Antibiotics in 3D-printed implants, instruments and materials: benefits, challenges and future directions

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

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

Post-sterilization Dimensional Accuracy of Methacrylate Monomer Biocompatible Three-Dimensionally Printed Mock Surgical Guides

OBJECTIVES

 The aim of this study was to evaluate the post-sterilization dimensional accuracy of a standardized drilling guide, three-dimensionally printed using biocompatible methacrylate monomers.

STUDY DESIGN

 A mock surgical guide was designed and printed in five resins (n = 5/material) using a commercially available desktop stereolithography printer. Pre- and post-sterilization dimensions were measured for each sterilization method (steam, ethylene oxide, hydrogen peroxide gas), then statistically compared; p-value less than or equal 0.05 was considered significant.

RESULTS

 While all resins produced highly accurate replicas of the designed guide, the amber and black resins were unaffected by any sterilization method (p ≥ 0.9). For other materials, ethylene oxide produced the largest dimensional changes. However, mean post-sterilization dimensional changes for all materials and sterilization methods remained less than or equal to 0.05mm CONCLUSION:  This study demonstrated that post-sterilization dimensional change of evaluated biomaterials was minimal, and less than previously reported. Additionally, amber and black resins may be preferred to reduce post-sterilization dimensional change, as they were unaffected by any sterilization method. Given the results of this study, surgeons should feel confident using the Form 3B printer to create patient surgical guides. Furthermore, bioresins may provide safer alternatives for patients compared with other three-dimensional printed materials.

The Use of 3D Printing Technology in Gynaecological Brachytherapy-A Narrative Review

Radiation therapy, including image-guided adaptive brachytherapy based on magnetic resonance imaging, is the standard of care in locally advanced cervical and vaginal cancer and part of the treatment in other primary and recurrent gynaecological tumours. Tumour control probability increases with dose and brachytherapy is the optimal technique to increase the dose to the target volume while maintaining dose constraints to organs at risk. The use of interstitial needles is now one of the quality indicators for cervical cancer brachytherapy and needles should optimally be used in ≥60% of patients. Commercially available applicators sometimes cannot be used because of anatomical barriers or do not allow adequate target volume coverage due to tumour size or topography. Over the last five to ten years, 3D printing has been increasingly used for manufacturing of customised applicators in brachytherapy, with gynaecological tumours being the most common indication. We present the rationale, techniques and current clinical evidence for the use of 3D-printed applicators in gynaecological brachytherapy.

3D Printed Materials for Combating Antimicrobial Resistance

Three-dimensional (3D) printing is a rapidly growing technology with a significant capacity for translational applications in both biology and medicine. 3D-printed living and non-living materials are being widely tested as a potential replacement for conventional solutions for testing and combating antimicrobial resistance (AMR). The precise control of cells and their microenvironment, while simulating the complexity and dynamics of an in vivo environment, provides an excellent opportunity to advance the modeling and treatment of challenging infections and other health conditions. 3D-printing models the complicated niches of microbes and host-pathogen interactions, and most importantly, how microbes develop resistance to antibiotics. In addition, 3D-printed materials can be applied to testing and delivering antibiotics. Here, we provide an overview of 3D printed materials and biosystems and their biomedical applications, focusing on ever increasing AMR. Recent applications of 3D printing to alleviate the impact of AMR, including developed bioprinted systems, targeted bacterial infections, and tested antibiotics are presented.

Efficacy and safety of 3D printing-assisted percutaneous nephrolithotomy in complex renal calculi

This study evaluated the efficacy and safety of 3D printing technology combined with percutaneous nephrolithotomy in the treatment of complex renal calculi. Ninety patients with complex renal calculi were randomly divided into a 3D printing group (45 patients) and a control group (45 patients). In the 3D printing group, a patient-specific 1:1 3D printing model was established based on the patient's thin-layer CT scanning data. A 3D printing model was used for preoperative communication between doctors and patients. Preoperative puncture training, channel design, residual stone prediction, and percutaneous nephrolithotomy were performed under the guidance of a 3D printing model and B-ultrasound. The control group was treated with the conventional B-ultrasound-guided puncture method. Results suggest that there was a statistically significant difference between the two groups (P < 0.05). The overall score of the doctor-patient communication objects in the 3D printing group was 19.32 ± 1.57 points, and in the control group, it was 14.51 ± 2.13 points. The operation time of the 3D printing group was 103.21 ± 13.49 min, and that of the control group was 126.12 ± 25.87 min. The calculi clearance rate of the 3D printing group was 96%, while that of the control group was 80%. The incidence of postoperative complications was 6.67% in the 3D printing group and 22.22% in the control group. Compared with traditional percutaneous nephrolithotomy, 3D printing technology combined with percutaneous nephrolithotomy can significantly enhance the effectiveness of doctor–patient communication, shorten operation time, reduce operation bleeding, improve the stone clearance rate, reduce the incidence of complications and shorten the length of hospital stay. The proposed method is thus a safe and effective method to treat complex renal calculi.

