3D printing of polyether-ether-ketone for biomedical applications

Thickness-extensible higher order plate theory with enforced C1 continuity for the analysis of PEEK medical implants

Plate-like structures had been thoroughly studied in literature over years to reduce the computational space from 3D to 2D. Many of these theories suffer either from satisfying the free traction condition or thickness extensibility in addition to the consistency of transverse shear strain energy. This work presents a higher order shear deformation thickness-extensible plate theory (eHSDT) for the analysis of plates. The proposed eHSDT satisfies the condition of free traction as other theories do but it also satisfies the condition of consistency of transverse shear strain energy which is neglected by many theories in the area of plates and shells. The implementation of the proposed theory in displacement-based finite element procedure requires continuity of derivatives across elements. This necessary condition was achieved using the penalty enforcement method for derivative-based nodal degrees of freedom across the standard 9-nodes Lagrange element. The theory was tested for elastic bending deformation of Polyether-ether-ketone (PEEK) which is one of the basic materials for medical implants. The theory showed good accuracy compared to experimental data of the three-points bending test. The present eHSDT was also tested for different conditions with a wide range of aspects ratios (thin to thick plates) and different boundary conditions. The accuracy of the proposed eHSDT was verified against exact solutions for these conditions which showed the advantage over other approaches and commercial finite element packages.

Trueness and intaglio fit of custom-made polyetheretherketone post-and-cores fabricated using different techniques

STATEMENT OF PROBLEM

Applications of polyetheretherketone (PEEK) as a promising alternative to ceramic materials have extended to include post-and-cores. However, information regarding the available fabrication techniques for producing custom-made PEEK post-and-cores and their effect on accuracy is still scarce.

PURPOSE

The purpose of this in vitro study was to evaluate the trueness and intaglio fit of custom-made PEEK post-and-cores fabricated using different techniques.

MATERIAL AND METHODS

Ten mandibular second premolars were collected, decoronated, and endodontically treated. For the fabrication of custom-made post-and-cores, each post space was prepared, scanned, and designed by using the exocad software program. Each reference design was used to fabricate PEEK post-and-cores with 3 different techniques (N=30): group P, heat pressing; group S, subtractive manufacturing, and group A, additive manufacturing. All the fabricated restorations were scanned, providing the test data as standard tessellation language (STL) files, which were imported with the reference data into a reverse engineering software program to evaluate the 3D trueness of each fabrication technique. To evaluate the intaglio fit, restorations coated with silicone material were scanned to provide the test data as STL files, which were superimposed on the STL files of the scanned restorations. One-way analysis of variance (ANOVA) and 2-way mixed model ANOVA tests were used to analyze the data (α=.05).

RESULTS

For 3D trueness, root mean square (RMS) values representing the deviations between the scans of the fabricated restorations and the reference designs varied significantly among different groups (P<.001), with the highest mean deviation found in group A (102.8 ±31 µm), while the lowest mean deviation was found in group S (42.2 ±11 µm). For the intaglio fit, the deviations between the scans of the fabricated restorations and the scans of the coated restorations varied significantly among different groups (P<.001), with the highest mean deviation found in group A (228.4 ±47 µm), while the lowest mean deviation was found in group S (96.2 ±14 µm). Simple effects comparisons showed the highest value of deviation in the apical area in group A (P<.001).

CONCLUSIONS

Custom-made PEEK post-and-cores fabricated by using subtractive manufacturing and heat pressing techniques showed better trueness and intaglio fit compared with additively manufactured restorations. Before printed PEEK restorations can be considered a suitable alternative to pressed or milled ones, improvements are required to confirm their reliability.

Advanced 3D Printing of Polyetherketoneketone Hydroxyapatite Composites via Fused Filament Fabrication with Increased Interlayer Connection

Additively manufactured implants, surgical guides, and medical devices that would have direct contact with the human body require predictable behaviour when stress is applied during their standard operation. Products built with Fused Filament Fabrication (FFF) possess orthotropic characteristics, thus, it is necessary to determine the properties that can be achieved in the XY- and Z-directions of printing. A concentration of 10 wt% of hydroxyapatite (HA) in polyetherketoneketone (PEKK) matrix was selected as the most promising biomaterial supporting cell attachment for medical applications and was characterized with an Ultimate Tensile Strength (UTS) of 78.3 MPa and 43.9 MPa in the XY- and Z-directions of 3D printing, respectively. The effect of the filler on the crystallization kinetics, which is a key parameter for the selection of semicrystalline materials suitable for 3D printing, was explained. This work clearly shows that only in situ crystallization provides the ability to build parts with a more thermodynamically stable primary form of crystallites.

Enhanced in-stent luminal visualization and restenosis diagnosis in coronary computed tomography angiography via coronary stent decomposition algorithm from dual-energy image

Stent implantation is a principal therapeutic approach for coronary artery diseases. Nonetheless, the presence of stents significantly interferes with in-stent luminal (ISL) visualization and complicates the diagnosis of in-stent restenosis (ISR), thereby increasing the risk of misdiagnoses and underdiagnoses in coronary computed tomography angiography (CCTA). Dual-energy (DE) CT could calculate the volume fraction for voxels from low- and high-energy images (LHEI) and provide information on specific three basic materials. In this study, the innovative coronary stent decomposition algorithm (CSDA) was developed from the DECT three materials decomposition (TMD), through spectral simulation to determine the scan and attenuation coefficient for the stent, and preliminary execution for an in vitro sophisticated polyether ether ketone (PEEK) 3D-printed right coronary artery (RCA) replica. Furthermore, the whole-coronary-artery replica with multi-stent implantation, the RCA replica with mimetic plaque embedded, and two patients with stent further validated the effectiveness of CSDA. Post-CSDA images manifested no weakened attenuation values, no elevated noise values, and maintained anatomical integrity in the coronary lumen. The stents were effectively removed, allowing for the ISL and ISR to be clearly visualized with a discrepancy in diameters within 10%. We believe that CSDA presents a promising solution for enhancing CCTA diagnostic accuracy post-stent implantation.

