Advances in Porous Biomaterials for Dental and Orthopaedic Applications

Comparison of stress distribution in fully porous and dense-core porous scaffolds in dental implantation

The aim of this study is to compare the stress distribution in porous scaffolds with different structures with similar geometric parameters to study a new approach in dental implantation. Three-dimensional finite element models of the fully porous and dense-core porous scaffolds with defined porosity parameters including space diameter and thickness with two porosity patterns were embedded in the jaw bone model with cortical and cancellous bone. The cylindrical shape was considered as the main shape of the scaffolds. To evaluate the mechanical performance, the Von Mises stress was compared in the models under static and dynamic masticatory loading. Incidentally, to validate the modeling results, experimental strain gauge tests were performed on four specimens fabricated from Ti6Al4V. Finally, the stress distribution in the models was compared with the results of previous studies on commercial implants. The results of the finite element analysis show that there are considerable differences in the magnitude of the equivalent stress in the models in static and dynamic phases. Also, changes in the defined geometric parameters have significant effects on the stress distribution in terms of Von Mises stress in the overall models. The experimental results indicated good agreement with those of the modeling. It can be concluded that some porous structures with optimal geometries can be proposed as a new structure for dental implants. However, considering the physiology of bone when confronted with porous structures, further studies such as in vivo experiments are needed in this field.

Design and Additive Manufacturing of Acetabular Implant with Continuously Graded Porosity

Porous structured metallic implants are preferable as bone graft substitutes due to their faster tissue integration mediated by bone in-growth and vascularization. The porous scaffolds/implants should also mimic the graded structure of natural bone to ensure a match of mechanical properties. This article presents a method for designing a graded porous structured acetabular implant and identifies suitable parameters for manufacturing the model through additive manufacturing. The design method is based on slice-wise modification to ensure continuity of gradation. Modification of the slices was achieved through the binary image processing route. A geodesic dome-type design was adopted for developing the acetabular cup model from the graded porous structure. The model had a solid shell with the target porosity and pore size gradually changing from 65% and 950 µm, respectively, in the inner side to 75% and 650 µm, respectively, towards the periphery. The required dimensions of the unit structures and the combinations of pore structure and strut diameter necessary to obtain the target porosity and pore size were determined analytically. Suitable process parameters were identified to manufacture the model by Direct Metal Laser Sintering (DMLS) using Ti6Al4V powder after carrying out a detailed experimental study to minimize the variation of surface roughness and warping over different build angles of the strut structures. Dual-contour scanning was implemented to simplify the scan strategy. The minimum diameter of struts that could be manufactured using the selected scanning strategy and scanning parameters was found to be 375 µm. Finally, the model was built and from the micro-CT data, the porosities and pore sizes were found to be closely conforming to the designed values. The stiffness of the structures, as found from compression testing, was also found to match with that of human trabecular bone well. Further, the structure exhibited compliant bending-dominated behaviour under compressive loading.

Functionalised Hybrid Collagen-Elastin for Acellular Cutaneous Substitute Applications

Wound contracture, which commonly happens after wound healing, may lead to physical distortion, including skin constriction. Therefore, the combination of collagen and elastin as the most abundant extracellular matrix (ECM) skin matrices may provide the best candidate biomaterials for cutaneous wound injury. This study aimed to develop a hybrid scaffold containing green natural resources (ovine tendon collagen type-I and poultry-based elastin) for skin tissue engineering. Briefly, freeze-drying was used to create the hybrid scaffolds, which were then crosslinked with 0.1% (w/v) genipin (GNP). Next, the physical characteristics (pore size, porosity, swelling ratio, biodegradability and mechanical strength) of the microstructure were assessed. Energy dispersive X-ray spectroscopy (EDX) and Fourier transform infrared (FTIR) spectrophotometry were used for the chemical analysis. The findings showed a uniform and interconnected porous structure with acceptable porosity (>60%) and high-water uptake capacity (>1200%), with pore sizes ranging between 127 ± 22 and 245 ± 35 µm. The biodegradation rate of the fabricated scaffold containing 5% elastin was lower (<0.043 mg/h) compared to the control scaffold (collagen only; 0.085 mg/h). Further analysis with EDX identified the main elements of the scaffold: it contained carbon (C) 59.06 ± 1.36-70.66 ± 2.89%, nitrogen (N) 6.02 ± 0.20-7.09 ± 0.69% and oxygen (O) 23.79 ± 0.65-32.93 ± 0.98%. FTIR analysis revealed that collagen and elastin remained in the scaffold and exhibited similar functional amides (amide A: 3316 cm^-1, amide B: 2932 cm^-1, amide I: 1649 cm^-1, amide II: 1549 cm^-1 and amide III: 1233 cm^-1). The combination of elastin and collagen also produced a positive effect via increased Young's modulus values. No toxic effect was identified, and the hybrid scaffolds significantly supported human skin cell attachment and viability. In conclusion, the fabricated hybrid scaffolds demonstrated optimum physicochemical and mechanical properties and may potentially be used as an acellular skin substitute in wound management.

Machine learning unifies flexibility and efficiency of spinodal structure generation for stochastic biomaterial design

Porous biomaterials design for bone repair is still largely limited to regular structures (e.g. rod-based lattices), due to their easy parameterization and high controllability. The capability of designing stochastic structure can redefine the boundary of our explorable structure-property space for synthesizing next-generation biomaterials. We hereby propose a convolutional neural network (CNN) approach for efficient generation and design of spinodal structure-an intriguing structure with stochastic yet interconnected, smooth, and constant pore channel conducive to bio-transport. Our CNN-based approach simultaneously possesses the tremendous flexibility of physics-based model in generating various spinodal structures (e.g. periodic, anisotropic, gradient, and arbitrarily large ones) and comparable computational efficiency to mathematical approximation model. We thus successfully design spinodal bone structures with target anisotropic elasticity via high-throughput screening, and directly generate large spinodal orthopedic implants with desired gradient porosity. This work significantly advances stochastic biomaterials development by offering an optimal solution to spinodal structure generation and design.

An Investigation into the Potential of Turning Induced Deformation Technique for Developing Porous Magnesium and Mg-SiO2 Nanocomposite

A new and novel method of synthesising porous Mg materials has been explored utilising a variant of a processing method previously used for the synthesis of dense Mg materials, namely the turning-induced deformation (TID) method combined with sintering. It was found that the Mg materials synthesised possessed comparable properties to previously-synthesised porous Mg materials in the literature while subsequent sintering resulted in a more consistent mechanical response, with microwave sintering showing the most promise. The materials were also found to possess mechanical response within the range of the human cancellous bone, and when reinforced with biocompatible silica nanoparticles, presented the most optimal combination of mechanical properties for potential use as biodegradable implants due to most similarity with cancellous bone properties.

