Calcium phosphate coated 3D printed porous titanium with nanoscale surface modification for orthopedic and dental applications

3D Printing and Surface Engineering of Ti6Al4V Scaffolds for Enhanced Osseointegration in an In Vitro Study

Ti6Al4V superalloy is recognized as a good candidate for bone implants owing to its biocompatibility, corrosion resistance, and high strength-to-weight ratio. While dense metal implants are associated with stress shielding issues due to the difference in densities, stiffness, and modulus of elasticity compared to bone tissues, the surface of the implant/scaffold should mimic the properties of the bone of interest to assure a good integration with a strong interface. In this study, we investigated the additive manufacturing of porous Ti6Al4V scaffolds and coating modification for enhanced osteoconduction using osteoblast cells. The results showed the successful fabrication of porous Ti6Al4V scaffolds with adequate strength. Additionally, the surface treatment with NaOH and Dopamine Hydrochloride (DOPA) promoted the formation of Dopamine Hydrochloride (DOPA) coating with an optimized coating process, providing an environment that supports higher cell viability and growth compared to the uncoated Ti6Al4V scaffolds, as demonstrated by the higher proliferation ratios observed from day 1 to day 29. These findings bring valuable insights into the surface modification of 3D-printed scaffolds for improved osteoconduction through the coating process in solutions.

Preparation of HA-MAO coatings on β-type alloys and its corrosion resistance in high glucose environments

Aim to provide practical clinical guidance for the treatment of implants in diabetic patients, this study investigated the corrosion mechanism of bionic coatings containing different Ca/P ratios in diabetic environments. The bionic coatings were prepared in β-titanium alloys using micro-arc oxidation (MAO) technology and evaluated for corrosion mechanism, biocompatibility, and safety by cytotoxicity, electrochemical corrosion, and coating bonding force experiments. Ca and P from the electrolyte were integrated into the coating during MAO discharge process to form hydroxyapatite. The coating Ca/P ratio initially increased and then decreased with the electrolyte Ca/P ratio. In vitro cellular experiments demonstrated that increasing the porosity of HA-containing coatings would be beneficial to the growth of cells adhering to their surfaces. Corrosion tests revealed that the corrosion tendency of the coating at higher sugar content was more severe, and a proper elevation of the Ca/P ratio was better for the corrosion resistance of the coating. The bonding analysis of the coatings before and after corrosion showed that an increase in the Ca/P ratio would improve the bonding of the MAO coatings in higher glucose content environments, thus improving the safety of the implants in diabetic patients.

Natural medicine delivery from 3D printed bone substitutes

Unmet medical needs in treating critical-size bone defects have led to the development of numerous innovative bone tissue engineering implants. Although additive manufacturing allows flexible patient-specific treatments by modifying topological properties with various materials, the development of ideal bone implants that aid new tissue regeneration and reduce post-implantation bone disorders has been limited. Natural biomolecules are gaining the attention of the health industry due to their excellent safety profiles, providing equivalent or superior performances when compared to more expensive growth factors and synthetic drugs. Supplementing additive manufacturing with natural biomolecules enables the design of novel multifunctional bone implants that provide controlled biochemical delivery for bone tissue engineering applications. Controlled release of naturally derived biomolecules from a three-dimensional (3D) printed implant may improve implant-host tissue integration, new bone formation, bone healing, and blood vessel growth. The present review introduces us to the current progress and limitations of 3D printed bone implants with drug delivery capabilities, followed by an in-depth discussion on cutting-edge technologies for incorporating natural medicinal compounds embedded within the 3D printed scaffolds or on implant surfaces, highlighting their applications in several pre- and post-implantation bone-related disorders.

The Era of Biomaterials: Smart Implants?

Conditions, accidents, and aging processes have brought with them the need to develop implants with higher technology that allow not only the replacement of missing tissue but also the formation of tissue and the recovery of its function. The development of implants is due to advances in different areas such as molecular-biochemistry (which allows the understanding of the molecular/cellular processes during tissue repair), materials engineering, tissue regeneration (which has contributed advances in the knowledge of the properties of the materials used for their manufacture), and the so-called intelligent biomaterials (which promote tissue regeneration through inductive effects of cell signaling in response to stimuli from the microenvironment to generate adhesion, migration, and cell differentiation processes). The implants currently used are combinations of biopolymers with properties that allow the formation of scaffolds with the capacity to mimic the characteristics of the tissue to be repaired. This review describes the advances of intelligent biomaterials in implants applied in different dental and orthopedic problems; by means of these advances, it is expected to overcome limitations such as additional surgeries, rejections and infections in implants, implant duration, pain mitigation, and mainly, tissue regeneration.

Surface Modification and Functionalities for Titanium Dental Implants

Dental implants have become the mainstream strategy for oral restoration, and implant materials are the most important research hot spot in this field. So far, Ti implants dominate all kinds of implants. The surface properties of the Ti implant play decisive roles in osseointegration and antibacterial performance. Surface modifications can significantly change the surface micro/nanotopography and composition of Ti implants, which will effectively improve their hydrophilicity, mechanical properties, osseointegration performance, antibacterial performance, etc. These optimizations will thus improve implant success and service life. In this paper, the latest surface modification techniques of Ti dental implants are systematically and comprehensively reviewed. The various biomedical functionalities of surface modifications are discussed in-depth. Finally, a profound comment on the challenges and opportunities of this frontier is proposed, and the most promising directions for the future were explored.

