Structure, properties, and bioactivity of 3D printed PAEKs for implant applications: A systematic review

Investigating the Feasibility and Performance of Hybrid Overmolded UHMWPE 3D-Printed PEEK Structural Composites for Orthopedic Implant Applications: A Pilot Study

Ultra-high-molecular-weight polyethylene (UHMWPE) components for orthopedic implants have historically been integrated into metal backings by direct-compression molding (DCM). However, metal backings are costly, stiffer than cortical bone, and may be associated with medical imaging distortion and metal release. Hybrid-manufactured DCM UHMWPE overmolded additively manufactured polyetheretherketone (PEEK) structural components could offer an alternative solution, but are yet to be explored. In this study, five different porous topologies (grid, triangular, honeycomb, octahedral, and gyroid) and three surface feature sizes (low, medium, and high) were implemented into the top surface of digital cylindrical specimens prior to being 3D printed in PEEK and then overmolded with UHMWPE. Separation forces were recorded as 1.97-3.86 kN, therefore matching and bettering the historical industry values (2-3 kN) recorded for DCM UHMWPE metal components. Infill topology affected failure mechanism (Type 1 or 2) and obtained separation forces, with shapes having greater sidewall numbers (honeycomb-60%) and interconnectivity (gyroid-30%) through their builds, tolerating higher transmitted forces. Surface feature size also had an impact on applied load, whereby those with low infill-%s generally recorded lower levels of performance vs. medium and high infill strategies. These preliminary findings suggest that hybrid-manufactured structural composites could replace metal backings and produce orthopedic implants with high-performing polymer-polymer interfaces.

3D Printing Materials and Technologies for Orthopaedic Applications

SUMMARY

3D printing technologies have evolved tremendously over the last decade for uses in orthopaedic surgical applications, including being used to manufacture implants for spine, upper extremity, foot and ankle, oncologic, and traumatic reconstructions. Materials used for 3D-printed orthopaedic devices include metals, degradable and nondegradable polymers, and ceramic composites. There are 2 primary advantages for use of 3D printing technologies for orthopaedics: first, the ability to create complex porous lattices that allow for osseointegration and improved implant stability and second, the enablement of complex geometric designs allowing for patient-specific devices based on preoperative imaging. Given continually evolving technology, and the relatively early stage of the materials and 3D printers themselves, the possibilities for continued innovation in orthopaedics are great.

Investigations of hybrid infill pattern in additive manufactured tablets: A novel approach towards tunable drug release

The significance of 3D printing has risen exponentially in biomedical and pharmaceutical applications. Its potential in the field of fabricating drug delivery systems, by virtue of processing biocompatible polymers, has been very lucrative. This work aims to tap the interstitial drug delivery kinetics that are often inaccessible through machine-specific infill patterns in additive manufactured tablets fabricated using PVA biopolymer as an excipient. In this regard, a myo-inositol containing tablet has been printed using Fused Deposition Modeling preceded by Hot Melt Extrusion drug loading route. Two machine-specific infill patterns were taken, namely straight and grid. Later, these two distinct patterns were juxtaposed to obtain novel hybrid infill patterns in the tablets. Then, these tablets and their filament were subjected to various thermal, mechanical, imaging and pharmaceutical characterization tests to assess the feasibility of the research attempt. Finally, dissolution tests were conducted to evaluate their dissolution behavior over a time period. The characterization tests proved the scientific viability of this attempt along with amorphous existence of drug in the polymeric filament. The dissolution results showed favorable drug release by achieving interstitial dissolution timings with surface area/volume (SA/V) ratio being found to be the principal factor.

Zirconia-veneered polyetherketoneketone frameworks of implant-supported complete arch fixed dental prostheses: A report on 5 patients

Metal frameworks have been used for implant-supported complete arch fixed dental prostheses (ISCFDPs) for maxillary or mandibular edentulous arches with a crown height space of more than 15 mm. However, technical difficulties in the casting, weight, and lack of passivity of the metal have led dentists and dental laboratory technicians to choose materials with different biomechanical properties, including polyetheretherketone (PEEK) and polyetherketoneketone (PEKK). This clinical report describes the design of ISCFDPs using PEKK frameworks, the number of cantilevers, the condition of the opposing dentition, and the incidence of complications, including zirconia crown or PEKK framework fracture, as well as the clinical outcomes of 5 patients observed prospectively over 8 to 65 months. No mechanical complications of PEKK-made ISCFDPs opposing removable prostheses occurred, regardless of the presence of cantilevers. The ISCFDPs that opposed natural dentition or a combination of the natural dentition and fixed prostheses showed different clinical outcomes depending on the length of cantilevers and the number and location of pontics.

