Concentrated hydroxyapatite inks for direct-write assembly of 3-D periodic scaffolds

Toughening 3D printed biomimetic hydroxyapatite scaffolds: Polycaprolactone-based self-hardening inks

The application of 3D printing to calcium phosphates has opened unprecedented possibilities for the fabrication of personalized bone grafts. However, their biocompatibility and bioactivity are counterbalanced by their high brittleness. In this work we aim at overcoming this problem by developing a self-hardening ink containing reactive ceramic particles in a polycaprolactone solution instead of the traditional approach that use hydrogels as binders. The presence of polycaprolactone preserved the printability of the ink and was compatible with the hydrolysis-based hardening process, despite the absence of water in the ink and its hydrophobicity. The microstructure evolved from a continuous polymeric phase with loose ceramic particles to a continuous network of hydroxyapatite nanocrystals intertwined with the polymer, in a configuration radically different from the polymer/ceramic composites obtained by fused deposition modelling. This resulted in the evolution from a ductile behavior, dominated by the polymer, to a stiffer behavior as the ceramic phase reacted. The polycaprolactone binder provides two highly relevant benefits compared to hydrogel-based inks. First, the handleability and elasticity of the as-printed scaffolds, together with the proven possibility of eliminating the solvent, opens the door to implanting the scaffolds freshly printed once lyophilized, while in a ductile state, and the hardening process to take place inside the body, as in the case of calcium phosphate cements. Second, even with a hydroxyapatite content of more than 92 wt.%, the flexural strength and toughness of the scaffolds after hardening are twice and five times those of the all-ceramic scaffolds obtained with the hydrogel-based inks, respectively. STATEMENT OF SIGNIFICANCE: Overcoming the brittleness of ceramic scaffolds would extend the applicability of synthetic bone grafts to high load-bearing situations. In this work we developed a 3D printing ink by replacing the conventional hydrogel binder with a water-free polycaprolactone solution. The presence of polycaprolactone not only enhanced significantly the strength and toughness of the scaffolds while keeping the proportion of bioactive ceramic phase larger than 90 wt.%, but it also conferred flexibility and manipulability to the as-printed scaffolds. Since they are able to harden upon contact with water under physiological conditions, this opens up the possibility of implanting them immediately after printing, while they are still in a ductile state, with clear advantages for fixation and press-fit in the bone defect.

3D Printing of Dental Prostheses: Current and Emerging Applications

Revolutionary fabrication technologies such as three-dimensional (3D) printing to develop dental structures are expected to replace traditional methods due to their ability to establish constructs with the required mechanical properties and detailed structures. Three-dimensional printing, as an additive manufacturing approach, has the potential to rapidly fabricate complex dental prostheses by employing a bottom-up strategy in a layer-by-layer fashion. This new technology allows dentists to extend their degree of freedom in selecting, creating, and performing the required treatments. Three-dimensional printing has been narrowly employed in the fabrication of various kinds of prostheses and implants. There is still an on-demand production procedure that offers a reasonable method with superior efficiency to engineer multifaceted dental constructs. This review article aims to cover the most recent applications of 3D printing techniques in the manufacturing of dental prosthetics. More specifically, after describing various 3D printing techniques and their advantages/disadvantages, the applications of 3D printing in dental prostheses are elaborated in various examples in the literature. Different 3D printing techniques have the capability to use different materials, including thermoplastic polymers, ceramics, and metals with distinctive suitability for dental applications, which are discussed in this article. The relevant limitations and challenges that currently limit the efficacy of 3D printing in this field are also reviewed. This review article has employed five major scientific databases, including Google Scholar, PubMed, ScienceDirect, Web of Science, and Scopus, with appropriate keywords to find the most relevant literature in the subject of dental prostheses 3D printing.

Hierarchical Porous Ceramics with Distinctive Microstructures by Emulsion-Based Direct Ink Writing

Hierarchical porous materials are ubiquitous in nature and have inspired the fabrication of cellular structures for a multitude of applications. As an extrusion-based 3D printing technique, direct ink writing (DIW) allows for customizable design and accurate control of printed structures. Recently, its combination with colloidal processing methods used for bulk porous ceramics, such as emulsion templating, has further extended its capability of fabricating porous ceramics across multiple length scales. In light of the recent development, the ink formulation for emulsion-based DIW can be further explored, and there is still a need for a better understanding of the structure-property relationship. Herein, we introduce two types of gelling additives, i.e., poly(ethylenimine) (PEI) and Pluronic F-127, respectively, into particle-stabilized emulsions and fabricate hierarchical porous alumina lattices by DIW. We discover that the two gelling additives can lead to distinctive microstructures due to their different gelling mechanisms. Moreover, the 3D printed hierarchical porous ceramic lattices are found to exhibit a potential energy absorption property. The effects of ink formulations, including gelling additives and solid loading, on ink rheology, microstructure, and mechanical properties are investigated. The 3D printed hierarchical porous ceramic lattices exhibit a high average porosity of 73.7%-79.3% with an average compressive strength of 1.53-9.61 MPa and a specific energy absorption of 0.33-2.67 J/g. Featuring two distinctive microstructures with tunable structural features and mechanical properties, the 3D printed hierarchical porous ceramics in this study have potential in many applications, including lightweight structures, tissue engineering scaffolds, filtration, etc.

Direct Ink Writing: A 3D Printing Technology for Diverse Materials

Additive manufacturing (AM) has gained significant attention due to its ability to drive technological development as a sustainable, flexible, and customizable manufacturing scheme. Among the various AM techniques, direct ink writing (DIW) has emerged as the most versatile 3D printing technique for the broadest range of materials. DIW allows printing of practically any material, as long as the precursor ink can be engineered to demonstrate appropriate rheological behavior. This technique acts as a unique pathway to introduce design freedom, multifunctionality, and stability simultaneously into its printed structures. Here, a comprehensive review of DIW of complex 3D structures from various materials, including polymers, ceramics, glass, cement, graphene, metals, and their combinations through multimaterial printing is presented. The review begins with an overview of the fundamentals of ink rheology, followed by an in-depth discussion of the various methods to tailor the ink for DIW of different classes of materials. Then, the diverse applications of DIW ranging from electronics to food to biomedical industries are discussed. Finally, the current challenges and limitations of this technique are highlighted, followed by its prospects as a guideline toward possible futuristic innovations.

