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Poologasundarampillai G, Nommeots-Nomm A. Materials for 3D printing in medicine. 3D Print Med 2017. [DOI: 10.1016/b978-0-08-100717-4.00002-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Cheng A, Cohen DJ, Boyan BD, Schwartz Z. Laser-Sintered Constructs with Bio-inspired Porosity and Surface Micro/Nano-Roughness Enhance Mesenchymal Stem Cell Differentiation and Matrix Mineralization In Vitro. Calcif Tissue Int 2016; 99:625-637. [PMID: 27501817 DOI: 10.1007/s00223-016-0184-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/28/2016] [Indexed: 12/17/2022]
Abstract
Direct metal laser sintering can produce porous Ti-6Al-4V orthopedic and dental implants. The process requires reduced resources and time and can provide greater structural control than machine manufacturing. Implants in bone are colonized by mesenchymal stem cells (MSCs), which can differentiate into osteoblasts and contribute to osseointegration. This study examined osteoblast differentiation and matrix mineralization of human MSCs cultured on laser-sintered Ti-6Al-4V constructs with varying porosity and at different time scales. 2D solid disks and low, medium and high porosity (LP, MP, and HP) 3D constructs based on a human trabecular bone template were laser sintered from Ti-6Al-4V powder and further processed to have micro- and nanoscale roughness. hMSCs exhibited greater osteoblastic differentiation and local factor production on all 3D porous constructs compared to 2D surfaces, which was sustained for 9 days without use of exogenous factors. hMSCs cultured for 8 weeks on MP constructs in osteogenic medium (OM), OM supplemented with BMP2 or collagen-coated MP constructs in OM exhibited bone-like extracellular matrix mineralization. Use of bio-inspired porosity for the 3D architecture of additively manufactured Ti-6Al-4V enhanced osteogenic differentiation of hMSCs beyond surface roughness alone. This study suggests that a 3D architecture may enhance the osseointegration of orthopedic and dental implants in vivo.
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Affiliation(s)
- Alice Cheng
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 313 Ferst Drive NW, Atlanta, GA, 30313, USA
- Department of Biomedical Engineering, Peking University, Peking University Hospital Building A503, Haidian District, Beijing, 100871, China
| | - David J Cohen
- Department of Biomedical Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA, 23284, USA
| | - Barbara D Boyan
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 313 Ferst Drive NW, Atlanta, GA, 30313, USA.
- Department of Biomedical Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA, 23284, USA.
| | - Zvi Schwartz
- Department of Biomedical Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA, 23284, USA
- Department of Periodontics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
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Provaggi E, Leong JJH, Kalaskar DM. Applications of 3D printing in the management of severe spinal conditions. Proc Inst Mech Eng H 2016; 231:471-486. [PMID: 27658427 DOI: 10.1177/0954411916667761] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The latest and fastest-growing innovation in the medical field has been the advent of three-dimensional printing technologies, which have recently seen applications in the production of low-cost, patient-specific medical implants. While a wide range of three-dimensional printing systems has been explored in manufacturing anatomical models and devices for the medical setting, their applications are cutting-edge in the field of spinal surgery. This review aims to provide a comprehensive overview and classification of the current applications of three-dimensional printing technologies in spine care. Although three-dimensional printing technology has been widely used for the construction of patient-specific anatomical models of the spine and intraoperative guide templates to provide personalized surgical planning and increase pedicle screw placement accuracy, only few studies have been focused on the manufacturing of spinal implants. Therefore, three-dimensional printed custom-designed intervertebral fusion devices, artificial vertebral bodies and disc substitutes for total disc replacement, along with tissue engineering strategies focused on scaffold constructs for bone and cartilage regeneration, represent a set of promising applications towards the trend of individualized patient care.
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Affiliation(s)
- Elena Provaggi
- 1 Centre for Nanotechnology & Tissue Engineering, Division of Surgery and Interventional Science, UCL Medical School, University College London, London, UK
| | - Julian J H Leong
- 1 Centre for Nanotechnology & Tissue Engineering, Division of Surgery and Interventional Science, UCL Medical School, University College London, London, UK.,2 Royal National Orthopaedic Hospital, Stanmore, UK
| | - Deepak M Kalaskar
- 1 Centre for Nanotechnology & Tissue Engineering, Division of Surgery and Interventional Science, UCL Medical School, University College London, London, UK
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Xiu P, Jia Z, Lv J, Yin C, Cheng Y, Zhang K, Song C, Leng H, Zheng Y, Cai H, Liu Z. Tailored Surface Treatment of 3D Printed Porous Ti6Al4V by Microarc Oxidation for Enhanced Osseointegration via Optimized Bone In-Growth Patterns and Interlocked Bone/Implant Interface. ACS APPLIED MATERIALS & INTERFACES 2016; 8:17964-17975. [PMID: 27341499 DOI: 10.1021/acsami.6b05893] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
3D printed porous titanium (Ti) holds enormous potential for load-bearing orthopedic applications. Although the 3D printing technique has good control over the macro-sturctures of porous Ti, the surface properties that affect tissue response are beyond its control, adding the need for tailored surface treatment to improve its osseointegration capacity. Here, the one step microarc oxidation (MAO) process was applied to a 3D printed porous Ti6Al4V (Ti64) scaffold to endow the scaffold with a homogeneous layer of microporous TiO2 and significant amounts of amorphous calcium-phosphate. Following the treatment, the porous Ti64 scaffolds exhibited a drastically improved apatite forming ability, cyto-compatibility, and alkaline phosphatase activity. In vivo test in a rabbit model showed that the bone in-growth at the untreated scaffold was in a pattern of distance osteogenesis by which bone formed only at the periphery of the scaffold. In contrast, the bone in-growth at the MAO-treated scaffold exhibited a pattern of contact osteogenesis by which bone formed in situ on the entire surface of the scaffold. This pattern of bone in-growth significantly increased bone formation both in and around the scaffold possibly through enhancement of bone formation and disruption of bone remodeling. Moreover, the implant surface of the MAO-treated scaffold interlocked with the bone tissues through the fabricated microporous topographies to generate a stronger bone/implant interface. The increased osteoinetegration strength was further proven by a push out test. MAO exhibits a high efficiency in the enhancement of osteointegration of porous Ti64 via optimizing the patterns of bone in-growth and bone/implant interlocking. Therefore, post-treatment of 3D printed porous Ti64 with MAO technology might open up several possibilities for the development of bioactive customized implants in orthopedic applications.
