The design and production of Co–Cr alloy implants with controlled surface topography by CAD–CAM method and their effects on osseointegration

Additive Manufacturing of Polymer/Mg-Based Composites for Porous Tissue Scaffolds

Due to their commercial availability, superior processability, and biocompatibility, polymers are frequently used to build three-dimensional (3D) porous scaffolds. The main issues limiting the widespread clinical use of monophasic polymer scaffolds in the bone healing process are their inadequate mechanical strength and inappropriate biodegradation. Due to their mechanical strength and biocompatibility, metal-based scaffolds have been used for various bone regenerative applications. However, due to the mismatch in mechanical properties and nondegradability, they lack integration with the host tissues, resulting in the production of fiber tissue and the release of toxic ions, posing a risk to the durability of scaffolds. Due to their natural degradability in the body, Mg and its alloys increasingly attract attention for orthopedic and cardiovascular applications. Incorporating Mg micro-nano-scale particles into biodegradable polymers dramatically improves scaffolds and implants' strength, biocompatibility, and biodegradability. Polymer biodegradable implants also improve the quality of life, particularly for an aging society, by eliminating the secondary surgery often needed to remove permanent implants and significantly reducing healthcare costs. This paper reviews the suitability of various biodegradable polymer/Mg composites for bone tissue scaffolds and then summarizes the current status and challenges of polymer/magnesium composite scaffolds. In addition, this paper reviews the potential use of 3D printing, which has a unique design capability for developing complex structures with fewer material waste at a faster rate, and with a personalized and on-site fabrication possibility.

Mechanical and Wetting Properties of Ta2O5 and ZnO Coatings on Alloy Substrate of Cardiovascular Stents Manufactured by Casting and DMLS

In the last years, additive manufacturing technologies have been developed, especially direct metal laser sintering, and used in the dental and medical implant domains. Cardiovascular stents have evolved from bioinert, bare metal cages to biomimetic devices that promote tissue regeneration or healing. In this paper, comparisons concerning mechanical properties between Co-Cr alloy and cast 304L stainless steel were realized using FEM analysis, necessary for manufacturing cardiovascular stents by DMLS technology using Co-Cr alloy. The purpose of this paper consists of the evaluation of the contact angle at the interface of the Co-Cr alloy manufactured by DMLS, respectively, cast stainless steel 304L, and thin film deposition realized by the e-gun method (Ta₂O₅ and ZnO). Scanning electronic microscopy SEM and EDX techniques were employed for morphological investigation of the sintered samples manufactured by the DMLS process. They were also used for semi-quantitative and qualitative chemical and metallographic analyses. The e-gun coating was used to obtain thin films with the nanometer order of Ta₂O₅ and ZnO with a protective role to improve the corrosion resistance, roughness, and antiseptic role.

(Bio)manufactured Solutions for Treatment of Bone Defects with Emphasis on US-FDA Regulatory Science Perspective

Bone defects, with second highest demand for surgeries around the globe, may lead to serious health issues and negatively influence patient lives. The advances in biomedical engineering and sciences have led to the development of several creative solutions for bone defect treatment. This review provides a brief summary of bone graft materials, an organized overview of top-down and bottom-up (bio)manufacturing approaches, plus a critical comparison between advantages and limitations of each method. We specifically discuss additive manufacturing techniques and their operation mechanisms in detail. Next, we review the hybrid methods and promising future directions for bone grafting, while giving a comprehensive US-FDA regulatory science perspective, biocompatibility concepts and assessments, and clinical considerations to translate a technology from a research laboratory to the market. The topics covered in this review could potentially fuel future research efforts in bone tissue engineering, and perhaps could also provide novel insights for other tissue engineering applications.

Patent landscape report on dental implants: A technical analysis

BACKGROUND AND PURPOSE

Significant research and development (R&D) has been conducted to make the best dental implants while developing various patent applications and registrations. In this study, we evaluated the current status of patents on dental implants and identified the future direction of R&D progress.

MATERIALS AND METHODS

A total of 29 711 patents related to dental implants were reviewed. These were published between 1909 and 2020 and retrieved from the Derwent Innovation patent database. The patents were grouped into three categories depending on the implant components: fixture, abutment, and artificial teeth.

RESULTS

The category with most patents was "abutment," and the most cited patent was "screw-type dental implant anchor." Global patenting trends over the past 20 years showed that both applicants and applications increased in the early 2010s; however, these have since been on the decline. Currently, the United States holds the largest number of patents, and Nobel Biocare Holding AG is the top assignee. Technic maturation prediction analysis showed that the current dental implant technology is in the "decline stage."

