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1. INTRODUCTION TO 3D PRINTING
1.1. 3D printing is a form of additive manufacturing technology where a three
dimensional object is created by laying down successive layers of material. It is also
known as rapid prototyping, is a mechanized method whereby 3D objects are quickly
made on a reasonably sized machine connected to a computer containing blueprints
for the object. The 3D printing concept of custom manufacturing is exciting to nearly
everyone. This revolutionary method for creating 3D models with the use of inkjet
technology saves time and cost by eliminating the need to design; print and glue
together separate model parts. Now, you can create a complete model in a single
process using 3D printing. The basic principles include materials cartridges, flexibility
of output, and translation of code into a visible pattern.

Fig. 1 Typical 3D Printer [5]

3D Printers are machines that produce physical 3D models from digital data by
printing layer by layer [1]. It can make physical models of objects either designed with
a CAD program or scanned with a 3D Scanner. It is used in a variety of industries
including jewelry, footwear, industrial design, architecture, engineering and
construction, automotive, aerospace, dental and medical industries, education and
consumer products.
1.2. History of 3d Printing [1]
The technology for printing physical 3D objects from digital data was first developed
by Charles Hull in 1984. He named the technique as Stereo lithography and obtained
a patent for the technique in 1986. While Stereo lithography systems had become
popular by the end of 1980s, other similar technologies such as Fused Deposition
Modeling (FDM) and Selective Laser Sintering (SLS) were introduced.
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In 1993, Massachusetts Institute of Technology (MIT) patented another technology,


named "3 Dimensional Printing techniques", which is similar to the inkjet technology
used in 2D Printers. In 1996, three major products, "Genisys" from Stratasys, "Actua
2100" from 3D Systems and "Z402" from Z Corporation, were introduced. In 2005, Z
Corp. launched a breakthrough product, named Spectrum Z510, which was the first
high definition color 3D Printer in the market another breakthrough in 3D Printing
occurred in 2006 with the initiation of an open source project, named Rep rap, which
was aimed at developing a self-replicating 3D printer.

Fig. 2 manufacturing 3D printer [9]

The model to be manufactured is built up a layer at a time. A layer of powder is


automatically deposited in the model tray. The print head then applies resin in the
shape of the model. The layer dries solid almost immediately. The model tray then
moves down the distance of a layer and another layer of power is deposited in
position, in the model tray. The print head again applies resin in the shape of the
model, binding it to the first layer [9]. This sequence occurs one layer at a time until
the model is complete
2. GENERAL PRINCIPLES
2.1 Modeling[1]
3D printable models may be created with a computer aided design (CAD) package or
via a 3Dscanner or via a plain digital camera and photogrammetric software. The
manual modeling process of preparing geometric data for 3D computer graphics is
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Fig. 3 manufacturing process printer [8]


similar to plastic arts such as sculpting. 3D scanning is a process of analyzing and
collecting digital data on the shape and appearance of a real object. Based on this
data, three-dimensional models of the scanned object can then be produced.
Regardless of the 3D modeling software used, the 3D model (often in .skp, .die, .3ds
or some other format) then needs to be converted to either a.STL or a .OBJ format, to
allow the printing (a.k.a. "CAM") software to be able to read it.
2.2 Printing
Before printing a 3D model from an STL file, it must first be examined for "manifold
errors", this step being called the "fix up". Especially STL's that have been produced
from a model obtained through 3D scanning often have many manifold errors in them
that need to be fixed. Examples of manifold errors are surfaces that do not connect,
gaps in the models, Examples of software that can be used to fix these errors are net
fabb and Mesh mixer, or even Cura, or Slic3r.Once that's done, the .STL file needs to
be processed by a piece of software called a "slicer" which converts the model into a
series of thin layers and produces a G-code file containing instructions tailored to a
specific type of 3D printer (FDM printers). This G-code file can then be printed with
3D printing client software (which loads the G-code, and uses it to instruct the 3D
printer during the 3D printing process). It should be noted here that often, the client

