A comparative analysis of scaffold material modifications for load-bearing applications in bone tissue engineering

Bibliometric Analysis-Based Review of Fused Deposition Modeling 3D Printing Method (1994-2020)

This study aimed at the detailed bibliometric analysis (BA) of fused deposition modeling (FDM) to understand the trend and research area. Web of Science database was used for extracting data using keywords, and 2793 documents were analyzed. From the analysis, the most influential and productive authors, countries, sources, and so on were identified and corresponding interrelations were represented by a three-field plot. Lotka's law was derived for author productivity and its reliability was verified by the Kolmogorov-Smirnov (K-S) test. Bradford's law was used for identifying the core sources contributing to the field of FDM. From the trend topic analysis, it was found that initially the research was focused upon removing error related to deposition as well as part orientation, but with the course of time, it diversified to include topics such as optimization of printing parameters, materials, and applications. Based on the inferences from BA, the article also discusses on current research trend and highlights certain future areas for research work.

An overview of translational research in bone graft biomaterials

Natural bone healing is often inadequate to treat fractures with critical size bone defects and massive bone loss. Immediate surgical interventions through bone grafts have been found to be essential on such occasions. Naturally harvested bone grafts, although are the preferred choice of the surgeons; they suffer from serious clinical limitations, including disease transmission, donor site morbidity, limited supply of graft etc. Synthetic bone grafts, on the other hand, offer a more clinically appealing approach to decode the pathways of bone repair through use of tissue engineered biomaterials. This article critically retrospects the translational research on various engineered biomaterials towards bringing transformative changes in orthopaedic healthcare. The first section of the article discusses about composition and ultrastructure of bone along with the global perspectives on statistical escalation of bone fracture surgeries requiring use of bone grafts. The next section reviews the types, benefits and challenges of various natural and synthetic bone grafts. An overview of clinically relevant biomaterials from traditionally used metallic, bioceramic, and biopolymeric biomaterials to new generation composites have been summarised. Finally, this narrative review concludes with the discussion on the emerging trends and future perspectives of the promising bone grafts.

Pellet-Based Fused Filament Fabrication (FFF)-Derived Process for the Development of Polylactic Acid/Hydroxyapatite Scaffolds Dedicated to Bone Regeneration

Scaffolds can be defined as 3D architectures with specific features (surface properties, porosity, rigidity, biodegradability, etc.) that help cells to attach, proliferate, and to differentiate into specific lineage. For bone regeneration, rather high mechanical properties are required. That is why polylactic acid (PLA) and PLA/hydroxyapatite (HA) scaffolds (10 wt.%) were produced by a peculiar fused filament fabrication (FFF)-derived process. The effect of the addition of HA particles in the scaffolds was investigated in terms of morphology, biological properties, and biodegradation behavior. It was found that the scaffolds were biocompatible and that cells managed to attach and proliferate. Biodegradability was assessed over a 5-month period (according to the ISO 13781-Biodegradability norm) through gel permeation chromatography (GPC), differential scanning calorimetry (DSC), and compression tests. The results revealed that the presence of HA in the scaffolds induced a faster and more complete polymer biodegradation, with a gradual decrease in the molar mass (Mn) and compressive mechanical properties over time. In contrast, the Mn of PLA only decreased during the processing steps to obtain scaffolds (extrusion + 3D-printing) but PLA scaffolds did not degrade during conditioning, which was highlighted by a high retention of the mechanical properties of the scaffolds after conditioning.

3D printed hydroxyapatite-nacre-starch based bone grafts: Evaluation of biological and mechanical properties

The possibilities of utilizing nacre as a reinforcing material to manufacture 3D printed bone grafts are yet to be explored. This work reports the feasibility of fabricating 3D printed nacre-hydroxyapatitestarch composite bone graft substitutes, emphasizing the effects of nacre addition on biological and mechanical properties. Pressure-less extrusion-based 3D printing of ceramic-polymer viscous slurry is challenging due to the composition and process-parameter variations. To overcome these challenges, a dual extrusion solid freeform fabricator (SFF) has been designed. An increase in nacre loading improves the compressive strength from 9.5 ± 0.1 MPa to 11.7 ± 0.2 MPa, without any post-processing or sintering. Nacre's in vitro osteogenic properties lead to a slight increase in hFOB cellular attachment on the graft surface by day 11. The fabricated structures show good mechanical integrity during the dissolution study in simulated body fluid (SBF). These bone graft substitutes may be utilized to repair low load bearing skeletal defects.

Harnessing artificial intelligence for the next generation of 3D printed medicines

Artificial intelligence (AI) is redefining how we exist in the world. In almost every sector of society, AI is performing tasks with super-human speed and intellect; from the prediction of stock market trends to driverless vehicles, diagnosis of disease, and robotic surgery. Despite this growing success, the pharmaceutical field is yet to truly harness AI. Development and manufacture of medicines remains largely in a 'one size fits all' paradigm, in which mass-produced, identical formulations are expected to meet individual patient needs. Recently, 3D printing (3DP) has illuminated a path for on-demand production of fully customisable medicines. Due to its flexibility, pharmaceutical 3DP presents innumerable options during formulation development that generally require expert navigation. Leveraging AI within pharmaceutical 3DP removes the need for human expertise, as optimal process parameters can be accurately predicted by machine learning. AI can also be incorporated into a pharmaceutical 3DP 'Internet of Things', moving the personalised production of medicines into an intelligent, streamlined, and autonomous pipeline. Supportive infrastructure, such as The Cloud and blockchain, will also play a vital role. Crucially, these technologies will expedite the use of pharmaceutical 3DP in clinical settings and drive the global movement towards personalised medicine and Industry 4.0.

