3D-printed poly(Ɛ-caprolactone) scaffold with gradient mechanical properties according to force distribution in the mandible for mandibular bone tissue engineering

Biomaterials-based approaches to mandibular tissue engineering: where we were, where we are, where we are going

The mandible is the largest craniofacial bone and plays a crucial role in speech, mastication, swallowing, and facial aesthetics. The form or function of the mandible can be altered by defects as a result of tumors, trauma, infection, and congenital conditions. This paper covers the evolution of biomaterials-based approaches to the reconstruction of critical size mandibular defects. Historically the gold standard for critical size mandibular defect repair has been autologous fibula grafts. The emergence of the field of tissue engineering has led to the current research on biomaterial scaffolds, cells, and biological factors to design highly tunable, bio-inspired, tissue regenerative implants. Scaffold materials can be synthetic or natural and can be fabricated using a variety of additive manufacturing techniques. Mesenchymal stem cells, bone morphogenetic proteins, and transforming growth factor-β are frequently added to scaffolds. While great progress has been made, there are still barriers to translating this research to patients, ranging from insufficient bone regeneration in animal studies to the feasibility of establishing a good manufacturing practice. To address these challenges, the future of mandibular tissue engineering will look toward improving implant vascularization and innervation, personalizing implant shape and biology, and enhancing spatiotemporal control of drug release. With these goals in mind, researchers will ultimately develop biomaterials that can regenerate bone that is structurally and biologically identical to native mandibular tissue, improving both function and quality of life for patients.

A review of graded scaffolds made by additive manufacturing for tissue engineering: design, fabrication and properties

The emergence of tissue engineering (TE) has provided new vital means for human body tissue/organ repair. TE scaffolds can provide temporary structural support for cell attachment, growth, and proliferation, until the body restores the mechanical and biological properties of the host tissues. Since native tissues are inhomogeneous and in many situations are graded structures for performing their unique functions, graded scaffolds have become increasingly attractive for regenerating particular types of tissues, which aim to offer a more accurate replication of native interactions and functions. Importantly, the advances introduced by additive manufacturing (AM) have now enabled more design freedom and are capable of tailoring both structural and compositional gradients within a single scaffold. In this context, graded TE scaffolds fabricated by AM technologies have been attracting increasing attention. In this review, we start with an introduction of common graded structures in the human body and analyse the advantages and strengths of AM-formed graded scaffolds. Various AM technologies that can be leveraged to produce graded scaffolds are then reviewed based on non-cellular 3D printing and cell-laden 3D bioprinting. The comparisons among various AM technologies for fabricating graded scaffolds are presented. Subsequently, we propose several types of gradients, structural, material, biomolecular and multi-gradients for scaffolds, and highlight the design methods, resulting mechanical properties and biological responses. Finally, current status, challenges and perspectives for AM in developing graded scaffolds are exhibited and discussed.

Polycaprolactone/β-Tricalcium Phosphate Composite Scaffolds with Advanced Pore Geometries Promote Human Mesenchymal Stromal Cells' Osteogenic Differentiation

Critical-sized mandibular bone defects, arising from, for example, resections after tumor surgeries, are currently treated with autogenous bone grafts. This treatment is considered very invasive and is associated with limitations such as morbidity and graft resorption. Tissue engineering approaches propose to use 3D scaffolds that combine structural features, biomaterial properties, cells, and biomolecules to create biomimetic constructs. However, mimicking the complex anatomy and composition of the mandible poses a challenge in scaffold design. In our study, we evaluated the dual effect of complex pore geometry and material composition on the osteogenic potential of 3D printed scaffolds. The scaffolds were made of polycaprolactone (PCL) alone (TCP0), or with a high concentration of β-tricalcium phosphate (β-TCP) up to 40% w/w (TCP40), with two complex pore geometries, namely a star- (S) and a diamond-like (D) shape. Scanning electron microscopy and microcomputed tomography images confirmed high fidelity during the printing process. The D-scaffolds displayed higher compressive moduli than the corresponding S-scaffolds. TCP40 scaffolds in simulated body fluid showed deposition of minerals on the surface after 28 days. Subsequently, we assessed the differentiation of seeded bone marrow-derived human mesenchymal stromal cells (hMSCs) over 28 days. The early expression of RUNX2 in the cell nuclei confirmed the commitment toward an osteogenic phenotype. Moreover, alkaline phosphatase (ALP) activity and collagen deposition displayed an increasing trend in the D-scaffolds. Collagen type I was mainly present in the deposited extracellular matrix (ECM), confirming deposition of bone matrix. Finally, Alizarin Red staining showed successful mineralization on all the TCP40 samples, with higher values for the S-shaped scaffolds. Taken together, our study demonstrated that the complex pore architectures of scaffolds comprised TCP40 stimulated osteogenic differentiation and mineralization of hMSCs in vitro. Future research will aim to validate these findings in vivo.