Design of customized implants and 3D printing of symmetric and asymmetric cranial cavities

A methodology has been developed in this work to design customized cranial implants from computed tomography (CT) scan images for symmetric as well as asymmetric defects. The two-dimensional CT scan images were converted into three-dimensional geometric models using software packages. Two cases of cranial cavities at different locations were considered for implant design using two different approaches. Case 1 is having a symmetric cranial cavity while Case 2 has an asymmetric frontal cranial cavity. The craniums with defects were 3D reconstructed. Customized cranial implants were made for the two cases. In Case 1, symmetry was used to design the cranial implant. Symmetry cannot be used in Case 2. In Case 2, the implant was designed by blending from the surface available adjacent to the missing portion of the cranium. 3D reconstructed bone models and customized implants were 3D printed in poly-lactic acid (PLA) using a fused deposition modeling process for form and fit evaluation. Finite element analysis was performed to compare the mechanical behavior of bone, and the two biomaterials - polyether ether ketone (PEEK), and Ti6Al4V. Static structural finite element analysis was performed to simulate the impact of falling off a bicycle with an impact on the cranial implants in the two cases. The load was modeled as a normal force acting on the surface of the implant. It was found that the stresses in the titanium alloy are comparable to those of PEEK for both the cases. However, the strains and deformation were found to be much smaller compared to those in PEEK. Therefore, the titanium alloy is the material of choice for both the cases among the materials under consideration. The designed implants are solid hence may face the challenge in bone ingrowth. In future studies, the implant can be made porous by incorporating a lattice structure to enhance osseointegration and promote bone ingrowth. Implants for both symmetric and asymmetric defect cases in cranium were successfully designed.

Taguchi optimization of 3D printed short carbon fiber polyetherketoneketone (CFR PEKK)

In this study, the Taguchi method was utilized to optimize fused filament fabrication (FFF) additive manufacturing with the goal of maximizing the flexural strength of 3D printed polyaryletherketone specimens. We analyzed 3D printed (3DP) carbon fiber reinforced poly-etherketoneketone (CFR PEKK), 3D printed and pressed (3DP + P) CFR PEKK, and injection molded medical grade polyetheretherketone (PEEK) as a control. Fracture surfaces were analyzed via scanning electron microscopy (SEM). The parameters that were varied in the optimization included nozzle diameter, layer height, print speed, raster angle, and nozzle temperature. We analyzed the flexural strength and flexural modulus determined from 3-point bending (ASTM D790). Using Taguchi optimization, the signal to noise ratio (SNR) was calculated to determine the relationship between the input parameters and flexural strength and to determine optimal print settings. Results were confirmed with analysis of variance (ANOVA). The raster angle and layer height were determined to have the greatest impact on the flexural strength of specimens printed in the FFF process for 3DP CFR PEKK. The optimized printing parameters were found to be 0/90 Raster Angle, 0.25 mm layer height, 0.8 mm Nozzle Diameter, 375 °C nozzle temperature, and 1100 mm/min print speed. The optimized 3DP CFR PEKK test samples had a flexural strength of 111.3 ± 5.3 MPa and a flexural modulus of 3.5 GPa. 3DP + P CFR PEKK samples had a flexural strength of 257.2 ± 17.8 MPa and a flexural modulus of 8.2 GPa. Statistical comparisons between means demonstrated that pressing significantly improves both flexural strength and flexural modulus of 3DP CFR PEKK. The results of this study support the hypothesis that post consolidation of 3DP specimens improves mechanical properties. Post-processing composites via pressing may allow greater design freedom within the 3DP process while improving mechanical properties.

