The effect of post-sintering treatments on the fatigue and biological behavior of Ti-6Al-4V ELI parts made by selective laser melting

Exploring the potential of intermetallic alloys as implantable biomaterials: A comprehensive review

This review delves into the utilization of intermetallic alloys (IMAs) as advanced biomaterials for medical implants, scrutinizing their conceptual framework, fabrication challenges, and diverse manufacturing techniques such as casting, powder metallurgy, and additive manufacturing. Manufacturing techniques such as casting, powder metallurgy, additive manufacturing, and injection molding are discussed, with specific emphasis on achieving optimal grain sizes, surface roughness, and mechanical properties. Post-treatment methods aimed at refining surface quality, dimensional precision, and mechanical properties of IMAs are explored, including the use of heat treatments to enhance biocompatibility and corrosion resistance. The review presents an in-depth examination of IMAs-based implantable biomaterials, covering lab-scale developments and commercial-scale implants. Specific IMAs such as Nickel Titanium, Titanium Aluminides, Iron Aluminides, Magnesium-based IMAs, Zirconium-based IMAs, and High-entropy alloys (HEAs) are highlighted, with detailed discussions on their mechanical properties, including strength, elastic modulus, and corrosion resistance. Future directions are outlined, with an emphasis on the anticipated growth in the orthopedic devices market and the role of IMAs in meeting this demand. The potential of porous IMAs in orthopedics is explored, with emphasis on achieving optimal pore sizes and distributions for enhanced osseointegration. The review concludes by highlighting the ongoing need for research and development efforts in IMAs technologies, including advancements in design and fabrication techniques.

Comparison of the Microstructural, Mechanical and Corrosion Resistance Properties of Ti6Al4V Samples Manufactured by LENS and Subjected to Various Heat Treatments

In this paper, the influences of two post-heat treatments on the structural, mechanical and corrosion resistance properties of additively manufactured Ti6Al4V alloys were discussed in detail. The materials were produced using the laser engineering net shaping (LENS) technique, and they were subjected to annealing without pressure and hot isostatic pressing (HIP) under a pressure of 300 MPa for 30 min at temperatures of 950 °C and 1050 °C. Annealing without pressure led to the formation of a thin plate structure, which was accompanied by decreasing mechanical properties and increasing elongation and corrosion resistance values. For the HIP process, the formation of a thick plate structure could be observed, resulting in the material exhibiting optimal mechanical properties and unusually high elongation. The best mechanical and corrosion resistance properties were obtained for the material subjected to HIP at 950 °C.

Effects of Shot Peening and Electropolishing Treatment on the Properties of Additively and Conventionally Manufactured Ti6Al4V Alloy: A Review

This literature review indicates that the basic microstructure of Ti6Al4V is bimodal, consisting of two phases, namely α + β, and it occurs after fabrication using conventional methods such as casting, plastic forming or machining processes. The fabrication of components via an additive manufacturing process significantly changes the microstructure and properties of Ti6Al4V. Due to the rapid heat exchange during heat treatment, the bimodal microstructure transforms into a lamellar microstructure, which consists of two phases: α' + β. Despite the application of optimum printing parameters, 3D printed products exhibit typical surface defects and discontinuities, and in turn, surface finishing using shot peening is recommended. A literature review signalizes that shot peening and electropolishing processes positively impact the corrosion behavior, the mechanical properties and the condition of the surface layer of conventionally manufactured titanium alloy. On the other hand, there is a lack of studies combining shot peening and electropolishing in one hybrid process for additively manufactured titanium alloys, which could synthesize the benefits of both processes. Therefore, this review paper clarifies the effects of shot peening and electropolishing treatment on the properties of both additively and conventionally manufactured Ti6Al4V alloys and shows the effect process on the microstructure and properties of Ti6Al4V titanium alloy.

Influence of Ion Nitriding on Microstructure and Properties of Haynes 282 Nickel Superalloy Specimens Produced Using DMLS Technique

The paper investigates the influence of the ion-nitriding process on the microstructure, corrosion resistance, and tensile strength at elevated temperatures of Haynes 282 nickel superalloy specimens produced by the Direct Metal Laser Sintering (DMLS) technique. The study was performed for two conditions, i.e., as-built by DMLS method and as-built by DMLS method + covered by a layer containing CrN + Cr₂N phases. An analysis of the surface morphology revealed that the ion-nitriding process significantly affects the physical and chemical phenomena occurring on the specimen's surface. The XRD measurement of the specimens showed that preparing them with the DMLS method as well as following a nitriding process produced residual tensile stresses. Based on the measurement of the nanohardness distribution through the layer approximatively of 7 μm in width and the superalloys substrate, the results of the nanohardness showed the maximum values of 27 GPa and 13.5 GPa for the nitrided layer and the substrate, respectively. The surface protection from the nitrided layer proved a positive effect on the corrosion resistance of the DMLS specimens in the solution of 0.1 M Na₂SO₄ + 0.1 M NaCl at room temperature. The results of the tensile tests at 750 °C showed that the ion-nitriding process did not significantly affect the elevated-temperature tensile strength of the superalloy specimens produced with the DMLS technique.

