4D Printing of Bioinspired Absorbable Left Atrial Appendage Occluders: A Proof-of-Concept Study

Integrative Modeling and Experimental Insights into 3D and 4D Printing Technologies

This review focuses on advancements in polymer science as it relates to three-dimensional (3D) and four-dimensional (4D) printing technologies, with a specific emphasis on applications in the biomedical field. While acknowledging the breadth of 3D and 4D printing applications, this paper concentrates on the use of polymers in creating biomedical devices and the challenges associated with their implementation. It explores integrative modeling and experimental insights driving innovations in these fields, focusing on sustainable manufacturing with biodegradable polymers, a comparative analysis of 3D and 4D printing techniques, and applications in biomedical devices. Additionally, the review examines the materials used in both 3D and 4D printing, offering a detailed comparison of their properties and applications. By highlighting the transformative potential of these technologies in various industrial and medical applications, the paper underscores the importance of continued research and development. The scope of this review also includes an overview of future research directions to address current challenges, enhance material capabilities, and explore practical applications.

4D Printing for Biomedical Applications

4D (bio-)printing endows 3D printed (bio-)materials with multiple functionalities and dynamic properties. 4D printed materials have been recently used in biomedical engineering for the design and fabrication of biomedical devices, such as stents, occluders, microneedles, smart 3D-cell engineered microenvironments, drug delivery systems, wound closures, and implantable medical devices. However, the success of 4D printing relies on the rational design of 4D printed objects, the selection of smart materials, and the availability of appropriate types of external (multi-)stimuli. Here, this work first highlights the different types of smart materials, external stimuli, and design strategies used in 4D (bio-)printing. Then, it presents a critical review of the biomedical applications of 4D printing and discusses the future directions of biomedical research in this exciting area, including in vivo tissue regeneration studies, the implementation of multiple materials with reversible shape memory behaviors, the creation of fast shape-transformation responses, the ability to operate at the microscale, untethered activation and control, and the application of (machine learning-based) modeling approaches to predict the structure-property and design-shape transformation relationships of 4D (bio)printed constructs.

Nanomaterials in 4D Printing: Expanding the Frontiers of Advanced Manufacturing

As an innovative technology, four-dimentional (4D) printing is built upon the principles of three-dimentional (3D) printing with an additional dimension: time. While traditional 3D printing creates static objects, 4D printing generates "responsive 3D printed structures", enabling them to transform or self-assemble in response to external stimuli. Due to the dynamic nature, 4D printing has demonstrated tremendous potential in a range of industries, encompassing aerospace, healthcare, and intelligent devices. Nanotechnology has gained considerable attention owing to the exceptional properties and functions of nanomaterials. Incorporating nanomaterials into an intelligent matrix enhances the physiochemical properties of 4D printed constructs, introducing novel functions. This review provides a comprehensive overview of current applications of nanomaterials in 4D printing, exploring their synergistic potential to create dynamic and responsive structures. Nanomaterials play diverse roles as rheology modifiers, mechanical enhancers, function introducers, and more. The overarching goal of this review is to inspire researchers to delve into the vast potential of nanomaterial-enabled 4D printing, propelling advancements in this rapidly evolving field.

Magnetic Stimulation for Programmed Shape Morphing: Review of Four-Dimensional Printing, Challenges and Opportunities

In the field of Additive Manufacturing, four-dimensional (4D) printing has emerged as a promising technique to fabricate smart structures capable of undergoing shape morphing in response to specific stimuli. Magnetic stimulation offers a safe, remote, and rapid actuation mechanism for magnetically responsive structures. This review provides a comprehensive overview of the various strategies and manufacturing approaches employed in the development of magnetically stimulated shape morphing 4D-printed structures, based on an extensive literature search. The review explores the use of magnetic stimulation either individually or in combination with other stimuli. While most of the literature focuses on single-stimulus responsive structures, a few examples of multi-stimuli responsive structures are also presented. We investigate the influence of the orientation of magnetic particles in smart material composites, which can be either random or programmed during or after printing. Finally, the similarities and differences among the different strategies and their impact on the resulting shape-morphing behavior are analyzed. This systematic overview functions as a guide for readers in selecting a manufacturing approach to achieve a specific magnetically actuated shape-morphing effect.

