Development of AM Technologies for Metals in the Sector of Medical Implants

Mechanical property of Ti6Al4V cylindrical porous structure for dental implants fabricated by selective laser melting

The commonly used titanium alloy dental implants currently apply solid structures. However, issues such as stress shielding and stress concentration may arise due to the significant difference in elastic modulus between the implant and host. In order to address these problems, this paper proposes five porous structures based on the Gibson-Ashby theoretical model. We utilized selective laser melting technology to shape a porous structure using Ti-6Al-4V material precisely. The mechanical properties of the porous structure were verified through simulation and compression experiments. The optimal porous structure, which best matched the human bone, was a circular ring structure with a pillar diameter of 0.6 mm and a layer height of 2 mm. The stress and strain of the porous implant on the surrounding cortical and cancellous bone under different biting conditions were studied to verify the effectiveness of the optimal circular ring porous structure in alleviating stress shielding in both standard and osteoporotic bone conditions. The results confirm that the circular ring porous structure meets implant requirements and provides a theoretical basis for clinical dental implantation.

A Review of the Metal Additive Manufacturing Processes

Metal additive manufacturing (AM) is a layer-by-layer process that makes the direct manufacturing of various industrial parts possible. This method facilitates the design and fabrication of complex industrial, advanced, and fine parts that are used in different industry sectors, such as aerospace, medicine, turbines, and jewelry, where the utilization of other fabrication techniques is difficult or impossible. This method is advantageous in terms of dimensional accuracy and fabrication speed. However, the parts fabricated by this method may suffer from faults such as anisotropy, micro-porosity, and defective joints. Metals like titanium, aluminum, stainless steels, superalloys, etc., have been used-in the form of powder or wire-as feed materials in the additive manufacturing of various parts. The main criterion that distinguishes different additive manufacturing processes from each other is the deposition method. With regard to this criterion, AM processes can be divided into four classes: local melting, sintering, sheet forming, and electrochemical methods. Parameters affecting the properties of the additive-manufactured part and the defects associated with an AM process determine the method by which a certain part should be manufactured. This study is a survey of different additive manufacturing processes, their mechanisms, capabilities, shortcomings, and the general properties of the parts manufactured by them.

The Upper Limb Orthosis in the Rehabilitation of Stroke Patients: The Role of 3D Printing

Stroke represents the third cause of long-term disability in the world. About 80% of stroke patients have an impairment of bio-motor functions and over half fail to regain arm functionality, resulting in motor movement control disorder with serious loss in terms of social independence. Therefore, rehabilitation plays a key role in the reduction of patient disabilities, and 3D printing (3DP) has showed interesting improvements in related fields, thanks to the possibility to produce customized, eco-sustainable and cost-effective orthoses. This study investigated the clinical use of 3DP orthosis in rehabilitation compared to the traditional ones, focusing on the correlation between 3DP technology, therapy and outcomes. We screened 138 articles from PubMed, Scopus and Web of Science, selecting the 10 articles fulfilling the inclusion criteria, which were subsequently examined for the systematic review. The results showed that 3DP provides substantial advantages in terms of upper limb orthosis designed on the patient's needs. Moreover, seven research activities used biodegradable/recyclable materials, underlining the great potential of validated 3DP solutions in a clinical rehabilitation setting. The aim of this study was to highlight how 3DP could overcome the limitations of standard medical devices in order to support clinicians, bioengineers and innovation managers during the implementation of Healthcare 4.0.

Gentamicin Eluting 3D-Printed Implants for Preventing Post-Surgical Infections in Bone Fractures