Advances in additive manufacturing for bone tissue engineering: materials, design strategies, and applications

The growing annual demand for bone grafts and artificial implants emphasizes the need for effective solutions to repair or replace injured bones. Additive manufacturing technology offers unique merits for advancing bone tissue engineering (BTE), enabling the creation of scaffolds and implants with customized shapes and designs, interconnected architecture, controlled mechanical properties and compositions, and broadening its range of applications. It overcomes the limitations of traditional manufacturing methods such as electrospinning, salt leaching, freeze drying, solvent casting etc. This review highlights additive manufacturing technologies and their applications in BTE, as well as materials and scaffold architectures to widen the potential of the biomedical sector. The selection of optimal printing methods for BTE requires careful consideration of the advantages and disadvantages against the needs for degradation, strength, and biocompatibility. Material extrusion and powder bed fusion techniques are the most widely used additive manufacturing processes in BTE. The comprehensive review also revealed that parametric designs such as triply periodic minimal surface (TPMS) and Voronoi hold better characteristics for their application in BTE. Voronoi designs exhibit exceptional randomness whereas TPMS structures feature high permeability with continuous surfaces. Topology optimized and gradient models exhibited superior physical and mechanical properties compared to uniform lattices. Future research should focus on the development of novel biomaterials, multi-material printing, assessing long-term impacts, and enhancing 3D printing technologies.

Shape/properties collaborative intelligent manufacturing of artificial bone scaffold: structural design and additive manufacturing process

Artificial bone graft stands out for avoiding limited source of autograft as well as susceptibility to infection of allograft, which makes it a current research hotspot in the field of bone defect repair. However, traditional design and manufacturing method cannot fabricate bone scaffold that well mimics complicated bone-like shape with interconnected porous structure and multiple properties akin to human natural bone. Additive manufacturing, which can achieve implant's tailored external contour and controllable fabrication of internal microporous structure, is able to form almost any shape of designed bone scaffold via layer-by-layer process. As additive manufacturing is promising in building artificial bone scaffold, only combining excellent structural design with appropriate additive manufacturing process can produce bone scaffold with ideal biological and mechanical properties. In this article, we sum up and analyze state of art design and additive manufacturing methods for bone scaffold to realize shape/properties collaborative intelligent manufacturing. Scaffold design can be mainly classified into design based on unit cells and whole structure, while basic additive manufacturing and 3D bioprinting are the recommended suitable additive manufacturing methods for bone scaffold fabrication. The challenges and future perspectives in additive manufactured bone scaffold are also discussed.

A review of computational optimization of bone scaffold architecture: methods, challenges, and perspectives

The design and optimization of bone scaffolds are critical for the success of bone tissue engineering (BTE) applications. This review paper provides a comprehensive analysis of computational optimization methods for bone scaffold architecture, focusing on the balance between mechanical stability, biological compatibility, and manufacturability. Finite element method (FEM), computational fluid dynamics (CFD), and various optimization algorithms are discussed for their roles in simulating and refining scaffold designs. The integration of multiobjective optimization and topology optimization has been highlighted for developing scaffolds that meet the multifaceted requirements of BTE. Challenges such as the need for consideration of manufacturing constraints and the incorporation of degradation and bone regeneration models into the optimization process have been identified. The review underscores the potential of advanced computational tools and additive manufacturing techniques in evolving the field of BTE, aiming to improve patient outcomes in bone tissue regeneration. The reliability of current optimization methods is examined, with suggestions for incorporating non-deterministic approaches andin vivovalidations to enhance the practical application of optimized scaffolds. The review concludes with a call for further research into artificial intelligence-based methods to advance scaffold design and optimization.

The Dual Angiogenesis Effects via Nrf2/HO-1 Signaling Pathway of Melatonin Nanocomposite Scaffold on Promoting Diabetic Bone Defect Repair

Purpose

Given the escalating prevalence of diabetes, the demand for specific bone graft materials is increasing, owing to the greater tendency towards bone defects and more difficult defect repair resulting from diabetic bone disease (DBD). Melatonin (MT), which is known for its potent antioxidant properties, has been shown to stimulate both osteogenesis and angiogenesis.

Methods

MT was formulated into MT@PLGA nanoparticles (NPs), mixed with sodium alginate (SA) hydrogel, and contained within a 3D printing polycaprolactone/β-Tricalcium phosphate (PCL/β-TCP) scaffold. The osteogenic capacity of the MT nanocomposite scaffold under diabetic conditions was demonstrated via in vitro and in vivo studies and the underlying mechanisms were investigated.

Results

Physicochemical characterization experiments confirmed the successful fabrication of the MT nanocomposite scaffold, which can achieve long-lasting sustained release of MT. The in vitro and in vivo studies demonstrated that the MT nanocomposite scaffold exhibited enhanced osteogenic capacity, which was elucidated by the dual angiogenesis effects activated through the NF-E2-related factor 2/Heme oxygenase 1 (Nrf2/HO-1) signaling pathway, including the enhancement of antioxidant enzyme activity to reduce the oxidative stress damage of vascular endothelial cells (VECs) and directly stimulating vascular endothelial growth factor (VEGF) production, which reversed the angiogenesis-osteogenesis uncoupling and promoted osteogenesis under diabetic conditions.

Conclusion

This study demonstrated the research prospective and clinical implications of the MT nanocomposite scaffold as a novel bone graft for treating bone defect and enhancing bone fusion in diabetic individuals.

Biomaterial scaffolds in maxillofacial bone tissue engineering: A review of recent advances

Maxillofacial bone defects caused by congenital malformations, trauma, tumors, and inflammation can severely affect functions and aesthetics of maxillofacial region. Despite certain successful clinical applications of biomaterial scaffolds, ideal bone regeneration remains a challenge in maxillofacial region due to its irregular shape, complex structure, and unique biological functions. Scaffolds that address multiple needs of maxillofacial bone regeneration are under development to optimize bone regeneration capacity, costs, operational convenience. etc. In this review, we first highlight the special considerations of bone regeneration in maxillofacial region and provide an overview of the biomaterial scaffolds for maxillofacial bone regeneration under clinical examination and their efficacy, which provide basis and directions for future scaffold design. Latest advances of these scaffolds are then discussed, as well as future perspectives and challenges. Deepening our understanding of these scaffolds will help foster better innovations to improve the outcome of maxillofacial bone tissue engineering.

