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Sadeghian Dehkord E, De Carvalho B, Ernst M, Albert A, Lambert F, Geris L. Influence of physicochemical characteristics of calcium phosphate-based biomaterials in cranio-maxillofacial bone regeneration. A systematic literature review and meta-analysis of preclinical models. Mater Today Bio 2024; 26:101100. [PMID: 38854953 PMCID: PMC11157282 DOI: 10.1016/j.mtbio.2024.101100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/11/2024] Open
Abstract
Objectives Calcium phosphate-based biomaterials (CaP) are the most widely used biomaterials to enhance bone regeneration in the treatment of alveolar bone deficiencies, cranio-maxillofacial and periodontal infrabony defects, with positive preclinical and clinical results reported. This systematic review aimed to assess the influence of the physicochemical properties of CaP biomaterials on the performance of bone regeneration in preclinical animal models. Methods The PubMed, EMBASE and Web of Science databases were searched to retrieve the preclinical studies investigating physicochemical characteristics of CaP biomaterials. The studies were screened for inclusion based on intervention (physicochemical characterization and in vivo evaluation) and reported measurable outcomes. Results A total of 1532 articles were retrieved and 58 studies were ultimately included in the systematic review. A wide range of physicochemical characteristics of CaP biomaterials was found to be assessed in the included studies. Despite a high degree of heterogeneity, the meta-analysis was performed on 39 studies and evidenced significant effects of biomaterial characteristics on their bone regeneration outcomes. The study specifically showed that macropore size, Ca/P ratio, and compressive strength exerted significant influence on the formation of newly regenerated bone. Moreover, factors such as particle size, Ca/P ratio, and surface area were found to impact bone-to-material contact during the regeneration process. In terms of biodegradability, the amount of residual graft was determined by macropore size, particle size, and compressive strength. Conclusion The systematic review showed that the physicochemical characteristics of CaP biomaterials are highly determining for scaffold's performance, emphasizing its usefulness in designing the next generation of bone scaffolds to target higher rates of regeneration.
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Affiliation(s)
- Ehsan Sadeghian Dehkord
- GIGA In Silico Medicine, Biomechanics Research Unit (Biomech), University of Liège, Belgium
- Prometheus, The R&D Division for Skeletal Tissue Engineering, KU Leuven, Belgium
| | - Bruno De Carvalho
- Department of Periodontology, Oral-Dental and Implant Surgery, CHU of Liège, Belgium
- Dental Biomaterials Research Unit (d-BRU), University of Liège, Belgium
| | - Marie Ernst
- Biostatistics and Research Method Center (B-STAT), CHU of Liège and University of Liège, Belgium
| | - Adelin Albert
- Biostatistics and Research Method Center (B-STAT), CHU of Liège and University of Liège, Belgium
- Department of Public Health Sciences, University of Liège, Belgium
| | - France Lambert
- Department of Periodontology, Oral-Dental and Implant Surgery, CHU of Liège, Belgium
- Dental Biomaterials Research Unit (d-BRU), University of Liège, Belgium
| | - Liesbet Geris
- GIGA In Silico Medicine, Biomechanics Research Unit (Biomech), University of Liège, Belgium
- Prometheus, The R&D Division for Skeletal Tissue Engineering, KU Leuven, Belgium
- Department of Mechanical Engineering, Biomechanics Section (BMe), KU Leuven, Belgium
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Rahimnejad M, Makkar H, Dal-Fabbro R, Malda J, Sriram G, Bottino MC. Biofabrication Strategies for Oral Soft Tissue Regeneration. Adv Healthc Mater 2024:e2304537. [PMID: 38529835 DOI: 10.1002/adhm.202304537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/01/2024] [Indexed: 03/27/2024]
Abstract
Gingival recession, a prevalent condition affecting the gum tissues, is characterized by the exposure of tooth root surfaces due to the displacement of the gingival margin. This review explores conventional treatments, highlighting their limitations and the quest for innovative alternatives. Importantly, it emphasizes the critical considerations in gingival tissue engineering leveraging on cells, biomaterials, and signaling factors. Successful tissue-engineered gingival constructs hinge on strategic choices such as cell sources, scaffold design, mechanical properties, and growth factor delivery. Unveiling advancements in recent biofabrication technologies like 3D bioprinting, electrospinning, and microfluidic organ-on-chip systems, this review elucidates their precise control over cell arrangement, biomaterials, and signaling cues. These technologies empower the recapitulation of microphysiological features, enabling the development of gingival constructs that closely emulate the anatomical, physiological, and functional characteristics of native gingival tissues. The review explores diverse engineering strategies aiming at the biofabrication of realistic tissue-engineered gingival grafts. Further, the parallels between the skin and gingival tissues are highlighted, exploring the potential transfer of biofabrication approaches from skin tissue regeneration to gingival tissue engineering. To conclude, the exploration of innovative biofabrication technologies for gingival tissues and inspiration drawn from skin tissue engineering look forward to a transformative era in regenerative dentistry with improved clinical outcomes.
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Affiliation(s)
- Maedeh Rahimnejad
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Hardik Makkar
- Faculty of Dentistry, National University of Singapore, Singapore, 119085, Singapore
| | - Renan Dal-Fabbro
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Jos Malda
- Regenerative Medicine Center Utrecht, Utrecht, 3584, The Netherlands
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, 3584, The Netherlands
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, 3584, The Netherlands
| | - Gopu Sriram
- Faculty of Dentistry, National University of Singapore, Singapore, 119085, Singapore
- NUS Centre for Additive Manufacturing (AM.NUS), National University of Singapore, Singapore, 117597, Singapore
- Department of Biomedical Engineering, National University of Singapore, Singapore, 117583, Singapore
| | - Marco C Bottino
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, 48109, USA
- Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
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Sonika S, Esther Nalini H, Renuka Devi R. Quintessential commence of three-dimensional printing in periodontal regeneration-A review. Saudi Dent J 2023; 35:876-882. [PMID: 38025599 PMCID: PMC10658379 DOI: 10.1016/j.sdentj.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/23/2023] [Accepted: 07/02/2023] [Indexed: 12/01/2023] Open
Abstract
The prime focus of regenerative periodontal therapy is to reconstruct or regenerate the lost periodontium, including both hard and soft tissues. Over the years, periodontics has witnessed different regenerative modalities, such as bone grafts, guided tissue membranes, growth factors, stem cell technology, 3D printing, etc. 3D printing is a newly emerging manufacturing technology that finds applications in diverse fields, including aerospace, defense, art and design, medical and dental field. Originally developed for non-biological applications, 3D printing has undergone modifications to print biocompatible materials and living cells to minimize any potential compromise on cell viability. Thus, the utilisation of 3D printing in the regeneration of lost periodontal tissues represents a novel approach that facilitates optimal cell interactions and promotes the successful regeneration of biological tissues.