CONCLUSION

Trend analysis of the dental implant patent indicates the main contributors of development are profit-oriented companies. Recent reduction in the number of new patent applications suggests the technology is in the mature declining stage. The emergence of new materials or technologies that may close the gap in clinical unmet needs would reverse the trend.

Bioresponsive starPEG-heparin hydrogel coatings on vascular stents for enhanced hemocompatibility

Hydrogel coatings can improve the biocompatibility of medical devices. However, stable surface bonding and homogeneity of hydrogel coatings are often challenging. This study exploits the benefits of biohybrid hydrogels of crosslinked four-armed poly(ethylene glycol) and heparin to enhance the hemocompatibility of cobalt‑chromium (CoCr) vascular stents. A bonding layer of dual silane and poly(ethylene-alt-maleic anhydride) (PEMA) treatment was applied to the stent to provide covalent immobilization and hydrophilicity for the homogeneous spreading of the hydrogel. A spray coating technology was used to distribute the aqueous solution of the reactive hydrogel precursors onto the sub-millimeter struts of the stents, where the solution polymerized to a homogeneous hydrogel film. The coating was mechanically stable on the stent after ethanol dehydration, and the stents could be stored in a dry state. The homogeneity and stability of the coating during stent expansion were verified. Quasistatic and dynamic whole blood incubation experiments showed substantial suppression of the pro-coagulant and inflammatory activity of the bare metal by the coating. Translation of the technology to industrial coating devices and future surface modification of stents with anti-inflammatory hydrogels are discussed.

Thin Films Deposition of Ta2O5 and ZnO by E-Gun Technology on Co-Cr Alloy Manufactured by Direct Metal Laser Sintering

In recent years in the dental field, new types of materials and techniques for the manufacturing of dental crowns and analog implants have been developed to improve the quality of these products. The objective of this article was to perform the surface characterization and determine the properties of Co-Cr alloy samples fabricated by the direct metal laser sintering (DMLS) process and coated by e-gun technology with thin films of Ta₂O₅ and ZnO. Both oxides are frequently used for dental products, in pharmacology, cosmetics, and medicine, due to their good anticorrosive, antibacterial, and photo-catalytic properties. Following the deposition of thin oxide films on the Co-Cr samples fabricated by DMLS, a very fine roughness in the order of nanometers was obtained. Thin films deposition was realized to improve the hardness and the roughness of the Co-Cr parts fabricated by the DMLS process. Surface characterization was performed using SEM-EDS, AFM, and XRD. AFM was used to determine the roughness of the samples and the nanoindentation curves were determined to establish the hardness values and modulus of elasticity.

Application of Extrusion-Based 3D Printed Dosage Forms in the Treatment of Chronic Diseases

Chronic disease management has been a significant burden in many countries. As most treatment options involve long-term pharmacotherapy, patient compliance has been a challenge, as patients have to remember taking medications on time at the prescribed dose for each disease state. Patients are often required to split the dosage unit, which may lead to under- or over-dose and dose-related adverse effects. However, 3D printing technologies have been used for fabricating personalized medications and multiple drugs in a single dose unit (polypills), which might greatly reduce treatment monitoring, dosing errors, and follow-ups with the health care providers. Extrusion-based 3D printing is the most used technology to fabricate polypills and to customize the dose, dosage form, and release kinetics, which might potentially reduce the risk of patient non-compliance. Although extrusion-based 3D printing has existed for some time, interest in its potential to fabricate dosage forms for treating chronic diseases is still in its infancy. This review focuses on the various extrusion-based 3D printing technologies such as fused deposition modeling, pressure-assisted microsyringe, and direct powder extrusion 3D printing in the preparation of customizable, multi-drug dosage forms for treating chronic diseases.

Artificial Bone via Bone Tissue Engineering: Current Scenario and Challenges

Bone provides mechanical support, and flexibility to the body as a structural frame work along with mineral storage, homeostasis, and blood pH regulation. The repair and/or replacement of injured or defective bone with healthy bone or bone substitute is a critical problem in orthopedic treatment. Recent advances in tissue engineering have shown promising results in developing bone material capable of substituting the conventional autogenic or allogenic bone transplants. In the present review, we have discussed natural and synthetic scaffold materials such as metal and metal alloys, ceramics, polymers, etc. which are widely being used along with their cellular counterparts such as stem cells in bone tissue engineering with their pros and cons.