Bioinspired synthetic peptide-based biomaterials regenerate bone through biomimicking of extracellular matrix

There have been remarkable advancements in regenerative medicine for bone regeneration, tackling the worldwide health concern of tissue loss. Tissue engineering uses the body's natural capabilities and applies biomaterials and bioactive molecules to replace damaged or lost tissues and restore their functionality. While synthetic ceramics have overcome some challenges associated with allografts and xenografts, they still need essential growth factors and biomolecules. Combining ceramics and bioactive molecules, such as peptides derived from biological motifs of vital proteins, is the most effective approach to achieve optimal bone regeneration. These bioactive peptides induce various cellular processes and modify scaffold properties by mimicking the function of natural osteogenic, angiogenic and antibacterial biomolecules. The present review aims to consolidate the latest and most pertinent information on the advancements in bioactive peptides, including angiogenic, osteogenic, antimicrobial, and self-assembling peptide nanofibers for bone tissue regeneration, elucidating their biological effects and potential clinical implications.

Towards Polycaprolactone-Based Scaffolds for Alveolar Bone Tissue Engineering: A Biomimetic Approach in a 3D Printing Technique

The alveolar bone is a unique type of bone, and the goal of bone tissue engineering (BTE) is to develop methods to facilitate its regeneration. Currently, an emerging trend involves the fabrication of polycaprolactone (PCL)-based scaffolds using a three-dimensional (3D) printing technique to enhance an osteoconductive architecture. These scaffolds are further modified with hydroxyapatite (HA), type I collagen (CGI), or chitosan (CS) to impart high osteoinductive potential. In conjunction with cell therapy, these scaffolds may serve as an appealing alternative to bone autografts. This review discusses research gaps in the designing of 3D-printed PCL-based scaffolds from a biomimetic perspective. The article begins with a systematic analysis of biological mineralisation (biomineralisation) and ossification to optimise the scaffold's structural, mechanical, degradation, and surface properties. This scaffold-designing strategy lays the groundwork for developing a research pathway that spans fundamental principles such as molecular dynamics (MD) simulations and fabrication techniques. Ultimately, this paves the way for systematic in vitro and in vivo studies, leading to potential clinical applications.

Advances in additive manufacturing of polycaprolactone based scaffolds for bone regeneration

Critical sized bone defects are difficult to manage and currently available clinical/surgical strategies for treatment are not completely successful. Polycaprolactone (PCL) which is a biodegradable and biocompatible thermoplastic can be 3D printed using medical images into patient specific bone implants. The excellent mechanical properties and low immunogenicity of PCL makes it an ideal biomaterial candidate for 3D printing of bone implants. Though PCL suffers from the limitation of being bio-inert. Here we describe the use of PCL as a biomaterial for 3D printing for bone regeneration, and advances made in the field. The specific focus is on the different 3D printing techniques used for this purpose and various modification that can enhance bone regeneration following the development pathways. We further describe the effect of various scaffold characteristics on bone regeneration both in vitro and the translational assessment of these 3D printed PCL scaffolds in animal studies. The generated knowledge will help understand cell-material interactions of 3D printed PCL scaffolds, to further improve scaffold chemistry and design that can replicate bone developmental processes and can be translated clinically.

Regeneration of Critical-Sized Mandibular Defects Using 3D-Printed Composite Scaffolds: A Quantitative Evaluation of New Bone Formation in In Vivo Studies

Mandibular tissue engineering aims to develop synthetic substitutes for the regeneration of critical size defects (CSD) caused by a variety of events, including tumor surgery and post-traumatic resections. Currently, the gold standard clinical treatment of mandibular resections (i.e., autologous fibular flap) has many drawbacks, driving research efforts toward scaffold design and fabrication by additive manufacturing (AM) techniques. Once implanted, the scaffold acts as a support for native tissue and facilitates processes that contribute to its regeneration, such as cells infiltration, matrix deposition and angiogenesis. However, to fulfil these functions, scaffolds must provide bioactivity by mimicking natural properties of the mandible in terms of structure, composition and mechanical behavior. This review aims to present the state of the art of scaffolds made with AM techniques that are specifically employed in mandibular tissue engineering applications. Biomaterials chemical composition and scaffold structural properties are deeply discussed, along with strategies to promote osteogenesis (i.e., delivery of biomolecules, incorporation of stem cells, and approaches to induce vascularization in the constructs). Finally, a comparison of in vivo studies is made by taking into consideration the amount of new bone formation (NB), the CSD dimensions, and the animal model.

