Porosity effect of 3D-printed polycaprolactone membranes on calvarial defect model for guided bone regeneration

3D-Printed Multifunctional Ag/CeO2/ZnO Reinforced Hydroxyapatite-Based Scaffolds with Effective Antibacterial and Mechanical Properties

Conventional three-dimensional (3D)-printed hydroxyapatite (HA)-based constructs have limited utility in bone tissue engineering due to their poor mechanical properties, elevated risk of microbial infection, and limited pore interconnectivity. 3D printing of complex multiple components to fabricate fully interconnected scaffolds is a challenging task; here, in this work, we have developed a procedure for fabrication of printable ink for complex systems containing multinanomaterials, i.e., HAACZ (containing 1 wt % Ag, 4 wt % CeO2, and 6 wt % ZnO) with better shear thinning and shape retention properties. Moreover, 3D-printed HAACZ scaffolds showed a modulus of 143.8 GPa, a hardness of 10.8 GPa, a porosity of 59.6%, effective antibacterial properties, and a fully interconnected pore network to be an ideal construct for bone healing. Macropores with an average size of ∼469 and ∼433 μm within the scaffolds of HA and HAACZ and micropores with an average size of ∼0.6 and ∼0.5 μm within the strut of HA and HAACZ were developed. The distribution of fully interconnected micropores was confirmed using computerized tomography, whereas the distribution of micropores within the strut was visualized using Voronoi tessellation. The water contact angle studies revealed the most suitable hydrophilic range of water contact angles of ∼71.7 and ∼76.6° for HA and HAACZ, respectively. HAACZ scaffolds showed comparable apatite formation and cytocompatibility as that of HA. Antibacterial studies revealed effective antibacterial properties for the HAACZ scaffold as compared to HA. There was a decrease in bacterial cell density for HAACZ from 1 × 105 to 1.2 × 103 cells/mm2 against Gram-negative (Escherichia coli) and from 1.9 × 105 to 5.6 × 103 bacterial cells/mm2 against Gram-positive (Staphylococcus aureus). Overall, the 3D-printed HAACZ scaffold resulted in mechanical properties, comparable to those of the cancellous bone, interconnected macro- and microporosities, and excellent antibacterial properties, which could be utilized for bone healing.

Durable and recyclable MOF@polycaprolactone mixed-matrix membranes with hierarchical porosity for wastewater treatment

With the fast-growing global water crisis, the development of novel technologies for water remediation and reuse is crucial. Industrial wastewater especially contains various toxic pollutants that pose an additional threat to the environment; thus, efficient removal of such contaminants can ensure safe reprocessing of industrial wastewater, thereby alleviating the demand for fresh water. Herein, we describe a novel and efficient approach for preparing porous polycaprolactone (PCL) membranes with a hierarchical architecture via a simple solvent/non-solvent methodology. A mixed-matrix membrane (MMM) was further constructed utilizing an amine-functionalized metal-organic framework as the sorbent filler nanoparticles and PCL as the polymer support matrix (MOF@PCL) for wastewater treatment applications. The MOF@PCL MMM demonstrated homogeneous morphology as well as exceptional performance towards the removal of both cationic (methylene blue, MB) and anionic (methyl orange, MO) organic dyes, where the maximum adsorption capacities reached 309 mg g-1 and 208 mg g-1, respectively. Kinetic and thermodynamic investigations revealed that the adsorption process was endothermic with a fast intraparticle diffusion rate constant. The MOF@PCL MMM also displayed excellent mechanical stability and recyclability, where the removal efficiency was maintained after 10 cycles.

Bone regeneration in implant dentistry: Which are the factors affecting the clinical outcome?

The key factors that are needed for bone regeneration to take place include cells (osteoprogenitor and immune-inflammatory cells), a scaffold (blood clot) that facilitates the deposition of the bone matrix, signaling molecules, blood supply, and mechanical stability. However, even when these principles are met, the overall amount of regenerated bone, its stability over time and the incidence of complications may significantly vary. This manuscript provides a critical review on the main local and systemic factors that may have an impact on bone regeneration, trying to focus, whenever possible, on bone regeneration simultaneous to implant placement to treat bone dehiscence/fenestration defects or for bone contouring. In the future, it is likely that bone tissue engineering will change our approach to bone regeneration in implant dentistry by replacing the current biomaterials with osteoinductive scaffolds combined with cells and mechanical/soluble factors and by employing immunomodulatory materials that can both modulate the immune response and control other bone regeneration processes such as osteogenesis, osteoclastogenesis, or inflammation. However, there are currently important knowledge gaps on the biology of osseous formation and on the factors that can influence it that require further investigation. It is recommended that future studies should combine traditional clinical and radiographic assessments with non-invasive imaging and with patient-reported outcome measures. We also envisage that the integration of multi-omics approaches will help uncover the mechanisms responsible for the variability in regenerative outcomes observed in clinical practice.

