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Three-dimensional printing has opened up new perspectives in bone substitution, facilitating the production of customized scaffolds. The advances of the last few years have placed this technology at the forefront of personalized medicine and virtual surgical planning. This article presents an overview of additive manufacturing of bioceramics for bone regeneration, covering both the additive manufacturing methods and the consolidation strategies that can be applied. We highlight the main progress made in recent years, with an insight into drug delivery applications and the advances in the translation of this technology to the biomedical industry and the clinics. Furthermore, the main challenges and future trends of this new medical technology are identified and discussed., Peer Reviewed, Postprint (author's final draft)

Concave surfaces have shown to promote bone regeneration in vivo. However, bone scaffolds obtained by direct ink writing, one of the most promising approaches for the fabrication of personalized bone grafts, consist mostly of convex surfaces, since they are obtained by microextrusion of cylindrical strands. By modifying the geometry of the nozzle, it is possible to print 3D structures composed of non-cylindrical strands and favor the presence of concave surfaces. In this work, we compare the in vivo performance of 3D-printed calcium phosphate scaffolds with either conventional cylindrical strands or star-shaped strands, in a rabbit femoral condyle model. Monocortical defects, drilled in contralateral positions, are randomly grafted with the two scaffold configurations, with identical composition. The samples are explanted eight weeks post-surgery and assessed by µ-CT and resin-embedded histological observations. The results reveal that the scaffolds containing star-shaped strands have better osteoconductive properties, guiding the newly formed bone faster towards the core of the scaffolds, and enhance bone regeneration, although the increase is not statistically significant (p > 0.05). This new approach represents a turning point towards the optimization of pore shape in 3D-printed bone grafts, further boosting the possibilities that direct ink writing technology offers for patient-specific applications., Peer Reviewed, Postprint (published version)

Hydrothermal (H) processes accelerate the hydrolysis reaction of a-tricalcium phosphate (a-TCP) compared to the long-established biomimetic (B) treatments. They are of special interest for patient-specific 3D-printed bone graft substitutes, where the manufacturing time represents a critical constraint. Altering the reaction conditions has implications for the physicochemical properties of the reaction product. However, the impact of the changes produced by the hydrothermal reaction on the in vivo performance was hitherto unknown. The present study compares the bone regeneration potential of 3D-printed a-TCP scaffolds hardened using these two treatments in rabbit condyle monocortical defects. Although both consolidation processes resulted in biocompatible scaffolds with osseointegrative and osteoconductive properties, the amount of newly formed bone increased by one third in the hydrothermal vs the biomimetic samples. B and H scaffolds consisted mostly of high specific surface area calcium-deficient hydroxyapatite (38 and 27 m2 g-1, respectively), with H samples containing also 10 wt.% ß-tricalcium phosphate (ß-TCP). The shrinkage produced during the consolidation process was shown to be very small in both cases, below 3%, and smaller for H than for B samples. The differences in the in vivo performance were mainly attributed to the distinct crystallisation nanostructures, which proved to have a major impact on permeability and protein adsorption capacity, using BSA as a model protein, with B samples being highly impermeable. Given the crucial role that soluble proteins play in osteogenesis, this is proposed to be a relevant factor behind the distinct in vivo performances observed for the two materials. Statement of significance The possibility to accelerate the consolidation of self-setting calcium phosphate inks through hydrothermal treatments has aroused great interest due to the associated advantages for the development of 3D-printed personalised bone scaffolds. U, Peer Reviewed, Postprint (published version)

Conventional direct ink writing uses circular nozzles and, therefore, results in cylindrical strands. 3D printing with non-circular nozzles adds new degrees of freedom to this versatile technology, and allows obtaining structures with higher specific surface area or even introducing concave surfaces in the printed architecture. This is an enticing prospect for countless applications, including tissue engineering, chemical reaction catalysts, water evaporators and electrochemical energy storage devices. Despite this, it has been hardly explored by the 3D-printing community. Herein, we develop for the first time 3D printed structures with complex filament section morphologies using a custom-made modular nozzle and a self-setting ceramic ink. The fast elastic recovery of the ink allows obtaining good shape fidelity in the printed filaments, permitting the creation of intricate surfaces with up to 30% concavity and increasing up to 2.5 times the specific surface area compared to cylindrical strands. The use of non-circular nozzles introduces some specific constraints in the printing process. The geometry of the nozzle determines the stable printing directions, and nozzle orientation becomes a critical parameter to achieve a stable printing. Strand torsion, a phenomenon that remains unnoticed with circular nozzles, may result in relevant changes in the geometrical features of the printed structures., Peer Reviewed, Postprint (published version)