Comprehensive Review on Design and Manufacturing of Bio-scaffolds for Bone Reconstruction

Bio-scaffolds are synthetic entities widely employed in bone and soft-tissue regeneration applications. These bio-scaffolds are applied to the defect site to provide support and favor cell attachment and growth, thereby enhancing the regeneration of the defective site. The progressive research in bio-scaffold fabrication has led to identification of biocompatible and mechanically stable materials. The difficulties in obtaining grafts and expenditure incurred in the transplantation procedures have also been overcome by the implantation of bio-scaffolds. Drugs, cells, growth factors, and biomolecules can be embedded with bio-scaffolds to provide localized treatments. The right choice of materials and fabrication approaches can help in developing bio-scaffolds with required properties. This review mostly focuses on the available materials and bio-scaffold techniques for bone and soft-tissue regeneration application. The first part of this review gives insight into the various classes of biomaterials involved in bio-scaffold fabrication followed by design and simulation techniques. The latter discusses the various additive, subtractive, hybrid, and other improved techniques involved in the development of bio-scaffolds for bone regeneration applications. Techniques involving multimaterial printing and multidimensional printing have also been briefly discussed.

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.

Three-Dimensional Printing of Hydroxyapatite Composites for Biomedical Application

Hydroxyapatite (HA) and HA-based nanocomposites have been recognized as ideal biomaterials in hard tissue engineering because of their compositional similarity to bioapatite. However, the traditional HA-based nanocomposites fabrication techniques still limit the utilization of HA in bone, cartilage, dental, applications, and other fields. In recent years, three-dimensional (3D) printing has been shown to provide a fast, precise, controllable, and scalable fabrication approach for the synthesis of HA-based scaffolds. This review therefore explores available 3D printing technologies for the preparation of porous HA-based nanocomposites. In the present review, different 3D printed HA-based scaffolds composited with natural polymers and/or synthetic polymers are discussed. Furthermore, the desired properties of HA-based composites via 3D printing such as porosity, mechanical properties, biodegradability, and antibacterial properties are extensively explored. Lastly, the applications and the next generation of HA-based nanocomposites for tissue engineering are discussed.

Dental 3D-Printing: Transferring Art from the Laboratories to the Clinics

The rise of three-dimensional (3D) printing technology has changed the face of dentistry over the past decade. 3D printing is a versatile technique that allows the fabrication of fully automated, tailor-made treatment plans, thereby delivering personalized dental devices and aids to the patients. It is highly efficient, reproducible, and provides fast and accurate results in an affordable manner. With persistent efforts among dentists for refining their practice, dental clinics are now acclimatizing from conventional treatment methods to a fully digital workflow to treat their patients. Apart from its clinical success, 3D printing techniques are now employed in developing haptic simulators, precise models for dental education, including patient awareness. In this narrative review, we discuss the evolution and current trends in 3D printing applications among various areas of dentistry. We aim to focus on the process of the digital workflow used in the clinical diagnosis of different dental conditions and how they are transferred from laboratories to clinics. A brief outlook on the most recent manufacturing methods of 3D printed objects and their current and future implications are also discussed.

Robocasting of Single and Multi-Functional Calcium Phosphate Scaffolds and Its Hybridization with Conventional Techniques: Design, Fabrication and Characterization

In this work, dense, porous, and, for the first time, functionally-graded bi-layer scaffolds with a cylindrical geometry were produced from a commercially available hydroxyapatite powder using the robocasting technique. The bi-layer scaffolds were made of a dense core part attached to a surrounding porous part. Subsequently, these bi-layer robocast scaffolds were joined with an outer shell of an antibacterial porous polymer layer fabricated by solvent casting/salt leaching techniques, leading to hybrid ceramic-polymer scaffolds. The antibacterial functionality was achieved through the addition of silver ions to the polymer layer. All the robocast samples, including the bi-layer ones, were first characterized through scanning electron microscopy observations, mechanical characterization in compression and preliminary bioactivity tests. Then, the hybrid bi-layer ceramic-polymer scaffolds were characterized through antimicrobial tests. After sintering at 1300 °C for 3 h, the compressive strengths of the structures were found to be equal to 29 ± 4 MPa for dense samples and 7 ± 4 MPa for lattice structures with a porosity of 34.1%. Bioactivity tests performed at 37 °C for 4 weeks showed that the precipitated layer on the robocast samples contained octacalcium phosphate. Finally, it was evidenced that the hybrid structure was effective in releasing antibacterial Ag+ ions to the surrounding medium showing its potential efficiency in limiting Staphylococcus aureus proliferation during surgery.

Recent additive manufacturing methods categorized by characteristics of ceramic slurries for producing dual-scale porous ceramics

Porous ceramics have been utilized in various fields due to their advantages derived from characteristics of ceramics and porous structure and they were produced by versatile fabricating methods. However, the adoption of differently scaled pores in the porous ceramics by conventional pore forming strategies which results in dual-scale porosity has been studied to combine the specific functional abilities of each scaled pore. Those proposed strategies were supplemented to the recent additive manufacturing methods for constructing complicated structure with precisely controlled fabricating conditions. In this review, we provide the researches creating dual-scale porous ceramics with additive manufacturing which utilized the ceramic slurries containing homogeneous solution of photocurable monomers and terpenes. Introduction of the basic way to prepare photocurable monomer and terpene incorporated ceramic slurries which are suitable for specific printing mechanism was firstly discussed. And based on the characteristics of slurries, lithography-based and extrusion-based method are discussed with the experimental results. Subsequently, the remaining challenges of the techniques are further discussed with suggesting potentially capable approaches to overcome the limitations.

Biological Responses of Ceramic Bone Spacers Produced by Green Processing of Additively Manufactured Thin Meshes

Bone spacers are exclusively used for replacing the tissue after trauma and/or diseases. Ceramic materials bring positive opportunities to enhance greater osteointegration and performance of implants, yet processing of porous geometries can be challenging. Additive Manufacturing (AM) opens opportunities to grade porosity levels in a part; however, its productivity may be low due to its batch processing approach. The paper studies the biological responses yielded by hydroxyapatite with β-TCP (tricalcium phosphate) ceramic porous bone spacers manufactured by robocasting 2-layer meshes that are rolled in green and sintered. The implants are assessed in vitro and in vivo for their compatibility. Human bone marrow mesenchymal stem cells attached, proliferated and differentiated on the bone spacers produced. Cells on the spacers presented alkaline phosphatase staining, confirming osteogenic differentiation. They also expressed bone-specific COL1A1, BGAP, BSP, and SPP1 genes. The fold change of these genes ranged between 8 to 16 folds compared to controls. When implanted into the subcutaneous tissue of rabbits, they triggered collagen fibre formation and mild fibroblastic proliferation. In conclusion, rolled AM-meshes bone spacers stimulated bone formation in vitro and were biocompatible in vivo. This technology may give the advantage to custom produce spacers at high production rates if industrially upscaled.

