Additive manufacturing of titanium alloys in the biomedical field: processes, properties and applications

Biological Characterization of Ti6Al4V Additively Manufactured Surfaces: Comparison Between Ultrashort Laser Texturing and Conventional Post-Processing

Among Additive Manufacturing (AM) technologies, Laser Powder Bed Fusion (LPBF) has made a great contribution to optimizing the production of customized implant materials. However, the design of the ideal surface topography, capable of exerting the best biological effect without drawbacks, is still a subject of study. The aim of the present study is to topographically and biologically characterize AM-produced Ti6Al4V ELI (Extra Low Interstitial) samples by comparing different surface finishing. Vertically and horizontally samples are realized by LPBF with four surface finishing conditions (as-built, corundum-sandblasted, zirconia-sandblasted, femtosecond laser textured). Bioactivity in vitro tests are performed with human osteoblasts evaluating morphology, metabolic activity, and differentiation capabilities in direct contact with surfaces. Scanning electron microscope and profilometry analysis are used to evaluate surface morphology and samples' roughness with and without cells. All tested surfaces show good biocompatibility. The influence of material surface features is evident in the early evaluation, with the most promising results of morphological study for laser texturing. Deposition orientations seem to influence metabolic activities, with XZ orientation more effective than XY. Current data provide the first positive feedback on the biocompatibility of laser texturing finishing, still poorly described in the literature, and support the future clinical development of devices produced with a combination of LPBF and different finishing treatments.

Evaluation of Treatment Effect and Mechanism Analysis of Ti6AL4V Porous Scaffolds Prepared by Selective Laser Melting with Different Chemical Polishing Processes

The large amount of unfused powder that remains on the surface of Ti6AL4V porous scaffolds prepared by selective laser melting technology is a common problem. Therefore, this article investigated the effects of three different chemical polishing processes on the surface state, pore structure, and mechanical properties of small pore size scaffold materials at different polishing times in the field of implantable medical devices. The results show that the overall treatment effect of the simple chemical polishing process is poor, the internal treatment depth of porous support is insufficient and uneven, and the overall mechanical properties of the sample with the same porosity are average. The outer structure during the electrochemical polishing process showed an obvious treatment effect. However, the internal treatment depth and uniformity were significantly lower compared with the simple chemical polishing process, and the overall mechanical properties of the sample with the same porosity were inferior. The overall treatment effect, depth, and uniformity of the inner and outer structure of the sample using a dynamic chemical polishing process were significantly optimized, and the overall mechanical properties of the sample with the same porosity were superior to the other two methods. Furthermore, the main reasons for the nonuniform treatment effect between the inner and outer layers during the chemical polishing of porous scaffolds were observed to be related to the restricted exchange of etchant caused by the complex internal structure of porous scaffolds and the gas generated by the chemical reaction.

Defects in Metal Additive Manufacturing: Formation, Process Parameters, Postprocessing, Challenges, Economic Aspects, and Future Research Directions

Metal additive manufacturing (AM) is a revolutionary technological advancement that has made significant inroads in a wide range of sectors, including aerospace, defense, automotive, health care, and engineering applications. It offers unprecedented design freedom, reduced material waste, and enhanced performance, in addition to significant enhancements to fabrication processes. Microstructural defects and internal stresses formed during fabrication directly affect the fabricated product's surface integrity, quality, and service life. Identification, characterization, and prediction of these defects help significant and direct production of defect-free structures with high density. This article provides detailed insights concerning the common defects, mitigation techniques, and challenges reported in both powder bed fusion-based and wire arc AM methods. Defects such as porosity may develop due to the powder sphericity, roughness of the powder, preheating, process parameters, build environment, postprocessing techniques, and environmental factors. Therefore, a critical study of the techniques, alloys, process parameter optimization, and different postprocessing techniques to tone down the defects is made from their formations.

Titanium: A systematic review of the relationship between crystallographic profile and cell adhesion

Dental implant surface properties such as roughness, wettability, and porosity ensure cell interaction and tissue integration. The clinical performance of dental implants depends on the crystallographic texture and protein and cell bonds to the substrates, where grain size, orientation, and inclination are parameters responsible for favoring osteoblast adhesion and limiting bacterial adhesion. The lack of consensus on the best crystallographic plan for cell adhesion prompted this systematic review, which aims to answer the following question: "What is the influence of the crystallographic plane on titanium surfaces on cell adhesion?" by evaluating the literature on the crystallographic characteristics of titanium and how these dictate topographical parameters and influence the cell adhesion of devices made from this material. It followed the Preferred Reporting Standards for Systematic Reviews and Meta-Analyses (PRISMA 2020) registered with the Open Science Framework (OSF) (osf.io/xq6kv). The search strategy was based on the PICOS method. It chose in vitro articles that analyzed crystallographic structure correlated with cell adhesion and investigated the microstructure and its effects on cell culture, different crystal orientation distributions, and the influence of crystallinity. The search strategies were applied to the different electronic databases: PubMed, Scopus, Science Direct, Embase, and Google Scholar, and the articles found were attached to the Rayyan digital platform and assessed blindly. The Joanna Bringgs Institute (JBI) tool assessed the risk of bias. A total of 248 articles were found. After removing duplicates, 192 were analyzed by title and abstract. Of these, 18 were selected for detailed reading in their entirety, 9 of which met the eligibility criteria. The included studies presented a low risk of bias. The role of the crystallographic orientation of the exposed faces in a multicrystalline material is little discussed in the scientific literature and its impact is recognized as dictating the topographical characteristics of the material that facilitate cell adhesion.

Biological Properties of 3D-Printed Zirconia Implants with p-Cell Structures

Research on 3-dimensional (3D) printed porous zirconia-based dental implants is still in its infancy. This study aimed to evaluate the biological responses of novel zirconia implants with p-cell structures fabricated by 3D printing. The solid zirconia samples exhibited comparable density, 3-point flexural strength, and accelerated aging properties compared to specimens prepared previously by conventional methods. Cell-based experiments showed that the p-cell structure promoted cell proliferation, adhesion, and osteogenesis-related protein expression. Mechanical tests showed that both p-cell and control implants could withstand a torque of 35 Ncm without breaking. The mean maximum breaking loads of p-cell and control implants were 1,222.429 ± 115.591 N and 1,903.857 ± 250.673 N, respectively, which were much higher than the human physiological chewing force and human mean maximum occlusal force. An animal experiment showed that the bone trabeculae around the implants were significantly thicker, more numerous, and denser in the p-cell group than in the control group. This work could provide promising guidance for further exploring 3D printing techniques for porous zirconia bionic implants in dentistry.

