Fabrication and evaluation of 3D printed BCP scaffolds reinforced with ZrO2 for bone tissue applications

The physical-mechanical properties of 3D-printed versus conventional milled zirconia for dental clinical applications: A systematic review with meta-analysis

AIM OF STUDY

This systematic review aimed to compare the physical-mechanical properties of 3D-printed (additively manufactured (AM)) zirconia compared to conventionally milled (subtractive manufactured: SM) zirconia specimens.

MATERIALS AND METHODS

A thorough search of Internet databases was conducted up to September 2023. The search retrieved studies that evaluated AM zirconia specimens and restorations regarding the physical-mechanical properties and mechanical behavior of zirconia. The main topic focused on 3Y-TZP. However, records of 4YSZ and 5YSZ were also included to gather more comprehensive evidence on additively manufactured zirconia ceramic. The quality of studies was assessed using the ROB2 tool, Newcastle Ottawa scale, and the Modified Consort Statement. Of 1736 records, 57 were assessed for eligibility, and 38 records were included in this review, only two clinical trials meet the inclusion criteria and 36 records were laboratory studies. There were no signs of mechanical complications and wear to antagonists with short-term clinical observation. SM thin specimens ≤1.5 mm showed statistically significant higher flexural strength than AM zirconia (p ≤ 0.01), while thicker specimens showed comparable outcomes (p > 0.5). The fracture resistance of dental restorations was dependent on the aging protocol, restoration type, and thickness. The bond strength of veneering ceramic to zirconia core was comparable.

CONCLUSIONS

The results pooled from two short-term clinical trials showed no signs of mechanical or biological complications of additively manufactured 3Y-TZP zirconia crowns. The flexural strength might depend on the specimens' thickness, but it showed promising results to be used in clinical applications, taking into account the printing technique and orientation, material composition (yttria content), solid loading, and sintering parameters. 3D-printed restorations fracture resistance improved when adhered to human teeth. The veneering ceramic bond was comparable to milled zirconia specimens. Long-term RCTs are recommended to confirm the mechanical behavior of 3D-printed restorations.

3D-printed versus conventionally milled zirconia for dental clinical applications: Trueness, precision, accuracy, biological and esthetic aspects

OBJECTIVES

This systematic review aimed to compare the clinical outcome, internal gap, trueness, precision, and biocompatibility of 3D-printed (AM) compared to milled (SM) zirconia restorations.

DATA SOURCE

A thorough search of Internet databases was conducted up to September 2023. The search retrieved studies compared AM zirconia to SM zirconia restorations regarding clinical outcome, fit, trueness, precision, and biocompatibility.

STUDY SELECTION

Of 1736 records, only 59 were screened for eligibility, and 22 records were included in this review. The quality of studies was assessed using the revised Cochrane risk-of-bias tool (ROB2), and the Modified Consort Statement. One clinical study exhibited a low risk of bias. All laboratory studies revealed some bias concerns. Short-term observation showed 100 % survival with no signs of periodontal complications. 3D-printed zirconia crowns showed statistically significant lower ΔE and a better match to adjacent teeth (p ≤ 0.5). The fit, trueness, and precision vary with the printing technique and the tooth surface.

CONCLUSIONS

3D-printed zirconia crowns provide better aesthetic color and contour match to adjacent natural teeth than milled crowns. Both 3D printing and milling result in crowns within the clinically acceptable internal and marginal fit. Except for nanoparticle jetting, the marginal gap of SM crowns was smaller than AM crowns, however, both were clinically acceptable. Laminate veneers might be more accurately produced by 3D printing. 3D-printed axial surface trueness was better than milled axial surfaces. Long-term RCTs are recommended to confirm the clinical applicability of 3D-printed restorations.

CLINICAL SIGNIFICANCE

Internal fit and gap, precision, and trueness are fundamental requirements for successful dental restorations. Both techniques produce restorations with clinically acceptable marginal and internal fit. Axial surfaces and narrow or constricted areas favored 3D-printed than conventionally milled zirconia.

Zirconia based composite scaffolds and their application in bone tissue engineering

In the field of bone tissue engineering, biomimetic scaffold utilization is deemed an immensely promising method. The bio-ceramic material Zirconia (ZrO2) has garnered significant attention in the biomimetic scaffolds realm due to its remarkable biocompatibility, superior mechanical strength, and exceptional chemical stability. Numerous examinations have been conducted to investigate the properties and functions of biomimetic structures built from zirconia. Generally, nano-ZrO2 materials have showcased encouraging applications in bone tissue engineering, providing a blend of mechanical robustness, bioactivity, drug delivery capabilities, and antibacterial properties. This review aims to concentrate on the properties and preparations of ZrO2 and its composite materials, while emphasizing its role along with other materials as scaffolds for bone tissue repair applications. The study also discusses the constraints of materials and technology involved in this domain. Ongoing research and development in this area are anticipated to further augment the potential of nano-ZrO2 for advancing bone regeneration therapies.

Enhanced Biomimetics of Three-Dimensional Osteosarcoma Models: A Scoping Review

This scoping review evaluated 3D osteosarcoma (OS) models' biomimicry, examining their ability to mimic the tumour microenvironment (TME) and their drug sensitivity. Adhering to PRISMA-ScR guidelines, the systematic search revealed 293 studies, with 70 selected for final analysis. Overall, 64% of 3D OS models were scaffold-based, compared to self-generated spheroid models. Scaffolds generated using native matrix were most common (42%) with collagen I/hydroxyapatite predominating. Both scaffold-based and scaffold-free models were used equally for drug screening. The sensitivity of cancer cells in 3D was reported to be lower than that of cells in 2D in ~90% of the drug screening studies. This correlates with the observed upregulation of drug resistance. OS cells cultured in extracellular matrix (ECM)-mimetic scaffolds and native biomaterials were more resistant than cells in 2D. Co-cultures of OS and stromal cells in 3D models enhanced osteogenic differentiation, ECM remodelling, mineralisation, and angiogenesis, suggesting that tumour-stroma crosstalk promotes disease progression. Seven studies demonstrated selective toxicity of chemotherapeutics towards OS cells while sparing stromal cells, providing useful evidence for developing biomimetic tumour-stroma models to test selective drug toxicity. In conclusion, this review highlights the need to enhance biomimicry in 3D OS models for TME recapitulation, especially in testing novel therapeutics. Future research should explore innovative 3D biomimetic models, biomaterials, and advancements in personalised medicine.

3D printed zirconia used as dental materials: a critical review

In view of its high mechanical performance, outstanding aesthetic qualities, and biological stability, zirconia has been widely used in the fields of dentistry. Due to its potential to produce suitable advanced configurations and structures for a number of medical applications, especially personalized created devices, ceramic additive manufacturing (AM) has been attracting a great deal of attention in recent years. AM zirconia hews out infinite possibilities that are otherwise barely possible with traditional processes thanks to its freedom and efficiency. In the review, AM zirconia's physical and adhesive characteristics, accuracy, biocompatibility, as well as their clinical applications have been reviewed. Here, we highlight the accuracy and biocompatibility of 3D printed zirconia. Also, current obstacles and a forecast of AM zirconia for its development and improvement have been covered. In summary, this review offers a description of the basic characteristics of AM zirconia materials intended for oral medicine. Furthermore, it provides a generally novel and fundamental basis for the utilization of 3D printed zirconia in dentistry.

