Trends in 3D Printing Processes for Biomedical Field: Opportunities and Challenges

In Vitro and In Vivo Drug Release from a Nano-Hydroxyapatite Reinforced Resorbable Nanofibrous Scaffold for Treating Female Pelvic Organ Prolapse

Pelvic prolapse stands as a substantial medical concern, notably impacting a significant segment of the population, predominantly women. This condition, characterized by the descent of pelvic organs, such as the uterus, bladder, or rectum, from their normal positions, can lead to a range of distressing symptoms, including pelvic pressure, urinary incontinence, and discomfort during intercourse. Clinical challenges abound in the treatment landscape of pelvic prolapse, stemming from its multifactorial etiology and the diverse array of symptoms experienced by affected individuals. Current treatment options, while offering relief to some extent, often fall short in addressing the full spectrum of symptoms and may pose risks of complications or recurrence. Consequently, there exists a palpable need for innovative solutions that can provide more effective, durable, and patient-tailored interventions for pelvic prolapse. We manufactured an integrated polycaprolactone (PCL) mesh, reinforced with nano-hydroxyapatite (nHA), along with drug-eluting poly(lactic-co-glycolic acid) (PLGA) nanofibers for a prolapse scaffold. This aims to offer a promising avenue for enhanced treatment outcomes and improved quality of life for individuals grappling with pelvic prolapse. Solution extrusion additive manufacturing and electrospinning methods were utilized to prepare the nHA filled PCL mesh and drug-incorporated PLGA nanofibers, respectively. The pharmaceuticals employed included metronidazole, ketorolac, bleomycin, and estrone. Properties of fabricated resorbable scaffolds were assessed. The in vitro release characteristics of various pharmaceuticals from the meshes/nanofibers were evaluated. Furthermore, the in vivo drug elution pattern was also estimated on a rat model. The empirical data show that nHA reinforced PCL mesh exhibited superior mechanical strength to virgin PCL mesh. Electrospun resorbable nanofibers possessed diameters ranging from 85 to 540 nm, and released effective metronidazole, ketorolac, bleomycin, and estradiol, respectively, for 9, 30, 3, and over 30 days in vitro. Further, the mesh/nanofiber scaffolds also liberated high drug levels at the target site for more than 28 days in vivo, while the drug concentrations in blood remained low. This discovery suggests that resorbable scaffold can serve as a viable option for treating female pelvic organ prolapse.

The Development of Sustainable Polyethylene Terephthalate Glycol-Based (PETG) Blends for Additive Manufacturing Processing-The Use of Multilayered Foil Waste as the Blend Component

The polymer foil industry is one of the leading producers of plastic waste. The development of new recycling methods for packaging products is one of the biggest demands in today's engineering. The subject of this research was the melt processing of multilayered PET-based foil waste with PETG copolymer. The resulting blends were intended for additive manufacturing processing using the fused deposition modeling (FDM) method. In order to improve the properties of the developed materials, the blends compounding procedure was conducted with the addition of a reactive chain extender (CE) and elastomeric copolymer used as an impact modifier (IM). The samples were manufactured using the 3D printing technique and, for comparison, using the traditional injection molding method. The obtained samples were subjected to a detailed characterization procedure, including mechanical performance evaluation, thermal analysis, and rheological measurements. This research confirms that PET-based film waste can be successfully used for the production of filament, and for most samples, the FDM printing process can be conducted without any difficulties. Unfortunately, the unmodified blends are characterized by brittleness, which makes it necessary to use an elastomer additive (IM). The presence of a semicrystalline PET phase improves the thermal resistance of the prepared blends; however, an annealing procedure is required for this purpose.

Accelerating neurotechnology development using an Agile methodology

Novel bioelectronic medical devices that target neural control of visceral organs (e.g., liver, gut, spleen) or inflammatory reflex pathways are innovative class III medical devices like implantable cardiac pacemakers that are lifesaving and life-sustaining medical devices. Bringing innovative neurotechnologies early into the market and the hands of treatment providers would benefit a large population of patients inflicted with autonomic and chronic immune disorders. Medical device manufacturers and software developers widely use the Waterfall methodology to implement design controls through verification and validation. In the Waterfall methodology, after identifying user needs, a functional unit is fabricated following the verification loop (design, build, and verify) and then validated against user needs. Considerable time can lapse in building, verifying, and validating the product because this methodology has limitations for adjusting to unanticipated changes. The time lost in device development can cause significant delays in final production, increase costs, and may even result in the abandonment of the device development. Software developers have successfully implemented an Agile methodology that overcomes these limitations in developing medical software. However, Agile methodology is not routinely used to develop medical devices with implantable hardware because of the increased regulatory burden of the need to conduct animal and human studies. Here, we provide the pros and cons of the Waterfall methodology and make a case for adopting the Agile methodology in developing medical devices with physical components. We utilize a peripheral nerve interface as an example device to illustrate the use of the Agile approach to develop neurotechnologies.

Towards Polycaprolactone-Based Scaffolds for Alveolar Bone Tissue Engineering: A Biomimetic Approach in a 3D Printing Technique

The alveolar bone is a unique type of bone, and the goal of bone tissue engineering (BTE) is to develop methods to facilitate its regeneration. Currently, an emerging trend involves the fabrication of polycaprolactone (PCL)-based scaffolds using a three-dimensional (3D) printing technique to enhance an osteoconductive architecture. These scaffolds are further modified with hydroxyapatite (HA), type I collagen (CGI), or chitosan (CS) to impart high osteoinductive potential. In conjunction with cell therapy, these scaffolds may serve as an appealing alternative to bone autografts. This review discusses research gaps in the designing of 3D-printed PCL-based scaffolds from a biomimetic perspective. The article begins with a systematic analysis of biological mineralisation (biomineralisation) and ossification to optimise the scaffold's structural, mechanical, degradation, and surface properties. This scaffold-designing strategy lays the groundwork for developing a research pathway that spans fundamental principles such as molecular dynamics (MD) simulations and fabrication techniques. Ultimately, this paves the way for systematic in vitro and in vivo studies, leading to potential clinical applications.

