3D Printed Composite Scaffolds in Bone Tissue Engineering: A Systematic Review

Objective: This study aimed to analyze the effect of fabrication factors on both biological and physico-chemical features of 3-dimensional (3D) printed composite scaffolds. Method: Electronic search was done according to the PRISMA guideline in PubMed and Scopus databases limited to English articles published until May 2021. Studies in which composite scaffolds were fabricated through computer-aided design and computer-aided manufacturing (CAD-CAM)-based methods were included. Articles regarding the features of the scaffolds fabricated through indirect techniques were excluded. Results: Full text of 121 studies were reviewed, and 69 met the inclusion criteria. According to analyzed studies, PCL and HA were the most commonly used polymer and ceramic, respectively. Besides, the solvent -based technique was the most commonly used composition technique. which enabled preparing blends with high concentrations of ceramic materials. The most common fabrication method used in the included studies was Fused Deposition Modeling (FDM). The addition of bio-ceramics enhanced the mechanical features and the biological behaviors of the printed scaffolds in a ratio-dependent manner. However, studies that analyzed the effect of irk ceramic weight ratio showed that scaffolds with the highest ceramic content did not necessarily possess the optimal biological and non-biological features, Conclusion: The biological and physico-chemical behaviors of the scaffold can be affected by pre-printing factors, including utilized materials, composition techniques. and fabrication methods. Fabricating scaffolds with high mineral content as of the natural bone may not provide the optimal condition for hone formation, Therefore, it is recommended that future studies compare the efficiency of different kinds of biomaterials rather than different weight ratios of one type.