1
|
Zhang Z, Zhang X, Zheng Z, Xin J, Han S, Qi J, Zhang T, Wang Y, Zhang S. Latest advances: Improving the anti-inflammatory and immunomodulatory properties of PEEK materials. Mater Today Bio 2023; 22:100748. [PMID: 37600350 PMCID: PMC10432209 DOI: 10.1016/j.mtbio.2023.100748] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023] Open
Abstract
Excellent biocompatibility, mechanical properties, chemical stability, and elastic modulus close to bone tissue make polyetheretherketone (PEEK) a promising orthopedic implant material. However, biological inertness has hindered the clinical applications of PEEK. The immune responses and inflammatory reactions after implantation would interfere with the osteogenic process. Eventually, the proliferation of fibrous tissue and the formation of fibrous capsules would result in a loose connection between PEEK and bone, leading to implantation failure. Previous studies focused on improving the osteogenic properties and antibacterial ability of PEEK with various modification techniques. However, few studies have been conducted on the immunomodulatory capacity of PEEK. New clinical applications and advances in processing technology, research, and reports on the immunomodulatory capacity of PEEK have received increasing attention in recent years. Researchers have designed numerous modification techniques, including drug delivery systems, surface chemical modifications, and surface porous treatments, to modulate the post-implantation immune response to address the regulatory factors of the mechanism. These studies provide essential ideas and technical preconditions for the development and research of the next generation of PEEK biological implant materials. This paper summarizes the mechanism by which the immune response after PEEK implantation leads to fibrous capsule formation; it also focuses on modification techniques to improve the anti-inflammatory and immunomodulatory abilities of PEEK. We also discuss the limitations of the existing modification techniques and present the corresponding future perspectives.
Collapse
Affiliation(s)
- Zilin Zhang
- Department of Spine Surgery, Center of Orthopedics, First Hospital of Jilin University, Changchun, 130021, China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, 130021, China
| | - Xingmin Zhang
- Department of Spine Surgery, Center of Orthopedics, First Hospital of Jilin University, Changchun, 130021, China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, 130021, China
| | - Zhi Zheng
- Department of Spine Surgery, Center of Orthopedics, First Hospital of Jilin University, Changchun, 130021, China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, 130021, China
| | - Jingguo Xin
- Department of Spine Surgery, Center of Orthopedics, First Hospital of Jilin University, Changchun, 130021, China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, 130021, China
| | - Song Han
- Department of Spine Surgery, Center of Orthopedics, First Hospital of Jilin University, Changchun, 130021, China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, 130021, China
| | - Jinwei Qi
- Department of Spine Surgery, Center of Orthopedics, First Hospital of Jilin University, Changchun, 130021, China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, 130021, China
| | - Tianhui Zhang
- Department of Spine Surgery, Center of Orthopedics, First Hospital of Jilin University, Changchun, 130021, China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, 130021, China
| | - Yongjie Wang
- Department of Spine Surgery, Center of Orthopedics, First Hospital of Jilin University, Changchun, 130021, China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, 130021, China
| | - Shaokun Zhang
- Department of Spine Surgery, Center of Orthopedics, First Hospital of Jilin University, Changchun, 130021, China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, 130021, China
| |
Collapse
|
2
|
Chen T, Jinno Y, Atsuta I, Tsuchiya A, Stocchero M, Bressan E, Ayukawa Y. Current surface modification strategies to improve the binding efficiency of emerging biomaterial polyetheretherketone (PEEK) with bone and soft tissue: A literature review. J Prosthodont Res 2023; 67:337-347. [PMID: 36372438 DOI: 10.2186/jpr.jpr_d_22_00138] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
PURPOSE The aim of this study was to review the literature on current surface modification strategies used to improve the binding efficiency of an emerging biological material, polyetheretherketone (PEEK), with bone and soft tissues. STUDY SELECTION This review was based on articles retrieved from PubMed, Google Scholar, Web of Science, and ScienceDirect databases. The main keywords used during the search were "polyetheretherketone (PEEK)," "implant," "surface modification," "biomaterials," "bone," "osseointegration," and "soft tissue." RESULTS The suitability of PEEK surface modification strategies has been critically analyzed and summarized here. Many cell and in vivo experiments in small animals have shown that the use of advanced modification technologies with appropriate surface modification strategies can effectively improve the surface inertness of PEEK, thereby improving its binding efficiency with bone and soft tissues. CONCLUSIONS Surface modifications of PEEK have revealed new possibilities for implant treatment; however, most results are based on in vitro or short-term in vivo evaluations in small animals. To achieve a broad application of PEEK in the field of oral implantology, more in vivo experiments and long-term clinical evaluations are needed to investigate the effects of various surface modifications on the tissue integration ability of PEEK to develop an ideal implant material.
