Drug eluting balloons

Ever since the first percutaneous transluminal angioplasty (PTA) was carried out in Switzerland in 1977, restenosis remains a major drawback of this minimally invasive treatment intervention. Numerous attempts to increase vessel patency after PTA have included systemic medications and endovascular brachytherapy, but these techniques have not met our expectations in preventing restenosis. Nitinol stents have been shown to reduce rates of restenosis and target lesion revascularization in patients undergoing endovascular treatment of long femoropopliteal obstructions. Despite further technical refinements in nitinol stent technology, restenosis occurs in approximately every third patient undergoing femoropopliteal stenting. Similarly, initial clinical trials with drug-eluting stents have failed to indicate restenosis inhibition in femoropopliteal segment. Unfortunately, restenosis rates after below-the-knee PTA and stenting have been reported to be even higher than those following femoropopliteal revascularization. Current concepts for the prevention and treatment of restenosis after PTA or stenting include the sustained release of antiproliferative paclitaxel into the vessel wall. Drug eluting balloons are a promising, novel technology aimed at inhibiting restenosis after PTA. Its clinical efficacy in reducing restenosis has already been proven for coronary arteries as well as for the femoropopliteal segment. The purpose of this article is to review the clinical utility of drug-eluting balloons for lower limb endovascular interventions.

Preliminary experimental evaluation of the immediate angiographic occlusion time with use of the AMPLATZER vascular plug II for carotid artery occlusion

Delayed occlusion time in parent artery occlusion of brain-supplying vessels might carry risk for thromboembolic complications. Vascular plug devices are successfully used in cardiopulmonary and peripheral interventions to occlude high-flow lesions and have been adapted for use in neurointerventions. The purpose of the present study was to experimentally evaluate the immediate occlusion time of the AMPLATZER vascular plug (AVP) II-a second-generation cylindrical, self-expandable, resheathable nitinol wire mesh consisting of three lobes-in the carotid artery.

Oversizing and Restenosis with Self-Expanding Stents in Iliofemoral Arteries

Uncoated self-expanding nitinol stents (NS) are commonly oversized in peripheral arteries. In current practice, 1-mm oversizing is recommended. Yet, oversizing of NS may be associated with increased restenosis. To provide further evidence, NS were implanted in porcine iliofemoral arteries with a stent-to-artery-ratio between 1.0 and 2.3. Besides conventional uncoated NS, a novel self-expanding NS with an antiproliferative titanium-nitride-oxide (TiNOX) coating was tested for safety and efficacy.

[Guidance of interventions in subintimal recanalization and fenestration of dissection membranes using a novel dual-lumen intravascular ultrasound catheter]

PURPOSE: To evaluate the feasibility and effectiveness of IVUS-guided puncture for gaining controlled target lumen reentry in subintimal recanalization of chronic iliac/femoral artery occlusions and in fenestration of aortic dissections. MATERIALS AND METHODS: Between 5/2004 and 12/2005 12 consecutive patients (7 male, 5 female; mean age 64.6 +/- 12.0 years) with chronic critical limb ischemia and ischemic complications of aortic dissection were treated using the Pioneer catheter. This 6.2-F dual-lumen catheter combines a 20-MHz IVUS transducer with a pre-shaped extendable, hollow 24-gauge nitinol needle. This coaxial needle allows real-time IVUS-guided puncture of the target lumen and after successful reentry a 0.014" guidewire may be advanced through the needle into the target lumen. 7 patients were treated for aortic dissection and 5 patients (with failed previous attempts at subintimal recanalization) for chronic arterial occlusion. Patients with aortic dissection (5 type A dissections, 2 type B dissections) had developed renal ischemia (n = 2), renal and mesenteric ischemia (n = 2), or low extremity ischemia (n = 3). Patients with chronic arterial occlusions (2 common iliac artery occlusions, 3 superficial femoral artery occlusions) experienced ischemic rest pain (n = 4), and a non-healing foot ulcer (n = 1). RESULTS: The technical success rate using the Pioneer catheter was 100%. The recanalization/fenestration time was 37 +/- 12 min. Procedure-related complications did not occur. In 10 cases a significant improvement of clinical symptoms was evident. One patient with aortic dissection and ischemic paraplegia required subsequent surgical intervention. One patient had persistent ischemic rest pain despite successful recanalization of a superficial femoral artery occlusion. CONCLUSION: The Pioneer catheter is a reliable device which may be helpful for achieving target lumen reentry in subintimal recanalization of chronic occlusions and in fenestration of aortic dissections.

