Recent Developments of Biomaterials for Additive Manufacturing of Bone Scaffolds

3D printed polycaprolactone scaffold incorporated with tragacanth gum/bioactive glass and cellulose nanocrystals for bone tissue engineering

Biomimetic organic-inorganic nanocomposite scaffolds hold tremendous potential to accelerate bone regeneration due to their ability to provide excellent structural and biological cues. Therefore, we employed a 3D-printed polycaprolactone host component as a mechanical support that was filled with a tragacanth gum-45S5 bioactive glass-cellulose nanocrystal guest component. The designed host-guest scaffolds were evaluated via physical, chemical, mechanical, and biological properties. Owing to the successful integration between host and guest components, the scaffolds showed enhanced physical and swelling properties (approximately 100 %) for nutrient transfer and cell proliferation. Furthermore, the host-guest scaffolds exhibited improved surface apatite formation and increased strength (3.35-16.55 MPa) within the ideal range for bone tissue engineering applications. It was verified in vitro that the host-guest scaffolds offer a highly desirable microenvironment for cell proliferation and attachment. Importantly, the host-guest scaffolds exhibited remarkable calcium deposition (4-56 %) and matrix formation. However, it was found that the proportion of cellulose nanocrystals can affect the properties of fabricated host-guest scaffolds. These results highlight the importance of optimizing the cellulose nanocrystal content in the scaffold composition to achieve the desired balance of properties for effective bone tissue engineering applications. The incorporation of cellulose nanocrystals at lower concentrations, particularly 3 wt%, represents a promising approach for developing biomimetic scaffolds that can enhance bone regeneration. Notably, the results of this study confirmed that incorporating cellulose nanocrystals at lower concentrations into the host-guest scaffolds is a viable strategy for fabricating a suitable biomaterial that enhances bone tissue engineering applications.

Review of 3D-printed bioceramic/biopolymer composites for bone regeneration: fabrication methods, technologies and functionalized applications

Biomaterials for orthopedic applications must have biocompatibility, bioactivity, and optimal mechanical performance. A suitable biomaterial formulation is critical for creating desired devices. Bioceramics with biopolymer composites and biomimetics with components similar to that of bone tissue, have been recognized as an area of research for orthopedic applications. The combination of bioceramics with biopolymers has the advantage of satisfying the need for robust mechanical support and extracellular matrices at the same time. Three-dimensional (3D) printing is a powerful method for restoring large bone defects and skeletal abnormalities owing to the favorable merits of preparing large, porous, patient-specific, and other intricate architectures. Bioceramic/biopolymer composites produced using 3D printing technology have several advantages, including desirable optimal architecture, enhanced tissue mimicry, and improved biological and physical properties. This review describes various 3D printing bioceramic/biopolymer composites for orthopedic applications. We hope that these technologies will inspire the future design and fabrication of 3D printing bioceramic/biopolymer composites for clinical and commercial applications.

Structural Evolution of an Optimized Highly Interconnected Hierarchical Porous Mg Scaffold under Dynamic Flow Challenges

The development of Mg and its alloys as bone screws has garnered significant attention due to their exceptional biocompatibility and unique biodegradability. Notably, the controlled release of Mg2+ ions during degradation can positively influence bone fracture healing. The advantages of Mg raise appeal for application in bone tissue engineering. However, porous Mg scaffolds, while offering high surface areas, face challenges in maintaining slow degradation rates and preserving interconnectivity, which are crucial features for tissue ingrowth. To address these issues, this study introduces a highly interconnected hierarchical porous Mg scaffold and investigates its degradation behavior within a bioreactor, simulating body fluid flow rates to mimic the in vivo degradation performance at different implantation sites. The focus lies on elucidating the evolution of the porous structure, particularly the impact of degradation behavior on scaffold interconnectivity. Our findings reveal that the initial high interconnectivity of the scaffold is significantly influenced by the flow rate. The dynamic fluid flow modulates the transport of degradation byproducts and the deposition patterns. At lower flow rates, Mg2+ ions accumulate within pores, leading to the formation of substantial deposits that directly reduce porosity. Specifically, after 42 days, porosities decreased to 68.80 ± 2.31, 58.52 ± 2.53, and 41.25 ± 2.82% at flow rates of 2.0, 1.0, and 0.5 mL/min, respectively. This porosity reduction and pore space occlusion by deposits sequentially hinder the interconnectivity. The magnitude of decreased porosity could be used to evaluate the ability of the microarchitecture to maintain scaffold interconnectivity. Meanwhile, the long-term degradation deposition behavior of the highly interconnected hierarchical porous Mg scaffold potentially revealed the structural integrity loss from the original design to its in vivo degraded structure at different body fluid flow rates. The present work might bring valuable insight into the design of pore strut and interconnectivity characterization methods for the progress of a high-performance tissue engineering scaffold.

Innovative 3D-printed porous TC4 prosthesis with nano-thin tantalum coating for treating complex wrist bone defects: A preliminary report of 3 cases

Background: Bone defects pose a significant orthopedic challenge, impacting millions of patients worldwide annually. In our prior research, we innovatively applied magnetron sputtering (MSP) technology to prepare nano thin amorphous tantalum (Ta) coatings on titanium alloy (Ti - 6Al - 4V, TC4) substrate, achieving exceptional interfacial adhesion, comprehensive coverage, and notable biological attributes. The purpose of this study is to investigate the clinical outcomes of TC4-based Ta-coated implants in addressing wrist bone defects, thereby offering valuable insights for future clinical applications. Methods: A prospective observational study was conducted from October 2023 to December 2024 to assess the clinical efficacy of TC4-based Ta-coated implants. Three patients, comprising two males and one females, were included and underwent personalized prosthesis design and surgical implantation in accordance with established protocols. Postoperative assessments were conducted utilizing the Visual Analogue Scale (VAS), and Cooney modification of the Green and O'Brien score to gauge the patients' symptomatic relief and functional recovery. Additionally, regular imaging follow-ups were implemented to monitor the progress and outcomes. Results: All three patients underwent surgery successfully. As of the latest follow-up, all patients exhibited significant improvements in pain symptoms (assessed using VAS scores) and functional outcomes. No patients experienced serious complications such as infection, prosthesis loosening, or vascular and nerve damage. Conclusion: This study confirmed the clinical efficacy of customized TC4-based Ta-coated implants in the treatment of wrist bone defects. The nanoscale Ta coating significantly enhances the bone integration ability, thereby effectively improving clinical outcomes. This innovative approach not only demonstrates the potential to overcome the inherent drawbacks of conventional titanium alloys and pure Ta but also offers a highly prospective solution for the treatment of complex wrist bone defects. Future research should be directed towards enhancing manufacturing processes and undertaking more extensive clinical trials for providing evidence-based guidance for clinical applications.

Visible Light-Sensitive Sustainable Quantum Dot Crystals of Co/Mg Doped Natural Hydroxyapatite Possessing Antimicrobial Activity and Biocompatibility

Cutting-edge research in advanced materials is increasingly turning toward the development of novel multifunctional nanomaterials for use in high-tech applications. This research uses the solid-state method as a solvent-free technique to create multifunctional quantum dot (QD) hydroxyapatite (HA) crystals from bovine bone waste. By incorporating cobalt (Co) and magnesium (Mg) into the HA structure, the crystallinity of the hexagonal HA nanoparticles (99.7%), showing QD crystals is enhanced. Oxygen vacancies on the surfaces of the HA nanoparticles contributed to their bandgap falling within the visible light range. In addition, the dopants substituted calcium in the HA crystal structure and generated a divalent oxidation state, shifting the bandgap of natural HA toward red wavelengths (3.26 to 1.94 eV). Moreover, the incorporation of Co led to magnetization within the HA structure through spin polarization. Additionally, the doped QD crystals of HA nanoparticles showed significant antimicrobial activity against Escherichia coli, Staphylococcus aureus, and bacteriophages MS2, particularly under visible light exposure. In short, the Co/Mg co-doped HA nanoparticles exhibited ferromagnetic properties, sensitivity to visible light, biocompatibility, and considerable antimicrobial effects, establishing their potential as sustainable multifunctional materials for biomedical applications, especially in anti-infection treatments.