Dental Materials Applied to 3D and 4D Printing Technologies: A Review

As computer-aided design and computer-aided manufacturing (CAD/CAM) technologies have matured, three-dimensional (3D) printing materials suitable for dentistry have attracted considerable research interest, owing to their high efficiency and low cost for clinical treatment. Three-dimensional printing technology, also known as additive manufacturing, has developed rapidly over the last forty years, with gradual application in various fields from industry to dental sciences. Four-dimensional (4D) printing, defined as the fabrication of complex spontaneous structures that change over time in response to external stimuli in expected ways, includes the increasingly popular bioprinting. Existing 3D printing materials have varied characteristics and scopes of application; therefore, categorization is required. This review aims to classify, summarize, and discuss dental materials for 3D printing and 4D printing from a clinical perspective. Based on these, this review describes four major materials, i.e., polymers, metals, ceramics, and biomaterials. The manufacturing process of 3D printing and 4D printing materials, their characteristics, applicable printing technologies, and clinical application scope are described in detail. Furthermore, the development of composite materials for 3D printing is the main focus of future research, as combining multiple materials can improve the materials' properties. Updates in material sciences play important roles in dentistry; hence, the emergence of newer materials are expected to promote further innovations in dentistry.

Physical Characteristics and Biocompatibility of 3D-Printed Polylactic-Co-Glycolic Acid Membranes Used for Guided Bone Regeneration

Bioresorbable polymeric membranes for guided bone regeneration (GBR) were fabricated using the three-dimensional printing technique. Membranes made of polylactic-co-glycolic acid (PLGA), which consist of lactic acid (LA) and glycolic acid in ratios of 10:90 (group A) and 70:30 (group B), were compared. Their physical characteristics including architecture, surface wettability, mechanical properties, and degradability were compared in vitro, and their biocompatibilities were compared in vitro and in vivo. The results demonstrated that the membranes of group B had mechanical strength and could support the proliferation of fibroblasts and osteoblasts significantly better than those of group A (p < 0.05). The degradation rate in Group B was significantly lower than that in Group A, but they significantly produced less acidic environment (p < 0.05). In vivo, the membranes of group B were compared with the commercially available collagen membranes (group C). The amount of newly formed bone of rat's calvarial defects covered with the membranes of group C was stable after week 2, whereas that of group B increased over time. At week 8, the new bone volumes in group B were greater than those in group C (p > 0.05). In conclusion, the physical and biological properties of the PLGA membrane (LA:GA, 70:30) were suitable for GBR.

Fabrication of Solvent-Free PCL/β-TCP Composite Fiber for 3D Printing: Physiochemical and Biological Investigation

Manufacturing three-dimensional (3D) objects with polymers/bioceramic composite materials has been investigated in recent years. In this study, we manufactured and evaluated solvent-free polycaprolactone (PCL) and beta-tricalcium phosphate (β-TCP) composite fiber as a scaffold material for 3D printing. To investigate the optimal ratio of feedstock material for 3D printing, the physical and biological characteristics of four different ratios of β-TCP compounds mixed with PCL were investigated. PCL/β-TCP ratios of 0 wt.%, 10 wt.%, 20 wt.%, and 30 wt.% were fabricated, with PCL melted at 65 °C and blended with β-TCP with no solvent added during the fabrication process. Electron microscopy revealed an even distribution of β-TCP in the PCL fibers, while Fourier transform infrared spectroscopy demonstrated that the biomaterial compounds remained intact after the heating and manufacturing process. In addition, adding 20% β-TCP into the PCL/β-TCP mixture significantly increased hardness and Young’s Modulus by 10% and 26.5%, respectively, suggesting that PCL-20 has better resistance to deformation under load. Cell viability, alkaline phosphatase (ALPase) activity, osteogenic gene expression, and mineralization were also observed to increase according to the amount of β-TCP added. Cell viability and ALPase activity were 20% higher with PCL-30, while upregulation for osteoblast-related gene expression was better with PCL-20. In conclusion, PCL-20 and PCL-30 fibers fabricated without solvent exhibited excellent mechanical properties, high biocompatibility, and high osteogenic ability, making them promising materials for 3D printing customized bone scaffolds promptly, sustainably, and cost-effectively.

