithium disilicate glass-ceramic as controls.

MATERIAL AND METHODS

Ceramic specimens from 1 anatomic-contour zirconia in a generic shade (CAP FZ) and 2 anatomic-contour zirconias in A2 shade (Zirlux and Luxisse) were used. Lithium disilicate in HT A2 shade (IPS e.max CAD) and traditional zirconia in a generic shade (CAP QZ) were used as controls. A total of 125 ceramic specimens (n=25) were fabricated to a final specimen dimension of 12×12 mm and in thicknesses of 1.0, 1.25, 1.5, 1.75, and 2.0 mm according to the manufacturers' recommendations. The CIELab color space for all specimens placed against a white and black background was measured with a spectrophotometer (CM-2600D), and the translucency parameters were calculated for the materials at various thicknesses. A light-polymerizing unit (DEMI LED) was used to polymerize the resin cement (Variolink II) placed beneath the ceramic specimens. Transmitted light intensity from the polymerization unit beneath the ceramic specimens was measured by using a spectrophotometer (MARC Resin Calibrator), and the transmittance of each specimen was calculated. The coefficient of absorption of each material was calculated from the regression analysis between the natural log of transmittance and specimen thickness. The degree of conversion of resin cement was measured by using a Fourier transformation infrared (FTIR) spectrophotometer. The results were analyzed by using 2-way ANOVA (α=.05). The relationship between the transmittance and the translucency parameter was evaluated by plotting the transmittance against the translucency parameter value of each specimen.

RESULTS

The translucency parameter decreased with increasing thickness in all 5 material groups. All anatomic-contour zirconia had lower translucency parameters than e.max CAD (P<.001). The same results were found for the intensity of the transmitted light (P<.001). Both A2 shade anatomic-contour zirconia (Zirlux and Luxisse) showed significantly lower light transmittance than a generic shade anatomic-contour zirconia (CAP FZ) (P<.001). The coefficients of absorption were found to range from 0.63 to 1.72 mm^-1, and reflectance from 0.10 to 0.25. The results from the degree of conversion of resin cement after polymerization through 1 to 2 mm of specimens showed a significantly higher degree of conversion in the e.max group than in all other groups (P<.001). The correlation between translucency parameter and the intensity of the transmitted light suggested that the relationship was shade dependent.

CONCLUSIONS

The translucency parameter and the transmitted light intensity of ceramic material were influenced by the type of ceramic and the shade and thickness of the ceramic. The combined effects of layer thickness and the intensity of the transmitted light in the A2 shade anatomic-contour zirconia (Zirlux and Luxisse) resulted in a lower degree of conversion in resin cement than in a generic shade anatomic-contour zirconia (CAP FZ) at layer thicknesses of 1.75 and 2 mm.

The Trueness of Scans using One Intraoral Scanner in Different Partially Edentulous Conditions

PURPOSE

To investigate the trueness of intraoral scanning in 8 commonly seen partially edentulous conditions.

MATERIALS AND METHODS

A maxillary dentoform was modified into the 8 commonly seen partially edentulous conditions. Each modification was scanned with a laboratory desktop scanner. Each modification was then scanned 10 times (n = 10) with an intraoral scanner. All scans were exported as STL files and then imported into a surface matching software using the best-fit alignment method. The dimensional differences between the study STL files from the intraoral scanner were compared to the corresponding reference STL files. The measurements were calculated as the root mean square (RMS) and defined as the trueness of the intraoral scans. In addition to the RMS values, qualitative assessments were completed on the color maps. The color maps produced by the surface matching software were used to visualize the areas of deviation between scans from the intraoral scanner and their corresponding reference files. One-way analysis of variance (ANOVA), followed by pair-wise comparisons using Fisher's Protected Least Significant Difference were utilized to compare the differences between the groups in RMS values (α = 0.05).

RESULTS

Partially edentulous condition significantly affected the trueness of the intraoral scans. Group 8 (Class IV) had significantly lower RMS (0.1878 ±0.0455 mm) than all other groups (P < 0.001). Group 2 (Class II) and Group 7 (Class III modification I) are not significantly different from each other (Group 2: 0.5758 ±0.0300 mm; Group 7: 0.5602 ±0.0231 mm, P = 0.571), while they both had significantly higher RMS than all other groups (P < .001). The remaining groups showed the RMS values were within the range of 0.3001 ±0.0891 mm (Group 6 - Class III with Long Edentulous Span) and 0.4541 ±0.1039 mm (Group 1 - Class I).

CONCLUSION

Different partially edentulous conditions affected the trueness of the scans generated from the selected intraoral scanner. Class IV edentulous condition had the highest intraoral scan trueness. It is unknown if RMS values are clinically significant, and the validity of using intraoral scans directly for PRDP fabrication will need further studies. This article is protected by copyright. All rights reserved.