The efficiency of tumble finishing as a final post-treatment for fatigue enhancement of notched laser powder bed fusion AlSi10Mg

A hybrid post-treatment combining tumble finishing as a final step after shot peening and heat treatment was developed to alleviate the adverse effects of internal and surface defects on the fatigue performance of laser powder bed fusion AlSi10Mg samples. The effects of each post-treatment were investigated individually and synergistically on microstructure, surface morphology and roughness, hardness, residual stresses, porosity, and rotating bending fatigue behavior of V-notched AlSi10Mg samples. The results reveal that tumble finishing can highly reduce surface roughness by 28 and 32% compared to the as-built and heat-treated states while inducing extra surface layer hardening and compressive residual stresses. The hybrid post-treatment of heat treatment + shot peening + tumble finishing significantly increased the fatigue life of the samples by over 500 times higher compared to the as-built series.

Assessment of Corrosion Resistance and Hardness of Shot Peened X5CrNi18-10 Steel

Although the application of shot peening facilitates increasing hardness and corrosion resistance of stainless steel, the inappropriate peening parameters result in overestimated hardening and exaggerated surface roughness, which deteriorate the surface morphology and negatively affect the corrosive behavior of treated steel. Therefore it is crucial to select the peening parameters that allow obtaining both high hardness and elevated corrosion resistance. This study aims to determine the effect of X5CrNi18-10 stainless steel samples shot peening on the surface morphology, hardness, and corrosion resistance. Samples were shot peened with a CrNi steel shot, applying 0.3 MPa and 0.4 MPa peening pressures and treatment times of 60 s and 120 s. Roughness analysis and microscopic and SEM-EDS examination were employed to state the effect of peening parameters on the sample's corrosive behavior in a 3.5% NaCl solution. The most promising shot peening parameters for Vickers hardness and electrochemical corrosion resistance were selected. It is revealed that the surface roughness increase has a detrimental effect on the corrosion behavior. Overall, high corrosion resistance and the high hardness of stainless steel samples were noted for the peening pressure of 0.4 MPa and time treatment of 60 s.

A review on in vitro/in vivo response of additively manufactured Ti-6Al-4V alloy

Bone replacement using porous and solid metallic implants, such as Ti-alloy implants, is regarded as one of the most practical therapeutic approaches in biomedical engineering. The bone is a complex tissue with various mechanical properties based on the site of action. Patient-specific Ti-6Al-4V constructs may address the key needs in bone treatment for having customized implants that mimic the complex structure of the natural tissue and diminish the risk of implant failure. This review focuses on the most promising methods of fabricating such patient-specific Ti-6Al-4V implants using additive manufacturing (AM) with a specific emphasis on the popular subcategory, which is powder bed fusion (PBF). Characteristics of the ideal implant to promote optimized tissue-implant interactions, as well as physical, mechanical/chemical treatments and modifications will be discussed. Accordingly, such investigations will be classified into 3B-based approaches (Biofunctionality, Bioactivity, and Biostability), which mainly govern native body response and ultimately the success in implantation.

Effect of Preheating on the Residual Stress and Material Properties of Inconel 939 Processed by Laser Powder Bed Fusion

One of the main limitations of laser powder bed fusion technology is the residual stress (RS) introduced into the material by the local heating of the laser beam. RS restricts the processability of some materials and causes shape distortions in the process. Powder bed preheating is a commonly used technique for RS mitigation. Therefore, the objective of this study was to investigate the effect of powder bed preheating in the range of room temperature to 400 °C on RS, macrostructure, microstructure, mechanical properties, and properties of the unfused powder of the nickel-based superalloy Inconel 939. The effect of base plate preheating on RS was determined by an indirect method using deformation of the bridge-shaped specimens. Inconel 939 behaved differently than titanium and aluminum alloys when preheated at high temperatures. Preheating at high temperatures resulted in higher RS, higher 0.2% proof stress and ultimate strength, lower elongation at brake, and higher material hardness. The increased RSs and the change in mechanical properties are attributed to changes in the microstructure. Preheating resulted in a larger melt pool, increased the width of columnar grains, and led to evolution of the carbide phase. The most significant microstructure change was in the increase of the size and occurrence of the carbide phase when higher preheating was applied. Furthermore, it was detected that the evolution of the carbide phase strongly corresponds to the build time when high-temperature preheating is applied. Rapid oxidation of the unfused powder was not detected by EDX or XRD analyses.

