Selective laser melting: A unit cell approach for the manufacture of porous, titanium, bone in-growth constructs, suitable for orthopedic applications. II. Randomized structures

Inverse design of anisotropic bone scaffold based on machine learning and regenerative genetic algorithm

Introduction: Triply periodic minimal surface (TPMS) is widely used in the design of bone scaffolds due to its structural advantages. However, the current approach to designing bone scaffolds using TPMS structures is limited to a forward process from microstructure to mechanical properties. Developing an inverse bone scaffold design method based on the mechanical properties of bone structures is crucial. Methods: Using the machine learning and genetic algorithm, a new inverse design model was proposed in this research. The anisotropy of bone was matched by changing the number of cells in different directions. The finite element (FE) method was used to calculate the TPMS configuration and generate a back propagation neural network (BPNN) data set. Neural networks were used to establish the relationship between microstructural parameters and the elastic matrix of bone. This relationship was then used with regenerative genetic algorithm (RGA) in inverse design. Results: The accuracy of the BPNN-RGA model was confirmed by comparing the elasticity matrix of the inverse-designed structure with that of the actual bone. The results indicated that the average error was below 3.00% for three mechanical performance parameters as design targets, and approximately 5.00% for six design targets. Discussion: The present study demonstrated the potential of combining machine learning with traditional optimization method to inversely design anisotropic TPMS bone scaffolds with target mechanical properties. The BPNN-RGA model achieves higher design efficiency, compared to traditional optimization methods. The entire design process is easily controlled.

Instrumented cervical fusion using patient specific end-plate conforming interbody devices with a micro-porous structure in nine dogs with disk-associated cervical spondylomyelopathy

Objective

To report the medium and long-term outcome of nine dogs with disk-associated cervical spondylomyelopathy (DA-CSM), treated by instrumented interbody fusion using patient specific end-plate conforming device that features a micro-porous structure to facilitate bone in-growth.

Study design

A retrospective clinical study.

Animals

Nine medium and large breed dogs.

Methods

Medical records at two institutions were reviewed between January 2020 and 2023. Following magnetic resonance imaging (MRI) diagnosis of DA-CSM, pre-operative computed tomography (CT) scans were exported to computer software for in-silico surgical planning. Interbody devices were 3D-manufactured by selecting laser melting in titanium alloy. These were surgically implanted at 13 segments alongside mono-or bi-cortical vertebral stabilization systems. Follow-up included neurologic scoring and CT scans post-operative, at medium-term follow up and at long-term follow-up where possible. Interbody fusion and implant subsidence were evaluated from follow-up CT scans.

Results

Nine dogs were diagnosed with DA-CSM between C5-C7 at a total of 13 operated segments. Medium-term follow up was obtained between 2 and 8 months post-operative (3.00 ± 1.82 months). Neurologic scoring improved (p = 0.009) in eight of nine dogs. Distraction was significant (p < 0.001) at all segments. Fusion was evident at 12/13 segments. Subsidence was evident at 3/13 operated segments but was only considered clinically relevant in one dog that did not improve; as clinical signs were mild, revision surgery was not recommended. Long-term follow up was obtained between 9 and 33 months (14.23 ± 8.24 months); improvement was sustained in 8 dogs. The dog that suffered worsened thoracic limb paresis at medium-term follow up was also diagnosed with immune-mediated polyarthropathy (IMPA) and was euthanased 9 months post-operative due to unacceptable side-effects of corticosteroid therapy.

Conclusion

End-plate conforming interbody devices with a micro-porous structure were designed, manufactured, and successfully implanted in dog with DA-CSM. This resulted in CT-determined fusion with minimal subsidence in the majority of operated segments.

Clinical significance

The technique described can be used to distract and fuse cervical vertebrae in dogs with DA-CSM, with favorable medium-and long-term outcomes.

Recent Advances of Ocular Drug Delivery Systems: Prominence of Ocular Implants for Chronic Eye Diseases

Chronic ocular diseases can seriously impact the eyes and could potentially result in blindness or serious vision loss. According to the most recent data from the WHO, there are more than 2 billion visually impaired people in the world. Therefore, it is pivotal to develop more sophisticated, long-acting drug delivery systems/devices to treat chronic eye conditions. This review covers several drug delivery nanocarriers that can control chronic eye disorders non-invasively. However, most of the developed nanocarriers are still in preclinical or clinical stages. Long-acting drug delivery systems, such as inserts and implants, constitute the majority of the clinically used methods for the treatment of chronic eye diseases due to their steady state release, persistent therapeutic activity, and ability to bypass most ocular barriers. However, implants are considered invasive drug delivery technologies, especially those that are nonbiodegradable. Furthermore, in vitro characterization approaches, although useful, are limited in mimicking or truly representing the in vivo environment. This review focuses on long-acting drug delivery systems (LADDS), particularly implantable drug delivery systems (IDDS), their formulation, methods of characterization, and clinical application for the treatment of eye diseases.

Structural Design and Finite Element Simulation Analysis of Grade 3 Graded Porous Titanium Implant

The metal titanium is often used as a dental implant material, and the elastic modulus of solid titanium implants does not match the biological bone tissue, which can easily produce a stress shielding effect and cause implant failure. In this paper, a three-level gradient porous structure implant was designed, and its mechanical and biological adaptability were studied by finite element simulation analysis. Combined with the comprehensive evaluation of the mechanical and biological properties of implants of various structures, the analysis found that a porous implant with porosity of 59.86% of the gradient was the best structure. The maximum equivalent stress of this structure in the mandible that simulated the oral environment was 154.34 MPa, which was less than half of its theoretical compression yield strength. The strain of the surrounding bone tissue lies in the bone compared with other structures, the proportion of the active state of plastic construction is larger, at 10.51%, and the fretting value of this structure and the bone tissue interface is the smallest, at only 10 μm.