Research progress of 3D printed poly (ether ether ketone) in the reconstruction of craniomaxillofacial bone defects

The clinical challenge of bone defects in the craniomaxillofacial region, which can lead to significant physiological dysfunction and psychological distress, persists due to the complex and unique anatomy of craniomaxillofacial bones. These critical-sized defects require the use of bone grafts or substitutes for effective reconstruction. However, current biomaterials and methods have specific limitations in meeting the clinical demands for structural reinforcement, mechanical support, exceptional biological performance, and aesthetically pleasing reconstruction of the facial structure. These drawbacks have led to a growing need for novel materials and technologies. The growing development of 3D printing can offer significant advantages to address these issues, as demonstrated by the fabrication of patient-specific bioactive constructs with controlled structural design for complex bone defects in medical applications using this technology. Poly (ether ether ketone) (PEEK), among a number of materials used, is gaining recognition as a feasible substitute for a customized structure that closely resembles natural bone. It has proven to be an excellent, conformable, and 3D-printable material with the potential to replace traditional autografts and titanium implants. However, its biological inertness poses certain limitations. Therefore, this review summarizes the distinctive features of craniomaxillofacial bones and current methods for bone reconstruction, and then focuses on the increasingly applied 3D printed PEEK constructs in this field and an update on the advanced modifications for improved mechanical properties, biological performance, and antibacterial capacity. Exploring the potential of 3D printed PEEK is expected to lead to more cost-effective, biocompatible, and personalized treatment of craniomaxillofacial bone defects in clinical applications.

Additive manufacturing technologies in the oral implant clinic: A review of current applications and progress

Additive manufacturing (AM) technologies can enable the direct fabrication of customized physical objects with complex shapes, based on computer-aided design models. This technology is changing the digital manufacturing industry and has become a subject of considerable interest in digital implant dentistry. Personalized dentistry implant treatments for individual patients can be achieved through Additive manufacturing. Herein, we review the applications of Additive manufacturing technologies in oral implantology, including implant surgery, and implant and restoration products, such as surgical guides for implantation, custom titanium meshes for bone augmentation, personalized or non-personalized dental implants, custom trays, implant casts, and implant-support frameworks, among others. In addition, this review also focuses on Additive manufacturing technologies commonly used in oral implantology. Stereolithography, digital light processing, and fused deposition modeling are often used to construct surgical guides and implant casts, whereas direct metal laser sintering, selective laser melting, and electron beam melting can be applied to fabricate dental implants, personalized titanium meshes, and denture frameworks. Moreover, it is sometimes required to combine Additive manufacturing technology with milling and other cutting and finishing techniques to ensure that the product is suitable for its final application.

Mechanical performance and bioactivation of 3D-printed PEEK for high-performance implant manufacture: a review

Polyetheretherketone (PEEK) has stood out as the leading high-performance thermoplastic for the replacement of metals in orthopaedic, trauma and spinal implant applications due to its high biocompatibility and mechanical properties. Despite its potential for custom-made medical devices, 3D-printed PEEK's mechanical performance depends on processing parameters and its bioinertness may hinder bone opposition to the implant. Concerning these challenges, this review focuses on the available literature addressing the improvement of the mechanical performance of PEEK processed through "fused filament fabrication" (FFF) along with literature on bioactivation of PEEK for improved osseointegration. The reviewed research suggests that improvements can be achieved in mechanical performance of 3D-printed PEEK with adequate FFF parametrization while different bioactivation techniques can be used to improve the bioperformance of 3D-printed PEEK. The adequate approaches towards these procedures can increase PEEK's potential for the manufacture of high-performance custom-made implantable devices that display improved bone-implant integration and prevent stress shielding of the treated bone.

Recent Advances on High-Performance Polyaryletherketone Materials for Additive Manufacturing

Polyaryletherketone (PAEK) is emerging as an important high-performance polymer material in additive manufacturing (AM) benefiting from its excellent mechanical properties, good biocompatibility, and high-temperature stability. The distinct advantages of AM facilitate the rapid development of PAEK products with complex customized structures and functionalities, thereby enhancing their applications in various fields. Herein, the recent advances on AM of high-performance PAEKs are comprehensively reviewed, concerning the materials properties, AM processes, mechanical properties, and potential applications of additively manufactured PAEKs. To begin, an introduction to fundamentals of AM and PAEKs, as well as the advantages of AM of PAEKs is provided. Discussions are then presented on the material properties, AM processes, processing-matter coupling mechanism, thermal conductivity, crystallization characteristics, and microstructures of AM-processed PAEKs. Thereafter, the mechanical properties and anisotropy of additively manufactured PAEKs are discussed in depth. Their representative applications in biomedical, aerospace, electronics, and other fields are systematically presented. Finally, current challenges and possible solutions are discussed for the future development of high-performance AM polymers.

