The contribution of pore size and porosity of 3D printed porous titanium scaffolds to osteogenesis

Towards the development of reliable finite element models of Ti6Al4V trabecular structures fabricated via laser powder bed fusion for biomedical applications

Additive manufacturing technologies are commonly adopted for the fabrication of trabecular-based orthopedic prostheses made of titanium alloys due to their ability in producing complex and intricate designs. In this scenario, the use of finite element models represents a powerful tool for designing such devices and assessing their biomechanical behavior. Nevertheless, the usefulness of a numerical approach depends on the reliability of the adopted models, a crucial aspect when dealing with trabecular structures present within orthopedic implants. Indeed, the description of their effective geometry and the characterization of the material mechanical properties represent a tough challenge that hinders the development of high-fidelity numerical models. Specifically, the small dimensions of the trabeculae approach the accuracy limit of additive manufacturing leading to relevant uncertainties in their production. The existing studies dealing with the finite element modeling of 3D-printed trabecular structures often neglect the geometrical and material peculiarities of thin struts, making questionable the reliability of the developed numerical models. Namely, they either make simplifications in describing the mechanical properties of the material or do not account for realistic geometries. To address this gap, the present work aims to propose a systematic approach that achieves the development of accurate finite element models of trabecular structures, by integrating experimental activities with numerical simulations. This approach is exemplified by using two distinct trabecular structures used in the design of a custom talus prosthesis.

Droplet capture mechanism and sustainable drug release of a titanium mandibular drug reservoir modified by laser grid texturing and silicone oil heat treatment

Customized titanium implants are commonly used for repairing mandibular defects caused by accidents. However, the semi-open nature of the oral environment increases the likelihood of inflammation around the implant, which has a significant impact on the therapeutic outcomes. Most existing research tackles this issue by achieving drug loading through surface modifications to create local drug delivery systems. Nevertheless, several technical challenges remain in constructing effective local drug delivery systems based on the implant structure. In this study, a titanium drug reservoir was designed and fabricated, incorporating laser grid texturing and silicone oil heat treatment. The droplet capture mechanism was analyzed, and the effect of the sustainable release area on droplet motion resistance was evaluated. In vitro antibacterial tests revealed that the modified drug reservoir, characterized by high adhesion and superhydrophobicity, exhibited the most effective sustained release. It had a texturing interval of 500 µm, and the duration of the zone of inhibition was 60 h. This approach presents a new method for fabricating titanium implants integrated with local drug delivery systems, offering significant potential for improved clinical outcomes.

Fast shape memory function and personalized PLTMC/SIM/MBG composite scaffold for bone regeneration

Orthopedic clinical practice faces significant challenges in treating critical-sized bone defects due to extensive tissue damage and prolonged healing. To address these limitations, this study integrated shape-memory polymers with 3D printing to engineer bioactive scaffolds composed of poly(l-lactide-co-trimethylene carbonate) (PLTMC), simvastatin (SIM), and mesoporous bioactive glass (MBG) via low-temperature rapid prototyping. The PLTMC/SIM/MBG composite scaffold exhibited exceptional porosity (78.5 % ± 1.5 %) and load-bearing compressive strength (66.33 ± 1.44 MPa at 30 % MBG). In addition, its thermoresponsive shape-memory behavior enabled intraoperative molding to precisely conform to defect geometries, while the sustained release of SIM and MBG ionic exchange together created a bioactive microenvironment. Mechanistically, the scaffold activated the Wnt pathway to enhance the osteogenic differentiation of mesenchymal stem cells, maintaining cytocompatibility. In vivo, directional bone regeneration occurred along the degradable scaffold, driven by synergistic topographical guidance from 3D-printed pores and biochemical cues from SIM and MBG. The shape-adaptive design preserved mechanical continuity with the host bone during remodeling. These results demonstrate a personalized solution for large defects, merging surgical adaptability through shape-memory functionality with bioactive efficacy via structural and biochemical synergy, overcoming the limitations of conventional implants in anatomical matching and regenerative performance.

Advances in the Fabrication of Polycaprolactone-Based Composite Scaffolds for Bone Tissue Engineering: From Chemical Composition to Scaffold Architecture

Thermoplastic polymer-based materials, which feature essential biological properties and opportunities to implement the cutting-edge additive manufacturing technologies aimed at obtaining high-precision 3D models, have attracted intense interest for porous and bioresorbable bone tissue implants development. Among the wide range of materials, polycaprolactone was found to provide a balance between the biodegradation rate and biocompatibility with various tissues. Recent advances in the fabrication of polymer-polymer and polymer-inorganic composites have opened new ways to improve biological and mechanical outcomes and expanded the range of applications for bone and cartilage restoration, including the development of conductive composites for electrostimulation. While the chemical composition of the manufactured scaffolds played a vital role in their general biological performance and biocompatibility with bone tissue, the micropattern and roughness of the surface were shown to be additional stimuli for stem cell differentiation. More challenges came from the fabrication technique suitable for the proposed scaffold design. Here we summarize the key challenges and advances in fabrication and approaches to the optimization of certain chemical, morphological, or geometrical parameters of polycaprolactone-based scaffolds for bone tissue engineering applications.

Clinical Application of 3D-Printed Custom Hemipelvic Prostheses With Negative Poisson's Ratio Porous Structures in Reconstruction After Resection of Pelvic Malignant Tumors

OBJECTIVES

Pelvic bone tumor resection and reconstruction present significant challenges due to complex anatomy and weight-bearing demands. 3D-printed hemipelvic prostheses, incorporating customized osteotomy guides and porous structures, offer a promising solution for enhancing osseointegration. This study evaluates the long-term outcomes of 3D-printed custom hemipelvic reconstruction with a focus on the integration of auxetic biomaterials with a negative Poisson's ratio to optimize mechanical properties.

METHODS

A retrospective analysis was conducted on 12 patients with primary pelvic malignancies who underwent reconstruction using 3D-printed hemipelvic prostheses between January 2018 and May 2023. Follow-up duration was 48 months (range, 29-64 months) Oncological, functional, surgical, pain control, and radiographic outcomes were assessed.

RESULTS

At the latest follow-up, 8 patients (66.7%) were disease-free, 3 (25%) had disease progression, and 1 (8.3%) died from metastatic complications. Functional outcomes improved significantly, with the MSTS-93 score increasing from 15 (range, 12-17) to 26 (range, 21-29). Pain scores decreased from 5 (range, 4-7) to 1 (range, 0-2). The median surgical duration was 270 min (range, 150-560 min), with intraoperative blood loss averaging 3200 mL (range, 1900-6300 mL). Complications included poor wound healing in 2 patients (16.7%), managed with VAC drainage. No mechanical failures, loosening, or fractures occurred. Accurate osteotomy, prosthesis implantation, and screw fixation were achieved. Successful osseointegration was observed in all cases, with no signs of bone absorption or osteolysis.

CONCLUSIONS

3D-printed custom hemipelvic prostheses with auxetic biomaterials offer an effective solution for pelvic reconstruction, providing promising oncological, functional, and radiographic outcomes. These findings support the use of 3D printing in complex pelvic defect reconstruction, optimizing both osteointegration and mechanical strength.

Biomechanics and Mechanobiology of Additively Manufactured Porous Load-Bearing Bone Implants

Given that they can replicate both the biomechanical and mechanobiological functions of natural bone, metal additively manufactured porous load-bearing bone implants present a significant advancement in orthopedic applications. Additive manufacturing (AM) of metals enables precise control over pore geometry, resulting in implants that provide effective mechanical support and minimize stress shielding. In addition to its mechanical benefits, the porous architecture of the implants facilitates essential mechanobiological processes, including the transmission of mechanical signals that regulate cellular processes such as adhesion, proliferation, and differentiation. Before clinical use, the implants should first be engineered to achieve a comparable elastic modulus to native bone, mitigating implant-induced bone resorption while promoting tissue regeneration. It is also noteworthy that the microstructural features of these implants support angiogenesis-a critical process for oxygen and nutrient delivery during bone healing. Despite their potential benefits, challenges remain in balancing mechanical stability for load-bearing applications with biofunctionality for effective integration and controlled degradation. This review comprehensively discusses the biomechanical and mechanobiological factors influencing the design and performance of additively manufactured porous bone implants, highlighting their potential to enhance clinical outcomes in bone repair and regeneration.

An integrated experimental and analytical approach for the analysis of the mechanical interaction between metal porous scaffolds and bone: implications for stress shielding in orthopedic implants

Introduction

Metal porous structures are becoming a standard design feature of orthopedic implants such as joint endoprostheses. The benefits of the pores are twofold: 1) help improve the cementless primary stabilization of the implant by increasing osteointegration and 2) reduce the overall stiffness of the metal implant thus minimizing stress-shielding. While the mechanical interaction between porous implants and bone has been extensively investigated via complex numerical and finite element models, scarce is the in vitro and in vivo data on the effect of porosity and materials on stress and strain distribution in the implant-bone compound.

