Additive Manufacturing Processes in Medical Applications

Patient-specific 3D in vitro modeling and fluid dynamic analysis of primary pulmonary vein stenosis

Introduction

Primary pulmonary vein stenosis (PVS) is a rare congenital heart disease that proves to be a clinical challenge due to the rapidly progressive disease course and high rates of treatment complications. PVS intervention is frequently faced with in-stent restenosis and persistent disease progression despite initial venous recanalization with balloon angioplasty or stenting. Alterations in wall shear stress (WSS) have been previously associated with neointimal hyperplasia and venous stenosis underlying PVS progression. Thus, the development of patient-specific three-dimensional (3D) in vitro models is needed to further investigate the biomechanical outcomes of endovascular and surgical interventions.

Methods

In this study, deidentified computed tomography images from three patients were segmented to generate perfusable phantom models of pulmonary veins before and after catheterization. These 3D reconstructions were 3D printed using a clear resin ink and used in a benchtop experimental setup. Computational fluid dynamic (CFD) analysis was performed on models in silico utilizing Doppler echocardiography data to represent the in vivo flow conditions at the inlets. Particle image velocimetry was conducted using the benchtop perfusion setup to analyze WSS and velocity profiles and the results were compared with those predicted by the CFD model.

Results

Our findings indicated areas of undesirable alterations in WSS before and after catheterization, in comparison with the published baseline levels in the healthy in vivo tissues that may lead to regional disease progression.

Discussion

The established patient-specific 3D in vitro models and the developed in vitro-in silico platform demonstrate great promise to refine interventional approaches and mitigate complications in treating patients with primary PVS.

Exploring the potential of intermetallic alloys as implantable biomaterials: A comprehensive review

This review delves into the utilization of intermetallic alloys (IMAs) as advanced biomaterials for medical implants, scrutinizing their conceptual framework, fabrication challenges, and diverse manufacturing techniques such as casting, powder metallurgy, and additive manufacturing. Manufacturing techniques such as casting, powder metallurgy, additive manufacturing, and injection molding are discussed, with specific emphasis on achieving optimal grain sizes, surface roughness, and mechanical properties. Post-treatment methods aimed at refining surface quality, dimensional precision, and mechanical properties of IMAs are explored, including the use of heat treatments to enhance biocompatibility and corrosion resistance. The review presents an in-depth examination of IMAs-based implantable biomaterials, covering lab-scale developments and commercial-scale implants. Specific IMAs such as Nickel Titanium, Titanium Aluminides, Iron Aluminides, Magnesium-based IMAs, Zirconium-based IMAs, and High-entropy alloys (HEAs) are highlighted, with detailed discussions on their mechanical properties, including strength, elastic modulus, and corrosion resistance. Future directions are outlined, with an emphasis on the anticipated growth in the orthopedic devices market and the role of IMAs in meeting this demand. The potential of porous IMAs in orthopedics is explored, with emphasis on achieving optimal pore sizes and distributions for enhanced osseointegration. The review concludes by highlighting the ongoing need for research and development efforts in IMAs technologies, including advancements in design and fabrication techniques.

A novel titanium alloy for load-bearing biomedical implants: Evaluating the antibacterial and biocompatibility of Ti536 produced via electron beam powder bed fusion additive manufacturing process

Additive manufacturing (AM) of Ti-based biomedical implants is a pivotal research topic because of its ability to produce implants with complicated geometries. Despite desirable mechanical properties and biocompatibility of Ti alloys, one major drawback is their lack of inherent antibacterial properties, increasing the risk of postoperative infections. Hence, this research focuses on the Ti536 (Ti5Al3V6Cu) alloy, developed through Electron Beam Powder Bed Fusion (EB-PBF), exploring bio-corrosion, antibacterial features, and cell biocompatibility. The microstructural characterization revealed grain refinement and the formation of Ti2Cu precipitates with different morphologies and sizes in the Ti matrix. Electrochemical tests showed that Cu content minimally influenced the corrosion current density, while it slightly affected the stability, defect density, and chemical composition of the passive film. According to the findings, the Ti536 alloy demonstrated enhanced antibacterial properties without compromising its cell biocompatibility and corrosion behavior, thanks to Ti2Cu precipitates. This can be attributed to both the release of Cu ions and the Ti2Cu precipitates. The current study suggests that the EB-PBF fabricated Ti536 sample is well-suited for use in load-bearing applications within the medical industry. This research also offers an alloy design roadmap for novel biomedical Ti-based alloys with superior biological performance using AM methods.

Treatment of complex limb fractures with 3D printing technology combined with personalized plates: a retrospective study of case series and literature review

Background

In recent years, 3D printing technology has made significant strides in the medical field. With the advancement of orthopedics, there is an increasing pursuit of high surgical quality and optimal functional recovery. 3D printing enables the creation of precise physical models of fractures, and customized personalized steel plates can better realign and more comprehensively and securely fix fractures. These technologies improve preoperative diagnosis, simulation, and planning for complex limb fractures, providing patients with better treatment options.

Patients and methods

Five typical cases were selected from a pool of numerous patients treated with 3D printing technology combined with personalized custom steel plates at our hospital. These cases were chosen to demonstrate the entire process of printing 3D models and customizing individualized steel plates, including details of the patients' surgeries and treatment procedures. Literature reviews were conducted, with a focus on highlighting the application of 3D printing technology combined with personalized custom steel plates in the treatment of complex limb fractures.

Results

3D printing technology can produce accurate physical models of fractures, and personalized custom plates can achieve better fracture realignment and more comprehensive and robust fixation. These technologies provide patients with better treatment options.

Conclusion

The use of 3D printing models and personalized custom steel plates can improve preoperative diagnosis, simulation, and planning for complex limb fractures, realizing personalized medicine. This approach helps reduce surgical time, minimize trauma, enhance treatment outcomes, and improve patient functional recovery.

Design Optimization of Printed Multi-Layered Electroactive Actuators Used for Steerable Guidewire in Micro-Invasive Surgery

To treat cardiovascular diseases (i.e., a major cause of mortality after cancers), endovascular-technique-based guidewire has been employed for intra-arterial navigation. To date, most commercially available guidewires (e.g., Terumo, Abbott, Cordis, etc.) are non-steerable, which is poorly suited to the human arterial system with numerous bifurcations and angulations. To reach a target artery, surgeons frequently opt for several tools (guidewires with different size integrated into angulated catheters) that might provoke arterial complications such as perforation or dissection. Steerable guidewires would, therefore, be of high interest to reduce surgical morbidity and mortality for patients as well as to simplify procedure for surgeons, thereby saving time and health costs. Regarding these reasons, our research involves the development of a smart steerable guidewire using electroactive polymer (EAP) capable of bending when subjected to an input voltage. The actuation performance of the developed device is assessed through the curvature behavior (i.e., the displacement and the angle of the bending) of a cantilever beam structure, consisting of single- or multi-stack EAP printed on a substrate. Compared to the single-stack architecture, the multi-stack gives rise to a significant increase in curvature, even when subjected to a moderate control voltage. As suggested by the design framework, the intrinsic physical properties (dielectric, electrical, and mechanical) of the EAP layer, together with the nature and thickness of all materials (EAP and substrate), do have strong effect on the bending response of the device. The analyses propose a comprehensive guideline to optimize the actuator performance based on an adequate selection of the relevant materials and geometric parameters. An analytical model together with a finite element model (FEM) are investigated to validate the experimental tests. Finally, the design guideline leads to an innovative structure (composed of a 10-stack active layer screen-printed on a thin substrate) capable of generating a large range of bending angle (up to 190°) under an acceptable input level of 550 V, which perfectly matches the standard of medical tools used for cardiovascular surgery.