The effects of additive manufacturing technologies and finish line designs on the trueness and dimensional stability of 3D-printed dies

PURPOSE

To evaluate the effects of 5 manufacturing technologies and 2 finish line designs on the trueness and dimensional stability of 3D-printed definitive dies at finish line regions under different storage conditions and time.

MATERIAL AND METHODS

Preparation of light chamfer and round shoulder finish lines were adopted individually on two mandibular first molar typodont teeth and digitalized as standard tessellation language (STL) files. A total of 240 samples (192 AM definitive dies and 48 definitive conventional stone dies) in 20 groups (n = 12) were manufactured based on 2 finishing line designs (chamfer and shoulder), 5 manufacturing technologies (4 additively manufactured technologies and conventional stone die), and 2 storage conditions (light exposure and dark). The 4 additively manufactured (AM) technologies include a DLP 3D-printer, an economic LED 3D-printer, a CLIP 3D-printer, and an SLA 3D-printer. All the study samples were distributed into two storage conditions. Subsequently, samples were digitalized to STL files at 3 different time points (within 36 hours, 1-month, and 3-months). A surface matching software was used to superimpose the sample STL files onto the corresponding original STL files with the best-fit alignment function. The trueness of each printed and stone definitive dies and their dimensional stabilities were measured by the root mean square (RMS, in mm). A linear mixed-effects model was used to test the effects of the finish line design, manufacturing technology, storage condition, and storage time on RMS values (α = 0.05).

RESULTS

While finish line designs had no significant effects [F(1, 220) = 0.85, P < 0.358], the manufacturing technologies [F(3, 220) = 33.02, P < .001], storage condition [F(1, 220) = 4.11, P = .044], and storage time F(2, 440) = 10.37, P < .001] affected the trueness and dimensional stability of 3D-printed dies at finish line regions. No significant interactions were found among the 4 factors. For the manufacturing technologies, Type IV stone groups and LCD 3D-printer groups had significantly higher RMS values than the other 3 printers (P < .001) with no significant differences between Type IV stone and LCD 3D-printer groups (P = .577). DLP 3D-printer groups had higher RMS values than both SLA 3D-printer groups and CLIP 3D-printer groups (P < .001). There were no significant differences between SLA 3D-printer groups and CLIP 3D-printer groups, P = 0.671. For the effects of storage conditions, RMS values were significantly higher in the groups stored with the direct light exposure than the ones stored in the dark, P = .044. In terms of the effects of storage time, the RMS values were significantly higher after 1-month storage, P = 0.002; and 3-month storage, P <.001, than the ones at the immediate post-manufacturing stage. However, the RMS values after 1-month and 3-month storage were not significantly different from each other (P = .169).

CONCLUSIONS

Manufacturing technologies, storage conditions, and storage time significantly affected the trueness and dimensional stability of 3D-printed dies at finish line regions, while finish line designs had no significant effects. Among the AM technologies tested, all have produced either comparable or truer 3D-printed dies than the Type IV dental stone dies, and the CLIP and SLA 3D-printers produced the best outcomes. 3D-printed dies showed significant distortion after 1-month and 3-months storage, especially under light exposure storage conditions. These findings may negate the clinical need to preserve 3D-printed dies, and digital data should be preserved instead. This article is protected by copyright. All rights reserved.

Translucency parameter and color masking ability of CAD/CAM denture base materials against metal substrates

PURPOSE

To investigate the translucency parameters of traditional, milled, and 3D-printed denture base materials at 3 different thicknesses and the color masking ability of each material against a metallic background between different thicknesses.

MATERIAL AND METHODS

A traditional heat-polymerizing polymethylmethacrylate (PMMA) (H-Lucitone) material was used as the control group. Two milled pre-polymerized resin blocks (M-Lucitone and IvoBase) and five 3D-printed denture base materials (P-Lucitone, Dentca LP, Dentca OP, Formlabs, and Kulzer) were used as experimental groups. A total of 240 samples, (n = 30, per material) were fabricated to a final specimen dimension of 12×12 mm and in thicknesses of 1.0, 2.0, and 3.0 mm (n = 10 per thickness/material) according to the manufacturers' recommendations. The color coordinates (L*, a*, b*) in CIELab color space for all specimens placed against a white, black, and metallic background were measured with a spectrophotometer. The translucency parameters (TP₀₀ ) at each thickness and the color differences between 1 mm and 2 mm (dE_00M1-2 ) and between 2 mm and 3 mm (dE_00M2-3 ) against the metallic background were calculated with the CIEDE2000 color matrix. Comparisons between the groups for differences in TP₀₀ were made using One-way ANOVA separately for each thickness. Comparisons of groups and materials for differences in dE_00M1-2 and dE_00M2-3 were made using Two-way ANOVA and Fisher's Protected Least Significant Differences (α = .05).