Collapse
Affiliation(s)
- Tianjie Chen
- Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Yohei Jinno
- Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Ikiru Atsuta
- Division of Advanced Dental Devices and Therapeutics, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Akira Tsuchiya
- Department of Biomaterials, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Michele Stocchero
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Eriberto Bressan
- Department of Neurosciences, Section of Dentistry, University of Padova, Padova, Italy
| | - Yasunori Ayukawa
- Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| |
Collapse
|
3
|
A biomimetic gradient porous cage with a micro-structure for enhancing mechanical properties and accelerating osseointegration in spinal fusion. Bioact Mater 2023; 23:234-246. [DOI: 10.1016/j.bioactmat.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/08/2022] [Accepted: 11/12/2022] [Indexed: 11/17/2022] Open
|
4
|
Wang X, Ma N, Feng L, Shen M, Zhou Y, Zhang X, Huang R, Zhou L, Ji S, Lou Y, Zhu Z. Fabrication of bFGF/polydopamine-loaded PEEK implants for improving soft tissue integration by upregulating Wnt/β-catenin signaling. Heliyon 2023; 9:e14800. [PMID: 37012909 PMCID: PMC10066536 DOI: 10.1016/j.heliyon.2023.e14800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 03/28/2023] Open
Abstract
The difficulties associated with polyetheretherketone (PEEK) implants and soft tissue integration for craniomaxillofacial bone repair have led to a series of complications that limit the clinical benefits. In this study, 3D printed multi-stage microporous PEEK implants coated with bFGF via polydopamine were fabricated to enhance PEEK implant-soft tissue integration. Multistage microporous PEEK scaffolds prepared by sulfonation of concentrated sulfuric acid were coated with polydopamine, and then used as templates for electrophoretic deposition of bFGF bioactive factors. Achieving polydopamine and bFGF sustained release, the composite PEEK scaffolds possessed good mechanical properties, hydrophilicity, protein adhesion properties. The in vitro results indicated that bFGF/polydopamine-loaded PEEK exhibited good biocompatibility to rabbit embryonic fibroblasts (REF) by promoting cell proliferation, adhesion, and migration. Ribonucleic acid sequencing (RNA-seq) revealed that bFGF/polydopamine-loaded PEEK implants significantly upregulated the expression of genes and proteins associated with soft tissue integration and activated Wnt/β-catenin signaling in biological processes, but related expression of genes and proteins was significantly downregulated when the Wnt/β-catenin signaling was inhibited. Furthermore, in vivo bFGF/polydopamine-loaded PEEK implants exhibited excellent performance in improving the growth and adhesion of the surrounding soft tissue. In summary, bFGF/polydopamine-loaded PEEK implants possess soft tissue integration properties by activating the Wnt/β-catenin signaling, which have a potential translational clinical application in the future.
Collapse
|
5
|
Raees S, Ullah F, Javed F, Akil HM, Jadoon Khan M, Safdar M, Din IU, Alotaibi MA, Alharthi AI, Bakht MA, Ahmad A, Nassar AA. Classification, processing, and applications of bioink and 3D bioprinting: A detailed review. Int J Biol Macromol 2023; 232:123476. [PMID: 36731696 DOI: 10.1016/j.ijbiomac.2023.123476] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/12/2023] [Accepted: 01/25/2023] [Indexed: 02/02/2023]
Abstract
With the advancement in 3D bioprinting technology, cell culture methods can design 3D environments which are both, complex and physiologically relevant. The main component in 3D bioprinting, bioink, can be split into various categories depending on the criterion of categorization. Although the choice of bioink and bioprinting process will vary greatly depending on the application, general features such as material properties, biological interaction, gelation, and viscosity are always important to consider. The foundation of 3D bioprinting is the exact layer-by-layer implantation of biological elements, biochemicals, and living cells with the spatial control of the implantation of functional elements onto the biofabricated 3D structure. Three basic strategies underlie the 3D bioprinting process: autonomous self-assembly, micro tissue building blocks, and biomimicry or biomimetics. Tissue engineering can benefit from 3D bioprinting in many ways, but there are still numerous obstacles to overcome before functional tissues can be produced and used in clinical settings. A better comprehension of the physiological characteristics of bioink materials and a higher level of ability to reproduce the intricate biologically mimicked and physiologically relevant 3D structures would be a significant improvement for 3D bioprinting to overcome the limitations.
Collapse
Affiliation(s)
- Sania Raees
- Department of Biosciences, COMSATS University Islamabad, Park Road, 45520 Islamabad, Pakistan
| | - Faheem Ullah
- Department of Biological Sciences, National University of Medical Sciences, NUMS, Rawalpindi 46000, Pakistan; School of Materials and Mineral Resources Engineering, Engineering Campus, Universiti Sains Malaysia, Seri Ampangan, 14300 Nibong Tebal, Pulau Pinang, Malaysia
| | - Fatima Javed
- Department of Chemistry, Shaheed Benazir Bhutto Women University, Peshawar 25000, KPK, Pakistan
| | - Hazizan Md Akil
- School of Materials and Mineral Resources Engineering, Engineering Campus, Universiti Sains Malaysia, Seri Ampangan, 14300 Nibong Tebal, Pulau Pinang, Malaysia
| | - Muhammad Jadoon Khan
- Department of Biosciences, COMSATS University Islamabad, Park Road, 45520 Islamabad, Pakistan
| | - Muhammad Safdar
- Department of Pharmacy, Gomal University D. I Khan, KPK, Pakistan
| | - Israf Ud Din
- Department of Chemistry, College of Science and Humanities, Prince Sattam bin Abdulaziz University, 16278 Al-Kharj, Saudi Arabia.