Initial clinical experience with the 4-F self-expanding XPERT stent system for infrapopliteal treatment of patients with severe claudication and critical limb ischemia

PURPOSE: To evaluate the primary success and short-term patency associated with a new 4-F sheath-compatible self-expanding nitinol stent after failed conventional angioplasty of distal popliteal and infrapopliteal lesions in severe lifestyle-limiting claudication (LLC) and chronic critical limb ischemia (CLI). MATERIALS AND METHODS: Between May 2003 and July 2005, 35 patients with Rutherford category 3-5 disease (16 patients with CLI, 19 patients with LLC) underwent percutaneous transluminal angioplasty (PTA) and stent implantation. Indications for stent placement were residual stenosis, flow-limiting dissections, or elastic recoil after PTA. Before and after the intervention and during the 6-month follow-up, clinical investigation, color-flow and duplex Doppler ultrasonography, and digital subtraction angiography were performed. Technical success, primary patency at 6 months, clinical improvement as defined by Rutherford with clinical and hemodynamic measures, and complications were evaluated. RESULTS: A total of 22 patients underwent distal popliteal artery stent placement and 13 underwent tibioperoneal artery stent placement. Stent implantation was successfully performed in all patients. After stent placement, the primary cumulative patency rate for the study group at 6 months was 82%. The mean resting ankle-brachial index at baseline was 0.50 +/- 0.16 and significantly increased to 0.90 +/- 0.17 at 12-24 hours after intervention and 0.82 +/- 0.24 at latest follow-up (P < .001 for both). The sustained clinical improvement rate was 80% at the 6-month follow-up. The 6-month limb salvage rate regarding major amputation was 100%. The rate of major complications was 17%. CONCLUSIONS: Infrapopliteal application of the new nitinol stent is a safe, feasible, and effective method with good short-term patency rate in the treatment of severe LLC and chronic CLI.

The frozen elephant trunk: an interesting hybrid endovascular-surgical technique to treat complex pathologies of the thoracic aorta

The treatment of complex aortic pathologies involving the ascending aorta, the aortic arch, and the descending aorta remains a challenging issue in aortic surgery. The frozen elephant trunk procedure effectively combines surgical and interventional technologies in the treatment of extensive aortic aneurysms and dissections. We present two patients with complex aortic lesions involving all three segments of the thoracic aorta. The device used in our series is the new E-vita open hybrid prosthesis consisting of a proximal woven polyester tube and a distal self-expandable nitinol stent graft, which can be delivered antegrade into the descending aorta.

Intravascular US-guided direct intrahepatic portocaval shunt with an expanded polytetrafluoroethylene-covered stent-graft

PURPOSE: To retrospectively evaluate the midterm patency rate of the nitinol (Viatorr, W.L. Gore and Associates, Flagstaff, Ariz) stent-graft for direct intrahepatic portacaval shunt (DIPS) creation. MATERIALS AND METHODS: Institutional Review Board approval for this retrospective HIPAA-compliant study was obtained with waiver of informed consent. DIPS was created in 18 men and one woman (median age, 54 years; range, 45-65 years) by using nitinol polytetrafluoroethylene (PTFE)-covered stent-grafts. The primary indications were intractable ascites (n = 14), acute variceal bleeding (n = 3), and hydrothorax (n = 2). Follow-up included Doppler ultrasonography at 1, 6, and 12 months and venography with manometry at 6-month intervals after the procedure. Shunt patency and cumulative survival were evaluated by using the Kaplan-Meier method and survival curves were plotted. Differences in mean portosystemic gradients (PSGs) were evaluated by using the Student t test. Multiple regression analysis for survival and DIPS patency were performed for the following parameters: Child-Pugh class, model of end-stage liver disease score, pre- and post-DIPS PSGs, pre-DIPS liver function tests, and pre-DIPS creatinine levels. RESULTS: DIPS creation was successful in all patients. Effective portal decompression and free antegrade shunt flow was achieved in all patients. Intraperitoneal bleeding occurred in one patient during the procedure and was controlled during the same procedure by placing a second nitinol stent-graft. The primary patency rate was 100% at all times during the follow-up period (range, 2 days to 30 months; mean, 256 days; median, 160 days). Flow restrictors were deployed in two (11%) of 19 patients. The 1-year mortality rate was 37% (seven of 19). CONCLUSION: Patency after DIPS creation with the nitinol PTFE-covered stent-graft was superior to that after TIPS with the nitinol stent-graft.