Graded or random - Effect of pore distribution in 3D titanium scaffolds on corrosion performance and response of hMSCs

Researchers agree that the ideal scaffold for tissue engineering should possess a 3D and highly porous structure, biocompatibility to encourage cell/tissue growth, suitable surface chemistry for cell attachment and differentiation, and mechanical properties that match those of the surrounding tissues. However, there is no consensus on the optimal pore distribution. In this study, we investigated the effect of pore distribution on corrosion resistance and performance of human mesenchymal stem cells (hMSC) using titanium scaffolds fabricated by laser beam powder bed fusion (PBF-LB). We designed two scaffold architectures with the same porosities (i.e., 75 %) but different distribution of pores of three sizes (200, 500, and 700 μm). The pores were either grouped in three zones (graded, GRAD) or distributed randomly (random, RAND). Microfocus X-ray computed tomography revealed that the chemically polished scaffolds had the porosity of 69 ± 4 % (GRAD) and 71 ± 4 % (RAND), and that the GRAD architecture had the higher surface area (1580 ± 101 vs 991 ± 62 mm2) and the thinner struts (221 ± 37 vs 286 ± 14 μm). The electrochemical measurements demonstrated that the apparent corrosion rate of chemically polished GRAD scaffold decreased with the immersion time extension, while that for polished RAND was increased. The RAND architecture outperformed the GRAD one with respect to hMSC proliferation (over two times higher although the GRAD scaffolds had 85 % higher initial cell retention) and migration from a monolayer. Our findings demonstrate that the pore distribution affects the biological properties of the titanium scaffolds for bone tissue engineering.

Prospective applications of bioactive materials in orthopedic therapies: A review

The biomedical application of biodegradable polymers for addressing bone-related diseases has garnered considerable attention in recent years. Advances in material technology have expanded the repertoire of materials suitable for orthopedic implants, with nanomaterials playing a pivotal role in replicating crucial surface properties akin to natural tissues. This comprehensive review explores the evaluation of bioactive glass ceramics, shedding light on their properties and applications. The synthesis of composites through composite manufacturing has emerged as a strategy to enhance biocompatibility and biomechanical characteristics. They are addressing challenges associated with conventional implants and nanomaterials, whether in the form of functional nano coatings or nanostructured surfaces, present opportunities to refine implant techniques. Novel developments in orthopedic biomaterials, such as smart biomaterials, porous structures, and 3D implants, offer stimuli-responsive behavior to achieve desired implant shapes and characteristics. Bioactive and biodegradable porous polymer/inorganic composite materials are explored for bone tissue engineering scaffolds, aiming to promote bone formation and regeneration. As a prospective direction, the integration of stem cells into scaffolds hints at the creation of next-generation synthetic/living hybrid biomaterials, displaying high adaptability in biological settings. This review establishes a foundation for nanotechnology-driven biomaterials by elucidating fundamental design factors crucial for orthopedic implant performance and their response to cell differentiation, proliferation, and adhesion.

An adaptive biodegradable zinc alloy with bidirectional regulation of bone homeostasis for treating fractures and aged bone defects

Healing of fractures or bone defects is significantly hindered by overactivated osteoclasts and inhibited osteogenesis in patients with abnormal bone metabolism. Current clinical approaches using titanium alloys or stainless steel provide mechanical support but have no biological effects on bone regeneration. Therefore, designing and fabricating degradable metal materials with sufficient mechanical strength and bidirectional regulation of both osteoblasts and osteoclasts is a substantial challenge. Here, this study first reported an adaptive biodegradable Zn-0.8 Mg alloy with bidirectional regulation of bone homeostasis, which promotes osteogenic differentiation by activating the Pi3k/Akt pathway and inhibits osteoclast differentiation by inhibiting the GRB2/ERK pathway. The anti-osteolytic ability of the Zn-0.8 Mg alloy was verified in a mouse calvarial osteolysis model and its suitability for internal fracture fixation with high-strength screws was confirmed in the rabbit femoral condyle fracture model. Furthermore, in an aged postmenopausal rat femoral condyle defect model, 3D printed Zn-0.8 Mg scaffolds promoted excellent bone regeneration through adaptive structures with good mechanical properties and bidirectionally regulated bone metabolism, enabling personalized bone defect repair. These findings demonstrate the substantial potential of the Zn-0.8 Mg alloy for treating fractures or bone defects in patients with aberrant bone metabolism.

Single-Atom Cu Nanozyme-Loaded Bone Scaffolds for Ferroptosis-Synergized Mild Photothermal Therapy in Osteosarcoma Treatment

The rapid multiplication of residual tumor cells and poor reconstruction quality of new bone are considered the major challenges in the postoperative treatment of osteosarcoma. It is a promising candidate for composite bone scaffold which combines photothermal therapy (PTT) and bone regeneration induction for the local treatment of osteosarcoma. However, it is inevitable to damage the normal tissues around the tumor due to the hyperthermia of PTT, while mild heat therapy shows a limited effect on antitumor treatment as the damage can be easily repaired by stress-induced heat shock proteins (HSP). This study reports a new type of single-atom Cu nanozyme-loaded bone scaffolds, which exhibit exceptional photothermal conversion properties as well as peroxidase and glutathione oxidase mimicking activities in vitro experiments. This leads to lipid peroxidation (LPO) and reactive oxygen species (ROS) upregulation, ultimately causing ferroptosis. The accumulation of LPO and ROS also contributes to HSP70 inactivation, maximizing PTT efficiency against tumors at an appropriate therapeutic temperature and minimizing the damage to surrounding normal tissues. Further, the bone scaffold promotes bone regeneration via a continuous release of bioactive ions (Ca2+, P5+, Si4+, and Cu2+). The results of in vivo experiments reveal that scaffolds inhibit tumor growth and promote bone repair.

3D-printed porous tantalum artificial bone scaffolds: fabrication, properties, and applications

Porous tantalum scaffolds offer a high degree of biocompatibility and have a low friction coefficient. In addition, their biomimetic porous structure and mechanical properties, which closely resemble human bone tissue, make them a popular area of research in the field of bone defect repair. With the rapid advancement of additive manufacturing, 3D-printed porous tantalum scaffolds have increasingly emerged in recent years, offering exceptional design flexibility, as well as facilitating the fabrication of intricate geometries and complex pore structures that similar to human anatomy. This review provides a comprehensive description of the techniques, procedures, and specific parameters involved in the 3D printing of porous tantalum scaffolds. Concurrently, the review provides a summary of the mechanical properties, osteogenesis and antibacterial properties of porous tantalum scaffolds. The use of surface modification techniques and the drug carriers can enhance the characteristics of porous tantalum scaffolds. Accordingly, the review discusses the application of these porous tantalum materials in clinical settings. Multiple studies have demonstrated that 3D-printed porous tantalum scaffolds exhibit exceptional corrosion resistance, biocompatibility, and osteogenic properties. As a result, they are considered highly suitable biomaterials for repairing bone defects. Despite the rapid development of 3D-printed porous tantalum scaffolds, they still encounter challenges and issues when used as bone defect implants in clinical applications. Ultimately, a concise overview of the primary challenges faced by 3D-printed porous tantalum scaffolds is offered, and corresponding insights to promote further exploration and advancement in this domain are presented.

Novel-Ink-Based Direct Ink Writing of Ti6Al4V Scaffolds with Sub-300 µm Structural Pores for Superior Cell Proliferation and Differentiation

Ti6Al4V scaffolds with pore sizes between 300 and 600 µm are deemed suitable for bone tissue engineering. However, a significant proportion of human bone pores are smaller than 300 µm, playing a crucial role in cell proliferation, differentiation, and bone regeneration. Ti6Al4V scaffolds with these small-sized pores are not successfully fabricated, and their cytocompatibility remains unknown. The study presents a novel ink formula specifically tailored for fabricating Ti6Al4V scaffolds featuring precise and unobstructed sub-300 µm structural pores, achieved by investigating the rheological properties and printability of five inks containing 60-77.5 vol% Ti6Al4V powders and bisolvent binders. Ti6Al4V scaffolds with 50-600 µm pores are fabricated via direct ink writing and subjected to in vitro assays with MC3T3-E1 and bone marrow mesenchymal stem cells. The 100 µm pore-sized scaffolds exhibit the highest cell adhesion and proliferation capacity based on live/dead assay, FITC-phalloidin/4',6-diamidino-2-phenylindole staining, and cell count kit 8 assay. The alizarin red staining, real-time quantitative PCR assay, and immunocytochemical staining demonstrate the superior osteogenic differentiation potential of 100 and 200 µm pore-sized scaffolds. The importance of sub-300 µm structrual pores is highlighted, redefining the optimal pore size for Ti6Al4V scaffolds and advancing bone tissue engineering and clinical medicine development.