| | - Mshari A Alotaibi
- Department of Chemistry, College of Science and Humanities, Prince Sattam bin Abdulaziz University, 16278 Al-Kharj, Saudi Arabia
| | - Abdulrahman I Alharthi
- Department of Chemistry, College of Science and Humanities, Prince Sattam bin Abdulaziz University, 16278 Al-Kharj, Saudi Arabia
| | - M Afroz Bakht
- Department of Chemistry, College of Science and Humanities, Prince Sattam bin Abdulaziz University, 16278 Al-Kharj, Saudi Arabia
| | - Akil Ahmad
- Department of Chemistry, College of Science and Humanities, Prince Sattam bin Abdulaziz University, 16278 Al-Kharj, Saudi Arabia
| | - Amal A Nassar
- Department of Chemistry, College of Science and Humanities, Prince Sattam bin Abdulaziz University, 16278 Al-Kharj, Saudi Arabia
| |
Collapse
|
6
|
Kjellin P, Danielsson K, Håkansson J, Agrenius K, Andersson T, Stenlund P. Biomechanical and histomorphometric evaluation of skin integration on titanium and PEEK implants with different surface treatments. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2022; 33:68. [PMID: 36178551 PMCID: PMC9525375 DOI: 10.1007/s10856-022-06687-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/22/2022] [Indexed: 05/14/2023]
Abstract
Percutaneous implants are frequently affected by bacterial growth at the skin-implant interface. Integration between implant and surrounding skin is important to prevent bacteria from spreading to the underlying tissue. The standard method to evaluate skin-implant integration is by histomorphometry on samples which have been placed in tissue grown in vivo or ex vivo. In this study, a biomechanical method was developed and evaluated. The integration of implants into porcine skin was studied in an ex vivo model, where pig skin samples were cultivated in a nutrient solution. Cylindrical shaped implants, consisting of polyether ether ketone (PEEK) and titanium (Ti) with different surface treatments, were implanted in the skin tissue and the skin was grown in nutrient solution for 2 weeks. The implants were then extracted from the implantation site and the mechanical force during extraction was measured as a quantitative assessment of skin-implant integration. Implants from each group were also processed for histomorphometry and the degree of epidermal downgrowth (ED) and tissue to implant contact (TIC) was measured. A higher mean pullout force was observed for the PEEK implants compared to the Ti implants. Applying nanosized hydroxyapatite (HA) on Ti and PEEK increased the pullout force compared to uncoated controls, 24% for machined and 70% for blasted Ti, and 51% for machined PEEK. Treatment of Ti and PEEK with nanosized zirconium phosphate (ZrP) did not increase the pullout force. The histomorphometry analysis showed correlation between ED and pullout force, where the pullout force was inversely proportional to ED. For TIC, no significant differences were observed between the groups of same material (i.e. Ti, Ti+HA, Ti+ZrP, and PEEK, PEEK + HA, PEEK + ZrP), but it was significantly higher for PEEK compared to Ti. Scanning electron microscopy analysis was done on samples before and after the pullout tests, showing that the ZrP coating was unaffected by the 2 week ex vivo implantation and pullout procedure, no dissolution or detachment of the coating was observed. For the HA coating, a loss of coating was seen on approximately 5% of the total surface area of the implant. Graphical abstract.
Collapse
Affiliation(s)
- Per Kjellin
- Promimic AB, AstraZeneca BioventureHub, SE, 43183, Mölndal, Sweden.
| | - Karin Danielsson
- Promimic AB, AstraZeneca BioventureHub, SE, 43183, Mölndal, Sweden
| | - Joakim Håkansson
- Department of Methodology, Textile and Medical Technology, RISE Research Institutes of Sweden, SE, 50115, Borås, Sweden
- Department of Laboratory Medicine, Institute of Biomedicine, Gothenburg University, SE, 40530, Göteborg, Sweden
| | - Karin Agrenius
- Department of Methodology, Textile and Medical Technology, RISE Research Institutes of Sweden, SE, 50115, Borås, Sweden
| | - Therese Andersson
- Department of Methodology, Textile and Medical Technology, RISE Research Institutes of Sweden, SE, 50115, Borås, Sweden
| | - Patrik Stenlund
- Department of Methodology, Textile and Medical Technology, RISE Research Institutes of Sweden, SE, 50115, Borås, Sweden
| |
Collapse
|
7
|
Li L, Gao H, Wang C, Ji P, Huang Y, Wang C. Assessment of Customized Alveolar Bone Augmentation Using Titanium Scaffolds vs Polyetheretherketone (PEEK) Scaffolds: A Comparative Study Based on 3D Printing Technology. ACS Biomater Sci Eng 2022; 8:2028-2039. [PMID: 35443132 DOI: 10.1021/acsbiomaterials.2c00060] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Customized alveolar bone augmentation provides sufficient and precisely regenerated bone tissue for subsequent dental implant placement. Although some clinical cases have confirmed the successful use of the patient-specific polyetheretherketone (PEEK) scaffolds, the biomechanical property and osteogenic performance of the patient-specific PEEK scaffolds remain unclear. The objectives of this study were (1) to evaluate the space maintenance capacity and osteogenic performance of the patient-specific PEEK scaffolds for customized alveolar bone augmentation and (2) to compare the biomechanical properties of three-dimensionally printed titanium scaffolds and PEEK scaffolds. Both titanium scaffolds and PEEK scaffolds were designed and manufactured via additive manufacturing technology combined with computer-aided design (CAD). In three-point bending tests, the bending strength of the PEEK scaffold was about 1/3 that of the titanium scaffold. Accordingly, the equivalent strain value of the internal bone graft beneath the PEEK scaffold was about 3 times that beneath the titanium scaffold in finite element analysis, but the maximum deformations of both scaffolds were less than 0.05 mm. Meanwhile, in in vivo experiments, it is demonstrated that both scaffolds have similar space maintenance capacity and bone ingrowth efficiency. In conclusion, patient-specific PEEK scaffolds showed significantly lower biomechanical strength but comparable space maintenance and osteogenic properties to the titanium counterpart. Compared with traditional guided bone regeneration (GBR) surgery, both patient-specific PEEK and titanium scaffolds can achieve excellent osteogenic space maintenance ability. This study provides a preliminary basis for the clinical translation of the nonmetallic barrier membrane in customized alveolar bone augmentation.