Fabrication and in vitro characterization of luffa-based composite scaffolds incorporated with gelatin, hydroxyapatite and psyllium husk for bone tissue engineering

Bone tissue engineering is an emerging technology that has been developed in recent years to address bone abnormalities by repairing, regenerating and replacing damaged/injured tissues. In present work, we report the fabrication and characterization of porous luffa-based composite scaffolds composed of Luffa cylindrica (sponge gourd) powder (LC)/hydroxyapatite (HA), psyllium husk (PH) and gelatin (G) in various combinations (w/v) i.e. 3% LC, 5% LC and control (C) (without luffa powder) by using freeze-drying method. The structural stability of the scaffolds was obtained after chemically crosslinking them with glutaraldehyde (GTA), which was identified via scanning electron microscopy (SEM), Fourier transform infrared (FTIR) spectroscopy and differential scanning calorimetry (DSC). The hydrophilic behavior of the samples was quantified by water contact angle measurements. The average pore size of the scaffolds was observed in a range of 20-240 µm. As per the obtained data, the apparent and effective porosities were estimated as ∼57.08 ± 4.38%, ∼50.58 ± 4.09%, ∼59.45 ± 1.60% and 51.37 ± 3.36%, 47.94 ± 4.57% and 53.09 ± 5.45% for 3% LC, 5% LC and control (C) scaffolds, respectively. The scaffolds were found to be noticeably stable for 50 days at 37 °C in a lysozyme solution. The liquid retention capacity of the scaffolds revealed that the luffa-based scaffolds gained lower retention capacity compared to the control (C) scaffold; indicating an increase in scaffold stiffness due to the addition of luffa. Compressive strength study demonstrated that the mechanical stability of the fabricated luffa-based scaffolds got increased significantly from ∼1.5 to ∼9.5 MPa, which is comparable to that of trabecular bone. In addition, proliferation and viability analysis of MG-63 osteoblast-like cells revealed a significant level of cellular compatibility i.e. approaching ∼64% proliferation by 6th day in vitro compared to control. Thus, the obtained results demonstrate that the fabricated novel luffa-based scaffolds exhibit good cytocompatibility, remarkable porosity and excellent mechanical strength comparable to native human bone. Therefore, we anticipate that the developed luffa-based scaffolds could be a promising candidate for bone tissue engineering applications.

In vivo evaluation of osseointegration ability of sintered bionic trabecular porous titanium alloy as artificial hip prosthesis

Hydroxyapatite (HA) coatings have been widely used for improving the bone-implant interface (BII) bonding of the artificial joint prostheses. However, the incidence of prosthetic revisions due to aseptic loosening remains high. Porous materials, including three-dimensional (3D) printing, can reduce the elastic modulus and improve osseointegration at the BII. In our previous study, we identified a porous material with a sintered bionic trabecular structure with in vitro and in vivo bio-safety as well as in vivo mechanical safety. This study aimed to compare the difference in osseointegration ability of the different porous materials and HA-coated titanium alloy in the BII. We fabricated sintered bionic trabecular porous titanium acetabular cups, 3D-printed porous titanium acetabular cups, and HA-coated titanium alloy acetabular cups for producing a hip prosthesis suitable for beagle dogs. Subsequently, the imaging and histomorphological analysis of the three materials under mechanical loading in animals was performed (at months 1, 3, and 6). The results suggested that both sintered bionic porous titanium alloy and 3D-printed titanium alloy exhibited superior performances in promoting osseointegration at the BII than the HA-coated titanium alloy. In particular, the sintered bionic porous titanium alloy exhibited a favorable bone ingrowth performance at an early stage (month 1). A comparison of the two porous titanium alloys suggested that the sintered bionic porous titanium alloys exhibit superior bone in growth properties and osseointegration ability. Overall, our findings provide an experimental basis for the clinical application of sintered bionic trabecular porous titanium alloys.

Biodegradable open-porous scaffolds made of sintered magnesium W4 and WZ21 short fibres show biocompatibility in vitro and in long-term in vivo evaluation

Open-porous scaffolds made of W4 and WZ21 fibres were evaluated to analyse their potential as an implant material. WZ21 scaffolds without any surface modification or coating, showed promising mechanical properties which were comparable to the W4 scaffolds tested in previous studies. Eudiometric testing results were dependent on the experimental setup, with corrosion rates differing by a factor of 3. Cytotoxicity testing of WZ21 showed sufficient cytocompatibility. The corrosion behavior of the WZ21 scaffolds in different cell culture media are indicating a selective dealloying of elements from the magnesium scaffold by different solutions. Long term in-vivo studies were using 24 W4 scaffolds and 12 WZ21 scaffolds, both implanted in rabbit femoral condyles. The condyles and important inner organs were explanted after 6, 12 and 24 weeks and analyzed. The in-vivo corrosion rate of the WZ21 scaffolds calculated by microCT-based volume loss was up to 49 times slower than the in-vitro corrosion rate based on weight loss. Intramembranous bone formation within the scaffolds of both alloys was revealed, however a low corrosion rate and formation of gas cavities at initial time points were also detected. No systemic or local toxicity could be observed. Investigations by μ-XRF did not reveal accumulation of yttrium in the neighboring tissue. In summary, the magnesium scaffold´s performance is biocompatible, but would benefit from a surface modification, such as a coating to obtain lower the initial corrosion rates, and hereby establish a promising open-porous implant material for load-bearing applications. STATEMENT OF SIGNIFICANCE: Magnesium is an ideal temporary implant material for non-load bearing applications like bigger bone defects, since it degrades in the body over time. Here we developed and tested in vitro and in a rabbit model in vivo degradable open porous scaffolds made of sintered magnesium W4 and WZ21 short fibres. These scaffolds allow the ingrowth of cells and blood vessels to promote bone healing and regeneration. Both fibre types showed in vitro sufficient cytocompatibility and proliferation rates and in vivo, no systemic toxicity could be detected. At the implantation site, intramembranous bone formation accompanied by ingrowth of supplying blood vessels within the scaffolds of both alloys could be detected.

Progress in manufacturing and processing of degradable Fe-based implants: a review

Biodegradable metals have gained vast attention as befitting candidates for developing degradable metallic implants. Such implants are primarily employed for temporary applications and are expected to degrade or resorbed after the tissue is healed. Fe-based materials have generated considerable interest as one of the possible biodegradable metals. Like other biometals such as Mg and Zn, Fe exhibits good biocompatibility and biodegradability. The versatility in the mechanical behaviour of Fe-based materials makes them a better choice for load-bearing applications. However, the very low degradation rate of Fe in the physiological environment needs to be improved to make it compatible with tissue growth. Several studies on tailoring the degradation behaviour of Fe in the human body are already reported. Majority of these works include studies on the effect of manufacturing and processing techniques on biocompatibility and biodegradability. This article focuses on a comprehensive review and analysis of the various manufacturing and processing techniques so far reported for developing biodegradable iron-based orthopaedic implants. The current status of research in the field is neatly presented, and a summary of the works is included in the article for the benefit of researchers in the field to contextualise their research and effectively find the lacunae in the existing scholarship.

Tunable Properties via Composition Modulations of Poly(vinyl alcohol)/Xanthan Gum/Oxalic Acid Hydrogels

The design of hydrogel networks with tuned properties is essential for new innovative biomedical materials. Herein, poly(vinyl alcohol) and xanthan gum were used to develop hydrogels by the freeze/thaw cycles method in the presence of oxalic acid as a crosslinker. The structure and morphology of the obtained hydrogels were investigated by means of scanning electron microscopy (SEM), Fourier transform infrared (FTIR) spectroscopy, and swelling behavior. The SEM analysis revealed that the surface morphology was mostly affected by the blending ratio between the two components, namely, poly(vinyl alcohol) and xanthan gum. From the swelling study, it was observed that the presence of oxalic acid influenced the hydrophilicity of blends. The hydrogels based on poly(vinyl alcohol) without xanthan gum led to structures with a smaller pore diameter, a lower swelling degree in pH 7.4 buffer solution, and a higher elastic modulus. The antimicrobial activity of the prepared hydrogels was tested and the results showed that the hydrogels conferred antibacterial activity against Gram positive bacteria (Staphylococcus aureus 25923 ATCC) and Gram negative bacteria (Escherichia coli 25922 ATCC).

