Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
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We wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
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Throughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\n
We wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
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\n
1. Introduction
\n
Traumatic brain injury (TBI) remains a major cause of death and disability [1]. The heterogeneity of TBI is considered to be a one of the most significant obstacles to the development of effective therapeutic interventions [2, 3]. Physicians in order to understand, treat and prognosticate patients suffering from TBI do rely mainly on three parameters: [1] the Glasgow Coma Scale (GCS) is a rapid and reproducible test, which assesses overall neurologic function; [2] the unenhanced CT findings, which can detect skull fractures, hematomas, cerebral contusions and some indirect sign of brain swelling (i.e., ventricles size, midline shift, uncal herniation); [3] the intracerebral pressure (ICP) monitoring, which requires a quite invasive intracerebral or intraventricular probe, to calculate and help maintaining adequate cerebral perfusion pressure (CPP) [2, 3, 4, 5, 6, 7, 8, 9, 10]. This information routinely utilized in clinical management algorithms tend to compromise accuracy for simplicity and suffer from several weaknesses. For example, all patients with GCS below nine will be diagnosed as having a severe degree of TBI and, as such, will be admitted to intensive care intubated and pharmacologically sedated. Instead, patients with GCS higher than nine are most often discharged home or admitted to low intensity wards (especially if screening unenhanced CT appears normal). But GCS can also be affected by drug/alcohol assumption, and by systemic hypoperfusion making decision based on GCS alone often inaccurate [5]. Similarly unenhanced CT, despite its status of “gold standard imaging” for acute TBI, deprives clinicians from crucial information on brain tissue vascularity, perfusion and viability. Unenhanced CT underestimates the ultimate size of parenchymal lesions and does not afford insight into secondary ischemic injuries related to systemic hypotension, traumatic cerebral edema and intracranial hypertension [8]. Lastly, the clinical use of ICP monitors in patients at risk of brain swelling, which is often burdened by complications from its invasiveness, can often only provide an inaccurate reading. Calculating CPP using ICP and mean systemic arterial pressure (MAP) does not take into account cerebral vasculature autoregulation or cerebral regional differences often observed with more advanced technology [9, 10]. The efficacy of ICP monitoring-based treatment has been recently challenged in a large-scale randomized trial on more than 300 severe TBI patients. It appeared that ICP-based treatment (focused on maintaining ICP < 20 mmHg) was not superior to that based on imaging and clinical examinations alone in terms of survival and functional outcome [9].
\n
It is of no wonder that these three pillars of TBI management have come under scrutiny recently, making sensible and grounded clinical decisions based on these limited and biased information alone resemble a dangerous gamble. As a possible result, most interventional studies investigating otherwise sensible therapeutic options have failed to identify successful treatments [4].
\n
In terms of imaging, several relatively new technologies are available to better understand the complexity of TBI. Many are still research tools; some require long acquisition times and some others are poorly available and/or logistically difficult to organize in critically ill ventilated patients. Perfusion CT instead is a not logistically demanding imaging technique that provides detailed maps of intracerebral vascular flow and brain tissue perfusion and affords direct insight into cerebral infarct and penumbra. Today, perfusion CT is routinely used in the early care of patients with acute stroke and other cerebrovascular disorders [11].
\n
The aim of this chapter is to evaluate potential benefits and limitation of perfusion CT as advanced diagnostic modality for patients suffering from TBI. Specifically, we overview the technical aspects, present published research and try to predict the future role of this diagnostic approach in patients suffering from TBI.
\n
\n
\n
2. Description of perfusion CT technology
\n
Several advanced imaging techniques exist, which can provide information about cerebral perfusion, such as stable xenon-enhanced CT (Xe-CT), single photon emission CT (SPECT) and perfusion-weighted magnetic resonance imaging (MRI) [12]. These techniques have logistic barriers to routine universal clinical use as they require specialized equipment and staffing and are burdened by long acquisition times [12]. Some, such as the 33% xenon mix used in Xe-CT that causes transitory ICP raise, can also be deleterious for patients [13]. These constrains are particularly relevant during the acute phase of severe TBI; when patients, often seriously injured polytrauma patients are intubated and ventilated, with ongoing needs for blood transfusions, vasoconstrictors. These patients need prompt and straightforward imaging to guide subsequent therapeutic options. Perfusion CT provides information about brain circulation and cerebral perfusion which can be obtained rapidly using wildly diffuse multidetector CT scanners [11, 14]. A perfusion CT can be obtained in few minutes utilizing a standard of care (more so in trauma centers) multidetector CT scanners (and dedicated post processing software) and does not require specialized technologists. The effective dose of ionizing radiation required for a head perfusion CT is about 5 mSv. The radiation-associated risks are believed to be low and approximately equivalent to about 2 years of background radiation [equates to an excess lifetime cancer risk = 0.025% (about 1:4000)] [15].
\n
Acquisition of perfusion CT involves the administration of intravenous iodine contrast with concurrent acquisition of images using a helical CT multidetector scanner in cine mode. This allows for measurement of the movement of contrast material through the vessels and tissues over time. Perfusion data are obtained by monitoring the first pass of a contrast material bolus through the cerebral vessels. The relationship between the contrast agent concentration and attenuation can be used to calculate the amount of contrast agent in a region. Time versus contrast concentration curves are generated for a reference arterial region and venous region as well as each pixel of the scan [11, 15]. Post processing of the data allows the generation of color coded maps and quantification of the perfusion parameters of cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) [16]. The CBF for each area is calculated as CBV/MTT. CBF is measured in milliliters per 100 g of tissue per minute (ml/100 g/min), and normal tissue has values around 40 ml/100 g/min while values of 20 ml/100 g/min or less are diagnostic for ischemia. The CBV is calculated as the area under the curve in a parenchymal pixel divided by the area under the curve in the reference venous pixel. CBV is measured in milliliters per 100 g of tissue (ml/100 g) and normal tissue has values around 4 ml/100 g, while values of 2 ml/100 g are indicative for a degree of ischemia. MTT is the average time taken by blood to cross the capillary network and is calculated from a deconvolution operation from the time concentration curve of each particular voxel and the arterial reference region. MTT is measured in seconds, and normal tissue has values around 5 s while values above 8 s are the rule in ischemic areas [11]. Perfusion CT thus provides a readily available means of examining brain perfusion and, by calculating MTT, CBV and CBF for different areas, can identify areas of abnormal perfusion and ischemia (Figures 1 and 2).
\n
Figure 1.
Axial computed tomography (CT) obtained 18 h from admission following a motor vehicle accident in a young male. (A) Noncontrast CT shows a left subgaleal hematoma, but no intracranial pathology. (B) Perfusion CT identifies an area of reduced perfusion on the right temporo-frontal lobe (white arrow): Cerebral blood volume (CBV) is reduced as per darker color, time-to-peak (TTP) is increased as per lighter color, and mean transient time (MTT) is decreased as per darker color. The axial image on the bottom right represents the delayed phase (which can be utilized by specific software to extrapolate permeability of brain–blood barrier).
\n
Figure 2.
(A) An arterial input function (AIF, arrow on the axial CT scan) is used to calibrate the whole brain contrast change when post processing a CT perfusion. (B) the drawing depicts the rise and fall of the contrast over time (in seconds). The time from the start of the scan to the peak signal intensity is the time-to-peak (TTP); the maximum slope of the contrast enhancement being measured is the cerebral blood flow (CBF); and the area under the curve of the whole AIF is the cerebral blood volume (CBV). The time it takes for contrast to enter and leave the voxel is the mean transit time (MTT).
\n
\n
\n
3. Perfusion CT and traumatic brain injury
\n
Perfusion CT has revolutionized the diagnostic and therapeutic approach to acute ischemic stroke [17]. The prompt availability of perfusion maps and CT angiogram has transformed an irreversible condition requiring only supportive care and rehabilitation to a treatable neurological emergency. Neurologists use perfusion CT maps to define areas of ischemic penumbra and guide decisions on thrombolytic therapy [17]. As such, perfusion CT has now a well-established role in the acute management of stroke.
\n
The potential role for perfusion CT in the management of TBI is still under investigation. A literature research including the terms “traumatic brain injury” and “perfusion CT” or “perfusion computed tomography” returned 185 results. Critical screening of the abstracts selected 18 papers that were considered as pertinent and relevant to this review and therefore they were analyzed and discussed in detail [16, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33]. Table 1 illustrates the studies’ characteristics and main findings. It appears that the published experience with perfusion CT in patients suffering from TBI is quite limited with a total of 540 patients investigated. Only three papers, including a total of 50 patients, were prospectively designed [24, 31, 33]. Almost all papers obtained a perfusion CT on admission following the standard of care unenhanced brain CT [18, 19, 21, 22, 24], while some timed the perfusion CT at the time of the first follow-up unenhanced CT [24, 31, 33], and two just before and after cranioplasty [25, 26]. Patients with severe TBI were most often investigated, with only one group investigating a total of 94 patients suffering from mild to moderate TBI [21, 24]. Most studies report perfusion CT maps produced using 64-slice multidetector CT scanner, which are limited to a small portion of the brain (usually two or four adjacent slabs taken just above the orbit), while a few and more recent papers benefited from technology improvements (320-slice CT scanner) and investigated the whole brain [23, 28, 31, 33].
Perfusion disturbance predicts therapeutic requirement for intracerebral hypertension
\n
\n\n
Table 1.
Studies published in English on the use of perfusion CT in patients with traumatic brain injury (in chronologic order of publication).
\n
\n
\n
4. Outcome prediction
\n
Several authors have investigated the role of perfusion CT to help functional outcome prediction in the heterogeneous population of patients suffering TBI. Wintermark et al. investigated with perfusion CT performed at admission a consecutive series of 130 patients with severe TBI (following standard unenhanced CT). The perfusion maps, specifically the number of arterial territories with oligemia (reduced regional CBV and CBF but not to the severity of ischemia), predicted poor functional outcome at 3 months, while hyperemia (increased regional CBV and CBF) was associated with a favorable functional outcome [18]. The subcohort of these patients who received an ICP monitor were presented in a subsequent study: perfusion parameters were correlated with CPP allowing to discriminate between patients with preserved or disrupted vascular autoregulation, and this was associated with functional outcome at 3-month follow-up [19].
\n
A prospectively designed study aimed at investigating the relationship between whole brain perfusion CT and functional outcome [31]. Fifty patients with severe TBI and who required follow-up unenhanced CT within 48 h from admission (the design selected the sickest TBI patients, excluding those whose neurology improved quickly, and did not require follow-up imaging) were examined with whole brain perfusion CT. This was a selected severe TBI population burdened by high (14%) mortality, and the perfusion maps were found to be often (67%) abnormal with areas of ischemia in 35% of patients. Poor functional outcome (defined as a Glasgow outcome scale-extended of four or less at 6-month follow-up) occurred to more than half of the population and was best predicted by perfusion CT findings. Logistic regression analysis showed that, among the most commonly used parameters used for outcome prognostication, preintubation GCS was a moderate predictor (AUC = 0.74), thus confirming several prior studies, but the inclusion of perfusion CT variables (specifically the presence of abnormal findings) in the model improved the performance of the prediction model to AUC = 0.92 [31]. Similarly, a study on 90 patients with severe TBI investigated with Xe-CT and perfusion CT confirmed that perfusion abnormalities (specifically low CBF and high MTT) were predictive for poor functional outcome [32].
\n
Furthermore, overall absence of CBF has helped a prompt diagnosis of brain death as demonstrated in a study on 27 patients investigated with perfusion CT and CT angiogram [16].
\n
The role of perfusion CT in outcome prediction of patients with mild-to-moderate TBI has been investigated by the van der Naalt group [21, 24]. In 76 patients with mild TBI and normal unenhanced CT, a perfusion CT was obtained on admission. Perfusion maps with decreased CBF and CBV in the frontal and occipital gray matter were associated on logistic regression analysis with a poorer functional outcome at 6-month follow-up [21]. Furthermore, when compared to the healthy controls, patients with post-traumatic amnesia were found to have reduced CBF in frontal gray matter and caudate nucleus [24]. Similarly, when neuropsychological tests were obtained in a subgroup of these patients, reduced perfusion of the frontal and parietotemporal regions was associated with impairment in executive functioning and emotion [24].