Nanosized Silk-Magnesium Complexes for Promotion of Angiogenic and Osteogenic Activities

Injectable hydrogels with osteogenic and angiogenetic properties are of interest in bone tissue engineering. Since the bioactivity of ions is concentration-dependent, nanosized silk-magnesium (Mg) complexes were previously developed and assembled into hydrogels with angiogenic capabilities but failed to control both osteogenic and angiogenetic activities effectively. Here, nanosized silk particles with different sizes were obtained by using ultrasonic treatment to control silk-Mg coordination and particle formation, resulting in silk-Mg hydrogels with different types of bioactivity. Fourier transform infrared and X-ray diffraction results revealed that different coordination intensities were present in the different complexes as a basis for the differences in activities. Slow Mg ion release was controlled by these nanosized silk-Mg complexes through degradation. With the same amount of Mg ions, the different silk-Mg complexes exhibited different angiogenic and osteogenic capacities. Complexes with both angiogenic and osteogenic capacities were developed by optimizing the sizes of the silk particles, resulting in faster and improved quality of bone formed in vivo than complexes with the same composition of silk and Mg but only angiogenic or osteogenic capacities. The biological selectivity of silk-Mg complexes should facilitate applications in tissue regeneration.

Construction of antibacterial bone implants and their application in bone regeneration

Bacterial infection represents a prevalent challenge during the bone repair process, often resulting in implant failure. However, the extensive use of antibiotics has limited local antibacterial effects at the infection site and is prone to side effects. In order to address the issue of bacterial infection during the transplantation of bone implants, four types of bone scaffold implants with long-term antimicrobial functionality have been constructed, including direct contact antimicrobial scaffold, dissolution-penetration antimicrobial scaffold, photocatalytic antimicrobial scaffold, and multimodal synergistic antimicrobial scaffold. The direct contact antimicrobial scaffold involves the physical penetration or disruption of bacterial cell membranes by the scaffold surface or hindrance of bacterial adhesion through surface charge, microstructure, and other factors. The dissolution-penetration antimicrobial scaffold releases antimicrobial substances from the scaffold's interior through degradation and other means to achieve local antimicrobial effects. The photocatalytic antimicrobial scaffold utilizes the absorption of light to generate reactive oxygen species (ROS) with enhanced chemical reactivity for antimicrobial activity. ROS can cause damage to bacterial cell membranes, deoxyribonucleic acid (DNA), proteins, and other components. The multimodal synergistic antimicrobial scaffold involves the combined use of multiple antimicrobial methods to achieve synergistic effects and effectively overcome the limitations of individual antimicrobial approaches. Additionally, the biocompatibility issues of the antimicrobial bone scaffold are also discussed, including in vitro cell adhesion, proliferation, and osteogenic differentiation, as well as in vivo bone repair and vascularization. Finally, the challenges and prospects of antimicrobial bone implants are summarized. The development of antimicrobial bone implants can provide effective solutions to bacterial infection issues in bone defect repair in the foreseeable future.

Advances in 3D Printing of Highly Bioadaptive Bone Tissue Engineering Scaffolds

The number of patients with bone defects caused by trauma, bone tumors, and osteoporosis has increased considerably. The repair of irregular, recurring, and large bone defects poses a great challenge to clinicians. Bone tissue engineering is emerging as an appropriate strategy to replace autologous bone grafting in the repair of critically sized bone defects. However, the suitability of bone tissue engineering scaffolds in terms of structure, mechanics, degradation, and the microenvironment is inadequate. Three-dimensional (3D) printing is an advanced additive-manufacturing technology widely used for bone repair. 3D printing constructs personalized structurally adapted scaffolds based on 3D models reconstructed from CT images. The contradiction between the mechanics and degradation is resolved by altering the stacking structure. The local microenvironment of the implant is improved by designing an internal pore structure and a spatiotemporal factor release system. Therefore, there has been a boom in the 3D printing of personalized bone repair scaffolds. In this review, successful research on the preparation of highly bioadaptive bone tissue engineering scaffolds using 3D printing is presented. The mechanisms of structural, mechanical, degradation, and microenvironmental adaptations of bone prostheses and their interactions were elucidated to provide a feasible strategy for constructing highly bioadaptive bone tissue engineering scaffolds.

Enhanced mechanic properties of calcium phosphate cements via mussel-inspired adhesive as bone substitute: Highlights of their interactions

BACKGROUND

Inspired by natural bones, many organic components were added to Calcium Phosphate Cements (CPCs) to improve their mechanical strength. However, the strength of these composite CPCs is limited by the low strength of organic components itself and the weak interaction between organic components and CPCs.

OBJECTIVE

Firstly, a composite CPC containing mussel-inspired adhesive, Poly-(Dopamine Methacrylamide-co-2-methoxy Ethylacrylate) (pDM) was developed. Secondly, the interactions between pDM and CPC and their effect on mechanical properties were investigated.

METHODS

The interactions between pDM and CPC were performed by Nuclear Magnetic Resonance, Laser Raman, X-ray Photoelectron Spectroscopy, Fourier Transform-Infrared Spectroscopy and X-ray Diffraction Analysis.

RESULTS

The toughness and compressive strength of pDM-CPC scaffold were both significantly enhanced, because of the enhanced interface binding strength among CPC and pDM due to their interaction and the improved mechanical strength of pDM owing to its self-oxidation cross-linking. The toughness of pDM-CPC scaffolds increased with the increased contents of pDM, while pDM-CPC scaffold containing 35 wt.% pDM had the highest compressive strength of all, which the latter was more than five times compared to that of CPC.

CONCLUSION

The mechanically strong pDM-CPC scaffolds has potential application in bone regeneration as well as in craniofacial and orthopedic repair.

Recent Progress in Advanced Polyester Elastomers for Tissue Engineering and Bioelectronics

Polyester elastomers are highly flexible and elastic materials that have demonstrated considerable potential in various biomedical applications including cardiac, vascular, neural, and bone tissue engineering and bioelectronics. Polyesters are desirable candidates for future commercial implants due to their biocompatibility, biodegradability, tunable mechanical properties, and facile synthesis and fabrication methods. The incorporation of bioactive components further improves the therapeutic effects of polyester elastomers in biomedical applications. In this review, novel structural modification methods that contribute to outstanding mechanical behaviors of polyester elastomers are discussed. Recent advances in the application of polyester elastomers in tissue engineering and bioelectronics are outlined and analyzed. A prospective of the future research and development on polyester elastomers is also provided.

Effects of Space Dimensionality within Scaffold for Bone Regeneration with Large and Oriented Blood Vessels

The internal structure of the scaffolds is a key factor for bone regeneration. In this study, we focused on the space dimensionality within the scaffold that may control cell migration and evaluated the effects on the size and orientation of blood vessels and the amount of bone formation in the scaffold. The carbonate apatite scaffolds with intrascaffold space allowing one-dimensional (1D), two-dimensional (2D), or three-dimensional (3D) cell migration were fabricated by 3D printing. These scaffolds had the same space size, i.e., distances between the struts (~300 µm). The scaffolds were implanted into the medial condyle of rabbit femurs for four weeks. Both the size and orientation degree of the blood vessels formed in the scaffolds allowing 1D cell migration were 2.5- to 4.0-fold greater than those of the blood vessels formed in the scaffolds allowing 2D and 3D cell migration. Furthermore, the amount of bone formed in the scaffolds allowing 1D cell migration was 1.4-fold larger than that formed in the scaffolds allowing 2D and 3D cell migration. These are probably because the 1D space limited the direction of cell migration and prevented the branching of blood vessels, whereas 2D and 3D spaces provided the opportunity for random cell migration and blood vessel branching. Thus, scaffolds with 1D space are advantageous for inducing large and oriented blood vessels, resulting in a larger amount of bone formation.