Development of lightweight and high-strength hollow titanium-plated denture material using three-dimensional printing

Owing to its desirable ability to fabricate complex shapes, three-dimensional printing is preferred over casting for manufacturing dentures. Furthermore, titanium is widely used in dental implants and dentures because of its high corrosion resistance, biocompatibility, strength, and low density. In this study, we aimed to develop a new metal denture material from three-dimensional-printed (3DP) to achieve lighter weight and greater strength than those of PMMA dentures. Hollow (3DP-H) structure and solid (3DP-S) structure titanium plate specimens of 0.5, 1.0, and 3.0 mm in thickness were used. Casted Ti, casted Co-Cr, and PMMA plates were fabricated for comparison. Elastic modulus, density, thermal conductivity, hardness, and proof stress of the specimens were measured and plotted on a radar chart to enable multifaceted evaluation. The results indicated that the density of the 3DP-H plates reduced by 28-36% compared with those of 3DP-S and cast Ti plates. The weight of the metal-denture-equivalent section of the 0.5-mm-thick 3DP-H titanium-plated denture reduced to two-thirds that of the 2.0-mm-thick PMMA denture. The proof stress of the 0.5-mm-thick 3DP-H plate increased to about 3 times that of the 2.0-mm-thick PMMA plate. The total value of the 0.5-mm-thick 3DP-H titanium plates was higher than it of the 1.0-mm-thick PMMA plates. This study suggests that it is possible to produce 3DP-H titanium plate dentures exhibiting not only extremely lightweight compared to conventional PMMA dentures but also sufficient strength.

Aortic Valve Engineering Advancements: Precision Tuning with Laser Sintering Additive Manufacturing of TPU/TPE Submillimeter Membranes

Synthetic biomaterials play a crucial role in developing tissue-engineered heart valves (TEHVs) due to their versatile mechanical properties. Achieving the right balance between mechanical strength and manufacturability is essential. Thermoplastic polyurethanes (TPUs) and elastomers (TPEs) garner significant attention for TEHV applications due to their notable stability, fatigue resistance, and customizable properties such as shear strength and elasticity. This study explores the additive manufacturing technique of selective laser sintering (SLS) for TPUs and TPEs to optimize process parameters to balance flexibility and strength, mimicking aortic valve tissue properties. Additionally, it aims to assess the feasibility of printing aortic valve models with submillimeter membranes. The results demonstrate that the SLS-TPU/TPE technique can produce micrometric valve structures with soft shape memory properties, resembling aortic tissue in strength, flexibility, and fineness. These models show promise for surgical training and manipulation, display intriguing echogenicity properties, and can potentially be personalized to shape biocompatible valve substitutes.

Graphene in 3D Bioprinting

Three-dimensional (3D) bioprinting is a fast prototyping fabrication approach that allows the development of new implants for tissue restoration. Although various materials have been utilized for this process, they lack mechanical, electrical, chemical, and biological properties. To overcome those limitations, graphene-based materials demonstrate unique mechanical and electrical properties, morphology, and impermeability, making them excellent candidates for 3D bioprinting. This review summarizes the latest developments in graphene-based materials in 3D printing and their application in tissue engineering and regenerative medicine. Over the years, different 3D printing approaches have utilized graphene-based materials, such as graphene, graphene oxide (GO), reduced GO (rGO), and functional GO (fGO). This process involves controlling multiple factors, such as graphene dispersion, viscosity, and post-curing, which impact the properties of the 3D-printed graphene-based constructs. To this end, those materials combined with 3D printing approaches have demonstrated prominent regeneration potential for bone, neural, cardiac, and skin tissues. Overall, graphene in 3D bioprinting may pave the way for new regenerative strategies with translational implications in orthopedics, neurology, and cardiovascular areas.

Future trends of additive manufacturing in medical applications: An overview

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

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.

Point-of-Need Additive Manufacturing in Austere Arctic Environments: An Evaluation of Medical Logistics Requirements and Capabilities Demonstration

Medical response to military conflicts, natural disasters, and humanitarian crises are challenged by operational logistics with unreliable supply chains, delayed medical evacuation, and compatibility of the disparate medical equipment and consumables. In these environments, stocks of supplies will become more quickly depleted and the need for equipment parts increases secondary to their higher likelihood for failure from overuse. Additive Manufacturing (AM), or 3D printing, at or closer to the point-of-need provides potential solutions to mitigate these logistics challenges. AM's ability to tailor the resultant product through computer design enables real-time modification of a product to meet a specific situation. In this study, we deployed two different 3D printers to an arctic locale to demonstrate the utility of 3D printing and bioprinting in austere environments. Deployment of AM solutions in austere environments will likely impact medical care following natural disasters and conflicts with contested logistics. The work presented here furthers the readiness status of AM for use in austere environments to manufacture medical equipment parts and demonstrates its potential use for tissue engineering and advanced medical treatments in remote environments.

Surgical Medical Education via 3D Bioprinting: Modular System for Endovascular Training

There is currently a shift in surgical training from traditional methods to simulation-based approaches, recognizing the necessity of more effective and controlled learning environments. This study introduces a completely new 3D-printed modular system for endovascular surgery training (M-SET), developed to allow various difficulty levels. Its design was based on computed tomography angiographies from real patient data with femoro-popliteal lesions. The study aimed to explore the integration of simulation training via a 3D model into the surgical training curriculum and its effect on their performance. Our preliminary study included 12 volunteer trainees randomized 1:1 into the standard simulation (SS) group (3 stepwise difficulty training sessions) and the random simulation (RS) group (random difficulty of the M-SET). A senior surgeon evaluated and timed the final training session. Feedback reports were assessed through the Student Satisfaction and Self-Confidence in Learning Scale. The SS group completed the training sessions in about half time (23.13 ± 9.2 min vs. 44.6 ± 12.8 min). Trainees expressed high satisfaction with the training program supported by the M-SET. Our 3D-printed modular training model meets the current need for new endovascular training approaches, offering a customizable, accessible, and effective simulation-based educational program with the aim of reducing the time required to reach a high level of practical skills.

Defect detection by multi-axis infrared process monitoring of laser beam directed energy deposition

Laser beam directed energy deposition (DED-LB) is an attractive additive manufacturing technique to produce versatile and complex 3D structures on demand, apply a cladding, or repair local defects. However, the quality of manufactured parts is difficult to assess by inspection prior to completion, and parts must be extensively inspected post-production to ensure conformance. Consequently, critical defects occurring during the build go undetected. In this work, a new monitoring system combining three infrared cameras along different optical axes capable of monitoring melt pool geometry and vertical displacement throughout deposition is reported. By combining multiple sensor data, an automated algorithm is developed which is capable of identifying the formation of structural features and defects. An intersecting, thin-walled geometry is used to demonstrate the capability of the system to detect process-induced porosity in samples with narrow intersection angles, which is validated using micro-CT observations. The recorded results indicate the root cause of this process-induced porosity at the intersection, and it is shown that advanced toolpath planning can eliminate such defects. The presented methodology demonstrates the value of multi-axis monitoring for identifying both defects and structural features, providing an advancement towards automated detection and alert systems in DED-LB.