Collapse
Affiliation(s)
- Linzhi Li
- Stomatological Hospital of Chongqing Medical University, Chongqing 401147, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China
| | - Hui Gao
- Stomatological Hospital of Chongqing Medical University, Chongqing 401147, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China
| | - Chunjuan Wang
- Stomatological Hospital of Chongqing Medical University, Chongqing 401147, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China
| | - Ping Ji
- Stomatological Hospital of Chongqing Medical University, Chongqing 401147, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China
| | - Yuanding Huang
- Stomatological Hospital of Chongqing Medical University, Chongqing 401147, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China
| | - Chao Wang
- Stomatological Hospital of Chongqing Medical University, Chongqing 401147, China.,Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China
| |
Collapse
|
8
|
Yu D, Lei X, Zhu H. Modification of polyetheretherketone (PEEK) physical features to improve osteointegration. J Zhejiang Univ Sci B 2022; 23:189-203. [PMID: 35261215 DOI: 10.1631/jzus.b2100622] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Polyetheretherketone (PEEK) has been widely applied in orthopedics because of its excellent mechanical properties, radiolucency, and biocompatibility. However, the bioinertness and poor osteointegration of PEEK have greatly limited its further application. Growing evidence proves that physical factors of implants, including their architecture, surface morphology, stiffness, and mechanical stimulation, matter as much as the composition of their surface chemistry. This review focuses on the multiple strategies for the physical modification of PEEK implants through adjusting their architecture, surface morphology, and stiffness. Many research findings show that transforming the architecture and incorporating reinforcing fillers into PEEK can affect both its mechanical strength and cellular responses. Modified PEEK surfaces at the macro scale and micro/nano scale have positive effects on cell-substrate interactions. More investigations are necessary to reach consensus on the optimal design of PEEK implants and to explore the efficiency of various functional implant surfaces. Soft-tissue integration has been ignored, though evidence shows that physical modifications also improve the adhesion of soft tissue. In the future, ideal PEEK implants should have a desirable topological structure with better surface hydrophilicity and optimum surface chemistry.
Collapse
Affiliation(s)
- Dan Yu
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Xiaoyue Lei
- Department of Stomatology, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Huiyong Zhu
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
| |
Collapse
|
9
|
Wang N, Qi D, Liu L, Zhu Y, Liu H, Zhu S. Fabrication of In Situ Grown Hydroxyapatite Nanoparticles Modified Porous Polyetheretherketone Matrix Composites to Promote Osteointegration and Enhance Bone Repair. Front Bioeng Biotechnol 2022; 10:831288. [PMID: 35295654 PMCID: PMC8919038 DOI: 10.3389/fbioe.2022.831288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/17/2022] [Indexed: 12/16/2022] Open
Abstract
The repairment of critical-sized bone defects is a serious problem that stimulates the development of new biomaterials. In this study, nanohydroxyapatite (nHA)-doped porous polyetheretherketone (pPEEK) were successfully fabricated by the thermally induced phase separation method and hydrothermal treatment. Structural analysis was performed by X-ray diffraction. The water contact angles and scanning electron microscopy were measured to assess physical properties of surfaces. The mechanical strength of the composites is also determined. Microcomputed tomography is used to characterize the nHA content of the composites. The in vitro bioactivity of the composites with or without nHA was investigated by using murine pre-osteoblasts MC3T3-E1, and the results of cytotoxicity and cell proliferation assays revealed that the cytocompatibility of all specimens was good. Adherence assays were employed to examine the adhesion and morphology of cells on different materials. However, nHA-doped composites induced cell attachment and cell spreading more significantly. Osteogenic differentiation was investigated using alkaline phosphatase activity and alizarin red staining, and these in vitro results demonstrated that composites containing nHA particles enhanced osteoblast differentiation. Its effectiveness for promoting osteogenesis was also confirmed in an in vivo animal experiment using a tibial defective rat model. After 8 weeks of implantation, compared to the pure PEEK and pPEEK without nHA groups, the nHA-pPEEK group showed better osteogenic activity. The results indicate that the nHA-pPEEK composites are possibly a well-designed bone substitute for critical-sized bone defects by promoting bone regeneration and osteointegration successfully.