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software and the slicer are combined into one software program in practice. Several
open source slicer programs exist, including Skein forgeSlic3r, and Cura as well as
closed source programs including Simplify 3D and KIS Slicer. Examples of 3D
printing clients include Repeater-Host, Replicator G, Print run / Printer face, Note that
there is one other piece of software that is often used by people using 3D printing,
namely a G Code viewer. This software lets one examine the route of travel of the
printer nozzle. By examining this, the user can decide to modify the G Code to print
the model a different way (for example in a different position, e.g. standing versus
lying down) so as to save plastic (depending on the position and nozzle travel, more
or less support material may be needed). Examples of G Code viewers are G code
Viewer for Blender and Pleasant3D.
The 3D printer follows the G-code instructions to lay down successive layers of
liquid, powder, paper or sheet material to build the model from a series of cross
sections. Materials such as plastic, sand, metal, or even chocolate can be used through
a print nozzle. These layers, which correspond to the virtual cross sections from the
CAD model, are joined or automatically fused to create the final shape. Depending on
what the printer is making, the process could take up to minutes or days. The primary
advantage of this technique is its ability to create almost any shape or geometric
feature [8].
Printer resolution describes layer thickness and X-Y resolution in dots per inch (dpi)
or micrometers (m). Typical layer thickness is around 100 m (250 DPI), although
some machines such as the Objet Convex series and 3D Systems' Pro Jet series can
print layers as thin as 16 m (1,600 DPI). X-Y resolution is comparable to that of
laser printers. The particles (3D dots) are around 50 to 100 m (510 to 250 DPI) in
diameter.
Construction of a model with contemporary methods can take anywhere from several
hours to several days, depending on the method used and the size and complexity of
the model. Additive systems can typically reduce this time to a few hours, although it
varies widely depending on the type of machine used and the size and number of
models being produced simultaneously.
Traditional techniques like injection moulding can be less expensive for
manufacturing polymer products in high quantities, but additive manufacturing can
be faster, more flexible and less expensive when producing relatively small quantities
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of parts. 3D printers give designers and concept development teams the ability to
produce parts and concept models using a desktop size printer.
2.3 Finishing
Though the printer-produced resolution is sufficient for many applications, printing
a slightly oversized version of the desired object in standard resolution and then
removing material with a higher resolution subtractive process can achieve greater
precision. Some printable polymers allow the surface finish to be smoothed and
improved using chemical vapor processes. Some additive manufacturing techniques
are capable of using multiple materials in the course of constructing parts. These
techniques are able to print in multiple colors and color combinations
simultaneously, and would not necessarily require painting. Some printing
techniques require internal supports to be built for overhanging features during
construction. These supports must be mechanically removed or dissolved upon
completion of the print [1].
All of the commercialized metal 3-D printers involve cutting the metal component
off of the metal substrate after deposition. A new process for the GMAW 3-D
printing allows for substrate surface modifications to remove aluminum components
manually with a hammer.

3. CURRENT 3D PRINTING TECHNOLOGIES[4]


3.1.Stereo lithography - Stereo lithographic 3D printers (known as SLAs or stereo
lithography apparatus) position a perforated platform just below the surface of a
vat of liquid photo curable polymer. A UV laser beam then traces the first slice of
an object on the surface of this liquid, causing a very thin layer of photopolymer
to harden. The perforated platform is then lowered very slightly and another slice
is traced out and hardened by the laser. Another slice is then created, and then
another, until a complete object has been printed and can be removed from the vat
of photopolymer, drained of excess liquid, and cured.
3.2.Fused deposition modeling- Here a hot thermoplastic is extruded from a
temperature controlled print head to produce fairly robust objects to a high degree
of accuracy.

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3.3.Selective laser sintering (SLS) this builds objects by using a laser to selectively
fuse together successive layers of a cocktail of powdered wax, ceramic, metal,
nylon or one of a range of other materials.
3.4.Multi-jet modeling (MJM) this again builds up objects from successive layers of
powder, with an inkjet-like print head used to spray on a binder solution that glues
only the required granules together.
3.5.The V Flash printer, manufactured by Canon, is low-cost 3D printer. Its known
to build layers with a light-curable film. Unlike other printers, the V Flash builds
its parts from the top down.
3.6.Desktop Factory is a startup launched by the Idea lab incubator in Pasadena,
California.
3.7.Fab @ home, an experimental project based at Cornell University, uses a syringe
to deposit material in a manner similar to FDM. The inexpensive syringe makes it
easy to experiment with different materials from glues to cake frosting.
3.8.The Nano factory 3D printing technologies are introduced that are related to the
nanotechnologies.

4 3D PRINTING AND ITS IMPACT ON MEDICAL DEVICE AND


HEALTH CARE[3]
3D printing will impact health care in many ways, including implantable and non-
implantable medical devices, as well as cost-effective customizable devices. One of
the most exciting prospects and radical ways that 3D printing is shaping the medical
industry is bio printing, the 3D printing of human tissues by depositing cells layer-by-
layer to grow organs. Should the promise become fully realized, the ability to print
organs on demand will mean more lives will be saved, particularly those of patients
currently waiting on lists and in desperate need of organ transplants. Gone will be the
day when immunosuppressants are needed to prevent rejection of transplanted
organs, because the organs will be printed using the patients own stem cells.3 Patients
will be able to receive the organ they need, when they need it, and one that is
customized to their body

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Figure 4: Medical Device Development Process,


mapped to Systems Engineering Life Cycle [5]
Developments in this area are progressing rapidly. In March 2011, Anthony
Atala, director of the Wake Forest Institute for Regenerative Medicine, gave a TED
talk regarding the future of bio printing and held in his hands a 3D printed kidney
prototype.3 Four years later, a company named Organology has announced the first
3D printed human kidney tissue, a key development toward the treatment of kidney
diseases and one step closer to making printing implantable kidneys a reality.3 In
addition, 3D printing of tissues has the potential to reduce the need for
experimentation and testing of drugs, cosmetics, and medical devices on animals.3 3D
printing holds promise for improving health care in other ways as well. In addition to
customized 3D printed medical devices, physicians now can use 3D printed models of
a particular patients organ or body part to better plan out and practice for complex
surgeries, and thus reduce surgery times, costs and risks associated with it, and
improve outcomes. Whether a complicated heart surgery or an attempt at facial
reconstruction, the longer the patients internal tissue is exposed during surgery, the
greater the risk of tissue damage.
But 3D printed cells, tissues and organs, and 3D printed medical models, are only two
types of examples of 3D printed objects that are, or could be, used to improve health
care and outcomes for patients. Custom 3D printed medical devices are another, more