A review on the recent applications of synthetic biopolymers in 3D printing for biomedical applications

3D printing technology is an emerging method that gained extensive attention from researchers worldwide, especially in the health and medical fields. Biopolymers are an emerging class of materials offering excellent properties and flexibility for additive manufacturing. Biopolymers are widely used in biomedical applications in biosensing, immunotherapy, drug delivery, tissue engineering and regeneration, implants, and medical devices. Various biodegradable and non-biodegradable polymeric materials are considered as bio-ink for 3d printing. Here, we offer an extensive literature review on the current applications of synthetic biopolymers in the field of 3D printing. A trend in the publication of biopolymers in the last 10 years are focused on the review by analyzing more than 100 publications. Their application and classification based on biodegradability are discussed. The various studies, along with their practical applications, are elaborated in the subsequent sections for polyethylene, polypropylene, polycaprolactone, polylactide, etc. for biomedical applications. The disadvantages of various biopolymers are discussed, and future perspectives like combating biocompatibility problems using 3D printed biomaterials to build compatible prosthetics are also discussed and the potential application of using resin with the combination of biopolymers to build customized implants, personalized drug delivery systems and organ on a chip technologies are expected to open a new set of chances for the development of healthcare and regenerative medicine in the future.

State-of-the-art polyetheretherketone three-dimensional printing and multifunctional modification for dental implants

Polyetheretherketone (PEEK) is a high-performance thermoplastic polymer with an elastic modulus close to that of the jawbone. PEEK has the potential to become a new dental implant material for special patients due to its radiolucency, chemical stability, color similarity to teeth, and low allergy rate. However, the aromatic main chain and lack of surface charge and chemical functional groups make PEEK hydrophobic and biologically inert, which hinders subsequent protein adsorption and osteoblast adhesion and differentiation. This will be detrimental to the deposition and mineralization of apatite on the surface of PEEK and limit its clinical application. Researchers have explored different modification methods to effectively improve the biomechanical, antibacterial, immunomodulatory, angiogenic, antioxidative, osteogenic and anti-osteoclastogenic, and soft tissue adhesion properties. This review comprehensively summarizes the latest research progress in material property advantages, three-dimensional printing synthesis, and functional modification of PEEK in the fields of implant dentistry and provides solutions for existing difficulties. We confirm the broad prospects of PEEK as a dental implant material to promote the clinical conversion of PEEK-based dental implants.

Tumor Shape-Specific Brachytherapy Implants by 3D-Printing, Precision Radioactivity Painting, and Biomedical Imaging

In brachytherapy (BT), or internal radiation therapy, cancer is treated by radioactive implants. For instance, episcleral plaques (EPs) for the treatment of uveal melanoma, are designed according to generic population approximations. However, more personalized implants can enhance treatment precision through better adjustment of dose profiles to the contours of cancerous tissues. An original approach integrating biomedical imaging, 3D printing, radioactivity painting, and biomedical imaging, is developed as a workflow for the development of tumor shape-specific BT implants. First, computer-aided design plans of EP are prepared according to guidelines prescribed by the Collaborative Ocular Melanoma Study protocol. Polyetheretherketone (PEEK), a high-performance polymer suitable for permanent implants, is used to 3D-print plaques and the geometrical accuracy of the printed design is evaluated by imaging. The possibility to modulate the dose distribution in a tridimensional manner is demonstrated by painting the inner surfaces of the EPs with radioactive 103Pd, followed by dose profile measurements. The possibility to modulate dose distributions generated by these 3D-printed plaques through radioactivity painting is therefore confirmed. Ex vivo surgical tests on human eyeballs are performed as an assessment of manipulation ease. Overall, this work provides a solution for the fabrication of tumor-specific radioactive implants requiring higher dose precision.

Polyetheretherketone development in bone tissue engineering and orthopedic surgery

Polyetheretherketone (PEEK) has been widely used in the medical field as an implant material, especially in bone tissue engineering and orthopedic surgery, in recent years. This material exhibits superior stability at high temperatures and is biosecured without harmful reactions. However, the chemical and biological inertness of PEEK still limits its applications. Recently, many approaches have been applied to improve its performance, including the modulation of physical morphology, chemical composition and antimicrobial agents, which advanced the osteointegration as well as antibacterial properties of PEEK materials. Based on the evolution of PEEK biomedical devices, many studies on the use of PEEK implants in spine surgery, joint surgery and trauma repair have been performed in the past few years, in most of which PEEK implants show better outcomes than traditional metal implants. This paper summarizes recent studies on the modification and application of biomedical PEEK materials, which provides further research directions for PEEK implants.

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.

Influence of Antibacterial Coating and Mechanical and Chemical Treatment on the Surface Properties of PA12 Parts Manufactured with SLS and MJF Techniques in the Context of Medical Applications

Additive manufacturing (AM) is a rapidly growing branch of manufacturing techniques used, among others, in the medical industry. New machines and materials and additional processing methods are improved or developed. Due to the dynamic development of post-processing and its relative novelty, it has not yet been widely described in the literature. This study focuses on the surface topography (parameters Sa, Sz, Sdq, Sds, Str, Sdr) of biocompatible polyamide 12 (PA12) samples made by selective laser sintering (SLS) and multi jet fusion (MJF). The surfaces of the samples were modified by commercial methods: four types of smoothing treatments (two mechanical and two chemical), and two antibacterial coatings. The smoothing treatment decreased the values of all analyzed topography parameters. On average, the Sa of the SLS samples was 33% higher than that of the MJF samples. After mechanical treatment, Sa decreased by 42% and after chemical treatment by 80%. The reduction in Sdq and Sdr is reflected in a higher surface gloss. One antibacterial coating did not significantly modify the surface topography. The other coating had a smoothing effect on the surface. The results of the study can help in the development of manufacturing methodologies for parts made of PA12, e.g., in the medical industry.