Optimizing the combined soft tissue repair and osteogenesis using double surfaces of crosslinked collagen scaffolds

Excessive tissue damage or loss has been solved by guided tissue regeneration and guided bone regeneration theories. However, the unfavorable degradation property of the resorbable collagen scaffold brings a big challenge to support soft tissue stabilization and time-consuming osteogenesis. The combined effect for soft tissue and bone of the collagen scaffold with better degradation pattern has not been clearly proven. This study determined whether the double surfaces of crosslinked collagen scaffolds could optimize the combined soft tissue repair and osteogenesis. In this study, we applied the chemically crosslinking treatment to the commercially available collagen scaffolds. Surface characterization, mechanical property and cell proliferation in vitro were evaluated. Combined bilateral skin and bone defects were established with the smooth surface of scaffold facing the skin defect and the rough surface facing the bone defect on the calvaria of rat. Micro-CT and histological evaluation were applied to determine the scaffold degradation pattern, soft tissue repair and osteogenesis. The crosslinked collagen scaffolds showed comparably favorable surface porosity, structure intactness, superhydrophilicity and mechanical properties. Compared to the native scaffolds, the crosslinked scaffolds could optimize the combined soft tissue repair and osteogenesis by preferably prolonged degradation time. Early pro-angiogenesis facilitated soft tissue repair and osteogenesis by upregulated soft tissue matrix degradation and balanced pro-osteogenesis with limited osteoclast-mediated bone resorption. Taken together, this study offers a promising repair strategy for the combined soft tissue and bone defects. Further, the possible mechanism of controllable scaffold degradation should be conducted.

3D-Printed Soft Membrane for Periodontal Guided Tissue Regeneration

OBJECTIVES

The current study aimed to perform an in vivo examination using a critical-size periodontal canine model to investigate the capability of a 3D-printed soft membrane for guided tissue regeneration (GTR). This membrane is made of a specific composition of gelatin, elastin, and sodium hyaluronate that was fine-tuned and fully characterized in vitro in our previous study. The value of this composition is its potential to be employed as a suitable replacement for collagen, which is the main component of conventional GTR membranes, to overcome the cost issue with collagen.

METHODS

Critical-size dehiscence defects were surgically created on the buccal surface of the roots of canine bilateral mandibular teeth. GTR treatment was performed with the 3D-printed membrane and two commercially available collagen membranes (Botiss Jason® and Smartbrane-Regedent membranes) and a group without any membrane placement was considered as the control group. The defects were submerged with tension-free closure of the gingival flaps. Histologic and histometric analyses were employed to assess the periodontal healing over an 8-week experimental period.

RESULTS

Histometric evaluations confirmed higher levels of new bone formation in the 3D-printed membrane group. Moreover, in all defects treated with the membranes, the formation of periodontal tissues, bone, periodontal ligaments, and cementum was observed after 8 weeks, while in the control group, only connective tissue was found in the defect sites. There was no clinical sign of inflammation or recession of gingiva in any of the groups.

SIGNIFICANCE

The 3D-printed gelatin/elastin/sodium hyaluronate membrane can be safe and effective for use in GTR for periodontal tissue regeneration therapies, with better or comparable results to the commercial collagen membranes.

Three-Dimensional Impression of Biomaterials for Alveolar Graft: Scoping Review

Craniofacial bone defects are one of the biggest clinical challenges in regenerative medicine, with secondary autologous bone grafting being the gold-standard technique. The development of new three-dimensional matrices intends to overcome the disadvantages of the gold-standard method. The aim of this paper is to put forth an in-depth review regarding the clinical efficiency of available 3D printed biomaterials for the correction of alveolar bone defects. A survey was carried out using the following databases: PubMed via Medline, Cochrane Library, Scopus, Web of Science, EMBASE, and gray literature. The inclusion criteria applied were the following: in vitro, in vivo, ex vivo, and clinical studies; and studies that assessed bone regeneration resorting to 3D printed biomaterials. The risk of bias of the in vitro and in vivo studies was performed using the guidelines for the reporting of pre-clinical studies on dental materials by Faggion Jr and the SYRCLE risk of bias tool, respectively. In total, 92 publications were included in the final sample. The most reported three-dimensional biomaterials were the PCL matrix, β-TCP matrix, and hydroxyapatite matrix. These biomaterials can be combined with different polymers and bioactive molecules such as rBMP-2. Most of the included studies had a high risk of bias. Despite the advances in the research on new three-dimensionally printed biomaterials in bone regeneration, the existing results are not sufficient to justify the application of these biomaterials in routine clinical practice.

Workflow for Fabricating 3D-Printed Resorbable Personalized Porous Scaffolds for Orofacial Bone Regeneration

Resorption of alveolar bone following tooth extraction is a physiological process that can often prevent the placement of dental implants due to the limited bone remaining. In severe cases, vertical bone augmentation, which aims to restore bone in an extraskeletal dimension (outside of the skeletal envelope), is required prior to implant placement. While current treatment strategies rely on autologous grafts, or "Guided Bone Regeneration" involving the placement of particulate bone grafting biomaterials under a protective membrane, the field is shifting to patient-matched solutions. Herein, we describe the various steps required for modeling the patient data, creating the patient-matched scaffold geometry and 3D-printing using the biodegradable polymer polycaprolactone for application in the oro-dental and craniofacial areas.

The effect of experimental diabetes and membrane occlusiveness on guided bone regeneration: A proof of principle study

OBJECTIVES

To evaluate the effect of membrane occlusiveness and experimental diabetes on early and late healing following guided bone regeneration.