Mechanical and morphological properties of additively manufactured SS316L and Ti6Al4V micro-struts as a function of build angle

Additive manufacturing methods such as laser powder bed fusion (PBF) can produce micro-lattice structures which consist of 'micro-struts', which have properties that differ from the bulk metal and that can vary depending on the orientation of the strut to the build direction (the strut build angle). Characterizing these mechanical and morphological changes would help explain macro-scale lattice behavior. Individual stainless steel (SS316L) and titanium alloy (Ti6Al4V) laser PBF struts were built at 20°, 40°, 70° and 90° to the build platform, with 3 designed diameters and tested in uniaxial tension (n = 5). Micro-CT was used to quantify changes in surface roughness, eccentricity and cross-section. Average elastic modulus was 61.5 GPa and 37.5 GPa for SS316L and Ti6Al4V respectively, less than the bulk material. Yield strength was uniform over build angle for SS316L, but for Ti6Al4V varied from 40% to 98% of the bulk value from 20° to 90° build angles. All lower angle struts had worse morphology, with higher roughness and less circular cross-sections. These data should help inform micro-lattice design, especially in safety critical applications where lower mechanical performance must be compensated for.

Reconstruction of bilateral ramus-condyle unit defect using custom titanium prosthesis with preservation of both condyles

BACKGROUND

Novel technologies for management and reconstruction of complex bony defects regarding both function and facial appearance are interestingly used in maxillofacial surgery. In the current study, we demonstrated reconstruction of a bilateral ramus-condyle unit (RCU) defect while preserving both condyles by a novel designed titanium prosthesis using virtual surgical planning (VSP), computer-aided design and manufacturing (CAD/CAM), and Selective Laser Melting (SLM) technologies.

MATERIALS AND METHODS

A 3D customized titanium prosthesis was designed for a 49 -year-old patient with bilateral mandibular aggressive central giant cell granuloma (CGCG) according to mandibular normal anatomy and structure while preserving bilateral intact condyles. Finite element study was performed to investigate the effects of new design strength and the stress shielding phenomenon. The design of macro-pores inside the body of prosthesis allowed it to act as a scaffold for bone tissue engineering under load bearing conditions.

RESULTS

Analysis of the strength and stress shielding phenomenon demonstrated favorable outcomes regarding the novel design. For instance, there was no stress shielding in any of the preserved condyles with regard to the size and distribution of stresses. Also, the stress distribution around the pores showed that these pores had no effect on the strength of the prosthesis. Thirty month follow-ups after reconstruction of bilateral RCU defect showed normal jaw function with a favorable facial appearance and mandibular contour.

CONCLUSION

We design a novel patient-specific prosthesis with desirable biomechanical features for reconstruction of bilateral RCU defect after resection of the benign tumor with preservation of bilateral intact condyles.

Geometrical Degrees of Freedom for Cellular Structures Generation: A New Classification Paradigm

Cellular structures (CSs) have been used extensively in recent years, as they offer a unique range of design freedoms. They can be deployed to create parts that can be lightweight by introducing controlled porous features, while still retaining or improving their mechanical, thermal, or even vibrational properties. Recent advancements in additive manufacturing (AM) technologies have helped to increase the feasibility and adoption of cellular structures. The layer-by-layer manufacturing approach offered by AM is ideal for fabricating CSs, with the cost of such parts being largely independent of complexity. There is a growing body of literature concerning CSs made via AM; this presents an opportunity to review the state-of-the-art in this domain and to showcase opportunities in design and manufacturing. This review will propose a novel way of classifying cellular structures by isolating their Geometrical Degrees of Freedom (GDoFs) and will explore the recent innovations in additively manufactured CSs. Based on the present work, the design inputs that are common in CSs generation will be highlighted. Furthermore, the work explores examples of how design inputs have been used to drive the design domain through various case studies. Finally, the review will highlight the manufacturability limitations of CSs in AM.

Comparative Analysis of 3D-Printed Artificial Vertebral Body Versus Titanium Mesh Cage in Repairing Bone Defects Following Single-Level Anterior Cervical Corpectomy and Fusion

Background

The aim of this study was to compare the clinical and radiological outcomes of the 3D-printed artificial vertebral body vs the titanium mesh cage in repairing bone defects for single-level anterior cervical corpectomy and fusion (ACCF).

Material/Methods

A total of 51 consecutive patients who underwent single-level ACCF in Huai’an Second People’s Hospital from July 2017 to August 2020 were retrospectively reviewed. According to the implant materials used, patients were divided into a 3D-printed artificial vertebral body group (3D-printed group) (n=20; 12 males, 8 females) and a titanium mesh cage group (TMC group) (n=31; 15 males, 16 females). General data, radiological parameters, and clinical outcomes were recorded.

Results

The rate of subsidence in the 3D-printed group (0.01, 2/20) was lower than in the TMC group (0.29, 9/31) (P<0.05). HAE and HPE of the patients in the 3D-printed group were significantly higher than those in the TMC group (P<0.05). C2–C7 Cobb angle and SA of the patients in the 3D-printed group were significantly larger than those in the TMC group (P<0.05). All patients in the 2 groups showed significant improvement in VAS, JOA, and NDI scores at 3 months and 1 year after surgery.

Conclusions

3D-printed artificial vertebral body helps maintain intervertebral height and cervical physiological curvature and is a good candidate for ACCF.

IN VITRO STUDY AND MECHANICAL CHARACTERISTICS OF DENTAL IMPLANTS MADE OF VARIOUS MATERIALS AND FABRICATION METHODS

Selecting materials and alloys, fabrication methods, surface characteristics and coatings, and topology design, all affect the mechanical properties, biocompatibility, and functionality of dental implants. The success in embedding implants in mouth and improving biocompatibility and consequently useful life of implants depends directly on proper adhesion of tissue to implant surface of a biocompatible alloy. In this research, experimental surface hardness and in vitro tests are carried out on samples with different alloys and different manufacturing methods. Various fabrication techniques, such as machining and 3D printing (Selective laser melting (SLM)), are considered for steel and titanium specimens. Results show that the hardness values of specimens made by the SLM method are higher than machined samples about 8% and also stainless steels samples have higher hardness than titanium specimens. A comparison of scanning electron microscopy (SEM) surface pictures indicates that applying modern fabrication methods for production which includes SLM improves the performance of implants in terms of mechanical and biocompatibility by increasing cell adhesion up to 21 times. In addition, results indicate that titanium alloys have almost 13% higher adhesion property than stainless steel and generally exhibit a higher balance of adhesion and cell growth.