3D/4D printing of cellulose nanocrystals-based biomaterials: Additives for sustainable applications

Cellulose nanocrystals (CNCs) have gained significant attraction from both industrial and academic sectors, thanks to their biodegradability, non-toxicity, and renewability with remarkable mechanical characteristics. Desirable mechanical characteristics of CNCs include high stiffness, high strength, excellent flexibility, and large surface-to-volume ratio. Additionally, the mechanical properties of CNCs can be tailored through chemical modifications for high-end applications including tissue engineering, actuating, and biomedical. Modern manufacturing methods including 3D/4D printing are highly advantageous for developing sophisticated and intricate geometries. This review highlights the major developments of additive manufactured CNCs, which promote sustainable solutions across a wide range of applications. Additionally, this contribution also presents current challenges and future research directions of CNC-based composites developed through 3D/4D printing techniques for myriad engineering sectors including tissue engineering, wound healing, wearable electronics, robotics, and anti-counterfeiting applications. Overall, this review will greatly help research scientists from chemistry, materials, biomedicine, and other disciplines to comprehend the underlying principles, mechanical properties, and applications of additively manufactured CNC-based structures.

In vivo characterization of 3D-printed polycaprolactone-hydroxyapatite scaffolds with Voronoi design to advance the concept of scaffold-guided bone regeneration

Three-dimensional (3D)-printed medical-grade polycaprolactone (mPCL) composite scaffolds have been the first to enable the concept of scaffold-guided bone regeneration (SGBR) from bench to bedside. However, advances in 3D printing technologies now promise next-generation scaffolds such as those with Voronoi tessellation. We hypothesized that the combination of a Voronoi design, applied for the first time to 3D-printed mPCL and ceramic fillers (here hydroxyapatite, HA), would allow slow degradation and high osteogenicity needed to regenerate bone tissue and enhance regenerative properties when mixed with xenograft material. We tested this hypothesis in vitro and in vivo using 3D-printed composite mPCL-HA scaffolds (wt 96%:4%) with the Voronoi design using an ISO 13485 certified additive manufacturing platform. The resulting scaffold porosity was 73% and minimal in vitro degradation (mass loss <1%) was observed over the period of 6 months. After loading the scaffolds with different types of fresh sheep xenograft and ectopic implantation in rats for 8 weeks, highly vascularized tissue without extensive fibrous encapsulation was found in all mPCL-HA Voronoi scaffolds and endochondral bone formation was observed, with no adverse host-tissue reactions. This study supports the use of mPCL-HA Voronoi scaffolds for further testing in future large preclinical animal studies prior to clinical trials to ultimately successfully advance the SGBR concept.

Application of 4D printing and bioprinting in cardiovascular tissue engineering

Cardiovascular diseases have remained the leading cause of death worldwide for the past 20 years. The current clinical therapeutic measures, including bypass surgery, stent implantation and pharmacotherapy, are not enough to repair the massive loss of cardiomyocytes after myocardial ischemia. Timely replenishment with functional myocardial tissue via biomedical engineering is the most direct and effective means to improve the prognosis and survival rate of patients. It is widely recognized that 4D printing technology introduces an additional dimension of time in comparison with traditional 3D printing. Additionally, in the context of 4D bioprinting, both the printed material and the resulting product are designed to be biocompatible, which will be the mainstream of bioprinting in the future. Thus, this review focuses on the application of 4D bioprinting in cardiovascular diseases, discusses the bottleneck of the development of 4D bioprinting, and finally looks forward to the future direction and prospect of this revolutionary technology.

Engineering Materials and Devices for the Prevention, Diagnosis, and Treatment of COVID-19 and Infectious Diseases

Following the global spread of COVID-19, scientists and engineers have adapted technologies and developed new tools to aid in the fight against COVID-19. This review discusses various approaches to engineering biomaterials, devices, and therapeutics, especially at micro and nano levels, for the prevention, diagnosis, and treatment of infectious diseases, such as COVID-19, serving as a resource for scientists to identify specific tools that can be applicable for infectious-disease-related research, technology development, and treatment. From the design and production of equipment critical to first responders and patients using three-dimensional (3D) printing technology to point-of-care devices for rapid diagnosis, these technologies and tools have been essential to address current global needs for the prevention and detection of diseases. Moreover, advancements in organ-on-a-chip platforms provide a valuable platform to not only study infections and disease development in humans but also allow for the screening of more effective therapeutics. In addition, vaccines, the repurposing of approved drugs, biomaterials, drug delivery, and cell therapy are promising approaches for the prevention and treatment of infectious diseases. Following a comprehensive review of all these topics, we discuss unsolved problems and future directions.

Recent patent-based review on the role of three-dimensional printing technology in pharmaceutical and biomedical applications

Three-dimensional printing (3DP) is emerging as an innovative manufacturing technology for biomedical and pharmaceutical applications, since the US FDA approval of Spritam as a 3D-printed drug. In the present review, we have highlighted the potential benefits of 3DP technology in healthcare, such as the ability to create patient-specific medical devices and implants, as well as the possibility of on-demand production of drugs and personalized dosage forms. We have further discussed future research to optimize 3DP processes and materials for pharmaceutical and biomedical applications. Cohesively, we have put forward the current state of active patents and applications related to 3DP technology in the healthcare and pharmaceutical industries including hearing aids, prostheses, medical devices and drug-delivery systems.