The Influence of Dimensions and Powder Recycling on the Roughness and Mechanical Properties of Ti-6Al-4V Parts Fabricated by Laser Powder Bed Fusion

Powder bed fusion technology has undergone a remarkable amount of development in recent years in the field of medical implants due to the advantages associated with it. In many implant applications that demand loads in parts with a high degree of roughness and small dimensions, the mechanical properties, especially fatigue properties, play a key role in the success of the implants. One of the most used materials in this field is Ti-6Al-4V. On the other hand, the high cost of titanium powders makes it necessary to search for suitable powder recycling strategies. In this work, the effects of dimensions and powder recycling on the roughness and the mechanical properties of cylinder specimens were obtained from tensile static and fatigue tests of Ti-6Al4V Extra-Low Interstitial (ELI) parts. Four types of specimens were fabricated by laser powder bed fusion (two dimensions (section diameters of 2 mm and 5 mm) with new powder and with recycled powder). Results show that the oxygen concentration increased with recycling. No significant effects of recycling were observed on the monotonic tensile strength specimens. However, specimens fabricated with recycled powder showed greater roughness, lower ductility, and lower fatigue strength than those fabricated with new powder. On the other hand, the 5-mm-diameter specimens showed slightly better fatigue behavior than the 2-mm-diameter ones.

Human Blood Platelets Adsorption on Polymeric Materials for Liquid Biopsy

Platelets are emerging as a promising source of blood biomarkers for several pathologies, including cancer. New automated techniques for easier manipulation of platelets in the context of lab-on-a-chips could be of great support for liquid biopsy. Here, several polymeric materials were investigated for their behavior in terms of adhesion and activation of human platelets. Polymeric materials were selected among the most used in microfabrication (PDMS, PMMA and COC) and commercial and home-made resins for 3D printing technology with the aim to identify the most suitable for the realization of microdevices for human platelets isolation and analysis. To visualize adherent platelets and their activation state scanning, electron microscopy was used, while confocal microscopy was used for evaluating platelets’ features. In addition, atomic force microscopy was employed to further study platelets adherent to the polymeric materials. Polymers were divided in two main groups: the most prone to platelet adhesion and materials that cause few or no platelets to adhere. Therefore, different polymeric materials could be identified as suitable for the realization of microdevices aimed at capturing human platelets, while other materials could be employed for the fabrication of microdevices or parts of microdevices for the processing of platelets, without loss on surfaces during the process.

Mechanical Properties of Ti6Al4V Fabricated by Laser Powder Bed Fusion: A Review Focused on the Processing and Microstructural Parameters Influence on the Final Properties

Ti6Al4V alloy is an ideal lightweight structural metal for a huge variety of engineering applications due to its distinguishing combination of high specific mechanical properties, excellent corrosion resistance and biocompatibility. In this review, the mechanical properties of selective laser-melted Ti6Al4V parts are addressed in detail, as well as the main processing and microstructural parameters that influence the final properties. Fundamental knowledge is provided by linking the microstructural features and the final mechanical properties of Ti6Al4V parts, including tensile strength, tensile strain, fatigue resistance, hardness and wear performance. A comparison between Laser Powder Bed Fusion and conventional processing routes is also addressed. The presence of defects in as-built Ti6Al4V parts and their influences on the mechanical performance are also critically discussed. The results available in the literature show that typical Laser Powder Bed–Fused Ti6Al4V tensile properties (>900 MPa yield strength and >1000 MPa tensile strength) are adequate when considering the minimum values of the standards for implants and for aerospace applications (e.g., ASTM F136–13; ASTM F1108–14; AMS4930; AMS6932).

Effects of Shot Peening and Cavitation Peening on Properties of Surface Layer of Metallic Materials-A Short Review

Shot peening is a dynamically developing surface treatment used to improve the surface properties modified by tool, impact, microblasting, or shot action. This paper reviews the basic information regarding shot peening methods. The peening processes and effects of the shot peening and cavitation peening treatments on the surface layer properties of metallic components are analysed. Moreover, the effects of peening on the operational performance of metallic materials are summarized. Shot peening is generally applied to reduce the surface roughness, increase the hardness, and densify the surface layer microstructure, which leads to work hardening effects. In addition, the residual compressive stresses introduced into the material have a beneficial effect on the performance of the surface layer. Therefore, peening can be beneficial for metallic structures prone to fatigue, corrosion, and wear. Recently, cavitation peening has been increasingly developed. This review paper suggests that most research on cavitation peening omits the treatment of additively manufactured metallic materials. Furthermore, no published studies combine shot peening and cavitation peening in one hybrid process, which could synthesize the benefits of both peening processes. Moreover, there is a need to investigate the effects of peening, especially cavitation peening and hybrid peening, on the anti-wear and corrosion performance of additively manufactured metallic materials. Therefore, the literature gap leading to the scope of future work is also included.

