Role of interconnections in porous bioceramics on bone recolonization in vitro and in vivo

3D Poly (L-lactic acid) fibrous sponge with interconnected porous structure for bone tissue scaffold

Large bone defects, often resulting from trauma and disease, present significant clinical challenges. Electrospun fibrous scaffolds closely resembling the morphology and structure of natural ECM are highly interested in bone tissue engineering. However, the traditional electrospun fibrous scaffold has some limitations, including lacking interconnected macropores and behaving as a 2D scaffold. To address these challenges, a sponge-like electrospun poly(L-lactic acid) (PLLA)/polycaprolactone (PCL) fibrous scaffold has been developed by an innovative and convenient method (i.e., electrospinning, homogenization, progen leaching and shaping). The resulting scaffold exhibited a highly porous structure (overall porosity = 85.9 %) with interconnected, regular macropores, mimicking the natural extracellular matrix. Moreover, the incorporation of bioactive glass (BG) particles improved the hydrophilicity (water contact angle = 79.7°) and biocompatibility and promoted osteoblast cell growth. In-vitro 10-day experiment revealed that the scaffolds led to high cell viability. The increment of the proliferation rates was 195.4 % at day 7 and 281.6 % at day 10. More importantly, Saos-2 cells could grow, proliferate, and infiltrate into the scaffold. Therefore, this 3D PLLA/PCL with BG sponge holds great promise for bone defect repair in tissue engineering applications.

Additive Manufacturing of Iron Carbide Incorporated Bioactive Glass Scaffolds for Bone Tissue Engineering and Drug Delivery Applications

In this study, we have synthesized a bioactive glass with composition 45SiO2-20Na2O-23CaO-6P2O5-2.5B2O3-1ZnO-2MgO-0.5CaF2 (wt %). Further, it has been incorporated with 0.4 wt % iron carbide nanoparticles to prepare magnetic bioactive glass (MBG) with good heat generation capability for potential applications in magnetic field-assisted hyperthermia. The MBG scaffolds have been fabricated using extrusion-based additive manufacturing by mixing MBG powder with 25% Pluronic F-127 solution as the binder. The saturation magnetization of iron carbide nanoparticles in the bioactive glass matrix has been found to be 80 emu/g. The morphological analysis (pore size distribution, porosity, open pore network modeling, tortuosity, and pore interconnectivity) was done using an in-house developed methodology that revealed the suitability of the scaffolds for bone tissue engineering. The compressive strength (14.3 ± 1.6 MPa) of the MBG scaffold was within the range of trabecular bone. The in vitro test using simulated body fluid (SBF) showed the formation of apatite indicating the bioactive nature of scaffolds. Further, the drug delivery behaviors of uncoated and polycaprolactone (PCL) coated MBG scaffolds have been evaluated by loading an anticancer drug (Mitomycin C) onto the scaffolds. While the uncoated scaffold demonstrated the drug's burst release for the initial 80 h, the PCL-coated scaffold showed the gradual release of the drug. These results demonstrate the potential of the proposed MBG for bone tissue engineering and drug delivery applications.

The development of non-resorbable bone allografts: Biological background and clinical perspectives

Bone grafts are typically categorized into four categories: autografts, allografts, xenografts, and synthetic alloplasts. While it was originally thought that all bone grafts should be slowly resorbed and replaced with native bone over time, accumulating evidence has in fact suggested that the use of nonresorbable xenografts is favored for certain clinical indications. Thus, many clinicians take advantage of the nonresorbable properties/features of xenografts for various clinical indications, such as contour augmentation, sinus grafting, and guided bone regeneration, which are often combined with allografts (e.g., human freeze-dried bone allografts [FDBAs] and human demineralized freeze-dried bone allografts [DFDBAs]). Thus, many clinicians have advocated different 50/50 or 70/30 ratios of allograft/xenograft combination approaches for various grafting procedures. Interestingly, many clinicians believe that one of the main reasons for the nonresorbability or low substitution rates of xenografts has to do with their foreign animal origin. Recent research has indicated that the sintering technique and heating conducted during their processing changes the dissolution rate of hydroxyapatite, leading to a state in which osteoclasts are no longer able to resorb (dissolve) the sintered bone. While many clinicians often combine nonresorbable xenografts with the bone-inducing properties of allografts for a variety of bone augmentation procedures, clinicians are forced to use two separate products owing to their origins (the FDA/CE does not allow the mixture of allografts with xenografts within the same dish/bottle). This has led to significant progress in understanding the dissolution rates of xenografts at various sintering temperature changes, which has since led to the breakthrough development of nonresorbable bone allografts sintered at similar temperatures to nonresorbable xenografts. The advantage of the nonresorbable bone allograft is that they can now be combined with standard allografts to create a single mixture combining the advantages of both allografts and xenografts while allowing the purchase and use of a single product. This review article presents the concept with evidence derived from a 52-week monkey study that demonstrated little to no resorption along with in vitro data supporting this novel technology as a "next-generation" biomaterial with optimized bone grafting material properties.

Octacalcium phosphate phase forming cements as an injectable bone substitute materials: Preparation and in vitro structural study

In the realm of regenerating damaged or degenerated bones through minimally invasive techniques, injectable materials have emerged as exceptionally promising. Among these, calcium phosphate bone cements (CPCs) have garnered significant interest due to their remarkable bioactivity, setting it apart from non-degradable alternatives such as polymethyl methacrylate cements. α-Tricalcium phosphate (α-TCP) is a widely used solid phase component in CPCs. It can transform into calcium-deficient hydroxyapatite (CDHAp) when it comes in contact with water. In this study, we aimed to create an injectable, self-setting bone cement using low-temperature synthesized α-TCP powder as a single precursor of the powder phase. We found that changes in the pH of the liquid phase (pH 6.0, pH 6.2, pH 7.0 and pH 7.4) significantly altered the cement's setting, handling, and mechanical properties. The formation of the octacalcium phosphate (OCP) phase was identified in our study, which positively affects the osteoblastic cell response. Hardened OCP-forming bone cements prepared using a liquid phase with pH 7.0 and 7.4 showed better osteogenic cell attachment and proliferation than those prepared with pH 6.0 and 6.2. Our study suggests that changes in the pH of the liquid phase can significantly affect the properties of α-TCP-based bone cement, and the presence of the OCP phase is crucial for optimal cement performance.

