Engineered Regeneration 3 (2022) 41–52

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Engineered Regeneration
journal homepage: http://www.keaipublishing.com/en/journals/engineered-regeneration/

3D Printing of Ceramic Biomaterials

Michael Ly, Sarah Spinelli, Shayne Hays, Donghui Zhu∗
Department of Biomedical Engineering, Stony Brook University, 100 Nicolls Rd, Stony Brook, NY 11794, United States

a r t i c l e i n f o a b s t r a c t

Keywords: Bioceramics are a popular class of materials used in biomedical applications due to their mechanical stability and
Extrusion biocompatibility. They exist in a variety of fields including hip joints for orthopedics, tooth fillings for dentistry,
Binder jetting and scaffolds for tissue engineering; however, the standard processes currently used to manufacture these ce-
Material jetting
ramic products can be time-consuming and costly. In response, current literature alternatively proposes additive
Powder bed fusion
manufacturing (3D printing) strategies to fabricate bioceramic materials in a cost-effective and efficient man-
Vat photopolymerization
ner. Herein, we briefly cover five common processes and materials used in additive manufacturing bioceramics:
fused deposition modeling, material jetting, binder jetting, powder bed fusion, and vat photopolymerization. Fur-
thermore, we discuss the potential of these 3D printed ceramic structures when applied to different biomedical
technologies such as bone tissue scaffolds and structural implants.

1. Introduction
The emergence of bioceramic materials leads to exciting and innova-
tive applications within biomedical engineering. Standard ceramic ma-
terials are hard, brittle, wear resistant, and corrosion resistant, which
all explain their orthopedic potential as medical implants like hip joint
prostheses [1]. Bioceramics are a subclass of ceramics developed in the
1970s. In addition to existing ceramic mechanical properties, bioce-
ramics include excellent biocompatibility and bioactivity potential [2].
Therefore, these biomaterials are also used in countless dental implants,
bone grafts, and scaffolds (see Fig. 1) to promote osteogenesis in the tis-
sue engineering field [3].
Three commonly used bioceramics include alumina, zirconia, and
hydroxyapatite. Alumina and zirconia are high density materials with
great mechanical strength and corrosion resistance; albeit previous lit-
erature suggests zirconia is slightly weaker than alumina against cor-
rosion. The two are also biocompatible and bioinert, which may serve
hip and knee replacement parts. As a body implant, they may supply
structural support preventing stress shielding and avoid adverse tissue
reactions to ion toxicity from metallic stents or prostheses. The third
bioceramic, hydroxyapatite, is a calcium phosphate bioceramic, which
is a primary mineral component of teeth and bone. Hydroxyapatite is
known for its ability to interconnect with neighboring tissues and re-
pair damaged cells. It is both bioactive and bioresorbable, which means
osteogenesis will end with the material’s eventual dissolution in the
body. Hydroxyapatite is brittle and used for implant coating since they
have a low load bearing resistance. For instance, coatings for metallic
biomedical devices like hip prosthetics and titanium tooth root pegs pro-
vide biocompatibility and bone repair attributes that metal devices lack
[5,6]. Structurally, ceramic morphology exists in crystalline or semi-
crystalline form, although there are exceptions depending on composi-
tion and fabrication method. Examples include certain amorphous ce-
ramics like bioactive glasses [3].
The growing demand for bioceramic devices and parts requires faster
and more accurate methods for creating ceramics. Subtractive manufac-
turing technology is common albeit imperfect. Most methods for creat-
ing ceramic scaffolds, by using polymer molds or foaming agents, are
created using subtractive methods. These methods unintendedly create
the pores in the scaffold randomly, and therefore cannot provide the
same amount of control [7]. For other applications like orthopedics, a
computerized numerical control machine may subtract unwanted parts
of a material and leave only the desired shape. The subtracted material
may then fabricate other smaller components or is disposed of waste-
fully. The assembly of all these components produce a complete object.
The advent of cost-effective additive manufacturing (AM) resolves these
issues; 3D printers may construct complex objects in less parts with less
wastage [8]. In 2018, General Electric followed an AM approach to re-
duce 855 car engine parts to only 12 parts. The simplification reduced
engine weight by over 100 pounds and significantly improved fuel use
by 20% [9]. While subtractive techniques are standardized, newer ad-
ditive manufacturing (AM) strategies may provide a higher degree of
dimensional accuracy and precision for bioceramic fabrication under
shorter times. A general comparison between additive and subtractive
processes is shown in Fig. 2.
AM, or simply 3D printing, is renowned for its ability to create highly
customizable structures from diverse materials. In essence, a 3D printer
receives a computer-aided design (CAD) model for its compatible slicer

∗
Corresponding author.
E-mail address: Donghui.Zhu@stonybrook.edu (D. Zhu).

https://doi.org/10.1016/j.engreg.2022.01.006
Received 22 December 2021; Received in revised form 21 January 2022; Accepted 21 January 2022
Available online 29 January 2022
2666-1381/© 2022 The Authors. Publishing Services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd. This is an open access article under the CC
BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
M. Ly, S. Spinelli, S. Hays et al.
Fig. 1. Grand overview of potential 3D-printed ceramic scaffold applications in fields like tissue engineering and drug delivery. (Reprinted, with permission, from
[4].
Fig. 2. Additive manufacturing sequentially adds layers until the entire print is
formed. Subtractive manufacturing begins with a starting shape that is modified
until the desired form is made. Both methods may create the same end shape.
software. Slicer programs, as in Fig. 3, provide further customization of
print parameters such as infill, temperature, and print speed. They con-
trol the overall print quality of the drawn object’s shape layer by layer
[10]. These shapes may be intricate and application-specific; however,
AM needs no molds or machining for complex construction of models
like scaffolds. Furthermore, AM is not limited only to plastic materials.
Present-day 3D printing technology incorporates alternative materials
including bioinks and of course, ceramics. This expansion elicits more
research strategies to effectively print materials for each application [8].
The AM of ceramics can be extremely useful, as it allows for more
standardized and precise control over creating intricate bioceramic de-
vices. These qualities are effective for fine-resolution scaffolds, osteo-
dental implants, as well as electronic devices and microfluidic chips.