RESULTS

The TP₀₀ decreased with increasing thickness in all 8 material groups. All 3D-printed materials, except P-Lucitone, had higher TP₀₀ than milled pre-polymerized resin materials (M-Lucitone and IvoBase), and traditional heat-polymerizing PMMA (H-Lucitone) material (P<.001) at all thicknesses. In the 1 mm and 2 mm thickness, heat-polymerizing acrylic resin (H-Lucitone) had the lowest TP₀₀ , and in the 3 mm thickness, milled acrylic resin (M-Lucitone and IVOBase) had had lowest TP₀₀ (P<.001). All material groups had significantly lower values of dE_00M2-3 than dE_00M1-2 (P<.001). The color differences dE_00M2-3 were significantly lower in H-Lucitone, M-Lucitone, P-Lucitone, and IvoBase groups than in other materials, while the color difference of dE_00M1-2 was significantly lower in H-Lucitone, P-Lucitone and Dentca LP than other materials (P<.001).

CONCLUSIONS

The results from this study provide clinicians and dental technicians with information regarding the selection of denture base materials to achieve desired color masking outcomes, according to available prosthetic space. Thicker prostheses significantly improved the color masking abilities of denture acrylic resins against a metallic background. In a thickness of 1 and 2 mm, the heat-polymerizing acrylic resin had a lower translucency parameter and better color masking ability. When the prosthesis thickness reached 3 mm, the milled acrylic resin had a lower translucency parameter and better color masking ability. When compared to the heat-polymerizing resin and milled acrylic resin materials, except for one 3D-printing resin (P-Lucitone), the color masking abilities of the remaining 3D-printing resin materials were low, regardless of prosthesis thickness. This article is protected by copyright. All rights reserved.

Effects on Ridge Dimensions, Bone Density, and Implant Primary Stability with Osseodensification Approach in Implant Osteotomy Preparation

PURPOSE

To compare the amount of bone expansion, bone density change, and implant primary stability with an osseodensification technique to a conventional drilling protocol.

MATERIALS AND METHODS

Twenty-four bovine rib segments (20 × 25 × 4 mm) with a 1-mm outer layer of cortical bone were randomly divided into two groups: an osseodensification group and a conventional drilling group. Each bone sample received one 4.1 × 10-mm implant. The density of the peri-implant bone before and after osteotomy was measured. After implant placement, primary stability was assessed. A laser surface scanner was used before and after implant placement to compare the dimension of crestal bone width and volumetric expansion. Histomorphometric analysis was performed to compare the bone-to-implant contact percentage (BIC%) of the two groups.

RESULTS

The peripheral and apical bone mineral density around the implants was significantly increased, and a statistically significantly higher peripheral BIC% was found in the osseodensification group. A significant increase in volume and bone width after implant placement was found in both groups. However, there were no significant differences in volume and bone width change at all three locations and in implant stability between the osseodensification and conventional drilling protocols.

CONCLUSION

Within the limitations of this study, the osseodensification protocol increased the bone mineral density and primary bone-to-implant contact. Also, this study suggests that implant placement by osseodensification or conventional drilling can increase ridge dimensions in narrow alveolar ridges.

The Trueness of Obturator Prosthesis Base Manufactured by Conventional and 3D Printing Techniques

PURPOSE

To compare the intaglio surface trueness of obturator prosthesis bases manufactured by traditional compression molding, injection molding, and 3D printing techniques.

MATERIALS AND METHODS

A complete edentulous master cast with Aramany Class I maxillary defect was selected for this in vitro study. Four study groups (n = 10/group) were included in this study, Group A: Compression Molding, Group B: Injection Molding, and Group C: Cara Print 3D DLP Printer, and Group D: Carbon 3D DLS Printer. All obturator prostheses' intaglio surfaces were scanned with a laboratory scanner (E4; 3Shape Inc, New Providence, NJ) and the dimensional differences between study samples and their corresponding casts were calculated as the root mean square (measured in mm, absolute value) using a surface matching software (Geomagic design X; 3D Systems, Rock Hill, SC). One-way Analysis of variance (ANOVA) and Fisher's least significant difference (LSD) test were used to compare groups differences in RMS (α = 0.05).

RESULTS

There was a significant effect of manufacturing technique on the RMS values for the 4 conditions [F(3,36) = 5.743, p = 0.003]. Injection Molding (0.070 mm) and Compression Molding groups (0.076 mm) had a lower interquartile range, and the Cara Print 3D-Printer group (0.427 mm) and Carbon 3D-Printer (0.149 mm) groups had a higher interquartile range. The Injection Molding group showed the best and uniform surface matching with the most area in green in the color maps. The Injection Molding group (0.139 ± 0.049 mm) had significantly lower RMS than all other groups (p < 0.001 for all comparisons). Compression Molding (0.269 ± 0.057 mm), Cara Print 3D-Printer (0.409 ± 0.270 mm), and Carbon 3D-Printer (0.291 ± 0.082 mm) groups were not significantly different from each other (Compression Molding versus Carbon 3D-Printer, p = 0.59; Compression Molding versus Cara Print 3D-Printer, p = 0.25; Cara Print 3D-Printer versus Carbon 3D-Printer, p = 0.40).