Mechanical properties and in vitro cytocompatibility of dense and porous Ti-6Al-4V ELI manufactured by selective laser melting technology for biomedical applications

The Ti-6Al-4V alloy is the most common biomaterial used for bone replacements and reconstructions. Despite its advantages, the Ti-6Al-4V has a high stiffness that can cause stress-shielding. In this work, we demonstrated that the selective laser melting (SLM) technology could be used to fabricate porosity in Ti-6Al-4V extra low interstitial (ELI) to reduce its stiffness while improving cell adhesion and proliferation. With a porosity of 14.04%, the elastic modulus of the porous Ti-6Al-4V ELI was reduced to 80 GPa. The compressive stress and the 3-point-bending flexural tests revealed that the porous Ti-6Al-4V ELI possessed a brittle characteristic. The additional pores within the beams of the lattice structures of porous Ti-6Al-4V ELI increased its surface arithmetic average roughness, R_a = 3.94 μm. The in vitro cytocompatibility test showed that the SLM printing process and the post-processes did not cause any toxicity in the MC3T3-E1 cells. The in vitro cell proliferation test also showed that the porous Ti-6Al-4V ELI increased the proliferation rate of osteogenic induced MC3T3-E1 cells on Day 7. The findings from this study would provide engineers and researchers with both the mechanical information and biological understanding of SLM printed porous Ti-6Al-4V ELI, and SLM printed dense Ti-6Al-4V ELI towards biomedical applications.

Shot peening increases resistance to cyclic fatigue fracture of endodontic files

The objective of this study was to assess the resistance to fatigue fracture of conventional nickel–titanium files after undergoing shot peening. Forty NITIFLEX endodontic files, number 30, were divided into two groups; one was submitted to shot peening treatment and the other was not. All instruments were tested for fatigue fracture in simulated canals with a TRI-AUTO ZX endodontic motor. One file of each group was subjected to a residual stress analysis by XRD. Finally, the fractured surface was observed and elemental analysis performed by means of SEM and EDX. Roughness analysis was made by focal variation microscope. The shot peening group showed greater resistance to fatigue fracture; there was no difference in the length of the fractured fragments. XRD results showed the presence of residual compression stresses in the file submitted to shot peening, a decrease in the interplanar spacing, and an increase in the full-width-at-half-maximum and the microstrains. SEM and EDX showed a ductile fracture with zones of fatigue and an equiatomic ratio between the nickel and titanium. Surface roughness increased after the file was subjected to the shot peening procedure. In conclusion, shot peening increases the resistance to fatigue fracture due to the presence of residual compression stresses in files manufactured from a conventional nickel–titanium alloy.

Influence of Successive Chemical and Thermochemical Treatments on Surface Features of Ti6Al4V Samples Manufactured by SLM

Ti6Al4V samples, obtained by selective laser melting (SLM), were subjected to successive treatments: acid etching, chemical oxidation in hydrogen peroxide solution and thermochemical processing. The effect of temperature and time of acid etching on the surface roughness, morphology, topography and chemical and phase composition after the thermochemical treatment was studied. The surfaces were characterized by scanning electron microscopy, energy dispersive X-ray spectroscopy, X-ray diffraction and contact profilometry. The temperature used in the acid etching had a greater influence on the surface features of the samples than the time. Acid etching provided the original SLM surface with a new topography prior to oxidation and thermochemical treatments. A nanostructure was observed on the surfaces after the full process, both on their protrusions and pores previously formed during the acid etching. After the thermochemical treatment, the samples etched at 40 °C showed macrostructures with additional submicro and nanoscale topographies. When a temperature of 80 °C was used, the presence of micropores and a thicker anatase layer, detectable by X-ray diffraction, were also observed. These surfaces are expected to generate greater levels of bioactivity and high biomechanics fixation of implants as well as better resistance to fatigue.

Selective Laser Melted Titanium Alloy for Transgingival Components: Influence of Surface Condition on Fibroblast Cell Behavior

PURPOSE

To mechanically characterize and assess the biological properties of Ti6Al4V surfaces obtained by Selective Laser Melting in order to determine whether this process is conceivable for production of implant-supported prostheses and particularly trans-gingival components. As-built and polished surfaces were studied in comparison with components obtained by computer numerical control machining technology in order to consider whether the properties are in the same range as the conventional method currently used.