Accelerated reconstruction of rat calvaria bone defect using 3D-printed scaffolds coated with hydroxyapatite/bioglass

Self-healing and autologous bone graft of calvaraial defects can be challenging. Therefore, the fabrication of scaffolds for its rapid and effective repair is a promising field of research. This paper provided a comparative study on the ability of Three-dimensional (3D) printed polycaprolactone (PCL) scaffolds and PCL-modified with the hydroxyapatite (HA) and bioglasses (BG) bioceramics scaffolds in newly bone formed in calvaria defect area. The studied 3D-printed PCL scaffolds were fabricated by fused deposition layer-by-layer modeling. After the evaluation of cell adhesion on the surface of the scaffolds, they were implanted into a rat calvarial defect model. The rats were divided into four groups with scaffold graft including PCL, PCL/HA, PCL/BG, and PCL/HA/BG and a non-explant control group. The capacity of the 3D-printed scaffolds in calvarial bone regeneration was investigated using micro computed tomography scan, histological and immunohistochemistry analyses. Lastly, the expression levels of several bone related genes as well as the expression of miR-20a and miR-17-5p as positive regulators and miR-125a as a negative regulator in osteogenesis pathways were also investigated. The results of this comparative study have showed that PCL scaffolds with HA and BG bioceramics have a great range of potential applications in the field of calvaria defect treatment.

Nanoscale Morphologies on the Surface of 3D-Printed Titanium Implants for Improved Osseointegration: A Systematic Review of the Literature

Three-dimensional (3D) printing is serving as the most promising approach to fabricate personalized titanium (Ti) implants for the precise treatment of complex bone defects. However, the bio-inert nature of Ti material limits its capability for rapid osseointegration and thus influences the implant lifetime in vivo. Despite the macroscale porosity for promoting osseointegration, 3D-printed Ti implant surface morphologies at the nanoscale have gained considerable attention for their potential to improve specific outcomes. To evaluate the influence of nanoscale surface morphologies on osseointegration outcomes of 3D-printed Ti implants and discuss the available strategies, we systematically searched evidence according to the PRISMA on PubMed, Embase, Web of Science, and Cochrane (until June 2022). The inclusion criteria were in vivo (animal) studies reporting the osseointegration outcomes of nanoscale morphologies on the surface of 3D-printed Ti implants. The risk of bias (RoB) was assessed using the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE's) tool. The quality of the studies was evaluated using the Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines. (PROSPERO: CRD42022334222). Out of 119 retrieved articles, 9 studies met the inclusion criteria. The evidence suggests that irregular nano-texture, nanodots and nanotubes with a diameter of 40-105nm on the surface of porous/solid 3D-printed Ti implants result in better osseointegration and vertical bone ingrowth compared to the untreated/polished ones by significantly promoting cell adhesion, matrix mineralization, and osteogenic differentiation through increasing integrin expression. The RoB was low in 41.1% of items, unclear in 53.3%, and high in 5.6%. The quality of the studies achieved a mean score of 17.67. Our study demonstrates that nanostructures with specific controlled properties on the surface of 3D-printed Ti implants improve their osseointegration. However, given the small number of studies, the variability in experimental designs, and lack of reporting across studies, the results should be interpreted with caution.

Tubular nanomaterials for bone tissue engineering

Nanomaterial composition, morphology, and mechanical performance are critical parameters for tissue engineering. Within this rapidly expanding space, tubular nanomaterials (TNs), including carbon nanotubes (CNTs), titanium oxide nanotubes (TNTs), halloysite nanotubes (HNTs), silica nanotubes (SiNTs), and hydroxyapatite nanotubes (HANTs) have shown significant potential across a broad range of applications due to their high surface area, versatile surface chemistry, well-defined mechanical properties, excellent biocompatibility, and monodispersity. These include drug delivery vectors, imaging contrast agents, and scaffolds for bone tissue engineering. This review is centered on the recent developments in TN-based biomaterials for structural tissue engineering, with a strong focus on bone tissue regeneration. It includes a detailed literature review on TN-based orthopedic coatings for metallic implants and composite scaffolds to enhance in vivo bone regeneration.

Design and manufacturing of patient-specific Ti6Al4V implants with inhomogeneous porosity

Stress shielding remains a challenge in orthopaedic implants, including total hip arthroplasty. Recent development in printable porous implants offers improved patient-specific solutions by providing adequate stability and reducing stress shielding possibilities. This work presents an approach for designing patient-specific implants with inhomogeneous porosity. A novel group of orthotropic auxetic structures is introduced, and their mechanical properties are computed. These auxetic structure units were distributed at different locations on the implant along with optimized pore distribution to achieve optimum performance. A computer tomography (CT) based finite element (FE) model was used to evaluate the performance of the proposed implant. The optimized implant and the auxetic structures were manufactured using laser powder bed-based laser metal additive manufacturing. Validation was done by comparing FE results with experimentally measured directional stiffness and Poisson's ratio of the auxetic structures and strain on the optimized implant. The correlation coefficient for the strain values was within a range of 0.9633-0.9844. Stress shielding was mainly observed in Gruen zones 1, 2, 6, and 7. The average stress shielding on the solid implant model was 56%, reduced to 18% when the optimized implant was used. This significant reduction in stress shielding can decrease the risk of implant loosening and create an osseointegration-friendly mechanical environment on the surrounding bone. The proposed approach can be effectively applied to the design of other orthopaedic implants to minimize stress shielding.