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Affiliation(s)
- S Sonika
- Department of Periodontology, KSR Institute of Dental Science and Research, Tiruchengode, Tamilnadu, India
| | - H Esther Nalini
- Department of Periodontology, KSR Institute of Dental Science and Research, Tiruchengode, Tamilnadu, India
| | - R Renuka Devi
- Department of Periodontology, KSR Institute of Dental Science and Research, Tiruchengode, Tamilnadu, India
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van Dijk LA, Janssen NG, Nurmohamed SJ, Muradin MSM, Longoni A, Bakker RC, de Groot FG, de Bruijn JD, Gawlitta D, Rosenberg AJWP. Osteoinductive calcium phosphate with submicron topography as bone graft substitute for maxillary sinus floor augmentation: A translational study. Clin Oral Implants Res 2023; 34:177-195. [PMID: 36645164 DOI: 10.1111/clr.14028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 11/25/2022] [Accepted: 11/30/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The aim of this study was the preclinical and clinical evaluation of osteoinductive calcium phosphate with submicron surface topography as a bone graft substitute for maxillary sinus floor augmentation (MSFA). MATERIAL AND METHODS A preclinical sheep model of MSFA was used to compare a calcium phosphate with submicron needle-shaped topography (BCPN , MagnetOs Granules, Kuros Biosciences BV) to a calcium phosphate with submicron grain-shaped topography (BCPG ) and autologous bone graft (ABG) as controls. Secondly, a 10-patient, prospective, randomized, controlled trial was performed to compare BCPN to ABG in MSFA with two-stage implant placement. RESULTS The pre-clinical study demonstrated that both BCPN and BCPG were highly biocompatible, supported bony ingrowth with direct bone apposition against the material, and exhibited bone formation as early as 3 weeks post-implantation. However, BCPN demonstrated significantly more bone formation than BCPG at the study endpoint of 12 weeks. Only BCPN reached an equivalent amount of bone formation in the available space and a greater proportion of calcified material (bone + graft material) in the maxillary sinus compared to the "gold standard" ABG after 12 weeks. These results were validated in a small prospective clinical study, in which BCPN was found comparable to ABG in implant stability, bone height, new bone formation in trephine core biopsies, and overall clinical outcome. CONCLUSION This translational work demonstrates that osteoinductive calcium phosphates are promising bone graft substitutes for MSFA, whereas their bone-forming potential depends on the design of their surface features. Netherlands Trial Register, NL6436.
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Affiliation(s)
- Lukas A van Dijk
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Regenerative Medicine Center Utrecht, Utrecht, the Netherlands
- Kuros Biosciences BV, Bilthoven, the Netherlands
| | - Nard G Janssen
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Silke J Nurmohamed
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marvick S M Muradin
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alessia Longoni
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Regenerative Medicine Center Utrecht, Utrecht, the Netherlands
| | - Robbert C Bakker
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Joost D de Bruijn
- Kuros Biosciences BV, Bilthoven, the Netherlands
- School of Materials Science and Engineering, Queen Mary University of London, London, UK
| | - Debby Gawlitta
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Regenerative Medicine Center Utrecht, Utrecht, the Netherlands
| | - Antoine J W P Rosenberg
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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Preliminary results of customized bone graft made by robocasting hydroxyapatite and tricalcium phosphates for oral surgery. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:192-203. [PMID: 36089487 DOI: 10.1016/j.oooo.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/24/2022] [Accepted: 06/05/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to assess the mechanical characteristics and the clinical usefulness of beta-tricalcium phosphate (β-TCP) and hydroxyapatite (HA) bioblocks grafted in edentulous jaws of 12 patients. METHODS The scaffolds were produced by robocasting ceramic inks containing 80%/20% β-TCP and HA, respectively, with an overall porosity of 60%, with a macropore size between 300 and 500 μm. The mechanical performance of cylindrical vs conical specimens was compared using a universal testing machine. The clinical study was performed on 12 edentulous patients who received 4 cylindrical bone bioblocks. After 10 to 16 weeks of osseointegration, the bioblocks were explanted with trephine for histologic analysis by Goldner and Von Kossa staining. RESULTS Conical shapes were significantly stronger (96.4 ± 8.7 MPa) than cylindrical shapes (87.8 ± 12.2 MPa). The overall degree of porosity ranged from 53.4% to 58.1% in the coronal region to 62.5% to 66.9% at the apex. After the maturation period, 41 valid bioblocks (85.4%) were obtained for histologic study. Bone showing some cellularity was found in 68.4% of the samples, indicating biologically active bone, and adequate calcification was found in 31.7% of the samples. In terms of biomaterial degradation, 73.2% of the samples were completely resorbed or showed significant resorption. CONCLUSIONS The 80%/20% β-TCP and HA grafts customized by robocasting appear adequate for regenerating self-contained defects.
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Thangavel M, Elsen Selvam R. Review of Physical, Mechanical, and Biological Characteristics of 3D-Printed Bioceramic Scaffolds for Bone Tissue Engineering Applications. ACS Biomater Sci Eng 2022; 8:5060-5093. [PMID: 36415173 DOI: 10.1021/acsbiomaterials.2c00793] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This review focuses on the advancements in additive manufacturing techniques that are utilized for fabricating bioceramic scaffolds and their characterizations leading to bone tissue regeneration. Bioscaffolds are made by mimicking the human bone structure, material composition, and properties. Calcium phosphate apatite materials are the most commonly used scaffold materials as they closely resemble live bone in their inorganic composition. The functionally graded scaffolds are fabricated by utilizing the right choice of the 3D printing method and material combinations to achieve the requirement of the bioscaffold. To tailor the physical, mechanical, and biological properties of the scaffold, certain materials are reinforced, doped, or coated to incorporate the functionality. The biomechanical loading conditions that involve flexion, torsion, and tension exerted on the implanted scaffold are discussed. The finite element analysis (FEA) technique is used to investigate the mechanical property of the scaffold before fabrication. This helps in reducing the actual number of samples used for testing. The FEA simulated results and the experimental result are compared. This review also highlights some of the challenges associated while processing the scaffold such as shrinkage, mechanical instability, cytotoxicity, and printability. In the end, the new materials that are evolved for tissue engineering applications are compiled and discussed.