Materials and methods

An integrated numerical and experimental approach was used to investigate the effect of material and porosity on the mechanical interaction in compression between porous metal scaffolds and bovine cortical bone. 18 × 18 × 6 mm cuboid samples were cut from fresh-frozen bovine cortical bones. A 9 × 6 × 6 cavity was obtained in each sample to allow insertion of CoCrMo porous and full density scaffolds. Digital Image Correlation analysis tracked bone strain during axial compression of the scaffold-bone samples up to bone failure. The experimental strain data were compared to those from finite element analysis (FEA) of the scaffold-bone compound. The effect of scaffold porosity and material - Ti6Al4V and CoCrMo - on bone strain distribution and reactions forces, with respect to full bone samples, was assessed via FEA and an analytical spring-based model of the bone-scaffold compound.

Results

The experimental data revealed that the porous scaffold resulted in bone strain closer to that of the intact bone with respect to full density scaffolds. FEA showed that Ti6Al4V scaffolds result in bone strain and reaction forces closer to the those in the intact bone with respect to those in CoCrMo scaffolds. The 1,000 µm pores scaffolds resulted significantly more effective in improving reaction forces with respect to the 500 µm pores scaffolds.

Conclusion

The present findings confirm that metal porous scaffolds help promote a more uniform distribution to the bone compared to full density implants. Ti6Al4V scaffolds demonstrated a more favorable mechanical interaction compared to CoCrMo. This integrated approach offers valuable insights into the design of orthopedic implants with optimized mechanical and osseointegration properties.

Biomechanical evaluation of novel 3D-printed magnesium alloy scaffolds for treating proximal humerus fractures with medial column instability

BACKGROUND

Patients with complex proximal humerus fractures (PHFs) have a higher complication rate when treated with locking compression plate (LCP) alone. This increased complication rate may be due to humeral head collapse and insufficient medial column support in the proximal humerus. In response, we proposed the use of bionic porous 3D-printed magnesium alloy scaffolds (MAS) in combination with LCP for the treatment of PHFs. The aim of this study is to compare the biomechanical characteristics of the LCP alone versus LCP-MAS fixation constructs in treating PHFs with medial column instability.

METHODS

A three-dimensional model of a PHF with medial column instability was developed using computed tomography, and fixation was applied using LCP and LCP-MAS. Finite element analysis was employed to evaluate the biomechanical characteristics of these two fixation models, focusing on construct stiffness, von Mises stress distribution, and fracture displacements.

RESULTS

The construct stiffness of the LCP-MAS fixation construct was approximately 3.50 to 7.30 times greater than that of the LCP fixation construct under normal bone conditions, and 2.60 to 4.90 times greater under osteoporotic bone conditions. The LCP-MAS fixation reduced the maximum von Mises stress on the implants by at least 70 %-80 %. Furthermore, the LCP-MAS fixation significantly minimized fracture displacement compared to LCP alone.

CONCLUSIONS

The findings of this study suggest that the additional use of MAS can significantly enhance both the overall and local stability of PHFs. Thus, the LCP-MAS fixation approach presents a viable alternative for the treatment of PHFs.

A deformable SIS/HA composite hydrogel coaxial scaffold promotes alveolar bone regeneration after tooth extraction

After tooth extraction, alveolar bone absorbs unevenly, leading to soft tissue collapse, which hinders full regeneration. Bone loss makes it harder to do dental implants and repairs. Inspired by the biological architecture of bone, a deformable SIS/HA (Small intestinal submucosa/Hydroxyapatite) composite hydrogel coaxial scaffold was designed to maintain bone volume in the socket. The SIS/HA scaffold containing GL13K as the outer layer, mimicking compact bone, while SIS hydrogel loaded with bone marrow mesenchymal stem cells-derived exosomes (BMSCs-Exos) was utilized as the inner core of the scaffolds, which are like soft tissue in the skeleton. This coaxial scaffold exhibited a modulus of elasticity of 0.82 MPa, enabling it to adaptively fill extraction sockets and maintain an osteogenic space. Concurrently, the inner layer of this composite scaffold, enriched with BMSCs-Exos, promoted the proliferation and migration of human umbilical vein endothelial cells (HUVECs) and BMSCs into the scaffold interior (≈3-fold to the control), up-regulated the expression of genes related to osteogenesis (BMP2, ALP, RUNX2, and OPN) and angiogenesis (HIF-1α and VEGF). This induced new blood vessels and bone growth within the scaffold, addressing the issue of low bone formation rates at the center of defects. GL13K was released by approximately 40.87 ± 4.37 % within the first three days, exerting a localized antibacterial effect and further promoting vascularization and new bone formation in peripheral regions. This design aims to achieve an all-around and efficient bone restoration effect in the extraction socket using coaxial scaffolds through a dual internal and external mechanism.

3D-Printed Polycaprolactone/Hydroxyapatite Bionic Scaffold for Bone Regeneration

The limitations of traditional, autologous bone grafts, such as the scarcity of donor material and the risks of secondary surgical trauma, have spurred the development of alternatives for the repair of large bone defects. Bionic bone scaffolds fabricated via fused deposition modeling (FDM)-a three-dimensional (3D) printing technique-are considered promising. While gyroid-structured scaffolds mimic the complex micro-architecture of cancellous bone, their application in FDM 3D printing remains understudied. Furthermore, no consensus has been reached on the ideal pore size for gyroid scaffolds, which is influenced by the infill density. In this study, we fabricated five groups of polycaprolactone/hydroxyapatite (PCL/HA) scaffolds with different infill densities (40%, 45%, 50%, 55%, and 60%) using a solvent-free filament preparation method. Scanning electron microscopy (SEM) observation showed that all scaffolds exhibit an interconnected porous structure. The scaffold with the 55% infill density, featuring a pore size of 465 ± 63 μm, demonstrated optimal hydrophilicity and mechanical properties comparable to natural cancellous bone. In addition, this scaffold supported cellular bridging within its pores and showed the highest alkaline phosphatase (ALP) activity and calcium salt deposition. Our findings offer novel insights into the design of gyroid-like scaffolds and their fabrication via FDM, paving the way for potential clinical applications.

Progress of porous tantalum surface-modified biomaterial coatings in bone tissue engineering

Tantalum (Ta) metal has emerged as a prominent material within the realm of bone tissue engineering, owing to its favorable biocompatibility, commendable mechanical attributes, and notable biological properties such as osteoconductivity, osteoinductivity, and angiogenic potential. However, as clinical applications have expanded, Ta implants have unveiled a spectrum of limitations. Consequently, porous tantalum (PTa) has garnered escalating interest, attributable to its unique microstructural attributes, tunable mechanical characteristics, and inherent biocompatibility. Various methodologies have been proposed to modify the surface of PTa, with the aim of accelerating and enhancing osseous integration while fostering more robust osseointegration. Strategic surface modifications have the potential to augment the inherent advantages of PTa, thereby offering diverse avenues for exploration within the realm of surface effects on PTa. This review elucidates the ongoing research endeavors concerning diverse biomaterial coatings applied to PTa surfaces in the context of bone tissue engineering.

Mechanical behaviour of additive manufactured PEEK/HA porous structure for orthopaedic implants: Materials, structures and manufacturing processes

Polyether-ether-ketone (PEEK) composites represent one of the most promising approaches to overcoming the weak osseointegration associated with the bioinertness of PEEK, making them highly suitable for clinical translation. Implants with porous structures fabricated by additive manufacturing offer the potential for long-term stability by promoting bone ingrowth. However, despite the importance of porous design, there is still no consensus on the optimal approach for PEEK-based composites. Given the significance of permeability and mechanical properties as functional indicators closely linked to osseointegration, the effects of material composition, structural design, and manufacturing processes on the permeability and mechanical properties of PEEK/hydroxyapatite (HA) scaffolds were systematically investigated in this study. In terms of permeability, the axial permeability of scaffolds with different pore sizes and representative volume elements varied within the range of 0.3-24.8 × 10-9 m2. Among scaffolds with similar relative density, the Gyroid structure exhibited the lowest permeability, while the orthogonal structure demonstrated the highest. For cylindrical scaffolds, circumferential permeability decreased with increasing penetration depth, suggesting a potential reduction in bone ingrowth speed with depth. As for mechanical properties, the experimentally determined effective elastic modulus and effective yield strength of the scaffolds ranged from 675.1 MPa to 65.2 MPa and 43.5 MPa to 4.1 MPa, respectively. The permeability and mechanical properties of PEEK/HA scaffolds with relative density ranging from 35% to 50% were aligned with the those of human cancellous bone. Heat treatment at 240 °C for 120 min increased the crystallinity of PEEK to 37.2%, resulting in a substantial improvement in both the strength and stiffness of the scaffolds. However, excessive crystallinity led to brittle fracture, which in turn reduced the strength of the scaffolds. This study employed a systematic research approach to investigate how material composition, structural design, and manufacturing processes influence the mechanical properties and permeability of PEEK composite bone scaffolds, which are crucial for bone ingrowth. The results offered insights that support the design, manufacturing, and performance evaluation of PEEK-based porous implants.