The State of Starch/Hydroxyapatite Composite Scaffold in Bone Tissue Engineering with Consideration for Dielectric Measurement as an Alternative Characterization Technique

Hydroxyapatite (HA) has been widely used as a scaffold in tissue engineering. HA possesses high mechanical stress and exhibits particularly excellent biocompatibility owing to its similarity to natural bone. Nonetheless, this ceramic scaffold has limited applications due to its apparent brittleness. Therefore, this had presented some difficulties when shaping implants out of HA and for sustaining a high mechanical load. Fortunately, these drawbacks can be improved by combining HA with other biomaterials. Starch was heavily considered for biomedical device applications in favor of its low cost, wide availability, and biocompatibility properties that complement HA. This review provides an insight into starch/HA composites used in the fabrication of bone tissue scaffolds and numerous factors that influence the scaffold properties. Moreover, an alternative characterization of scaffolds via dielectric and free space measurement as a potential contactless and nondestructive measurement method is also highlighted.

Biomimetic Mineralization on 3D Printed PLA Scaffolds: On the Response of Human Primary Osteoblasts Spheroids and In Vivo Implantation

This study aimed to assess the response of 3D printed polylactic acid (PLA) scaffolds biomimetically coated with apatite on human primary osteoblast (HOb) spheroids and evaluate the biological response to its association with Bone Morphogenetic Protein 2 (rhBMP-2) in rat calvaria. PLA scaffolds were produced via 3D printing, soaked in simulated body fluid (SBF) solution to promote apatite deposition, and characterized by physical-chemical, morphological, and mechanical properties. PLA-CaP scaffolds with interconnected porous and mechanical properties suitable for bone repairing were produced with reproducibility. The in vitro biological response was assessed with human primary osteoblast spheroids. Increased cell adhesion and the rise of in vitro release of growth factors (Platelet-Derived Growth Factor (PDGF), Basic Fibroblast Growth Factor (bFGF), Vascular Endothelial Growth Factor (VEGF) was observed for PLA-CaP scaffolds, when pre-treated with fetal bovine serum (FBS). This pre-treatment with FBS was done in a way to enhance the adsorption of serum proteins, increasing the number of bioactive sites on the surface of scaffolds, and to partially mimic in vivo interactions. The in vivo analysis was conducted through the implantation of 3D printed PLA scaffolds either alone, coated with apatite (PLA-CaP) or PLA-CaP loaded with rhBMP-2 on critical-sized defects (8 mm) of rat calvaria. PLA-CaP+rhBMP2 presented higher values of newly formed bone (NFB) than other groups at all in vivo experimental periods (p < 0.05), attaining 44.85% of NFB after six months. These findings indicated two new potential candidates as alternatives to autogenous bone grafts for long-term treatment: (i) 3D-printed PLA-CaP scaffold associated with spheroids, since it can reduce the time of repair in situ by expression of biomolecules and growth factors; and (ii) 3D-printed PLA-CaP functionalized rhBMP2 scaffold, a biocompatible, bioactive biomaterial, with osteoconductivity and osteoinductivity.

3D printing technology as innovative solutions for biomedical applications

3D printing was once predicted to be the third industrial revolution. Today, the use of 3D printing is found across almost all industries. This article discusses the latest 3D printing applications in the biomedical industry.

Dual Nanofibrous Bioactive Coatings on TiZr Implants

The objective of this research was to obtain a dual coating with antimicrobial properties on TiZr implants. The metallic surfaces were modified with two biopolymers (poly(lactic acid) and polycaprolactone), the first deposited by dip coating and the second by electrospinning, in order to create a nanofibers type of coating with antibacterial and bioactive effect. The surface characteristics of the obtained bioactive coatings were evaluated by Fourier Transformed Infrared Spectroscopy, by scanning electron microscopy and by contact angle measurements. The electrochemical characterization of the coatings was performed in simulated body fluid. The metallic ion release from the coated implant materials was measured by inductively coupled plasma mass spectrometry. The in vitro antimicrobial properties of the coatings were studied using agar disc diffusion method and percentage inhibition of growth method for two bacterial strains—S. aureus and E. coli. The presence of silver nanoparticles presented high inhibition zone against gram negative bacteria like E. coli. Cell viability of MC3T3-E1 osteoblasts and cytoskeleton morphology, were tested in vitro for the biological evaluation. The results on in vitro cell response indicated good cell membrane integrity and viability for such nanofibrous bioactive coatings compared to the control substrate. These surface architectures design on implant materials holds promise for biomedical applications, presenting good antimicrobial properties and promote cell adhesion and proliferation.