A surgically implantable device is an inevitable treatment option for millions of people worldwide suffering from diseases arising from orthopedic injuries. A global paradigm shift is currently underway to tailor and personalize replacement or reconstructive joints. Additive manufacturing (AM) has provided dynamic outflow to the customized fabrication of orthopedic implants by enabling need-based design and surface modification possibilities. Surgical grade 316L Stainless Steel (316L SS) is promising with its cost, strength, composition, and corrosion resistance to fabricate 3D implants. This work investigates the possibilities of application of the laser powder bed fusion (L-PBF) technique to fabricate 3D-printed (3DP) implants, which are functionalized with a multilayered antimicrobial coating to treat potential complications arising due to postsurgical infections (PSIs). Postsurgical implant-associated infection is a primary reason for implantation failure and is complicated mainly by bacterial colonization and biofilm formation at the installation site. PLGA (poly-d,l-lactide-co-glycolide), a biodegradable polymer, was utilized to impart multiple layers of coating using the airbrush spray technique on 3DP implant surfaces loaded with gentamicin (GEN). Various PLGA-based polymers were tested to optimize the ideal lactic acid: glycolic acid ratio and molecular weight suited for our investigation. 3D-Printed PLGA-GEN substrates sustained the release of gentamicin from the surface for approximately 6 weeks. The 3DP surface modification with PLGA-GEN facilitated cell adhesion and proliferation compared to control surfaces. The cell viability studies showed that the implants were safe for application. The 3DP PLGA-GEN substrates showed good concentration-dependent antibacterial efficacy against the common PSI pathogen Staphylococcus aureus (S. aureus) and Staphylococcus epidermidis (S. epidermidis). The GEN-loaded substrates demonstrated antimicrobial longevity and showed significant biofilm growth inhibition compared to control. The substrates offered great versatility regarding the in vitro release rates, antimicrobial properties, and biocompatibility studies. These results radiate great potential in future human and veterinary clinical applications pertinent to complications arising from PSIs, focusing on personalized sustained antibiotic delivery.

Preparation and Characterization for the Thermal Stability and Mechanical Property of PLA and PLA/CF Samples Built by FFF Approach

Currently, the mechanical performances of polylactic acid (PLA) samples prepared using the fused filament fabrication (FFF) technique are relatively poor. Hence, the carbon fiber (CF) is used to improve the thermal stability and mechanical property of FFF-ed PLA samples in this paper. The crystalline structure, thermal stability, melt flow rate, tensile strength and fractured surface morphology of PLA and PLA/CF samples were investigated with an X-ray diffraction device, differential scanning calorimeter, thermogravimetric analyzer, melt flow rate equipment, universal tensile test machine and scanning electron microscope, respectively. Meanwhile, the reinforcement mechanism of CF on the mechanical property of PLA samples was also analyzed. XRD results revealed that the diffraction peaks intensities of PLA/CF sample were obviously lower than those of PLA sample. TGA and DSC curves illustrated that the initial thermal decomposition temperature, thermal stability and crystallinity of the PLA/CF sample improved significantly. The tensile strength of the PLA/CF sample was 91.58 MPa, which was 42.49% higher than that of the PLA sample. Moreover, SEM images showed that the fractured behavior of the PLA sample varied from brittle fracture to ductile fracture after the introduction of CF. The results concluded the CF is a feasible fiber for enhancing the performances of the PLA sample.

3D printed biomedical devices and their applications: A review on state-of-the-art technologies, existing challenges, and future perspectives

3D printing, also known as Additive manufacturing (AM), has emerged as a transformative technology with applications across various industries, including the medical sector. This review paper provides an overview of the current status of AM technology, its challenges, and its application in the medical industry. The paper covers the different types of AM technologies, such as fused deposition modeling, stereolithography, selective laser sintering, digital light processing, binder jetting, and electron beam melting, and their suitability for medical applications. The most commonly used biomedical materials in AM, such as plastic, metal, ceramic, composite, and bio-inks, are also viewed. The challenges of AM technology, such as material selection, accuracy, precision, regulatory compliance, cost and quality control, and standardization, are also discussed. The review also highlights the various applications of AM in the medical sector, including the production of patient-specific surgical guides, prosthetics, orthotics, and implants. Finally, the review highlights the Internet of Medical Things (IoMT) and artificial intelligence (AI) for regulatory frameworks and safety standards for 3D-printed biomedical devices. The review concludes that AM technology can transform the healthcare industry by enabling patients to access more personalized and reasonably priced treatment alternatives. Despite the challenges, integrating AI and IoMT with 3D printing technology is expected to play a vital role in the future of biomedical device applications, leading to further advancements and improvements in patient care. More research is needed to address the challenges and optimize its use for medical applications to utilize AM's potential in the medical industry fully.