CONCLUSION

Obturator prosthesis bases manufactured with injection molding technique showed better intaglio surface trueness than ones made by the compression molding technique and 3D printers. Although obturator prosthesis bases manufactured from different 3D printers showed similar trueness, a DLP 3D printer produced less consistent outcome than a DLS 3D printer.

Bonding between implant attachment pickup materials and CAD-CAM denture base material

STATEMENT OF PROBLEM

Adequate bonding between pickup material and the newer generation of prepolymerized polymethyl methacrylate (PMMA) for computer-aided-design and computer-aided manufacturing (CAD-CAM) dentures is essential to the success of treatment. However, studies on the bond between these 2 materials are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the bond strength of 3 different chairside implant LOCATOR attachment pickup material groups and prepolymerized PMMA by investigating their pushout force.

MATERIAL AND METHODS

Prepolymerized PMMA, (Lucitone 199) was used as the denture base material. The material was cut into 25×25×5-mm disks, and a Ø6.5-mm hole was drilled into the center of the disks. Six pickup materials from 3 groups were tested: composite resin with bonding agent (N=3, EZ PickUp, Quick Up, and Triad gel), composite resin without bonding agent (N=1, Chairside), and acrylic resin (N=2, Jet denture repair acrylic, and Duralay). All materials were prepared as per the manufacturers' recommendations and were used to fill the center hole. The specimens were left for 48 hours to completely polymerize before testing. Half of the specimens from each material then received thermocycling treatment. All specimens were subjected to axial pushout testing with a universal testing machine.

RESULTS

In the nonthermocycled specimens, Duralay and Jet denture repair acrylic resin showed significantly higher pushout force than that of the other groups (P<.001). Triad gel showed higher pushout force than EZ PickUp and Quick Up (P<.001). Chairside showed the lowest push-out force. The same trend was also observed in the thermocycled specimens. The peak pushout force of nonthermocycled Chairside composite resin was significantly lower than that of thermocycled Chairside composite resin (P=.03). Conversely, the peak pushout force of nonthermocycled EZ PickUp specimens was significantly higher than that of thermocycled EZ PickUp specimens (P=.01). Variation in fracture patterns among groups was observed, and the correlation between pushout force and fracture patterns was recorded.

CONCLUSIONS

Two materials from the acrylic resin group, Jet denture repair acrylic and Duralay, showed higher pushout forces, indicating a better bond with Lucitone 199 CAD-CAM denture base material compared with other tested materials, including composite resin with bonding agent (EZ PickUp, Quick Up, and Triad gel) and composite resin without bonding agent (Chairside).

Development of a step-down method for altering male C57BL/6 mouse housing density and hierarchical structure: Preparations for spaceflight studies

This study was initiated as a component of a larger undertaking designed to study bone healing in microgravity aboard the International Space Station (ISS). Spaceflight experimentation introduces multiple challenges not seen in ground studies, especially with regard to physical space, limited resources, and inability to easily reproduce results. Together, these can lead to diminished statistical power and increased risk of failure. It is because of the limited space, and need for improved statistical power by increasing sample size over historical numbers, NASA studies involving mice require housing mice at densities higher than recommended in the Guide for the Care and Use of Laboratory Animals (National Research Council, 2011). All previous NASA missions in which mice were co-housed, involved female mice; however, in our spaceflight studies examining bone healing, male mice are required for optimal experimentation. Additionally, the logistics associated with spaceflight hardware and our study design necessitated variation of density and cohort make up during the experiment. This required the development of a new method to successfully co-house male mice while varying mouse density and hierarchical structure. For this experiment, male mice in an experimental housing schematic of variable density (Spaceflight Correlate) analogous to previously established NASA spaceflight studies was compared to a standard ground based housing schematic (Normal Density Controls) throughout the experimental timeline. We hypothesized that mice in the Spaceflight Correlate group would show no significant difference in activity, aggression, or stress when compared to Normal Density Controls. Activity and aggression were assessed using a novel activity scoring system (based on prior literature, validated in-house) and stress was assessed via body weights, organ weights, and veterinary assessment. No significant differences were detected between the Spaceflight Correlate group and the Normal Density Controls in activity, aggression, body weight, or organ weight, which was confirmed by veterinary assessments. Completion of this study allowed for clearance by NASA of our bone healing experiments aboard the ISS, and our experiment was successfully launched February 19, 2017 on SpaceX CRS-10.