Embedded 3D Printing of Thermally-Cured Thermoset Elastomers and the Interdependence of Rheology and Machine Pathing

Thermoset elastomers are widely used high-performance materials due to their thermal stability, chemical resistance, and mechanical properties. However, established casting and molding techniques limit the overall 3D complexity of parts that can be fabricated. Advanced manufacturing methods such as 3D printing have improved design flexibility and reduced development time but have proved challenging using thermally-cured thermosets due to their viscosity, slow gelation kinetics and high surface tension. To address this, freeform reversible embedding (FRE) 3D printing extrudes thermosets such as polydimethylsiloxane (PDMS) elastomer within a carbomer support bath, but due to the liquid-like state of the prepolymer during extrusion has been limited to hollow structures. Here, we have significantly improved FRE printing through rheological modification of PDMS with a thixotropic additive (1.0-10.0 wt%) that imparts a yield stress (30-120 Pa) to help control filament morphology. Further, to minimize the interaction of the nozzle with previously printed PDMS we implemented print process controls consisting of region-specific slicing, filament retraction, and non-print travel moves outside of the print. The combined result is the FRE printing of PDMS in complex 3D parts with high fidelity, establishing a 3D printing methodology that can be used broadly with thermally-cured thermoset elastomers and related polymers.

Fabrication and properties of interweaved poly(ether ether ketone) composite scaffolds

This paper interweaved scaffolds with poly(ether ether ketone) (PEEK) and poly(lactic acid)/Walnut shell/hydroxypatite (PLA/WS/HA) composites by using fused filament fabrication technology, although there was a huge difference in thermal property term between PLA and PEEK. In order to keep mechanical properties of PEEK scaffold and remedy the stress loss produced by pores, PLA/WS/HA composites were used to fill the pores with gradient form outside-in (0.4-0.8 mm, 0.6-1.0 mm, 0.8-1.2 mm and 1.6-2.0 mm). The thermal stability, tensile and compression properties, tensile fracture surface morphology, cytotoxicity and in vivo experiment were investigated. The results showed: the scaffolds were intact without any flashes and surface destruction, and kept a well thermal stability. Compared with the PEEK porous scaffolds, the tensile fracture stress and strain, compression yield stress and strain of interweaved scaffolds were dramatically enhanced by 24.1%, 438%, 359.1% and 921.2%, respectively, and they climbed to the climax at 8 wt% of WS. In vivo experiment showed that the degradation of PLA/WS/HA composites synchronized with the adhesion, proliferation and ingrowth of bone cells, keeping the stable biomechanical properties of interweaved scaffolds. Those experiments showed that interweaved PEEK-PLA/WS/HA scaffolds had the potential to be used as bone implant in tissue engineering.

Effect of Heat Treatment on Elastic Properties and Fracture Toughness of Fused Filament Fabricated PEEK for Biomedical Applications

This work presents the results of an experimental investigation of the mechanical properties of polyetheretherketone (PEEK) specimens additively manufactured (AM) by using fused filament fabrication with different printing parameters and subjected to postprocessing heat treatment. Standard and compact tension samples were manufactured with a different infill angle using 0.4 mm and 0.6 mm nozzle diameters. Some of the samples were subjected to heat treatment at 220 °C after manufacturing. Tensile tests were conducted to determine the values of elastic modulus, tensile strength, as well as mode-I fracture toughness and critical strain energy release rate. Tensile properties of single-thread and as-delivered filaments were also studied. It was concluded that heat treatment significantly improved the elastic properties, tensile strength and fracture toughness of the AM PEEK samples: the fracture resistance increased by 33 to 45% depending on the stacking order, while the tensile strength increased by some 45-65%, with the elasticity modulus grown by up to 20%. Strain fields induced in specimens by crack propagation were captured with a digital image correlation technique and compared with results of numerical simulations implemented with the extended finite-element method (XFEM). Conclusions on the optimal parameters of 3D printing of PEEK were made.

Recent Advances on High-Performance Polyaryletherketone Materials for Additive Manufacturing

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

Thermoelectric Properties of N-Type Poly (Ether Ether Ketone)/Carbon Nanofiber Melt-Processed Composites

The thermoelectric properties, at temperatures from 30 °C to 100 °C, of melt-processed poly(ether ether ketone) (PEEK) composites prepared with 10 wt.% of carbon nanofibers (CNFs) are discussed in this work. At 30 °C, the PEEK/CNF composites show an electrical conductivity (σ) of ~27 S m^-1 and a Seebeck coefficient (S) of -3.4 μV K^-1, which means that their majority charge carriers are electrons. The origin of this negative Seebeck is deduced because of the impurities present in the as-received CNFs, which may cause sharply varying and localized states at approximately 0.086 eV above the Fermi energy level (E_F) of CNFs. Moreover, the lower S, in absolute value, found in PEEK/CNF composites, when compared with the S of as-received CNFs (-5.3 μV K^-1), is attributed to a slight electron withdrawing from the external layers of CNFs by the PEEK matrix. At temperatures from 30 °C to 100 °C, the σ (T) of PEEK/CNF composites, in contrast to the σ (T) of as-received CNFs, shows a negative temperature effect, understood through the 3D variable-range hopping (VRH) model, as a thermally activated hopping mechanism across a random network of potential wells. Moreover, their nonlinear S (T) follows the same behavior reported before for polypropylene composites melt-processed with similar CNFs at the same interval of temperatures.

Functionally graded additive manufacturing for orthopedic applications

Background

Additive Manufacturing due to its benefits in developing parts with complex geometries and shapes, has evolved as an alternate manufacturing process to develop implants with desired properties. The structure of human bones being anisotropic in nature is biologically functionally graded i,e. The structure possesses different properties in different directions. Therefore, various orthopedic implants such as knee, hip and other bone plates, if functionally graded can perform better. In this context, the development of functionally graded (FG) parts for orthopedic application with tailored anisotropic properties has become easier through the use of additive manufacturing (AM).