Future trends of additive manufacturing in medical applications: An overview

Additive Manufacturing (AM) has recently demonstrated significant medical progress. Due to advancements in materials and methodologies, various processes have been developed to cater to the medical sector's requirements, including bioprinting and 4D, 5D, and 6D printing. However, only a few studies have captured these emerging trends and their medical applications. Therefore, this overview presents an analysis of the advancements and achievements obtained in AM for the medical industry, focusing on the principal trends identified in the annual report of AM3DP.

Shape Memory Polymer Composites: 4D Printing, Smart Structures, and Applications

Shape memory polymers (SMPs) and their composites (SMPCs) are smart materials that can be stably deformed and then return to their original shape under external stimulation, thus having a memory of their shape. Three-dimensional (3D) printing is an advanced technology for fabricating products using a digital software tool. Four-dimensional (4D) printing is a new generation of additive manufacturing technology that combines shape memory materials and 3D printing technology. Currently, 4D-printed SMPs and SMPCs are gaining considerable research attention and are finding use in various fields, including biomedical science. This review introduces SMPs, SMPCs, and 4D printing technologies, highlighting several special 4D-printed structures. It summarizes the recent research progress of 4D-printed SMPs and SMPCs in various fields, with particular emphasis on biomedical applications. Additionally, it presents an overview of the challenges and development prospects of 4D-printed SMPs and SMPCs and provides a preliminary discussion and useful reference for the research and application of 4D-printed SMPs and SMPCs.

4D Printing Shape-Morphing Hybrid Biomaterials for Advanced Bioengineering Applications

Four-dimensional (4D) printing is an innovative additive manufacturing technology used to fabricate structures that can evolve over time when exposed to a predefined environmental stimulus. 4D printed objects are no longer static objects but programmable active structures that accomplish their functions thanks to a change over time in their physical/chemical properties that usually displays macroscopically as a shapeshifting in response to an external stimulus. 4D printing is characterized by several entangled features (e.g., involved material(s), structure geometry, and applied stimulus entities) that need to be carefully coupled to obtain a favorable fabrication and a functioning structure. Overall, the integration of micro-/nanofabrication methods of biomaterials with nanomaterials represents a promising approach for the development of advanced materials. The ability to construct complex and multifunctional triggerable structures capable of being activated allows for the control of biomedical device activity, reducing the need for invasive interventions. Such advancements provide new tools to biomedical engineers and clinicians to design dynamically actuated implantable devices. In this context, the aim of this review is to demonstrate the potential of 4D printing as an enabling manufacturing technology to code the environmentally triggered physical evolution of structures and devices of biomedical interest.

Near-Infrared Remotely Controllable Shape Memory Biodegradable Occluder Based on Poly(l-lactide-co-ε-caprolactone)/Gold Nanorod Composite

Biodegradable occluders, which can efficiently eliminate the complications caused by permanent foreign implants, are considered to be the next-generation devices for the interventional treatment of congenital heart disease. However, the controllability of the deployment process of degradable occluders remains a challenge. In this work, a near-infrared (NIR) remotely controllable biodegradable occluder is explored by integrating poly(l-lactide-co-ε-caprolactone) (PLCL) with poly(ethylene glycol)-modified gold nanorods (GNR/PEG). The caprolactone structural units can effectively increase the toughness of poly(l-lactide) and reduce the shape-memory transition temperature of the occluder to a more tissue-friendly temperature. Gold nanorods endow the PLCL-GNR/PEG composite with an excellent photothermal effect. The obtained occluder can be easily loaded into a catheter for transport and spatiotemporally expanded under irradiation with near-infrared light to block the defect site. Both in vitro and in vivo biological experiments showed that PLCL-GNR/PEG composites have good biocompatibility, and the PEGylated gold nanorods could improve the hemocompatibility of the composites to a certain extent by enhancing their hydrophilicity. As a thermoplastic shape-memory polymer, PLCL-GNR/PEG can be easily processed into various forms and structures for different patients and lesions. Therefore, PLCL-GNR/PEG has the potential to be considered as a competitive biodegradable material not only for occluders but also for other biodegradable implants.

