Design of Porous Three-Dimensional PDLLA/nano-hap Composite Scaffolds Using Stereolithography

Development of hybrid 3D printing approach for fabrication of high-strength hydroxyapatite bioscaffold using FDM and DLP techniques

This study develops a hybrid 3D printing approach that combines fused deposition modeling (FDM) and digital light processing (DLP) techniques for fabricating bioscaffolds, enabling rapid mass production. The FDM technique fabricates outer molds, while DLP prints struts for creating penetrating channels. By combining these components, hydroxyapatite (HA) bioscaffolds with different channel sizes (600, 800, and 1000μm) and designed porosities (10%, 12.5%, and 15%) are fabricated using the slurry casting method with centrifugal vacuum defoaming for significant densification. This innovative method produces high-strength bioscaffolds with an overall porosity of 32%-37%, featuring tightly bound HA grains and a layered surface structure, resulting in remarkable cell viability and adhesion, along with minimal degradation rates and superior calcium phosphate deposition. The HA scaffolds show hardness ranging from 1.43 to 1.87 GPa, with increasing compressive strength as the designed porosity and channel size decrease. Compared to human cancellous bone at a similar porosity range of 30%-40%, exhibiting compressive strengths of 13-70 MPa and moduli of 0.8-8 GPa, the HA scaffolds demonstrate robust strengths ranging from 40 to 73 MPa, paired with lower moduli of 0.7-1.23 GPa. These attributes make them well-suited for cancellous bone repair, effectively mitigating issues like stress shielding and bone atrophy.

Advances in additive manufacturing processes and their use for the fabrication of lower limb prosthetic devices

INTRODUCTION

Traditional methods of prosthesis fabrication are not efficient and user centric and are made for common purposes without focusing on individual demands of user which leads to rejection of prosthesis for long-term use. Utilizing advanced additive manufacturing techniques for fabrication of prosthesis makes the development process user centric and covers all the user demands thus providing better fit, comfort, and more stable gait rehabilitation for the user.

AREAS COVERED

The articles reporting fabrication of lower limb prosthesis and its socket are included in the study. Standard fabrication and additive manufacturing method are both systematically assessed by the reviewers. The review also covers the advanced methods of additive manufacturing that are presently being used for fabrication of rehabilitation devices.

EXPERT OPINION

Additive manufacturing method of fabrication of prosthesis provides more flexibility for manufacturing prosthesis parts as per demand of the user. The fabrication method takes into account the residual limb and thus makes the prosthesis user-specific providing better comfort and fit.

3D-Printing for Critical Sized Bone Defects: Current Concepts and Future Directions

The management and definitive treatment of segmental bone defects in the setting of acute trauma, fracture non-union, revision joint arthroplasty, and tumor surgery are challenging clinical problems with no consistently satisfactory solution. Orthopaedic surgeons are developing novel strategies to treat these problems, including three-dimensional (3D) printing combined with growth factors and/or cells. This article reviews the current strategies for management of segmental bone loss in orthopaedic surgery, including graft selection, bone graft substitutes, and operative techniques. Furthermore, we highlight 3D printing as a technology that may serve a major role in the management of segmental defects. The optimization of a 3D-printed scaffold design through printing technique, material selection, and scaffold geometry, as well as biologic additives to enhance bone regeneration and incorporation could change the treatment paradigm for these difficult bone repair problems.

A Comparative Study for Material Selection in 3D Printing of Scoliosis Back Brace

In recent years, many research studies have focused on the application of 3D printing in the production of orthopaedic back braces. Several advantages, such as the ability to customise complex shapes, improved therapeutic effect and reduced production costs place this technology at the forefront in the ongoing evolution of the orthopaedic sector. In this work, four different materials, two of them poly(lactic acid) (PLA) and two of them poly(ethylene terephthalate glycol) (PETG), were characterised from a thermal, mechanical, rheological and morphological point of view. Our aim was to understand the effects of the material properties on the quality and functionality of a 3D-printed device. The specimens were cut from 3D-printed hemi-cylinders in two different orientation angles. Our results show that PETG-based samples have the best mechanical properties in terms of elastic modulus and elongation at break. The PLA-based samples demonstrated typical brittle behaviour, with elongation at break one order of magnitude lower. Impact tests demonstrated that the PETG-based samples had better properties in terms of energy absorption. Moreover, 3D-printed PETG samples demonstrated a better surface finishing with a more homogenous fibre-fibre interface. In summary, we demonstrate that the right choice of material and printing conditions are fundamental to satisfy the quality and functionality required for a scoliosis back brace.