Objectives

and Rationale: The current paper aims to study the various aspects of additively manufactured FG parts for orthopedic applications. It presents the details of various orthopedic implants such as knee, hip and other bone plates in a structured manner. A systematic literature review is conducted to study the various material and functional aspects of functionally graded parts for orthopedic applications. A section is also dedicated to discuss the mechanical properties of functionally graded parts.

Conclusion

The literature revealed that additive manufacturing can provide lot of opportunities for development of functionally graded orthopedic implants with improved properties and durability. Further, the effect of various FG parameters on the mechanical behavior of these implants needs to be studied in detail. Also, with the advent of various AM technologies, the functional grading can be achieved by various means e.g. density, porosity, microstructure, composition, etc. By varying the AM parameters. However, the current limitations of cost and material biocompatibility prevent the widespread exploitation of AM technologies for various orthopedic applications.

Multifunctional exosomes derived from bone marrow stem cells for fulfilled osseointegration

Bone marrow mesenchymal stem cells (BMSCs) have self-renewal, multi-directional differentiation potential, and immune regulation function and are widely used for de novo bone formation. However, the wide variation in individual amplification, the potential risk of cancer cell contamination, and the need for culture time significantly limit their widespread use clinically. Alternatively, numerous studies have shown that exosomes secreted by BMSCs in the nanoscale can also affect the functionality of endothelial cells (angiogenesis), macrophages (immunomodulation), and osteoblasts/osteoclasts (osteogenesis), which is a highly promising therapy for osseointegration with pronounced advantages (e.g., safety, high efficiency, and no ethical restrictions). The review aims to summarize the multifaceted effect of BMSCs-derived exosomes on osseointegration and provide reference and basis for rapid and qualified osseointegration.

Improved Mechanical Properties and Bioactivity of Silicate Based Bioceramics Reinforced Poly(ether-ether-ketone) Nanocomposites for Prosthetic Dental Implantology

Polyether-ether-ketone (PEEK) biomaterial has been increasingly employed for orthopedic, trauma, spinal, and dental implants due to its biocompatibility and in vivo stability. However, a lack of bioactivity and binding ability to natural bone tissue has significantly limited PEEK for many challenging dental implant applications. In this work, nanocomposites based on PEEK reinforced with bioactive silicate-based bioceramics (forsterite or bioglass) as nanofillers were prepared using high energy ball milling followed by melt blending and compression molding. The influence of nanofillers type and content (10, 20 and 30 wt.%) on the crystalline structure, morphology, surface roughness, hydrophilicity, microhardness, elastic compression modulus, and flexural strength of the nanocomposites was investigated. The scanning electron microscopy images of the nanocomposites with low nanofillers content showed a homogenous surface with uniform dispersion within the PEEK matrix with no agglomerates. All nanocomposites showed an increased surface roughness compared to pristine PEEK. It was found that the incorporation of 20 wt.% forsterite was the most effective in the nanocomposite formulation compared with bioglass-based nanocomposites; it has significantly improved the elastic modulus, flexural strength, and microhardness. In vitro bioactivity evaluation, which used biomimetic simulated body fluid indicated the ability of PEEK nanocomposites loaded with forsterite or bioglass nanofillers to precipitate calcium and phosphate bone minerals on its surface. These nanocomposites are expected to be used in long-term load-bearing implant applications and could be recommended as a promising alternative to titanium and zirconia when used as a dental implant material.

Antibacterial Activity Studies of 3D-Printing Polyetheretherketone Substrates with Surface Growth of 2D TiO2/ZnO Rodlike Arrays

Heterogeneous metal implants have been applied in clinical treatments of skeletal wounds, but their low antibacterial properties and the possibility of a release of metal ions may have harmful influences on the human body. Therefore, a polymer implant with low cost, high safety, an elastic modulus similar to that of human bone, and a good antibacterial property must be produced for orthopedic treatments. In this study, the surface of a 3D-printed polyetheretherketone (PEEK) disk was grown with ZnO/TiO2 rodlike arrays using a chemical bath deposition. X-ray diffraction patterns and transmission electron microscopy images showed that TiO2/ZnO rodlike arrays were deposited onto the PEEK substrate. With the direct absorption of antibiotic agents onto the surface of TiO2/ZnO/PEEK samples, their antibacterial performances greater than the values of minimum inhibitory concentration required to inhibit the growth of 90% of Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) remained for around 10 days. The concentration of Zn2+ ions in a buffer solution is reduced with the coating of a TiO2 layer on a ZnO rodlike array. The sample with absorption from a mixture containing ampicillin and vancomycin salts with a weight ratio of 1:1 had the best inhibitory effect on the growth of E. coli and S. aureus.

Physical and Chemical Sensors on the Basis of Laser-Induced Graphene: Mechanisms, Applications, and Perspectives

Laser-induced graphene (LIG) is produced rapidly by directly irradiating carbonaceous precursors, and it naturally exhibits as a three-dimensional porous structure. Due to advantages such as simple preparation, time-saving, environmental friendliness, low cost, and expanding categories of raw materials, LIG and its derivatives have achieved broad applications in sensors. This has been witnessed in various fields such as wearable devices, disease diagnosis, intelligent robots, and pollution detection. However, despite LIG sensors having demonstrated an excellent capability to monitor physical and chemical parameters, the systematic review of synthesis, sensing mechanisms, and applications of them combined with comparison against other preparation approaches of graphene is still lacking. Here, graphene-based sensors for physical, biological, and chemical detection are reviewed first, followed by the introduction of general preparation methods for the laser-induced method to yield graphene. The preparation and advantages of LIG, sensing mechanisms, and the properties of different types of emerging LIG-based sensors are comprehensively reviewed. Finally, possible solutions to the problems and challenges of preparing LIG and LIG-based sensors are proposed. This review may serve as a detailed reference to guide the development of LIG-based sensors that possess properties for future smart sensors in health care, environmental protection, and industrial production.