Future of dental biomaterials: Gazing into Bob's crystal ball

In February 2019, the American Prosthodontics Society asked me to "ponder" the future of dental biomaterials. This talk was titled, "Gazing Into Bob's Crystal Ball". My basic approach was guided by the words of Confucius, "Study the past if you would define the future." As I have often studied and lectured on how many of our important materials got into dentistry, it was a natural assignment. In this article, I review how key materials came to be used in dental practice and organize these "sources" into an extended classification, assuming future materials will likely derive from one of these. Then, I identify important examples in each category and then expound on likely future developments, some already in progress. These include increasing the use of and benefiting from automated systems; better engineering with existing materials by means of failure analysis (from clinically retrieved specimens); iterative improvements in materials and practices, again based on observations from clinical behavior; the use of scaffolds for both hard- and soft-tissue repair; and the development of "smart" materials. I hope this contribution survives the test of time. Please note that, importantly, this list includes not just materials but often-overlooked steps in processing that will affect their properties and clinical durability.

Reconstruction of Large Skeletal Defects: Current Clinical Therapeutic Strategies and Future Directions Using 3D Printing

The healing of bone fractures is a well-orchestrated physiological process involving multiple cell types and signaling molecules interacting at the fracture site to replace and repair bone tissue without scar formation. However, when the lesion is too large, normal healing is compromised. These so-called non-union bone fractures, mostly arising due to trauma, tumor resection or disease, represent a major therapeutic challenge for orthopedic and reconstructive surgeons. In this review, we firstly present the current commonly employed surgical strategies comprising auto-, allo-, and xenograft transplantations, as well as synthetic biomaterials. Further to this, we discuss the multiple factors influencing the effectiveness of the reconstructive therapy. One essential parameter is adequate vascularization that ensures the vitality of the bone grafts thereby supporting the regeneration process, however deficient vascularization presents a frequently encountered problem in current management strategies. To address this challenge, vascularized bone grafts, including free or pedicled fibula flaps, or in situ approaches using the Masquelet induced membrane, or the patient’s body as a bioreactor, comprise feasible alternatives. Finally, we highlight future directions and novel strategies such as 3D printing and bioprinting which could overcome some of the current challenges in the field of bone defect reconstruction, with the benefit of fabricating personalized and vascularized scaffolds.

Development and thorough characterization of the processing steps of an ink for 3D printing for bone tissue engineering

Achieving reproducibility in the 3D printing of biomaterials requires a robust polymer synthesis method to reduce batch-to-batch variation as well as methods to assure a thorough characterization throughout the manufacturing process. Particularly biomaterial inks containing large solid fractions such as ceramic particles, often required for bone tissue engineering applications, are prone to inhomogeneity originating from inadequate mixing or particle aggregation which can lead to inconsistent printing results. The production of such an ink for bone tissue engineering consisting of gellan gum methacrylate (GG-MA), hyaluronic acid methacrylate and hydroxyapatite (HAp) particles was therefore optimized in terms of GG-MA synthesis and ink preparation process, and the ink's printability was thoroughly characterized to assure homogeneous and reproducible printing results. A new buffer mediated synthesis method for GG-MA resulted in consistent degrees of substitution which allowed the creation of large 5 g batches. We found that both the new synthesis as well as cryomilling of the polymer components of the ink resulted in a decrease in viscosity from 113 kPa·s to 11.3 kPa·s at a shear rate of 0.1 s^-1 but increased ink homogeneity. The ink homogeneity was assessed through thermogravimetric analysis and a newly developed extrusion force measurement setup. The ink displayed strong inter-layer adhesion between two printed ink layers as well as between a layer of ink with and a layer without HAp. The large polymer batch production along with the characterization of the ink during the manufacturing process allows ink production in the gram scale and could be used in applications such as the printing of osteochondral grafts.

3D Printing of Bioceramic Scaffolds-Barriers to the Clinical Translation: From Promise to Reality, and Future Perspectives

In this review, we summarize the challenges of the three-dimensional (3D) printing of porous bioceramics and their translational hurdles to clinical applications. The state-of-the-art of the major 3D printing techniques (powder-based and slurry-based), their limitations and key processing parameters are discussed in detail. The significant roadblocks that prevent implementation of 3D printed bioceramics in tissue engineering strategies, and medical applications are outlined, and the future directions where new research may overcome the limitations are proposed. In recent years, there has been an increasing demand for a nanoscale control in 3D fabrication of bioceramic scaffolds via emerging techniques such as digital light processing, two-photon polymerization, or large area maskless photopolymerization. However, these techniques are still in a developmental stage and not capable of fabrication of large-sized bioceramic scaffolds; thus, there is a lack of sufficient data to evaluate their contribution. This review will also not cover polymer matrix composites reinforced with particulate bioceramics, hydrogels reinforced with particulate bioceramics, polymers coated with bioceramics and non-porous bioceramics.

