Calcium phosphates (CaPs) are the most widely used bone substitutes in bone tissue engineering due to their compositional similarities to bone mineral and excellent biocompatibility. In recent years, CaPs, especially hydroxyapatite and tricalcium phosphate, have attracted significant interest in simultaneous use as bone substitute and drug delivery vehicle, adding a new dimension to their application. CaPs are more biocompatible than many other ceramic and inorganic nanoparticles. Their biocompatibility and variable stoichiometry, thus surface charge density, functionality, and dissolution properties, make them suitable for both drug and growth factor delivery. CaP matrices and scaffolds have been reported to act as delivery vehicles for growth factors and drugs in bone tissue engineering. Local drug delivery in musculoskeletal disorder treatments can address some of the critical issues more effectively and efficiently than the systemic delivery. CaPs are used as coatings on metallic implants, CaP cements, and custom designed scaffolds to treat musculoskeletal disorders. This review highlights some of the current drug and growth factor delivery approaches and critical issues using CaP particles, coatings, cements, and scaffolds towards orthopedic and dental applications.

The general trends in synthetic bone grafting materials are shifting towards approaches that can illicit osteoinductive properties. Pharmacologics and biologics have been used in combination with calcium phosphate (CaP) ceramics, however, recently have become the target of scrutiny over the safety. The importance of trace elements in natural bone health is well documented. Ions, e.g. lithium, zinc, magnesium, manganese, silicon, strontium etc. have shown to increase osteogenesis and neovascularization. Incorporation of dopants into CaPs can provide a platform for safe and efficient delivery in clinical applications where increased bone healing is favorable. This review highlights use of trace elements in CaP biomaterials, and offers an insight into the mechanisms of how metal ions can enhance both osteogenesis and angiogenesis.

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We report here the fabrication of three dimensional (3D) interconnected macro porous tricalcium phosphate (TCP) scaffolds with controlled internal architecture by direct 3D printing (3DP), and high mechanical strength by microwave sintering. TCP scaffolds with 27%, 35% and 41% designed macro porosity having pore sizes of 500 μm, 750 μm, and 1000 μm, respectively, have been fabricated via direct 3DP. These scaffolds are then sintered at 1150 °C and 1250 °C in conventional electric muffle furnace as well as microwave furnace. Total open porosity between 42% and 63% is obtained in the sintered scaffolds due to the presence of intrinsic micro pores along with the designed pores. A significant increase in compressive strength, between 46% and 69%, is achieved by microwave sintering as compared to conventional sintering as a result of efficient densification. A maximum compressive strength of 10.95 ± 1.28 MPa and 6.62 ± 0.67 MPa is achieved for scaffolds with 500 μm designed pores (~400 μm after sintering) sintered in microwave and conventional furnaces, respectively. An increase in cell density with a decrease in macro pore size is observed during in vitro cell-material interactions using human osteoblast cells. Histomorphological analysis reveals that the presence of both micro and macro pores facilitated osteoid like new bone formation when tested in the femoral defect on Sprague-Dawley rats. Our results show that bioresorbable 3D printed TCP scaffolds have great potential in tissue engineering applications for bone tissue repair and regeneration.

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The aim of this work is to evaluate the influence of MgO, SrO and SiO2 doping on mechanical and biological properties of β-tricalcium phosphate (β-TCP) to achieve controlled resorption kinetics of β-TCP system for maxillofacial and spinal fusion application. We prepared dense TCP compacts of four different compositions, i) pure β-TCP, ii) β-TCP with 1.0 wt. % MgO + 1.0 wt. % SrO, iii) β-TCP with 1.0 wt. % SrO + 0.5 wt. % SiO2, and iv) β-TCP with 1.0 wt. % MgO + 1.0 wt. % SrO + 0.5 wt. % SiO2, by uniaxial pressing and sintering at 1250 °C. β phase stability is observed at 1250 °C sintering temperature due to MgO doping in β-TCP. In vitro mineralization in simulated body fluid (SBF) for 16 weeks shows excellent apatite growth on undoped and doped samples. Strength degradation of TCP samples in SBF is significantly influenced by both dopant chemistry and amount of dopant. Compressive strengths for all samples show degradation in SBF over the 16 week time period with varying degradation kinetics. MgO/SrO/SiO2 doped sample shows no strength loss, while undoped TCP shows the maximum strength loss from 419 ±28 MPa to 158 ±28 MPa over the 16 week study. In case of MgO/SrO doped TCP, strength loss is slow and gradual. TCP doped with 1.0 wt. % MgO and 1.0 wt. % SrO shows excellent in vivo biocompatibility when tested in male Sprague-Dawley rats for 16 weeks. Histomorphology analysis reveals that MgO/SrO doped TCP promoted osteogenesis by excellent early stage bone remodeling as compared to undoped TCP.

