Additive Manufacturing of Bioactive Poly(trimethylene carbonate)/β-Tricalcium Phosphate Composites for Bone Regeneration

Enabling New Approaches: Recent Advances in Processing Aliphatic Polycarbonate-Based Materials

Aliphatic polycarbonates (aPCs) have become increasingly popular as functional materials due to their biocompatibility and capacity for on-demand degradation. Advances in polymerization techniques and the introduction of new functional monomers have expanded the library of aPCs available, offering a diverse range of chemical compositions and structures. To accommodate the emerging requirements of new applications in biomedical and energy-related fields, various manufacturing techniques have been adopted for processing aPC-based materials. However, a summary of these techniques has yet to be conducted. The aim of this paper is to enrich the toolbox available to researchers, enabling them to select the most suitable technique for their materials. In this paper, a concise review of the recent progress in processing techniques, including controlled self-assembly, electrospinning, additive manufacturing, and other techniques, is presented. We also highlight the specific challenges and opportunities for the sustainable growth of this research area and the successful integration of aPCs in industrial applications.

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.

Structural Mechanical Properties of 3D Printing Biomimetic Bone Replacement Materials

One of the primary challenges in developing bone substitutes is to create scaffolds with mechanical properties that closely mimic those of regenerated tissue. Scaffolds that mimic the structure of natural cancellous bone are believed to have better environmental adaptability. In this study, we used the porosity and thickness of pig cancellous bone as biomimetic design parameters, and porosity and structural shape as differential indicators, to design a biomimetic bone beam scaffold. The mechanical properties of the designed bone beam model were tested using the finite element method (FEM). PCL/β-TCP porous scaffolds were prepared using the FDM method, and their mechanical properties were tested. The FEM simulation results were compared and validated, and the effects of porosity and pore shape on the mechanical properties were analyzed. The results of this study indicate that the PCL/β-TCP scaffold, prepared using FDM 3D printing technology for cancellous bone tissue engineering, has excellent integrity and stability. Predicting the structural stability using FEM is effective. The triangle pore structure has the most stability in both simulations and tests, followed by the rectangle and honeycomb shapes, and the diamond structure has the worst stability. Therefore, adjusting the porosity and pore shape can change the mechanical properties of the composite scaffold to meet the mechanical requirements of customized tissue engineering.

Development of Strong and Tough β-TCP/PCL Composite Scaffolds with Interconnected Porosity by Digital Light Processing and Partial Infiltration

Strong and tough β-TCP/PCL composite scaffolds with interconnected porosity were developed by combining digital light processing and vacuum infiltration. The composite scaffolds were comprised of pure β-TCP, β-TCP matrix composite and PCL matrix composite. The porous β-TCP/PCL composite scaffolds showed remarkable mechanical advantages compared with ceramic scaffolds with the same macroscopic pore structure (dense scaffolds). The composite scaffolds exhibited a significant increase in strain energy density and fracture energy density, though with similar compressive and flexural strengths. Moreover, the composite scaffolds had a much higher Weibull modulus and longer fatigue life than the dense scaffolds. It was revealed that the composite scaffolds with interconnected porosity possess comprehensive mechanical properties (high strength, excellent toughness, significant reliability and fatigue resistance), which suggests that they could replace the pure ceramic scaffolds for degradable bone substitutes, especially in complex stress environments.