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mature, use of this technology. For example, prosthetic limbs are now being made to
mirror the size and shape of the patients corresponding limb through 3D scanning
technology. An image is first taken of the patients sound-side limb and existing
prosthetic. The image of the sound-side limb is then laid over the former image to
create a design for the fairing that is then 3D printed and fitted to the patient, restoring
symmetry to the patients body and resulting in increased function, comfort and
mobility. Some such uses are no longer investigational. To date, the U.S. Food and
Drug Administration (FDA) has granted clearance through the 510(k) process for
several 3D printed medical devices, some implantable. These include hearing aids3,
dental crowns3, bone tether plates, skull plates, hip cups, spinal cages, knee trays,
facial implants screws, surgical instruments3 and Invisalign braces.3 Some of these
like Invisalign braces are 3D-printed at a central facility and then shipped to the
prescribing health care provider, reflecting a more traditional distribution system.
However, the non-traditional devolution of the manufacturing function that 3D
printing promises has also made its way to the medical device sphere. The tracheal
splints discussed in the Introduction are being printed on-site at the health care
facility. Either way, by using 3D printing, these devices can be easily and rapidly
customized for each patient. After digitally scanning the area to be operated on,
surgeons can print 3D models to scale sometimes with mixed colors and media to
reflect different structures to map out the planned procedure or to confirm that
implants will fit as expected.
Describing some of the relatively new companies leading the way in innovation of 3D
printed medical devices provides just a glimpse of the possibilities that exist:
4.1.Clear Correct, LLC uses 3D printers to manufacture clear plastic braces. First, a
patients teeth are scanned and then a computer model of the patients teeth is created,
showing the teeths current alignment and desired alignment. Next, a 3D printer is
used to create a series of models of the teeth, which represent a progression of the
teeths current alignment to a straight alignment. Traditional manufacturing
techniques can then be used to create the aligners. The aligners and 3D printed models
are then sent to the patients dentist, who can utilize the 3D printed model to assist the
dentist in fitting the patient with the appropriate aligners.
4.2.Med Shape, Inc. develops and commercializes orthopedic devices using
proprietary shape memory technology On December 18, 2014, the FDA granted
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510(k) clearance to Med Shapes Class II implantable medical device, the Fast-
forward Bone Tether Plate, which is created through the 3D printing of medical
grade titanium alloy, which allows fabrication of devices with complex and
customizable geometries. The plate serves as the primary component in the Fast
Forward Bunion Correction System, a new approach for surgical correction of hallux
valgus deformities that preserves and protects the native bone anatomy. (510(k)
Number: K141420).
4.3.Oxford Performance Materials (OPM) announced August 19, 2014, that it
received 510(k) clearance for its 3D-printed OsteoFab Patient-Specific Facial
Device, the first and only FDA cleared 3D printed polymeric implant for facial
indications, and follows FDA clearance of the first and only 3D printed polymeric
implant, OPMs OsteoFab Patient Specific Cranial Device, which was granted in
February 2013.3 Both products are Class II medical devices (510(k) Numbers:
K133809 and K121818).
4.4. Renovos Surgical Technologies, Inc. supplies orthopedic implants to surgeons
and hospitals for adult spinal joint reconstruction, and trauma surgery applications.
Renovos received 510(k) clearance for its Tesera Stand alone ALIF Cage, a
titanium implant that uses additive manufacturing to create porous surfaces that aid
bone in-growth from the vertebral endplates.3 (510(k) Number: K132312).
4.5. New Trade These are only a few of the companies that are now using additive
manufacturing technology to create medical devices. Each of these companies
receives patient specifications (often through a scanned image sent in by a physician
or dentist) and prints the medical device to those specifications. Printing the devices at
a central facility allows these companies to regulate quality, biocompatibility of
materials, and sterility and in many ways is only slightly different from how medical
device manufacturers traditionally have produced their products, with the main
difference being cost. As the technology develops further and 3D printers become
ever more accessible, increased migration of the manufacturing function toward on-
site printing is inevitable, as with the tracheal splints discussed in the Introduction.
This migration of manufacturing to non-traditional and dispersed locations will
undoubtedly present numerous additional technological, regulatory, and legal
complications.

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4.6 Impact on Medical Device Orthopedics3 ,Orthopedics as a sub-sector of the


health care industry makes up around 3% of total health care spending accounting for
about 75 billion of the nearly 2.5 trillion total spent in 2009 (1, 2). According to the
American Board of Orthopedic Surgery there are 20,400 actively practicing
orthopedic surgeons in the USA with 650 completing orthopedic residencies each
year. 3DP can potentially have a great impact on orthopedics and orthopedic surgery
in two very distinct ways: new patient specific ways of fabricating orthopedic
implants as well as large cost advantages.3DP allows for patient specific implants to
be customizable and quickly produced in a way not currently available. At present a
patients orthopedic physician or surgeon works with a team and fabrication lab to
create implants for operations, for example a hip replacement. The hip must be
customized to each patient and because of this the process is long, involves a number
of parties, and is extremely costly. 3DPs effects on orthopedics will be discussed in
further depth later in the paper.