MATERIALS AND METHODS

Cylindrical specimens of Ti6Al4V (n = 6) were built with Selective Laser Melting for the characterization of mechanical properties according to ISO 22674 and discs (n = 12) were fabricated in the same conditions for cytotoxicity evaluation. Discs (n = 12) of Ti6Al4V were also obtained by computer numerical control machining as control. Half of the number of discs (n = 6) from each process were polished, to simulate the laboratory protocol for polishing of transmucosal components and half of the discs remained unaltered (as-built). Surface roughness measurements of disc specimens (as-built and polished) were compared with computer numerical control milling specimens (as-built and polished). Proliferation of human gingival fibroblasts on Ti6Al4V surfaces was also assessed for each condition. Viability and cell morphology were then evaluated qualitatively. Ra and Sa data were compared using Student's t-test (α = 0.05) and metabolic activity data were compared using Kruskal-Wallis statistical test (α = 0.05).

RESULTS

Selective Laser Melting specimens showed elongation at break greater than 2% and 0.2% yield strength better than 500MPa which complied with ISO 22674 standards. Although Selective Laser Melting samples displayed significantly increased roughness on as-built surfaces compared to computer numerically controlled milling samples (p < 0.05), no statistically significant difference was observed after mechanical polishing (p = 0.279). Regarding metabolic activity, no statistical difference was observed between groups at day 3 (p > 0.05) and fibroblasts showed a viability higher than 97% on all discs. Cell shapes on polished samples suggested moderate adhesion compared to unpolished samples.

CONCLUSION

With the manufacturing parameters selected in this study, Selective Laser Melting of Ti6Al4V appeared to be compatible with a prosthetic application type 4 according to ISO 22674. Surfaces obtained, followed by recommended postprocessing provided components with equivalent biological properties compared to computer numerical control machining technology.

Strain Analysis of Ti6Al4V Titanium Alloy Samples Using Digital Image Correlation

Digital image correlation (DIC) is a non-contact optical method that allows measuring displacements on a plane used to determine the strains caused by external loads of a structural element (mechanical or thermal). Currently, digital image correlation is a widely used experimental technique to assess the mechanical behavior of materials, in particular cracking characteristics and destruction methods of various structural elements. In this paper, the DIC method is applied to determine local strains of titanium alloy Ti6Al4V specimen. The samples used in the tests were made with two different technologies: (a) from a drawn bar by machining process; and (b) by the additive manufacturing method Direct Metal Laser Sintering (DMLS). The aim of the paper is to present the mechanical properties test results of the Ti6Al4V titanium alloy produced by the DMLS additive manufacturing under static loads using the digital image correlation method. As a result of the tests carried out on the drawn bar specimens, it was concluded that the change in the measurement base affects the difference in the Young’s E modulus value in the range from 89.2 to 103.8 GPa. However, for samples formed using the DMLS method, the change in the Young’s modulus value was from 112.9 to 115.3 GPa for the same measurement base.

A Review of Heat Treatments on Improving the Quality and Residual Stresses of the Ti–6Al–4V Parts Produced by Additive Manufacturing

Additive manufacturing (AM) can be seen as a disruptive process that builds complex components layer upon layer. Two of its distinct technologies are Selective Laser Melting (SLM) and Electron Beam Melting (EBM), which are powder bed fusion processes that create metallic parts with the aid of a beam source. One of the most studied and manufactured superalloys in metal AM is the Ti–6Al–4V, which can be applied in the aerospace field due to its low density and high melting point, and in the biomedical area owing to its high corrosion resistance and excellent biocompatibility when in contact with tissues or bones of the human body. The research novelty of this work is the aggregation of all kinds of data from the last 20 years of investigation about Ti–6Al–4V parts manufactured via SLM and EBM, namely information related to residual stresses (RS), as well as the influence played by different heat treatments in reducing porosity and increasing mechanical properties. Throughout the report, it can be seen that the expected microstructure of the Ti–6Al–4V alloy is different in both manufacturing processes, mainly due to the distinct cooling rates. However, heat treatments can modify the microstructure, reduce RS, and increase the ductility, fatigue life, and hardness of the components. Furthermore, distinct post-treatments can induce compressive RS on the part’s surface, consequently enhancing the fatigue life.

A 3D-Printed Ultra-Low Young's Modulus β-Ti Alloy for Biomedical Applications

The metastable β-Ti21S alloy is evaluated as a potential candidate for biomedical parts. Near fully dense (99.75 ± 0.02%) samples are additively manufactured (that is, 3D-printed) by laser powder-bed fusion (L-PBF). In the as-built condition, the material consists of metastable β-phase only, with columnar grains oriented along the building direction. The material exhibits an extremely low Young’s modulus (52 ± 0.3 GPa), which was never reported for this type of alloy. The combination of good mechanical strength (σ_y0.2 = 709 ± 6 MPa, ultimate tensile strength (UTS) = 831 ± 3 MPa) and high total elongation during tensile test (21% ± 1.2%) in the as-built state, that is, without any heat treatment, is close to that of the wrought alloy and comparable to that of heat treated Ti grade 5. The good biocompatibility attested by cytotoxicity tests confirms its great suitability for biomedical applications.