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Affiliation(s)
- Mahendran Thangavel
- School of Mechanical Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu 632014, India
| | - Renold Elsen Selvam
- School of Mechanical Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu 632014, India
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Mangano C, Luongo G, Luongo F, Lerner H, Margiani B, Admakin O, Mangano F. Custom-made computer-aided-design/ computer-assisted-manufacturing (CAD/CAM) synthetic bone grafts for alveolar ridge augmentation: A retrospective clinical study with 3 years of follow-up. J Dent 2022; 127:104323. [PMID: 36241044 DOI: 10.1016/j.jdent.2022.104323] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To report on the results obtained with computer-aided-design/ computer-assisted-manufacturing (CAD/CAM) custom-made synthetic hydroxyapatite/beta-tricalcium-phosphate (HA/beta-TCP) bone grafts in alveolar ridge augmentation for dental implant placement. METHODS The procedure included: (1) cone-beam computed tomography (CBCT) of the bone defect; (2) virtual design of the custom-made onlay bone grafts; (3) milling of grafts from a pre-formed block of synthetic HA/beta-TCP; and (4) bone reconstructive surgery. Implants were placed 8 months later. The patients were followed for 3 years. The study outcomes were: (1) intra- and immediate post-operative complications; (2) 8-month vertical and horizontal bone gain; (3) implant survival; (4) implant-crown success; and (5) peri-implant marginal bone loss (MBL). RESULTS Twenty-six patients underwent ridge augmentation with custom-made CAD/CAM HA/beta-TCP onlay grafts. Eight months later, these patients were rehabilitated with dental implants. During surgery, 25/26 (96.1%) of the grafts adapted well to the bone defect. Immediate post-operative complications were pain and swelling (2/26 patients: 7.6%), and bone graft exposure (3/26: 11.5%); one exposure led to infection, removal of the graft, and failure of the procedure. Excellent integration of the other grafts was observed 8 months after the regenerative procedure, with mean vertical and horizontal bone gains of 2.10 mm (± 0.35) and 2.96 mm (± 0.45), respectively. Twenty-five implants were placed and restored with single crowns. Three years later, all implants were in function. The 3-year implant crown success rate and peri-implant MBL were 92.0% and 0.7 mm (±0.19), respectively. CONCLUSIONS With custom-made CAD/CAM synthetic HA/beta-TCP onlay grafts reconstruction of small vertical and/or horizontal defects of the alveolar ridge was obtained; this enabled implant placement, with high implant-crown success rate after 3 years. Further studies are needed to validate this technique. STATEMENT OF CLINICAL RELEVANCE Custom-made CAD/CAM synthetic HA/beta-TCP onlay grafts may represent an option for regeneration of small bone defects prior to implant placement.
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Affiliation(s)
| | | | | | - Henriette Lerner
- Academic Teaching and Research Institution of Johann Wolfgang Goethe University, Frankfurt, Germany.
| | - Bidzina Margiani
- Department of Department of Pediatric, Preventive Dentistry and Orthodontics, Sechenov First State Medical University, Moscow, Russia.
| | - Oleg Admakin
- Department of Department of Pediatric, Preventive Dentistry and Orthodontics, Sechenov First State Medical University, Moscow, Russia.
| | - Francesco Mangano
- Department of Department of Pediatric, Preventive Dentistry and Orthodontics, Sechenov First State Medical University, Moscow, Russia.
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Sufaru IG, Macovei G, Stoleriu S, Martu MA, Luchian I, Kappenberg-Nitescu DC, Solomon SM. 3D Printed and Bioprinted Membranes and Scaffolds for the Periodontal Tissue Regeneration: A Narrative Review. MEMBRANES 2022; 12:membranes12090902. [PMID: 36135920 PMCID: PMC9505571 DOI: 10.3390/membranes12090902] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 05/31/2023]
Abstract
Numerous technologies and materials were developed with the aim of repairing and reconstructing the tissue loss in patients with periodontitis. Periodontal guided bone regeneration (GBR) and guided tissue regeneration (GTR) involves the use of a membrane which prevents epithelial cell migration, and helps to maintain the space, creating a protected area in which tissue regeneration is favored. Over the time, manufacturing procedures of such barrier membranes followed important improvements. Three-dimensional (3D) printing technology has led to major innovations in periodontal regeneration methods, using technologies such as inkjet printing, light-assisted 3D printing or micro-extrusion. Besides the 3D printing of monophasic and multi-phasic scaffolds, bioprinting and tissue engineering have emerged as innovative technologies which can change the way we see GTR and GBR.
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Affiliation(s)
- Irina-Georgeta Sufaru
- Department of Periodontology, Grigore T. Popa University of Medicine and Pharmacy, Universitatii Street 16, 700115 Iasi, Romania
| | - Georgiana Macovei
- Department of Oral and Dental Diagnostics, Grigore T. Popa University of Medicine and Pharmacy, Universitatii Street 16, 700115 Iasi, Romania
| | - Simona Stoleriu
- Department of Cariology and Restorative Dental Therapy, Grigore T. Popa University of Medicine and Pharmacy, Universitatii Street 16, 700115 Iasi, Romania
| | - Maria-Alexandra Martu
- Department of Periodontology, Grigore T. Popa University of Medicine and Pharmacy, Universitatii Street 16, 700115 Iasi, Romania
| | - Ionut Luchian
- Department of Periodontology, Grigore T. Popa University of Medicine and Pharmacy, Universitatii Street 16, 700115 Iasi, Romania
| | | | - Sorina Mihaela Solomon
- Department of Periodontology, Grigore T. Popa University of Medicine and Pharmacy, Universitatii Street 16, 700115 Iasi, Romania
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Iezzi G, Scarano A, Valbonetti L, Mazzoni S, Furlani M, Mangano C, Muttini A, Raspanti M, Barboni B, Piattelli A, Giuliani A. Biphasic Calcium Phosphate Biomaterials: Stem Cell-Derived Osteoinduction or In Vivo Osteoconduction? Novel Insights in Maxillary Sinus Augmentation by Advanced Imaging. MATERIALS 2021; 14:ma14092159. [PMID: 33922799 PMCID: PMC8122985 DOI: 10.3390/ma14092159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022]
Abstract
Maxillary sinus augmentation is often necessary prior to implantology procedure, in particular in cases of atrophic posterior maxilla. In this context, bone substitute biomaterials made of biphasic calcium phosphates, produced by three-dimensional additive manufacturing were shown to be highly biocompatible with an efficient osteoconductivity, especially when combined with cell-based tissue engineering. Thus, in the present research, osteoinduction and osteoconduction properties of biphasic calcium-phosphate constructs made by direct rapid prototyping and engineered with ovine-derived amniotic epithelial cells or amniotic fluid cells were evaluated. More in details, this preclinical study was performed using adult sheep targeted to receive scaffold alone (CTR), oAFSMC, or oAEC engineered constructs. The grafted sinuses were explanted at 90 days and a cross-linked experimental approach based on Synchrotron Radiation microCT and histology analysis was performed on the complete set of samples. The study, performed taking into account the distance from native surrounding bone, demonstrated that no significant differences occurred in bone regeneration between oAEC-, oAFMSC-cultured, and Ctr samples and that there was a predominant action of the osteoconduction versus the stem cells osteo-induction. Indeed, it was proven that the newly formed bone amount and distribution decreased from the side of contact scaffold/native bone toward the bulk of the scaffold itself, with almost constant values of morphometric descriptors in volumes more than 1 mm from the border.