\n
Taken together, these studies suggest a potential role for perfusion CT in early prediction of functional outcome in both the severe and less severe TBI population. These promising results are burdened by the limited experience but are consistent with similar previous studies, which utilized Xe-CT to prove the concept that an insight in cerebral circulation allows a more accurate functional outcome prediction [34, 35].
\n
\n
\n
5. Perfusion CT and cerebral contusion
\n
The role of perfusion CT in patients with cerebral contusions has been investigated by Soustiel et al. [20]. In this retrospective study on 30 patients, perfusion maps obtained 48 hours from injury predicted contusions progression better than unenhanced CT. Specifically, areas of hypoperfusion around the contusions resulted in areas of brain necrosis at follow-up unenhanced CT (CBV-derived maps showed congruence with the unenhanced CT at 7 days in 60% of lesions). This small study confirms the presence of a degree of ischemia around cerebral contusion (a regional secondary brain injury), which without perfusion CT would run completely undiagnosed till fully established and irreversible, and therefore, visible on unenhanced CT. Although not investigated in this study, it is foreseeable that overall intracerebral pressures (as measured by an ICP monitor) would be completely normal in these patients as the remaining brain adapts to the localized swelling. This kind of findings is exactly what physicians treating TBI patient need in order to craft appropriate and individualized therapeutic options. For example, in a recent study on 22 TBI patients with cerebral contusions, who were investigated acutely with contrast-enhanced CT and perfusion CT, the presence of contrast extravasation (identified in 40%) was predictive for hemorrhage progression [22]. Usually, hemorrhage progressions are otherwise diagnosed either by observing increased ICP (if monitored) or worsening GCS (if not three already) or by scheduling follow-up unenhanced CT (which may cause deleterious delays to diagnosis and treatment).
\n
\n
\n
6. Cerebral perfusion pressure and perfusion CT
\n
Wintermark et al. [19], in a subgroup of the previously mentioned severe TBI patients, studied the correlation between invasive ICP, CPP and perfusion CT findings. About 60% of patients were shown to have a weak dependence between CBF and corresponding CPP values (most likely due to preserved autoregulation), while the rest of the patients showed a strong dependence between CPP and CBF (disrupted autoregulation group). The relationship between perfusion CT findings and invasive ICP and calculated CPP has been more recently investigated by Honda et al. [27]. The perfusion maps of 25 patients with severe TBI and ICP monitor were obtained with combination of Xe-CT and perfusion CT. The CPP values were positively correlated with CBF, negatively correlated with MTT and did not correlate with CBV. If this well reflects the expected physiology and Monro-Kellie hypothesis, it is interesting to notice that the correlation between CPP and CBF was disturbed by intracerebral hypertension (defined as ICP above 20 mmHg). In patients without intracerebral hypertension, CBF values did not correlate with CPP (preserved autoregulation), while in patients with cerebral hypertension, the CBF negatively correlated with the CPP value (disrupted autoregulation). In our experience, with 28 patients with severe TBI and ICP monitor investigated with perfusion CT within 48 h from trauma, the presence of abnormalities on perfusion maps (specifically, the presence of ischemia) was associated with the requirement for increased level of intervention for cerebral hypertension [33]. Two small studies investigated the functional outcomes before and after cranioplasty in patients suffering from severe TBI treated with decompressive craniectomy. An improvement of neurocognitive functions was observed after cranioplasty (especially if done within 3 months from trauma). Interestingly, serial perfusion CTs (performed in a subgroup of nine patients) also confirmed an improvement in cerebral perfusion in both the operated and the contralateral side [26, 30].
\n
It certainly appears that we have a very limited understanding of the degree and location of perfusion abnormalities and that we do not know how to act once these are identified and quantified; it also appears that physicians tend to treat severe TBI patients and their CPP very homogenously despite quite obvious differences in autoregulation mechanisms and degree of hypoperfusion and ischemia. These interesting studies, albeit preliminary, certainly suggest a potential crucial role for perfusion CT. Perfusion maps will clarify almost real time the extent and the degree of perfusion deficits and the association with MAP and CPP. This will help physicians to diagnose disrupted autoregulation and predicting patients who will benefit from ICP monitors and aggressive treatment of cerebral hypertension.
\n
\n
\n
7. Cerebral oxygen saturation and perfusion CT
\n
The relationship between cerebral oxygen saturation and brain perfusion maps has been investigated in a heterogeneous cohort of patients with a degree of TBI ranging from severe to moderate [29]. The authors obtained perfusion maps using single slice technology and compared with frontal cerebral oximetry in 25 patients (16 with cerebral ischemia on perfusion CT maps). A proportional dependence was observed between cerebral tissue oxygenation and CBV, but not with CBF and MTT. Possibly, vasospasm and cerebral autoregulation were responsible for the lack of maintained relationship between cerebral oxygenation and CBF (which should otherwise be observed considering that CBF=CBV/MTT) [29].
\n
\n
\n
8. Cerebral permeability perfusion CT
\n
When the blood–brain barrier is altered, contrast material extravasation can be observed during the delayed phase of perfusion CT. This has been observed in stroke patients and recently in a small study of TBI patients. Seventeen patients with severe TBI and three controls were investigated with perfusion CT within 48 h from admission. Increased permeability was observed in the pericontusional area in patients who later developed increased ICP [28]. This is extremely relevant as small molecular permeability will influence capillary hydrostatic and oncotic pressures and influence edema development. Possibly, osmotic treatment (such as hypertonic saline) might be efficient only when all or most of the brain has an intact blood–brain barrier. The implications of understanding and diagnosing blood–brain barrier dysfunction are huge. Potentially perfusion CT might help selecting patients for osmotic therapy rather than the use of sedation agents and/or craniectomy.
\n
\n
\n
9. Future of perfusion CT
\n
The routine imaging protocol for multiple injured trauma patients includes an unenhanced cerebral and cervical CT and an enhanced thoracic-abdominal-pelvic CT. Routinely, also patients with risk factors for cerebrovascular injuries (deceleration, seatbelt mark on the neck, massive facial bleeding) will have the neck and cerebral vasculature evaluated by enhanced CT. Early detection of cerebrovascular injuries is crucial as these arterial injuries can be repaired, stented or otherwise medically treated to minimize the risk or the extent of embolic strokes. We can foresee a near future in which brain perfusion CT becomes part of admission imaging for patients with TBI. The prompt availability of brain perfusion maps might have a huge impact on understanding and treating TBI. With or without the involvement of neurologist and interventional neurologist, these patients might be offered a better targeted treatment and their families are made aware of long-term outcomes by making decisions such as palliation or further treatment based on a more thorough understanding of cerebral perfusion and secondary brain injury.
\n
\n
\n
10. Conclusion
\n
In this chapter, we have identified, reviewed and discussed several aspects of implementation of perfusion CT in clinical diagnostics and research of TBI disease. These include assessment of TBI pathogenesis and prediction of functional outcomes, development of guidance for osmotic treatment, selection of patients for trial inclusion and development of regiments for surgical intervention. Perfusion CT imaging is a technology readily available and ripe for use in the vast majority of patients suffering from TBI. Perfusion CT should be considered in the context of audited research in patients with clinically proven severe TBI and possibly in patients with a less severe degree of TBI. Evidently, perfusion CT possesses eminent potentials and demonstrates a superior efficacy when compared to traditional noncontrast CT.
\n
\n\n',keywords:"perfusion CT, severe traumatic brain injury, neuroimaging, Subject area: neuroimaging in traumatic brain injury",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/58648.pdf",chapterXML:"https://mts.intechopen.com/source/xml/58648.xml",downloadPdfUrl:"/chapter/pdf-download/58648",previewPdfUrl:"/chapter/pdf-preview/58648",totalDownloads:1139,totalViews:173,totalCrossrefCites:0,totalDimensionsCites:0,totalAltmetricsMentions:0,introChapter:null,impactScore:0,impactScorePercentile:11,impactScoreQuartile:1,hasAltmetrics:0,dateSubmitted:"June 6th 2017",dateReviewed:"November 21st 2017",datePrePublished:"January 30th 2018",datePublished:"May 9th 2018",dateFinished:"January 8th 2018",readingETA:"0",abstract:"Introduction: Almost 50 years ago, computed tomography (CT) revolutionized the management of traumatic brain injury (TBI) by imagining intracranial hematomas. This allowed prompt and accurate selection of patients who would benefit from surgical evacuation. Since then, unenhanced CT has been the gold standard imaging modality for patients with acute TBI. Today, multidetector CT can track intravenous contrasts flowing through brain creating maps that depict the speed and the amount of blood at capillary level. This imaging modality takes the name of perfusion CT. Perfusion CT is routinely used during the hyperacute phase of patients suffering from stroke to diagnose areas of penumbra (poorly perfused but still viable brain tissue) that may benefit from revascularization. Here, we summarize the current status of the research on the role of perfusion CT in patients suffering from TBI.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/58648",risUrl:"/chapter/ris/58648",book:{id:"6207",slug:"traumatic-brain-injury-pathobiology-advanced-diagnostics-and-acute-management"},signatures:"Cino Bendinelli, Shannon Cooper, Christian Abel, Andrew Bivard\nand Zsolt J. Balogh",authors:[{id:"26682",title:"Prof.",name:"Zsolt",middleName:null,surname:"Balogh",fullName:"Zsolt Balogh",slug:"zsolt-balogh",email:"zsolt.balogh@hnehealth.nsw.gov.au",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"26684",title:"Dr.",name:"Cino",middleName:null,surname:"Bendinelli",fullName:"Cino Bendinelli",slug:"cino-bendinelli",email:"cino.bendinelli@hnehealth.nsw.gov.au",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Hunter New England Health",institutionURL:null,country:{name:"Australia"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Description of perfusion CT technology",level:"1"},{id:"sec_3",title:"3. Perfusion CT and traumatic brain injury",level:"1"},{id:"sec_4",title:"4. Outcome prediction",level:"1"},{id:"sec_5",title:"5. Perfusion CT and cerebral contusion",level:"1"},{id:"sec_6",title:"6. Cerebral perfusion pressure and perfusion CT",level:"1"},{id:"sec_7",title:"7. Cerebral oxygen saturation and perfusion CT",level:"1"},{id:"sec_8",title:"8. Cerebral permeability perfusion CT",level:"1"},{id:"sec_9",title:"9. Future of perfusion CT",level:"1"},{id:"sec_10",title:"10. Conclusion",level:"1"}],chapterReferences:[{id:"B1",body:'Evans JA, van Wessem KJ, McDougall D, Lee KA, Lyons T, Balogh ZJ. Epidemiology of traumatic deaths: Comprehensive population-based assessment. World Journal of Surgery. 2010;34:158-163\n'},{id:"B2",body:'Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons. Guidelines for the management of severe traumatic brain injury. Journal of Neurotrauma. 