Biomineralized fluorocanasite-reinforced biocomposite scaffolds demonstrate expedited osteointegration of critical-sized bone defects

The development of patient-specific bone scaffolds that can expedite bone regeneration has been gaining increased attention, especially for critical-sized bone defects or fractures. Precise adaptation of the scaffold to the region of implantation and reduced surgery times are also crucial at clinical scales. To this end, bioactive fluorcanasite glass-ceramic microparticulates were incorporated within a biocompatible photocurable resin matrix following which the biocomposite resin precursor was 3D-printed with digital light processing method to develop the bone scaffold. The printing parameters were optimized based on spot curing investigation, particle size data, and UV-visible spectrophotometry. In vitro cell culture with MG-63 osteosarcoma cell lines and pH study within simulated body fluid demonstrated a noncytotoxic response of the scaffold samples. Further, the in vivo bone regeneration ability of the 3D-printed biocomposite bone scaffolds was investigated by implantation of the scaffold samples in the rabbit femur bone defect model. Enhanced angiogenesis, osteoblastic, and osteoclastic activities were observed at the bone-scaffold interface, while examining through fluorochrome labelling, histology, radiography, field emission scanning electron microscopy, and x-ray microcomputed tomography. Overall, the results demonstrated that the 3D-printed biocomposite bone scaffolds have promising potential for bone loss rehabilitation.

TCP Doped with Metal Ions Reinforced with Tetragonal and Cubic Zirconia

Ceramic biocomposites based on bioactive tricalcium phosphate doped with metal ions are a strategy for obtaining good biomimetics for human bone composition. Manufacturing with PMMA porogen also induces bone-like porosity morphology. The poor strength of tricalcium phosphate can be overcomed by designing ceramic composites reinforced with tetragonal and cubic zirconia. In this work, five different bioceramic composites were manufactured without and with induced porosity and their physical, mechanical, microstructural, and biological properties were studied. With the addition of tetragonal and cubic zirconia, an improvement in strength of 22% and 55%, respectively, was obtained, corresponding to up to 20.7 MPa. PMMA was suitable for adding porosity, up to 30%, with interconnectivity while an excellent hOB cellular viability was achieved for all biocomposites.

A review on design of scaffold for osteoinduction: Toward the unification of independent design variables

Biophysical stimulus quantifies the osteoinductivity of the scaffold concerning the mechanoregulatory mathematical models of scaffold-assisted cellular differentiation. Consider a set of independent structural variables ($) that comprises bulk porosity levels ([Formula: see text]) and a set of morphological features of the micro-structure ([Formula: see text]) associated with scaffolds, i.e., [Formula: see text]. The literature suggests that biophysical stimulus ([Formula: see text]) is a function of independent structural variables ($). Limited understanding of the functional correlation between biophysical stimulus and structural features results in the lack of the desired osteoinductivity in a scaffold. Consequently, it limits their broad applicability to assist bone tissue regeneration for treating critical-sized bone fractures. The literature indicates the existence of multi-dimensional independent design variable space as a probable reason for the general lack of osteoinductivity in scaffolds. For instance, known morphological features are the size, shape, orientation, continuity, and connectivity of the porous regions in the scaffold. It implies that the number of independent variables ([Formula: see text]) is more than two, i.e., [Formula: see text], which interact and influence the magnitude of [Formula: see text] in a unified manner. The efficiency of standard engineering design procedures to analyze the correlation between dependent variable ([Formula: see text]) and independent variables ($) in 3D mutually orthogonal Cartesian coordinate system diminishes proportionally with the increase in the number of independent variables ([Formula: see text]) (Deb in Optimization for engineering design-algorithms and examples, PHI Learning Private Limited, New Delhi, 2012). Therefore, there is an immediate need to devise a framework that has the potential to quantify the micro-structural's morphological features in a unified manner to increase the prospects of scaffold-assisted bone tissue regeneration.

[Synthetic bone replacement substances]

Bone substitute materials have been successfully used for bone defects in orthopedics and trauma surgery for a long time; however, there are cases, especially in bone defects with a critical size, in which the treatment is complicated. Nowadays, multiple bone substitute materials are available. Autologous cancellous bone grafts remain the gold standard among the bone replacement materials; however, donor site morbidity and the limited availability of autologous cancellous bone represent restrictions for autologous bone grafting. Allogeneic cancellous bone grafts have also been successfully for years in the treatment of bone defects; however, infection rates of more than 10% have been described for the use of allogeneic cancellous bone. By introducing synthetic bone substitutes further alternatives are currently available to the user for the individual treatment of bone defects. The aim of this study is to demonstrate the advantages and disadvantages of various synthetic bone substitute materials.

Synthesis and characterization of a calcium phosphate bone cement with quercetin-containing PEEK/PLGA microparticles

This study aimed to describe the synthesis and characterization of a calcium phosphate cement (CPC) with polyetheretherketone/poly (lactic-co-glycolic) acid (PEEK/PLGA) micro-particles containing quercetin. CPC powder was synthesized by mixing dicalcium phosphate anhydrate and tetracalcium phosphate. To synthesize PEEK/PLGA microparticles, PLGA85:15 was mixed with 90 wt% PEEK. The weight ratio of quercetin/PLGA/PEEK was 1:9:90 wt%. PEEK/PLGA/quercetin microparticles with 3, 5, and 6 wt% was added to CPC. The setting time, compressive strength, drug release profile, solubility, pH, and porosity of synthesized cement were evaluated. The morphology and physicochemical properties of particles was analyzed by scanning electron microscopy, Fourier-transform infrared spectroscopy (FTIR), x-ray diffraction (XRD), and inductively coupled plasma. Cytotoxicity was assessed by the methyl thiazolyl tetrazolium assay using dental pulp stem cells. Expression of osteoblastic differentiation genes was evaluated by real-time polymerase chain reaction. Data were analyzed by one-way ANOVA and Tukey's test (alpha = 0.05). The setting time of 3 wt% CPC was significantly longer than 5 and 6 wt% CPC (P< 0.001). The 6 wt% CPC had significantly higher compressive strength than other groups (P= 0.001). The release of quercetin from CPCs increased for 5 d, and then reached a plateau. XRD and FTIR confirmed the presence of hydroxyapatite in cement composition. Significantly higher expression of osteocalcin (OCN) and osteopontin (OPN) was noted in 3 wt% and 6 wt% CPCs. Addition of quercetin-containing PEEK/PLGA microparticles to CPC enhanced its compressive strength, decreased its setting time, enabled controlled drug release, and up-regulated OPN and OCN.

Preparation and characterization of two novel osteoinductive fishbone-derived biphasic calcium phosphate bone graft substitutes

Many studies have reported on the conversion of natural resources into xenografts with hydroxyapatite (HA) as major component, but the extraction of biphasic calcium phosphate (HA/β-TCP) from animal bones and transformation into bone graft substitutes are rarely reported. In this research, two kinds of fish bones were made into granular porous biphasic calcium phosphate bone graft substitutes with particle sizes between 500 to 1000 μm through a series of preparation procedures (Salmo salar calcined at 900°C named Sa900 and Anoplopoma fimbria calcined at 800°C named An800). The chemical composition was characterized by X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR). The morphology and porous structure of the scaffolds were comparatively analyzed by scanning electron microscopy (SEM) and mercury porosimeter. The specific surface area of materials was measured by the nitrogen adsorption technique based on BET theory. Cytotoxicity and ectopic osteogenesis were also carried out to investigate the biocompatibility and osteoinductive potential of these materials. The results showed that both fishbone-derived scaffolds were composed of HA and β-TCP with different proportions, and numerous interconnected pores with different sizes were observed at the surface of materials. An800 had higher total porosity reaching 74.8% with higher interconnectivity and micropores mostly distributed at 0.27 μm and 0.12 μm, while Sa900 had a higher specific surface area and higher intraparticle porosity with nanopores mostly distributed at 0.07 μm. CCK-8 assays and Live/dead staining demonstrated excellent biocompatibility. Material-induced osteoid formation were observed on the interface of both internal pores and periphery of materials after implantation in muscle pouch of Wistar rats for 8 weeks which indicated some extent of osteoinductive potential of materials. The possible mechanism of material-induced osteogenesis and the effects of chemical composition, surface topography, and spatial structure on osteogenesis were also discussed in this paper.