3D printed osteochondral scaffolds: design strategies, present applications and future perspectives

Articular osteochondral (OC) defects are a global clinical problem characterized by loss of full-thickness articular cartilage with underlying calcified cartilage through to the subchondral bone. While current surgical treatments can relieve pain, none of them can completely repair all components of the OC unit and restore its original function. With the rapid development of three-dimensional (3D) printing technology, admirable progress has been made in bone and cartilage reconstruction, providing new strategies for restoring joint function. 3D printing has the advantages of fast speed, high precision, and personalized customization to meet the requirements of irregular geometry, differentiated composition, and multi-layered boundary layer structures of joint OC scaffolds. This review captures the original published researches on the application of 3D printing technology to the repair of entire OC units and provides a comprehensive summary of the recent advances in 3D printed OC scaffolds. We first introduce the gradient structure and biological properties of articular OC tissue. The considerations for the development of 3D printed OC scaffolds are emphatically summarized, including material types, fabrication techniques, structural design and seed cells. Especially from the perspective of material composition and structural design, the classification, characteristics and latest research progress of discrete gradient scaffolds (biphasic, triphasic and multiphasic scaffolds) and continuous gradient scaffolds (gradient material and/or structure, and gradient interface) are summarized. Finally, we also describe the important progress and application prospect of 3D printing technology in OC interface regeneration. 3D printing technology for OC reconstruction should simulate the gradient structure of subchondral bone and cartilage. Therefore, we must not only strengthen the basic research on OC structure, but also continue to explore the role of 3D printing technology in OC tissue engineering. This will enable better structural and functional bionics of OC scaffolds, ultimately improving the repair of OC defects.

Bamboo-Inspired Porous Scaffolds for Advanced Orthopedic Implants: Design, Mechanical Properties, and Fluid Characteristics

In orthopedic implant development, incorporating a porous structure into implants can reduce the elastic modulus to prevent stress shielding but may compromise yield strength, risking prosthesis fracture. Bamboo's natural structure, with its exceptional strength-to-weight ratio, serves as inspiration. This study explores biomimicry using bamboo-inspired porous scaffolds (BISs) resembling cortical bone, assessing their mechanical properties and fluid characteristics. The BIS consists of two 2D units controlled by structural parameters α and β. The mechanical properties, failure mechanisms, energy absorption, and predictive performance are investigated. BIS exhibits mechanical properties equivalent to those of natural bone. Specifically, α at 4/3 and β at 2/3 yield superior mechanical properties, and the destruction mechanism occurs layer by layer. Besides, the Gibson-Ashby models with different parameters are established to predict mechanical properties. Fluid dynamics analysis reveals two high-flow channels in BISs, enhancing nutrient delivery through high-flow channels and promoting cell adhesion and proliferation in low-flow regions. For wall shear stress below 30 mPa (ideal for cell growth), α at 4/3 achieves the highest percentage (99.04%), and β at 2/3 achieves 98.46%. Permeability in all structural parameters surpasses that of human bone. Enhanced performance of orthopedic implants through a bionic approach that enables the creation of pore structures suitable for implants.

Synergistic effect of hierarchical topographic structure on 3D-printed Titanium scaffold for enhanced coupling of osteogenesis and angiogenesis

The significance of the osteogenesis-angiogenesis relationship in the healing process of bone defects has been increasingly emphasized in recent academic research. Surface topography plays a crucial role in guiding cellular behaviors. Metal-organic framework (MOF) is an innovative biomaterial with nanoscale structural and topological features, enabling the modulation of scaffold physicochemical properties. This study involved the loading of varying quantities of UiO-66 nanocrystals onto alkali-heat treated 3D-printed titanium scaffolds, resulting in the formation of hierarchical micro/nano topography named UiO-66/AHTs. The physicochemical properties of these scaffolds were subsequently characterized. Furthermore, the impact of these scaffolds on the osteogenic potential of BMSCs, the angiogenic potential of HUVECs, and their intercellular communication were investigated. The findings of this study indicated that 1/2UiO-66/AHT outperformed other groups in terms of osteogenic and angiogenic induction, as well as in promoting intercellular crosstalk by enhancing paracrine effects. These results suggest a promising biomimetic hierarchical topography design that facilitates the coupling of osteogenesis and angiogenesis.

Enhancing the mechanical properties and surface morphology of individualized Ti-mesh fabricated through additive manufacturing for the treatment of alveolar bone defects

Titanium meshes are widely utilized in alveolar bone augmentation, and this study aims to enhance the properties of titanium meshes through heat treatment (HT) and the synergistic finishing technology of electric field and flow field (EFSF). Our findings illustrate that the titanium mesh exhibits improved mechanical properties following HT treatment. The innovative EFSF technique, in combination with HT, has a substantial impact on improving the surface properties of titanium meshes. HT initiates grain fusion and reduces surface pores, resulting in enhanced tensile and elongation properties. EFSF further enhances these improvements by significantly reducing surface roughness and eliminating adhered titanium powder, a byproduct of selective laser melting printing. Increased hydrophilicity and surface-free energy are achieved after EFSF treatment. Notably, the EFSF-treated titanium mesh exhibits reduced bacterial adhesion and is non-toxic to osteoblast proliferation. These advancements increase its suitability for clinical alveolar bone augmentation.

Biocompatibility and osseointegration properties of a novel high strength and low modulus β- Ti10Mo6Zr4Sn3Nb alloy

Introduction: Ti6Al4V titanium alloy is widely used in producing orthopedic and maxillofacial implants, but drawbacks include high elastic modulus, poor osseointegration performance, and toxic elements. A new medical titanium alloy material with better comprehensive performance is urgently needed in the clinic. Methods: Ti10Mo6Zr4Sn3Nb titanium alloy (referred to as Ti-B12) is a unique medical ß titanium alloy material developed by us. The mechanical properties of Ti-B12 depict that it has advantages, such as high strength, low elastic modulus, and fatigue resistance. In our study, the biocompatibility and osseointegration properties of Ti-B12 titanium alloy are further studied to provide theoretical guidance for its clinical transformation. Results and Discussion: The titanium alloy Ti-B12 displays no significant effect on MC3T3-E1 cell morphology, proliferation, or apoptosis in vitro. Neither Ti-B12 titanium alloy nor Ti6Al4V titanium alloy depicts a significant difference (p > 0.05); Ti-B12 material extract injected into the abdominal cavity of mice does not cause acute systemic toxicity. The skin irritation test and intradermal irritation test reveal that Ti-B12 does not cause skin allergic reactions in rabbits. Compared to Ti6Al4V, Ti-B12 titanium alloy material has more advantages in promoting osteoblast adhesion and ALP secretion (p < 0.05). Although there is no significant difference in OCN and Runx2 gene expression between the three groups on the 7th and 14th days of differentiation induction (p > 0.05), the expression of Ti-B12 group is higher than that of Ti6Al4V group and blank control group. Furthermore, the rabbit in vivo test present that 3 months after the material is implanted in the lateral epicondyle of the rabbit femur, the Ti-B12 material fuses with the surrounding bone without connective tissue wrapping. This study confirms that the new β-titanium alloy Ti-B12 not only has low toxicity and does not cause rejection reaction but also has better osseointegration performance than the traditional titanium alloy Ti6Al4V. Therefore, Ti-B12 material is expected to be further promoted in clinical practice.