Polysaccharide-based biomaterials in a journey from 3D to 4D printing

3D printing is a state-of-the-art technology for the fabrication of biomaterials with myriad applications in translational medicine. After stimuli-responsive properties were introduced to 3D printing (known as 4D printing), intelligent biomaterials with shape configuration time-dependent character have been developed. Polysaccharides are biodegradable polymers sensitive to several physical, chemical, and biological stimuli, suited for 3D and 4D printing. On the other hand, engineering of mechanical strength and printability of polysaccharide-based scaffolds along with their aneural, avascular, and poor metabolic characteristics need to be optimized varying printing parameters. Multiple disciplines such as biomedicine, chemistry, materials, and computer sciences should be integrated to achieve multipurpose printable biomaterials. In this work, 3D and 4D printing technologies are briefly compared, summarizing the literature on biomaterials engineering though printing techniques, and highlighting different challenges associated with 3D/4D printing, as well as the role of polysaccharides in the technological shift from 3D to 4D printing for translational medicine.

Insight into the Latest Medical Applications of Nanocellulose

Nanocelluloses (NCs) are appealing nanomaterials that have experienced rapid development in recent years, with great potential in the biomedical field. This trend aligns with the increasing demand for sustainable materials, which will contribute both to an improvement in wellbeing and an extension of human life, and with the demand to keep up with advances in medical technology. In recent years, due to the diversity of their physical and biological properties and the possibility of tuning them according to the desired goal, these nanomaterials represent a point of maximum interest in the medical field. Applications such as tissue engineering, drug delivery, wound dressing, medical implants or those in cardiovascular health are some of the applications in which NCs have been successfully used. This review presents insight into the latest medical applications of NCs, in the forms of cellulose nanocrystals (CNCs), cellulose nanofibers (CNFs) and bacterial nanocellulose (BNC), with an emphasis on the domains that have recently experienced remarkable growth, namely wound dressing, tissue engineering and drug delivery. In order to highlight only the most recent achievements, the presented information is focused on studies from the last 3 years. Approaches to the preparation of NCs are discussed either by top-down (chemical or mechanical degradation) or by bottom-up (biosynthesis) techniques, along with their morphological characterization and unique properties, such as mechanical and biological properties. Finally, the main challenges, limitations and future research directions of NCs are identified in a sustained effort to identify their effective use in biomedical fields.

Additive manufacturing of sustainable biomaterials for biomedical applications

Biopolymers are promising environmentally benign materials applicable in multifarious applications. They are especially favorable in implantable biomedical devices thanks to their excellent unique properties, including bioactivity, renewability, bioresorbability, biocompatibility, biodegradability and hydrophilicity. Additive manufacturing (AM) is a flexible and intricate manufacturing technology, which is widely used to fabricate biopolymer-based customized products and structures for advanced healthcare systems. Three-dimensional (3D) printing of these sustainable materials is applied in functional clinical settings including wound dressing, drug delivery systems, medical implants and tissue engineering. The present review highlights recent advancements in different types of biopolymers, such as proteins and polysaccharides, which are employed to develop different biomedical products by using extrusion, vat polymerization, laser and inkjet 3D printing techniques in addition to normal bioprinting and four-dimensional (4D) bioprinting techniques. This review also incorporates the influence of nanoparticles on the biological and mechanical performances of 3D-printed tissue scaffolds. This work also addresses current challenges as well as future developments of environmentally friendly polymeric materials manufactured through the AM techniques. Ideally, there is a need for more focused research on the adequate blending of these biodegradable biopolymers for achieving useful results in targeted biomedical areas. We envision that biopolymer-based 3D-printed composites have the potential to revolutionize the biomedical sector in the near future.

Facile Surface Treatment of 3D-Printed PLA Filter for Enhanced Graphene Oxide Doping and Effective Removal of Cationic Dyes

The structured adsorption filter material is one of the ways to enhance the practical applicability of powdered adsorbents, which have limitations in the real water treatment process due to difficulty in the separation process. In this study, three-dimensional (3D) printing technology was applied to prepare filter materials for water treatment processes. A 3D-printed graphene-oxide (GO)-based adsorbent is prepared on a polylactic acid (PLA) scaffold. The surface of the PLA scaffold was modified by subjecting it to strong alkaline or organic solvent treatment to enhance GO doping for realizing effective adsorption of cationic dye solutions. When subjected to 95% acetone treatment, the structural properties of PLA changed, and particularly, two main hydrophilic functional groups (carboxylic acids and hydroxyls) were newly formed on the PLA through cleavage of the ester bond of the aliphatic polyester. Owing to these changes, the roughness of the PLA surface increased, and its tensile strength decreased. Meanwhile, its surface was doped mainly with GO, resulting in approximately 75% methylene blue (MB) adsorption on the 3D-printed GO-based PLA filter. Based on the established optimal pretreatment conditions, a kinetic MB sorption study and an isotherm study were conducted to evaluate the 3D-printed GO-based PLA filter. The pseudo-second-order model yielded the best fit, and the MB adsorption was better fitted to the Langmuir isotherm. These results suggested that chemical adsorption was the main driver of the reaction, and monolayer sorption occurred on the adsorbent surface. The results of this study highlight the importance of PLA surface modification in enhancing GO doping and achieving effective MB adsorption in aqueous solutions. Ultimately, this study highlights the potential of using 3D printing technology to fabricate the components required for implementing water treatment processes.