(Bio)manufactured Solutions for Treatment of Bone Defects with Emphasis on US-FDA Regulatory Science Perspective

Bone defects, with second highest demand for surgeries around the globe, may lead to serious health issues and negatively influence patient lives. The advances in biomedical engineering and sciences have led to the development of several creative solutions for bone defect treatment. This review provides a brief summary of bone graft materials, an organized overview of top-down and bottom-up (bio)manufacturing approaches, plus a critical comparison between advantages and limitations of each method. We specifically discuss additive manufacturing techniques and their operation mechanisms in detail. Next, we review the hybrid methods and promising future directions for bone grafting, while giving a comprehensive US-FDA regulatory science perspective, biocompatibility concepts and assessments, and clinical considerations to translate a technology from a research laboratory to the market. The topics covered in this review could potentially fuel future research efforts in bone tissue engineering, and perhaps could also provide novel insights for other tissue engineering applications.

3D Printed Composite Scaffolds in Bone Tissue Engineering: A systematic review

OBJECTIVE

This study aimed to analyze the effect of fabrication factors on both biological and physico-chemical features of 3-dimensional (3D) printed composite scaffolds.

METHOD

Electronic search was done according to the PRISMA guideline in PubMed and Scopus databases limited to English articles published until May 2021.Studies in which composite scaffolds were fabricated through computer-aided design and computer-aided manufacturing (CAD-CAM)-based methods were included.Articles regarding the features of the scaffolds fabricated through indirect techniques were excluded.

RESULTS

Full text of 121 studies were reviewed, and 69 met the inclusion criteria. According to analyzed studies, PCL and HA were the most commonly used polymer and ceramic,respectively. Besides,the Solvent-based technique was the most commonly used composition technique, which enabled preparing blends with high concentrations of ceramic materials. The most common fabrication method used in the included studies was Fused deposition modeling (FDM).The addition of bio-ceramics enhanced the mechanical features and the biological behaviors of the printed scaffolds in a ratio-dependent manner. However,studies that analyzed the effect of ceramic weight ratio showed that scaffolds with the highest ceramic content did not necessarily possess the optimal biological and non-biological features.

CONCLUSION

The biological and physico-chemical behaviors of the scaffold can be affected by pre-printing factors, including utilized materials, composition techniques, and fabrication methods. Fabricating scaffolds with high mineral content as of the natural bone may not provide the optimal condition for bone formation. Therefore, it is recommended that future studies compare the efficiency of different kinds of biomaterials rather than different weight ratios of one type.

Review on Nanocrystalline Cellulose in Bone Tissue Engineering Applications

Nanocrystalline cellulose is an abundant and inexhaustible organic material on Earth. It can be derived from many lignocellulosic plants and also from agricultural residues. They endowed exceptional physicochemical properties, which have promoted their intensive exploration in biomedical application, especially for tissue engineering scaffolds. Nanocrystalline cellulose has been acknowledged due to its low toxicity and low ecotoxicological risks towards living cells. To explore this field, this review provides an overview of nanocrystalline cellulose in designing materials of bone scaffolds. An introduction to nanocrystalline cellulose and its isolation method of acid hydrolysis are discussed following by the application of nanocrystalline cellulose in bone tissue engineering scaffolds. This review also provides comprehensive knowledge and highlights the contribution of nanocrystalline cellulose in terms of mechanical properties, biocompatibility and biodegradability of bone tissue engineering scaffolds. Lastly, the challenges for future scaffold development using nanocrystalline cellulose are also included.