On-Growth and In-Growth Osseointegration Enhancement in PM Porous Ti-Scaffolds by Two Different Bioactivation Strategies: Alkali Thermochemical Treatment and RGD Peptide Coating

A lack of primary stability and osteointegration in metallic implants may result in implant loosening and failure. Adding porosity to metallic implants reduces the stress shielding effect and improves implant performance, allowing the surrounding bone tissue to grow into the scaffold. However, a bioactive surface is needed to stimulate implant osteointegration and improve mechanical stability. In this study, porous titanium implants were produced via powder sintering to create different porous diameters and open interconnectivity. Two strategies were used to generate a bioactive surface on the metallic foams: (1) an inorganic alkali thermochemical treatment, (2) grafting a cell adhesive tripeptide (RGD). RGD peptides exhibit an affinity for integrins expressed by osteoblasts, and have been reported to improve osteoblast adhesion, whereas the thermochemical treatment is known to improve titanium implant osseointegration upon implantation. Bioactivated scaffolds and control samples were implanted into the tibiae of rabbits to analyze the effect of these two strategies in vivo regarding bone tissue regeneration through interconnected porosity. Histomorphometric evaluation was performed at 4 and 12 weeks after implantation. Bone-to-implant contact (BIC) and bone in-growth and on-growth were evaluated in different regions of interest (ROIs) inside and outside the implant. The results of this study show that after a long-term postoperative period, the RGD-coated samples presented higher quantification values of quantified newly formed bone tissue in the implant's outer area. However, the total analyzed bone in-growth was observed to be slightly greater in the scaffolds treated with alkali thermochemical treatment. These results suggest that both strategies contribute to enhancing porous metallic implant stability and osteointegration, and a combination of both strategies might be worth pursuing.

3D models of dilated cardiomyopathy: Shaping the chemical, physical and topographical properties of biomaterials to mimic the cardiac extracellular matrix

The pathophysiology of dilated cardiomyopathy (DCM), one major cause of heart failure, is characterized by the dilation of the heart but remains poorly understood because of the lack of adequate in vitro models. Current 2D models do not allow for the 3D organotypic organization of cardiomyocytes and do not reproduce the ECM perturbations. In this review, the different strategies to mimic the chemical, physical and topographical properties of the cardiac tissue affected by DCM are presented. The advantages and drawbacks of techniques generating anisotropy required for the cardiomyocytes alignment are discussed. In addition, the different methods creating macroporosity and favoring organotypic organization are compared. Besides, the advances in the induced pluripotent stem cells technology to generate cardiac cells from healthy or DCM patients will be described. Thanks to the biomaterial design, some features of the DCM extracellular matrix such as stiffness, porosity, topography or chemical changes can impact the cardiomyocytes function in vitro and increase their maturation. By mimicking the affected heart, both at the cellular and at the tissue level, 3D models will enable a better understanding of the pathology and favor the discovery of novel therapies.

A review on bovine hydroxyapatite; extraction and characterization

High rate of bone grafting surgeries emphasizes the need for optimal bone substitutes. Biomaterials mimicking the interconnected porous structure of the original bone with osteoconductive and osteoinductive capabilities have long been considered. Hydroxyapatite (HA), as the main inorganic part of natural bone, has exhibited excellent regenerative properties in bone tissue engineering. This manuscript reviews the HA extraction methods from bovine bone, as one of the principal biosources. Essential points in the extraction process have also been highlighted. Characterization of the produced HA through gold standard methods such as XRD, FTIR, electron microscopies (SEM and TEM), mechanical/thermodynamic tests, and bioactivity analysis has been explained in detail. Finally, future perspectives for development of HA constructs are mentioned.

Influence of Culture Period on Osteoblast Differentiation of Tissue-Engineered Bone Constructed by Apatite-Fiber Scaffolds Using Radial-Flow Bioreactor

With the limitation of autografts, the development of alternative treatments for bone diseases to alleviate autograft-related complications is highly demanded. In this study, a tissue-engineered bone was formed by culturing rat bone marrow cells (RBMCs) onto porous apatite-fiber scaffolds (AFSs) with three-dimensional (3D) interconnected pores using a radial-flow bioreactor (RFB). Using the optimized flow rate, the effect of different culturing periods on the development of tissue-engineered bone was investigated. The 3D cell culture using RFB was performed for 0, 1 or 2 weeks in a standard medium followed by 0, 1 or 2 weeks in a differentiation medium. Osteoblast differentiation in the tissue-engineered bone was examined by alkaline phosphatase (ALP) and osteocalcin (OC) assays. Furthermore, the tissue-engineered bone was histologically examined by hematoxylin and eosin and alizarin red S stains. We found that the ALP activity and OC content of calcified cells tended to increase with the culture period, and the differentiation of tissue-engineered bone could be controlled by varying the culture period. In addition, the employment of RFB and AFSs provided a favorable 3D environment for cell growth and differentiation. Overall, these results provide valuable insights into the design of tissue-engineered bone for clinical applications.

Toward stronger robocast calcium phosphate scaffolds for bone tissue engineering: A mini-review and meta-analysis

Among different treatments of critical-sized bone defects, bone tissue engineering (BTE) is a fast-developing strategy centering around the fabrication of scaffolds that can stimulate tissue regeneration and provide mechanical support at the same time. This area has seen an extensive application of bioceramics, such as calcium phosphate, for their bioactivity and resemblance to the composition of natural bones. Moreover, recent advances in additive manufacturing (AM) have unleashed enormous potential in the fabrication of BTE scaffolds with tailored porous structures as well as desired biological and mechanical properties. Robocasting is an AM technique that has been widely applied to fabricate calcium phosphate scaffolds, but most of these scaffolds do not meet the mechanical requirements for load-bearing BTE scaffolds. In light of this challenge, various approaches have been utilized to mechanically strengthen the scaffolds. In this review, the current state of knowledge and existing research on robocasting of calcium phosphate scaffolds are presented. Applying the Gibson-Ashby model, this review provides a meta-analysis from the published literature of the compressive strength of robocast calcium phosphate scaffolds. Furthermore, this review evaluates different approaches to the mechanical strengthening of robocast calcium phosphate scaffolds. The aim of this review is to provide insightful data and analysis for future research on mechanical strengthening of robocast calcium phosphate scaffolds and ultimately for their clinical applications.