The presence of interconnected macro pores is important in tissue engineering scaffolds for guided tissue regeneration. This study reports in vivo biological performance of interconnected macro porous tricalcium phosphate (TCP) scaffolds due to the addition of SrO and MgO as dopants in TCP. We have used direct three dimensional printing (3DP) technology for scaffold fabrication followed by microwave sintering. Mechanical strength was evaluated by scaffolds with 500 µm, 750 µm, and 1000 µm interconnected designed pore sizes. Maximum compressive strength of 12.01 ± 1.56 MPa was achieved for 500 µm interconnected designed pore size Sr-Mg doped scaffold. In vivo biological performance of the microwave sintered pure TCP and Sr-Mg doped TCP scaffolds was assessed by implanting 350 µm designed interconnected macro porous scaffolds in rat distal femoral defect. Sintered pore size of these 3D printed scaffolds were 311 ± 5.9 µm and 245 ± 7.5 µm for pure and SrO-MgO doped TCP scaffolds, respectively. These 3D printed scaffolds possessed multiscale porosity, i.e., 3D interconnected designed macro pores along with intrinsic micro pores. Histomorphology and histomorphometric analysis revealed a significant increase in osteoid like new bone formation, and accelerated mineralization inside SrO and MgO doped 3D printed TCP scaffolds as compared to pure TCP scaffolds. An increase in osteocalcin and type I collagen level was also observed in rat blood serum with SrO and MgO doped TCP scaffolds compared to pure TCP scaffolds. Our results show that these 3D printed SrO and MgO doped TCP scaffolds with multiscale porosity contributed to early healing through accelerated osteogenesis.

Three dimensional (3D) printing has emerged as an efficient tool for tissue engineering and regenerative medicine, given its advantages for constructing custom-designed scaffolds with tunable microstructure/physical properties. Here we developed a micro-precise spatiotemporal delivery system embedded in 3D printed scaffolds. PLGA microspheres (μS) were encapsulated with growth factors (GFs) and then embedded inside PCL microfibers that constitute custom-designed 3D scaffolds. Given the substantial difference in the melting points between PLGA and PCL and their low heat conductivity, μS were able to maintain its original structure while protecting GF's bioactivities. Micro-precise spatial control of multiple GFs was achieved by interchanging dispensing cartridges during a single printing process. Spatially controlled delivery of GFs, with a prolonged release, guided formation of multi-tissue interfaces from bone marrow derived mesenchymal stem/progenitor cells (MSCs). To investigate efficacy of the micro-precise delivery system embedded in 3D printed scaffold, temporomandibular joint (TMJ) disc scaffolds were fabricated with micro-precise spatiotemporal delivery of CTGF and TGFβ3, mimicking native-like multiphase fibrocartilage. In vitro, TMJ disc scaffolds spatially embedded with CTGF/TGFβ3-μS resulted in formation of multiphase fibrocartilaginous tissues from MSCs. In vivo, TMJ disc perforation was performed in rabbits, followed by implantation of CTGF/TGFβ3-μS-embedded scaffolds. After 4 wks, CTGF/TGFβ3-μS embedded scaffolds significantly improved healing of the perforated TMJ disc as compared to the degenerated TMJ disc in the control group with scaffold embedded with empty μS. In addition, CTGF/TGFβ3-μS embedded scaffolds significantly prevented arthritic changes on TMJ condyles. In conclusion, our micro-precise spatiotemporal delivery system embedded in 3D printing may serve as an efficient tool to regenerate complex and inhomogeneous tissues.