Fig. 5: Artificial bone assembly and surgical implantation with durable clinical performance and radiological evidence of in vivo osteogenesis within the gyroid structure.

A–D Components of the construct: PIII-treated LS-PEK frame (A); 3D-printed nylon-12 surgical guide for osteotomy and screw placement (B); βTCP lattice and supporting structure (C); and βTCP lattice with ADSC-laden GelMA in culture media (D). E–G Surgical implantation: LS-PEK frame inserted into a segmental mandibular defect (E), followed by βTCP lattice (F) and LS-PEK restraining crossbar (G). H–I Postoperative recovery: sheep begin oral intake immediately (H). All animals showed excellent tissue healing at 6 months, with no inflammation or implant failure (I). J–N 3D reconstructed CBCT images at 6 months (J–M) and 10 months (N) show progressive bone formation. Black arrows indicate new bone within LS-PEK; red arrows indicate new bone within the βTCP lattice. O–P Quantification: new bone volume increased significantly across all sheep (A–E) over the implantation period, while βTCP lattice volume decreased, indicating concurrent bone ingrowth and material resorption. Q All sheep maintained or gained weight during implantation, similar to non-implanted controls. R–T Repeated-measures one-way ANOVA confirmed significant bone volume increases and βTCP resorption over time, with no significant change in body weight (n = 5). Grouped analysis: bone volume, F(1.462, 5.849) = 25.35, p = 0.0018; βTCP volume, F(1.740, 6.959) = 25.25, p < 0.0008; body weight, F(1.693, 8.463) = 4.261, p = 0.0570. Data are mean ± SEM. U–W Sagittal CBCT images at 6 months demonstrate new bone interlocking within LS-PEK gyroid spaces, consistent with device osseointegration and durable clinical performance. White arrows indicate bone within LS-PEK; yellow arrows indicate bone within βTCP lattice. Source data are provided as a Source Data file.