Collapse
Affiliation(s)
- Ningning Wang
- Department of Prosthetic Dentistry, School and Hospital of Stomatology, Jilin University, Changchun, China
| | - Desheng Qi
- College of Chemistry, Engineering Research Center of Special Engineering Plastics, Ministry of Education, Jilin University, Changchun, China
| | - Lu Liu
- Department of Stomatology, China-Japan Friendship Hospital, Jilin University, Changchun, China
| | - Yanlin Zhu
- Department of Oral Implantology, School and Hospital of Stomatology, Jilin University, Changchun, China
| | - Hong Liu
- Department of General Dentistry, School and Hospital of Stomatology, Jilin University, Changchun, China
| | - Song Zhu
- Department of Prosthetic Dentistry, School and Hospital of Stomatology, Jilin University, Changchun, China
- *Correspondence: Song Zhu,
| |
Collapse
|
10
|
Liu M, Wang Y, Zhang S, Wei Q, Li X. Success Factors of Additive Manufactured Root Analogue Implants. ACS Biomater Sci Eng 2022; 8:360-378. [PMID: 34990114 DOI: 10.1021/acsbiomaterials.1c01079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Dental implantation is an effective method for the treatment of loose teeth, but the threaded dental implants used in the clinic cannot match with the tooth extraction socket. A root analogue implant (RAI) has the congruence shape, which reduces the damage to bone and soft tissue. Additive manufacturing (AM) technologies have the advantages of high precision, flexibility, and easy operation, becoming the main manufacturing method of RAI in basic research. The purpose of this systematic review is to summarize AM technologies used for RAI manufacturing as well as the factors affecting successful implantation. First, it introduces the AM technologies according to different operating principles and summarizes the advantages and disadvantages of each method. Then the influences of materials, structure design, surface characteristics, implant site, and positioning are discussed, providing reference for designers and dentists. Finally, it addresses the gap between basic research and clinical application for additive manufactured RAIs and discusses the current challenges and future research directions for this field.
Collapse
Affiliation(s)
- Minyan Liu
- Department of Industry Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, China
| | - Yanen Wang
- Department of Industry Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, China
| | - Shan Zhang
- Department of Industry Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, China
| | - Qinghua Wei
- Department of Industry Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, China
| | - Xinpei Li
- Department of Industry Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, China
| |
Collapse
|
11
|
Cheng L, Suresh K S, He H, Rajput RS, Feng Q, Ramesh S, Wang Y, Krishnan S, Ostrovidov S, Camci-Unal G, Ramalingam M. 3D Printing of Micro- and Nanoscale Bone Substitutes: A Review on Technical and Translational Perspectives. Int J Nanomedicine 2021; 16:4289-4319. [PMID: 34211272 PMCID: PMC8239380 DOI: 10.2147/ijn.s311001] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/17/2021] [Indexed: 12/19/2022] Open
Abstract
Recent developments in three-dimensional (3D) printing technology offer immense potential in fabricating scaffolds and implants for various biomedical applications, especially for bone repair and regeneration. As the availability of autologous bone sources and commercial products is limited and surgical methods do not help in complete regeneration, it is necessary to develop alternative approaches for repairing large segmental bone defects. The 3D printing technology can effectively integrate different types of living cells within a 3D construct made up of conventional micro- or nanoscale biomaterials to create an artificial bone graft capable of regenerating the damaged tissues. This article reviews the developments and applications of 3D printing in bone tissue engineering and highlights the numerous conventional biomaterials and nanomaterials that have been used in the production of 3D-printed scaffolds. A comprehensive overview of the 3D printing methods such as stereolithography (SLA), selective laser sintering (SLS), fused deposition modeling (FDM), and ink-jet 3D printing, and their technical and clinical applications in bone repair and regeneration has been provided. The review is expected to be useful for readers to gain an insight into the state-of-the-art of 3D printing of bone substitutes and their translational perspectives.