Osteointegration of 3D-Printed Fully Porous Polyetheretherketone Scaffolds with Different Pore Sizes

Polyetheretherketone (PEEK) constitutes a preferred alternative material for orthopedic implants owing to its good mechanical properties and biocompatibility. However, the poor osseointegration property of PEEK implants has limited their clinical applications. To address this issue, in this study, we investigated the mechanical and biological properties of fully porous PEEK scaffolds with different pore sizes both in vitro and in vivo. PEEK scaffolds with designed pore sizes of 300, 450, and 600 μm and a porosity of 60% were manufactured via fused deposition modeling (FDM) to explore the optimum pore size. Smooth solid PEEK cylinders (PEEK-S) were used as the reference material. The mechanical, cytocompatibility, proliferative, and osteogenic properties of PEEK scaffolds were characterized in comparison to those of PEEK-S. In vivo dynamic contrast-enhanced magnetic resonance imaging, microcomputed tomography, and histological observation were performed after 4 and 12 weeks of implantation to evaluate the microvascular perfusion and bone formation afforded by the various PEEK implants using a New Zealand white rabbit model with distal femoral condyle defects. Results of in vitro testing supported the good biocompatibility of the porous PEEK scaffolds manufactured via FDM. In particular, the PEEK-450 scaffolds were most beneficial for cell adhesion, proliferation, and osteogenic differentiation. Results of in vivo analysis further indicated that PEEK-450 scaffolds exhibited preferential potential for bone ingrowth and vascular perfusion. Together, our findings support that porous PEEK implants designed with a suitable pore size and fabricated via three-dimensional printing constitute promising alternative biomaterials for bone grafting and tissue engineering applications with marked potential for clinical applications.

Mechanical properties and osteoblast proliferation of complex porous dental implants filled with magnesium alloy based on 3D printing

In this paper, a complex porous dental implant with biodegradable magnesium alloy was designed based on selective laser melting (SLM). Finite element analysis (FEA) was used to simulate the stress distribution of dental implant and alveolar bone in two models of preliminary and later stages of implant. The stress concentration area of dental implants was found not in the porous structure, and the weak part of mechanical properties accords with the work requirements. The porous structure of dental implants can promote the function of cancellous bone in the process of conducting the stress of the dental implant, thus improving the bearing capacity of dental implants. In vitro fatigue experiments were carried out on the experimental samples produced by 3D printing. Through the cell contrast experiment, it was proved that the decomposed Mg²⁺ could reach the titanium surface smoothly through the porous structure and complete the proliferation of osteoblasts.

Three-Dimensional Printed Porous Titanium Screw with Bioactive Surface Modification for Bone-Tendon Healing: A Rabbit Animal Model

The interference screw fixation method is used to secure a graft in the tibial tunnel during anterior cruciate ligament reconstruction surgery. However, several complications have been reported, such as biodegradable screw breakage, inflammatory or foreign body reaction, tunnel enlargement, and delayed graft healing. Using additive manufacturing (AM) technology, we developed a titanium alloy (Ti₆Al₄V) interference screw with chemically calcium phosphate surface modification technology to improve bone integration in the tibial tunnel. After chemical and heat treatment, the titanium screw formed a dense apatite layer on the metal surface in simulated body fluid. Twenty-seven New Zealand white rabbits were randomly divided into control and additive manufactured (AMD) screw groups. The long digital extensor tendon was detached and translated into a tibial plateau tunnel (diameter: 2.0 mm) and transfixed with an interference screw while the paw was in dorsiflexion. Biomechanical analyses, histological analyses, and an imaging study were performed at 1, 3, and 6 months. The biomechanical test showed that the ultimate pull-out load failure was significantly higher in the AMD screw group in all tested periods. Micro-computed tomography analyses revealed early woven bone formation in the AMD screw group at 1 and 3 months. In conclusion, AMD screws with bioactive surface modification improved bone ingrowth and enhanced biomechanical performance in a rabbit model.

Hot isostatic pressure treatment of 3D printed Ti6Al4V alters surface modifications and cellular response

Additive manufacturing can be used to create personalized orthopedic and dental implants with varying geometries and porosities meant to mimic morphological properties of bone. These qualities can alleviate stress shielding and increase osseointegration through bone ingrowth, but at the expense of reduced fatigue properties compared to machined implants, and potential for loose build particle erosion. Hot isostatic pressure (HIP) treatment is used to increase fatigue resistance; implant surface treatments like grit-blasting and acid-etching create microroughness and reduce the presence of loose particles. However, it is not known how HIP treatment affects surface treatments and osseointegration of the implant to bone. We manufactured two titanium-aluminum-vanadium constructs, one with simple through-and-through porosity and one possessing complex trabecular bone-like porosity. We observed HIP treatment varied in effect and was dependent on architecture. Micro/meso/nano surface properties generated by grit-blasting and acid-etching were altered on biomimetic HIP-treated constructs. Human mesenchymal stem cells (MSCs) were cultured on constructs fabricated +/- HIP and subsequently surface-treated. MSCs were sensitive to 3D-architecture, exhibiting greater osteogenic differentiation on constructs with complex trabecular bone-like porosity. HIP-treatment did not alter the osteogenic response of MSCs to these constructs. Thus, HIP may provide mechanical and biological advantages during implant osseointegration and function.

Laser Polishing of Ti6Al4V Fabricated by Selective Laser Melting

Selective laser melting (SLM) is emerging as a promising 3D printing method for orthopedic and dental applications. However, SLM-based Ti6Al4V components frequently exhibit high roughness values and partial surface defects. Laser polishing (LP) is a newly developed technology to improve the surface quality of metals. In this research, LP is applied to improve the surface finish of components. The results show that the laser beam can neatly ablate the aggregates of metallic globules and repair cracks and pores on the surface, resulting in a smooth surface with nanocomposites. Overall, the results indicate that using LP optimizes surface morphology to favor fatigue behavior and osteoblastic differentiation. These findings provide foundational data to improve the surface roughness of a laser-polished implant and pave the way for optimized mechanical behavior and biocompatibility via the laser process.