Three/Four-Dimensional Printed PLA Nano/Microstructures: Crystallization Principles and Practical Applications

Compared to traditional methods, three/four-dimensional (3D/4D) printing technologies allow rapid prototyping and mass customization, which are ideal for preparing nano/microstructures of soft polymer materials. Poly (lactic acid) (PLA) is a biopolymer material widely used in additive manufacturing (AM) because of its biocompatibility and biodegradability. Unfortunately, owing to its intrinsically poor nucleation ability, a PLA product is usually in an amorphous state after industrial processing, leading to some undesirable properties such as a barrier property and low thermal resistance. Crystallization mediation offers a most practical way to improve the properties of PLA products. Herein, we summarize and discuss 3D/4D printing technologies in the processing of PLA nano/microstructures, focusing on crystallization principles and practical applications including bio-inspired structures, flexible electronics and biomedical engineering mainly reported in the last five years. Moreover, the challenges and prospects of 3D/4D printing technologies in the fabrication of high-performance PLA materials nano/microstructures will also be discussed.

Study of Ni/Y2O3/Polylactic Acid Composite

This study demonstrates the successful synthesis of Ni/Y₂O₃ nanocomposite particles through the application of ultrasound-assisted precipitation using the ultrasonic spray pyrolysis technique. They were collected in a water suspension with polyvinylpyrrolidone (PVP) as the stabiliser. The presence of the Y₂O₃ core and Ni shell was confirmed with transmission electron microscopy (TEM) and with electron diffraction. The TEM observations revealed the formation of round particles with an average diameter of 466 nm, while the lattice parameter on the Ni particle's surface was measured to be 0.343 nm. The Ni/Y₂O₃ nanocomposite particle suspensions were lyophilized, to obtain a dried material that was suitable for embedding into a polylactic acid (PLA) matrix. The resulting PLA/Ni/Y₂O₃ composite material was extruded, and the injection was moulded successfully. Flexural testing of PLA/Ni/Y₂O₃ showed a slight average decrease (8.55%) in flexural strength and a small decrease from 3.7 to 3.3% strain at the break, when compared to the base PLA. These findings demonstrate the potential for utilising Ni/Y₂O₃ nanocomposite particles in injection moulding applications and warrant further exploration of their properties and new applications in various fields.

3D and 4D Bioprinting Technologies: A Game Changer for the Biomedical Sector?

Bioprinting is an innovative and emerging technology of additive manufacturing (AM) and has revolutionized the biomedical sector by printing three-dimensional (3D) cell-laden constructs in a precise and controlled manner for numerous clinical applications. This approach uses biomaterials and varying types of cells to print constructs for tissue regeneration, e.g., cardiac, bone, corneal, cartilage, neural, and skin. Furthermore, bioprinting technology helps to develop drug delivery and wound healing systems, bio-actuators, bio-robotics, and bio-sensors. More recently, the development of four-dimensional (4D) bioprinting technology and stimuli-responsive materials has transformed the biomedical sector with numerous innovations and revolutions. This issue also leads to the exponential growth of the bioprinting market, with a value over billions of dollars. The present study reviews the concepts and developments of 3D and 4D bioprinting technologies, surveys the applications of these technologies in the biomedical sector, and discusses their potential research topics for future works. It is also urged that collaborative and valiant efforts from clinicians, engineers, scientists, and regulatory bodies are needed for translating this technology into the biomedical, pharmaceutical, and healthcare systems.

4D Printing of Overall Radiopaque Customized Bionic Occlusion Devices

Percutaneous closure of ventricular septal defect (VSD) can effectively occlude abnormal blood flow between ventricles. However, commonly used Nitinol occlusion devices have non-negligible limitations, such as nondegradability leading to life-threatening embolization; limited device size predisposing to displacement and wear; only a few radiopaque markers resulting in inaccurate positioning. Nevertheless, the exploration of customized, biodegradable, and overall radiopaque occluders is still vacant. Here, overall radiopaque, biodegradable, and dynamic reconfigurable 4D printed VSD occluders are developed. Based on wavy bionic structures, various VSD occluders are designed and manufactured to adapt to the position diversity of VSD. The customized configuration, biocompatibility, and biodegradability of the developed 4D printed bionic occluders can eliminate the series of complications caused by traditional occluders. The overall radiopacity of 4D printed VSD occluders is validated ex vivo and in vivo, whereby accurate positioning can be assured. Notably, the preparation strategies for 4D printed occluders are scalable, eliminating the barriers to mass production, and marking a meaningful step in bridging the gap between modeling and clinical application of 4D printed occlusion devices. This work opens attractive perspectives for the rapid manufacturing of customized intelligent medical devices for which overall radiopacity, dynamic reconfigurability, biocompatibility, and biodegradability are sought.