In bone tissue engineering, scaffolds require fine resolution of their
pores. Scaffolds are bioactive matrices which provide structural support
and encourage osteoregeneration. Scaffold porosity provides spaces for
cellular growth and attachment [11]. The difficulty lies in achieving
the right degree of porosity using conventional scaffold-making tech-
nologies. In short, the procedure involves a foaming agent added to a
ceramic slurry, which is later burned out of the product to leave only
the ceramic matrix behind [12]. The 3D printing of bioceramics is a rel-
atively novel strategy that may fabricate such highly porous matrices
with a higher degree of precision [13]. The scaffold’s success measured
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Engineered Regeneration 3 (2022) 41–52
by geometry and porosity may even be predicted using computation
modeling before the printing starts [7]. Although still a novel approach,
the 3D printing of bioceramics proves to be a promising alternative to
the conventional methods for scaffold creation.
AM may aid other applications other than scaffolds in bone regen-
eration. Dental implants and prosthetics require precise control during
manufacturing. The increased control and reproducibility that 3D print-
ing provides enables the customization and mass production of dental
parts [14]. Electronics and fluidics systems may also benefit from AM’s
ability to resolve cavities and channels at the micron scale [15].
In this review, we provide a cursory look at multiple strategies for
the additive manufacturing of bioceramic materials as well as several of
their applications.
2. Printing methods
Additive manufacturing may construct identical 3D models with sim-
ilar morphology using diverse techniques. Each technique still maintains
the layer-by-layer method of printing that defines AM; however, varia-
tions in printing method or materials may result in immense changes in
features like mechanical strength, biocompatibility, porosity, and even
cost. These features depend on the certain application, available bioce-
ramic materials, and funding & equipment. Thus, there is no universal
‘best’ printing method for AM of bioceramics. Herein, we briefly cover
five common processes and materials used in additive manufacturing
bioceramics: fused deposition modeling, material jetting, binder jetting,
powder bed fusion, and vat photopolymerization.
2.1. Material extrusion
Extrusion-based printing, or Fused Deposition Modeling (FDM), is
one of the more recognizable techniques. A device first receives an up-
loaded 3D model and then begins the print by heating up the print-head
and print-bed. The nozzle then extrudes ceramic material layer by layer.
Each layer hardens as it is placed and becomes a solid product. FDM con-
sumes low energy and costs less than a few of other AM techniques. For
this reason, they are desired for bone tissue engineering [16–18].
2.1.1. Selected materials
Ceramic biomaterials are favored for their durability, biocompatibil-
ity, and sintering window temperatures. For the FDM of scaffolds, bioce-
M. Ly, S. Spinelli, S. Hays et al.
Fig. 3. (A) Slicer software like Ultimaker Cura, as used in extrusion-based printing, separates CAD models into distinct layers and estimates overall print time. (B)
Commercial material extrusion printers often focus on plastic materials; however, they may also print non-plastic materials like bioceramics in lieu of standard PLA
filament. (C) Slicers provide detailed control of printing parameters like infill, travel speeds, and build plate adhesion.
Fig. 4. A generalized 5-step procedure of extrusion (fused deposition modeling).
ramic materials involved may include bioactive glasses or calcium phos-
phates such as hydroxyapatite. This material holds a nonlinear structure
and succeeds at biocompatibility. Hydroxyapatite is often chosen for its
similarity to natural bone tissue. It has osteoconductive and osteoin-
ductive properties and encourages cellular attachment within its pores
[17,19].
Pure hydroxyapatite may not be printed through heat and pressure
extrusion alone. The material must first become softened to form the
desired shape. One method is to create a hydroxyapatite paste using
polyvinyl butyral (PVB) and polyethylene glycol (PEG) dissolved in
propan-2-ol solvent. PEG acts as a plasticizer to reduce viscosity and im-
prove flexibility of the material, whereas PVB acts as an adhesive binder
for the PVB and hydroxyapatite ceramic powder. About 60% of the paste
consists of hydroxyapatite. After the desired paste is developed, excess
solvent is evaporated until the desired ceramic paste is left [16]. An al-
ternative method uses melt blending between a ceramic filler and a PLA
matrix. Micron-sized hydroxyapatite spheres are added to a screw mixer
with melted PLA to form one highly loaded composite filament [17,20].
2.1.2. General process
Once a desired paste or filament for FDM is obtained, the material ex-
trusion procedure as summarized in Fig. 4 may begin. First, the compos-
ite filament or ceramic-laden paste is inserted into the extrusion cham-
ber. The printer warms up both the printhead and the print platform.
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Engineered Regeneration 3 (2022) 41–52
This softens the material in the chamber to lower viscosity and allow for
easier extrusion. The platform allows for easier adherence, less shrink-
age, and prevents curling from the temperature difference. The material
is pressure-driven through the nozzle at a designated velocity and onto
the print bed, layer by layer. These bioceramic composites may develop
into lattice shaped 3D structures like scaffolds for bone tissue engineer-
ing applications.
When fully printed, the model experiences post-processing. This may
include drying for up to 24 h to fully evaporate any solvents introduced
in the paste. Drying leaves behind a purer ceramic substance. To im-
prove ceramic mechanical strength, the body is sintered at temperatures
below 1650 degrees Celsius, the melting point of pure hydroxyapatite
[16].
One of the primary reasons 3D printing hydroxyapatite scaffolds has
been so successful is because of the mathematical equations that are
fairly accurate at predicting the shrinkage of the mold after the sintering
and drying processes [21].
Most time spent in FDM printing is waiting for the material to dry
and sinter. The sintering process can also increase prices due to the high
amount of heat needed to properly sinter the material. Overall, this pro-
cess takes about 2-3 days, depending on how long the actual printing
process takes for the scaffold structure.
2.2. Material jetting
Material jetting is another AM technique that may include bioce-
ramic materials. Its technology is popularly attributed to household
printers for color staining paper documents; however, material jetting
may also form complex 3D ceramic geometries without noticeable mi-
crostructural defects over glass [22]. With material jetting, picolitre
quantities of ceramic-suspended droplets are dispersed precisely onto a
substrate material or printing surface. These droplets then solidify either
through solvent evaporation, temperature-induced gelation, or chemical
reactions [23]. The process repeats layer-by-layer until a 3D amalgama-
tion of the desired object is fabricated.
M. Ly, S. Spinelli, S. Hays et al.
Fig. 5. Material jetting printing can be divided into two major groups, con-
tinuous inkjet (CIJ) and drop-on-demand (DOD). They are further specified by
actuator type. CIJ uses charged inks to direct streams into a catcher or the sur-
face region. Droplets in DOD systems fall directly to the printing surface.