Evaluation and optimization of physical, mechanical, and biological characteristics of 3D printed Whitlockite/calcium silicate composite scaffold for bone tissue regeneration using response surface methodology

Calcium phosphate-based bioscaffolds are used for bone tissue regeneration because of their physical and chemical resemblance to human bone. Calcium, phosphate, sodium, potassium, magnesium, and silicon are important components of human bone. The successful biomimicking of human bone characteristics involves incorporating all the human bone elements into the scaffold material. In this work, Mg-Whitlockite (WH) and Calcium Silicate (CS) were selected as matrix and reinforcement respectively, because of their desirable elemental composition and regenerative properties. The magnesium in WH increases mineralization in bone, and the silicon ions in CS support vascularization. The Mg-WH was synthesized using the wet chemical method, and powder characterization tests were performed. Response surface methodology (RSM) is used to design the experiments with a combination of material compositions, infill ratios (IFs), and sintering temperatures (STs). The WH/CS bioceramic composite is 3D printed in three different compositions: 100/0, 75/25, and 50/50 wt%, with IFs of 50%, 75%, and 100%. The physical and mechanical characterization study of printed samples is conducted and the result is optimized using RSM. ANOVA (Analysis of Variance) is used to establish the relationship between input parameters and responses. The optimized input parameters were the WH/CS composition of 50/50 wt%, IF of 50%, and ST of 1150 °C, which bring out the best possible combination of physical and mechanical characteristics. The RSM optimized response was a density of 2.27 g cm-3, porosity of 36.74%, wettability of 45.79%, shrinkage of 25.13%, compressive strength of 12 MPa, and compressive modulus of 208.49 MPa with 92% desirability. The biological characterization studies were conducted for the scaffold samples prepared with optimized input parameters. The biological studies confirmed the capabilities of the WH/CS composite scaffolds in bone regenerative applications.

Advances in the application and research of biomaterials in promoting bone repair and regeneration through immune modulation

With the ongoing development of osteoimmunology, increasing evidence indicates that the local immune microenvironment plays a critical role in various stages of bone formation. Consequently, modulating the immune inflammatory response triggered by biomaterials to foster a more favorable immune microenvironment for bone regeneration has emerged as a novel strategy in bone tissue engineering. This review first examines the roles of various immune cells in bone tissue injury and repair. Then, the contributions of different biomaterials, including metals, bioceramics, and polymers, in promoting osteogenesis through immune regulation, as well as their future development directions, are discussed. Finally, various design strategies, such as modifying the physicochemical properties of biomaterials and integrating bioactive substances, to optimize material design and create an immune environment conducive to bone formation, are explored. In summary, this review comprehensively covers strategies and approaches for promoting bone tissue regeneration through immune modulation. It offers a thorough understanding of current research trends in biomaterial-based immune regulation, serving as a theoretical reference for the further development and clinical application of biomaterials in bone tissue engineering.

Optimising β-Ti21S Alloy Lattice Structures for Enhanced Femoral Implants: A Study on Mechanical and Biological Performance

The metastable β-Ti21S alloy exhibits a lower elastic modulus than Ti-6Al-4V ELI while maintaining high mechanical strength and ductility. To address stress shielding, this study explores the integration of lattice structures within prosthetics, which is made possible through additive manufacturing. Continuous adhesion between the implant and bone is essential; therefore, auxetic bow-tie structures with a negative Poisson's ratio are proposed for regions under tensile stress, while Triply Periodic Minimal Surface (TPMS) structures with a positive Poisson's ratio are recommended for areas under compressive stress. This research examines the manufacturability and quasi-static mechanical behaviour of two auxetic bow-tie (AUX 2.5 and AUX 3.5) and two TPMS structures (TPMS 2.5 and TPMS 1.5) in β-Ti21S alloy produced via laser powder bed fusion. Micro-CT reveals printability issues in TPMS 1.5, affecting pore size and reducing fatigue resistance compared to TPMS 2.5. AUX 3.5's low stiffness matches cancellous bone but shows insufficient yield strength and fatigue resistance for femoral implants. Biological tests confirm non-toxicity and enhanced cell activity in β-Ti21S structures. The study concludes that the β-Ti21S alloy, especially with TPMS 2.5 structures, demonstrates promising mechanical and biological properties for femoral implants. However, challenges like poor printability in TPMS 1.5 are acknowledged and should be addressed in future research.

Microplasma-Sprayed Titanium and Hydroxyapatite Coatings on Ti6Al4V Alloy: in vitro Biocompatibility and Corrosion Resistance: Part I

This two-part paper investigates the bioactivity and mechanical properties of coatings applied to Ti6Al4V, a common titanium alloy used in endoprosthetic implants. Coatings made from hydroxyapatite (HA) powder and commercially pure titanium (CP-Ti) wires were applied using microplasma spraying. The study focuses on the responses of rat mesenchymal stem cells (MSCs), which are essential for bone healing, to these coatings. Part I shows how adjusting the microplasma spraying process allows coatings with varying porosity and surface roughness to be achieved.

Evaluation of biological performance of 3D printed trabecular porous tantalum spine fusion cage in large animal models

Background

The materials for artificial bone scaffolds have long been a focal point in biomaterials research. Tantalum, with its excellent bioactivity and tissue compatibility, has gradually become a promising alternative material. 3D printing technology shows unique advantages in designing complex structures, reducing costs, and providing personalized customization in the manufacture of porous tantalum fusion cages. Here we report the pre-clinical large animal (sheep) study on the newly developed 3D printed biomimetic trabecular porous tantalum fusion cage for assessing the long-term intervertebral fusion efficacy and safety.

Methods

Porous tantalum fusion cages were fabricated using laser powder bed fusion (LPBF) and chemical vapor deposition (CVD) methods. The fusion cages were characterized using scanning electron microscopy (SEM) and mechanical compression tests. Small-Tailed Han sheep served as the animal model, and the two types of fusion cages were implanted in the C3/4 cervical segments and followed for up to 12 months. Imaging techniques, including X-ray, CT scans, and Micro CT, were used to observe the bone integration of the fusion cages. Hard tissue sections were used to assess osteogenic effects and bone integration. The range of motion (ROM) of the motion segments was evaluated using a biomechanical testing machine. Serum biochemical indicators and pathological analysis of major organs were conducted to assess biocompatibility.

Results

X-ray imaging showed that both the 3D-printed and chemical vapor deposition porous tantalum fusion cages maintained comparable average intervertebral disc heights. Due to the presence of metal artifacts, CT and Micro CT imaging could not effectively analyze bone integration. Histomorphology data indicated that both the 3D-printed and chemical vapor deposition porous tantalum fusion cages exhibited similar levels of bone contact and integration at 3, 6, and 12 months, with bone bridging observed at 12 months. Both groups of fusion cages demonstrated consistent mechanical stability across all time points. Serum biochemistry showed no abnormalities, and no significant pathological changes were observed in the heart, liver, spleen, lungs, and kidneys.

Conclusion

This study confirms that 3D-printed and chemical vapor deposition porous tantalum fusion cages exhibit comparable, excellent osteogenic effects and long-term biocompatibility. Additionally, 3D-printed porous tantalum fusion cages offer unique advantages in achieving complex structural designs, low-cost manufacturing, and personalized customization, providing robust scientific support for future clinical applications.

The translational potential of this article

The translational potential of this paper is to use 3D printed biomimetic trabecular porous tantalum spine fusion cage with bone trabecular structure and validating its feasibility in large animal models (sheep). This study provides a basis for further research into the clinical application of the 3D printed biomimetic trabecular porous tantalum spine fusion cage.

Combined release of LL37 peptide and zinc ion from a mussel-inspired coating on porous titanium for infected bone defect repairing

Implant-associated infections impose great burden on patient health and public healthcare. Antimicrobial peptides and metal ions are generally incorporated onto implant surface to deter bacteria colonization. However, it is still challenging to efficiently prevent postoperative infections at non-cytotoxic dosages. Herein, a scaffold based on porous titanium coated with a mussel-inspired dual-diameter TiO2 nanotubes is developed for loading dual drugs of LL37 peptide and Zn2+ with different sizes and characteristics. Benefiting from in-situ formed polydopamine layer and dual-diameter nanotubular structure, the scaffold provides an efficient platform for controllable drugs elution: accelerated release under acidic condition and sustained release for up to 28 days under neutral/alkalescent circumstances. Such combination of dual drugs simultaneously enhanced antibacterial efficacy and osteogenesis. In antibacterial test, LL37 peptide serving as bacteria membrane puncture agent, and Zn2+ acting as ROS generator, cooperatively destroyed bacterial membrane integrity and subsequently damaged bacterial DNA, endowing dual-drug loaded scaffold with remarkable bactericidal efficiency of > 92 % in vitro and > 99 % in vivo. Noteworthily, dual-drug loaded scaffold promoted bone-implant osteointegration under infectious microenvironment, overmatching single-drug load ones. It provides a promising strategy on surface modification of implant for infected bone defect repairing.