Osteogenic Activity on NaOH-Etched Three-Dimensional-Printed Poly-ɛ-Caprolactone Scaffolds in Perfusion or Spinner Flask Bioreactor

Bioreactor systems, for example, spinner flask and perfusion bioreactors, and cell-seeded three-dimensional (3D)-printed scaffolds are used in bone tissue engineering strategies to stimulate cells and produce bone tissue suitable for implantation into the patient. The construction of functional and clinically relevant bone graft using cell-seeded 3D-printed scaffolds within bioreactor systems is still a challenge. Bioreactor parameters, for example, fluid shear stress and nutrient transport, will crucially affect cell function on 3D-printed scaffolds. Therefore, fluid shear stress induced by spinner flask and perfusion bioreactors might differentially affect osteogenic responsiveness of pre-osteoblasts inside 3D-printed scaffolds. We designed and fabricated surface-modified 3D-printed poly-ɛ-caprolactone (PCL) scaffolds, as well as static, spinner flask, and perfusion bioreactors to determine fluid shear stress and osteogenic responsiveness of MC3T3-E1 pre-osteoblasts seeded on the scaffolds in the bioreactors using finite element (FE)-modeling and experiments. FE-modeling was used to quantify wall shear stress (WSS) distribution and magnitude inside 3D-printed PCL scaffolds within spinner flask and perfusion bioreactors. MC3T3-E1 pre-osteoblasts were seeded on NaOH surface-modified 3D-printed PCL scaffolds, and cultured in customized static, spinner flask, and perfusion bioreactors up to 7 days. The scaffolds' physicochemical properties and pre-osteoblast function were assessed experimentally. FE-modeling showed that spinner flask and perfusion bioreactors locally affected WSS distribution and magnitude inside the scaffolds. The WSS distribution was more homogeneous inside scaffolds in perfusion than in spinner flask bioreactors. The average WSS on scaffold-strand surfaces ranged from 0 to 6.5 mPa for spinner flask bioreactors, and from 0 to 4.1 mPa for perfusion bioreactors. Surface modification of scaffolds by NaOH resulted in a surface with a honeycomb-like pattern and increased surface roughness (1.6-fold), but decreased water contact angle (0.3-fold). Both spinner flask and perfusion bioreactors increased cell spreading, proliferation, and distribution throughout the scaffolds. Perfusion, but not spinner flask bioreactors more strongly enhanced collagen (2.2-fold) and calcium deposition (2.1-fold) throughout the scaffolds after 7 days compared with static bioreactors, likely due to uniform WSS-induced mechanical stimulation of the cells revealed by FE-modeling. In conclusion, our findings indicate the importance of using accurate FE models to estimate WSS and determine experimental conditions for designing cell-seeded 3D-printed scaffolds in bioreactor systems. Impact Statement The success of cell-seeded three-dimensional (3D)-printed scaffolds depends on cell stimulation by biomechanical/biochemical factors to produce bone tissue suitable for implantation into the patient. We designed and fabricated surface-modified 3D-printed poly-ɛ-caprolactone (PCL) scaffolds, as well as static, spinner flask, and perfusion bioreactors to determine wall shear stress (WSS) and osteogenic responsiveness of pre-osteoblasts seeded on the scaffolds using finite element (FE)-modeling and experiments. We found that cell-seeded 3D-printed PCL scaffolds within perfusion bioreactors more strongly enhanced osteogenic activity than within spinner flask bioreactors. Our results indicate the importance of using accurate FE-models to estimate WSS and determine experimental conditions for designing cell-seeded 3D-printed scaffolds in bioreactor systems.

Soft Functionally Gradient Materials and Structures - Natural and Manmade: A Review

Functionally gradient materials (FGM) have gradual variations in their properties along one or more dimensions due to local compositional or structural distinctions by design. Traditionally, hard materials (e.g., metals, ceramics) are used to design and fabricate FGMs; however, there is increasing interest in polymer-based soft and compliant FGMs mainly because of their potential application in the human environment. Soft FGMs are ideally suitable to manage interfacial problems in dissimilar materials used in many emerging devices and systems for human interaction, such as soft robotics and electronic textiles and beyond. Soft systems are ubiquitous in everyday lives; they are resilient and can easily deform, absorb energy, and adapt to changing environments. Here, the basic design and functional principles of biological FGMs and their manmade counterparts are discussed using representative examples. The remarkable multifunctional properties of natural FGMs resulting from their sophisticated hierarchical structures, built from a relatively limited choice of materials, offer a rich source of new design paradigms and manufacturing strategies for manmade materials and systems for emerging technological needs. Finally, the challenges and potential pathways are highlighted to leverage soft materials' facile processability and unique properties toward functional FGMs.

Fabrication and properties of interweaved poly(ether ether ketone) composite scaffolds

This paper interweaved scaffolds with poly(ether ether ketone) (PEEK) and poly(lactic acid)/Walnut shell/hydroxypatite (PLA/WS/HA) composites by using fused filament fabrication technology, although there was a huge difference in thermal property term between PLA and PEEK. In order to keep mechanical properties of PEEK scaffold and remedy the stress loss produced by pores, PLA/WS/HA composites were used to fill the pores with gradient form outside-in (0.4-0.8 mm, 0.6-1.0 mm, 0.8-1.2 mm and 1.6-2.0 mm). The thermal stability, tensile and compression properties, tensile fracture surface morphology, cytotoxicity and in vivo experiment were investigated. The results showed: the scaffolds were intact without any flashes and surface destruction, and kept a well thermal stability. Compared with the PEEK porous scaffolds, the tensile fracture stress and strain, compression yield stress and strain of interweaved scaffolds were dramatically enhanced by 24.1%, 438%, 359.1% and 921.2%, respectively, and they climbed to the climax at 8 wt% of WS. In vivo experiment showed that the degradation of PLA/WS/HA composites synchronized with the adhesion, proliferation and ingrowth of bone cells, keeping the stable biomechanical properties of interweaved scaffolds. Those experiments showed that interweaved PEEK-PLA/WS/HA scaffolds had the potential to be used as bone implant in tissue engineering.