The Surface Characteristics, Microstructure and Mechanical Properties of PEEK Printed by Fused Deposition Modeling with Different Raster Angles

Additive manufacturing provides a novel and robust way to prepare medical product with anatomic matched geometry and tailored mechanical performance. In this study, the surface characteristics, microstructure, and mechanical properties of fused deposition modeling (FDM) prepared polyether-ether-ketone (PEEK) were systematically studied. During the FDM process, the crystal unit cell and thermal attribute of PEEK material remained unchanged, whereas the surface layer generally became more hydrophilic with an obvious reduction in surface hardness. Raster angle has a significant effect on the mechanical strength but not on the failure mechanism. In practice, FDM fabricated PEEK acted more like a laminate rather than a unified structure. Its main failure mechanism was correlated to the internal voids. The results show that horizontal infill orientation with 30° raster angle is promising for a better comprehensive mechanical performance, and the corresponding tensile, flexural, and shear strengths are (76.5 ± 1.4) MPa, (149.7 ± 3.0) MPa, and (55.5 ± 1.8) MPa, respectively. The findings of this study provide guidelines for FDM-PEEK to enable its realization in applications such as orthopedic implants.

Thermoplastic Extrusion Additive Manufacturing of High-Performance Carbon Fiber PEEK Lattices

Polyetheretherketone (PEEK) has been the focus of substantial additive manufacturing research for two principal reasons: (a) the mechanical performance approaches that of aluminum at relatively high temperatures for thermoplastics and (b) the potential for qualification in both the aerospace and biomedical industries. Although PEEK provides outstanding strength and thermal stability, printing can be difficult due to the high melting point. Recently, high-temperature soluble support has enabled the printing of lattices and stochastic foams with overhanging features in these high-performance carbon fiber thermoplastics, in which density can be optimized to strike a balance between weight and strength to enhance performance in applications such as custom implants or aerospace structures. Although polymer powder bed fusion has long been capable of the combination of these geometries and materials, material extrusion with high-temperature sacrificial support is dramatically less expensive. This research provides a comprehensive mechanical analysis and CT-scan-based dimensional study of carbon fiber PEEK lattice structures enabled with high-temperature support and including model validation.

The Surface Characterisation of Fused Filament Fabricated (FFF) 3D Printed PEEK/Hydroxyapatite Composites

Polyetheretherketone (PEEK) is a high-performance thermoplastic polymer which has found increasing application in orthopaedics and has shown a lot of promise for 'made-to-measure' implants via additive manufacturing approaches. However, PEEK is bioinert and needs to undergo surface modification to make it at least osteoconductive to ensure a more rapid, improved, and stable fixation that will last longer in vivo. One approach to solving this issue is to modify PEEK with bioactive agents such as hydroxyapatite (HA). The work reported in this study demonstrates the direct 3D printing of PEEK/HA composites of up to 30 weight percent (wt%) HA using a Fused Filament Fabrication (FFF) approach. The surface characteristics and in vitro properties of the composite materials were investigated. X-ray diffraction revealed the samples to be semi-crystalline in nature, with X-ray Photoelectron Spectroscopy and Time-of-Flight Secondary Ion Mass Spectrometry revealing HA materials were available in the uppermost surface of all the 3D printed samples. In vitro testing of the samples at 7 days demonstrated that the PEEK/HA composite surfaces supported the adherence and growth of viable U-2 OS osteoblast like cells. These results demonstrate that FFF can deliver bioactive HA on the surface of PEEK bio-composites in a one-step 3D printing process.

The Extent of Interlayer Bond Strength during Fused Filament Fabrication of Nylon Copolymers: An Interplay between Thermal History and Crystalline Morphology

One of the main drawbacks of Fused Filament Fabrication is the often-inadequate mechanical performance of printed parts due to a lack of sufficient interlayer bonding between successively deposited layers. The phenomenon of interlayer bonding becomes especially complex for semi-crystalline polymers, as, besides the extremely non-isothermal temperature history experienced by the extruded layers, the ongoing crystallization process will greatly complicate its analysis. This work attempts to elucidate a possible relation between the degree of crystallinity attained during printing by mimicking the experienced thermal history with Fast Scanning Chip Calorimetry, the extent of interlayer bonding by performing trouser tear fracture tests on printed specimens, and the resulting crystalline morphology at the weld interface through visualization with polarized light microscopy. Different printing conditions are defined, which all vary in terms of processing parameters or feedstock molecular weight. The concept of an equivalent isothermal weld time is utilized to validate whether an amorphous healing theory is capable of explaining the observed trends in weld strength. Interlayer bond strength was found to be positively impacted by an increased liquefier temperature and reduced feedstock molecular weight as predicted by the weld time. An increase in liquefier temperature of 40 °C brings about a tear energy value that is three to four times higher. The print speed was found to have a negligible effect. An elevated build plate temperature will lead to an increased degree of crystallinity, generally resulting in about a 1.5 times larger crystalline fraction compared to when printing occurs at a lower build plate temperature, as well as larger spherulites attained during printing, as it allows crystallization to occur at higher temperatures. Due to slower crystal growth, a lower tie chain density in the amorphous interlamellar regions is believed to be created, which will negatively impact interlayer bond strength.