Fig. 5 Future use of organ printing [4]

4.7 Impact on Medical Device Prosthetics3 Similar to orthopedics and in many


ways overlapping prosthetics is the second medical sub- sector that will be affected by
3DP technology. Prosthetics involves the development and production of
replacements for missing body parts. Prosthetics is a technologically advanced sub-
sector, which has integrated robotics complex materials science and a variety of
offered products from replacement limbs, to fully articulating robotic hands. 3DPs
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largest impact on prosthetics will be the ability to create highly customized and
detailed parts at a much lower cost. 3DP also allows for the use of a much wider
variety of materials in the production of prosthetics giving doctors a wider variety of
products to choose from.
4.8 Technology Development &Industry Trends
The global medical equipment industry was valued at USD 280 billion in 2009, and is
forecasted to grow by more than 8% annually for the next seven years to exceed USD
490 billion in 2016. There are several reasons as to why the medical industry is
expected to grow so much in the coming years. As people continue to live longer
lives, it is ensured that there will be a steady demand for medical equipment and
healthcare services. As long as awareness, affordability and improving health
infrastructure remain under penetrated in emerging economies, there will be a huge
opportunity for growth. And finally, the fact that most demand for healthcare is not
linked to discretionary consumer spending will ensure that the medical industry will
continue to grow.
The graph below shows how the number of patents in the medical device industry has
grown since 1995.As previously mentioned, the medical industry is still in the growth
stage. 3D printing is a fairly new technology, and thus has yet to disrupt the medical
device industry. The figure below illustrates this point; while the medical devices
industry continues to grow 3D printing is still in the developmental stage. While
traditional device users have another 20-30 years before this technology is developed,
they should keep an eye on the advances of 3D printing. With promises to be a
cheaper, safer, and quicker alternative, 3-D printing is sure to progress from only an
emerging technology to a disruptive technology.

Chart No. 1 grown since 1995[3]

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5 Bone tissue engineering using 3D printing6

5.1 Bone tissue Osseous tissue, known as bone, is made of two different structures;
cancellous and cortical bone. Cancellous, or the inner part of bone, is spongy in nature
having 5090 vol. % porosity. However, cortical bone is the dense outer layer of bone
with less than 10 vol. % porosity. Both types of bone undergo dynamic remodeling,
maturation, differentiation, and restoration that are controlled via interactions among
osteocyte, osteoblast, and osteoclast cells. Osteoblasts are primarily responsible for
new bone formation while osteoclasts are responsible for the restoration of old bone.
Such a dynamic process involving osteoclasts and osteoblasts is known as bone
remodeling, and is responsible for maintaining a healthy bone. Bone is well known
for its self-healing abilities however, large-scale bone defects cannot be healed
completely by the body, and in most cases, external intervention is needed to restore
normal operations. Among different treatment options such as auto grafts (bone taken
from the same persons body) and allografts (bone tissue from a deceased donor),
bone tissue engineering that is focused on methods to synthesize and/or regenerate
bone to restore, maintain or improve its functions in vivo is becoming popular.
Successful application of bone tissue engineering can avoid challenges related to
other treatment options involving different materials such as auto grafts or allografts.
Apart from material issues, a clear understanding of biology involving cells,
extracellular matrix (ECM) and growth factors are pivotal in bone tissue engineering.
5.2 Scaffolds, Scaffolds are an integral part of bone tissue engineering. Scaffolds
are three dimensional (3D) biocompatible structures which can mimic the ECM
properties (such as mechanical support, cellular activity and protein production
through biochemical and mechanical interactions), and provide a template for cell
attachment and stimulate bone tissue formation in vivo. Besides chemistry, pore size,
pore volume and mechanical strength are critical parameters which define a scaffolds
performance. At an early stage, bone in growth happens at the periphery of scaffolds
with a negative gradient in mineralization toward the inner parts. For continuous in
growth of bone tissue, interconnected porosity is important. Open and interconnected
pores allow nutrients and molecules to transport to inner parts of a scaffold to
facilitate cell in growth, vascularization, as well as waste material removal. Since
higher porosity increases surface area per unit volume, the biodegradation kinetics of
scaffolds can be influenced by varying pore parameters. Biodegradation through a
cell-mediated process or chemical dissolution are both important to ascertain