MATERIAL AND METHODS

A total of 30 Wistar rats were randomly allocated to three groups: healthy (H), uncontrolled diabetic (UD) and controlled diabetic (CD). A critical size calvarial defect (CSD) was created at the mid-portion of one parietal bone, and it was treated with a double layer of e-PTFE membrane presenting 0.5 mm perforations. The animals were killed at 7 and 30 days of healing, and qualitative and quantitative histological evaluations were performed. Data were compared with the ones previously obtained from other 30 animals (10H, 10UD, 10 CD), where two CSDs were randomly treated with a double-layer e-PTFE occlusive membrane or left empty.

RESULTS

Following application of cell occlusive or cell permeable membranes, significant regeneration can be observed. However, at 30 days in the H group occlusive compared to cell permeable membranes promoted enhanced bone regeneration (83.9 ± 7.3% vs. 52.5 ± 8.6%), while no significant differences were observed within the CD and UD groups. UD led to reduced regeneration compared to H when an occlusive barrier was applied, whereas comparable outcomes to H and CD were observed when placing perforated membranes.

CONCLUSION

The application of cell permeable membranes may have masked the potentially adverse effect of experimental UD on bone regeneration.

CLINICAL RELEVANCE

Membrane porosity might contribute to modulate the bone regenerative response in UD conditions. Future studies are needed to establish the degree of porosity associated with the best regenerative outcomes as well as the underlying molecular mechanisms.

3D-printed bi-layered polymer/hydrogel construct for interfacial tissue regeneration in a canine model

OBJECTIVES

There are complications in applying regenerative strategies at the interface of hard and soft tissues due to the limited designs of constructs that can accommodate different cell types in different sites. The problem originates from the challenges in the adhesion of dissimilar materials, such as polymers and hydrogels, that can be suitable for regenerating different tissues such as bone and soft tissues. This paper presents a design of a new hybrid construct in which a polymer (polycaprolactone (PCL)) membrane firmly adheres to a layer of hydrogen (gelatin).

METHODS

PCL membranes with defined size and porosity were fabricated using 3D printing. The gelatin layer was attached to the PCL membranes using the aminolysis procedure. We have examined this construct for the application of Guided Bone Regeneration (GBR) as a typical surgical regenerative procedure of the oral cavity at the interface of bone and soft tissue. Complete in vitro and in vivo investigations on canine tibia bone defects have been performed. Histological analyses for fibrosis morphometric and bone morphometric evaluation, as well as bone-fibrosis histological grading and CBCT imaging, were conducted.

RESULTS

Chemical and morphological studies of the membrane proved that gelatin was uniformly attached to the aminolyzed PCL membranes. The in vitro and in vivo studies indicated the membrane's biocompatibility, mechanical stability, and barrier function for the GBR application. Furthermore, in vitro study showed that the membranes could improve osteogenesis and the regeneration of bone defects. The results illustrated that the mean bone density in the membrane groups was about three times more than that of the control group.

SIGNIFICANCE

The fabricated 3D-printed hybrid Gelatin/PCL bi-layered membrane can be a good candidate for interfacial tissue engineering and a promising membrane for GBR procedure.

Polycaprolactone Mesh for Asian Rhinoplasty: Outcomes and Complications of Composite Septal Extension Graft Compared to Mesh-Only Graft

Despite the great demand of aesthetic rhinoplasty in Asian population, it is difficult to obtain the lasting ideal tip projection along with lengthening of the nose due to the small and weak nasal septum. The shortage of available septal cartilage to work with is another major obstacle. A retrospective study was conducted between January 2017 and December 2019 in Seoul, Korea. A total of 774 patients underwent septorhinoplasty using polycaprolactone (PCL) mesh for the cosmetic enhancement of the nasal tip and the projection. Comparisons of aesthetic outcomes, patients' satisfaction surveys, and complications were performed between PCL mesh-only group and composite PCL group. Of all the patients, 97.5% of the patients in composite PCL group were rated more than 3 scores in aesthetic outcomes, whereas 90.4% in mesh-only group (p-value = 0.0002). About 96.7% of the patients with composite PCL rated their satisfaction level as more than satisfied, whereas 94.3% in mesh-only group (p-value = 0.0365). Overall, there were 17 patients in composite PCL group who exhibited complications including decreased tip projection, deviated nasal tip, mesh infection, and mesh exposure. However, there were two patients who had mesh injection in mesh-only group. Septorhinoplasty with septal extension graft using composite PCL graft provides robust support to the aesthetically modified projection and the lengthened nose without obvious complications on the nasal tip. Such technique allows surgeons to overcome the nature of Asian nose that is weak and small, and also provides satisfaction to patients who desire ideal tip projections and dramatic changes.