Porous Tantalum and Titanium in Orthopedics: A Review

Porous metal is metal with special porous structures, which can offer high biocompatibility and low Young's modulus to satisfy the need for orthopedic applications. Titanium and tantalum are the most widely used porous metals in orthopedics due to their excellent biomechanical properties and biocompatibility. Porous titanium and tantalum have been studied and applied for a long history until now. Here in this review, various manufacturing methods of titanium and tantalum porous metals are introduced. Application of these porous metals in different parts of the body are summarized, and strengths and weaknesses of these porous metal implants in clinical practice are discussed frankly for future improvement from the viewpoint of orthopedic surgeons. Then according to the requirements from clinics, progress in research for clinical use is illustrated in four aspects. Various creative designs of microporous and functionally gradient structure, surface modification, and functional compound systems of porous metal are exhibited as reference for future research. Finally, the directions of orthopedic porous metal development were proposed from the clinical view based on the rapid progress of additive manufacturing. Controllable design of both macroscopic anatomical bionic shape and microscopic functional bionic gradient porous metal, which could meet the rigorous mechanical demand of bone reconstruction, should be developed as the focus. The modification of a porous metal surface and construction of a functional porous metal compound system, empowering stronger cell proliferation and antimicrobial and antineoplastic property to the porous metal implant, also should be taken into consideration.

Microstructure and mechanical properties of additive manufactured porous Ti-33Nb-4Sn scaffolds for orthopaedic applications

Customized porous titanium alloys have become the emerging materials for orthopaedic implant applications. In this work, diamond and rhombic dodecahedron porous Ti-33Nb-4Sn scaffolds were fabricated by selective laser melting (SLM). The phase, microstructure and defects characteristics were investigated systematically and correlated to the effects of pore structure, unit cell size and processing parameter on the mechanical properties of the scaffolds. Fine β phase dendrites were obtained in Ti-33Nb-4Sn scaffolds due to the fast solidification velocity in SLM process. The compressive and bending strength of the scaffolds decrease with the decrease of strut size and diamond structures showed both higher compressive and bending strength than the dodecahedron structures. Diamond Ti-33Nb-4Sn scaffold with compressive strength of 76 MPa, bending strength of 127 MPa and elastic modulus of 2.3 GPa was achieved by SLM, revealing the potential of Ti-33Nb-4Sn scaffolds for applications on orthopaedic implant.

Improvement of bone-tendon fixation by porous titanium interference screw: A rabbit animal model

The interference screw is a widely used fixation device in the anterior cruciate ligament (ACL) reconstruction surgeries. Despite the generally satisfactory results, problems of using interference screws were reported. By using additive manufacturing (AM) technology, we developed an innovative titanium alloy (Ti₆ Al₄ V) interference screw with rough surface and inter-connected porous structure designs to improve the bone-tendon fixation. An innovative Ti₆ Al₄ V interference screws were manufactured by AM technology. In vitro mechanical tests were performed to validate its mechanical properties. Twenty-seven New Zealand white rabbits were randomly divided into control and AM screw groups for biomechanical analyses and histological analysis at 4, 8, and 12 weeks postoperatively; while micro-CT analysis was performed at 12 weeks postoperatively. The biomechanical tests showed that the ultimate failure load in the AM interference screw group was significantly higher than that in the control group at all tested periods. These results were also compatible with the findings of micro-CT and histological analyses. In micro-CT analysis, the bone-screw gap was larger in the control group; while for the additive manufactured screw, the screw and bone growth was in close contact. In histological study, the bone-screw gaps were wider in the control group and were almost invisible in the AM screw group. The innovative AM interference screws with surface roughness and inter-connected porous architectures demonstrated better bone-tendon-implant integration, and resulted in stronger biomechanical characteristics when compared to traditional screws. These advantages can be transferred to future interference screw designs to improve their clinical performance. The AM interference screw could improve graft fixation and eventually result in better biomechanical performance of the bone-tendon-screw construct. The innovative AM interference screws can be transferred to future interference screw designs to improve the performance of implants. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2633-2640, 2018.

Additive manufactured push-fit implant fixation with screw-strength pull out

Additive manufacturing offers exciting new possibilities for improving long-term metallic implant fixation in bone through enabling open porous structures for bony ingrowth. The aim of this research was to investigate how the technology could also improve initial fixation, a precursor to successful long-term fixation. A new barbed fixation mechanism, relying on flexible struts was proposed and manufactured as a push-fit peg. The technology was optimized using a synthetic bone model and compared with conventional press-fit peg controls tested over a range of interference fits. Optimum designs, achieving maximum pull-out force, were subsequently tested in a cadaveric femoral condyle model. The barbed fixation surface provided more than double the pull-out force for less than a third of the insertion force compared to the best performing conventional press-fit peg (p < 0.001). Indeed, it provided screw-strength pull out from a push-fit device (1,124 ± 146 N). This step change in implant fixation potential offers new capabilities for low profile, minimally invasive implant design, while providing new options to simplify surgery, allowing for one-piece push-fit components with high levels of initial stability. © 2017 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society. J Orthop Res 36:1508-1518, 2018.

The influence of direct laser metal sintering implants on the early stages of osseointegration in diabetic mini-pigs

Background

High failure rates of oral implants have been reported in diabetic patients due to the disruption of osseointegration. The aim of this study was to investigate whether direct laser metal sintering (DLMS) could improve osseointegration in diabetic animal models.

Methods

Surface characterizations were carried out on two types of implants. Cell morphology and the osteogenic-related gene expression of MG63 cells were observed under conditions of DLMS and microarc oxidation (MAO). A diabetes model in mini-pigs was established by intravenous injection of streptozotocin (150 mg/kg), and a total of 36 implants were inserted into the mandibular region. Micro-computed tomography (micro-CT) and histologic evaluations were performed 3 and 6 months after implantation.

Results

The Ra (the average of the absolute height of all points) of MAO surface was 2.3±0.3 µm while the DLMS surface showed the Ra of 27.4±1.1 µm. The cells on DLMS implants spread out more podia than those on MAO implants through cell morphology analysis. Osteogenic-related gene expression was also dramatically increased in the DLMS group. Obvious improvement was observed in the micro-CT and Van Gieson staining analyses of DLMS implants compared with MAO at 3 months, although this difference disappeared by 6 months. DLMS implants showed a higher bone–implant contact percentage (33.2%±11.2%) at 3 months compared with MAO group (18.9%±7.3%) while similar results were showed at 6 months between DLMS group (42.8%±10.1%) and MAO group (38.3%±10.8%).

Conclusion

The three-dimensional environment of implant surfaces with highly porous and fully interconnected channel and pore architectures can improve cell spreading and accelerate the progress of osseointegration in diabetic mini-pigs.

