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Material choice for bone reconstruction

Biomaterials, titanium or polymers?

A wide range of metal-, plastic- and biomaterials are used to repair and replace damaged bone today. However, no type of bone graft is currently able to meet all clinical needs, and the question of which material is most suitable for bone reconstruction remains controversial.

The ideal bone graft is biocompatible, bioactive, osteoinductive, and biodegradable or bioresorbable. Furthermore, it must possess a highly interconnected porous architecture, comprising both macro- and micropores, to allow for cellularization and vascularization throughout the bone graft. Meanwhile, certain mechanical strength and stiffness are necessary, requiring some level of density. This poses an important challenge, requiring a compromise between porosity and mechanical strength (1).

Biomaterials for biomedical applications

​Biomaterials ― which may be natural or synthetic ― are often biodegradable, and some are bioabsorbable, meaning that they are gradually degraded or reabsorbed by the body after fulfilling a function. For example, such a function could be to support, enhance or replace damaged tissue or a biological function in the body.

In consequence, biomaterials are widely used as biocompatible, temporary scaffolds that promote the formation of new bone by allowing for the migration, proliferation, and differentiation of cells.

Biomaterials are recognized to have several advantages over non-degradable bone implants in reconstructive surgery. Namely, as they possess the desired native qualities of bone, and have a lesser risk of graft migration, infection, and inflammation.

Bioceramics

Bioceramics promote rapid bone formation on their surface (2). Great efficacy for osteogenesis
Calcium phosphate bioceramics represent the majority of inorganic scaffolds (2).

Brittle

The resorbable bone implant P3D Bone is made from the biomaterial ß-tricalcium phosphate (ß-TCP), belonging to the bioceramic segment which also includes hydroxyapatite, α-TCP, and biphasic calcium phosphates among others.

β-TCP is the major mineral of the intercellular composite of human bones and has been used clinically for reconstructing and filling bony defects in orthopedic surgery and dentistry for 30 years. Now, by 3D printing the bioceramic material, Ossiform creates implants that are far less dense than usual and not only replace damaged bone, but encourage new bone to grow back.

The β-TCP material demonstrates favorable biocompatibility, osteoconduction with a rapid formation of new vascularized bone, and a simultaneous and balanced biodegradability.
As new bone marrow and blood vessels develop inside the implant, it gradually remodels into the patient’s own living bone.

Although bioceramics represent the preferred material type for bone reconstruction ― of which β-TCP is the most commonly used degradable bone graft - implant manufacturers widely use non-biodegradable materials such as titanium, polymers, or bioceramic-polymer mixes.​

Biopolymers

​Synthetic polymer grafts have been developed with a view to better control mechanical properties of the scaffold. These include poly (ε-caprolactone) (PCL), polylactic acid (PLA), polyglycolide (PGA), poly (lactide-co-glycolide) (PLGA), poly(propylene fumarate) (PPF) and polyhydroxyalkanoates (PHA).

The most commonly used synthetic polymers are PCL, PLA, PGA, and PLGA as they are both mechanically stable and resorbable. However, their degradation products are often acidic which causes undesirable changes in pH and negatively affects bone development (2).

Foreign body materials with high loading tolerances

Manufactured implants, particularly those that are patient specific, are often made from titanium which is non-degradable or synthetic polymer materials that exhibit slow degradation rates. These are foreign body materials that don’t behave like organic matter like biomaterials, and are associated with high complication rates, namely infection. Unlike biomaterial-based implants that support strong bone ingrowth, implants made from plastic or metal are permanent. However, they demonstrate favorable load-bearing properties that are required for some bone implants where the stability of the bone is affected.

One of the most widely used synthetic materials, polyetheretherketone (PEEK), has the favorable properties of being biocompatible, resistant to thermal and ionizing radiation, and resembles cortical bone biomechanically. Additionally, it is suitable for load-bearing implants in reconstructive surgeries. In consequence, PEEK has proved useful in complex reconstructions of maxillofacial and cranial defects.

​Meanwhile, titanium is the most widely used material for patient specific bone implants, especially in orthopedic surgery. Titanium provides great mechanical properties with a compressive strength that is required for load-bearing indications, for example in the knee or hip. This adds another level of safety in terms of stability with which biomaterials cannot compete.

Particularly, for bone repair in lower limp orthopedic surgery, the loading tolerance of the material is of vital importance, therefore favoring titanium. If bioceramics were to be used in such indications where the stability of the bone is affected, a titanium plate would likely need to be added. On the other hand, when in non-load bearing indications, the compressive strength of bioceramics is satisfactory, and the degradable biomaterials prove to be safer and better than foreign body materials on several parameters.

If you have any questions, please email info@ossiform.com.

References​

1. ​Canillas, Maria, et al. "Calcium phosphates for biomedical applications."​Boletín de la Sociedad Española de Cerámica y Vidrio​56.3 (2017): 91-112.

2. Thrivikraman, Greeshma, et al. "Biomaterials for craniofacial bone regeneration."​Dental Clinics ​61.4 (2017): 835-856.

Our mission is your benefits

Our mission is to provide 3D printed natural bone implants to reduce complications, improve functional & aesthetic outcomes, and obtain faster recovery.

Natural bone porosity, optimized for bone regeneration 

The unique structure of the P3D Bone is designed to facilitate the natural forming of new bone.

Remodels into real living bone

The natural material and structure ensure effective remodeling of the implant into new vascularized bone.

Patient specific - designed with the patient's uniqueness in mind

The P3D Bone is 3D printed to enable a full restoration of the functionality and appearance of bones.

Resorbable material with structural support

P3D Bone eliminates the need to harvest bone as well as the need for permanent and ill-fitting implants.

P3D Bone Void Filler is expected to launch in 2023

Our first 3D printed, resorbable P3D Bone with modifiable dimensions and a lifelike bone architecture

P3D Bone Patient Specific Implant is expected to launch in 2024

Our patient specific and resorbable P3D Bone based on the patient’s own CT/MRI scan data

We Print Bone​™

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Ossiform ApS - We Print Bone™

​Oslogade 1, 5000 Odense C​, Denmark

CVR. 38838512

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