Clinically relevant preclinical animal models for testing novel cranio-maxillofacial bone 3D-printed biomaterials

Bone tissue engineering is a rapidly developing field with potential for the regeneration of craniomaxillofacial (CMF) bones, with 3D printing being a suitable fabrication tool for patient‐specific implants. The CMF region includes a variety of different bones with distinct functions. The clinical implementation of tissue engineering concepts is currently poor, likely due to multiple reasons including the complexity of the CMF anatomy and biology, and the limited relevance of the currently used preclinical models. The ‘recapitulation of a human disease’ is a core requisite of preclinical animal models, but this aspect is often neglected, with a vast majority of studies failing to identify the specific clinical indication they are targeting and/or the rationale for choosing one animal model over another. Currently, there are no suitable guidelines that propose the most appropriate animal model to address a specific CMF pathology and no standards are established to test the efficacy of biomaterials or tissue engineered constructs in the CMF field. This review reports the current clinical scenario of CMF reconstruction, then discusses the numerous limitations of currently used preclinical animal models employed for validating 3D‐printed tissue engineered constructs and the need to reduce animal work that does not address a specific clinical question. We will highlight critical research aspects to consider, to pave a clinically driven path for the development of new tissue engineered materials for CMF reconstruction.

Engineer a pre-metastatic niched microenvironment to attract breast cancer cells by utilizing a 3D printed polycaprolactone/nano-hydroxyapatite osteogenic scaffold - An in vitro model system for proof of concept

Breast cancer bone metastasis is not a random process. It is affected by the local microenvironment which determines the propensity of cancer cells to invade and colonize into the secondary sites. This microenvironment is termed a pre-metastatic niche. With the flexibility to incorporate different biofactors, tissue-engineering scaffolds provide an advantageous environment to promote "designed" osteogenesis that may mimic the bony pre-metastatic niche. In the current study, designed polycaprolactone (PCL) scaffolds enriched with nano-hydroxyapatite (nHA) were fabricated through three-dimensional (3D) printing. Subsequently, human mesenchymal stem cells (hMSCs) were seeded onto PCL-nHA scaffolds for osteogenic differentiation to establish the pre-metastatic niched microenvironment. Furthermore, transwell migration assay was used to investigate recruitment of MDA-MB-231, MCF-7, and MDA-MB-453 breast cancer cells to the osseous PCL-nHA scaffolds. Our results showed that the mRNA levels of alkaline phosphatase (ALP), runt-related transcription factor 2 (Runx2), and osteocalcin (OCN) of hMSCs on the PCL-nHA scaffolds were dramatically increased compared those with the PCL scaffolds (control) at day 7, 14, and 28. Meanwhile, the migration analysis showed that the higher maturation of osteogenesis and bone metabolism collectively contributed to the creation of a more favorable niched site for the cancerous invasion. Moreover, one of the hypothesized key mediators for the promoted migration, CXCL12, was confirmed using an assay of antagonist LIT-927. This early study demonstrated that a designed tissue engineering scaffold can be utilized to create a bone-mimicking environment that serves as a novel platform to recapitulate the pre-metastatic niche and help interrogate the scheme of bone metastasis by breast cancer.

Efficacy of TnR Nasal Mesh for prevention of septal perforation during septoplasty

OBJECTIVE

Septoplasty has been reported as the most common cause of the septal perforation. The interposition of the graft materials between the flaps at the site of the tear may be helpful to decrease the likelihood of septal perforation. The purpose of this study was to investigate the efficacy of TnR Nasal Mesh on the prevention of septal perforation following septoplasty.

METHODS

Among 46 patients had septal perforation after septoplasty, 35 patients were treated with TnR Nasal Mesh and 11 with autologous septal cartilage for bilateral mucosal tears at the corresponding area of the nasal septum. TnR Nasal Mesh or septal cartilage was placed between the injured mucoperichondrial flaps and confirmed in its original position at both sides under nasal endoscope. Objective endoscopic examination for septal mucosa status was evaluated between the patients who were treated with TnR Nasal Mesh or septal cartilage.

RESULTS

Twenty patients (57.1%) showed complete bilateral mucosa healing and nine (25.7%) had unilateral healing after TnR Nasal Mesh insertion. However, complete bilateral and unilateral mucosa healing was observed in 4 (36.4%) and 1 patients (9.1%) treated with septal cartilage, respectively. Complete healing rate for septal perforation was significantly higher in TnR Nasal Mesh than in septal cartilage insertion (p=0.022). None of the patients showed complications or adverse reactions after TnR Nasal Mesh or septal cartilage treatment.

CONCLUSION

TnR Nasal Mesh insertion after bilateral septal mucosal tear during septoplasty reduces permanent septal perforation without an apparent adverse effect. Therefore, TnR Nasal Mesh may be a safe and effective graft material for the prevention of septal perforation following septoplasty.