New Insights into the Application of 3D-Printing Technology in Hernia Repair

Abdominal hernia repair using prosthetic materials is among the surgical interventions most widely performed worldwide. These materials, or meshes, are implanted to close the hernial defect, reinforcing the abdominal muscles and reestablishing mechanical functionality of the wall. Meshes for hernia repair are made of synthetic or biological materials exhibiting multiple shapes and configurations. Despite the myriad of devices currently marketed, the search for the ideal mesh continues as, thus far, no device offers optimal tissue repair and restored mechanical performance while minimizing postoperative complications. Additive manufacturing, or 3D-printing, has great potential for biomedical applications. Over the years, different biomaterials with advanced features have been successfully manufactured via 3D-printing for the repair of hard and soft tissues. This technological improvement is of high clinical relevance and paves the way to produce next-generation devices tailored to suit each individual patient. This review focuses on the state of the art and applications of 3D-printing technology for the manufacture of synthetic meshes. We highlight the latest approaches aimed at developing improved bioactive materials (e.g., optimizing antibacterial performance, drug release, or device opacity for contrast imaging). Challenges, limitations, and future perspectives are discussed, offering a comprehensive scenario for the applicability of 3D-printing in hernia repair.

Three-dimensional printed personalized drug devices with anatomical fit: a review

OBJECTIVES

Three-dimensional printing (3DP) has opened the era of drug personalization, promising to revolutionize the pharmaceutical field with improvements in efficacy, safety and compliance of the treatments. As a result of these investigations, a vast therapeutic field has opened for 3DP-loaded drug devices with an anatomical fit. Along these lines, innovative dosage forms, unimaginable until recently, can be obtained. This review explores 3DP-engineered drug devices described in recent research articles, as well as in patented inventions, and even devices already produced by 3DP with drug-loading potential.

KEY FINDINGS

3D drug-loaded stents, implants and prostheses are reviewed, along with devices produced to fit hard-to-attach body parts such as nasal masks, vaginal rings or mouthguards. The most promising 3DP techniques for such devices and the complementary technologies surrounding these inventions are also discussed, particularly the scanners useful for mapping body parts. Health regulatory concerns regarding the new use of such technology are also analysed.

SUMMARY

The scenario discussed in this review shows that for wearable 3DP drug devices to become a tangible reality to users, it will be necessary to overcome the existing regulatory barriers, create new interfaces with electronic systems and improve the mapping mechanisms of body surfaces.

Studying the influence of Solcoseryl drug and vitamin C on the inflammatory reaction and proliferation of fibroblastic cells in the filed of polypropylene endoprosthesis implantation

Introduction: Applying a coating on hernia endoprosthesis prevents recurrent anterior abdominal wall hernias, reduces inflammatory response and stimulates reparative processes in the area of its implantation. The aim of investigation was to study the effect of Solcoseryl and Vitamin C in a collagen-stimulating coating of hernioendoprosthesis on a morphological picture in anterior abdominal wall plastic surgery.

Materials and methods: The study was performed on 180 laboratory mice divided into three groups of 60 animals each: the first group animals were implanted with polypropylene endoprostheses without a collagen-stimulating coating, the second group animals – polypropylene endoprostheses with a collagen-stimulating coating with Vitamin C, and the third group animals – polypropylene endoprostheses with a collagen-stimulating coating with Solcoseryl. The laboratory animals were withdrawn from the experiment on the 10th, 30th, 60th, and 90th days. The excised sections of the abdominal wall were stained with G+E to determine the nature of inflammation and the number of cell elements.