Atomic Layer Deposition of Antibacterial Nanocoatings: A Review

In recent years, antibacterial coatings have become an important approach in the global fight against bacterial pathogens. Developments in materials science, chemistry, and biochemistry have led to a plethora of materials and chemical compounds that have the potential to create antibacterial coatings. However, insufficient attention has been paid to the analysis of the techniques and technologies used to apply these coatings. Among the various inorganic coating techniques, atomic layer deposition (ALD) is worthy of note. It enables the successful synthesis of high-purity inorganic nanocoatings on surfaces of complex shape and topography, while also providing precise control over their thickness and composition. ALD has various industrial applications, but its practical application in medicine is still limited. In recent years, a considerable number of papers have been published on the proposed use of thin films and coatings produced via ALD in medicine, notably those with antibacterial properties. The aim of this paper is to carefully evaluate and analyze the relevant literature on this topic. Simple oxide coatings, including TiO2, ZnO, Fe2O3, MgO, and ZrO2, were examined, as well as coatings containing metal nanoparticles such as Ag, Cu, Pt, and Au, and mixed systems such as TiO2-ZnO, TiO2-ZrO2, ZnO-Al2O3, TiO2-Ag, and ZnO-Ag. Through comparative analysis, we have been able to draw conclusions on the effectiveness of various antibacterial coatings of different compositions, including key characteristics such as thickness, morphology, and crystal structure. The use of ALD in the development of antibacterial coatings for various applications was analyzed. Furthermore, assumptions were made about the most promising areas of development. The final section provides a comparison of different coatings, as well as the advantages, disadvantages, and prospects of using ALD for the industrial production of antibacterial coatings.

Synergistic coupling between 3D bioprinting and vascularization strategies

Three-dimensional (3D) bioprinting offers promising solutions to the complex challenge of vascularization in biofabrication, thereby enhancing the prospects for clinical translation of engineered tissues and organs. While existing reviews have touched upon 3D bioprinting in vascularized tissue contexts, the current review offers a more holistic perspective, encompassing recent technical advancements and spanning the entire multistage bioprinting process, with a particular emphasis on vascularization. The synergy between 3D bioprinting and vascularization strategies is crucial, as 3D bioprinting can enable the creation of personalized, tissue-specific vascular network while the vascularization enhances tissue viability and function. The review starts by providing a comprehensive overview of the entire bioprinting process, spanning from pre-bioprinting stages to post-printing processing, including perfusion and maturation. Next, recent advancements in vascularization strategies that can be seamlessly integrated with bioprinting are discussed. Further, tissue-specific examples illustrating how these vascularization approaches are customized for diverse anatomical tissues towards enhancing clinical relevance are discussed. Finally, the underexplored intraoperative bioprinting (IOB) was highlighted, which enables the direct reconstruction of tissues within defect sites, stressing on the possible synergy shaped by combining IOB with vascularization strategies for improved regeneration.

Rapid Prototyping Technologies: 3D Printing Applied in Medicine

Three-dimensional printing technology has been used for more than three decades in many industries, including the automotive and aerospace industries. So far, the use of this technology in medicine has been limited only to 3D printing of anatomical models for educational and training purposes, which is due to the insufficient functional properties of the materials used in the process. Only recent advances in the development of innovative materials have resulted in the flourishing of the use of 3D printing in medicine and pharmacy. Currently, additive manufacturing technology is widely used in clinical fields. Rapid development can be observed in the design of implants and prostheses, the creation of biomedical models tailored to the needs of the patient and the bioprinting of tissues and living scaffolds for regenerative medicine. The purpose of this review is to characterize the most popular 3D printing techniques.

Biomedical Applications of Zirconia-Based Nanomaterials: Challenges and Future Perspectives

ZrO₂ nanoparticles have received substantially increased attention in every field of life owing to their wide range of applications. Zirconium oxide is a commercially economical, non-hazardous, and sustainable metal oxide having diversified potential applications. ZrO₂ NPs play a vast role in the domain of medicine and pharmacy such as anticancer, antibacterial, and antioxidant agents and tissue engineering owing to their reliable curative biomedical applications. In this review article, we address all of the medical and biomedical applications of ZrO₂ NPs prepared through various approaches in a critical way. ZrO₂ is a bio-ceramic substance that has received increased attention in biomimetic scaffolds owing to its high mechanical strength, excellent biocompatibility, and high chemical stability. ZrO₂ NPs have demonstrated potential anticancer activity against various cancer cells. ZrO₂-based nanomaterials have exhibited potential antibacterial activity against various bacterial strains and have also demonstrated excellent antioxidant activity. The ZrO₂ nanocomposite also exhibits highly sensitive biosensing activity toward the sensing of glucose and other biological species.

3D-Printed PLA Scaffold with Fibronectin Enhances In Vitro Osteogenesis

BACKGROUND

Tricalcium phosphate (TCP, Molecular formula: Ca₃(PO₄)₂) is a hydrophilic bone graft biomaterial extensively used for guided bone regeneration (GBR). However, few studies have investigated 3D-printed polylactic acid (PLA) combined with the osteo-inductive molecule fibronectin (FN) for enhanced osteoblast performance in vitro, and specialized bone defect treatments.

AIM

This study evaluated PLA properties and efficacy following glow discharge plasma (GDP) treatment and FN sputtering for fused deposition modeling (FDM) 3D printed PLA alloplastic bone grafts.

METHODS

3D trabecular bone scaffolds (8 × 1 mm) were printed by the 3D printer (XYZ printing, Inc. 3D printer da Vinci Jr. 1.0 3-in-1). After printing PLA scaffolds, additional groups for FN grafting were continually prepared with GDP treatment. Material characterization and biocompatibility evaluations were investigated at 1, 3 and 5 days.

RESULTS

SEM images showed the human bone mimicking patterns, and EDS illustrated the increased C and O after fibronectin grafting, XPS and FTIR results together confirmed the presence of FN within PLA material. Degradation increased after 150 days due to FN presence. 3D immunofluorescence at 24 h demonstrated better cell spreading, and MTT assay results showed the highest proliferation with PLA and FN (p < 0.001). Cells cultured on the materials exhibited similar alkaline phosphatase (ALP) production. Relative quantitative polymerase chain reaction (qPCR) at 1 and 5 days revealed a mixed osteoblast gene expression pattern.

CONCLUSION

In vitro observations over a period of five days, it was clear that PLA/FN 3D-printed alloplastic bone graft was more favorable for osteogenesis than PLA alone, thereby demonstrating great potential for applications in customized bone regeneration.