3D plotting in the preparation of newberyite, struvite, and brushite porous scaffolds: using magnesium oxide as a starting material

Calcium phosphate (CaP)-containing materials, such as hydroxyapatite and brushite, are well studied bone grafting materials owing to their similar chemical compositions to the mineral phase of natural bone and kidney calculi. In recent studies, magnesium phosphate (MgP)-containing compounds, such as newberyite and struvite, have shown promise as alternatives to CaP. However, the different ways in degradation and release of Mg²⁺ and Ca²⁺ ions in vitro may affect the biocompatibility of CaP and MgP-containing compounds. In the present paper, newberyite, struvite, and brushite 3D porous structures were constructed by 3D-plotting combining with a two-step cementation process, using magnesium oxide (MgO) as a starting material. Briefly, 3D porous green bodies fabricated by 3D-plotting were soaked in (NH₄)₂HPO₄ solution to form semi-manufactured 3D porous structures. These structures were then soaked in different phosphate solutions to translate the structures into newberyite, struvite, and brushite porous scaffolds. Powder X-ray diffraction (XRD), scanning electron microscopy (SEM), and energy dispersive spectrometry (EDS) were used to characterize the phases, morphologies, and compositions of the 3D porous scaffolds. The porosity, compressive strength, in vitro degradation and cytotoxicity on MC3T3-E1 osteoblast cells were assessed as well. The results showed that extracts obtained from immersing scaffolds in alpha-modified essential media induced minimal cytotoxicity and the cells could be attached merely onto newberyite and brushite scaffolds. Newberyite and brushite scaffolds produced through our 3D-plotting and two-step cementation process showed the sustained in vitro degradation and excellent biocompatibility, which could be used as scaffolds for the bone tissue engineering.

Long Liquid Crystal Elastomer Fibers with Large Reversible Actuation Strains for Smart Textiles and Artificial Muscles

A method for fabricating long, soft, and reversibly actuatable liquid crystal elastomer (LCE) fibers by using direct ink write (DIW) printing was developed. Here, the LCE was produced based on a two-stage thermal-photo curing reaction between a difunctional acrylate monomer and thiol. The LCE ink, mixed with nanoclay to increase the viscosity, was extruded through a nozzle onto a rotating mandrel to obtain a long fiber. After printing, the fiber was first thermally cured on the mandrel, then mechanically stretched, and photocured to achieve liquid crystal chain alignment for stress-free reversible activation. Upon optimizing the ink viscosity and DIW printing parameters, long fibers (up to 1.5 m long from the laboratory) were obtained. The resulting fiber had a modulus of 2 MPa, 51% actuation strain, and a failure strain of well over 100%. The potential of these fibers for applications was demonstrated. The LCE fibers were knit, sewn, and woven to form a variety of smart textiles. The fiber was also used to mimic bicep muscles with both large activation force and activation strain. By incorporating further intelligent characteristics, such as conductivity and biosensing into a single fiber, the LCE fibers could be potentially used for smart clothing, soft robotics, and biomedical devices.

Mineralization in micropores of calcium phosphate scaffolds

With the increasing demand for novel bone repair solutions that overcome the drawbacks of current grafting techniques, the design of artificial bone scaffolds is a central focus in bone regeneration research. Calcium phosphate scaffolds are interesting given their compositional similarity with bone mineral. The majority of studies focus on bone growth in the macropores (>100 µm) of implanted calcium phosphate scaffolds where bone structures such as osteons and trabeculae can form. However, a growing body of research shows that micropores (<50 µm) play an important role not only in improving bone growth in the macropores, but also in providing additional space for bone growth. Bone growth in the micropores of calcium phosphate scaffolds offers major mechanical advantages as it improves the mechanical properties of the otherwise brittle materials, further stabilizes the implant, improves load transfer, and generally enhances osteointegration. In this paper, we review evidence in the literature of bone growth into micropores, emphasizing on identification techniques and conditions under which bone components are observed in the micropores. We also review theories on mineralization and propose mechanisms, mediated by cells or not, by which mineralization may occur in the confined micropore space of calcium phosphate scaffolds. Understanding and validating these mechanisms will allow to better control and enhance mineralization in micropores to improve the design and efficiency of bone implants. STATEMENT OF SIGNIFICANCE: The design of synthetic bone scaffolds remains a major focus for engineering solutions to repair damaged and diseased bone. Most studies focus on the design of and growth in macropores (>100 µm), however research increasingly shows the importance of microporosity (<50 µm). Micropores provide an additional space for bone growth, which provides multiple mechanical advantages to the scaffold/bone composite. Here, we review evidence of bone growth into micropores in calcium phosphate scaffolds and conditions under which growth occurs in micropores, and we propose mechanisms that enable or facilitate growth in these pores. Understanding these mechanisms will allow researchers to exploit them and improve the design and efficiency of bone implants.

Ceramic Robocasting: Recent Achievements, Potential, and Future Developments

Additive manufacturing (AM) of ceramic materials has attracted tremendous attention in recent years, due to its potential to fabricate suitable advanced ceramic structures for various engineering applications. Robocasting, a subset of ceramic AM, is an ideal technique for constructing fine and dense ceramic structures with geometrically complex morphology. With the freedom and convenience to deposit various materials within any 3D spatial position, ceramic robocasting opens up unlimited opportunities, which are otherwise hardly attainable from other AM techniques. Here, a summary of the recent progress on the fabrication of single and multi-ceramic structures by robocasting is provided, as well as the prospects of achieving shapeable ceramic structures. The current challenges in ceramic robocasting and an outlook on its development, especially toward the fabrication of self-shaping ceramic structures, are also discussed.

Porous Calcium Phosphate Ceramic Scaffolds with Tailored Pore Orientations and Mechanical Properties Using Lithography-Based Ceramic 3D Printing Technique

This study demonstrates the usefulness of the lithography-based ceramic 3-dimensional printing technique with a specifically designed top-down process for the production of porous calcium phosphate (CaP) ceramic scaffolds with tailored pore orientations and mechanical properties. The processing parameters including the preparation of a photocurable CaP slurry with a high solid loading (φ = 45 vol%), the exposure time for photocuring process, and the initial designs of the porous scaffolds were carefully controlled. Three types of porous CaP scaffolds with different pore orientations (i.e., 0°/90°, 0°/45°/90°/135°, and 0°/30°/60°/90°/120°/150°) were produced. All the scaffolds exhibited a tightly controlled porous structure with straight CaP frameworks arranged in a periodic pattern while the porosity was kept constant. The porous CaP scaffold with a pore orientation of 0°/90° demonstrated the highest compressive strength and modulus due to a number of CaP frameworks parallel to the loading direction. On the other hand, scaffolds with multiple pore orientations may exhibit more isotropic mechanical properties regardless of the loading directions. The porous CaP scaffolds exhibited an excellent in vitro apatite-forming ability in a stimulated body fluid (SBF) solution. These findings suggest that porous CaP scaffolds with tailored pore orientations may provide tunable mechanical properties with good bone regeneration ability.