Results and discussion: When using endoprostheses with a collagen-stimulating coating, the stages of inflammatory process proceeded more quickly, which was confirmed by a reliable (р ≤ 0.05) decrease in the number of neutrophils, macrophages and lymphocytes at all stages of the study. By the 90th day of the experiment, the number of fibroblasts in the control group was by 22.64% less than in the study groups with a coating.

Conclusion: A cytological and histological analysis in the control group determined a consistent decrease in an exudative phase of inflammatory reaction. When using endoprosthesis with coatings, its acceleration and lower intensity was noted throughout the study. In the group with Solcoseryl, the formation of a dense connective capsule around the endoprosthesis indicates its quality and better adaptation of the endoprosthesis in body tissues.

Three-Dimensional Printing of Curcumin-Loaded Biodegradable and Flexible Scaffold for Intracranial Therapy of Glioblastoma Multiforme

A novel drug delivery system preventing Glioblastoma multiforme (GBM) recurrence after resection surgery is imperatively required to overcome the mechanical limitation of the current local drug delivery system and to offer personalised treatment options for GBM patients. In this study, 3D printed biodegradable flexible porous scaffolds were developed via Fused Deposition Modelling (FDM) three-dimensional (3D) printing technology for the local delivery of curcumin. The flexible porous scaffolds were 3D printed with various geometries containing 1, 3, 5, and 7% (w/w) of curcumin, respectively, using curcumin-loaded polycaprolactone (PCL) filaments. The scaffolds were characterised by a series of characterisation studies and in vitro studies were also performed including drug release study, scaffold degradation study, and cytotoxicity study. The curcumin-loaded PCL scaffolds displayed versatile spatiotemporal characteristics. The polymeric scaffolds obtained great mechanical flexibility with a low tensile modulus of less than 2 MPa, and 4 to 7-fold ultimate tensile strain, which can avoid the mechanical mismatch problem of commercially available GLIADEL wafer with a further improvement in surgical margin coverage. In vitro release profiles have demonstrated the sustained release patterns of curcumin with adjustable release amounts and durations up to 77 h. MTT study has demonstrated the great cytotoxic effect of curcumin-loaded scaffolds against the U87 human GBM cell line. Therefore, 3D printed curcumin-loaded scaffold has great promise to provide better GBM treatment options with its mechanical flexibility and customisability to match individual needs, preventing post-surgery GBM recurrence and eventually prolonging the life expectancy of GBM patients.

3D-Printed Objects for Multipurpose Applications

3D printing is a popular nonconventional manufacturing technique used to print 3D objects by using conventional and nonconventional materials. The application and uses of 3D printing are rapidly increasing in each dimension of the engineering and medical sectors. This article overviews the multipurpose applications of 3D printing based on current research. In the beginning, various popular methods including fused deposition method, stereolithography 3D printing method, powder bed fusion method, digital light processing method, and metal transfer dynamic method used in 3D printing are discussed. Popular materials utilized randomly in printing techniques such as hydrogel, ABS, steel, silver, and epoxy are overviewed. Engineering applications under the current development of the printing technique which include electrode, 4D printing technique, twisting object, photosensitive polymer, and engines are focused. Printing of medical equipment including artificial tissues, scaffolds, bioprinted model, prostheses, surgical instruments, COVID-19, skull, and heart is of major focus. Characterization techniques of the printed 3D products are mentioned. In addition, potential challenges and future prospects are evaluated based on the current scenario. This review article will work as a masterpiece for the researchers interested to work in this field.

Additive Manufacturing Processes in Medical Applications

Additive manufacturing (AM, 3D printing) is used in many fields and different industries. In the medical and dental field, every patient is unique and, therefore, AM has significant potential in personalized and customized solutions. This review explores what additive manufacturing processes and materials are utilized in medical and dental applications, especially focusing on processes that are less commonly used. The processes are categorized in ISO/ASTM process classes: powder bed fusion, material extrusion, VAT photopolymerization, material jetting, binder jetting, sheet lamination and directed energy deposition combined with classification of medical applications of AM. Based on the findings, it seems that directed energy deposition is utilized rarely only in implants and sheet lamination rarely for medical models or phantoms. Powder bed fusion, material extrusion and VAT photopolymerization are utilized in all categories. Material jetting is not used for implants and biomanufacturing, and binder jetting is not utilized for tools, instruments and parts for medical devices. The most common materials are thermoplastics, photopolymers and metals such as titanium alloys. If standard terminology of AM would be followed, this would allow a more systematic review of the utilization of different AM processes. Current development in binder jetting would allow more possibilities in the future.