2.2.1. Selected materials
Droplet mechanics are a major contributor to ceramic ink selection.
As such, custom-made bioceramic inks can be created by suspending ce-
ramic particles into an aqueous medium using dispersants and a binder
to create a ceramic slurry [22]. In multiple studies performed by Ains-
ley et al. [24], up to 40% by volume of alumina was suspended in a
paraffin wax medium. The group learned lower percentages of ceramics
were adequate to form small green bodies. Sadly, these bodies suffered
from distortion when sintering.
Purchasable graphic inks are often provided with recommended
ranges of viscosity and surface tension values; however, they are not
an excellent model for ceramic-laden inks since they are generally less
dense. Compatible ceramic inks depend on fluid behavior models like
Reynolds, Weber, and Ohnesorge numbers [23]. Simply put, there exists
a crucial balance between the volume percentage of ceramic particles
and the selected medium. Higher volume percentages reduce distortions
but increase the viscosity of the ink requiring high pressures to extrude
the ink [24].
2.2.2. General process
The exact mechanism by which material jetting functions depends
highly on the general ink system. Material jetting printers pressurize
the ink from a reservoir up into the print head. Then, a controlled actu-
ator releases the fluid onto a printed surface in the desired location. The
mode of droplet transportation is classified into either continuous inkjet
(CIJ) and drop-on-demand (DOD) systems. In a CIJ system, a printer
extrudes a stream of fluid composed of droplets. Selected droplets are
electrically deflected to a desired position. The remainder recirculates
into the system. In contrast, a DOD printer emits only the precise number
of droplets to print an object [24]. Most industrial applications prefer
DOD systems over CIJ for printing functional parts. One reason is that
the recirculated ink in CIJ may be contaminated thus limiting itself from
certain ceramic applications [23,24]. The process then repeats continu-
ously for each layer until the overall object is formed as shown in Fig. 5.
In the CIJ system, typically a single jet releases a fluid stream toward
the printed surface. A piezoelectric transducer acting under a modulated
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Engineered Regeneration 3 (2022) 41–52
voltage creates regular vibrational disturbances to the stream at a spec-
ified frequency [25]. These disturbances divide the high-velocity inkjet
stream into monodisperse droplets due to Rayleigh instability. This in-
stability occurs when the wavelength is greater than the jet circum-
ference. Then, electrically conducting ink droplets are charged using
a nearby charging electrode. Diverse range of voltages provide differ-
ent charge levels for each droplet [26]. Deflector plates located below
these electrodes provide a fixed electric field which separates incoming
droplets by their level of charge. Lower charged droplets are deflected
to a catcher for recirculation while higher charged droplets bypass the
catcher and are directed to the substrate. To position droplet placement,
the substrate meticulously translates within the XY plane [25].
In a DOD system, the exact number of required ink droplets are re-
leased from an array of printheads and nozzles. This method is more
commonly used in ceramic industrial applications [23]. Actuators for a
DOD system are either piezoelectric, thermo, or a combination of both.
In a study conducted by Ainsley et al. [24], a piezoelectric jet head with a
heating jacket could adjust the extrusion characteristics of a droplet like
driving pulse amplitude, duration, peak shape, and fluid temperature.
In general, actuators create momentum within a fluid through dramatic
changes in cavity geometry. The fluid’s momentum causes droplet for-
mation outside of the selected nozzle. The ejected ink droplet is directed
down towards the print substrate [25].
Droplets formed by either CIJ, or DOD impact the print surface and
react with the substrate before the solidification process. The initial
droplet reaches the substrate and forms a semi-spherical shape deter-
mined by the surface energy of the substrate and rheological properties
of the droplet. Behind the initial droplet are satellite droplets. Satellite
droplets are formed mid-fall due to the axial vibration and separation
of droplets from unstable jet streams [26]. These satellite droplets can
merge with the initial droplet to form a larger shape.
Solidification typically occurs due to an evaporating solvent or a
phase change on substrate impact. Solvent evaporation is favored over
the latter in the construction of ceramic models because it generates a
much denser structure than the latter. Regardless of the solidification
method, the layer must fully solidify continuing with the next. Other-
wise, the droplets may fuse together unevenly [23].
The green bodies that result from an inkjet print must face post-
processing to improve rigidity and strength; material jetting prints are
debinded and sintered [23]. Depending on the specific composition and
geometry of the print, the post-processing details may vary in value. One
method performed by Cappi et al. [22], debinded green bodies com-
posed by Si3N4 suspensions at 500C for 2 h. They subsequently placed
these green bodies in a Si3N4, YAG, and boron nitride powder bed to
avoid decomposition. Finally, they sintered the green bodies at 1780C
for 2 h.
Material properties of the models after post-processing can be re-
viewed using scanning electron microscopy (SEM) and transmission
electron microscopy (TEM). These imaging techniques allow one to ob-
serve the microstructure and chemical composition of the sintered sam-
ples. The resulting microstructures of these prints can be extremely ho-
mogeneous without any defects or flaws [22].
CIJ and DOD both have their advantages and limitations in terms of
production. CIJ generates monodisperse droplets at a high throughput
since the liquid streams can flow nonstop [26]. Unfortunately, a major
issue with CIJ-type printers is contamination. While it is economic to
recirculate unused droplets back into the system, this methodology is
prone to environmental hazards. Hence, it is not often used for many
ceramic applications. Conversely, DOD can produce accurate droplets
without fear of contamination but does not have the same processing
speed as CJI. The slowdown is also attributed to high specificity in
droplet placement [24].
In general, material jetting production is limited to small-scale appli-
cations. Most results from studies conducted with material jetting print
in the centimeter or millimeter order of magnitude [26]. One reason
is because the repeated process of waiting for solidification and start-
M. Ly, S. Spinelli, S. Hays et al.
ing a new layer droplet-by-droplet is highly time-consuming. Other AM
techniques like photopolymerization or FDM would be better suited for
larger scale applications.
2.3. Binder jetting (3DP)
Binder jetting is another form of additive manufacturing capable of
performing solid freeform fabrication of ceramic materials. 3DP is a
poor abbreviation for binder jetting as it can be confused with three-
dimensional printing, which includes binder jetting. In 3DP, layers of
bioceramic powders are evenly dispersed on a building platform. A car-
riage drops binder fluid on the powder to bind layers of powder together.