When the Total Hip Replacement Fails: A Review on the Stress-Shielding Effect

Total hip arthroplasty is one of the most common and successful orthopedic surgeries. Sometimes, periprosthetic osteolysis occurs associated with the stress-shielding effect: it results in the reduction of bone density, where the femur is not correctly loaded, and in the formation of denser bone, where stresses are confined. This paper illustrates the stress shielding effect as a cause of the failing replacement of the hip joint. An extensive literature survey has been accomplished to describe the phenomenon and identify solutions. The latter refer to the design criteria and the choice of innovative materials/treatments for prosthetic device production. Experimental studies and numerical simulations have been reviewed. The paper includes an introduction to explain the scope; a section illustrating the causes of the stress shielding effect; a section focusing on recent attempts to redefine prosthetic device design criteria, current strategies to improve the osteointegration process, and a number of innovative biomaterials; functionally graded materials are presented in a dedicated section: they allow customizing prosthesis features with respect to the host bone. Conclusions recommend an integrated approach for the production of new prosthetic devices: the “engineering community” has to support the “medical community” to assure an effective translation of research results into clinical practice.

3D-printed porous condylar prosthesis for temporomandibular joint replacement: Design and biomechanical analysis

BACKGROUND

Customized prosthetic joint replacements have crucial applications in severe temporomandibular joint problems, and the combined use of porous titanium scaffold is a potential method to rehabilitate the patients.

OBJECTIVE

The objective of the study was to develop a design method to obtain a titanium alloy porous condylar prosthesis with good function and esthetic outcomes for mandibular reconstruction.

METHODS

A 3D virtual mandibular model was created from CBCT data. A condylar defect model was subsequently created by virtual condylectomy on the initial mandibular model. The segmented condylar defect model was reconstructed by either solid or porous condyle with a fixation plate. The porous condyle was created by a density-driven modeling scheme with an inhomogeneous tetrahedral lattice structure. The porous condyle, supporting fixation plate, and screw locations were topologically optimized. Biomechanical behaviors of porous and solid condylar prostheses made of Ti-6Al-4V alloy were compared. Finite element analysis (FEA) was used to evaluate maximum stress distribution on both prostheses and the remaining mandibular ramus.

RESULTS

The FEA results showed levels of maximum stresses were 6.6%, 36.4% and 47.8% less for the porous model compared to the solid model for LCI, LRM, and LBM loading conditions. Compared to the solid prosthesis, the porous prosthesis had a weight reduction of 57.7% and the volume of porosity of the porous condyle was 65% after the topological optimization process.

CONCLUSIONS

A custom-made porous condylar prosthesis with fixation plate was designed in this study. The 3D printed Ti-6Al-4V porous condylar prosthesis had reduced weight and effective modulus of elasticity close to that of cortical bone. The.

Influence of strut-size and cell-size variations on porous Ti6Al4V structures for load-bearing implants

Mechanical properties of porous metal coatings in load-bearing implants play a critical role in determining the in vivo lifetime. However, there is a knowledge gap in measuring the shear strength of porous metal coatings at the porous-dense interface. This study evaluated pore morphology dependence and strut-size on compression, shear deformation, and in vitro response of additively manufactured porous Ti6Al4V structures. Selective laser melting (SLM)-based additive manufacturing (AM) technique was used to process two types of structures with honeycomb cell design-one with constant cell-size of ∼470 μm with mean strut-size varying from 92 to 134 μm, and denoted as strut-size variation (SSV); and the other with a constant strut-size of ∼135 μm with mean cell-size varying from 580 to 740 μm, denoted as cell-size variation (CSV). It was observed that under compressive loading, changes in elastic modulus were more sensitive to variations in strut-size over cell-size. Under shear loading at the porous-dense interface, strength enhancement and material hardening were observed in both SSV and CSV samples due to pore-collapsing. Our results show that for hexagonal cell designs, shear behavior is more sensitive to variations in cell-size over strut-size, although elastic modulus is more sensitive to changes in strut-size for porous metallic structures. From in vitro hFOB analysis, it was observed that pore size of 670 μm demonstrated the highest osteoblast cell viability among porous structures with evidence of pore-bridging by cells. P. aeruginosa bacterial culture showed that bacterial cell viability was higher for porous structures than dense Ti, with evidence of pore-bridging by bacterial cells.

Macrophage responses to selective laser-melted Ti-6Al-4V scaffolds of different pore geometries and the corresponding osteoimmunomodulatory effects toward osteogenesis

Following recent advances in osteoimmunology, there is growing recognition of the vital role of immune cells in the osteogenesis process. The 3D-printed scaffold, as a substitute for injured and/or diseased bone tissues, has demonstrated satisfactory pro-osteogenetic performance. However, whether immune cells prompt the above pro-osteogenetic performance has not been elucidated in detail. In the present study, highly controllable Ti-6Al-4V scaffolds with different pore geometries were fabricated using a selective laser-melting technique, to reveal their osteoimmunological functions with macrophages. The results showed that macrophages displayed characteristics of M2 phenotype in response to scaffolds. As a result, an anti-inflammatory microenvironment was generated. When the pore geometry was considered, such observations were more apparent with the hexagonal pore scaffold than with the triangular one. In addition, inhibition of the toll-like receptor signaling pathway in macrophages has been proposed to cause the above phenomenon. Upon applying conditioned media derived from macrophages on pre-osteoblasts, the hexagonal pore scaffold group was found to significantly enhance osteoblastic differentiation, via macrophage-to-implant interactions. However, the effect of triangular pore scaffold was not statistically significant compared to that of hexagonal pore scaffolds or nonporous samples. In an attempt to quantify scaffold pore geometries, it was suggested that pores with higher circularity values tended to induce M2 polarization of macrophages, promote an anti-inflammatory milieu, and therefore, achieve better osteogenetic performance via immunomodulation.

Surface functionalized bioceramics coated on metallic implants for biomedical and anticorrosion performance - a review

In modern days, the usage of trauma fixation devices has significantly increased due to sports injury, age-related issues, accidents, and revision surgery purposes. Numerous materials such as stainless steel, titanium, Co-Cr alloy, polymers, and ceramics have been used to replace the missing or defective parts of the human body. After implantation, body fluids (Na⁺, K⁺, and Cl^-), protein, and blood cells interact with the surface of metallic implants, which favours the release of ions from the metallic surface to surrounding body tissues, leading to a hypersensitive reaction. Body pH, temperature, and interaction of immune cells also cause metal ion leaching and lose host cell interaction and effective mineralization for better durability. Moreover, microbial invasion is another important crisis, which produces extracellular compounds onto the biomaterial surface through which it escapes from the antimicrobial agents. To enhance the performance of materials by improving mechanical, corrosion resistance, antimicrobial, and biocompatibility properties, surface modification is a prerequisite method in which chemical vapour deposition (CVD), physical vapour deposition (PVD), sol-gel method, and electrochemical deposition are generally involved. The properties of bioceramics such as chemical inertness, bioactivity, biocompatibility, and corrosion protection make them most suitable for the surface functionalization of metallic implants. To the best of our knowledge, very limited literature is available to discuss the interaction of body proteins, pH, and temperature onto bioceramic coatings. Hence, the present review focuses on the corrosion behaviour of different ceramic composite coating materials with different conditions. This review initially briefs the properties and surface chemistry of metal implants and the need for surface modifications by different deposition techniques. Further, mechanical, cytotoxicity, antimicrobial property, and electrochemical behaviour of ceramics and metal nitride coatings are discussed. Finally, future perspectives of coatings are outlined for biomedical applications.

