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Riordan, E.; Yung, A.; Cheng, K.; Lim, L.; Clark, J.; Rtshiladze, M.; Ch’ng, S. Modeling Methods in Craniofacial Virtual Surgical Planning. J. Craniofac. Surg. 2023. [ Google Scholar] [ CrossRef]

of Biomedical Engineering, Medical Additive Manufacturing Research Group (SwissMAM), University of Basel, Allschwil, Switzerland Crawford, K.; Berrey, B.H.; Pierce, W.A.; Welch, R.D. In vitro strength comparison of hydroxyapatite cement and polymethylmethacrylate in subchondral defects in caprine femora. J. Orthop. Res. 2005, 16, 715–719. [ Google Scholar] [ CrossRef] Yu W, Lia M, Lib X. Fragmented skull modeling using heat kernels. Graphical Models. 2012; 74(4): 140–151. We are grateful to Lorenzo Rook, Pasquale Raia, and Josep Fortuny for inviting us to contribute to this volume. We are also especially grateful to Paul Palmqvist for his comments on an earlier version of this manuscript. We are specially grateful to Jordi Marcé-Nogué and Vincent Fernandez for their highly constructive review of our paper. Supplementary Material Rosenthal, A.L.; Rovell, J.M.; Girard, A.E. Polyacrylic Bone Cement Containing Erythromycin and Colistin. I. In Vitro Bacteriological Activity and Diffusion Properties of Erythromycin, Colistin and Erythromycin/Colistin Combination. J. Int. Med. Res. 1976, 4, 296–304. [ Google Scholar] [ CrossRef]Cuc, N.T.K.; Cao, X.B.; Vu, T.D.; Thang, V.T. Design and Mechanical Evaluation of a Large Cranial Implant and Fixation Parts. Interdiscip. Neurosurg. 2023, 31, 101676. [ Google Scholar] [ CrossRef] Li, J.; Egger, J. (Eds.) Towards the Automatization of Cranial Implant Design in Cranioplasty II. In Proceedings of the Second Challenge, AutoImplant 2021, Held in Conjunction with MICCAI 2021, Strasbourg, France, 1 October 2021. [ Google Scholar] [ CrossRef] Rokaya, D.; Singh, A.K.; Sanohkan, S.; Nayar, S. Advanced Polymers for Craniomaxillofacial Reconstruction. In Chapter in Specialty Polymers, 1st ed.; Gupta, R.K., Ed.; CRC Press: Boca Raton, FL, USA, 2023; p. 13. ISBN 9781003278269. [ Google Scholar] Zafar, M.S. Prosthodontic Applications of Polymethyl Methacrylate (PMMA): An Update. Polymers 2020, 12, 2299. [ Google Scholar] [ CrossRef] [ PubMed]

Osenbach, R.K.; Haines, S.J. Infections in Neurological Surgery. In Neurosurgery; Springer Specialist Surgery, Series; Moore, A.J., Newell, D.W., Eds.; Springer: London, UK, 2005. [ Google Scholar] [ CrossRef] This section describes the most common methods used for reconstructing the 3D models of fossil skulls following different sources (i.e., Zollikofer and Ponce de León, 2005; Abel et al., 2012; Cunningham et al., 2014; Sutton et al., 2014; Tallman et al., 2014; Lautenschlager, 2016; Mostakhdemin et al., 2016; Gunz et al., 2020). Moreover, for a correct anatomical reconstruction, one usually has to use different specific bibliographic sources on the anatomy of the group studied. In our case, we have followed Moore (1982) and Novacek (1993), and we have also relied on the anatomy of the skull of living bears, especially those species with a closer phylogenetic relationship with the cave bear (i.e., U. arctos, Ursus americanus, Ursus maritimus, and Ursus thibetanus).