After completion, the developed ceramic is sintered for structural in-
tegrity [27].
2.3.1. Selected materials
Binder jetting operates using ceramic powders and polymeric
binders. The powders form the final ceramic structure, while the binder
acts as temporary material to hold each layer together before sinteriza-
tion.
Like FDM, there exists flexibility in powder selection for 3DP. 3DP
may process a wide array of metal and ceramic materials including 316
SS, 420 SS, and alumina [27]. Binder jetting is relatively new with ce-
ramics, so there is much literature discussion on the optimal material
powder for each application. The powders are chosen based on their
mechanical properties and structural shapes. The morphology and dis-
tribution of ceramic powders by the roller determine the density and
stiffness of the preform. Generally, larger particle sizes pack better with
binder while smaller particles sinter faster [28].
The binder must complement the powder chosen. Ideally, the binder
fluid has low enough viscosity to separate into individual droplets. Ce-
ramic particles may bind through two methods: In-Liquid and In-Bed
binding. The binding agent in the In-Liquid method is found in the jetted
liquid while in the In-Bed method, it occurs with the interaction between
the liquid and powder bed. In-Liquid strategies decompose thermally in
post-processing; however, they may easily dry and clog the print-head
nozzle. Post-processing of In-Bed mechanisms tend to dissolve adhesive
agents and leave a porous structure which may be beneficial for scaf-
folds [29].
2.3.2. General process
Ceramic powders are poured inside the printer’s material container.
When the printing process begins, a roller evenly disperses the material
as a layer on the powder bed. Excess material that is spilled may be col-
lected by the overflow bin for recycling. Simultaneously, a carriage with
an array of print heads follows the roller and selectively deposits bind-
ing agents to adhere the powder together. These binding agents must be
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Engineered Regeneration 3 (2022) 41–52
Fig. 6. A generalized 7-step procedure for
binder jetting.
of low enough viscosity to perforate the ceramic powder [30]. The build
plate is lowered for the subsequent layer and the process repeats until
the desired structure is fully complete [28]. The 3DP process is briefly
outlined in Fig. 6.
Afterwards, the model enters a post-processing stage where the ma-
terial is dried and cured. Air is gently blown onto the product to remove
any unused powder collected on the model to be recycled into the over-
flow bin. The product is then sintered for completion. If the product
is not sintered, it will be left in what is called a green state, where it
is porous and not structurally strong. Eventual removal of the binder
will weaken mechanical stability; however, the structural drying and
sintering process will help rebuild its integrity. Ceramic materials must
undergo this process before it may be used in any functional application
[29].
2.4. Powder bed fusion
Besides using deposits from droplets, laser-based approaches to the
AM of bioceramic materials exist. Selective laser sintering (SLS) is a
powder-based method of AM. It uses a laser to partially melt ceramic
particles until they become bonded, or “sintered.” The powder is de-
posited layer by layer onto a bed. After each layer is deposited, an over-
passing laser scans the powder in a certain pattern [31]. This process
is repeated for each layer until the final product is formed. The imme-
diate product that is produced from this process could be quite porous,
making it an optimal choice for tissue engineering scaffolds.
2.4.1. Selected materials
The base material for this process is ceramic powder. The specific
powder used determines the purpose of the final print. For instance,
one study successfully created a bioactive glass 13-93 scaffold using
this method. The powder’s particle size was 16 micrometers [32]. Other
bioactive glass powders include nano-58 S and hydroxyapatite [33,34].
For orthopedic applications, a more structural ceramic may be formed
using alumina powder. Ball milling, dispersion polymerizations, and
thermally induced phase separation are several methods to create these
ceramic particles [35].
In addition to ceramic and bioactive glass powders, polymer binders
may optionally be incorporated within the powder to stabilize the ce-
ramic shape and function as a glue during sinterization [36]. They
usually have lower melting temperatures when compared to ceramics,
so they can eventually be removed later through firing. Furthermore,
these binders can be made of nylon polymers, or other types of semi-
crystalline polymers. These semi-crystalline polymers have a clear melt-
ing and glass transition temperature window [35].
One study used a Sinterization 2000 machine (DTM Corporation /
3DSystems, USA), which had a carbon dioxide laser of 100 W of power.
M. Ly, S. Spinelli, S. Hays et al.
Fig. 7. A selective laser sintering setup for constructing flexible sinusoidal scaf-
folds. (Reprinted, with permission, from [36]).
This laser had a wavelength of 10.6 micrometers and a diameter of 400
micrometers, and a scan speed and spacing of 300-1250 mm/s, 80-500
micrometers [35]. Laser sintering machines usually have a laser power
that ranges from 30 to 400 W (higher wattage is used for ceramics, as
well as metals). These lasers should also have a lower scan speed, which
increases the amount of powder that is melted with contact. Faster scan
speeds will decrease the amount of powder that is melted, which can
cause balling and produce uneven surfaces. Shorter scan lengths are
also desired, as they prevent the sample from cooling before a second
pass [37]. If the powder sample cools, there is a greater opportunity
for polymer binder crystallization, which can then lead to warping and
distortion.
Finally, the particle powder size is especially important, as too small
of a particle will cause the powder to pack together and form clumps.
However, particles that are too large can reduce the density of the pow-
der [38]. Therefore, the particle size of the powder is usually about 10–
150 micrometers [39]. Finding the balance between particle size and
composition, as well as laser characteristics and scan time is essential to
creating a successful powder ceramic part using this method.
2.4.2. General process
SLS operates through polymer binder crystallization, which is con-
trolled by heating the powder bed before and during the printing pro-
cess. A visual representation of the SLS process in the context of scaffolds
is shown in Fig. 7. Before the powder bed is preheated, a thin layer of
the powder is deposited on the bed and then a roller is used to flatten the
powder [35]. The polymer binder eventually melts and forms a glassy
phase around the ceramic powders. This phase helps stabilize the ce-
ramic when it is bonded by the overpassing laser beam, which partially
melts the particles. Upon melting by the laser beam, if the melted solu-
tion is more viscous, it prevents the escaping of bubbles. This can com-
promise the stability of the completed structure [40]. Once the bonding
is completed for a layer, a new layer of ceramic and polymer binder
powder is deposited, and the laser passes over once again. This process
is repeated until a final product is formed. The body may then increase
its density and structural stability with isostatic pressing. Afterwards,
the product is fired to debind any polymer binders [41].