A Novel Magnetic Resonance Imaging-Compatible Titanium Alloy Wire-Reinforced Endotracheal Tube

Reinforced endotracheal tubes (ET) are advantageous in preventing tube obstruction and kinking by procedural compression during neurosurgeries. However, the standard reinforced ET contains an embedded stainless steel (SS) helical wire, which produces artifacts and heat during magnetic resonance imaging (MRI). Therefore, MRI is not indicated in the presence of a reinforced ET containing SS. To overcome this challenge, we developed an MRI-compatible titanium (Ti) reinforced ET. A newly developed Ti alloy helical wire was inserted in a reinforced ET. Here, we report our first clinical experience with six patients who underwent neurosurgery intubated with this Ti-alloy-reinforced ET. The Ti-alloy-reinforced ET was used in six patients requiring reinforced ET intubation. It was clearly delineated on radiography, and metal artifacts were small on computed tomography. Patients intubated with the Ti-alloy-reinforced ET could safely undergo MRI under sedation. MR images without remarkable susceptibility artifacts were obtained without noted adverse effects. We invented a novel Ti-alloy-reinforced ET. This device allows clinical use during MRI because it is less susceptible to artifacts in high magnetic fields.

In vivo study of dual functionalized mussel-derived bioactive peptides promoting 3D-printed porous Ti6Al4V scaffolds for repair of rabbit femoral defects

The 3D printed porous titanium alloy scaffolds are beneficial to enhance angiogenesis, osteoblast adhesion, and promote osseointegration. However, titanium alloys are biologically inert, which makes the bond between the implant and bone tissue weak and prone to loosening. Inspired by the natural biological marine mussels, we designed four-claw-shaped mussel-derived bioactive peptides for the decoration of porous titanium alloy scaffolds: adhesion peptide-DOPA, anchoring peptide-RGD and osteogenic-inducing peptide-BMP-2. And the bifunctionalization of 3D-printed porous titanium alloy scaffolds was evaluated in vivo in a rabbit model of bone defect with excellent promotion of osseointegration and mechanical stability. Our results show that the in vivo osseointegration ability of the modified 3D printed porous titanium alloy test piece is significantly improved, and the bifunctional polypeptide coating group E has the strongest osseointegration ability. In conclusion, our experimental design partially solves the problems of stress shielding effect and biological inertness, and provides a convenient and feasible method for the clinical application of titanium alloy implants in biomedical implant materials.

An Experimental Analysis to Determine the Load-Bearing Capacity of 3D Printed Metals

Reverse engineering is conducted based on the analysis of an already existing product. The results of such an analysis can be used to improve the functioning of the product or develop new organizational, economic, information technology, and other solutions that increase the efficiency of the entire business system, in particular 3D printed products. Therefore, the main aim of this research is to focus on evaluation of the load-bearing capacity of already existing 3D printed metals in order to see their suitability for the intended application and to obtain their relevant mechanical properties. To this end, 3D printed metallic bars with almost square cross-sections were acquired from an external company in China without any known processing parameters, apart from the assumption that specimens No. 1–3 are printed horizontally, and specimens No. 4–7 are printed vertically. Various experiments were conducted to study microstructural characteristics and mechanical properties of 3D printed metals. It was observed that specimens No. 1–6, were almost similar in hardness, while specimen No. 7 was reduced by about 4.5% due to the uneven surface. The average value of hardness for the specimens was found to be approximately 450 HV, whereas the load-extension graphs assessed prior point towards the conclusion that the specimens’ fractured in a brittle status, is due to the lack of plastic deformation. For different specimens of the 3D printed materials, the main defects were identified, namely, lack of fusion and porosity are directly responsible for the cracks and layer delamination, prevalent in SLM printed metals. An extensive presence of cracks and layer delamination prove that the printing of these metallic bars was completed in a quick and inaccurate manner, which led to higher percentages of lack of fusion due to either low laser power, high scan speed, or the wrong scan strategy.

Effect of Aging and Cooling Path on the Super β-Transus Heat-Treated Ti-6Al-4V Alloy Produced via Electron Beam Melting (EBM)

This work focuses on the effect of different heat treatments on the Ti-6Al-4V alloy processed by means of electron beam melting (EBM). Super β-transus annealing was conducted at 1050 °C for 1 h on Ti-6Al-4V samples, considering two different cooling paths (furnace cooling and water quenching). This heat treatment induces microstructural recrystallization, thus reducing the anisotropy generated by the EBM process (columnar prior-β grains). Subsequently, the annealed furnace-cooled and water-quenched samples were aged at 540 °C for 4 h. The results showed the influence of the aging treatment on the microstructure and the mechanical properties of the annealed EBM-produced Ti-6Al-4V. A comparison with the traditional processed heat-treated material was also conducted. In the furnace-cooled specimens consisting of lamellar α+β, the aging treatment improved ductility and strength by inducing microstructural thickening of the α laths and reducing the β fraction. The effect of the aging treatment was also more marked in the water-quenched samples, characterized by high tensile strengths but limited ductility due to the presence of martensite. In fact, the aging treatment was effective in the recovery of the ductility loss, maintaining high tensile strength properties due to the variation in the relative number of α/α’ interfaces resulting from α’ decomposition. This study, therefore, offers an in-depth investigation of the potential beneficial effects of the aging treatment on the microstructure and mechanical properties of the EBM-processed super β-transus heat-treated Ti-6Al-4V alloy under different cooling conditions.

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.

Adaptive Mechanism for Designing a Personalized Cranial Implant and Its 3D Printing Using PEEK

The rehabilitation of the skull's bones is a difficult process that poses a challenge to the surgical team. Due to the range of design methods and the availability of materials, the main concerns are the implant design and material selection. Mirror-image reconstruction is one of the widely used implant reconstruction techniques, but it is not a feasible option in asymmetrical regions. The ideal design approach and material should result in an implant outcome that is compact, easy to fit, resilient, and provides the perfect aesthetic and functional outcomes irrespective of the location. The design technique for the making of the personalized implant must be easy to use and independent of the defect's position on the skull. As a result, this article proposes a hybrid system that incorporates computer tomography acquisition, an adaptive design (or modeling) scheme, computational analysis, and accuracy assessment. The newly developed hybrid approach aims to obtain ideal cranial implants that are unique to each patient and defect. Polyetheretherketone (PEEK) is chosen to fabricate the implant because it is a viable alternative to titanium implants for personalized implants, and because it is simpler to use, lighter, and sturdy enough to shield the brain. The aesthetic result or the fitting accuracy is adequate, with a maximum deviation of 0.59 mm in the outside direction. The results of the biomechanical analysis demonstrate that the maximum Von Mises stress (8.15 MPa), Von Mises strain (0.002), and deformation (0.18 mm) are all extremely low, and the factor of safety is reasonably high, highlighting the implant's load resistance potential and safety under high loading. Moreover, the time it takes to develop an implant model for any cranial defect using the proposed modeling scheme is very fast, at around one hour. This study illustrates that the utilized 3D reconstruction method and PEEK material would minimize time-consuming alterations while also improving the implant's fit, stability, and strength.