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stabilized repair and scaffold replacement with new bone without any remnant. A
minimum pore size between 100 and 150 mm is needed for bone formation however,
enhanced bone formation and vascularization are reported for scaffolds with pore size
larger than 300 mm. Pore size also plays an important role in ECM production and
organization. Poly(D,L-lactic acid) (PDLLA) scaffolds with pore size 325 and 420
mm led to well-organized collagen I network; whereas, smaller pore size of 275 mm
prevented the human osteosarcoma-derived osteoblasts to proliferate, differentiate
and produce functional ECM. Pore volume also controls the permeability of nutrients
to the scaffold and their mechanical properties. Permeability in poly-e-caprolac-tone
(PCL) increased with higher pore volume and resulted in better bone regeneration,
blood vessel infiltration, and compressive strength in vivo, when other pore
parameters were kept the same. Apart from biological performance, the initial
mechanical properties and strength degradation rate should match that of the host
tissue for optimum bone healing. The strength degradation kinetics of porous
scaffolds are highly affected by pore size, geometry, and strut orientation with respect
to the loading direction. Finally, surface properties such as chemistry, surface charge
and topography also influence hydrophobicity and in turn cell material interactions
for bone tissue in growth.
RP techniques for bone scaffold fabrication.
Techniqu Process details Processed materials Advantages and Refe
e for bone tissue disadvantages renc
engineering e
3D (in solution form) PCL [32
Plotting/d extrusion based 38]
irect
Strands of
paste/visc
ous
material
ink (in solution form) Hydroxy apatite Mild condition of
writing extrusion based on (HA) Bioactive process allows
the predesigned glasses esoporous drug and bio
structure Layer by
layer deposition of bioactive composite molecules (proteins
strands at constant Poly lactic acid and living cells)
rate, under specific (PLA)/polyethylene plotting
pressure Disruption glycol(PEG) Heating/post-
of strands according
PLA/(PEG)/G5 processing needed
to the tear of speed
glass Poly (hydroxyl for some materials
methyl glycol lide- restricts the bio
co- e-caprolac tone) molecule

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(PHMGCL) incorporation
Bioactive 6P53B
glass
Laser- Coating the desired HA [39
assisted material on 42]
Bio transparent quartz Zirconia Ambient condition
printing disk (ribbon)
(LAB) Deposition control HA/MG63 osteo Applicable for
by laser pulse energy blast-like cell Nano organic, inorganic
Resolution control HA Human osteo materials and cells
by distance between
ribbon/substrate, progenitor cell Quantitatively
spot size and stage Human umbilical controlled3D stage
movement vein endothelial cell movement
Homogeneous
ribbons needed
SLS Preparing the PCL Nano HA No need for [43
powder bed Layer by Calcium phosphate support No post 48]
layer addition of (CaP)/poly(hydroxy processing is
powder Sintering
each layer according butyrateco- needed Feature
to the CAD file, hydroxyvalerate) resolution depends
using laser source (PHBV) Carbonated on laser beam
hydroxyl apatite(CH diameter
Ap)/poly(L-lactic
acid) (PLLA) PLLA
b-Tri calcium
phosphate (b-TCP)
PHBV
SLA Immersion of Poly(propylene Complex internal [49
platform in a fumarate) features can be 52]
photopolymer liquid (PPF)/diethyl obtained Growth
Exposure to focused
light according to fumarate (DEF) factors, proteins
desired design PPF/DEF-HA and cell patterning
Polymer solidifying PDLLA/HA b-TCP is possible Only
at focal point, non- applicable for
exposed polymer
photopolymers
remains liquid,
Layer by layer
fabrication by
platform moving
downward
FDM Strands of heated Tri calcium No need for [26,3
polymer/ceramics
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extrusion through phosphate (TCP) platform/support 0,31,


nozzle TCP/polypropylene Material restriction
(PP) Alumina due to need for
(Al2O3) PCL molten phase
TCP/PCL
Robotic Direct writing of HA/PLA Independent 3D [59]
assisted liquid using a nozzle HA/PCL6P53B nozzle movement
Consolidation
deposition glass/PCL Precise control on
through liquid-to-
/ robo gel transition thickness No need
casting for
platform/support
Material restriction

Table No. 1 RP techniques for bone scaffold fabrication. [6]


5.3 Mechanical properties of 3D printed scaffolds
Low mechanical strength is a major challenge in porous scaffolds, and is primarily
controlled by pore volume. This is also true for 3D printed ceramic scaffolds and
limits their use only in non-load bearing and low-load bearing applications. Optimized
post process-sing approaches and compositional modifications can improve
mechanical properties of ceramic scaffolds. The compressive strength of 3D printed
TCP sintered scaffolds. In agreement with observed shrinkage and increased density,
micro-wave sintering results in a higher compressive strength. The strength of the
scaffold increases with decreasing pore size or volume, and a maximum strength of
10.95 1.28 MPa has been observed for scaffolds with 500 mm pores, with 42% total
open porosity, when sintered at 1250 8C for 1 h in a microwave furnace. In another
study, when a mixture of TTCP/b-TCP was sintered at 1400 8C, it increased the
strength of the 3D printed scaffold. However, sintering a TTCP/calcium sulfate
dehydrate composite caused a decrease in the strength due to water release.
Tarafderetal. Reported an effective densification approach; using microwave sintering
compared to conventional heating, and improved the mechanical properties of 3D-
printed TCP scaffolds. Bioactive liquid phase sintering aids have also been reported to
increase strength. 3D printed HA/A-W glass, where the glassy phase is added as a
liquid phase sintering aid, showed an increase in strength from 1.27 MPa to 76.82
MPa when sintered at 1300 8C for 3 h. The enhancement of tensile properties was
also found in PE scaffolds as a result of thermally induced densification and binder