Electrospun PCL/PGS Composite Fibers Incorporating Bioactive Glass Particles for Soft Tissue Engineering Applications

Poly(glycerol-sebacate) (PGS) and poly(epsilon caprolactone) (PCL) have been widely investigated for biomedical applications in combination with the electrospinning process. Among others, one advantage of this blend is its suitability to be processed with benign solvents for electrospinning. In this work, the suitability of PGS/PCL polymers for the fabrication of composite fibers incorporating bioactive glass (BG) particles was investigated. Composite electrospun fibers containing silicate or borosilicate glass particles (13-93 and 13-93BS, respectively) were obtained and characterized. Neat PCL and PCL composite electrospun fibers were used as control to investigate the possible effect of the presence of PGS and the influence of the bioactive glass particles. In fact, with the addition of PGS an increase in the average fiber diameter was observed, while in all the composite fibers, the presence of BG particles induced an increase in the fiber diameter distribution, without changing significantly the average fiber diameter. Results confirmed that the blended fibers are hydrophilic, while the addition of BG particles does not affect fiber wettability. Degradation test and acellular bioactivity test highlight the release of the BG particles from all composite fibers, relevant for all applications related to therapeutic ion release, i.e., wound healing. Because of weak interface between the incorporated BG particles and the polymeric fibers, mechanical properties were not improved in the composite fibers. Promising results were obtained from preliminary biological tests for potential use of the developed mats for soft tissue engineering applications.

Use of Biomaterials for 3D Printing by Fused Deposition Modeling Technique: A Review

Three-dimensional (3D) printing is a revolutionary manufacturing technique that can fabricate a 3D object by depositing materials layer by layer. Different materials such as metals, polymers, and concretes are generally used for 3D printing. In order to make 3D printing sustainable, researchers are working on the use of different bioderived materials for 3D printing. Because of the abundant and sustainable sources, and versatile properties, biomaterials are considered as the potential candidates that have the ability to replace petroleum-based polymers. This review highlights the basic overview of fused deposition modeling (FDM) technique of 3D printing and recent developments that have occurred on FDM printing using biomaterials. Specifically, FDM printing process, final properties, and characteristics of biopolymers, their composites, and polymers containing biofillers are discussed.

Vascularization and biocompatibility of poly(ε-caprolactone) fiber mats for rotator cuff tear repair

Rotator cuff tear is the most frequent tendon injury in the adult population. Despite current improvements in surgical techniques and the development of grafts, failure rates following tendon reconstruction remain high. New therapies, which aim to restore the topology and functionality of the interface between muscle, tendon and bone, are essentially required. One of the key factors for a successful incorporation of tissue engineered constructs is a rapid ingrowth of cells and tissues, which is dependent on a fast vascularization. The dorsal skinfold chamber model in female BALB/cJZtm mice allows the observation of microhemodynamic parameters in repeated measurements in vivo and therefore the description of the vascularization of different implant materials. In order to promote vascularization of implant material, we compared a porous polymer patch (a commercially available porous polyurethane based scaffold from Biomerix™) with electrospun polycaprolactone (PCL) fiber mats and chitosan-graft-PCL coated electrospun PCL (CS-g-PCL) fiber mats in vivo. Using intravital fluorescence microscopy microcirculatory parameters were analyzed repetitively over 14 days. Vascularization was significantly increased in CS-g-PCL fiber mats at day 14 compared to the porous polymer patch and uncoated PCL fiber mats. Furthermore CS-g-PCL fiber mats showed also a reduced activation of immune cells. Clinically, these are important findings as they indicate that the CS-g-PCL improves the formation of vascularized tissue and the ingrowth of cells into electrospun PCL scaffolds. Especially the combination of enhanced vascularization and the reduction in immune cell activation at the later time points of our study points to an improved clinical outcome after rotator cuff tear repair.

Starch-Hydroxyapatite Composite Bone Scaffold Fabrication Utilizing a Slurry Extrusion-Based Solid Freeform Fabricator

Significant efforts have been made to treat bone disorders through the development of composite scaffolds utilizing calcium phosphate (CaP) through additive manufacturing techniques. However, the incorporation of natural polymers with CaP during 3D printing is difficult and remains a formidable challenge in bone and tissue engineering applications. The objective of this study is to understand the use of a natural polymer binder system in ceramic composite scaffolds using a ceramic slurry-based solid freeform fabricator (SFF). This was achieved through the utilization of naturally sourced gelatinized starch with hydroxyapatite (HA) ceramic in order to obtain high mechanical strength and enhanced biological properties of the green part without the need for cross-linking or post processing. The parametric effects of solids loading, polycaprolactone (PCL) polymer addition, and designed porosity on starch-HA composite scaffolds were assessed through mechanical strength, microstructure, and in vitro biocompatibility utilizing human osteoblast cells. It was hypothesized that starch incorporation would improve the mechanical strength of the scaffolds and increase proliferation of osteoblast cells in vitro. Starch loading was shown to improve mechanical strength from 4.07 ± 0.66 MPa to 10.35 ± 1.10 MPa, more closely resembling the mechanical strength of cancellous bone. Based on these results, a reinforcing mechanism of gelatinized starch based on interparticle and apatite crystal interlocking is proposed. Morphological characterization utilizing FESEM and MTT cell viability assay showed enhanced osteoblast cell proliferation in the presence of starch and PCL. Overall, the utilization of starch as a natural binder system in SFF scaffolds was found to improve both green strength and in vitro biocompatibility.

In vivo biocompatibility and degradation of novel Polycaprolactone-Biphasic Calcium phosphate scaffolds used as a bone substitute

BACKGROUND

Biocompatibility and degradation of poly ε-caprolactone (PCL)-Biphasic Calcium Phosphate (BCP) scaffolds fabricated by the "Melt Stretching and Compression Molding (MSCM)" technique were evaluated in rat models.