Optimising soft tissue in-growth in vivo in additive layer manufactured osseointegrated transcutaneous implants

Osseointegrated transcutaneous implants could provide an alternative and improved means of attaching artificial limbs for amputees, however epithelial down growth, inflammation, and infections are common failure modalities associated with their use. To overcome these problems, a tight seal associated with the epidermal and dermal adhesion to the implant is crucial. This could be achieved with specific biomaterials (that mimic the surrounding tissue), or a tissue-specific design to enhance the proliferation and attachment of dermal fibroblasts and keratinocytes. The intraosseous transcutaneous amputation prosthesis is a new device with a pylon and a flange, which is specifically designed for optimising soft tissue attachment. Previously the flange has been fabricated using traditional machining techniques, however, the advent of additive layer manufacturing (ALM) has enabled 3-dimensional porous flanges with specific pore sizes to be used to optimise soft tissue integration and reduce failure of osseointegrated transcutaneous implants. The study aimed to investigate the effect of ALM-manufactured porous flanges on soft tissue ingrowth and attachment in an in vivo ovine model that replicates an osseointegrated percutaneous implant. At 12 and 24 weeks, epithelial downgrowth, dermal attachment and revascularisation into ALM-manufactured flanges with three different pore sizes were compared with machined controls where the pores were made using conventional drilling. The pore sizes of the ALM flanges were 700, 1000 and 1250 μm. We hypothesised that ALM porous flanges would reduce downgrowth, improve soft tissue integration and revascularisation compared with machined controls. The results supported our hypothesis with significantly greater soft tissue integration and revascularisation in ALM porous flanges compared with machined controls.

Three-Dimensional Culture for In Vitro Folliculogenesis in the Aspect of Methods and Materials

In vitro ovarian follicle culture is a reproduction technique used to obtain fertilizable oocytes, for overcoming fertility issues due to premature ovarian failure. This requires the establishment of an in vitro culture model that is capable of better simulating the in vivo ovarian growth environment. Two-dimensional (2D) culture systems have been successfully set up in rodent models. However, they are not suitable for larger animal models as the follicles of larger animals cultured in 2D culture systems often lose their shape due to dysfunction in the gap junctions. Three-dimensional (3D) culture systems are more suitable for maintaining follicle architecture, and therefore are proposed for the successful in vitro culturing of follicles in various animal models. The role of different methods, scaffolds, and suspension cultures in supporting follicle development has been studied to provide direction for improving in vitro follicle culture technologies. The three major strategies for in vitro 3D follicle cultures are discussed in this article. First, the in vitro culture systems, such as microfluidics, hanging drop, hydrogels, and 3D-printing, are reviewed. We have focused on the 3D hydrogel system as it uses different materials for supporting follicular growth and oocyte maturation in several animal models and in humans. We have also discussed the criteria used for biomaterial evaluations such as solid concentration, elasticity, and rigidity. In addition, future research directions for advancing in vitro 3D follicle culture system are discussed. Impact statement A new frontier in assisted reproductive technology is in vitro tissue or follicle culture, particularly for fertility preservation. The in vitro three-dimensional (3D) culture technique enhances follicular development and provides mature oocytes, overcoming the limitations of traditional in vitro two-dimensional cultures. Polymer biomaterials have good compatibility and retain the physiological structure of follicles in the 3D culture system. Utilizing hybrid in vitro culture materials by merging matrix, hydrogel, and unique patterned materials may facilitate follicular growth in the future.

Advances in Biodegradable Soft Robots

Biodegradable soft robots have been proposed for a variety of intelligent applications in soft robotics, flexible electronics, and bionics. Biodegradability offers an extraordinary functional advantage to soft robots for operations accompanying smart shape transformation in response to external stimuli such as heat, pH, and light. This review primarily surveyed the current advanced scientific and engineering strategies for integrating biodegradable materials within stimuli-responsive soft robots. It also focused on the fabrication methodologies of multiscale biodegradable soft robots, and highlighted the role of biodegradable soft robots in enhancing the multifunctional properties of drug delivery capsules, biopsy tools, smart actuators, and sensors. Lastly, the current challenges and perspectives on the future development of intelligent soft robots for operation in real environments were discussed.

One-Step Preparation of Carboxymethyl Cellulose—Phytic Acid Hydrogels with Potential for Biomedical Applications

Hydrogels based on natural, biodegradable materials have gained considerable interest in the medical field due to their improved drug delivery profiles and tissue-mimicking architecture. In this regard, this study was devoted to the preparation and characterization of new physically crosslinked hydrogels based on carboxymethyl cellulose and an unconventional crosslinking agent, phytic acid. Phytic acid, in addition to its antioxidant and antibacterial effects, can improve the biological properties and stability of gels, without adding toxicity. Fourier transform infrared (FTIR) spectroscopy, rheological studies and thermal analysis confirmed the hydrogel formation. The influence of the ratio between the cellulose derivative and the crosslinker upon the morphological structure and water uptake was evidenced by scanning electron microscopy (SEM) and swelling measurements in simulated body fluids. Furthermore, procaine was entrapped within the hydrogels and used as a model drug for in vitro studies, which highlighted the dependence of the drug release on the phytic acid content of the matrix. The materials demonstrated antibacterial effects against Escherichia coli and Staphylococcus aureus bacteria. The biocompatibility was assessed on fibroblast cells, and according to our results, hydrogels can improve cell viability highlighting the potential of these systems as therapeutic scaffolds for skin tissue engineering.

Three-Dimensional Printing and Its Potential to Develop Sensors for Cancer with Improved Performance

Cancer is the second leading cause of death globally and early diagnosis is the best strategy to reduce mortality risk. Biosensors to detect cancer biomarkers are based on various principles of detection, including electrochemical, optical, electrical, and mechanical measurements. Despite the advances in the identification of biomarkers and the conventional 2D manufacturing processes, detection methods for cancers still require improvements in terms of selectivity and sensitivity, especially for point-of-care diagnosis. Three-dimensional printing may offer the features to produce complex geometries in the design of high-precision, low-cost sensors. Three-dimensional printing, also known as additive manufacturing, allows for the production of sensitive, user-friendly, and semi-automated sensors, whose composition, geometry, and functionality can be controlled. This paper reviews the recent use of 3D printing in biosensors for cancer diagnosis, highlighting the main advantages and advances achieved with this technology. Additionally, the challenges in 3D printing technology for the mass production of high-performance biosensors for cancer diagnosis are addressed.

