Modulating Bioglass Concentration in 3D Printed Poly(propylene fumarate) Scaffolds for Post-Printing Functionalization with Bioactive Functional Groups

Use of Biomaterials in 3D Printing as a Solution to Microbial Infections in Arthroplasty and Osseous Reconstruction

The incidence of microbial infections in orthopedic prosthetic surgeries is a perennial problem that increases morbidity and mortality, representing one of the major complications of such medical interventions. The emergence of novel technologies, especially 3D printing, represents a promising avenue of development for reducing the risk of such eventualities. There are already a host of biomaterials, suitable for 3D printing, that are being tested for antimicrobial properties when they are coated with bioactive compounds, such as antibiotics, or combined with hydrogels with antimicrobial and antioxidant properties, such as chitosan and metal nanoparticles, among others. The materials discussed in the context of this paper comprise beta-tricalcium phosphate (β-TCP), biphasic calcium phosphate (BCP), hydroxyapatite, lithium disilicate glass, polyetheretherketone (PEEK), poly(propylene fumarate) (PPF), poly(trimethylene carbonate) (PTMC), and zirconia. While the recent research results are promising, further development is required to address the increasing antibiotic resistance exhibited by several common pathogens, the potential for fungal infections, and the potential toxicity of some metal nanoparticles. Other solutions, like the incorporation of phytochemicals, should also be explored. Incorporating artificial intelligence (AI) in the development of certain orthopedic implants and the potential use of AI against bacterial infections might represent viable solutions to these problems. Finally, there are some legal considerations associated with the use of biomaterials and the widespread use of 3D printing, which must be taken into account.

Biomaterials Adapted to Vat Photopolymerization in 3D Printing: Characteristics and Medical Applications

Along with the rapid and extensive advancements in the 3D printing field, a diverse range of uses for 3D printing have appeared in the spectrum of medical applications. Vat photopolymerization (VPP) stands out as one of the most extensively researched methods of 3D printing, with its main advantages being a high printing speed and the ability to produce high-resolution structures. A major challenge in using VPP 3D-printed materials in medicine is the general incompatibility of standard VPP resin mixtures with the requirements of biocompatibility and biofunctionality. Instead of developing completely new materials, an alternate approach to solving this problem involves adapting existing biomaterials. These materials are incompatible with VPP 3D printing in their pure form but can be adapted to the VPP chemistry and general process through the use of innovative mixtures and the addition of specific pre- and post-printing steps. This review's primary objective is to highlight biofunctional and biocompatible materials that have been adapted to VPP. We present and compare the suitability of these adapted materials to different medical applications and propose other biomaterials that could be further adapted to the VPP 3D printing process in order to fulfill patient-specific medical requirements.

Additive Manufacturing of Bioactive Glass and Its Polymer Composites as Bone Tissue Engineering Scaffolds: A Review

Bioactive glass (BG) and its polymer composites have demonstrated great potential as scaffolds for bone defect healing. Nonetheless, processing these materials into complex geometry to achieve either anatomy-fitting designs or the desired degradation behavior remains challenging. Additive manufacturing (AM) enables the fabrication of BG and BG/polymer objects with well-defined shapes and intricate porous structures. This work reviewed the recent advancements made in the AM of BG and BG/polymer composite scaffolds intended for bone tissue engineering. A literature search was performed using the Scopus database to include publications relevant to this topic. The properties of BG based on different inorganic glass formers, as well as BG/polymer composites, are first introduced. Melt extrusion, direct ink writing, powder bed fusion, and vat photopolymerization are AM technologies that are compatible with BG or BG/polymer processing and were reviewed in terms of their recent advances. The value of AM in the fabrication of BG or BG/polymer composites lies in its ability to produce scaffolds with patient-specific designs and the on-demand spatial distribution of biomaterials, both contributing to effective bone defect healing, as demonstrated by in vivo studies. Based on the relationships among structure, physiochemical properties, and biological function, AM-fabricated BG or BG/polymer composite scaffolds are valuable for achieving safer and more efficient bone defect healing in the future.

Grafting of maleic anhydride on poly(lactic acid)/hydroxyapatite composites augments their ability to support osteogenic differentiation of human mesenchymal stem cells

Implantation of bone substitutes is the treatment of choice for bone defects exceeding a critical size, when self-healing becomes impossible. The use of 3D printing techniques allows the construction of scaffolds with customized properties. However, there is a lack of suitable materials for bone replacement. In this study, maleic anhydride-grafted poly (lactic acid) (MAPLA) was investigated as a potential compatibilizer agent for 3D-printed polylactic acid (PLA)/hydroxyapatite (HA) composites, in order to enhance the physicochemical and biological properties of the scaffolds. The grafting process was performed by reactive processing in a torque rheometer, with the evaluation of the use of different concentrations of maleic anhydride (MA). The success of the grafting reaction was confirmed by titration of acid groups and spectroscopic analyses, indicating the presence of succinic anhydride groups on the PLA chain. Morphological analysis of the PLA/HA 3D scaffolds, using SEM, revealed that the use of the compatibilizer resulted in a structure free from voids and holes. The compatibilization also increased the degradation process. On the other hand, TGA and DSC analyses revealed that the use of a compatibilizer had little effect on the thermal properties of the composite. Most importantly, the samples with compatibilizer were demonstrated to have a minimal cytotoxic effect on human mesenchymal stem cells (MSCs), promoting the osteogenic differentiation of these cells in a medium without the addition of classical osteogenic factors. Therefore, the grafting of PLA/HA composites improved their physicochemical and biological properties, especially the induction of MSC osteogenic differentiation, demonstrating the potential of these scaffolds for bone tissue replacement.