Cohousing Male Mice with and without Segmental Bone Defects

Spaceflight results in bone loss like that associated with osteoporosis or decreased weight-bearing (for example, high-energy trauma such as explosive injuries and automobile accidents). Thus, the unique spaceflight laboratory on the International Space Station presents the opportunity to test bone healing agents during weightlessness. We are collaborating with NASA and the US Army to study bone healing in spaceflight. Given the unique constraints of spaceflight, study design optimization was required. Male mice were selected primarily because their femur is larger than females', allowing for more reproducible surgical outcomes. However, concern was raised regarding male mouse aggression. In addition, the original spaceflight study design included cohousing nonoperated control mice with mice that had undergone surgery to create a segmental bone defect. This strategy prompted the concern that nonoperated mice would exhibit aggressive behavior toward vulnerable operated mice. We hypothesized that operated and nonoperated male mice could be cohoused successfully when they were cagemates since birth and underwent identical anesthetic, analgesic, preoperative, and postoperative conditions. Using quantitative behavioral scoring, body weight, and organ weight analyses (Student t test and ANOVA), we found that nonoperated and operated C57BL/6 male mice could successfully be housed together. The male mice did not exhibit aggressive behavior toward cagemates, whether operated or nonoperated, and the mice did not show evidence of stress, as indicated by veterinary assessment, or change in body or proportional organ weights. These findings allowed our mission to proceed (launched February 2017) and may inform future surgical study designs, potentially increasing housing flexibility.

Forces associated with launch into space do not impact bone fracture healing

Segmental bone defects (SBDs) secondary to trauma invariably result in a prolonged recovery with an extended period of limited weight bearing on the affected limb. Soldiers sustaining blast injuries and civilians sustaining high energy trauma typify such a clinical scenario. These patients frequently sustain composite injuries with SBDs in concert with extensive soft tissue damage. For soft tissue injury resolution and skeletal reconstruction a patient may experience limited weight bearing for upwards of 6 months. Many small animal investigations have evaluated interventions for SBDs. While providing foundational information regarding the treatment of bone defects, these models do not simulate limited weight bearing conditions after injury. For example, mice ambulate immediately following anesthetic recovery, and in most cases are normally ambulating within 1-3 days post-surgery. Thus, investigations that combine disuse with bone healing may better test novel bone healing strategies. To remove weight bearing, we have designed a SBD rodent healing study in microgravity (µG) on the International Space Station (ISS) for the Rodent Research-4 (RR-4) Mission, which launched February 19, 2017 on SpaceX CRS-10 (Commercial Resupply Services). In preparation for this mission, we conducted an end-to-end mission simulation consisting of surgical infliction of SBD followed by launch simulation and hindlimb unloading (HLU) studies. In brief, a 2 mm defect was created in the femur of 10 week-old C57BL6/J male mice (n = 9-10/group). Three days after surgery, 6 groups of mice were treated as follows: 1) Vivarium Control (maintained continuously in standard cages); 2) Launch Negative Control (placed in the same spaceflight-like hardware as the Launch Positive Control group but were not subjected to launch simulation conditions); 3) Launch Positive Control (placed in spaceflight-like hardware and also subjected to vibration followed by centrifugation); 4) Launch Positive Experimental (identical to Launch Positive Control group, but placed in qualified spaceflight hardware); 5) Hindlimb Unloaded (HLU, were subjected to HLU immediately after launch simulation tests to simulate unloading in spaceflight); and 6) HLU Control (single housed in identical HLU cages but not suspended). Mice were euthanized 28 days after launch simulation and bone healing was examined via micro-Computed Tomography (µCT). These studies demonstrated that the mice post-surgery can tolerate launch conditions. Additionally, forces and vibrations associated with launch did not impact bone healing (p = .3). However, HLU resulted in a 52.5% reduction in total callus volume compared to HLU Controls (p = .0003). Taken together, these findings suggest that mice having a femoral SBD surgery tolerated the vibration and hypergravity associated with launch, and that launch simulation itself did not impact bone healing, but that the prolonged lack of weight bearing associated with HLU did impair bone healing. Based on these findings, we proceeded with testing the efficacy of FDA approved and novel SBD therapies using the unique spaceflight environment as a novel unloading model on SpaceX CRS-10.

The Effects of Fluoride Treatment Time and Concentration on In Vitro Caries Lesion Demineralisation and Remineralisation

PURPOSE

To investigate the possible interaction between fluoride treatment time and concentration on enamel caries lesion de-/remineralisation.

MATERIALS AND METHODS

The study design followed a three (fluoride concentration: 0, 275, 1250 ppm as sodium fluoride) x four (treatment time: 10, 30, 60, 120 s) factorial design. Caries lesions were created in bovine enamel and the extent of demineralisation determined using Vickers surface microhardness (VHN). Lesions were pH cycled (18 days) with the daily schedule consisting of two fluoride treatments, a 4-h demineralisation period and exposure to artificial saliva at all other times. VHN was determined again after pH cycling and changes to baseline values calculated (∆VHN). Enamel fluoride uptake (EFU) was determined using the microbiopsy technique. Data were analyzed using two-way ANOVA.