OBJECTIVES

Degradation behaviors and histological biocompatibility of the PCL-20% BCP MSCM scaffolds and compare with those of PCL-20% β-tricalcium phosphate (TCP) scaffolds commercially fabricated by Fused Deposition Modeling (FDM) were evaluated.

METHODS

The study groups included Group A: PCL-20% BCP MSCM scaffolds and Group B: PCL-20% TCP FDM scaffolds, which were implanted subcutaneously in twelve male Wistar rats. On day 14, 30, 60 and 90, dimensional changes of the scaffolds and their surrounding histological features were assessed using Micro-Computed Tomography (μ-CT) and histological analysis. Changes of their molecular weight were assessed using Gel Permeation Chromatography (GPC).

RESULTS

Formation of collagen and new blood vessels throughout the scaffolds of both groups increased with time with low degrees of inflammation. The μ-CT and GPC analysis demonstrated that the scaffolds of both groups degraded with time, but, their molecular weight slightly changed over the observation periods. All results of both groups were not significantly different.

CONCLUSIONS

The PCL-20% BCP MSCM scaffolds were biocompatible and biodegradable in vivo. Their properties were comparable to those of the commercial PCL-20% TCP scaffolds.

3D printed medicines: A new branch of digital healthcare

Three-dimensional printing (3DP) is a highly disruptive technology with the potential to change the way pharmaceuticals are designed, prescribed and produced. Owing to its low cost, diversity, portability and simplicity, fused deposition modeling (FDM) is well suited to a multitude of pharmaceutical applications in digital health. Favourably, through the combination of digital and genomic technologies, FDM enables the remote fabrication of drug delivery systems from 3D models having unique shapes, sizes and dosages, enabling greater control over the release characteristics and hence bioavailability of medications. In turn, this system could accelerate the digital healthcare revolution, enabling medicines to be tailored to the individual needs of each patient on demand. To date, a variety of FDM 3D printed medical products (e.g. implants) have been commercialised for clinical use. However, within pharmaceuticals, certain regulatory hurdles still remain. This article reviews the current state-of-the-art in FDM technology for medical and pharmaceutical research, including its use for personalised treatments and interconnection within digital health networks. The outstanding challenges are also discussed, with a focus on the future developments that are required to facilitate its integration within pharmacies and hospitals.

Three-Dimensional Printing of Wood-Derived Biopolymers: A Review Focused on Biomedical Applications

Wood-derived biopolymers have attracted great attention over the past few decades due to their abundant and versatile properties. The well-separated three main components, i.e., cellulose, hemicelluloses, and lignin, are considered significant candidates for replacing and improving on oil-based chemicals and materials. The production of nanocellulose from wood pulp opens an opportunity for novel material development and applications in nanotechnology. Currently, increased research efforts are focused on developing 3D printing techniques for wood-derived biopolymers for use in emerging application areas, including as biomaterials for various biomedical applications and as novel composite materials for electronics and energy devices. This Review highlights recent work on emerging applications of wood-derived biopolymers and their advanced composites with a specific focus on customized pharmaceutical products and advanced functional biomedical devices prepared via three-dimensional printing. Specifically, various biofabrication strategies in which woody biopolymers are used to fabricate customized drug delivery devices, cartilage implants, tissue engineering scaffolds and items for other biomedical applications are discussed.

Physical characteristics and biocompatibility of the polycaprolactone-biphasic calcium phosphate scaffolds fabricated using the modified melt stretching and multilayer deposition

Physical properties and biocompatibility of polycaprolactone (PCL)-biphasic calcium phosphate (BCP) scaffolds fabricated by the modified melt stretching and multilayer deposition (mMSMD) technique were evaluated in vitro. The PCL-BCP scaffold specimens included group A; PCL: BCP (wt%) = 80:20 and group B; 70:30. Mechanical properties of the scaffolds were assessed using a universal testing machine. Degradation behaviors of the scaffolds were assessed over 60 days. The amount of calcium and phosphate ions released from the scaffolds was detected over 30 days. Attachment and growth of osteoblasts on the scaffolds and indirect cytocompatibility to those cells were evaluated. The results showed that the scaffolds of both groups could withstand compressive forces on their superior aspect very well; however, their lateral aspect could only withstand light forces. Degradation of the scaffolds over 2 months was low (group A = 1.92 ± 0.47% and group B = 2.9 ± 1.3%,p > 0.05). The concentrations of calcium and phosphate ions released from the scaffolds of both groups significantly increased on day 7 (p < 0.05). Growth of the cells seemed to relate to accumulative increase in those ions. All results between the two ratios of the scaffolds were not statistically different.

Collagen-Hydroxyapatite Scaffolds Induce Human Adipose Derived Stem Cells Osteogenic Differentiation In Vitro

Mesenchymal stem cells (MSCs) play a crucial role in regulating normal skeletal homeostasis and, in case of injury, in bone healing and reestablishment of skeletal integrity. Recent scientific literature is focused on the development of bone regeneration models where MSCs are combined with biomimetic three-dimensional scaffolds able to direct MSC osteogenesis. In this work the osteogenic potential of human MSCs isolated from adipose tissue (hADSCs) has been evaluated in vitro in combination with collagen/Mg doped hydroxyapatite scaffolds. Results demonstrate the high osteogenic potential of hADSCs when cultured in specific differentiation induction medium, as revealed by the Alizarin Red S staining and gene expression profile analysis. In combination with collagen/hydroxyapatite scaffold, hADSCs differentiate into mature osteoblasts even in the absence of specific inducing factors; nevertheless, the supplement of the factors markedly accelerates the osteogenic process, as confirmed by the expression of specific markers of pre-osteoblast and mature osteoblast stages, such as osterix, osteopontin (also known as bone sialoprotein I), osteocalcin and specific markers of extracellular matrix maturation and mineralization stages, such as ALPL and osteonectin. Hence, the present work demonstrates that the scaffold per se is able to induce hADSCs differentiation, while the addition of osteo-inductive factors produces a significant acceleration of the osteogenic process. This observation makes the use of our model potentially interesting in the field of regenerative medicine for the treatment of bone defects.