Extrusion-based 3D printing of biodegradable, osteogenic, paramagnetic, and porous FeMn-akermanite bone substitutes

The development of biodegradable Fe-based bone implants has rapidly progressed in recent years. Most of the challenges encountered in developing such implants have been tackled individually or in combination using additive manufacturing technologies. Yet not all the challenges have been overcome. Herein, we present porous FeMn-akermanite composite scaffolds fabricated by extrusion-based 3D printing to address the unmet clinical needs associated with Fe-based biomaterials for bone regeneration, including low biodegradation rate, MRI-incompatibility, mechanical properties, and limited bioactivity. In this research, we developed inks containing Fe, 35 wt% Mn, and 20 or 30 vol% akermanite powder mixtures. 3D printing was optimized together with the debinding and sintering steps to obtain scaffolds with interconnected porosity of 69%. The Fe-matrix in the composites contained the γ-FeMn phase as well as nesosilicate phases. The former made the composites paramagnetic and, thus, MRI-friendly. The in vitro biodegradation rates of the composites with 20 and 30 vol% akermanite were respectively 0.24 and 0.27 mm/y, falling within the ideal range of biodegradation rates for bone substitution. The yield strengths of the porous composites stayed within the range of the values of the trabecular bone, despite in vitro biodegradation for 28 d. All the composite scaffolds favored the adhesion, proliferation, and osteogenic differentiation of preosteoblasts, as revealed by Runx2 assay. Moreover, osteopontin was detected in the extracellular matrix of cells on the scaffolds. Altogether, these results demonstrate the remarkable potential of these composites in fulfilling the requirements of porous biodegradable bone substitutes, motivating future in vivo research. STATEMENT OF SIGNIFICANCE: We developed FeMn-akermanite composite scaffolds by taking advantage of the multi-material capacity of extrusion-based 3D printing. Our results demonstrated that the FeMn-akermanite scaffolds showed an exceptional performance in fulfilling all the requirements for bone substitution in vitro, i.e., a sufficient biodegradation rate, having mechanical properties in the range of trabecular bone even after 4 weeks biodegradation, paramagnetic, cytocompatible and most importantly osteogenic. Our results encourage further research on Fe-based bone implants in in vivo.

Investigation of the In Vitro and In Vivo Biocompatibility of a Three-Dimensional Printed Thermoplastic Polyurethane/Polylactic Acid Blend for the Development of Tracheal Scaffolds

Tissue-engineered polymeric implants are preferable because they do not cause a significant inflammatory reaction in the surrounding tissue. Three-dimensional (3D) technology can be used to fabricate a customised scaffold, which is critical for implantation. This study aimed to investigate the biocompatibility of a mixture of thermoplastic polyurethane (TPU) and polylactic acid (PLA) and the effects of their extract in cell cultures and in animal models as potential tracheal replacement materials. The morphology of the 3D-printed scaffolds was investigated using scanning electron microscopy (SEM), while the degradability, pH, and effects of the 3D-printed TPU/PLA scaffolds and their extracts were investigated in cell culture studies. In addition, subcutaneous implantation of 3D-printed scaffold was performed to evaluate the biocompatibility of the scaffold in a rat model at different time points. A histopathological examination was performed to investigate the local inflammatory response and angiogenesis. The in vitro results showed that the composite and its extract were not toxic. Similarly, the pH of the extracts did not inhibit cell proliferation and migration. The analysis of biocompatibility of the scaffolds from the in vivo results suggests that porous TPU/PLA scaffolds may facilitate cell adhesion, migration, and proliferation and promote angiogenesis in host cells. The current results suggest that with 3D printing technology, TPU and PLA could be used as materials to construct scaffolds with suitable properties and provide a solution to the challenges of tracheal transplantation.

Additive Manufacturing of Bioceramic Implants for Restoration Bone Engineering: Technologies, Advances, and Future Perspectives

Treating bone defects is highly challenging because they do not heal on their own inside the patients, so implants are needed to assist in the reconstruction of the bone. Bioceramic implants based on additive manufacturing (AM) are currently emerging as promising treatment options for restoration bone engineering. On the one hand, additively manufactured bioceramic implants have excellent mechanical properties and biocompatibility, which are suitable for bone regeneration. On the other hand, the designable structure and adjustable pores of additively manufactured bioceramic implants allow them to promote suitable cell growth and tissue climbing. Herein, this review unfolds to introduce several frequently employed AM technologies for bioceramic implants. After that, advances in commonly used additively manufactured bioceramic implants, including bioinert ceramic implants, bioactive ceramic implants, and bioceramic/organic composite implants, are categorized and summarized. Finally, the future perspectives of additively manufactured bioceramic implants, in terms of mechanical performance improvement, innovative structural design, biological property enhancement, and other functionalization approaches, are proposed and forecasted. This review is believed to provide some fundamental understanding and cutting-edge knowledge for the additive manufacturing of bioceramic implants for restoration bone engineering.

The Dual Effect of 3D-Printed Biological Scaffolds Composed of Diverse Biomaterials in the Treatment of Bone Tumors

Bone tumors, including primary bone tumors, invasive bone tumors, metastatic bone tumors, and others, are one of the most clinical difficulties in orthopedics. Once these tumors have grown and developed in the bone system, they will interact with osteocytes and other environmental cells in the bone system's microenvironment, leading to the eventual damage of the bone's physical structure. Surgical procedures for bone tumors may result in permanent defects. The dual-efficacy of tissue regeneration and tumor treatment has made biomaterial scaffolds frequently used in treating bone tumors. 3D printing technology, also known as additive manufacturing or rapid printing prototype, is the transformation of 3D computer models into physical models through deposition, curing, and material fusion of successive layers. Adjustable shape, porosity/pore size, and other mechanical properties are an advantage of 3D-printed objects, unlike natural and synthetic material with fixed qualities. Researchers have demonstrated the significant role of diverse 3D-printed biological scaffolds in the treatment for bone tumors and the regeneration of bone tissue, and that they enhanced various performance of the products. Based on the characteristics of bone tumors, this review synthesized the findings of current researchers on the application of various 3D-printed biological scaffolds including bioceramic scaffold, metal alloy scaffold and nano-scaffold, in bone tumors and discussed the advantages, disadvantages, and future application prospects of various types of 3D-printed biological scaffolds. Finally, the future development trend of 3D-printed biological scaffolds in bone tumor is summarized, providing a theoretical foundation and a larger outlook for the use of biological scaffolds in the treatment of patients with bone tumors.

Photothermal Sensitive 3D Printed Biodegradable Polyester Scaffolds with Polydopamine Coating for Bone Tissue Engineering

Biodegradable scaffolds with photothermal effects and customizable pore structures are a hot topic of research in the field of bone repair. In this study, we prepared porous scaffolds using poly(lactic acid) (PLA) as the raw material and customized the pore structure with 3D printing technology. First, we investigated the effect of pore structure on the mechanical properties of this 3D PLA scaffold. Subsequently, the optimally designed PLA scaffolds were coated with PDA to enhance their hydrophilicity and bioactivity. XRD (X-ray diffraction), FTIR (Fourier transform infrared spectroscopy) and EDS (Energy dispersive spectroscopy) results indicated that PDA was successfully coated on the surface of PLA scaffolds. SEM (Scanning electron microscopy) micrographs showed that the surface of the PDA/PLA scaffolds became rough. WCA (water contact angle) confirmed that the material has enhanced hydrophilic properties. PDA/PLA scaffolds exhibit a tunable photothermal effect under NIR (near infrared) irradiation. The 3D-printed PLA/PDA scaffolds have remarkable potential as an alternative material for repairing bone defects.

Advances in additive manufacturing processes and their use for the fabrication of lower limb prosthetic devices

INTRODUCTION

Traditional methods of prosthesis fabrication are not efficient and user centric and are made for common purposes without focusing on individual demands of user which leads to rejection of prosthesis for long-term use. Utilizing advanced additive manufacturing techniques for fabrication of prosthesis makes the development process user centric and covers all the user demands thus providing better fit, comfort, and more stable gait rehabilitation for the user.

AREAS COVERED

The articles reporting fabrication of lower limb prosthesis and its socket are included in the study. Standard fabrication and additive manufacturing method are both systematically assessed by the reviewers. The review also covers the advanced methods of additive manufacturing that are presently being used for fabrication of rehabilitation devices.

EXPERT OPINION

Additive manufacturing method of fabrication of prosthesis provides more flexibility for manufacturing prosthesis parts as per demand of the user. The fabrication method takes into account the residual limb and thus makes the prosthesis user-specific providing better comfort and fit.