3D-printed Mg-incorporated PCL-based scaffolds: A promising approach for bone healing

3D-printed scaffolds have been developed as potential therapeutic strategies in bone tissue engineering. Mg/PCL biomaterials have been attracted much attention owing to biocompatibility, biodegradability as well as tunable mechanical properties. In this work, we developed 3D-printed customized Mg/PCL composite scaffolds with enhanced osteogenesis and biomineralization. Mg microparticles embedded in PCL-based scaffolds took a positive role in the improvement of biocompatibility, biomineralization, and biodegradable abilities. When incorporated with 3 wt% Mg, PCL-based scaffolds exhibited the optimal bone repairing ability in vitro and in vivo. The in vitro experiments indicated that 3 Mg/PCL scaffolds had improved mechanical properties, good biocompatibility, enhanced osteogenic and angiogenic activities. Besides, the in vivo studies demonstrated that Mg/PCL scaffolds promoted tissue ingrowth and new bone formation. In sum, these findings indicated that 3D-printed cell-free Mg/PCL scaffolds are promising strategies for bone healing application.

The Application of Polycaprolactone in Three-Dimensional Printing Scaffolds for Bone Tissue Engineering

Bone tissue engineering commonly encompasses the use of three-dimensional (3D) scaffolds to provide a suitable microenvironment for the propagation of cells to regenerate damaged tissues or organs. 3D printing technology has been extensively applied to allow direct 3D scaffolds manufacturing. Polycaprolactone (PCL) has been widely used in the fabrication of 3D scaffolds in the field of bone tissue engineering due to its advantages such as good biocompatibility, slow degradation rate, the less acidic breakdown products in comparison to other polyesters, and the potential for loadbearing applications. PCL can be blended with a variety of polymers and hydrogels to improve its properties or to introduce new PCL-based composites. This paper describes the PCL used in developing state of the art of scaffolds for bone tissue engineering. In this review, we provide an overview of the 3D printing techniques for the fabrication of PCL-based composite scaffolds and recent studies on applications in different clinical situations. For instance, PCL-based composite scaffolds were used as an implant surgical guide in dental treatment. Furthermore, future trend and potential clinical translations will be discussed.

Innovations in Craniofacial Bone and Periodontal Tissue Engineering - From Electrospinning to Converged Biofabrication

From a materials perspective, the pillars for the development of clinically translatable scaffold-based strategies for craniomaxillofacial (CMF) bone and periodontal regeneration have included electrospinning and 3D printing (biofabrication) technologies. Here, we offer a detailed analysis of the latest innovations in 3D (bio)printing strategies for CMF bone and periodontal regeneration and provide future directions envisioning the development of advanced 3D architectures for successful clinical translation. First, the principles of electrospinning applied to the generation of biodegradable scaffolds are discussed. Next, we present on extrusion-based 3D printing technologies with a focus on creating scaffolds with improved regenerative capacity. In addition, we offer a critical appraisal on 3D (bio)printing and multitechnology convergence to enable the reconstruction of CMF bones and periodontal tissues. As a future outlook, we highlight future directions associated with the utilization of complementary biomaterials and (bio)fabrication technologies for effective translation of personalized and functional scaffolds into the clinics.

Stem cell-seeded 3D-printed scaffolds combined with self-assembling peptides for bone defect repair

Bone defects caused by infection, tumor, trauma and so on remain difficult to treat clinically. Bone tissue engineering (BTE) has great application prospect in promoting bone defect repair. Polycaprolactone (PCL) is a commonly used material for creating BTE scaffolds. In addition, self-assembling peptides (SAPs) can function as the extracellular matrix and promote osteogenesis and angiogenesis. In the work, a PCL scaffold was constructed by 3D printing, then integrated with bone marrow mesenchymal stem cells (BMSCs) and SAPs. The research aimed to assess the bone repair ability of PCL/BMSC/SAP implants. BMSC proliferation in PCL/SAP scaffolds was assessed via Cell Counting Kit-8. In vitro osteogenesis of BMSCs cultured in PCL/SAP scaffolds was assessed by alkaline phosphatase staining and activity assays. Enzyme linked immunosorbent assays were also performed to detect the levels of osteogenic factors. The effects of BMSC-conditioned medium from 3D culture systems on the migration and angiogenesis of human umbilical vein endothelial cells (HUVECs) were assessed by scratch, transwell, and tube formation assays. After 8 weeks of in vivo transplantation, radiography and histology were used to evaluate bone regeneration, and immunohistochemistry staining was utilized to detect neovascularization. In vitro results demonstrated that PCL/SAP scaffolds promoted BMSC proliferation and osteogenesis compared to PCL scaffolds, and the PCL/BMSC/SAP conditional medium (CM) enhanced HUVEC migration and angiogenesis compared to the PCL/BMSC CM. In vivo results showed that, compared to the blank control, PCL, and PCL/BMSC groups, the PCL/BMSC/SAP group had significantly increased bone and blood vessel formation. Thus, the combination of BMSC-seeded 3D-printed PCL and SAPs can be an effective approach for treating bone defects.