Design, materials, and mechanobiology of biodegradable scaffolds for bone tissue engineering

A review about design, manufacture, and mechanobiology of biodegradable scaffolds for bone tissue engineering is given. First, fundamental aspects about bone tissue engineering and considerations related to scaffold design are established. Second, issues related to scaffold biomaterials and manufacturing processes are discussed. Finally, mechanobiology of bone tissue and computational models developed for simulating how bone healing occurs inside a scaffold are described.

Biomineral coating increases bone formation by ex vivo BMP-7 gene therapy in rapid prototyped poly(L-lactic acid) (PLLA) and poly(ε-caprolactone) (PCL) porous scaffolds

Porousbiodegradable polymer scaffolds are widely utilized for bone tissue engineering, but are not osteoconductive like calcium phosphate scaffolds. We combine indirect solid freeform fabrication (SFF), ex vivo gene therapy, with biomineral coating to compare the effect of biomineral coating on bone regeneration for Poly (L-lactic acid) (PLLA) and Poly (ε-caprolactone) (PCL) scaffolds with the same porous architecture. Scanning electron microscope (SEM) and micro-computed tomography (μ-CT) demonstrate PLLA and PCL scaffolds have the same porous architecture and are completely coated. All scaffolds are seeded with human gingival fibroblasts (HGF) transduced with adenovirus encoded with either bone morphogenetic protein 7 (BMP-7) or green fluorescent protein (GFP), and implanted into mice subcutaneously for 3 and 10 weeks. Only scaffolds with BMP-7 transduced HGFs show mineralized tissue formation. At 3 weeks some blood vessel-like structures are observed in coated PLLA and PCL scaffolds, but there is no significant difference in bone ingrowth between the coated and uncoated scaffolds for either PLLA or PCL. At 10 weeks, however, coated scaffolds (both PLLA and PCL) have significantly more bone ingrowth than uncoated scaffolds, which have more fibrous tissue. Coated PLLA scaffolds have improved mechanical properties compared with uncoated PLLA scaffolds due to increased bone ingrowth.

3D artificial bones for bone repair prepared by computed tomography-guided fused deposition modeling for bone repair

The medical community has expressed significant interest in the development of new types of artificial bones that mimic natural bones. In this study, computed tomography (CT)-guided fused deposition modeling (FDM) was employed to fabricate polycaprolactone (PCL)/hydroxyapatite (HA) and PCL 3D artificial bones to mimic natural goat femurs. The in vitro mechanical properties, in vitro cell biocompatibility, and in vivo performance of the artificial bones in a long load-bearing goat femur bone segmental defect model were studied. All of the results indicate that CT-guided FDM is a simple, convenient, relatively low-cost method that is suitable for fabricating natural bonelike artificial bones. Moreover, PCL/HA 3D artificial bones prepared by CT-guided FDM have more close mechanics to natural bone, good in vitro cell biocompatibility, biodegradation ability, and appropriate in vivo new bone formation ability. Therefore, PCL/HA 3D artificial bones could be potentially be of use in the treatment of patients with clinical bone defects.

Solid Free-form Fabrication Technology and Its Application to Bone Tissue Engineering

The development of scaffolds for use in cell-based therapies to repair damaged bone tissue has become a critical component in the field of bone tissue engineering. However, design of scaffolds using conventional fabrication techniques has limited further advancement, due to a lack of the required precision and reproducibility. To overcome these constraints, bone tissue engineers have focused on solid free-form fabrication (SFF) techniques to generate porous, fully interconnected scaffolds for bone tissue engineering applications. This paper reviews the potential application of SFF fabrication technologies for bone tissue engineering with respect to scaffold fabrication. In the near future, bone scaffolds made using SFF apparatus should become effective therapies for bone defects.

Enhanced osteogenicity of bioactive composites with biomimetic treatment

Purpose. This study aimed to explore if initiation of biomimetic apatite nucleation can be used to enhance osteoblast response to biodegradable tissue regeneration composite membranes. Materials and Methods. Bioactive thermoplastic composites consisting of poly(ε-caprolactone/DL-lactide) and bioactive glass (BAG) were prepared at different stages of biomimetic calcium phosphate deposition by immersion in simulated body fluid (SBF). The modulation of the BAG dissolution and the osteogenic response of rat mesenchymal stem cells (MSCs) were analyzed. Results. SBF treatment resulted in a gradual calcium phosphate deposition on the composites and decreased BAG reactivity in the subsequent cell cultures. Untreated composites and composites covered by thick calcium phosphate layer (14 days in SBF) expedited MSC mineralization in comparison to neat polymers without BAG, whereas other osteogenic markers—alkaline phosphatase activity, bone sialoprotein, and osteocalcin expression—were initially decreased. In contrast, surfaces with only small calcium phosphate aggregates (five days in SBF) had similar early response than neat polymers but still demonstrated enhanced mineralization. Conclusion. A short biomimetic treatment enhances osteoblast response to bioactive composite membranes.

