Mechanics Predicts Effective Critical-Size Bone Regeneration Using 3D-Printed Bioceramic Scaffolds.

BACKGROUND: 3D-printed bioceramic scaffolds have gained popularity due to their controlled microarchitecture and their proven biocompatibility. However, their high brittleness makes their surgical implementation complex for weight-bearing bone treatments. Thus, they would require difficult-to-instrument rigid internal fixations that limit a rigorous evaluation of the regeneration progress through the analysis of mechanic-structural parameters. METHODS: We investigated the compatibility of flexible fixations with fragile ceramic implants, and if mechanical monitoring techniques are applicable to bone tissue engineering applications. Tissue engineering experiments were performed on 8 ovine metatarsi. A 15 mm bone segment was directly replaced with a hydroxyapatite scaffold and stabilized by an instrumented Ilizarov-type external fixator. Several in vivo monitoring techniques were employed to assess the mechanical and structural progress of the tissue. RESULTS: The applied surgical protocol succeeded in combining external fixators and subject-specific bioceramic scaffolds without causing fatal fractures of the implant due to stress concentrator. The bearing capacity of the treated limb was initially altered, quantifying a 28-56% reduction of the ground reaction force, which gradually normalized during the consolidation phase. A faster recovery was reported in the bearing capacity, stiffening and bone mineral density of the callus. It acquired a predominant mechanical role over the fixator in the distribution of internal forces after one post-surgical month. CONCLUSION: The bioceramic scaffold significantly accelerated in vivo the bone formation compared to other traditional alternatives in the literature (e.g., distraction osteogenesis). In addition, the implemented assessment techniques allowed an accurate quantitative evaluation of the bone regeneration through mechanical and imaging parameters.

Robocasting and Laser Micromachining of Sol-Gel Derived 3D Silica/Gelatin/ß-TCP Scaffolds for Bone Tissue Regeneration.

The design and synthesis of sol-gel silica-based hybrid materials and composites offer significant benefits to obtain innovative biomaterials with controlled porosity at the nanostructure level for applications in bone tissue engineering. In this work, the combination of robocasting with sol-gel ink of suitable viscosity prepared by mixing tetraethoxysilane (TEOS), gelatin and ß-tricalcium phosphate (ß-TCP) allowed for the manufacture of 3D scaffolds consisting of a 3D square mesh of interpenetrating rods, with macropore size of 354.0 ± 17.0 µm, without the use of chemical additives at room temperature. The silica/gelatin/ß-TCP system underwent irreversible gelation, and the resulting gels were also used to fabricate different 3D structures by means of an alternative scaffolding method, involving high-resolution laser micromachining by laser ablation. By this way, 3D scaffolds made of 2 mm thick rectangular prisms presenting a parallel macropore system drilled through the whole thickness and consisting of laser micromachined holes of 350.8 ± 16.6-micrometer diameter, whose centers were spaced 1312.0 ± 23.0 µm, were created. Both sol-gel based 3D scaffold configurations combined compressive strength in the range of 2-3 MPa and the biocompatibility of the hybrid material. In addition, the observed Si, Ca and P biodegradation provided a suitable microenvironment with significant focal adhesion development, maturation and also enhanced in vitro cell growth. In conclusion, this work successfully confirmed the feasibility of both strategies for the fabrication of new sol-gel-based hybrid scaffolds with osteoconductive properties.

Effect of Polymer Infiltration on the Flexural Behavior of ß-Tricalcium Phosphate Robocast Scaffolds.