Effect of Porosity and Pore Shape on the Mechanical and Biological Properties of Additively Manufactured Bone Scaffolds

This study investigates the effect of porosity and pore shape on the biological and mechanical behavior of additively manufactured scaffolds for bone tissue engineering (BTE). Polylactic acid scaffolds with varying porosity levels (15-78%) and pore shapes, including regular (rectangular pores), gyroid, and diamond (triply periodic minimal surfaces) structures, are fabricated by fused filament fabrication. Murine-derived macrophages and human bone marrow-derived mesenchymal stromal cells (hBMSCs) are seeded onto the scaffolds. The compressive behavior and surface morphology of the scaffolds are characterized. The results show that scaffolds with 15%, 30%, and 45% porosity display the highest rate of macrophage and hBMSC growth. Gyroid and diamond scaffolds exhibit a higher rate of macrophage proliferation, while diamond scaffolds exhibit a higher rate of hBMSC proliferation. Additionally, gyroid and diamond scaffolds exhibit better compressive behavior compared to regular scaffolds. Of particular note, diamond scaffolds have the highest compressive modulus and strength. Surface morphology characterization indicates that the surface roughness of diamond and gyroid scaffolds is greater than that of regular scaffolds at the same porosity level, which is beneficial for cell attachment and proliferation. This study provides valuable insights into porosity and pore shape selection for additively manufactured scaffolds in BTE.

Enhancing bone tissue engineering with 3D-Printed polycaprolactone scaffolds integrated with tragacanth gum/bioactive glass

Tissue-engineered bone substitutes, characterized by favorable physicochemical, mechanical, and biological properties, present a promising alternative for addressing bone defects. In this study, we employed an innovative 3D host-guest scaffold model, where the host component served as a mechanical support, while the guest component facilitated osteogenic effects. More specifically, we fabricated a triangular porous polycaprolactone framework (host) using advanced 3D printing techniques, and subsequently filled the framework's pores with tragacanth gum-45S5 bioactive glass as the guest component. Comprehensive assessments were conducted to evaluate the physical, mechanical, and biological properties of the designed scaffolds. Remarkably, successful integration of the guest component within the framework was achieved, resulting in enhanced bioactivity and increased strength. Our findings demonstrated that the scaffolds exhibited ion release (Si, Ca, and P), surface apatite formation, and biodegradation. Additionally, in vitro cell culture assays revealed that the scaffolds demonstrated significant improvements in cell viability, proliferation, and attachment. Significantly, the multi-compartment scaffolds exhibited remarkable osteogenic properties, indicated by a substantial increase in the expression of osteopontin, osteocalcin, and matrix deposition. Based on our results, the framework provided robust mechanical support during the new bone formation process, while the guest component matrix created a conducive micro-environment for cellular adhesion, osteogenic functionality, and matrix production. These multi-compartment scaffolds hold great potential as a viable alternative to autografts and offer promising clinical applications for bone defect repair in the future.

Intelligent Vascularized 3D/4D/5D/6D-Printed Tissue Scaffolds

Blood vessels are essential for nutrient and oxygen delivery and waste removal. Scaffold-repairing materials with functional vascular networks are widely used in bone tissue engineering. Additive manufacturing is a manufacturing technology that creates three-dimensional solids by stacking substances layer by layer, mainly including but not limited to 3D printing, but also 4D printing, 5D printing and 6D printing. It can be effectively combined with vascularization to meet the needs of vascularized tissue scaffolds by precisely tuning the mechanical structure and biological properties of smart vascular scaffolds. Herein, the development of neovascularization to vascularization to bone tissue engineering is systematically discussed in terms of the importance of vascularization to the tissue. Additionally, the research progress and future prospects of vascularized 3D printed scaffold materials are highlighted and presented in four categories: functional vascularized 3D printed scaffolds, cell-based vascularized 3D printed scaffolds, vascularized 3D printed scaffolds loaded with specific carriers and bionic vascularized 3D printed scaffolds. Finally, a brief review of vascularized additive manufacturing-tissue scaffolds in related tissues such as the vascular tissue engineering, cardiovascular system, skeletal muscle, soft tissue and a discussion of the challenges and development efforts leading to significant advances in intelligent vascularized tissue regeneration is presented.

Mechanical properties, in vitro biodegradable behavior, biocompatibility and osteogenic ability of additively manufactured Zn-0.8Li-0.1Mg alloy scaffolds

Alloying and structural design provide flexibility to modulate performance of biodegradable porous implants manufactured by laser powder bed fusion (L-PBF). Herein, bulk Zn-0.8Li-0.1Mg was first fabricated to indicate the influence of the ternary alloy system on strengthening effect. Porous scaffolds with different porosities, including 60 % (P60), 70 % (P70) and 80 % (P80), were designed and fabricated to study the influence of porosity on mechanical properties, in vitro degradation behavior, biocompatibility and osteogenic ability. Pure Zn (Zn-P70) scaffolds with a porosity of 70 % were utilized for the comparison. The results showed Zn-0.8Li-0.1Mg bulks had an ultimate tensile strength of 460.78 ± 5.79 MPa, which was more than 3 times that of pure Zn ones and was the highest value ever reported for Zn alloys fabricated by L-PBF. The compressive strength (CS) and elastic modulus (E) of scaffolds decreased with increasing porosities. The CS of P70 scaffolds was 24.59 MPa, more than 2 times that of Zn-P70. The weight loss of scaffolds during in vitro immersion increased with increasing porosities. Compared with Zn-P70, a lower weight loss, better biocompatibility and improved osteogenic ability were observed for P70 scaffolds. P70 scaffolds also exhibited the best biocompatibility and osteogenic ability among all the used porosities. Influence mechanism of alloying elements and structural porosities on mechanical behaviors, in vitro biodegradation behavior, biocompatibility and osteogenic ability of scaffolds were discussed using finite element analysis and the characterization of degradation products. The results indicated that the proper design of alloying and porosity made Zn-0.8Li-0.1Mg scaffolds promising for biodegradable applications.

Microstructure and Biomechanical Properties in Selective Laser Melting of Porous Metal Implants

Two kinds of porous structure design strategies, ring-support (RS) and column-support (CS), are proposed for human implants. The accurate design of porosity is realized by adjusting the pore characteristics, such as strut diameter, pore diameter, and unit size. Porous specimens with porosity of 50%, 60%, 70%, and 80% were prepared by selective laser melting. The three-dimensional pore structure is basically consistent with the design characteristics, and the measured porosity is slightly lower than design value. The microstructure, microhardness, and friction and wear properties of the samples were studied. The results show that the performance along the scanning orientation is slightly better than that along the forming orientation. The compression and dynamic elastic modulus of porous specimens with different structures and porosities were analyzed. The CS porous with 60-80% porosity has suitable compressive strength and elastic modulus, which is close to that of human tissue, and effectively avoids the stress shielding phenomenon.

Research progress of 3D printed poly (ether ether ketone) in the reconstruction of craniomaxillofacial bone defects

The clinical challenge of bone defects in the craniomaxillofacial region, which can lead to significant physiological dysfunction and psychological distress, persists due to the complex and unique anatomy of craniomaxillofacial bones. These critical-sized defects require the use of bone grafts or substitutes for effective reconstruction. However, current biomaterials and methods have specific limitations in meeting the clinical demands for structural reinforcement, mechanical support, exceptional biological performance, and aesthetically pleasing reconstruction of the facial structure. These drawbacks have led to a growing need for novel materials and technologies. The growing development of 3D printing can offer significant advantages to address these issues, as demonstrated by the fabrication of patient-specific bioactive constructs with controlled structural design for complex bone defects in medical applications using this technology. Poly (ether ether ketone) (PEEK), among a number of materials used, is gaining recognition as a feasible substitute for a customized structure that closely resembles natural bone. It has proven to be an excellent, conformable, and 3D-printable material with the potential to replace traditional autografts and titanium implants. However, its biological inertness poses certain limitations. Therefore, this review summarizes the distinctive features of craniomaxillofacial bones and current methods for bone reconstruction, and then focuses on the increasingly applied 3D printed PEEK constructs in this field and an update on the advanced modifications for improved mechanical properties, biological performance, and antibacterial capacity. Exploring the potential of 3D printed PEEK is expected to lead to more cost-effective, biocompatible, and personalized treatment of craniomaxillofacial bone defects in clinical applications.