Biotransformation of Silver Released from Nanoparticle Coated Titanium Implants Revealed in Regenerating Bone

Antimicrobial silver nanoparticle coatings have attracted interest for reducing prosthetic joint infection. However, few studies report in vivo investigations of the biotransformation of silver nanoparticles within the regenerating tissue and its impact on bone formation. We present a longitudinal investigation of the osseointegration of silver nanoparticle-coated additive manufactured titanium implants in rat tibial defects. Correlative imaging at different time points using nanoscale secondary ion mass spectrometry, transmission electron microscopy (TEM), histomorphometry, and 3D X-ray microcomputed tomography provided quantitative insight from the nano- to macroscales. The quality and quantity of newly formed bone is comparable between the uncoated and silver coated implants. The newly formed bone demonstrates a trabecular morphology with bone being located at the implant surface, and at a distance, at two weeks. Nanoscale elemental mapping of the bone-implant interface showed that silver was present primarily in the osseous tissue and colocalized with sulfur. TEM revealed silver sulfide nanoparticles in the newly regenerated bone, presenting strong evidence that the previously in vitro observed biotransformation of silver to silver sulfide occurs in vivo.

Analysis of variability in additive manufactured open cell porous structures

In this article, a novel method of analysing build consistency of additively manufactured open cell porous structures is presented. Conventionally, methods such as micro computed tomography or scanning electron microscopy imaging have been applied to the measurement of geometric properties of porous material; however, high costs and low speeds make them unsuitable for analysing high volumes of components. Recent advances in the image-based analysis of open cell structures have opened up the possibility of qualifying variation in manufacturing of porous material. Here, a photogrammetric method of measurement, employing image analysis to extract values for geometric properties, is used to investigate the variation between identically designed porous samples measuring changes in material thickness and pore size, both intra- and inter-build. Following the measurement of 125 samples, intra-build material thickness showed variation of ±12%, and pore size ±4% of the mean measured values across five builds. Inter-build material thickness and pore size showed mean ranges higher than those of intra-build, ±16% and ±6% of the mean material thickness and pore size, respectively. Acquired measurements created baseline variation values and demonstrated techniques suitable for tracking build deviation and inspecting additively manufactured porous structures to indicate unwanted process fluctuations.

Uncertainty quantification and validation of 3D lattice scaffolds for computer-aided biomedical applications

A methodology is proposed for uncertainty quantification and validation to accurately predict the mechanical response of lattice structures used in the design of scaffolds. Effective structural properties of the scaffolds are characterized using a developed multi-level stochastic upscaling process that propagates the quantified uncertainties at strut level to the lattice structure level. To obtain realistic simulation models for the stochastic upscaling process and minimize the experimental cost, high-resolution finite element models of individual struts were reconstructed from the micro-CT scan images of lattice structures which are fabricated by selective laser melting. The upscaling method facilitates the process of determining homogenized strut properties to reduce the computational cost of the detailed simulation model for the scaffold. Bayesian Information Criterion is utilized to quantify the uncertainties with parametric distributions based on the statistical data obtained from the reconstructed strut models. A systematic validation approach that can minimize the experimental cost is also developed to assess the predictive capability of the stochastic upscaling method used at the strut level and lattice structure level. In comparison with physical compression test results, the proposed methodology of linking the uncertainty quantification with the multi-level stochastic upscaling method enabled an accurate prediction of the elastic behavior of the lattice structure with minimal experimental cost by accounting for the uncertainties induced by the additive manufacturing process.

Osseointegration of three-dimensional designed titanium implants manufactured by selective laser melting

The selective laser melting (SLM) technique is a recent additive manufacturing (AM) technique. Several studies have reported success in the SLM-based production of biocompatible orthopaedic implants and three-dimensional bone defect constructs. In this study, we evaluated the surface properties and biocompatibility of an SLM titanium implant in vitro and compared them with those of a machined (MA) titanium control surface. In addition, we evaluated the osseointegration capability of the SLM implants in vivo and compared it with those of MA and Nobel-speedy (Nobel-S) implants. SLM microtopographical surface analysis revealed porous and high roughness with varied geometry compared with a smooth surface in MA Ti samples but with similar favourable wettability. Osteoblast proliferation and alkaline phosphatase activity were significantly enhanced on the SLM surface. Histological analysis of the bone-implant contact ratio revealed no significant difference among SLM, MA, and Nobel-S implants. Micro-CT assessment indicated that there was no significant difference in bone volume fraction around the implant among SLM implants and other types of surface modification implants. The removal torque value measurement of SLM implants was significantly lower that of than Nobel-S implants P < 0.001 and higher than that of MA implants. The study demonstrates the capability of SLM implants to integrate with living bone. The SLM technique holds promise as a new dental implant manufacturing technique.

Proliferation of mouse fibroblast-like and osteoblast-like cells on pure titanium films manufactured by electron beam melting

The physical characteristics and biological compatibility of surfaces produced by electron beam melting (EBM) are not well known. In particular, there are not many reports on biocompatibility qualities. In this study, pure Ti films were manufactured using EBM. While it is reported that moderately hydrophilic biomaterial surfaces display improved cell growth and biocompatibility, contact angle measurements on the EBM-produced pure Ti films showed slight hydrophobicity. Nonetheless, we found the cell count of both fibroblast-like cells (L929) and osteoblast-like cells (MC3T3-E1) increased on pure Ti films, especially the MC3T3-E1, which increased more than that of the control. In addition, the morphology of L929 and MC3T3-E1 was polygonal and spindle-shaped and the cytoskeleton was well developed in the pure Ti surface groups. Upon staining with Alizarin red S, a slight calcium deposition was observed and this level gradually rose to a remarkable level. These results indicate that pure Ti films manufactured by EBM have good biocompatibility and could be widely applied as biomedical materials in the near future.