The influence of polymer infiltration on the flexural strength and toughness of ß-tricalcium phosphate (ß-TCP) scaffolds fabricated by robocasting (direct-write assembly) is analyzed. Porous structures consisting of a tetragonal three-dimensional lattice of interpenetrating rods were impregnated with biodegradable polymers (poly(lactic acid) (PLA) and poly(ε-caprolactone) (PCL)) by immersion of the structure in a polymer melt. Infiltration increased the flexural strength of these model scaffolds by a factor of 5 (PCL) or 22 (PLA), an enhancement considerably greater than that reported for compression strength of analogue materials. The greater strength improvement in bending was attributed to a more effective transfer of stress to the polymer under this solicitation since the degree of strengthening associated to the sealing of precursor flaws in the ceramic rod surfaces should remain unaltered. Impregnation with either polymer also improved further than in compression the fracture energy of the scaffolds (by more than two orders of magnitude). This increase is associated to the extraordinary strengthening provided by impregnation and to a crack bridging toughening mechanism produced by polymer fibrils.

Reinforcing bioceramic scaffolds with in situ synthesized ε-polycaprolactone coatings.

In situ ring-opening polymerization of ε-caprolactone (ε-CL) was performed to coat ß-tricalcium phosphate (ß-TCP) scaffolds fabricated by robocasting in order to enhance their mechanical performance while preserving the predesigned macropore architecture. Concentrated colloidal inks prepared from ß-TCP commercial powders were used to fabricate porous structures consisting of a three-dimensional mesh of interpenetrating rods. Then, ε-CL was in situ polymerized within the ceramic structure using a lipase as catalyst and toluene as solvent, to obtain a highly homogeneous coating and full impregnation of in-rod microporosity. The strength and toughness of scaffolds coated by ε-polycaprolactone (ε-PCL) were significantly increased (twofold and fivefold increase, respectively) over those of the bare structures. Enhancement of both properties is associated to the healing of preexisting microdefects in the bioceramic rods. These enhancements are compared to results from previous work on fully impregnated structures. The implications of the results for the optimization of the mechanical and biological performance of scaffolds for bone tissue engineering applications are discussed.

Impregnation of ß-tricalcium phosphate robocast scaffolds by in situ polymerization.

Ring-opening polymerization of ε-caprolactone (ε-CL) and L-lactide (LLA) was performed to impregnate ß-tricalcium phosphate (ß-TCP) scaffolds fabricated by robocasting. Concentrated colloidal inks prepared from ß-TCP commercial powders were used to fabricate porous structures consisting of a 3D mesh of interpenetrating rods. ε-CL and LLA were in situ polymerized within the ceramic structure by using a lipase and stannous octanoate, respectively, as catalysts. The results show that both the macropores inside the ceramic mesh and the micropores within the ceramic rods are full of polymer in either case. The mechanical properties of scaffolds impregnated by in situ polymerization (ISP) are significantly increased over those of the bare structures, exhibiting similar values than those obtained by other, more aggressive, impregnation methods such as melt-immersion (MI). ISP using enzymatic catalysts requires a reduced processing temperature which could facilitate the incorporation of growth factors and other drugs into the polymer composition, thus enhancing the bioactivity of the composite scaffold. The implications of these results for the optimization of the mechanical and biological performance of scaffolds for bone tissue engineering applications are discussed.

Improving the compressive strength of bioceramic robocast scaffolds by polymer infiltration.

The effect of polymer infiltration on the compressive strength of ß-tricalcium phosphate (TCP) scaffolds fabricated by robocasting (direct write assembly) is analyzed in this work. Porous structures consisting of a tetragonal three-dimensional mesh of interpenetrating rods were fabricated from concentrated TCP inks with suitable viscoelastic properties. Biodegradable polymers (polylactic acid (PLA) and poly(ε-caprolactone) (PCL)) were infiltrated into selected scaffolds by immersion of the structure in a polymer melt. Infiltration increased the uniaxial compressive strength of these model scaffolds by a factor of three (PCL) or six (PLA). It also considerably improved the mechanical integrity of the structures after initial cracking, with the infiltrated structure retaining a significant load-bearing capacity after fracture of the ceramic rods. The strength improvement in the infiltrated scaffolds was attributed to two different contributions: the sealing of precursor flaws in the ceramic rod surfaces and the partial transfer of stress to the polymer, as confirmed by finite element analysis. The implications of these results for the mechanical optimization of scaffolds for bone tissue engineering applications are discussed.