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Affiliation(s)
- Peng Xiu
- Department of Orthopedics, Peking University Third Hospital , Beijing 100191, People's Republic of China
- Beijing Key Laboratory of Spinal Diseases , Beijing 100191, People's Republic of China
| | - Zhaojun Jia
- Center for Biomedical Materials and Tissue Engineering, Academy for Advanced Interdisciplinary Studies, Peking University , Beijing 100871, People's Republic of China
| | - Jia Lv
- Department of Orthopedics, Peking University Third Hospital , Beijing 100191, People's Republic of China
- Beijing Key Laboratory of Spinal Diseases , Beijing 100191, People's Republic of China
| | - Chuan Yin
- Department of Orthopedics, Peking University Third Hospital , Beijing 100191, People's Republic of China
- Beijing Key Laboratory of Spinal Diseases , Beijing 100191, People's Republic of China
| | - Yan Cheng
- Center for Biomedical Materials and Tissue Engineering, Academy for Advanced Interdisciplinary Studies, Peking University , Beijing 100871, People's Republic of China
| | - Ke Zhang
- Department of Orthopedics, Peking University Third Hospital , Beijing 100191, People's Republic of China
- Beijing Key Laboratory of Spinal Diseases , Beijing 100191, People's Republic of China
| | - Chunli Song
- Department of Orthopedics, Peking University Third Hospital , Beijing 100191, People's Republic of China
- Beijing Key Laboratory of Spinal Diseases , Beijing 100191, People's Republic of China
| | - Huijie Leng
- Department of Orthopedics, Peking University Third Hospital , Beijing 100191, People's Republic of China
- Beijing Key Laboratory of Spinal Diseases , Beijing 100191, People's Republic of China
| | - Yufeng Zheng
- Center for Biomedical Materials and Tissue Engineering, Academy for Advanced Interdisciplinary Studies, Peking University , Beijing 100871, People's Republic of China
- Department of Materials Science and Engineering, College of Engineering, Peking University , Beijing 100871, People's Republic of China
| | - Hong Cai
- Department of Orthopedics, Peking University Third Hospital , Beijing 100191, People's Republic of China
- Beijing Key Laboratory of Spinal Diseases , Beijing 100191, People's Republic of China
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital , Beijing 100191, People's Republic of China
- Beijing Key Laboratory of Spinal Diseases , Beijing 100191, People's Republic of China
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Topological design and additive manufacturing of porous metals for bone scaffolds and orthopaedic implants: A review. Biomaterials 2016. [DOI: 10.1016/j.biomaterials.2016.01.012 pmid: 26773669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Wang X, Xu S, Zhou S, Xu W, Leary M, Choong P, Qian M, Brandt M, Xie YM. Topological design and additive manufacturing of porous metals for bone scaffolds and orthopaedic implants: A review. Biomaterials 2016; 83:127-41. [PMID: 26773669 DOI: 10.1016/j.biomaterials.2016.01.012] [Citation(s) in RCA: 634] [Impact Index Per Article: 79.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 12/31/2015] [Accepted: 01/01/2016] [Indexed: 02/06/2023]
Abstract
One of the critical issues in orthopaedic regenerative medicine is the design of bone scaffolds and implants that replicate the biomechanical properties of the host bones. Porous metals have found themselves to be suitable candidates for repairing or replacing the damaged bones since their stiffness and porosity can be adjusted on demands. Another advantage of porous metals lies in their open space for the in-growth of bone tissue, hence accelerating the osseointegration process. The fabrication of porous metals has been extensively explored over decades, however only limited controls over the internal architecture can be achieved by the conventional processes. Recent advances in additive manufacturing have provided unprecedented opportunities for producing complex structures to meet the increasing demands for implants with customized mechanical performance. At the same time, topology optimization techniques have been developed to enable the internal architecture of porous metals to be designed to achieve specified mechanical properties at will. Thus implants designed via the topology optimization approach and produced by additive manufacturing are of great interest. This paper reviews the state-of-the-art of topological design and manufacturing processes of various types of porous metals, in particular for titanium alloys, biodegradable metals and shape memory alloys. This review also identifies the limitations of current techniques and addresses the directions for future investigations.