Laser Powder Bed Fusion Additive Manufacturing of a Low-Modulus Ti-35Nb-7Zr-5Ta Alloy for Orthopedic Applications

Laser powder bed fusion (L-PBF) was attempted here to additively manufacture a new generation orthopedic β titanium alloy Ti-35Nb-7Zr-5Ta toward engineering patient-specific implants. Parts were fabricated using four different values of energy density (ED) input ranging from 46.6 to 54.8 J/mm³ through predefined laser beam parameters from prealloyed powders. All the conditions yielded parts of >98.5% of theoretical density. X-ray microcomputed tomography analyses of the fabricated parts revealed minimal imperfections with enhanced densification at a higher ED input. X-ray diffraction analysis indicated a marginally larger d-spacing and tensile residual stress at the highest ED input that is ascribed to the steeper temperature gradients. Cellular to columnar dendritic transformation was observed at the highest ED along with an increase in the size of the solidified features indicating the synergetic effects of the temperature gradient and solidification growth rate. Density measurements indicated ≈99.5% theoretical density achieved for an ED of 50.0 J/mm³. The maximum tensile strength of ≈660 MPa was obtained at an ED of 54.8 J/mm³ through the formation of the columnar dendritic substructure. High ductility ranging from 25 to 30% was observed in all the fabricated parts irrespective of ED. The assessment of cytocompatibility in vitro indicated good attachment and proliferation of osteoblasts on the fabricated samples that were similar to the cell response on commercially pure titanium, confirming the potential of the additively manufactured Ti-35Nb-7Zr-5Ta as a suitable material for biomedical applications. Taken together, these results demonstrate the feasibility of L-PBF of Ti-35Nb-7Zr-5Ta for potentially engineering patient-specific orthopedic implants.

Effect of different structures fabricated by additive manufacturing on bone ingrowth

OBJECTIVE

To study the effects of different structures (solid/hollow) and pore diameters (300/600 μm) on bone ingrowth.

METHODS

Porous titanium alloy scaffolds (3.2 * 10.5 mm) were printed using electron beam melting. The implants were divided into either Hollow or Solid Group. The upper half of each implant was printed with a pore diameter of 600 μm while the bottom half was printed with a pore diameter of 300 μm. Visualization of the structural morphology was done using Scanning Electron Microscope (SEM). Cell proliferation was evaluated with the cell counting kit-8 assay and live/dead staining assay. The different lateral femoral condyles of 15 New Zealand rabbits were implanted with different groups of scaffolds. The rabbits were randomly sacrificed at the 4th, 8th, and 12th week postoperatively. Bone mineral density (BMD) and bone volume fraction (BV/TV) evaluation was completed by quantitative Micro-Computed Tomography (Micro-CT). Tissue histology were stained with toluidine blue to observe bone ingrowth under an optical microscope, and the percentage of new bone area were calculated using Image Pro-Plus 6.0.

RESULTS

SEM images showed a significant decrease in residual powder in the hollow implant and cell studies showed no obvious cytotoxicity for the Ti₆Al₄V scaffolds. Micro-CT reconstruction revealed high levels of new bone formation around the scaffolds. The trabeculae around the implants showed a gradual increase with each week, and new bone filled the scaffold pores gradually. BMD, BV/TV, and tissue histology revealed the 300 μm pore diameter is more conducive to bone ingrowth than the 600 μm (p < .05).

CONCLUSION

Our study revealed that Ti₆Al₄V implants with hollow structure could reduce the residual metal powder and implants with 300 μm pore diameter were more effective on bone formation than a 600 μm.

Main Applications and Recent Research Progresses of Additive Manufacturing in Dentistry

In recent ten years, with the fast development of digital and engineering manufacturing technology, additive manufacturing has already been more and more widely used in the field of dentistry, from the first personalized surgical guides to the latest personalized restoration crowns and root implants. In particular, the bioprinting of teeth and tissue is of great potential to realize organ regeneration and finally improve the life quality. In this review paper, we firstly presented the workflow of additive manufacturing technology. Then, we summarized the main applications and recent research progresses of additive manufacturing in dentistry. Lastly, we sketched out some challenges and future directions of additive manufacturing technology in dentistry.

Accuracy and Sheet Thinning Improvement of Deep Titanium Alloy Part with Warm Incremental Sheet-Forming Process

Incremental forming is a recent forming process that allows a sheet to be locally deformed with a hemispherical tool in order to gradually shape it. Despite good lubrication between the sheet and the tip of the smooth hemisphere tool, ductility often occurs, limiting the formability of titanium alloys due to the geometrical inaccuracy of the parts and the inability to form parts with a large depth and wall angle. Several technical solutions are proposed in the literature to increase the working temperature, allowing improvement in the titanium alloys’ formability and reducing the sheet thinning, plastic instability, and failure localization. An experimental procedure and numerical simulation were performed in this study to improve the warm single-point incremental sheet forming of a deep truncated cone in Ti-6Al-4V titanium alloy based on the use of heating cartridges. The effect of the depth part (two experiments with a truncated cone having a depth of 40 and 60 mm) at hot temperature (440 °C) on the thickness distribution and sheet shape accuracy are performed. Results show that the formability is significantly improved with the heating to produce a deep part. Small errors are observed between experimental and theoretical profiles. Moreover, errors between experimental and numerical displacements are less than 6%, which shows that the Finite Element (FE) model gives accurate predictions for titanium alloy deep truncated cones.

A state-of-the-art review of the fabrication and characteristics of titanium and its alloys for biomedical applications

Abstract

Commercially pure titanium and titanium alloys have been among the most commonly used materials for biomedical applications since the 1950s. Due to the excellent mechanical tribological properties, corrosion resistance, biocompatibility, and antibacterial properties of titanium, it is getting much attention as a biomaterial for implants. Furthermore, titanium promotes osseointegration without any additional adhesives by physically bonding with the living bone at the implant site. These properties are crucial for producing high-strength metallic alloys for biomedical applications. Titanium alloys are manufactured into the three types of α, β, and α + β. The scientific and clinical understanding of titanium and its potential applications, especially in the biomedical field, are still in the early stages. This review aims to establish a credible platform for the current and future roles of titanium in biomedicine. We first explore the developmental history of titanium. Then, we review the recent advancement of the utility of titanium in diverse biomedical areas, its functional properties, mechanisms of biocompatibility, host tissue responses, and various relevant antimicrobial strategies. Future research will be directed toward advanced manufacturing technologies, such as powder-based additive manufacturing, electron beam melting and laser melting deposition, as well as analyzing the effects of alloying elements on the biocompatibility, corrosion resistance, and mechanical properties of titanium. Moreover, the role of titania nanotubes in regenerative medicine and nanomedicine applications, such as localized drug delivery system, immunomodulatory agents, antibacterial agents, and hemocompatibility, is investigated, and the paper concludes with the future outlook of titanium alloys as biomaterials.