Fabrication and characterization of a bioactive polymethylmethacrylate-based porous cement loaded with strontium/calcium apatite nanoparticles

Polymethylmethacrylate (PMMA)-based cements are used for bone reparation due to their biocompatibility, suitable mechanical properties, and mouldability. However, these materials suffer from high exothermic polymerization and poor bioactivity, which can cause the formation of fibrous tissue around the implant and aseptic loosening. Herein, we tackled these problems by adding Sr²⁺ -substituted hydroxyapatite nanoparticles (NPs) and a porogenic compound to the formulations, thus creating a microenvironment suitable for the proliferation of osteoblasts. The NPs resembled the structure of the bone's apatite and enabled the controlled release of Sr²⁺ . Trends in the X-ray patterns and infrared spectra confirmed that Sr²⁺ replaced Ca²⁺ in the whole composition range of the NPs. The inclusion of an effervescent additive reduced the polymerization temperature and lead to the formation of highly porous cement exhibiting mechanical properties comparable to the trabecular bone. The formation of an opened and interconnected matrix allowed osteoblasts to penetrate the cement structure. Most importantly, the gas formation confined the NPs at the surface of the pores, guaranteeing the controlled delivery of Sr²⁺ within a concentration sufficient to maintain osteoblast viability. Additionally, the cement was able to form apatite when immersed into simulated body fluids, further increasing its bioactivity. Therefore, we offer a formulation of PMMA cement with improved in vitro performance supported by enhanced bioactivity, increased osteoblast viability and deposition of mineralized matrix assigned to the loading with Sr²⁺ -substituted hydroxyapatite NPs and the creation of an interconnected porous structure. Altogether, our results hold promise for enhanced bone reparation guided by PMMA cements.

The effect of pores and connections geometries on bone ingrowth into titanium scaffolds: an assessment based on 3D microCT images

In order to support bone tissue regeneration, porous biomaterial implants (scaffolds) must offer chemical and mechanical properties, besides favorable fluid transport. Titanium implants provide these requirements, and depending on their microstructural parameters, the osteointegration process can be stimulated. The pore structure of scaffolds plays an essential role in this process, guiding fluid transport for neo-bone regeneration. The objective of this work was to analyze geometric and morphologic parameters of the porous microstructure of implants and analyze their influences in the bone regeneration process, and then discuss which parameters are the most fundamental. Bone ingrowths into two different sorts of porous titanium implants were analyzed after 7, 14, 21, 28, and 35 incubation days in experimental animal models. Measurements were accomplished with x-ray microtomography image analysis from rabbit tibiae, applying a pore-network technique. Taking into account the most favorable pore sizes for neo-bone regeneration, a novel approach was employed to assess the influence of the pore structure on this process: the analyses were carried out considering minimum pore and connection sizes. With this technique, pores and connections were analyzed separately and the influence of connectivity was deeply evaluated. This investigation showed a considerable influence of the size of connections on the permeability parameter and consequently on the neo-bone regeneration. The results indicate that the processing of porous scaffolds must be focused on deliver pore connections that stimulate the transport of fluids throughout the implant to be applied as a bone replacer.

Microarchitecture of titanium cylinders obtained by additive manufacturing does not influence osseointegration in the sheep

Large bone defects are a challenge for orthopedic surgery. Natural (bone grafts) and synthetic biomaterials have been proposed but several problems arise such as biomechanical resistance or viral/bacterial safety. The use of metallic foams could be a solution to improve mechanical resistance and promote osseointegration of large porous metal devices. Titanium cylinders have been prepared by additive manufacturing (3D printing/rapid prototyping) with a geometric or trabecular microarchitecture. They were implanted in the femoral condyles of aged ewes; the animals were left in stabling for 90 and 270 days. A double calcein labeling was done before sacrifice; bones were analyzed by histomorphometry. Neither bone volume, bone/titanium interface nor mineralization rate were influenced by the cylinder's microarchitecture; the morphometric parameters did not significantly increase over time. Bone anchoring occurred on the margins of the cylinders and some trabeculae extended in the core of the cylinders but the amount of bone inside the cylinders remained low. The rigid titanium cylinders preserved bone cells from strains in the core of the cylinders. Additive manufacturing is an interesting tool to prepare 3D metallic scaffolds, but microarchitecture does not seem as crucial as expected and anchoring seems limited to the first millimeters of the graft.

Polymer Coated and Nanofiber Reinforced Functionally Graded Bioactive Glass Scaffolds Fabricated using Additive Manufacturing

In this study, carbon nanotube (CNT) reinforced functionally graded bioactive glass scaffolds have been fabricated using additive manufacturing technique. Sol-gel method was used for the synthesis of the bioactive glass. For ink preparation, Pluronic F-127 was used as an ink carrier. The CNT-reinforced scaffolds were coated with the polymer polycaprolactone (PCL) using dip-coating method to improve their properties further by sealing the micro cracks. The CNT-reinforcement and polymer coating resulted in an improvement in the compressive strength of the additively manufactured scaffolds by 98% in comparison to pure bioactive glass scaffolds. Further, the morphological analysis revealed interconnected pores and their size appropriate for osteogenesis and angiogenesis. Evaluation of the in vitro bioactivity of the scaffolds after immersion in simulated body fluid (SBF) confirmed the formation of hydroxyapatite (HA). Further, the cellular studies showed good cell viability and initiation of osteogensis. These results demonstrate the potential of these scaffolds for bone tissue engineering applications.

Construction of chitosan scaffolds with controllable microchannel for tissue engineering and regenerative medicine

Microchannels are effective means of enabling the functional performance of tissue engineering scaffolds. Chitosan, a partial deacetylation derivative of chitin, exhibiting excellent biocompatibility, has been widely used in clinical practice. However, development of chitosan scaffolds with controllable microchannels architecture remains an engineering challenge. Here, we generated chitosan scaffolds with adjustable microchannel by combining a 3D printing microfiber templates-leaching method and a freeze-drying method. We can precisely control the arrangement, diameter and density of microchannel within chitosan scaffolds. Moreover, the integrated bilayer scaffolds with the desired structural parameters in each layer were fabricated and exhibited no delamination. The flow rate and volume of the simulated fluid can be modulated by diverse channels architecture. Additionally, the microchannel structure promoted cell survival, proliferation and distribution in vitro, and improved cell and tissue ingrowth and vascular formation in vivo. This study opens a new road for constructing chitosan scaffolds, and can further extend their application scope across tissue engineering and regenerative medicine.