3D-Printed hydrogel scaffolds with drug- and stem cell-laden core/shell filaments for cancer therapy and soft tissue repair

Treatment of local tumor recurrence and repair of the tissue defects after tumorectomy still remain clinical challenges. Currently, controlled release of therapeutic drugs is one of the widely used approaches to kill the residual and recurrent cancer cells, and stem cell-laden hydrogel scaffolds are promising candidates for soft tissue repair. However, hydrogel scaffolds with the bifunction of controlled release of therapeutic drugs for cancer therapy and loading stem cells for tissue repair are still not well established. In this study, we fabricated a biphasic hydrogel scaffold containing two types of core/shell filaments with drugs and stem cells loaded in the core part of these two filaments. Black phosphorus nanosheets were added to alginate (the shell layer) in the drug-loaded filament, endowing the scaffold with a photothermal effect under near infrared (NIR) laser irradiation. Moreover, NIR could trigger the drug release from the core/shell filaments to achieve photothermal-chemotherapy of cancer. Additionally, stem cells embedded in the core parts of the other filaments could maintain high cell viability due to the protection of the shell layer (pure alginate), which promoted soft tissue regeneration in vivo. Thus, the prepared biphasic scaffold with drug- and stem cell-laden core/shell filaments may be a potential candidate to fill the tissue defects after the surgical resection of tumors to kill the residual and recurrent cancer and repair the tissue defects.

Optimizing scaffold pore size for tissue engineering: insights across various tissue types

Scaffold porosity is a critical factor in replicating the complex in vivo microenvironment, directly influencing cellular interactions, migration, nutrient transfer, vascularization, and the formation of functional tissues. For optimal tissue formation, scaffold design must account for various parameters, including material composition, morphology, mechanical properties, and cellular compatibility. This review highlights the importance of interconnected porosity and pore size, emphasizing their impact on cellular behavior and tissue formation across several tissue engineering domains, such as skin, bone, cardiovascular, and lung tissues. Specific pore size ranges enhance scaffold functionality for different tissues: small pores (∼1-2 µm) aid epidermal cell attachment in skin regeneration, moderate pores (∼2-12 µm) support dermal migration, and larger pores (∼40-100 µm) facilitate vascular structures. For bone tissue engineering, multi-layered scaffolds with smaller pores (50-100 µm) foster cell attachment, while larger pores (200-400 µm) enhance nutrient diffusion and angiogenesis. Cardiovascular and lung tissues benefit from moderate pore sizes (∼25-60 µm) to balance cell integration and nutrient diffusion. By addressing critical design challenges and optimizing pore size distributions, this review provides insights into scaffold innovations, ultimately advancing tissue regeneration strategies.

Study on Optimization of the Structural Mechanical Properties of Personalized Porous Implant Prosthesis

Porous implant prostheses can effectively reduce the stress shielding effect. Still, the single elastic modulus prosthesis cannot adapt to the individual skeletal variability, so it is necessary to optimize the structural parameters of the prosthesis to overcome the individual variability. In this regard, this study analyzes the law of structural parameters and mechanical properties after selecting the type of porous structure (diamond structure). It proposes the optimization method of the structural parameters on this basis. First, the functional relationship equations between the unit mass of the porous implant prosthesis, the elastic modulus of the porous implant prosthesis, and the structural parameters were established respectively. Second, the support rod length and radius of the porous implant prosthesis are optimized by a genetic algorithm to form the optimization design method of the porous implant prosthesis. Finally, the feasibility and effectiveness of the optimized design of the porosity implanted prosthesis were verified by animal experiments, and the optimized implanted prosthesis with optimized structural parameters increased bone growth by 20-30% compared to the control group in the animal body. The proposed method provides a theoretical basis and technical support for the rehabilitation of patients and the production of prostheses by physicians.

3D-printed biomimetic scaffolds loaded with ADSCs and BMP-2 for enhanced rotator cuff repair

Rotator cuff tear repair poses significant challenges due to the complex gradient interface structure. In the face of disease-related disruptions in the tendon-bone interface (TBI), the strategy of constructing a biomimetic scaffold is a promising avenue. A novel 3D-printed rotator cuff scaffold loaded adipose stem cells (ADSCs), bone morphogenetic protein-2 (BMP-2), and collagen type I (COL I). The efficiency of the slow-release BMP-2 design depended on the dopamine-hyaluronic acid (HAD) and BMP-2 reaction. The cumulative release of BMP-2 was 44.97 ± 5.45% at 4 weeks. The 3D-printed bilayer scaffold, incorporating COL I and BMP-2, effectively promoted the differentiation of ADSCs into osteogenic, tenogenic, and chondrogenic lineages in vitro. The combination of 3D-printed bioactive scaffolds and ADSCs demonstrated a superior repair effect on rotator cuff injuries in vivo. Therefore, these findings indicates that the 3D-printed biomimetic scaffold loaded with ADSCs and BMP-2 holds potential as a promising graft for TBI healing.

Porous metal materials for applications in orthopedic field: A review on mechanisms in bone healing

Background

Porous metal materials have been widely studied for applications in orthopedic field, owing to their excellent features and properties in bone healing. Porous metal materials with different compositions, manufacturing methods, and porosities have been developed. Whereas, the systematic mechanisms on how porous metal materials promote bone healing still remain unclear.

Methods

This review is concerned on the porous metal materials from three aspects with accounts of specific mechanisms, inflammatory regulation, angiogenesis and osteogenesis. We place great emphasis on different cells regulated by porous metal materials, including mesenchymal stem cells (MSCs), macrophages, endothelial cells (ECs), etc.

Result

The design of porous metal materials is diversified, with its varying pore sizes, porosity material types, modification methods and coatings help researchers create the most experimentally suitable and clinically effective scaffolds. Related signal pathways presented from different functions showed that porous metal materials could change the behavior of cells and the amount of cytokines, achieving good influence on osteogenesis.

Conclusion

This article summarizes the current progress achieved in the mechanism of porous metal materials promoting bone healing. By modulating the cellular behavior and physiological status of a spectrum of cellular constituents, such as macrophages, osteoblasts, and osteoclasts, porous metal materials are capable of activating different pathways and releasing regulatory factors, thus exerting pivotal influence on improving the bone healing effect.

The translational potential of this article

Porous metal materials play a vital role in the treatment of bone defects. Unfortunately, although an increasing number of studies have been concentrated on the effect of porous metal materials on osteogenesis-related cells, the comprehensive regulation of porous metal materials on the host cell functions during bone regeneration and the related intrinsic mechanisms remain unclear. This review summarizes different design methods for porous metal materials to fabricate the most suitable scaffolds for bone remodeling, and systematically reviews the corresponding mechanisms on inflammation, angiogenesis and osteogenesis of porous metal materials. This review can provide more theoretical framework and innovative optimization for the application of porous metal materials in orthopedics, dentistry, and other areas, thereby advancing their clinical utility and efficacy.

3D-printing hydrogel programmed released exosomes to restore aortic medial degeneration through inhibiting VSMC ferroptosis in aortic dissection

Aortic dissection (AD) is a devastating disease with a high mortality rate. Exosomes derived from mesenchymal stem cells (exo-MSCs) offer a promising strategy to restore aortic medial degeneration and combat ferroptosis in AD. However, their rapid degradation in the circulatory system and low treatment efficiency limit their clinical application. Methylacrylated gelatin (Gelma) was reported as a matrix material to achieve controlled release of exosomes. Herein, exo-MSCs-embedded in Gelma hydrogels (Gelma-exos) using ultraviolet light and three-dimensional (3D) printing technology. These Gelma-exos provide a sustained release of exo-MSCs as Gelma gradually degrades, helping to restore aortic medial degeneration and prevent ferroptosis. The sustained release of exosomes can inhibit the phenotypic switch of vascular smooth muscle cells (VSMCs) to a proliferative state, and curb their proliferation and migration. Additionally, the 3D-printed Gelma-exos demonstrated the ability to inhibit ferroptosis in vitro, in vivo and ex vivo experiments. In conclusion, our Gelma-exos, combined with 3D-printed technology, offer an alternative treatment approach for repairing aortic medial degeneration and ferroptosis in AD, potentially reducing the incidence of aortic dissection rupture.