RESULTS

The concentration x treatment time interaction was significant for ∆VHN (p < 0.0001) and EFU (p = 0.0298). Dose-response relationships were observed for both variables for fluoride concentration and treatment time. ∆VHN: higher fluoride concentration compensated for shorter treatment time (e.g. ∆VHN [mean ± SD] = 85.5 ± 60.6 for 30 s with 1250 ppm fluoride vs ∆VHN = 84.3 ± 26.9 for 120s with 275 ppm fluoride). EFU data were similar but highlighted a greater ability to discern between fluoride concentrations (e.g. EFU = 4364 ± 1166 ppm vs 8538 ± 9531 ppm; above examples). Although ∆VHN and EFU correlated well (r = 0.723; p < 0.001), lesion demonstrated a greater ability to acquire fluoride than to remineralise.

CONCLUSIONS

Behavioural aspects relating to caries can be studied in vitro, although model limitations must be considered. Adequate exposure times to cariostatic concentrations of fluoride are important in maximising caries prevention.

The Effect of Polymerization Methods and Fiber Types on the Mechanical Behavior of Fiber-Reinforced Resin-Based Composites

PURPOSE

Glass fibers were introduced to increase the fracture resistance of resin-based composites restorations; however, the poor polymerization between fibers and resin-based composite were sometimes noted and can cause debonding and failure. The purpose of this study was to investigate the effects of different polymerization methods as well as fiber types on the mechanical behavior of fiber-reinforced resin-based composites.

MATERIALS AND METHODS

Seventy-five specimens were fabricated and divided into one control group and four experimental groups (n = 15), according to the type of glass fiber (strip or mesh) and polymerization methods (one- or two-step). A 0.2-mm-thick fiber layer was fabricated with different polymerization methods, on top of which a 1.8 mm resin-based composite layer was added to make a bar-shape specimen, followed by a final polymerization. Specimens were tested for flexural strength and flexural modulus. The failure modes of specimens were observed by scanning electron microscopy.

RESULTS

The fiber types showed significant effect on the flexural strength of test specimens (F = 469.48, p < 0.05), but the polymerization methods had no significant effect (F = 0.05, p = 0.82). The interaction between these two variables was not significant (F = 1.73, p = 0.19). In addition, both fiber type (F = 9.71, p < 0.05) and polymerization method (F = 12.17, p < 0.05) affected the flexural modulus of test specimens; however, the interaction between these two variables was not significant (F = 0.40, p = 0.53).

CONCLUSIONS

The strip fibers showed better mechanical behavior than mesh fibers and were suggested for resin-based composites restorations reinforcement; however, different polymerization methods did not have a significant effect on the strength and failure mode of fiber-reinforced resin-based composites.

Tetracycline-incorporated polymer nanofibers as a potential dental implant surface modifier

This study investigated the antimicrobial and osteogenic properties of titanium (Ti) disks superficially modified with tetracycline (TCH)-incorporated polymer nanofibers. The experiments were carried out in two phases. The first phase dealt with the synthesis and characterization (i.e., morphology, mechanical strength, drug release, antimicrobial activity, and cytocompatibility) of TCH-incorporated fibers. The second phase was dedicated to evaluating both the antimicrobial and murine-derived osteoprecursor cell (MC3T3-E1) response of Ti-modified with TCH-incorporated fibers. TCH was successfully incorporated into the submicron-sized and cytocompatible fibers. All TCH-incorporated mats presented significant antimicrobial activity against periodontal pathogens. The antimicrobial potential of the TCH-incorporated fibers-modified Ti was influenced by both the TCH concentration and bacteria tested. At days 5 and 7, a significant increase in MC3T3-E1 cell number was observed for TCH-incorporated nanofibers-modified Ti disks when compared to that of TCH-free nanofibers-modified Ti-disks and bare Ti. A significant increase in alkaline phosphatase (ALP) levels on the Ti disks modified with TCH-incorporated nanofiber on days 7 and 14 was seen, suggesting that the proposed surface promotes early osteogenic differentiation. Collectively, the data suggest that TCH-incorporated nanofibers could function as an antimicrobial surface modifier and osteogenic inducer for Ti dental implants. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2085-2092, 2017.

Effect of mica reinforcement on the flexural strength and microhardness of polymethyl methacrylate denture resin

PURPOSE

Conventional denture base polymethyl methacrylate (PMMA) is low in strength, soft, and brittle on impact. Improvements in the mechanical properties of denture base materials have been sought by adding different reinforcing phases to the PMMA matrix. The purpose of this work was to study the effects of mica reinforcement on the mechanical properties, flexural strength, and microhardness of PMMA denture base resin.