A Study to Derive Equivalent Mechanical Properties of Porous Materials with Orthotropic Elasticity

The need for diverse materials has emerged as industry becomes more developed, and there is a need for materials with pores in various industries, including the energy storage field. However, there is difficulty in product design and development using the finite element method because the mechanical properties of a porous material are different from those of a base material due to the pores. Therefore, in this study, a Python program that can estimate the equivalent property of a material with pores was developed and its matching was verified through comparison with the measurement results. For high-efficiency calculation, the pores were assumed to be circular or elliptical, and they were also assumed to be equally distributed in each direction. The material with pores was assumed to be an orthotropic material, and its equivalent mechanical properties were calculated using the equivalent strain and equivalent stress by using the appropriate material property matrix. The material properties of a specimen with the simulated pores were measured using UTM, and the results were compared with the simulation results to confirm that the degree of matching achieved 6.4%. It is expected that this study will contribute to the design and development of a product in the industrial field.

Contemporary Approach to the Porosity of Dental Materials and Methods of Its Measurement

Porosity is an important parameter for characterizing the microstructure of solids that corresponds to the volume of the void space, which may contain fluid or air, over the total volume of the material. Many materials of natural and technically manufactured origin have a large number of voids in their internal structure, relatively small in size, compared to the characteristic dimensions of the body itself. Thus, porosity is an important feature of industrial materials, but also of biological ones. The porous structure affects a number of material properties, such as sorption capacity, as well as mechanical, thermal, and electrical properties. Porosity of materials is an important factor in research on biomaterials. The most popular materials used to rebuild damaged tooth tissues are composites and ceramics, whilst titanium alloys are used in the production of implants that replace the tooth root. Research indicates that the most comprehensive approach to examining such materials should involve an analysis using several complementary methods covering the widest possible range of pore sizes. In addition to the constantly observed increase in the resolution capabilities of devices, the development of computational models and algorithms improving the quality of the measurement signal remains a big challenge.

Tantalum as a Novel Biomaterial for Bone Implant: A Literature Review

Titanium (Ti) has been used in metallic implants since the 1950s due to various biocompatible and mechanical properties. However, due to its high Young’s modulus, it has been modified over the years in order to produce a better biomaterial. Tantalum (Ta) has recently emerged as a new potential biomaterial for bone and dental implants. It has been reported to have better corrosion resistance and osteo-regenerative properties as compared to Ti alloys which are most widely used in the bone-implant industry. Currently, Tantalum cannot be widely used yet due to its limited availability, high melting point, and high-cost production. This review paper discusses various manufacturing methods of Tantalum alloys, including conventional and additive manufacturing and also discusses their drawbacks and shortcomings. Recent research includes surface modification of various metals using Tantalum coatings in order to combine bulk material properties of different materials and the porous surface properties of Tantalum. Design modification also plays a crucial role in controlling bulk properties. The porous design does provide a lower density, wider surface area, and more immense specific strength. In addition to improved mechanical properties, a porous design could also escalate the material's biological and permeability properties. With current advancement in additive manufacturing technology, difficulties in processing Tantalum could be resolved. Therefore, Tantalum should be considered as a serious candidate material for future bone and dental implants.

Three dimensional printed nanostructure biomaterials for bone tissue engineering

The suffering from organ dysfunction due to damaged or diseased tissue/bone has been globally on the rise. Current treatment strategies for non-union bone defects include: the use of autografts, allografts, synthetic grafts and free vascularized fibular grafts. Bone tissue engineering has emerged as an alternative for fracture repair to satisfy the current unmet need of bone grafts and to alleviate the problems associated with autografts and allografts. The technology offers the possibility to induce new functional bone regeneration using synergistic combination of functional biomaterials (scaffolds), cells, and growth factors. Bone scaffolds are typically made of porous biodegradable materials that provide the mechanical support during repair and regeneration of damaged or diseased bone. Significant progress has been made towards scaffold materials for structural support, desired osteogenesis and angiogenesis abilities. Thanks for innovative scaffolds fabrication technologies, bioresorbable scaffolds with controlled porosity and tailored properties are possible today. Despite the presence of different bone scaffold fabrication methods, pore size, shape and interconnectivity have not yet been fully controlled in most of the methods. Moreover, scaffolds with tailored porosity for specific defects are still difficult to manufacture. Nevertheless, such scaffolds can be designed and fabricated using three dimensional (3D) printing approaches. 3D printing technology, as an advanced tissue scaffold fabrication method, offers the opportunity to produce complex geometries with distinct advantages. The technology has been used for the production of various types of bodily constructs such as blood vessels, vascular networks, bones, cartilages, exoskeletons, eyeglasses, cell cultures, tissues, organs and novel drug delivery devices. This review focuses on 3D printed scaffolds and their application in bone repair and regeneration. In addition, different classes of biomaterials commonly employed for the fabrication of 3D nano scaffolds for bone tissue engineering application so far are briefly discussed.

Ceramic Biomaterial Pores Stereology Analysis by the Use of Microtomography

The main aim of this study was to analyze microtomographic data to determine the geometric dimensions of a ceramic porous material’s internal structure. Samples of a porous corundum biomaterial were the research material. The samples were prepared by chemical foaming and were measured using an X-ray scanner. In the next stage, 3D images of the samples were generated and analyzed using Thermo Scientific Avizo software. The analysis enabled the isolation of individual pores. Then, the parameters characterizing the pore geometry and the porosity of the samples were calculated. The last part of the research consisted of verifying the developed method by comparing the obtained results with the parameters obtained from the microscopic examinations of the biomaterial. The comparison of the results confirmed the correctness of the developed method. The developed methodology can be used to analyze biomaterial samples to assess the geometric dimensions of biomaterial pores.

Hybrid mesoporous nanostructured scaffolds as dielectric biosimilar restorative materials

BACKGROUND

The intricate structure of natural materials is in correspondence with its highly complex functional behaviour. The health of teeth depends, in a complex way, on a heterogeneous arrangement of soft and hard porous tissues that allow for an adequate flow of minerals and oxygen to provide continuous restoration. Although restorative materials, used in clinics, have been evolving from the silver amalgams to actual inorganic fillers, their structural and textural properties are scarcely biomimetic, hindering the functional recovery of the tissue.

OBJECTIVE

The objective of this work is to compare and test the hybrid mesoporous silica-based scaffolds as candidates for dentine restoration applications.

METHODS

In this work, we present the development and the physical properties study of biocompatible hybrid mesoporous nanostructured scaffolds with a chemically versatile surface and biosimilar architecture. We test their textural (BET) and dielectric permittivity (ac impedance) properties.

RESULTS

These materials, with textural and dielectric properties similar to dentine and large availability for the payload of therapeutic agents, are promising candidates as functional restorative materials, suitable for impedance characterization techniques in dental studies.

CONCLUSIONS

Structural, textural, morphological characterization and electrical properties of hybrid mesoporous show a large degree of similarity to natural dentin samples.