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Affiliation(s)
- Giovanna Iezzi
- Department of Medical, Oral and Biotechnological Sciences, Dental School, University G. D’Annunzio of Chieti-Pescara, 66100 Chieti, CH, Italy; (G.I.); (A.S.); (A.P.)
| | - Antonio Scarano
- Department of Medical, Oral and Biotechnological Sciences, Dental School, University G. D’Annunzio of Chieti-Pescara, 66100 Chieti, CH, Italy; (G.I.); (A.S.); (A.P.)
| | - Luca Valbonetti
- Faculty of Biosciences and Technology for Food, Agriculture and Environment, University of Teramo, 64100 Teramo, TE, Italy; (L.V.); (A.M.); (B.B.)
- Institute of Biochemistry and Cell Biology (CNR-IBBC/EMMA/Infrafrontier/IMPC), National Research Council, Monterotondo Scalo, 00015 Rome, RM, Italy
| | - Serena Mazzoni
- Department of Clinical Science, Polytechnic University of Marche, Via Brecce Bianche, 60131 Ancona, AN, Italy; (S.M.); (M.F.)
| | - Michele Furlani
- Department of Clinical Science, Polytechnic University of Marche, Via Brecce Bianche, 60131 Ancona, AN, Italy; (S.M.); (M.F.)
| | | | - Aurelio Muttini
- Faculty of Biosciences and Technology for Food, Agriculture and Environment, University of Teramo, 64100 Teramo, TE, Italy; (L.V.); (A.M.); (B.B.)
| | - Mario Raspanti
- Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, 21100 Varese, VA, Italy;
| | - Barbara Barboni
- Faculty of Biosciences and Technology for Food, Agriculture and Environment, University of Teramo, 64100 Teramo, TE, Italy; (L.V.); (A.M.); (B.B.)
| | - Adriano Piattelli
- Department of Medical, Oral and Biotechnological Sciences, Dental School, University G. D’Annunzio of Chieti-Pescara, 66100 Chieti, CH, Italy; (G.I.); (A.S.); (A.P.)
- Fondazione Villaserena per la Ricerca, 65013 Città S. Angelo, PE, Italy
- Casa di Cura Villa Serena del Dott. L. Petruzzi, 65013 Città S. Angelo, PE, Italy
| | - Alessandra Giuliani
- Department of Clinical Science, Polytechnic University of Marche, Via Brecce Bianche, 60131 Ancona, AN, Italy; (S.M.); (M.F.)
- Correspondence: ; Tel.: +39-0712204603
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Garot C, Bettega G, Picart C. Additive Manufacturing of Material Scaffolds for Bone Regeneration: Toward Application in the Clinics. ADVANCED FUNCTIONAL MATERIALS 2021; 31:2006967. [PMID: 33531885 PMCID: PMC7116655 DOI: 10.1002/adfm.202006967] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Indexed: 05/07/2023]
Abstract
Additive manufacturing (AM) allows the fabrication of customized bone scaffolds in terms of shape, pore size, material type and mechanical properties. Combined with the possibility to obtain a precise 3D image of the bone defects using computed tomography or magnetic resonance imaging, it is now possible to manufacture implants for patient-specific bone regeneration. This paper reviews the state-of-the-art of the different materials and AM techniques used for the fabrication of 3D-printed scaffolds in the field of bone tissue engineering. Their advantages and drawbacks are highlighted. For materials, specific criteria, were extracted from a literature study: biomimetism to native bone, mechanical properties, biodegradability, ability to be imaged (implantation and follow-up period), histological performances and sterilization process. AM techniques can be classified in three major categories: extrusion-based, powder-based and liquid-base. Their price, ease of use and space requirement are analyzed. Different combinations of materials/AM techniques appear to be the most relevant depending on the targeted clinical applications (implantation site, presence of mechanical constraints, temporary or permanent implant). Finally, some barriers impeding the translation to human clinics are identified, notably the sterilization process.
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Affiliation(s)
- Charlotte Garot
- CEA, Université de Grenoble Alpes, CNRS, ERL 5000, IRIG Institute, 17 rue des Martyrs, F-38054, Grenoble, France
- CNRS and Grenoble Institute of Engineering, UMR 5628, LMGP, 3 parvis Louis Néel F-38016 Grenoble, France
| | - Georges Bettega
- Service de chirurgie maxillo-faciale, Centre Hospitalier Annecy-Genevois, 1 avenue de l’hôpital, F-74370 Epagny Metz-Tessy, France
- INSERM U1209, Institut Albert Bonniot, F-38000 Grenoble, France
| | - Catherine Picart
- CEA, Université de Grenoble Alpes, CNRS, ERL 5000, IRIG Institute, 17 rue des Martyrs, F-38054, Grenoble, France
- CNRS and Grenoble Institute of Engineering, UMR 5628, LMGP, 3 parvis Louis Néel F-38016 Grenoble, France
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Raveau S, Jordana F. Tissue Engineering and Three-Dimensional Printing in Periodontal Regeneration: A Literature Review. J Clin Med 2020; 9:jcm9124008. [PMID: 33322447 PMCID: PMC7763147 DOI: 10.3390/jcm9124008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 02/06/2023] Open
Abstract
The three-dimensional printing of scaffolds is an interesting alternative to the traditional techniques of periodontal regeneration. This technique uses computer assisted design and manufacturing after CT scan. After 3D modelling, individualized scaffolds are printed by extrusion, selective laser sintering, stereolithography, or powder bed inkjet printing. These scaffolds can be made of one or several materials such as natural polymers, synthetic polymers, or bioceramics. They can be monophasic or multiphasic and tend to recreate the architectural structure of the periodontal tissue. In order to enhance the bioactivity and have a higher regeneration, the scaffolds can be embedded with stem cells and/or growth factors. This new technique could enhance a complete periodontal regeneration. This review summarizes the application of 3D printed scaffolds in periodontal regeneration. The process, the materials and designs, the key advantages and prospects of 3D bioprinting are highlighted, providing new ideas for tissue regeneration.