2007;24:S1-106\n'},{id:"B3",body:'Haddad SH, Arabi YM. Critical care management of severe traumatic brain injury in adults. Scandinavian Journal of Trauma, Resuscitation and Emergency. 2012;20:15\n'},{id:"B4",body:'Carney N, Totten AM, O\'Reilly C, Ullman JS, Hawryluk GWJ, Bell MJ, et al. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2017;80:6-15\n'},{id:"B5",body:'Foreman BP, Caesar R, Parks J, Madden C, Gentilello LM, Shafi S, et al. Usefulness of the abbreviated injury score and the injury severity score in comparison to the Glasgow coma scale in predicting outcome after traumatic brain injury. Journal of Trauma. 2007;62:946-950\n'},{id:"B6",body:'Kubal WS. Updated imaging of traumatic brain injury. Radiology Clinics of North America. 2012;50:15-41\n'},{id:"B7",body:'Yuh EL, Cooper SR, Ferguson AR, Manley GT. Quantitative CT improves outcome prediction in acute traumatic brain injury. Journal of Neurotrauma. 2012;29:735-746\n'},{id:"B8",body:'Jacobs B, Beems T, van der Vliet TM, van Vugt AB, Hoedemaekers C, Horn J, et al. Outcome prediction in moderate and severe traumatic brain injury: A focus on computed tomography variables. Neurocritic Care. 2013;19:79-89\n'},{id:"B9",body:'Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, et al. A trial of intracranial-pressure monitoring in traumatic brain injury. New England Journal of Medicine. 2012;367:2471-2481\n'},{id:"B10",body:'Shen L, Wang Z, Su Z, Qiu S, Xu J, Zhou Y, et al. Effects of intracranial pressure monitoring on mortality in patients with severe traumatic brain injury: A meta-analysis. PLoS One. 2016:111-115\n'},{id:"B11",body:'Huang AP, Tsai JC, Kuo LT, Lee CW, Lai HS, Tsai LK, Huang SJ, Chen CM, Chen YS, Chuang HY, Wintermark M. Clinical application of perfusion computed tomography in neurosurgery. Journal of Neurosurgery. 2014;120:473-488\n'},{id:"B12",body:'Wintermark M, Sanelli PC, Anzai Y, Tsiouris AJ, Whitlow CT. Imaging evidence and recommendations for traumatic brain injury: Advanced neuro- and neurovascular imaging techniques. AJNR American Journal of Neuroradiology. 2015;36:E1-E11\n'},{id:"B13",body:'Plougmann J, Astrup J, Pedersen J, Gyldensted C. Effect of stable xenon inhalation on intracranial pressure during measurement of cerebral blood flow in head injury. Journal of Neurosurgery. 1994;81:822-828\n'},{id:"B14",body:'Metting Z, Rodiger LA, Keyser JD, Jvd N. Structural and functional neuroimaging in mild-to-moderate head injury. Lancet Neurology. 2007;6:699-710\n'},{id:"B15",body:'Shankar JJS, Lum C, Sharma M. Whole-brain perfusion imaging with 320-MDCT scanner: Reducing radiation dose by increasing sampling interval. American Journal of Roentgenology. 2010;195:1183-1186\n'},{id:"B16",body:'Escudero D, Otero J, Marqués L, Parra D, Gonzalo JA, Albaiceta GM, Cofiño L, Blanco A, Vega P, Murias E, Meilan A, Roger RL, Taboada F. Diagnosing brain death by CT perfusion and multislice CT angiography. Neurocritical Care. 2009;11:261-271\n'},{id:"B17",body:'Bivard A, Levi C, Krishnamurthy V, McElduff P, Miteff F, Spratt NJ, Bateman G, Donnan G, Davis S, Parsons M. Perfusion computed tomography to assist decision making for stroke thrombolysis. Brain. 2015;138:1919-1931\n'},{id:"B18",body:'Wintermark M, Gv M, Schnyder P, Revelly J-P, Porchet F, Regali L, et al. Admission perfusion CT: Prognostic value in patients with severe head trauma. Radiology. 2004;232:211-220\n'},{id:"B19",body:'Wintermark M, Chiolero R, Melle Gv, Revelly JP, Porchet F, Regali L, et al. Relationship between brain perfusion computed tomography variables and cerebral perfusion pressure in severe head trauma patients. Critical Care Medicine. 2004;32:1579-1587\n'},{id:"B20",body:'Soustiel JF, Mahamid E, Goldsher D, Zaaroor M. Perfusion-CT for early assessment of traumatic cerebral contusions. Neuroradiology. 2008;50:189-196\n'},{id:"B21",body:'Metting Z, Rodiger LA, Stewart RE, Oudkerk M, Keyser JD, Naalt Jvd. Perfusion computed tomography in the acute phase of mild head injury: Regional dysfunction and prognostic value. Annals of Neurology. 2009;66:809-816\n'},{id:"B22",body:'Huang AP, Lee CW, Hsieh HJ, Yang CC, Tsai YH, Tsuang FY, Kuo LT, Chen YS, YK T, Huang SJ, Liu HM, Tsai JC. Early parenchymal contrast extravasation predicts subsequent hemorrhage progression, clinical deterioration, and need for surgery in patients with traumatic cerebral contusion. The Journal of Trauma and Acute Care Surgery. 2011;71:1593-1599\n'},{id:"B23",body:'Bendinelli C, Bivard A, Nebauer S, Parsons MW, Balogh ZJ. Brain CT perfusion provides additional useful information in severe traumatic brain injury. Injury. 2013;44:1208-1212\n'},{id:"B24",body:'Metting Z1, Cerliani L, Rödiger LA, van der Naalt Jvd. Pathophysiological concepts in mild traumatic brain injury: Diffusion tensor imaging related to acute perfusion CT imaging. PLoS One. 2013;21:8. 64461\n'},{id:"B25",body:'Sarubbo S, Latini F, Ceruti S, Chieregato A, d\'Esterre C, Lee TY, Cavallo M, Fainardi E. Temporal changes in CT perfusion values before and after cranioplasty in patients without symptoms related to external decompression: A pilot study. Neuroradiology. 2014;56:237-234\n'},{id:"B26",body:'Wen L, Lou HY, Xu J, Wang H, Huang X, Gong JB, Xiong B, Yang XF. The impact of cranioplasty on cerebral blood perfusion in patients treated with decompressive craniectomy for severe traumatic brain injury. Brain Injury. 2015;29:1654-1660\n'},{id:"B27",body:'Honda M, Ichibayashi R, Yokomuro H, Yoshihara K, Masuda H, Haga D, Seiki Y, Kudoh C, Kishi T. Early cerebral circulation disturbance in patients suffering from severe traumatic brain injury (TBI): A xenon CT and perfusion CT study. Neurologia Medico-Chirurgica (Tokyo). 2016;56:501-509\n'},{id:"B28",body:'Jungner M, Siemund R, Venturoli D, Reinstrup P, SCHALéN W, Bentzer P. Blood-brain barrier permeability following traumatic brain injury. Minerva Anestesiologica. 2016;82:525-533\n'},{id:"B29",body:'Trofimov AO, Kalentiev G, Voennov O, Grigoryeva V. Comparison of cerebral oxygen saturation and cerebral perfusion computed tomography in cerebral blood flow in patients with brain injury. Advances in Experimental Medicine and Biology. 2016;876:145-149\n'},{id:"B30",body:'Songara A, Gupta R, Jain N, Rege S, Masand R. Early cranioplasty in patients with posttraumatic decompressive craniectomy and its correlation with changes in cerebral perfusion parameters and neurocognitive outcome. World Neurosurgery. 2016;94:303-308\n'},{id:"B31",body:'Bendinelli C, Cooper S, Evans T, Bivard A, Pacey D, Parsons M, Balough ZJ. Perfusion abnormalities are frequently detected by early CT perfusion and predict unfavourable outcome following severe traumatic brain injury. World Journal of Surgery. 2017\n'},{id:"B32",body:'Honda M, Ichibayashi R, Suzuki G, Yokomuro H, Seiki Y, Sase S, Kishi T. Consideration of the intracranial pressure threshold value for the initiation of traumatic brain injury treatment: A xenon CT and perfusion CT study. Neurocritical Care. 2017\n'},{id:"B33",body:'Shannon C, Bendinelli C, Bivard A, Parson M, Balogh Z. Brain perfusion disturbances predict therapeutic requirements for management of intracerebral hypertension. Injury (submitted for publication)\n'},{id:"B34",body:'Fridley J, Robertson C, Gopinath S. Quantitative lobar cerebral blood flow for outcome prediction after traumatic brain injury. Journal of Neurotrauma. 2015;32:75-82\n'},{id:"B35",body:'Kaloostian P, Robertson C, Gopinath SP, Stippler M, King CC, Qualls C, Yonas H, Nemoto EM. Outcome prediction within twelve hours after severe traumatic brain injury by quantitative cerebral blood flow. Journal of Neurotrauma. 2012;29:727-734\n'}],footnotes:[],contributors:[{corresp:null,contributorFullName:"Cino Bendinelli",address:null,affiliation:'
Hunter Medical Research Institute, University of Newcastle, AU
'},{corresp:"yes",contributorFullName:"Zsolt J. Balogh",address:"zsolt.balogh@hnehealth.nsw.gov.au",affiliation:'
John Hunter Hospital, University of Newcastle, AU
'}],corrections:null},book:{id:"6207",type:"book",title:"Traumatic Brain Injury",subtitle:"Pathobiology, Advanced Diagnostics and Acute Management",fullTitle:"Traumatic Brain Injury - Pathobiology, Advanced Diagnostics and Acute Management",slug:"traumatic-brain-injury-pathobiology-advanced-diagnostics-and-acute-management",publishedDate:"May 9th 2018",bookSignature:"Nikolai V. Gorbunov and Joseph B. 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1. Introduction
Human teeth have a complex structure with an inner core of highly vascular, soft, and delicate pulp surrounded by the highly mineralized enamel and dentin tissues (Figure 1) [1]. The structure of teeth can be altered by diet, age, or diseases such as caries and sclerosis. Currently, dental caries is among the most prevalent chronic diseases of childhood, affecting 60–90% of school-aged children and the larger part of adults [2]. Non-treated enamel caries can lead to destruction and then spreads into the underlying softer and sensitive dentine layer. Dental caries could attack the cement of the root and cause gum recession and periodontitis [3]. Dental enamel is composed of long and parallel mineralized crystals containing 90–92% hydroxyapatite, 1–2% organic matrix proteins, and 4–12% water [4]. In addition, the thickness of enamel is different in different anatomical parts of different teeth. For instance, the enamel thickness at the cementum-enamel junction (CEJ) is thinner than the occlusal/incisal surface. Further, the average enamel thickness of incisal edge, premolar cusp, and molar cusp are 2 mm, 2.3–2.5 mm, and 2.5–3 mm, respectively [5]. Dentin is composed of inorganic (50% by volume) and organic material (30% by volume; 90% of which is type 1 collagen and 10% non-collagenous proteins) [6]. Dentin covers most of the tooth structure, and it is externally covered by enamel and cementum.
Figure 1.
Structure of human tooth. Human teeth have a complex structure with an inner core of highly vascular, soft, and delicate pulp surrounded by the highly mineralized enamel and dentin tissues.
Unfortunately, dental caries is non-avoidable disease. The tooth’s hard tissue, included the enamel and dentin, is typically damaged by dental caries. The shape and function of the teeth are also impaired. In spite of much effort in oral health promotion and preventive methods, dental restorations are still needed. Natural teeth are always considered to be a reference while employing biomimetic approaches to restore diseased or fractured dental tissues [7]. The main goal of restorative dentistry is to create a restoration that can mineralize initial enamel and dentinal lesions in native form. Besides, restorative dentistry aims to develop material that can mimic natural teeth’ structural, functional, and biological properties.
Dental restorative materials are applied to treat and reconstruct damaged teeth clinically and recover their functions [8]. Currently, there are various dental restorative materials available, and many appropriate materials are used to restore dental carious teeth. At a macrostructural level, various biomimetic restorative materials can be applied to achieve the teeth’ biomechanical, structural, and aesthetic integrity. For this purpose, materials scientists take natural teeth as a reference during the development of dental restorative materials. The widespread application of bionic principles in the field of dentistry can also promote the innovation of restorative dentistry, especially in the field of protection and preservation of teeth. For example, when restoring damaged parts of teeth, dentists should pay more attention to factors, such as color tone, internal coronal anatomy, mechanics, and tooth position in the dental arch [9]. There are three types of materials commonly used in dental restorations: resin, alloys, and ceramic [10]. In dental clinical, resin dental composites and glass-ionomer cements are commonly used to restore features depending on the extent of damage and aesthetic requirement. While alloy and ceramic materials are mainly used for fixed restorations (e.g., fixed dentures), removable restorations mainly use nano-resins and alloys. Recently, the most prevalent clinical materials in oral restorations are ceramics and nano-resins.