Accelerated hardening of nanotextured 3D-plotted self-setting calcium phosphate inks

Direct ink writing (DIW) techniques open up new possibilities for the fabrication of patient-specific bone grafts. Self-setting calcium phosphate inks, which harden at low temperature, allow obtaining nanostructured scaffolds with biomimetic properties and enhanced bioactivity. However, the slow hardening kinetics hampers the translation to the clinics. Different hydrothermal treatments for the consolidation of DIW scaffolds fabricated with an α-tricalcium phosphate /pluronic F127 ink were explored, comparing them with a biomimetic treatment. Three different scaffold architectures were analysed. The hardening process, associated to the conversion of α-tricalcium phosphate to hydroxyapatite was drastically accelerated by the hydrothermal treatments, reducing the time for complete reaction from 7 days to 30 minutes, while preserving the scaffold architectural integrity and retaining the nanostructured features. β-tricalcium phosphate was formed as a secondary phase, and a change of morphology from plate-like to needle-like crystals in the hydroxyapatite phase was observed. The binder was largely released during the treatment. The hydrothermal treatment resulted in a 30% reduction of the compressive strength, associated to the residual presence of β-tricalcium phosphate. Biomimetic and hydrothermally treated scaffolds supported the adhesion and proliferation of rat mesenchymal stem cells, indicating a good suitability for bone tissue engineering applications.

STATEMENT OF SIGNIFICANCE

3D plotting has opened up new perspectives in the bone regeneration field allowing the customisation of synthetic bone grafts able to fit patient-specific bone defects. Moreover, this technique allows the control of the scaffolds' architecture and porosity. The present work introduces a new method to harden biomimetic hydroxyapatite 3D-plotted scaffolds which avoids high-temperature sintering. It has two main advantages: i) it is fast and simple, reducing the whole fabrication process from the several days required for the biomimetic processing to a few hours; and ii) it retains the nanostructured character of biomimetic hydroxyapatite and allows controlling the porosity from the nano- to the macroscale. Moreover, the good in vitro cytocompatibility results support its suitability for cell-based bone regeneration therapies.

3D printing of ceramic-based scaffolds for bone tissue engineering: an overview

Currently, one of the most promising strategies in bone tissue engineering focuses on the development of biomimetic scaffolds. Ceramic-based scaffolds with favorable osteogenic ability and mechanical properties are promising candidates for bone repair. Three-dimensional (3D) printing is an additive manufacturing technique, which allows the fabrication of patient-specific scaffolds with high structural complexity and design flexibility, and gains growing attention. This review aims to highlight advances in 3D printing of ceramic-based scaffolds for bone tissue engineering. Technical limitations and practical challenges are emphasized and design considerations are also discussed.

Coextrusion-Based 3D Plotting of Ceramic Pastes for Porous Calcium Phosphate Scaffolds Comprised of Hollow Filaments

This paper demonstrates the utility of coextrusion-based 3D plotting of ceramic pastes (CoEx-3DP) as a new type of additive manufacturing (AM) technique, which can produce porous calcium phosphate (CaP) ceramic scaffolds comprised of hollow CaP filaments. In this technique, green filaments with a controlled core/shell structure can be produced by coextruding an initial feedrod, comprised of the carbon black (CB) core and CaP shell, through a fine nozzle in an acetone bath and then deposited in a controlled manner according to predetermined paths. In addition, channels in CaP filaments can be created through the removal of the CB cores during heat-treatment. Produced CaP scaffolds had two different types of pores with well-defined geometries: three-dimensionally interconnected pores (~360 × 230 μm² in sizes) and channels (>100 μm in diameter) in hollow CaP filaments. The porous scaffolds showed high compressive strengths of ~12.3 ± 2.2 MPa at a high porosity of ~73 vol % when compressed parallel to the direction of the hollow CaP filaments. In addition, the mechanical properties of porous CaP scaffolds could be tailored by adjusting their porosity, for example, compressive strengths of 4.8 ± 1.1 MPa at a porosity of ~82 vol %. The porous CaP scaffold showed good biocompatibility, which was assessed by in vitro cell tests, where several the cells adhered to and spread actively with the outer and inner surfaces of the hollow CaP filaments.

Design and Structure-Function Characterization of 3D Printed Synthetic Porous Biomaterials for Tissue Engineering

3D printing is now adopted for use in a variety of industries and functions. In biomedical engineering, 3D printing has prevailed over more traditional manufacturing methods in tissue engineering due to its high degree of control over both macro- and microarchitecture of porous tissue scaffolds. However, with the improved flexibility in design come new challenges in characterizing the structure-function relationships between various architectures and both mechanical and biological properties in an assortment of clinical applications. Presently, the field of tissue engineering lacks a comprehensive body of literature that is capable of drawing meaningful relationships between the designed structure and resulting function of 3D printed porous biomaterial scaffolds. This work first discusses the role of design on 3D printed porous scaffold function and then reviews characterization of these structure-function relationships for 3D printed synthetic metallic, polymeric, and ceramic biomaterials.

Synthesis and Characterization of Jellified Composites from Bovine Bone-Derived Hydroxyapatite and Starch as Precursors for Robocasting

Hydroxyapatite-starch composites solidify rapidly via jellification, making them suitable candidates for robocasting. However, many aspects related to hydroxyapatite powder characteristics, hydroxyapatite-starch interaction, and composites composition and properties need to be aligned with robocasting requirements to achieve a notable improvement in the functionality of printed scaffolds intended for bone regeneration. This article presents a preliminary evaluation of hydroxyapatite-starch microcomposites. Thermal analysis of the starting powders was performed for predicting composites' behavior during heat-induced densification. Also, morphology, mechanical properties, and hydroxyapatite-starch interaction were evaluated for the jellified composites and the porous bodies obtained after conventional sintering, for different starch additions, and for ceramic particle size distributions. The results indicate that starch could be used for hydroxyapatite consolidation in limited quantities, whereas the composites shall be processed under controlled temperature. Due to a different mechanical behavior induced by particle size and geometry, a wide particle size distribution of hydroxyapatite powder is recommended for further robocasting ink development.

