Selective Laser Sintering (SLS), a New Chapter in the Production of Solid Oral Forms (SOFs) by 3D Printing

Emerging 3D printing technologies for solid oral dosage forms: Processes, materials and analytical tools for real-time assessment

Three-dimensional (3D) printing is an emerging technology with the potential to increase manufacturing flexibility and enable personalized drug delivery. 3D printing may form tablets using digitally controlled layer-by-layer material deposition, permitting the tailoring of solid oral dosage geometry and facile modifications of drug release profiles without requiring extensive alterations to the pharmaceutical formulation and process. The challenge to assure the quality of drugs still lies in monitoring and controlling critical steps in the 3D printing process. Optimizing an 3D printing process requires a comprehensive understanding of the critical process parameters, material attributes and their impact on the performance of 3D-printed tablets. This review focuses on recent advances in 3D printing technologies for solid oral dosage forms, emphasizing critical process parameters and material attributes that may be considered for optimizing printing processes and enhancing the quality of printed tablets. Additionally, this review explores real-time analytical tools and the crucial considerations for ensuring the performance of building materials, printing processes, and manufactured solid drug products. This review contributes to the ongoing discourse on harnessing the potential of 3D printing in the pharmaceutical field while emphasizing the imperative need for quality assurance throughout additive manufacturing processes.

Current developments in 3D printing technology for orthopedic trauma: A review

Three-dimensional (3D) printing technology has emerged as a revolutionary tool in orthopedic trauma surgery, offering unprecedented opportunities for personalized patient care. This comprehensive review explores the current developments and applications of 3D printing in orthopedic trauma, highlighting its potential to address complex surgical challenges. We provide an in-depth analysis of various 3D printing technologies applicable to orthopedic surgery, including vat photopolymerization, material extrusion, powder bed fusion, and sheet lamination. The review examines the use of 3D printing in preoperative planning, surgical simulation, and the creation of patient-specific implants and surgical guides. We discuss applications across different anatomical regions, including upper limb, lower limb, and pelvic and spinal trauma. Evidence from recent studies demonstrates that 3D printing-assisted surgeries can lead to reduced operative times, decreased blood loss, improved fracture reduction quality, and potentially better clinical outcomes. This review synthesizes the latest research and clinical experiences, providing insights into the current state of 3D printing in orthopedic trauma and its future perspectives. As the technology continues to evolve, 3D printing holds promise for increasingly personalized and effective treatments in orthopedic trauma care, potentially transforming surgical practices and improving patient outcomes.

Selective laser sintering for printing bilayer tablets

In this study Selective Laser Sintering (SLS) was used to produce bilayer tablets containing rosuvastatin and acetylsalicylic acid. Initially, monolithic tablets of each drug were manufactured using different laser intensities in order to identify their impact on the tablet's dissolution, friability and hardness. After the optimization, the final bilayer tablet was fabricated using a new method, that allowed the printing using different powder blends. For that, a 3D-printed casing was employed to maintain the compartments of the tablet in the correct position during the printing process. The results demonstrated that the increased laser intensities led to denser inner cores, enhanced hardness, decreased friability, and slower drug release. Moreover, the new method was able to produce bilayer tablets completely aligned, showing a minor impact on dissolution when the two compartments were printed together in a single tablet. The work demonstrated the feasibility of using SLS in the production of multi-material drug delivery systems.

3D printed gastroretentive floating-hollow capsular device (GRF-HCD) for levofloxacin oral delivery using selective laser sintering (SLS) platform technology

The development of gastroretentive drug delivery systems is one such instance, which was developed to improve the oral bioavailability and effectiveness of drugs, which has a poor absorption window in the upper GIT and/or triggers local activity such as duodenal and stomach activity. In this work, the objective of sintering gastroretentive dosage forms was to sustain the release of levofloxacin in the gastric region for an extended period of time. Selective laser sintering (SLS)-mediated powder bed fusion 3D printing technology was utilized to design and fabricate a modified-release gastroretentive floating-hollow capsular device (GRF-HCD) in three distinct capsule sizes namely, 000, 00, and 0 with the aid of pharmaceutical grade polymers (combinations of Kolliphor P188 and Kollidon SR in 1:1 ratio). Sintered GRF-HCD was further subjected to morphological analysis, weight variation, and swelling index. In addition, in vitro and in vivo buoyancy studies were performed in an animal model using X-ray imaging. Finally, the in vitro drug release from GRF-HCD was performed in simulated gastric pH condition (pH-1.2) upto 12 h. Levofloxacin concentration was then quantified using validated RP-HPLC method. The in vitro floating behaviour was mimicked with the in vivo floating, where the GRF-HCD was retained in the rabbit stomach for an extended period which will help to sustain the drug release for a longer period and maintained the maximum concentration of levofloxacin in the gastric region.

Recent Developments and Applications of 3D-Printing Technology in Pharmaceutical Drug Delivery Systems: A New Research Direction and Future Trends

The advent of 3D printing technology has emerged as a key technical revolution in recent years, enabling the development and production of innovative medication delivery methods in the pharmaceutical sector. The designs, concepts, techniques, key challenges, and potential benefits during 3D-printing technology are the key points discussed in this review. This technology primarily enables rapid, safe, and low-cost development of pharmaceutical formulations during the conventional and additive manufacturing processes. This phenomenon has wide-ranging implications in current as well as future medicinal developments. Advanced technologies such as Ink-Jet printing, drop-on-demand printing, Zip dose, Electrohydrodynamic Printing (Ejet) etc., are the current focus of the drug delivery systems for enhancing patient convenience and improving medication compliance. The current and future applications of various software, such as CAD software, and regulatory aspects in 3D and 4D printing technology are discussed briefly in this article. With respect to the prospective trajectory of 3D and 4D printing, it is probable that the newly developed methods will be predominantly utilized in pharmacies and hospitals to accommodate the unique requirements of individuals or niche groups. As a result, it is imperative that these technologies continue to advance and be improved in comparison to 2D printing in order to surmount the aforementioned regulatory and technical obstacles, render them applicable to a vast array of drug delivery systems, and increase their acceptability among patients of every generation.