Extracellular Matrix-Surrogate Advanced Functional Composite Biomaterials for Tissue Repair and Regeneration

Native tissues, comprising multiple cell types and extracellular matrix components, are inherently composites. Mimicking the intricate structure, functionality, and dynamic properties of native composite tissues represents a significant frontier in biomaterials science and tissue engineering research. Biomimetic composite biomaterials combine the benefits of different components, such as polymers, ceramics, metals, and biomolecules, to create tissue-template materials that closely simulate the structure and functionality of native tissues. While the design of composite biomaterials and their in vitro testing are frequently reviewed, there is a considerable gap in whole animal studies that provides insight into the progress toward clinical translation. Herein, we provide an insightful critical review of advanced composite biomaterials applicable in several tissues. The incorporation of bioactive cues and signaling molecules into composite biomaterials to mimic the native microenvironment is discussed. Strategies for the spatiotemporal release of growth factors, cytokines, and extracellular matrix proteins are elucidated, highlighting their role in guiding cellular behavior, promoting tissue regeneration, and modulating immune responses. Advanced composite biomaterials design challenges, such as achieving optimal mechanical properties, improving long-term stability, and integrating multifunctionality into composite biomaterials and future directions, are discussed. We believe that this manuscript provides the reader with a timely perspective on composite biomaterials.

In Vivo Assessment of a Triple Periodic Minimal Surface Based Biomimmetic Gyroid as an Implant Material in a Rabbit Tibia Model

Biomimetic approaches to implant construction are a rising frontier in implantology. Triple Periodic Minimal Surface (TPMS)-based additively manufactured gyroid structures offer a mean curvature of zero, rendering this structure an ideal porous architecture. Previous studies have demonstrated the ability of these structures to effectively mimic the mechanical cues required for optimal implant construction. The porous nature of gyroid materials enhances bone ingrowth, thereby improving implant stability within the body. This enhancement is attributed to the increased surface area of the gyroid structure, which is approximately 185% higher than that of a dense material of the same form factor. This larger surface area allows for enhanced cellular attachment and nutrient circulation facilitated by the porous channels. This study aims to evaluate the biological performance of a gyroid-based Ti6Al-4V implant material compared to a dense alloy counterpart. Cellular viability was assessed using the lactate dehydrogenase (LDH) assay, which demonstrated that the gyroid surface allowed marginally higher viability than dense material. The in vivo integration was studied over 6 weeks using a rabbit tibia model and characterized using X-ray, micro-CT, and histopathological examination. With a metal volume of 8.1%, the gyroid exhibited a bone volume/total volume (BV/TV) ratio of 9.6%, which is 11-fold higher than that of dense metal (0.8%). Histological assessments revealed neovascularization, in-bone growth, and the presence of a Haversian system in the gyroid structure, hinting at superior osteointegration.

Electrophoretic Deposition of Chitosan Coatings on the Porous Titanium Substrate

Medicine is looking for solutions to help implant patients recover more smoothly. The porous implants promote osteointegration, thereby providing better stabilization. Introducing porosity into metallic implants enhances their biocompatibility and facilitates osteointegration. The introduction of porosity is also associated with a reduction in Young's modulus, which reduces the risk of tissue outgrowth around the implant. However, the risk of chronic inflammation remains a concern, necessitating the development of coatings to mitigate adverse reactions. An interesting biomaterial for such modifications is chitosan, which has antimicrobial, antifungal, and osteointegration properties. In the present work, a porous titanium biomaterial was obtained by powder metallurgy, and electrophoretic deposition of chitosan coatings was used to modify its surface. This study investigated the influence of ethanol content in the deposition solution on the quality of chitosan coatings. The EPD process facilitates the control of coating thickness and morphology, with higher voltages resulting in thicker coatings and increased pore formation. Ethanol concentration in the solution affects coating quality, with higher concentrations leading to cracking and peeling. Optimal coating conditions (30 min/10 V) yield high-quality coatings, demonstrating excellent cell viability and negligible cytotoxicity. The GIXD and ATR-FTIR analysis confirmed the presence of deposited chitosan coatings on Ti substrates. The microstructure of the chitosan coatings was examined by scanning electron microscopy. Biological tests showed no cytotoxicity of the obtained materials, which allows for further research and the possibility of their use in medicine. In conclusion, EPD offers a viable method for producing chitosan-based coatings with controlled properties for biomedical applications, ensuring enhanced patient outcomes and implant performance.

Platelet-rich fibrin (PRF) modified nano-hydroxyapatite/chitosan/gelatin/alginate scaffolds increase adhesion and viability of human dental pulp stem cells (DPSC) and osteoblasts derived from DPSC

Bone tissue regeneration strategies have incorporated the use of natural polymers, such as hydroxyapatite (nHA), chitosan (CH), gelatin (GEL), or alginate (ALG). Additionally, platelet concentrates, such as platelet-rich fibrin (PRF) have been suggested to improve scaffold biocompatibility. This study aimed to develop scaffolds composed of nHA, GEL, and CH, with or without ALG and lyophilized PRF, to evaluate the scaffold's properties, growth factor release, and dental pulp stem cells (DPSC), and osteoblast (OB) derived from DPSC viability. Four scaffold variations were synthesized and lyophilized. Then, degradation, swelling profiles, and morphological analysis were performed. Furthermore, PDGF-BB and FGF-B growth factors release were quantified by ELISA, and cytotoxicity and cell viability were evaluated. The swelling and degradation profiles were similar in all scaffolds, with pore sizes ranging between 100 and 250 μm. FGF-B and PDGF-BB release was evidenced after 24 h of scaffold immersion in cell culture medium. DPSC and OB-DPSC viability was notably increased in PRF-supplemented scaffolds. The nHA-CH-GEL-PRF scaffold demonstrated optimal physical-biological characteristics for stimulating DPSC and OB-DPSC cell viability. These results suggest lyophilized PRF improves scaffold biocompatibility for bone tissue regeneration purposes.

Complete Removal of Residual Particles and Realization of Mechanical Properties to Improve Osseointegration in Additively Manufactured Ti6Al4 V Scaffolds through Flowing Acid Etching

Massive unmelted Ti6Al4 V (Ti64) particles presented across all surfaces of additively manufactured Ti64 scaffolds significantly impacted the designed surface topography, mechanical properties, and permeability, reducing the osseointegration of the scaffolds. In this study, the proposed flowing acid etching (FAE) method presented high efficiency in eliminating Ti64 particles and enhancing the surface modification capacity across all surfaces of Ti64 scaffolds. The Ti64 particles across all surfaces of the scaffolds were completely removed effectively and evenly. The surface topography of the scaffolds closely resembled the design after the 75 s FAE treatment. The actual elastic modulus of the treated scaffolds (3.206 ± 0.040 GPa) was closer to the designed value (3.110 GPa), and a micrometer-scale structure was constructed on the inner and outer surfaces of the scaffolds after the 90 s FAE treatment. However, the yield strength of scaffolds was reduced to 89.743 ± 0.893 MPa from 118.251 ± 0.982 MPa after the 90 s FAE treatment. The FAE method also showed higher efficiency in decreasing the roughness and enhancing the hydrophilicity and surface energy of all of the surfaces. The FAE treatment improved the permeability of scaffolds efficiently, and the permeability of scaffolds increased to 11.93 ± 0.21 × 10-10 mm2 from 8.57 ± 0.021 × 10-10 mm2 after the 90 s FAE treatment. The treated Ti64 scaffolds after the 90 s FAE treatment exhibited optimized osseointegration effects in vitro and in vivo. In conclusion, the FAE method was an efficient way to eliminate unmelted Ti64 particles and obtain ideal surface topography, mechanical properties, and permeability to promote osseointegration in additively manufactured Ti64 scaffolds.

