Effect of Model Body Type and Print Angle on the Accuracy of 3D-Printed Orthodontic Models.

The assortment of low-cost 3D printers for "in-practice" use, e.g., for clear aligner therapies, is ever increasing. To address concerns about the accuracy of orthodontic models produced on such printers when cost-efficient modes of 3D printing are employed, this study examined the effect of print model body type and print angulation on accuracy. Six printing-configuration groups were included: two model types (solid or hollow shell) combined with three print angles (0°, 70°, or 90°) with 10 models/group; all models were printed with 100 µm layer thickness using a digital light processing-based three-dimensional printer. Eleven selected structures and distances were measured on the printed models with a digital microscope and compared to the same measures on a digitized master model. The clinically acceptable range was set at ±0.25 mm difference from the master model for single tooth measurements (intra-tooth) and ±0.5 mm for cross-arch measurements (inter-tooth). For individual measurements across all models, 98% fell within clinical acceptability. For mean measurements within each model group, only canine height for the shell-0° model had a mean difference (-0.26 mm ± 0.03) outside the clinically acceptable range for intra-tooth measurements. Standard deviations for all intra-tooth measurements were within 0.07 mm. While none of the mean inter-tooth measurements exceeded the acceptability range, the standard deviations were larger (0.04 to 0.30 mm). The accuracy of the orthodontic models for clear aligner therapies was not impacted beyond the clinically acceptable range when altering model body type and print angulation to improve efficiency of 3D printing. These findings suggest greater flexibility of the practitioner to alter print settings to address time and cost efficiency in various clinical scenarios and still maintain clinically acceptable model accuracy.

The 3D-McMap Guidelines: Three-Dimensional Multicomposite Microsphere Adaptive Printing.

Microspheres, synthesized from diverse natural or synthetic polymers, are readily utilized in biomedical tissue engineering to improve the healing of various tissues. Their ability to encapsulate growth factors, therapeutics, and natural biomolecules, which can aid tissue regeneration, makes microspheres invaluable for future clinical therapies. While microsphere-supplemented scaffolds have been investigated, a pure microsphere scaffold with an optimized architecture has been challenging to create via 3D printing methods due to issues that prevent consistent deposition of microsphere-based materials and their ability to maintain the shape of the 3D-printed structure. Utilizing the extrusion printing process, we established a methodology that not only allows the creation of large microsphere scaffolds but also multicomposite matrices into which cells, growth factors, and therapeutics encapsulated in microspheres can be directly deposited during the printing process. Our 3D-McMap method provides some critical guidelines for issues with scaffold shape fidelity during and after printing. Carefully timed breaks, minuscule drying steps, and adjustments to extrusion parameters generated an evenly layered large microsphere scaffold that retained its internal architecture. Such scaffolds are superior to other microsphere-containing scaffolds, as they can release biomolecules in a highly controlled spatiotemporal manner. This capability permits us to study cell responses to the delivered signals to develop scaffolds that precisely modulate new tissue formation.

Effect of fluoride varnish in combination with simulated oral environment on enamel-bracket shear bond strength.

To determine the effect of fluoride varnish application combined with a simulated oral environment prior to bracket bonding on the shear bond strength (SBS) between brackets and tooth enamel. Sixty de-identified, extracted teeth were grouped to either receive or not receive fluoride varnish and then stored for 7 days at 37 °C in phosphate-buffered saline (PBS) solution or PBS combined with three 15-min cycles/day in a demineralizing solution to simulate pH variation following meals. Subsequently, brackets were bonded and after 24-h dark cure at 37 °C, debonded using shear forces in a simulated oral environment. The maximum shear force was used to calculate SBS, and the adhesive remnant index (ARI) was determined by image analysis of photos of the bracket mesh pad after debonding. A statistically higher SBS (10.16 MPa) was observed when fluoride varnish was applied prior to storage in PBS + demineralizing solution compared to SBS (6.38 MPa) following storage in the same solution without varnish application. Based on 37% effect size, this difference is also clinically relevant. In contrast, no significant differences in SBS were observed with varnish application combined with PBS with no demineralizing solution or between storage solution alone. Moreover, there was no significant difference in ARI due to varnish combined with either storage method or storage solution only. Results suggest varnish application prior to bracket bonding in combination with simulated oral environment that included acid exposure is beneficial in maintaining higher SBS between bracket and enamel. Despite higher SBS, adhesive remaining on enamel did not increase.

Implant system for large osteochondral defects.

Issues with current treatments for osteochondral defects such as mosaicplasty and autologous chondrocyte implantation (ACI) are lack of donor material, problems associated with donor sites, necessity of second surgical intervention and cell expansion, difficult site preparation and implant fitting to match the surrounding tissue. This study presents the development of a patient specific implant system for focal osteochondral defects that addresses these issues. Using computer aided design and manufacturing techniques, computed tomography scans are utilized to design the implant and templates that facilitate site preparation to allow for precise and easy implantation of the designed perfectly fitting tissue replacement. Functionality of the system and accurate restoration of a defect is demonstrated by digital before/after comparison and with a prototype. With the presented implantation system larger defects in curved joint surfaces can be restored to an optimal shape in an easier procedure than for instance mosaicplasty. The proposed system potentially allows for later replacement of worn implants.