Powder Bed Fusion 3D Printing in Precision Manufacturing for Biomedical Applications: A Comprehensive Review

Precision manufacturing requirements are the key to ensuring the quality and reliability of biomedical implants. The powder bed fusion (PBF) technique offers a promising solution, enabling the creation of complex, patient-specific implants with a high degree of precision. This technology is revolutionizing the biomedical industry, paving the way for a new era of personalized medicine. This review explores and details powder bed fusion 3D printing and its application in the biomedical field. It begins with an introduction to the powder bed fusion 3D-printing technology and its various classifications. Later, it analyzes the numerous fields in which powder bed fusion 3D printing has been successfully deployed where precision components are required, including the fabrication of personalized implants and scaffolds for tissue engineering. This review also discusses the potential advantages and limitations for using the powder bed fusion 3D-printing technology in terms of precision, customization, and cost effectiveness. In addition, it highlights the current challenges and prospects of the powder bed fusion 3D-printing technology. This work offers valuable insights for researchers engaged in the field, aiming to contribute to the advancement of the powder bed fusion 3D-printing technology in the context of precision manufacturing for biomedical applications.

Status of Polymer Fused Deposition Modeling (FDM)-Based Three-Dimensional Printing (3DP) in the Pharmaceutical Industry

Additive manufacturing (AM) or 3D printing (3DP) is arguably a versatile and more efficient way for the production of solid dosage forms such as tablets. Of the various 3DP technologies currently available, fused deposition modeling (FDM) includes unique characteristics that offer a range of options in the production of various types of tablets. For example, amorphous solid dispersions (ASDs), enteric-coated tablets or poly pills can be produced using an appropriate drug/polymer combination during FDM 3DP. The technology offers the possibility of evolving personalized medicines into cost-effective production schemes at pharmacies and hospital dispensaries. In this review, we highlight key FDM features that may be exploited for the production of tablets and improvement of therapy, with emphasis on gastrointestinal delivery. We also highlight current constraints that must be surmounted to visualize the deployment of this technology in the pharmaceutical and healthcare industries.

Innovative Approaches to 3D Printing of PA12 Forearm Orthoses: A Comprehensive Analysis of Mechanical Properties and Production Efficiency

This research paper aims to explore the mechanical characteristics of polyamide PA12 (PA12) as a 3D material printed utilizing Selective Laser Sintering (SLS) and HP MultiJet Fusion (HP MJF) technologies in order to design and manufacture forearm orthoses. The study assessed the flowability of the materials used and compared the mechanical performance of PA12 with each other using tensile, flexure, and impact tests in five different fabrication orientations: X, Y, Z, tilted 45° XZ, and tilted 45° YZ. The results of the study provide, firstly-the data for testing the quality of the applied polyamide powder blend and, secondly-the data for the design of the orthosis geometry from the aspect of its strength parameters and the safety of construction. The mechanical parameters of SLS specimens had less variation than MJF specimens in a given orientation. The difference in tensile strength between the 3D printing technologies tested was 1.8%, and flexural strength was 4.7%. A process analysis of the forearm orthoses revealed that the HP MJF 5200 system had a higher weekly production capacity than the EOS P396 in a production variance based on obtaining maximum strength parameters and a variance based on maximizing economic efficiency. The results suggest that medical device manufacturers can use additive manufacturing technologies to produce prototypes and small-batch parts for medical applications. This paper pioneers using 3D printing technology with Powder Bed Fusion (PBF) methods in designing and manufacturing forearm orthoses as a low- to medium-volume product. The applied solution addresses the problem of medical device manufacturers with regard to the analysis of production costs and mechanical properties when using 3D printing for certified medical devices.

Nanostructuring of Additively Manufactured 316L Stainless Steel Using High-Pressure Torsion Technique: An X-ray Line Profile Analysis Study

Experiments were conducted to reveal the nanostructure evolution in additively manufactured (AMed) 316L stainless steel due to severe plastic deformation (SPD). SPD-processing was carried out using the high-pressure torsion (HPT) technique. HPT was performed on four different states of 316L: the as-built material and specimens heat-treated at 400, 800 and 1100 °C after AM-processing. The motivation for the extension of this research to the annealed states is that heat treatment is a usual step after 3D printing in order to reduce the internal stresses formed during AM-processing. The nanostructure was studied by X-ray line profile analysis (XLPA), which was completed by crystallographic texture measurements. It was found that the as-built 316L sample contained a considerable density of dislocations (1015 m-2), which decreased to about half the original density due to the heat treatments at 800 and 1100 °C. The hardness varied accordingly during annealing. Despite this difference caused by annealing, HPT processing led to a similar evolution of the microstructure by increasing the strain for the samples with and without annealing. The saturation values of the crystallite size, dislocation density and twin fault probability were about 20 nm, 3 × 1016 m-2 and 3%, respectively, while the maximum achievable hardness was ~6000 MPa. The initial <100> and <110> textures for the as-built and the annealed samples were changed to <111> due to HPT processing.

Surface characteristics of 3D printed PEEK polymer using atomic force microscopy

High-performance polymer three-dimensional printing is becoming more popular for producing unique parts suitable for different applications. It has been utilized extensively in biomedical applications such as dental prosthetics, surgical equipment, and implants. However, the performance of the material is significantly influenced by its surface qualities, particularly in aspects of its adhesion and biocompatibility. This study involves the fabrication of PEEK specimens S1, S2, S3, and S4 with different printing parameters such as layer height of 0.10 and 0.15 mm and printing speed of 20 and 25 mm/s using a fused deposition modeling process. The surface roughness of the fabricated specimens is measured using atomic force microscopy. The results showed that the printing parameters significantly impact the surface roughness of the PEEK specimens. The surface roughness of specimen S3, printed at a layer height of 0.15 mm and a speed of 20 mm/s, has a low roughness value of 0.017 μm, which is considerable in comparison to the other specimens. In addition to the measurement of surface roughness from roughness profile, the force curve separation graph was plotted and the adhesion force values were calculated for all the specimens to determine the interlayer bonding strength.

Functionally graded 3D printed plates for rib fracture fixation

BACKGROUND

Design freedom offered by additive manufacturing allows for the implementation of functional gradients - where mechanical stiffness is decreased along the length of the implant. It is unclear if such changes will influence failure mechanisms in the context of rib fracture repair. We hypothesized that our novel functionally graded rib implants would be less stiff than controls and decrease occurrence of secondary fracture at implant ends.

METHODS

Five novel additively manufactured rib implants were tested along with a clinically used Control implant. Fracture reconstructions were modeled with custom synthetic rib bones with a transverse B1 fracture. Ribs were compressed in a cyclic two-point bend test for 360,000 cycles followed by a ramp to failure test. Differences in cyclic stiffness, 3D interfragmentary motions, ramp-to-failure stiffness, maximum load, and work to failure were determined.

FINDINGS

The Control group had lower construct stiffness (0.76 ± 0.28 N/mm), compared to all novel implant designs (means: 1.35-1.61 N/mm, p < 0.05) and rotated significantly more about the bending axis (2.7° ± 1.3°) than the additively manufactured groups (means between 1.2° - 1.6°, p < 0.05). All constructs failed via bone fracture at the most posterior screw hole. Experimental implants were stiffer than Controls, and there were few significant differences between functional gradient groups.

INTERPRETATION

Additively manufactured, functionally graded designs have the potential to change the form and function of trauma implants. Here, the impact of functional gradients was limited because implants had small cross-sectional areas.