Additive Manufacturing of Bioceramic Implants for Restoration Bone Engineering: Technologies, Advances, and Future Perspectives

Treating bone defects is highly challenging because they do not heal on their own inside the patients, so implants are needed to assist in the reconstruction of the bone. Bioceramic implants based on additive manufacturing (AM) are currently emerging as promising treatment options for restoration bone engineering. On the one hand, additively manufactured bioceramic implants have excellent mechanical properties and biocompatibility, which are suitable for bone regeneration. On the other hand, the designable structure and adjustable pores of additively manufactured bioceramic implants allow them to promote suitable cell growth and tissue climbing. Herein, this review unfolds to introduce several frequently employed AM technologies for bioceramic implants. After that, advances in commonly used additively manufactured bioceramic implants, including bioinert ceramic implants, bioactive ceramic implants, and bioceramic/organic composite implants, are categorized and summarized. Finally, the future perspectives of additively manufactured bioceramic implants, in terms of mechanical performance improvement, innovative structural design, biological property enhancement, and other functionalization approaches, are proposed and forecasted. This review is believed to provide some fundamental understanding and cutting-edge knowledge for the additive manufacturing of bioceramic implants for restoration bone engineering.

3D Printing of Bioinert Oxide Ceramics for Medical Applications

Three-dimensionally printed metals and polymers have been widely used and studied in medical applications, yet ceramics also require attention. Ceramics are versatile materials thanks to their excellent properties including high mechanical properties and hardness, good thermal and chemical behavior, and appropriate, electrical, and magnetic properties, as well as good biocompatibility. Manufacturing complex ceramic structures employing conventional methods, such as ceramic injection molding, die pressing or machining is extremely challenging. Thus, 3D printing breaks in as an appropriate solution for complex shapes. Amongst the different ceramics, bioinert ceramics appear to be promising because of their physical properties, which, for example, are similar to those of a replaced tissue, with minimal toxic response. In this way, this review focuses on the different medical applications that can be achieved by 3D printing of bioinert ceramics, as well as on the latest advances in the 3D printing of bioinert ceramics. Moreover, an in-depth comparison of the different AM technologies used in ceramics is presented to help choose the appropriate methods depending on the part geometry.

Investigation of MAO Coatings Characteristics on Titanium Products Obtained by EBM Method Using Additive Manufacturing

Coatings with a thickness from 27 to 62 µm on electron beam melted Ti-6Al-4V have been formed by micro-arc oxidation (MAO) in a silicate-hypophosphite electrolyte. MAO tests in the anode-cathode mode (50 Hz) with an anode-to-cathode current ratio of 1:1 and sum current densities 10 and 20 A/dm² were carried out. The duration of the MAO treatment was 30 and 60 min. The effect of the processing parameters on the structural properties of the MAO treated coatings was studied. The current density and treatment time significantly affect the coating thickness and surface roughness. The values of these characteristics increase as the current density increases. The effect of thermal cycling tests on surface morphology, thickness and roughness, and elemental and phase composition of MAO coatings was analyzed. After 50 cycles of thermal cycling from +200 °C to −50 °C, no cracking or delamination of coatings was observed. Coatings formed in 30 min at a current density of 20 A/dm² turned out to be the best in terms of such indicators as surface morphology, thickness, and roughness.

Medical 3D Printing: Tools and Techniques, Today and Tomorrow

Three-dimensional printing is a still-emerging technology with high impact for the medical community, particularly in the development of tissues for the clinic. Many types of printers are under development, including extrusion, droplet, melt, and light-curing technologies. Herein we discuss the various types of 3D printers and their strengths and weaknesses concerning tissue engineering. Despite the advantages of 3D printing, challenges remain in the development of large, clinically relevant tissues. Advancements in bioink development, printer technology, tissue vascularization, and cellular sourcing/expansion are discussed, alongside future opportunities for the field. Trends regarding in situ printing, personalized medicine, and whole organ development are highlighted. Expected final online publication date for the Annual Review of Chemical and Biomolecular Engineering, Volume 13 is October 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Modeling of the Influence of Input AM Parameters on Dimensional Error and Form Errors in PLA Parts Printed with FFF Technology

As is widely known, additive manufacturing (AM) allows very complex parts to be manufactured with porous structures at a relatively low cost and in relatively low manufacturing times. However, it is necessary to determine in a precise way the input values that allow better results to be obtained in terms of microgeometry, form errors, and dimensional error. In an earlier work, the influence of the process parameters on surface roughness obtained in fused filament fabrication (FFF) processes was analyzed. This present study focuses on form errors as well as on dimensional error of hemispherical cups, with a similar shape to that of the acetabular cup of hip prostheses. The specimens were 3D printed in polylactic acid (PLA). Process variables are nozzle diameter, temperature, layer height, print speed, and extrusion multiplier. Their influence on roundness, concentricity, and dimensional error is considered. To do this, adaptive neuro-fuzzy inference systems (ANFIS) models were used. It was observed that dimensional error, roundness, and concentricity depend mainly on the nozzle diameter and on layer height. Moreover, high nozzle diameter of 0.6 mm and high layer height of 0.3 mm are not recommended. A desirability function was employed along with the ANFIS models in order to determine the optimal manufacturing conditions. The main aim of the multi-objective optimization study was to minimize average surface roughness (Ra) and roundness, while dimensional error was kept within the interval Dimensional Error≤0.01. When the simultaneous optimization of both the internal and the external surface of the parts is performed, it is recommended that a nozzle diameter of 0.4 mm be used, to have a temperature of 197 °C, a layer height of 0.1 mm, a print speed of 42 mm/s, and extrusion multiplier of 94.8%. This study will help to determine the influence of the process parameters on the quality of the manufactured parts.