Selective Laser Sintering 3D Printing of Carvedilol Tablets: Enhancing Dissolution Through Amorphization

BACKGROUND/OBJECTIVES

Selective laser sintering (SLS) is one of the most promising 3D printing techniques for pharmaceutical applications as it offers numerous advantages, such as suitability to work with already approved pharmaceutical excipients, the elimination of solvents, and the ability to produce fast-dissolving, porous dosage forms with high drug loading. When the powder mixture is exposed to elevated temperatures during SLS printing, the active ingredients can be converted from the crystalline to the amorphous state, which can be used as a strategy to improve the dissolution rate and bioavailability of poorly soluble drugs. This study investigates the potential application of SLS 3D printing for the fabrication of tablets containing the poorly soluble drug carvedilol with the aim of improving the dissolution rate of the drug by forming an amorphous form through the printing process.

METHODS

Using SLS 3D printing, eight tablet formulations were produced using two different powder mixtures and four combinations of experimental conditions, followed by physicochemical characterization and dissolution testing.

RESULTS

Physicochemical characterization revealed that at least partial amorphization of carvedilol occurred during the printing process. Although variations in process parameters were minimal, higher temperatures in combination with lower laser speeds appeared to facilitate a greater degree of amorphization. Ultimately, the partial conversion to the amorphous form significantly improved the dissolution of carvedilol compared to its pure crystalline form.

CONCLUSIONS

Obtained results suggest that the SLS 3D printing technique can be effectively used to convert poorly water-soluble drugs to their amorphous state, thereby improving solubility and bioavailability.

Current developments and advancements of 3-dimensional printing in personalized medication and drug screening

INTRODUCTION

3-Dimensional printing (3DP) is an additive manufacturing (AM) technique that is expanding quickly because of its low cost and excellent efficiency. The 3D printing industry grew by 19.5 % in 2021 in spite of the COVID-19 epidemic, and by 2026, the worldwide market is expected to be valued up to 37.2 billion US dollars.

CONTENT

Science Direct, Scopus, MEDLINE, EMBASE, PubMed, DOAJ, and other academic databases provide evidence of the increased interest in 3DP technology and innovative drug delivery approaches in recent times.

SUMMARY

In this review four main 3DP technologies that are appropriate for pharmaceutical applications: extrusion-based, powder-based, liquid-based, and sheet lamination-based systems are discussed. This study is focused on certain 3DP technologies that may be used to create dosage forms, pharmaceutical goods, and other items with broad regulatory acceptance and technological viability for use in commercial manufacturing. It also discusses pharmaceutical applications of 3DP in drug delivery and drug screening.

OUTLOOK

The pharmaceutical sector has seen the prospect of 3D printing in risk assessment, medical personalisation, and the manufacture of complicated dose formulas at a reasonable cost. AM has great promise to revolutionise the manufacturing and use of medicines, especially in the field of personalized medicine. The need to understand more about the potential applications of 3DP in medical and pharmacological contexts has grown over time.

3D printing in vaginal drug delivery: a revolution in pharmaceutical manufacturing

INTRODUCTION

The Food and Drug Administration's approval of the first three-dimensional (3D) printed tablet, Spritam®, led to a burgeoning interest in using 3D printing to fabricate numerous drug delivery systems for different routes of administration. The high degree of manufacturing flexibility achieved through 3D printing facilitates the preparation of dosage forms with many actives with complex and tailored release profiles that can address individual patient needs.

AREAS COVERED

This comprehensive review provides an in-depth look into the several 3D printing technologies currently utilized in pharmaceutical research. Additionally, the review delves into vaginal anatomy and physiology, 3D-printed drug delivery systems for vaginal applications, the latest research studies, and the challenges of 3D printing technology and future possibilities.

EXPERT OPINION

3D printing technology can produce drug-delivery devices or implants optimized for vaginal applications, including vaginal rings, intra-vaginal inserts, or biodegradable microdevices loaded with drugs, all custom-tailored to deliver specific medications with controlled release profiles. However, though the potential of 3D printing in vaginal drug delivery is promising, there are still challenges and regulatory hurdles to overcome before these technologies can be widely adopted and approved for clinical use. Extensive research and testing are necessary to ensure safety, effectiveness, and biocompatibility.

3D-printed immediate release solid dosage forms: a patent evaluation of US11622940B2

Three-dimensional (3D) printing is one of the most flexible technologies for preparing tablets, offering controlled drug release profiles. The current patent describes the preparation of immediate-release 3D-printed tablets of hydrochlorothiazide to improve disintegration and dissolution profile. The patent involves the preparation of drug-loaded filament via hot-melt extrusion and utilizing the same filaments for printing 3D-printed tablets using fused deposition modeling. The tablets were printed with different shapes and sizes by incorporating channels within the tablet spaces, termed as gaplets. The introduction of channels within the tablet design improves the disintegration and dissolution profile of the drug significantly. The morphological characteristic of 3D-printed tablets was studied by using scanning electron microscopy and revealed the presence of gaplets in the tablets.

Additive Manufacturing: A Paradigm Shift in Revolutionizing Catalysis with 3D Printed Photocatalysts and Electrocatalysts Toward Environmental Sustainability

Semiconductor-based materials utilized in photocatalysts and electrocatalysts present a sophisticated solution for efficient solar energy utilization and bias control, a field extensively explored for its potential in sustainable energy and environmental management. Recently, 3D printing has emerged as a transformative technology, offering rapid, cost-efficient, and highly customizable approaches to designing photocatalysts and electrocatalysts with precise structural control and tailored substrates. The adaptability and precision of printing facilitate seamless integration, loading, and blending of diverse photo(electro)catalytic materials during the printing process, significantly reducing material loss compared to traditional methods. Despite the evident advantages of 3D printing, a comprehensive compendium delineating its application in the realm of photocatalysis and electrocatalysis is conspicuously absent. This paper initiates by delving into the fundamental principles and mechanisms underpinning photocatalysts electrocatalysts and 3D printing. Subsequently, an exhaustive overview of the latest 3D printing techniques, underscoring their pivotal role in shaping the landscape of photocatalysts and electrocatalysts for energy and environmental applications. Furthermore, the paper examines various methodologies for seamlessly incorporating catalysts into 3D printed substrates, elucidating the consequential effects of catalyst deposition on catalytic properties. Finally, the paper thoroughly discusses the challenges that necessitate focused attention and resolution for future advancements in this domain.