MATERIALS AND METHODS

Wet ground muscovite mica and Lucitone 199 original shade denture base resin were used. Two micas were tested: W200 and P66 with average particle sizes (d50) of 131 μm and 30 μm, respectively. The mica was silane treated in a solution of 3-methacryloxypropyl trimethoxysilane, ethanol, and water, and then dried. The specimens were fabricated using the denture base resin manufacturer's instructions with a powder : liquid ratio of 21 g/10 ml and a mixing time of 30 seconds. Five treatment groups were produced with differing amounts of mica added to the PMMA denture base resin: (A) control group with 0 vol% mica, (B) 10 vol% W200 mica, (C) 20 vol% W200 mica, (D) 10 vol% P66 mica, (E) 20 vol% P66 mica. The mica replaced equal volumes of the PMMA powder component to minimize changes in viscosity. The three-point bending flexural strength specimens were 70 × 11 × 3 mm(3) . Seven specimens were prepared for each treatment group. The hardness specimens were prepared from the ends of the three-point bend specimens after they were broken (N = 7). After deflasking, the specimens were polished with 600 grit silicon carbide paper to achieve smooth surfaces. A standard three-point bending jig with a span length of 50 mm was attached to an Instron universal testing machine. The specimens were placed on the jig, and loading was carried out using a 1 mm/min crosshead speed until failure. Microhardness was measured using a Clark microhardness tester with a Knoop indenter. The load was set to 200 g and the dwell time to 15 seconds. ANOVA and Tukey tests were used for statistical analyses (Alpha = 0.05).

RESULTS

The flexural strength of the control group was between 77% and 94% higher than all the mica-containing groups (p≤ 0.05). No significant differences were found within the four mica groups. Microhardnesses of the 20% mica groups (both fine and coarse) were 33% and 26% higher than the control (p≤ 0.05). The 10% mica groups had higher hardness than the control group, but the increase was not statistically significant (p > 0.05).

CONCLUSION

Mica additions to denture PMMA reduced flexural strength; however, with the specimens containing highest mica concentrations (20%), microhardness significantly increased.

Segmental bone regeneration using a load-bearing biodegradable carrier of bone morphogenetic protein-2

Segmental defect regeneration has been a clinical challenge. Current tissue-engineering approach using porous biodegradable scaffolds to delivery osteogenic cells and growth factors demonstrated success in facilitating bone regeneration in these cases. However, due to the lack of mechanical property, the porous scaffolds were evaluated in non-load bearing area or were stabilized with stress-shielding devices (bone plate or external fixation). In this paper, we tested a scaffold that does not require a bone plate because it has sufficient biomechanical strength. The tube-shaped scaffolds were manufactured from poly(propylene) fumarate/tricalcium phosphate (PPF/TCP) composites. Dicalcium phosphate dehydrate (DCPD) were used as bone morphogenetic protein-2 (BMP-2) carrier. Twenty-two scaffolds were implanted in 5mm segmental defects in rat femurs stabilized with K-wire for 6 and 15 weeks with and without 10 microg of rhBMP-2. Bridging of the segmental defect was evaluated first radiographically and was confirmed by histology and micro-computer tomography (microCT) imaging. The scaffolds in the BMP group maintained the bone length throughout the duration of the study and allow for bridging. The scaffolds in the control group failed to induce bridging and collapsed at 15 weeks. Peripheral computed tomography (pQCT) showed that BMP-2 does not increase the bone mineral density in the callus. Finally, the scaffold in BMP group was found to restore the mechanical property of the rat femur after 15 weeks. Our results demonstrated that the load-bearing BMP-2 scaffold can maintain bone length and allow successfully regeneration in segmental defects.

Preliminary evaluation of a load-bearing BMP-2 carrier for segmental defect regeneration

Large segmental defects in bones can result from tumor removal, massive trauma, congenital malformation, or non-union fractures. Such defects often are difficult to manage and require multiple-phase surgery to achieve adequate union and function. In this study, we propose a novel design of bone morphogenetic protein 2 (BMP-2) carrier for tissue engineering of segmental defect regeneration. The tube-shaped BMP-2 carrier was fabrication from a poly(propylene fumarate)/tricalcium phosphate (PPF/TCP) composite via casting technique developed in our laboratory. An in vitro evaluation showed that the compressive strength of the carrier decreased about 48% in 12 weeks while maintained a pH in the 6.8-7.4 range. In vivo study was conducted by implanting carriers loaded with 10 microg of BMP-2 in 5 mm rat femur gap model for 15 weeks. X-ray evidence of bridging was first found in the BMP group at 3 weeks. Bridging in all animals (N = 4) in the BMP group was found at 9 weeks. No x-ray evidence of bridging was found in the No BMP group (N = 3). pQCT analysis indicated that the bone mineral density of the callus in the BMP group has reached the level of native femur at 15 weeks after implantation, while the callus in the No BMP group has a bone mineral density at a lower level of 84% to the native femur. Histology analysis shows that a normal fatty bone marrow was restored and mineralized callus formed and bridged the segmental defect.