3D-Printing for Critical Sized Bone Defects: Current Concepts and Future Directions

The management and definitive treatment of segmental bone defects in the setting of acute trauma, fracture non-union, revision joint arthroplasty, and tumor surgery are challenging clinical problems with no consistently satisfactory solution. Orthopaedic surgeons are developing novel strategies to treat these problems, including three-dimensional (3D) printing combined with growth factors and/or cells. This article reviews the current strategies for management of segmental bone loss in orthopaedic surgery, including graft selection, bone graft substitutes, and operative techniques. Furthermore, we highlight 3D printing as a technology that may serve a major role in the management of segmental defects. The optimization of a 3D-printed scaffold design through printing technique, material selection, and scaffold geometry, as well as biologic additives to enhance bone regeneration and incorporation could change the treatment paradigm for these difficult bone repair problems.

Influence of Multiple Thermomechanical Processing of 3D Filaments Based on Polylactic Acid and Polyhydroxybutyrate on Their Rheological and Utility Properties

This study focused on material recycling of a biodegradable blend based on PLA and PHB for multiple applications of biodegradable polymeric material under real conditions. In this study, we investigated the effect of multiple processing of a biodegradable polymer blend under the trade name NONOILEN^®, which was processed under laboratory as well as industrial conditions. In this article, we report on testing the effect of blending and multiple processing on thermomechanical stability, molecular characteristics, as well as thermophysical and mechanical properties of experimental- and industrial-type tested material suitable for FDM 3D technology. The results showed that the studied material degraded during blending and subsequently during multiple processing. Even after partial degradation, which was demonstrated by a decrease in average molecular weight and a decrease in complex viscosity in the process of multiple reprocessing, there was no significant change in the material’s thermophysical properties, either in laboratory or industrial conditions. There was also no negative impact on the strength characteristics of multiple processed samples. The results of this work show that a biodegradable polymer blend based on PLA and PHB is a suitable candidate for material recycling even in industrial processing conditions. In addition, the results suggest that the biodegradable polymeric material NONOILEN^® 3D 3056-2 is suitable for multiple uses in FDM technology.

Can 3D-Printed Bioactive Glasses Be the Future of Bone Tissue Engineering?

According to the Global Burden of Diseases, Injuries, and Risk Factors Study, cases of bone fracture or injury have increased to 33.4% in the past two decades. Bone-related injuries affect both physical and mental health and increase the morbidity rate. Biopolymers, metals, ceramics, and various biomaterials have been used to synthesize bone implants. Among these, bioactive glasses are one of the most biomimetic materials for human bones. They provide good mechanical properties, biocompatibility, and osteointegrative properties. Owing to these properties, various composites of bioactive glasses have been FDA-approved for diverse bone-related and other applications. However, bone defects and bone injuries require customized designs and replacements. Thus, the three-dimensional (3D) printing of bioactive glass composites has the potential to provide customized bone implants. This review highlights the bottlenecks in 3D printing bioactive glass and provides an overview of different types of 3D printing methods for bioactive glass. Furthermore, this review discusses synthetic and natural bioactive glass composites. This review aims to provide information on bioactive glass biomaterials and their potential in bone tissue engineering.

Polymer Composites Based on Glycol-Modified Poly(Ethylene Terephthalate) Applied to Additive Manufacturing Using Melted and Extruded Manufacturing Technology

As part of the work, innovative polymer composites dedicated to 3D printing applications were developed. For this purpose, the influence of modified fillers, such as silica modified with alumina, bentonite modified with quaternary ammonium salt, and hybrid filler lignin/silicon dioxide, on the functional properties of composites based on glycol-modified poly(ethylene terephthalate) (PET-G) was investigated. In the first part of the work, using the proprietary technological line, filaments from unfilled polymer and its composites were obtained, which contained modified fillers in an amount from 1.5% to 3.0% by weight. The fittings for the testing of functional properties were obtained using the 3D printing technique in the Melted and Extruded Manufacturing (MEM) technology and the injection molding technique. In a later part of the work, rheological properties such as mass melt flow rate (MFR) and viscosity, and mechanical properties such as Rockwell hardness, Charpy impact strength, and static tensile strength with Young's modulus were presented. The structure of the obtained composites was also described and determined using scanning electron microscopy with an attachment for the microanalysis of chemical composition (SEM/EDS) and the atomic force microscope (AFM). The correct dispersion of the fillers in the polymer matrix was confirmed by wide-angle X-ray scattering analysis (WAXS). In turn, the physicochemical properties were presented on the basis of the research results: thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), and Fourier transform infrared spectroscopy (FT-IR). On the basis of the obtained results, it was found that both the amount and the type of fillers used significantly affected the functional properties of the tested composites.