3D-Printed Barrier Membrane Using Mixture of Polycaprolactone and Beta-Tricalcium Phosphate for Regeneration of Rabbit Calvarial Defects

Background: Polycarprolactone and beta tricalcium phosphate (PCL/β-TCP) are resorbable biomaterials that exhibit ideal mechanical properties as well as high affinity for osteogenic cells. Aim: Objective of this study was to evaluate healing and tissue reaction to the PCL/β-TCP barrier membrane in the rabbit calvaria model for guided bone regeneration. Materials and Methods: The PCL/β-TCP membranes were 3D printed. Three circular defects were created in calvaria of 10 rabbits. The three groups were randomly allocated for each specimen: (i) sham control; (ii) PCL/β-TCP membrane (PCL group); and (iii) PCL/β-TCP membrane with synthetic bone graft (PCL-BG group). The animals were euthanized after two (n = 5) and eight weeks (n = 5) for volumetric and histomorphometric analyses. Results: The greatest augmented volume was achieved by the PCL-BG group at both two and eight weeks (p < 0.01). There was a significant increase in new bone after eight weeks in the PCL group (p = 0.04). The PCL/β-TCP membrane remained intact after eight weeks with slight degradation, and showed good tissue integration. Conclusions: PCL/β-TCP membrane exhibited good biocompatibility, slow degradation, and ability to maintain space over eight weeks. The 3D-printed PCL/β-TCP membrane is a promising biomaterial that could be utilized for reconstruction of critical sized defects.

Mesenchymal stem cells and three-dimensional-osteoconductive scaffold regenerate calvarial bone in critical size defects in swine

Craniofacial bones protect vital organs, perform important physiological functions, and shape facial identity. Critical‐size defects (CSDs) in calvarial bones, which will not heal spontaneously, are caused by trauma, congenital defects, or tumor resections. They pose a great challenge for patients and physicians, and significantly compromise quality of life. Currently, calvarial CSDs are treated either by allogenic or autologous grafts, metal or other synthetic plates that are associated with considerable complications. While previous studies have explored tissue regeneration for calvarial defects, most have been done in small animal models with limited translational value. Here we define a swine calvarial CSD model and show a novel approach to regenerate high‐quality bone in these defects by combining mesenchymal stem cells (MSCs) with a three‐dimensional (3D)‐printed osteoconductive HA/TCP scaffold. Specifically, we have compared the performance of dental pulp neural crest MSCs (DPNCCs) to bone marrow aspirate (BMA) combined with a 3D‐printed HA/TCP scaffold to regenerate bone in a calvarial CSD (>7.0 cm²). Both DPNCCs and BMA loaded onto the 3D‐printed osteoconductive scaffold support the regeneration of calvarial bone with density, compression strength, and trabecular structures similar to native bone. Our study demonstrates a novel application of an original scaffold design combined with DPNCCs or BMA to support regeneration of high‐quality bone in a newly defined and clinically relevant swine calvarial CSD model. This discovery may have important impact on bone regeneration beyond the craniofacial region and will ultimately benefit patients who suffer from debilitating CSDs.

Membranes for Guided Bone Regeneration: A Road from Bench to Bedside

Bone resorption can negatively influence the osseointegration of dental implants. Barrier membranes for guided bone regeneration (GBR) are used to exclude nonosteogenic tissues from influencing the bone healing process. In addition to the existing barrier membranes available on the market, a growing variety of membranes for GBR with tailorable physicochemical properties are under preclinical evaluation. Hence, the aim of this review is to provide a comprehensive description of materials used for GBR and to report the main industrial and regulatory aspects allowing the commercialization of these medical devices (MDs). In particular, a summary of the main attributes defining a GBR membrane is reported along with a description of commercially available and under development membranes. Finally, strategies for the scaling-up of the manufacturing process and the regulatory framework of the main MD producers (USA, EU, Japan, China, and India) are presented. The description of the regulatory approval process of GBR membranes is representative of the typical path that medium- to high-risk MDs have to follow for an effective medical translation, which is of fundamental importance to increase the impact of biomedical research on public health.

The bone regeneration capacity of 3D-printed templates in calvarial defect models: A systematic review and meta-analysis