Manufacturing and Characterization of Ti6Al4V Lattice Components Manufactured by Selective Laser Melting

The paper investigates the fabrication of Selective Laser Melting (SLM) titanium alloy Ti6Al4V micro-lattice structures for the production of lightweight components. Specifically, the pillar textile unit cell is used as base lattice structure and alternative lattice topologies including reinforcing vertical bars are also considered. Detailed characterizations of dimensional accuracy, surface roughness, and micro-hardness are performed. In addition, compression tests are carried out in order to evaluate the mechanical strength and the energy absorbed per unit mass of the lattice truss specimens made by SLM. The built structures have a relative density ranging between 0.2234 and 0.5822. An optimization procedure is implemented via the method of Taguchi to identify the optimal geometric configuration which maximizes peak strength and energy absorbed per unit mass.

Anti-fibrosis effect of BMP-7 peptide functionalization on cobalt chromium alloy

Orthopedic metallic prosthetic implants are commonly made of cobalt chromium (CoCr) alloys. However, such metal-based implants are susceptible to fibrous capsule formation on the implant surface after implantation. At the bone-implant interface, this capsule can prevent implant integration, resulting in loosening and failure. Minimizing the development of such a capsule on the CoCr surface would improve direct bone-implant bonding leading to long-term implant functionality. We evaluated the anti-fibrosis effect of bone morphogenic protein-7 (BMP-7) peptide covalently bonded to CoCr alloy. This peptide, a biomimetic derivation of the knuckle epitope of BMP-7, was conjugated at the N-terminus with a cysteine amino acid. X-ray photoelectron spectroscopy (XPS) and probe binding assay were used to evaluate different stages of grafting and surface functionalization using polydopamine coating. Cellular functions were studied using fibroblast attachment, cell proliferation, and MTT assays. Fibroblasts were grown on functionalized and pristine CoCr substrates, and the efficacy of BMP-7 peptide on anti-fibrosis was analyzed via gene expression and protein expression of fibrosis markers ACTA2, Collagen 1A1, and fibronectin. The peptide functionalized substrates showed significant reduction of fibrosis markers expression after 1 week of incubation compared to controls. BMP-7 signaling pathway activation was shown by the presence of phosphorylation of Smad1/5/8. These findings may contribute to the improvement of CoCr implants in orthopedic surgery applications.

Multifunctional composite coating as a wear-resistant layer for the bearing in total hip joint replacement

In this study, we developed Ti-TiN composite coatings with fine lamellar structures for use as an enhanced wear-resistant layer between the bearing components of the polymer-lined acetabular cup and the metal femoral head of total hip joint replacements (THRs). A plasma spraying deposition method was used to apply the composite coatings, and the thickness of TiN layer in the composite could be controlled by varying the flow rate of N(2) atmospheric gas. The surface properties, such as roughness and hardness, were analyzed, and the friction coefficient (μ) and wear rate (k) were measured using a bovine serum wear test. A biocompatibility test was performed to evaluate the toxicity of the composite coatings. Our experimental results reveal that the friction and wear resistance of composite coatings is superior to that of the metallic implant materials, and they have a higher level of fracture toughness as compared with other ceramic coatings because of a good balance between the hardness of the TiN and the toughness of the Ti. Furthermore, these coatings possessed excellent biocompatibility. The experimental results also demonstrate that the improved wear properties can be attributed to a certain level of unavoidable porosity that is due to the rapid solidification of liquid droplets during the plasma spraying process. The pores in the coating surface play an important role as a lubricant (bovine serum) reservoir, reducing the actual contact area and friction losses.

Selective laser sintering in biomedical engineering

Selective laser sintering (SLS) is a solid freeform fabrication technique, developed by Carl Deckard for his master's thesis at the University of Texas, patented in 1989. SLS manufacturing is a technique that produces physical models through a selective solidification of a variety of fine powders. SLS technology is getting a great amount of attention in the clinical field. In this paper the characteristics features of SLS and the materials that have been developed for are reviewed together with a discussion on the principles of the above-mentioned manufacturing technique. The applications of SLS in tissue engineering, and at-large in the biomedical field, are reviewed and discussed.