Influence of stent type on hemodynamic depression after carotid artery stent placement

PURPOSE: To assess the effect of stent type on hypotension and bradycardia after carotid artery stent placement. MATERIALS AND METHODS: A retrospective analysis on a prospectively maintained database was conducted in 256 patients (126 men; mean age, 71.8 years +/- 8.6; 194 de novo lesions) undergoing carotid artery stent placement between January 1996 and January 2007 by using self-expanding stents. Braided Elgiloy stents (Wallstents) were used in 44 of the 256 patients (17.2%) and slotted-tube nitinol stents were deployed in 212 (82.8%). Bivariate and multivariable logistic regression models were used to determine the influence of stent design on procedural and 24-hour hypotension and bradycardia. RESULTS: Procedural hemodynamic depression (HD) was encountered in 73 of the 256 patients (28.5%) due to hypotension in 24 (9.4%), bradycardia in 12 (4.7%), or both in 37 (14.5%) patients. Rates of procedural hypotension were 11.3% with nitinol stents and 0% with braided Elgiloy stents (P = .0188). Persistent postprocedural HD occurred in 91 of the 256 patients (35.5%) due to hypotension in 40 patients (15.6%), bradycardia in 23 (9.0%), or both in 28 (10.9%). Within a multivariable analysis adjusted for clinically relevant factors affecting rates of HD, the use of braided Elgiloy stents was associated with a decreased rate of procedural hypotension (odds ratio: 0.165; 95% confidence interval: 0.038, 0.721; P = .017). Procedural hypotension and bradycardia were not correlated to incidence of major adverse events but were associated with an increased duration of hospital stay (P = .0059 and P = .0335, respectively). CONCLUSIONS: Nitinol stents are associated with a higher risk of hypotension as compared to braided Elgiloy stents during carotid artery stent placement.

Stent placement vs. balloon angioplasty for popliteal artery treatment: two-year results of a prospective, multicenter, randomized trial.

PURPOSE To investigate the 2-year technical and clinical results of primary nitinol stent placement in comparison with percutaneous transluminal angioplasty (PTA) in the treatment of de novo lesions of the popliteal artery. METHODS The ETAP study (Endovascular Treatment of Atherosclerotic Popliteal Artery Lesions: balloon angioplasty vs. primary stenting; www.ClinicalTrials.gov identifier NCT00712309) is a prospective, randomized trial that enrolled 246 patients (158 men; mean age 72 years) who were randomly assigned to receive a nitinol stent (n=119) or PTA (n=127) for lesions averaging 42.3 mm in length. The results of the primary study endpoint were published. Secondary outcome measures and endpoints included primary patency (freedom from duplex-detected target lesion restenosis), target lesion revascularization (TLR), secondary patency, changes in ankle-brachial index and Rutherford class, and event-free survival (freedom from target limb amputation, TLR, myocardial infarction, and death). RESULTS In total, 183 patients (89 stent and 94 PTA) were available for the 2-year analysis. The primary patency rate was significantly higher in the stent group (64.2%) than in the PTA group (31.3%, p=0.0001). TLR rates were 22.4% and 59.5%, respectively (p=0.0001). When provisional stent placement in the PTA arm was not considered as TLR and loss in patency, the differences prevailed between the study groups but were not significant (64.2% vs. 56.1% for primary patency, respectively; p=0.44). A significant improvement in ABI and Rutherford category was observed at 2 years in both groups. CONCLUSION In treatment of obstructive popliteal artery lesions, provisional stenting reveals equivalent patency in comparison to primary stenting. However, the 2-year results of this trial suggest the possibility of a shift toward higher patency rates in favor of primary stenting.