Supercritical Impregnation of PLA Filaments with Mango Leaf Extract to Manufacture Functionalized Biomedical Devices by 3D Printing

Polylactic Acid (PLA) filaments impregnated with ethanolic mango leaves extract (MLE) with pharmacological properties were obtained by supercritical impregnation. The effects of pressure, temperature and amount of extract on the response variables, i.e., swelling, extract loading and bioactivity of the PLA filaments, were determined. The analysis of the filaments biocapacities revealed that impregnated PLA filaments showed 11.07% antidenaturant capacity and 88.13% antioxidant activity, which after a 9-day incubation shifted to 30.10% and 9.90%, respectively. Subsequently, the same tests were conducted on printed samples. Before their incubation, the printed samples showed 79.09% antioxidant activity and no antidenaturant capacity was detected. However, after their incubation, the antioxidant activity went down to only 2.50%, while the antidenaturant capacity raised up to 23.50%. The persistence of the bioactive properties after printing opens the possibility of using the functionalized PLA filaments as the feed for a three-dimensional (3D) printer.

3D Printing of Micro- and Nanoscale Bone Substitutes: A Review on Technical and Translational Perspectives

Recent developments in three-dimensional (3D) printing technology offer immense potential in fabricating scaffolds and implants for various biomedical applications, especially for bone repair and regeneration. As the availability of autologous bone sources and commercial products is limited and surgical methods do not help in complete regeneration, it is necessary to develop alternative approaches for repairing large segmental bone defects. The 3D printing technology can effectively integrate different types of living cells within a 3D construct made up of conventional micro- or nanoscale biomaterials to create an artificial bone graft capable of regenerating the damaged tissues. This article reviews the developments and applications of 3D printing in bone tissue engineering and highlights the numerous conventional biomaterials and nanomaterials that have been used in the production of 3D-printed scaffolds. A comprehensive overview of the 3D printing methods such as stereolithography (SLA), selective laser sintering (SLS), fused deposition modeling (FDM), and ink-jet 3D printing, and their technical and clinical applications in bone repair and regeneration has been provided. The review is expected to be useful for readers to gain an insight into the state-of-the-art of 3D printing of bone substitutes and their translational perspectives.

Preparation and Performance Evaluation of Duotone 3D-Printed Polyetheretherketone as Oral Prosthetic Materials: A Proof-of-Concept Study

Literature has reported the successful use of 3D printed polyetheretherketone (PEEK) to fabricate human body implants and oral prostheses. However, the current 3D printed PEEK (brown color) cannot mimic the vivid color of oral tissues and thus cannot meet the esthetical need for dental application. Therefore, titanium dioxide (TiO₂) and ferric oxide (Fe₂O₃) were incorporated into PEEK to prepare a series of tooth-color and gingival-color PEEK composites in this study. Through color measurements and mechanical tests, the color value and mechanical performance of the 3D printed PEEK composites were evaluated. In addition, duotone PEEK specimens were printed by a double nozzle with an interface between tooth-color and gingival-color parts. The mechanical performance of duotone PEEK with two different interfaces (horizontal and vertical) was investigated. With the addition of TiO₂ and Fe₂O₃, the colors of 3D printed PEEK composites become closer to that of dental shade guides. 3D printed PEEK composites generally demonstrated superior tensile and flexural properties and hence have great potential in the dental application. In addition, duotone 3D printed PEEK with a horizontal interfacial orientation presented better mechanical performance than that with a vertical one.

Thermo-Mechanical Behavior of Poly(ether ether ketone): Experiments and Modeling

Observations are reported on poly(ether ether ketone) (PEEK) in uniaxial tensile tests, relaxation tests and creep tests with various stresses in a wide interval of temperatures ranging from room temperature to 180 °C. Constitutive equations are developed for the thermo-mechanical behavior of PEEK under uniaxial deformation. Adjustable parameters in the governing equations are found by matching the experimental data. Good agreement is demonstrated between the observations and results of numerical simulation. It is shown that the activation energies for the elastoplastic, viscoelastic and viscoelastoplastic responses adopt similar values at temperatures above the glass transition point.

Interlayer bonding strength of 3D printed PEEK specimens

Recent advances in extrusion-based filament 3D printing technology enable the processability of high-performance polymers. Poly(ether ether ketone) (PEEK) is an important group of high-performance polymer that has been widely used in aerospace, automotive, and biomedical applications. The interlayer bonding strength of 3D printed PEEK is crucial for load-bearing applications, yet studies on 3D printed PEEK are sparse due to processing challenges. In this study, the three-point flexural test is used to study the interlayer bonding strength of 3D-printed PEEK specimens with respect to the printing process parameters, including nozzle temperature, print speed, layer height, and wait-time. A design of experiment (DOE) approach is developed to study correlations between printing parameters and the end-use properties, including flexural stress (σf) and strain at break (εf), flexural modulus (Ef), and crystallinity (χ). Our results show that the nozzle temperature, layer height, and wait-time significantly affect the interlayer bonding strength, with nozzle temperature being the most influential parameter to enhance interlayer bonding strength indicated by a significant increase in σf, εf, and χ. Thermal annealing post-printing is shown to increase the degree of χ and Ef, yet its effect on interlayer bonding strength is minimal, indicating that the interlayer bonding strength is primarily determined during the printing process. This study demonstrates the use of a three-point flexural test integrated with a versatile and robust DOE approach to study the interlayer bonding strength of PEEK to reduce product development time while improving mechanical properties.

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

Additive manufacturing (AM) of high temperature polymers, specifically polyaryletherketones (PAEK), is gaining significant attention for medical implant applications. As 3D printing systems evolve toward point of care manufacturing, research on this topic continues to expand. Specific regulatory guidance is being developed for the safe management of 3D printing systems in a hospital environment. PAEK implants can benefit from many advantages of AM such as design freedom, material and antibacterial drug incorporation, and enhanced bioactivity provided by cancellous bone-like porous designs. In addition to AM PAEK bioactivity, the biomechanical strength of 3D printed implants is crucial to their performance and thus widely studied. In this review, we discuss the printing conditions that have been investigated so far for additively manufactured PAEK implant applications. The effect of processing parameters on the biomechanical strength of implants is summarized, and the bioactivity of PAEKs, along with material and drug incorporation, is also covered in detail. Finally, the therapeutic areas in which 3D printed PAEK implants are investigated and utilized are reviewed.