Design of Ti64/Ta Hybrid Materials by Powder Metallurgy Mimicking Bone Structure

This work reports on the fabrication of a novel two-layer material composed of a porous tantalum core and a dense Ti6Al4V (Ti64) shell by powder metallurgy. The porous core was obtained by mixing Ta particles and salt space-holders to create large pores, the green compact was obtained by pressing. The sintering behavior of the two-layer sample was studied by dilatometry. The interface bonding between the Ti64 and Ta layers was analyzed by SEM, and the pore characteristics were analyzed by computed microtomography. Images showed that two distinct layers were obtained with a bonding achieved by the solid-state diffusion of Ta particles into Ti64 during sintering. The formation of β-Ti and α' martensitic phases confirmed the diffusion of Ta. The pore size distribution was in the size range of 80 to 500 µm, and a permeability value of 6 × 10^-10 m² was close to the trabecular bones one. The mechanical properties of the component were dominated mainly by the porous layer, and Young's modulus of 16 GPa was in the range of bones. Additionally, the density of this material (6 g/cm³) was much lower than the one of pure Ta, which helps to reduce the weight for the desired applications. These results indicate that structurally hybridized materials, also known as composites, with specific property profiles can improve the response to osseointegration for bone implant applications.

Design and Additive Manufacturing of Acetabular Implant with Continuously Graded Porosity

Porous structured metallic implants are preferable as bone graft substitutes due to their faster tissue integration mediated by bone in-growth and vascularization. The porous scaffolds/implants should also mimic the graded structure of natural bone to ensure a match of mechanical properties. This article presents a method for designing a graded porous structured acetabular implant and identifies suitable parameters for manufacturing the model through additive manufacturing. The design method is based on slice-wise modification to ensure continuity of gradation. Modification of the slices was achieved through the binary image processing route. A geodesic dome-type design was adopted for developing the acetabular cup model from the graded porous structure. The model had a solid shell with the target porosity and pore size gradually changing from 65% and 950 µm, respectively, in the inner side to 75% and 650 µm, respectively, towards the periphery. The required dimensions of the unit structures and the combinations of pore structure and strut diameter necessary to obtain the target porosity and pore size were determined analytically. Suitable process parameters were identified to manufacture the model by Direct Metal Laser Sintering (DMLS) using Ti6Al4V powder after carrying out a detailed experimental study to minimize the variation of surface roughness and warping over different build angles of the strut structures. Dual-contour scanning was implemented to simplify the scan strategy. The minimum diameter of struts that could be manufactured using the selected scanning strategy and scanning parameters was found to be 375 µm. Finally, the model was built and from the micro-CT data, the porosities and pore sizes were found to be closely conforming to the designed values. The stiffness of the structures, as found from compression testing, was also found to match with that of human trabecular bone well. Further, the structure exhibited compliant bending-dominated behaviour under compressive loading.

The state of additive manufacturing in dental research - A systematic scoping review of 2012-2022

Background/purpose

Additive manufacturing (AM), also known as 3D printing, has the potential to transform the industry. While there have been advancements in using AM for dental restorations, there is still a need for further research to develop functional biomedical and dental materials. It's crucial to understand the current status of AM technology and research trends to advance dental research in this field. The aim of this study is to reveal the current status of international scientific publications in the field of dental research related to AM technologies.

Materials and methods

In this study, a systematic scoping review was conducted using appropriate keywords within the scope of international scientific publishing databases (PubMed and Web of Science). The review included related clinical and laboratory research, including both human and animal studies, case reports, review articles, and questionnaire studies. A total of 187 research studies were evaluated for quantitative synthesis in this review.

Results

The findings highlighted a rising trend in research numbers over the years (From 2012 to 2022). The most publications were produced in 2020 and 2021, with annual percentage increases of 25.7% and 26.2%, respectively. The majority of AM-related publications in dentistry research originate from Korea. The pioneer dental sub-fields with the ost publications in its category are prosthodontics and implantology, respectively.

Conclusion

The final review result clearly stated an expectation for the future that the research in dentistry would concentrate on AM technologies in order to increase the new product and process development in dental materials, tools, implants and new generation modelling strategy related to AM. The results of this work can be used as indicators of trends related to AM research in dentistry and/or as prospects for future publication expectations in this field.

A novel peptide isolated from Catla skin collagen acts as a self-assembling scaffold promoting nucleation of calcium-deficient hydroxyapatite nanocrystals

Catla collagen hydrolysate (CH) was fractionated by chromatography and each fraction was subjected to HA nucleation, with the resultant HA-fraction composites being scored based on the structural and functional group of the HA formed. The process was repeated till a single peptide with augmented HA nucleation capacity was obtained. The peptide (4.6 kDa), exhibited high solubility, existed in polyproline-II conformation and displayed a dynamic yet stable hierarchical self-assembling property. The 3D modelling of the peptide revealed multiple calcium and phosphate binding sites and a high propensity to self-assemble. Structural analysis of the peptide-HA crystals revealed characteristic diffraction planes of HA with mineralization following the (002) plane, retention of the self-assembled hierarchy of the peptide and intense ionic interactions between carboxyl groups and calcium. The peptide-HA composite crystals were mostly of 25-40 nm dimensions and displayed 79% mineralization, 92% crystallinity, 39.25% porosity, 12GPa Young's modulus and enhanced stability in physiological pH. Cells grown on peptide-HA depicted faster proliferation rates and higher levels of osteogenic markers. It was concluded that the prerequisite for HA nucleation by a peptide included: a conserved sequence with a unique charge topology allowing calcium chelation and its ability to form a dynamic self-assembled hierarchy for crystal propagation.

Improved Osseointegration of Selective Laser Melting Titanium Implants with Unique Dual Micro/Nano-Scale Surface Topography

Selective laser melting manufacture of patient specific Ti implants is serving as a promising approach for bone tissue engineering. The success of implantation is governed by effective osseointegration, which depends on the surface properties of implants. To improve the bioactivity and osteogenesis, the universal surface treatment for SLM-Ti implants is to remove the primitive roughness and then reengineer new roughness by various methods. In this study, the micro-sized partially melted Ti particles on the SLM-Ti surface were preserved for assembling mesoporous bioactive glass nanospheres to obtain a unique micro/nano- topography through combination of SLM manufacture and sol-gel processes. The results of simulated body fluid immersion test showed that bioactive ions (Ca, Si) can be continuously and stably released from the MBG nanospheres. The osseointegration properties of SLM-Ti samples, examined using pre-osteoblast cells, showed enhanced adhesion and osteogenic differentiation compared with commercial pure titanium commonly used as orthopedic implants. Overall, the developed approach of construction of the dual micro/nano topography generated on the SLM-Ti native surface could be critical to enhance musculoskeletal implant performance.