Internal surface modification of additively manufactured macroporous TiAl6V4 biomimetic implants via a calciothermic reaction-based process and osteogenic in vivo responses

Three-dimensional macroporous titanium-aluminum-vanadium (TiAl6V4) implants produced by additive manufacturing (AM) can be grit blasted (GB) to yield microtextured exterior surfaces, with additional micro/nano-scale surface features provided by subsequent acid etching (AE). However, the line-of-sight nature of GB causes the topography of exterior GB + AE-modified surfaces to differ from internal GB-inaccessible surfaces. Previous in vitro studies using dense TiAl6V4 substrates indicated that a nonline-of-sight, calciothermic-reaction (CaR)-based process provided homogeneous osteogenic nanotextures on GB + AE surfaces, suggesting it could be used to achieve a homogeneous nanotopography on external and internal surfaces of macroporous AM constructs. Macroporous TiAl6V4 (3D) constructs were produced by direct laser melting and modified by GB + AE, with the CaR process then applied to 50% of constructs (3DCaR). The CaR process yielded nanoporous/nanorough internal surfaces throughout the macroporous constructs. Skeletally mature, male Sprague-Dawley rats were implanted with these constructs using a cranial on-lay model. Prior to implantation, a Cu++-free click hydrogel was applied to half of the constructs (3D + H, 3DCaR + H) to act as a challenge to osseointegration. Osseointegration was compared between the four implant groups (3D, 3DCaR, 3D + H, 3DCaR + H) at 4w. 3D + H implants exhibited lower bone volume (BV) and percent bone ingrowth (%BI) than the 3D implants. In contrast, osseointegrated 3DCaR + H implants had similar BV and %BI as the 3DCaR implants. Implant pull-off forces correlated with these results. In vitro analyses indicated that human bone marrow stromal cells (MSCs) exhibited enhanced production of osteoblast differentiation markers and factors associated with osteogenesis when grown on CaR-modified 3D substrates relative to control (TCPS) substrates. This work confirms that the CaR process provides osteogenic nanotextures on internal surfaces of macroporous 3D implants, and suggests that CaR-modified surfaces can promote osseointegration in cases where osteogenesis is impaired.

Point-of-Care Orthopedic Oncology Device Development

BACKGROUND

The triad of 3D design, 3D printing, and xReality technologies is explored and exploited to collaboratively realize patient-specific products in a timely manner with an emphasis on designs with meta-(bio)materials.

METHODS

A case study on pelvic reconstruction after oncological resection (osteosarcoma) was selected and conducted to evaluate the applicability and performance of an inter-epistemic workflow and the feasibility and potential of 3D technologies for modeling, optimizing, and materializing individualized orthopedic devices at the point of care (PoC).

RESULTS

Image-based diagnosis and treatment at the PoC can be readily deployed to develop orthopedic devices for pre-operative planning, training, intra-operative navigation, and bone substitution.

CONCLUSIONS

Inter-epistemic symbiosis between orthopedic surgeons and (bio)mechanical engineers at the PoC, fostered by appropriate quality management systems and end-to-end workflows under suitable scientifically amalgamated synergies, could maximize the potential benefits. However, increased awareness is recommended to explore and exploit the full potential of 3D technologies at the PoC to deliver medical devices with greater customization, innovation in design, cost-effectiveness, and high quality.

Biomaterials Adapted to Vat Photopolymerization in 3D Printing: Characteristics and Medical Applications

Along with the rapid and extensive advancements in the 3D printing field, a diverse range of uses for 3D printing have appeared in the spectrum of medical applications. Vat photopolymerization (VPP) stands out as one of the most extensively researched methods of 3D printing, with its main advantages being a high printing speed and the ability to produce high-resolution structures. A major challenge in using VPP 3D-printed materials in medicine is the general incompatibility of standard VPP resin mixtures with the requirements of biocompatibility and biofunctionality. Instead of developing completely new materials, an alternate approach to solving this problem involves adapting existing biomaterials. These materials are incompatible with VPP 3D printing in their pure form but can be adapted to the VPP chemistry and general process through the use of innovative mixtures and the addition of specific pre- and post-printing steps. This review's primary objective is to highlight biofunctional and biocompatible materials that have been adapted to VPP. We present and compare the suitability of these adapted materials to different medical applications and propose other biomaterials that could be further adapted to the VPP 3D printing process in order to fulfill patient-specific medical requirements.

Potential Applications and Additive Manufacturing Technology-Based Considerations of Mesoporous Silica: A Review

Nanoporous materials are categorized as microporous (pore sizes 0.2-2 nm), mesoporous (pore sizes 2-50 nm), and macroporous (pore sizes 50-1000 nm). Mesoporous silica (MS) has gained a significant interest due to its notable characteristics, including organized pore networks, specific surface areas, and the ability to be integrated in a variety of morphologies. Recently, MS has been widely accepted by range of manufacturer and as drug carrier. Moreover, silica nanoparticles containing mesopores, also known as mesoporous silica nanoparticles (MSNs), have attracted widespread attention in additive manufacturing (AM). AM commonly known as three-dimensional printing is the formalized rapid prototyping (RP) technology. AM techniques, in comparison to conventional methods, aid in reducing the necessity for tooling and allow versatility in product and design customization. There are generally several types of AM processes reported including VAT polymerization (VP), powder bed fusion (PBF), sheet lamination (SL), material extrusion (ME), binder jetting (BJ), direct energy deposition (DED), and material jetting (MJ). Furthermore, AM techniques are utilized in fabrication of various classified fields such as architectural modeling, fuel cell manufacturing, lightweight machines, medical, and fabrication of drug delivery systems. The review concisely elaborates on applications of mesoporous silica as versatile material in fabrication of various AM-based pharmaceutical products with an elaboration on various AM techniques to reduce the knowledge gap.

Bone Regeneration Induced by Patient-Adapted Mg Alloy-Based Scaffolds for Bone Defects: Present and Future Perspectives

Treatment of bone defects resulting after tumor surgeries, accidents, or non-unions is an actual problem linked to morbidity and the necessity of a second surgery and often requires a critical healthcare cost. Although the surgical technique has changed in a modern way, the treatment outcome is still influenced by patient age, localization of the bone defect, associated comorbidities, the surgeon approach, and systemic disorders. Three-dimensional magnesium-based scaffolds are considered an important step because they can have precise bone defect geometry, high porosity grade, anatomical pore shape, and mechanical properties close to the human bone. In addition, magnesium has been proven in in vitro and in vivo studies to influence bone regeneration and new blood vessel formation positively. In this review paper, we describe the magnesium alloy's effect on bone regenerative processes, starting with a short description of magnesium's role in the bone healing process, host immune response modulation, and finishing with the primary biological mechanism of magnesium ions in angiogenesis and osteogenesis by presenting a detailed analysis based on a literature review. A strategy that must be followed when a patient-adapted scaffold dedicated to bone tissue engineering is proposed and the main fabrication technologies are combined, in some cases with artificial intelligence for Mg alloy scaffolds, are presented with examples. We emphasized the microstructure, mechanical properties, corrosion behavior, and biocompatibility of each study and made a basis for the researchers who want to start to apply the regenerative potential of magnesium-based scaffolds in clinical practice. Challenges, future directions, and special potential clinical applications such as osteosarcoma and persistent infection treatment are present at the end of our review paper.

Additive manufacturing and three-dimensional printing in obstetrics and gynecology: a comprehensive review

Three-dimensional (3D) printing, also known as additive manufacturing, is a technology used to create complex 3D structures out of a digital model that can be almost any shape. Additive manufacturing allows the creation of customized, finely detailed constructs. Improvements in 3D printing, increased 3D printer availability, decreasing costs, development of biomaterials, and improved cell culture techniques have enabled complex, novel, and customized medical applications to develop. There have been rapid development and utilization of 3D printing technologies in orthopedics, dentistry, urology, reconstructive surgery, and other health care areas. Obstetrics and Gynecology (OBGYN) is an emerging application field for 3D printing. This technology can be utilized in OBGYN for preventive medicine, early diagnosis, and timely treatment of women-and-fetus-specific health issues. Moreover, 3D printed simulations of surgical procedures enable the training of physicians according to the needs of any given procedure. Herein, we summarize the technology and materials behind additive manufacturing and review the most recent advancements in the application of 3D printing in OBGYN studies, such as diagnosis, surgical planning, training, simulation, and customized prosthesis. Furthermore, we aim to give a future perspective on the integration of 3D printing and OBGYN applications and to provide insight into the potential applications.