Photocurable Methacrylate Derivatives of Polylactide: A Two-Stage Synthesis in Supercritical Carbon Dioxide and 3D Laser Structuring

A two-stage polylactide modification was performed in the supercritical carbon dioxide medium using the urethane formation reaction. The modification resulted in the synthesis of polymerizable methacrylate derivatives of polylactide for application in the spatial 3D structuring by laser stereolithography. The use of the supercritical carbon dioxide medium allowed us to obtain for the first time polymerizable oligomer-polymer systems in the form of dry powders convenient for further application in the preparation of polymer compositions for photocuring. The photocuring of the modified polymers was performed by laser stereolithography and two-photon crosslinking. Using nanoindentation, we found that Young’s modulus of the cured compositions corresponded to the standard characteristics of implants applied in regenerative medicine. As shown by thermogravimetric analysis, the degree of crosslinking and, hence, the local stiffness of scaffolds were determined by the amount of the crosslinking agent and the photocuring regime. No cytotoxicity was observed for the structures.

Improved Bone Regeneration in Rabbit Bone Defects Using 3D Printed Composite Scaffolds Functionalized with Osteoinductive Factors

Large critical size bone defects are complicated to treat, and in many cases, autografts become a challenge due to size and availability. In such situations, a synthetic bone implant that can be patient-specifically designed and fabricated with control over parameters such as porosity, rigidity, and osteogenic cues can act as a potential synthetic bone substitute. In this study, we produced photocuring composite resins with poly(trimethylene carbonate) containing high ratios of bioactive ceramics and printed porous 3D composite scaffolds to be used as bone grafts. To enhance the overall surface area available for cell infiltration, the scaffolds were also filled with a macroporous cryogel. Furthermore, the scaffolds were functionalized with osteoactive factors: bone morphogenetic protein and zoledronic acid. The scaffolds were evaluated in vitro for biocompatibility and for functionality in vivo in critical bone defects (∼8 mm) in two clinically relevant rabbit models. These studies included a smaller study in rabbit tibia and a larger study in the rabbit cranium. It was observed that the bioactive molecule-functionalized 3D printed porous composite scaffolds provide an excellent conductive surface inducing higher bone formation and improved defect healing in both critical size long bones and cranial defects. Our findings provide strong evidence in favor of these composites as next generation synthetic bone substitutes.

Additive manufacturing of PLA-based scaffolds intended for bone regeneration and strategies to improve their biological properties

Polylactic acid (PLA) is one of the most commonly used materials in the biomedical sector because of its processability, mechanical properties and biocompatibility. Among the different techniques that are feasible to process this biomaterial, additive manufacturing (AM) has gained attention recently, as it provides the possibility of tuning the design of the structures. This flexibility in the design stage allows the customization of the parts in order to optimize their use in the tissue engineering field. In the recent years, the application of PLA for the manufacture of bone scaffolds has been especially relevant, since numerous studies have proven the potential of this biomaterial for bone regeneration. This review contains a description of the specific requirements in the regeneration of bone and how the state of the art have tried to address them with different strategies to develop PLA-based scaffolds by AM techniques and with improved biofunctionality.

In situ sol-gel synthesis of hyaluronan derivatives bio-nanocomposite hydrogels

The main driving idea of the present study was the comparison between two different chemical modifications of hyaluronic acid (HA) followed by the development of nanocomposite hydrogels directly in situ by biomineralization of photocrosslinkable HA polymers through sol-gel synthesis. In this way, it has been possible to overcome some limitations due to classical approaches based on the physical blending of inorganic fillers into polymer matrix. To this aim, methacrylated and maleated HA, synthesized with similar degree of substitution (DS) were compared in terms of mechanical and physico-chemical properties. The success of in situ biomineralization was highlighted by reflect Fourier transform infrared spectroscopy and thermogravimetric analysis. Furthermore, mechanical characterization demonstrated the reinforcing effect of inorganic fillers evidencing a strong correlation with DS. The swelling behavior resulted to be correlated with filler concentration. Finally, the cytotoxicity tests revealed the absence of toxic components and an increase of cell proliferation over culture time was observed, highlighting these bio-nanocomposite hyaluronan derivatives as biocompatible hydrogel with tunable properties.