2. Dental restorative materials
2.1 Resin
Most dental ceramics and hybrid resin composites have the potential to mimic the enamel and dentin, respectively. However, it has been suggested that moderate damage to teeth could be restored with resin composites. For the resin composites restorations, minimal preparation of teeth is required, reducing the likelihood of pulpal involvement and tooth fracture [11].
The filling resin composite can strengthen the remaining tooth structure in some cases. For example, cemented porcelain restorations are recommended for severely damaged, worn, or broken teeth in dental clinics. Besides, alumina and nano-hydroxyapatite are also widely used in dentistry [12]. Alumina is recommended because it has good fracture resistance, abrasion resistance, and high compressive strength. In addition, nano-hydroxyapatite is an essential part of teeth and bones. Therefore, it should achieve biomimetic properties in the restoration. Glass ionomer cement has a bactericidal effect because it releases fluoride and can stimulate hardened dentin [13]. In addition, these cements have properties comparable to dentin, thus realizing the concept of bionics. Glass-ionomer cements are used as restorative materials in deep class I or II cavities in pedodontics and restoration of class V cavities [14]. Glass-ionomer cements are not generally recommended in load-bearing posterior dentition due to low tensile strength. Therefore, in the context of mismatched elastic modulus between enamel and the direct restorative materials, more stresses may be transferred to teeth, leading to either tooth damage or failure of the restoration.
Nowadays, many clinicians take direct resin composite posterior restoration as their first choice in treating carious lesions or other tooth defects, including restoration of large cavities [15]. However, partial indirect restorations (inlay, onlay, and overlay) for excessive posterior tooth defects have started to replace direct resin composite restorations since the development of modern chairside computer-aided design/computer-aided manufacturing (CAD/CAM) systems [16].
One of the most important advancements in chairside CAD/CAM systems is the production of resin composite blocks [17, 18]. Paradigm MZ100, as an industrial polymerized version of direct resin composite (Z100), is the first product in this field [19]. Paradigm MZ100 contains bisphenol A-glycidyl methacrylate (Bis-GMA), triethylene glycol dimethacrylate, and 85% (by weight) zirconia-silica filler. Therefore, its degree of polymerization and mechanical properties are better than Z100 [20]. Later, a new resin composite block containing urethane dimethacrylate instead of Bis-GMA was produced under high temperature and pressure. This kind of resin was developed with the ambition of increasing the degree of polymerization [21, 22]. Recently, the flexibility and convenience of CAD/CAM resin composite are similar to resin composites, combined with durability, and surface finish characteristics are identical to ceramics. In addition, compared with glass ceramics, the resin composite block has minor wear on the relative teeth and can maintain its gloss for a longer time. Their non-fusion and composite-like properties make them easier to grind, polish, and adapt. Due to the less brittleness, the resin composite block has better edge characteristics. Furthermore, these materials produced less blunting on the drills during milling. They can also be repaired using resin composites with cutback or adding techniques. Besides, physical (color stability, water sorption, and water solubility) and mechanical (fracture-resistant, wear, compressive strength, hardness, and elastic modulus) properties of resin composite blocks were found better than that of conventional resin composite because of their higher degree of polymerization [23, 24].
Tunac et al. evaluate the 2 year clinical performance of computer-aided design/computer-aided manufacturing (CAD/CAM) resin composite inlay restorations in comparison with direct resin composite restorations. According to FDI standards, the results show that the 2 year clinical performance of CAD/CAM resin composite inlay restorations is similar to that of direct resin composite restorations. After 2 years of clinical trials, CAD/CAM resin composite inlays have shown exemplary performance in class II cavities and meet clinical needs [25].
Despite the above advantages, due to the high degree of polymerization, discoloration, tarnishing, and fracture of the resin composite block overtime after the repair, the adhesion failure of the cement interface is a problem that may need to be considered for its long-term clinical performance [26]. However, data on CAD/CAM resin composite partial crowns (inlays, onlays, and overlying) restorations are limited. Therefore, more clinical trials are needed to draw further conclusions about its clinical behavior.
2.2 Alloy
Porcelain fused to metal (PFM) restoration comprises a metal coping that supports overlying ceramic (Figure 2) [27]. PFM restorations have a long clinical track record. However, the PFM fixed partial denture (FPD) failure rates were 4% after 5 years, 12% after 10 years, and 32% after 15 years [28].
Figure 2.
Porcelain fused to metal (PFM). Porcelain fused to metal (PFM) restoration comprises a metal coping that supports overlying ceramic.
To date, PFM restorations remain the most widely and successfully used option for FPDs because their failure rates are often low (8–10% within 10 years) [29]. It was reported that clinical survival rates of FPDs are between 72% and 87% after 10 years, between 69% and 74% after 15 years, and 53% after 30 years [30, 31]. However, as is well-known, the metals used in PFM restorations can cause allergic or toxic reactions within soft or hard tissue [32]. Besides, PFM is known to cause graying of the gingival margin because of metal show-through [33].
Compatibility between the ceramic and the metal alloy is of paramount importance. PFM ceramic veneers consist of an opaque ceramic (e.g., a titanium oxide glass) that is required to mask the color of the underlying metal and provides the bond with the metal alloy [34, 35].
Opaque ceramics are combined with metal alloys through an oxide layer formed on the metal surface. This process is called degassing [36]. The degassing process can also remove contaminants on the surface of the alloy—coating dentin/body ceramics on opaque ceramics. Dentin ceramics can mimic natural dentin. Then apply the incisal ceramic to the dentin/body ceramic on the incisal third. The restoration can also be polished by using low-melting glazed ceramics or self-glazing.
One of PFM restoration’s main disadvantages is its inability to transmit light, thus having a negative effect on the aesthetic outcome of the restoration because it may appear dark in color [37]. This drawback is noticeable at the restoration’s cervical area, where it is sometimes difficult to get enough room. Therefore, a sufficient tooth structure should be removed to accommodate the ceramic material, mask the underlying metal without overly modifying the restoration. In addition, the metal braces should stop 1 mm from the buccal finish line, and ceramic edges (shoulder ceramics) are recommended. Another disadvantage of a PFM restoration is allergic reactions in some patients to metal elements such as nickel in the metal alloy [32].
2.3 Ceramic
All-ceramic restorations refer to ceramic restorations made entirely of ceramic materials [38]. There are two kinds of all-ceramic restorations. One is monolithic (single layer), which composes of a single ceramic material. The other is a two-layer all-ceramic restoration which consists of a ceramic core material covered with a ceramic veneer [39, 40]. In the bi-layered, all-ceramic restoration, the ceramic core supports the restoration and gives it strength, while the veneer provides the restoration with its final shape, shade, and aesthetic [41]. Nevertheless, the veneer-core bond strength is considered one of the weakest links of the bi-layered all-ceramic restorations because they are prone to delamination and fracture [39]. Nowadays, with the increasing interest in aesthetics, a bi-layered all-ceramic restoration is widely applied in dentistry. However, the main disadvantages associated with this repair include delamination and fracture of the veneer [42]. In addition, it is sometimes difficult to achieve excellent occlusal contact with the structure of the opposing tooth. Finally, to achieve a lasting repair, the compatibility of the core and veneer materials is crucial [43].
When aesthetics is the priority, dental ceramics are the material of choice because they can successfully mimic the tooth substance’s character (Figure 3) [44]. Ceramics can successfully simulate the visual characteristics of the tooth substance. Ceramics are biocompatible and inert material and have a high degree of intra-oral stability. Therefore, they can be safely used in the oral cavity. For example, the use of all-ceramic restorations has increased in recent years [45]. However, there are many ceramic materials and systems on the market that can be used in dentistry. The increased use of ceramics for restorative procedures and the need to improve clinical performance has led to the development and introduction of several new ceramic restorative materials and techniques [46].
Figure 3.
Ceramics. Ceramics can successfully simulate the visual characteristics of the tooth substance. Ceramics are biocompatible and inert material and have a high degree of intra-oral stability.
The all-ceramic restorations can be used as a bi-layered restoration, in which the more aesthetic ceramic veneer is the core or framework. They can also be used as full-contour (monolithic) restorations, which can be stained when required [47].
In the past decade, countless types of all-ceramic crown systems have been introduced unprecedentedly. Many of these systems have been criticized for their failure in restorations. It was reported that the survival rate of all-ceramic restorations ranges from 88–100% after 2–5 years of use and can still reach 97% after 5–15 years of use [48]. Although all-ceramic restorations have been greatly improved, zirconia is still the best all-ceramic restoration currently available. Since the end of the 1990s, due to many clinical and basic scientific research, this form of partially stabilized zirconia has been popularized for application in dentistry due to its excellent strength and excellent fracture resistance [49]. Currently, two main types of all-ceramic FDP systems have been proposed. The first of these systems involves the use of a single material to make full-contour crowns. For instance, a single crown in anterior teeth and premolars is made by reinforced glass materials successfully [50]. Further, a full-contour crown in the molar region is prepared with polycrystalline zirconia with improved translucency [51]. For the second system, porcelain and other glass materials are fused into a frame made of high-strength ceramics [52]. Dense sintered polycrystalline zirconia-based materials are expected to be used in FDP frameworks [53].
Yttrium partially stabilized tetragonal zirconia polycrystalline (Y-TZP), due to its superior mechanical properties and excellent fracture resistance, has drawn lots of attention in clinical applications. For instance, the fracture toughness of Y-TZP ranges from 5 to 10 MPa m1/2, and bending strength varies from 900 to 1400 MPa [54]. Y-TZP-based systems are a recent addition to the high-strength, all-ceramic systems used for crowns and fixed partial dentures.
Zirconia is a white crystalline oxide of zirconium with high mechanical strength, toughness, and corrosion resistance. Besides, zirconia has excellent biocompatibility, which can significantly reduce dental plaque [55]. However, zirconia is degradable at low temperatures, and this is a gradual, spontaneous phenomenon. Recently, the introduction of stabilized zirconia is supposed to overcome this drawback and promote the application of zirconia in dental restorations [56].
Marchack et al. proposed a custom-designed powerful grinding ceramic core technology for all-ceramic crowns [57]. This technique can eliminate the porcelain covering of the zirconia inner crown and frame to reduce the incidence of chipping or cracking of the porcelain veneer. The fracture of veneering ceramic is the most common complication for zirconia restorations. Thus, some suggestions for optimizing the manufacturing process of zirconia-based FPDs have been issued, including changes to the firing protocol. It was recommended because it can reduce the chipping rate. In addition, zirconia-ceramic FDP shows more clinical problems like prolonged fracture of the veneer ceramic [58]. Therefore, dentists should pay more attention to zirconia-ceramic FDP generated by CAD/CAM system before all treatment procedures [29]. On the other hand, with the development of ceramics on zirconia, people invented the framework of lithium disilicate glass-ceramics.
Cercon ht (Dentsply Intl., York, PA, USA) is developed from a clinically proven Cercon-based yttria-stabilized zirconia material formulation. It represents a new generation of zirconia with excellent transparency and can be used for esthetic restorations without build-up porcelain [29]. In order to better reproduce the color of natural teeth, some zirconia-based materials have been developed as translucent [59]. Among them, zirconia is widely applied as crown and FDP without veneer or pressed ceramics. Zirconia has a high flexural strength of more than 1200 MPa and has excellent veneer properties [60]. In the dental clinic, zirconia has proven to be a durable and reliable frame material that can inhibit crack propagation and prevent catastrophic failure. However, there are clinical studies show that zirconia has an abrasive effect on the dentition, leading to excessive wear of the tooth structure [61]. The in vivo studies indicated that polished zirconia has higher wear resistance and lower resistance to wear than porcelain [62]. Currently, the new zirconia materials make the surface of the antagonist smooth, just like natural tooth enamel [63]. Although more and more research is focused on zirconia, there is still much to be understood about the production of zirconia and the production of zirconia inner crowns and frames. Dentists and researchers need further studies with larger sample sizes and extended follow-up periods to investigate the possible influencing factors of technical failures.