Polymer-ceramic spiral structured scaffolds for bone tissue engineering: effect of hydroxyapatite composition on human fetal osteoblasts

For successful bone tissue engineering, a scaffold needs to be osteoconductive, porous, and biodegradable, thus able to support attachment and proliferation of bone cells and guide bone formation. Recently, hydroxyapatites (HA), a major inorganic component of natural bone, and biodegrade polymers have drawn much attention as bone scaffolds. The present study was designed to investigate whether the bone regenerative properties of nano-HA/polycaprolactone (PCL) spiral scaffolds are augmented in an HA dose dependent manner, thereby establishing a suitable composition as a bone formation material. Nano-HA/PCL spiral scaffolds were prepared with different weight ratios of HA and PCL, while porosity was introduced by a modified salt leaching technique. Human fetal osteoblasts (hFOBs) were cultured on the nano-HA/PCL spiral scaffolds up to 14 days. Cellular responses in terms of cell adhesion, viability, proliferation, differentiation, and the expression of bone-related genes were investigated. These scaffolds supported hFOBs adhesion, viability and proliferation. Cell proliferation trend was quite similar on polymer-ceramic and neat polymer spiral scaffolds on days 1, 7, and 14. However, the significantly increased amount of alkaline phosphatase (ALP) activity and mineralized matrix synthesis was evident on the nano-HA/PCL spiral scaffolds. The HA composition in the scaffolds showed a significant effect on ALP and mineralization. Bone phenotypic markers such as bone sialoprotein (BSP), osteonectin (ON), osteocalcin (OC), and type I collagen (Col-1) were semi-quantitatively estimated by reverse transcriptase polymerase chain reaction analysis. All of these results suggested the osteoconductive characteristics of HA/PCL nanocomposite and cell maturation were HA dose dependent. For instance, HA∶PCL = 1∶4 group showed significantly higher ALP mineralization and elevated levels of BSP, ON, OC and Col-I expression as compared other lower or higher ceramic ratios. Amongst the different nano-HA/PCL spiral scaffolds, the 1∶4 weight ratio of HA and PCL is shown to be the most optimal composition for bone tissue regeneration.

The role of scaffold architecture and composition on the bone formation by adipose-derived stem cells

Scaffold architecture and composition are crucial parameters determining the initial cell spatial distribution and consequently bone tissue formation. Three-dimensional poly-ε-caprolactone (PCL) scaffolds with a 0/90° lay-down pattern were plotted and subjected to (1) an oxygen plasma (PCL O) or (2) a postargon plasma modification with gelatin and fibronectin (PCL Fn). These scaffolds with an open pore structure were compared with more compact scaffolds fabricated by conventional processing techniques: oxidized polylactic acid (LA O) and collagen (COL) scaffolds. Human adipose tissue-derived stem cell/scaffold interactions were studied. The study revealed that the biomimetic surface modification of plotted scaffolds did not increase the seeding efficiency. The proliferation and colonization was superior for PCL Fn in comparison with PCL O. The plotted PCL Fn was completely colonized throughout the scaffold, whereas conventional scaffolds only at the edge. Protein-based scaffolds (PCL Fn and COL) enhanced the differentiation, although plotted scaffolds showed a delay in their differentiation compared with compact scaffolds. In conclusion, protein modification of plotted PCL scaffolds enhances uniform tissue formation, but shows a delayed differentiation in comparison with compact scaffolds. The present study demonstrates that biomimetic PCL scaffolds could serve as a guiding template to obtain a uniform bone tissue formation in vivo.

Challenges in the characterization of plasma-processed three-dimensional polymeric scaffolds for biomedical applications

Low-temperature plasmas offer a versatile method for delivering tailored functionality to a range of materials. Despite the vast array of choices offered by plasma processing techniques, there remain a significant number of hurdles that must be overcome to allow this methodology to realize its full potential in the area of biocompatible materials. Challenges include issues associated with analytical characterization, material structure, plasma processing, and uniform composition following treatment. Specific examples and solutions are presented utilizing results from analyses of three-dimensional (3D) poly(ε-caprolactone) scaffolds treated with different plasma surface modification strategies that illustrate these challenges well. Notably, many of these strategies result in 3D scaffolds that are extremely hydrophilic and that enhance human Saos-2 osteoblast cell growth and proliferation, which are promising results for applications including tissue engineering and advanced biomedical devices.

Influence of substrate curvature on osteoblast orientation and extracellular matrix deposition

Background

The effects of microchannel diameter in hydroxyapatite (HAp) substrates on osteoblast behavior were investigated in this study. Microchannels of 100, 250 and 500 μm diameter were created on hydroxyapatite disks. The changes in osteoblast precursor growth, differentiation, extra cellular matrix (ECM) secretion and cell attachment/orientation were investigated as a function of microchannel diameter.

Results

Curvature did not impact cellular differentiation, however organized cellular orientation was achieved within the 100 and 250 μm microchannels (mc) after 6 days compared to the 12 days it took for the 500mc group, while the flat substrate remained disorganized. Moreover, the 100, 250 and 500mc groups expressed a specific shift in orientation of 17.45°, 9.05°, and 22.86° respectively in 24 days. The secreted/mineralized ECM showed the 100 and 250mc groups to have higher modulus (E) and hardness (h) (E = 42.6GPa; h = 1.6GPa) than human bone (E = 13.4-25.7GPa; h = 0.47-0.74GPa), which was significantly greater than the 500mc and control groups (p < 0.05). It was determined that substrate curvature affects the cell orientation, the time required for initial response, and the shift in orientation with time.