Collapse
Affiliation(s)
- Lijia Cheng
- School of Basic Medicine, Chengdu University, Chengdu, 610106, People’s Republic of China
| | - Shoma Suresh K
- Biomaterials and Organ Engineering Group, Centre for Biomaterials, Cellular, and Molecular Theranostics, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, 632014, India
| | - Hongyan He
- School of Basic Medicine, Chengdu University, Chengdu, 610106, People’s Republic of China
| | - Ritu Singh Rajput
- Biomaterials and Organ Engineering Group, Centre for Biomaterials, Cellular, and Molecular Theranostics, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, 632014, India
| | - Qiyang Feng
- School of Basic Medicine, Chengdu University, Chengdu, 610106, People’s Republic of China
| | - Saravanan Ramesh
- Biomaterials and Organ Engineering Group, Centre for Biomaterials, Cellular, and Molecular Theranostics, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, 632014, India
| | - Yuzhuang Wang
- School of Basic Medicine, Chengdu University, Chengdu, 610106, People’s Republic of China
| | - Sasirekha Krishnan
- Biomaterials and Organ Engineering Group, Centre for Biomaterials, Cellular, and Molecular Theranostics, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, 632014, India
| | - Serge Ostrovidov
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Gulden Camci-Unal
- Department of Chemical Engineering, University of Massachusetts Lowell, Lowell, MA, 01854, USA
| | - Murugan Ramalingam
- Biomaterials and Organ Engineering Group, Centre for Biomaterials, Cellular, and Molecular Theranostics, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, 632014, India
| |
Collapse
|
12
|
Zheng J, Kang J, Sun C, Yang C, Wang L, Li D. Effects of printing path and material components on mechanical properties of 3D-printed polyether-ether-ketone/hydroxyapatite composites. J Mech Behav Biomed Mater 2021; 118:104475. [PMID: 33773239 DOI: 10.1016/j.jmbbm.2021.104475] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 12/19/2022]
Abstract
Polyether-ether-ketone (PEEK) exhibits excellent mechanical properties and biocompatibility. Three-dimensional (3D) printing of PEEK bone substitutes has been widely used in clinical application. However, the inertness of pure PEEK hinders its integration with the surrounding bone tissue. In this study, for the first time, PEEK/hydroxyapatite (HA) composite specimens were fabricated using fused filament fabrication (FFF) technology. PEEK/HA filaments with HA contents of 0-30 wt% were fabricated via mechanical mixing and extrusion. The HA distributions inside the composite matrix and the surface morphology characteristics of the PEEK/HA composites were examined. The effects of the printing path and HA content on the mechanics of the PEEK/HA composites were systematically investigated. The results indicated that the HA particles were uniformly distributed on the composite matrix. With an increase in the HA content, the modulus of the PEEK/HA composite increased, while the strength and failure strain concomitantly decreased. When the HA content increased to 30 wt%, the tensile modulus of the composite increased by 68.6% compared with that of pure PEEK printed along the horizontal 90° path, while the tensile strength decreased by 48.2% compared with that of pure PEEK printed along the vertical 90° path. The fracture elongation of the printed specimens with different HA contents decreased in the following order: horizontal 0° > horizontal 90° > vertical 90°. The best comprehensive mechanical properties were achieved for pure PEEK fabricated along the horizontal 0° path. The results indicate that FFF technology is applicable for additive manufacturing of PEEK/HA composites with controllable compositions. Printed PEEK/HA composites have potential for applications in the design and manufacturing of personalized bone substitutes.
Collapse
Affiliation(s)
- Jibao Zheng
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | | | - Changning Sun
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Chuncheng Yang
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Ling Wang
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China.
| | - Dichen Li
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China.
| |
Collapse
|
13
|
Hu X, Mei S, Wang F, Tang S, Xie D, Ding C, Du W, Zhao J, Yang L, Wu Z, Wei J. A microporous surface containing Si 3N 4/Ta microparticles of PEKK exhibits both antibacterial and osteogenic activity for inducing cellular response and improving osseointegration. Bioact Mater 2021; 6:3136-3149. [PMID: 33778194 PMCID: PMC7960946 DOI: 10.1016/j.bioactmat.2021.02.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/31/2021] [Accepted: 02/17/2021] [Indexed: 01/06/2023] Open
Abstract
As an implantable biomaterial, polyetherketoneketone (PEKK) exhibits good mechanical strength but it is biologically inert while tantalum (Ta) possesses outstanding osteogenic bioactivity but has a high density and elastic modulus. Also, silicon nitride (SN) has osteogenic and antibacterial activity. In this study, a microporous surface containing both SN and Ta microparticles on PEKK (STP) exhibiting excellent osteogenic and antibacterial activity was created by sulfonation. Compared with sulfonated PEKK (SPK) without microparticles, the surface properties (roughness, surface energy, hydrophilicity and protein adsorption) of STP significantly increased due to the SN and Ta particles presence on the microporous surface. In addition, STP also exhibited outstanding antibacterial activity, which inhibited bacterial growth in vitro and prevented bacterial infection in vivo because of the presence of SN particles. Moreover, the microporous surface of STP containing both SN and Ta particles remarkably induced response (e.g., proliferation and differentiation) of rat bone mesenchymal stem (rBMS) cells in vitro. Furthermore, STP significantly improved new bone regeneration and osseointegration in vivo. Regarding the induction of cellular response in vitro and improvement of osseointegration in vivo, the microporous surface containing Ta was better than the surface with SN particles. In conclusion, STP with optimized surface properties activated cellular responses in vitro, enhanced osseointegration and prevented infection in vivo. Therefore, STP possessed the dual biofunctions of excellent osteogenic and antibacterial activity, showing great potential as a bone substitute. •Microporous surface containing SN/Ta microparticles on PEKK (STP) was created. •Surface performances (e.g., roughness) of STP were significantly increased. •STP exhibited antibacterial activity in vitro and prevented infection in vivo. •STP remarkably induced response of bone mesenchymal stem cells in vitro. •STP obviously improved bone regeneration and osseointegration in vivo.