Ceria-stabilized tetragonal zirconia polycrystalline (Ce-TZP) is a newly developed ceramic material, which has not yet been used in the dental field. Its fracture toughness is 19 MPa m1/2, which is significantly better than Y-TZP. However, Ce-TZP has lower bending strength and hardness than Y-TZP [64]. Then, Ce-TZP/alumina nanocomposite (Ce-TZP/A) was developed to improve the property of Ce-TZP [65]. Ce-TZP/A contains nano-sized Al2O3 particles and Ce-TZP particles dispersed in Ce-TZP grains and grain boundaries [66]. This uniform dispersion of alumina in the Ce-TZP matrix plays a positive role in grain growth. However, it also negatively affects flexural strength, hardness, and hydrothermal stability of tetragonal zirconia. As reported, Ce-TZP/A is currently the toughest zirconia material available, and its fracture toughness reaches 19 MPa m1/2, and the flexural strength is high as 1400 MPa [65]. More importantly, Ce-TZP/A is entirely resistant to low-temperature aging degradation (LTAD), a critical drawback of Y-TZP [67]. The tremendous improvement of these characteristics is expected to extend the clinical application of dental ceramics to all-ceramic restorations and other areas, such as implant abutments, implants, removable denture bases, and components.
3. Conclusions
In conclusion, various dental restorative materials are available, and many appropriate materials are used to restore dental carious teeth. Among them, zirconia-based ceramics have been successfully introduced into the clinic due to acceptable biocompatibility, lower price compared with gold restorations and better appearance than traditional metal-ceramic restorations. In summary, zirconia restoration is an acceptable treatment option in restorative dentistry and a developing trend in esthetic dentistry.
Acknowledgments
This study was supported by the CSA Clinical Research Foundation for Young Scholars-All Ceramic Material Research Project (CSA-P2019-01).
Conflict of interest
The authors declare no conflict of interest.
\n',keywords:"dental caries, dental restorative materials, biomimetic principles, resin, zirconia",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/79529.pdf",chapterXML:"https://mts.intechopen.com/source/xml/79529.xml",downloadPdfUrl:"/chapter/pdf-download/79529",previewPdfUrl:"/chapter/pdf-preview/79529",totalDownloads:86,totalViews:0,totalCrossrefCites:0,dateSubmitted:"March 5th 2021",dateReviewed:"October 14th 2021",datePrePublished:"January 3rd 2022",datePublished:"February 9th 2022",dateFinished:"December 2nd 2021",readingETA:"0",abstract:"Dental caries is among the most prevalent chronic diseases of childhood, affecting larger part of children and adults. Non-treated enamel caries can lead to destruction and then spreads into the underlying softer and sensitive dentine layer. Dental restorative materials are applied to treat and reconstruct damaged teeth clinically and recover their functions. Currently, there are various dental restorative materials available, and many appropriate materials are used to restore dental carious teeth. The applicability of biomimetic principles can elicit innovations in restorative dentistry for tooth conservation and preservation. There are three types of materials commonly used in dental restorations: resin, alloys, and ceramic. During the past decade, zirconia-based ceramics have been successfully introduced into the clinic due to acceptable biocompatibility, lower price compared with gold restorations, and better appearance than traditional metal-ceramic restorations. Recently, zirconia restoration is an acceptable treatment option in restorative dentistry and a developing trend in esthetic dentistry.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/79529",risUrl:"/chapter/ris/79529",signatures:"Feng Luo, Hongyan Luo, Ruyi Li, Changxing Qu, Guang Hong and Qianbing Wan",book:{id:"9588",type:"book",title:"Clinical Concepts and Practical Management Techniques in Dentistry",subtitle:null,fullTitle:"Clinical Concepts and Practical Management Techniques in Dentistry",slug:"clinical-concepts-and-practical-management-techniques-in-dentistry",publishedDate:"February 9th 2022",bookSignature:"Aneesa Moolla",coverURL:"https://cdn.intechopen.com/books/images_new/9588.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83962-846-7",printIsbn:"978-1-83962-842-9",pdfIsbn:"978-1-83962-847-4",isAvailableForWebshopOrdering:!0,editors:[{id:"318170",title:"Dr.",name:"Aneesa",middleName:null,surname:"Moolla",slug:"aneesa-moolla",fullName:"Aneesa Moolla"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"315775",title:"Dr.",name:"Feng",middleName:null,surname:"Luo",fullName:"Feng Luo",slug:"feng-luo",email:"luofeng0122@icloud.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Sichuan University",institutionURL:null,country:{name:"China"}}},{id:"315776",title:"Prof.",name:"Qianbing",middleName:null,surname:"Wan",fullName:"Qianbing Wan",slug:"qianbing-wan",email:"wanqianbing@126.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"352120",title:"BSc.",name:"Hongyan",middleName:null,surname:"Luo",fullName:"Hongyan Luo",slug:"hongyan-luo",email:"1822830813@qq.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"352122",title:"MSc.",name:"Ruyi",middleName:null,surname:"Li",fullName:"Ruyi Li",slug:"ruyi-li",email:"2216845404@qq.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"352125",title:"BSc.",name:"Changxing",middleName:null,surname:"Qu",fullName:"Changxing Qu",slug:"changxing-qu",email:"qcx1152527420@163.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"352126",title:"Prof.",name:"Guang",middleName:null,surname:"Hong",fullName:"Guang Hong",slug:"guang-hong",email:"hong@m.tohoku.ac.jp",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. 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International Journal of Prosthodontics. 2013;26(5)'},{id:"B34",body:'Alikhasi M, Monzavi A, Ebrahimi H, et al. Debonding time and dental pulp temperature with the Er, Cr: YSGG laser for debonding feldespathic and lithium disilicate veneers. Journal of Lasers in Medical Sciences. 2019;10(3):211'},{id:"B35",body:'Zhang Y, Kelly JR. Dental ceramics for restoration and metal veneering. Dental Clinics. 2017;61(4):797-819'},{id:"B36",body:'Yoo SY, Kim SK, Heo SJ, et al. Effects of bonding agents on metal-ceramic bond strength of Co-Cr alloys fabricated by selective laser melting. Materials. 2020;13(19):4322'},{id:"B37",body:'Trushkowsky RD. Esthetic and functional consideration in restoring endodontically treated teeth. Dental Clinics. 2011;55(2):403-410'},{id:"B38",body:'Warreth A, Elkareimi Y. All-ceramic restorations: A review of literature. Saudi Dental Journal. 2020'},{id:"B39",body:'Li SL, Zhang Q , Wu FF, et al. Research progress on all ceramic zirconia core/veneer interface: A review. Science of Advanced Materials. 2020;12(1):5-14'},{id:"B40",body:'Toyama DY, Alves LMM, Ramos GF, et al. Bioinspired silica-infiltrated zirconia bilayers: Strength and interfacial bonding. Journal of the Mechanical Behavior of Biomedical Materials. 2019;89:143-149'},{id:"B41",body:'Xie Z, Wang X, Chen J, et al. The effects of core material and cooling rate on fabrication defects in the veneer of bi-layered all-ceramic systems. Ceramics International. 2019;45(13):15876-15882'},{id:"B42",body:'Aboushelib MN, De Jager N, Kleverlaan CJ, et al. Microtensile bond strength of different components of core veneered all-ceramic restorations. Dental Materials. 2005;21(10):984-991'},{id:"B43",body:'Kang W, Park JK, Kim SR, et al. Effects of core and veneer thicknesses on the color of CAD-CAM lithium disilicate ceramics. 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International Journal of Esthetic Dentistry. 2014;9(1):98-110'},{id:"B48",body:'Moscovitch M. Consecutive case series of monolithic and minimally veneered zirconia restorations on teeth and implants: Up to 68 months. International Journal of Periodontics & Restorative Dentistry. 2015;35(3)'},{id:"B49",body:'Sulaiman TA, Abdulmajeed AA, Shahramian K, et al. Effect of different treatments on the flexural strength of fully versus partially stabilized monolithic zirconia. The Journal of Prosthetic Dentistry. 2017;118(2):216-220'},{id:"B50",body:'Beuer F, Stimmelmayr M, Gueth JF, et al. In vitro performance of full-contour zirconia single crowns. Dental Materials. 2012;28(4):449-456'},{id:"B51",body:'Rosentritt M, Preis V, Behr M, et al. Fatigue and wear behaviour of zirconia materials. Journal of the Mechanical Behavior of Biomedical Materials. 2020;110:103970'},{id:"B52",body:'Takeichi T, Katsoulis J, Blatz MB. Clinical outcome of single porcelain-fused-to-zirconium dioxide crowns: A systematic review. The Journal of Prosthetic Dentistry. 2013;110(6):455-461'},{id:"B53",body:'Zarone F, Di Mauro MI, Spagnuolo G, et al. Fourteen-year evaluation of posterior zirconia-based three-unit fixed dental prostheses: A Prospective clinical study of all ceramic prosthesis. Journal of Dentistry. 2020;101:103419'},{id:"B54",body:'Ab-Ghani Z. Non-aqueous sol-gel derived calcia partially stabilized zirconia: Synthesis and characterizations. Malaysian Journal of Microscopy. 2020;16(1)'},{id:"B55",body:'Yu T, Zhang Z, Liu Q , et al. Extrusion-based additive manufacturing of yttria-partially-stabilized zirconia ceramics. Ceramics International. 2020;46(4):5020-5027'},{id:"B56",body:'Camposilvan E, Leone R, Gremillard L, et al. Aging resistance, mechanical properties and translucency of different yttria-stabilized zirconia ceramics for monolithic dental crown applications. Dental Materials. 2018;34(6):879-890'},{id:"B57",body:'Marchack BW, Sato S, Marchack CB, et al. Complete and partial contour zirconia designs for crowns and fixed dental prostheses: A clinical report. The Journal of Prosthetic Dentistry. 2011;106(3):145-152'},{id:"B58",body:'Vigolo P, Mutinelli S. Evaluation of zirconium-oxide-based ceramic single-unit posterior fixed dental prostheses (FDPs) generated with two CAD/CAM systems compared to porcelain-fused-to-metal single-unit posterior FDPs: A 5-year clinical prospective study. Journal of Prosthodontics: Implant, Esthetic and Reconstructive Dentistry. 2012;21(4):265-269'},{id:"B59",body:'Capa N, Tuncel I, Tak O, et al. The effect of luting cement and titanium base on the final color of zirconium oxide core material. Journal of Prosthodontics. 2017;26(2):136-140'},{id:"B60",body:'Tabatabaian F. Color in zirconia-based restorations and related factors: A literature review. Journal of Prosthodontics. 2018;27(2):201-211'},{id:"B61",body:'Huang Z, Huang J, Li C, et al. The application of 3D printed self-glazed zirconia for full-mouth rehabilitation in a patient with severely worn dentition: A case report. Advances in Applied Ceramics. 2020;119(5-6):305-311'},{id:"B62",body:'Zhang F, Spies BC, Vleugels J, et al. High-translucent yttria-stabilized zirconia ceramics are wear-resistant and antagonist-friendly. Dental Materials. 2019;35(12):1776-1790'},{id:"B63",body:'Shi A, Wu Z, Huang J, et al. Wear performance of self-glazed zirconia crowns with different amount of occlusal adjustment after 6 months of clinical use. Advances in Applied Ceramics. 2018;117(8):445-451'},{id:"B64",body:'Abi CBE. Toughening mechanisms in dental composites. Toughening Mechanisms in Composite Materials. 2015:321-337'},{id:"B65",body:'Hagiwara Y, Nakajima K. Application of Ce-TZP/Al2O3 nanocomposite to the framework of an implant-fixed complete dental prosthesis and a complete denture. Journal of Prosthodontic Research. 2016;60(4):337-343'},{id:"B66",body:'Omori S, Komada W, Yoshida K, et al. Effect of thickness of zirconia-ceramic crown frameworks on strength and fracture pattern. Dental Materials Journal. 2013;32(1):189-194'},{id:"B67",body:'Hussein AI, Ab-Ghani Z, Che Mat AN, et al. Synthesis and Characterization of Spherical Calcium Carbonate Nanoparticles Derived from Cockle Shells. Applied Sciences. 2020;10(20):7170'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Feng Luo",address:"luofeng0122@scu.edu.cn",affiliation:'