Stereochemistry and Stoichiometry in Aliphatic Polyester Photopolymers for 3D Printing Tailored Biomaterial Scaffolds

Stereoselective aliphatic polyesters were synthesized through the ring opening copolymerization of cyclic anhydrides and epoxides using a tin catalyst to yield Mn ~ 10-13 kDa macromolecules (Đ < 1.6). Isomerization...

Biodegradable and Crosslinkable Poly(propylene fumarate) Liquid Crystal Polymers

In recent years, liquid crystal polymers (LCPs) have attracted extensive attention due to their widespread applications in artificial muscles, engineering plastics and high-modulus fibers, etc. However, the design and fabrication...

Dexamethasone-loaded, injectable pullulan-poly(ethylene glycol) hydrogels for bone tissue regeneration in chronic inflammatory conditions

Chronic inflammation, infection, and fixation stability disrupts bone tissue regeneration by implants. The elevated levels of inflammatory markers and reactive oxygen species (ROS) damage tissues, inhibit osteoblastic differentiation, and promote bone resorption. Activation of local and chronic inflammatory responses due to the implantable biomaterial poses a high risk of implant failure and compromised bone repair in several pathological conditions. Not much progress has been made in the development of biomaterials that can counter inflammation and ROS along with inducing osteogenic activities for managing bone defects/injuries. We have developed, for the first time, injectable polymeric hydrogels by crosslinking oxidized pullulan (OP, 1% w/v) and 8-arm PEG hydrazine (PEG-HY, 10% w/v) using pH-sensitive and dynamic hydrazone linkages at 37 °C in buffer. The hydrogels were loaded with dexamethasone (Dex), an anti-inflammatory corticosteroid and osteogenic inducer, by covalently linking it to PEG-HY by hydrazone linkages, and their morphological, injectability, viscoelastic, self-healing, swelling, and drug-release properties were investigated. The hydrogels provided a pH-sensitive sustained release of PEG-Dex conjugate (3.62 wt%, 9.22 × 10^-5 mol of Dex/gram) for 28 days, with 74.54 and 55.15% PEG-Dex conjugate being released at pH 6.5 and 7.4. ABTS assay showed that hydrogels inhibited 68% radicals within 1 h, and treatment with hydrogel releasates inhibited the pro-inflammatory markers, IL-6 and IL-1β, and elevated the anti-inflammatory marker, TGF-β, in murine osteoblast precursor cells (MC3T3-E1). The hydrogels were found suitable for cell encapsulation and they exhibited 110% viability on treatment with releasates. Finally, the osteogenic activities of hydrogels were ascertained by alkaline phosphatase (ALP) activities, alizarin red S staining, and osteogenic gene expressions- RUNX2, Col-I, OPN, and IBSP. Overall, PEG-Dex conjugate released from hydrogels improved the cell viability and proliferation, and induced the osteoblastic differentiation. The hydrogels with their promising antioxidant and anti-inflammatory properties along with the osteogenic activities show a strong potential as an injectable, extracellular matrix (ECM)-mimicking implantable drug-depot for bone repair applications in chronic inflammatory conditions.

Filament extrusion of bioresorbable PDLGA for additive manufacturing utilising diatom biosilica to inhibit process-induced thermal degradation

Bone scaffolds are often fabricated by initially producing custom-made filaments by twin-screw extruder and subsequently fabricating into 3D scaffolds using fused deposition modelling. This study aims to directly compare the effect of two alternative silica-rich filler materials on the thermo-mechanical properties of such scaffolds after extrusion and printing. Poly (DL-lactide-co-glycolide) (PDLGA) was blended with either 45S5 Bioglass (5 wt %) or Biosilica (1 and 5 wt%) isolated from Cyclotella meneghiniana a freshwater diatom were tested. Diatom-PDLGA was found to have similar mechanical strength and ductility to pure-PDLGA, whereas Bioglass-PDLGA was found induce a more brittle behaviour. Bioglass-PDLGA was also found to have the lowest toughness in terms of energy absorption to failure. The TGA results suggested that significant thermal degradation in both the Bioglass filaments and scaffolds had occurred as a result of processing. However, diatom biosilica was found to inhibit thermal degradation of the PDLGA. Furthermore, evidence suggested the agglomeration of Bioglass particles occurred during processing the Bioglass-PDLGA filaments. Overall, diatom biosilica was found to be a promising candidate as a bone filler additive in 3D printed PDLGA scaffolds, whereas Bioglass caused some potentially detrimental effects on performance.