A similar process to SLS is selective laser melting (SLM), which may
be identified as a subset of SLS and a type of powder bed fusion. It is
an identical process to SLS except it requires no binders and uses high-
energy lasers to fully melt ceramic particles together. Objects formed
through SLM make for very dense structural ceramics. Therefore, the
technique is efficient since it bypasses post-processing modifications like
isostatic pressing to improve density. Unfortunately, SLM products are
prone to cracking. For instance, alumina powders are prone to both
transverse and longitudinal cracks from internal stresses and solidifi-
cation shrinkage [42].
Although the cost may be higher, the production time for selective
laser sintering is generally faster than other methods. It also does not
involve the printing of a support material like many additive manufac-
turing processes require. Of course, production time can be impacted
by the final part’s size and how many parts that are being created from
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Engineered Regeneration 3 (2022) 41–52
one print bed. Production time can also be increased through speeding
up the laser’s scan speed, but that may decrease the number of particles
that are sintered within a scan, which can in turn cause other issues
[37]. Overall, SLS can be a beneficial technique for ceramic additive
manufacturing, as it can have a fast production time and bypasses the
need for scaffolding. However, it is still a process that can be researched
even more, as the relationships between powder particle size, powder
composition, laser intensity and more are not as understood even though
they impact the process significantly.
2.5. Vat photopolymerization
Vat photopolymerization, or simply resin 3D printing, is another dis-
tinctive AM technique, which fabricates 3D ceramic objects freeform.
This strategy offers high resolution prints without any need for special
molds or tooling. Current vat photopolymerization methods have used
ceramic materials mixed within resin for precise and fine-detailed prints
[43]. Simply put, a container filled with photosensitive resin is cured
through UV light exposure one layer at a time. The resulting green body
is then post-processed via sintering and debinding to establish rigidity
[44]. The method of UV exposure is distinguished as digital light pro-
cessing (DLP) or stereolithography (SLA). As such, DLP and SLA share
mostly the same experimental setup but differ in the general process.
2.5.1. Selected materials
In vat preparation, a ceramic powder is incrementally added to a UV
curing monomer made up of dispersant, crosslinker, and photoinitiator
to form a viscous slurry [45,46]. Ceramic materials involved in both DLP
and SLA depend on the specific application which they are intended. For
instance, investment casting may use a silica material while structural
components may opt for alumina or silicon oxide [43]. Homogeneous
dispersion of the ceramic powder in suspension is essential for excellent
curing performance. Light-sensitive reagents and the dispersant first un-
dergo ultrasonic agitation. The gradual addition of ceramic material is
stirred slowly into the mix. Lastly, the photoinitiators are introduced
and ball milled [47]. The combination of all these material components
is entered in a tinted-color vat to prevent unintended exposures and pre-
mature curing; these steps are all crucial in constructing green bodies
with desired shape and structure.
The suspension composition must ideally include a high percentage
of ceramic volume while adhering to optical and rheologic laws. The
method of green body formation is with UV light as it passes through
the resin. Under the Beer-Lambert Law, the cure depth is influenced by
particle size, exposure, ceramic volume percentage, and scattering effi-
ciency [43]. Ceramic suspensions made with fine particles typically are
high in viscosity and cause issues printing smooth layers. Conversely,
large-scale particles reduce viscosity but cause challenges during post-
processing when sintering [44]. The choice between using aqueous
acrylamide-based and nonaqueous diacrylate-based UV-curable solu-
tions should also be kept in mind. For instance, ceramic binders are
often made up of acrylate polymers in SLA even though diacrylate is
more viscous and offers a higher refractive index/cure depth. Moreover,
certain photo-monomers may hold viscosity values on the order of tens
to thousands of mPa∗ s. In terms of SLA, the suspension system’s vis-
cosity should mimic the fluidity of convention resins (<3000 mPa∗ s) to
allow for proper layer recoating; although Griffith was referring to SLA,
the idea may hold true for DLP printers. High viscosity values may be
balanced with the introduction of optional nonreactive solvents [43].
2.5.2. General process
Like other AM procedures, vat photopolymerization requires users to
first create their desired 3D models within a computer aided design soft-
ware. Once finished, the watertight mesh may be transferred to a digital
slicing program as an STL file format. The model is then virtually di-
vided into layers of user-defined thickness [48]. Thinner layers provide
smoother surfaces and finer resolutions. In an experiment conducted
M. Ly, S. Spinelli, S. Hays et al.
by Diptanshu, Miao et al, fine powder ceramics were printed with a
50-micrometer layer thickness [44]. For SLA, polymers provide smooth
surfaces and fine features at a > 150-micrometer thickness; ceramics
require a minimum a 200-micrometer thickness [43]. Once sliced, the
model is converted into G-code which delivers numerical control of the
printing machine. The model is ready to begin the vat polymerization
process [48].
In vat photopolymerization, structures are formed in a layer-by-layer
process where UV exposes the photosensitive resin from the bottom of
the vat in the pattern indicated within the uploaded G-code. Light can
only pass through a clear window for curing; light from external sources
is blocked by tints which attempt to block UV light. When UV light
exposes the photosensitive resin, a chemical reaction occurs between
the monomers and oligomers causing crossing linking to occur. DLP uses
a projector to shine UV light at all targeted locations simultaneously as
shown in Fig. 8. SLA is more specific and uses a combination of mirrors
to direct the path of a laser to the target as shown in Fig. 9. After each
layer is cured, the stage will move clear from the window, or a blade will
allow a fresh coating of uncured resin for the next layer. UV light then
polymerizes the layer once again so that the current layer is adhered to
the previous. The entire process repeats until the entire model is drawn
[48,49].
DLP and SLA both have the option to print either from top-to-bottom
or bottom-to-top configurations. In a top-to-bottom configuration, the
light source exposes the first layer from the top of an entirely filled vat.
As each layer cures, the platform along with the model moves down-
47
Engineered Regeneration 3 (2022) 41–52
Fig. 8. Bottom-to-top configuration of a digi-
tal light processing printer. A projector emits
light through a lens that scatters UV in a broad
field. Regions circled in red at the surface layer
are cured simultaneously by the projector. The
platform is raised after each layer cures.
Fig. 9. Top-to-bottom configuration of a stere-
olithography printer. A set of mirrors direct the
path of a UV laser. Circled in red are resins that
were cured sequentially at the surface layer.