3D printed hydroxyapatite - Zn2+ functionalized starch composite bone grafts for orthopedic and dental applications

Hydroxyapatite (HA) - polymer composite based 3D printed bone grafts require extensive mechanical and biological property optimization for specific clinical needs. This fuels the need to develop innovative methods of optimization. Using an in-house extrusion-based 3D printer, we show the feasibility of fabricating hydroxyapatite- Zn2+ functionalized starch composites as artificial bone graft substitutes. The experimental procedure for this purpose is fortified with a univariate multi-objective optimization strategy to predict the best composition. The compressive strength of the grafts improves up to ~ 4 folds by parametric optimization and Zn2+ functionalization, without any post-processing. These grafts maintain mechanical integrity and strength during 6 weeks of dissolution study in simulated body fluid (SBF), while the non -functionalized starch-HA grafts fully degrade within a week. The Zn2+ functionalization results in up to ~ 79% antibacterial efficacy against S. aureus. Osteoblast cell viability increases ~ 1.6 folds on these graft surfaces on day 11. Our innovative methods of optimization are expected to reduce the experiment time, cost, and chance of human error in 3D printing. This study redefines the importance of understanding composition and process dependence for making a functionalized 3D printed bone graft for repairing low load-bearing defects such as craniomaxillofacial bone.

3D-Printed PCL Scaffolds Coated with Nanobioceramics Enhance Osteogenic Differentiation of Stem Cells

With advances in bone tissue engineering, various materials and methods have been explored to find a better scaffold that can help in improving bone growth and regeneration. Three-dimensional (3D) printing by fused deposition modeling can produce customized scaffolds from biodegradable polyesters such as polycaprolactone (PCL). Although the fabricated PCL scaffolds exhibited a lack of bioactivity and poor cell attachment on their surfaces, herein, using a simple postfabrication modification method with hydroxyapatite (HA) and bioglasses (BGs), we obtained better cell proliferation and attachment. Biological behavior and osteosupportive capacity of the 3D-printed scaffolds including PCL, PCL/HA, PCL/BG, and PCL/HA/BG were evaluated in this study, while human adipose tissue-derived mesenchymal stem cells (hADSCs) were cultured on the scaffolds. The cell morphology, attachment, and proliferation were investigated using scanning electron microscopy (SEM), 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay, and 4',6-diamidino-2-phenylindole (DAPI) staining. In the next step, the ability of stem cells to differentiate into osteoblasts was evaluated by measuring alkaline phosphatase (ALP) activity, calcium deposition, and bone-related gene and protein expression. In the end, the expression levels of miR-20a, miR-125a, and their target genes were also investigated as positive and negative regulators in osteogenesis pathways. The results showed that the coated scaffolds with bioceramics present a more appropriate surface for cell adhesion and proliferation, as well as efficient potential in inducing osteoconduction and osteointegration compared to PCL alone and control. The PCL/HA/BG scaffold exhibited higher in vitro cell viability and bone formation compared to the other groups, which can be due to the synergistic effect of HA and BG. On the whole, this tricomponent 3D-printing scaffold has a promising prospect for bone tissue engineering applications.

Anodic TiO2 Nanotubes on 3D-Printed Titanium Meshes for Photocatalytic Applications

In this work, large 3D Ti meshes fabricated by direct ink writing were wirelessly anodized for the first time to prepare highly photocatalytically active TiO₂ nanotube (TNT) layers. The use of bipolar electrochemistry enabled the fabrication of TNT layers within the 3D Ti meshes without the establishment of an electrical contact between Ti meshes and the potentiostat, confirming its unique ability and advantage for the synthesis of anodic structures on metallic substrates with a complex geometry. TNT layers with nanotube diameters of up to 110 nm and thicknesses of up to 3.3 μm were formed. The TNT-layer-modified 3D Ti meshes showed a superior performance for the photocatalytic degradation of methylene blue in comparison to TiO₂-nanoparticle-decorated and nonanodized Ti meshes (with a thermal oxide layer), resulting in multiple increases in the dye degradation rate. The results presented here open new horizons for the employment of anodized 3D Ti meshes in various flow-through (photo)catalytic reactors.

Plasma Spray vs. Electrochemical Deposition: Toward a Better Osteogenic Effect of Hydroxyapatite Coatings on 3D-Printed Titanium Scaffolds

Surface modification of three-dimensional (3D)-printed titanium (Ti) scaffolds with hydroxyapatite (HA) has been a research hotspot in biomedical engineering. However, unlike HA coatings on a plain surface, 3D-printed Ti scaffolds have inherent porous structures that influence the characteristics of HA coatings and osteointegration. In the present study, HA coatings were successfully fabricated on 3D-printed Ti scaffolds using plasma spray and electrochemical deposition, named plasma sprayed HA (PSHA) and electrochemically deposited HA (EDHA), respectively. Compared to EDHA scaffolds, HA coatings on PSHA scaffolds were smooth and continuous. In vitro cell studies confirmed that PSHA scaffolds have better potential to promote bone mesenchymal stem cell adhesion, proliferation, and osteogenic differentiation than EDHA scaffolds in the early and late stages. Moreover, in vivo studies showed that PSHA scaffolds were endowed with superior bone repair capacity. Although the EDHA technology is simpler and more controllable, its limitation due to the crystalline and HA structures needs to be improved in the future. Thus, we believe that plasma spray is a better choice for fabricating HA coatings on implanted scaffolds, which may become a promising method for treating bone defects.