Graphic abstract

Intervention of 3D printing in health care: transformation for sustainable development

INTRODUCTION

Three-dimensional (3D) technology is the practice of dropping material layer-by-layer in the construction of the desired object. The application of the 3D printing technique has been observed in miscellaneous domains. Personalized medicine becomes the most demanding trend in the health-care segment. Several advancements have been observed in the progress of 3D printing. However, the availability of finished products in the marketplace is very less. There is an utmost requirement to improve the knowledge and skills in the sustainable development of pharmaceutical and medical products by selecting suitable techniques and materials.

AREAS COVERED

This article covers the fundamental process of 3D printing, types, pharmaceutical-medical application, benefits, and challenges.

EXPERT OPINION

This technology is capable of designing the complex geometry of an organ. It is feasible to produce drug products by incorporating multiple drugs in various compartments in such a fashion that these drugs can release from the compartment at a predetermined rate. Additionally, this 3D process has the potential to revolutionize personalized therapy to different age-groups through design flexibility and accurate dosing. In the upcoming years, the potential application of this technology can be seen in a clinical setting where patients will get individualized medicine as per their needs.

Tunable, Anisotropic Permeability and Spatial Flow of SLM Manufactured Structures

In this study, we report on a novel approach to produce defined porous selectively laser molten structures with predictable anisotropic permeability. For this purpose, in an initial step, the smallest possible wall proximity distance for selectively laser molten structures is investigated by applying a single line scan strategy. The obtained parameters are adapted to a rectangular and, subsequently, to a more complex honeycomb structure. As variation of the hatch distance directly affects the pore size, and thus the resulting porosity and finally permeability, we, in addition, propose and verify a mathematical correlation between selective laser melting process parameters, porosity, and permeability. Moreover, a triangular based anisotropic single line selectively laser molten structure is introduced, which offers the possibility of controlling the three-dimensional flow ratio of passing fluids. Basically, one spatial direction exhibits unhindered flow, whereas the second nearly completely prohibits any passage of the fluid. The amount to which the remaining orientation accounts for is controlled by spreading the basic triangular structure by variation of the included angle. As acute angles yield low passage ratios of 0.25 relative to continuous flow, more obtuse angles show increased ratios up to equal bidirectional flow. Hence, this novel procedure permits (for the first time) fabrication of selective laser molten structures with adjustable permeable properties independent of the applied process parameters.

CAD/CAM scaffolds for bone tissue engineering: investigation of biocompatibility of selective laser melted lightweight titanium

The objective of the current in-vitro study was to evaluate the biocompatibility of a new type of CAD/CAM scaffold for bone tissue engineering by using human cells. Porous lightweight titanium scaffolds and Bio-Oss® scaffolds as well as their eluates were used for incubation with human osteoblasts, fibroblasts and osteosarcoma cells. The cell viability was assessed by using fluorescein diazo-acetate propidium iodide staining. Cell proliferation and metabolism was examined by using MTT-, WST-Test and BrdU-ELISA tests. Scanning electron microscope was used for investigation of the cell adhesion behaviour. The number of devitalised cells in all treatment groups did not significantly deviate from the control group. According to MTT and WST results, the number of metabolically active cells was decreased by the eluates of both test groups with a more pronounced impact of the eluate from Bio-Oss®. The proliferation of the cells was inhibited by the addition of the eluates. Both scaffolds showed a partial surface coverage after 1 week and an extensive to complete coverage after 3 weeks. The CAD/CAM titanium scaffolds showed favourable biocompatibility compared to Bio-Oss® scaffolds in vitro. The opportunity of a defect-specific design and rapid prototyping by selective laser melting are relevant advantages in the field of bone tissue engineering and regenerative medicine.

Single-Step Fabrication Method toward 3D Printing Composite Diamond-Titanium Interfaces for Neural Applications

Owing to several key attributes, diamond is an attractive candidate material for neural interfacing electrodes. The emergence of additive-manufacturing (AM) of diamond-based materials has addressed multiple challenges associated with the fabrication of diamond electrodes using the conventional chemical vapor deposition (CVD) approach. Unlike the CVD approach, AM methods have enabled the deposition of three-dimensional diamond-based material at room temperature. This work demonstrates the feasibility of using laser metal deposition to fabricate diamond-titanium hybrid electrodes for neuronal interfacing. In addition to exhibiting a high electrochemical capacitance of 1.1 mF cm^-2 and a low electrochemical impedance of 1 kΩ cm² at 1 kHz in physiological saline, these electrodes exhibit a high degree of biocompatibility assessed in vitro using cortical neurons. Furthermore, surface characterization methods show the presence of an oxygen-rich mixed-phase diamond-titanium surface along the grain boundaries. Overall, we demonstrated that our unique approach facilitates printing biocompatible titanium-diamond site-specific coating-free conductive hybrid surfaces using AM, which paves the way to printing customized electrodes and interfacing implantable medical devices.

Mechanical Properties and Corrosion Resistance of TiAl6V4 Alloy Produced with SLM Technique and Used for Customized Mesh in Bone Augmentations

Bone augmentation procedures represent a real clinical challenge. One option is the use of titanium meshes. Additive manufacturing techniques can provide custom-made devices in titanium alloy. The purpose of this study was to investigate the material used, which can influence the outcomes of the bone augmentation procedure. Specific test samples were obtained from two different manufacturers with two different shapes: surfaces without perforations and with calibrated perforations. Three-point bending tests were run as well as internal friction tests to verify the Young’s modulus. Test samples were placed in two different buffered solutions and analyzed with optical microscopy. A further SEM analysis was done to observe any microstructural modification. Three-point flexural tests were conducted on 12 specimens. Initial bending was observed at lower applied stresses for the perforated samples (503 MPa) compared to non-perforated ones (900 MPa); the ultimate flexural strength was registered at 513 MPa and 1145 MPa for perforated and non-perforated samples, respectively. Both microscopic analyses (optical and SEM) showed no significant alterations. Conclusions: A normal masticatory load cannot modify the device. Chemical action in the case of exposure does not create macroscopic and microscopic alterations of the surface.

Toward Bactericidal Enhancement of Additively Manufactured Titanium Implants

Implant-associated infections (IAIs) are among the most intractable and costly complications in implant surgery. They can lead to surgery failure, a high economic burden, and a decrease in patient quality of life. This manuscript is devoted to introducing current antimicrobial strategies for additively manufactured (AM) titanium (Ti) implants and fostering a better understanding in order to pave the way for potential modern high-throughput technologies. Most bactericidal strategies rely on implant structure design and surface modification. By means of rational structural design, the performance of AM Ti implants can be improved by maintaining a favorable balance between the mechanical, osteogenic, and antibacterial properties. This subject becomes even more important when working with complex geometries; therefore, it is necessary to select appropriate surface modification techniques, including both topological and chemical modification. Antibacterial active metal and antibiotic coatings are among the most commonly used chemical modifications in AM Ti implants. These surface modifications can successfully inhibit bacterial adhesion and biofilm formation, and bacterial apoptosis, leading to improved antibacterial properties. As a result of certain issues such as drug resistance and cytotoxicity, the development of novel and alternative antimicrobial strategies is urgently required. In this regard, the present review paper provides insights into the enhancement of bactericidal properties in AM Ti implants.