3D Printing and NIR Fluorescence Imaging Techniques for the Fabrication of Implants

Three-dimensional (3D) printing technology holds great potential to fabricate complex constructs in the field of regenerative medicine. Researchers in the surgical fields have used 3D printing techniques and their associated biomaterials for education, training, consultation, organ transplantation, plastic surgery, surgical planning, dentures, and more. In addition, the universal utilization of 3D printing techniques enables researchers to exploit different types of hardware and software in, for example, the surgical fields. To realize the 3D-printed structures to implant them in the body and tissue regeneration, it is important to understand 3D printing technology and its enabling technologies. This paper concisely reviews 3D printing techniques in terms of hardware, software, and materials with a focus on surgery. In addition, it reviews bioprinting technology and a non-invasive monitoring method using near-infrared (NIR) fluorescence, with special attention to the 3D-bioprinted tissue constructs. NIR fluorescence imaging applied to 3D printing technology can play a significant role in monitoring the therapeutic efficacy of 3D structures for clinical implants. Consequently, these techniques can provide individually customized products and improve the treatment outcome of surgeries.

3D printed antimicrobial PLA constructs functionalised with zinc- coated halloysite nanotubes-Ag-chitosan oligosaccharide lactate

The control and inhibition of microbial infection are of critical importance for patients undergoing dental or orthopedic surgery. A critical requirement is the prevention of bacterial growth, subsequent bacterial colonization of implant surfaces, and biofilm formation. Among biofilm-forming bacteria, S. aureus and S. epidermidis are the most common bacteria responsible for causing implant-related infections. The ability to produce customized and patient-specific antimicrobial treatments will significantly reduce infections leading to enhanced patient recovery. We propose that 3D-printed antimicrobial biomedical devices for on-demand infection prophylaxis and disease prevention are a rational solution for the prevention of infection. In this study, we modified 3D printed polylactic acid (PLA) constructs using an alkali treatment to increase hydrophilicity and functionalized the surface of the constructs using a suspension of Zinc/HNTs-Ag-Chitosan Oligosaccharide Lactate (ZnHNTs-Ag-COS). The morphologies of printed constructs were analyzed using Scanning Electron Microscopy-Energy Dispersive X-Ray Spectroscopy (SEM-EDS), and chemical analysis by Fourier-transform infrared spectroscopy (FTIR). Assessment of the antimicrobial potential of our constructs was assessed using agar diffusion and biofilm assays. The surface of 3D printed PLA constructs were chemically modified to increase hydrophilicity and suspensions of COS-ZnHNTs-Ag were adsorbed on the construct surface. Surface adsorption of ZnHNTs-Ag-COS on PLA printed constructs was determined to be a function of relative pore size. Morphological surface characterization using SEM-EDS confirmed the presence of the suspension coatings on the constructs, and FTIR analysis confirmed the presence of COS-ZnHNTs-Ag in the coatings. The inhibition of bacterial growth was evaluated using the agar diffusion method. Results obtained confirmed the antimicrobial potential of the PLA constructs (which was a function of the Ag content in the material).

The Production Possibility of the Antimicrobial Filaments by Co-Extrusion of the PLA Pellet with Chitosan Powder for FDM 3D Printing Technology

The last decades have witnessed a major advancement and development in three-dimensional (3D) printing technology. In the future, the trend’s utilization of 3D printing is expected to play an important role in the biomedical field. This work presents co-extrusion of the polylactic acid (PLA), its derivatives (sPLA), and chitosan with the aim of achieving filaments for printing 3D objects, such as biomedical tools or implants. The physicochemical and antimicrobial properties were evaluated using SEM, FT-IR, DSC, instrumental mechanical test, and based on the ASTM E2149 standard, respectively. The addition of chitosan in the PLA and sPLA filaments increased their porosity and decreased density. The FT-IR analysis showed that PLA and chitosan only formed a physical mixture after extrusion. The addition of chitosan caused deterioration of the mechanical properties of filaments, especially elongation at break and Young’s modulus. The addition of chitosan to the filaments improved their ability to crystallize and provide their antimicrobial properties against Escherichia coli and Staphylococcus aureus.