A Multi-Element-Doped Porous Bioactive Glass Coating for Implant Applications

Objectives: The objectives of the study were (1) to develop a novel multi-element-doped porous 58S bioactive glass coating for titanium implants and (2) to investigate the physiochemical, cell cytotoxic and antibacterial properties of this novel coating for titanium implants. Methods: This study employed the sol–gel method to develop a silver-, cobalt (II) oxide- and titanium dioxide-doped 58S bioactive glass coating. The surface topography and in vitro bioactivity of the new bioactive glass-coated implants were studied using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy. The surface nanohardness and coating degradation were evaluated using atomic force microscopy (AFM) and inductively coupled plasma atomic emission spectroscopy (ICP-AES), respectively. The cell cytotoxicity was assessed using cell viability of osteoblast-like mouse cells. The antibacterial property was examined using colony-forming units (CFUs) of the implant coating against Porphyromonas gingivalis. Results: The multi-element-doped porous 58S bioactive glass-coated titanium implant was synthesized. SEM showed that calcium phosphate was formed on the novel coating but not on the 58S bioactive glass coating. The mean surface nanohardness of the novel coating and the 58S coating were 124 ± 24 and 50 ± 17 MPa, respectively (p < 0.001). ICP-AES showed that the releases of Si, Ca and P ions of the novel coating were significantly higher than that of a 58S bioactive glass-coated implant. No significant difference in cell cytotoxicity was found between the novel coating and the 58S coating (p > 0.1). The mean CFUs of the novel coating and the conventional coating were 120 × 10⁶ and 49 × 10⁶ /mL. Conclusion: A novel multielement-doped porous bioactive glass coating for titanium implants was developed. The coating displays promising biocompatibility and antibacterial activity. Clinical significance: the coating can be used to improve the clinical success of dental implants for patient care if it shows success in clinical trials.

Mixed oxide nanotubes in nanomedicine: A dead-end or a bridge to the future?

Nanomedicine has seen a significant rise in the development of new research tools and clinically functional devices. In this regard, significant advances and new commercial applications are expected in the pharmaceutical and orthopedic industries. For advanced orthopedic implant technologies, appropriate nanoscale surface modifications are highly effective strategies and are widely studied in the literature for improving implant performance. It is well-established that implants with nanotubular surfaces show a drastic improvement in new bone creation and gene expression compared to implants without nanotopography. Nevertheless, the scientific and clinical understanding of mixed oxide nanotubes (MONs) and their potential applications, especially in biomedical applications are still in the early stages of development. This review aims to establish a credible platform for the current and future roles of MONs in nanomedicine, particularly in advanced orthopedic implants. We first introduce the concept of MONs and then discuss the preparation strategies. This is followed by a review of the recent advancement of MONs in biomedical applications, including mineralization abilities, biocompatibility, antibacterial activity, cell culture, and animal testing, as well as clinical possibilities. To conclude, we propose that the combination of nanotubular surface modification with incorporating sensor allows clinicians to precisely record patient data as a critical contributor to evidence-based medicine.

Osteoconductive and Osteoinductive Surface Modifications of Biomaterials for Bone Regeneration: A Concise Review

The main aim of bone tissue engineering is to fabricate highly biocompatible, osteoconductive and/or osteoinductive biomaterials for tissue regeneration. Bone implants should support bone growth at the implantation site via promotion of osteoblast adhesion, proliferation, and formation of bone extracellular matrix. Moreover, a very desired feature of biomaterials for clinical applications is their osteoinductivity, which means the ability of the material to induce osteogenic differentiation of mesenchymal stem cells toward bone-building cells (osteoblasts). Nevertheless, the development of completely biocompatible biomaterials with appropriate physicochemical and mechanical properties poses a great challenge for the researchers. Thus, the current trend in the engineering of biomaterials focuses on the surface modifications to improve biological properties of bone implants. This review presents the most recent findings concerning surface modifications of biomaterials to improve their osteoconductivity and osteoinductivity. The article describes two types of surface modifications: (1) Additive and (2) subtractive, indicating biological effects of the resultant surfaces in vitro and/or in vivo. The review article summarizes known additive modifications, such as plasma treatment, magnetron sputtering, and preparation of inorganic, organic, and composite coatings on the implants. It also presents some common subtractive processes applied for surface modifications of the biomaterials (i.e., acid etching, sand blasting, grit blasting, sand-blasted large-grit acid etched (SLA), anodizing, and laser methods). In summary, the article is an excellent compendium on the surface modifications and development of advanced osteoconductive and/or osteoinductive coatings on biomaterials for bone regeneration.

Effect of Porous Microstructures on the Biomechanical Characteristics of a Root Analogue Implant: An Animal Study and a Finite Element Analysis

BACKGROUND

Full ceramic or metal custom-made root analogue implants (RAIs) are made by replicating the natural tooth geometry. However, it may lead to the stress shielding of the surrounding bone, and an RAI is unable to easily achieve primary stability. Therefore, to improve primary stability and reduce stress shielding, RAI porous structures are proposed. The purpose of this study was to evaluate the effect of porous microstructures on the biomechanical characteristics of the custom-made RAI.

METHODS

Porous and bulk titanium cylinders and porous RAI and conventional implants for in vivo tests were fabricated using a selective laser melting (SLM) technology. The elastic modulus and the compressive strength of porous titanium cylinders were evaluated. These samples were then implanted into rabbit femurs (cylinders) and beagle dog mandibles (RAI and conventional implants). A simplified three-dimensional geometry of the anterior maxilla of a patient was constructed. Then, based on the extracted standard template library (STL) data, five different RAI models were constructed: (A) smooth surface, (B) pit surface, (C) bulb surface, (D) threaded surface, and (E) porous surface. A conventional implant model was also constructed. A static load of 100 N was applied to the crown in the multivectoral direction.

RESULTS

The results of the in vivo experiment confirmed that the porous structure decreased the elastic modulus of Ti6Al4V. Additionally, the implantation of the porous custom-made RAIs resulted in increased new bone ingrowth and decreased bone resorption compared to conventional implants. Moreover, the 3D finite element analysis suggested that the bone surrounding porous custom-made RAIs was subjected to a more uniform stress distribution, and the strain values of the surrounding bone were more conducive to bone formation.

CONCLUSION

Based on these findings, a custom-made RAI with a porous surface accelerates bone formation and might reduce the stress-shielding effect.

Enhancing Corrosion and Wear Resistance of Ti6Al4V Alloy Using CNTs Mixed Electro-Discharge Process

This paper presents wear and corrosion resistance analysis of carbon nanotubes coated with Ti-6Al-4V alloy processed by electro-discharge treatment. The reported work is carried out using Taguchi's L18 orthogonal array to design the experimental matrix by varying five input process parameters i.e., dielectric medium (plain dielectric, multi-walled carbon nanotubes (MWCNTs) mixed dielectric), current (1-4 A), pulse-on-time (30-60 µs), pulse-off-time (60-120 µs), and voltage (30-50 V). The output responses are assessed in terms of microhardness and surface roughness of the treated specimen. X-ray diffraction (XRD) spectra of the coated sample reveal the formation of intermetallic compounds, oxides, and carbides, whereas surface morphology is observed using scanning electron microscopy (SEM) analysis. For the purpose of the in-vitro wear behavior of treated samples, the surface with superior microhardness values in plain dielectric and MWCNTs mixed dielectric is compared using a pin-on-disc type wear test. Furthermore, electrochemical corrosion test is also conducted to portray the dominance of treated substrate of Ti-6Al-4V alloy for biomedical applications. It is concluded that the wear-resistant and the corrosion protection efficiency of the MWCNTs treated substrate enhanced to 95%, and 96.63%, respectively.