A review of biomaterials scaffold fabrication in additive manufacturing for tissue engineering

The current developments in three-dimensional printing also referred as “additive manufacturing” have transformed the scenarios for modern manufacturing and engineering design processes which show greatest advantages for the fabrication of complex structures such as scaffold for tissue engineering. This review aims to introduce additive manufacturing techniques in tissue engineering, types of biomaterials used in scaffold fabrication, as well as in vitro and in vivo evaluations. Biomaterials and fabrication methods could critically affect the outcomes of scaffold mechanical properties, design architectures, and cell proliferations. In addition, an ideal scaffold aids the efficiency of cell proliferation and allows the movements of cell nutrient inside the human body with their specific material properties. This article provides comprehensive review that covers broad range of all the biomaterial types using various additive manufacturing technologies. The data were extracted from 2008 to 2018 mostly from Google Scholar, ScienceDirect, and Scopus using keywords such as “Additive Manufacturing,” “3D Printing,” “Tissue Engineering,” “Biomaterial” and “Scaffold.” A 10 years research in this area was found to be mostly focused toward obtaining an ideal scaffold by investigating the fabrication strategies, biomaterials compatibility, scaffold design effectiveness through computer-aided design modeling, and optimum printing machine parameters identification. As a conclusion, this ideal scaffold fabrication can be obtained with the combination of different materials that could enhance the material properties which performed well in optimum additive manufacturing condition. Yet, there are still many challenges from the printing methods, bioprinting and cell culturing that needs to be discovered and investigated in the future.

An introduction to bone tissue engineering

Bone tissue has the capability to regenerate itself; however, defects of a critical size prevent the bone from regenerating and require additional support. To aid regeneration, bone scaffolds created out of autologous or allograft bone can be used, yet these produce problems such as fast degradation rates, reduced bioactivity, donor site morbidity or the risk of pathogen transmission. The development of bone tissue engineering has been used to create functional alternatives to regenerate bone. This can be achieved by producing bone tissue scaffolds that induce osteoconduction and integration, provide mechanical stability, and either integrate into the bone structure or degrade and are excreted by the body. A range of different biomaterials have been used to this end, each with their own advantages and disadvantages. This review will introduce the requirements of bone tissue engineering, beginning with the regeneration process of bone before exploring the requirements of bone tissue scaffolds. Aspects covered include the manufacturing process as well as the different materials used and the incorporation of bioactive molecules, growth factors and cells.

Advances in three-dimensional bioprinting of bone: Progress and challenges

Several attempts have been made to engineer a viable three-dimensional (3D) bone tissue equivalent using conventional tissue engineering strategies, but with limited clinical success. Using 3D bioprinting technology, scientists have developed functional prototypes of clinically relevant and mechanically robust bone with a functional bone marrow. Although the field is in its infancy, it has shown immense potential in the field of bone tissue engineering by re-establishing the 3D dynamic micro-environment of the native bone. Inspite of their in vitro success, maintaining the viability and differentiation potential of such cell-laden constructs overtime, and their subsequent preclinical testing in terms of stability, mechanical loading, immune responses, and osseointegrative potential still needs to be explored. Progress is slow due to several challenges such as but not limited to the choice of ink used for cell encapsulation, optimal cell source, bioprinting method suitable for replicating the heterogeneous tissues and organs, and so on. Here, we summarize the recent advancements in bioprinting of bone, their limitations, challenges, and strategies for future improvisations. The generated knowledge will provide deep insights on our current understanding of the cellular interactions with the hydrogel matrices and help to unravel new methodologies for facilitating precisely regulated stem cell behaviour.