Evolution of anodised titanium for implant applications

Anodised titanium has a long history as a coating structure for implants due to its bioactive and ossified surface, which promotes rapid bone integration. In response to the growing literature on anodised titanium, this article is the first to revisit the evolution of anodised titanium as an implant coating. The review reports the process and mechanisms for the engineering of distinctive anodised titanium structures, the significant factors influencing the mechanisms of its formation, bioactivity, as well as recent pre- and post-surface treatments proposed to improve the performance of anodised titanium. The review then broadens the discussion to include future functional trends of anodised titanium, ranging from the provision of higher surface energy interactions in the design of biocomposite coatings (template stencil interface for mechanical interlock) to techniques for measuring the bone-to-implant contact (BIC), each with their own challenges. Overall, this paper provides up-to-date information on the impacts of the structure and function of anodised titanium as an implant coating in vitro and in/ex vivo tests, as well as the four key future challenges that are important for its clinical translations, namely (i) techniques to enhance the mechanical stability and (ii) testing techniques to measure the mechanical stability of anodised titanium, (iii) real-time/in-situ detection methods for surface reactions, and (iv) cost-effectiveness for anodised titanium and its safety as a bone implant coating.

Titania-based sol-gel coatings with Ag, Ca-P applied on titanium substrate developed for implantation

This research work is focused on the investigation of newly developed titania sol-gel coatings containing silver, calcium and phosphate with appropriate abilities to be implanted into the human body. These abilities include adhesion, bioactivity, antibacterial property and cytocompatibility of prepared coatings. Four types of coatings were applied on a titanium substrate by dip-coating technique under different conditions (TCP1, TCP2, TCPA1 and TCPA2). Surfaces of coatings after the firing without silver featured different distribution of circular areas containing Ca. The coatings TCPA1 and TCPA2 were made up of unhomogeneously situated silver. Adhesion of the coatings to the substrates was measured by a tape test. All types of the coatings demonstrated very good adhesion. Isolated cracks that appeared during the firing did not have a negative influence on the adhesion properties. Bioactivity of the coatings was tested in vitro using a simulated body fluid. Three of the four types demonstrated bioactive properties (TCP1, TCP2 and TCPA2), that is, precipitation of crystalline hydroxyapatite as was confirmed by X-ray diffraction. The antibacterial effect (against Escherichia coli and Staphylococcus epidermidis) and cytotoxicity (toward L929 and U-2 OS cell lines, direct and indirect test) were then tested. All the coatings demonstrated very good antibacterial effect against both bacteria after 4- and 24-hr interaction. All the coating types were evaluated as cytocompatible in the indirect test. Cells were able to grow even directly on the coatings.

Surface engineering of biomaterials in orthopedic and dental implants: Strategies to improve osteointegration, bacteriostatic and bactericidal activities

BACKGROUND

The success of biomedical implants in orthopedic and dental applications is usually limited due to insufficient bone-implant integration, and implant-related infections. Biointerfaces are critical in regulating their interactions and the desirable performance of biomaterials in biological environment. Surface engineering has been widely studied to realize better control of the interface interaction to further enhance the desired behavior of biomaterials.

PURPOSE AND SCOPE

This review aims to investigate surface coating strategies in hard tissue applications to address insufficient osteointegration and implant-related infection problems.

SUMMARY

We first focused on surface coatings to enhance the osteointegration and biocompatibility of implants by emphasizing calcium phosphate-related, nanoscale TiO₂ -related, bioactive tantalum-based and biomolecules incorporated coatings. Different coating strategies such as plasma spraying, biomimetic deposition, electrochemical anodization and LENS are discussed. We then discussed techniques to construct anti-adhesive and bactericidal surface while emphasizing multifunctional surface coating techniques that combine potential osteointegration and antibacterial activities. The effects of nanotopography via TiO₂ coatings on antibacterial performance are interesting and included. A smart bacteria-responsive titanium dioxide nanotubes coating is also attractive and elaborated.

CONCLUSION

Developing multifunctional surface coatings combining osteogenesis and antimicrobial activity is the current trend. Surface engineering methods are usually combined to obtain hierarchical multiscale surface structures with better biofunctionalization outcomes.

Mixed oxide nanotubes in nanomedicine: A dead-end or a bridge to the future?

Nanomedicine has seen a significant rise in the development of new research tools and clinically functional devices. In this regard, significant advances and new commercial applications are expected in the pharmaceutical and orthopedic industries. For advanced orthopedic implant technologies, appropriate nanoscale surface modifications are highly effective strategies and are widely studied in the literature for improving implant performance. It is well-established that implants with nanotubular surfaces show a drastic improvement in new bone creation and gene expression compared to implants without nanotopography. Nevertheless, the scientific and clinical understanding of mixed oxide nanotubes (MONs) and their potential applications, especially in biomedical applications are still in the early stages of development. This review aims to establish a credible platform for the current and future roles of MONs in nanomedicine, particularly in advanced orthopedic implants. We first introduce the concept of MONs and then discuss the preparation strategies. This is followed by a review of the recent advancement of MONs in biomedical applications, including mineralization abilities, biocompatibility, antibacterial activity, cell culture, and animal testing, as well as clinical possibilities. To conclude, we propose that the combination of nanotubular surface modification with incorporating sensor allows clinicians to precisely record patient data as a critical contributor to evidence-based medicine.