Debulking of the Femoral Stem in a Primary Total Hip Joint Replacement: A Novel Method to Reduce Stress Shielding

In current-generation designs of total primary hip joint replacement, the prostheses are fabricated from alloys. The modulus of elasticity of the alloy is substantially higher than that of the surrounding bone. This discrepancy plays a role in a phenomenon known as stress shielding, in which the bone bears a reduced proportion of the applied load. Stress shielding has been implicated in aseptic loosening of the implant which, in turn, results in reduction in the in vivo life of the implant. Rigid implants shield surrounding bone from mechanical loading, and the reduction in skeletal stress necessary to maintain bone mass and density results in accelerated bone loss, the forerunner to implant loosening. Femoral stems of various geometries and surface modifications, materials and material distributions, and porous structures have been investigated to achieve mechanical properties of stems closer to those of bone to mitigate stress shielding. For improved load transfer from implant to femur, the proposed study investigated a strategic debulking effort to impart controlled flexibility while retaining sufficient strength and endurance properties. Using an iterative design process, debulked configurations based on an internal skeletal truss framework were evaluated using finite element analysis. The implant models analyzed were solid; hollow, with a proximal hollowed stem; FB-2A, with thin, curved trusses extending from the central spine; and FB-3B and FB-3C, with thick, flat trusses extending from the central spine in a balanced-truss and a hemi-truss configuration, respectively. As outlined in the International Organization for Standardization (ISO) 7206 standards, implants were offset in natural femur for evaluation of load distribution or potted in testing cylinders for fatigue testing. The commonality across all debulked designs was the minimization of proximal stress shielding compared to conventional solid implants. Stem topography can influence performance, and the truss implants with or without the calcar collar were evaluated. Load sharing was equally effective irrespective of the collar; however, the collar was critical to reducing the stresses in the implant. Whether bonded directly to bone or cemented in the femur, the truss stem was effective at limiting stress shielding. However, a localized increase in maximum principal stress at the proximal lateral junction could adversely affect cement integrity. The controlled accommodation of deformation of the implant wall contributes to the load sharing capability of the truss implant, and for a superior biomechanical performance, the collared stem should be implanted in interference fit. Considering the results of all implant designs, the truss implant model FB-3C was the best model.

Use of 3D-Printed Implants in Complex Foot and Ankle Reconstruction

SUMMARY

Treatment of traumatic critical-sized bone defects remains a challenge for orthopaedic surgeons. Autograft remains the gold standard to address bone loss, but for larger defects, different strategies must be used. The use of 3D-printed implants to address lower extremity trauma and bone loss is discussed with current techniques including bone transport, Masquelet, osteomyocutaneous flaps, and massive allografts. Considerations and future directions of implant design, augmentation, and optimization of the peri-implant environment to maximize patient outcome are reviewed.

Mechanical, bioactive, and long-lasting antibacterial properties of a Ti scaffold with gradient pores releasing iodine ions

The ideal bone implant would effectively prevent aseptic as well as septic loosening by minimizing stress shielding, maximizing bone ingrowth, and preventing implant-associated infections. Here, a novel gradient-pore-size titanium scaffold was designed and manufactured to address these requirements. The scaffold features a larger pore size (900 μm) on the top surface, gradually decreasing to small sizes (600 μm to 300 μm) towards the center, creating a gradient structure. To enhance its functionality, the additively manufactured scaffolds were biofunctionalized using simple chemical and heat treatments so as to incorporate calcium and iodine ions throughout the surface. This unique combination of varying pore sizes with a biofunctional surface provides highly desirable mechanical properties, bioactivity, and notably, long-lasting antibacterial activity. The target mechanical aspects, including low elastic modulus, high compression, compression-shear, and fatigue strength, were effectively achieved. Furthermore, the biofunctional surface exhibits remarkable in vitro bioactivity and potent antibacterial activity, even under conditions specifically altered to be favorable for bacterial growth. More importantly, the integration of small pores alongside larger ones ensures a sustained high release of iodine, resulting in antimicrobial activity that persisted for over three months, with full eradication of the bacteria. Taken together, this gradient structure exhibits obvious superiority in combining most of the desired properties, making it an ideal candidate for orthopedic and dental implant applications.

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

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

Surface Functionalization of Titanium-Based Implants with a Nanohydroxyapatite Layer and Its Impact on Osteoblasts: A Systematic Review

This study aims to evaluate the influence of a nanohydroxyapatite layer applied to the surface of titanium or titanium alloy implants on the intricate process of osseointegration and its effect on osteoblast cell lines, compared to uncoated implants. Additionally, the investigation scrutinizes various modifications of the coating and their consequential effects on bone and cell line biocompatibility. On the specific date of November 2023, an exhaustive electronic search was conducted in esteemed databases such as PubMed, Web of Science, and Scopus, utilizing the meticulously chosen keywords ((titanium) AND ((osteoblasts) and hydroxyapatite)). Methodologically, the systematic review meticulously adhered to the PRISMA protocol. Initially, a total of 1739 studies underwent scrutiny, with the elimination of 741 duplicate records. A further 972 articles were excluded on account of their incongruence with the predefined subjects. The ultimate compilation embraced 26 studies, with a predominant focus on the effects of nanohydroxyapatite coating in isolation. However, a subset of nine papers delved into the nuanced realm of its modifiers, encompassing materials such as chitosan, collagen, silver particles, or gelatine. Across many of the selected studies, the application of nanohydroxyapatite coating exhibited a proclivity to enhance the osseointegration process. The modifications thereof showcased a positive influence on cell lines, manifesting in increased cellular spread or the attenuation of bacterial activity. In clinical applications, this augmentation potentially translates into heightened implant stability, thereby amplifying the overall procedural success rate. This, in turn, renders nanohydroxyapatite-coated implants a viable and potentially advantageous option in clinical scenarios where non-modified implants may not suffice.

High temperature oxidation treated 3D printed anatomical WE43 alloy scaffolds for repairing periarticular bone defects: In vitro and in vivo studies

Reconstruction of subarticular bone defects is an intractable challenge in orthopedics. The simultaneous repair of cancellous defects, fractures, and cartilage damage is an ideal surgical outcome. 3D printed porous anatomical WE43 (magnesium with 4 wt% yttrium and 3 wt% rare earths) scaffolds have many advantages for repairing such bone defects, including good biocompatibility, appropriate mechanical strength, customizable shape and structure, and biodegradability. In a previous investigation, we successfully enhanced the corrosion resistance of WE43 samples via high temperature oxidation (HTO). In the present study, we explored the feasibility and effectiveness of HTO-treated 3D printed porous anatomical WE43 scaffolds for repairing the cancellous bone defects accompanied by split fractures via in vitro and in vivo experiments. After HTO treatment, a dense oxidation layer mainly composed of Y2O3 and Nd2O3 formed on the surface of scaffolds. In addition, the majority of the grains were equiaxed, with an average grain size of 7.4 μm. Cell and rabbit experiments confirmed the non-cytotoxicity and biocompatibility of the HTO-treated WE43 scaffolds. After the implantation of scaffolds inside bone defects, their porous structures could be maintained for more than 12 weeks without penetration and for more than 6 weeks with penetration. During the postoperative follow-up period for up to 48 weeks, radiographic examinations and histological analysis revealed that abundant bone gradually regenerated along with scaffold degradation, and stable osseointegration formed between new bone and scaffold residues. MRI images further demonstrated no evidence of any obvious damage to the cartilage, ligaments, or menisci, confirming the absence of traumatic osteoarthritis. Moreover, finite element analysis and biomechanical tests further verified that the scaffolds was conducive to a uniform mechanical distribution. In conclusion, applying the HTO-treated 3D printed porous anatomical WE43 scaffolds exhibited favorable repairing effects for subarticular cancellous bone defects, possessing great potential for clinical application.

Additively Manufactured Zn-2Mg Alloy Porous Scaffolds with Customizable Biodegradable Performance and Enhanced Osteogenic Ability

The combination of bioactive Zn-2Mg alloy and additively manufactured porous scaffold is expected to achieve customizable biodegradable performance and enhanced bone regeneration. Herein, Zn-2Mg alloy scaffolds with different porosities, including 40% (G-40-2), 60% (G-60-2), and 80% (G-80-2), and different unit sizes, including 1.5 mm (G-60-1.5), 2 mm (G-60-2), and 2.5 mm (G-60-2.5), are manufactured by a triply periodic minimal surface design and a reliable laser powder bed fusion process. With the same unit size, compressive strength (CS) and elastic modulus (EM) of scaffolds substantially decrease with increasing porosities. With the same porosity, CS and EM just slightly decrease with increasing unit sizes. The weight loss after degradation increases with increasing porosities and decreasing unit sizes. In vivo tests indicate that Zn-2Mg alloy scaffolds exhibit satisfactory biocompatibility and osteogenic ability. The osteogenic ability of scaffolds is mainly determined by their physical and chemical characteristics. Scaffolds with lower porosities and smaller unit sizes show better osteogenesis due to their suitable pore size and larger surface area. The results indicate that the biodegradable performance of scaffolds can be accurately regulated on a large scale by structure design and the additively manufactured Zn-2Mg alloy scaffolds have improved osteogenic ability for treating bone defects.