Current advances for bone regeneration based on tissue engineering strategies

Bone tissue engineering (BTE) is a rapidly developing strategy for repairing critical-sized bone defects to address the unmet need for bone augmentation and skeletal repair. Effective therapies for bone regeneration primarily require the coordinated combination of innovative scaffolds, seed cells, and biological factors. However, current techniques in bone tissue engineering have not yet reached valid translation into clinical applications because of several limitations, such as weaker osteogenic differentiation, inadequate vascularization of scaffolds, and inefficient growth factor delivery. Therefore, further standardized protocols and innovative measures are required to overcome these shortcomings and facilitate the clinical application of these techniques to enhance bone regeneration. Given the deficiency of comprehensive studies in the development in BTE, our review systematically introduces the new types of biomimetic and bifunctional scaffolds. We describe the cell sources, biology of seed cells, growth factors, vascular development, and the interactions of relevant molecules. Furthermore, we discuss the challenges and perspectives that may propel the direction of future clinical delivery in bone regeneration.

Multidimensional mass spectrometry characterization of isomeric biodegradable polyesters

The biodegradable polyester copolymer poly(propylene fumarate) (PPF) is increasingly utilized in bone tissue engineering studies due to its suitability as inert cross-linkable scaffold material. The well-defined poly(propylene fumarate) oligomers needed for this purpose are synthesized by post-polymerization isomerization of poly(propylene maleate), which is prepared by ring opening polymerization of maleic anhydride and propylene oxide. In this study, multidimensional mass spectrometry methodologies, interfacing matrix-assisted laser desorption ionization and electrospray ionization with mass analysis, tandem mass spectrometry fragmentation and/or ion mobility mass spectrometry, have been employed to characterize the composition, end groups, chain connectivity and isomeric purity of the isomeric copolyesters poly(propylene maleate)and poly(propylene fumarate). It is demonstrated that the polymerization catalyst is incorporated into the polymer chain (as the initiating chain end) and that the poly(propylene maleate) to poly(propylene fumarate) isomerization using an amine base proceeds with quantitative yield. Hydrolytic degradation is shown not to alter the double bond geometry of the poly(propylene fumarate) or poly(propylene maleate) chains.

Rapid prototyping technology and its application in bone tissue engineering

Bone defects arising from a variety of reasons cannot be treated effectively without bone tissue reconstruction. Autografts and allografts have been used in clinical application for some time, but they have disadvantages. With the inherent drawback in the precision and reproducibility of conventional scaffold fabrication techniques, the results of bone surgery may not be ideal. This is despite the introduction of bone tissue engineering which provides a powerful approach for bone repair. Rapid prototyping technologies have emerged as an alternative and have been widely used in bone tissue engineering, enhancing bone tissue regeneration in terms of mechanical strength, pore geometry, and bioactive factors, and overcoming some of the disadvantages of conventional technologies. This review focuses on the basic principles and characteristics of various fabrication technologies, such as stereolithography, selective laser sintering, and fused deposition modeling, and reviews the application of rapid prototyping techniques to scaffolds for bone tissue engineering. In the near future, the use of scaffolds for bone tissue engineering prepared by rapid prototyping technology might be an effective therapeutic strategy for bone defects.

Surface functionalization of acrylic based photocrosslinkable resin for 3D printing applications

The limited number of resins, available for stereolithography applications, is one of the key drivers in research applied to rapid prototyping. In this work an acrylic photocrosslinkable resin based on methyl methacrylate (MMA), butyl methacrylate (BMA) and poly(ethylene glycol) dimethacrylate (PEGDA) was developed with different composition and characterized in terms of mechanical, thermal and biological behaviour. Two different systems have been developed using different amount of reagent. The influence of every components have been evaluated on the final characteristic of the resin in order to optimize the final composition for applications in bone tissue engineering. The crosslinked materials showed good mechanical properties and thermal stabilities and moreover cytotoxicity test confirms good biocompatibility with no cytotoxic effect on cells metabolism. Moreover two different treatments have been proposed, using fetal bovine serum (FBS) and methanol (MeOH), in order to improve cell recognition of the surfaces. Samples threatened with MeOH allow cell adhesion and survival, promoting spreading, elongation and fusion of C2C12 muscle myoblast cells.

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Photocrosslinkable biocompatible resin for application in tissue engineering.

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Surface treatment to improve materials wettability.

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Myoblast spreading and elongation on photocrosslinked modified surfaces.