On the Evolution of Additive Manufacturing (3D/4D Printing) Technologies: Materials, Applications, and Challenges

The scientific community is and has constantly been working to innovate and improve the available technologies in our use. In that effort, three-dimensional (3D) printing was developed that can construct 3D objects from a digital file. Three-dimensional printing, also known as additive manufacturing (AM), has seen tremendous growth over the last three decades, and in the last five years, its application has widened significantly. Three-dimensional printing technology has the potential to fill the gaps left by the limitations of the current manufacturing technologies, and it has further become exciting with the addition of a time dimension giving rise to the concept of four-dimensional (4D) printing, which essentially means that the structures created by 4D printing undergo a transformation over time under the influence of internal or external stimuli. The created objects are able to adapt to changing environmental variables such as moisture, temperature, light, pH value, etc. Since their introduction, 3D and 4D printing technologies have extensively been used in the healthcare, aerospace, construction, and fashion industries. Although 3D printing has a highly promising future, there are still a number of challenges that must be solved before the technology can advance. In this paper, we reviewed the recent advances in 3D and 4D printing technologies, the available and potential materials for use, and their current and potential future applications. The current and potential role of 3D printing in the imperative fight against COVID-19 is also discussed. Moreover, the major challenges and developments in overcoming those challenges are addressed. This document provides a cutting-edge review of the materials, applications, and challenges in 3D and 4D printing technologies.

Efficacy Evaluation of Ciprofloxacin-Loaded Poly (Trimethylene Carbonate) Implants in the Treatment of Chronic Osteomyelitis

In this study, poly (trimethylene carbonate) (PTMC) with excellent biocompatibility was synthesized via ring-opening of TMC to prepare the Ciprofloxacin-loaded PTMC implants, and antibacterial effects in vitro or in vivo of the resulting implants were investigated to evaluate the potential for treating chronic osteomyelitis. The in vitro results showed the Ciprofloxacin-loaded PTMC implants could sustain release ciprofloxacin at a release amount of about 90 μg/d for 28 days and possessed excellent antibacterial effect, as evidenced by the smaller size of the antibacterial ring of 32.6 ± 0.64 mm and the biofilm inhibition of 60% after 28 days of release. The in vivo results showed that after 28 days of treatment, the body weight and the white blood cell counts of chronic-osteomyelitis-model rats in the treatment group reached 381.6 ± 16.8 g and (7.86 ± 0.91) ×10⁹/L, respectively, returning to normal rapidly compared with the control and blank group, indicating the remarkable antibacterial effect of the Ciprofloxacin-loaded PTMC implants. X-ray images and HE staining results also confirmed that most of the proximal and middle parts of the tibia returned to typical structures and new and trabecular bone had been formed for the rats in the treatment group, and no inflammatory cells were found as compared to the control and blank groups, after 28 days of treatment. The significant lower number of colonies of (9.92 ± 1.56) × 10 CFU/g in the treatment group also suggests that the Ciprofloxacin-loaded PTMC implants achieve a practical antibacterial effect through a local application.

Patient-Specific Bioimplants and Reconstruction Plates for Mandibular Defects: Production Workflow and In Vivo Large Animal Model Study

A major challenge with extensive craniomaxillofacial bone reconstruction is the limited donor-site availability to reconstruct defects predictably and accurately according to the anatomical shape of the patient. Here, patient-specific composite bioimplants, consisting of cross-linked poly(trimethylene carbonate) (PTMC) networks and β-tricalcium phosphate (β-TCP), were tested in vivo in twelve Göttingen minipigs in a large mandibular continuity defect model. The 25 mm defects were supported by patient-specific titanium reconstruction plates and received either osteoconductive composite bioimplants (PTMC+TCP), neat polymer network bioimplants (PTMC), autologous bone segments (positive control) or were left empty (negative control). Post-operatively, defects treated with bioimplants showed evident ossification at 24 weeks. Histopathologic evaluation revealed that neat PTMC bioimplant surfaces were largely covered with fibrous tissue, while in the PTMC+TCP bioimplants, bone attached directly to the implant surface showing good osteoconduction and histological signs of osteoinductivity. However, PTMC+TCP bioimplants were associated with high incidence of necrosis and infection, possibly due to rapid resorption and/or particle size of the used β-TCP. The study highlights the importance of testing bone regeneration implants in a clinically relevant large animal model and at the in situ reconstruction site, since results on small animal models and studies in non-loadbearing areas do not translate directly. This article is protected by copyright. All rights reserved.