Metal and Polymer Based Composites Manufactured Using Additive Manufacturing-A Brief Review

This review examines the mechanical performance of metal- and polymer-based composites fabricated using additive manufacturing (AM) techniques. Composite materials have significantly influenced various industries due to their exceptional reliability and effectiveness. As technology advances, new types of composite reinforcements, such as novel chemical-based and bio-based, and new fabrication techniques are utilized to develop high-performance composite materials. AM, a widely popular concept poised to shape the development of Industry 4.0, is also being utilized in the production of composite materials. Comparing AM-based manufacturing processes to traditional methods reveals significant variations in the performance of the resulting composites. The primary objective of this review is to offer a comprehensive understanding of metal- and polymer-based composites and their applications in diverse fields. Further on this review delves into the intricate details of metal- and polymer-based composites, shedding light on their mechanical performance and exploring the various industries and sectors where they find utility.

Bone Tissue Engineering Scaffolds: Function of Multi-Material Hierarchically Structured Scaffolds

Bone tissue engineering (BTE) is a topic of interest for the last decade, and advances in materials, processing techniques, and the understanding of bone healing pathways have opened new avenues of research. The dual responsibility of BTE scaffolds in providing load-bearing capability and interaction with the local extracellular matrix to promote bone healing is a challenge in synthetic scaffolds. This article describes the usage and processing of multi-materials and hierarchical structures to mimic the structure of natural bone tissues to function as bioactive and load-bearing synthetic scaffolds. The first part of this literature review describes the physiology of bone healing responses and the interactions at different stages of bone repair. The following section reviews the available literature on biomaterials used for BTE scaffolds followed by some multi-material approaches. The next section discusses the impact of the scaffold's structural features on bone healing and the necessity of a hierarchical distribution in the scaffold structure. Finally, the last section of this review highlights the emerging trends in BTE scaffold developments that can inspire new tissue engineering strategies and truly develop the next generation of synthetic scaffolds.

3D printing of conch-like scaffolds for guiding cell migration and directional bone growth

Regeneration of severe bone defects remains an enormous challenge in clinic. Developing regenerative scaffolds to directionally guide bone growth is a potential strategy to overcome this hurdle. Conch, an interesting creature widely spreading in ocean, has tough spiral shell that can continuously grow along the spiral direction. Herein, inspired by the physiological features of conches, a conch-like (CL) scaffold based on β-TCP bioceramic material was successfully prepared for guiding directional bone growth via digital light processing (DLP)-based 3D printing. Benefiting from the spiral structure, the CL scaffolds significantly improved cell adhesion, proliferation and osteogenic differentiation in vitro compared to the conventional 3D scaffolds. Particularly, the spiral structure in the scaffolds could efficiently induce cells to migrate from the bottom to the top of the scaffolds, which was like “cells climbing stairs”. Furthermore, the capability of guiding directional bone growth for the CL scaffolds was demonstrated by a special half-embedded femoral defects model in rabbits. The new bone tissue could consecutively grow into the protruded part of the scaffolds along the spiral cavities. This work provides a promising strategy to construct biomimetic biomaterials for guiding directional bone tissue growth, which offers a new treatment concept for severe bone defects, and even limb regeneration.

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A conch-like scaffold was firstly developed for guiding directional bone growth.

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The CL scaffolds efficiently induced cells “climbing stairs”- like-migrating.

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The CL scaffolds showed improved bioactivities benefited from the spiral structure.

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This work provided a new treatment concept for severe bone defects.

Bone tissue engineering for treating osteonecrosis of the femoral head

Osteonecrosis of the femoral head (ONFH) is a devastating and complicated disease with an unclear etiology. Femoral head-preserving surgeries have been devoted to delaying and hindering the collapse of the femoral head since their introduction in the last century. However, the isolated femoral head-preserving surgeries cannot prevent the natural progression of ONFH, and the combination of autogenous or allogeneic bone grafting often leads to many undesired complications. To tackle this dilemma, bone tissue engineering has been widely developed to compensate for the deficiencies of these surgeries. During the last decades, great progress has been made in ingenious bone tissue engineering for ONFH treatment. Herein, we comprehensively summarize the state-of-the-art progress made in bone tissue engineering for ONFH treatment. The definition, classification, etiology, diagnosis, and current treatments of ONFH are first described. Then, the recent progress in the development of various bone-repairing biomaterials, including bioceramics, natural polymers, synthetic polymers, and metals, for treating ONFH is presented. Thereafter, regenerative therapies for ONFH treatment are also discussed. Finally, we give some personal insights on the current challenges of these therapeutic strategies in the clinic and the future development of bone tissue engineering for ONFH treatment.

Additive Manufacturing of Bioceramic Implants for Restoration Bone Engineering: Technologies, Advances, and Future Perspectives

Treating bone defects is highly challenging because they do not heal on their own inside the patients, so implants are needed to assist in the reconstruction of the bone. Bioceramic implants based on additive manufacturing (AM) are currently emerging as promising treatment options for restoration bone engineering. On the one hand, additively manufactured bioceramic implants have excellent mechanical properties and biocompatibility, which are suitable for bone regeneration. On the other hand, the designable structure and adjustable pores of additively manufactured bioceramic implants allow them to promote suitable cell growth and tissue climbing. Herein, this review unfolds to introduce several frequently employed AM technologies for bioceramic implants. After that, advances in commonly used additively manufactured bioceramic implants, including bioinert ceramic implants, bioactive ceramic implants, and bioceramic/organic composite implants, are categorized and summarized. Finally, the future perspectives of additively manufactured bioceramic implants, in terms of mechanical performance improvement, innovative structural design, biological property enhancement, and other functionalization approaches, are proposed and forecasted. This review is believed to provide some fundamental understanding and cutting-edge knowledge for the additive manufacturing of bioceramic implants for restoration bone engineering.

MXene-Functionalized Ferroelectric Nanocomposite Membranes with Modulating Surface Potential Enhance Bone Regeneration

Rapid and effective bone defect repair remains a challenging issue for clinical treatment. Applying biomaterials with endogenous surface potential has been widely studied to enhance bone regeneration, but how to regulate the electric potential and surface morphology of the implanted materials precisely to achieve an optimal bioelectric microenvironment is still a major challenge. The aim of this study is to develop electroactive biomaterials that better mimic the extracellular microenvironment for bone regeneration. Hence, MXene/polyvinylidene fluoride (MXene/PVDF) ferroelectric nanocomposite membranes were prepared by electrospinning. Physicochemical characterization demonstrated that Ti₃C₂T_x MXene nanosheets were wrapped in PVDF shell layer and the surface morphology and potential were modulated by altering the content of MXene, where uniform distribution of fibers and enhanced electric potential can be obtained and precisely assembled into a natural extracellular matrix (ECM) in bone tissue. Consequently, the MXene/PVDF membranes facilitated cell adhesion, stretching, and growth, showing good biocompatibility; meanwhile, their intrinsic electric potential promoted the recruitment of osteogenic cells and accelerated the differentiation of osteoblast. Furthermore, 1 wt % MXene/PVDF membrane with a suitable surface potential and better topographical structure for bone regeneration qualitatively and quantitatively promoted bone tissue formation in a rat calvarial bone defect after 4 and 8 weeks of healing. The fabricated MXene/PVDF ferroelectric nanocomposite membranes show a biomimetic microenvironment with a sustainable electric potential and optimal 3D topographical structure, providing an innovative and well-suited strategy for application in bone regeneration.