Effect of Various Peening Methods on the Fatigue Properties of Titanium Alloy Ti6Al4V Manufactured by Direct Metal Laser Sintering and Electron Beam Melting

Titanium alloy Ti6Al4V manufactured by additive manufacturing (AM) is an attractive material, but the fatigue strength of AM Ti6Al4V is remarkably weak. Thus, post-processing is very important. Shot peening can improve the fatigue strength of metallic materials, and novel peening methods, such as cavitation peening and laser peening, have been developed. In the present paper, to demonstrate an improvement of the fatigue strength of AM Ti6Al4V, Ti6Al4V manufactured by direct metal laser sintering (DMLS) and electron beam melting (EBM) was treated by cavitation peening, laser peening, and shot peening, then tested by a plane bending fatigue test. To clarify the mechanism of the improvement of the fatigue strength of AM Ti6Al4V, the surface roughness, residual stress, and surface hardness were measured, and the surfaces with and without peening were also observed using a scanning electron microscope. It was revealed that the fatigue strength at N = 10⁷ of Ti6Al4V manufactured by DMLS was slightly better than that of Ti6Al4V manufactured by EBM, and the fatigue strength of both the DMLS and EBM specimens was improved by about two times through cavitation peening, compared with the as-built ones. An experimental formula to estimate fatigue strength from the mechanical properties of a surface was proposed.

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.

The Effect of Ti-6Al-4V Alloy Surface Structure on the Adhesion and Morphology of Unidirectional Freeze-Coated Gelatin

The modification of a metal implant surface with a biomimetic coating of bone-like anisotropic and graded porosity structures to improve its biological anchorage with the surrounding bone tissue at implanting, is still a high challenge. In this paper, we present an innovative way of a gelatin (GEL) dip-coating on Ti-6Al-4V substrates of different square-net surface textures by the unidirectional deep-freezing process at simultaneous cross-linking using carbodiimide chemistry. Different concentrations of GEL solution were used to study the changes in morphology, density, and mechanical properties of the coatings. In addition, the surface free energy and polarity of Ti-6Al-4V substrate surfaces and GEL solutions have been evaluated to assess the wetting properties at the substrate interfaces, and to describe the adhesion of GEL macromolecules with their surfaces, being supported by mechanical pull-out testing. The results indicate that the coating’s morphology depends primarily on the Ti-6Al-4V substrate’s surface texture and second, on the concentration of GEL, which further influences their adhesion properties, orientation, morphological arrangement, as well as compression strength. The substrate with a 300 × 300 μm2 texture resulted in a highly adhered GEL coating with ≥80% porosity, interconnected and well-aligned pores of 75–200 μm, required to stimulate the bone ingrowth, mechanically and histologically.

Additive Manufacturing for Metal Applications in Orthopaedic Surgery

Metallic additive manufacturing, a process by which metal structures are created in a layered fashion, is poised to revolutionize orthopaedic implants and instruments. It allows for the design and manufacture of devices, which not only macroscopically more closely match patient-specific anatomy but also have improved microscopic detail for more rapid and durable host integration. In addition, additive manufacturing-designed implants have improved biomechanical properties and fixation systems allowing use in areas where current implants are not well suited. This review provides an overview of the technology and both its current and future use in orthopaedic surgery.

Effect of Shot Peening on the Mechanical Properties and Cytotoxicity Behaviour of Titanium Implants Produced by 3D Printing Technology

Structural discontinuities characterize the implants produced directly from metal powders in 3D printing technology. Mainly, the surface defects should be subjected to procedures associated with surface layer modification (likewise shot peening) resulting in the increase of the implant service life maintaining optimal biocompatibility. Therefore, the purpose of the present study was to investigate the effect of type of shot used for the peening process on the Ti-6Al-4V implants functional properties as well as the biological properties. The components were produced by DMLS (direct metal laser sintering) additive technology. The surfaces of titanium specimens have been subjected to the shot peening process by means of three different shots, i.e., CrNi steel shot, crushed nut shells, and ceramic balls shot. Then, the specimens have been subjected to profilometric analysis, microhardness tests, and static strength testing as well as to the assessment of biocompatibility in respect of cytotoxicity using human BJ fibroblasts. The shot peening process causes the strengthening of surface layer and the increase of strength parameters. Furthermore, the test results indicate good biocompatibility of surfaces being tested, and the effect of shot peening process on the titanium alloy cytotoxicity is acceptable. At the same time, most favourable behaviour in respect of cytotoxicity has been found in the case of surfaces modified by means of ceramic balls > nut shells > CrNi steel shot correspondingly.