Synergistic Amelioration of Osseointegration and Osteoimmunomodulation with a Microarc Oxidation-Treated Three-Dimensionally Printed Ti-24Nb-4Zr-8Sn Scaffold via Surface Activity and Low Elastic Modulus

Biomaterial scaffolds, including bone substitutes, have evolved from being primarily a biologically passive structural element to one in which material properties such as surface topography and chemistry actively direct bone regeneration by influencing stem cells and the immune microenvironment. Ti-6Al-4V(Ti6Al4V) implants, with a significantly higher elastic modulus than human bone, may lead to stress shielding, necessitating improved stability at the bone-titanium alloy implant interface. Ti-24Nb-4Zr-8Sn (Ti2448), a low elastic modulus β-type titanium alloy devoid of potentially toxic elements, was utilized in this study. We employed 3D printing technology to fabricate a porous scaffold structure to further decrease the structural stiffness of the implant to approximate that of cancellous bone. Microarc oxidation (MAO) surface modification technology is then employed to create a microporous structure and a hydrophilic oxide ceramic layer on the surface and interior of the scaffold. In vitro studies demonstrated that MAO treatment enhances the proliferation, adhesion, and osteogenesis capabilities on the scaffold surface. The chemical composition of the MAO-Ti2448 oxide layer is found to enhance the transcription and expression of osteogenic genes in bone mesenchymal stem cells (BMSCs), potentially related to the enrichment of Nb2O5 and SnO2 in the oxide layer. The MAO-Ti2448 scaffold, with its synergistic surface activity and low stiffness, significantly activates the anti-inflammatory macrophage phenotype, creating an immune microenvironment that promotes the osteogenic differentiation of BMSCs. In vivo experiments in a rabbit model demonstrated a significant improvement in the quantity and quality of the newly formed bone trabeculae within the scaffold under the contact osteogenesis pattern with a matched elastic modulus. These trabeculae exhibit robust connections to the external structure of the scaffold, accelerating the formation of an interlocking structure between the bone and implant and providing higher implantation stability. These findings suggest that the MAO-Ti2448 scaffold has significant potential as a bone defect repair material by regulating osteoimmunomodulation and osteogenesis to enhance osseointegration. This study demonstrates an optional strategy that combines the mechanism of reducing the elastic modulus with surface modification treatment, thereby extending the application scope of β-type titanium alloy.

"Metal-bone" scaffold for accelerated peri-implant endosseous healing

Restoring bone defects caused by conditions such as tumors, trauma, or inflammation is a significant clinical challenge. Currently, there is a need for the development of bone tissue engineering scaffolds that meet clinical standards to promote bone regeneration in these defects. In this study, we combined the porous Ti6Al4V scaffold in bone tissue engineering with advanced bone grafting techniques to create a novel "metal-bone" scaffold for enhanced bone regeneration. Utilizing 3D printing technology, we fabricated a porous Ti6Al4V scaffold with an average pore size of 789 ± 22.69 μm. The characterization and biocompatibility of the scaffold were validated through in vitro experiments. Subsequently, the scaffold was implanted into the distal femurs of experimental animals, removed after 3 months, and transformed into a "metal-bone" scaffold. When this "metal-bone" scaffold was re-implanted into bone defects in the animals, the results demonstrated that, in comparison to a plain porous Ti6Al4V scaffold, the scaffold containing bone tissue achieved accelerated early-stage bone regeneration. The experimental group exhibited more bone tissue generation in the early stages at the defect site, resulting in superior bone integration. In conclusion, the "metal-bone" scaffold, containing bone tissue, proves to be an effective bone-promoting scaffold with promising clinical applications.

Novel 3D printed TPMS scaffolds: microstructure, characteristics and applications in bone regeneration

Bone defect disease seriously endangers human health and affects beauty and function. In the past five years, the three dimension (3D) printed radially graded triply periodic minimal surface (TPMS) porous scaffold has become a new solution for repairing bone defects. This review discusses 3D printing technologies and applications for TPMS scaffolds. To this end, the microstructural effects of 3D printed TPMS scaffolds on bone regeneration were reviewed and the structural characteristics of TPMS, which can promote bone regeneration, were introduced. Finally, the challenges and prospects of using TPMS scaffolds to treat bone defects were presented. This review is expected to stimulate the interest of bone tissue engineers in radially graded TPMS scaffolds and provide a reliable solution for the clinical treatment of personalised bone defects.

Titanium Alloy Implants with Lattice Structures for Mandibular Reconstruction

In recent years, the field of mandibular reconstruction has made great strides in terms of hardware innovations and their clinical applications. There has been considerable interest in using computer-aided design, finite element modelling, and additive manufacturing techniques to build patient-specific surgical implants. Moreover, lattice implants can mimic mandibular bone's mechanical and structural properties. This article reviews current approaches for mandibular reconstruction, their applications, and their drawbacks. Then, we discuss the potential of mandibular devices with lattice structures, their development and applications, and the challenges for their use in clinical settings.

Novel 3D-printing bilayer GelMA-based hydrogel containing BP,β-TCP and exosomes for cartilage-bone integrated repair

The integrated repair of cartilage and bone involves the migration and differentiation of cells, which has always been a difficult problem to be solved. We utilize the natural biomaterial gelatin to construct gelatin methacryloyl (GelMA), a hydrogel scaffold with high cell affinity. GelMA is mixed with different components to print a bi-layer porous hydrogel scaffold with different modulus and composition in upper and lower layers through three-dimensional (3D) printing technology. The upper scaffold adds black phosphorus (BP) and human umbilical cord mesenchymal stem cells (hUMSCs) exosomes (exos) in GelMA, which has a relatively lower elastic modulus and is conducive to the differentiation of BMSCs into cartilage. In the lower scaffold, in addition to BP and hUMSCs exos,β-tricalcium phosphate (β-TCP), which has osteoconductive and osteoinductive effects, is added to GelMA. The addition ofβ-TCP significantly enhances the elastic modulus of the hydrogel scaffold, which is conducive to the osteogenic differentiation of bone marrow mesenchymal stem cells(BMSCs).In vitroexperiments have confirmed that the bi-layer scaffolds can promote osteogenesis and chondrogenic differentiation respectively. And in the rabbit cartilage-bone injury model, MRI and micro-CT results show that the 3D printed bi-layer GelMA composite scaffold has a repair effect close to normal tissue.

Design and fabrication of biomimicking radially graded scaffolds via digital light processing 3D printing for bone regeneration

Scaffolds are an essential component in bone tissue engineering (BTE). However, most of the current BTE scaffolds are homogeneous structures and do not resemble the graded architectures of native bone. In the current study, four types of biomimicking scaffold designs based on gyroid (G) and primitive (P) units with radially graded pore sizes were devised, and scaffolds of these designs with two porosity groups (65 vol% and 75 vol%) were fabricated via digital light processing (DLP) 3D printing using biphasic calcium phosphate (BCP). Scaffolds of the gyroid-gyroid (G-G) design displayed better dimensional accuracy, compressive property, and cell proliferation rate than gyroid-primitive (G-P), primitive-gyroid (P-G), and primitive-primitive (P-P) scaffolds. Subsequently, graded G-G scaffolds with different porosities were fabricated and the relationship between compressive strength and porosity was determined. Furthermore, the sintered BCP bioceramics fabricated via current manufacturing process exhibited excellent biocompatibility and bioactivity, indicating their high potential for BTE.

In vitro fatigue behavior and in vivo osseointegration of the auxetic porous bone screw

The incidence of screw loosening, migration, and pullout caused by the insufficient screw-bone fixation stability is relatively high in clinical practice. To solve this issue, the auxetic unit-based porous bone screw (AS) has been put forward in our previous work. Its favorable auxetic effect can improve the primary screw-bone fixation stability after implantation. However, porous structure affected the fatigue behavior and in vivo longevity of bone screw. In this study, in vitro fatigue behaviors and in vivo osseointegration performance of the re-entrant unit-based titanium auxetic bone screw were studied. The tensile-tensile fatigue behaviors of AS and nonauxetic bone screw (NS) with the same porosity (51%) were compared via fatigue experiments, fracture analysis, and numerical simulation. The in vivo osseointegration of AS and NS were compared via animal experiment and biomechanical analysis. Additionally, the effects of in vivo dynamic tensile loading on the osseointegration of AS and NS were investigated and analyzed. The fatigue strength of AS was approximately 43% lower while its osseointegration performance was better than NS. Under in vivo dynamic tensile loading, the osseointegration of AS and NS both improved significantly, with the maximum increase of approximately 15%. Preferrable osseointegration of AS might compensate for the shortage of fatigue resistance, ensuring its long-term stability in vivo. Adequate auxetic effect and long-term stability of the AS was supposed to provide enough screw-bone fixation stability to overcome the shortages of the solid bone screw, developing the success of surgery and showing significant clinical application prospects in orthopedic surgery. STATEMENT OF SIGNIFICANCE: This research investigated the high-cycle fatigue behavior of re-entrant unit-based auxetic bone screw under tensile-tensile cyclic loading and its osseointegration performance, which has not been focused on in existing studies. The fatigue strength of auxetic bone screw was lower while the osseointegration was better than non-auxetic bone screw, especially under in vivo tensile loading. Favorable osseointegration of auxetic bone screw might compensate for the shortage of fatigue resistance, ensuring its long-term stability and longevity in vivo. This suggested that with adequate auxetic effect and long-term stability, the auxetic bone screw had significant application prospects in orthopedic surgery. Findings of this study will provide a theoretical guidance for design optimization and clinical application of the auxetic bone screw.