3D Printed Lattice Template by Material Extrusion Technique for Fabrication of Pixelated Photodetector

Rigid and flexible, pixelated ultraviolet photodetectors (PD) based on ZnO have been fabricated by material extrusion 3D printing technique. The photoresponse is studied in an out-of-plane configuration. An open lattice structure is printed using PLA over ITO/Glass substrate for rigid, and TPU over ITO/PET substrate for flexible PDs. ZnO slurry is filled selectively into the columnar matrix by the microdispensing technique. The optical detector printed on ITO/Glass substrate shows a sensitivity of 25 and responsivity of 1.55 nA/mW with a rise and decay time of 1.6 and 0.6 s, respectively. Similarly, the flexible PD printed using TPU lattice shows a sensitivity of 9.5 and responsivity of 0.38 nA/mW with a rise and decay time of 1.8 and 0.6 s, respectively. The charge transport mechanism is studied using band diagram analysis. 3D printed open lattice structure is found to be a potential template for sensor fabrication. This work demonstrates the capability of material extrusion 3D printing with an open lattice structure for the fabrication of high-resolution pixelated PDs.

Propagation characteristics of ultrasonic in SLM manufactured AlSi10Mg

Porosity is a crucial quality evaluation criterion in metal additive manufacturing. To investigate the propagation characteristics of ultrasonic longitudinal waves with different incident frequencies in AlSi10Mg prepared by selective laser melting, specimens with varying porosity were created using printing process adjustments. Ultrasonic longitudinal wave tests and COMSOL simulations based on 2.5 MHz, 3.5 MHz, 5 MHz, and 7.5 MHz incident frequencies were carried out to establish a linear relationship between average wave velocity, average attenuation coefficient, and porosity at different frequencies. Results indicate that sound velocity and porosity are inversely proportional for each frequency longitudinal wave, while the attenuation coefficient is proportional to the porosity. Linear fitting expressions suggest that the best fit for both sound velocity and attenuation coefficient occurs at 5 MHz. Simulation results demonstrate that using 5 MHz as the incident frequency can better balance detection sensitivity and linearity. These findings provide more data support for establishing the intrinsic connection between acoustic parameters and porosity of AlSi10Mg prepared by selective laser melting in the selected area and serve as a reference for selecting ultrasonic incident frequencies in practical inspection.

Development of reduced volume endosseous cuspid tooth implant using topology optimization by SIMP technique for improved osseointegration

The article aims to design and develop a topology-optimized endosseous cuspid tooth implant of the maxilla region. The manuscript presents a numerical analysis of the resulting von Mises stresses and effective strain resulting in the topology-optimized implant with occlusal loading of 110 N. Solid Isotropic Material with Penalization (SIMP) method is employed for topology optimization and four different models, namely model-1, model-2, model-3, and model-4, are developed based on volume reduction rates of 8%, 16%, 24%, and 32%, respectively. FEA results highlight that the maximum stress and strain in the screw increases with volume reduction rates. The comparative analyses of the resulting stresses in the compact and cancellous bone along with the strain in the screw led to the conclusion that model-1, model-2, and model-3 resulted in moderate stresses on compact and cancellous bone compared to the original model of the implant. However, the screw and bones are subjected to maximum stress and strain in the model-4. The study concludes that model-2, with 16% reduced volume and 14.2% reduced mass as compared to the original implant, may be considered as the optimized design of the model. The resulting model offers a significant reduction in the weight and volume with a minor increase in effective stress and strain without negatively impacting the functionality and bio-mechanical performance of the implant. The optimized dental implant prototype is also fabricated as a proof of concept by the Fused Deposition Modelling process.

Ankle and Foot Arthroplasty and Prosthesis: A Review on the Current and Upcoming State of Designs and Manufacturing

The foot and ankle serve vital roles in weight bearing, balance, and flexibility but are susceptible to many diverse ailments, making treatment difficult. More commonly, Total Ankle Arthroplasty (TAA) and Total Talus Replacement (TTR) are used for patients with ankle degeneration and avascular necrosis of the talus, respectively. Ankle prosthesis and orthosis are also indicated for use with lower limb extremity amputations or locomotor disability, leading to the development of powered exoskeletons. However, patient outcomes remain suboptimal, commonly due to the misfitting of implants to the patient-specific anatomy. Additive manufacturing (AM) is being used to create customized, patient-specific implants and porous implant cages that provide structural support while allowing for increased bony ingrowth and to develop customized, lightweight exoskeletons with multifunctional actuators. AM implants and devices have shown success in preserving stability and mobility of the joint and achieving fast recovery, as well as significant improvements in gait rehabilitation, gait assistance, and strength for patients. This review of the literature highlights various devices and technologies currently used for foot and ankle prosthesis and orthosis with deep insight into improvements from historical technologies, manufacturing methods, and future developments in the biomedical space.

Resorbable GBR Scaffolds in Oral and Maxillofacial Tissue Engineering: Design, Fabrication, and Applications

Guided bone regeneration (GBR) is a promising technique in bone tissue engineering that aims to replace lost or injured bone using resorbable scaffolds. The promotion of osteoblast adhesion, migration, and proliferation is greatly aided by GBR materials, and surface changes are critical in imitating the natural bone structure to improve cellular responses. Moreover, the interactions between bioresponsive scaffolds, growth factors (GFs), immune cells, and stromal progenitor cells are essential in promoting bone regeneration. This literature review comprehensively discusses various aspects of resorbable scaffolds in bone tissue engineering, encompassing scaffold design, materials, fabrication techniques, and advanced manufacturing methods, including three-dimensional printing. In addition, this review explores surface modifications to replicate native bone structures and their impact on cellular responses. Moreover, the mechanisms of bone regeneration are described, providing information on how immune cells, GFs, and bioresponsive scaffolds orchestrate tissue healing. Practical applications in clinical settings are presented to underscore the importance of these principles in promoting tissue integration, healing, and regeneration. Furthermore, this literature review delves into emerging areas of metamaterials and artificial intelligence applications in tissue engineering and regenerative medicine. These interdisciplinary approaches hold immense promise for furthering bone tissue engineering and improving therapeutic outcomes, leading to enhanced patient well-being. The potential of combining material science, advanced manufacturing, and cellular biology is showcased as a pathway to advance bone tissue engineering, addressing a variety of clinical needs and challenges. By providing this comprehensive narrative, a detailed, up-to-date account of resorbable scaffolds' role in bone tissue engineering and their transformative potential is offered.

The Upper Limb Orthosis in the Rehabilitation of Stroke Patients: The Role of 3D Printing

Stroke represents the third cause of long-term disability in the world. About 80% of stroke patients have an impairment of bio-motor functions and over half fail to regain arm functionality, resulting in motor movement control disorder with serious loss in terms of social independence. Therefore, rehabilitation plays a key role in the reduction of patient disabilities, and 3D printing (3DP) has showed interesting improvements in related fields, thanks to the possibility to produce customized, eco-sustainable and cost-effective orthoses. This study investigated the clinical use of 3DP orthosis in rehabilitation compared to the traditional ones, focusing on the correlation between 3DP technology, therapy and outcomes. We screened 138 articles from PubMed, Scopus and Web of Science, selecting the 10 articles fulfilling the inclusion criteria, which were subsequently examined for the systematic review. The results showed that 3DP provides substantial advantages in terms of upper limb orthosis designed on the patient's needs. Moreover, seven research activities used biodegradable/recyclable materials, underlining the great potential of validated 3DP solutions in a clinical rehabilitation setting. The aim of this study was to highlight how 3DP could overcome the limitations of standard medical devices in order to support clinicians, bioengineers and innovation managers during the implementation of Healthcare 4.0.