Challenges in the design and regulatory approval of 3D-printed surgical implants: a two-case series

BACKGROUND

Additive manufacturing or three-dimensional (3D) printing of metal implants can provide novel solutions for difficult-to-treat conditions, yet legislation concerning patient-specific implants complicates the implementation of these techniques in daily practice. In this Article, we share our acquired knowledge of the logistical and legal challenges associated with the use of patient-specific 3D-printed implants to treat spinal instabilities.

METHODS

Two patients with semiurgent cases of spinal instability presented to our hospital in the Netherlands. In case 1, severe kyphotic deformity of the thoracic spine due to neurofibromatosis type 1 had led to incomplete paralysis, and a strong metallic strut extending from C6 to T11 was deemed necessary to provide long-term anterior support. In case 2, the patient presented with progressive paralysis caused by cervicothoracic dissociation due to vanishing bone disease. As the C5-T1 vertebral bodies had mostly vanished, an implant spanning the anterior spine from C4 to T2 was required. Because of the complex and challenging nature of both cases, conventional approaches were deemed inadequate; instead, patient-specific implants were designed with use of CT scans and computer-aided design software, and 3D printed in titanium with direct metal printing. For each implant, to ensure patient safety, a comprehensive technical file (describing the clinical substantiation, technical and design considerations, risk analysis, manufacturing process, and labelling) was produced in collaboration with a university department certified for the development and manufacturing of medical devices. Because the implants were categorised as custom-made or personalised devices under the EU Medical Device Regulation, the usual procedures for review and approval of medical devices by a notified body were not required. Finite-element analyses, compression strength tests, and cadaveric experiments were also done to ensure the devices were safe to use.

FINDINGS

The planning, design, production, and insertion of the 3D-printed personalised implant took around 6 months in the first patient, but, given the experience from the first case, only took around 6 weeks in the second patient. In both patients, the surgeries went as planned and good positioning of each implant was confirmed. Both patients were discharged home within 1 week after the surgery. In the first patient, a fatigue fracture occured in one of the conventional posterior fusion rods after 10 months, which we repaired, without any deformation of the spine or signs of failure of the personalised implant observed. No other adverse events occurred up to 25 months of follow-up in case 1 and 6 months of follow-up in case 2.

INTERPRETATION

Patient-specific treatment approaches incorporating 3D-printed implants can be helpful in carefully selected cases when conventional methods are not an option. Comprehensive and efficient interactions between medical engineers and physicians are essential to establish well designed frameworks to navigate the logistical and regulatory aspects of technology development to ensure the safety and legal validity of patient-specific treatments. The framework described here could encourage physicians to treat (once untreatable) patients with novel personalised techniques.

FUNDING

Interreg VA Flanders-The Netherlands programme, Applied and Engineering Sciences research programme, the Netherlands Organisation for Scientific Research, and the Dutch Arthritis Foundation VIDEO ABSTRACT.

Fabrication and Analysis of a Ti6Al4V Implant for Cranial Restoration

A custom made implant is critical in cranioplasty to cushion and restore intracranial anatomy, as well as to recover the appearance and attain cognitive stability in the patient. The utilization of customized titanium alloy implants using three-dimensional (3D) reconstruction technique and fabricated using Electron Beam Melting (EBM) has gained significant recognition in recent years, owing to their convenience and effectiveness. Besides, the conventional technique or the extant practice of transforming the standard plates is unreliable, arduous and tedious. As a result, this work aims to produce a customized cranial implant using 3D reconstruction that is reliable in terms of fitting accuracy, appearance, mechanical strength, and consistent material composition. A well-defined methodology initiating from EBM fabrication to final validation has been outlined in this work. The custom design of the implant was carried out by mirror reconstruction of the skull’s defective region, acquired through computer tomography. The design of the customized implant was then analyzed for mechanical stresses by applying finite element analysis. Consequently, the 3D model of the implant was fabricated from Ti6Al4V ELI powder with a thickness of ≃1.76–2 mm. Different tests were employed to evaluate the bio-mechanical stability and strength of the fabricated customized implant design. A 3D comparison study was performed to ensure there was anatomical accuracy, as well as to maintain gratifying aesthetics. The bio-mechanical analysis results revealed that the maximum Von Mises stress (2.5 MPa), strain distribution (1.49 × 10−4) and deformation (3.26 × 10−6 mm) were significantly low in magnitude, thus proving the implant load resistance ability. The average yield and tensile strengths for the fabricated Ti6Al4V ELI EBM specimen were found to be 825 MPa and 880 MPa, respectively, which were well over the prescribed strength for Ti6Al4V ELI implant material. The hardness study also resulted in an acceptable outcome within the acceptable range of 30–35 HRC. Certainly, the chemical composition of the fabricated EBM specimen was intact as established in EDX analysis. The weight of the cranial implant (128 grams) was also in agreement with substituted defected bone portion, ruling out any stress shielding effect. With the proposed approach, the anatomy of the cranium deformities can be retrieved effectively and efficiently. The implementation of 3D reconstruction techniques can conveniently reduce tedious alterations in the implant design and subsequent errors. It can be a valuable and reliable approach to enhance implant fitting, stability, and strength.

