Biomechanics of Vertebroplasty: Effect of Cement Viscosity on Mechanical Behaviour

Vertebroplasty is a minimally invasive surgical procedure, which requires efficacious percutaneous cement delivery via a cannulated needle to restore the strength and stiffness in osteoporotic vertebral bodies. Cement viscosity is understood to influence the injectability, cohesion and cement retention within the vertebral body. Altering the liquid to powder ratio modifies the viscosity of bone cement; however, the cement viscosity-response association between cement fill and augmentation of strength and stiffness is unknown. The aim of this study was to determine the relationship between viscosity, cement fill and the potential augmentation of strength and stiffness in an open pore foam structure that was representative of osteoporotic cancellous bone using an in vitro prophylactic vertebroplasty model. The results showed a strong linear correlation between compressive strength and stiffness augmentation with percentage cement fill, the extent of which was strongly dependent on the cement viscosity. Significant forces were required to ensure maximum delivery of the high viscosity cement using a proprietary screw-driven cement delivery technology. These forces could potentially exceed the normal human physical limit. Similar trends were observed when comparing the results from this study and previously reported cadaveric and animal based in vitro models.

Finite element modelling of the formation of pre-load damage in cement mantles of orthopaedic joint replacements

Finite element modeling of the formation of pre-loaded damage in cement mantles of orthopaedic joint replacements was presented. The existence of cracking suggested a high level of residual stress. The direction of maximum principal stress vectors corresponded well with the observed crack orientation. Results suggested that cracking depends upon a combination of residual stress, porosity and temperature rise during polymerization.

Fracture strength of machined ceramic crowns as a function of tooth preparation design and the elastic modulus of the cement

Objectives: To determine, by means of static fracture testing the effect of the tooth preparation design and the elastic modulus of the cement on the structural integrity of the cemented machined ceramic crown-tooth complex. 
Methods: Human maxillary extracted premolar teeth were prepared for all-ceramic crowns using two preparation designs; a standard preparation in accordance with established protocols and a novel design with a flat occlusal design. All-ceramic feldspathic (Vita MK II) crowns were milled for all the preparations using a CAD/CAM system (CEREC-3). The machined all-ceramic crowns were resin bonded to the tooth structure using one of three cements with different elastic moduli: Super-Bond C&B, Rely X Unicem and Panavia F 2.0. The specimens were subjected to compressive force through a 4 mm diameter steel ball at a crosshead speed of 1 mm/min using a universal test machine (Loyds Instrument Model LRX.). The load at the fracture point was recorded for each specimen in Newtons (N). These values were compared to a control group of unprepared/unrestored teeth. 
Results: There was a significant difference between the control group, with higher fracture strength, and the cemented samples regardless of the occlusal design and the type of resin cement. There was no significant difference in mean fracture load between the two designs of occlusal preparation using Super-Bond C&B. For the Rely X Unicem and Panavia F 2.0 cements, the proposed preparation design with a flat occlusal morphology provides a system with increased fracture strength. 
Significance: The proposed novel flat design showed less dependency on the resin cement selection in relation to the fracture strength of the restored tooth. The choice of the cement resin, with respect to its modulus of elasticity, is more important in the anatomic design than in the flat design. © 2013 Academy of Dental Materials.

Modelling fatigue of bone cement

Accurate models of cement and interface fatigue are essential if computationally assessing risk of aseptic loosening of cemented joint replacements is to become clinically relevant. A series of approaches will be presented that attempt to model several aspects of bone cement fatigue relevant to predicting cemented joint replacement failure. Failure models for homogeneous (bulk) bone cement and its interface with implant and host tissue are reviewed. Variability introduced by porosity and interaction between fatigue and creep are also considered. Finally, some current and potential future developments are discussed.

Effect of Nanosilica on Rheology, Fresh Properties, and Strength of Cement-Based Grouts

The effect of colloidal nanosilica on the fresh and rheological parameters, plastic shrinkage, heat of hydration, and compressive strength of cement-based grouts is investigated in this paper. The fresh and rheological properties were evaluated by the minislump flow, Marsh cone flow time, Lombardi plate cohesion meter, yield value, and plastic viscosity. The key parameters investigated were the dosages of nanosilica and superplasticizer and temperature of mixing water. Statistical models and isoresponse curves were developed to capture the significant trends. The dosage of nanosilica had a significant effect on the results. The increase in the dosage of nanosilica led to increasing the values of flow time, plate cohesion meter, yield stress, plastic viscosity, heat of hydration at 1 day and 3 days, and compressive strength at 1 day, while reducing the minislump, plastic shrinkage up 24 h, and compressive strength at 3, 7, and 28 days. Conversely, the increase in the dosage of superplasticizer led to decreasing the values of flow time, plate cohesion meter, yield stress, plastic viscosity, heat of hydration at 1 day and 3 days, and compressive strength at 1 day, while increasing the minislump, plastic shrinkage, and compressive strength at 3 and 7 days. Increasing the temperature of mixing water led to a notable increase in the results of minislump, flow time, plastic viscosity, heat of hydration at 3 days, and compressive strength at 1 day, while it reduced the plate cohesion, compressive strength at 3, 7, and 28 days. The statistical models developed in this study can facilitate optimizing the mixture proportions of grouts for target performance by reducing the number of trial batches needed.