Conclusions

These findings demonstrate the ability of osteoblasts to organize and mineralize differentially in microchannels similar to those found in the osteons of compact bone. These investigations could lead to the development of osteon-like scaffolds to support the regeneration of organized bone.

Synergistic effect of surface modification and scaffold design of bioplotted 3-D poly-ε-caprolactone scaffolds in osteogenic tissue engineering

The hydrophobic nature and the regular scaffold architecture of bioplotted poly(ε-caprolactone) (PCL) scaffolds present some hurdles for homogeneous tissue formation and differentiation. The current hypothesis is that a synergistic effect of applied surface modification and scaffold design enhances colonization and osteogenic differentiation. First, PCL scaffolds with a 0/90° lay-down pattern (0/90) were plotted and subjected to an oxygen plasma (O2) or multistep surface modification, including post-argon 2-amino-ethylmethacrylate grafting (AEMA), followed by immobilization of gelatin type B (gelB) and physisorption of fibronectin (gelB Fn). Secondly, scaffolds of different designs were plotted (0/90° shift (0/90 S), 0/45° and 0/90° with narrow pores (0/90 NP)) and subjected to the double protein coating. Preosteoblasts were cultured on the scaffolds and the seeding efficiency, colonization and differentiation were studied. The data revealed that a biomimetic surface modification improved colonization (gelB Fn>gelB>AEMA>O2). Compact scaffold architectures (0/90 NP, 0/45, 0/90 S>0/90) positively influenced the seeding efficiency and differentiation. Interestingly, the applied surface modification had a greater impact on colonization than the scaffold design. In conclusion, the combination of a double protein coating with a compact design enhances tissue formation in the plotted PCL scaffolds.

Development of composite scaffolds for load-bearing segmental bone defects

The need for a suitable tissue-engineered scaffold that can be used to heal load-bearing segmental bone defects (SBDs) is both immediate and increasing. During the past 30 years, various ceramic and polymer scaffolds have been investigated for this application. More recently, while composite scaffolds built using a combination of ceramics and polymeric materials are being investigated in a greater number, very few products have progressed from laboratory benchtop studies to preclinical testing in animals. This review is based on an exhaustive literature search of various composite scaffolds designed to serve as bone regenerative therapies. We analyzed the benefits and drawbacks of different composite scaffold manufacturing techniques, the properties of commonly used ceramics and polymers, and the properties of currently investigated synthetic composite grafts. To follow, a comprehensive review of in vivo models used to test composite scaffolds in SBDs is detailed to serve as a guide to design appropriate translational studies and to identify the challenges that need to be overcome in scaffold design for successful translation. This includes selecting the animal type, determining the anatomical location within the animals, choosing the correct study duration, and finally, an overview of scaffold performance assessment.

The effect of polystyrene sodium sulfonate grafting on polyethylene terephthalate artificial ligaments on in vitro mineralisation and in vivo bone tissue integration

This study investigates the impact of polystyrene sodium sulfonate (PolyNaSS) grafting onto the osseo-integration of a polyethylene terephthalate artificial ligament (Ligament Advanced Reinforcement System, LARS™) used for Anterior Cruciate Ligament (ACL). The performance of grafted and non-grafted ligaments was assessed in vitro by culturing human osteoblasts under osteogenic induction and this demonstrated that the surface modification was capable of up-regulating the secretion of ALP and induced higher level of mineralisation as measured 6 weeks post-seeding by Micro-Computed Tomography. Grafted and non-grafted LARS™ were subsequently implanted in an ovine model for ACL reconstruction and the ligament-to-bone interface was evaluated by histology and biomechanical testings 3 and 12 months post-implantation. The grafted ligaments exhibited more frequent direct ligament-to-bone contact and bone formation in the core of the ligament at the later time point than the non-grafted specimens, the grafting also significantly reduced the fibrous encapsulation of the ligament 12 months post-implantation. However, this improved osseo-integration was not translated into a significant increase in the biomechanical pull-out loads. These results provide evidences that PolyNaSS grafting improved the osseo-integration of the artificial ligament within the bone tunnels. This might positively influence the outcome of the surgical reconstructions, as higher ligament stability is believed to limit micro-movement and therefore permits earlier and enhanced healing.

Use of micro-computed tomography to nondestructively characterize biomineral coatings on solid freeform fabricated poly (L-lactic acid) and poly ((ε-caprolactone) scaffolds in vitro and in vivo