Additive Manufacturing of Material Scaffolds for Bone Regeneration: Toward Application in the Clinics

Additive manufacturing (AM) allows the fabrication of customized bone scaffolds in terms of shape, pore size, material type and mechanical properties. Combined with the possibility to obtain a precise 3D image of the bone defects using computed tomography or magnetic resonance imaging, it is now possible to manufacture implants for patient-specific bone regeneration. This paper reviews the state-of-the-art of the different materials and AM techniques used for the fabrication of 3D-printed scaffolds in the field of bone tissue engineering. Their advantages and drawbacks are highlighted. For materials, specific criteria, were extracted from a literature study: biomimetism to native bone, mechanical properties, biodegradability, ability to be imaged (implantation and follow-up period), histological performances and sterilization process. AM techniques can be classified in three major categories: extrusion-based, powder-based and liquid-base. Their price, ease of use and space requirement are analyzed. Different combinations of materials/AM techniques appear to be the most relevant depending on the targeted clinical applications (implantation site, presence of mechanical constraints, temporary or permanent implant). Finally, some barriers impeding the translation to human clinics are identified, notably the sterilization process.

A systematic review of preclinical in vivo testing of 3D printed porous Ti6Al4V for orthopedic applications, part I: Animal models and bone ingrowth outcome measures

For Ti6Al4V orthopedic and spinal implants, osseointegration is often achieved using complex porous geometries created via additive manufacturing (AM). While AM porous titanium (pTi) has shown clinical success, concerns regarding metallic implants have spurred interest in alternative AM biomaterials for osseointegration. Insights regarding the evaluation of these new materials may be supported by better understanding the role of preclinical testing for AM pTi. We therefore asked: (a) What animal models have been most commonly used to evaluate AM porous Ti6Al4V for orthopedic bone ingrowth; (b) What were the primary reported quantitative outcome measures for these models; and (c) What were the bone ingrowth outcomes associated with the most frequently used models? We performed a systematic literature search and identified 58 articles meeting our inclusion criteria. We found that AM pTi was evaluated most often using rabbit and sheep femoral condyle defect (FCD) models. Additional ingrowth models including transcortical and segmental defects, spinal fusions, and calvarial defects were also used with various animals based on the study goals. Quantitative outcome measures determined via histomorphometry including ''bone ingrowth'' (range: 3.92-53.4% for rabbit/sheep FCD) and bone-implant contact (range: 9.9-59.7% for rabbit/sheep FCD) were the most common. Studies also used 3D imaging to report outcomes such as bone volume fraction (BV/TV, range: 4.4-61.1% for rabbit/sheep FCD), and push-out testing for outcomes such as maximum removal force (range: 46.6-3092 N for rabbit/sheep FCD). Though there were many commonalities among the study methods, we also found significant heterogeneity in the outcome terms and definitions. The considerable diversity in testing and reporting may no longer be necessary considering the reported success of AM pTi across all model types and the ample literature supporting the rabbit and sheep as suitable small and large animal models, respectively. Ultimately, more standardized animal models and reporting of bone ingrowth for porous AM materials will be useful for future studies.

Enhanced Osseointegration by the Hierarchical Micro-Nano Topography on Selective Laser Melting Ti-6Al-4V Dental Implants

Currently, selective laser melting (SLM) has been thriving in implant dentistry for on-demand fabricating dental implants. Based on the coarse microtopography of SLM titanium surfaces, constructing nanostructure to form the hierarchical micro-nano topography is effective in enhancing osseointegration. Given that current nanomodification techniques of SLM implants, such as anodization and hydrothermal treatment, are facing the inadequacy in costly specific apparatus and reagents, there has been no recognized nanomodified SLM dental implants. The present study aimed to construct hierarchical micro-nano topography on self-made SLM dental implants by a simple and safe inorganic chemical oxidation, and to evaluate its contribution on osteoblastic cells bioactivity and osseointegration. The surface chemical and physical parameters were characterized by FE-SEM, EDS, profilometer, AFM, and contact angle meter. The alteration on bioactivity of MG-63 human osteoblastic cells were detected by qRT-PCR. Then the osseointegration was assessed by implanting implants on the femur condyle of New Zealand Rabbits. The hierarchical micro-nano topography was constituted by the microrough surface of SLM implants and nanoneedles (diameter: 20∼50 nm, height: 150∼250 nm), after nanomodifying SLM implants in 30% hydrogen peroxide and 30% hydrochloride acid (volume ratio 1:2.5) at room temperature for 36 h. Low chemical impurities content and high hydrophilicity were observed in the nanomodified group. Cell experiments on the nanomodified group showed higher expression of mitophagy related gene (PINK1, PARKIN, LC3B, and LAMP1) at 5 days and higher expression of osteogenesis related gene (Runx2 and OCN) at 14 days. In the early stage of bone formation, the nanomodified SLM implants demonstrated higher bone-to-implant contact. Intriguingly, the initial bone-to-implant contact of nanomodified SLM implants consisted of more mineralized bone with less immature osteoid. After the cessation of bone formation, the bone-to-implant contact of nanomodified SLM implants was equal to untreated SLM implants and marketable TixOs implants. The overall findings indicated that the inorganic chemical oxidized hierarchical micro-nano topography could enhance the bioactivity of osteoblastic cells, and consequently promote the peri-implant bone formation and mineralization of SLM dental implants. This study sheds some light on improvements in additive manufactured dental implants.

Topological, Mechanical and Biological Properties of Ti6Al4V Scaffolds for Bone Tissue Regeneration Fabricated with Reused Powders via Electron Beam Melting

Cellularized scaffold is emerging as the preferred solution for tissue regeneration and restoration of damaged functionalities. However, the high cost of preclinical studies creates a gap between investigation and the device market for the biomedical industry. In this work, bone-tailored scaffolds based on the Ti6Al4V alloy manufactured by electron beam melting (EBM) technology with reused powder were investigated, aiming to overcome issues connected to the high cost of preclinical studies. Two different elementary unit cell scaffold geometries, namely diamond (DO) and rhombic dodecahedron (RD), were adopted, while surface functionalization was performed by coating scaffolds with single layers of polycaprolactone (PCL) or with mixture of polycaprolactone and 20 wt.% hydroxyapatite (PCL/HA). The mechanical and biological performances of the produced scaffolds were investigated, and the results were compared to software simulation and experimental evidence available in literature. Good mechanical properties and a favorable environment for cell growth were obtained for all combinations of scaffold geometry and surface functionalization. In conclusion, powder recycling provides a viable practice for the biomedical industry to strongly reduce preclinical costs without altering biomechanical performance.