Recent advances in 3D-printed polylactide and polycaprolactone-based biomaterials for tissue engineering applications

The three-dimensional printing (3DP) also known as the additive manufacturing (AM), a novel and futuristic technology that facilitates the printing of multiscale, biomimetic, intricate cytoarchitecture, function-structure hierarchy, multi-cellular tissues in the complicated micro-environment, patient-specific scaffolds, and medical devices. There is an increasing demand for developing 3D-printed products that can be utilized for organ transplantations due to the organ shortage. Nowadays, the 3DP has gained considerable interest in the tissue engineering (TE) field. Polylactide (PLA) and polycaprolactone (PCL) are exemplary biomaterials with excellent physicochemical properties and biocompatibility, which have drawn notable attraction in tissue regeneration. Herein, the recent advancements in the PLA and PCL biodegradable polymer-based composites as well as their reinforcement with hydrogels and bio-ceramics scaffolds manufactured through 3DP are systematically summarized and the applications of bone, cardiac, neural, vascularized and skin tissue regeneration are thoroughly elucidated. The interaction between implanted biodegradable polymers, in-vivo and in-vitro testing models for possible evaluation of degradation and biological properties are also illustrated. The final section of this review incorporates the current challenges and future opportunities in the 3DP of PCL- and PLA-based composites that will prove helpful for biomedical engineers to fulfill the demands of the clinical field.

From Three-Dimensional (3D)- to 6D-Printing Technology in Orthopedics: Science Fiction or Scientific Reality?

Over the past three decades, additive manufacturing has changed from an innovative technology to an increasingly accessible tool in all aspects of different medical practices, including orthopedics. Although 3D-printing technology offers a relatively inexpensive, rapid and less risky route of manufacturing, it is still quite limited for the fabrication of more complex objects. Over the last few years, stable 3D-printed objects have been converted to smart objects or implants using novel 4D-printing systems. Four-dimensional printing is an advanced process that creates the final object by adding smart materials. Human bones are curved along their axes, a morphological characteristic that augments the mechanical strain caused by external forces. Instead of the three axes used in 4D printing, 5D-printing technology uses five axes, creating curved and more complex objects. Nowadays, 6D-printing technology marries the concepts of 4D- and 5D-printing technology to produce objects that change shape over time in response to external stimuli. In future research, it is obvious that printing technology will include a combination of multi-dimensional printing technology and smart materials. Multi-dimensional additive manufacturing technology will drive the printing dimension to higher levels of structural freedom and printing efficacy, offering promising properties for various orthopedic applications.

A new trend of using poly(vinyl alcohol) in 3D and 4D printing technologies: Process and applications

Recently, 3D/4D printing technologies have been the researchers' interest, and they are getting improved more important. They are applicable in various fields like medical fields, pharmaceutics, construction, tissue engineering, dentistry, water treatment, etc. These technologies overcame the difficulty of the conventional methods in producing complicated structures. They can be fed by different materials such as nanomaterials, smart polymers, responsive polymers, metamaterials, synthetic polymers, natural polymers, and so forth. One of the smart and stimuli-responsive polymers is poly(vinyl alcohol) (PVA). In addition to numerous applications of PVA like medicine, environmental fields, etc., researchers are showing a tendency to use PVA in 3D/4D printing technologies. The main reasons for PVA's increased interest in 3D/4D printing technologies are suitable flowability, stimuli-responsivity, extrudability, biocompatibility, biodegradability, cost-effectiveness, and other features. This review aims to introduce the 3D/4D printing technologies' knowledge and then the applications of PVA as a feed in these novel technologies.

3D Printed Polylactic Acid Well-Plate for Multi-enzyme Immobilization

3D printing is lately utilized in biological sciences under the scope to develop customized scaffolds that will host biomolecules, either whole cells or parts of them, like enzymes. In the present work, we present a protocol to modify the surface of 3D printed polylactic acid (PLA) well-plates with the aim to co-immobilize multiple enzymes that will perform cascade reactions. Detailed steps to design and print the final models are described. The developed protocol for surface modification is based on coating with chitosan biopolymer and covalent immobilization of the enzymes β-glucosidase, glucose oxidase, and peroxidase via glutaraldehyde cross-linking. Enzymatic activity measurements indicative of the catalytic performance of the system are also presented.

Nanocomposite Conductive Bioinks Based on Low-Concentration GelMA and MXene Nanosheets/Gold Nanoparticles Providing Enhanced Printability of Functional Skeletal Muscle Tissues

There is a growing need to develop novel well-characterized biological inks (bioinks) that are customizable for three-dimensional (3D) bioprinting of specific tissue types. Gelatin methacryloyl (GelMA) is one such candidate bioink due to its biocompatibility and tunable mechanical properties. Currently, only low-concentration GelMA hydrogels (≤5% w/v) are suitable as cell-laden bioinks, allowing high cell viability, elongation, and migration. Yet, they offer poor printability. Herein, we optimize GelMA bioinks in terms of concentration and cross-linking time for improved skeletal muscle C2C12 cell spreading in 3D, and we augment these by adding gold nanoparticles (AuNPs) or a two-dimensional (2D) transition metal carbide (MXene nanosheets) for enhanced printability and biological properties. AuNP and MXene addition endowed GelMA with increased conductivity (up to 0.8 ± 0.07 and 0.9 ± 0.12 S/m, respectively, compared to 0.3 ± 0.06 S/m for pure GelMA). Furthermore, it resulted in an improvement of rheological properties and printability, specifically at 10 °C. Improvements in electrical and rheological properties led to enhanced differentiation of encapsulated myoblasts and allowed for printing highly viable (97%) stable constructs. Taken together, these results constitute a significant step toward fabrication of 3D conductive tissue constructs with physiological relevance.