The platform translates downwards, and the
process repeats as shown.
wards. This setup is commonly used in SLA setups for experiments like
that of Zhou et al [49]. Conversely, a bottom-to-top configuration would
begin the print’s first layer at the bottom of the vat. The print is made
upside-down as the platform along with the model moves upwards after
each layer. This option is frequently used for vat photopolymerization
as it requires less resin and thereby costs less. Moreover, a Teflon layer
at the bottom toward the projection reduces the UV radiation with neg-
ligible dispersion. This layer helps with DLP but does not aid SLA as
much. Despite this, the top-to-bottom positioning is still preferred for
SLA since light dispersion issues are minimized [48].
The result of ceramic vat photopolymerization is a cured green body
that must be post-treated. Removal of excess or unwanted material is
done using a chemical wash followed by a UV bath [48]. Afterwards,
the green body may hold residual water that must be dried [49]. Photo-
sensitive resin functioned as a binder for the ceramic material and must
be removed to increase structural strength. The remaining material is
then sintered to reach desired shape and density [47]. These processes
should be conducted carefully to reduce material deformation.
The drying process to remove residual water is the prerequisite step
before any other post-processing techniques can be made. Tradition-
ally, a freshly made green body is left to the elements in an environ-
ment where the liquid can naturally evaporate. Certain procedures use
a stove to dry the bodies and remove any volatiles. An alternative tac-
tic uses liquid desiccants like PEG 400 to uniformly extract liquids in
multiple directions. This method would limit the possibility of uneven
evaporation and sample deformation [48,49].
M. Ly, S. Spinelli, S. Hays et al.
Table 1
3D Printing Method Classification and Comparison [4–6,13,15,41,43,48]
3D Printing
Technique Strategy Relative Cost
Extrusion Ceramic paste with Low – Moderate.
polymer binder and
plasticizer.
Binder Jetting Ceramic powder bed and Moderate – High.
polymer binder.
Material Jetting Ceramic-suspended Low – Moderate.
droplets on substrate.
Powder Bed Fusion Ceramic powder bed High.
with laser.
Vat Ceramic dispersed in Moderate.
Photopolymerization photosensitive resin.
The debinding process is not required for all compositions but al-
lows for higher quality structures. Varghese et al. [48] sintered alumina
and 3-YSZ ceramic bodies separately and produced satisfactory quality
ceramics. 8-YSZ, however, required a debinding route to prevent crack
generation. In the debinding process proposed by Zhou et al. [49], a
vacuum pyrolysis step is followed by air debinding for a zirconia ce-
ramic body with minimal defects. First, the vacuum reduces the rate of
organic decomposition and lowers the chance of crack and bubble for-
mation. Then, the air debinding purifies the bodies and extracts leftover
carbon residues.
Sintering is the last and most crucial step of post-processing. The ce-
ramic material fuses together improving structural strength and density.
The specific parameters such as temperature and time depend highly
on the involved material and application. Li et al. [45,46] investigated
kaolin ceramic shells for precision casting. The group heated the bod-
ies at 375, 450, 500, and 1200C for 3 h each at either 0.5 or 2C/min
heating rates before cooling. They observed fusion between layer bound-
aries and a reduction in crack defects. Other effects of general sintering
are increased bulk density, decreased porosities, and improved densities
[44].
In certain applications, vat photopolymerization can fabricate spe-
cific objects much quicker than the traditional methods. For instance,
ceramic shells used in precision casting are manufactured using wax pat-
tern preparation and slurry-stucco dip-coating. These methods of shell
building are not only financially costly, but also are time-consuming.
The DLP process conducted by Li et al successfully printed out a com-
plex shell with minimal microstructural deformities [45,46].
3. Applications
Fused deposition modeling, binder-jetting, powder bed fusion, mate-
rial jetting, and vat photopolymerization are all useful technologies for
the AM of ceramic materials. A brief comparison between these meth-
ods is presented in Table 1. There are many diverse applications, most
notably tissue engineering and implants, that each technique may be
considered. Moreover, one approach may serve one specific application
significantly greater than another. Decisions must therefore be made
with great consideration to receive the desired print quality.
3.1. Tissue-engineered scaffolds
In the tissue engineering field, 3D-printed scaffolds derived from
ceramics are increasingly desired. Ideal scaffolds are biocompatible,
biodegradable, and bioactive; however, they hold low mechanical
strengths and prevent the longevity of the device under heavy loads
Engineered Regeneration 3 (2022) 41–52
Production Time Advantages Disadvantages
Slow. Straightforward process. Limited resolution.
Flexible in porous scaffolds
or dense structures.
Moderate/ Great for larger, porous Challenging for very
Fast. ceramic structures. dense ceramics.
Requires few sacrificial
materials.
Slow/ Beneficial for small models. Difficult for large
Moderate. Creates smooth surfaces. models.
Fast. Flexible in porous scaffolds Distortion and
or dense structures. warping leading to
microcracks.
Moderate/ Precise. Requires extensive
Fast. Creates smooth surfaces. post processing.
[4]. In addition, their complex porosity and interconnectivity is not eas-
ily replicable. Bioceramic materials hold great mechanical strength and
wear resistance. They are also easily accommodative to complex struc-
tures when 3D printed making them an excellent fit as a replacement
material. Currently, FDM, 3DP, SLS, and vat photopolymerization are
existing techniques that are commonly used for producing porous ce-
ramic scaffolds [50].
The goal is to construct bioactive ceramic scaffolds that are porous
enough to sustain a large amount of bioactivity and have decent me-
chanical properties like compressive strength. Oftentimes, the more
porous a scaffold is the less strong it is, as a greater porosity and a
smaller density go hand in hand. As of now, there are post-processing
methods that can be used to solve this problem, such as sintering and
the introduction of polymer coatings. However, there has been research
into ceramic-polymer composite materials that can be manufactured
without the need for other post-processing methods. One study found
that a ceramic-polymer composite of poly-𝜀-caprolactone (PCL) and 𝛽-
tri-calcium phosphate (TCP), creating through the additive manufactur-
ing method of extrusion, had a high degree of biocompatibility with a
compressive strength of up to 90 MPa [18]. Finding a method of scaf-
fold construction that provides decent mechanical properties as well as a
suitable level of bioactivity, without lengthy post-processing techniques,
is a promising future direction in this field.