Humidity-Responsive Shape Memory Polyurea with a High Energy Output Based on Reversible Cross-Linked Networks

High-performance shape memory polymers with multifunctions are essential in sensors, wearable flexible electronics, artificial muscle actuators, and reversible morphing structures. In this work, a transparent and humidity-responsive shape memory polyurea featuring a high tensile strength (51 MPa), a high recovery stress (12 MPa) with an high energy output (0.98 J/g), and tolerance to extreme environments (retains great malleability at -196 °C) is prepared through constructing a bioinspired hard-soft nanophase structure and through hierarchical hydrogen bonding in the molecular network. The hard segment of a strong hydrogen bonding region is in charge of humidity-responsive behavior, and the soft segment of a weak bonding region provides the flexibility of the molecular chain. Furthermore, the periodicity of the phase-separated domains is 12 nm as characterized by small-angle X-ray scattering. The hydrogen bonding cross-linked network can be opened under the action of stress and re-bonded by heating, just like a zipper structure of reversible linking property. This unique molecular structure contributes to the humidity-responsive behavior of polyurea rolling up 160° in 20 s on the palm, as well as a high energy output lifting a 100 g weight exceeding 1631 times its own mass to 60 mm. The molecular structure of the hard-soft nanophase and the hierarchical hydrogen bonding offer an effective approach toward achieving a high-performance shape memory polymer with humidity-sensitive functions.

A Biocompatible 4D Printing Shape Memory Polymer as Emerging Strategy for Fabrication of Deployable Medical Devices

The rapid development of 4D printing provides a potential strategy for the fabrication of deployable medical devices (DMD). The minimally invasive surgery to implant the DMD into the body is critical, 4D printing DMD allows the well-defined device to be implanted with a high-compacted shape and transformed into their designed shape to meet the requirement. Herein, a 4D printing tissue engineering material is developed with excellent biocompatibility and shape memory effect based on the photocrosslinked polycaprolactone (PCL). The fast thiol-acrylate click reaction is applied for photocrosslinking of the acrylates capped star polymer (s-PCL-MA) with poly-thiols, that enable the 3D printing for the DMD fabrication. The cell viability, erythrocyte hemolysis, and platelet adhesion results indicate the excellent biocompatibility of the 4D printing polymer, especially the biological subcutaneous implantation results confirm the promote tissue growth and good histocompatibility. A 4D printing stent with deformable shape and recovery at a temperature close to human body temperature demonstrated the potential application as DMD. In addition, the everolimus is loaded to the polymer (ps1-PCL) through host-guest coordination with β-cyclodextrin as the core of the star polymer, which shows sustained drug release and improved body's inflammatory response.

Research Progress of Shape Memory Polymer and 4D Printing in Biomedical Application

As a kind of smart material, shape memory polymer (SMP) shows great application potential in the biomedical field. Compared with traditional metal-based medical devices, SMP-based devices have the following characteristics: 1) The adaptive ability allows the biomedical device to better match the surrounding tissue after being implanted into the body by minimally invasive implantation; 2) it has better biocompatibility and adjustable biodegradability; 3) mechanical properties can be regulated in a large range to better match with the surrounding tissue. 4D printing technology is a comprehensive technology based on smart materials and 3D printing, which has great application value in the biomedical field. 4D printing technology breaks through the technical bottleneck of personalized customization and provides a new opportunity for the further development of the biomedical field. This paper summarizes the application of SMP and 4D printing technology in the field of bone tissue scaffolds, tracheal scaffolds, and drug release, etc. Moreover, this paper analyzes the existing problems and prospects, hoping to provide a preliminary discussion and useful reference for the application of SMP in biomedical engineering.