Chondroitin sulfate and hydroxyapatite from Prionace glauca shark jaw: Physicochemical and structural characterization

In the present work, the potential of the Prionace glauca jaw as a source of both chondroitin sulfate and bioapatite is explored. The sandwich-type structure in cross section of the jaw based on alternate layers with prevalence in organic tissue or mineralized is shown and these bands respectively confirmed as CS or hydroxyapatite -enriched zones. As result of this, an optimized process in sequential steps for the recovery of both biomaterials and their purification process is proposed, by combining enzymatic proteolysis, chemical precipitation and separation using ultrafiltration membrane for CS production together with controlled thermal treatment for hydroxyapatite obtaining. The purified CS was characterized by Gel Permeation Chromatography, Nuclear Magnetic Resonance and Strong Anion Exchange Chromatography, revealing a polymeric material with a molecular weight of 67 kDa, and prevalent 6S-GalNAc sulfation (68%), followed by 4S-GalNAc (13%), a significant proportion of disulfated disaccharides (12%) and only 7% of non-sulfated units. In the case of the bioapatite a purified biphasic 60:40 porous calcium phosphate of hydroxyapatite: whitlockite/β-TCP was confirmed. Hydroxyapatite as major component (85%) was also obtained for jaws directly subjected to the thermal treatment. This proved the influence of the enzymatic hydrolysis and centrifugation on the composition of the mineral fraction.

Fabrication of Boronized Ti6Al4V/HA Composites by Microwave Sintering in Mixed Gases

The effect of atmosphere on the fabrication of boronized Ti6Al4V/hydroxyapatite (HA) composites was investigated by microwave sintering of the mixture of Ti6Al4V alloy, HA, and TiB₂ powders at 1050 °C for 30 min in the mixed gases of Ar + N₂, Ar + CO, and Ar + H₂, respectively. The presence of N₂, CO, and H₂ in the atmosphere caused formations of TiN, TiC, and TiH₂ in the composites, respectively, together with evident microstructural changes that determined the mechanical properties (compressive strength, compressive modulus, and Vickers microhardness) and wettabilities of the composites after sintering. It was found that the composite exhibited the best mechanical performance with compressive strength of 148.59 MPa, compressive modulus of 13.9 GPa, and Vickers microhardness of 300.39 HV by microwave sintering in the mixed gas of Ar + H₂, followed by those obtained in the mixed gases of Ar + N₂ and Ar + CO. All of the composites possessed desirable wettabilities, irrespective of the sintering atmosphere, as demonstrated by their very low water contact angles (≤31.9°). The results indicated that it is critical to control the extents of nitration and carbonization for maintaining the performance of the composites, especially the mechanical properties, whereas there is no strict requirement for the same objective using the mixed gas of Ar + H₂ in which qualified composites could be obtained for implant applications.

Multifunctional Biomaterials: Combining Material Modification Strategies for Engineering of Cell-Contacting Surfaces

In the human body, cells in a tissue are exposed to signals derived from their specific extracellular matrix (ECM), such as architectural structure, mechanical properties, and chemical composition (proteins, growth factors). Research on biomaterials in tissue engineering and regenerative medicine aims to recreate such stimuli using engineered materials to induce a specific response of cells at the interface. Although traditional biomaterials design has been mostly limited to varying individual signals, increasing interest has arisen on combining several features in recent years to improve the mimicry of extracellular matrix properties. Tremendous progress in combinatorial surface modification exploiting, for example, topographical features or variations in mechanics combined with biochemical cues has enabled the identification of their key regulatory characteristics on various cell fate decisions. Gradients especially facilitated such research by enabling the investigation of combined continuous changes of different signals. Despite unravelling important synergies for cellular responses, challenges arise in terms of fabrication and characterization of multifunctional engineered materials. This review summarizes recent work on combinatorial surface modifications that aim to control biological responses. Modification and characterization methods for enhanced control over multifunctional material properties are highlighted and discussed. Thereby, this review deepens the understanding and knowledge of biomimetic combinatorial material modification, their challenges but especially their potential.

A comparative study of three biomaterials in an ovine bone defect model

BACKGROUND

Polyetheretherketone (PEEK), and more recently titanium-coated PEEK, have been given serious consideration as biomaterial design choices for spinal interbody implants. Shortcomings in these materials necessitate further innovation into materials research, for example, on PEKK. Common complications such as surface delamination (as with titanium coating) and lack of bone apposition (as with PEEK) indicate the need for a new material that inherently displays preferable bone growth characteristics without sacrificing structural integrity.

PURPOSE

To compare three biomaterials with respect to their osseointegrative capacity.

STUDY DESIGN

Evaluate the in vivo material characteristics of three separate biomaterials in an ovine bone defect model: PEEK, titanium-coated PEEK (Ti-coated PEEK), and 3D-printed PEKK. Biomechanical, histologic, and radiographic testing was the basis for evaluation and material characterization.

METHODS

Eight ovine specimens were implanted with one of each of the three types of biomaterials tested in both left and right epicondyles using a femoral bone defect model, and were sacrificed at 8 and 16 weeks. Implants were then analyzed using a push-out method, histologic staining, and various radiographic tests. Industry funding was provided for the completion of this research study, followed by an independent third party review of all relevant data for publication.

RESULTS

PEKK implants demonstrated bone ingrowth, no radiographic interference, no fibrotic tissue membrane formation, significant increase in bony apposition over time, and significantly higher push-out strength compared to standard PEEK. The PEKK implant displayed bone growth characteristics comparable to Ti-coated PEEK with significant improvements in implant integrity and radiographic properties.

CONCLUSION

This study found that PEKK displayed preferable characteristics when compared to PEEK and Ti-coated PEEK, and is therefore a potential alternative to their use.

Antibacterial PMMA Composite Cements with Tunable Thermal and Mechanical Properties

PMMA-based cements are the most used bone cements in vertebroplasty and total hip arthroplasty. However, they present several drawbacks, including susceptibility to bacterial infection, monomer leakage toxicity, and high polymerization temperature, which can all lead to damage to the surrounding tissues and their failure. In the present study, silver nanowires (AgNWs) have been introduced to bestow antibacterial properties; chitosan (CS) to promote porosity and to reduce the polymerization temperature, without negatively affecting the mechanical performance; and methacryloyl chitosan (CSMCC) to promote cross-linking with methyl methacrylate (MMA) and reduce the quantity of monomer required for polymerization. Novel PMMA cements were formulated containing AgNWs (0 and 1% w/w) and CS or CSMCC at various concentrations (0, 10, 20, and 30% w/w), testing two different ratios of powder and MMA (P/L). Mechanical, thermal, antibacterial, and cytotoxic properties of the resulting composite cements were tested. Cements with concentrations of CS > 10% presented a significantly reduced polymerization temperature. The mechanical performances were affected for concentrations > 20% with a P/L concentration equal to 2:1. Concentrations of AgNWs as low as 1% w/w conferred antimicrobial activity against S. aureus, whereas biofilm formation on the surface of the cements was increased when CS was included in the preparation. The combination of CS and AgNWs allowed a higher concentration of Ag⁺ to be released over time with enhanced antimicrobial activity. Inclusion of AgNWs did not affect cell viability on the scaffolds. In conclusion, a combination of CS and AgNWs may be beneficial for reducing both polymerization temperature and biofilm formation, without significantly affecting mesenchymal stem cell proliferation on the scaffolds. No advantages have been noticed as a result of the reducing P/L ratio or using CSMCC instead of CS.