Sulfated carboxymethyl cellulose and carboxymethyl κ-carrageenan immobilization on 3D-printed poly-ε-caprolactone scaffolds differentially promote pre-osteoblast proliferation and osteogenic activity

The lack of bioactivity in three-dimensional (3D)-printing of poly-є-caprolactone (PCL) scaffolds limits cell-material interactions in bone tissue engineering. This constraint can be overcome by surface-functionalization using glycosaminoglycan-like anionic polysaccharides, e.g., carboxymethyl cellulose (CMC), a plant-based carboxymethylated, unsulfated polysaccharide, and κ-carrageenan, a seaweed-derived sulfated, non-carboxymethylated polysaccharide. The sulfation of CMC and carboxymethylation of κ-carrageenan critically improve their bioactivity. However, whether sulfated carboxymethyl cellulose (SCMC) and carboxymethyl κ-carrageenan (CM-κ-Car) affect the osteogenic differentiation potential of pre-osteoblasts on 3D-scaffolds is still unknown. Here, we aimed to assess the effects of surface-functionalization by SCMC or CM-κ-Car on the physicochemical and mechanical properties of 3D-printed PCL scaffolds, as well as the osteogenic response of pre-osteoblasts. MC3T3-E1 pre-osteoblasts were seeded on 3D-printed PCL scaffolds that were functionalized by CM-κ-Car (PCL/CM-κ-Car) or SCMC (PCL/SCMC), cultured up to 28 days. The scaffolds’ physicochemical and mechanical properties and pre-osteoblast function were assessed experimentally and by finite element (FE) modeling. We found that the surface-functionalization by SCMC and CM-κ-Car did not change the scaffold geometry and structure but decreased the elastic modulus. Furthermore, the scaffold surface roughness and hardness increased and the scaffold became more hydrophilic. The FE modeling results implied resilience up to 2% compression strain, which was below the yield stress for all scaffolds. Surface-functionalization by SCMC decreased Runx2 and Dmp1 expression, while surface-functionalization by CM-κ-Car increased Cox2 expression at day 1. Surface-functionalization by SCMC most strongly enhanced pre-osteoblast proliferation and collagen production, while CM-κ-Car most significantly increased alkaline phosphatase activity and mineralization after 28 days. In conclusion, surface-functionalization by SCMC or CM-κ-Car of 3D-printed PCL-scaffolds enhanced pre-osteoblast proliferation and osteogenic activity, likely due to increased surface roughness and hydrophilicity. Surface-functionalization by SCMC most strongly enhanced cell proliferation, while CM-κ-Car most significantly promoted osteogenic activity, suggesting that surface-functionalization by CM-κ-Car may be more promising, especially in the short-term, for in vivo bone formation.

Nanomaterials in Scaffolds for Periodontal Tissue Engineering: Frontiers and Prospects

The regeneration of periodontium represents important challenges to controlling infection and achieving functional regeneration. It has been recognized that tissue engineering plays a vital role in the treatment of periodontal defects, profiting from scaffolds that create the right microenvironment and deliver signaling molecules. Attributable to the excellent physicochemical and antibacterial properties, nanomaterials show great potential in stimulating tissue regeneration in tissue engineering. This article reviewed the up-to-date development of nanomaterials in scaffolds for periodontal tissue engineering. The paper also represented the merits and defects of different materials, among which the biocompatibility, antibacterial properties, and regeneration ability were discussed in detail. To optimize the project of choosing materials and furthermore lay the foundation for constructing a series of periodontal tissue engineering scaffolds, various nanomaterials and their applications in periodontal regeneration were introduced.

Synergetic osteogenesis of extracellular vesicles and loading RGD colonized on 3D-printed titanium implants

Titanium (Ti) and its alloys have been universally used as surgical implants, and the clinical need for modifying titanium surfaces to accelerate early stage osseointegration and prevent implant loosening is in huge demand. 3D printing technology is an accurate and controllable method to create titanium implants with complex nanostructures, which provide enough space to react and fit in the microenvironment of cells. Recently, extracellular vesicles (EVs) have attracted attention in promoting osteogenesis. The vesicles derived from bone marrow mesenchymal stem cells (BMSC-EVs) have been proved to pack osteogenic-relative RNAs thereby regulating the osteogenic differentiation and mineralization of the target BMSCs. Arg-Gly-Asp (RGD)-derived peptides are typical peptides used to improve cell attachment and proliferation in bone tissue engineering. A novel strategy is proposed to load RGD-derived peptides on EVs with a fusion peptide (EVsRGD) and colonize EVsRGD on the titanium surface via a specific bonding peptide. In this study, we verify that the presence of EVsRGD enables the realization of the synergetic effect of EVs and RGD, enhancing the osteogenic differentiation and mineralization of BMSCs in vitro, resulting in satisfactory osseointegration around implants in vivo.

Additive Manufacturing Technologies for Fabrication of Biomaterials for Surgical Procedures in Dentistry: A Narrative Review

PURPOSE

To screen and critically appraise available literature regarding additive manufacturing technologies for bone graft material fabrication in dentistry.

MATERIAL AND METHODS

PubMed and Scopus were searched up to May 2021. Studies reporting the additive manufacturing techniques to manufacture scaffolds for intraoral bone defect reconstruction were considered eligible. A narrative review was synthesized to discuss the techniques for bone graft material fabrication in dentistry and the biomaterials used.

RESULTS

The databases search resulted in 933 articles. After removing duplicate articles (128 articles), the titles and abstracts of the remaining articles (805 articles) were evaluated. A total of 89 articles were included in this review. Reading these articles, 5 categories of additive manufacturing techniques were identified: material jetting, powder bed fusion, vat photopolymerization, binder jetting, and material extrusion.