BaTboT: a biologically inspired flapping and morphing bat robot actuated by SMA-based artificial muscles

Bats are animals that posses high maneuvering capabilities. Their wings contain dozens of articulations that allow the animal to perform aggressive maneuvers by means of controlling the wing shape during flight (morphing-wings). There is no other flying creature in nature with this level of wing dexterity and there is biological evidence that the inertial forces produced by the wings have a key role in the attitude movements of the animal. This can inspire the design of highly articulated morphing-wing micro air vehicles (not necessarily bat-like) with a significant wing-to-body mass ratio. This thesis presents the development of a novel bat-like micro air vehicle (BaTboT) inspired by the morphing-wing mechanism of bats. BaTboT’s morphology is alike in proportion compared to its biological counterpart Cynopterus brachyotis, which provides the biological foundations for developing accurate mathematical models and methods that allow for mimicking bat flight. In nature bats can achieve an amazing level of maneuverability by combining flapping and morphing wingstrokes. Attempting to reproduce the biological wing actuation system that provides that kind of motion using an artificial counterpart requires the analysis of alternative actuation technologies more likely muscle fiber arrays instead of standard servomotor actuators. Thus, NiTinol Shape Memory Alloys (SMAs) acting as artificial biceps and triceps muscles are used for mimicking the morphing wing mechanism of the bat flight apparatus. This antagonistic configuration of SMA-muscles response to an electrical heating power signal to operate. This heating power is regulated by a proper controller that allows for accurate and fast SMA actuation. Morphing-wings will enable to change wings geometry with the unique purpose of enhancing aerodynamics performance. During the downstroke phase of the wingbeat motion both wings are fully extended aimed at increasing the area surface to properly generate lift forces. Contrary during the upstroke phase of the wingbeat motion both wings are retracted to minimize the area and thus reducing drag forces. Morphing-wings do not only improve on aerodynamics but also on the inertial forces that are key to maneuver. Thus, a modeling framework is introduced for analyzing how BaTboT should maneuver by means of changing wing morphology. This allows the definition of requirements for achieving forward and turning flight according to the kinematics of the wing modulation. Motivated by the biological fact about the influence of wing inertia on the production of body accelerations, an attitude controller is proposed. The attitude control law incorporates wing inertia information to produce desired roll (φ) and pitch (θ) acceleration commands. This novel flight control approach is aimed at incrementing net body forces (Fnet) that generate propulsion. Mimicking the way how bats take advantage of inertial and aerodynamical forces produced by the wings in order to both increase lift and maneuver is a promising way to design more efficient flapping/morphing wings MAVs. The novel wing modulation strategy and attitude control methodology proposed in this thesis provide a totally new way of controlling flying robots, that eliminates the need of appendices such as flaps and rudders, and would allow performing more efficient maneuvers, especially useful in confined spaces. As a whole, the BaTboT project consists of five major stages of development: - Study and analysis of biological bat flight data reported in specialized literature aimed at defining design and control criteria. - Formulation of mathematical models for: i) wing kinematics, ii) dynamics, iii) aerodynamics, and iv) SMA muscle-like actuation. It is aimed at modeling the effects of modulating wing inertia into the production of net body forces for maneuvering. - Bio-inspired design and fabrication of: i) skeletal structure of wings and body, ii) SMA muscle-like mechanisms, iii) the wing-membrane, and iv) electronics onboard. It is aimed at developing the bat-like platform (BaTboT) that allows for testing the methods proposed. - The flight controller: i) control of SMA-muscles (morphing-wing modulation) and ii) flight control (attitude regulation). It is aimed at formulating the proper control methods that allow for the proper modulation of BaTboT’s wings. - Experiments: it is aimed at quantifying the effects of properly wing modulation into aerodynamics and inertial production for maneuvering. It is also aimed at demonstrating and validating the hypothesis of improving flight efficiency thanks to the novel control methods presented in this thesis. This thesis introduces the challenges and methods to address these stages. Windtunnel experiments will be oriented to discuss and demonstrate how the wings can considerably affect the dynamics/aerodynamics of flight and how to take advantage of wing inertia modulation that the morphing-wings enable to properly change wings’ geometry during flapping. Resumen: Los murciélagos son mamíferos con una alta capacidad de maniobra. Sus alas están conformadas por docenas de articulaciones que permiten al animal maniobrar gracias al cambio geométrico de las alas durante el vuelo. Esta característica es conocida como (alas mórficas). En la naturaleza, no existe ningún especimen volador con semejante grado de dexteridad de vuelo, y se ha demostrado, que