4D Printing of Origami Structures for Minimally Invasive Surgeries Using Functional Scaffold

Origami structures have attracted attention in biomedical applications due to their ability to develop surgical tools that can be expanded from a minimal volume to a larger and functional device. On the other hand, four-dimensional (4D) printing is an emerging technology, which involves 3D printing of smart materials that can respond to external stimuli such as heat. This short communication introduces the proof of concept of merging origami and 4D printing technologies to develop minimally invasive delivery of functional biomedical scaffolds with high shape recovery. The shape-memory effect (SME) of the PLA filament and the origami designs were also assessed in terms of deformability and recovery rate. The results showed that herringbone tessellation origami structure combined with internal natural cancellous bone core satisfies the design requirement of foldable scaffolds. The substantial and consistent SME of the 4D printed herringbone tessellation origami, which exhibited 96% recovery compared to 61% for PLA filament, was the most significant discovery of this paper. The experiments demonstrated how the use of 4D printing in situ with origami structures could achieve reliable and repeatable results, therefore conclusively proving how 4D printing of origami structures can be applied to biomedical scaffolds.

Osseointegration of additive manufacturing Ti-6Al-4V and Co-Cr-Mo alloys, with and without surface functionalization with hydroxyapatite and type I collagen

The introduction of additive manufacturing (AM) technologies has profoundly revolutionized the implant manufacturing industry, with a particularly significant impact on the field of orthopedics. Electron Beam Melting (EBM) and Direct Metal Laser Sintering (DMLS) represents AM fabrication techniques with a pivotal role in the realization of complex and innovative structure starting from virtual 3D model data. In this study, Ti-6Al-4V and Co-Cr-Mo materials, developed by EBM (Ti-POR) and DMLS (Co-POR) techniques, respectively, with hydroxyapatite (Ti-POR + HA; Co-POR + HA) and type I collagen (Ti-POR-COLL; Co-POR-COLL) coatings, were implanted into lateral femoral condyles of rabbits. Osseointegration process was investigated by histological, histomorphometrical and microhardness evaluations at 4 and 12 weeks after implantation. Both Ti-6Al-4V and Co-Cr-Mo implants, with or without HA and COLL coatings, demonstrated good biocompatibility. As expected, HA coating hastened bone-to-implant contact (BIC) process, while collagen did not significantly improved the osseointegration process in comparison to controls. Regarding newly trabecular bone formation (B.Ar/T.Ar), Co-POR presented the highest values, significantly different from those of Co-POR-COLL. Over time, an increase of BIC parameter and a decrease of B.Ar/T.Ar were detected. Higher mineral apposition rate was observed for Ti-POR and Co-POR in comparison to Ti-POR-COLL and Co-POR-COLL, respectively, at 12 weeks. The same behavior was found for bone formation rate between Co-POR and Co-POR-COLL at 12 weeks. In conclusion, the AM materials guarantee a good osseointegration and provide a suitable environment for bone regeneration with the peculiarity of allowing personalized and patient-specific needs customization to further improve the long-term clinical outcomes.

3D Printing Technologies in Metallic Implants: A Thematic Review on the Techniques and Procedures

Additive manufacturing (AM) is among the most attractive methods to produce implants, the processes are very swift and it can be precisely controlled to meet patient's requirement since they can be produced in exact shape, dimension, and even texture of different living tissues. Until now, lots of methods have emerged and used in this field with diverse characteristics. This review aims to comprehensively discuss 3D printing (3DP) technologies to manufacture metallic implants, especially on techniques and procedures. Various technologies based on their main properties are categorized, the effecting parameters are introduced, and the history of AM technology is briefly analyzed. Subsequently, the utilization of these AM-manufactured components in medicine along with their effectual variables is discussed, and special attention is paid on to the production of porous scaffolds, taking pore size, density, etc., into consideration. Finally, 3DP of the popular metallic systems in medical applications such as titanium, Ti6Al4V, cobalt-chromium alloys, and shape memory alloys are studied. In general, AM manufactured implants need to comply with important requirements such as biocompatibility, suitable mechanical properties (strength and elastic modulus), surface conditions, custom-built designs, fast production, etc. This review aims to introduce the AM technologies in implant applications and find new ways to design more sophisticated methods and compatible implants that mimic the desired tissue functions.

Innovative Molecular and Cellular Therapeutics in Cleft Palate Tissue Engineering

Clefts of the lip and/or palate are the most prevalent orofacial birth defects occurring in about 1:700 live human births worldwide. Early postnatal surgical interventions are extensive and staged to bring about optimal growth and fusion of palatal shelves. Severe cleft defects pose a challenge to correct with surgery alone, resulting in complications and sequelae requiring life-long, multidisciplinary care. Advances made in materials science innovation, including scaffold-based delivery systems for precision tissue engineering, now offer new avenues for stimulating bone formation at the site of surgical correction for palatal clefts. In this study, we review the present scientific literature on key developmental events that can go awry in palate development and the common surgical practices and challenges faced in correcting cleft defects. How key osteoinductive pathways implicated in palatogenesis inform the design and optimization of constructs for cleft palate correction is discussed within the context of translation to humans. Finally, we highlight new osteogenic agents and innovative delivery systems with the potential to be adopted in engineering-based therapeutic approaches for the correction of palatal defects. Impact statement Tissue-engineered scaffolds supplemented with osteogenic growth factors have attractive, largely unexplored possibilities to modulate molecular signaling networks relevant to driving palatogenesis in the context of congenital anomalies (e.g., cleft palate). Constructs that address this need may obviate current use of autologous bone grafts, thereby avoiding donor-site morbidity and other regenerative challenges in patients afflicted with palatal clefts. Combinations of biomaterials and drug delivery of diverse regenerative cues and biologics are currently transforming strategies exploited by engineers, scientists, and clinicians for palatal cleft repair.