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degradation.To increase the strength of ceramic scaffolds without impairing biological


properties of scaffolds, another approach is monomer or polymer infiltration. A
mixture of bismuthacrylated oligolactid emacromer (DLM-1), containing 10 wt% of
2-hydroxyethyl methacrylate has been used to increase the strength of scaffolds
before and after sintering. The immersion of HA scaffolds in tri ethylene glycol
dimethacrylate (TEGDMA), 2,2-bis[4 (2-hydroxy-3thacryloy-loxypropyloxy)-henyl]
propane (bis-GMA) resulted in an increase of the flexural strength by at least 20
times. Table 1summarizes the mechanical properties of 3D printed scaffolds tailored
for bone tissue engineering.
5.4 Organ Printing Processing
One of the most comprehensive approach to modeling organ printing technology
and application of modern information technology tools is a development of virtual
organ bio fabrication line (Fig. 5).The development of virtual organ bio fabrication
line is another interesting approach and logical and advanced way for industrial and
clinical translation of emerging organ printing technology. Virtual organ bio
fabrication line must combine all possible visual information about machines,
devices and processes through an interactive computer system capable to generate
real-time animation and data and also and capable to provide a visit by virtual
reality to the organ bio fabrication plant as an avatar to visually, observe and
virtually interact with all components of organ bio fabrication line.
The initial step is a computer simulation and virtual representation of major bio
fabrication equipment such as cell sorters, robotic tissue spheroid bio fabricator, and
robotic bio printer and perfusion bioreactor. Second step is virtual placing bio
fabrication equipment into virtual building based according to logics of bio
fabrication process and restrictions imposed by related regulatory requirement.
Finally, sequential steps of bio processing and organ bio assembly processes have
been simulated on micro level and seamlessly integrated with correspondent virtual
bio fabrication equipment. The resulted virtual bio fabrication line should be
additionally optimized and integrated.
The virtual organ bio fabrication line will be a needed step toward development of
real organ bio fabrication industrial plant. Thus, computer aided design, computer
simulation, mathematical modeling, virtual reality methods and informational

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technologies are essential tools for developing organ printing technologies and
industrial scale bio fabrication process engineering

Fig. 6. Virtual organ bio fabrication line [3]


5.6 Organ Printing Post-Processing
Post-processing starts immediately after finishing bio printing process (processing).
The main task of designing post- processing is ensuring viability and survival of 3D
bio printed organ construct, fusion tissue spheroids into integrated constructs and its
accelerated maturation. Modeling post-processing will enable non-destructive and
non-invasive bio monitoring viability, integration and maturation of bio printed organ
constructs.
Predictive mathematical modeling and computer simulation of tissue spheroids fusion
in bio printed construct is one of the most interesting problems which already
attracted attention of several groups of researchers. There are several mathematical
approaches starting from field theory and finishing molecular dynamics. The scalable
mathematical modeling of tissue spheroid fusion in whole bio printed organ construct
is still limited by computer power. Implementing powerful parallel computing is one
approach. The second approach based on approximation of tissue spheroid with foam
bubbles and using well developed open source software Surface Evolver. In this case
modeling post-processed tissue spheroid fusion in large size 3D tissue constructs is
possible. In our group, we used Surface Evolver software for modeling fusion of
vascular tissue spheroids in bio printed segment of vascular tree. This approach
enables to estimate how many concentric layers of tissue spheroid must be printed in
sequential vascular segments in order to get authentic for each vascular segment
diameter of vascular wall. One obvious limitation of Surface Evolver which must be
optimized is impossibility of changing topological position of tissue spheroids inside
3D construct.

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Modeling interstitial interspheroidal perfusion in 3D bio printed construct during post


processing tissue spheroid fusion process is another important problem which needs
systematic investigation.
Mathematical modeling and computer simulation of emerging material properties of
bio printed constructs is still practically untouched area in the ongoing application of
information technology tools in 3D bio printing. The need for accelerated post-printed
tissue maturation in 3D bio printed tissue construct is obvious because it reduces the
cost of final product. As we indicated most of the complex human organ are highly
vascularized and their integration in pre-existing recipient vascular system required
achievement of certain level of material properties of large diameter extra organ
segment of their vascular tree such as, for example, kidney artery and vein in case of
kidney.
The first step in modeling tissue maturation is an identification of structural
determinants of material properties of tissue and organs. The main structural
determinants of material properties of vascular wall in the large diameter blood vessel
is an extracellular matrix usually consisted of two load bearing structural extracellular
matrix proteins collagen and elastin. The best way to identify the relative contribution
of these two proteins is using method of selection digestions or the observation of co-
evolution material properties of with structural-functional parameters. Using this
approach, we recently were able to identify concentration of collagen, diameter of
collagen micro fibrils and level of collagen cross-linking as most essential structural
determinants of material properties of heart valve. The application of mathematical
modeling for solving so-called ill-posed inverse problems in biology is another
potentially perspective direction of application computational tools for predictive
description of tissue maturation during post-processing in organ printing technology.
Exploring this approach is highly desirable.
6. Present information Chinese Girl Becomes World's First To
Receive Full Skull Reconstruction Via 3D Printing
Jul 16, 2015 02:17 PM By LizetteBorreli@lizcelineb