Polymer-coated microparticle scaffolds engineered for potential use in musculoskeletal tissue regeneration.

Biomaterials constructed exclusively of sintered microspheres have great potential in tissue engineering scaffold applications, offering the ability to create shape-specific scaffolds with precise controlled release yet to be matched by traditional additive manufacturing methods. The problem is that these microsphere-based scaffolds are limited in their stiffness for applications such as bone regeneration. Our vision to solve this problem was borne from a hierarchical structure perspective, focusing on the individual unit of the structure: the microsphere itself. In a core-shell approach, we envisioned a stiff core to create a stiff microsphere unit, with a polymeric shell that would enable sintering to the other microsphere units. Therefore, the current study provided a comparison of macroscopic biomaterials built on either polymer microspheres or polymer-coated hard glass microspheres. Identical polycaprolactone (PCL) polymer solutions were used to fabricate microspheres and as a thin coating on soda lime glass microspheres (hard phase). The materials were characterized as loose particles and as scaffolds via scanning electron microscopy, thermogravimetry, differential scanning calorimetry, Raman spectroscopy, mechanical testing, and a live/dead analysis with human umbilical cord-derived Wharton's jelly cells. The elastic modulus of the scaffolds with the thinly coated hard phase was about five times higher with glass microspheres (up to about 25 MPa) than pure polymer microspheres, while retaining the structure, cell adhesion, and chemical properties of the PCL polymer. This proof-of-concept study demonstrated the ability to achieve at least a five-fold increase in macroscopic stiffness via altering the core microsphere units with a core-shell approach.

Fabrication of a Double-Cross-Linked Interpenetrating Polymeric Network (IPN) Hydrogel Surface Modified with Polydopamine to Modulate the Osteogenic Differentiation of Adipose-Derived Stem Cells.

Hydrogel surface properties can be modified to form bioactive interfaces to modulate the osteogenic differentiation of stem cells. In this work, a hydrogel made of gelatin methacrylamide (GelMA) and alginate was designed and tested as a scaffold to control stem-cell osteogenic differentiation. The hydrogel's surface was treated with polydopamine (pDA) to create an adhesive layer for the adsorption of the osteoinductive drug dexamethasone (Dex). The presence of the pDA coating enhanced Dex adsorption and retention over 21 days. This effect resulted in a delay in the osteogenic differentiation of hASCs cultured on the hydrogel treated with a pDA layer.

Evaluating the effect of increasing ceramic content on the mechanical properties, material microstructure and degradation of selective laser sintered polycaprolactone/ß-tricalcium phosphate materials.

Orthopaedic scaffold materials were fabricated from polycaprolactone (PCL) and composite PCL-ß-tricalcium phosphate (PCL/ß-TCP) powders using selective laser sintering (SLS). Incorporating ß-TCP particles is desirable to promote osteogenesis. The effects of increasing ß-TCP content on the material's mechanical properties and microstructure were evaluated. The wt% of ß-TCP and PCL particle sizes were found to influence material microstructure and mechanical properties, with increasing ceramic content causing a small but significant increase in stiffness but significant reductions in strength. Degradation of materials was achieved using accelerated ageing methods. The influence of ß-TCP content on degradation at 7 weeks was evaluated through changes in mechanical properties and microstructure, and the ceramic particles were found to reduce elastic modulus and increase strength. The results of this study highlight the influence of ceramic content on mechanical properties and degradation behaviour of PCL/ß-TCP SLS materials, and indicate that these changes must be considered in the design of scaffolds for critical-sized defects.

Computational modelling of ovine critical-sized tibial defects with implanted scaffolds and prediction of the safety of fixator removal.

Computational model geometries of tibial defects with two types of implanted tissue engineering scaffolds, ß-tricalcium phosphate (ß-TCP) and poly-ε-caprolactone (PCL)/ß-TCP, are constructed from µ-CT scan images of the real in vivo defects. Simulations of each defect under four-point bending and under simulated in vivo axial compressive loading are performed. The mechanical stability of each defect is analysed using stress distribution analysis. The results of this analysis highlights the influence of callus volume, and both scaffold volume and stiffness, on the load-bearing abilities of these defects. Clinically-used image-based methods to predict the safety of removing external fixation are evaluated for each defect. Comparison of these measures with the results of computational analyses indicates that care must be taken in the interpretation of these measures.

Evaluation of a Multiscale Modelling Methodology to Predict the Mechanical Properties of PCL/ß-TCP Sintered Scaffold Materials.