Improved bioactivity of selective laser melting titanium: Surface modification with micro-/nano-textured hierarchical topography and bone regeneration performance evaluation

Selective laser melting (SLM) titanium requires surface modification to improve its bioactivity. The microrough surface of it can be utilized as the micro primary substrate to create a micro-/nano-textured topography for improved bone regeneration. In this study, the microrough SLM titanium substrate was optimized by sandblasting, and nano-porous features of orderly arranged nanotubes and disorderly arranged nanonet were produced by anodization (SAN) and alkali-heat treatment (SAH), respectively. The results were compared with the control group of an untreated surface (native-SLM) and a microtopography only surface treated by acid etching (SLA). The effects of the different topographies on cell functions and bone formation performance were evaluated in vitro and in vivo. It was found that micro-/nano-textured topographies of SAN and SAH showed enhanced cell behaviour relative to the microtopography of SLA with significantly higher proliferation on the 1st, 3rd, 5th and 7th day (P<0.05) and higher total protein contents on the 14th day (P<0.05). In vivo, SAN and SAH formed more successively regenerated bone, which resulted in higher bone-implant contact (BIC%) and bone-bonding force than native-SLM and SLA. In addition, the three-dimensional nanonet of SAH was expected to be more similar to native extracellular matrix (ECM) and thus led to better bone formation. The alkaline phosphatase activity of SAH was significantly higher than the other three groups at an earlier stage of the 7th day (P<0.05) and the BIC% was nearly double that of native-SLM and SLA in the 8th week. In conclusion, the addition of nano-porous features on the microrough SLM titanium surface is effective in improving the bioactivity and bone regeneration performance, in which the ECM-like nanonet with a disorderly arranged biomimetic feature is suggested to be more efficient than nanotubes.

Compensation strategy to reduce geometry and mechanics mismatches in porous biomaterials built with Selective Laser Melting

The accuracy of Additive Manufacturing processes in fabricating porous biomaterials is currently limited by their capacity to render pore morphology that precisely matches its design. In a porous biomaterial, a geometric mismatch can result in pore occlusion and strut thinning, drawbacks that can inherently compromise bone ingrowth and severely impact mechanical performance. This paper focuses on Selective Laser Melting of porous microarchitecture and proposes a compensation scheme that reduces the morphology mismatch between as-designed and as-manufactured geometry, in particular that of the pore. A spider web analog is introduced, built out of Ti-6Al-4V powder via SLM, and morphologically characterized. Results from error analysis of strut thickness are used to generate thickness compensation relations expressed as a function of the angle each strut formed with the build plane. The scheme is applied to fabricate a set of three-dimensional porous biomaterials, which are morphologically and mechanically characterized via micro Computed Tomography, mechanically tested and numerically analyzed. For strut thickness, the results show the largest mismatch (60% from the design) occurring for horizontal members, reduces to 3.1% upon application of the compensation. Similar improvement is observed also for the mechanical properties, a factor that further corroborates the merit of the design-oriented scheme here introduced.

High-strength porous biomaterials for bone replacement: A strategy to assess the interplay between cell morphology, mechanical properties, bone ingrowth and manufacturing constraints

High-strength fully porous biomaterials built with additive manufacturing provide an exciting opportunity for load-bearing orthopedic applications. While factors controlling their mechanical and biological response have recently been the subject of intense research, the interplay between mechanical properties, bone ingrowth requirements, and manufacturing constraints, is still unclear. In this paper, we present two high-strength stretch-dominated topologies, the Tetrahedron and the Octet truss, as well as an intuitive visualization method to understand the relationship of cell topology, pore size, porosity with constraints imposed by bone ingrowth requirements and additive manufacturing. 40 samples of selected porosities are fabricated using Selective Laser Melting (SLM), and their morphological deviations resulting from SLM are assessed via micro-CT. Mechanical compression testing is used to obtain stiffness and strength properties, whereas bone ingrowth is assessed in a canine in vivo model at four and eight weeks. The results show that the maximum strength and stiffness ranged from 227.86±10.15 to 31.37±2.19MPa and 4.58±0.18 to 1.23±0.40GPa respectively, and the maximum 0.2% offset strength is almost 5 times stronger than that of tantalum foam. For Tetrahedron samples, bone ingrowth after four and eight weeks is 28.6%±11.6%, and 41.3%±4.3%, while for the Octet truss 35.5%±1.9% and 56.9%±4.0% respectively. This research is the first to demonstrate the occurrence of bone ingrowth into high-strength porous biomaterials which have higher structural efficiency than current porous biomaterials in the market.

STATEMENT OF SIGNIFICANCE

We present two stretch-dominated cell topologies for porous biomaterials that can be used for load-bearing orthopaedic applications, and prove that they encourage bone ingrowth in a canine model. We also introduce an intuitive method to visualize and understand the relationship of cell topology, pore size, porosity with constraints imposed by bone ingrowth requirements and additive manufacturing. We show this strategy helps to gain insight into the interaction of exogenous implant factors and endogenous system factors that can affect the success of load-bearing orthopaedic devices.

Porous titanium bases for osteochondral tissue engineering

Tissue engineering of osteochondral grafts may offer a cell-based alternative to native allografts, which are in short supply. Previous studies promote the fabrication of grafts consisting of a viable cell-seeded hydrogel integrated atop a porous, bone-like metal. Advantages of the manufacturing process have led to the evaluation of porous titanium as the bone-like base material. Here, porous titanium was shown to support the growth of cartilage to produce native levels of Young's modulus, using a clinically relevant cell source. Mechanical and biochemical properties were similar or higher for the osteochondral constructs compared to chondral-only controls. Further investigation into the mechanical influence of the base on the composite material suggests that underlying pores may decrease interstitial fluid pressurization and applied strains, which may be overcome by alterations to the base structure. Future studies aim to optimize titanium-based tissue engineered osteochondral constructs to best match the structural architecture and strength of native grafts.

STATEMENT OF SIGNIFICANCE

The studies described in this manuscript follow up on previous studies from our lab pertaining to the fabrication of osteochondral grafts that consist of a bone-like porous metal and a chondrocyte-seeded hydrogel. Here, tissue engineered osteochondral grafts were cultured to native stiffness using adult chondrocytes, a clinically relevant cell source, and a porous titanium base, a material currently used in clinical implants. This porous titanium is manufactured via selective laser melting, offering the advantages of precise control over shape, pore size, and orientation. Additionally, this manuscript describes the mechanical influence of the porous base, which may have applicability to porous bases derived from other materials.

Custom-made titanium devices as membranes for bone augmentation in implant treatment: Clinical application and the comparison with conventional titanium mesh

OBJECTIVE

Development of new custom-made devices to reconstruct alveolar bone for implantation, and comparison with conventional methods were the goals of this study.

