Tissue engineering (TE) is a branch of regenerative medicine with enormous potential to regenerate damaged tissues using synthetic grafts such as scaffolds. Polymers and bioactive glasses (BGs) are popular materials for scaffold production because of their tunable properties and ability to interact with the body for effective tissue regeneration. Due to their composition and amorphous structure, BGs possess a significant affinity with the recipient’s tissue. Additive manufacturing (AM), a method that allows the creation of complex shapes and internal structures, is a promising approach for scaffold production. However, despite the promising results obtained so far, several challenges remain in the field of TE. One critical area for improvement is tailoring the mechanical properties of scaffolds to meet specific tissue requirements. In addition, achieving improved cell viability and controlled degradation of scaffolds is necessary to ensure successful tissue regeneration. This review provides a critical summary of the potential and limitations of polymer/BG scaffold production via AM covering extrusion-, lithography-, and laser-based 3D-printing techniques. The review highlights the importance of addressing the current challenges in TE to develop effective and reliable strategies for tissue regeneration.

Biomaterials can be defined as materials that interact positively with living tissues, restoring compromised functions, or enhancing tissue regeneration. Currently, biomaterial research often relies on a “trial-and-error method”, involving numerous experiments driven largely by experience. This strategy leads to a substantial waste of resources, such as manpower, time, materials, and finances. Optimizing the process is therefore essential. A recent and promising approach to this challenge involves artificial intelligence (AI), as demonstrated by the growing number of studies in this field. AI algorithms rely on data and empower computers with decision-making capabilities, mimicking aspects of the human mind and solving complex tasks with little to no human intervention. Due to their potential, AI and its derivatives are now widely used both in everyday life and in scientific research. In biomaterials science, AI models enable data analysis, pattern recognition, and property prediction. The aim of this review article is to highlight the key results achieved through the application of AI in the field of polymers for biomedical applications and, more broadly, in the development of advanced biomaterials. An overview will be provided on how an AI algorithm works, the differences between traditional programming and AI-based approaches, and their main limitations. Finally, the core topic will be addressed by categorizing biomaterials according to material class.

Background: Ceramic bearings are used in total hip arthroplasty due to their excellent wear behaviour and biocompatibility. The major concern related to their use is material brittleness, which significantly impacts on the risk of fracture of ceramic components. Fracture toughness improvement has contributed to the decrease in fracture rate, at least of the prosthetic head. However, the root cause behind these rare events is not fully understood. This study evaluated head fracture occurrence in a sizeable cohort of patients with fourth-generation ceramic-on-ceramic implants and described the circumstances reported by patients in the rare cases of head fracture. Methods: The clinical survivorship of 29,495 hip prostheses, with fourth-generation ceramic bearings, was determined using data from a joint replacement registry. The average follow-up period was 5.2 years (range 0.1–15.6). Retrieval analysis was performed in one case for which the ceramic components were available. Results: Clinical outcomes confirmed the extremely low fracture rate of fourth-generation ceramic heads: only two out of 29,495 heads fractured. The two fractures, both involving 36 mm heads, occurred without a concurrent or previous remarkable trauma. Considering the feature of the fractured head, a multi-stage crack growth mechanism has been hypothesized to occur following damage at the head–neck taper interface. Conclusions: Surgeons must continue to pay attention to the assembly of the femoral head: achieving a proper head seating on a clean taper is a prerequisite to decrease the risk of occurrence of any damage process within head–neck junction, which may cause high stress concentration at the contact surface, promoting crack nucleation and propagation even in toughened ceramics.

The development of new bioactive glasses (BGs) with enhanced bioactivity and improved resistance to crystallization is crucial for overcoming the main challenges faced by commercial BGs. Most shaping processes require thermal treatments, which can induce partial crystallization, negatively impacting the biological and mechanical properties of the final product. In this study, we present a novel bioactive glass composition, S53P4_MSK, produced by a melt–quench route. This novel composition includes magnesium and strontium, known for their therapeutic effects, and potassium, recognized for improving the thermal properties of bioactive glasses. The thermal properties were investigated through differential thermal analysis, heating microscopy and sintering tests from 600 °C to 900 °C. These characterizations, combined with X-ray diffraction analysis, demonstrated the high sinterability without crystallization of S53P4_MSK, effectively mitigating related issues. The mechanical properties—elastic modulus, hardness and fracture toughness—were evaluated on the sintered sample by micro-indentation, showing high elastic modulus and hardness. The bioactivity of the novel BG was assessed following Kokubo’s protocol and confirmed by scanning electron microscopy, X-ray energy dispersive spectroscopy, and Raman spectroscopy. The novel bioactive glass composition has shown high sinterability without crystallization at 700 °C, along with good mechanical properties and bioactivity.

Ti6Al4V titanium alloy (Ti-alloy) sleeved ceramic heads have become widely used in revision surgery when the hip stem is left in situ. This solution guarantees a new junction between the bore of the ceramic head and the Ti-alloy sleeve, regardless of any possible, slight surface damage to the Ti-alloy taper of the stem. However, this solution introduces an additional Ti-alloy/Ti-alloy interface pairing, which is potentially susceptible to mechanically assisted crevice corrosion. This study evaluated both qualitatively and quantitatively the damage that occurred in vivo on Ti-alloy micro-grooved 12/14 tapers of (i) primary implants with non-sleeved ceramic heads (Group 1), (ii) secondary implants with non-sleeved ceramic heads (Group 2), and (iii) secondary implants with sleeved ceramic heads (Group 3). A total of 45 explants—15 for each group, including short-, medium- and long-neck heads—underwent optical evaluation for surface damage (Goldberg scoring), surface roughness analysis, and SEM/EDX analysis. The Goldberg scores did not reveal different patterns in the tapers’ surface damage; surface damage was classified as absent or mild (surface damage score ≤2) in 94%, another 94%, and 92% of the analysed regions for Group 1, Group 2, and Group 3, respectively. Small but significant differences in morphological changes occurred in the tapers of the three groups: reductions no greater than a few percentage points in median values of roughness parameters were found in Group 1 and Group 2, while negligible changes were found in Group 3. SEM/EDX analysis revealed little (i.e., a slight increase in the oxygen content) to undetectable changes in the chemical composition on the Ti-alloy surface independently of the group. These results suggest that the Ti-alloy/Ti-alloy sleeve/taper junction is only mildly susceptible to mechanically assisted crevice corrosion. Assembling a sleeved ceramic head, with variable neck lengths up to a “long-neck”, to a Ti-alloy micro-grooved 12/14 taper of a stem left in situ does not seem to increase the risk of revision due to trunnionosis, as long as junction stability (i.e., the proper seating of the sleeved ceramic head on the 12/14 taper) is achieved intraoperatively.