State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, China
State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, China
State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, China
State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, China
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Through a series of experiments for uncovered solid electrolyte films, stacked devices, and nanofabricated cells, formation and erasure of the copper filaments and deposits were confirmed. The behavior of the filament and deposit depended on the switching condition and history. Based on these in situ TEM results, the switching schematics and the degradation process were discussed.",signatures:"Masashi Arita, Atsushi Tsurumaki-Fukuchi and Yasuo Takahashi",authors:[{id:"174249",title:"Prof.",name:"Masashi",surname:"Arita",fullName:"Masashi Arita",slug:"masashi-arita",email:"arita@nano.ist.hokudai.ac.jp"},{id:"203259",title:"Dr.",name:"Atsushi",surname:"Tsurumaki-Fukuchi",fullName:"Atsushi Tsurumaki-Fukuchi",slug:"atsushi-tsurumaki-fukuchi",email:"a.fukuchi@ist.hokudai.ac.jp"},{id:"203260",title:"Prof.",name:"Yasuo",surname:"Takahashi",fullName:"Yasuo Takahashi",slug:"yasuo-takahashi",email:"y-taka@ist.hokudai.ac.jp"}],book:{id:"5973",title:"Memristor and Memristive Neural Networks",slug:"memristor-and-memristive-neural-networks",productType:{id:"1",title:"Edited Volume"}}}],collaborators:[{id:"174249",title:"Prof.",name:"Masashi",surname:"Arita",slug:"masashi-arita",fullName:"Masashi Arita",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/174249/images/system/174249.jpeg",biography:"Masashi Arita received the B.S. degree in materials science from Hiroshima University, Hiroshima, Japan, in 1980, and the Ph.D. degree in solid state physics from Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland, in 1987. He joined Ciba-Geigy Japan in 1987, where he was engaged in research on crystallography and electrophotography of organic substances. Since joining Nagoya University, Nagoya, Japan, in 1990, he has been engaged in research on crystallography and physical properties of metallic nano particles and ultrathin films. Since 1997, he has been an Associate Professor at the Graduate School of Engineering as well as the Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan. His major subject at present is in-situ electron microscopy of electronic devices.",institutionString:"Hokkaido University",institution:{name:"Hokkaido University",institutionURL:null,country:{name:"Japan"}}},{id:"201955",title:"Dr.",name:"Yao-Feng",surname:"Chang",slug:"yao-feng-chang",fullName:"Yao-Feng Chang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/201955/images/system/201955.jpg",biography:"Dr. Yao-Feng Chang is a reliability memory engineer at Intel. He received a BS from National Sun Yat-sen University, Taiwan, in 2007; an MS in Electronics Engineering from National Chiao Tung University, Taiwan, in 2009; and a Ph.D. in Electrical Engineering from the University of Texas at Austin, USA, in 2015. He has more than 100 journal publications to his credit. His research interests include SiOx- and SiNx- Based ReRAM fabrication, characterization, and mechanism; stateful Boolean logic and synaptic post-Moore’s computing and bio-inspiration biomimetic systems in electronic devices; and selector integration for large-scale, low-power array design.",institutionString:null,institution:{name:"The University of Texas at Austin",institutionURL:null,country:{name:"United States of America"}}},{id:"201984",title:"Mr.",name:"Cheng Chih",surname:"Hsieh",slug:"cheng-chih-hsieh",fullName:"Cheng Chih Hsieh",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"The University of Texas at Austin",institutionURL:null,country:{name:"United States of America"}}},{id:"201985",title:"Ms.",name:"Ying-Chen",surname:"Chen",slug:"ying-chen-chen",fullName:"Ying-Chen Chen",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"The University of Texas at Austin",institutionURL:null,country:{name:"United States of America"}}},{id:"201986",title:"Mr.",name:"Chih-Yang",surname:"Lin",slug:"chih-yang-lin",fullName:"Chih-Yang Lin",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Sun Yat-sen University",institutionURL:null,country:{name:"Taiwan"}}},{id:"201989",title:"Ms.",name:"Meiqi",surname:"Guo",slug:"meiqi-guo",fullName:"Meiqi Guo",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"The University of Texas at Austin",institutionURL:null,country:{name:"United States of America"}}},{id:"201990",title:"Dr.",name:"Fei",surname:"Zhou",slug:"fei-zhou",fullName:"Fei Zhou",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"The University of Texas at Austin",institutionURL:null,country:{name:"United States of America"}}},{id:"201991",title:"Dr.",name:"Burt W.",surname:"Fowler",slug:"burt-w.-fowler",fullName:"Burt W. 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Lee",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"The University of Texas at Austin",institutionURL:null,country:{name:"United States of America"}}}]},generic:{page:{slug:"customer-complaints",title:"Customer Complaints",intro:'
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His studies in robotics lead him not only to a PhD degree but also inspired him to co-found and build the International Journal of Advanced Robotic Systems - world's first Open Access journal in the field of robotics.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"441",title:"Ph.D.",name:"Jaekyu",middleName:null,surname:"Park",slug:"jaekyu-park",fullName:"Jaekyu Park",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/441/images/1881_n.jpg",biography:null,institutionString:null,institution:{name:"LG Corporation (South Korea)",country:{name:"Korea, South"}}},{id:"465",title:"Dr.",name:"Christian",middleName:null,surname:"Martens",slug:"christian-martens",fullName:"Christian Martens",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Rheinmetall (Germany)",country:{name:"Germany"}}},{id:"479",title:"Dr.",name:"Valentina",middleName:null,surname:"Colla",slug:"valentina-colla",fullName:"Valentina Colla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/479/images/358_n.jpg",biography:null,institutionString:null,institution:{name:"Sant'Anna School of Advanced Studies",country:{name:"Italy"}}},{id:"494",title:"PhD",name:"Loris",middleName:null,surname:"Nanni",slug:"loris-nanni",fullName:"Loris Nanni",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/494/images/system/494.jpg",biography:"Loris Nanni received his Master Degree cum laude on June-2002 from the University of Bologna, and the April 26th 2006 he received his Ph.D. in Computer Engineering at DEIS, University of Bologna. On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. His research interests include pattern recognition, bioinformatics, and biometric systems (fingerprint classification and recognition, signature verification, face recognition).",institutionString:null,institution:null},{id:"496",title:"Dr.",name:"Carlos",middleName:null,surname:"Leon",slug:"carlos-leon",fullName:"Carlos Leon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Seville",country:{name:"Spain"}}},{id:"512",title:"Dr.",name:"Dayang",middleName:null,surname:"Jawawi",slug:"dayang-jawawi",fullName:"Dayang Jawawi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Technology Malaysia",country:{name:"Malaysia"}}},{id:"528",title:"Dr.",name:"Kresimir",middleName:null,surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/528/images/system/528.jpg",biography:"K. Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. His current research interests are in the fields of intelligent control and robotics.",institutionString:null,institution:{name:"Technical University of Sofia",country:{name:"Bulgaria"}}},{id:"585",title:"Prof.",name:"Munir",middleName:null,surname:"Merdan",slug:"munir-merdan",fullName:"Munir Merdan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/585/images/system/585.jpg",biography:"Munir Merdan received the M.Sc. degree in mechanical engineering from the Technical University of Sarajevo, Bosnia and Herzegovina, in 2001, and the Ph.D. degree in electrical engineering from the Vienna University of Technology, Vienna, Austria, in 2009.Since 2005, he has been at the Automation and Control Institute, Vienna University of Technology, where he is currently a Senior Researcher. His research interests include the application of agent technology for achieving agile control in the manufacturing environment.",institutionString:null,institution:null},{id:"605",title:"Prof",name:"Dil",middleName:null,surname:"Hussain",slug:"dil-hussain",fullName:"Dil Hussain",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/605/images/system/605.jpg",biography:"Dr. Dil Muhammad Akbar Hussain is a professor of Electronics Engineering & Computer Science at the Department of Energy Technology, Aalborg University Denmark. Professor Akbar has a Master degree in Digital Electronics from Govt. College University, Lahore Pakistan and a P-hD degree in Control Engineering from the School of Engineering and Applied Sciences, University of Sussex United Kingdom. Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. 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\r\n\tTransforming our World: the 2030 Agenda for Sustainable Development endorsed by United Nations and 193 Member States, came into effect on Jan 1, 2016, to guide decision making and actions to the year 2030 and beyond. Central to this Agenda are 17 Goals, 169 associated targets and over 230 indicators that are reviewed annually. The vision envisaged in the implementation of the SDGs is centered on the five Ps: People, Planet, Prosperity, Peace and Partnership. This call for renewed focused efforts ensure we have a safe and healthy planet for current and future generations.
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\r\n\tThis Series focuses on covering research and applied research involving the five Ps through the following topics:
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\r\n\t1. Sustainable Economy and Fair Society that relates to SDG 1 on No Poverty, SDG 2 on Zero Hunger, SDG 8 on Decent Work and Economic Growth, SDG 10 on Reduced Inequalities, SDG 12 on Responsible Consumption and Production, and SDG 17 Partnership for the Goals
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\r\n\t2. Health and Wellbeing focusing on SDG 3 on Good Health and Wellbeing and SDG 6 on Clean Water and Sanitation
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\r\n\t3. Inclusivity and Social Equality involving SDG 4 on Quality Education, SDG 5 on Gender Equality, and SDG 16 on Peace, Justice and Strong Institutions
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\r\n\t4. Climate Change and Environmental Sustainability comprising SDG 13 on Climate Action, SDG 14 on Life Below Water, and SDG 15 on Life on Land
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\r\n\t5. Urban Planning and Environmental Management embracing SDG 7 on Affordable Clean Energy, SDG 9 on Industry, Innovation and Infrastructure, and SDG 11 on Sustainable Cities and Communities.
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\r\n\t
\r\n
\r\n\tThe series also seeks to support the use of cross cutting SDGs, as many of the goals listed above, targets and indicators are all interconnected to impact our lives and the decisions we make on a daily basis, making them impossible to tie to a single topic.