Simulating and Predicting the Part Warping in Fused Deposition Modeling by Thermal-Structural Coupling Analysis

As the most commonly used additive manufacturing technology, fused deposition modeling (FDM) still faces some technical issues caused by temperature change-induced unsteady thermal stress and warping. These issues can further lead to the deformation of printed parts and even terminate the printing process. In response to these issues, this article established a numerical model of temperature field and thermal stress field for FDM by finite element modeling and "birth-death element" technique to predict the deformation of the part. What makes sense in this process is that the logic of elements sort based on ANSYS Parametric Design Language (APDL) was proposed to sort the meshed elements, which was aimed to perform FDM simulation quickly on the model. In this work, the effects of the sheets shape and infill line directions (ILDs) on the distortion during FDM were simulated and verified. From the analysis of stress field and deformation nephogram, the simulation results indicated that ILD had greater effects on the distortion. Moreover, the sheet warping became most serious when the ILD was aligned with the diagonal of the sheet. The simulation results matched well with the experimental results. Thus, the proposed method in this work can be used to optimize the printing parameters for FDM process.

Influence of porosity on osteogenesis, bone growth and osteointegration in trabecular tantalum scaffolds fabricated by additive manufacturing

Porous tantalum implants are a class of materials commonly used in clinical practice to repair bone defects. However, the cumbersome and problematic preparation procedure have limited their widespread application. Additive manufacturing has revolutionized the design and process of orthopedic implants, but the pore architecture feature of porous tantalum scaffolds prepared from additive materials for optimal osseointegration are unclear, particularly the influence of porosity. We prepared trabecular bone-mimicking tantalum scaffolds with three different porosities (60%, 70% and 80%) using the laser powder bed fusing technique to examine and compare the effects of adhesion, proliferation and osteogenic differentiation capacity of rat mesenchymal stem cells on the scaffolds in vitro. The in vivo bone ingrowth and osseointegration effects of each scaffold were analyzed in a rat femoral bone defect model. Three porous tantalum scaffolds were successfully prepared and characterized. In vitro studies showed that scaffolds with 70% and 80% porosity had a better ability to osteogenic proliferation and differentiation than scaffolds with 60% porosity. In vivo studies further confirmed that tantalum scaffolds with the 70% and 80% porosity had a better ability for bone ingrowh than the scaffold with 60% porosity. As for osseointegration, more bone was bound to the material in the scaffold with 70% porosity, suggesting that the 3D printed trabecular tantalum scaffold with 70% porosity could be the optimal choice for subsequent implant design, which we will further confirm in a large animal preclinical model for better clinical use.

Comprehensive review of additively manufactured biodegradable magnesium implants for repairing bone defects from biomechanical and biodegradable perspectives

Bone defect repair is a complicated clinical problem, particularly when the defect is relatively large and the bone is unable to repair itself. Magnesium and its alloys have been introduced as versatile biomaterials to repair bone defects because of their excellent biocompatibility, osteoconductivity, bone-mimicking biomechanical features, and non-toxic and biodegradable properties. Therefore, magnesium alloys have become a popular research topic in the field of implants to treat critical bone defects. This review explores the popular Mg alloy research topics in the field of bone defects. Bibliometric analyses demonstrate that the degradation control and mechanical properties of Mg alloys are the main research focus for the treatment of bone defects. Furthermore, the additive manufacturing (AM) of Mg alloys is a promising approach for treating bone defects using implants with customized structures and functions. This work reviews the state of research on AM-Mg alloys and the current challenges in the field, mainly from the two aspects of controlling the degradation rate and the fabrication of excellent mechanical properties. First, the advantages, current progress, and challenges of the AM of Mg alloys for further application are discussed. The main mechanisms that lead to the rapid degradation of AM-Mg are then highlighted. Next, the typical methods and processing parameters of laser powder bed fusion fabrication on the degradation characteristics of Mg alloys are reviewed. The following section discusses how the above factors affect the mechanical properties of AM-Mg and the recent research progress. Finally, the current status of research on AM-Mg for bone defects is summarized, and some research directions for AM-Mg to drive the application of clinical orthopedic implants are suggested.

Functional engineering strategies of 3D printed implants for hard tissue replacement

Three-dimensional printing technology with the rapid development of printing materials are widely recognized as a promising way to fabricate bioartificial bone tissues. In consideration of the disadvantages of bone substitutes, including poor mechanical properties, lack of vascularization and insufficient osteointegration, functional modification strategies can provide multiple functions and desired characteristics of printing materials, enhance their physicochemical and biological properties in bone tissue engineering. Thus, this review focuses on the advances of functional engineering strategies for 3D printed biomaterials in hard tissue replacement. It is structured as introducing 3D printing technologies, properties of printing materials (metals, ceramics and polymers) and typical functional engineering strategies utilized in the application of bone, cartilage and joint regeneration.

Novel Approaches and Biomaterials for Bone Tissue Engineering: A Focus on Silk Fibroin

Bone tissue engineering (BTE) represents a multidisciplinary research field involving many aspects of biology, engineering, material science, clinical medicine and genetics to create biological substitutes to promote bone regeneration. The definition of the most appropriate biomaterials and structures for BTE is still a challenge for researchers, aiming at simultaneously combining different features such as tissue generation properties, biocompatibility, porosity and mechanical strength. In this scenario, among the biomaterials for BTE, silk fibroin represents a valuable option for the development of functional devices because of its unique biological properties and the multiple chances of processing. This review article aims at providing the reader with a general overview of the most recent progresses in bone tissue engineering in terms of approaches and materials with a special focus on silk fibroin and the related mechanisms involved in bone regeneration, and presenting interesting results obtained by different research groups, which assessed the great potential of this protein for bone tissue engineering.

Low-Temperature Printed Hierarchically Porous Induced-Biomineralization Polyaryletherketone Scaffold for Bone Tissue Engineering

Polyetheretherketone (PEEK) as a popular orthopaedic implant is usually fabricated into a hierarchically porous structure for improving osteogenic activity. However, the applications are limited due to the excessively high processing temperature and uncontrollably tedious modification routes. Here, an amorphous polyaryletherketone with carboxyl groups (PAEK-COOH) is synthesized and fabricated to the hierarchically controllable porous scaffolds via a low-temperature 3D-printing process. The prepared PAEK-COOH scaffolds present controllable porous structures ranging from nano- to micro-scale, and their mechanical strengths are comparable to that of trabecular bone. More importantly, the in vitro experiments show that the nanoporous surface is conducive to promoting cellular adhesion, and carboxyl groups can induce hydroxyapatite mineralization via electrostatic interaction. The in vivo experiments demonstrate that the PAEK-COOH scaffolds offer much better osseointegration without additional active ingredients, compared to that of PEEK. Therefore, this work will not only develop a promising candidate for bone tissue engineering, but provide a viable method to design PAEK biomaterials.

Fabrication, morphological, mechanical and biological performance of 3D printed poly(ε-caprolactone)/bioglass composite scaffolds for bone tissue engineering applications

Several techniques, such as additive manufacturing, have been used for the manufacture of polymer-ceramic composite scaffolds for bone tissue engineering. A new extruder head recently developed for improving the manufacturing process is an experimental 3D printer Fab@CTI that enables the use of ceramic powders in the processing of composite materials or polymer blends. Still, the manufacturing process needs improvement to promotes the dispersion of ceramic particles in the polymer matrix. This article addresses the manufacture of scaffolds by 3D printing from mixtures of poly(ε-caprolactone) (PCL) and a glass powder of same composition of 45S5Bioglass®, labeled as synthesized bioglass (SBG), according to two different methods that investigated the efficiency of the new extruder head. The first one is a single extrusion process in a Fab@CTI 3D printer, and the other consists in the pre-processing of the PCL-SBG mixture in a mono-screw extruder with a Maddock^®element, followed by direct extrusion in the experimental Fab@CTI 3D printer. The morphological characterization of the extruded samples by SEM showed an architecture of 0o/90o interconnected struts and suitable porosity for bone tissue engineering applications. Scaffolds fabricated by two methods shows compressive modulus ranging from 54.4 ± 14.2 MPa to 155.9 ± 20.4 MPa, results that are compatible to use in bone tissue engineering. Cytotoxicity assays showed non-toxic effects and viability for in vitro MG-63 cell proliferation. Alizarin Red staining test showed calcium deposition in all scaffolds, which suggests PCL/SBG composites promising candidates for use in bone tissue engineering. Results of cell morphology suggest more cell growth and adhesion for scaffolds fabricated using the pre-processing in a mono-screw extruder.