3D printing technology and its revolutionary role in stent implementation in cardiovascular disease

Cardiovascular disease (CVD), exemplified by coronary artery disease (CAD), is a global health concern, escalating in prevalence and burden. The etiology of CAD is intricate, involving different risk factors. CVD remains a significant cause of mortality, driving the need for innovative interventions like percutaneous coronary intervention and vascular stents. These stents aim to minimize restenosis, thrombosis, and neointimal hyperplasia while providing mechanical support. Notably, the challenges of achieving ideal stent characteristics persist. An emerging avenue to address this involves enhancing the mechanical performance of polymeric bioresorbable stents using additive manufacturing techniques And Three-dimensional (3D) printing, encompassing various manufacturing technologies, has transcended its initial concept to become a tangible reality in the medical field. The technology's evolution presents a significant opportunity for pharmaceutical and medical industries, enabling the creation of targeted drugs and swift production of medical implants. It revolutionizes medical procedures, transforming the strategies of doctors and surgeons. Patient-specific 3D-printed anatomical models are now pivotal in precision medicine and personalized treatment approaches. Despite its ongoing development, additive manufacturing in healthcare is already integrated into various medical applications, offering substantial benefits to a sector under pressure for performance and cost reduction. In this review primarily emphasizes stent technology, different types of stents, highlighting its application with some potential complications. Here we also address their benefits, potential issues, effectiveness, indications, and contraindications. In future it can potentially reduce complications and help in improving patients' outcomes. 3DP technology offers the promise to customize solutions for complex CVD conditions and help or fostering a new era of precision medicine in cardiology.

Powder bed fusion-laser beam (PBF-LB) three-dimensional (3D) printing: Influence of laser hatching distance on the properties of zolpidem tartrate tablets

Laser sintering, known as powder bed fusion-laser beam (PBF-LB), offers promising potential for the fabrication of patient-specific drugs. The aim of this study was to provide an insight into the PBF-LB process with regard to the process parameters, in particular the laser hatching distance, and its influence on the properties of zolpidem tartrate (ZT) tablets. PHARMACOAT® 603 was used as the polymer, while Candurin® Gold Sheen and AEROSIL® 200 were added to facilitate 3D printing. The particle size distribution of the powder blend showed that the layer height should be set to 100 µm, while the laser hatching distance was varied in five different steps (50, 100, 150, 200 and 250 µm), keeping the temperature and laser scanning speed constant. Increasing the laser hatching distance and decreasing the laser energy input led to a decrease in the colour intensity, mass, density and hardness of the ZT tablets, while the disintegration and dissolution rate were faster due to the more fragile bonds between the particles. The laser hatching distance also influenced the ZT dosage, indicating the importance of this process parameter in the production of presonalized drugs. The absence of drug-polymer interactions and the amorphization of the ZT were confirmed.

Additive Manufacturing: A Comprehensive Review

Additive manufacturing has revolutionized manufacturing across a spectrum of industries by enabling the production of complex geometries with unparalleled customization and reduced waste. Beginning as a rapid prototyping tool, additive manufacturing has matured into a comprehensive manufacturing solution, embracing a wide range of materials, such as polymers, metals, ceramics, and composites. This paper delves into the workflow of additive manufacturing, encompassing design, modeling, slicing, printing, and post-processing. Various additive manufacturing technologies are explored, including material extrusion, VAT polymerization, material jetting, binder jetting, selective laser sintering, selective laser melting, direct metal laser sintering, electron beam melting, multi-jet fusion, direct energy deposition, carbon fiber reinforced, laminated object manufacturing, and more, discussing their principles, advantages, disadvantages, material compatibilities, applications, and developing trends. Additionally, the future of additive manufacturing is projected, highlighting potential advancements in 3D bioprinting, 3D food printing, large-scale 3D printing, 4D printing, and AI-based additive manufacturing. This comprehensive survey aims to underscore the transformative impact of additive manufacturing on global manufacturing, emphasizing ongoing challenges and the promising horizon of innovations that could further elevate its role in the manufacturing revolution.

3D printing processes in precise drug delivery for personalized medicine

With the advent of personalized medicine, the drug delivery system will be changed significantly. The development of personalized medicine needs the support of many technologies, among which three-dimensional printing (3DP) technology is a novel formulation-preparing process that creates 3D objects by depositing printing materials layer-by-layer based on the computer-aided design method. Compared with traditional pharmaceutical processes, 3DP produces complex drug combinations, personalized dosage, and flexible shape and structure of dosage forms (DFs) on demand. In the future, personalized 3DP drugs may supplement and even replace their traditional counterpart. We systematically introduce the applications of 3DP technologies in the pharmaceutical industry and summarize the virtues and shortcomings of each technique. The release behaviors and control mechanisms of the pharmaceutical DFs with desired structures are also analyzed. Finally, the benefits, challenges, and prospects of 3DP technology to the pharmaceutical industry are discussed.

Application of 3D printing in early phase development of pharmaceutical solid dosage forms

Three-dimensional printing (3DP) is an emerging technology, offering the possibility for the development of dose-customized, effective, and safe solid oral dosage forms (SODFs). Although 3DP has great potential, it does come with certain limitations, and the traditional drug manufacturing platforms remain the industry standard. The consensus appears to be that 3DP technology is expected to benefit personalized medicine the most, but that it is unlikely to replace conventional manufacturing for mass production. The 3DP method, on the other hand, could prove well-suited for producing small batches as an adaptive manufacturing technique for enabling adaptive clinical trial design for early clinical studies. The purpose of this review is to discuss recent advancements in 3DP technologies for SODFs and to focus on the applications for SODFs in the early clinical development stages, including a discussion of current regulatory challenges and quality controls.

Sketching feasibility of additively manufactured different size gradient conventional hollow capsular shells (HCSs) by selective laser sintering (SLS): From design to applications

Additive manufacturing (AM) is widely used to fabricate 3D printed objects from Computer-aided Design (CAD) prepared using the SolidWorks CAD modelling software. Different printing techniques are used to fabricate desired 3D objects; among all these techniques, it is widely accepted that SLS is one of the most effective methods of 3D printing for fabricating drug-loaded solid oral dosage forms (SODFs) in bulk quantities using the single-step process. Different SODFs, such as pills, miniprintlets, dual miniprintlets, and tablets, were fabricated with different sizes and shapes. In this study, for the first time, we introduce SLS-mediated hollow capsular shells (HCSs) with the help of the SLS 3D printing technique. This work aimed to explore the sinterability and feasibility of sketching HCSs using the SLS-mediated sintering technique with different marketed sizes of capsules ranging from 000 to 5. Here, we have utilized Kolliphor P 188 (KP 188) and Kollidon SR (KSR) in a 1:1 ratio as a matrix-forming agent and 1% charcoal as a laser absorption-enhancing material. In accordance with the CAD models, we have fabricated the gradient conventional different sizes of HCSs ranging from 000 to 5 using the constant printing parameters and composition. Fabricated all biobased HCSs were subjected to the assessment of mechanistic and physicochemical parameters using varied analytical tools. In the current study, tartrazine dye is used to assess the release pattern from HCSs, which resulted in the modified release pattern. The adapted approach will be the futuristic approach to replace animal-based gelatin capsules with pharmaceutical-grade polymer-based HCSs with a modified release with optimum mechanical strength.