A novel hydroxyapatite fiber material for the regeneration of critical-sized rabbit calvaria defects

Hydroxyapatite (HA) [Ca₁₀ (PO₄)₆ (OH)₂] has a high degree of chemical similarity with the mineral composition of animal bone. Hydroxyapatite fiber scaffold (HAF) is a biological material with a highly interconnected porous structure. We aimed to study the physical and biological characteristics of HAF and compare the osteogenic effects of HAF, natural osteogenic materials (NOM), and carbonate apatite (CO₃Ap-DP) in the parietal defects of a rabbit's skull. X-ray analysis and histological assessment showed that HAF followed a trend of early initial osteogenesis and bone trabecular structure formation, especially at the cortical bone portion.Compared to the other two materials, HAF was more absorptive. Results indicated that HAF had the same osteoconductive and new bone formation properties as NOM and CO₃Ap-DP. These findings will provide options for future material development and novel protocols for use in surgeries, ultimately leading to better patient outcomes.

Precise Control of the Surface and Internal Morphologies of Porous Particles Prepared Using a Spontaneous Emulsification Method

Porous particles with controllable surface and internal morphologies were successfully prepared by a "one-step mechanical emulsification" technique via the control of spontaneous emulsification where self-emulsification is followed by mechanical emulsification. The morphological changes in the porous particles were determined not by the preparation conditions of the water-in-oil-in-water (w/o/w) emulsion but by the proportion of solvents that favors the stabilization of the spontaneously prepared water-in-oil (w/o) emulsion droplets acting as porogens. The proposed method for controlling the morphology of the porous particles could be applied to all particle-preparation systems based on emulsion-solvent evaporation using organic solvents. The methodology for the morphological control of porous particles independent of the concentration or composition of the polymer is considered valuable for future investigations into the aerodynamic performance and drug-release behavior of biomedical porous particles with complex shapes.

Micro-/Nano-Structured Ceramic Scaffolds That Mimic Natural Cancellous Bone

Micro-/nano-structured scaffolds with a weight composition of 46.6% α-tricalcium phosphate (α-TCP)-53.4% silicocarnotite (SC) were synthesized by the polymer replica method. The scanning electron microscopy (SEM) analysis of the scaffolds and natural cancellous bone was performed for comparison purposes. Scaffolds were obtained at three cooling rates via the eutectoid temperature (50 °C/h, 16.5 °C/h, 5.5 °C/h), which allowed the surface nanostructure and mechanical strength to be controlled. Surface nanostructures were characterized by transmission electron microscopy (TEM) and Raman analysis. Both phases α-TCP and SC present in the scaffolds were well-identified, looked compact and dense, and had neither porosities nor cracks. The non-cytotoxic effect was evaluated in vitro by the proliferation ability of adult human mesenchymal stem cells (ah-MSCs) seeded on scaffold surfaces. There was no evidence for cytotoxicity and the number of cells increased with culture time. A dense cell-hydroxyapatite layer formed until 28 days. The SEM analysis suggested cell-mediated extracellular matrix formation. Finally, scaffolds were functionalized with the alkaline phosphatase enzyme (ALP) to achieve biological functionalization. The ALP was successfully grafted onto scaffolds, whose enzymatic activity was maintained. Scaffolds mimicked the micro-/nano-structure and chemical composition of natural cancellous bone by considering cell biology and biomolecule functionalization.

How Surface Properties of Silica Nanoparticles Influence Structural, Microstructural and Biological Properties of Polymer Nanocomposites

The aim of this work was to study effect of the type of silica nanoparticles on the properties of nanocomposites for application in the guided bone regeneration (GBR). Two types of nanometric silica particles with different size, morphology and specific surface area (SSA) i.e., high specific surface silica (hss-SiO₂) and low specific surface silica (lss-SiO₂), were used as nano-fillers for a resorbable polymer matrix: poly(L-lactide-co-D,L-lactide), called PLDLA. It was shown that higher surface specific area and morphology (including pore size distribution) recorded for hss-SiO₂ influences chemical activity of the nanoparticle; in addition, hydroxyl groups appeared on the surface. The nanoparticle with 10 times lower specific surface area (lss-SiO₂) characterized lower chemical action. In addition, a lack of hydroxyl groups on the surface obstructed apatite nucleation (reduced zeta potential in comparison to hss-SiO₂), where an apatite layer appeared already after 48 h of incubation in the simulated body fluid (SBF), and no significant changes in crystallinity of PLDLA/lss-SiO₂ nanocomposite material in comparison to neat PLDLA foil were observed. The presence and type of inorganic particles in the PLDLA matrix influenced various physicochemical properties such as the wettability, and the roughness parameter note for PLDLA/lss-SiO₂ increased. The results of biological investigation show that the bioactive nanocomposites with hss-SiO₂ may stimulate osteoblast and fibroblast cells’proliferation and secretion of collagen type I. Additionally, both nanocomposites with the nanometric silica inducted differentiation of mesenchymal cells into osteoblasts at a proliferation stage in in vitro conditions. A higher concentration of alkaline phosphatase (ALP) was observed on the material modified with hss-SiO₂ silica.

Customized additive manufacturing of porous Ti6Al4V scaffold with micro-topological structures to regulate cell behavior in bone tissue engineering

Scaffold micro-topological structure plays an important role in the regulation of cell behavior in bone tissue engineering. This paper investigated the effect of 3D printing parameters on the scaffold micro-topological structure and its subsequent cell behaviors. By setting of different 3D printing parameters, i.e., the 3D printing laser power, the scanning interval and the thickness of sliced layers, the highest resolution up to 20 μm can be precisely fabricated. Scaffolds' characterization results indicated that the laser power affected the forming quality of melt tracks, the scanning interval distance determined the size of regularly arranged pores, and the thickness of sliced layers affected the morphological and structural characteristics. By regulating of these printing parameters, customized porous Ti6Al4V scaffold with varied hierarchical micro-topological structure can be obtained. In vitro cell culturing results showed that the regular porous micro-topological structure of scaffolds with the aperture close to cell size was more suitable for cell proliferation and adhesion. The overall distribution of cells on regular porous scaffolds was similar to the orderly arrangement of cultivated crops in the field. The findings suggested that customization of the scaffold provided an effective way to regulate cellular behavior and biological properties.

3D-printed porous tantalum: recent application in various drug delivery systems to repair hard tissue defects

INTRODUCTION

The treatment of hard tissue defects, especially those of bone and cartilage, induced by infections or tumors remains challenging. Traditional methods, including debridement with systematic chemotherapy, have shortcomings owing to their inability to eliminate infections and high systematic toxicity.

AREA COVERED

This review comprehensively summarizes and discusses the current applications of 3D-printed porous tantalum (3D-P-p-Ta), a novel drug delivery strategy, in drug delivery systems to repair hard tissue defects, as well as the limitations of existing data and potential future research directions.