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Affiliation(s)
- Simon Raveau
- Dental Faculty, University of Nantes, 44000 Nantes, France;
- Dentistry Department, University Health Centre, 44000 Nantes, France
| | - Fabienne Jordana
- Dental Faculty, University of Nantes, 44000 Nantes, France;
- Dentistry Department, University Health Centre, 44000 Nantes, France
- Correspondence: ; Tel.: +33-24041-2928
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Integrated 3D Information for Custom-Made Bone Grafts: Focus on Biphasic Calcium Phosphate Bone Substitute Biomaterials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144931. [PMID: 32650587 PMCID: PMC7399868 DOI: 10.3390/ijerph17144931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/02/2020] [Accepted: 07/05/2020] [Indexed: 12/24/2022]
Abstract
Purpose: Several studies showed that the sintering temperature of 1250 °C could affect the formation of α-Ca3(PO4)2, which is responsible for the reduction of the hardness value of biphasic calcium phosphate biocomposites, but they did not evaluate the inference of the sintering time at peak temperature on transition of β-Ca3(PO4)2 to α-Ca3(PO4)2. This analysis explored, in an innovative way, inferences and correlations between volumetric microstructure, mechanical properties, sintering temperature, and time at peak temperature in order to find the best sintering conditions for biphasic calcium phosphate composites grafted in severe alveolar bone defects. Methods: Sintered biphasic calcium phosphates (30%-hydroxyapatite/70%-tricalcium phosphate) were tested by microCT imaging for the 3D morphometric analysis, by compressive loading to find their mechanical parameters, and by X-ray diffraction to quantify the phases via Rietveld refinement for different sintering temperatures and times at the peak temperature. Data were analysed in terms of statistical inference using Pearson’s correlation coefficients. Results: All the studied scaffolds closely mimicked the alveolar organization of the jawbone, independently on the sintering temperatures and times; however, mechanical testing revealed that the group with peak temperature, which lasted for 2 hours at 1250 °C, showed the highest strength both at the ultimate point and at fracture point. Conclusion: The good mechanical performances of the group with peak temperature, which lasted for 2 hours at 1250 °C, is most likely due to the absence of the α-Ca3(PO4)2 phase, as revealed by X-ray diffraction. However, we detected its presence after sintering at the same peak temperature for longer times, showing the time-dependence, combined with the temperature-dependence, of the β-Ca3(PO4)2 to α-Ca3(PO4)2 transition.
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Comparative Study between Laser Light Stereo-Lithography 3D-Printed and Traditionally Sintered Biphasic Calcium Phosphate Scaffolds by an Integrated Morphological, Morphometric and Mechanical Analysis. Int J Mol Sci 2019; 20:ijms20133118. [PMID: 31247936 PMCID: PMC6651383 DOI: 10.3390/ijms20133118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 06/24/2019] [Accepted: 06/24/2019] [Indexed: 01/05/2023] Open
Abstract
In dental districts, successful bone regeneration using biphasic calcium phosphate materials was recently explored. The present study aimed to perform a comparative study between 3D-printed scaffolds produced by laser light stereo-lithography (SLA) and traditionally sintered biphasic calcium phosphate scaffolds by an integrated morphological, morphometric and mechanical analysis. Methods: Biphasic calcium phosphate (30% HA/70% β-TCP) samples, produced by SLA-3D-printing or by traditional sintering methods, were tested. The experimental sequence included: (1) Microtomography (microCT) analyses, to serve as control-references for the 3D morphometric analysis; (2) loading tests in continuous mode, with compression up to fracture, to reconstruct their mechanical characteristics; and (3) microCT of the same samples after the loading tests, for the prediction of the morphometric changes induced by compressive loading of the selected materials. All the biomaterials were also studied by complementary scanning electron microscopy to evaluate fracture regions and surfaces. Results: The characterization of the 3D mineralized microarchitecture showed that the SLA-3D-printed biomaterials offer performances comparable to and in some cases better than the traditionally sintered ones, with higher mean thickness of struts and pores. Interestingly, the SLA-3D-printed samples had a higher ultimate strength than the sintered ones, with a smaller plastic region. Moreover, by SEM observation, it was observed that fractures in the SLA-3D-printed samples were localized in the structure nodes or on the external shells of the rods, while all the traditionally sintered samples revealed a ductile fracture surface. Conclusions: The reduction of the region of plastic deformation in the SLA-3D-printed samples with respect to traditionally sintered biomaterials is expected to positively influence, in vivo, the cell adhesion. Both microCT and SEM imaging revealed that the studied biomaterials exhibit a structure more similar to human jaw than the sintered biomaterials.
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Past, Present, and Future of Regeneration Therapy in Oral and Periodontal Tissue: A Review. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9061046] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic periodontitis is the most common disease which induces oral tissue destruction. The goal of periodontal treatment is to reduce inflammation and regenerate the defects. As the structure of periodontium is composed of four types of different tissue (cementum, alveolar bone periodontal ligament, and gingiva), the regeneration should allow different cell proliferation in the separated spaces. Guided tissue regeneration (GTR) and guided bone regeneration (GBR) were introduced to prevent epithelial growth into the alveolar bone space. In the past, non-absorbable membranes with basic functions such as space maintenance were used with bone graft materials. Due to several limitations of the non-absorbable membranes, membranes of the second and third generation equipped with controlled absorbability, and a functional layer releasing growth factors or antimicrobials were introduced. Moreover, tissue engineering using biomaterials enabled faster and more stable tissue regeneration. The scaffold with three-dimensional structures manufactured by computer-aided design and manufacturing (CAD/CAM) showed high biocompatibility, and promoted cell infiltration and revascularization. In the future, using the cell sheath, pre-vascularizing and bioprinting techniques will be applied to the membrane to mimic the original tissue itself. The aim of the review was not only to understand the past and the present trends of GTR and GBR, but also to be used as a guide for a proper future of regeneration therapy in the oral region.