CONCLUSIONS

Additive manufacturing technologies for bone graft material fabrication in dentistry, especially 3D bioprinting approaches, have been successfully used to fabricate bone graft material with distinct compositions.

Nitric Oxide-Releasing Gelatin Methacryloyl/Silk Fibroin Interpenetrating Polymer Network Hydrogels for Tissue Engineering Applications

Bacterial infection is one of the principal reasons for the failure of tissue engineering scaffolds. Therefore, the development of multifunctional scaffolds that not only are able to guide tissue regeneration but also can inhibit bacterial colonization is of great importance for tissue engineering applications. In this study, a highly antibacterial, biocompatible, and biodegradable scaffold based on silk fibroin (SF) and gelatin methacryloyl (GelMA) was prepared. Sequential cross-linking of GelMA and SF under UV irradiation and methanol treatment, respectively, resulted in the formation of interpenetrating network (IPN) hydrogels with a porous structure. In addition, impregnation of the hydrogels with a nitric oxide (NO) donor molecule, S-nitroso-N-acetylpenicillamine (SNAP), led to the development of NO-releasing scaffolds with strong antibacterial properties. According to the obtained results, the addition of SF to GelMA hydrogels caused an enhancement in the mechanical properties and NO release kinetics and prevented their rapid enzymatic degradation in aqueous media. Furthermore, swelling the GelMA-SF scaffolds with SNAP resulted in a bacteria reduction efficiency of >99.9% against Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli) bacteria. The scaffolds also showed great cytocompatibility in vitro by increasing the proliferation and supporting the adhesion of 3T3 mouse fibroblast cells. Overall, GelMA-SF-SNAP showed great promise to be used as a scaffold for tissue engineering and wound healing applications.

Biomimetic 3D-printed PCL scaffold containing a high concentration carbonated-nanohydroxyapatite with immobilized-collagen for bone tissue engineering: enhanced bioactivity and physicomechanical characteristics

A challenging approach of three-dimensional (3D)-biomimetic scaffold design for bone tissue engineering is to improve scaffold bioactivity and mechanical properties. We aimed to design and fabricate 3D-polycaprolactone (PCL)-based nanocomposite scaffold containing a high concentration homogeneously distributed carbonated-nanohydroxyapatite (C-nHA)-particles in combination with immobilized-collagen to mimic real bone properties. PCL-scaffolds without/with C-nHA at 30%, 45%, and 60% (wt/wt) were 3D-printed. PCL/C-nHA60%-scaffolds were surface-modified by NaOH-treatment and collagen-immobilization. Physicomechanical and biological properties were investigated experimentally and by finite-element (FE) modeling. Scaffold surface-roughness enhanced by increasing C-nHA (1.7 - 6.1-fold), but decreased by surface-modification (0.6-fold). The contact angle decreased by increasing C-nHA (0.9 - 0.7-fold), and by surface-modification (0.5-fold). The zeta potential decreased by increasing C-nHA (3.2-9.9-fold). Average elastic modulus, compressive strength, and reaction force enhanced by increasing C-nHA and by surface-modification. FE modeling revealed that von Mises stress distribution became less homogeneous by increasing C-nHA, and by surface-modification. Maximal von Mises stress for 2% compression strain in all scaffolds did not exceed yield stress for bulk-material. 3D-printed PCL/C-nHA60% with surface-modification enhanced pre-osteoblast spreading, proliferation, collagen deposition, alkaline phosphatase activity, and mineralization. In conclusion, a novel biomimetic 3D-printed PCL-scaffold containing a high concentration C-nHA with surface-modification was successfully fabricated. It exhibited superior physicomechanical and biological properties, making it a promising biomaterial for bone tissue engineering.

Design and research of bone repair scaffold based on two-way fluid-structure interaction

BACKGROUND AND OBJECTIVE

Porous bone repair scaffolds are an important method of repairing bone defects. Fluid flow in the scaffold plays a vital role in tissue differentiation and permeability and fluid shear stress (FSS) are two important factors. The differentiation of bone tissue depends on the osteogenic differentiation of cells, FSS affects cell proliferation and differentiation, and permeability affects the transportation of nutrients and metabolic waste. Therefore, it is necessary to better understand and analyze the FSS on the cell surface and the permeability of the scaffold to obtain better osteogenic performance.

METHODS

In this study, computational fluid dynamics (CFD) was used to analyze fluid flow in the scaffold. Three structures and nine scaffold unit cell models were designed and the cell models were loaded onto the scaffold surface. Considering cell deformability, the two-way fluid-structure interaction (FSI) method was used to evaluate the FSS on the cell surface.

RESULTS

The simulation results showed that as the pore size of the scaffold increases, its permeability increases and the FSS decreases. The FSS received on the cell surface was much larger than scaffold surface. Moreover the FSS on the cell surface was distributed in steps.

CONCLUSIONS

The results showed the permeability of all models matches that of human bone tissue. Based on the cell surface FSS as the criterion, it was found that the spherical-560 scaffold exhibited the best osteogenic performance. This provided a strategy to design a better bone repair scaffold from biological aspects.