las fuerzas inerciales producidas por el batir de las alas juega un papel fundamental en los movimientos que orientan al animal en vuelo. Estas características pueden inspirar el diseño de un micro vehículo aéreo compuesto por alas mórficas con redundantes grados de libertad, y cuya proporción entre la masa de sus alas y el cuerpo del robot sea significativa. Esta tesis doctoral presenta el desarrollo de un novedoso robot aéreo inspirado en el mecanismo de ala mórfica de los murciélagos. El robot, llamado BaTboT, ha sido diseñado con parámetros morfológicos muy similares a los descritos por su símil biológico Cynopterus brachyotis. El estudio biológico de este especimen ha permitido la definición de criterios de diseño y modelos matemáticos que representan el comportamiento del robot, con el objetivo de imitar lo mejor posible la biomecánica de vuelo de los murciélagos. La biomecánica de vuelo está definida por dos tipos de movimiento de las alas: aleteo y cambio de forma. Intentar imitar como los murciélagos cambian la forma de sus alas con un prototipo artificial, requiere el análisis de métodos alternativos de actuación que se asemejen a la biomecánica de los músculos que actúan las alas, y evitar el uso de sistemas convencionales de actuación como servomotores ó motores DC. En este sentido, las aleaciones con memoria de forma, ó por sus siglas en inglés (SMA), las cuales son fibras de NiTinol que se contraen y expanden ante estímulos térmicos, han sido usados en este proyecto como músculos artificiales que actúan como bíceps y tríceps de las alas, proporcionando la funcionalidad de ala mórfica previamente descrita. De esta manera, los músculos de SMA son mecánicamente posicionados en una configuración antagonista que permite la rotación de las articulaciones del robot. Los actuadores son accionados mediante una señal de potencia la cual es regulada por un sistema de control encargado que los músculos de SMA respondan con la precisión y velocidad deseada. Este sistema de control mórfico de las alas permitirá al robot cambiar la forma de las mismas con el único propósito de mejorar el desempeño aerodinámico. Durante la fase de bajada del aleteo, las alas deben estar extendidas para incrementar la producción de fuerzas de sustentación. Al contrario, durante el ciclo de subida del aleteo, las alas deben contraerse para minimizar el área y reducir las fuerzas de fricción aerodinámica. El control de alas mórficas no solo mejora el desempeño aerodinámico, también impacta la generación de fuerzas inerciales las cuales son esenciales para maniobrar durante el vuelo. Con el objetivo de analizar como el cambio de geometría de las alas influye en la definición de maniobras y su efecto en la producción de fuerzas netas, simulaciones y experimentos han sido llevados a cabo para medir cómo distintos patrones de modulación de las alas influyen en la producción de aceleraciones lineales y angulares. Gracias a estas mediciones, se propone un control de vuelo, ó control de actitud, el cual incorpora información inercial de las alas para la definición de referencias de aceleración angular. El objetivo de esta novedosa estrategia de control radica en el incremento de fuerzas netas para la adecuada generación de movimiento (Fnet). Imitar como los murciélagos ajustan sus alas con el propósito de incrementar las fuerzas de sustentación y mejorar la maniobra en vuelo es definitivamente un tópico de mucho interés para el diseño de robots aéros mas eficientes. La propuesta de control de vuelo definida en este trabajo de investigación podría dar paso a una nueva forma de control de vuelo de robots aéreos que no necesitan del uso de partes mecánicas tales como alerones, etc. Este control también permitiría el desarrollo de vehículos con mayor capacidad de maniobra. El desarrollo de esta investigación se centra en cinco etapas: - Estudiar y analizar el vuelo de los murciélagos con el propósito de definir criterios de diseño y control. - Formular modelos matemáticos que describan la: i) cinemática de las alas, ii) dinámica, iii) aerodinámica, y iv) actuación usando SMA. Estos modelos permiten estimar la influencia de modular las alas en la producción de fuerzas netas. - Diseño y fabricación de BaTboT: i) estructura de las alas y el cuerpo, ii) mecanismo de actuación mórfico basado en SMA, iii) membrana de las alas, y iv) electrónica abordo. - Contro de vuelo compuesto por: i) control de la SMA (modulación de las alas) y ii) regulación de maniobra (actitud). - Experimentos: están enfocados en poder cuantificar cuales son los efectos que ejercen distintos perfiles de modulación del ala en el comportamiento aerodinámico e inercial. El objetivo es demostrar y validar la hipótesis planteada al inicio de esta investigación: mejorar eficiencia de vuelo gracias al novedoso control de orientación (actitud) propuesto en este trabajo. A lo largo del desarrollo de cada una de las cinco etapas, se irán presentando los retos, problemáticas y soluciones a abordar. Los experimentos son realizados utilizando un túnel de viento con la instrumentación necesaria para llevar a cabo las mediciones de desempeño respectivas. En los resultados se discutirá y demostrará que la inercia producida por las alas juega un papel considerable en el comportamiento dinámico y aerodinámico del sistema y como poder tomar ventaja de dicha característica para regular patrones de modulación de las alas que conduzcan a mejorar la eficiencia del robot en futuros vuelos.