3D printing of PEEK and its composite to increase biointerfaces as a biomedical material- A review

Poly ether-ether-ketone (PEEK) is a polymer with better lignin biocompatibility than other polymers. It is good for biomedical engineering applications. This research summarises the outcomes of an evaluation conducted on PEEK material composites, such as cellular calcium hydroxyapatite (CHAp) for medical applications. Prospects of PEEK for medical implant are highlighted. Critical analysis and review on 3D printing of PEEK, CHAp and their biological macromolecular behaviours are presented. An electronic search was carried out on Scupos database, Google search and peer-reviewed papers published in the last ten years. Because of the extraordinary strength and biological behaviours of PEEK and its composite of CHAp, 3D-printed PEEK has several biomedical applications, and its biological macromolecular behaviour leads to health sustainability. This work highlights its biological macromolecular behaviours as a bone implant material and the optimum 3D printing process for PEEK and CHAp for medical applications. The current problems with printing PEEK and CHAp are investigated along with their possible uses. Possible solutions to improve the 3D printability of PEEK and CHAp are explained based on scientific mechanisms. This detailed report stands to benefit both scientific community and medical industry to enhance 3D printing concepts for PEEK and CHAp.

The Direct 3D Printing of Functional PEEK/Hydroxyapatite Composites via a Fused Filament Fabrication Approach

The manufacture of polyetheretherketone/hydroxyapatite (PEEK/HA) composites is seen as a viable approach to help enhance direct bone apposition in orthopaedic implants. A range of methods have been used to produce composites, including Selective Laser Sintering and injection moulding. Such techniques have drawbacks and lack flexibility to manufacture complex, custom-designed implants. 3D printing gets around many of the restraints and provides new opportunities for innovative solutions that are structurally suited to meet the needs of the patient. This work reports the direct 3D printing of extruded PEEK/HA composite filaments via a Fused Filament Fabrication (FFF) approach. In this work samples are 3D printed by a custom modified commercial printer Ultimaker 2+ (UM2+). SEM-EDX and µCT analyses show that HA particles are evenly distributed throughout the bulk and across the surface of the native 3D printed samples, with XRD highlighting up to 50% crystallinity and crystalline domains clearly observed in SEM and HR-TEM analyses. This highlights the favourable temperature conditions during 3D printing. The yield stress and ultimate tensile strength obtained for all the samples are comparable to human femoral cortical bone. The results show how FFF 3D printing of PEEK/HA composites up to 30 wt% HA can be achieved.

Modern Porous Polymer Implants: Synthesis, Properties, and Application

Abstract

The needs of modern surgery triggered the intensive development of transplantology, medical materials science, and tissue engineering. These directions require the use of innovative materials, among which porous polymers occupy one of the leading positions. The use of natural and synthetic polymers makes it possible to adjust the structure and combination of properties of a material to its particular application. This review generalizes and systematizes the results of recent studies describing requirements imposed on the structure and properties of synthetic (or artificial) porous polymer materials and implants on their basis and the advantages and limitations of synthesis methods. The most extensively employed, promising initial materials are considered, and the possible areas of application of polymer implants based on these materials are highlighted.

Digital fabrication of an adult speech aid prosthesis by using a 3-dimensionally printed polyetheretherketone framework

This article presents a digital fabrication method for a speech aid prosthesis by using a 3D-printed polyetheretherketone (PEEK) framework. The computer-aided design (CAD) of the speech aid prosthesis framework was based on oral scan data. The framework was printed with PEEK filament material supplemented with nanoTiO₂ powder by fused deposition modeling (FDM). A resin preliminary cast was 3D printed, and an altered cast technique was adopted to fabricate the definitive cast. The PEEK framework exhibited precise fit, toothlike color, excellent mechanical properties, and reduced weight as compared with a typical metal framework. This technique describes the successful clinical application of 3D-printed PEEK material for the fabrication of an adult speech aid prosthesis.

Preparation of Poly(ether-ether-ketone)/Nanohydroxyapatite Composites with Improved Mechanical Performance and Biointerfacial Affinity

Poly(ether-ether-ketone) (PEEK) displays promising potential in hard tissue repair and orthopedic surgery due to its adaptable mechanical performance, good chemical resistance, and bioinertness. However, the low biointerfacial affinity of pure PEEK implants and the decrease of mechanical strength after processing greatly limit their clinical applications. In this work, the influences on mechanical performance and biointerfacial affinity of the PEEK/nanohydroxyapatite (nHA) composites are systematically investigated. Results show that the mechanical performance of PEEK/nHA composites was improved by adjusting the nHA content. The maximum values of the tensile, compressive, bending, and impact strength of the composites were increased by approximately 16.2, 25, 54, and 21%, respectively, when compared with that of pure PEEK. Studies in vitro show that PEEK/nHA composites display good cytocompatibility and promote the biomimic formation of HA, adhesion, and proliferation of L929 cells on the surface. Studies in vivo demonstrate that, compared to the pure PEEK, PEEK/nHA composites exhibit higher biointerfacial affinity, including the adhesion and encapsulation of muscle tissues on the surface of the implants and the suppression of inflammatory reaction around the implants. Our findings could pave the way for extensive applications of PEEK/nHA composites in hard tissue repair, particularly orthopedic surgery.