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He is an academic staff member of the Department of Reproduction and Artificial Insemination, Selçuk University, Turkey. He manages several studies on sperms and embryos and is an editorial board member for several international journals. His studies include sperm cryobiology, in vitro fertilization, and embryo production in animals.",institutionString:"Selçuk University, Faculty of Veterinary Medicine",institution:null},{id:"90846",title:"Prof.",name:"Yusuf",middleName:null,surname:"Bozkurt",slug:"yusuf-bozkurt",fullName:"Yusuf Bozkurt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/90846/images/system/90846.jpg",biography:"Yusuf Bozkurt has a BSc, MSc, and Ph.D. from Ankara University, Turkey. He is currently a Professor of Biotechnology of Reproduction in the field of Aquaculture, İskenderun Technical University, Turkey. His research interests include reproductive biology and biotechnology with an emphasis on cryo-conservation. He is on the editorial board of several international peer-reviewed journals and has published many papers. Additionally, he has participated in many international and national congresses, seminars, and workshops with oral and poster presentations. He is an active member of many local and international organizations.",institutionString:"İskenderun Technical University",institution:{name:"İskenderun Technical University",country:{name:"Turkey"}}},{id:"61139",title:"Dr.",name:"Sergey",middleName:null,surname:"Tkachev",slug:"sergey-tkachev",fullName:"Sergey Tkachev",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/61139/images/system/61139.png",biography:"Dr. Sergey Tkachev is a senior research scientist at the Institute of Fundamental Medicine and Biology, Kazan Federal University, Russia, and at the Institute of Chemical Biology and Fundamental Medicine SB RAS, Novosibirsk, Russia. He received his Ph.D. in Molecular Biology with his thesis “Genetic variability of the tick-borne encephalitis virus in natural foci of Novosibirsk city and its suburbs.” His primary field is molecular virology with research emphasis on vector-borne viruses, especially tick-borne encephalitis virus, Kemerovo virus and Omsk hemorrhagic fever virus, rabies virus, molecular genetics, biology, and epidemiology of virus pathogens.",institutionString:"Russian Academy of Sciences",institution:{name:"Russian Academy of Sciences",country:{name:"Russia"}}},{id:"310962",title:"Dr.",name:"Amlan",middleName:"Kumar",surname:"Patra",slug:"amlan-patra",fullName:"Amlan Patra",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/310962/images/system/310962.jpg",biography:"Amlan K. Patra, FRSB, obtained a Ph.D. in Animal Nutrition from Indian Veterinary Research Institute, India, in 2002. He is currently an associate professor at West Bengal University of Animal and Fishery Sciences. He has more than twenty years of research and teaching experience. He held previous positions at the American Institute for Goat Research, The Ohio State University, Columbus, USA, and Free University of Berlin, Germany. His research focuses on animal nutrition, particularly ruminants and poultry nutrition, gastrointestinal electrophysiology, meta-analysis and modeling in nutrition, and livestock–environment interaction. He has authored around 175 articles in journals, book chapters, and proceedings. Dr. Patra serves on the editorial boards of several reputed journals.",institutionString:null,institution:{name:"West Bengal University of Animal and Fishery Sciences",country:{name:"India"}}},{id:"53998",title:"Prof.",name:"László",middleName:null,surname:"Babinszky",slug:"laszlo-babinszky",fullName:"László Babinszky",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/53998/images/system/53998.png",biography:"László Babinszky is Professor Emeritus, Department of Animal Nutrition Physiology, University of Debrecen, Hungary. He has also worked in the Department of Animal Nutrition, University of Wageningen, Netherlands; the Institute for Livestock Feeding and Nutrition (IVVO), Lelystad, Netherlands; the Agricultural University of Vienna (BOKU); the Institute for Animal Breeding and Nutrition, Austria; and the Oscar Kellner Research Institute for Animal Nutrition, Rostock, Germany. In 1992, Dr. Babinszky obtained a Ph.D. in Animal Nutrition from the University of Wageningen. His main research areas are swine and poultry nutrition. He has authored more than 300 publications (papers, book chapters) and edited four books and fourteen international conference proceedings.",institutionString:"University of Debrecen",institution:{name:"University of Debrecen",country:{name:"Hungary"}}},{id:"201830",title:"Dr.",name:"Fernando",middleName:"Sanchez",surname:"Davila",slug:"fernando-davila",fullName:"Fernando Davila",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/201830/images/5017_n.jpg",biography:"I am a professor at UANL since 1988. My research lines are the development of reproductive techniques in small ruminants. We also conducted research on sexual and social behavior in males.\nI am Mexican and study my professional career as an engineer in agriculture and animal science at UANL. Then take a masters degree in science in Germany (Animal breeding). Take a doctorate in animal science at the UANL.",institutionString:null,institution:{name:"Universidad Autónoma de Nuevo León",country:{name:"Mexico"}}},{id:"309250",title:"Dr.",name:"Miguel",middleName:null,surname:"Quaresma",slug:"miguel-quaresma",fullName:"Miguel Quaresma",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/309250/images/9059_n.jpg",biography:"Miguel Nuno Pinheiro Quaresma was born on May 26, 1974 in Dili, Timor Island. He is married with two children: a boy and a girl, and he is a resident in Vila Real, Portugal. He graduated in Veterinary Medicine in August 1998 and obtained his Ph.D. degree in Veterinary Sciences -Clinical Area in February 2015, both from the University of Trás-os-Montes e Alto Douro. He is currently enrolled in the Alternative Residency of the European College of Animal Reproduction. He works as a Senior Clinician at the Veterinary Teaching Hospital of UTAD (HVUTAD) with a role in clinical activity in the area of livestock and equine species as well as to support teaching and research in related areas. He teaches as an Invited Professor in Reproduction Medicine I and II of the Master\\'s in Veterinary Medicine degree at UTAD. Currently, he holds the position of Chairman of the Portuguese Buiatrics Association. He is a member of the Consultive Group on Production Animals of the OMV. He has 19 publications in indexed international journals (ISIS), as well as over 60 publications and oral presentations in both Portuguese and international journals and congresses.",institutionString:"University of Trás-os-Montes and Alto Douro",institution:{name:"University of Trás-os-Montes and Alto Douro",country:{name:"Portugal"}}},{id:"38652",title:"Prof.",name:"Rita",middleName:null,surname:"Payan-Carreira",slug:"rita-payan-carreira",fullName:"Rita Payan-Carreira",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRiFPQA0/Profile_Picture_1614601496313",biography:"Rita Payan Carreira earned her Veterinary Degree from the Faculty of Veterinary Medicine in Lisbon, Portugal, in 1985. She obtained her Ph.D. in Veterinary Sciences from the University of Trás-os-Montes e Alto Douro, Portugal. After almost 32 years of teaching at the University of Trás-os-Montes and Alto Douro, she recently moved to the University of Évora, Department of Veterinary Medicine, where she teaches in the field of Animal Reproduction and Clinics. Her primary research areas include the molecular markers of the endometrial cycle and the embryo–maternal interaction, including oxidative stress and the reproductive physiology and disorders of sexual development, besides the molecular determinants of male and female fertility. She often supervises students preparing their master's or doctoral theses. She is also a frequent referee for various journals.",institutionString:null,institution:{name:"University of Évora",country:{name:"Portugal"}}},{id:"283019",title:"Dr.",name:"Oudessa",middleName:null,surname:"Kerro Dego",slug:"oudessa-kerro-dego",fullName:"Oudessa Kerro Dego",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/283019/images/system/283019.png",biography:"Dr. Kerro Dego is a veterinary microbiologist with training in veterinary medicine, microbiology, and anatomic pathology. Dr. Kerro Dego is an assistant professor of dairy health in the department of animal science, the University of Tennessee, Institute of Agriculture, Knoxville, Tennessee. He received his D.V.M. (1997), M.S. (2002), and Ph.D. (2008) degrees in Veterinary Medicine, Animal Pathology and Veterinary Microbiology from College of Veterinary Medicine, Addis Ababa University, Ethiopia; College of Veterinary Medicine, Utrecht University, the Netherlands and Western College of Veterinary Medicine, University of Saskatchewan, Canada respectively. He did his Postdoctoral training in microbial pathogenesis (2009 - 2015) in the Department of Animal Science, the University of Tennessee, Institute of Agriculture, Knoxville, Tennessee. Dr. Kerro Dego’s research focuses on the prevention and control of infectious diseases of farm animals, particularly mastitis, improving dairy food safety, and mitigation of antimicrobial resistance. Dr. Kerro Dego has extensive experience in studying the pathogenesis of bacterial infections, identification of virulence factors, and vaccine development and efficacy testing against major bacterial mastitis pathogens. Dr. Kerro Dego conducted numerous controlled experimental and field vaccine efficacy studies, vaccination, and evaluation of immunological responses in several species of animals, including rodents (mice) and large animals (bovine and ovine).",institutionString:"University of Tennessee at Knoxville",institution:{name:"University of Tennessee at Knoxville",country:{name:"United States of America"}}},{id:"251314",title:"Dr.",name:"Juan Carlos",middleName:null,surname:"Gardón Poggi",slug:"juan-carlos-gardon-poggi",fullName:"Juan Carlos Gardón Poggi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/251314/images/system/251314.jpeg",biography:"Juan Carlos Gardón Poggi received University degree from the Faculty of Agrarian Science in Argentina, in 1983. Also he received Masters Degree and PhD from Córdoba University, Spain. He is currently a Professor at the Catholic University of Valencia San Vicente Mártir, at the Department of Medicine and Animal Surgery. He teaches diverse courses in the field of Animal Reproduction and he is the Director of the Veterinary Farm. He also participates in academic postgraduate activities at the Veterinary Faculty of Murcia University, Spain. His research areas include animal physiology, physiology and biotechnology of reproduction either in males or females, the study of gametes under in vitro conditions and the use of ultrasound as a complement to physiological studies and development of applied biotechnologies. Routinely, he supervises students preparing their doctoral, master thesis or final degree projects.",institutionString:null,institution:{name:"Valencia Catholic University Saint Vincent Martyr",country:{name:"Spain"}}},{id:"309529",title:"Dr.",name:"Albert",middleName:null,surname:"Rizvanov",slug:"albert-rizvanov",fullName:"Albert Rizvanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/309529/images/9189_n.jpg",biography:'Albert A. Rizvanov is a Professor and Director of the Center for Precision and Regenerative Medicine at the Institute of Fundamental Medicine and Biology, Kazan Federal University (KFU), Russia. He is the Head of the Center of Excellence “Regenerative Medicine” and Vice-Director of Strategic Academic Unit \\"Translational 7P Medicine\\". Albert completed his Ph.D. at the University of Nevada, Reno, USA and Dr.Sci. at KFU. He is a corresponding member of the Tatarstan Academy of Sciences, Russian Federation. Albert is an author of more than 300 peer-reviewed journal articles and 22 patents. He has supervised 11 Ph.D. and 2 Dr.Sci. dissertations. Albert is the Head of the Dissertation Committee on Biochemistry, Microbiology, and Genetics at KFU.\nORCID https://orcid.org/0000-0002-9427-5739\nWebsite https://kpfu.ru/Albert.Rizvanov?p_lang=2',institutionString:"Kazan Federal University",institution:{name:"Kazan Federal University",country:{name:"Russia"}}},{id:"210551",title:"Dr.",name:"Arbab",middleName:null,surname:"Sikandar",slug:"arbab-sikandar",fullName:"Arbab Sikandar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/210551/images/system/210551.jpg",biography:"Dr. Arbab Sikandar, PhD, M. Phil, DVM was born on April 05, 1981. He is currently working at the College of Veterinary & Animal Sciences as an Assistant Professor. He previously worked as a lecturer at the same University. \nHe is a Member/Secretory of Ethics committee (No. CVAS-9377 dated 18-04-18), Member of the QEC committee CVAS, Jhang (Regr/Gen/69/873, dated 26-10-2017), Member, Board of studies of Department of Basic Sciences (No. CVAS. 2851 Dated. 12-04-13, and No. CVAS, 9024 dated 20/11/17), Member of Academic Committee, CVAS, Jhang (No. CVAS/2004, Dated, 25-08-12), Member of the technical committee (No. CVAS/ 4085, dated 20,03, 2010 till 2016).