3D-printed templates are being used for bone tissue regeneration (BTR) as temporary guides. In the current review, we analyze the factors considered in producing potentially bioresorbable/degradable 3D-printed templates and their influence on BTR in calvarial bone defect (CBD) animal models. In addition, a meta-analysis was done to compare the achieved BTR for each type of template material (polymer, ceramic or composites). Database collection was completed by January 2018, and the inclusion criteria were all titles and keywords combining 3D printing and BTR in CBD models. Clinical trials and poorly-documented in vivo studies were excluded from this study. A total of 45 relevant studies were finally included and reviewed, and an additional check list was followed before inclusion in the meta-analysis, where material type, porosity %, and the regenerated bone area were collected and analyzed statistically. Overall, the capacity of the printed templates to support BTR was found to depend in large part on the amount of available space (porosity %) provided by the printed templates. Printed ceramic and composite templates showed the best BTR capacity, and the optimum printed template structure was found to have total porosity >50% with a pore diameter between 300 and 400 µm. Additional features and engineered macro-channels within the printed templates increased BTR capacity at long time points (12 weeks). Although the size of bone defects in rabbits was larger than in rats, BTR was greater in rabbits (almost double) at all time points and for all materials used. STATEMENT OF SIGNIFICANCE: In the present study, we reviewed the factors considered in producing degradable 3D-printed templates and their influence on bone tissue regeneration (BTR) in calvarial bone defects through the last 15 years. A meta-analysis was applied on the collected data to quantify and analyze BTR related to each type of template material. The concluded data states the importance of 3D-printed templates for BTR and indicates the ideal design required for an effective clinical translation. The evidence-based guidelines for the best BTR capacity endorse the use of printed composite and ceramic templates with total porosity >50%, pore diameter between 300 and 400 µm, and added engineered macro-channels within the printed templates.

Clinical Application of Three-Dimensionally Printed Biomaterial Polycaprolactone (PCL) in Augmentation Rhinoplasty

BACKGROUND

This clinical study aimed to investigate the safety and surgical outcome of three-dimensionally (3D) fabricated polycaprolactone (PCL) mesh in rhinoplasty. In particular, this study explored how a 3D-printed PCL mesh performs as a bioabsorbable scaffold after a long period following implantation.

METHODS

A retrospective review of 101 patients who received primary or secondary rhinoplasty with a PCL mesh was performed. Patient demographics and surgery-related outcomes were examined. Clinical efficacy and safety were evaluated using the Global Aesthetic Improvement Scale at postoperative 18 months. From two revisional cases, a biopsy specimen of implanted PCL was acquired and histopathological analysis was performed.

RESULTS

Of all the patients, 98.0% showed no postoperative infection-related foreign body reaction or distinct abnormal reaction, and the implants were observed to maintain long-term efficacy until 18-month follow-up. In patients who received spreader grafts, significant differences between preoperative and postoperative Cottle sign scores were found. Histopathological analysis showed features of adjacent tissue infiltration into pores of the PCL mesh and regeneration of neo-cartilaginous tissue and collagen around the mesh 20 months after implantation.

CONCLUSION

This study demonstrates that a novel biodegradable PCL mesh with a 3D structure is a safe and effective material for corrective rhinoplasty because it is easy to use and capable of maintaining its volume in the long term without foreign body response. This biocompatible material will have a wide range of applications as the most suitable alternative to nonabsorbable materials in rhinoplasty and reconstruction surgeries, such as fashioning spreader grafts and septal extension grafts.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Three-Dimensional Printing of Drug-Loaded Scaffolds for Antibacterial and Analgesic Applications

Pneumatic extrusion-based three-dimensional (3D) printing can be used to fabricate custom-made scaffolds to restore irregular bone defects. During the 3D printing process, therapeutic agents can be added to the scaffolds. This study aimed to develop a polycaprolactone (PCL) scaffold loaded with Ag₃PO₄ to prevent infections and lidocaine for pain relief by one-step 3D printing. We hypothesized that the drug release could be controlled by varying the filament diameter of the 3D printed scaffolds. To this end, PCL slurry mixed with different amounts of silver phosphate and lidocaine was printed via differently sized nozzles. The obtained cylindric scaffolds displayed a porous interconnected microstructure with high fidelity. The Ag₃PO₄ and lidocaine were distributed homogeneously. The lidocaine release could be controlled by adjusting the filament diameter while the silver release is correlated with the Ag₃PO₄ loading amount. The released medium from silver-loaded scaffolds exhibited an obvious inhibition zone against Staphylococcus aureus and Escherichia coli upon loading with 1% Ag₃PO₄ for up to 6 days and with 3% Ag₃PO₄ for at least 7 days. Cytotoxicity of all scaffolds was screened by cell assay. In conclusion, the pneumatic extrusion-based 3D printing provides a practical technique to fabricate drug-loaded scaffolds. The Ag₃PO₄ and lidocaine loaded PCL scaffolds showed the potential for infection prevention and pain relief.

Star-poly(ε-caprolactone) as the stationary phase for capillary gas chromatographic separation

This work presents the separation performance of star-poly(ε-caprolactone) (star-PCL) as the stationary phase for capillary gas chromatography (GC). The statically coated star-PCL column showed a column efficiency of 3345 plates per m and moderate polarity. Importantly, the star-PCL column exhibited high selectivity and resolving capability for more than a dozen mixtures covering a wide-ranging variety of analytes and isomers. Among them, the star-PCL column displayed advantageous resolving capability over the commercial DB-1701 column for aromatic amine isomers such as toluidine, chloroaniline and bromoaniline. Moreover, it was applied for the determination of isomer impurities in real samples, showing good potential in GC applications.

This work presents the separation performance of star-poly(ε-caprolactone) (star-PCL) as the stationary phase for capillary gas chromatography (GC).