Additive manufacturing enables personalised porous high-density polyethylene surgical implant manufacturing with improved tissue and vascular ingrowth

Paxton, Naomi; Dinoro, Jeremy; Ren, Jiongyu; Ross, Maureen T.; Daley, Ryan; Zhou, Renwu; Bazaka, Kateryna; Thompson, Robert G.; Yue, Zhilian; Beirne, Stephen; Harkin, Damien G.; Allenby, Mark C.; Wong, Cynthia S.; Wallace, Gordon G.; Woodruff, Maria A.

doi:10.1016/j.apmt.2021.100965

Cited by 10 publications

(8 citation statements)

References 64 publications

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“…MEW scaffolds are emerging in popularity for a wide range of tissue engineering applications, 16 and are routinely plasma treated or etched using sodium hydroxide (NaOH) to achieve improved hydrophilicity and enable cell attachment 12 . Meanwhile, porous high‐density polyethylene (pHDPE) scaffolds are the gold standard in commercial surgical implant biomaterials, particularly due to their porous structure enabling tissue ingrowth and ability to be sculpted and molded to conform to patient anatomy, or directly manufacturing into patient‐specific implants 7,17 …”

Section: Resultsmentioning

confidence: 99%

“…Many of these materials are designed to have rough surfaces which are known to improve cell attachment in some contexts, as well as porosity, which plays a vital role in enabling tissue ingrowth for implanted materials 6 . Furthermore, hydrophilicity is often highly desired, particularly for polymer biomaterials, to improve the ability to seed and attach cells to biomaterial surfaces 7 . Many physical and chemical treatment strategies have been proposed to induce hydrophilicity and the effects of such surface property modifications have been well‐studied 8 .…”

Section: Introductionmentioning

confidence: 99%

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Measuring contact angles on hydrophilic porous scaffolds by implementing a novel raised platform approach: A technical note

Paxton

Woodruff

2022

Polymers for Advanced Techs

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Contact angle (CA) analysis is a widely employed technique to assess the surface properties of solid samples, including in tissue engineering research where scaffolds are typically designed to be both porous and hydrophilic to enable cell and tissue infiltration. Paradoxically, the types of scaffolds that possess the most optimal hydrophilic surface properties for cell attachment are the most challenging surfaces to attain accurate CA measurements. Here, we propose the use of a small 3D printed platform to elevate samples above the CA measurement substrate and demonstrate reproducible and accurate CA measurements on a range of popular polymer scaffolds that had undergone 5 min plasma treatment to instigate hydrophilicity. Using four polycaprolactone or high-density polyethylene scaffolds with porosity ranging from 35.8%-93.1%, 0 CAs were reproducibly observed by measuring the CA while the scaffolds were elevated on the 3D printed platform, compared to the highly variable false-positive results when measuring the scaffolds while directly sitting on measurement substrates of various materials. This versatile, low-cost modification to CA hardware overcomes the challenges associated with measuring the surface properties of porous, hydrophilic scaffolds and provides a simple tool for tissue engineering researchers to perform CA measurements for any biomaterial scaffolds to ascertain hydrophilicity which is used to infer the suitability of scaffold surfaces for cell attachment.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Measuring contact angles on hydrophilic porous scaffolds by implementing a novel raised platform approach: A technical note

Paxton

Woodruff

2022

Polymers for Advanced Techs

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“…For example, the introduction of selenium or calcium sodium phosphosilicate nanoparticles into the StarPore® pHDPE scaffold promises optimised antimicrobial and bony integration properties of the material. Plasma treated StarPore® pHDPE particles have increased hydrophilicity, which improves cell attachment [ 27 ]. In addition, the advent of 3D-printed electronics expands the possibility of manufacturing sensors directly into patient-specific CMF implants for remote clinical monitoring.…”

Section: Discussionmentioning

confidence: 99%

Patient-specific implants for craniomaxillofacial surgery: A manufacturer's experience