Review of Physical, Mechanical, and Biological Characteristics of 3D-Printed Bioceramic Scaffolds for Bone Tissue Engineering Applications

This review focuses on the advancements in additive manufacturing techniques that are utilized for fabricating bioceramic scaffolds and their characterizations leading to bone tissue regeneration. Bioscaffolds are made by mimicking the human bone structure, material composition, and properties. Calcium phosphate apatite materials are the most commonly used scaffold materials as they closely resemble live bone in their inorganic composition. The functionally graded scaffolds are fabricated by utilizing the right choice of the 3D printing method and material combinations to achieve the requirement of the bioscaffold. To tailor the physical, mechanical, and biological properties of the scaffold, certain materials are reinforced, doped, or coated to incorporate the functionality. The biomechanical loading conditions that involve flexion, torsion, and tension exerted on the implanted scaffold are discussed. The finite element analysis (FEA) technique is used to investigate the mechanical property of the scaffold before fabrication. This helps in reducing the actual number of samples used for testing. The FEA simulated results and the experimental result are compared. This review also highlights some of the challenges associated while processing the scaffold such as shrinkage, mechanical instability, cytotoxicity, and printability. In the end, the new materials that are evolved for tissue engineering applications are compiled and discussed.

Assessment of 3D-Printed Polycaprolactone, Hydroxyapatite Nanoparticles and Diacrylate Poly(ethylene glycol) Scaffolds for Bone Regeneration

Notwithstanding the advances achieved in the last decades in the field of synthetic bone substitutes, the development of biodegradable 3D-printed scaffolds with ideal mechanical and biological properties remains an unattained challenge. In the present work, a new approach to produce synthetic bone grafts that mimic complex bone structure is explored. For the first time, three scaffolds of various composition, namely polycaprolactone (PCL), PCL/hydroxyapatite nanoparticles (HANp) and PCL/HANp/diacrylate poly(ethylene glycol) (PEGDA), were manufactured by extrusion. Following the production and characterisation of the scaffolds, an in vitro evaluation was carried out using human dental pulp stem/stromal cells (hDPSCs). Through the findings, it was possible to conclude that, in all groups, the scaffolds were successfully produced presenting networks of interconnected channels, adequate porosity for migration and proliferation of osteoblasts (approximately 50%). Furthermore, according to the in vitro analysis, all groups were considered non-cytotoxic in contact with the cells. Nevertheless, the group with PEGDA revealed hydrophilic properties (15.15° ± 4.06) and adequate mechanical performance (10.41 MPa ± 0.934) and demonstrated significantly higher cell viability than the other groups analysed. The scaffolds with PEGDA suggested an increase in cell adhesion and proliferation, thus are more appropriate for bone regeneration. To conclude, findings in this study demonstrated that PCL, HANp and PEGDA scaffolds may have promising effects on bone regeneration and might open new insights for 3D tissue substitutes.

Functional engineering strategies of 3D printed implants for hard tissue replacement

Three-dimensional printing technology with the rapid development of printing materials are widely recognized as a promising way to fabricate bioartificial bone tissues. In consideration of the disadvantages of bone substitutes, including poor mechanical properties, lack of vascularization and insufficient osteointegration, functional modification strategies can provide multiple functions and desired characteristics of printing materials, enhance their physicochemical and biological properties in bone tissue engineering. Thus, this review focuses on the advances of functional engineering strategies for 3D printed biomaterials in hard tissue replacement. It is structured as introducing 3D printing technologies, properties of printing materials (metals, ceramics and polymers) and typical functional engineering strategies utilized in the application of bone, cartilage and joint regeneration.

Additive Manufacturing Technologies for Fabrication of Biomaterials for Surgical Procedures in Dentistry: A Narrative Review

PURPOSE

To screen and critically appraise available literature regarding additive manufacturing technologies for bone graft material fabrication in dentistry.

MATERIAL AND METHODS

PubMed and Scopus were searched up to May 2021. Studies reporting the additive manufacturing techniques to manufacture scaffolds for intraoral bone defect reconstruction were considered eligible. A narrative review was synthesized to discuss the techniques for bone graft material fabrication in dentistry and the biomaterials used.

RESULTS

The databases search resulted in 933 articles. After removing duplicate articles (128 articles), the titles and abstracts of the remaining articles (805 articles) were evaluated. A total of 89 articles were included in this review. Reading these articles, 5 categories of additive manufacturing techniques were identified: material jetting, powder bed fusion, vat photopolymerization, binder jetting, and material extrusion.

CONCLUSIONS

Additive manufacturing technologies for bone graft material fabrication in dentistry, especially 3D bioprinting approaches, have been successfully used to fabricate bone graft material with distinct compositions.

Fabrication and Characterization of PCL/HA Filament as a 3D Printing Material Using Thermal Extrusion Technology for Bone Tissue Engineering

The most common three-dimensional (3D) printing method is material extrusion, where a pre-made filament is deposited layer-by-layer. In recent years, low-cost polycaprolactone (PCL) material has increasingly been used in 3D printing, exhibiting a sufficiently high quality for consideration in cranio-maxillofacial reconstructions. To increase osteoconductivity, prefabricated filaments for bone repair based on PCL can be supplemented with hydroxyapatite (HA). However, few reports on PCL/HA composite filaments for material extrusion applications have been documented. In this study, solvent-free fabrication for PCL/HA composite filaments (HA 0%, 5%, 10%, 15%, 20%, and 25% weight/weight PCL) was addressed, and parameters for scaffold fabrication in a desktop 3D printer were confirmed. Filaments and scaffold fabrication temperatures rose with increased HA content. The pore size and porosity of the six groups’ scaffolds were similar to each other, and all had highly interconnected structures. Six groups’ scaffolds were evaluated by measuring the compressive strength, elastic modulus, water contact angle, and morphology. A higher amount of HA increased surface roughness and hydrophilicity compared to PCL scaffolds. The increase in HA content improved the compressive strength and elastic modulus. The obtained data provide the basis for the biological evaluation and future clinical applications of PCL/HA material.

Advances in 3D printing of composite scaffolds for the repairment of bone tissue associated defects

The conventional methods of using autografts and allografts for repairing defects in bone, the osteochondral bone and the cartilage tissue have many disadvantages, like donor site morbidity and shortage of donors. Moreover, only 30% of the implanted grafts are shown to be successful in treating the defects. Hence, exploring alternative techniques such as tissue engineering to treat bone tissue associated defects is promising as it eliminates the above-mentioned limitations. To enhance the mechanical and biological properties of the tissue engineered product, it is essential to fabricate the scaffold used in tissue engineering by the combination of various biomaterials. Three-dimensional (3D) printing, with its ability to print composite materials and with complex geometry seems to have a huge potential in scaffold fabrication technique for engineering bone associated tissues.This review summarizes the recent applications and future perspectives of 3D printing technologies in the fabrication of composite scaffolds used in bone, osteochondral and cartilage tissue engineering. Key developments in the field of 3D printing technologies involves the incorporation of various biomaterials and cells in printing composite scaffolds mimicking physiologically relevant complex geometry & gradient porosity. Much recently, the emerging trend of printing smart scaffolds which can respond to external stimulus such as temperature, pH and magnetic field, known as 4D printing is gaining immense popularity and can be considered as the future of 3D printing applications in the field of tissue engineering. This article is protected by copyright. All rights reserved.