4D Printing: A Cutting-edge Platform for Biomedical Applications

Nature's materials have evolved over time to be able to respond to environmental stimuli by generating complex structures that can change their functions in response to distance, time, and direction of stimuli. A number of technical efforts are currently being made to improve printing resolution, shape fidelity, and printing speed to mimic the structural design of natural materials with three-dimensional (3D) printing. Unfortunately, this technology is limited by the fact that printed objects are static and cannot be reshaped dynamically in response to stimuli. In recent years, several smart materials have been developed that can undergo dynamic morphing in response to a stimulus, thus resolving this issue. Four-dimensional (4D) printing refers to a manufacturing process involving additive manufacturing, smart materials, and specific geometries. It has become an essential technology for biomedical engineering and has the potential to create a wide range of useful biomedical products. This paper will discuss the concept of 4D bioprinting and the recent developments in smart matrials, which can be actuated by different stimuli and be exploited to develop biomimetic materials and structures, with significant implications for pharmaceutics and biomedical research, as well as prospects for the future.

3D Printed Bioinspired Stents with Photothermal Effects for Malignant Colorectal Obstruction

Stent placement is an effective palliation therapy for malignant colorectal obstruction. However, recurrent obstruction is a common severe complication caused by tumor ingrowth into the stent lumen. Conventional covered stents play a part in preventing the tumor from growing inward but at the expense of significantly increasing the risk of stent migration. Therefore, there is an urgent demand to develop stents with sustained antitumor and antimigration abilities. Herein, we propose a facile method for fabricating multifunctional bioinspired colorectal stents using 3D printing technology. Inspired by high-adhesion biological structures (gecko feet, tree frog toe pads, and octopus suckers) in nature, different types of bioinspired colorectal stents are designed to reduce migration. After functionalization with graphene oxide (GO), bioinspired colorectal stents show excellent and controllable photothermal performance, which is validated by effective ablation of colon cancer cells in vitro and tumors in vivo. Besides, the bioinspired colorectal stents demonstrate the feasibility of transanal placement and opening of the obstructed colon. More importantly, the facile manufacturing process of multifunctional bioinspired colorectal stents is appealing for mass production. Hence, the developed multifunctional bioinspired colorectal stents exhibit a highly promising potential in clinical applications.

4D Printing Applications in the Development of Smart Cardiovascular Implants

Smart materials are able to react to different stimuli and adapt their shape to the environment. Although the development of 3D printing technology increased the reproducibility and accuracy of scaffold fabrication, 3D printed scaffolds can still be further improved to resemble the native anatomy. 4D printing is an innovative fabrication approach combining 3D printing and smart materials, also known as stimuli-responsive materials. Especially for cardiovascular implants, 4D printing can promisingly create programmable, adaptable prostheses, which facilitates implantation and/or create the topology of the target tissue post implantation. In this review, the principles of 4D printing with a focus on the applied stimuli are explained and the underlying 3D printing technologies are presented. Then, according to the type of stimulus, recent applications of 4D printing in constructing smart cardiovascular implants and future perspectives are discussed.

Bio-Inspired Bianisotropic Magneto-Sensitive Elastomers with Excellent Multimodal Transformation

Magneto-sensitive soft materials that can accomplish fast, remote, and reversible shape morphing are highly desirable for practical applications including biomedical devices, soft robotics, and flexible electronics. In conventional magneto-sensitive elastomers (MSEs), there is a tradeoff between employing hard magnetic particles with costly magnetic programming and utilizing soft magnetic particle chains causing tedious and small deformation. Here, inspired by the shape and movement of mimosa, a novel soft magnetic particle doped shape material bianisotropic magneto-sensitive elastomer (SM bianisotropic MSE) with multimodal transformation and superior deformability is developed. The high-aspect-ratio shape anisotropy and the material anisotropy in which the magnetic particles are arranged in a chainlike structure together impart magnetic anisotropy to the SM bianisotropic MSE. A magneto-elastic analysis model is proposed, and it is elucidated that magnetic anisotropy leads to peculiar field-direction-dependent multimodal transformation. More importantly, a quadrilateral assembly and a regular hexagon assembly based on this SM bianisotropic MSE are designed, and they exhibit 2.4 and 1.7 times the deformation capacity of shape anisotropic samples, respectively. By exploiting the multidegree of freedom and excellent deformability of the SM bianisotropic MSE, flexible logic switches and ultrasoft magnetic manipulators are further demonstrated, which prove its potential applications in future intelligent flexible electronics and autonomous soft robotics.