Electrochemical Deposition of Nanostructured Hydroxyapatite Coating on Titanium with Enhanced Early Stage Osteogenic Activity and Osseointegration

Purpose

The aim of research is to fabricate nanostructured hydroxyapatite (HA) coatings on the titanium via electrochemical deposition (ED). Additionally, the biological properties of the ED-produced HA (EDHA) coatings with a plate-like nanostructure were evaluated in vitro and in vivo by undertaking comparisons with those prepared by acid/alkali (AA) treatment and by plasma spray-produced HA (PSHA) nanotopography-free coatings.

Materials and Methods

Nanoplate-like HA coatings were prepared through ED, and nanotopography-free PSHA coatings were fabricated. The surface morphology, phase composition, roughness, and wettability of these samples were investigated. Furthermore, the growth, proliferation, and osteogenic differentiation of MC3T3-E1 cells cultured on each sample were evaluated via in vitro experiments. Histological assessment and push-out tests for the bone–implant interface were performed to explore the effect of the EDHA coatings on the interfacial osseointegration in vivo.

Results

XRD analysis showed that the strongest intensity for the EDHA coatings was at the (002) plane rather than at the regular (211) plane. Relatively higher surface roughness and greater wettability were observed for the EDHA coatings. Cellular experiments revealed that the plate-like nanostructured EDHA coatings not only possessed an ability, similar to that of PSHA coatings, to promote the adhesion and proliferation of MC3T3-E1 cells but also demonstrated significantly enhanced early or intermediate markers of osteogenic differentiation. Significant osseointegration enhancement in the early stage of implantation period and great bonding strength were observed at the interface of bone and EDHA samples. In comparison, relatively weak osseointegration and bonding strength of the bone–implant interface were observed for the AA treatment.

Conclusion

The biological performance of the plate-like nanostructured EDHA coating, which was comparable with that of the PSHA, improves early-stage osteogenic differentiation and osseointegration abilities and has great potential for enhancing the initial stability and long-term survival of uncemented or 3D porous titanium implants.

Functionalization of 3D-printed titanium alloy orthopedic implants: a literature review

Titanium alloy orthopedic implants produced by 3D printing combine the dual advantages of having a complex structure that cannot be manufactured by traditional techniques and the excellent physical and chemical properties of titanium and its alloys; they have been widely used in the field of orthopedics in recent years. The inherent porous structure of 3D-printed implants and the original modification processes for titanium alloys provide conditions for the functionalization of implants. To meet the needs of orthopedic surgeons and patients, functionalized implants with long-term stability and anti-infection or anti-tumor properties have been developed. The various methods of functionalization deserve to be summarized, compared and analyzed. Therefore, in this review, we will collect and discuss existing knowledge on the functionalization of 3D-printed titanium alloy orthopedic implants.

Multi-Scale Surface Treatments of Titanium Implants for Rapid Osseointegration: A Review

The propose of this review was to summarize the advances in multi-scale surface technology of titanium implants to accelerate the osseointegration process. The several multi-scaled methods used for improving wettability, roughness, and bioactivity of implant surfaces are reviewed. In addition, macro-scale methods (e.g., 3D printing (3DP) and laser surface texturing (LST)), micro-scale (e.g., grit-blasting, acid-etching, and Sand-blasted, Large-grit, and Acid-etching (SLA)) and nano-scale methods (e.g., plasma-spraying and anodization) are also discussed, and these surfaces are known to have favorable properties in clinical applications. Functionalized coatings with organic and non-organic loadings suggest good prospects for the future of modern biotechnology. Nevertheless, because of high cost and low clinical validation, these partial coatings have not been commercially available so far. A large number of in vitro and in vivo investigations are necessary in order to obtain in-depth exploration about the efficiency of functional implant surfaces. The prospective titanium implants should possess the optimum chemistry, bionic characteristics, and standardized modern topographies to achieve rapid osseointegration.

Additive Manufacturing Technologies for Drug Delivery Applications

Patient to patient variability is one of the issues when administering medications to individuals with different health conditions, pharmacokinetic, age, fitness, gender, and race. This requires introducing smart and personalised drug delivery systems with controlled release profile manufactured using novel approaches. Additive manufacturing (AM) provides opportunities such as full customisation, design freedom, and on-site manufacturing, and materials recycling. As a result, the academic and industrial demand for additive manufacturing for drug delivery has been continuously increasing and showing impressive results for a wide range of products. This paper provides an extensive overview of AM technologies and their applications for drug delivery. The review discusses AM technologies including their working principles, processed materials, as well as current progress in drug delivery to produce personalized dosages for every patient with controlled release profile. AM potentials, industrial scale, and challenges are investigated with regards to practice and industrial applications. The paper covers novel possibilities of AM technologies and their pharmaceuticals applications, which indicate a promising healthcare future.

Substituted hydroxyapatite coatings of bone implants

Surface modification of orthopedic and dental implants has been demonstrated to be an effective strategy to accelerate bone healing at early implantation times. Among the different alternatives, coating implants with a layer of hydroxyapatite (HAp) is one of the most used techniques, due to its excellent biocompatibility and osteoconductive behavior. The composition and crystalline structure of HAp allow for numerous ionic substitutions that provide added value, such as antibiotic properties or osteoinduction. In this article, we will review and critically analyze the most important advances in the field of substituted hydroxyapatite coatings. In recent years substituted HAp coatings have been deposited not only on orthopedic prostheses and dental implants, but also on macroporous scaffolds, thus expanding their applications towards bone regeneration therapies. Besides, the capability of substituted HAps to immobilize proteins and growth factors by non-covalent interactions has opened new possibilities for preparing hybrid coatings that foster bone healing processes. Finally, the most important in vivo outcomes will be discussed to understand the prospects of substituted HAp coatings from a clinical point of view.