MATERIALS AND METHODS

Using a computer-aided design technique, three-dimensional images were constructed. From these data, custom-made devices were produced by a selective laser melting method with pure titanium. Clinical trials also have been conducted with 26 participants who needed bone reconstruction before implantation; they were divided into 2 groups with 13 patients each. The first group uses custom-made devices; the other uses commercial titanium meshes that need to bend during operation. Some clinical aspects are evaluated after the trial.

RESULTS

The custom-made devices can be produced closely by following the data precisely. Devices are fit for bone defect site. Moreover, the operation time of the custom-made group (75.4 ± 11.6 min) was significantly shorter than that of the conventional group (111.9 ± 17.8 min) (p < 0.01). Mucosal rupture occurs, without significant difference (p = 0.27), in a patient in the custom-made without severe infection (7.7%), and 3 in conventional (23.1%), respectively. The retaining screw is significantly fewer in the custom-made group than commercial mesh group (p < 0.01).

CONCLUSION

These results indicate that our novel protocol could be simple and safe for providing powerful support for guided bone regeneration.

Comparison of high-intensity sound and mechanical vibration for cleaning porous titanium cylinders fabricated using selective laser melting

Orthopedic components, such as the acetabular cup in total hip joint replacement, can be fabricated using porous metals, such as titanium, and a number of processes, such as selective laser melting. The issue of how to effectively remove loose powder from the pores (residual powder) of such components has not been addressed in the literature. In this work, we investigated the feasibility of two processes, acoustic cleaning using high‐intensity sound inside acoustic horns and mechanical vibration, to remove residual titanium powder from selective laser melting‐fabricated cylinders. With acoustic cleaning, the amount of residual powder removed was not influenced by either the fundamental frequency of the horn used (75 vs. 230 Hz) or, for a given horn, the number of soundings (between 1 and 20). With mechanical vibration, the amount of residual powder removed was not influenced by the application time (10 vs. 20 s). Acoustic cleaning was found to be more reliable and effective in removal of residual powder than cleaning with mechanical vibration. It is concluded that acoustic cleaning using high‐intensity sound has significant potential for use in the final preparation stages of porous metal orthopedic components. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 117–123, 2017.

Additively Manufactured Open-Cell Porous Biomaterials Made from Six Different Space-Filling Unit Cells: The Mechanical and Morphological Properties

It is known that the mechanical properties of bone-mimicking porous biomaterials are a function of the morphological properties of the porous structure, including the configuration and size of the repeating unit cell from which they are made. However, the literature on this topic is limited, primarily because of the challenge in fabricating porous biomaterials with arbitrarily complex morphological designs. In the present work, we studied the relationship between relative density (RD) of porous Ti6Al4V EFI alloy and five compressive properties of the material, namely elastic gradient or modulus (E_s20–70), first maximum stress, plateau stress, yield stress, and energy absorption. Porous structures with different RD and six different unit cell configurations (cubic (C), diamond (D), truncated cube (TC), truncated cuboctahedron (TCO), rhombic dodecahedron (RD), and rhombicuboctahedron (RCO)) were fabricated using selective laser melting. Each of the compressive properties increased with increase in RD, the relationship being of a power law type. Clear trends were seen in the influence of unit cell configuration and porosity on each of the compressive properties. For example, in terms of E_s20–70, the structures may be divided into two groups: those that are stiff (comprising those made using C, TC, TCO, and RCO unit cell) and those that are compliant (comprising those made using D and RD unit cell).

Modeling of time dependent localized flow shear stress and its impact on cellular growth within additive manufactured titanium implants

Bone augmentation implants are porous to allow cellular growth, bone formation and fixation. However, the design of the pores is currently based on simple empirical rules, such as minimum pore and interconnects sizes. We present a three-dimensional (3D) transient model of cellular growth based on the Navier-Stokes equations that simulates the body fluid flow and stimulation of bone precursor cellular growth, attachment, and proliferation as a function of local flow shear stress. The model's effectiveness is demonstrated for two additive manufactured (AM) titanium scaffold architectures. The results demonstrate that there is a complex interaction of flow rate and strut architecture, resulting in partially randomized structures having a preferential impact on stimulating cell migration in 3D porous structures for higher flow rates. This novel result demonstrates the potential new insights that can be gained via the modeling tool developed, and how the model can be used to perform what-if simulations to design AM structures to specific functional requirements.

Properties of open-cell porous metals and alloys for orthopaedic applications

One shortcoming of metals and alloys used to fabricate various components of orthopaedic systems, such as the femoral stem of a total hip joint replacement and the tibial plate of a total knee joint replacement, is well-recognized. This is that the material modulus of elasticity (E') is substantially larger than that of the contiguous cancellous bone, a consequence of which is stress shielding which, in turn, has been postulated to be implicated in a cascade of events that culminates in the principal life-limiting phenomenon of these systems, namely, aseptic loosening. Thus, over the years, a host of research programs have focused on the synthesis of metallic biomaterials whose E' can be tailored to match that of cancellous bone. The present work is a review of the extant large volume of literature on these materials, which are called open-cell porous metals/alloys (or, sometimes, metal foams or cellular materials). As such, its range is wide, covering myriad aspects such as production methods, characterization studies, in vitro evaluations, and in vivo performance. The review also includes discussion of seven areas for future research, such as parametric studies of the influence of an assortment of process variables (such as the space holder material and the laser power in the space holder method and the laser-engineered net-shaping process, respectively) on various properties (notably, permeability, fatigue strength, and corrosion resistance) of a given porous metal/alloy, innovative methods of determining fatigue strength, and modeling of corrosion behavior.

