Clinical Application of Three-Dimensional Printing of Polycaprolactone/Beta-Tricalcium Phosphate Implants for Cranial Reconstruction

Abstract

Polycaprolactone (PCL) implants are a biodegradable polymeric material with appropriate mechanical strength and durability for use in cranioplasty. They can be manufactured as patient-customized implants using a three-dimensional (3D) printer. Herein, the authors aimed to share our experience in cranioplasty of patients with deformed and asymmetric skulls using PCL/beta-tricalcium phosphate (ß-TCP) implants.Seven patients underwent cranioplasty using patient-specific PCL/ß-TCP implants. Cranial computed tomography images were converted to a 3D model and mirrored to design a patientspecific implant. Based on the 3D simulation, an implant was 3D printed using PCL/ß-TCP. A 6-month follow-up was conducted with periodic visits and computed tomography scans. Symmetry after surgery and complications were evaluated.Postoperatively, the soft tissue volumes increased to 15.8 ± 17.2 cm 3 and 14.9 ± 15.7 cm 3 at 2 weeks and 6 months of follow-up, respectively. The volume change from 2 weeks to 6 months was -4.4 ± 2.5%. Six patients achieved complete symmetry after cranioplasty, whereas 1 patient noticed partial symmetry. The symmetry remained unchanged at 6 months of follow-up. Upon palpation to assess smoothness, 6 patients exhibited a smooth edge interface, whereas 1 patient had a slightly irregular edge.Based on these findings, 3D-printed PCL/ß-TCP implants are an excellent material for cranioplasty, and a favorable cosmetic outcome can be achieved. Specifically, these novel PCL/ß-TCP implants have good biocompatibility and mechanical strength without any postoperative foreign body reaction.

Mechanism and application of 3D-printed degradable bioceramic scaffolds for bone repair

“…Further evidence that the mechanical properties of PCL/β-TCP implants are adequate for cranioplasty is that cranial symmetry was attained immediately following surgery and that neither implant dislocation nor fracture was seen during postoperative follow-up. 200…”

3D printing for bone regeneration: challenges and opportunities for achieving predictability

“…Due to its biocompatibility and versatility, 3D-printed PCL scaffolds have already been used clinically for a variety of clinical indications in the craniofacial region. Although still in its infancy, PCL scaffolds have been used for calvarial or rhinoplasty contour restoration as an alternative to other inert implantable materials, 138,139 for cartilage regeneration 140 and bone regeneration.…”

Current Applications of Polycaprolactone as a Scaffold Material for Heart Regeneration

“…For example, during tooth extraction, 3D PCL scaffolds inserted into the tooth socket have allowed for improved alveolar ridge preservation and bone healing during clinical trials . Further, PCL scaffolds have been utilized for treatment of facial fracture to promote bone healing. − In one study, 3D-printed, patient-specific PCL scaffolds were fabricated for complex maxillary defects, , thus highlighting the advanced biofabrication that can leveraged with PCL. Cosmetically, PCL-based material has been utilized as a soft tissue filler in various applications such as correction of nasolabial folds, dorsal hand volume loss due to aging and facial lifting. , 3D PCL scaffolds have further been used in clinical rhinoplasty procedures, with 98.0% of patients showing no postoperative infection-related foreign body reaction or distinct abnormal reaction .…”

“…Further, PCL scaffolds have been utilized for treatment of facial fracture to promote bone healing. − In one study, 3D-printed, patient-specific PCL scaffolds were fabricated for complex maxillary defects, , thus highlighting the advanced biofabrication that can leveraged with PCL. Cosmetically, PCL-based material has been utilized as a soft tissue filler in various applications such as correction of nasolabial folds, dorsal hand volume loss due to aging and facial lifting. , 3D PCL scaffolds have further been used in clinical rhinoplasty procedures, with 98.0% of patients showing no postoperative infection-related foreign body reaction or distinct abnormal reaction . More relevant to cardiovascular applications and discussed further in the future directions section, is the application of PCL as a drug delivery system.…”

“…166,167 3D PCL scaffolds have further been used in clinical rhinoplasty procedures, with 98.0% of patients showing no postoperative infection-related foreign body reaction or distinct abnormal reaction. 163 More relevant to cardiovascular applications and discussed further in the future directions section, is the application of PCL as a drug delivery system. In clinical trials, PCL has been used as a drug delivery system for Doxycycline, 168 Tinidazole 169 and Minocycline 164 in periodontal infections.…”