Easy Printing of High Viscous Microdots by Spontaneous Breakup of Thin Fibers

Electrohydrodynamic jetting is emerging as a successful technique for printing inks with resolutions well beyond those offered by conventional inkjet printers. However, the variety of printable inks is still limited to those with relatively low viscosities (typically <20 mPa s) due to nozzle clogging problems. Here, we show the possibility of printing ordered microdots of high viscous inks such as poly(lactic-co-glycolic acid) (PLGA) by exploiting the spontaneous breakup of a thin fiber generated through nozzle-free pyro-electrospinning. The PLGA fiber is deposited onto a partially wetting surface, and the breakup is achieved simply by applying an appropriate thermal stimulation, which is able to induce polymer melting and hence a mechanism of surface area minimization due to the Plateau-Rayleigh instability. The results show that this technique is a good candidate for extending the printability at the microscale to high viscous inks, thus extending their applicability to additional applications, such as cell behavior under controlled morphological constraints.

A New Leap in Periodontics: Three-dimensional (3D) Printing

Dentistry is truly a great profession and recently it is coming to the terms of use of technology and tech-savvy dentists, who nowadays use smart devices to make their life easier. Researchers are constantly innovating to integrate techno-logy into dentistry. Of all the latest technological innovations in dentistry, the most talked about innovations are three-dimensional (3D) printing and cone beam computed tomography (CBCT), which have made the treatment planning and execution a whole lot easier. Three-dimensional printing like CBCT has been gaining much popularity in the masses. Three-dimensional printing technologies are evolving rapidly in the recent years and can be used with a wide array of different materials. In addition to rapid prototyping, the dominant use in the past, they are now being used in all manner of manufacturing applications in a diversity of industries such as sports goods, fashion items such as jewelry and necklaces to aerospace components, tools for automobile industry, and medical implants also in dentistry for producing models, making scaffolds, etc. In future, 3D printing has ability to change the way many products are manufactured and produced and bring an era of ‘personal manufacturing’. This article introduces 3D printing and gives little information about the technology behind the working of 3D printers. It also gives information about the applications of 3D printers and materials most often used for 3D printed scaffolds for periodontal regeneration.

Ticagrelor regulates osteoblast and osteoclast function and promotes bone formation in vivo via an adenosine-dependent mechanism

As many as 10% of bone fractures heal poorly, and large bone defects resulting from trauma, tumor, or infection may not heal without surgical intervention. Activation of adenosine A2A receptors (A2ARs) stimulates bone formation. Ticagrelor and dipyridamole inhibit platelet function by inhibiting P2Y12 receptors and platelet phosphodiesterase, respectively, but share the capacity to inhibit cellular uptake of adenosine and thereby increase extracellular adenosine levels. Because dipyridamole promotes bone regeneration by an A2AR-mediated mechanism we determined whether ticagrelor could regulate the cells involved in bone homeostasis and regeneration in a murine model and whether inhibition of P2Y12 or indirect A2AR activation via adenosine was involved. Ticagrelor, dipyridamole and the active metabolite of clopidogrel (CAM), an alternative P2Y12 antagonist, inhibited osteoclast differentiation and promoted osteoblast differentiation in vitro. A2AR blockade abrogated the effects of ticagrelor and dipyridamole on osteoclast and osteoblast differentiation whereas A2BR blockade abrogated the effects of CAM. Ticagrelor and CAM, when applied to a 3-dimentional printed resorbable calcium-triphosphate/hydroxyapatite scaffold implanted in a calvarial bone defect, promoted significantly more bone regeneration than the scaffold alone and as much bone regeneration as BMP-2, a growth factor currently used to promote bone regeneration. These results suggest novel approaches to targeting adenosine receptors in the promotion of bone regeneration.-Mediero, A., Wilder, T., Reddy, V. S. R., Cheng, Q., Tovar, N., Coelho, P. G., Witek, L., Whatling, C., Cronstein, B. N. Ticagrelor regulates osteoblast and osteoclast function and promotes bone formation in vivo via an adenosine-dependent mechanism.

Designing Biomaterials for 3D Printing

Three-dimensional (3D) printing is becoming an increasingly common technique to fabricate scaffolds and devices for tissue engineering applications. This is due to the potential of 3D printing to provide patient-specific designs, high structural complexity, rapid on-demand fabrication at a low-cost. One of the major bottlenecks that limits the widespread acceptance of 3D printing in biomanufacturing is the lack of diversity in "biomaterial inks". Printability of a biomaterial is determined by the printing technique. Although a wide range of biomaterial inks including polymers, ceramics, hydrogels and composites have been developed, the field is still struggling with processing of these materials into self-supporting devices with tunable mechanics, degradation, and bioactivity. This review aims to highlight the past and recent advances in biomaterial ink development and design considerations moving forward. A brief overview of 3D printing technologies focusing on ink design parameters is also included.

Recent advancements in regenerative dentistry: A review

Although human mouth benefits from remarkable mechanical properties, it is very susceptible to traumatic damages, exposure to microbial attacks, and congenital maladies. Since the human dentition plays a crucial role in mastication, phonation and esthetics, finding promising and more efficient strategies to reestablish its functionality in the event of disruption has been important. Dating back to antiquity, conventional dentistry has been offering evacuation, restoration, and replacement of the diseased dental tissue. However, due to the limited ability and short lifespan of traditional restorative solutions, scientists have taken advantage of current advancements in medicine to create better solutions for the oral health field and have coined it "regenerative dentistry." This new field takes advantage of the recent innovations in stem cell research, cellular and molecular biology, tissue engineering, and materials science etc. In this review, the recently known resources and approaches used for regeneration of dental and oral tissues were evaluated using the databases of Scopus and Web of Science. Scientists have used a wide range of biomaterials and scaffolds (artificial and natural), genes (with viral and non-viral vectors), stem cells (isolated from deciduous teeth, dental pulp, periodontal ligament, adipose tissue, salivary glands, and dental follicle) and growth factors (used for stimulating cell differentiation) in order to apply tissue engineering approaches to dentistry. Although they have been successful in preclinical and clinical partial regeneration of dental tissues, whole-tooth engineering still seems to be far-fetched, unless certain shortcomings are addressed.