Additive Manufacturing of Biomaterials-Design Principles and Their Implementation

Additive manufacturing (AM, also known as 3D printing) is an advanced manufacturing technique that has enabled progress in the design and fabrication of customised or patient-specific (meta-)biomaterials and biomedical devices (e.g., implants, prosthetics, and orthotics) with complex internal microstructures and tuneable properties. In the past few decades, several design guidelines have been proposed for creating porous lattice structures, particularly for biomedical applications. Meanwhile, the capabilities of AM to fabricate a wide range of biomaterials, including metals and their alloys, polymers, and ceramics, have been exploited, offering unprecedented benefits to medical professionals and patients alike. In this review article, we provide an overview of the design principles that have been developed and used for the AM of biomaterials as well as those dealing with three major categories of biomaterials, i.e., metals (and their alloys), polymers, and ceramics. The design strategies can be categorised as: library-based design, topology optimisation, bio-inspired design, and meta-biomaterials. Recent developments related to the biomedical applications and fabrication methods of AM aimed at enhancing the quality of final 3D-printed biomaterials and improving their physical, mechanical, and biological characteristics are also highlighted. Finally, examples of 3D-printed biomaterials with tuned properties and functionalities are presented.

Advances of Stimulus-Responsive Hydrogels for Bone Defects Repair in Tissue Engineering

Bone defects, as one of the most urgent problems in the orthopedic clinic, have attracted much attention from the biomedical community and society. Hydrogels have been widely used in the biomedical field for tissue engineering research because of their excellent hydrophilicity, biocompatibility, and degradability. Stimulus-responsive hydrogels, as a new type of smart biomaterial, have more advantages in sensing external physical (light, temperature, pressure, electric field, magnetic field, etc.), chemical (pH, redox reaction, ions, etc.), biochemical (glucose, enzymes, etc.) and other different stimuli. They can respond to stimuli such as the characteristics of the 3D shape and solid-liquid phase state, and exhibit special properties (injection ability, self-repair, shape memory, etc.), thus becoming an ideal material to provide cell adhesion, proliferation, and differentiation, and achieve precise bone defect repair. This review is focused on the classification, design concepts, and research progress of stimulus-responsive hydrogels based on different types of external environmental stimuli, aiming at introducing new ideas and methods for repairing complex bone defects.

Morphological and Biological Evaluations of Human Periodontal Ligament Fibroblasts in Contact with Different Bovine Bone Grafts Treated with Low-Temperature Deproteinisation Protocol

Several types of deproteinised bovine bone mineral (DBBM) are available on the market, and each one is obtained with a thermic and chemical process that can differ, achieving different results. Currently, several protocols using low temperature are suggested to reduce the possible particle crystallisation during the production process. This study aimed to evaluate the biomorphological reaction of periodontal fibroblast cultures in contact with different DBBM particles treated with a low-temperature protocol (Thermagen^®) and without exposure to sodium hydroxide (NaOH). Morphological evaluation was performed using light, confocal laser, and scanning electron microscopy, and the biological reaction in terms of proliferation was performed using an XTT proliferation assay at 24 h (T1), 72 h (T2), and 7 days (T3). The morphological analysis highlighted how the presence of the materials stimulated a change in the morphology of the cells into a polygonal shape, surface reactions with the thickening of the membrane, and expression of actin. In particular, the morphological changes were appreciable from T1, with a progressive increase in the considered morphological characteristics at T2 and T3 follow-ups. The proliferation assay showed a statistical significance between the different experimental materials and the negative control in T2 and T3 follow-ups. The post hoc analysis did not reveal any differences between the materials. In conclusion, the grafts obtained with the low-temperature extractions protocol and not exposed to NaOH solution showed positive morphological reactions with no differences in the sizes of particles.

Heterostructured Metal-Organic Frameworks/Polydopamine Coating Endows Polyetheretherketone Implants with Multimodal Osteogenicity and Photoswitchable Disinfection

Clinically, bacteria-induced contagion and insufficient osseointegrative property inevitably elicit the failure of orthopedic implants. Herein, a heterostructured coating consisting of simvastatin (SIM)-laden metal-organic frameworks and polydopamine nanolayers is created on a porous bioinert polyetheretherketone implant. The heterostructured coating significantly promotes cytocompatibility and osteogenic differentiation through multimodal osteogenicity mechanisms of zinc ion (Zn²⁺ ) therapy, SIM drug therapy, and surface micro-/nano-topological stimulation. Under the illumination of near-infrared (NIR) light, singlet oxygen (¹ O₂ ) and local hyperthermia are produced; besides, NIR light dramatically accelerates the release of Zn²⁺ ions from heterostructured coatings. Gram-positive and -negative bacteria are effectively eradicated by the synergy of photothermal/photodynamic effects and photo-induced accelerated delivery of Zn²⁺ ions. The superior osteogenicity and osseointegration, as well as photoswitchable disinfection controlled by NIR light are corroborated via in vivo results. This work highlights the great potential of photoresponsive heterostructured orthopedic implants in treatment of the noninvasive bone reconstruction of bacteria-associated infectious tissues through multimodal phototherapy and photoswitchable ion-therapy.

Improved 3D Printing and Cell Biology Characterization of Inorganic-Filler Containing Alginate-Based Composites for Bone Regeneration: Particle Shape and Effective Surface Area Are the Dominant Factors for Printing Performance

The use of organic-inorganic 3D printed composites with enhanced properties in biomedical applications continues to increase. The present study focuses on the development of 3D printed alginate-based composites incorporating inorganic fillers with different shapes (angular and round), for bone regeneration. Reactive fillers (bioactive glass 13-93 and hydroxyapatite) and non-reactive fillers (inert soda-lime glass) were investigated. Rheological studies and the characterization of various extrusion-based parameters, including material throughput, printability, shape fidelity and filament fusion, were carried out to identify the parameters dominating the printing process. It was shown that the effective surface area of the filler particle has the highest impact on the printing behavior, while the filler reactivity presents a side aspect. Composites with angular particle morphologies showed the same high resolution during the printing process, almost independent from their reactivity, while composites with comparable amounts of round filler particles lacked stackability after printing. Further, it could be shown that a higher effective surface area of the particles can circumvent the need for a higher filler content for obtaining convincing printing results. In addition, it was proven that, by changing the particle shape, the critical filler content for the obtained adequate printability can be altered. Preliminary in vitro biocompatibility investigations were carried out with the bioactive glass containing ink. The 3D printed ink, forming an interconnected porous scaffold, was analyzed regarding its biocompatibility in direct or indirect contact with the pre-osteoblast cell line MC3T3-E1. Both kinds of cell tests showed increased viability and a high rate of proliferation, with complete coverage of the 3D scaffolds' surface already after 7 d post cell-seeding.

Novel Approaches Guiding the Future of Spinal Biologics for Bone Regeneration

Purpose of Review

Despite the continued growth of spine fusion procedures, the ideal material for bone regeneration remains unclear. Current bone graft substitutes and extenders in use such as exogenous BMP-2 or demineralized bone matrix and hydroxyapatite either have serious complications associated with use or lead to clinically significant rates of non-union. The introduction of nanotechnology and 3D printing to regenerative medicine facilitates the development of safer and more efficacious bone regenerative scaffolds that present solutions to these problems. Many researchers in orthopedics recognize the importance of lowering the dose of recombinant growth factors like BMP-2 to avoid the complications associated with its normal required supraphysiologic dosing to achieve high rates of fusion in spine surgery.

Recent Findings

Recent iterations of bioactive scaffolds have moved towards peptide amphiphiles that bind endogenous osteoinductive growth factor sources at the site of implantation. These molecules have been shown to provide a highly fluid, natural mimetic of natural extracellular matrix to achieve 100% fusion rates at 10–100 times lower doses of BMP-2 relative to controls in pre-clinical animal posterolateral fusion models. Alternative approaches to bone regeneration include the combination of existing natural growth factor sources like human bone combined with bioactive, biocompatible components like hydroxyapatite using 3D-printing technologies. Their elastomeric, 3D-printed scaffolds demonstrate an optimal safety profile and high rates of fusion (~92%) in the rat posterolateral fusion model.