Collapse
Affiliation(s)
- Xinglong Hu
- Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology, Shanghai, 200237, China
| | - Shiqi Mei
- Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology, Shanghai, 200237, China
| | - Fan Wang
- Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology, Shanghai, 200237, China
| | - Songchao Tang
- Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology, Shanghai, 200237, China
| | - Dong Xie
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Chao Ding
- Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology, Shanghai, 200237, China
| | - Wenli Du
- Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology, Shanghai, 200237, China
| | - Jun Zhao
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Department of Orthodontics, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, 200011, China
| | - Lili Yang
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Zhaoying Wu
- School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, Guangdong, 510006, China
| | - Jie Wei
- Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology, Shanghai, 200237, China
| |
Collapse
|
14
|
Liu L, Ma HY, Yuan QL, Zhao XM, Lou XX, Zhang YG. Biomechanical effects of reconstruction of the posterior structures after laminectomy with an individualized poly-ether-ether-ketone (PEEK) artificial lamina. J Biomater Appl 2020; 35:1327-1336. [PMID: 33349103 DOI: 10.1177/0885328220981191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Laminectomy is a traditional method for treating lumbar diseases; however, the destruction of the posterior structures may cause postoperative symptoms. An individualized poly-ether-ether-ketone (PEEK) artificial lamina was designed to reconstruct the posterior structures after laminectomy. This study aimed to explore the biomechanical effects of reconstruction of the posterior structures with an individualized PEEK artificial lamina using validated finite element models. OBJECTIVE To examine the biomechanical effects of individualized PEEK artificial lamina on postlaminectomy lumbar. METHODS A finite element (FE) model of L3-5 was developed based on computed tomography images. Four surgical models (laminectomy, artificial lamina alone, ligament reconstruction, and osseointegration) were constructed, representing different stages of L4 artificial lamina implantation. The range of motion (ROM), intradiscal pressure (IDP), stresses in the annulus fibrosus at the surgical level and cephalad adjacent level, and stresses in the artificial lamina and screws were measured. RESULTS The ROM, IDP, and stresses in the annulus fibrosus of the different artificial lamina models decreased compared to those of the laminectomy model at both surgical and adjacent levels for all motion patterns, most notably in the osseointegration model. In addition, the results of the stresses in the implants showed that the artificial lamina could enhance the lumbar isthmus and disperse the abnormally concentrated stresses after laminectomy. CONCLUSION The application of a PEEK artificial lamina has the potential to stabilize the postlaminectomy lumbar spine and prevent adjacent segment disease (ASD) and iatrogenic lumbar deformities, resulting in a reduction in the incidence of post-lumbar surgery syndrome.
Collapse
Affiliation(s)
- Liang Liu
- Department of Orthopaedics, First Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China.,Department of Talent Highland, First Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Hong-Yun Ma
- Department of Orthopaedics, First Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Qi-Ling Yuan
- Department of Orthopaedics, First Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Xiao-Ming Zhao
- Department of Orthopaedics, First Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Xiao-Xiao Lou
- Department of Orthopaedics, First Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Yin-Gang Zhang
- Department of Orthopaedics, First Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| |
Collapse
|
15
|
Liao C, Li Y, Tjong SC. Polyetheretherketone and Its Composites for Bone Replacement and Regeneration. Polymers (Basel) 2020; 12:E2858. [PMID: 33260490 PMCID: PMC7760052 DOI: 10.3390/polym12122858] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/23/2020] [Accepted: 07/25/2020] [Indexed: 12/18/2022] Open
Abstract
In this article, recent advances in the development, preparation, biocompatibility and mechanical properties of polyetheretherketone (PEEK) and its composites for hard and soft tissue engineering are reviewed. PEEK has been widely employed for fabricating spinal fusions due to its radiolucency, chemical stability and superior sterilization resistance at high temperatures. PEEK can also be tailored into patient-specific implants for treating orbital and craniofacial defects in combination with additive manufacturing process. However, PEEK is bioinert, lacking osseointegration after implantation. Accordingly, several approaches including surface roughening, thin film coating technology, and addition of bioactive hydroxyapatite (HA) micro-/nanofillers have been adopted to improve osseointegration performance. The elastic modulus of PEEK is 3.7-4.0 GPa, being considerably lower than that of human cortical bone ranging from 7-30 GPa. Thus, PEEK is not stiff enough to sustain applied stress in load-bearing orthopedic implants. Therefore, HA micro-/nanofillers, continuous and discontinuous carbon fibers are incorporated into PEEK for enhancing its stiffness for load-bearing applications. Among these, carbon fibers are more effective than HA micro-/nanofillers in providing additional stiffness and load-bearing capabilities. In particular, the tensile properties of PEEK composite with 30wt% short carbon fibers resemble those of cortical bone. Hydrophobic PEEK shows no degradation behavior, thus hampering its use for making porous bone scaffolds. PEEK can be blended with hydrophilic polymers such as polyglycolic acid and polyvinyl alcohol to produce biodegradable scaffolds for bone tissue engineering applications.