Papel do ecocardiograma transesofágico tridimensional na ótima seleção do dispositivo para o tratamento percutâneo da comunicação interatrial tipo ostium secundum

INTRODUCAO: A comunicação interatrial tipo \"ostium secundum\" é um defeito cardíaco congênito caracterizado pela deficiência parcial ou total da lâmina da fossa oval, também chamada de septo primo. Corresponde a 10 a 12% do total de cardiopatias congênitas, sendo a mais frequente na idade adulta. Atualmente a oclusão percutânea é o método terapêutico de escolha em defeitos com características anatômicas favoráveis para o implante de próteses na maioria dos grandes centros mundiais. A ecocardiografia transesofágica bidimensional com mapeamento de fluxo em cores é considerada a ferramenta padrão-ouro para a avaliação anatômica e monitoração durante do procedimento, sendo crucial para a ótima seleção do dispositivo. Neste sentido, um balão medidor é introduzido e insuflado através do defeito de forma a ocluí-lo temporariamente. A medida da cintura que se visualiza no balão (diâmetro estirado) é utilizada como referência para a escolha do tamanho da prótese. Recentemente a ecocardiografia tridimensional transesofágica em tempo real tem sido utilizada neste tipo de intervenção percutânea. Neste estudo avaliamos o papel da mesma na ótima seleção do dispositivo levando-se em consideração as dimensões e a geometria do defeito e a espessura das bordas do septo interatrial. METODO: Estudo observacional, prospectivo, não randomizado, de único braço, de uma coorte de 33 pacientes adultos portadores de comunicação interatrial submetidos a fechamento percutâneo utilizando dispositivo de nitinol autocentrável (Cera ®, Lifetech Scientific, Shenzhen, China). Foram analisadas as medidas do maior e menor diâmetro do defeito, sua área e as medidas do diâmetro estirado com balão medidor obtidas por meio das duas modalidades ecocardiográficas. Os defeitos foram considerados como elípticos ou circulares segundo a sua geometria; as bordas ao redor da comunicação foram consideradas espessas (>2 mm) ou finas. O dispositivo selecionado foi igual ou ate 2 mm maior que o diâmetro estirado na ecocardiografia transesofágica bidimensional (padrão-ouro). Na tentativa de identificar uma variável que pudesse substituir o diâmetro estirado do balão para a ótima escolha do dispositivo uma série de correlações lineares foram realizadas. RESULTADOS: A idade e peso médio foram de 42,1 ± 14,9 anos e 66,0 ± 9,4kg, respectivamente; sendo 22 de sexo feminino. Não houve diferenças estatísticas entre os diâmetros maior e menor ou no diâmetro estirado dos defeitos determinados por ambas as modalidades ecocardiográficas. A correlação entre as medidas obtidas com ambos os métodos foi ótima (r > 0,90). O maior diâmetro do defeito, obtido à ecoardiografia transesofágica tridimensional, foi a variável com melhor correlação com o tamanho do dispositivo selecionado no grupo como um todo (r= 0,89) e, especialmente, nos subgrupos com geometria elíptica (r= 0,96) e com bordas espessas ao redor do defeito (r= 0,96). CONCLUSÃO: Neste estudo em adultos com comunicações interatriais tipo ostium secundum submetidos à oclusão percutânea com a prótese Cera ®, a ótima seleção do dispositivo pôde ser realizada utilizando-se apenas a maior medida do defeito obtida na ecocardiografia transesofágica tridimensional em tempo real, especialmente nos pacientes com defeitos elípticos e com bordas espessas.