Summary

Bioactive peptide amphiphiles and developments in 3D printing offer the promising future of a recombinant growth factor- free bone graft substitute with similar efficacy but improved safety profiles compared to existing bone graft substitutes.

Using scaffolds as drug delivery systems to treat bone tumor

Surgery is the principal strategy to treat osteosarcoma and other types of bone tumors, but it causes bone defects that cannot be healed spontaneously. After surgery, patients still need to receive radiotherapy and/or chemotherapy to prevent tumor recurrence and metastasis, which leads to systemic side effects. Bone scaffolds exhibit the potentials to load cargos (drugs or growth factors) and act as drug delivery systems (DDSs) in the osteosarcoma postoperative treatment. This review introduces current types of bone scaffolds and highlights representative works using scaffolds as DDSs to treat osteosarcomas. Challenges and perspectives in the scaffold-based DDSs are also discussed. This review may provide references to develop effective and safe strategies for osteosarcoma postoperative treatment.

Evaluation of graphene-derived bone scaffold exposure to the calvarial bone_in-vitro and in-vivo studies

Graphene is a novel material which has recently been gaining great interest in the biomedical fields. Our previous study observed that graphene-derived particles help induce bone formation in a murine calvarial model. Here, we further developed a blended graphene-contained polycaprolactone (PCL/G) filament for application in a 3D-printed bone scaffold. Since implants are expected to be for long-term usage, in vitro cell culture and in vivo scaffold implants were evaluated in a critical-size bone defect calvarial model for over 60 weeks. Graphene greatly improved the mechanical strength by 30.2% compared to pure PCL. The fabricated PCL/G scaffolds also showed fine cell viability. In animal model, an abnormal electroencephalogram power spectrum and early signs of aging, such as hair graying and hair loss, were found in the group with a PCL/G scaffold compared to pure PCL scaffold. Neither of the abnormal symptoms caused death of all animals in both groups. The long-term use of graphene-derived biomaterials for in-vivo implants seems to be safe. But the comprehensive biosafety still needs further evaluation.

Characterization of Porous Scaffolds Fabricated by Joining Stacking Based Laser Micro-Spot Welding (JS-LMSW) for Tissue Engineering Applications

A novel manufacturing approach was used to fabricate metallic scaffolds. A calibration of the laser cutting process was performed using the kerf width compensation in the calculations of the tool trajectory. Welding defects were studied through X-ray microtomography. Penetration depth and width resulted in relative errors of 9.4%, 1.0%, respectively. Microhardness was also measured, and the microstructure was studied in the base material. The microhardness values obtained were 400 HV, 237 HV, and 215 HV for the base material, HAZ, and fusion zone, respectively. No significant difference was found between the microhardness measurement along with different height positions of the scaffold. The scaffolds' dimensions and porosity were measured, their internal architecture was observed with micro-computed tomography. The results indicated that geometries with dimensions under 500 µm with different shapes resulted in relative errors of ~2.7%. The fabricated scaffolds presented an average compressive modulus ~13.15 GPa, which is close to cortical bone properties. The proposed methodology showed a promising future in bone tissue engineering applications.

Comprehensive Review on Design and Manufacturing of Bio-scaffolds for Bone Reconstruction

Bio-scaffolds are synthetic entities widely employed in bone and soft-tissue regeneration applications. These bio-scaffolds are applied to the defect site to provide support and favor cell attachment and growth, thereby enhancing the regeneration of the defective site. The progressive research in bio-scaffold fabrication has led to identification of biocompatible and mechanically stable materials. The difficulties in obtaining grafts and expenditure incurred in the transplantation procedures have also been overcome by the implantation of bio-scaffolds. Drugs, cells, growth factors, and biomolecules can be embedded with bio-scaffolds to provide localized treatments. The right choice of materials and fabrication approaches can help in developing bio-scaffolds with required properties. This review mostly focuses on the available materials and bio-scaffold techniques for bone and soft-tissue regeneration application. The first part of this review gives insight into the various classes of biomaterials involved in bio-scaffold fabrication followed by design and simulation techniques. The latter discusses the various additive, subtractive, hybrid, and other improved techniques involved in the development of bio-scaffolds for bone regeneration applications. Techniques involving multimaterial printing and multidimensional printing have also been briefly discussed.

Mechanical Performance of 3D-Printed Biocompatible Polycarbonate for Biomechanical Applications

Additive manufacturing has experienced remarkable growth in recent years due to the customisation, precision, and cost savings compared to conventional manufacturing techniques. In parallel, materials with great potential have been developed, such as PC-ISO polycarbonate, which has biocompatibility certifications for use in the biomedical industry. However, many of these synthetic materials are not capable of meeting the mechanical stresses to which the biological structure of the human body is naturally subjected. In this study, an exhaustive characterisation of the PC-ISO was carried out, including an investigation on the influence of the printing parameters by fused filament fabrication on its mechanical behaviour. It was found that the effect of the combination of the printing parameters does not have a notable impact on the mass, cost, and manufacturing time of the specimens; however, it is relevant when determining the tensile, bending, shear, impact, and fatigue strengths. The best combinations for its application in biomechanics are proposed, and the need to combine PC-ISO with other materials to achieve the necessary strengths for functioning as a bone scaffold is demonstrated.

Ursolic Acid Loaded-Mesoporous Hydroxylapatite/ Chitosan Therapeutic Scaffolds Regulate Bone Regeneration Ability by Promoting the M2-Type Polarization of Macrophages

PURPOSE

Mesoporous hydroxylapatite (MHAP) might be important for bone regeneration, and ursolic acid (UA) has anti-inflammatory effects. Accordingly, we developed, for the first time, ursolic acid-loaded MHAP-chitosan (MHAP-CS-UA) scaffolds to treat bone defects.

METHODS

In vitro, we synthesize biomaterial scaffolds. By SEM, XRD, EDS and FTIR, we test the performance of the hybrid scaffolds. By drug release, flow cytometry, immunofluorescence, alizarin red staining, and Western blotting, we test the anti-inflammatory and osteo-inductive properties of scaffolds. In vivo, we verify osseointegration ability and bone regeneration.

RESULTS

The MHAP is a rod-shaped structure with a length of 100~300nm and a diameter of 40~60nm. The critical structure gives the micro-scaffold a property of control release due to the pore sizes of 1.6~4.3 nm in hydroxyapatite and the hydrogen bonding between the scaffolds and UA drugs. The released UA drugs could notably inhibit the polarization of macrophages to pro-inflammatory macrophages (M1 type) and promote the expression of osteogenic-related genes (COL1, ALP and OPG) and osteogenic-related proteins (BMP-2, RUNX2 and COL1).

CONCLUSION

The MHAP-CS-UA scaffolds have good anti-inflammatory, osseointegration, osteo-inductivity and bone regeneration. And they will be the novel and promising candidates to cure the bone disease.

Recent applications of electrical, centrifugal, and pressurised emerging technologies for fibrous structure engineering in drug delivery, regenerative medicine and theranostics

Advancements in technology and material development in recent years has led to significant breakthroughs in the remit of fiber engineering. Conventional methods such as wet spinning, melt spinning, phase separation and template synthesis have been reported to develop fibrous structures for an array of applications. However, these methods have limitations with respect to processing conditions (e.g. high processing temperatures, shear stresses) and production (e.g. non-continuous fibers). The materials that can be processed using these methods are also limited, deterring their use in practical applications. Producing fibrous structures on a nanometer scale, in sync with the advancements in nanotechnology is another challenge met by these conventional methods. In this review we aim to present a brief overview of conventional methods of fiber fabrication and focus on the emerging fiber engineering techniques namely electrospinning, centrifugal spinning and pressurised gyration. This review will discuss the fundamental principles and factors governing each fabrication method and converge on the applications of the resulting spun fibers; specifically, in the drug delivery remit and in regenerative medicine.