Collapse
Affiliation(s)
- Chengzhu Liao
- Department of Materials Science and Engineering, Southern University of Science and Technology, Shenzhen 518055, China;
| | - Yuchao Li
- Department of Materials Science and Engineering, Liaocheng University, Liaocheng 252000, China
| | - Sie Chin Tjong
- Department of Physics, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong, China
| |
Collapse
|
16
|
D'Ercole S, Cellini L, Pilato S, Di Lodovico S, Iezzi G, Piattelli A, Petrini M. Material characterization and Streptococcus oralis adhesion on Polyetheretherketone (PEEK) and titanium surfaces used in implantology. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2020; 31:84. [PMID: 32989624 PMCID: PMC7522102 DOI: 10.1007/s10856-020-06408-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/12/2020] [Indexed: 05/27/2023]
Abstract
The aim of this study was to evaluate the interaction between Streptococcus oralis and Polyetheretherketone (PEEK), a novel material recently introduced in implantology. The topographical characterization and the Streptococcus oralis adhesion on this material were compared with other titanium surfaces, currently used for the production of dental implants: machined and double etched (DAE). The superficial micro-roughness of the PEEK discs was analyzed by scanning electron microscopy (SEM) and, the Energy Dispersive Spectrometer (EDS) analyzed their chemical composition. Atomic Force Microscopy (AFM) was used to characterize the micro-topography and the sessile method to evaluate the wettability of the samples. Microbiological analysis measured the colony forming units (CFUs), the biomass (OD570 detection) and the cell viability after 24 and 48 h after Streptococcus oralis cultivation on the different discs, that were previously incubated with saliva. Results showed that PEEK was characterized by a micro-roughness that was similar to machined titanium but at nano-level the nano-roughness was significantly higher in respect to the other samples. The EDS showed that PEEK superficial composition was characterized mainly by Carbonium and Oxygen. The hydrophilicity and wetting properties of PEEK were similar to machined titanium; on the contrary, double etched discs (DAE) samples were characterized by significantly higher levels (p < 0.05). PEEK was characterized by significant lower CFUs, biomass and viable cells in respect to the titanium surfaces. No differences were found between machined and DAE. The anti-adhesive and antibacterial properties showed by PEEK at 24 and 48 h against a pioneer such as S. oralis, could have an important role in the prevention of all pathologies connected with biofilm formation, like peri-implantitis in dentistry or prosthetic failures in orthopedics.
Collapse
Affiliation(s)
- Simonetta D'Ercole
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Luigina Cellini
- Department of Pharmacy, University of Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Serena Pilato
- Department of Pharmacy, University of Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Silvia Di Lodovico
- Department of Pharmacy, University of Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Giovanna Iezzi
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Adriano Piattelli
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti, Via dei Vestini 31, 66100, Chieti, Italy
- Fondazione Villa Serena per la Ricerca, Città S. Angelo, Via Petruzzi 42, 65013, Chieti, Italy
| | - Morena Petrini
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti, Via dei Vestini 31, 66100, Chieti, Italy.
| |
Collapse
|
17
|
3D printed porous PEEK created via fused filament fabrication for osteoconductive orthopaedic surfaces. J Mech Behav Biomed Mater 2020; 109:103850. [DOI: 10.1016/j.jmbbm.2020.103850] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/05/2020] [Indexed: 02/01/2023]
|
18
|
Sharma N, Aghlmandi S, Cao S, Kunz C, Honigmann P, Thieringer FM. Quality Characteristics and Clinical Relevance of In-House 3D-Printed Customized Polyetheretherketone (PEEK) Implants for Craniofacial Reconstruction. J Clin Med 2020; 9:jcm9092818. [PMID: 32878160 PMCID: PMC7563642 DOI: 10.3390/jcm9092818] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/13/2020] [Accepted: 08/30/2020] [Indexed: 12/11/2022] Open
Abstract
Additive manufacturing (AM) of patient-specific implants (PSIs) is gradually moving towards in-house or point-of-care (POC) manufacturing. Polyetheretherketone (PEEK) has been used in cranioplasty cases as a reliable alternative to other alloplastic materials. As only a few fused filament fabrication (FFF) printers are suitable for in-house manufacturing, the quality characteristics of the implants fabricated by FFF technology are still under investigated. This paper aimed to investigate PEEK PSIs fabricated in-house for craniofacial reconstruction, discussing the key challenges during the FFF printing process. Two exemplary cases of class III (Group 1) and class IV (Group 2) craniofacial defects were selected for the fabrication of PEEK PSIs. Taguchi’s L9 orthogonal array was selected for the following nonthermal printing process parameters, i.e., layer thickness, infill rate, number of shells, and infill pattern, and an assessment of the dimensional accuracy of the fabricated implants was made. The root mean square (RMS) values revealed higher deviations in Group 1 PSIs (0.790 mm) compared to Group 2 PSIs (0.241 mm). Horizontal lines, or the characteristic FFF stair-stepping effect, were more perceptible across the surface of Group 1 PSIs. Although Group 2 PSIs revealed no discoloration, Group 1 PSIs displayed different zones of crystallinity. These results suggest that the dimensional accuracy of PSIs were within the clinically acceptable range; however, attention must be paid towards a requirement of optimum thermal management during the printing process to fabricate implants of uniform crystallinity.
Collapse
Affiliation(s)
- Neha Sharma
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (S.C.); (C.K.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
| | - Soheila Aghlmandi
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, CH-4031 Basel, Switzerland;
| | - Shuaishuai Cao
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (S.C.); (C.K.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
| | - Christoph Kunz
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (S.C.); (C.K.)
| | - Philipp Honigmann
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
- Hand Surgery, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Florian M. Thieringer
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (S.C.); (C.K.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
- Correspondence:
| |
Collapse
|