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Gul M, Arif A, Ghafoor R. Role of three-dimensional printing in periodontal regeneration and repair: Literature review. J Indian Soc Periodontol 2019; 23:504-510. [PMID: 31849394 PMCID: PMC6906903 DOI: 10.4103/jisp.jisp_46_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Three-dimensional (3D) printing is the process of building 3D objects by additive manufacturing approach. It is being used in endodontics, periodontology, maxillofacial surgery, prosthodontics, orthodontics, and restorative dentistry, but our review article is focused on periodontal application. A detailed literature search was done on PubMed/Medline and Google Scholar using various key terms. A total of 45 articles were included in this study. Most of the studies were in vitro, preclinical, case reports, retrospective, and prospective studies. Few clinical trials have also been done. Periodontal applications included education models, scaffolds, socket preservation, and sinus and bone augmentation and guided implant placement. It showed better alveolar ridge preservation, better regenerative capabilities, greater reduction in pocket depth and bony fill, ease of implant placement in complex cases with greater precision and reduced time with improved outcome and an important tool for education and training using simulated models.
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Affiliation(s)
- Meisha Gul
- Department of Surgery, JHS Building 1st Floor Dental Clinics, Aga Khan University Hospital, Karachi, Pakistan
| | - Aysha Arif
- Department of Surgery, JHS Building 1st Floor Dental Clinics, Aga Khan University Hospital, Karachi, Pakistan
| | - Robia Ghafoor
- Department of Surgery, JHS Building 1st Floor Dental Clinics, Aga Khan University Hospital, Karachi, Pakistan
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Rider P, Kačarević ŽP, Alkildani S, Retnasingh S, Schnettler R, Barbeck M. Additive Manufacturing for Guided Bone Regeneration: A Perspective for Alveolar Ridge Augmentation. Int J Mol Sci 2018; 19:E3308. [PMID: 30355988 PMCID: PMC6274711 DOI: 10.3390/ijms19113308] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/18/2018] [Accepted: 10/21/2018] [Indexed: 12/14/2022] Open
Abstract
Three-dimensional (3D) printing has become an important tool in the field of tissue engineering and its further development will lead to completely new clinical possibilities. The ability to create tissue scaffolds with controllable characteristics, such as internal architecture, porosity, and interconnectivity make it highly desirable in comparison to conventional techniques, which lack a defined structure and repeatability between scaffolds. Furthermore, 3D printing allows for the production of scaffolds with patient-specific dimensions using computer-aided design. The availability of commercially available 3D printed permanent implants is on the rise; however, there are yet to be any commercially available biodegradable/bioresorbable devices. This review will compare the main 3D printing techniques of: stereolithography; selective laser sintering; powder bed inkjet printing and extrusion printing; for the fabrication of biodegradable/bioresorbable bone tissue scaffolds; and, discuss their potential for dental applications, specifically augmentation of the alveolar ridge.
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Affiliation(s)
- Patrick Rider
- Botiss Biomaterials GmbH, Hauptstr. 28, 15806 Zossen, Germany.
| | - Željka Perić Kačarević
- Department of Anatomy, Histology and Embryology, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek 31000, Croatia.
| | - Said Alkildani
- Department of Biomedical Engineering, Faculty of Applied Medical Sciences, German-Jordanian University, Amman 11180, Jordan.
| | - Sujith Retnasingh
- Institutes for Environmental Toxicology, Martin-Luther-Universität, Halle-Wittenberg and Faculty of Biomedical Engineering, Anhalt University of Applied Science, 06366 Köthen, Germany.
| | - Reinhard Schnettler
- Department of Oral and Maxillofacial Surgery, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Mike Barbeck
- Department of Oral and Maxillofacial Surgery, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany.
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Raymond S, Maazouz Y, Montufar EB, Perez RA, González B, Konka J, Kaiser J, Ginebra MP. Accelerated hardening of nanotextured 3D-plotted self-setting calcium phosphate inks. Acta Biomater 2018; 75:451-462. [PMID: 29842972 DOI: 10.1016/j.actbio.2018.05.042] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/03/2018] [Accepted: 05/25/2018] [Indexed: 11/30/2022]
Abstract
Direct ink writing (DIW) techniques open up new possibilities for the fabrication of patient-specific bone grafts. Self-setting calcium phosphate inks, which harden at low temperature, allow obtaining nanostructured scaffolds with biomimetic properties and enhanced bioactivity. However, the slow hardening kinetics hampers the translation to the clinics. Different hydrothermal treatments for the consolidation of DIW scaffolds fabricated with an α-tricalcium phosphate /pluronic F127 ink were explored, comparing them with a biomimetic treatment. Three different scaffold architectures were analysed. The hardening process, associated to the conversion of α-tricalcium phosphate to hydroxyapatite was drastically accelerated by the hydrothermal treatments, reducing the time for complete reaction from 7 days to 30 minutes, while preserving the scaffold architectural integrity and retaining the nanostructured features. β-tricalcium phosphate was formed as a secondary phase, and a change of morphology from plate-like to needle-like crystals in the hydroxyapatite phase was observed. The binder was largely released during the treatment. The hydrothermal treatment resulted in a 30% reduction of the compressive strength, associated to the residual presence of β-tricalcium phosphate. Biomimetic and hydrothermally treated scaffolds supported the adhesion and proliferation of rat mesenchymal stem cells, indicating a good suitability for bone tissue engineering applications. STATEMENT OF SIGNIFICANCE 3D plotting has opened up new perspectives in the bone regeneration field allowing the customisation of synthetic bone grafts able to fit patient-specific bone defects. Moreover, this technique allows the control of the scaffolds' architecture and porosity. The present work introduces a new method to harden biomimetic hydroxyapatite 3D-plotted scaffolds which avoids high-temperature sintering. It has two main advantages: i) it is fast and simple, reducing the whole fabrication process from the several days required for the biomimetic processing to a few hours; and ii) it retains the nanostructured character of biomimetic hydroxyapatite and allows controlling the porosity from the nano- to the macroscale. Moreover, the good in vitro cytocompatibility results support its suitability for cell-based bone regeneration therapies.