Emerging 4D Printing Strategies for Next-Generation Tissue Regeneration and Medical Devices

The rapid development of 3D printing has led to considerable progress in the field of biomedical engineering. Notably, 4D printing provides a potential strategy to achieve a time-dependent physical change within tissue scaffolds or replicate the dynamic biological behaviors of native tissues for smart tissue regeneration and the fabrication of medical devices. The fabricated stimulus-responsive structures can offer dynamic, reprogrammable deformation or actuation to mimic complex physical, biochemical, and mechanical processes of native tissues. Although there is notable progress made in the development of the 4D printing approach for various biomedical applications, its more broad-scale adoption for clinical use and tissue engineering purposes is complicated by a notable limitation of printable smart materials and the simplistic nature of achievable responses possible with current sources of stimulation. In this review, the recent progress made in the field of 4D printing by discussing the various printing mechanisms that are achieved with great emphasis on smart ink mechanisms of 4D actuation, construct structural design, and printing technologies, is highlighted. Recent 4D printing studies which focus on the applications of tissue/organ regeneration and medical devices are then summarized. Finally, the current challenges and future perspectives of 4D printing are also discussed.

Four-Dimensional Printed Shape Memory Metasurface to Memorize Absorption and Reflection Functions

Functional metasurfaces help wireless communication to reach beyond current electromagnetic control device limitations. However, current reconfigurable functional metasurfaces require separate systems for function control. In particular, it is difficult to realize millimeter-wavelength regimes due to the increasing number of active elements with the reduction in unit cell size. This paper proposes a four-dimensional printed memory metasurface to memorize absorption and reflection function in millimeter-wavelength regimes. Thus, metasurfaces with electromagnetic absorption and reflection functions can be realized through mechanical shape memory by memorizing electromagnetic properties using four-dimensional printed structures. The desired electromagnetic performance was experimentally demonstrated and deformation time to memorize the initial structure was measured. The results confirmed that the proposed four-dimensional printed metasurface has potential for considerable contribution to multifunctional wireless devices such as smart electromagnetic wave control systems in reconfigurable intelligent surface, stealth, and wireless sensing systems.

4D printing in biomedical applications: emerging trends and technologies

Nature's material systems during evolution have developed the ability to respond and adapt to environmental stimuli through the generation of complex structures capable of varying their functions across direction, distances and time. 3D printing technologies can recapitulate structural motifs present in natural materials, and efforts are currently being made on the technological side to improve printing resolution, shape fidelity, and printing speed. However, an intrinsic limitation of this technology is that printed objects are static and thus inadequate to dynamically reshape when subjected to external stimuli. In recent years, this issue has been addressed with the design and precise deployment of smart materials that can undergo a programmed morphing in response to a stimulus. The term 4D printing was coined to indicate the combined use of additive manufacturing, smart materials, and careful design of appropriate geometries. In this review, we report the recent progress in the design and development of smart materials that are actuated by different stimuli and their exploitation within additive manufacturing to produce biomimetic structures with important repercussions in different but interrelated biomedical areas.

3D and 4D printing: From innovation to evolution

The world and science are moving forward nonstop. Every day, we see novel technologies that are coming to improve life quality. One of them is 3D printing or additive manufacturing. This technology covers the shortage of the current manufacturing technologies, and it has been enhanced by introducing smart materials like smart polymers as feed. The following product can adapt to circumstance conditions such as temperature changes, compression alteration, etc. These responses resulted in an advanced 3D printing technology called 4D printing. 3D and 4D printing technologies found their applications in all areas and industry sizes, from home-scale to large-scale industries. Regardless of all advantages of these technologies, there are still some shortages like low printing speed. But this never stops their progression and promotion. In this review, we aimed to cover general knowledge about 3D and 4D printing and their recent applications in various fields.