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Fig. 7 Chinese Girl


A 3-year-old in China becomes the worlds first to receive entire skull reconstruction
surgery via 3D printing technology. @MailOnline/Twitter
A 3-year-old girl in China will finally be able to lift her head from the pillow after
receiving the worlds first full skull reconstruction surgery via 3D printing
technology. The toddler, referred to as Han Han, underwent 17 hours of surgery at
the Second Peoples Hospital of Hunan Province in China after suffering from a rare
condition that caused her head to grow four times the normal size. The procedure,
translated from Chinese as whole brain shrinking plastic surgery, involved a full 3D
reconstruction and 3D printing of a new titanium skull to reposition her brain.CT
results showed that Han Hans brain was filled 80 percent with water, said Dr. Bo of
the Second Peoples Hospital of Hunan Province, 3Dprint.com reported. If she was
not sent to hospital for treatment, Han would not have survived the summer. We had
to first eliminate the infection in Han Hans head because the brain wound area was
too large, and we needed to do skin graft surgery and insert a shunt to help eliminate
the infection, and remove the fluid from her brain.
She was first diagnosed with congenital hydrocephalus at the age of 6 months. This
type of hydrocephalus is present at birth and can either be caused by events or
influences that occur during fetal development, or genetic abnormalities, according to
the National Institute of Neurological Disorders and Stroke. Typically in congenital
hydrocephalus, the cerebrospinal fluid (CSF) surrounds the brain and spinal cord.
Excessive accumulation of CSF leads to abnormal widening of spaces in the brain
called ventricles. This creates potentially harmful pressure on the tissues of the brain.
In infancy, the most notable symptom of hydrocephalus is a rapid increase in head
circumference of an unusually large head size. For Han, the pressure of the excess
fluid on the brain made her head weigh more than half her body weight, so much so

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she struggled to lift it from the pillow or get out of bed, the Mail reported. The toddler
also developed medical problems, such as a thinning skull and poor blood supply.
This prompted the family to take immediate action.

7 3D PRINT IN MEDICINE RIGHT NOW[7]


7.1 Tissues with blood vessels:
Researchers at Harvard University are making great progress in bio printing blood
vessels, a crucial step towards printing tissues with a blood supply. The lab of Dr.
Jennifer Lewis designed a custom-built 3D printer and a dissolving ink to create a
swatch of tissue containing skin cells interwoven with structural material that can
potentially function as blood vessels.
7.2 LowCost Prosthetic Parts

Fig. 8 Prosthetic Parts


Creating traditional prosthetics is very time-consuming and destructive, in that any
modifications to the prosthetics would destroy the original molds. Moreover, the cost
of traditional prosthetics is a significant barrier to those without significant resources.
Researchers at the University of Toronto, in collaboration with Autodesk Research
and CBM Canada, used 3D printing to quickly produce cheap and easily customizable
prosthetic sockets for patients in the developing world, particularly Uganda.
Similarly, Not Impossible Labs based in Venice, California took 3D printers to
Sudan where the chaos of war has left many people with amputated limbs. The
organizations founder, Mick Ebeling, trained locals how to operate the machinery,
create patient specific limbs, and fit these new, very inexpensive prosthetics. This
work is also being driven quite significantly by two major organizations, Robo hand
and E-Nable, whose 3D printable prosthetics have proliferated with wild success.
7.3 Drugs

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Lee Cronin, a chemist at the University of Glasgow, wants to do for the discovery and
distribution of prescription drugs what Apple did for music. In a TED talk Cronin
describes a prototype 3D printer capable of assembling chemical compounds at the
molecular level. Patients would go to an online drugstore with their digital
prescription, buy the blueprint and the chemical ink needed, and then print the drug at
home. In the future Cronin suggests that we might sell not drugs but rather blueprints
or apps. Progress is already being made in this direction as Louisiana Technical
University researchers have printed biocompatible, biodegradable devices for
delivering bone cancer medicines.
7.4 Tailor-made sensors
Researchers at Washington University in St. Louis have used scans of animal hearts to
create printed models, around which, stretchable electronics were wrapped. The
silicon device can be peeled off of the printed model and attached onto a human heart
for a perfect fit. Though the electronic sensors can detect oxygenation detectors, heart
strain strain, and temperature, the next step is to enhance the electronics with multiple
sensors, including those that measure acidic conditions to detect blocked arteries.
7.5 Medical Models
A 3D printed heart from catalog. A group of researchers in China and the US have
printed models of cancerous tumors to aid discovery of new anti-cancer drugs and to

Fig. 9 3D printed heart


better understand how tumors develop, grow, and spread. Creating patient-specific
models from CT and MRI scans expands from medical research into practical
application with the ability to prepare doctors for surgeries, thus drastically reducing
surgery times. Taking this one step further, there are numerous examples of using
medical scan data to 3D print implants tailor-made to the patient.