FDM is used with hydroxyapatite materials for many bone tissue en-
gineering applications for its great mechanical characteristics. A bone
graft constructed using FDM involves carbonated hydroxyapatite and
polylactic acid materials. The microstructural analysis of these hybrid
scaffolds proved that the morphological blend provides a significantly
greater toughness than a standard PLA scaffold. Composite scaffolds
studied by Corcione et al. [17,20] also determined that the stiffness val-
ues were much more compatible with that of bone tissue. Esslinger et al.
[19] used an indirect approach of creating bioceramic scaffolds made of
bioactive glasses and tricalcium phosphates. In older experiments, they
used direct binder jetting to manufacture scaffolds and learned that the
resulting green bodies were very fragile and would damage during de-
powdering. Therefore, the group decided to use an indirect approach
and print a PLA and ABS sacrificial thermoplastic mold in which a ce-
ramic slurry would be placed within.
3DP is another common method of creating ceramic scaffolds us-
ing 3D printing technology. Tarafder et al. [50] performed direct 3DP
on tricalcium phosphate to create micro-porosities of 27%, 35%, and
41% for associated pore sizes of 500 micrometers, 750 micrometers, and
1000 micrometers. After microwave sintering, maximum compressive
strengths of 10.95 +- 1.28 MPa and 6.62 +- 0.67 MPa were recorded.
48
M. Ly, S. Spinelli, S. Hays et al.
Fig. 10. SLS technique may fabricate biphasic calcium phosphate scaffolds with
∼61% porosity determined by Archimedes method. (Reprinted, with permission,
from [51].)
Bone formation due to scaffolding in the Sprague-Dawley rats justifies
3DP as an excellent choice for making scaffolds.
Vat photopolymerization and SLS techniques are another option for
scaffold fabrication. DLP is often used for its high printing accuracy and
printing speed and is capable of printing 3D-printed scaffolds that may
even include human tissues like liver lobules. SLS also provides high
accuracy and surface qualities which are also heavily desired in scaf-
fold engineering [4]. In addition, Shuai, Li et al. [51] conducted a study
on the biological and mechanical properties of scaffolds made with cal-
cium phosphate ceramics. Their SLS print is shown in Fig. 10. The group
concluded a hydroxyapatite to 𝛽-tricalcium phosphate (70/30) ratio op-
timized the biological stability of an in vivo culture against material
biodegradation. Further, it exhibited great fracture toughness at 1.33
MPa m1/2 and compressive strength at 18.35 MPa.
3.2. Bone grafts & dentistry
Bioceramic materials are widely used in any bone tissue engineering,
specifically bone grafts and implants. In dentistry, bioceramics coupled
with AM make for excellent implants and restorations like crowns, in-
lays, and dentures. Bioceramics themselves are biocompatible, mechan-
ically strong, and aesthetic as teeth. The inclusion of AM enables the
printing of complex 3D parts that are difficult to manufacture through
conventional subtractive practices. Together, the AM of bioceramics
provides a sustainable and tightly controlled method of delivering vi-
able solutions for numerous bone tissue applications.
One hot topic that benefits from 3D printed bioceramics is the devel-
opment of hip prosthetics used in orthopedic surgeries. Patients under-
going replacement procedures for a hip joint provide unique morpholog-
ical challenges for their surgeons. Hip joints are complex 3D structures
that must be highly individualized to the patient’s anatomy. Currently,
operating rooms provide variant shapes and sizes to fit in the hip struc-
ture; however, these non-customizable are not ‘one-size-fits all’ and lead
to material waste. During a procedure, the lengthy time to find a suitable
part increases the patient’s risk of infection and may lead to intraoper-
ative blood loss. Hip joints fabricated using FDM and gel-cast molding
have been proposed by Zhu, Liu et al. [1] to resolve these issues. While
the ceramic material provided high biocompatibility with neighboring
tissue and exhibits high wear resistance, the group mentions their initial
issues with sintering caused irregular shrinkage. This would not do well
with the specificity required of the site.
Roopavath et al. [21] used computed tomography (CT) in combi-
nation with extrusion-based printing to construct bone grafts as shown
49
Engineered Regeneration 3 (2022) 41–52
in Fig.11. In the study, the group scanned a CT-based anatomical bone
model and used hydroxyapatite as reconstruction material. The result-
ing grafts are patient-specific with a comprehensive modulus ranging
from 33-200 MPa.
Material jet methods have also been employed in dental restoration.
Ebert et al. [52] modified a conventional DOD inkjet printer and devel-
oped a zirconia-based ceramic suspension with 27 vol% solid content.
The group printed a dense posterior crown with characteristic strengths
of 763 MPa and mean fracture toughness of 6.7 MPam0.5 . The printer
did face issues with clogged nozzles which explains any process-related
defects.
Researchers have also developed strategies for the SLM fabrication
of dental parts. Wilkes, Hagedorn et al. [53] investigated the limits SLM
face when printing freeform structures. Using a focused laser beam and
ZrO2 /Al2 O3 powder mixtures, the group discovered ceramics may be
printed close to 100% density without sintering or other post-processing.
Further, they exhibit no microcracks when the bed is preheated. Sadly,
these crack-free dental restoration framework suffer when melt escapes
the laser path. The resulting print may end with rough and uneven sur-
face.
Moin et al. [54] discusses a DLP approach to constructing zirconia
root analogue implants. The group took a CT scan of a human cadaver’s
mandible and recreated the structure the using CAD. The DLP projector
then cured the liquid photopolymer dispersed with ceramic material.
Superimposing the 3D printed tooth model with the original tooth and
CAD version revealed 1.55% and 4.86% of surface areas above threshold
distance of 5 mm, respectively.
3.3. Implant coatings
Perhaps, a more understudied area of research is the AM of bioce-
ramic hip coating. In biomedical devices, metal is used in stents, heart
pumps, orthopedic implants, dental parts, and more. Common metal
materials include titanium, stainless steel, and cobalt-chromiums. Sur-
face modifications like micro- and macro-sized pores are made to metal
implant surface to improve cellular attachment and growth through nu-
trient infiltration [55,56]. Unfortunately, long-term use of metallic im-
plants may produce certain metal ion toxins that damage neighboring
cells and may lead to necrosis and cell death [57]. Porous bioceramic
coatings over these implants may be the solution to improve biocom-
patibility at the implant-tissue interface while encouraging tissue inte-
gration. AM may provide finer control of the mechanical and biological
capabilities of this bioceramic coating than traditional methods like dip
coating.