Visualizing disintegration of 3D printed tablets in humans using MRI and comparison with in vitro data

Three-dimensional (3D) printing is revolutionising the way that medicines are manufactured today, paving the way towards more personalised medicine. However, there is limited in vivo data on 3D printed dosage forms, and no studies to date have been performed investigating the intestinal behaviour of these drug products in humans, hindering the complete translation of 3D printed medications into clinical practice. Furthermore, it is unknown whether conventional in vitro release tests can accurately predict the in vivo performance of 3D printed formulations in humans. In this study, selective laser sintering (SLS) 3D printing technology has been used to produce two placebo torus-shaped tablets (printlets) using different laser scanning speeds. The printlets were administered to 6 human volunteers, and in vivo disintegration times were assessed using magnetic resonance imaging (MRI). In vitro disintegration tests were performed using a standard USP disintegration apparatus, as well as an alternative method based on the use of reduced media volume and minimal agitation. Printlets fabricated at a laser scanning speed of 90 mm/s exhibited an average in vitro disintegration time of 7.2 ± 1 min (measured using the USP apparatus) and 25.5 ± 4.1 min (measured using the alternative method). In contrast, printlets manufactured at a higher laser scanning speed of 130 mm/s had an in vitro disintegration time of 2.8 ± 0.8 min (USP apparatus) and 18.8 ± 1.9 min (alternative method). When tested in humans, printlets fabricated at a laser scanning speed of 90 mm/s showed an average disintegration time of 17.3 ± 7.2 min, while those manufactured at a laser scanning speed of 130 mm/s exhibited a shorter disintegration time of 12.7 ± 6.8 min. Although the disintegration times obtained using the alternative method more closely resembled those obtained in vivo, no clear correlation was observed between the in vitro and in vivo disintegration times, highlighting the need to develop better in vitro methodology for 3D printed drug products.

Impact of polymer chemistry on critical quality attributes of selective laser sintering 3D printed solid oral dosage forms

The aim of this study is to investigate the influence of polymer chemistry on the properties of oral dosage forms produced using selective laser sintering (SLS). The dosage forms were printed using different grades of polyvinyl alcohol or copovidone in combination with indomethacin as the active pharmaceutical ingredient. The properties of the printed structures were assessed according to European Pharmacopoeia guidelines at different printing temperatures and laser scanning speeds in order to determine the suitable printing parameters. The results of the study indicate that the chemical properties of the polymers, such as dynamic viscosity, degree of hydrolyzation, and molecular weight, have significant impact on drug release and kinetics. Drug release rate and supersaturation can be modulated by selecting the appropriate polymer type. Furthermore, the physical properties of the dosage forms printed under the same settings are influenced by the selected polymer type, which determines the ideal manufacturing settings. This study demonstrates how the chemical properties of the polymer can determine the appropriate choice of manufacturing settings and the final properties of oral dosage forms produced using SLS.

A Bibliometric Analysis of 3D Printing in Personalized Medicine Research from 2012 to 2022

In recent years, the 3D printing of personalized drug formulations has attracted the attention of medical practitioners and academics. However, there is a lack of data-based analyses on the hotspots and trends of research in this field. Therefore, in this study, we performed a bibliometric analysis to summarize the 3D printing research in the field of personalized drug formulation from 2012 to 2022. This study was based on the Web of Science Core Collection Database, and a total of 442 eligible publications were screened. Using VOSviewer and online websites for bibliometric analysis and scientific mapping, it was observed that annual publications have shown a significant growth trend over the last decade. The United Kingdom and the United States, which account for 45.5% of the total number of publications, are the main drivers of this field. The International Journal of Pharmaceutics and University College London are the most prolific and cited journals and institutions. The researchers with the most contributions are Basit, Abdul W. and Goyanes Alvaro. The keyword analysis concluded that the current research hotspots are "drug release" and "drug dosage forms". In conclusion, 3D printing has broad application prospects in the field of personalized drugs, which will bring the pharmaceutical industry into a new era of innovation.

Computer numerical control (CNC) carving as an on-demand point-of-care manufacturing of solid dosage form: A digital alternative method for 3D printing

Computer numerical control (CNC) carving is a widely used method of industrial subtractive manufacturing of wood, plastics, and metal products. However, there have been no previous reports of applying this approach to manufacture medicines. In this work, the novel method of tablet production using CNC carving is introduced for the first time. This report provides a proof-of-concept for applying subtractive manufacturing as an alternative to formative (powder compression) and additive (3D printing) manufacturing for the on-demand production of solid dosage forms. This exemplar manufacturing approach was employed to produce patient-specific hydrocortisone (HC) tablets for the treatment of children with congenital adrenal hyperplasia. A specially made drug-polymer cast based on polyethene glycol (PEG 6,000) and hydroxypropyl cellulose was produced using thermal casting. The cast was used as a workpiece and digitally carved using a small-scale 3-dimensional (3D) CNC carving. To establish the ability of this new approach to provide an accurate dose of HC, four different sizes of CNC carved tablet were manufactured to achieve HC doses of 2.5, 5, 7.5 and 10 mg with a relative standard deviation of the tablet weight in the range of 3.69-4.79%. In addition, batches of 2.5 and 5 mg HC tablets met the British Pharmacopeia standards for weight uniformity. Thermal analysis and X-ray powder diffraction indicated that the model drug was in amorphous form. In addition, HPLC analysis indicated a level of purity of 96.5 ± 1.1% of HC. In addition, the process yielded mechanically strong cylindrical tablets with tensile strength ranging from 0.49 to 1.6 MPa and friability values of <1%, whilst maintaining an aesthetic look. In vitro, HC release from the CNC-carved tablets was slower with larger tablet sizes and higher binder contents. This is the first report on applying CNC carving in the pharmaceutical context of producing solid dosage forms. The work showed the potential of this technology as an alternative method for the on-demand manufacturing of patient-specific dosage forms.