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Affiliation(s)
- Santiago Raymond
- Dept. Materials Science and Metallurgical Engineering, Group of Biomaterials, Biomechanics and Tissue Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain; Barcelona Research Centre for Multiscale Science and Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain; Mimetis Biomaterials, Cerdanyola del Vallès, Barcelona, Spain
| | - Yassine Maazouz
- Dept. Materials Science and Metallurgical Engineering, Group of Biomaterials, Biomechanics and Tissue Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain; Barcelona Research Centre for Multiscale Science and Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain; Mimetis Biomaterials, Cerdanyola del Vallès, Barcelona, Spain
| | - Edgar B Montufar
- Dept. Materials Science and Metallurgical Engineering, Group of Biomaterials, Biomechanics and Tissue Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain; CEITEC - Central European Institute of Technology, Brno University of Technology, Brno, Czech Republic
| | - Roman A Perez
- Dept. Materials Science and Metallurgical Engineering, Group of Biomaterials, Biomechanics and Tissue Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain; UIC Regenerative Medicine Research Institute. Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Borja González
- Dept. Materials Science and Metallurgical Engineering, Group of Biomaterials, Biomechanics and Tissue Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Joanna Konka
- Dept. Materials Science and Metallurgical Engineering, Group of Biomaterials, Biomechanics and Tissue Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain; Barcelona Research Centre for Multiscale Science and Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Jozef Kaiser
- CEITEC - Central European Institute of Technology, Brno University of Technology, Brno, Czech Republic
| | - Maria-Pau Ginebra
- Dept. Materials Science and Metallurgical Engineering, Group of Biomaterials, Biomechanics and Tissue Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain; Barcelona Research Centre for Multiscale Science and Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain; Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Baldiri Reixac 10-12, 08028 Barcelona, Spain.
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Yen HH, Stathopoulou PG. CAD/CAM and 3D-Printing Applications for Alveolar Ridge Augmentation. ACTA ACUST UNITED AC 2018; 5:127-132. [PMID: 30505646 DOI: 10.1007/s40496-018-0180-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose of review CAD/CAM and 3D-printing are emerging manufacturing technologies in dentistry. In the field of alveolar ridge augmentation, graft customization utilizing these technologies can result in significant reduction of surgical time. A review of the literature on materials, techniques and applications of CAD/CAM and 3D-printing available for alveolar ridge augmentation was performed. Recent findings CAD/CAM applications for milling of customized block grafts of allogeneic, xenogeneic, and alloplastic origins have been reported, and currently only limited products are commercially available. 3D-printing applications are limited to alloplastic graft materials and containment shells, and have been mostly used in animal studies for optimizing biomaterials' properties. Summary While current data support the potential use of CAD/CAM and 3D-printing for graft customization for alveolar ridge augmentation procedures, additional research is needed on predictability and long-term stability of the grafted sites.
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Affiliation(s)
- Howard H Yen
- Postdoctoral Periodontics Resident, Department of Periodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
| | - Panagiota G Stathopoulou
- Assistant Professor of Periodontics and Director of Postdoctoral Periodontics, Department of Periodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
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Human Adipose-Derived Stem Cells on Rapid Prototyped Three-Dimensional Hydroxyapatite/Beta-Tricalcium Phosphate Scaffold. J Craniofac Surg 2017; 27:727-32. [PMID: 27092915 DOI: 10.1097/scs.0000000000002567] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In the study, we assess a rapid prototyped scaffold composed of 30/70 hydroxyapatite (HA) and beta-tricalcium-phosphate (β-TCP) loaded with human adipose-derived stem cells (hASCs) to determine cell proliferation, differentiation toward osteogenic lineage, adhesion and penetration on/into the scaffold.In this in vitro study, hASCs isolated from fat tissue discarded after plastic surgery were expanded, characterized, and then loaded onto the scaffold. Cells were tested for: viability assay (Alamar Blue at days 3, 7 and Live/Dead at day 32), differentiation index (alkaline phosphatase activity at day 14), scaffold adhesion (standard error of the mean analysis at days 5 and 18), and penetration (ground sections at day 32).All the hASC populations displayed stemness markers and the ability to differentiate toward adipogenic and osteogenic lineages.Cellular vitality increased between 3 and 7 days, and no inhibitory effect by HA/β-TCP was observed. Under osteogenic stimuli, scaffold increased alkaline phosphatase activity of +243% compared with undifferentiated samples. Human adipose-derived stem cells adhered on HA/β-TCP surface through citoplasmatic extensions that occupied the macropores and built networks among them. Human adipose derived stem cells were observed in the core of HA/β-TCP. The current combination of hASCs and HA/β-TCP scaffold provided encouraging results. If authors' data will be confirmed in preclinical models, the present engineering approach could represent an interesting tool in treating large bone defects.
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Quantitative Kinetics Evaluation of Blocks Versus Granules of Biphasic Calcium Phosphate Scaffolds (HA/β-TCP 30/70) by Synchrotron Radiation X-ray Microtomography: A Human Study. IMPLANT DENT 2017; 25:6-15. [PMID: 26630463 DOI: 10.1097/id.0000000000000363] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Successful bone regeneration using both granules and blocks of biphasic calcium phosphate materials has been reported in the recent literature, in some clinical applications for maxillary sinus elevation, but the long-term kinetics of bone regeneration has still not been fully investigated. MATERIALS AND METHODS Twenty-four bilateral sinus augmentation procedures were performed and grafted with hydroxyapatite/β-tricalcium phosphate 30/70, 12 with granules and 12 with blocks. The samples were retrieved at different time points and were evaluated for bone regeneration, graft resorption, neovascularization, and morphometric parameters by computed microtomography and histology. RESULTS A large amount of newly formed bone was detected in the retrieved specimens, together with a good rate of biomaterial resorption and the formation of a homogeneous and rich net of new vessels. The morphometric values were comparable at 5/6 months from grafting but, 9 months after grafting, revealed that the block-based specimens mimicked slightly better than granule-based samples the healthy native bone of the maxillary site. CONCLUSION The scaffold morphology was confirmed to influence the long-term kinetics of bone regeneration.