Assessing the Radiological Density and Accuracy of Mandible Polymer Anatomical Structures Manufactured Using 3D Printing Technologies

Nowadays, 3D printing technologies are among the rapidly developing technologies applied to manufacture even the most geometrically complex models, however no techniques dominate in the area of craniofacial applications. This study included 12 different anatomical structures of the mandible, which were obtained during the process of reconstructing data from the Siemens Somatom Sensation Open 40 system. The manufacturing process used for the 12 structures involved the use of 8 3D printers and 12 different polymer materials. Verification of the accuracy and radiological density was performed with the CT160Xi Benchtop tomography system. The most accurate results were obtained in the case of models manufactured using the following materials: E-Model (Standard Deviation (SD) = 0.145 mm), FullCure 830 (SD = 0.188 mm), VeroClear (SD = 0.128 mm), Digital ABS-Ivory (SD = 0.117 mm), and E-Partial (SD = 0.129 mm). In the case of radiological density, ABS-M30 was similar to spongious bone, PC-10 was similar to the liver, and Polylactic acid (PLA) and Polyethylene terephthalate (PET) were similar to the spleen. Acrylic resin materials were able to imitate the pancreas, kidney, brain, and heart. The presented results constitute valuable guidelines that may improve currently used radiological phantoms and may provide support to surgeons in the process of performing more precise treatments within the mandible area.

Quality Characteristics and Clinical Relevance of In-House 3D-Printed Customized Polyetheretherketone (PEEK) Implants for Craniofacial Reconstruction

Additive manufacturing (AM) of patient-specific implants (PSIs) is gradually moving towards in-house or point-of-care (POC) manufacturing. Polyetheretherketone (PEEK) has been used in cranioplasty cases as a reliable alternative to other alloplastic materials. As only a few fused filament fabrication (FFF) printers are suitable for in-house manufacturing, the quality characteristics of the implants fabricated by FFF technology are still under investigated. This paper aimed to investigate PEEK PSIs fabricated in-house for craniofacial reconstruction, discussing the key challenges during the FFF printing process. Two exemplary cases of class III (Group 1) and class IV (Group 2) craniofacial defects were selected for the fabrication of PEEK PSIs. Taguchi’s L9 orthogonal array was selected for the following nonthermal printing process parameters, i.e., layer thickness, infill rate, number of shells, and infill pattern, and an assessment of the dimensional accuracy of the fabricated implants was made. The root mean square (RMS) values revealed higher deviations in Group 1 PSIs (0.790 mm) compared to Group 2 PSIs (0.241 mm). Horizontal lines, or the characteristic FFF stair-stepping effect, were more perceptible across the surface of Group 1 PSIs. Although Group 2 PSIs revealed no discoloration, Group 1 PSIs displayed different zones of crystallinity. These results suggest that the dimensional accuracy of PSIs were within the clinically acceptable range; however, attention must be paid towards a requirement of optimum thermal management during the printing process to fabricate implants of uniform crystallinity.

Fused Filament Fabrication of PEEK: A Review of Process-Structure-Property Relationships

Poly (ether ether ketone) (PEEK) is a high-performance engineering thermoplastic polymer with potential for use in a variety of metal replacement applications due to its high strength to weight ratio. This combination of properties makes it an ideal material for use in the production of bespoke replacement parts for out-of-earth manufacturing purposes, in particular on the International Space Station (ISS). Additive manufacturing (AM) may be employed for the production of these parts, as it has enabled new fabrication pathways for articles with complex design considerations. However, AM of PEEK via fused filament fabrication (FFF) encounters significant challenges, mostly stemming from the semi crystalline nature of PEEK and its associated high melting temperature. This makes PEEK highly susceptible to changes in processing conditions which leads to a large reported variation in the literature on the final performance of PEEK. This has limited the adaption of FFF printing of PEEK in space applications where quality assurance and reproducibility are paramount. In recent years, several research studies have examined the effect of printing parameters on the performance of the 3D-printed PEEK parts. The aim of the current review is to provide comprehensive information in relation to the process-structure-property relationships in FFF 3D-printing of PEEK to provide a clear baseline to the research community and assesses its potential for space applications, including out-of-earth manufacturing.

Identification of Optimal Process Parameter Settings Based on Manufacturing Performance for Fused Filament Fabrication of CFR-PEEK

Fused filament fabrication (FFF) has been proven to be an effective additive manufacturing technique for carbon fiber reinforced polyether–ether–ketone (CFR-PEEK) due to its practicality in use. However, the relationships between the process parameters and their trade-offs in manufacturing performance have not been extensively studied for CFR-PEEK although they are essential to identify the optimal parameter settings. This study therefore investigates the impact of critical FFF parameters (i.e., layer thickness, build orientation, and printing speed) on the manufacturing performance (i.e., printing time, dimensional accuracy, and material cost) of CFR-PEEK outputs. A full factorial design of the experiments is performed for each of the three sample designs to identify the optimal parameter combinations for each performance measure. In addition, multiple response optimization was used to derive optimal parameter settings for the overall performance. The results show that the optimal parameter settings depend on the performance measures regardless of the designs, and that the layer thickness plays a critical role in the performance trade-offs. In addition, lower layer thickness, horizontal orientation, and higher speed form the optimal settings to maximize the overall performance. The findings from this study indicate that FFF parameter settings for CFR-PEEK should be identified through multi-objective decision making that involves conflicts between the operational objectives for the parameter settings.

Engineered 3D Polymer and Hydrogel Microenvironments for Cell Culture Applications

The realization of biomimetic microenvironments for cell biology applications such as organ-on-chip, in vitro drug screening, and tissue engineering is one of the most fascinating research areas in the field of bioengineering. The continuous evolution of additive manufacturing techniques provides the tools to engineer these architectures at different scales. Moreover, it is now possible to tailor their biomechanical and topological properties while taking inspiration from the characteristics of the extracellular matrix, the three-dimensional scaffold in which cells proliferate, migrate, and differentiate. In such context, there is therefore a continuous quest for synthetic and nature-derived composite materials that must hold biocompatible, biodegradable, bioactive features and also be compatible with the envisioned fabrication strategy. The structure of the current review is intended to provide to both micro-engineers and cell biologists a comparative overview of the characteristics, advantages, and drawbacks of the major 3D printing techniques, the most promising biomaterials candidates, and the trade-offs that must be considered in order to replicate the properties of natural microenvironments.