Progress in microsphere-based scaffolds in bone/cartilage tissue engineering

Bone/cartilage repair and regeneration have been popular and difficult issues in medical research. Tissue engineering is rapidly evolving to provide new solutions to this problem, and the key point is to design the appropriate scaffold biomaterial. In recent years, microsphere-based scaffolds have been considered suitable scaffold materials for bone/cartilage injury repair because microporous structures can form more internal space for better cell proliferation and other cellular activities, and these composite scaffolds can provide physical/chemical signals for neotissue formation with higher efficiency. This paper reviews the research progress of microsphere-based scaffolds in bone/chondral tissue engineering, briefly introduces types of microspheres made from polymer, inorganic and composite materials, discusses the preparation methods of microspheres and the exploration of suitable microsphere pore size in bone and cartilage tissue engineering, and finally details the application of microsphere-based scaffolds in biomimetic scaffolds, cell proliferation and drug delivery systems.

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

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

Comparison of osteogenic capability of 3D-printed bioceramic scaffolds and granules with different porosities for clinical translation

Pore parameters, structural stability, and filler morphology of artificial implants are key factors influencing the process of bone tissue repair. However, the extent to which each of these factors contributes to bone formation in the preparation of porous bioceramics is currently unclear, with the two often being coupled. Herein, we prepared magnesium-doped wollastonite (Mg-CSi) scaffolds with 57% and 70% porosity (57-S and 70-S) via a 3D printing technique. Meanwhile, the bioceramic granules (57-G and 70-G) with curved pore topography (IWP) were prepared by physically disrupting the 57-S and 70-S scaffolds, respectively, and compared for in vivo osteogenesis at 4, 10, and 16 weeks. The pore parameters and the mechanical and biodegradable properties of different porous bioceramics were characterized systematically. The four groups of porous scaffolds and granules were then implanted into a rabbit femoral defect model to evaluate the osteogenic behavior in vivo. 2D/3D reconstruction and histological analysis showed that significant bone tissue production was visible in the central zone of porous granule groups at the early stage but bone tissue ingrowth was slower in the porous scaffold groups. The bone tissue regeneration and reconstruction capacity were stronger after 10 weeks, and the porous architecture of the 57-S scaffold was maintained stably at 16 weeks. These experimental results demonstrated that the structure-collapsed porous bioceramic is favorable for early-stage osteoconduction and that the 3D topological scaffolds may provide more structural stability for bone tissue growth for a long-term stage. These findings provide new ideas for the selection of different types of porous bioceramics for clinical bone repair.

Architecture-Engineered Electrospinning Cascade Regulates Spinal Microenvironment to Promote Nerve Regeneration

The inflammatory cascade after spinal cord injury (SCI) causes necrotizing apoptosis of local stem cells, which limits nerve regeneration. Therefore, coordinating the inflammatory immune response and neural stem cell (NSC) functions is key to promoting the recovery of central nervous system function. In this study, a hydrogel "perfusion" system and electrospinning technology are integrated, and a "concrete" composite support for the repair of nerve injuries is built. The hydrogel's hydrophilic properties activate macrophage integrin receptors to mediate polarization into anti-inflammatory subtypes and cause a 10% increase in polarized M2 macrophages, thus reprogramming the SCI immune microenvironment. Programmed stromal cell-derived factor-1α and brain-derived neurotrophic factor released from the composite increase recruitment and neuronal differentiation of NSCs by approximately four- and twofold, respectively. The fiber system regulates the SCI immune inflammatory microenvironment, recruits endogenous NSCs, promotes local blood vessel germination and maturation, and improves nerve function recovery in a rat SCI model. In conclusion, the engineering fiber composite improves the local inflammatory response. It promotes nerve regeneration through a hydrophilic programmed cytokine-delivery system, which further improves and supplements the immune response mechanism regulated by the inherent properties of the biomaterial. The new fiber composite may serve as a new treatment approach for SCI.

3D-Printed GelMA/PEGDA/F127DA Scaffolds for Bone Regeneration

Tissue-engineered scaffolds are an effective method for the treatment of bone defects, and their structure and function are essential for bone regeneration. Digital light processing (DLP) printing technology has been widely used in bone tissue engineering (BTE) due to its high printing resolution and gentle printing process. As commonly used bioinks, synthetic polymers such as polyethylene glycol diacrylate (PEGDA) and Pluronic F127 diacrylate (F127DA) have satisfactory printability and mechanical properties but usually lack sufficient adhesion to cells and tissues. Here, a compound BTE scaffold based on PEGDA, F127DA, and gelatin methacrylate (GelMA) was successfully prepared using DLP printing technology. The scaffold not only facilitated the adhesion and proliferation of cells, but also effectively promoted the osteogenic differentiation of mesenchymal stem cells in an osteoinductive environment. Moreover, the bone tissue volume/total tissue volume (BV/TV) of the GelMA/PEGDA/F127DA (GPF) scaffold in vivo was 49.75 ± 8.50%, higher than the value of 37.10 ± 7.27% for the PEGDA/F127DA (PF) scaffold and 20.43 ± 2.08% for the blank group. Therefore, the GPF scaffold prepared using DLP printing technology provides a new approach to the treatment of bone defects.

High porosity 3D printed titanium mesh allows better bone regeneration

BACKGROUND

Most patients with insufficient bone mass suffer from severe horizontal or vertical bone defects in oral implant surgery. The purpose of this study was to compare the bone regeneration effects of titanium meshes with different porosity in the treatment of bone defects.

METHODS

Nine beagle dogs were equally divided into three groups based on execution time. Three months after the extraction of the first to fourth premolars of the mandible, three bone defects were randomly made in the mandible. Bone particles and three kinds of three-dimensional (3D) printed titanium nets with different porosities (low porosity group (LP), 55%; medium porosity group (MP), 62%; and high porosity group (HP), 68%) were replanted in situ. The beagles were killed 4, 8, and 12 weeks after surgery. Formalin-fixed specimens were embedded in acrylic resin. The specimens were stained with micro-CT, basic fuchsin staining, and toluidine blue staining.

RESULTS

Micro-CT analysis showed that the trabecular thickness, trabecular number, and bone volume fraction of the HP group were higher than those of the other two groups. Moreover, the trabecular separation of the HP group decreased slightly and was lower than that of the MP and LP groups. Histological staining analysis showed that the trabecular number in the HP group was higher than in the other two groups at 8 and 12 weeks, and the bone volume fraction of the HP was higher than that in the other two groups at 12 weeks. Moreover, the trabecular thickness of the MP was higher than that of the LP group at 12 weeks and the trabecular separation was lower in the HP group at 4 and 8 weeks. The differences were statistically significant (p < 0.05).

CONCLUSION

A 3D printed titanium mesh with HP in a certain range may have more advantages than a titanium mesh with LP in repairing large bone defects.

The combination of a 3D-Printed porous Ti-6Al-4V alloy scaffold and stem cell sheet technology for the construction of biomimetic engineered bone at an ectopic site

Cell sheet technology has been widely used in bone tissue engineering and regenerative medicine. However, controlling the shape and volume of large pieces of engineered bone tissue remains impossible without additional suitable scaffolds. Three-dimensional (3D) printed titanium (Ti) alloy scaffolds are mostly used as implant materials for repairing bone defects, but the unsatisfactory bioactivities of traditional Ti-based scaffolds severely limit their clinical applications. Herein, we hypothesize that the combination of bone marrow mesenchymal stem cell (BMSC) sheet technology and 3D porous Ti–6Al–4V (PT) alloy scaffolds could be used to fabricate biomimetic engineered bone. First, various concentrations of BMSCs were directly cocultured with PT scaffolds to obtain complexes of osteoblastic cell sheets and scaffolds. Then, as an experimental control, an osteoblastic BMSC sheet was prepared by continuous culturing under osteogenic conditions for 2 weeks without passaging and used to wrap the scaffolds. The BMSC sheet was composed of several layers of extracellular matrix (ECM) and a mass of BMSCs. The BMSCs exhibited excellent adherent, proliferative and osteogenic potential when cocultured with PT scaffolds, which may be attributed to the ability of the 3D microstructure of scaffolds to facilitate the biological behaviors of cells, as confirmed by the in vitro results. Moreover, the presence of BMSCs and ECM increased the angiogenic potential of PT scaffolds by the secretion of VEGF. Micro-CT and histological analysis confirmed the in vivo formation of biomimetic engineered bone when the complex of cocultured BMSCs and PT scaffolds and the scaffolds wrapped by prepared BMSC sheets were implanted subcutaneously into nude mice. Therefore, the combination of BMSC sheet technology and 3D-printed PT scaffolds could be used to construct customized biomimetic engineered bone, offering a novel and promising strategy for the precise repair of bone defects.