Effect of crosslinking density on swelling and mechanical properties of PEGDA400/PCLTMA900 hydrogels

A biodegradable polymer network hydrogel was fabricated and characterized for neural tissue engineering purposes. The proposed hydrogel contains both hydrophobic and hydrophilic components. The hydrophobic component is a three-arm poly(e-caprolactone) maleic acid with molecular weight of 900 (PCLTMA), and the hydrophilic component is poly(ethylene glycol) diacrylate macromer (PEGDA) with molecular weight of 400. A monolithic hard gel was generated by chemical photo-crosslinking. Three different networks, with varied ratios of PEGDA to PCLTMA including 25/75, 50/50 and 75/25, were characterized by compression testing, and the swelling properties were studied in phosphate-buffered saline (PBS, 7.4). The results of this study show that a wide-range of swelling data was obtained when the composition of PEGDA to PCLTMA was changed. The compressive modulus was measured for each composition, and the 75/25 gel was stiffer than the other compositions. These basic material properties will provide preliminary data for hydrogel development to be conducted in our laboratory.

Effects of growth factors on cell migration and alkaline phosphatase release

Segmental defects in long bones pose a clinical challenge in orthopaedic surgery. These defects often require multiple surgeries to achieve the desired bridging and union. Bone morphogenetic protein 2 (BMP-2) has been used extensively to facilitate regeneration in these large defects. The two important roles that BMP-2 has to play in large defect regeneration are chemotaxis to bone cells to migrate and induction of bone matrix production. Experiments were designed to study the effect of BMP-2 on alkaline phosphatase (ALP) production in cells that have migrated through a porous membrane in a cell migration chamber under the influence of culture media supplemented with BMP-2. Two cell lines, UMR cells and MC3T3-E1 cells, were used. A modified Boyden chamber with 8 microm membrane filter was used. Cell migration under the influence of BMP-2 concentration of 1, 10, 100, and 1000 ng/ml was studied. In both cells, the highest chemotactic effect was observed at 10 ng/ml. The ALP activity in the migrated cell was then characterized. A pattern of increase in ALP activity with increased BMP-2 dose was observed in the migrated cells.

Bovine albumin release and degradation analysis of dicalcium phosphate dihydrate cement

Dicalcium phosphate dihydrate (DCPD) cement was effective in our prior study as a bone morphogenetic protein-2 (BMP-2) delivery vehicle in a rat segmental defect regeneration study. In this study, we investigated the effects of liquid-to-powder (L/P) ratio on the in vitro degradation and protein release behavior of this material. The L/P ratios used in this study ranged from 0.50 to 0.83. DCPD cylinders were formed with a diameter of 1/4" and a height of 1/4". The effect of L/P on the initial compressive strength was found to be related to the porosity of the material at different L/P level. The strength of the material in phosphate buffered solution was found to degrade roughly 20% in 14 days. The relation between the final porosity and the compressive strength after degradation was modeled with Ryshkewitch equation. A liquid-to-powder ratio of 0.55, 0.7, and 0.8 was then used to fabricate samples for the protein release kinetic study. The low porosity (L/P = 0.55) group was found to have the fastest release rate, while the L/P = 0.8 group had the lowest. More then 60% of the loaded protein was released after 10 hours in all three groups with a final total release ranging between 75% and 93%. The findings suggested that the protein release profile of DCPD cements can be adjusted by the L/P ratio.

Design variables for mechanical properties of bone tissue scaffolds

The reconstruction of segmental defect in long bone is a clinical challenge. Multiple surgeries are typically required to restore the structure and function of the affected defect site. In order to overcome this defect a biodegradable bone tissue engineering scaffold is used. This scaffold acts as a carrier of proteins and growth factors, while also supporting the load that the bone would normally sustain, until the natural bone can regenerate in its place. Work was done to optimize an existing solid free-form scaffold design. The goal of the optimization was to increase the porosity of the scaffold while maintaining the strength of a previously-tested prototype design. With this in mind, eight new designs were created. These designs were drawn using CAD software and then through the use of finite element analysis the theoretical ultimate compressive strength of each design was obtained. Each scaffold design was constructed by casting a thermal-curable poly(propylene fumarate)/tricalcium phosphate (PPF/TCP) suspension into wax molds fabricated on inkjet printing rapid prototyping machine. The constructs were then experimentally tested by applying a uniaxial compressive load. The theoretical and experimental values of ultimate compressive strength and specific strength of each design were compared. Theoretically, the best scaffold design produced from this work improved upon the current design by increasing the porosity by 46% and also increasing the ultimate compressive strength by 27%. The experimental data was found to match the theoretical strength in four designs, but deviate from the theoretical strength in five designs. The reasons for the deviations and their relation to the rapid prototyping manufacturing technique were discussed. The results of this work show that it is possible to increase the porosity and strength of a bone tissue engineering scaffold through simple iterations in architectural design.