In vitro engineering of human ear-shaped cartilage assisted with CAD/CAM technology

Due to the lack of appropriate scaffolds, the in vitro engineering of cartilage tissue with a sophisticated structure, such as a human ear, remains a great challenge. Although polyglycolic acid (PGA) has become one of the most successful scaffolds for cartilage regeneration, how to overcome its limitations in achieving desirable mechanical strength and accurate control over shape remains an unsolved problem. In this study, the mechanical strength of PGA scaffold was enhanced by coating with polylactic acid (PLA). The content of PLA was optimized by balancing the scaffold's biocompatibility and mechanical strength. The PLA/PGA scaffold was then fabricated into a human ear-shape mirror-symmetrical to a normal ear by pressing the scaffold in the ear negative molds, which were fabricated by the computer aided design and manufacturing (CAD/CAM) technique according to the CT scan data from the normal ear. The ear-shaped scaffold reached a similarity level of over 97% compared to the positive ear mold by the shape analysis using a 3D laser scan system. Most importantly, after chondrocyte seeding, the constructs largely retained the original shape during culture with a similarity level of over 84%. Furthermore, the constructs formed ear-shaped cartilage-like tissues at 12 weeks, which revealed a tissue structure with abundant cartilage extracellular matrices and mature lacuna. Additionally, the ear-shaped cartilage at 12 weeks also exhibited fine elasticity and good mechanical strength. These results may provide a useful strategy for reconstructing cartilage tissue with complicated shapes such as a human ear by an in vitro engineering approach.