Polymeric drug delivery systems by additive manufacturing

Additive manufacturing (AM) is gaining interests in drug delivery applications, offering innovative opportunities for the design and development of systems with complex geometry and programmed controlled release profile. In addition, polymer-based drug delivery systems can improve drug safety, efficacy, patient compliance, and are the key materials in AM. Therefore, combining AM and polymers can be beneficial to overcome the existing limitations in the development of controlled release drug delivery systems. Considering these advantages, here we are focusing on the recent developments in the field of polymeric drug delivery systems prepared by AM. This review provides a comprehensive overview on a holistic polymer-AM perspective for drug delivery systems with discussion on the materials, properties, design and fabrication techniques and the mechanisms used to achieve a controlled release system. The current challenges and future perspectives for personalized medicine and clinical use of these systems are also briefly discussed.

Improved Bone Regeneration in Rabbit Bone Defects Using 3D Printed Composite Scaffolds Functionalized with Osteoinductive Factors

Large critical size bone defects are complicated to treat, and in many cases, autografts become a challenge due to size and availability. In such situations, a synthetic bone implant that can be patient-specifically designed and fabricated with control over parameters such as porosity, rigidity, and osteogenic cues can act as a potential synthetic bone substitute. In this study, we produced photocuring composite resins with poly(trimethylene carbonate) containing high ratios of bioactive ceramics and printed porous 3D composite scaffolds to be used as bone grafts. To enhance the overall surface area available for cell infiltration, the scaffolds were also filled with a macroporous cryogel. Furthermore, the scaffolds were functionalized with osteoactive factors: bone morphogenetic protein and zoledronic acid. The scaffolds were evaluated in vitro for biocompatibility and for functionality in vivo in critical bone defects (∼8 mm) in two clinically relevant rabbit models. These studies included a smaller study in rabbit tibia and a larger study in the rabbit cranium. It was observed that the bioactive molecule-functionalized 3D printed porous composite scaffolds provide an excellent conductive surface inducing higher bone formation and improved defect healing in both critical size long bones and cranial defects. Our findings provide strong evidence in favor of these composites as next generation synthetic bone substitutes.

Fabrication of Photo-Crosslinkable Poly(Trimethylene Carbonate)/Polycaprolactone Nanofibrous Scaffolds for Tendon Regeneration

BACKGROUND

The treatment of tendon injuries remains a challenging problem in clinical due to their slow and insufficient natural healing process. Scaffold-based tissue engineering provides a promising strategy to facilitate tendon healing and regeneration. However, many tissue engineering scaffolds have failed due to their poor and unstable mechanical properties. To address this, we fabricated nanofibrous polycaprolactone/methacrylated poly(trimethylene carbonate) (PCL/PTMC-MA) composite scaffolds via electrospinning.

MATERIALS AND METHODS

PTMC-MA was characterized by nuclear magnetic resonance. Fiber morphology of composite scaffolds was evaluated using scanning electron microscopy. The monotonic tensile test was performed for determining the mechanical properties of composite scaffolds. Cell viability and collagen deposition were assessed via PrestoBlue assay and enzyme-linked immunosorbent assay, respectively.

RESULTS

These PCL/PTMC-MA composite scaffolds had an increase in mechanical properties as PTMC-MA content increase. After photo-crosslinking, they showed further enhanced mechanical properties including creep resistance, which was superior to pure PCL scaffolds. It is worth noting that photo-crosslinked PCL/PTMC-MA (1:3) composite scaffolds had a Young's modulus of 31.13 ± 1.30 MPa and Max stress at break of 23.80 ± 3.44 MPa that were comparable with the mechanical properties of native tendon (Young's modulus 20-1200 MPa, max stress at break 5-100 MPa). In addition, biological experiments demonstrated that PCL/PTMC-MA composite scaffolds were biocompatible for cell adhesion, proliferation, and differentiation.