EXPERT OPINION

Drug delivery systems have advanced medical treatments, with the advantages of high local drug concentration, long drug-release period, and minimal systematic toxicity. Due to its excellent biocompatibility, ideal mechanical property, and anti-corrosion ability, porous tantalum is one of the most preferable loading scaffolds. 3D printing allows for freedom of design and facilitates the production of regular porous implants with high repeatability. There are several reports on the application of 3D-P-p-Ta in drug delivery systems for the management of infection- or tumor-associated bone defects, yet, to the best of our knowledge, no reviews have summarized the current research progress.

Copper containing silicocarnotite bioceramic with improved mechanical strength and antibacterial activity

Copper is well known for its multifunctional biological effects including antibacterial and angiogenic activities, while silicon-containing bioceramic has proved to possess superior biological properties to hydroxyapatite (HA). In this work, CuO was introduced to silicocarnotite (Ca₅(PO₄)₂SiO₄, CPS) to simultaneously enhance its mechanical and antibacterial properties, and its cytocompatibility was also evaluated. Results showed that CuO could significantly facilitate the densification process of CPS bioceramic through liquid-phase sintering. The bending strength of CPS with the addition of 3.0 wt% CuO improved from 29.2 MPa to 63.4 MPa after sintered at 1200 °C. Moreover, Cu-CPS bioceramics demonstrated superior in vitro antibacterial property against both S. aureus and E. coli strains by destroying their membrane integrity, and the antibacterial activity augmented with CuO content. Meanwhile, the released Cu ions from Cu-CPS bioceramics could promote the proliferation of human umbilical vein endothelial cells (HUVECs), and the in vitro cytocompatibility exhibited concentration dependence on Cu ions. These suggest that Cu-CPS bioceramics might be promising candidates for bone tissue regeneration with an ability to prevent postoperative infections.

In vitro biological response of human osteoblasts in 3D chitosan sponges with controlled degree of deacetylation and molecular weight

We have studied the effect of chitosan sponges, produced from chitosan batches with distinct degree of deacetylation (DDA) and molecular weight (Mw), on the adhesion, growth and differentiation of primary human osteoblasts with an aim to offer a suitable tool for guided bone regeneration. All the chitosan sponges revealed similar microstructure, irrespective of the DDA (58, 73, 82, 88, and 91 %) and Mw (749, 547, 263, 215, and 170 kDa, respectively). Cell spreading was higher on sponges having a higher DDA. Higher DDA induced a more pronounced increase in alkaline phosphatase activity, osteopontin (OPN), vascular endothelial growth factor-A (VEGF), interleukin-6 (IL-6), and reduction in monocyte chemoattractant protein-1 (MCP-1), sclerostin (SOST) and dickkopf related protein-1 as compared to lower DDA. Lower DDA induced the increased secretion of osteoprotegerin and SOST as compared to higher DDA. The combination of higher DDA and Mw induced an increased secretion of VEGF and IL-6, however reduced the secretion of OPN as compared to chitosan with similar DDA but with lower Mw. In summary, the variations in cellular responses to the different chitosan sponges indicate a potential for individual tailoring of desired responses in guided bone regeneration.

Morphological and mechanical characterization of 3D printed PLA scaffolds with controlled porosity for trabecular bone tissue replacement

Bone transplant is still the gold standard approach when dealing with orthopedic trauma or disease. When this solution is not possible, scaffolding is a possibility provided by bone tissue engineering. To support the regeneration process, damaged bone tissue is removed and replaced by porous scaffold structures. In recent years, additive manufacturing has shown huge potential to produce scaffold structures with the required performance. In the current work, PLA scaffolds with different designs were 3D printed, using optimal manufacturing parameters. Scaffolds with three different porosity values were obtained by changing the filament offset from 571 to 1333 μm. A total of twelve designs were tested under monotonic and dynamic compression conditions. Numerical analysis showed good correlation with experimental results, allowing for a better assessment of scaffold mechanical behavior. Stress relaxation was measured on four different strain levels, assessing scaffold's behavior after implantation and consequent static response over time. Overall, orthogonal design provided better performance, due to improved material deposition. With lower porosity scaffolds equilibrium stress reached 24 MPa after 300 s relaxation time under 4% deformation, and the obtained equilibrium modulus was 428 MPa. Overall, attained results show that 3D printing with PLA can be applied in the manufacture of scaffolds for trabecular bone replacement.

Combined culture experiment of mouse bone marrow mesenchymal stem cells and bioceramic scaffolds

Articular cartilage injuries are common orthopedic conditions that severely affect the quality of life of patients. Tissue engineering can facilitate cartilage repair and the key points involve scaffolding and seed cell selection. Pre-experiments found a range of microstructures of bioceramic scaffolds suitable for chondrocyte adhesion and proliferation, and maintaining chondrocyte phenotype. Three-dimensional cultures of bone marrow mesenchymal stem cell (BMSC) scaffolds were implanted into mice. According to the shape of the bioceramic scaffolds and the implantation time in vivo, RNA sequencing was performed on the removed scaffolds to explore the molecular mechanism. The in vitro bone plate culture can induce differentiation of chondrocytes, making culture different to that produced in vitro. Implantation of scaffolds in vivo increases the expression of bone-related genes. The ceramic rod-like material was found to be superior to the disc shape, and the bone repair effect was more marked with longer implantation times. Gene Ontology analysis revealed that ‘cell chemotaxis’, ‘negative regulation of ossification’ and ‘bone development’ pathways were involved in recovery. It was further confirmed that BMSCs were suitable as seed cells for cartilage tissue engineering, and that the β-tricalcium phosphate scaffold maybe ideal as cartilage tissue engineering scaffold material. The present research provided new insights into the molecular mechanism of cartilage repair by BMSCs and bioceramic scaffolds. Bioinformatics analysis revealed that AMMECR1L-like protein, tumor necrosis factor-induced protein 2, inhibitor of nuclear factor-B kinase subunit and protein kinase C type and ‘negative regulation of ossification’ and ‘bone development’ pathways may be involved in osteoblast maturation and bone regeneration.

Bone Substitutes in Orthopaedic Surgery: Current Status and Future Perspectives

Bone replacement materials have been successfully supplied for a long time. But there are cases, especially in critical sized bone defects, in which the therapy is not sufficient. Nowadays, there are multiple bone substitutes available. Autologous bone grafts remain the "gold standard" in bone regeneration. Yet, donor-site morbidity and the available amount of sufficient material are limitations for autologous bone grafting. This study aimed to provide information about the current status in research regarding bone substitutes. We report on the advantages and drawbacks of several bone substitutes. At the end, we discuss the current developments of combining ceramic substitutes with osteoinductive substances.

