Table 9.

Applications of prostheses manufactured by electron beam melting (additive manufacturing).

Application	Result, modification, or treatment
Dental implants	The presence of an oxide layer, such as titanium dioxide (TiO2), on their surfaces favors osseointegration, specifically in endosseous dental implants (e.g., screws, rods, posts, and blades) [186].
Osteoblasts	Manufactured structures provide a way to initiate cell migration and impregnation of cells and tissues into the manufactured structure, thus leading to a regeneration of the mineralized extracellular matrix by differentiation of pre-osteoblasts [187], [188]. Regarding their potential use in orthopedic applications, osteoblast organization, as well as adhesion, spreading, and alignment to the geometries of the biomaterial struts, has been observed on the surfaces of EBM-manufactured samples [189]. There is a significant difference in cellular response depending on the pore size of manufactured structures [190]. For manufactured samples, an average surface roughness below 24.9 μm allows for an adequate cell proliferation, while an average surface roughness above 56.9 μm reduces the proliferation of human fetal osteoblasts [191]. Also, the presence of an oxide layer on the surface of samples enables the absorption of fibronectin, a protein that favors osteoblast adhesion and osseointegration [192]. Osteoblast organization, as well as adhesion, spreading, and alignment to the geometries of the biomaterial struts, has been identified within complex titanium surface geometries [189].
Bioactivity	The bioactivity of manufactured and modified samples has been improved via micro-arc oxidation/anodizing, which provides a multimodal surface roughness (nano-, micro-, and macro-scale roughness) [193]. By biologically modifying the surface of samples using bone morphogenic protein-2 and a decellularized extracellular matrix, the bioactivity of porous surfaces can be enhanced. This, in turn, increases the fixation of the implant to the bone surroundings, thus improving long-term stability [194], [195]. Chemically modifying the surface of samples using hydrogen chloride (HCl) and sodium hydroxide (NaOH) has also proven to increase surface bioactivity and bone fixation for a better long-term stability [23,196,197]
Bone defects in diabetic patients	An induced accumulation of induced oxygen species on porous titanium implants is a promising strategy for diabetic patients [198].
Osseointegration and vascularization	Manufactured implants have shown a good performance in favoring osseointegration and vascularization, leading to a living implant after six months of being incorporated [199].
Astragalus osteonecrosis treatment	Through in vivo tests, porous titanium alloy rods have proven to have good biocompatibility, as well as adequate mechanical properties, which makes them suitable to be used to treat early-stage osteonecrosis in this bone [200].
Cell adhesion and proliferation	Each build orientation (horizontal, vertical, and inclined) generates a different surface roughness, with this latter being higher in vertical and inclined orientations. This feature favors a greater vitality and proliferation of L929 cells in in vitro tests [201].