3D printed hybrid bone constructs of PCL and dental pulp stem cells loaded GelMA

Fabrication of scaffolds using polymers and then cell seeding is a routine protocol of tissue engineering applications. Synthetic polymers have adequate mechanical properties to substitute for some bone tissue, but they are generally hydrophobic and have no specific cell recognition sites, which leads to poor cell affinity and adhesion. Some natural polymers, have high cell affinity but are mechanically weak and do not have the strength required as a bone supporting material. In the present study, 3D printed hybrid scaffolds were fabricated using PCL and GelMA carrying dental pulp stem cells (DPSCs), which is printed in the gaps between the PCL struts. This cell loaded GelMA was shown to support osteoinductivity, while the PCL provided mechanical strength needed to mimic the bone tissue. 3D printed PCL/GelMA and GelMA scaffolds were highly stable during 21 days of incubation in PBS. The compressive moduli of the hybrid scaffolds were in the range of the compressive moduli of trabecular bone. DPSCs were homogeneously distributed throughout the entire hydrogel component and exhibited high cell viability in both scaffolds during 21 days of incubation. Upon osteogenic differentiation DPSCs expressed two key matrix proteins, osteopontin and osteocalcin. Alizarin red staining showed mineralized nodules, which demonstrates osteogenic differentiation of DPSCs within GelMA. This construct yielded a very high cell viability, osteogenic differentiation and mineralization comparable to cell culture without compromising mechanical strength suitable for bone tissue engineering applications. Thus, 3D printed, cell loaded PCL/GelMA hybrid scaffolds have a great potential for use in bone tissue engineering applications.

Cryogenic 3D printing of dual-delivery scaffolds for improved bone regeneration with enhanced vascularization

Three-dimensional (3D) printing has been increasingly employed to produce advanced bone tissue engineering scaffolds with biomimetic structures and matched mechanical strengths, in order to induce improved bone regeneration in defects with a critical size. Given that the successful bone regeneration requires both excellent osteogenesis and vascularization, endowing scaffolds with both strong bone forming ability and favorable angiogenic potential would be highly desirable to induce improved bone regeneration with required vascularization. In this investigation, customized bone tissue engineering scaffolds with balanced osteoconductivity/osteoinductivity were produced via cryogenic 3D printing of β-tricalcium phosphate and osteogenic peptide (OP) containing water/poly(lactic-co-glycolic acid)/dichloromethane emulsion inks. The fabricated scaffolds had a hierarchically porous structure and were mechanically comparable to human cancellous bone. Angiogenic peptide (AP) containing collagen I hydrogel was then coated on scaffold surface to further provide scaffolds with angiogenic capability. A sequential release with a quick AP release and a slow but sustained OP release was obtained for the scaffolds. Both rat endothelial cells (ECs) and rat bone marrow derived mesenchymal stem cells (MSCs) showed high viability on scaffolds. Improved in vitro migration and angiogenesis of ECs were obtained for scaffolds delivered with AP while enhanced osteogenic differentiation was observed in scaffolds containing OP. The in vivo results showed that, toward scaffolds containing both AP and OP, the quick release of AP induced obvious angiogenesis in vivo, while the sustained OP release significantly improved the new bone formation. This study provides a facile method to produce dual-delivery scaffolds to achieve multiple functions.

Advances in Biodegradable 3D Printed Scaffolds with Carbon-Based Nanomaterials for Bone Regeneration

Bone possesses an inherent capacity to fix itself. However, when a defect larger than a critical size appears, external solutions must be applied. Traditionally, an autograft has been the most used solution in these situations. However, it presents some issues such as donor-site morbidity. In this context, porous biodegradable scaffolds have emerged as an interesting solution. They act as external support for cell growth and degrade when the defect is repaired. For an adequate performance, these scaffolds must meet specific requirements: biocompatibility, interconnected porosity, mechanical properties and biodegradability. To obtain the required porosity, many methods have conventionally been used (e.g., electrospinning, freeze-drying and salt-leaching). However, from the development of additive manufacturing methods a promising solution for this application has been proposed since such methods allow the complete customisation and control of scaffold geometry and porosity. Furthermore, carbon-based nanomaterials present the potential to impart osteoconductivity and antimicrobial properties and reinforce the matrix from a mechanical perspective. These properties make them ideal for use as nanomaterials to improve the properties and performance of scaffolds for bone tissue engineering. This work explores the potential research opportunities and challenges of 3D printed biodegradable composite-based scaffolds containing carbon-based nanomaterials for bone tissue engineering applications.

Two-Photon Polymerized Poly(2-Ethyl-2-Oxazoline) Hydrogel 3D Microstructures with Tunable Mechanical Properties for Tissue Engineering

The main task of tissue engineering (TE) is to reproduce, replicate, and mimic all kinds of tissues in the human body. Nowadays, it has been proven useful in TE to mimic the natural extracellular matrix (ECM) by an artificial ECM (scaffold) based on synthetic or natural biomaterials to regenerate the physiological tissue/organ architecture and function. Hydrogels have gained interest in the TE community because of their ability to absorb water similar to physiological tissues, thus mechanically simulating the ECM. In this work, we present a novel hydrogel platform based on poly(2-ethyl-2-oxazoline)s, which can be processed to 3D microstructures via two-photon polymerization (2PP) with tunable mechanical properties using monomers and crosslinker with different degrees of polymerization (DP) for future applications in TE. The ideal parameters (laser power and writing speed) for optimal polymerization via 2PP were obtained using a specially developed evaluation method in which the obtained structures were binarized and compared to the computer-aided design (CAD) model. This evaluation was performed for each composition. We found that it was possible to tune the mechanical properties not only by application of different laser parameters but also by mixing poly(2-ethyl-2-oxazoline)s with different chain lengths and variation of the crosslink density. In addition, the swelling behavior of different fabricated hydrogels were investigated. To gain more insight into the viscoelastic behavior of different fabricated materials, stress relaxation tests via nanoindentation experiments were performed. These new hydrogels can be processed to 3D microstructures with high structural integrity using optimal laser parameter settings, opening a wide range of application properties in TE for this material platform.