Application of Patient-Specific PEEK Implant for Aesthetic Considerations in Paranasal Augmentation

The paranasal area is closely associated with midfacial esthetics. However, there is no special technique available to achieve ideal esthetics paranasal restoration. The present study aims to apply the 3D printed PolyEtherEtherKetone (PEEK) implants as an innovative solution for esthetic paranasal reconstruction. On the basis of the CT scan, the patient-specific PEEK implant and a surgical guiding plate were manufactured aided by a computer. Preoperative and postoperative CBCT data were utilized to evaluate esthetic outcomes. The average follow-up period was 13 months. All patients' wounds healed by first intention. The statistical analysis of preoperative and postoperative esthetic indices revealed light levels of postoperative paranasal depression (P<0.001) and the wrinkle severity rating scale for nasolabial folds (P<0.001). Moreover, the nasolabial angle increased (P<0.05). The established 3D-printing PEEK implanted prosthesis can individually correct the depressed deformity of the paranasal region, and achieve favorable clinical esthetic outcomes.

Viscoelastic Characterization of a Thermoplastic Elastomer Processed through Material Extrusion

Objective. We aim to characterize the viscoelastic behavior of Polyether-Block-Amide (PEBA 90A), provide reference values for the parameters of a constitutive model for the simulation of mechanical behaviors, and paying attention to the influence of the manufacturing conditions. Methods. Uniaxial relaxation tests of filaments of PEBA were used to determine the values of the parameters of a Prony series for a Quasi-Linear Visco-Elastic (QLVE) model. Additional, fast cyclic loading tests were used to corroborate the adequacy of the model under different test criteria in a second test situation. Results. The QLVE model predicts the results of the relaxation tests very accurately. In addition, the behavior inferred from this model fits very well with the measurements of fast cyclic loading tests. The viscoelastic behavior of PEBA under small strain polymer fits very well to a six-parameter QLVE model.

Tailoring the biologic responses of 3D printed PEEK medical implants by plasma functionalization

OBJECTIVE

The objective of this study was to determine the effect of two plasma surface treatments on the biologic responses of PEEK medical implants manufactured by fused filament fabrication (FFF) 3D printing technology.

METHODS

This study created standard PEEK samples using an FFF 3D printer. After fabrication, half of the samples were polished to simulate a smooth PEEK surface. Then, argon (Ar) or oxygen (O₂) plasma was used to modify the bioactivity of FFF 3D printed and polished PEEK samples. Scanning electron microscopy (SEM) and a profilometer were used to determine the microstructure and roughness of the sample surfaces. The wettability of the sample surface was assessed using a drop shape analyzer (DSA) after plasma treatment and at various time points following storage in a closed environment. Cell adhesion, metabolic activity, proliferation, and osteogenic differentiation of SAOS-2 osteoblasts were evaluated to determine the in vitro osteogenic activity.

RESULTS

SEM analysis revealed that several spherical nanoscale particles and humps appeared on sample surfaces following plasma treatment. The wettability measurement demonstrated that plasma surface treatment significantly increased the surface hydrophilicity of PEEK samples, with only a slight aging effect found after 21 days. Cell adhesion, spreading, proliferation, and differentiation of SAOS-2 osteoblasts were also up-regulated after plasma treatment. Additionally, PEEK samples treated with O₂ plasma demonstrated a higher degree of bioactivation than those treated with Ar.

SIGNIFICANCE

Plasma-modified PEEK based on FFF 3D printing technology was a feasible and prospective bone grafting material for bone/dental implants.