COMPARAÇÃO DAS FORÇAS DE DEFLEXÃO LIBERADAS ENTRE OS FIOS ORTODÔNTICOS ESTÉTICOS E SUA RELAÇÃO COM O REVESTIMENTO

O objetivo do presente estudo consistiu em comparar as forças de deflexão in vitro entre fios estéticos e fio NiTi, para verificar a força máxima e da região platô e determinar sua correlação com o diâmetro do fio com e sem revestimento. Foram realizados dez ensaios de sete marcas comerciais de arcos précontornados, sendo seis fios estéticos (Invu (I), Optis (O), Flexy Super Elastic Esthetic (FSEE), Niticosmetic (N), Orthocosmetic Elastinol (OE) e Pro Form Coated Nitanium (PFCN)) e um fio NiTi superelástico (Nitinol Super Elastic (NSE)), aplicando-se o teste de curvatura de três pontos, associado a máquina de ensaios universal EMIC. Desenvolveu-se um dispositivo com braquetes cerâmicos (Transcend), cujos fios foram presos por elásticos modulares, sendo obtidos os valores da força de deflexão em 3,0, 2,0 e 1,0mm. O diâmetro dos fios com e sem revestimento foram mensurados com o especímetro digital Micromaster. A análise de variância a um critério (p<0,05) mostrou diferença significante entre os fios e o teste post-hoc de Tukey determinou que a força de deflexão em 3mm para o O

ANÁLISE MICROSCÓPICA E DA RUGOSIDADE DE SUPERFÍCIE DE FIOS ORTODÔNTICOS ESTÉTICOS, ANTES E APÓS DEFLEXÃO

O objetivo deste estudo foi avaliar a topografia de superfície dos fios estéticos, antes e após teste de deflexão. A amostra foi composta por 70 corpos de prova de fios 0,014 redondos, sendo 10 de cada uma das marcas comerciais avaliadas: Orthocosmetic Elastinol (Masel), Flexy Super Elastic Esthetic (Orthometric), InVu (TP Orthodontics) e ProForm Nitanium (Ortho Organizers) fios de NiTi revestidos por Teflon®; Optis (TP Orthodontics) fio de resina reforçado por fibra de vidro ou FRP; Niticosmetic (Tecnident) fio de NiTi revestido por resina epoxídica; e Nitinol SE (3M Unitek) fio de NiTi superelástico, usado para controle. A topografia de superfície de cada fio foi avaliada por rugosímetro e por microscópio óptico, antes e após ser submetido a ensaio de deflexão, no lado em que a força foi aplicada e no lado oposto a este. Cada fio foi defletido em 3,1mm, a uma velocidade de 1mm/min, com célula de carga de 5N a 36⁰C + 1⁰C. A análise de variância a três critérios (p<0,05) mostrou diferença significante entre os fios e o teste de Tukey mostrou que o fio Optis (TP Orthodontics) apresentou aumento nos parâmetros de rugosidade Ra, Rt e Rz, após a deflexão. O fio Niticosmetic (Tecnident) apresentou aumento na rugosidade média (Ra). O fio InVu (TP Orthodontics) foi o único que mostrou aumento na rugosidade no lado em que a força foi aplicada. A análise visual por meio de microscopia óptica revelou alterações na superfície em todos os fios estéticos após o teste de deflexão, desde delaminações do revestimento, observadas nos fios Orthocosmetic Elastinol e InVu, riscos permanentes na superfície, como visto nos fios Flexy Super Elastic Esthetic, Niticosmetic e ProForm Nitanium, e até mesmo fratura incompleta, no fio Optis. Concluiu-se que o fio Niticosmetic apresentou topografia de superfície similar ao fio metálico, e os demais fios estéticos apresentaram maior rugosidade e alterações visuaisna superfície.