Additive manufacturing technology of polymeric materials for customized products: recent developments and future prospective

The worldwide demand for additive manufacturing (AM) is increasing due to its ability to produce more challenging customized objects based on the process parameters for engineering applications. The processing of conventional materials by AM processes is a critically demanded research stream, which has generated a path-breaking scenario in the rapid manufacturing and upcycling of plastics. The exponential growth of AM in the worldwide polymer market is expected to exceed 20 billion US dollars by 2021 in areas of automotive, medical, aerospace, energy and customized consumer products. The development of functional polymers and composites by 3D printing-based technologies has been explored significantly due to its cost-effective, easier integration into customized geometries, higher efficacy, higher precision, freedom of material utilization as compared to traditional injection molding, and thermoforming techniques. Since polymers are the most explored class of materials in AM to overcome the limitations, this review describes the latest research conducted on petroleum-based polymers and their composites using various AM techniques such as fused filament fabrication (FFF), selective laser sintering (SLS), and stereolithography (SLA) related to 3D printing in engineering applications such as biomedical, automotive, aerospace and electronics.

An Overview of Natural Polymers as Reinforcing Agents for 3D Printing

Three-dimensional (3D) printing, or additive manufacturing, is a group of innovative technologies that are increasingly employed for the production of 3D objects in different fields, including pharmaceutics, engineering, agri-food and medicines. The most processed materials by 3D printing techniques (e.g., fused deposition modelling, FDM; selective laser sintering, SLS; stereolithography, SLA) are polymeric materials since they offer chemical resistance, are low cost and have easy processability. However, one main drawback of using these materials alone (e.g., polylactic acid, PLA) in the manufacturing process is related to the poor mechanical and tensile properties of the final product. To overcome these limitations, fillers can be added to the polymeric matrix during the manufacturing to act as reinforcing agents. These include inorganic or organic materials such as glass, carbon fibers, silicon, ceramic or metals. One emerging approach is the employment of natural polymers (polysaccharides and proteins) as reinforcing agents, which are extracted from plants or obtained from biomasses or agricultural/industrial wastes. The advantages of using these natural materials as fillers for 3D printing are related to their availability together with the possibility of producing printed specimens with a smaller environmental impact and higher biodegradability. Therefore, they represent a “green option” for 3D printing processing, and many studies have been published in the last year to evaluate their ability to improve the mechanical properties of 3D printed objects. The present review provides an overview of the recent literature regarding natural polymers as reinforcing agents for 3D printing.

4D printing in biomedical applications: emerging trends and technologies

Nature's material systems during evolution have developed the ability to respond and adapt to environmental stimuli through the generation of complex structures capable of varying their functions across direction, distances and time. 3D printing technologies can recapitulate structural motifs present in natural materials, and efforts are currently being made on the technological side to improve printing resolution, shape fidelity, and printing speed. However, an intrinsic limitation of this technology is that printed objects are static and thus inadequate to dynamically reshape when subjected to external stimuli. In recent years, this issue has been addressed with the design and precise deployment of smart materials that can undergo a programmed morphing in response to a stimulus. The term 4D printing was coined to indicate the combined use of additive manufacturing, smart materials, and careful design of appropriate geometries. In this review, we report the recent progress in the design and development of smart materials that are actuated by different stimuli and their exploitation within additive manufacturing to produce biomimetic structures with important repercussions in different but interrelated biomedical areas.

A Critical Review on Polymeric Biomaterials for Biomedical Applications

Natural and synthetic polymers have been explored for many years in the field of tissue engineering and regeneration. Researchers have developed many new strategies to design successful advanced polymeric biomaterials. In this review, we summarized the recent notable advancements in the preparation of smart polymeric biomaterials with self-healing and shape memory properties. We also discussed novel approaches used to develop different forms of polymeric biomaterials such as films, hydrogels and 3D printable biomaterials. In each part, the applications of the biomaterials in soft and hard tissue engineering with their in vitro and in vivo effects are underlined. The future direction of the polymeric biomaterials that could pave a path towards successful clinical implications is also underlined in this review.

Mesenchymal Stem Cells, Bioactive Factors, and Scaffolds in Bone Repair: From Research Perspectives to Clinical Practice

Mesenchymal stem cell-based therapies are promising tools for bone tissue regeneration. However, tracking cells and maintaining them in the site of injury is difficult. A potential solution is to seed the cells onto a biocompatible scaffold. Construct development in bone tissue engineering is a complex step-by-step process with many variables to be optimized, such as stem cell source, osteogenic molecular factors, scaffold design, and an appropriate in vivo animal model. In this review, an MSC-based tissue engineering approach for bone repair is reported. Firstly, MSC role in bone formation and regeneration is detailed. Secondly, MSC-based bone tissue biomaterial design is analyzed from a research perspective. Finally, examples of animal preclinical and human clinical trials involving MSCs and scaffolds in bone repair are presented.

Single-Step Fabrication Method toward 3D Printing Composite Diamond-Titanium Interfaces for Neural Applications

Owing to several key attributes, diamond is an attractive candidate material for neural interfacing electrodes. The emergence of additive-manufacturing (AM) of diamond-based materials has addressed multiple challenges associated with the fabrication of diamond electrodes using the conventional chemical vapor deposition (CVD) approach. Unlike the CVD approach, AM methods have enabled the deposition of three-dimensional diamond-based material at room temperature. This work demonstrates the feasibility of using laser metal deposition to fabricate diamond-titanium hybrid electrodes for neuronal interfacing. In addition to exhibiting a high electrochemical capacitance of 1.1 mF cm^-2 and a low electrochemical impedance of 1 kΩ cm² at 1 kHz in physiological saline, these electrodes exhibit a high degree of biocompatibility assessed in vitro using cortical neurons. Furthermore, surface characterization methods show the presence of an oxygen-rich mixed-phase diamond-titanium surface along the grain boundaries. Overall, we demonstrated that our unique approach facilitates printing biocompatible titanium-diamond site-specific coating-free conductive hybrid surfaces using AM, which paves the way to printing customized electrodes and interfacing implantable medical devices.