Bone regeneration by the osteoconductivity of porous titanium implants manufactured by selective laser melting: a histological and micro computed tomography study in the rabbit

The treatment of large bone defects still poses a major challenge in orthopaedic and cranio-maxillofacial surgery. One possible solution could be the development of personalized porous titanium-based implants that are designed to meet all mechanical needs with a minimum amount of titanium and maximum osteopromotive properties so that it could be combined with growth factor-loaded hydrogels or cell constructs to realize advanced bone tissue engineering strategies. Such implants could prove useful for mandibular reconstruction, spinal fusion, the treatment of extended long bone defects, or to fill in gaps created on autograft harvesting. The aim of this study was to determine the mechanical properties and potential of bone formation of light weight implants generated by selective laser melting (SLM). We mainly focused on osteoconduction, as this is a key feature in bone healing and could serve as a back-up for osteoinduction and cell transplantation strategies. To that end, defined implants were produced by SLM, and their surfaces were left untreated, sandblasted, or sandblasted/acid etched. In vivo bone formation with the different implants was tested throughout calvarial defects in rabbits and compared with untreated defects. Analysis by micro computed tomography (μCT) and histomorphometry revealed that all generatively produced porous Ti structures were well osseointegrated into the surrounding bone. The histomorphometric analysis revealed that bone formation was significantly increased in all implant-treated groups compared with untreated defects and significantly increased in sand blasted implants compared with untreated ones. Bone bridging was significantly increased in sand blasted acid-etched scaffolds. Therefore, scaffolds manufactured by SLM should be surface treated. Bone augmentation beyond the original bone margins was only seen in implant-treated defects, indicating an osteoconductive potential of the implants that could be utilized clinically for bone augmentation purposes. Therefore, designed porous, lightweight structures have potential for bone regeneration and augmentation purposes, especially when complex and patient-specific geometries are essential.

Bone ingrowth potential of electron beam and selective laser melting produced trabecular-like implant surfaces with and without a biomimetic coating

The bone ingrowth potential of trabecular-like implant surfaces produced by either selective laser melting (SLM) or electron beam melting (EBM), with or without a biomimetic calciumphosphate coating, was examined in goats. For histological analysis and histomorphometry of bone ingrowth depth and bone implant contact specimens were implanted in the femoral condyle of goats. For mechanical push out tests to analyse mechanical implant fixation specimens were implanted in the iliac crest. The follow up periods were 4 (7 goats) and 15 weeks (7 goats). Both the SLM and EBM produced trabecular-like structures showed a variable bone ingrowth after 4 weeks. After 15 weeks good bone ingrowth was found in both implant types. Irrespective to the follow up period, and the presence of a coating, no histological differences in tissue reaction around SLM and EBM produced specimens was found. Histological no coating was detected at 4 and 15 weeks follow up. At both follow up periods the mechanical push out strength at the bone implant interface was significantly lower for the coated SLM specimens compared to the uncoated SLM specimens. The expected better ingrowth characteristics and mechanical fixation strength induced by the coating were not found. The lower mechanical strength of the coated specimens produced by SLM is a remarkable result, which might be influenced by the gross morphology of the specimens or the coating characteristics, indicating that further research is necessary.

The effect of pore geometry on the in vitro biological behavior of human periosteum-derived cells seeded on selective laser-melted Ti6Al4V bone scaffolds

The specific aim of this study was to gain insight into the influence of scaffold pore size, pore shape and permeability on the in vitro proliferation and differentiation of three-dimensional (3-D) human periosteum-derived cell (hPDC) cultures. Selective laser melting (SLM) was used to produce six distinct designed geometries of Ti6Al4V scaffolds in three different pore shapes (triangular, hexagonal and rectangular) and two different pore sizes (500 μm and 1000 μm). All scaffolds were characterized by means of two-dimensional optical microscopy, 3-D microfocus X-ray computed tomography (micro-CT) image analysis, mechanical compression testing and computational fluid dynamical analysis. The results showed that SLM was capable of producing Ti6Al4V scaffolds with a broad range of morphological and mechanical properties. The in vitro study showed that scaffolds with a lower permeability gave rise to a significantly higher number of cells attached to the scaffolds after seeding. Qualitative analysis by means of live/dead staining and scanning electron micrography showed a circular cell growth pattern which was independent of the pore size and shape. This resulted in pore occlusion which was found to be the highest on scaffolds with 500 μm hexagonal pores. Interestingly, pore size but not pore shape was found to significantly influence the growth of hPDC on the scaffolds, whereas the differentiation of hPDC was dependent on both pore shape and pore size. The results showed that, for SLM-produced Ti6Al4V scaffolds with specific morphological and mechanical properties, a functional graded scaffold will contribute to enhanced cell seeding and at the same time can maintain nutrient transport throughout the whole scaffold during in vitro culturing by avoiding pore occlusion.

Extrusion printed polymer structures: a facile and versatile approach to tailored drug delivery platforms

A novel extrusion printing system was used to create drug delivery structures wherein dexamethasone-21-phosphate disodium salt (Dex21P) was encapsulated within a biodegradable polymer (PLGA) and water soluble poly(vinyl alcohol) (PVA) configurations. The ability to control the drug release profile through the spatial distribution of drug within the printed 3-dimensional structures is demonstrated. The fabricated configurations were characterised by optical microscopy and SEM to evaluate surface morphology. The results clearly demonstrate the successful encapsulation of dexamethasone within a laminated PLGA:PVA structure. The resulting drug release profiles from the structures show a two stage release profile with distinctly different release rates and minimal initial burst release observed. Dexamethasone release was monitored over a 4-month period. This approach clearly demonstrates that the extrusion printing technique provides a facile and versatile approach to fabrication of novel drug delivery platforms.

Osteoinduction of porous Ti implants with a channel structure fabricated by selective laser melting

Many studies have shown that certain biomaterials with specific porous structures can induce bone formation in non-osseous sites without the need for osteoinductive biomolecules, however, the mechanisms responsible for this phenomenon (intrinsic osteoinduction of biomaterials) remain unclear. In particular, to our knowledge the type of pore structure suitable for osteoinduction has not been reported in detail. In the present study we investigated the effects of interconnective pore size on osteoinductivity and the bone formation processes during osteoinduction. Selective laser melting was employed to fabricate porous Ti implants (diameter 3.3mm, length 15 mm) with a channel structure comprising four longitudinal square channels, representing pores, of different diagonal widths, 500, 600, 900, and 1200 μm (termed p500, p600, p900, and p1200, respectively). These were then subjected to chemical and heat treatments to induce bioactivity. Significant osteoinduction was observed in p500 and p600, with the highest observed osteoinduction occurring at 5mm from the end of the implants. A distance of 5mm probably provides a favorable balance between blood circulation and fluid movement. Thus, the simple architecture of the implants allowed effective investigation of the influence of the interconnective pore size on osteoinduction, as well as the relationship between bone quantity and its location for different pore sizes.