Advanced Composite Materials Utilized in FDM/FFF 3D Printing Manufacturing Processes: The Case of Filled Filaments

The emergence of additive manufacturing technologies has brought about a significant transformation in several industries. Among these technologies, Fused Deposition Modeling/Fused Filament Fabrication (FDM/FFF) 3D printing has gained prominence as a rapid prototyping and small-scale production technique. The potential of FDM/FFF for applications that require improved mechanical, thermal, and electrical properties has been restricted due to the limited range of materials that are suitable for this process. This study explores the integration of various reinforcements, including carbon fibers, glass fibers, and nanoparticles, into the polymer matrix of FDM/FFF filaments. The utilization of advanced materials for reinforcing the filaments has led to the enhancement in mechanical strength, stiffness, and toughness of the 3D-printed parts in comparison to their pure polymer counterparts. Furthermore, the incorporation of fillers facilitates improved thermal conductivity, electrical conductivity, and flame retardancy, thereby broadening the scope of potential applications for FDM/FFF 3D-printed components. Additionally, the article underscores the difficulties linked with the utilization of filled filaments in FDM/FFF 3D printing, including but not limited to filament extrusion stability, nozzle clogging, and interfacial adhesion between the reinforcement and matrix. Ultimately, a variety of pragmatic implementations are showcased, wherein filled filaments have exhibited noteworthy benefits in comparison to standard FDM/FFF raw materials. The aforementioned applications encompass a wide range of industries, such as aerospace, automotive, medical, electronics, and tooling. The article explores the possibility of future progress and the incorporation of innovative reinforcement materials. It presents a plan for the ongoing growth and application of advanced composite materials in FDM/FFF 3D printing.

Recent Advances in the Production of Pharmaceuticals Using Selective Laser Sintering

Selective laser sintering (SLS) is an additive manufacturing process that has shown promise in the production of medical devices, including hip cups, knee trays, dental crowns, and hearing aids. SLS-based 3D-printed dosage forms have the potential to revolutionise the production of personalised drugs. The ability to manipulate the porosity of printed materials is a particularly exciting aspect of SLS. Porous tablet formulations produced by SLS can disintegrate orally within seconds, which is challenging to achieve with traditional methods. SLS also enables the creation of amorphous solid dispersions in a single step, rather than the multi-step process required with conventional methods. This review provides an overview of 3D printing, describes the operating mechanism and necessary materials for SLS, and highlights recent advances in SLS for biomedical and pharmaceutical applications. Furthermore, an in-depth comparison and contrast of various 3D printing technologies for their effectiveness in tissue engineering applications is also presented in this review.

3D Printed Pharmaceutical Systems for Personalized Treatment in Metabolic Syndrome

The current healthcare system is widely based on the concept of “one size fit for all”, which emphasizes treating a disease by prescribing the same drug to all patients with equivalent doses and dosing frequency. This medical treatment scenario has shown varied responses with either no or weak pharmacological effects and exaggerated adverse reactions preceded by more patient complications. The hitches to the concept of “one size fits all” have devoted the attention of many researchers to unlocking the concept of personalized medicine (PM). PM delivers customized therapy with the highest safety margin for an individual patient’s needs. PM has the potential to revolutionize the current healthcare system and pave the way to alter drug choices and doses according to a patient’s clinical responses, providing physicians with the best treatment outcomes. The 3D printing techniques is a solid-form fabrication method whereby successive layers of materials based on computer-aided designs were deposited to form 3D structures. The 3D printed formulation achieves PM goals by delivering the desired dose according to patient needs and drug release profile to achieve a patient’s personal therapeutic and nutritional needs. This pre-designed drug release profile attains optimum absorption and distribution, exhibiting maximum efficacy and safety profiles. This review aims to focus on the role of the 3D printing technique as a promising tool to design PM in metabolic syndrome (MS).

Selective laser sintering additive manufacturing of dosage forms: Effect of powder formulation and process parameters on the physical properties of printed tablets

Large batches of placebo and drug-loaded solid dosage forms were successfully fabricated using selective laser sintering (SLS) 3D printing in this study. The tablet batches were prepared using either copovidone (N-vinyl-2-pyrrolidone and vinyl acetate, PVP/VA) or polyvinyl alcohol (PVA) and activated carbon (AC) as radiation absorbent, which was added to improve the sintering of the polymer. The physical properties of the dosage forms were evaluated at different pigment concentrations (i.e., 0.5 and 1.0 wt%) and at different laser energy inputs. The mass, hardness, and friability of the tablets were found to be tunable and structures with greater mass and mechanical strength were obtained with increasing carbon concentration and energy input. Amorphization of the active pharmaceutical ingredient in the drug-loaded batches, containing 10 wt% naproxen and 1 wt% AC, was achieved in-situ during printing. Thus, amorphous solid dispersions were prepared in a single-step process and produced tablets with mass losses below 1 wt%. These findings show how the properties of dosage forms can be tuned by careful selection of the process parameters and the powder formulation. SLS 3D printing can therefore be considered to be an interesting and promising technique for the fabrication of personalized medicines.

Application of 3D Printing in Bone Grafts

The application of 3D printing in bone grafts is gaining in importance and is becoming more and more popular. The choice of the method has a direct impact on the preparation of the patient for surgery, the probability of rejection of the transplant, and many other complications. The aim of the article is to discuss methods of bone grafting and to compare these methods. This review of literature is based on a selective literature search of the PubMed and Web of Science databases from 2001 to 2022 using the search terms “bone graft”, “bone transplant”, and “3D printing”. In addition, we also reviewed non-medical literature related to materials used for 3D printing. There are several methods of bone grafting, such as a demineralized bone matrix, cancellous allograft, nonvascular cortical allograft, osteoarticular allograft, osteochondral allograft, vascularized allograft, and an autogenic transplant using a bone substitute. Currently, autogenous grafting, which involves removing the patient’s bone from an area of low aesthetic importance, is referred to as the gold standard. 3D printing enables using a variety of materials. 3D technology is being applied to bone tissue engineering much more often. It allows for the treatment of bone defects thanks to the creation of a porous scaffold with adequate mechanical strength and favorable macro- and microstructures. Bone tissue engineering is an innovative approach that can be used to repair multiple bone defects in the process of transplantation. In this process, biomaterials are a very important factor in supporting regenerative cells and the regeneration of tissue. We have years of research ahead of us; however, it is certain that 3D printing is the future of transplant medicine.