Fabrication of Drug-Eluting Polycaprolactone/poly(lactic-co-glycolic Acid) Prolapse Mats Using Solution-Extrusion 3D Printing and Coaxial Electrospinning Techniques

We developed biodegradable drug-eluting prolapse mats using solution-extrusion 3D printing and coaxial electrospinning techniques. The mats were composed of polycaprolactone (PCL) mesh and lidocaine-, estradiol-, metronidazole-, and connective tissue growth factor (CTGF)-incorporated poly(lactic-co-glycolic acid) (PLGA) nanofibers that mimic the structure of the natural extracellular matrix of most connective tissues. The mechanical properties of degradable prolapse membrane were assessed and compared to commercial non-degradable polypropylene knitted meshes clinically used for pelvic organ prolapse (POP) repair. The release behaviors of the drug-loaded hybrid degradable membranes were also characterized. The experimental results suggest that 3D-printed PCL meshes exhibited comparable strengths to commercial POP meshes and survived through 10,000 cycles of fatigue test without breakage. Hybrid PCL meshes/PLGA nanofibrous membranes provided a sustainable release of metronidazole, lidocaine, and estradiol for 4, 25, and 30 days, respectively, in vitro. The membranes further liberated high levels of CTGF for more than 30 days. The animal tests show that the mechanical property of PCL mesh decreased with time, mainly due to degradation of the polymers post-implantation. No adverse effect of the mesh/nanofibers was noted in the histological images. By adopting solution-extrusion 3D printing and coaxial electrospinning, degradable drug-eluting membranes can be fabricated for POP applications.

Design and Additive Manufacturing of a Biomimetic Customized Cranial Implant Based on Voronoi Diagram

Reconstruction of cranial defects is an arduous task for craniomaxillofacial surgeons. Additive manufacturing (AM) or three-dimensional (3D) printing of titanium patient-specific implants (PSIs) made its way into cranioplasty, improving the clinical outcomes in complex surgical procedures. There has been a significant interest within the medical community in redesigning implants based on natural analogies. This paper proposes a workflow to create a biomimetic patient-specific cranial prosthesis with an interconnected strut macrostructure mimicking bone trabeculae. The method implements an interactive generative design approach based on the Voronoi diagram or tessellations. Furthermore, the quasi-self-supporting fabrication feasibility of the biomimetic, lightweight titanium cranial prosthesis design is assessed using Selective Laser Melting (SLM) technology.

Extrusion-Based 3D Printing Applications of PLA Composites: A Review

Polylactic acid (PLA) is the most widely used raw material in extrusion-based three-dimensional (3D) printing (fused deposition modeling, FDM approach) in many areas since it is biodegradable and environmentally friendly, however its utilization is limited due to some of its disadvantages such as mechanical weakness, water solubility rate, etc. FDM is a simple and more cost-effective fabrication process compared to other 3D printing techniques. Unfortunately, there are deficiencies of the FDM approach, such as mechanical weakness of the FDM parts compared to the parts produced by the conventional injection and compression molding methods. Preparation of PLA composites with suitable additives is the most useful technique to improve the properties of the 3D-printed PLA parts obtained by the FDM method. In the last decade, newly developed PLA composites find large usage areas both in academic and industrial circles. This review focuses on the chemistry and properties of pure PLA and also the preparation methods of the PLA composites which will be used as a raw material in 3D printers. The main drawbacks of the pure PLA filaments and the necessity for the preparation of PLA composites which will be employed in the FDM-based 3D printing applications is also discussed in the first part. The current methods to obtain PLA composites as raw materials to be used as filaments in the extrusion-based 3D printing are given in the second part. The applications of the novel PLA composites by utilizing the FDM-based 3D printing technology in the fields of biomedical, tissue engineering, human bone repair, antibacterial, bioprinting, electrical conductivity, electromagnetic, sensor, battery, automotive, aviation, four-dimensional (4D) printing, smart textile, environmental, and luminescence applications are presented and critically discussed in the third part of this review.

Short-Pulse Lasers: A Versatile Tool in Creating Novel Nano-/Micro-Structures and Compositional Analysis for Healthcare and Wellbeing Challenges

Driven by flexibility, precision, repeatability and eco-friendliness, laser-based technologies have attracted great interest to engineer or to analyze materials in various fields including energy, environment, biology and medicine. A major advantage of laser processing relies on the ability to directly structure matter at different scales and to prepare novel materials with unique physical and chemical properties. It is also a contact-free approach that makes it possible to work in inert or reactive liquid or gaseous environment. This leads today to a unique opportunity for designing, fabricating and even analyzing novel complex bio-systems. To illustrate this potential, in this paper, we gather our recent research on four types of laser-based methods relevant for nano-/micro-scale applications. First, we present and discuss pulsed laser ablation in liquid, exploited today for synthetizing ultraclean "bare" nanoparticles attractive for medicine and tissue engineering applications. Second, we discuss robust methods for rapid surface and bulk machining (subtractive manufacturing) at different scales by laser ablation. Among them, the microsphere-assisted laser surface engineering is detailed for its appropriateness to design structured substrates with hierarchically periodic patterns at nano-/micro-scale without chemical treatments. Third, we address the laser-induced forward transfer, a technology based on direct laser printing, to transfer and assemble a multitude of materials (additive structuring), including biological moiety without alteration of functionality. Finally, the fourth method is about chemical analysis: we present the potential of laser-induced breakdown spectroscopy, providing a unique tool for contact-free and space-resolved elemental analysis of organic materials. Overall, we present and discuss the prospect and complementarity of emerging reliable laser technologies, to address challenges in materials' preparation relevant for the development of innovative multi-scale and multi-material platforms for bio-applications.