State-of-the-art polyetheretherketone three-dimensional printing and multifunctional modification for dental implants

Polyetheretherketone (PEEK) is a high-performance thermoplastic polymer with an elastic modulus close to that of the jawbone. PEEK has the potential to become a new dental implant material for special patients due to its radiolucency, chemical stability, color similarity to teeth, and low allergy rate. However, the aromatic main chain and lack of surface charge and chemical functional groups make PEEK hydrophobic and biologically inert, which hinders subsequent protein adsorption and osteoblast adhesion and differentiation. This will be detrimental to the deposition and mineralization of apatite on the surface of PEEK and limit its clinical application. Researchers have explored different modification methods to effectively improve the biomechanical, antibacterial, immunomodulatory, angiogenic, antioxidative, osteogenic and anti-osteoclastogenic, and soft tissue adhesion properties. This review comprehensively summarizes the latest research progress in material property advantages, three-dimensional printing synthesis, and functional modification of PEEK in the fields of implant dentistry and provides solutions for existing difficulties. We confirm the broad prospects of PEEK as a dental implant material to promote the clinical conversion of PEEK-based dental implants.

Mechanical and Surface Characteristics of Selective Laser Melting-Manufactured Dental Prostheses in Different Processing Stages

Due to the expansion of the use of powder bed fusion metal additive technologies in the medical field, especially for the realization of dental prostheses, in this paper, the authors propose a comparative experimental study of the mechanical characteristics and the state of their microscale surfaces. The comparison was made from material considerations starting from two dental alloys commonly used to realize dental prostheses: Ni-Cr and Co-Cr, but also technologies for obtaining selective laser melting (SLM) and conventional casting. In addition, to compare the performances with the classical casting technology, for the dental prostheses obtained through SLM, the post-processing stage in which they are in a preliminary finishing and polished state was considered. Therefore, for the determination of important mechanical characteristics and the comparative study of dental prostheses, the indentation test was used, after which the hardness, penetration depths (maximum, permanent, and contact depth), contact stiffness, and contact surface were established, and for the determination of the microtopography of the surfaces, atomic force microscopy (AFM) was used, obtaining the local areal roughness parameters at the miniaturized scale-surface average roughness, root-mean-square roughness (RMS), and peak-to-peak values. Following the research carried out, several interesting conclusions were drawn, and the superiority of the SLM technology over the classic casting method for the production of dental prostheses in terms of some mechanical properties was highlighted. At the same time, the degree of finishing of dental prostheses made by SLM has a significant impact on the mechanical characteristics and especially the local roughness parameters on a miniaturized scale, and if we consider the same degree of finishing, no major differences are observed in the roughness parameters of the surfaces of the prostheses produced by different technologies.

The Beating Heart of Untapped Business Opportunities for Additive Manufacturing

This article presents a case that joins user-driven innovation and additive manufacturing (AM) towards latent business opportunities in the preparation for life threatening operations. Surgeons, confronted with a patient with a delicate heart condition, collaborated with a prototyping facility to print a realistic 3D model of the patient's aortic aneurysm. The model allowed the surgeons to first study and then experiment to determine the most effective operation procedure before the actual operation, which shortened the surgery time by approximately 70%. Reducing surgery time creates two forms of value: improving patient outcomes and reducing costs. Shorter times under anesthetic and on cardiopulmonary bypass correlate with better surgical results. Reducing healthcare costs brings broad societal benefits in both publicly and privately funded healthcare systems. We outline a case for makerspaces to capture value by joining their expertise and manufacturing equipment with the needs of nearby healthcare systems for novel business developments.

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.

The Progress in Bioprinting and Its Potential Impact on Health-Related Quality of Life

The intensive development of technologies related to human health in recent years has caused a real revolution. The transition from conventional medicine to personalized medicine, largely driven by bioprinting, is expected to have a significant positive impact on a patient's quality of life. This article aims to conduct a systematic review of bioprinting's potential impact on health-related quality of life. A literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was undertaken using the PubMed, Scopus, Google Scholar, and ScienceDirect databases between 2019 and 2023. We have identified some of the most significant potential benefits of bioprinting to improve the patient's quality of life: personalized part production; saving millions of lives; reducing rejection risks after transplantation; accelerating the process of skin tissue regeneration; homocellular tissue model generation; precise fabrication process with accurate specifications; and eliminating the need for organs donor, and thus reducing patient waiting time. In addition, these advances in bioprinting have the potential to greatly benefit cancer treatment and other research, offering medical solutions tailored to each individual patient that could increase the patient's chance of survival and significantly improve their overall well-being. Although some of these advancements are still in the research stage, the encouraging results from scientific studies suggest that they are on the verge of being integrated into personalized patient treatment. The progress in bioprinting has the power to revolutionize medicine and healthcare, promising to have a profound impact on improving the quality of life and potentially transforming the field of medicine and healthcare.

Mechanical and surface properties of additive manufactured zirconia under the different building directions

PURPOSE

This study investigates the mechanical and surface properties of zirconia manufactured using additive manufacturing (AM) technology and the effect of the building direction on the mechanical and surface properties.

METHODS

Specimens were prepared using ZrO₂ paste (3DMix ZrO₂; 3DCeram) and a three-dimensional printing system (CeraMaker 900; 3DCeram) based on the principles of stereolithography (SLA). The mechanical properties (flexural strength, Vickers hardness, fracture toughness, elastic modulus, and Poisson's ratio) and surface properties (chemical composition and surface observation) were evaluated for three building directions (parallel, diagonal, and perpendicular) to investigate the relationship between the building directions and the anisotropy of the mechanical and surface properties of SLA-manufactured zirconia. Statistical analysis was performed using a one-way analysis of variance and Tukey's honestly significant difference test.

RESULTS

The highest flexural strength was obtained for a perpendicular building direction. The flexural strength was significantly higher in the perpendicular direction than in the parallel and diagonal directions; it was also significantly higher in the diagonal direction than in the parallel direction (P<0.05). The Vickers hardness, fracture toughness, elastic modulus, Poisson's ratio, and chemical composition did not differ significantly. Microstructural observations revealed that the layers, large crystals, and pores were more prominent in the parallel direction.

CONCLUSIONS

The flexural strength and surface structure of the tested SLA-manufactured zirconia were influenced by the building direction; however, other mechanical properties remained unaffected. The layer boundaries affected the anisotropic behavior of the builds to a certain extent, owing to the layer-by-layer production method.