Mechanical performance of additively manufactured meta-biomaterials

Additive manufacturing (AM) (=3D printing) and rational design techniques have enabled development of meta-biomaterials with unprecedented combinations of mechanical, mass transport, and biological properties. Such meta-biomaterials are usually topologically ordered and are designed by repeating a number of regular unit cells in different directions to create a lattice structure. Establishing accurate topology-property relationships is of critical importance for these materials. In this paper, we specifically focus on AM metallic meta-biomaterials aimed for application as bone substitutes and orthopaedic implants and review the currently available evidence regarding their mechanical performance under quasi-static and cyclic loading conditions. The topology-property relationships are reviewed for regular beam-based lattice structures, sheet-based lattice structures including those based on triply periodic minimal surface, and graded designs. The predictive models used for establishing the topology-property relationships including analytical and computational models are covered as well. Moreover, we present an overview of the effects of the AM processes, material type, tissue regeneration, biodegradation, surface bio-functionalization, post-manufacturing (heat) treatments, and loading profiles on the quasi-static mechanical properties and fatigue behavior of AM meta-biomaterials. AM meta-biomaterials exhibiting unusual mechanical properties such as negative Poisson's ratios (auxetic meta-biomaterials), shape memory behavior, and superelasitcity as well as the potential applications of such unusual behaviors (e.g. deployable implants) are presented too. The paper concludes with some suggestions for future research. STATEMENT OF SIGNIFICANCE: Additive manufacturing enables fabrication of meta-biomaterials with rare combinations of topological, mechanical, and mass transport properties. Given that the micro-scale topological design determines the macro-scale properties of meta-biomaterials, establishing topology-property relationships is the central research question when rationally designing meta-biomaterials. The interest in understanding the relationship between the topological design and material type on the one hand and the mechanical properties and fatigue behavior of meta-biomaterials on the other hand is currently booming. This paper presents and critically evaluates the most important trends and findings in this area with a special focus on the metallic biomaterials used for skeletal applications to enable researchers better understand the current state-of-the-art and to guide the design of future research projects.

Current Trends in Metallic Orthopedic Biomaterials: From Additive Manufacturing to Bio-Functionalization, Infection Prevention, and Beyond

There has been a growing interest in metallic biomaterials during the last five years, as recent developments in additive manufacturing (=3D printing), surface bio-functionalization techniques, infection prevention strategies, biodegradable metallic biomaterials, and composite biomaterials have provided many possibilities to develop biomaterials and medical devices with unprecedented combinations of favorable properties and advanced functionalities. Moreover, development of biomaterials is no longer separated from the other branches of biomedical engineering, particularly tissue biomechanics, musculoskeletal dynamics, and image processing aspects of skeletal radiology. In this editorial, I will discuss all the above-mentioned topics, as they constitute some of the most important trends of research on metallic biomaterials. This editorial will, therefore, serve as a foreword to the papers appearing in a special issue covering the current trends in metallic biomaterials.

How does the surface treatment change the cytocompatibility of implants made by selective laser melting?

INTRODUCTION

The study investigates the potential for producing medical components via Selective Laser Melting technology (SLM). The material tested consisted of the biocompatible titanium alloy Ti6Al4V. The research involved the testing of laboratory specimens produced using SLM technology both in vitro and for surface roughness. The aim of the research was to clarify whether SLM technology affects the cytocompatibility of implants and, thus, whether SLM implants provide suitable candidates for medical use following zero or minimum post-fabrication treatment. Areas covered: The specimens were tested with an osteoblast cell line and, subsequently, two post-treatment processes were compared: non-treated (as-fabricated) and glass-blasted. Interactions with MG-63 cells were evaluated by means of metabolic MTT assay and microscope techniques (scanning electron microscopy, fluorescence microscopy). Surface roughness was observed on both the non-treated and glass-blasted SLM specimens. Expert Commentary: The research concluded that the glass-blasting of SLM Ti6Al4V significantly reduces surface roughness. The arithmetic mean roughness Ra was calculated at 3.4 µm for the glass-blasted and 13.3 µm for the non-treated surfaces. However, the results of in vitro testing revealed that the non-treated surface was better suited to cell growth.