Development of an Electromagnetic Micromanipulator Levitation System for Metal Additive Manufacturing Applications

Magnetism and magnetic levitation has found significant interest within the field of micromanipulation of objects. Additive manufacturing (AM), which is the computer-controlled process for creating 3D objects through the deposition of materials, has also been relevant within the academic environment. Despite the research conducted individually within the two fields, there has been minimal overlapping research. The non-contact nature of magnetic micromanipulator levitation systems makes it a prime candidate within AM environments. The feasibility of integrating magnetic micromanipulator levitation system, which includes two concentric coils embedded within a high permeability material and carrying currents in opposite directions, for additive manufacturing applications is presented in this article. The working principle, the optimization and relevant design decisions pertaining to the micromanipulator levitation system are discussed. The optimized dimensions of the system allow for 920 turns in the inner coil and 800 turns in the outer coil resulting in a Ninnercoil:Noutercoil ratio of 1.15. Use of principles of free levitation, which is production of levitation and restoration forces with the coils, to levitate non-magnetic conductive materials with compatibility and applications within the AM environment are discussed. The Magnetomotive Force (MMF) ratio of the coils are adjusted by incorporation of an resistor in parallel to the outer coil to facilitate sufficient levitation forces in the axial axis while producing satisfactory restoration forces in the lateral axes resulting in the levitation of an aluminum disc with a levitation height of 4.5 mm. An additional payload of up to 15.2 g (59% of mass of levitated disc) was added to a levitated aluminum disk of 26 g showing the system capability coping with payload variations, which is crucial in AM process to gradually deploy masses. The final envisioned system is expected to have positional stability within the tolerance range of a few μm. The system performance is verified through the use of simulations (ANSYS Maxwell) and experimental analyses. A novel method of using the ratio of conductivity (σ) of the material to density (ρ) of the material to determine the compatibility of the levitation ability of non-magnetic materials with magnetic levitation application is also formulated. The key advantage of this method is that it does not rely on experimental analyses to determine the levitation ability of materials.

A Multi-Criteria Assessment Strategy for 3D Printed Porous Polyetheretherketone (PEEK) Patient-Specific Implants for Orbital Wall Reconstruction

Pure orbital blowout fractures occur within the confines of the internal orbital wall. Restoration of orbital form and volume is paramount to prevent functional and esthetic impairment. The anatomical peculiarity of the orbit has encouraged surgeons to develop implants with customized features to restore its architecture. This has resulted in worldwide clinical demand for patient-specific implants (PSIs) designed to fit precisely in the patient's unique anatomy. Material extrusion or Fused filament fabrication (FFF) three-dimensional (3D) printing technology has enabled the fabrication of implant-grade polymers such as Polyetheretherketone (PEEK), paving the way for a more sophisticated generation of biomaterials. This study evaluates the FFF 3D printed PEEK orbital mesh customized implants with a metric considering the relevant design, biomechanical, and morphological parameters. The performance of the implants is studied as a function of varying thicknesses and porous design constructs through a finite element (FE) based computational model and a decision matrix based statistical approach. The maximum stress values achieved in our results predict the high durability of the implants, and the maximum deformation values were under one-tenth of a millimeter (mm) domain in all the implant profile configurations. The circular patterned implant (0.9 mm) had the best performance score. The study demonstrates that compounding multi-design computational analysis with 3D printing can be beneficial for the optimal restoration of the orbital floor.

Quantitative Assessment of Point-of-Care 3D-Printed Patient-Specific Polyetheretherketone (PEEK) Cranial Implants

Recent advancements in medical imaging, virtual surgical planning (VSP), and three-dimensional (3D) printing have potentially changed how today's craniomaxillofacial surgeons use patient information for customized treatments. Over the years, polyetheretherketone (PEEK) has emerged as the biomaterial of choice to reconstruct craniofacial defects. With advancements in additive manufacturing (AM) systems, prospects for the point-of-care (POC) 3D printing of PEEK patient-specific implants (PSIs) have emerged. Consequently, investigating the clinical reliability of POC-manufactured PEEK implants has become a necessary endeavor. Therefore, this paper aims to provide a quantitative assessment of POC-manufactured, 3D-printed PEEK PSIs for cranial reconstruction through characterization of the geometrical, morphological, and biomechanical aspects of the in-hospital 3D-printed PEEK cranial implants. The study results revealed that the printed customized cranial implants had high dimensional accuracy and repeatability, displaying clinically acceptable morphologic similarity concerning fit and contours continuity. From a biomechanical standpoint, it was noticed that the tested implants had variable peak load values with discrete fracture patterns and failed at a mean (SD) peak load of 798.38 ± 211.45 N. In conclusion, the results of this preclinical study are in line with cranial implant expectations; however, specific attributes have scope for further improvements.