Characterization of New PEEK/HA Composites with 3D HA Network Fabricated by Extrusion Freeforming

Addition of bioactive materials such as calcium phosphates or Bioglass, and incorporation of porosity into polyetheretherketone (PEEK) has been identified as an effective approach to improve bone-implant interfaces and osseointegration of PEEK-based devices. In this paper, a novel production technique based on the extrusion freeforming method is proposed that yields a bioactive PEEK/hydroxyapatite (PEEK/HA) composite with a unique configuration in which the bioactive phase (i.e., HA) distribution is computer-controlled within a PEEK matrix. The 100% interconnectivity of the HA network in the biocomposite confers an advantage over alternative forms of other microstructural configurations. Moreover, the technique can be employed to produce porous PEEK structures with controlled pore size and distribution, facilitating greater cellular infiltration and biological integration of PEEK composites within patient tissue. The results of unconfined, uniaxial compressive tests on these new PEEK/HA biocomposites with 40% HA under both static and cyclic mode were promising, showing the composites possess yield and compressive strength within the range of human cortical bone suitable for load bearing applications. In addition, preliminary evidence supporting initial biological safety of the new technique developed is demonstrated in this paper. Sufficient cell attachment, sustained viability in contact with the sample over a seven-day period, evidence of cell bridging and matrix deposition all confirmed excellent biocompatibility.

Advancing the field of 3D biomaterial printing

3D biomaterial printing has emerged as a potentially revolutionary technology, promising to transform both research and medical therapeutics. Although there has been recent progress in the field, on-demand fabrication of functional and transplantable tissues and organs is still a distant reality. To advance to this point, there are two major technical challenges that must be overcome. The first is expanding upon the limited variety of available 3D printable biomaterials (biomaterial inks), which currently do not adequately represent the physical, chemical, and biological complexity and diversity of tissues and organs within the human body. Newly developed biomaterial inks and the resulting 3D printed constructs must meet numerous interdependent requirements, including those that lead to optimal printing, structural, and biological outcomes. The second challenge is developing and implementing comprehensive biomaterial ink and printed structure characterization combined with in vitro and in vivo tissue- and organ-specific evaluation. This perspective outlines considerations for addressing these technical hurdles that, once overcome, will facilitate rapid advancement of 3D biomaterial printing as an indispensable tool for both investigating complex tissue and organ morphogenesis and for developing functional devices for a variety of diagnostic and regenerative medicine applications.

Net shape fabrication of calcium phosphate scaffolds with multiple material domains

Calcium phosphate (CaP) materials have been proven to be efficacious as bone scaffold materials, but are difficult to fabricate into complex architectures because of the high processing temperatures required. In contrast, polymeric materials are easily formed into scaffolds with near-net-shape forms of patient-specific defects and with domains of different materials; however, they have reduced load-bearing capacity compared to CaPs. To preserve the merits of CaP scaffolds and enable advanced scaffold manufacturing, this manuscript describes an additive manufacturing process that is coupled with a mold support for overhanging features; we demonstrate that this process enables the fabrication of CaP scaffolds that have both complex, near-net-shape contours and distinct domains with different microstructures. First, we use a set of canonical structures to study the manufacture of complex contours and distinct regions of different material domains within a mold. We then apply these capabilities to the fabrication of a scaffold that is designed for a 5 cm orbital socket defect. This scaffold has complex external contours, interconnected porosity on the order of 300 μm throughout, and two distinct domains of different material microstructures.

Bone regeneration in critical bone defects using three-dimensionally printed β-tricalcium phosphate/hydroxyapatite scaffolds is enhanced by coating scaffolds with either dipyridamole or BMP-2

Bone defects resulting from trauma or infection need timely and effective treatments to restore damaged bone. Using specialized three-dimensional (3D) printing technology we have created custom 3D scaffolds of hydroxyapatite (HA)/beta-tri-calcium phosphate (β-TCP) to promote bone repair. To further enhance bone regeneration we have coated the scaffolds with dipyridamole, an agent that increases local adenosine levels by blocking cellular uptake of adenosine. Nearly 15% HA:85% β-TCP scaffolds were designed using Robocad software, fabricated using a 3D Robocasting system, and sintered at 1100°C for 4 h. Scaffolds were coated with BMP-2 (200 ng mL^-1 ), dypiridamole 100 µM or saline and implanted in C57B6 and adenosine A2A receptor knockout (A2AKO) mice with 3 mm cranial critical bone defects for 2-8 weeks. Dipyridamole release from scaffold was assayed spectrophotometrically. MicroCT and histological analysis were performed. Micro-computed tomography (microCT) showed significant bone formation and remodeling in HA/β-TCP-dipyridamole and HA/β-TCP-BMP-2 scaffolds when compared to scaffolds immersed in vehicle at 2, 4, and 8 weeks (n = 5 per group; p ≤ 0.05, p ≤ 0.05, and p ≤ 0.01, respectively). Histological analysis showed increased bone formation and a trend toward increased remodeling in HA/β-TCP- dipyridamole and HA/β-TCP-BMP-2 scaffolds. Coating scaffolds with dipyridamole did not enhance bone regeneration in A2AKO mice. In conclusion, scaffolds printed with HA/β-TCP promote bone regeneration in critical bone defects and coating these scaffolds with agents that stimulate A2A receptors and growth factors can further enhance bone regeneration. These coated scaffolds may be very useful for treating critical bone defects due to trauma, infection or other causes. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 366-375, 2017.

Effect of Ceramic Scaffold Architectural Parameters on Biological Response

Numerous studies have focused on the optimization of ceramic architectures to fulfill a variety of scaffold functional requirements and improve biological response. Conventional fabrication techniques, however, do not allow for the production of geometrically controlled, reproducible structures and often fail to allow the independent variation of individual geometric parameters. Current developments in additive manufacturing technologies suggest that 3D printing will allow a more controlled and systematic exploration of scaffold architectures. This more direct translation of design into structure requires a pipeline for design-driven optimization. A theoretical framework for systematic design and evaluation of architectural parameters on biological response is presented. Four levels of architecture are considered, namely (1) surface topography, (2) pore size and geometry, (3) porous networks, and (4) macroscopic pore arrangement, including the potential for spatially varied architectures. Studies exploring the effect of various parameters within these levels are reviewed. This framework will hopefully allow uncovering of new relationships between architecture and biological response in a more systematic way as well as inform future refinement of fabrication techniques to fulfill architectural necessities with a consideration of biological implications.

Design and characterization of calcium phosphate ceramic scaffolds for bone tissue engineering

OBJECTIVES

Our goal is to review design strategies for the fabrication of calcium phosphate ceramic scaffolds (CPS), in light of their transient role in bone tissue engineering and associated requirements for effective bone regeneration.