Free form fabricated features on CoCr implants with and without hydroxyapatite coating in vivo: a comparative study of bone contact and bone growth induction

The current study evaluates the in vivo response to free form fabricated cobalt chromium (CoCr) implants with and without hydroxyapatite (HA) plasma sprayed coatings. The free form fabrication method allowed for integration of complicated pyramidal surface structures on the cylindrical implant. Implants were press fit into the tibial metaphysis of nine New Zealand white rabbits. Animals were sacrificed and implants were removed and embedded. Histological analysis, histomorphometry and electron microscopy studies were performed. Focused ion beam was used to prepare thin sections for high-resolution transmission electron microscopy examination. The fabricated features allowed for effective bone in-growth and firm fixation after 6 weeks. Transmission electron microscopy investigations revealed intimate bone-implant integration at the nanometre scale for the HA coated samples. In addition, histomorphometry revealed a significantly higher bone contact on HA coated implants compared to native CoCr implants. It is concluded that free form fabrication in combination with HA coating improves the early fixation in bone under experimental conditions.

In vitro biocompatibility of hydroxyapatite-reinforced polymeric composites manufactured by selective laser sintering

The selective laser sintering (SLS) technique was used to manufacture hydroxyapatite-reinforced polyethylene and polyamide composites as potential customized maxillofacial implants. In vitro tests were carried out to assess cellular responses, in terms of cell attachment, morphology, proliferation, differentiation, and mineralized nodule formation, using primary human osteoblast cells. This study showed that the SLS composite processed was biocompatible, with no adverse effects observed on cell viability and metabolic activity, supporting a normal metabolism and growth pattern for osteoblasts. Positive von Kossa staining demonstrated the presence of bone-like mineral on the SLS materials. Higher hydroxyapatite content composites enhanced cell proliferation, increased alkaline phosphatase activity, and produced more osteocalcin. The present findings showed that SLS materials have good in vitro biocompatibility and hence demonstrated biologically the potential of SLS for medical applications.

Development of Custom-Built Bone Scaffolds Using Mesenchymal Stem Cells and Apatite-Wollastonite Glass-Ceramics

There is a clinical need for new bone replacement materials that combine long implant life with complete integration and appropriate mechanical properties. We have used human mesenchymal stem cells (MSCs) to populate porous apatite-wollastonite (A-W) glass-ceramic scaffolds produced by the layer manufacturing technique, selective laser sintering, to create custom-built bone replacements. Confocal and scanning electron microscopy were used to determine optimal seeding densities and to demonstrate that MSCs adhered and retained viability on the surface of A-W scaffolds over a culture period of 21 days. We found a significant increase in the number of MSCs growing on the scaffolds over 7 days. Using bromodeoxyuridine incorporation we demonstrated that MSCs proliferated on the scaffolds. Using real-time PCR we analyzed the expression of the osteogenic markers alkaline phosphatase, collagen type-I, Cbfa-1, osteocalcin, osteonectin, and osteopontin by MSCs cultured in the absence of osteogenic supplements. The expression of the osteogenic markers by MSCs was equivalent to or significantly greater on A-W scaffolds than on tissue culture plastic. We also identified significantly higher alkaline phosphatase activity on A-W compared to a commercial calcium phosphate scaffold. These results indicate for the first time the biocompatibility and osteo-supportive capacity of A-W scaffolds and their potential as patient-specific bone replacement materials.

Effect of titanium carbide coating on the osseointegration response in vitro and in vivo

Titanium has limitations in its clinical performance in dental and orthopaedic applications. This study describes a coating process using pulsed laser deposition (PLD) technology to produce surfaces of titanium carbide (TiC) on titanium substrates and evaluates the biological response both in vitro and in vivo. X-ray photoelectron spectroscopy (XPS) analysis revealed the presence of 18.6-21.5% TiC in the surface layer, accompanied by oxides of titanium 78.5-81.4% in the following concentrations: 11.1-13.0% Ti(2)O(3), 50.8-55.8% TiO(2), 14.5-14.7% TiO. Expression of genes central to osteoblast differentiation (alkaline phosphatase, A2 pro-collagen type 1, osteocalcin, BMP-4, TGFbeta and Cbfa-1) were up-regulated in all cell lines (primary human osteoblasts, hFOB1.19 and ROS.MER#14) grown on TiC compared with uncoated titanium when measured by semiquantitative PCR and real time-PCR, whilst genes involved in modulation of osteoclastogenesis and osteoclast activity (IL-6 and M-CSF) were unchanged. Bone density was shown to be greater around TiC-coated implants after 2 and 4 weeks in sheep and both 4 and 8 weeks in rabbits compared to uncoated titanium. Rapid bone deposition was demonstrated after only 2 weeks in the rabbit model when visualized with intravital staining. It is concluded that coating with TiC will, in comparison to uncoated titanium, improve implant hardness, biocompatibility through surface stability and osseointegration through improved bone growth.