Applying extrusion-based 3D printing technique accelerates fabricating complex biphasic calcium phosphate-based scaffolds for bone tissue regeneration

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Biphasic calcium phosphates offer a chemically similar biomaterial to the natural bone, which can significantly accelerate bone formation and reconstruction.

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Robocasting is a suitable technique to produce porous scaffolds supporting cell viability, proliferation, and differentiation.

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This review discusses materials and methods utilized for BCP robocasting, considering recent advancements and existing challenges in using additives for bioink preparation.

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Commercialization and marketing approach, in-vitro and in-vivo evaluations, biologic responses, and post-processing steps are also investigated.

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Possible strategies and opportunities for the use of BCP toward injured bone regeneration along with clinical applications are discussed.

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The study proposes that BCP possesses an acceptable level of bone substituting, considering its challenges and struggles.

Background

Aim of review

Key scientific concepts of review

Toward stronger robocast calcium phosphate scaffolds for bone tissue engineering: A mini-review and meta-analysis

Among different treatments of critical-sized bone defects, bone tissue engineering (BTE) is a fast-developing strategy centering around the fabrication of scaffolds that can stimulate tissue regeneration and provide mechanical support at the same time. This area has seen an extensive application of bioceramics, such as calcium phosphate, for their bioactivity and resemblance to the composition of natural bones. Moreover, recent advances in additive manufacturing (AM) have unleashed enormous potential in the fabrication of BTE scaffolds with tailored porous structures as well as desired biological and mechanical properties. Robocasting is an AM technique that has been widely applied to fabricate calcium phosphate scaffolds, but most of these scaffolds do not meet the mechanical requirements for load-bearing BTE scaffolds. In light of this challenge, various approaches have been utilized to mechanically strengthen the scaffolds. In this review, the current state of knowledge and existing research on robocasting of calcium phosphate scaffolds are presented. Applying the Gibson-Ashby model, this review provides a meta-analysis from the published literature of the compressive strength of robocast calcium phosphate scaffolds. Furthermore, this review evaluates different approaches to the mechanical strengthening of robocast calcium phosphate scaffolds. The aim of this review is to provide insightful data and analysis for future research on mechanical strengthening of robocast calcium phosphate scaffolds and ultimately for their clinical applications.

Fabrication and properties of PLA/nano-HA composite scaffolds with balanced mechanical properties and biological functions for bone tissue engineering application

Repair of critical bone defects is a challenge in the orthopedic clinic. 3D printing is an advanced personalized manufacturing technology that can accurately shape internal structures and external contours. In this study, the composite scaffolds of polylactic acid (PLA) and nano-hydroxyapatite (n-HA) were manufactured by the fused deposition modeling (FDM) technique. Equal mass PLA and n-HA were uniformly mixed to simulate the organic and inorganic phases of natural bone. The suitability of the composite scaffolds was evaluated by material characterization, mechanical property, and in vitro biocompatibility, and the osteogenesis induction in vitro was further tested. Finally, the printed scaffold was implanted into the rabbit femoral defect model to evaluate the osteogenic ability in vivo. The results showed that the composite scaffold had sufficient mechanical strength, appropriate pore size, and biocompatibility. Most importantly, the osteogenic induction performance of the composite scaffold was significantly better than that of the pure PLA scaffold. In conclusion, the PLA/n-HA scaffold is a promising composite biomaterial for bone defect repair and has excellent clinical transformation potential.

Three-Dimensional Zirconia-Based Scaffolds for Load-Bearing Bone-Regeneration Applications: Prospects and Challenges

The design of zirconia-based scaffolds using conventional techniques for bone-regeneration applications has been studied extensively. Similar to dental applications, the use of three-dimensional (3D) zirconia-based ceramics for bone tissue engineering (BTE) has recently attracted considerable attention because of their high mechanical strength and biocompatibility. However, techniques to fabricate zirconia-based scaffolds for bone regeneration are in a stage of infancy. Hence, the biological activities of zirconia-based ceramics for bone-regeneration applications have not been fully investigated, in contrast to the well-established calcium phosphate-based ceramics for bone-regeneration applications. This paper outlines recent research developments and challenges concerning numerous three-dimensional (3D) zirconia-based scaffolds and reviews the associated fundamental fabrication techniques, key 3D fabrication developments and practical encounters to identify the optimal 3D fabrication technique for obtaining 3D zirconia-based scaffolds suitable for real-world applications. This review mainly summarized the articles that focused on in vitro and in vivo studies along with the fundamental mechanical characterizations on the 3D zirconia-based scaffolds.

Advances in 3D Printing for Tissue Engineering

Tissue engineering (TE) scaffolds have enormous significance for the possibility of regeneration of complex tissue structures or even whole organs. Three-dimensional (3D) printing techniques allow fabricating TE scaffolds, having an extremely complex structure, in a repeatable and precise manner. Moreover, they enable the easy application of computer-assisted methods to TE scaffold design. The latest additive manufacturing techniques open up opportunities not otherwise available. This study aimed to summarize the state-of-art field of 3D printing techniques in applications for tissue engineering with a focus on the latest advancements. The following topics are discussed: systematics of the available 3D printing techniques applied for TE scaffold fabrication; overview of 3D printable biomaterials and advancements in 3D-printing-assisted tissue engineering.

Design and characterization of 3D printed, neomycin-eluting poly-L-lactide mats for wound-healing applications

This study evaluates the suitability of 3D printed biodegradable mats to load and deliver the topical antibiotic, neomycin, for up to 3 weeks in vitro. A 3D printer equipped with a hot melt extruder was used to print bandage-like wound coverings with porous sizes appropriate for cellular attachment and viability. The semicrystalline polyester, poly-l-lactic acid (PLLA) was used as the base polymer, coated (post-printing) with polyethylene glycols (PEGs) of MWs 400 Da, 6 kDa, or 20 kDa to enable manipulation of physicochemical and biological properties to suit intended applications. The mats were further loaded with a topical antibiotic (neomycin sulfate), and cumulative drug-release monitored for 3 weeks in vitro. Microscopic imaging as well as Scanning Electron Microscopy (SEM) studies showed pore dimensions of 100 × 400 µm. These pore dimensions were achieved without compromising mechanical strength; because of the "tough" individual fibers constituting the mat (Young's Moduli of 50 ± 20 MPa and Elastic Elongation of 10 ± 5%). The in vitro dissolution study showed first-order release kinetics for neomycin during the first 20 h, followed by diffusion-controlled (Fickian) release for the remaining duration of the study. The release of neomycin suggested that the ability to load neomycin on to PLLA mats increases threefold, as the MW of the applied PEG coating is lowered from 20 kDa to 400 Da. Overall, this study demonstrates a successful approach to using a 3D printer to prepare porous degradable mats for antibiotic delivery with potential applications to dermal regeneration and tissue engineering. Illustration of the process used to create and characterize 3D printed PLLA mats.

3D printed bioactive and antibacterial silicate glass-ceramic scaffold by fused filament fabrication

The fused filament fabrication (FFF) technique was applied for the first time to fabricate novel 3D printed silicate bioactive and antibacterial Ag-doped glass-ceramic (Ag-BG) scaffolds. A novel filament consisting primarily of polyolefin and Ag-BG micro-sized particles was developed and its thermal properties characterized by thermogravimetric analysis (TGA) to define the optimum heat treatment with minimal macrostructural deformation during thermal debinding and sintering. Structural characteristics of the Ag-BG scaffolds were evaluated from macro- to nanoscale using microscopic and spectroscopic techniques. The compressive strength of the Ag-BG scaffolds was found to be in the range of cancellous bone. Bioactivity of the 3D printed Ag-BG scaffolds was evaluated in vitro through immersion in simulated body fluid (SBF) and correlated to the formation of an apatite-like phase. Methicillin-resistant Staphylococcus aureus (MRSA) inoculated with the Ag-BG scaffolds exhibited a significant decrease in viability underscoring a potent anti-MRSA effect. This study demonstrates the potential of the FFF technique for the fabrication of bioactive 3D silicate scaffolds with promising characteristics for orthopedic applications.