Pre-screening the intrinsic angiogenic capacity of biomaterials in an optimised ex ovo chorioallantoic membrane model

Biomaterial development for clinical applications is currently on the rise. This necessitates adequate in vitro testing, where the structure and composition of biomaterials must be specifically tailored to withstand in situ repair and regeneration responses for a successful clinical outcome. The chorioallantoic membrane of chicken embryos has been previously used to study angiogenesis, a prerequisite for most tissue repair and regeneration. In this study, we report an optimised ex ovo method using a glass-cling film set-up that yields increased embryo survival rates and has an improved protocol for harvesting biomaterials. Furthermore, we used this method to examine the intrinsic angiogenic capacity of a variety of biomaterials categorised as natural, synthetic, natural/synthetic and natural/natural composites with varying porosities. We detected significant differences in biomaterials' angiogenesis with natural polymers and polymers with a high overall porosity showing a greater vascularisation compared to synthetic polymers. Therefore, our proposed ex ovo chorioallantoic membrane method can be effectively used to pre-screen biomaterials intended for clinical application.

Enhanced osteogenesis of honeycomb β-tricalcium phosphate scaffold by construction of interconnected pore structure: An in vivo study

Pore structure plays an important role in the in vivo osteogenesis for bone repair materials. In this study, honeycomb β-tricalcium phosphate (β-TCP) scaffolds were prepared by extrusion method, and gelatin microspheres were used as porogens to modify the pore structure of the scaffolds. The honeycomb β-TCP scaffolds were characterized by channel-like square macropores and unidirectional interconnection. To improve the pore interconnectivity of the scaffold, the spherical pores were formed in the channel walls by burning off the gelatin microspheres. Compared with unidirectional honeycomb β-TCP scaffold, the honeycomb β-TCP scaffold with interconnected pore structure had significantly higher porosity and faster degradation rate, at the expense of the mechanical strength. The in vivo assessment results demonstrated excellent osteogenesis of the honeycomb scaffolds. Moreover, the honeycomb β-TCP scaffold with interconnected pore structure markedly promoted new bone formation in comparison with the unidirectional honeycomb β-TCP scaffold. This work provides a new approach to prepare scaffolds with interconnected pore structure, and the honeycomb β-TCP scaffold with interconnected pore structure is expected to serve as an efficient bone repair material.

Immobilization of BMP-2-derived peptides on 3D-printed porous scaffolds for enhanced osteogenesis

Three-dimensional (3D) printing technologies open up new perspectives for customizing the external shape and internal architecture of bone scaffolds. In this study, an oligopeptide (SSVPT, Ser-Ser-Val-Pro-Thr) derived from bone morphogenetic protein 2 was conjugated with a dopamine coating on a 3D-printed poly(lactic acid) (PLA) scaffold to enhance osteogenesis. Cell experiments in vitro showed that the scaffold was highly osteoconductive to the adhesion and proliferation of rat marrow mesenchymal stem cells (MSCs). In addition, RT-PCR analysis showed that the scaffold was able to promote the expression of osteogenesis-related genes, such as alkaline phosphatase (ALP), runt-related transcription factor 2 (RUNX2), osteocalcin (OCN) and osteopontin (OPN). Images of the micro-CT 3D reconstruction from the rat cranial bone defect model showed that bone regeneration patterns occurred from one side edge towards the center of the area implanted with the prepared biomimetic peptide hydrogels, demonstrating significantly accelerated bone regeneration. This work will provide a basis to explore the application potential of bioactive scaffolds further.

Modification of Titanium Implant and Titanium Dioxide for Bone Tissue Engineering

Bone tissue engineering using titanium (Ti) implant and titanium dioxide (TiO₂) with their modification is gaining increasing attention. Ti has been adopted as an implant material in dental and orthopedic fields due to its superior properties. However, it still requires modification in order to achieve robust osteointegration between the Ti implant and surrounding bone. To modify the Ti implant, numerous methods have been introduced to fabricate porous implant surfaces with a variety of coating materials. Among these, plasma spraying of hydroxyapatite (HA) has been the most commonly used with commercial success. Meanwhile, TiO₂ nanotubes have been actively studied as the coating material for implants, and promising results have been reported about improving osteogenic activity around implants recently. Also porous three-dimensional constructs based on TiO₂ have been proposed as scaffolding material with high biocompatibility and osteoconductivity in large bone defects. However, the use of the TiO₂ scaffolds in load-bearing environment is somewhat limited. In order to optimize the TiO₂ scaffolds, studies have tried to combine various materials with TiO₂ scaffolds including drug, mesenchymal stem cells, Al₂O₃-SiO₂ solid and HA. This article will shortly introduce the properties of Ti and Ti-based implants with their modification, and review the progress of bone tissue engineering using the TiO₂ nanotubes and scaffolds.

[Application of bone-plastic materials for mastoidoplasty]

The aim of this study is comparative assessment of of different bone-plastic materials for mastoidoplasty. The study included 30 patients who underwent 'canal wall down' mastoid surgery with mastoidoplasty. The following criteria were used for comparing: 1) simplicity of modeling of the material 2) the wound healing process 3) osteointegration - the process of formation of 'new bone' tissue (CT of temporal bones 6 and 12 months after oreretion). It was confirmed that the main groups of bone-plastic material (bioglass, composite materials and β-tricalcium phosphate) is suitable for mastoidoplasty after 'canal wall down' mastoid surgery.

Biomimetic porous silk fibroin/biphasic calcium phosphate scaffold for bone tissue regeneration

The purpose of our study is to prepare a biomimetic porous silk fibroin (SF)/biphasic calcium phosphate (BCP) scaffold, and evaluate its performance in bone tissue regeneration. The differences in pore size, porosity, mechanical strength and biocompatibility of four different fibroin-containing scaffolds (0, 20, 40, and 60% SF) were studied in vitro. After inoculation with MC3T3-E1 cells, the ectopic bone formation ability of the SF/BCP bionic scaffold was evaluated in a rat model. The SEM and CT demonstrated that compared with pure BCP group (0% SF), the pore size and porosity of SF/BCP scaffolds were proportional to SF content, of which 40% of SF and 60% of SF groups were more suitable for cell growth. The compressive strength of SF/BCP scaffold was greater than that of the pure BCP scaffold, and showed a trend of first increasing and then decreasing with the increase of SF content, among which 40% of SF group had the maximum compressive strength (40.80 + 0.68) MPa. The SF/BCP scaffold had good biocompatibility, under the electron microscope, the cells can be smoothly attached to and propagated on the scaffold. After loading the osteoblasts, it showed excellent osteogenic capacity in the rat model. The SF/BCP scaffold can highly simulate the micro-environment of natural bone formation and can meet the requirements of tissue engineering. The SF/BCP biomimetic porous scaffold has excellent physical properties and biocompatibility. It can highly simulate the natural bone matrix composition and microenvironment, and can promote the adhesion and proliferation of osteoblasts. The SF/BCP scaffold has good ectopic osteogenesis after loading with osteoblasts, which can meet the requirements of scaffold materials in tissue engineering, and has broad application prospects in clinical application.