METHODS

We examine the various design options available to meet mechanical and biological requirements of CPS and later focus on the importance of proper characterization of CPS in terms of architecture, mechanical properties and time-sensitive properties such as biodegradability. Finally, relationships between in vitro versus in vivo testing are addressed, with an attempt to highlight reliable performance predictors.

RESULTS

A combinatory design strategy should be used with CPS, taking into consideration 3D architecture, adequate surface chemistry and topography, all of which are needed to promote bone formation. CPS represent the media of choice for delivery of osteogenic factors and anti-infectives. Non-osteoblast mediated mineral deposition can confound in vitro osteogenesis testing of CPS and therefore the expression of a variety of proteins or genes including collagen type I, bone sialoprotein and osteocalcin should be confirmed in addition to increased mineral content.

CONCLUSIONS

CPS are a superior scaffold material for bone regeneration because they actively promote osteogenesis. Biodegradability of CPS via calcium and phosphate release represents a unique asset. Structural control of CPS at the macro, micro and nanoscale and their combination with cells and polymeric materials is likely to lead to significant developments in bone tissue engineering.

Three-Dimensional Bioprinting for Regenerative Dentistry and Craniofacial Tissue Engineering

Craniofacial tissues are organized with complex 3-dimensional (3D) architectures. Mimicking such 3D complexity and the multicellular interactions naturally occurring in craniofacial structures represents one of the greatest challenges in regenerative dentistry. Three-dimensional bioprinting of tissues and biological structures has been proposed as a promising alternative to address some of these key challenges. It enables precise manufacture of various biomaterials with complex 3D architectures, while being compatible with multiple cell sources and being customizable to patient-specific needs. This review describes different 3D bioprinting methods and summarizes how different classes of biomaterials (polymer hydrogels, ceramics, composites, and cell aggregates) may be used for 3D biomanufacturing of scaffolds, as well as craniofacial tissue analogs. While the fabrication of scaffolds upon which cells attach, migrate, and proliferate is already in use, printing of all the components that form a tissue (living cells and matrix materials together) to produce tissue constructs is still in its early stages. In summary, this review seeks to highlight some of the key advantages of 3D bioprinting technology for the regeneration of craniofacial structures. Additionally, it stimulates progress on the development of strategies that will promote the translation of craniofacial tissue engineering from the laboratory bench to the chair side.

Fabrication and characterization of toughness-enhanced scaffolds comprising β-TCP/POC using the freeform fabrication system with micro-droplet jetting

A novel elastomeric material, poly(1,8-octanediol-co-citrate) (POC), has demonstrated tremendous versatility because of its advantageous toughness, tunable degradation properties, and efficient drug release capability. In this study, POC was used to improve the mechanical performance of β-tricalcium phosphate (β-Ca3(PO4)2, β-TCP). (3D) β-TCP/POC composite scaffolds were fabricated by a 3D printing technique based on the freeform fabrication system with micro-droplet jetting (FFS-MDJ). The physiochemical properties, compressive modulus, drug release behavior, and cell response of β-TCP/POC composite scaffolds were systematically investigated. The results showed that β-TCP/POC scaffolds had uniform macropores of 300-400 μm, porosity of approximately 45%, biodegradability in phosphate-buffered saline, and high compressive modulus of 50-75 MPa. With the incorporation of POC into β-TCP, the toughness of the composite scaffolds was improved significantly. Moreover, β-TCP/POC scaffolds exhibited sustained drug (ibuprofen (IBU)) release capability. Additionally, β-TCP/POC scaffolds facilitated C2C12 cell attachment and proliferation. It was indicated that the 3D-printed porous β-TCP/POC scaffolds with high compressive modulus and good drug delivery performance might be a promising candidate for bone defect repair.

A Human Clinical, Histological, Histomorphometrical, and Radiographical Study on Biphasic HA-Beta-TCP 30/70 in Maxillary Sinus Augmentation

BACKGROUND

By mixing hydroxyapatite (HA) and tricalcium phosphate (TCP), biphasic calcium phosphate ceramics can be obtained, and by varying their ratio it is possible to tailor the characteristics of the biomaterial.

PURPOSE

The aim of the present human study was to evaluate the histological and radiographical aspects of bone formation in maxillary sinus augmentation using a 30/70 HA-beta-TCP with a reticular structure.

MATERIALS AND METHODS

A total of 12 patients, undergoing two-stage sinus augmentation procedure using HA-beta-TCP at a ratio of 30/70, were included in the present study. After a 6-month healing period, during implant insertion, radiographical analysis was performed, and then the bone core biopsies were harvested and processed for histology.

RESULTS

At radiographic evaluation, the bone gain was on average 6.85 ± 0.60 mm. HA-beta-TCP 30/70 appeared to be lined by newly formed bone, with no gaps at the interface. The histomorphometric analysis revealed 26 ± 2% of residual grafted biomaterial, 29 ± 3% of newly formed bone, and 45 ± 2% of marrow spaces.

CONCLUSIONS

The present results indicate histologically the high biocompatibility and osteoconductivity of HA-beta-TCP 30/70, and clinically its successful use for sinus augmentation procedures.

A mechanism for effective cell-seeding in rigid, microporous substrates

Seeding cells into porous ceramic substrates has been shown to improve outcomes in surgical repair of large bone defects, but the physics underlying cellular ingress into such scaffolds remains elusive. This paper demonstrates capillary forces as a novel, yet simple, self-loading or self-seeding mechanism for rigid, microporous substrates. Capillary forces were found to draw cells through a microporous network with interconnections smaller than the diameter of the cells in suspension. Work here emphasizes CaP-based bone scaffolds containing both macroporosity (>100μm) and microporosity (5-50μm); these have been shown to improve bone formation in vivo as compared to their macroporous counterparts and also performed better than microporous scaffolds containing BMP-2 by some measures of bone regeneration. We hypothesize that capillary force driven self-seeding in both macro- and micropores may underlie this improvement, and present a mathematical model and experiments that support this hypothesis. The cell localization and penetration depth within these two-dimensional substrates in vitro depends upon both the cell type (size and stiffness) and the capillary forces generated by the microstructure. Additional experiments showing that cell penetration depth in vitro depends on cell size and stiffness suggest that microporosity could be tailored to optimize cell infiltration in a cell-specific way. Endogenous cells are also drawn into the microporous network in vivo. Results have important implications for design of scaffolds for the healing of large bone defects, and for controlled release of drugs in vivo.