Facile manufacturing of fused deposition modelled composite scaffold for tissue engineering - An embedment model with plasticity for incorporation of additives

Fused deposition modeling (FDM) process is carried out at an elevated temperature, preventing the addition of biological factors, drugs, bioactive compounds, etc., during fabrication. To surpass this disadvantage, 3D interlinked porous PLA (Polylactic acid) scaffold was fabricated by FDM, followed by embedment of PCL (polycaprolactone) scaffold into the pores of PLA at room temperature yielding PLA-PCL scaffold. In addition, PLA-PCL scaffold with nanohydroxyapatite (PLA-PCL-nHAP) and multiwalled carbon nanotubes (PLA-PCL-MWCNT) were also fabricated. Herein, FDM fabricated PLA scaffold functions as a "structural component" whereas embedded PCL scaffold acts as "functional component" which provides a provision to functionalize the scaffolds with desired chemical or biological materials. The embedment process is straightforward, cost effective, and does not require sophistication. Mechanical characterization of scaffolds suggests Young's modulus of PLA-PCL scaffold (16.02 MPa) was higher than FDM fabricated PLA (9.98 MPa) scaffold by virtue of embedded PCL matrix. Besides, Finite element analysis showed, von Mises stress on mandible with scaffolds at 4.04 MPa, whereas mandible with the defect was 6.7 MPa suggesting stress distribution efficiency and mechanical stability of these scaffolds. Further, field emission scanning electron microscope (FESEM) analysis implied interlinked porous structures with a pore diameter of 50 µm to 300 µm. X-Ray diffraction (XRD) results revealed an increased crystallinity (%) of embedment models (PLA-PCL, PLA-PCL-nHAP and PLA-PCL-MWCNT) compared to PLA printed scaffold. Additionally, Raman analysis revealed that the embedment process did not impart chemical alterations in polymeric chains. In vitro analysis with human osteoblasts exhibited osteoconductive nature of the scaffold by supporting mineralization. In brief, the advantages the model is that, it helps to overcome the hassles of manufacturing a filament with desired additives for FDM, and offers provision to incorporate desired concentrations of heat labile bioactive molecules during embedment process at ambient temperature.

Comprehensive Survey on Nanobiomaterials for Bone Tissue Engineering Applications

One of the most important ideas ever produced by the application of materials science to the medical field is the notion of biomaterials. The nanostructured biomaterials play a crucial role in the development of new treatment strategies including not only the replacement of tissues and organs, but also repair and regeneration. They are designed to interact with damaged or injured tissues to induce regeneration, or as a forest for the production of laboratory tissues, so they must be micro-environmentally sensitive. The existing materials have many limitations, including impaired cell attachment, proliferation, and toxicity. Nanotechnology may open new avenues to bone tissue engineering by forming new assemblies similar in size and shape to the existing hierarchical bone structure. Organic and inorganic nanobiomaterials are increasingly used for bone tissue engineering applications because they may allow to overcome some of the current restrictions entailed by bone regeneration methods. This review covers the applications of different organic and inorganic nanobiomaterials in the field of hard tissue engineering.

Hydroxyapatite and β-TCP modified PMMA-TiO2 and PMMA-ZrO2 coatings for bioactive corrosion protection of Ti6Al4V implants

Organic-inorganic hybrid coatings deposited on different types of metallic alloys have shown outstanding anticorrosive performance. The incorporation of osteoconductive additives such as hydroxyapatite (HA) and β-tricalcium phosphate (β-TCP) into organic-inorganic hybrid coatings is promising to improve the osseointegration and corrosion resistance of Ti6Al4V alloys, which are the most widely used metallic orthopedic and dental implant materials today. Therefore, this study evaluated the capability of poly(methyl methacrylate) (PMMA)-TiO₂ and PMMA-ZrO₂ hybrid coatings modified with HA and β-TCP to act as bioactive and corrosion protection coatings for Ti6Al4V alloys. In terms of cell growth and mineralization, osteoblast viability, Ca⁺² deposition and alkaline phosphatase assays revealed a significant improvement for the HA and β-TCP modified coatings, compared to the bare alloy. This can be explained by an increase in nanoscale roughness and associated higher surface free energy, which lead to enhanced protein adsorption to promote osteoblast attachment and functions on the coatings. The effect of HA and β-TCP additives on the anticorrosive efficiency was studied by electrochemical impedance spectroscopy (EIS) in a simulated body fluid (SBF) solution. The coatings presented a low-frequency impedance modulus of up to 430 GΩ cm², 5 decades higher than the bare Ti6Al4V alloy. These findings provide clear evidence of the beneficial role of HA and β-TCP modified hybrid coatings, improving both the biocompatibility and corrosion resistance of the Ti6Al4V alloy.

Direct Ink Writing Technology (3D Printing) of Graphene-Based Ceramic Nanocomposites: A Review

In the present work, the state of the art of the most common additive manufacturing (AM) technologies used for the manufacturing of complex shape structures of graphene-based ceramic nanocomposites, ceramic and graphene-based parts is explained. A brief overview of the AM processes for ceramic, which are grouped by the type of feedstock used in each technology, is presented. The main technical factors that affect the quality of the final product were reviewed. The AM processes used for 3D printing of graphene-based materials are described in more detail; moreover, some studies in a wide range of applications related to these AM techniques are cited. Furthermore, different feedstock formulations and their corresponding rheological behavior were explained. Additionally, the most important works about the fabrication of composites using graphene-based ceramic pastes by Direct Ink Writing (DIW) are disclosed in detail and illustrated with representative examples. Various examples of the most relevant approaches for the manufacturing of graphene-based ceramic nanocomposites by DIW are provided.

3D printing applications in bone tissue engineering

PURPOSE

3D printing technology provides an excellent capability to manufacture customised implants for patients. Now, its applications are also successful in bone tissue engineering. This paper tries to provide a review of the applications of 3D printing in bone tissue engineering.

METHODS

Searching by keywords, from the Scopus database, to identify relevant latest research articles on 3D printing in bone tissue engineering, through "3D printing" "bone tissue engineering". This study makes a bibliometric analysis of the identified research articles and identified major applications and steps.

RESULTS

3D printing technology creates innovative development in bone tissue engineering. It involves the manufacturing of a scaffold with the combination of cells and materials. We identified a total number of 257 research articles through bibliometric analysis by searching through keywords "3D printing" "bone tissue engineering". This paper studies 3D printing technology and its significant contributions, benefits and steps used for bone tissue engineering. Result discusses the essential elements of bone tissue engineering and identifies its five significant advancements when 3D printing is used. Finally, ten useful applications of 3D printing in bone tissue engineering are identified and studied with a brief description.