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Trombetta R, Inzana JA, Schwarz EM, Kates SL, Awad HA. 3D Printing of Calcium Phosphate Ceramics for Bone Tissue Engineering and Drug Delivery. Ann Biomed Eng 2016; 45:23-44. [PMID: 27324800 DOI: 10.1007/s10439-016-1678-3] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/08/2016] [Indexed: 01/16/2023]
Abstract
Additive manufacturing, also known as 3D printing, has emerged over the past 3 decades as a disruptive technology for rapid prototyping and manufacturing. Vat polymerization, powder bed fusion, material extrusion, and binder jetting are distinct technologies of additive manufacturing, which have been used in a wide variety of fields, including biomedical research and tissue engineering. The ability to print biocompatible, patient-specific geometries with controlled macro- and micro-pores, and to incorporate cells, drugs and proteins has made 3D-printing ideal for orthopaedic applications, such as bone grafting. Herein, we performed a systematic review examining the fabrication of calcium phosphate (CaP) ceramics by 3D printing, their biocompatibility in vitro, and their bone regenerative potential in vivo, as well as their use in localized delivery of bioactive molecules or cells. Understanding the advantages and limitations of the different 3D printing approaches, CaP materials, and bioactive additives through critical evaluation of in vitro and in vivo evidence of efficacy is essential for developing new classes of bone graft substitutes that can perform as well as autografts and allografts or even surpass the performance of these clinical standards.
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Affiliation(s)
- Ryan Trombetta
- Department of Biomedical Engineering, University of Rochester, Robert B. Goergen Hall, Rochester, NY, 14627, USA.,Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA
| | - Jason A Inzana
- Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA.,AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Edward M Schwarz
- Department of Biomedical Engineering, University of Rochester, Robert B. Goergen Hall, Rochester, NY, 14627, USA.,Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA.,Department of Orthopedics, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA
| | - Stephen L Kates
- Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA.,Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, 23298, USA
| | - Hani A Awad
- Department of Biomedical Engineering, University of Rochester, Robert B. Goergen Hall, Rochester, NY, 14627, USA. .,Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA. .,Department of Orthopedics, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
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3D-Printed Scaffolds and Biomaterials: Review of Alveolar Bone Augmentation and Periodontal Regeneration Applications. Int J Dent 2016; 2016:1239842. [PMID: 27366149 PMCID: PMC4913015 DOI: 10.1155/2016/1239842] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/17/2016] [Accepted: 05/10/2016] [Indexed: 12/23/2022] Open
Abstract
To ensure a successful dental implant therapy, the presence of adequate vertical and horizontal alveolar bone is fundamental. However, an insufficient amount of alveolar ridge in both dimensions is often encountered in dental practice due to the consequences of oral diseases and tooth loss. Although postextraction socket preservation has been adopted to lessen the need for such invasive approaches, it utilizes bone grafting materials, which have limitations that could negatively affect the quality of bone formation. To overcome the drawbacks of routinely employed grafting materials, bone graft substitutes such as 3D scaffolds have been recently investigated in the dental field. In this review, we highlight different biomaterials suitable for 3D scaffold fabrication, with a focus on “3D-printed” ones as bone graft substitutes that might be convenient for various applications related to implant therapy. We also briefly discuss their possible adoption for periodontal regeneration.
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Zizzari VL, Zara S, Tetè G, Vinci R, Gherlone E, Cataldi A. Biologic and clinical aspects of integration of different bone substitutes in oral surgery: a literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:392-402. [PMID: 27496576 DOI: 10.1016/j.oooo.2016.04.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/12/2016] [Indexed: 12/21/2022]
Abstract
Many bone substitutes have been proposed for bone regeneration, and researchers have focused on the interactions occurring between grafts and host tissue, as the biologic response of host tissue is related to the origin of the biomaterial. Bone substitutes used in oral and maxillofacial surgery could be categorized according to their biologic origin and source as autologous bone graft when obtained from the same individual receiving the graft; homologous bone graft, or allograft, when harvested from an individual other than the one receiving the graft; animal-derived heterologous bone graft, or xenograft, when derived from a species other than human; and alloplastic graft, made of bone substitute of synthetic origin. The aim of this review is to describe the most commonly used bone substitutes, according to their origin, and to focus on the biologic events that ultimately lead to the integration of a biomaterial with the host tissue.
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Affiliation(s)
| | - Susi Zara
- Department of Pharmacy, University "G. d'Annunzio", Chieti, Italy
| | - Giulia Tetè
- Dental School, Vita-Salute University and Department of Dentistry, IRCCS San Raffaele Hospital, Milan, Italy
| | - Raffaele Vinci
- Dental School, Vita-Salute University and Department of Dentistry, IRCCS San Raffaele Hospital, Milan, Italy
| | - Enrico Gherlone
- Dental School, Vita-Salute University and Department of Dentistry, IRCCS San Raffaele Hospital, Milan, Italy
| | - Amelia Cataldi
- Department of Pharmacy, University "G. d'Annunzio", Chieti, Italy
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Histological and Histomorphometric Human Results of HA-Beta-TCP 30/70 Compared to Three Different Biomaterials in Maxillary Sinus Augmentation at 6 Months: A Preliminary Report. BIOMED RESEARCH INTERNATIONAL 2015; 2015:156850. [PMID: 26273589 PMCID: PMC4529888 DOI: 10.1155/2015/156850] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 12/13/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this investigation was to examine the bone regenerative potential of newly biphasic calcium phosphate ceramics (HA-β-TCP 30/70), by assessing histological and histomorphometric results of human specimens retrieved from sinuses augmented with HA-β-TCP 30/70, and comparing them to anorganic bovine bone (ABB), mineralized solvent-dehydrated bone allograft (MSDBA), and equine bone (EB), after a healing period of 6 months. MATERIALS AND METHODS Four consecutive patients with edentulous atrophic posterior maxilla were included in this report. A two-stage procedure was carried out for sinus augmentation with HA-β-TCP 30/70, ABB, MSDBA, and EB. After 6 months, specimens were retrieved at the time of implant placement and processed for histological and histomorphometric analyses. RESULTS At histological examination, all biomaterials were in close contact with the newly formed bone and showed the same pattern of bone formation; the grafted granules were surrounded by a bridge-like network of newly formed bone. A limited number of ABB particles were partially covered by connective tissue. The histomorphometric analysis revealed 30.2% newly formed bone for Ha-β-TCP 30/70, 20.1% for ABB, 16.4% for MSDBA, and 21.9% for EB. CONCLUSIONS Within the limitations of the present investigation, these results support the successful use of HA-β-TCP 30/70 for sinus augmentation.
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