Nanoscale Morphologies on the Surface of 3D-Printed Titanium Implants for Improved Osseointegration: A Systematic Review of the Literature

Three-dimensional (3D) printing is serving as the most promising approach to fabricate personalized titanium (Ti) implants for the precise treatment of complex bone defects. However, the bio-inert nature of Ti material limits its capability for rapid osseointegration and thus influences the implant lifetime in vivo. Despite the macroscale porosity for promoting osseointegration, 3D-printed Ti implant surface morphologies at the nanoscale have gained considerable attention for their potential to improve specific outcomes. To evaluate the influence of nanoscale surface morphologies on osseointegration outcomes of 3D-printed Ti implants and discuss the available strategies, we systematically searched evidence according to the PRISMA on PubMed, Embase, Web of Science, and Cochrane (until June 2022). The inclusion criteria were in vivo (animal) studies reporting the osseointegration outcomes of nanoscale morphologies on the surface of 3D-printed Ti implants. The risk of bias (RoB) was assessed using the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE's) tool. The quality of the studies was evaluated using the Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines. (PROSPERO: CRD42022334222). Out of 119 retrieved articles, 9 studies met the inclusion criteria. The evidence suggests that irregular nano-texture, nanodots and nanotubes with a diameter of 40-105nm on the surface of porous/solid 3D-printed Ti implants result in better osseointegration and vertical bone ingrowth compared to the untreated/polished ones by significantly promoting cell adhesion, matrix mineralization, and osteogenic differentiation through increasing integrin expression. The RoB was low in 41.1% of items, unclear in 53.3%, and high in 5.6%. The quality of the studies achieved a mean score of 17.67. Our study demonstrates that nanostructures with specific controlled properties on the surface of 3D-printed Ti implants improve their osseointegration. However, given the small number of studies, the variability in experimental designs, and lack of reporting across studies, the results should be interpreted with caution.

Plant Fibers as Composite Reinforcements for Biomedical Applications

Plant fibers possess high strength, high fracture toughness and elasticity, and have proven useful because of their diversity, versatility, renewability, and sustainability. For biomedical applications, these natural fibers have been used as reinforcement for biocomposites to infer these hybrid biomaterials mechanical characteristics, such as stiffness, strength, and durability. The reinforced hybrid composites have been tested in structural and semi-structural biodevices for potential applications in orthopedics, prosthesis, tissue engineering, and wound dressings. This review introduces plant fibers, their properties and factors impacting them, in addition to their applications. Then, it discusses different methodologies used to prepare hybrid composites based on these widespread, renewable fibers and the unique properties that the obtained biomaterials possess. It also examines several examples of hybrid composites and their biomedical applications. Finally, the findings are summed up and some thoughts for future developments are provided. Overall, the focus of the present review lies in analyzing the design, requirements, and performance, and future developments of hybrid composites based on plant fibers.

A Comprehensive Review of the Current Research Status of Biodegradable Zinc Alloys and Composites for Biomedical Applications

Zinc (Zn)-based biodegradable materials show moderate degradation rates in comparison with other biodegradable materials (Fe and Mg). Biocompatibility and non-toxicity also make them a viable option for implant applications. Furthermore, Pure Zn has poor mechanical behavior, with a tensile strength of around 100-150 MPa and an elongation of 0.3-2%, which is far from reaching the strength required as an orthopedic implant material (tensile strength is more than 300 MPa, elongation more than 15%). Alloy and composite fabrication have proven to be excellent ways to improve the mechanical performance of Zn. Therefore, their alloys and composites have emerged as an innovative category of biodegradable materials. This paper summarizes the most important recent research results on the mechanical and biological characteristics of biodegradable Zn-based implants for orthopedic applications and the most commonly added components in Zn alloys and composites.

3D printed biomedical devices and their applications: A review on state-of-the-art technologies, existing challenges, and future perspectives

3D printing, also known as Additive manufacturing (AM), has emerged as a transformative technology with applications across various industries, including the medical sector. This review paper provides an overview of the current status of AM technology, its challenges, and its application in the medical industry. The paper covers the different types of AM technologies, such as fused deposition modeling, stereolithography, selective laser sintering, digital light processing, binder jetting, and electron beam melting, and their suitability for medical applications. The most commonly used biomedical materials in AM, such as plastic, metal, ceramic, composite, and bio-inks, are also viewed. The challenges of AM technology, such as material selection, accuracy, precision, regulatory compliance, cost and quality control, and standardization, are also discussed. The review also highlights the various applications of AM in the medical sector, including the production of patient-specific surgical guides, prosthetics, orthotics, and implants. Finally, the review highlights the Internet of Medical Things (IoMT) and artificial intelligence (AI) for regulatory frameworks and safety standards for 3D-printed biomedical devices. The review concludes that AM technology can transform the healthcare industry by enabling patients to access more personalized and reasonably priced treatment alternatives. Despite the challenges, integrating AI and IoMT with 3D printing technology is expected to play a vital role in the future of biomedical device applications, leading to further advancements and improvements in patient care. More research is needed to address the challenges and optimize its use for medical applications to utilize AM's potential in the medical industry fully.

Multimetal Research in Powder Bed Fusion: A Review

This article discusses the different forms of powder bed fusion (PBF) techniques, namely laser powder bed fusion (LPBF), electron beam powder bed fusion (EB-PBF) and large-area pulsed laser powder bed fusion (L-APBF). The challenges faced in multimetal additive manufacturing, including material compatibility, porosity, cracks, loss of alloying elements and oxide inclusions, have been extensively discussed. Solutions proposed to overcome these challenges include the optimization of printing parameters, the use of support structures, and post-processing techniques. Future research on metal composites, functionally graded materials, multi-alloy structures and materials with tailored properties are needed to address these challenges and improve the quality and reliability of the final product. The advancement of multimetal additive manufacturing can offer significant benefits for various industries.

Bone marrow stromal cells are sensitive to discrete surface alterations in build and post-build modifications of bioinspired Ti6Al4V 3D-printed in vitro testing constructs

Current standards in bone-facing implant fabrication by metal 3D (M3D) printing require post-manufacturing modifications to create distinct surface properties and create implant microenvironments that promote osseointegration. However, the biological consequences of build parameters and surface modifications are not well understood. This study evaluated the relative contributions of build parameters and post-manufacturing modification techniques to cell responses that impact osseointegration in vivo. Biomimetic testing constructs were created by using a M3D printer with standard titanium-aluminum-vanadium (Ti6Al4V) print parameters. These constructs were treated by either grit-blasting and acid-etching (GB + AE) or GB + AE followed by hot isostatic pressure (HIP) (GB + AE, HIP). Next, nine constructs were created by using a M3D printer with three build parameters: (1) standard, (2) increased hatch spacing, and (3) no infill, and additional contour trace. Each build type was further processed by either GB + AE, or HIP, or a combination of HIP treatment followed by GB + AE (GB + AE, HIP). Resulting constructs were assessed by SEM, micro-CT, optical profilometry, XPS, and mechanical compression. Cellular response was determined by culturing human bone marrow stromal cells (MSCs) for 7 days. Surface topography differed depending on processing method; HIP created micro-/nano-ridge like structures and GB + AE created micro-pits and nano-scale texture. Micro-CT showed decreases in closed pore number and closed porosity after HIP treatment in the third build parameter constructs. Compressive moduli were similar for all constructs. All constructs exhibited ability to differentiate MSCs into osteoblasts. MSCs responded best to micro-/nano-structures created by final post-processing by GB + AE, increasing OCN, OPG, VEGFA, latent TGFβ1, IL4, and IL10. Collectively these data demonstrate that M3D-printed constructs can be readily manufactured with distinct architectures based on the print parameters and post-build modifications. MSCs are sensitive to discrete surface topographical differences that may not show up in qualitative assessments of surface properties and respond by altering local factor production. These factors are vital for osseointegration after implant insertion, especially in patients with compromised bone qualities.