Analysis of AM Parameters on Surface Roughness Obtained in PLA Parts Printed with FFF Technology

Fused filament fabrication (FFF) 3D printing technology allows very complex parts to be obtained at a relatively low cost and in reduced manufacturing times. In the present work, the effect of main 3D printing parameters on roughness obtained in curved surfaces is addressed. Polylactic acid (PLA) hemispherical cups were printed with a shape similar to that of the acetabular part of the hip prostheses. Different experiments were performed according to a factorial design of experiments, with nozzle diameter, temperature, layer height, print speed and extrusion multiplier as variables. Different roughness parameters were measured—Ra, Rz, Rku, Rsk—both on the outer surface and on the inner surface of the parts. Arithmetical mean roughness value Ra and greatest height of the roughness profile Rz are usually employed to compare the surface finish among different manufacturing processes. However, they do not provide information about the shape of the roughness profile. For this purpose, in the present work kurtosis Rku and skewness Rsk were used. If the height distribution in a roughness profile follows a normal law, the Rku parameter will take a value of 3. If the profile distribution is symmetrical, the Rsk parameter will take a value of 0. Adaptive neural fuzzy inference system (ANFIS) models were obtained for each response. Such models are often employed to model different manufacturing processes, but their use has not yet been extended to 3D printing processes. All roughness parameters studied depended mainly on layer height, followed by nozzle diameter. In the present work, as a general trend, Rsk was close to but lower than 0, while Rku was slightly lower than 3. This corresponds to slightly higher valleys than peaks, with a rounded height distribution to some degree.

Additive manufacturing of Ti6Al4V alloy via electron beam melting for the development of implants for the biomedical industry

Additive Manufacturing (AM) or rapid prototyping technologies are presented as one of the best options to produce customized prostheses and implants with high-level requirements in terms of complex geometries, mechanical properties, and short production times. The AM method that has been more investigated to obtain metallic implants for medical and biomedical use is Electron Beam Melting (EBM), which is based on the powder bed fusion technique. One of the most common metals employed to manufacture medical implants is titanium. Although discovered in 1790, titanium and its alloys only started to be used as engineering materials for biomedical prostheses after the 1950s. In the biomedical field, these materials have been mainly employed to facilitate bone adhesion and fixation, as well as for joint replacement surgeries, thanks to their good chemical, mechanical, and biocompatibility properties. Therefore, this study aims to collect relevant and up-to-date information from an exhaustive literature review on EBM and its applications in the medical and biomedical fields. This AM method has become increasingly popular in the manufacturing sector due to its great versatility and geometry control.

Effect of Printing Parameters on Dimensional Error, Surface Roughness and Porosity of FFF Printed Parts with Grid Structure

Extrusion printing processes allow for manufacturing complex shapes in a relatively cheap way with low-cost machines. The present study analyzes the effect of printing parameters on dimensional error, roughness, and porosity of printed PLA parts obtained with grid structure. Parts are obtained by means of the fused filament fabrication (FFF) process. Four variables are chosen: Layer height, temperature, speed, and flow rate. A two-level full factorial design with a central point is used to define the experimental tests. Dimensional error and porosity are measured with a profile projector, while roughness is measured with a contact roughness meter. Mathematical regression models are found for each response, and multi-objective optimization is carried out by means of the desirability function. Dimensional error and roughness depend mainly on layer height and flow rate, while porosity depends on layer height and printing speed. Multi-objective optimization shows that recommended values for the variables are layer height 0.05 mm, temperature 195 ºC, speed 50 mm/min, and flow rate 0.93, when dimensional error and roughness are to be minimized, and porosity requires a target value of 60%. The present study will help to select appropriate printing parameters for printing porous structures such as those found in prostheses, by means of extrusion processes.