Enhancing the mechanical performance of 3D-printed self-hardening calcium phosphate bone scaffolds: PLGA-based strategies

Over the last decade, 3D-printed porous calcium phosphates have emerged in the market for customized bone reconstruction. However, despite their excellent biological properties, the inherent brittleness is an obstacle that limits their clinical applications, as the scaffolds must withstand the surgical procedures and the mechanical stresses once implanted. Low-temperature self-hardening calcium phosphate inks offer unique possibilities to be reinforced with polymers, as they do not require high-temperature treatments. This study compares two routes for incorporating poly (lactic-co-glycolic acid) (PLGA) into 3D-printed calcium phosphate scaffolds: i) the use of a PLGA solution as a binder in an alpha-tricalcium phosphate self-hardening ink; ii) the infiltration of a PLGA solution into previously hardened 3D-printed calcium-deficient hydroxyapatite scaffolds. The influence of the added PLGA on the physical-chemical properties, mechanical performance and in vitro biological properties is assessed using a commercially available biomimetic calcium phosphate scaffold as a control. The addition of PLGA increases the plastic deformation capacity and the strength, both in compression and bending, and significantly improves the work of fracture of the scaffolds, up to an 8-fold in compression when PLGA is incorporated as a binder in the ink. Moreover, screwability tests demonstrate the enhanced fixability of the composite scaffolds in a knife-edge ridge indication with challenging fixation in the jaw. Importantly, the improvement of the mechanical properties by the addition of PLGA does not impair the good cytocompatibility of the material. Regarding the two routes studied, the PLGA incorporation in the ink is the best option in terms of overall improvement of the mechanical performance and osteogenic cell response.