Conflicts of Interest

Field DA. Laplacian smoothing and delaunay triangulations. International Journal for Numerical Methods in Biomedical Engineering 1988; 4(6): 709–712. Data Availability: All relevant data are within the paper and hosted at the public repository Figshare. Please see data hosted at Figshare at the following URL: https://figshare.com/articles/Cranial_Defect_Datasets/4659565. Among all alloplastic materials, titanium continues to be the mainstream material used in cranioplasty due to its excellent biocompatibility, resistance to infection, high strength to weight ratio, corrosion resistance, non-magnetic properties, and toughness ( Niinomi, 1998; Zhang and Chen, 2019). Titanium plates for cranial defect reconstructions were first described in 1974 ( Gordon and Blair, 1974). Since then, cranial reconstructions have witnessed tremendous progress in using computer-aided design (CAD) methods ( Cabraja et al., 2009; Wiggins et al., 2013; Bonda et al., 2015). Additive manufacturing (AM) or three-dimensional (3D) printing of titanium patient-specific implants (PSIs) made its way into cranioplasty, improving the clinical outcomes in complex surgical procedures ( Cho et al., 2015; Park et al., 2016; Moiduddin et al., 2019; Sharma et al., 2020). Furthermore, there has been a significant interest within the medical community in redesigning implants based on natural analogies ( Tejero et al., 2014; Brett et al., 2017).

Piitulainen, J.M.; Kauko, T.; Aitasalo, K.M.; Vuorinen, V.; Vallittu, P.K.; Posti, J.P. Outcomes of Cranioplasty with Synthetic Materials and Autologous Bone Grafts. World Neurosurg. 2015, 83, 708–714. [ Google Scholar] [ CrossRef] [ PubMed]

X-Ray Computed Tomography Acquisition

Nguyen, B.; Ashraf, O.; Richards, R.; Tra, H.; Huynh, T. Cranioplasty Using Customized 3-Dimensional-Printed Titanium Implants: An International Collaboration Effort to Improve Neurosurgical Care. World Neurosurg. 2021, 149, 174–180. [ Google Scholar] [ CrossRef] Skervin, A.; Levy, B. Management of Common Surgical Complications. Surgery 2023, 41, 76–80. [ Google Scholar] [ CrossRef] In any acquisition from XCT systems, various artifacts may appear because of physical problems of the object, such as (i) a high density of the material, (ii) an excessive size of the object for the limits of the scanning envelope of the machine, and (iii) displacement of the object during the acquisition process or due to the inaccurate calibration of the machine (i.e., the parameters of acquisition used). Accordingly, the first step to follow is to review and to calibrate the images obtained to eliminate artifacts.

Gopi M, Krishnan S, Silva CT. Surface reconstruction based on lower dimensional localized Delaunay triangulation. Computer Graphics Forum 2000; 19(3): 467–478.

Funding: The work received funding from BioTechMed-Graz in Austria (Hardware accelerated intelligent medical imaging) and the 6th Call of the Initial Funding Program from the Research & Technology House (F&T-Haus) at the Graz University of Technology (PI: Jan Egger). Dr. Xiaojun Chen receives support by the Natural Science Foundation of China (Grant No.: 81511130089) and the Foundation of Science and Technology Commission of Shanghai Municipality (Grants No.: 14441901002, 15510722200 and 16441908400). Replogle RE, Lanzino G, Francel P, Henson S, Lin K, Jane JA. Acrylic cranioplasty using miniplate struts. Neurosurgery 1996; 39(4): 747–749. pmid:8880768 ii) This analytical process quantifies the topological deviations between two mesh models. In our case, it helps us to quantify if the simplification of the mesh and cleaning of the artifacts have been very aggressive or poorly applied, generating significant deformations in the original topology of the model. This process is explained in Figure 11, using the skull of U. ingressus as an example. In the case of comparing the original skulls with the reconstructed ones, the information is obtained as a heat map, reflecting the topological arrangement of the added bone structures ( Figures 11D,E). Therefore, those structures artificially added will have a positive deviation with warm colors, and those that have been removed or are below the topological profile of the original skull will have cold colors ( Figure 11E). For such a comparison ( Figure 12D), the reconstructed skull is chosen as the topological pattern against the original skull. For example, if the topology of the restored skull is above the surface pattern of the topology of the non-restored skull, the mesh color will be warm. In contrast, if the topology of the restored skull is below the surface pattern of the non-restored skull, the mesh color will be blue. Therefore, the topological information obtained is different from that in the first case ( Figure 12C). This information is used to quantify the level of preservation of the element (skull, jaw, etc.) and its preservational condition. Another important aspect is to quantify the effect of repairing the skull and postprocessing the model mesh. For example, a high smoothing can cause various details to disappear, such as reliefs and roughness of the muscle insertions, loss of bone sutures. and loss of details of the dental topology, among others.