4D printing technology in medical engineering: a narrative review

Abstract The addition of the time dimension to three-dimensional (3D) printing has introduced four-dimensional (4D) printing technology, which has gained considerable attention in different fields such as medical, art, and engineering. Nowadays, bioscience has introduced some ideas which can be fulfilled by 4D printing. Blending time with variations caused by the situation has many beneficial aspects such as perceptibility and adaptability. Since 4D printing can create a dynamic structure with stimuli-responsive materials, the applications of smart materials, stimulus, and 3D printing are the effective criteria in 4D printing technology. Smart materials with their flexible properties can reshape, recolor, or change function under the effect of the internal or exterior stimuli. Thus, an attractive prospect in the medical field is the integration of the 4D printing approach along with smart materials. This research aims to show the most recent applications of 4D printing technology and smart materials in medical engineering which can show better prospective of 4D printing applications in the future. Also, it describes smart medical implants, tissue engineering, and bioprinting and how they are being used for the 4D printing approach in medical engineering applications. In this regard, a particular emphasis is dedicated to the latest progress in the innovation and development of stimuli-responsive materials that are activated and respond over time to physical, chemical, and biological stimuli and their exploitation through 3D printing methods to fabrication 4D printing smart parts such as intelligent tissue-engineered scaffolds, smart orthopedic implants, and targeted drug delivery systems. On the other hand, major challenges in this technology are explained along with some suggestions for future works to address existing limitations. It is worth noting that despite significant research that has been carried out into 4D printing, it might be more valuable if some investigation is done into 4D bio-printing applications and how this approach will be developed.