Discovery of New Ti-Based Alloys Aimed at Avoiding/Minimizing Formation of α” and ω-Phase Using CALPHAD and Artificial Intelligence

In this work, we studied a Ti-Nb-Zr-Sn system for exploring novel composition and temperatures that will be helpful in maximizing the stability of β phase while minimizing the formation of α” and ω-phase. The Ti-Nb-Zr-Sn system is free of toxic elements. This system was studied under the framework of CALculation of PHAse Diagram (CALPHAD) approach for determining the stability of various phases. These data were analyzed through artificial intelligence (AI) algorithms. Deep learning artificial neural network (DLANN) models were developed for various phases as a function of alloy composition and temperature. Software was written in Python programming language and DLANN models were developed utilizing TensorFlow/Keras libraries. DLANN models were used to predict various phases for new compositions and temperatures and provided a more complete dataset. This dataset was further analyzed through the concept of self-organizing maps (SOM) for determining correlations between phase stability of various phases, chemical composition, and temperature. Through this study, we determined candidate alloy compositions and temperatures that will be helpful in avoiding/minimizing formation of α” and ω-phase in a Ti-Zr-Nb-Sn system. This approach can be utilized in other systems such as ω-free shape memory alloys. DLANN models can even be used on a common Android mobile phone.

Selective Laser Melting of Patient Individualized Osteosynthesis Plates-Digital to Physical Process Chain

We report on the exemplified realization of a digital to physical process chain for a patient individualized osteosynthesis plate for the tarsal bone area. Anonymized patient-specific data of the right feet were captured by computer tomography, which were then digitally processed to generate a surface file format (standard tessellation language, STL) ready for additive manufacturing. Physical realization by selective laser melting in titanium using optimized parameter settings and post-processing by stress relief annealing results in a customized osteosynthesis plate with superior properties fulfilling medical demands. High fitting accuracy was demonstrated by applying the osteosynthesis plate to an equally good 3D printed bone model, which likewise was generated using the patient-specific computer tomography (CT) data employing selective laser sintering and polyamid 12. Proper fixation has been achieved without any further manipulation of the plate using standard screws, proving that based on CT data, individualized implants well adapted to the anatomical conditions can be accomplished without the need for additional steps, such as bending, cutting and shape trimming of precast bone plates during the surgical intervention. Beyond parameter optimization for selective laser melting, this exemplified digital to physical process chain highlights the potential of additive manufacturing for individualized osteosynthesis.

Structural and Biomedical Properties of Common Additively Manufactured Biomaterials: A Concise Review

Biomaterials are in high demand due to the increasing geriatric population and a high prevalence of cardiovascular and orthopedic disorders. The combination of additive manufacturing (AM) and biomaterials is promising, especially towards patient-specific applications. With AM, unique and complex structures can be manufactured. Furthermore, the direct link to computer-aided design and digital scans allows for a direct replicable product. However, the appropriate selection of biomaterials and corresponding AM methods can be challenging but is a key factor for success. This article provides a concise material selection guide for the AM biomedical field. After providing a general description of biomaterial classes—biotolerant, bioinert, bioactive, and biodegradable—we give an overview of common ceramic, polymeric, and metallic biomaterials that can be produced by AM and review their biomedical and mechanical properties. As the field of load-bearing metallic implants experiences rapid growth, we dedicate a large portion of this review to this field and portray interesting future research directions. This article provides a general overview of the field, but it also provides possibilities for deepening the knowledge in specific aspects as it comprises comprehensive tables including materials, applications, AM techniques, and references.

Mechanical, Histological, and Scanning Electron Microscopy Study of the Effect of Mixed-Acid and Heat Treatment on Additive-Manufactured Titanium Plates on Bonding to the Bone Surface

The additive manufacturing (AM) technique has attracted attention as one of the fully customizable medical material technologies. In addition, the development of new surface treatments has been investigated to improve the osteogenic ability of the AM titanium (Ti) plate. The purpose of this study was to evaluate the osteogenic activity of the AM Ti with mixed-acid and heat (MAH) treatment. Fully customized AM Ti plates were created with a curvature suitable for rat calvarial bone, and they were examined in a group implanted with the MAH-treated Ti in comparison with the untreated (UN) group. The AM Ti plates were fixed to the surface of rat calvarial bone, followed by extraction of the calvarial bone 1, 4, 8, and 12 weeks after implantation. The bonding between the bone and Ti was evaluated mechanically. In addition, AM Ti plates removed from the bone were examined histologically by electron microscopy and Villanueva-Goldner stain. The mechanical evaluation showed significantly stronger bone-bonding in the MAH group than in the UN group. In addition, active bone formation was seen histologically in the MAH group. Therefore, these findings indicate that MAH resulted in rapid and strong bonding between cortical bone and Ti.

Osteoconductivity of bioactive Ti-6Al-4V implants with lattice-shaped interconnected large pores fabricated by electron beam melting

Additive manufacturing has facilitated the fabrication of orthopedic metal implants with interconnected pores. Recent reports have indicated that a pore size of 600 μm is beneficial for material-induced osteogenesis. However, the complete removal of the metal powder from such small pores of implants is extremely difficult especially in electron beam melting (EBM). We therefore developed a new type of Ti-6Al-4V implant with lattice-shaped interconnected pores measuring 880-1400 μm, which allowed for the easy removal of metal powder. This implant was fabricated by EBM and treated with NaOH, CaCl₂, heat, and water (ACaHW treatment) to render the metal surface bioactivity. In the present study, the mechanical and chemical property of the implants and the biocompatibility were evaluated. The SEM and micro-CT images demonstrated the 3D interconnectivity of the porous structures. The average porosity of the porous titanium implant was 57.5%. The implant showed maximum compressive load of 78.9 MPa and Young's modulus of 3.57 GPa which matches that of human cortical bone. ACaHW treatment of the porous Ti-6Al-4V implants induced apatite formation in simulated body fluid in vitro. The ACaHW-treated porous implants harvested from rabbit femoral bone showed direct bonding of bone to the metal surface without interposition of fibrous tissue. The porous ACaHW-treated implant had a higher affinity to the bone than the untreated one. The mechanical strength of implant fixation assessed using the push-out test was significantly higher in the ACaHW-treated implant than in untreated one. FE-SEM analysis and EDX mapping after push-out test of solid implants showed a lot of bone tissue patches on the surface of the ACaHW-treated implant. These results suggest that the new ACaHW-treated Ti-6Al-4V implant with lattice-shaped interconnected pores is a superior alternative to conventional materials for medical application.

Tissue Integration and Biological Cellular Response of SLM-Manufactured Titanium Scaffolds

Background: SLM (Selective Laser Melting)–manufactured Titanium (Ti) scaffolds have a significant value for bone reconstructions in the oral and maxillofacial surgery field. While their mechanical properties and biocompatibility have been analysed, there is still no adequate information regarding tissue integration. Therefore, the aim of this study is a comprehensive systematic assessment of the essential parameters (porosity, pore dimension, surface treatment, shape) required to provide the long-term performance of Ti SLM medical implants. Materials and methods: A systematic literature search was conducted via electronic databases PubMed, Medline and Cochrane, using a selection of relevant search MeSH terms. The literature review was conducted using the preferred reporting items for systematic reviews and meta-analysis (PRISMA). Results: Within the total of 11 in vitro design studies, 9 in vivo studies, and 4 that had both in vitro and in vivo designs, the results indicated that SLM-generated Ti scaffolds presented no cytotoxicity, their tissue integration being assured by pore dimensions of 400 to 600 µm, high porosity (75–88%), hydroxyapatite or SiO2–TiO2 coating, and bioactive treatment. The shape of the scaffold did not seem to have significant importance. Conclusions: The SLM technique used to fabricate the implants offers exceptional control over the structure of the base. It is anticipated that with this technique, and a better understanding of the physical interaction between the scaffold and bone tissue, porous bases can be tailored to optimize the graft’s integrative and mechanical properties in order to obtain structures able to sustain osseous tissue on Ti.