Porous shape memory dental implant by reactive sintering of TiH2-Ni-Urea mixture

We produced bifurcated bone-like shape memory implant (BL-SMI) with desirable tooth-root fixation capability by compact-sintering of TiH₂-Ni-urea mixture. The primary constituents of the porous product were Ni and Ti. We could adjust the pores' shape, size, and interconnectivity for favorite bone ingrowth by using urea as a space holder. Without urea, we obtained an average porosity of 0.30, and a mean void size of 100 μm. With 70 vol % urea, we got 62% interconnected pores of 400 μm average size. Aging allowed us to tune the austenite-martensite transformation temperatures towards the needed body tissue arouse. Differential scanning calorimetry measured the transformation temperatures. Their austenite start, austenite peak, and austenite finish values were A_s = 4, A_p = 22, and A_f = 34 °C, respectively. They retained functional shape recovery and superelastic effect at the body temperature. Mechanical properties, including Young's modulus of the specimens, matched well to maxilla and mandible bone tissue. The measured Young's modulus of the NiTi specimens was as low as 3.5 GPa, which decreased to ∼2.1 GPa with further porosity increase at higher space holder percentages. Superelasticity regime and low Young's modulus of the implant could potentially prevent stress-shielding from the surrounding bone tissues and give rise to secure fixation of the implant into the bone socket. Bending tests showed 0.9 mm recoverable deflection for specimens which assisted immediate self-fixation of the implant into the jaw bone cavity.

Simulated Performance of a Xenohybrid Bone Graft (SmartBone®) in the Treatment of Acetabular Prosthetic Reconstruction

Total hip arthroplasty (THA) is a surgical procedure for the replacement of hip joints with artificial prostheses. Several approaches are currently employed in the treatment of this kind of defect. Overall, the most common method involves using a quite invasive metallic support (a Burch-Schneider ring). Moreover, valid alternatives and less invasive techniques still need to be supported by novel material development. In this work, we evaluated the performance of SmartBone®, a xenohybrid bone graft composed of a bovine bone matrix reinforced with biodegradable polymers and collagen, as an effective support in acetabular prosthesis reconstruction. Specifically, the material's mechanical properties were experimentally determined (E = ~1.25 GPa, Ef = ~0.34 GPa, and Et = ~0.49 GPa) and used for simulation of the hip joint system with a SmartBone® insert. Moreover, a comparison with a similar case treated with a Burch-Schneider ring was also conducted. It was found that it is possible to perform THA revision surgeries without the insertion of an invasive metal support and it can be nicely combined with SmartBone®'s osteointegration characteristics. The material can withstand the loads independently (σmax = ~12 MPa) or be supported by a thinner titanium plate in contact with the bone in the worst cases. This way, improved bone regeneration can be achieved.

Improvement of osseointegration by recruiting stem cells to titanium implants fabricated with 3D printing

Slow and incomplete osseointegration and loss of osseointegration are major problems in dental and bone implants. We designed implants with interconnected 3D-tubulous structures and hypothesized that such interconnecting 3D (I3D) structures would serve as a repository for chemoattractants to recruit stem cells to promote osseointegration. A concept Laser Mlab-cusing-R laser-powder-bed-fusion (LPBF) 3D printing system was used to produce titanium implants with designed features. The implants were loaded (coated) with stromal cell-derived factor-1 alpha (SDF-1α), and subjected to stem cell recruitment. Implants were then surgically transplanted into the rabbit skull bone. After 12 weeks, osseointegration was analyzed by reverse-torque test and the implants were examined for calcium deposition by Alizarin Red staining. The I3D implants attracted significantly more stem cells than solid implants when coated (loaded) with SDF-1α. Greater torque force was needed to extract the I3D implants with 200 and 300 µm I3D structures than to extract solid implants from the skull. Generally, more calcium deposition was observed on the I3D implants than on the solid counterparts. LPBF 3D printing can be used to fabricate implants with complex structures. I3D-tubulous structures of implants can retain chemoattractant for recruitment of stem cells to enhance osseointegration.

Development and Optimization of the Novel Fabrication Method of Highly Macroporous Chitosan/Agarose/Nanohydroxyapatite Bone Scaffold for Potential Regenerative Medicine Applications

Bone scaffolds mimicking the three-dimensional bone structure are of essential importance for bone regeneration. The aim of this study was to develop and optimize the production method of highly macroporous bone scaffold composed of polysaccharide matrix (chitosan-agarose) reinforced with nanohydroxyapatite. The highly macroporous structure was obtained by the simultaneous application of a gas-foaming agent and freeze-drying technique. Fabricated variants of biomaterials (produced using different gas-foaming agent and solvent concentrations) were subjected to porosity evaluation and compression test in order to select the scaffold with the best properties. Then, bioactivity, cytotoxicity, and cell growth on the surface of the selected biomaterial were assessed. The obtained results showed that the simultaneous application of gas-foaming and freeze-drying methods allows for the production of biomaterials characterized by high total and open porosity. It was proved that the best porosity is obtained when solvent (CH3COOH) and foaming agent (NaHCO3) are applied at ratio 1:1. Nevertheless, the high porosity of novel biomaterial decreases its mechanical strength as determined by compression test. Importantly, novel scaffold is non-toxic to osteoblasts and favors cell attachment and growth on its surface. All mentioned properties make the novel biomaterial a promising candidate to be used in regenerative medicine in non-load bearing implantation sites.

Physiochemical characteristics and bone/cartilage tissue engineering potentialities of protein-based macromolecules - A review

Protein-based macromolecules such as keratin, silk fibroin, collagen, gelatin, and fibrin have emerged as potential candidate materials with unique structural and functional characteristics. Despite many advantages, the development of tissue-engineered constructs that can match the biological context of real tissue matrix remains a challenge in tissue engineering (TE). The tissue-engineered constructs should also support vascularization. Protein-based macromolecules, in pristine or combine form, provide a promising platform to engineer constructs with unique design and functionalities which are highly essential for an appropriate stimulation and differentiation of cells in a specific TE approach. However, much work remains to be undertaken with particular reference to in-depth interactions between constructed cues and target host tissues. Thus, modern advancements are emphasizing to understand critiques and functionalization of protein-based macromolecule that organize not only cellular activities but also tissue regenerations. In this review, numerous physicochemical, functional, and structural characteristics of protein-based macromolecules such as keratin, silk fibroin, collagen, gelatin, and fibrin are discussed. This review also presents the hope vs. hype phenomenon for tissue engineering. Later part of the review focuses on different requisite characteristics and their role in TE. The discussion presented here could prove highly useful for the construction of scaffolds with requisite features.

Effects of Mo contents on the microstructure, properties and cytocompatibility of the microwave sintered porous Ti-Mo alloys

The porous Ti-Mo alloys were prepared by microwave sintering, and the effects of Mo contents on the pore structure, phase composition, compressive strength, elastic modulus, bending strength, corrosion resistance and cytocompatibility of porous Ti-Mo alloys were investigated. The results show that the porous Ti-Mo alloys are composed of α phase and β phase, and the volume fraction of β phase increases with increasing the Mo contents. The amount of Kirkendall pores distributed over the porous Ti-Mo alloys skeleton increases with increasing the Mo contents, which greatly increases the porosities and pore sizes of the porous Ti-Mo alloys. Correspondingly, all of the compressive strength, elastic modulus and bending strength of the porous Ti-Mo alloys decrease with increasing the Mo contents. The porous Ti-Mo alloys present excellent corrosion resistance in the Hank's solution due to the oxidation film of TiO₂, MoO₂ and MoO₃ naturally formed on the surface, and the Mo contents have no obvious effect on the corrosion resistance. The cell viabilities of the porous Ti-Mo alloys are higher than 94%, indicating the porous Ti-Mo alloys possess favorable cytocompatibility. Moreover, the porous Ti-Mo alloys are beneficial to the spread, proliferation and differentiation of osteoblast-like cells, and the Mo contents have no significant effect on the cytocompatibility of the porous Ti-Mo alloys.