Drug Delivery Systems in Regenerative Medicine: An Updated Review

Modern drug discovery methods led to evolving new agents with significant therapeutic potential. However, their properties, such as solubility and administration-related challenges, may hinder their benefits. Moreover, advances in biotechnology resulted in the development of a new generation of molecules with a short half-life that necessitates frequent administration. In this context, controlled release systems are required to enhance treatment efficacy and improve patient compliance. Innovative drug delivery systems are promising tools that protect therapeutic proteins and peptides against proteolytic degradation where controlled delivery is achievable. The present review provides an overview of different approaches used for drug delivery.

Microfluidic Organ-on-A-chip: A Guide to Biomaterial Choice and Fabrication

Organ-on-A-chip (OoAC) devices are miniaturized, functional, in vitro constructs that aim to recapitulate the in vivo physiology of an organ using different cell types and extracellular matrix, while maintaining the chemical and mechanical properties of the surrounding microenvironments. From an end-point perspective, the success of a microfluidic OoAC relies mainly on the type of biomaterial and the fabrication strategy employed. Certain biomaterials, such as PDMS (polydimethylsiloxane), are preferred over others due to their ease of fabrication and proven success in modelling complex organ systems. However, the inherent nature of human microtissues to respond differently to surrounding stimulations has led to the combination of biomaterials ranging from simple PDMS chips to 3D-printed polymers coated with natural and synthetic materials, including hydrogels. In addition, recent advances in 3D printing and bioprinting techniques have led to the powerful combination of utilizing these materials to develop microfluidic OoAC devices. In this narrative review, we evaluate the different materials used to fabricate microfluidic OoAC devices while outlining their pros and cons in different organ systems. A note on combining the advances made in additive manufacturing (AM) techniques for the microfabrication of these complex systems is also discussed.

Influence of Process Parameters on the Characteristics of Additively Manufactured Parts Made from Advanced Biopolymers

Over the past few decades, additive manufacturing (AM) has become a reliable tool for prototyping and low-volume production. In recent years, the market share of such products has increased rapidly as these manufacturing concepts allow for greater part complexity compared to conventional manufacturing technologies. Furthermore, as recyclability and biocompatibility have become more important in material selection, biopolymers have also become widely used in AM. This article provides an overview of AM with advanced biopolymers in fields from medicine to food packaging. Various AM technologies are presented, focusing on the biopolymers used, selected part fabrication strategies, and influential parameters of the technologies presented. It should be emphasized that inkjet bioprinting, stereolithography, selective laser sintering, fused deposition modeling, extrusion-based bioprinting, and scaffold-free printing are the most commonly used AM technologies for the production of parts from advanced biopolymers. Achievable part complexity will be discussed with emphasis on manufacturable features, layer thickness, production accuracy, materials applied, and part strength in correlation with key AM technologies and their parameters crucial for producing representative examples, anatomical models, specialized medical instruments, medical implants, time-dependent prosthetic features, etc. Future trends of advanced biopolymers focused on establishing target-time-dependent part properties through 4D additive manufacturing are also discussed.

3D Printing Technologies in Personalized Medicine, Nanomedicines, and Biopharmaceuticals

3D printing technologies enable medicine customization adapted to patients' needs. There are several 3D printing techniques available, but majority of dosage forms and medical devices are printed using nozzle-based extrusion, laser-writing systems, and powder binder jetting. 3D printing has been demonstrated for a broad range of applications in development and targeting solid, semi-solid, and locally applied or implanted medicines. 3D-printed solid dosage forms allow the combination of one or more drugs within the same solid dosage form to improve patient compliance, facilitate deglutition, tailor the release profile, or fabricate new medicines for which no dosage form is available. Sustained-release 3D-printed implants, stents, and medical devices have been used mainly for joint replacement therapies, medical prostheses, and cardiovascular applications. Locally applied medicines, such as wound dressing, microneedles, and medicated contact lenses, have also been manufactured using 3D printing techniques. The challenge is to select the 3D printing technique most suitable for each application and the type of pharmaceutical ink that should be developed that possesses the required physicochemical and biological performance. The integration of biopharmaceuticals and nanotechnology-based drugs along with 3D printing ("nanoprinting") brings printed personalized nanomedicines within the most innovative perspectives for the coming years. Continuous manufacturing through the use of 3D-printed microfluidic chips facilitates their translation into clinical practice.

Releasing fast and slow: Non-destructive prediction of density and drug release from SLS 3D printed tablets using NIR spectroscopy

Selective laser sintering (SLS) 3D printing is a revolutionary 3D printing technology that has been found capable of creating drug products with varied release profiles by changing the laser scanning speed. Here, SLS 3D printed formulations (printlets) loaded with a narrow therapeutic index drug (theophylline) were produced using SLS 3D printing at varying laser scanning speeds (100-180 mm/s). The use of reflectance Fourier Transform - Near Infrared (FT-NIR) spectroscopy was evaluated as a non-destructive approach to predicting 3D printed tablet density and drug release at 2 h and 4 h. The printed drug products formulated with a higher laser speed exhibited an accelerated drug release and reduced density compared with the slower laser scanning speeds. Univariate calibration models were developed based on a baseline shift in the spectra in the third overtone region upon changing physical properties. For density prediction, the developed univariate model had high linearity (R² value = 0.9335) and accuracy (error < 0.029 mg/mm³). For drug release prediction at 2 h and 4 h, the developed univariate models demonstrated a linear correlation (R² values of 0.9383 and 0.9167, respectively) and accuracy (error < 4.4%). The predicted vs. actual dissolution profiles were found to be statistically similar (f₂ > 50) for all of the test printlets. Overall, this article demonstrates the feasibility of SLS 3D printing to produce drug products containing a narrow therapeutic index drug across a range of drug release profiles, as well as the potential for FT-NIR spectroscopy to predict the physical characteristics of SLS 3D printed drug products (drug release and density) as a non-destructive quality control method at the point-of-care.