CONCLUSION

In orthopaedics, bone defects create a high impact on the quality of life of the patient. It leads to a higher demand for bone substitutes for replacement of bone defect. Bone tissue engineering can help to replace a critical defect bone. 3D printing is a useful technology for the fabrication of scaffolds critical in bone tissue engineering. There are different binders which can create bone scaffolds with requisite mechanical strength. These binders are used to create excellent osteoconductive, bioactive scaffolds. Computed tomography (CT) and Magnetic resonance imaging (MRI) help to provide images of specific defects of an individual patient, and these images can further be used for 3D printing the detective object. A bone defect caused by specific disease is sorted out by transplantation in clinical practice. Now a day bone tissue engineering opens a new option for this treatment of bone defects with the manufacturing of porous bone scaffold using 3D printing technology.

Mechanobiological Approach to Design and Optimize Bone Tissue Scaffolds 3D Printed with Fused Deposition Modeling: A Feasibility Study

In spite of the rather large use of the fused deposition modeling (FDM) technique for the fabrication of scaffolds, no studies are reported in the literature that optimize the geometry of such scaffold types based on mechanobiological criteria. We implemented a mechanobiology-based optimization algorithm to determine the optimal distance between the strands in cylindrical scaffolds subjected to compression. The optimized scaffolds were then 3D printed with the FDM technique and successively measured. We found that the difference between the optimized distances and the average measured ones never exceeded 8.27% of the optimized distance. However, we found that large fabrication errors are made on the filament diameter when the filament diameter to be realized differs significantly with respect to the diameter of the nozzle utilized for the extrusion. This feasibility study demonstrated that the FDM technique is suitable to build accurate scaffold samples only in the cases where the strand diameter is close to the nozzle diameter. Conversely, when a large difference exists, large fabrication errors can be committed on the diameter of the filaments. In general, the scaffolds realized with the FDM technique were predicted to stimulate the formation of amounts of bone smaller than those that can be obtained with other regular beam-based scaffolds.

Rapid Fabrication of Anatomically-Shaped Bone Scaffolds Using Indirect 3D Printing and Perfusion Techniques

Fused deposit modeling (FDM) 3D printing technology cannot generate scaffolds with high porosity while maintaining good integrity, anatomical-surface detail, or high surface area-to-volume ratio (S/V). Solvent casting and particulate leaching (SCPL) technique generates scaffolds with high porosity and high S/V. However, it is challenging to generate complex-shaped scaffolds; and solvent, particle and residual water removal are time consuming. Here we report techniques surmounting these problems, successfully generating a highly porous scaffold with the anatomical-shape characteristics of a human femur by polylactic acid polymer (PLA) and PLA-hydroxyapatite (HA) casting and salt leaching. The mold is water soluble and is easily removable. By perfusing with ethanol, water, and dry air sequentially, the solvent, salt, and residual water were removed 20 fold faster than utilizing conventional methods. The porosities are uniform throughout the femoral shaped scaffold generated with PLA or PLA-HA. Both scaffolds demonstrated good biocompatibility with the pre-osteoblasts (MC3T3-E1) fully attaching to the scaffold within 8 h. The cells demonstrated high viability and proliferation throughout the entire time course. The HA-incorporated scaffolds demonstrated significantly higher compressive strength, modulus and osteoinductivity as evidenced by higher levels of alkaline-phosphatase activity and calcium deposition. When 3D printing a 3D model at 95% porosity or above, our technology preserves integrity and surface detail when compared with FDM-generated scaffolds. Our technology can also generate scaffolds with a 31 fold larger S/V than FDM. We have developed a technology that is a versatile tool in creating personalized, patient-specific bone graft scaffolds efficiently with high porosity, good scaffold integrity, high anatomical-shaped surface detail and large S/V.

Poly(Dopamine) Coating on 3D-Printed Poly-Lactic-Co-Glycolic Acid/β-Tricalcium Phosphate Scaffolds for Bone Tissue Engineering

Bone defects caused by osteoporosis, bone malignant tumors, and trauma are very common, but there are many limiting factors in the clinical treatment of them. Bone tissue engineering is the most promising treatment and is considered to be the main strategy for bone defect repair. We prepared polydopamine-coated poly-(lactic-co-glycolic acid)/β-tricalcium phosphate composite scaffolds via 3D printing, and a series of characterization and biocompatibility tests were carried out. The results show that the mechanical properties and pore-related parameters of the composite scaffolds are not affected by the coatings, and the hydrophilicities of the surface are obviously improved. Scanning electron microscopy and micro-computed tomography display the nanoscale microporous structure of the bio-materials. Biological tests demonstrate that this modified surface can promote cell adhesion and proliferation and improve osteogenesis through the increase of polydopamine (PDA) concentrations. Mouse cranial defect experiments are conducted to further verify the conclusion that scaffolds with a higher content of PDA coatings have a better effect on the formation of new bones. In the study, the objective of repairing critical-sized defects is achieved by simply adding PDA as coatings to obtain positive results, which can suggest that this modification method with PDA has great potential.

A review of biomaterials scaffold fabrication in additive manufacturing for tissue engineering

The current developments in three-dimensional printing also referred as “additive manufacturing” have transformed the scenarios for modern manufacturing and engineering design processes which show greatest advantages for the fabrication of complex structures such as scaffold for tissue engineering. This review aims to introduce additive manufacturing techniques in tissue engineering, types of biomaterials used in scaffold fabrication, as well as in vitro and in vivo evaluations. Biomaterials and fabrication methods could critically affect the outcomes of scaffold mechanical properties, design architectures, and cell proliferations. In addition, an ideal scaffold aids the efficiency of cell proliferation and allows the movements of cell nutrient inside the human body with their specific material properties. This article provides comprehensive review that covers broad range of all the biomaterial types using various additive manufacturing technologies. The data were extracted from 2008 to 2018 mostly from Google Scholar, ScienceDirect, and Scopus using keywords such as “Additive Manufacturing,” “3D Printing,” “Tissue Engineering,” “Biomaterial” and “Scaffold.” A 10 years research in this area was found to be mostly focused toward obtaining an ideal scaffold by investigating the fabrication strategies, biomaterials compatibility, scaffold design effectiveness through computer-aided design modeling, and optimum printing machine parameters identification. As a conclusion, this ideal scaffold fabrication can be obtained with the combination of different materials that could enhance the material properties which performed well in optimum additive manufacturing condition. Yet, there are still many challenges from the printing methods, bioprinting and cell culturing that needs to be discovered and investigated in the future.

The Applications of 3D Printing for Craniofacial Tissue Engineering

Three-dimensional (3D) printing is an emerging technology in the field of dentistry. It uses a layer-by-layer manufacturing technique to create scaffolds that can be used for dental tissue engineering applications. While several 3D printing methodologies exist, such as selective laser sintering or fused deposition modeling, this paper will review the applications of 3D printing for craniofacial tissue engineering; in particular for the periodontal complex, dental pulp, alveolar bone, and cartilage. For the periodontal complex, a 3D printed scaffold was attempted to treat a periodontal defect; for dental pulp, hydrogels were created that can support an odontoblastic cell line; for bone and cartilage, a polycaprolactone scaffold with microspheres induced the formation of multiphase fibrocartilaginous tissues. While the current research highlights the development and potential of 3D printing, more research is required to fully understand this technology and for its incorporation into the dental field.

Three-dimensional Printed Mg-Doped β-TCP Bone Tissue Engineering Scaffolds: Effects of Magnesium Ion Concentration on Osteogenesis and Angiogenesis In Vitro

Background

Three-dimensional (3D) printed bone tissue engineering scaffolds have been widely used in research and clinical applications. β-TCP is a biomaterial commonly used in bone tissue engineering to treat bone defects, and its multifunctionality can be achieved by co-doping different metal ions. Magnesium doping in biomaterials has been shown to alter physicochemical properties of cells and enhance osteogenesis.