Preparation of informative wafers (info-wafers) by combination of 3D printing, code design and photopolymerization

3D printing is used in manufacturing of personalized and customized medications. Moreover, information technology has been integrated with 3D printing, which builds the basis of informative medications. Here, clonidine hydrochloride (CH) was formulated in informative wafers (info-wafers) by combination of 3D printing, code design and photopolymerization. Braille code (recognized by blind persons), bar code, and quick response (QR) code were used for the design of info-wafers. A code positive mold was 3D-printed with rigid resins by stereolithography, which was transformed to the silicone negative mold by thermal polymerization. A homogeneous CH suspension in N-vinyl pyrrolidone was casted into the negative mold followed by photopolymerization to form CH info-wafers. The bulgy parts of info-wafers were painted with edible ink except for Braille code info-wafers. The CH in info-wafers maintained the amorphous state, which was demonstrated by X-ray diffraction. The amorphous CH had rapid dissolution. Bar code info-wafers were scanned by smartphone though only simple information was obtained. QR code info-wafers were smartphone-scanned to link a website that contained sufficient information such as the instruction of CH application and the collection of patient information. Info-wafers provide online drug information and use instructions for patients to make the treatment standardization and normalization.

Influence of Antibacterial Coating and Mechanical and Chemical Treatment on the Surface Properties of PA12 Parts Manufactured with SLS and MJF Techniques in the Context of Medical Applications

Additive manufacturing (AM) is a rapidly growing branch of manufacturing techniques used, among others, in the medical industry. New machines and materials and additional processing methods are improved or developed. Due to the dynamic development of post-processing and its relative novelty, it has not yet been widely described in the literature. This study focuses on the surface topography (parameters Sa, Sz, Sdq, Sds, Str, Sdr) of biocompatible polyamide 12 (PA12) samples made by selective laser sintering (SLS) and multi jet fusion (MJF). The surfaces of the samples were modified by commercial methods: four types of smoothing treatments (two mechanical and two chemical), and two antibacterial coatings. The smoothing treatment decreased the values of all analyzed topography parameters. On average, the Sa of the SLS samples was 33% higher than that of the MJF samples. After mechanical treatment, Sa decreased by 42% and after chemical treatment by 80%. The reduction in Sdq and Sdr is reflected in a higher surface gloss. One antibacterial coating did not significantly modify the surface topography. The other coating had a smoothing effect on the surface. The results of the study can help in the development of manufacturing methodologies for parts made of PA12, e.g., in the medical industry.

Molecular Pathways for Polymer Degradation during Conventional Processing, Additive Manufacturing, and Mechanical Recycling

The assessment of the extent of degradation of polymer molecules during processing via conventional (e.g., extrusion and injection molding) and emerging (e.g., additive manufacturing; AM) techniques is important for both the final polymer material performance with respect to technical specifications and the material circularity. In this contribution, the most relevant (thermal, thermo-mechanical, thermal-oxidative, hydrolysis) degradation mechanisms of polymer materials during processing are discussed, addressing conventional extrusion-based manufacturing, including mechanical recycling, and AM. An overview is given of the most important experimental characterization techniques, and it is explained how these can be connected with modeling tools. Case studies are incorporated, dealing with polyesters, styrene-based materials, and polyolefins, as well as the typical AM polymers. Guidelines are formulated in view of a better molecular scale driven degradation control.

A systematic review of follow-up results of additively manufactured customized implants for the pelvic area

INTRODUCTION

While 3D printing of bone models for preoperative planning or customized surgical templating has been successfully implemented, the use of patient-specific additively manufactured (AM) implants is a newer application not yet well established. To fully evaluate the advantages and shortcomings of such implants, their follow-up results need to be evaluated.

AREA COVERED

This systematic review provides a survey of the reported follow-ups on AM implants used for oncologic reconstruction, total hip arthroplasty both primary and revision, acetabular fracture, and sacrum defects.

EXPERT OPINION

The review shows that Titanium alloy (Ti4AL6V) is the most common type of material system used due to its excellent biomechanical properties. Electron beam melting (EBM) is the predominant AM process for manufacturing implants. In almost all cases, porosity at the contact surface is implemented through the design of lattice or porous structures to enhance osseointegration. The follow-up evaluations show promising results, with only a small number of patients suffering from aseptic loosening, wear, or malalignment. The longest reported follow-up length was 120 months for acetabular cages and 96 months for acetabular cups. The AM implants have proven to serve as an excellent option to restore premorbid skeletal anatomy of the pelvis.

Printing Crack-Free Microporous Structures by Combining Additive Manufacturing with Colloidal Assembly

To date high printing resolution and scalability, i.e., macroscale component dimensions and fast printing, are incompatible characteristics for additive manufacturing (AM) processes. It is hereby demonstrated that the combination of direct writing as an AM process with colloidal assembly enables the breaching of this processing barrier. By tailoring printing parameters for polystyrene (PS) microparticle-templates, how to avoid coffee ring formation is demonstrated, thus printing uniform single lines and macroscale areas. Moreover, a novel "comb"-strategy is introduced to print macroscale, crack-free colloidal coatings with low viscous colloidal suspensions. The printed templates are transformed into ceramic microporous channels as well as photonic coatings via atomic layer deposition (ALD) and calcination. The obtained structures reveal promising wicking capabilities and broadband reflection in the near-infrared, respectively. This work provides guidelines for printing low viscous colloidal suspensions and highlights the advancements that this printing process offers toward novel applications of colloidal-based printed structures.

Additive manufacturing technologies in the oral implant clinic: A review of current applications and progress

Additive manufacturing (AM) technologies can enable the direct fabrication of customized physical objects with complex shapes, based on computer-aided design models. This technology is changing the digital manufacturing industry and has become a subject of considerable interest in digital implant dentistry. Personalized dentistry implant treatments for individual patients can be achieved through Additive manufacturing. Herein, we review the applications of Additive manufacturing technologies in oral implantology, including implant surgery, and implant and restoration products, such as surgical guides for implantation, custom titanium meshes for bone augmentation, personalized or non-personalized dental implants, custom trays, implant casts, and implant-support frameworks, among others. In addition, this review also focuses on Additive manufacturing technologies commonly used in oral implantology. Stereolithography, digital light processing, and fused deposition modeling are often used to construct surgical guides and implant casts, whereas direct metal laser sintering, selective laser melting, and electron beam melting can be applied to fabricate dental implants, personalized titanium meshes, and denture frameworks. Moreover, it is sometimes required to combine Additive manufacturing technology with milling and other cutting and finishing techniques to ensure that the product is suitable for its final application.

A Review of Image-Based Simulation Applications in High-Value Manufacturing

Image-Based Simulation (IBSim) is the process by which a digital representation of a real geometry is generated from image data for the purpose of performing a simulation with greater accuracy than with idealised Computer Aided Design (CAD) based simulations. Whilst IBSim originates in the biomedical field, the wider adoption of imaging for non-destructive testing and evaluation (NDT/NDE) within the High-Value Manufacturing (HVM) sector has allowed wider use of IBSim in recent years. IBSim is invaluable in scenarios where there exists a non-negligible variation between the 'as designed' and 'as manufactured' state of parts. It has also been used for characterisation of geometries too complex to accurately draw with CAD. IBSim simulations are unique to the geometry being imaged, therefore it is possible to perform part-specific virtual testing within batches of manufactured parts. This novel review presents the applications of IBSim within HVM, whereby HVM is the value provided by a manufactured part (or conversely the potential cost should the part fail) rather than the actual cost of manufacturing the part itself. Examples include fibre and aggregate composite materials, additive manufacturing, foams, and interface bonding such as welding. This review is divided into the following sections: Material Characterisation; Characterisation of Manufacturing Techniques; Impact of Deviations from Idealised Design Geometry on Product Design and Performance; Customisation and Personalisation of Products; IBSim in Biomimicry. Finally, conclusions are drawn, and observations made on future trends based on the current state of the literature.