Fabrication of Sustained-Release Dosages Using Powder-Based Three-Dimensional (3D) Printing Technology

Three-dimensional (3D)-printed tablets prepared using powder-based printing techniques like selective laser sintering (SLS) typically disintegrate/dissolve and release the drug within a few minutes because of their inherent porous nature and loose structure. The goal of this study was to demonstrate the suitability of SLS 3DP technology for fabricating sustained-release dosages utilizing Kollidon^® SR (KSR), a matrix-forming excipient composed of polyvinyl acetate and polyvinylpyrrolidone (8:2). A physical mixture (PM), comprising 10:85:5 (% w/w) of acetaminophen (ACH), KSR, and Candurin^®, was sintered using a benchtop SLS 3D printer equipped with a 2.3-W 455-nm blue visible laser. After optimization of the process parameters and formulation composition, robust 3D-printed tablets were obtained as per the computer-aided design (CAD) model. Advanced solid-state characterizations by powder X-ray diffraction (PXRD) and wide-angle X-ray scattering (WAXS) confirmed that ACH remained in its native crystalline state after sintering. In addition, X-ray micro-computed tomography (micro-CT) studies revealed that the tablets contain a total porosity of 57.7% with an average pore diameter of 24.8 μm. Moreover, SEM images exhibited a morphological representation of the ACH sintered tablets' exterior surface. Furthermore, the KSR matrix 3D-printed tablets showed a sustained-release profile, releasing roughly 90% of the ACH over 12 h as opposed to a burst release from the free drug and PM. Overall, our work shows for the first time that KSR can be used as a suitable polymer matrix to create sustained-release dosage forms utilizing the digitally controllable SLS 3DP technology, showcasing an alternative technique and pharmaceutical excipient.

Investigation of Microstructure and Mechanical Properties of SLM-Fabricated AlSi10Mg Alloy Post-Processed Using Equal Channel Angular Pressing (ECAP)

With the aim of improving the excellent mechanical properties of the SLM-produced AlSi10Mg alloy, this research focuses on post-processing using ECAP (Equal Channel Angular Pressing). In our article, two different post-processing strategies were investigated: (1) low-temperature annealing (LTA) and subsequent ECAP processing at 150 °C; (2) no heat treatment and subsequent ECAP processing at 350 °C, 400 °C and 450 °C. The microstructure and mechanical properties of this alloy were analyzed at each stage of post-treatment. Metallographic observations, combined with SEM and EBSD studies, showed that the alloys produced by SLM have a unique cellular microstructure consisting of Si networks surrounding the Al-based matrix phase. Low-temperature annealing (LTA), followed by ECAP treatment, facilitated the microstructural evolution of the alloy with partial breakup of the Si network and observed nucleation of β-Si precipitates throughout the Al matrix. This resulted in a Vickers microhardness of 153 HV and a yield strength of 415 MPa. The main results show that post-processing of SLM-produced AlSi10Mg alloys using ECAP significantly affects the microstructural evolution and mechanical properties of the alloy.

Recent Advances in Amorphous Solid Dispersions: Preformulation, Formulation Strategies, Technological Advancements and Characterization

Amorphous solid dispersions (ASDs) are among the most popular and widely studied solubility enhancement techniques. Since their inception in the early 1960s, the formulation development of ASDs has undergone tremendous progress. For instance, the method of preparing ASDs evolved from solvent-based approaches to solvent-free methods such as hot melt extrusion and Kinetisol^®. The formulation approaches have advanced from employing a single polymeric carrier to multiple carriers with plasticizers to improve the stability and performance of ASDs. Major excipient manufacturers recognized the potential of ASDs and began introducing specialty excipients ideal for formulating ASDs. In addition to traditional techniques such as differential scanning calorimeter (DSC) and X-ray crystallography, recent innovations such as nano-tomography, transmission electron microscopy (TEM), atomic force microscopy (AFM), and X-ray microscopy support a better understanding of the microstructure of ASDs. The purpose of this review is to highlight the recent advancements in the field of ASDs with respect to formulation approaches, methods of preparation, and advanced characterization techniques.

Low-Cost Cranioplasty-A Systematic Review of 3D Printing in Medicine

The high cost of biofabricated titanium mesh plates can make them out of reach for hospitals in low-income countries. To increase the availability of cranioplasty, the authors of this work investigated the production of polymer-based endoprostheses. Recently, cheap, popular desktop 3D printers have generated sufficient opportunities to provide patients with on-demand and on-site help. This study also examines the technologies of 3D printing, including SLM, SLS, FFF, DLP, and SLA. The authors focused their interest on the materials in fabrication, which include PLA, ABS, PET-G, PEEK, and PMMA. Three-dimensional printed prostheses are modeled using widely available CAD software with the help of patient-specific DICOM files. Even though the topic is insufficiently researched, it can be perceived as a relatively safe procedure with a minimal complication rate. There have also been some initial studies on the costs and legal regulations. Early case studies provide information on dozens of patients living with self-made prostheses and who are experiencing significant improvements in their quality of life. Budget 3D-printed endoprostheses are reliable and are reported to be significantly cheaper than the popular counterparts manufactured from polypropylene polyester.

The Evolution of the 3D-Printed Drug Delivery Systems: A Review

Since the appearance of the 3D printing in the 1980s it has revolutionized many research fields including the pharmaceutical industry. The main goal is to manufacture complex, personalized products in a low-cost manufacturing process on-demand. In the last few decades, 3D printing has attracted the attention of numerous research groups for the manufacturing of different drug delivery systems. Since the 2015 approval of the first 3D-printed drug product, the number of publications has multiplied. In our review, we focused on summarizing the evolution of the produced drug delivery systems in the last 20 years and especially in the last 5 years. The drug delivery systems are sub-grouped into tablets, capsules, orodispersible films, implants, transdermal delivery systems, microneedles, vaginal drug delivery systems, and micro- and nanoscale dosage forms. Our classification may provide guidance for researchers to more easily examine the publications and to find further research directions.