Electrochemical Studies on CaP Electrodeposition on Three Dimensional Surfaces of Selective Laser Melted Titanium Scaffold

In this work, calcium phosphate (CaP) coating was electrodeposited on the three dimensional surface of SLM-Ti scaffolds. The in situ measurement showed that the potential variation within 5 mm thickness porous selective laser melting (SLM)-Ti samples was about 80 mV as a result of the low conductivity of CaP coatings. SEM observation results revealed that the coating morphology depended on the distance between the surface position of porous SLM-Ti electrode and the auxiliary electrode. Based on the compared electrochemical experiments, it was found that the top and the bottom surfaces of SLM-Ti scaffolds exhibited continuous nucleation and instantaneous nucleation behavior respectively. The Electrochemical impedance spectroscopy (EIS) results also revealed that the electrodeposition processes at different depth of SLM-Ti scaffolds were not synchronized. These differences were ultimately caused by the non-uniform distribution of the potential and the current inside porous SLM-Ti electrodes. The present work provides a basic research method for studying the mechanism of the electrochemical process on three dimensional surfaces of SLM-Ti scaffolds.

Effects of Aloe Vera Gel Extract in Doped Hydroxyapatite-Coated Titanium Implants on in Vivo and in Vitro Biological Properties

Hydroxyapatite-coated titanium alloys have been a popular choice as bone implants for load-bearing applications for the compositional similarity of hydroxyapatite to natural bone. The limited osteoinductive properties exhibited by the hydroxyapatite (HA) coatings have led to the incorporation of growth factor or dopants for improved osseointegration. This study aims to investigate the effects of a naturally occurring aloe vera gel extract, acemannan, in doped hydroxyapatite coatings on the in vitro osteoblast cell viability and in vivo new bone formation in a rat distal femur model. Silver oxide and silica-doped hydroxyapatite coatings were developed by the induction plasma spray coating method on Ti alloys to introduce antibacterial properties along with induction of angiogenic properties, respectively. The doped coating was further consecutively dip coated with acemannan to analyze its effects on the in vivo early stage osseointegration and chitosan to control the burst release of the acemannan from the calcium phosphate matrix. The results show controlled release of acemannan from the chitosan coatings, with enhanced osteoblast cell viability by the incorporation of acemannan in vitro. Improved osseointegration with a seamless implant interface and improved new bone formation was noted by the acemannan and chitosan coating in vivo, 5 weeks after implantation. Our results demonstrate the efficacy of a combination of natural medicine and naturally occurring polymer in a doped hydroxyapatite-coated titanium implant on the bone tissue regeneration for load-bearing orthopedic applications.

Clinical significance of three-dimensional printed biomaterials and biomedical devices

Three-dimensional printing (3DP) is becoming a standard manufacturing practice for a variety of biomaterials and biomedical devices. This layer-by-layer methodology provides the ability to fabricate parts from computer-aided design files without the need for part-specific tooling. Three-dimensional printed medical components have transformed the field of medicine through on-demand patient care with specialized treatment such as local, strategically timed drug delivery, and replacement of once-functioning body parts. Not only can 3DP technology provide individualized components, it also allows for advanced medical care, including surgical planning models to aid in training and provide temporary guides during surgical procedures for reinforced clinical success. Despite the advancement in 3DP technology, many challenges remain for forward progress, including sterilization concerns, reliability, and reproducibility. This article offers an overview of biomaterials and biomedical devices derived from metals, ceramics, polymers, and composites that can be three-dimensionally printed, as well as other techniques related to 3DP in medicine, including surgical planning, bioprinting, and drug delivery.

Characterization and in ovo vascularization of a 3D-printed hydroxyapatite scaffold with different extracellular matrix coatings under perfusion culture

For the fabrication of appropriate bone tissue-engineered constructs several prerequisites should be fulfilled. They should offer long-term stability, allow proper cell attachment and proliferation and furthermore be osteoinductive and easy to be vascularized. Having these requirements as background, we fabricated a novel porous 3D-printed hydroxyapatite (HA) scaffold and treated it with oxygen plasma (OPT). MG-63 pre-osteoblast-seeded bone constructs allowed good cell attachment and proliferation, which was even better when cultivated in a perfusion flow bioreactor. Moreover, the deposition of extracellular matrix (ECM) on the otherwise inorganic surface changed the mechanical properties in a favourable manner: elasticity increased from 42.95±1.09 to 91.9±5.1 MPa (assessed by nanoindentation). Compared to static conditions, osteogenic differentiation was enhanced in the bioreactor, with upregulation of ALP, collagen I and osteocalcin gene expression. In parallel experiments, primary human bone marrow mesenchymal stromal cells (hBMSCs) were used and findings under dynamic conditions were similar; with a higher commitment towards osteoblasts compared to static conditions. In addition, angiogenic markers CD31, eNOS and VEGF were upregulated, especially when osteogenic medium was used rather than proliferative medium. To compare differently fabricated ECMs in terms of vascularization, decellularized constructs were tested in the chorioallantoic membrane (CAM) assay with subsequent assessment of the functional perfusion capacity by MRI in the living chick embryo. Here, vascularization induced by ECM from osteogenic medium led to a vessel distribution more homogenous throughout the construct, while ECM from proliferative medium enhanced vessel density at the interface and, to a lower extent, at the middle and top. We conclude that dynamic cultivation of a novel porous OPT HA scaffold with hBMSCs in osteogenic medium and subsequent decellularization provides a promising off-the-shelf bone tissue-engineered construct.