Additive manufacturing technique-designed metallic porous implants for clinical application in orthopedics

Traditional metallic scaffold prostheses, as vastly applied implants in clinical orthopedic operations, have achieved great success in rebuilding limb function. However, mismatch of bone defects and additional coating requirements limit the long-term survival of traditional prostheses. Recently, additive manufacturing (AM) has opened up unprecedented possibilities for producing complicated structures in prosthesis shapes and microporous surface designs of customized prostheses, which can solve the drawback of traditional prostheses mentioned above. This review presents the most commonly used metallic additive manufacturing techniques, the microporous structure design of metallic scaffolds, and novel applications of customized prostheses in the orthopedic field. Challenges and future perspectives on AM fabricated scaffolds are also summarized.

Biologically anchored chitosan/gelatin-SrHAP scaffold fabricated on Titanium against chronic osteomyelitis infection

The obstacles faced to treat chronic osteomyelitis infection clinically led to the search for an ideal biomaterial, resulted in combining two major aspects of bone tissue engineering namely surface modified metallic implant and polymer nanocomposite scaffold. In the present study Gelatin - Strontium incorporated Hydroxyapatite (SrHAP) forming HG scaffold, vancomycin loaded chitosan -gelatin polyelectrolyte complex incorporated gelatin-SrHAP, forming HV scaffolds (HV1-0.5wt% and HV2-1wt% vancomycin) were investigated. The HG, HV1 and HV2 scaffolds were successfully fabricated on Cp-Ti through anchoring by treatment with dopamine, which forms a bidentate co-ordination through NH bonding. Interconnected porous morphology of the scaffolds was confirmed, besides the globular Sr-HAP found in HV2 scaffold. The total amount of vancomycin encapsulation for HV1 and HV2 scaffolds were determined to be 47.55±1.6μg and 82.45±3.5μg respectively. Among the scaffolds studied HV2 scaffold were found to have a significant antibacterial activity for both MRSA and MSSA strains compared to Cp-Ti, HG and HV1 scaffolds. The HV2 scaffold also had significantly higher% of cell viability compared to Cp-Ti, HG and HV1 scaffolds. Furthermore, the presence of the drug vancomycin had no toxic effect on the cells, rather it aided in enhanced cell proliferation and spreading.

In Vitro Evaluation of PCL and P(3HB) as Coating Materials for Selective Laser Melted Porous Titanium Implants

Titanium is widely used as a bone implant material due to its biocompatibility and high resilience. Since its Young’s modulus differs from bone tissue, the resulting “stress shielding” could lead to scaffold loosening. However, by using a scaffold-shaped geometry, the Young’s modulus can be adjusted. Also, a porous geometry enables vascularisation and bone ingrowth inside the implant itself. Additionally, growth factors can improve these effects. In order to create a deposit and release system for these factors, the titanium scaffolds could be coated with degradable polymers. Therefore, in the present study, synthetic poly-ε-caprolactone (PCL) and the biopolymer poly(3-hydroxybutyrate) (P(3HB)) were tested for coating efficiency, cell adhesion, and biocompatibility to find a suitable coating material. The underlying scaffold was created from titanium by Selective Laser Melting (SLM) and coated with PCL or P(3HB) via dip coating. To test the biocompatibility, Live Cell Imaging (LCI) as well as vitality and proliferation assays were performed. In addition, cell adhesion forces were detected via Single Cell Force Spectroscopy, while the coating efficiency was observed using environmental scanning electron microscopy (ESEM) and energy-dispersive X-ray (EDX) analyses. Regarding the coating efficiency, PCL showed higher values in comparison to P(3HB). Vitality assays revealed decent vitality values for both polymers, while values for PCL were significantly lower than those for blank titanium. No significant differences could be observed between PCL and P(3HB) in proliferation and cell adhesion studies. Although LCI observations revealed decreasing values in cell number and populated area over time on both polymer-coated scaffolds, these outcomes could be explained by the possibility of coating diluent residues accumulating in the culture medium. Overall, both polymers fulfill the requirements regarding biocompatibility. Nonetheless, since only PCL coating ensured the maintenance of the porous implant structure, it is preferable to be used as a coating material for creating a deposit and release system for growth factors.

A New Level A Type IVIVC for the Rational Design of Clinical Trials Toward Regulatory Approval of Generic Polymeric Long-Acting Injectables

Chronic neuropsychiatric disorders and diabetes mellitus affect millions of patients and require long-term supervision and expensive medical care. Although repeated drug administration can help manage these diseases, relapses and re-hospitalization owing to patient non-adherence and reduced therapeutic efficacy remain challenging. In response, long-acting injectables, which provide sustained drug release over longer periods at concentrations close to therapeutic ranges, have been proposed. Recent advancements include polymeric long-acting injectables (pLAIs), in which the active pharmaceutical ingredient (API) is encapsulated within U.S. Food and Drug Administration (FDA)-approved biocompatible polymers, such as poly(lactic-co-glycolic acid), or PLGA. Despite significant progress and development in the global pLAI market, FDA guidance for the approval of complex drug products, such as generic pLAIs, is not clearly defined. Although in vitro to in vivo correlation (IVIVC) can facilitate the identification of critical quality attributes (CQAs), drug formulations, and in vitro test platforms for evaluating drug performance in vivo, the application of IVIVC in order to shortlist time- and resource-intensive clinical trials for generic pLAIs has not been reported. Here, we propose a new Level A Type IVIVC that directly correlates the in vitro outcomes, such as drug dissolution, of candidate generic formulations with the clinical characteristics, such as drug absorption, of a reference listed drug (RLD), to help identify the specific generic pLAI formulations with clinical absorptions that are likely to be similar to that of the RLD, thereby reducing the number of clinical trials required for evaluation of clinical bioequivalence (BE). Therefore, the scope of the proposed method is intended only for the rational design of clinical trials, i.e., to shortlist the specific pLAI generic formulations for clinical BE evaluation, and not necessarily to analyze drug performances (i.e., drug safety and effectiveness) in the shortlisted clinical trials or post-approval. Once validated, this method will be of great value to developers of generic pLAIs and regulatory bodies to accelerate their approval of these generic pLAIs.

Bioresorbable Fe-Mn and Fe-Mn-HA Materials for Orthopedic Implantation: Enhancing Degradation through Porosity Control

Resorbable, porous iron-manganese-hydroxyapatite biocomposites with suitable degradation rates for orthopedic applications are prepared using salt-leaching for the first time. These transient biomaterials have the potential to replace inert, permanent implants that can suffer from long-term complications, or have to be surgically removed, leaving an unfavorable void. Fe30Mn-10HA materials are newly developed to address inadequate resorption rates of degradable materials proposed for orthopedic environments in the past. In this study, controllable porosities with 300 µm diameter pores are introduced into Fe30Mn alloys and Fe30Mn-10HA composites, which enhance tissue ingrowth. For the composites, a Ca₂ Mn₇ O₁₄ phase generated within the Fe30Mn matrix during the sintering process greatly increases degradability. The combination of this second phase and added porosity is found to contribute to increased bone-like apatite layer formation, mouse bone marrow mesenchymal stem cell attachment, and reduction of detrimental oxide layer flaking. Remarkably, after thirty days in vitro, there is a significant increase in degradation up to 0.82 ± 0.04 mm per year for 30 wt% porous Fe30Mn-10HA biocomposites, compared to 0.02 ± 0.00 mm per year for traditional nonporous Fe30Mn, thereby increasing the viability of these materials for future clinical studies.