UV-Assisted 3D Printing of Polymer Composites from Thermally and Mechanically Recycled Carbon Fibers

Despite the growing global interest in 3D printed carbon fiber reinforced polymers, most of the applications are still limited to high-performance sectors due to the low effectiveness-cost ratio of virgin carbon fibers. However, the use of recycled carbon fibers in 3D printing is almost unexplored, especially for thermoset-based composites. This paper aims to demonstrate the feasibility of recycled carbon fibers 3D printing via UV-assisted direct ink writing. Pyrolyzed recycled carbon fibers with a sizing treatment were firstly shredded to be used as a reinforcement of a thermally and photo-curable acrylic resin. UV-differential scanning calorimetry analyses were then performed to define the material crosslinking of the 3D printable ink. Because of the poor UV reactivity of the resin loaded with carbon fibers, a rheology modifier was added to guarantee shape retention after 3D printing. Thanks to a customized 3D printer based on a commercial apparatus, a batch of specimens was successfully 3D printed. According to the tensile tests and Scanning Electron Microscopy analysis, the material shows good mechanical properties and the absence of layer marks related to the 3D printing. These results will, therefore, pave the way for the use of 3D printed recycled carbon fiber reinforced polymers in new fields of application.

Chitosan based-nanoparticles and nanocapsules: Overview, physicochemical features, applications of a nanofibrous scaffold, and bioprinting

Recent advancements in the synthesis, properties, and applications of chitosan as the second after cellulose available biopolymer in nature were discussed in this review. A general overview of processing and production procedures from A to Z was highlighted. Chitosan exists in three polymorphic forms which differ in degree of crystallinity (α, β, and γ). Thus, the degree of deacetylation, crystallinity, surface area, and molecular mass significantly affect most applications. Otherwise, the synthesis of chitosan nanofibers is suffering from many drawbacks that were recently treated by co-electrospun with other polymers such as polyvinyl alcohol (PVA), polyethylene oxide (PEO), and polycaprolactone (PCL). Ultimately, this review focuses on the area of new trend utilization of chitosan nanoparticles as nanospheres and nanocapsules, in cartilage and bone regenerative medicine. Owing to its biocompatibility, bioavailability, biodegradability, and costless synthesis, chitosan is a promising biopolymeric structure for water remediation, drug delivery, antimicrobials, and tissue engineering.

New horizons for carbon dots: quantum nano-photoinitiating catalysts for cationic photopolymerization and three-dimensional (3D) printing under visible light

Citric acid-based carbon dots (CDs) as nano-photoinitiating catalysts for 3D printing.

Synthetic Polymeric Materials for Bone Replacement

Some treatment options available to repair bone defects are the use of autogenous and allogeneic bone grafts. The drawback of the first one is the donor site’s limitation and the need for a second operation on the same patient. In the allograft method, the problems are associated with transmitted diseases and high susceptibility to rejection. As an alternative to biological grafts, polymers can be used in bone repair. Some polymers used in the orthopedic field are poly(methyl methacrylate), poly(ether-ether-ketone), and ultra-high molecular weight polyethylene (UHMWPE). UHMWPE has drawn much attention since it combines low friction coefficient and high wear and impact resistance. However, UHMWPE is a bioinert material, which means that it does not interact with the bone tissue. UHMWPE composites and nanocomposites with hydroxyapatite (HA) are widely studied in the literature to mitigate these issues. HA is the main component of the inorganic phase in the natural bone, and the addition of this bioactive filler to the polymeric matrix aims to mimic bone composition. This brief review discusses some polymers used in orthopedic applications, focusing on the UHMWPE/HA composites as a potential bone substitute.

3D printing technology as innovative solutions for biomedical applications

3D printing was once predicted to be the third industrial revolution. Today, the use of 3D printing is found across almost all industries. This article discusses the latest 3D printing applications in the biomedical industry.

Polyelectrolyte Multilayer Capsule (PEMC)-Based Scaffolds for Tissue Engineering

Tissue engineering (TE) is a highly multidisciplinary field that focuses on novel regenerative treatments and seeks to tackle problems relating to tissue growth both in vitro and in vivo. These issues currently involve the replacement and regeneration of defective tissues, as well as drug testing and other related bioapplications. The key approach in TE is to employ artificial structures (scaffolds) to support tissue development; these constructs should be capable of hosting, protecting and releasing bioactives that guide cellular behaviour. A straightforward approach to integrating bioactives into the scaffolds is discussed utilising polyelectrolyte multilayer capsules (PEMCs). Herein, this review illustrates the recent progress in the use of CaCO3 vaterite-templated PEMCs for the fabrication of functional scaffolds for TE applications, including bone TE as one of the main targets of PEMCs. Approaches for PEMC integration into scaffolds is addressed, taking into account the formulation, advantages, and disadvantages of such PEMCs, together with future perspectives of such architectures.

3D Printing Technologies: Recent Development and Emerging Applications in Various Drug Delivery Systems

The 3D printing is considered as an emerging digitized technology that could act as a key driving factor for the future advancement and precise manufacturing of personalized dosage forms, regenerative medicine, prosthesis and implantable medical devices. Tailoring the size, shape and drug release profile from various drug delivery systems can be beneficial for special populations such as paediatrics, pregnant women and geriatrics with unique or changing medical needs. This review summarizes various types of 3D printing technologies with advantages and limitations particularly in the area of pharmaceutical research. The applications of 3D printing in tablets, films, liquids, gastroretentive, colon, transdermal and intrauterine drug delivery systems as well as medical devices have been briefed. Due to the novelty and distinct features, 3D printing has the inherent capacity to solve many formulation and drug delivery challenges, which are frequently associated with poorly aqueous soluble drugs. Recent approval of Spritam® and publication of USFDA technical guidance on additive manufacturing related to medical devices has led to an extensive research in various field of drug delivery systems and bioengineering. The 3D printing technology could be successfully implemented from pre-clinical phase to first-in-human trials as well as on-site production of customized formulation at the point of care having excellent dose flexibility. Advent of innovative 3D printing machineries with built-in flexibility and quality with the introduction of new regulatory guidelines would rapidly integrate and revolutionize conventional pharmaceutical manufacturing sector.