Development of Composite, Reinforced, Highly Drug-Loaded Pharmaceutical Printlets Manufactured by Selective Laser Sintering-In Search of Relevant Excipients for Pharmaceutical 3D Printing

3D printing by selective laser sintering (SLS) of high-dose drug delivery systems using pure brittle crystalline active pharmaceutical ingredients (API) is possible but impractical. Currently used pharmaceutical grade excipients, including polymers, are primarily designed for powder compression, ensuring good mechanical properties. Using these excipients for SLS usually leads to poor mechanical properties of printed tablets (printlets). Composite printlets consisting of sintered carbon-stained polyamide (PA12) and metronidazole (Met) were manufactured by SLS to overcome the issue. The printlets were characterized using DSC and IR spectroscopy together with an assessment of mechanical properties. Functional properties of the printlets, i.e., drug release in USP3 and USP4 apparatus together with flotation assessment, were evaluated. The printlets contained 80 to 90% of Met (therapeutic dose ca. 600 mg), had hardness above 40 N (comparable with compressed tablets) and were of good quality with internal porous structure, which assured flotation. The thermal stability of the composite material and the identity of its constituents were confirmed. Elastic PA12 mesh maintained the shape and structure of the printlets during drug dissolution and flotation. Laser speed and the addition of an osmotic agent in low content influenced drug release virtually not changing composition of the printlet; time to release 80% of Met varied from 0.5 to 5 h. Composite printlets consisting of elastic insoluble PA12 mesh filled with high content of crystalline Met were manufactured by 3D SLS printing. Dissolution modification by the addition of an osmotic agent was demonstrated. The study shows the need to define the requirements for excipients dedicated to 3D printing and to search for appropriate materials for this purpose.

Prediction of Solid-State Form of SLS 3D Printed Medicines Using NIR and Raman Spectroscopy

Selective laser sintering (SLS) 3D printing is capable of revolutionising pharmaceutical manufacturing, by producing amorphous solid dispersions in a one-step manufacturing process. Here, 3D-printed formulations loaded with a model BCS class II drug (20% w/w itraconazole) and three grades of hydroxypropyl cellulose (HPC) polymer (-SSL, -SL and -L) were produced using SLS 3D printing. Interestingly, the polymers with higher molecular weights (HPC-L and -SL) were found to undergo a uniform sintering process, attributed to the better powder flow characteristics, compared with the lower molecular weight grade (HPC-SSL). XRPD analyses found that the SLS 3D printing process resulted in amorphous conversion of itraconazole for all three polymers, with HPC-SSL retaining a small amount of crystallinity on the drug product surface. The use of process analytical technologies (PAT), including near infrared (NIR) and Raman spectroscopy, was evaluated, to predict the amorphous content, qualitatively and quantitatively, within itraconazole-loaded formulations. Calibration models were developed using partial least squares (PLS) regression, which successfully predicted amorphous content across the range of 0–20% w/w. The models demonstrated excellent linearity (R² = 0.998 and 0.998) and accuracy (RMSEP = 1.04% and 0.63%) for NIR and Raman spectroscopy models, respectively. Overall, this article demonstrates the feasibility of SLS 3D printing to produce solid dispersions containing a BCS II drug, and the potential for NIR and Raman spectroscopy to quantify amorphous content as a non-destructive quality control measure at the point-of-care.

Understanding the Effect of Energy Density and Formulation Factors on the Printability and Characteristics of SLS Irbesartan Tablets-Application of the Decision Tree Model

Selective laser sintering (SLS) is a rapid prototyping technique for the production of three-dimensional objects through selectively sintering powder-based layer materials. The aim of the study was to investigate the effect of energy density (ED) and formulation factors on the printability and characteristics of SLS irbesartan tablets. The correlation between formulation factors, ED, and printability was obtained using a decision tree model with an accuracy of 80%. FT-IR results revealed that there was no interaction between irbesartan and the applied excipients. DSC results indicated that irbesartan was present in an amorphous form in printed tablets. ED had a significant influence on tablets’ physical, mechanical, and morphological characteristics. Adding lactose monohydrate enabled faster drug release while reducing the possibility for printing with different laser speeds. However, formulations with crospovidone were printable with a wider range of laser speeds. The adjustment of formulation and process parameters enabled the production of SLS tablets with hydroxypropyl methylcellulose with complete release in less than 30 min. The results suggest that a decision tree could be a useful tool for predicting the printability of pharmaceutical formulations. Tailoring the characteristics of SLS irbesartan tablets by ED is possible; however, it needs to be governed by the composition of the whole formulation.

A QbD Approach for Evaluating the Effect of Selective Laser Sintering Parameters on Printability and Properties of Solid Oral Forms

The aim of this work was to investigate the effect of process parameters on the printability of a formulation containing copovidone and paracetamol, and on the properties of solid oral forms 3D-printed through selective laser sintering. Firstly, the influence of the heating temperature was evaluated individually, and it was revealed that this parameter was critical for printability, as a sufficiently high temperature (100 °C) is necessary to avoid curling. Secondly, the effects of laser power, scan speed, and layer thickness were determined using a Box-Behnken design. The measured responses, printing yield, height, weight, hardness, disintegration time, and percentage of drug release at 10 min showed the following ranges of values: 55.6-100%, 2.92-3.96 mm, 98.2-187.2 mg, 9.2-83.4 N, 9.7-997.7 s, and 25.8-99.9%, respectively. Analysis of variance (ANOVA) proved that the generated quadratic models and the effect of the three-process parameters were significant (p < 0.05). Yield improved at high laser power, low scan speed, and increased layer thickness. Height was proportional to laser power, and inversely proportional to scan speed and layer thickness. Variations in the other responses were related to the porosity of the SOFs, which were dependent on the value of energy density. Low laser power, fast scan speed, and high layer thickness values favored a lower energy density, resulting in low weight and hardness, rapid disintegration, and a high percentage of drug release at 10 min. Finally, an optimization was performed, and an additional experiment validated the model. In conclusion, by applying a Quality by Design approach, this study demonstrates that process parameters are critical for printability, but also offer a way to personalize the properties of the SOFs.

3D/4D Printing of Polymers: Fused Deposition Modelling (FDM), Selective Laser Sintering (SLS), and Stereolithography (SLA)

Additive manufacturing (AM) or 3D printing is a digital manufacturing process and offers virtually limitless opportunities to develop structures/objects by tailoring material composition, processing conditions, and geometry technically at every point in an object. In this review, we present three different early adopted, however, widely used, polymer-based 3D printing processes; fused deposition modelling (FDM), selective laser sintering (SLS), and stereolithography (SLA) to create polymeric parts. The main aim of this review is to offer a comparative overview by correlating polymer material-process-properties for three different 3D printing techniques. Moreover, the advanced material-process requirements towards 4D printing via these print methods taking an example of magneto-active polymers is covered. Overall, this review highlights different aspects of these printing methods and serves as a guide to select a suitable print material and 3D print technique for the targeted polymeric material-based applications and also discusses the implementation practices towards 4D printing of polymer-based systems with a current state-of-the-art approach.