Methods

A series of Mg-doped TCP scaffolds were manufactured by using cryogenic 3D printing technology and sintering. The characteristics of the porous scaffolds, such as microstructure, chemical composition, mechanical properties, apparent porosity, etc., were examined. To further study the role of magnesium ions in simultaneously inducing osteogenesis and angiogenesis, human bone marrow mesenchymal stem cells (hBMSCs) and human umblical vein endothelial cells (HUVECs) were cultured in scaffold extracts to investigate cell proliferation, viability, and expression of osteogenic and angiogenic genes.

Results

The results showed that Mg-doped TCP scaffolds have the advantages of precise design, interconnected porous structure, and similar compressive strength to natural cancellous bone. hBMSCs and HUVECs exhibit high proliferation rate, cell morphology and viability in a certain amount of Mg²⁺. In addition, this concentration of magnesium can also increase the expression levels of osteogenic and angiogenic biomarkers.

Conclusion

A certain concentration of magnesium ions plays an important role in new bone regeneration and reconstruction. It can be used as a simple and effective method to enhance the osteogenesis and angiogenesis of bioceramic scaffolds, and support the development of biomaterials and bone tissue engineering scaffolds.

Fabrication of Demineralized Bone Matrix/Polycaprolactone Composites Using Large Area Projection Sintering (LAPS)

Cadaveric decellularized bone tissue is utilized as an allograft in many musculoskeletal surgical procedures. Typically, the allograft acts as a scaffold to guide tissue regeneration with superior biocompatibility relative to synthetic scaffolds. Traditionally these scaffolds are machined into the required dimensions and shapes. However, the geometrical simplicity and, in some cases, limited dimensions of the donated tissue restrict the use of allograft scaffolds. This could be overcome by additive manufacturing using granulated bone that is both decellularized and demineralized. In this study, the large area projection sintering (LAPS) method is evaluated as a fabrication method to build porous structures composed of granulated cortical bone bound by polycaprolactone (PCL). This additive manufacturing method utilizes visible light to selectively cure the deposited material layer-by-layer to create 3D geometry. First, the spreading behavior of the composite mixtures is evaluated and the conditions to attain improved powder bed density to fabricate the test specimens are determined. The tensile strength of the LAPS fabricated samples in both dry and hydrated states are determined and compared to the demineralized cancellous bone allograft and the heat treated demineralized-bone/PCL mixture in mold. The results indicated that the projection sintered composites of 45–55 wt %. Demineralized bone matrix (DBM) particulates produced strength comparable to processed and demineralized cancellous bone.

Three-dimensional (3D) printed scaffold and material selection for bone repair

Critical-sized bone defect repair remains a substantial challenge in clinical settings and requires bone grafts or bone substitute materials. However, existing biomaterials often do not meet the clinical requirements of structural support, osteoinductive property, and controllable biodegradability. To treat large-scale bone defects, the development of three-dimensional (3D) porous scaffolds has received considerable focus within bone engineering. A variety of biomaterials and manufacturing methods, including 3D printing, have emerged to fabricate patient-specific bioactive scaffolds that possess controlled micro-architectures for bridging bone defects in complex configurations. During the last decade, with the development of the 3D printing industry, a large number of tissue-engineered scaffolds have been created for preclinical and clinical applications using novel materials and innovative technologies. Thus, this review provides a brief overview of current progress in existing biomaterials and tissue engineering scaffolds prepared by 3D printing technologies, with an emphasis on the material selection, scaffold design optimization, and their preclinical and clinical applications in the repair of critical-sized bone defects. Furthermore, it will elaborate on the current limitations and potential future prospects of 3D printing technology. STATEMENT OF SIGNIFICANCE: 3D printing has emerged as a critical fabrication process for bone engineering due to its ability to control bulk geometry and internal structure of tissue scaffolds. The advancement of bioprinting methods and compatible ink materials for bone engineering have been a major focus to develop optimal 3D scaffolds for bone defect repair. Achieving a successful balance of cellular function, cellular viability, and mechanical integrity under load-bearing conditions is critical. Hybridization of natural and synthetic polymer-based materials is a promising approach to create novel tissue engineered scaffolds that combines the advantages of both materials and meets various requirements, including biological activity, mechanical strength, easy fabrication and controllable degradation. 3D printing is linked to the future of bone grafts to create on-demand patient-specific scaffolds.

Poly(alkyl glycidyl ether) hydrogels for harnessing the bioactivity of engineered microbes

Herein, we describe a method to produce yeast-laden hydrogel inks for the direct-write 3D printing of cuboidal lattices for immobilized whole-cell catalysis.

3D printing in cell culture systems and medical applications

3D printing plays an important role in various biomedical research applications including, but not limited to, culture systems and implantable devices. In this review, we discuss recent development in the applications of 3D printing technologies for clinically motivated research, particularly focusing on the fabrication of constructs subsequently incorporated with cells. Applications of this technology include pharmaceutical delivery, bioreactor culture platforms, acellular scaffolds, imaging modalities, and organ-on-a chip systems. Emphasis is placed on technological developments not possible without 3D printing technologies: where traditional manufacturing approaches would be cumbersome to demonstrate research objectives. The clinical applications of 3D printing are rapidly moving from the research to production phases and will certainly continue to grow, with ever increasing numbers of therapies becoming commercialized. The work discussed here holds promise for various applications in structural improvements, drug delivery, and physiology research.

Recent Advances in Biomaterials for 3D Printing and Tissue Engineering

Three-dimensional printing has significant potential as a fabrication method in creating scaffolds for tissue engineering. The applications of 3D printing in the field of regenerative medicine and tissue engineering are limited by the variety of biomaterials that can be used in this technology. Many researchers have developed novel biomaterials and compositions to enable their use in 3D printing methods. The advantages of fabricating scaffolds using 3D printing are numerous, including the ability to create complex geometries, porosities, co-culture of multiple cells, and incorporate growth factors. In this review, recently-developed biomaterials for different tissues are discussed. Biomaterials used in 3D printing are categorized into ceramics, polymers, and composites. Due to the nature of 3D printing methods, most of the ceramics are combined with polymers to enhance their printability. Polymer-based biomaterials are 3D printed mostly using extrusion-based printing and have a broader range of applications in regenerative medicine. The goal of tissue engineering is to fabricate functional and viable organs and, to achieve this, multiple biomaterials and fabrication methods need to be researched.

Novel Biomaterials Used in Medical 3D Printing Techniques

The success of an implant depends on the type of biomaterial used for its fabrication. An ideal implant material should be biocompatible, inert, mechanically durable, and easily moldable. The ability to build patient specific implants incorporated with bioactive drugs, cells, and proteins has made 3D printing technology revolutionary in medical and pharmaceutical fields. A vast variety of biomaterials are currently being used in medical 3D printing, including metals, ceramics, polymers, and composites. With continuous research and progress in biomaterials used in 3D printing, there has been a rapid growth in applications of 3D printing in manufacturing customized implants, prostheses, drug delivery devices, and 3D scaffolds for tissue engineering and regenerative medicine. The current review focuses on the novel biomaterials used in variety of 3D printing technologies for clinical applications. Most common types of medical 3D printing technologies, including fused deposition modeling, extrusion based bioprinting, inkjet, and polyjet printing techniques, their clinical applications, different types of biomaterials currently used by researchers, and key limitations are discussed in detail.