Fabrication of piezoelectric porous BaTiO3 scaffold to repair large segmental bone defect in sheep

Porous titanium scaffolds can provide sufficient mechanical support and bone growth space for large segmental bone defect repair. However, they fail to restore the physiological environment of bone tissue. Barium titanate (BaTiO3) is considered a smart material that can produce an electric field in response to dynamic force. Low-intensity pulsed ultrasound stimulation (LIPUS), as a kind of micromechanical wave, can not only promote bone repair but also induce BaTiO3 to generate an electric field. In our studies, BaTiO3 was coated on porous Ti6Al4V and LIPUS was externally applied to observe the influence of the piezoelectric effect on the repair of large bone defects in vitro and in vivo. The results show that the piezoelectric effect can effectively promote the osteogenic differentiation of bone marrow stromal cells (BMSCs) in vitro as well as bone formation and growth into implants in vivo. This study provides an optional alternative to the conventional porous Ti6Al4V scaffold with enhanced osteogenesis and osseointegration for the repair of large bone defects.

Surface modification of titanium manufactured through selective laser melting inhibited osteoclast differentiation through mitogen-activated protein kinase signaling pathway

Selective laser melting used in manufacturing custom-made titanium implants becomes more popular. In view of the important role played by osteoclasts in peri-implant bone resorption and osseointegration, we modified selective laser melting-manufactured titanium surfaces using sandblasting/alkali-heating and sandblasting/acid-etching, and investigated their effect on osteoclast differentiation as well as their underlying mechanisms. The properties of the surfaces, including elements, roughness, wettability and topography, were analyzed. We evaluated the proliferation and morphology of primary mouse bone marrow-derived monocytes, as well as induced osteoclasts derived from bone marrow-derived monocytes, on samples. Then, osteoclast differentiation was determined by the tartrate-resistant acid phosphatase activity assay, calcitonin receptors immunofluorescence staining and the expression of osteoclast-related genes. The results showed that sandblasting/alkali-heating established nanonet structure with the lowest water contact angle, and both sandblasting/alkali-heating and sandblasting/acid-etching significantly decreased surface roughness and heterogeneity compared with selective laser melting. Surface modifications of selective laser melting-produced titanium altered bone marrow-derived monocyte morphology and suppressed bone marrow-derived monocyte proliferation and osteoclastogenesis in vitro (sandblasting/alkali-heating>sandblasting/acid-etching>selective laser melting). These surface modifications reduced the activation of extracellular signal-regulated kinase and c-Jun N-terminal kinases compared to native-selective laser melting. Sandblasting/alkali-heating additionally blocked tumor necrosis factor receptor-associated factor 6 recruitment. The results suggested that sandblasting/alkali-heating and sandblasting/acid-etching modifications on selective laser melting titanium could inhibit osteoclast differentiation through suppressing extracellular signal-regulated kinase and c-Jun N-terminal kinase phosphorylation in mitogen-activated protein kinase signaling pathway and provide a promising technique which might reduce peri-implant bone resorption for optimizing native-selective laser melting implants.

Design of Additively Manufactured Structures for Biomedical Applications: A Review of the Additive Manufacturing Processes Applied to the Biomedical Sector

Additive manufacturing (AM) is a disruptive technology as it pushes the frontier of manufacturing towards a new design perspective, such as the ability to shape geometries that cannot be formed with any other traditional technique. AM has today shown successful applications in several fields such as the biomedical sector in which it provides a relatively fast and effective way to solve even complex medical cases. From this point of view, the purpose of this paper is to illustrate AM technologies currently used in the medical field and their benefits along with contemporary. The review highlights differences in processes, materials, and design of additive manufacturing techniques used in biomedical applications. Successful case studies are presented to emphasise the potentiality of AM processes. The presented review supports improvements in materials and design for future researches in biomedical surgeries using instruments and implants made by AM.

Numerical-Experimental Study of the Consolidation Phenomenon in the Selective Laser Melting Process with a Thermo-Fluidic Coupled Model

One of the main limiting factors for a widespread industrial use of the Selective Laser Melting Process it its lack of productivity, which restricts the use of this technology just for high added-value components. Typically, the thickness of the metallic powder that is used lies on the scale of micrometers. The use of a layer up to one millimeter would be necessarily associated to a dramatic increase of productivity. Nevertheless, when the layer thickness increases, the complexity of consolidation phenomena makes the process difficult to be governed. The present work proposes a 3D finite element thermo-coupled model to study the evolution from the metallic powder to the final consolidated material, analyzing specifically the movements and loads of the melt pool, and defining the behavior of some critical thermophysical properties as a function of temperature and the phase of the material. This model uses advanced numerical tools such as the Arbitrary Lagrangean⁻Eulerian formulation and the Automatic Remeshing technique. A series of experiments have been carried out, using a high thickness powder layer, allowing for a deeper understanding of the consolidation phenomena and providing a reference to compare the results of the numerical calculations.

Production of Single Tracks of Ti-6Al-4V by Directed Energy Deposition to Determine the Layer Thickness for Multilayer Deposition

Directed Energy Deposition (DED), which is an additive manufacturing technique, involves the creation of a molten pool with a laser beam where metal powder is injected as particles. In general, this technique is employed to either fabricate or repair different components. In this technique, the final characteristics are affected by many factors. Indeed, one of the main tasks in building components by DED is the optimization of process parameters (such as laser power, laser speed, focus, etc.) which is usually carried out through an extensive experimental investigation. However, this sort of experiment is extremely lengthy and costly. Thus, in order to accelerate the optimization process, an investigation was conducted to develop a method based on the melt pool characterizations. In fact, in these experiments, single tracks of Ti-6Al-4V were deposited by a DED process with multiple combinations of laser power and laser speed. Surface morphology and dimensions of single tracks were analyzed, and geometrical characteristics of melt pools were evaluated after polishing and etching the cross-sections. Helpful information regarding the selection of optimal process parameters can be achieved by examining the melt pool features. These experiments are being extended to characterize the larger blocks with multiple layers. Indeed, this manuscript describes how it would be possible to quickly determine the layer thickness for the massive deposition, and avoid over or under-deposition according to the calculated energy density of the optimum parameters. Apart from the over or under-deposition, time and materials saving are the other great advantages of this approach in which the deposition of multilayer components can be started without any parameter optimization in terms of layer thickness.