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Affiliation(s)
- Xiaojian Wang
- Centre for Innovative Structures and Materials, School of Engineering, RMIT University, GPO Box 2476, Melbourne 3001, Victoria, Australia
| | - Shanqing Xu
- Centre for Innovative Structures and Materials, School of Engineering, RMIT University, GPO Box 2476, Melbourne 3001, Victoria, Australia
| | - Shiwei Zhou
- Centre for Innovative Structures and Materials, School of Engineering, RMIT University, GPO Box 2476, Melbourne 3001, Victoria, Australia
| | - Wei Xu
- Centre for Additive Manufacturing, School of Engineering, RMIT University, GPO Box 2476, Melbourne 3001, Victoria, Australia
| | - Martin Leary
- Centre for Additive Manufacturing, School of Engineering, RMIT University, GPO Box 2476, Melbourne 3001, Victoria, Australia
| | - Peter Choong
- Department of Surgery, University of Melbourne, St. Vincent's Hospital, Melbourne 3001, Victoria, Australia
| | - M Qian
- Centre for Additive Manufacturing, School of Engineering, RMIT University, GPO Box 2476, Melbourne 3001, Victoria, Australia
| | - Milan Brandt
- Centre for Additive Manufacturing, School of Engineering, RMIT University, GPO Box 2476, Melbourne 3001, Victoria, Australia
| | - Yi Min Xie
- Centre for Innovative Structures and Materials, School of Engineering, RMIT University, GPO Box 2476, Melbourne 3001, Victoria, Australia; Centre for Additive Manufacturing, School of Engineering, RMIT University, GPO Box 2476, Melbourne 3001, Victoria, Australia.
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Reconstruction of the Upper Cervical Spine Using a Personalized 3D-Printed Vertebral Body in an Adolescent With Ewing Sarcoma. Spine (Phila Pa 1976) 2016; 41:E50-4. [PMID: 26335676 DOI: 10.1097/brs.0000000000001179] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To describe a three-dimensional (3D) printed axial vertebral body used in upper cervical spine reconstruction after a C2 Ewing sarcoma resection in an adolescent boy. SUMMARY OF BACKGROUND DATA Ewing sarcoma is a malignant musculoskeletal neoplasm with a peak incidence in adolescents. Cervical spine as the primary site of the tumor has been related to a worse prognosis. Tumor resection is particularly challenging in the atlantoaxial region due to complexity of the anatomy, necessity for extensive resection according to oncological principles, and a lack of specialized implants for reconstruction. 3D printing refers to a process where 3D objects are created through successive layering of material under computer control. Although this technology potentially enables accurate fabrication of patient-specific orthopedic implants, literature on its utilization in this regard is rare. METHODS A 12-year-old boy with a C2 Ewing sarcoma underwent a staged spondylectomy. Wide resection of the posterior elements was first performed. Two weeks later, a high anterior retropharyngeal approach was taken to remove the remains of the C2 vertebra. A customized artificial vertebral body fabricated according to a computer model using titanium alloy powder was inserted to replace the defect between C1 and C3. The microstructure of the implant was optimized for better biomechanical stability and enhanced bone healing. RESULTS Patient had an uneventful recovery and began to ambulate on postoperative day 7. Adjuvant treatment commenced 3 weeks after the surgery. He was tumor-free at the 1-year follow-up. Computed tomography studies revealed evidence of implant osseointegration and no subsidence or displacement of the construct. CONCLUSION This is a case example on the concept of personalized precision medicine in a surgical setting and demonstrates how 3D-printed, patient-specific implants may bring individualized solutions to rare problems wherein restoration of the specific anatomy of each patient is a key prognostic factor.
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Eltorai AEM, Nguyen E, Daniels AH. Three-Dimensional Printing in Orthopedic Surgery. Orthopedics 2015; 38:684-7. [PMID: 26558661 DOI: 10.3928/01477447-20151016-05] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 07/14/2015] [Indexed: 02/03/2023]
Abstract
Three-dimensional (3D) printing is emerging as a clinically promising technology for rapid prototyping of surgically implantable products. With this commercially available technology, computed tomography or magnetic resonance images can be used to create graspable objects from 3D reconstructed images. Models can enhance patients' understanding of their pathology and surgeon preoperative planning. Customized implants and casts can be made to match an individual's anatomy. This review outlines 3D printing, its current applications in orthopedics, and promising future directions.
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Cai H. Application of 3D printing in orthopedics: status quo and opportunities in China. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:S12. [PMID: 26046057 DOI: 10.3978/j.issn.2305-5839.2015.01.38] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 01/23/2015] [Indexed: 01/13/2023]
Affiliation(s)
- Hong Cai
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
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