\n\nDr. Arbab Sikandar contributed in five days hands-on-training on Histopathology at the Department of Pathology, UVAS from 12-16 June 2017. He received a Certificate of appreciation for contributions for Popularization of Science and Technology in the Society on 17-11-15. He was the resource person in the lecture series- ‘scientific writing’ at the Department of Anatomy and Histology, UVAS, Lahore on 29th October 2015. He won a full fellowship as a principal candidate for the year 2015 in the field of Agriculture, EICA, Egypt with ref. to the Notification No. 12(11) ACS/Egypt/2014 from 10 July 2015 to 25th September 2015.; he received a grant of Rs. 55000/- as research incentives from Director, Advanced Studies and Research, UVAS, Lahore upon publications of research papers in IF Journals (DR/215, dated 19-5-2014.. He obtained his PhD by winning a HEC Pakistan indigenous Scholarship, ‘Ph.D. fellowship for 5000 scholars – Phase II’ (2av1-147), 17-6/HEC/HRD/IS-II/12, November 15, 2012. \n\nDr. Sikandar is a member of numerous societies: Registered Veterinary Medical Practitioner (life member) and Registered Veterinary Medical Faculty of Pakistan Veterinary Medical Council. The Registration code of PVMC is RVMP/4298 and RVMF/ 0102.; Life member of the University of Veterinary and Animal Sciences, Lahore, Alumni Association with S# 664, dated: 6-4-12. ; Member 'Vets Care Organization Pakistan” with Reference No. VCO-605-149, dated 05-04-06. :Member 'Vet Crescent” (Society of Animal Health and Production), UVAS, Lahore.",institutionString:"University of Veterinary & Animal Science",institution:{name:"University of Veterinary and Animal Sciences",country:{name:"Pakistan"}}},{id:"311663",title:"Dr.",name:"Prasanna",middleName:null,surname:"Pal",slug:"prasanna-pal",fullName:"Prasanna Pal",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311663/images/13261_n.jpg",biography:null,institutionString:null,institution:{name:"National Dairy Research Institute",country:{name:"India"}}},{id:"202192",title:"Dr.",name:"Catrin",middleName:null,surname:"Rutland",slug:"catrin-rutland",fullName:"Catrin Rutland",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202192/images/system/202192.png",biography:"Catrin Rutland is an Associate Professor of Anatomy and Developmental Genetics at the University of Nottingham, UK. She obtained a BSc from the University of Derby, England, a master’s degree from Technische Universität München, Germany, and a Ph.D. from the University of Nottingham. She undertook a post-doctoral research fellowship in the School of Medicine before accepting tenure in Veterinary Medicine and Science. Dr. Rutland also obtained an MMedSci (Medical Education) and a Postgraduate Certificate in Higher Education (PGCHE). She is the author of more than sixty peer-reviewed journal articles, twelve books/book chapters, and more than 100 research abstracts in cardiovascular biology and oncology. She is a board member of the European Association of Veterinary Anatomists, Fellow of the Anatomical Society, and Senior Fellow of the Higher Education Academy. Dr. Rutland has also written popular science books for the public. https://orcid.org/0000-0002-2009-4898. www.nottingham.ac.uk/vet/people/catrin.rutland",institutionString:null,institution:{name:"University of Nottingham",country:{name:"United Kingdom"}}},{id:"283315",title:"Prof.",name:"Samir",middleName:null,surname:"El-Gendy",slug:"samir-el-gendy",fullName:"Samir El-Gendy",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRduYQAS/Profile_Picture_1606215849748",biography:"Samir El-Gendy is a Professor of anatomy and embryology at the faculty of veterinary medicine, Alexandria University, Egypt. Samir obtained his PhD in veterinary science in 2007 from the faculty of veterinary medicine, Alexandria University and has been a professor since 2017. Samir is an author on 24 articles at Scopus and 12 articles within local journals and 2 books/book chapters. His research focuses on applied anatomy, imaging techniques and computed tomography. Samir worked as a member of different local projects on E-learning and he is a board member of the African Association of Veterinary Anatomists and of anatomy societies and as an associated author at local and international journals. Orcid: https://orcid.org/0000-0002-6180-389X",institutionString:null,institution:{name:"Alexandria University",country:{name:"Egypt"}}},{id:"246149",title:"Dr.",name:"Valentina",middleName:null,surname:"Kubale",slug:"valentina-kubale",fullName:"Valentina Kubale",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246149/images/system/246149.jpg",biography:"Valentina Kubale is Associate Professor of Veterinary Medicine at the Veterinary Faculty, University of Ljubljana, Slovenia. Since graduating from the Veterinary faculty she obtained her PhD in 2007, performed collaboration with the Department of Pharmacology, University of Copenhagen, Denmark. She continued as a post-doctoral fellow at the University of Copenhagen with a Lundbeck foundation fellowship. She is the editor of three books and author/coauthor of 23 articles in peer-reviewed scientific journals, 16 book chapters, and 68 communications at scientific congresses. Since 2008 she has been the Editor Assistant for the Slovenian Veterinary Research journal. She is a member of Slovenian Biochemical Society, The Endocrine Society, European Association of Veterinary Anatomists and Society for Laboratory Animals, where she is board member.",institutionString:"University of Ljubljana",institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"258334",title:"Dr.",name:"Carlos Eduardo",middleName:null,surname:"Fonseca-Alves",slug:"carlos-eduardo-fonseca-alves",fullName:"Carlos Eduardo Fonseca-Alves",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/258334/images/system/258334.jpg",biography:"Dr. Fonseca-Alves earned his DVM from Federal University of Goias – UFG in 2008. He completed an internship in small animal internal medicine at UPIS university in 2011, earned his MSc in 2013 and PhD in 2015 both in Veterinary Medicine at Sao Paulo State University – UNESP. Dr. Fonseca-Alves currently serves as an Assistant Professor at Paulista University – UNIP teaching small animal internal medicine.",institutionString:null,institution:{name:"Universidade Paulista",country:{name:"Brazil"}}},{id:"245306",title:"Dr.",name:"María Luz",middleName:null,surname:"Garcia Pardo",slug:"maria-luz-garcia-pardo",fullName:"María Luz Garcia Pardo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/245306/images/system/245306.png",biography:"María de la Luz García Pardo is an agricultural engineer from Universitat Politècnica de València, Spain. She has a Ph.D. in Animal Genetics. Currently, she is a lecturer at the Agrofood Technology Department of Miguel Hernández University, Spain. Her research is focused on genetics and reproduction in rabbits. The major goal of her research is the genetics of litter size through novel methods such as selection by the environmental sensibility of litter size, with forays into the field of animal welfare by analysing the impact on the susceptibility to diseases and stress of the does. Details of her publications can be found at https://orcid.org/0000-0001-9504-8290.",institutionString:null,institution:{name:"Miguel Hernandez University",country:{name:"Spain"}}},{id:"350704",title:"M.Sc.",name:"Camila",middleName:"Silva Costa",surname:"Ferreira",slug:"camila-ferreira",fullName:"Camila Ferreira",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/350704/images/17280_n.jpg",biography:"Graduated in Veterinary Medicine at the Fluminense Federal University, specialist in Equine Reproduction at the Brazilian Veterinary Institute (IBVET) and Master in Clinical Veterinary Medicine and Animal Reproduction at the Fluminense Federal University. She has experience in analyzing zootechnical indices in dairy cattle and organizing events related to Veterinary Medicine through extension grants. I have experience in the field of diagnostic imaging and animal reproduction in veterinary medicine through monitoring and scientific initiation scholarships. I worked at the Equus Central Reproduction Equine located in Santo Antônio de Jesus – BA in the 2016/2017 breeding season. I am currently a doctoral student with a scholarship from CAPES of the Postgraduate Program in Veterinary Medicine (Pathology and Clinical Sciences) at the Federal Rural University of Rio de Janeiro (UFRRJ) with a research project with an emphasis on equine endometritis.",institutionString:null,institution:null},{id:"41319",title:"Prof.",name:"Lung-Kwang",middleName:null,surname:"Pan",slug:"lung-kwang-pan",fullName:"Lung-Kwang Pan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41319/images/84_n.jpg",biography:null,institutionString:null,institution:null},{id:"125292",title:"Dr.",name:"Katy",middleName:null,surname:"Satué Ambrojo",slug:"katy-satue-ambrojo",fullName:"Katy Satué Ambrojo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/125292/images/system/125292.jpeg",biography:"Katy Satué Ambrojo received her Veterinary Medicine degree, Master degree in Equine Technology and doctorate in Veterinary Medicine from the Faculty of Veterinary, CEU-Cardenal Herrera University in Valencia, Spain.Dr. Satué is accredited as a Private University Doctor Professor, Doctor Assistant, and Contracted Doctor by AVAP (Agència Valenciana d'Avaluació i Prospectiva) and currently, as a full professor by ANECA (since January 2022). To date, Katy has taught 22 years in the Department of Animal Medicine and Surgery at the CEU-Cardenal Herrera University in undergraduate courses in Veterinary Medicine (General Pathology, integrated into the Applied Basis of Veterinary Medicine module of the 2nd year, Clinical Equine I of 3rd year, and Equine Clinic II of 4th year). Dr. Satué research activity is in the field of Endocrinology, Hematology, Biochemistry, and Immunology in the Spanish Purebred mare. She has directed 5 Doctoral Theses and 5 Diplomas of Advanced Studies, and participated in 11 research projects as a collaborating researcher. She has written 2 books and 14 book chapters in international publishers related to the area, and 68 scientific publications in international journals. Dr. Satué has attended 63 congresses, participating with 132 communications in international congresses and 19 in national congresses related to the area. Dr. Satué is a scientific reviewer for various prestigious international journals such as Animals, American Journal of Obstetrics and Gynecology, Veterinary Clinical Pathology, Journal of Equine Veterinary Science, Reproduction in Domestic Animals, Research Veterinary Science, Brazilian Journal of Medical and Biological Research, Livestock Production Science and Theriogenology, among others. Since 2014 she has been responsible for the Clinical Analysis Laboratory of the CEU-Cardenal Herrera University Veterinary Clinical Hospital.",institutionString:null,institution:null},{id:"201721",title:"Dr.",name:"Beatrice",middleName:null,surname:"Funiciello",slug:"beatrice-funiciello",fullName:"Beatrice Funiciello",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/201721/images/11089_n.jpg",biography:"Graduated from the University of Milan in 2011, my post-graduate education included CertAVP modules mainly on equines (dermatology and internal medicine) and a few on small animal (dermatology and anaesthesia) at the University of Liverpool. After a general CertAVP (2015) I gained the designated Certificate in Veterinary Dermatology (2017) after taking the synoptic examination and then applied for the RCVS ADvanced Practitioner status. After that, I completed the Postgraduate Diploma in Veterinary Professional Studies at the University of Liverpool (2018). My main area of work is cross-species veterinary dermatology.",institutionString:null,institution:null},{id:"291226",title:"Dr.",name:"Monica",middleName:null,surname:"Cassel",slug:"monica-cassel",fullName:"Monica Cassel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/291226/images/8232_n.jpg",biography:'Degree in Biological Sciences at the Federal University of Mato Grosso with scholarship for Scientific Initiation by FAPEMAT (2008/1) and CNPq (2008/2-2009/2): Project \\"Histological evidence of reproductive activity in lizards of the Manso region, Chapada dos Guimarães, Mato Grosso, Brazil\\". Master\\\'s degree in Ecology and Biodiversity Conservation at Federal University of Mato Grosso with a scholarship by CAPES/REUNI program: Project \\"Reproductive biology of Melanorivulus punctatus\\". PhD\\\'s degree in Science (Cell and Tissue Biology Area) \n at University of Sao Paulo with scholarship granted by FAPESP; Project \\"Development of morphofunctional changes in ovary of Astyanax altiparanae Garutti & Britski, 2000 (Teleostei, Characidae)\\". She has experience in Reproduction of vertebrates and Morphology, with emphasis in Cellular Biology and Histology. She is currently a teacher in the medium / technical level courses at IFMT-Alta Floresta, as well as in the Bachelor\\\'s degree in Animal Science and in the Bachelor\\\'s degree in Business.',institutionString:null,institution:null},{id:"442807",title:"Dr.",name:"Busani",middleName:null,surname:"Moyo",slug:"busani-moyo",fullName:"Busani Moyo",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Gwanda State University",country:{name:"Zimbabwe"}}},{id:"439435",title:"Dr.",name:"Feda S.",middleName:null,surname:"Aljaser",slug:"feda-s.-aljaser",fullName:"Feda S. 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The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",hasOnlineFirst:!0,hasPublishedBooks:!0,annualVolume:11403,editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",slug:"slawomir-wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",biography:"Professor Sławomir Wilczyński, Head of the Chair of Department of Basic Biomedical Sciences, Faculty of Pharmaceutical Sciences, Medical University of Silesia in Katowice, Poland. 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