Biomineral coatings have been extensively used to enhance the osteoconductivity of polymeric scaffolds. Numerous porous scaffolds have previously been coated with a bone-like apatite mineral through incubation in simulated body fluid (SBF). However, characterization of the mineral layer formed on scaffolds, including the amount of mineral within the scaffolds, often requires destructive methods. We have developed a method using micro-computed tomography (μ-CT) scanning to nondestructively quantify the amount of mineral in vitro and in vivo on biodegradable scaffolds made of poly (L-lactic acid) (PLLA) and poly (ε-caprolactone) (PCL). PLLA and PCL scaffolds were fabricated using an indirect solid freeform fabrication (SFF) technique to achieve orthogonally interconnected pore architectures. Biomineral coatings were formed on the fabricated PLLA and PCL scaffolds after incubation in modified SBF (mSBF). Scanning electron microscopy and X-ray diffraction confirmed the formation of an apatite-like mineral. The scaffolds were implanted into mouse ectopic sites for 3 and 10 weeks. The presence of a biomineral coating within the porous scaffolds was confirmed through plastic embedding and μ-CT techniques. Tissue mineral content (TMC) and volume of mineral on the scaffold surfaces detected by μ-CT had a strong correlation with the amount of calcium measured by the orthocresolphthalein complex-one (OCPC) method before and after implantation. There was a strong correlation between OCPC pre- and postimplantation and μ-CT measured TMC (R(2)=0.96 preimplant; R(2)=0.90 postimplant) and mineral volume (R(2)=0.96 preimplant; R(2)=0.89 postimplant). The μ-CT technique showed increases in mineral following implantation, suggesting that μ-CT can be used to nondestructively determine the amount of calcium on coated scaffolds.

Fabrication of Photo-Polymerized PCL Tissue Engineering Scaffolds by Dynamic Masking Rapid Prototyping System

PCL is one of the popular biomaterials used in tissue engineering scaffolds, but it is seldom shaped by photo-polymerization. Layered manufacturing techniques, also known as Rapid Prototyping (RP) processes, provide a great opportunity to fabricate 3D scaffolds without problems such as limited control of pore-size and restricted geometric shapes in traditional methods. In our previous researches, the Biomedical Dynamic Masking Rapid Prototyping System was developed to photo-cure biodegradable materials through visible light. In this research, the Dynamic Masking RP System was modified to photo-polymerize cross-linkable PCL to form tissue engineering scaffolds. The cross-linkable PCL was synthesized by reacting PCL and acryloyl chloride, and dissolved in acetone mixing with photo-initiator. The tensile test and degradation test were performed on the cured PCL samples. Fabrication of single-layer pattern was first tested to understand the system’s capability and showed the errors were within 7%. Two types of scaffold design concepts were adopted—one took square, hexagon, or triangle as a basic element to create 2D grid patterns, and the interconnected pore were produced by offsetting the 2D pattern in alternating layers; the other took a double-sided trapezoid as a unit and arrayed it into tube shape with interconnected pore network. Various PCL porous tube scaffolds have been successfully fabricated in this study. In the future, they can be utilized to cell growth or mass cell duplication applications.

Human adipose-derived stem cells and three-dimensional scaffold constructs: a review of the biomaterials and models currently used for bone regeneration

In the past decade, substantial strides have been taken toward the use of human adipose-derived stromal/stem cells (hASC) in the regeneration of bone. Since the discovery of the hASC osteogenic potential, many models have combined hASC with biodegradable scaffold materials. In general, rats and immunodeficient (nude) mice models for nonweight bearing bone formation have led the way to assess hASC osteogenic potential in vivo. The goal of this review is to present an overview of the recent literature describing hASC osteogenesis in conjunction with three-dimensional scaffolds for bone regeneration.

Fabrication, mechanical and in vivo performance of polycaprolactone/tricalcium phosphate composite scaffolds

This paper explores the use of selective laser sintering (SLS) for the generation of bone tissue engineering scaffolds from polycaprolactone (PCL) and PCL/tricalcium phosphate (TCP). Different scaffold designs are generated, and assessed from the point of view of manufacturability, porosity and mechanical performance. Large scaffold specimens are produced, with a preferred design, and are assessed through an in vivo study of the critical size bone defect in sheep tibia with subsequent microscopic, histological and mechanical evaluation. Further explorations are performed to generate scaffolds with increasing TCP content. Scaffold fabrication from PCL and PCL/TCP mixtures with up to 50 mass% TCP is shown to be possible. With increasing macroporosity the stiffness of the scaffolds is seen to drop; however, the stiffness can be increased by minor geometrical changes, such as the addition of a cage around the scaffold. In the animal study the selected scaffold for implantation did not perform as well as the TCP control in terms of new bone formation and the resulting mechanical performance of the defect area. A possible cause for this is presented.

Biomechanical properties of novel biodegradable poly ε-caprolactone-chitosan scaffolds

AIM

To investigate the biomechanical properties of poly ε-caprolactone (PCL)-chitosan (CS) scaffolds fabricated by the melt stretching and multilayer deposition technique.

METHODS

The PCL-CS scaffolds containing CS at 0% (pure PCL), 10%, and 20% by weight were prepared. For the monolayer scaffolds, shear and blending tests simulating the reconstruction of orbital floor defects (situation A) and mandibular defects (situation B) were conducted. For the 3-D scaffolds, compression tests of their superior and lateral aspects were done.

RESULTS

For the monolayer scaffolds, the pure PCL group had remarkably lower shear strength than the other groups (P > 0.05). In situation A, all groups withstood the forces without any significant difference. In situation B, the pure PCL group could withstand the forces remarkably lower than those of the other group (P < 0.05). The 3-D scaffolds of all groups could withstand compressive forces directed towards their superior aspects. However, they could not withstand the forces directed towards their lateral aspects at the limited strain.

CONCLUSIONS

The monolayer scaffolds were suitable for reconstruction of the orbital floor and mandibular defects under light load-bearing conditions. The 3-D scaffolds could be used in the high load bearing-areas only if the forces were directed at their superior aspects.