3D bioprinting and craniofacial regeneration

BACKGROUND

Considering the structural and functional complexity of the craniofacial tissues, 3D bioprinting can be a valuable tool to design and create functional 3D tissues or organs in situ for in vivo applications. This review aims to explore the various aspects of this emerging 3D bioprinting technology and its application in the craniofacial bone or cartilage regeneration.

METHOD

Electronic database searches were undertaken on pubmed, google scholar, medline, embase, and science direct for english language literature, published for 3D bioprinting in craniofacial regeneration. The search items used were 'craniofacial regeneration' OR 'jaw regeneration' OR 'maxillofacial regeneration' AND '3D bioprinting' OR 'three dimensional bioprinting' OR 'Additive manufacturing' OR 'rapid prototyping' OR 'patient specific bioprinting'. Reviews and duplicates were excluded.

RESULTS

Search with above described criteria yielded 476 articles, which reduced to 108 after excluding reviews. Further screening of individual articles led to 77 articles to which 9 additional articles were included from references, and 18 duplicate articles were excluded. Finally we were left with 68 articles to be included in the review.

CONCLUSION

Craniofacial tissue and organ regeneration has been reported a success using bioink with different biomaterial and incorporated stem cells in 3D bioprinters. Though several attempts have been made to fabricate craniofacial bone and cartilage, the strive to achieve desired outcome still continues.

Hierarchical porosity in additively manufactured bioengineering scaffolds: Fabrication & characterisation

Biomedical scaffolds with a high degree of porosity are known to facilitate the growth of healthy functioning tissues. In this study, scaffolds with hierarchical porosity are manufactured and their mechanical and thermal properties are characterised. Multi-scale porosity is achieved in scaffolds fabricated by Fused Deposition Modelling (FDM) in a novel way. Random intrinsic porosity at micron length scale obtained from particulate leaching is combined with the structured extrinsic porosity at millimeter length scales afforded by controlling the spacing between the struts. Polylactic acid (PLA) is blended with Polyvinyl alcohol (PVA) and an inorganic sacrificial phase, sodium chloride (NaCl), to produce pores at length scales of up to two orders of magnitude smaller than the inter-filament voids within 3D printed lattices. The specific elastic modulus and specific strength are maximised by optimising the polymer blends. The porosity level and pore size distribution of the foamy filaments within lattices are quantified statistically. Compression tests are performed on the porous samples and the observed mechanical response is attributed to the microstructure and density. Simple cellular solid models that possess power law are used to explain the measured trends and the dependence is associated with various mechanisms of elastic deformation of the cell walls. The relationship between pore architecture, pore connectivity, the blend material composition, and mechanical response of produced foams is brought out. Foams obtained using the PLA:PVA:NaCl 42%-18%-40% material blends show relatively high specific elastic modulus, specific strength and strain at failure. A quadratic power law relating the Young's modulus with the relative density is experimentally obtained, which is consistent with theoretical models for open-cell foams. 3D printing with blends, followed by leaching, produces structures with cumulative intrinsic and extrinsic porosity as high as 80%, in addition to good mechanical integrity.

Inlet flow rate of perfusion bioreactors affects fluid flow dynamics, but not oxygen concentration in 3D-printed scaffolds for bone tissue engineering: Computational analysis and experimental validation

Fluid flow dynamics and oxygen-concentration in 3D-printed scaffolds within perfusion bioreactors are sensitive to controllable bioreactor parameters such as inlet flow rate. Here we aimed to determine fluid flow dynamics, oxygen-concentration, and cell proliferation and distribution in 3D-printed scaffolds as a result of different inlet flow rates of perfusion bioreactors using experiments and finite element modeling. Pre-osteoblasts were treated with 1 h pulsating fluid flow with low (0.8 Pa; PFF^low) or high peak shear stress (6.5 Pa; PFF^high), and nitric oxide (NO) production was measured to validate shear stress sensitivity. Computational analysis was performed to determine fluid flow between 3D-scaffold-strands at three inlet flow rates (0.02, 0.1, 0.5 ml/min) during 5 days. MC3T3-E1 pre-osteoblast proliferation, matrix production, and oxygen-consumption in response to fluid flow in 3D-printed scaffolds inside a perfusion bioreactor were experimentally assessed. PFF^high more strongly stimulated NO production by pre-osteoblasts than PFF^low. 3D-simulation demonstrated that dependent on inlet flow rate, fluid velocity reached a maximum (50-1200 μm/s) between scaffold-strands, and fluid shear stress (0.5-4 mPa) and wall shear stress (0.5-20 mPa) on scaffold-strands surfaces. At all inlet flow rates, gauge fluid pressure and oxygen-concentration were similar. The simulated cell proliferation and distribution, and oxygen-concentration data were in good agreement with the experimental results. In conclusion, varying a perfusion bioreactor's inlet flow rate locally affects fluid velocity, fluid shear stress, and wall shear stress inside 3D-printed scaffolds, but not gauge fluid pressure, and oxygen-concentration, which seems crucial for optimized bone tissue engineering strategies using bioreactors, scaffolds, and cells.