Laser Engineered Net Shaping (LENSTM ) to AM. This printing strat-
egy is similar to selective laser melting; however, it uses a deposition
head to release an appropriate amount of powder compared to having
an entire powder bed. Heer, Zhang et al. [58] performed a layer-by-layer
addition of Al2 O3 and SiO2 ceramics to a base Ti64 alloy as represented
in Fig. 12. Under an additional laser pass over implant surface, the re-
sulting Ti64 structure held improved wear resistance and hardened by
186%. In another study using this technique, Zhang et al. [59] used
LENS to coat a ceramic layer of Ti-Si-N over commercially pure tita-
nium substrate. Their print exhibited graded microstructures and in situ
formed phases which explain its high hardness (90%) and wear resis-
tance.
4. Discussion
Bioceramic AM processes are not without fault. Research focus has
shifted to correct gaps in knowledge. With more studies completed, the
material properties of many ceramics are evaluated, along with the lim-
itations and parameters of additive manufacturing processes [38]. The
more research completed, the greater understanding of how the mi-
crostructure of ceramics, as well as several distinct aspects of the manu-
facturing process may be manipulated to produce desirable results. The
M. Ly, S. Spinelli, S. Hays et al.
AM of bioceramics is promising; however, there remain certain chal-
lenges engineers still face.
Firstly, is the excessive cost. The initial purchase and operation cost
of a 3D printer is already significantly larger than other subtractive man-
ufacturing methods. With the cheapest of the printing techniques be-
ing in the thousands of dollars, successfully developing industrial sized
equipment is not where it should be for efficient production. Further-
more, prices rise higher when considering the cost of raw materials for
each line of production. Raw bioceramic materials come in powdered
form and are fairly expensive compared to polymer materials like PLA
used in other material prints.
Another issue with current production of 3D printed bioceramics is
the high shrinkage rate and decrease in ceramic qualities after sinter-
ing. A visual example exists in Fig. 11. Currently, when pure ceramic
powder is used in the 3D printing process, the result usually undergoes
a sintering and drying process. An indirect result of this process is slight
shrinkage in the structure of the material. Calculations may estimate
50
Engineered Regeneration 3 (2022) 41–52
Fig. 11. Computed tomography (CT) scans
may locate regions of defect bone. CAD and 3D
printing may create grafts for 3D bone recon-
struction through a virtual surgery. (Reprinted,
under Attribution 4.0 International (CC BY
4.0), from [21].)
Fig. 12. LENS method of coating titanium surfaces.
(Reprinted, with permission, from [58].)
shrinkage amounts albeit not always precisely. One necessary precau-
tion to circumvent this issue is to combine the ceramic material with
other, non-ceramic materials. The resulting mixture stays together and
does not produce as much shrinkage. Unfortunately, this method may
sacrifice important bioceramic characteristics, like biocompatibility and
osteogenic capability [60] Fig. 13.
Researchers have developed methods to limit shrinkage, distortion
and microcracking. One study photopolymerized a polysiloxane pre-
cursor to eventually form silicon oxycarbide microstructures. Polymer-
derived ceramics created by this method involve pyrolysis of their green
bodies. This method resulted in low porosity bodies with no recorded
cracks or distortions and 30% shrinkage [61]. Recent studies incorporate
supplemental materials like polymers into the manufacturing process.
For example, vat photopolymerization methods like DLP as shown by Li
et al. [45] may use a ceramic suspension of kaolin powder (solid load-
ing of 45% volume) in a UV-curable resin binder. This study reported a
shrinkage of approximately 20%, with no microcracks. Other methods
M. Ly, S. Spinelli, S. Hays et al.
Fig. 13. An example of shrinkage throughout the stages of post-processing. (a,
e) Green bodies. (b, d) Brown bodies. (c, f) Sintered bodies. (Reprinted, with
permission, from [47]).
of crack and distortion reduction employed include heating the bed in
powder-based additive manufacturing processes. One study conducted
by Wilkes, Hagedorn et al. [53] used selective laser sintering to melt
together alumina and zirconia for applications like all-ceramic dental
restorations. The group found that preheating the powder bed reduced
thermal stresses helps prevent cracks and limit distortion.
3D printing failures may happen with any material, but common is-
sues related to bioceramic printing are sticking, splitting, dropping, and
flaking [62]. Sticking is the most common. In the case of DLP, sticking
occurs when the build plate cures only the initial layer of resin since the
platform does not lower enough to accommodate further layers. Split-
ting is when the printer continues to form new layers of the model de-
spite not combining and sticking to one another. Splitting may occur
because of the material not sticking together or unwanted movement
in the base of the 3D printer. Depending on the AM technique and ma-
terial used, the binding agent plays a key role in preventing splitting
within bioceramics. Specifically, it determines how much binding agent
is needed to prevent splitting without disrupting the actual functionality
of the bioceramic being printed.
5. Conclusion
The bioceramics printing techniques presented herein each have spe-
cific characteristics that make them suitable for unique needs. In the AM
of bioceramics, there is no singular ‘best’ technique. Rather, it heavily
depends on the necessary constraints regarding a facility’s production
and desired application. For example, smaller scale production could
be satisfied by the extrusion technique, whereas larger scale production
might require the binder jetting technique.
Furthermore, it is important to consider the microstructure, as well
as the other material properties of the ceramics that are being printed.
Ceramic particle size and composition can affect overall homogeneity,
porosity, and mechanical properties after sinterization. In addition, the
use of binder materials may also contribute to the stabilization of the
print and how the structure will hold after debinding. There are many
more parameters to consider with each process, and further research is
needed to establish more standard protocols for controlling these param-
eters. A greater understanding of how bioceramic materials are affected
by the certain methods of an additive manufacturing process may help
understand and prevent prevalent issues like microcracking and distor-
tion, as well as the tradeoff between bioactivity and desired mechanical
properties.
Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
51
Engineered Regeneration 3 (2022) 41–52
CRediT authorship contribution statement
Michael Ly: Conceptualization, Writing – original draft, Writing –
review & editing. Sarah Spinelli: Conceptualization, Writing – orig-
inal draft. Shayne Hays: Conceptualization, Writing – original draft.
Donghui Zhu: Supervision, Writing – review & editing.
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