A multiscale modelling methodology to predict the macroscale stiffness of selective laser sintered polycaprolactone (PCL)/ß-tricalcium phosphate (ß-TCP) materials is evaluated. The relationship between a micromechanics-evaluated composite material elastic modulus (E eff) and segment grey-value (GVave) is established for a 90/10 wt% PCL/ß-TCP material and compared to the previously established E eff vs. GVave relationship for a 50/50 wt% PCL/ß-TCP material. The increase in E eff with GVave was found to be greater for the 90/10 wt% material than for the 50/50 wt% material. Differences in the material microstructures are visible with greater local conglomerations of ß-TCP in the 90/10 wt% material compared to the 50/50 wt% material. These results indicate that the relationship between E eff and GVave is material-specific and that one definition cannot be used to describe both materials. We have used the E eff and GVave relationship specific to the 90/10 wt% material to assign element-specific elastic properties in a high resolution macroscale strut finite element model to successfully predict the experimentally-evaluated strut effective stiffness of the 90/10 wt%. These results combined indicate that this multiscale modelling methodology reasonably predicts the effective elastic modulus of selective laser sintering struts with different material configurations, and that it can be used to determine the material-specific definition of the relationship between E eff and GVave for a particular material.

Predicting the elastic properties of selective laser sintered PCL/ß-TCP bone scaffold materials using computational modelling.

This study assesses the ability of finite element (FE) models to capture the mechanical behaviour of sintered orthopaedic scaffold materials. Individual scaffold struts were fabricated from a 50:50 wt% poly-ε-caprolactone (PCL)/ß-tricalcium phosphate (ß-TCP) blend, using selective laser sintering. The tensile elastic modulus of single struts was determined experimentally. High resolution FE models of single struts were generated from micro-CT scans (28.8 µm resolution) and an effective strut elastic modulus was calculated from tensile loading simulations. Three material assignment methods were employed: (1) homogeneous PCL elastic constants, (2) composite PCL/ß-TCP elastic constants based on rule of mixtures, and (3) heterogeneous distribution of micromechanically-determined elastic constants. In comparison with experimental results, the use of homogeneous PCL properties gave a good estimate of strut modulus; however it is not sufficiently representative of the real material as it neglects the ß-TCP phase. The rule of mixtures method significantly overestimated strut modulus, while there was no significant difference between strut modulus evaluated using the micromechanically-determined elastic constants and experimentally evaluated strut modulus. These results indicate that the multi-scale approach of linking micromechanical modelling of the sintered scaffold material with macroscale modelling gives an accurate prediction of the mechanical behaviour of the sintered structure.

Laser sintering for the fabrication of tissue engineering scaffolds.

Laser sintering (LS) utilises a laser to sinter powder particles. A volumetric model is sliced and processed cross section by cross section to create a physical part. In theory, all powdered materials are suitable for sintering; however, only few have been tested successfully. For tissue engineering (TE) applications of this rapid prototyping technology it is an advantage that no toxic solvents or binders are necessary. This chapter reviews the direct and indirect use of LS to fabricate scaffolds for TE from single and multiphase materials.

Fabrication, mechanical and in vivo performance of polycaprolactone/tricalcium phosphate composite scaffolds.

This paper explores the use of selective laser sintering (SLS) for the generation of bone tissue engineering scaffolds from polycaprolactone (PCL) and PCL/tricalcium phosphate (TCP). Different scaffold designs are generated, and assessed from the point of view of manufacturability, porosity and mechanical performance. Large scaffold specimens are produced, with a preferred design, and are assessed through an in vivo study of the critical size bone defect in sheep tibia with subsequent microscopic, histological and mechanical evaluation. Further explorations are performed to generate scaffolds with increasing TCP content. Scaffold fabrication from PCL and PCL/TCP mixtures with up to 50 mass% TCP is shown to be possible. With increasing macroporosity the stiffness of the scaffolds is seen to drop; however, the stiffness can be increased by minor geometrical changes, such as the addition of a cage around the scaffold. In the animal study the selected scaffold for implantation did not perform as well as the TCP control in terms of new bone formation and the resulting mechanical performance of the defect area. A possible cause for this is presented.

Selective laser sintering of hydroxyapatite/poly-epsilon-caprolactone scaffolds.

Selective laser sintering (SLS) enables the fabrication of complex geometries with the intricate and controllable internal architecture required in the field of tissue engineering. In this study hydroxyapatite and poly-epsilon-caprolactone, considered suitable for hard tissue engineering purposes, were used in a weight ratio of 30:70. The quality of the fabricated parts is influenced by various process parameters. Among them Four parameters, namely laser fill power, outline laser power, scan spacing and part orientation, were identified as important. These parameters were investigated according to a central composite design and a model of the effects of these parameters on the accuracy and mechanical properties of the fabricated parts was developed. The dimensions of the fabricated parts were strongly dependent on the manufacturing direction and scan spacing. Repeatability analysis shows that the fabricated features can be well reproduced. However, there were deviations from the nominal dimensions, with the features being larger than those designed. The compressive modulus and yield strength of the fabricated microstructures with a designed relative density of 0.33 varied between 0.6 and 2.3 and 0.1 and 0.6 MPa, respectively. The mechanical behavior was strongly dependent on the manufacturing direction.