Pore size directs bone marrow stromal cell fate and tissue regeneration in nanofibrous macroporous scaffolds by mediating vascularization

In the U.S., 30% of adults suffer joint pain, most commonly in the knee, which severely limits mobility and is often attributed to injury of cartilage and underlying bone in the joint. Current treatment methods such as microfracture result in less resilient fibrocartilage with eventual failure; autografting can cause donor site morbidity and poor integration. To overcome drawbacks in treatment, tissue engineers can design cell-instructive biomimetic scaffolds using biocompatible materials as alternate therapies for osteochondral defects. Nanofibrous poly (l-lactic acid) (PLLA) scaffolds of uniform, spherical, interconnected and well-defined pore sizes that are fabricated using a thermally-induced phase separation and sugar porogen template method create an extracellular matrix-like environment which facilitates cell adhesion and proliferation. Herein we report that chondrogenesis and endochondral ossification of rabbit and human bone marrow stromal cells (BMSCs) can be controlled by scaffold pore architecture, particularly pore size. Small-pore scaffolds support enhanced chondrogenic differentiation in vitro and cartilage formation in vivo compared to large-pore scaffolds. Endochondral ossification is prevented in scaffolds with very small pore sizes; pore interconnectivity is critical to promote capillary ingrowth for mature bone formation. These results provide a novel strategy to control tissue regenerative processes by tunable architecture of macroporous nanofibrous scaffolds. STATEMENT OF SIGNIFICANCE: Progress in understanding the relationship between cell fate and architectural features of tissue engineering scaffolds is critical for engineering physiologically functional tissues. Sugar porogen template scaffolds have uniform, spherical, highly interconnected macropores. Tunable pore-size guides the fate of bone marrow stromal cells (BMSCs) towards chondrogenesis and endochondral ossification, and is a critical design parameter to mediate neotissue vascularization. Preventing vascularization favors a chondrogenic cell fate while allowing vascularization results in endochondral ossification and mineralized bone formation. These results provide a novel strategy to control tissue regenerative processes by tunable architecture of macroporous nanofibrous scaffolds.

Core-Shell Biphasic Microspheres with Tunable Density of Shell Micropores Providing Tailorable Bone Regeneration

IMPACT STATEMENT

We have developed the new core-shell bioceramic CSi-Sr4@CaP-px microspheres with tuning porous shell layer so that the biodegradation of both CSi-Sr4 core and CaP shell is readily adjusted synergistically. This is for the first time, to the best of our knowledge, that the bioceramic scaffolds concerning gradient distribution and microstructure-tailoring design is available for tailoring biodegradation and ion release (bioactivity) to optimizing osteogenesis. Furthermore, it is possibly helpful to develop new bioactive scaffold system for time-dependent tailoring bioactivity and microporous structure to significantly enhance bone regeneration and repair applications, especially in some non-load-bearing arbitrary 3D anatomical bone and teeth defects.

Current state of fabrication technologies and materials for bone tissue engineering

A range of traditional and free-form fabrication technologies have been investigated and, in numerous occasions, commercialized for use in the field of regenerative tissue engineering (TE). The demand for technologies capable of treating bone defects inherently difficult to repair has been on the rise. This quest, accompanied by the advent of functionally tailored, biocompatible, and biodegradable materials, has garnered an enormous research interest in bone TE. As a result, different materials and fabrication methods have been investigated towards this end, leading to a deeper understanding of the geometrical, mechanical and biological requirements associated with bone scaffolds. As our understanding of the scaffold requirements expands, so do the capability requirements of the fabrication processes. The goal of this review is to provide a broad examination of existing scaffold fabrication processes and highlight future trends in their development. To appreciate the clinical requirements of bone scaffolds, a brief review of the biological process by which bone regenerates itself is presented first. This is followed by a summary and comparisons of commonly used implant techniques to highlight the advantages of TE-based approaches over traditional grafting methods. A detailed discussion on the clinical and mechanical requirements of bone scaffolds then follows. The remainder of the manuscript is dedicated to current scaffold fabrication methods, their unique capabilities and perceived shortcomings. The range of biomaterials employed in each fabrication method is summarized. Selected traditional and non-traditional fabrication methods are discussed with a highlight on their future potential from the authors' perspective. This study is motivated by the rapidly growing demand for effective scaffold fabrication processes capable of economically producing constructs with intricate and precisely controlled internal and external architectures. STATEMENT OF SIGNIFICANCE: The manuscript summarizes the current state of fabrication technologies and materials used for creating scaffolds in bone tissue engineering applications. A comprehensive analysis of different fabrication methods (traditional and free-form) were summarized in this review paper, with emphasis on recent developments in the field. The fabrication techniques suitable for creating scaffolds for tissue engineering was particularly targeted and their use in bone tissue engineering were articulated. Along with the fabrication techniques, we emphasized the choice of materials in these processes. Considering the limitations of each process, we highlighted the materials and the material properties critical in that particular process and provided a brief rational for the choice of the materials. The functional performance for bone tissue engineering are summarized for different fabrication processes and the choice of biomaterials. Finally, we provide a perspective on the future of the field, highlighting the knowledge gaps and promising avenues in pursuit of effective scaffolds for bone tissue engineering. This extensive review of the field will provide research community with a reference source for current approaches to scaffold preparation. We hope to encourage the researchers to generate next generation biomaterials to be used in these fabrication processes. By providing both advantages and disadvantage of each fabrication method in detail, new fabrication techniques might be devised that will overcome the limitations of the current approaches. These studies should facilitate the efforts of researchers interested in generating ideal scaffolds, and should have applications beyond the repair of bone tissue.

3D-Plotted Beta-Tricalcium Phosphate Scaffolds with Smaller Pore Sizes Improve In Vivo Bone Regeneration and Biomechanical Properties in a Critical-Sized Calvarial Defect Rat Model

Due to the difficulty in fabricating bioceramic scaffolds with smaller pore sizes by the current 3D printing technique, the effect of smaller pore sizes (below 400 µm) of 3D printed bioceramic scaffolds on the bone regeneration and biomechanical behavior is never studied. Herein beta-tricalcium phosphate (β-TCP) scaffolds with interconnected smaller pores of three different sizes (100, 250, and 400 µm) are fabricated by 3D plotting. The resultant scaffolds are then implanted into rat critical-sized calvarial defects without any seeded cells. A custom-designed device is developed to investigate the biomechanical properties of the scaffolds after surgical implantation for 4, 8, and 12 weeks. The scaffolds with the 100 µm pore size are found to present the highest maximum load and stiffness, comparable to those of the autogenous bone, after being implanted for 12 weeks. Micro-computed tomography (micro-CT) and histological analysis further indicate that the scaffolds with the 100 µm pore size achieve the highest percentage of new bone ingrowth, which correlates to their best in vivo biomechanical properties. This study demonstrates that tailoring the pore size of β-TCP scaffolds to a smaller range by 3D-plotting can be a facile and efficient approach to enhanced bone regeneration and biomechanical behaviors in bone repair.