Thayaparan

Lewis

Thompson³

et al. 2021

Annals of Medicine &Amp; Surgery

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Additive manufacturing technologies have enabled the development of customised implants for craniomaxillofacial applications using biomaterials such as polymethylmethacrylate (PMMA), porous high-density polyethylene (pHDPE), and titanium mesh. This study aims to report an Australian manufacturer's experience in developing, designing and supplying patient-specific craniomaxillofacial implants over 23 years and summarise feedback received from clinicians. The authors conducted a retrospective review of the manufacturer's implant database of orders placed for custom craniomaxillofacial implants between 1996 and 2019. The variables collected included material, country of order, gender, patient age, and reported complications, which included a measure of custom implant “fit” and adverse events. The development of critical checkpoints in the custom manufacturing process that minimise clinical or logistical non-conformities is highlighted and discussed. A total of 4120 patient-specific implants were supplied, of which 2689 were manufactured from PMMA, 885 from titanium mesh, and 546 from pHDPE. The majority of the implants were used in Australia (2260), United Kingdom (412), Germany (377), and New Zealand (338). PMMA was the preferred material for cranial implants whereas pHDPE was preferred for maxillofacial applications. Age or gender did not influence the material choice. Implant “fit” and adverse outcomes were used as a metric of implant performance. Between 2007 and 2019 there were 37 infections (0.98%) and 164 non-conformities recorded of which 75 (1.8%) were related to implant ‘fit’. Our experience demonstrates a safe, reliable, and clinically streamlined manufacturing process which supports surgeons that require bespoke craniomaxillofacial solutions for reconstruction surgery.

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“…They concluded that the discrepancies between mechanical properties were a result of limited necking of adjacent particles. A more recent study compared commercially available porous HDPE implants with SLS printed scaffolds in vivo [139]. They found that the SLS printed scaffolds demonstrated higher scaffold porosity compared to traditional moulding, and this supported good tissue integration after implantation.…”

Section: Polyethylenementioning

confidence: 99%

“…They found that the SLS printed scaffolds demonstrated higher scaffold porosity compared to traditional moulding, and this supported good tissue integration after implantation. Additionally, the functionalisation of the HDPE surface using plasma was also demonstrated to improve the formation of blood vessels within the implant, enabling more rapid tissue ingrowth and maturity [139]. Overall, although PE has been used sparingly in SLS systems, due the limitations mentioned, it has established uses in biomedicine, warranting further exploration within the BTE and AM landscapes.…”

Section: Polyethylenementioning

confidence: 99%

Laser Sintering Approaches for Bone Tissue Engineering

et al. 2022

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The adoption of additive manufacturing (AM) techniques into the medical space has revolutionised tissue engineering. Depending upon the tissue type, specific AM approaches are capable of closely matching the physical and biological tissue attributes, to guide tissue regeneration. For hard tissue such as bone, powder bed fusion (PBF) techniques have significant potential, as they are capable of fabricating materials that can match the mechanical requirements necessary to maintain bone functionality and support regeneration. This review focuses on the PBF techniques that utilize laser sintering for creating scaffolds for bone tissue engineering (BTE) applications. Optimal scaffold requirements are explained, ranging from material biocompatibility and bioactivity, to generating specific architectures to recapitulate the porosity, interconnectivity, and mechanical properties of native human bone. The main objective of the review is to outline the most common materials processed using PBF in the context of BTE; initially outlining the most common polymers, including polyamide, polycaprolactone, polyethylene, and polyetheretherketone. Subsequent sections investigate the use of metals and ceramics in similar systems for BTE applications. The last section explores how composite materials can be used. Within each material section, the benefits and shortcomings are outlined, including their mechanical and biological performance, as well as associated printing parameters. The framework provided can be applied to the development of new, novel materials or laser-based approaches to ultimately generate bone tissue analogues or for guiding bone regeneration.

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Additive manufacturing enables personalised porous high-density polyethylene surgical implant manufacturing with improved tissue and vascular ingrowth

Cited by 10 publications

References 64 publications

Measuring contact angles on hydrophilic porous scaffolds by implementing a novel raised platform approach: A technical note

Measuring contact angles on hydrophilic porous scaffolds by implementing a novel raised platform approach: A technical note

Patient-specific implants for craniomaxillofacial surgery: A manufacturer's experience

Laser Sintering Approaches for Bone Tissue Engineering

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