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7.6 Bone
In 2011, Professor Susmita Bose, of Washington State University, modified a Pro
Metal 3D printer to bind chemicals to a ceramic powder, creating intricate scaffolds
that promote the growth of bone in any shape. Prof. Boses goal is to, one day, be able
to implant the bone scaffold with bone growth factors in such a way that the implant
is dissolved by natural bone material in even load-bearing bone structures.
7.7 Heart Valve

Fig. 10 3D printed Heart Valve


Jonathan Butcher, at Cornell University has printed a heart valve that will soon be
tested in sheep. With a dual-syringe machine, he was able to print a combination of
alginate, smooth muscle cells, and valve interstitial cells, to control the valves
stiffness.
7.8 Ear cartilage

Fig. 11 3D printed Ear cartilage


Cornells Lawrence Bonassar used 3D photos of human ears to create ear molds.
These molds were then filled with a gel containing bovine cartilage cells suspended in
collagen, which held the shape of the ear while cells grew their extracellular matrix.
Bonassar and his team have since gone on to 3D print intervertebral discs to treat
major spinal complications, while researchers at Princeton have 3D printed their own
collagen ear, this time, with built-in electronic components for superhuman hearing.
7.9 Medical equipment
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Already, 3D printing is occurring in poverty-stricken areas of the world. Due to the


ability to manufacture items that may be difficult or expensive to obtain by traditional
means, groups like iLab//Haiti have taken to 3D printing umbilical chord clamps for
local hospitals in Haiti.

Fig. 12 Medical equipment


7.10. Cranium Replacement

Fig. 13 skull with a customized printed


approval. A team of Dutch surgeons at the University Medical Center in Utrecht
replaced the entire top portion of a 22 yearold womans skull with a customized
printed implant made from plastic. This story has been replayed in China, where a
man with a crushed skull was given a tailor-made, 3D printed, titanium replacement,
and in Slovakia, in which a different man with brain damage received a similar, 3D
printed treatment.
7.11 Synthetic skin
James Yoo at the Wake Forest School of Medicine in the US has developed a printer
that can print skin straight onto the wounds of burn victims. With the ability to scan a
wound, the printer can then fabricate the appropriate number of skin layers to fill the
wound. Yoos research was able to successfully demonstrate the viability of a 10-cm
piece of skin transplanted onto a pig and has since been funded by the US Army to

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Fig. 14 Synthetic skin


use the technology to treat wounded soldiers.
7.12 Organs
Organovo recently announced the commercial launch of their bio printed liver assays,
3D printed liver cells that able to function for more than 40 days. While, at the
moment, the product is used for testing new pharmaceuticals, Organovos top
executives and other industry experts suggest that within a decade we will be able to

Fig. 153D printed liver cells


print solid organs such as liver, heart, and kidney. Hundreds of thousands of people
worldwide are waiting for an organ donor; imagine how such a technology could
transform their lives.

8. FUTURE DIRECTION AND CHALLENGES


AM offers unique advantages toward part fabrication that are needed for the
production of small volumes or one of a kind product manufacturing. Among the
different AM techniques, 3DP is a versatile tool that has become popular for making
scaf-folds for bone tissue engineering. 3DP can fabricate scaffolds with defined
shapes, with controlled and interconnected porous structures. Although the process
characteristics provide the opportunity for the fabrication of almost all types of
materials, the selection of a suitable binder for 3DP is still a challenge, and extensive

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optimization may be needed before high quality parts can be made. Among different
binders, organic binders work well, however, they can affect the plastic parts of 3DP
machines during long term operation. The residue from binders may be difficult to
remove during sintering, an issue that may need special attention for biomaterials.
Moreover, to achieve the desired accuracy and resolution in 3DP, a minimum distance
between pores is necessary which is dependent on powder characteristics and the
build parameters. The minimum distance requirement for a powder based process
makes it difficult to print highly porous scaffolds with a sintered pore size below 300
mm [68].Post processing is always required for 3DP processed parts. Sintering or
densification at high temperature is just one of them. During sintering, parts shrink
and the shrinkage is not necessarily uniform throughout the part. Non-uniform
shrinkage can cause extensive cracking in parts and make them unusable. This is a
particular challenge for porous scaffolds. Since the outside part of bone is a dense
structure with 10% or less porosity while inside it

8.1 CONCLUSION

3D Printing technology could revolutionize and reshape the world. Advances 3D


printing technology can significantly change and improve the way we manufacture
products and produce goods worldwide. An object is scanned or designed with
Computer Aided Design software, then sliced up into thin layers, which can then be
printed out to form a solid three-dimensional product. As previously described, the
importance of an invention can be appraised by determining which of the human
needs it fulfills.
As shown, 3D printing can have an application in almost all of the categories of
human needs as described by Maslow. While it may not fill an empty unloved heart, it
will provide companies and individuals fast and easy manufacturing in any size or
scale limited only by their imagination. One of the main advantages of the
industrialization revolution was that parts could be made nearly identically which
meant they could be easily replaced without individual tailoring.
3D printing, on the other hand, can enable fast, reliable, and repeatable means of
producing tailor-made products which can still be made inexpensively due to
automation of processes and distribution of manufacturing needs. If the last
industrial revolution brought us mass production and the advent of economies of
scale - the digital 3D printing revolution could bring mass manufacturing back a full
circle - to an era of mass personalization, and a return to individual craftsmanship.

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References

Reference Books

[1] Low cost 3D printing for science , Education & Sub stainable Development
Editors: Enrique Canessa, Carlo Fonda and Marco Zennaro
Publisher ICTPThe Abdus Salam International Centre for Theoretical Physics
2013 ICTP Science Dissemination Unit, e-mail: sdu@ictp.it Printing history: May
2013, First Edition

Papers from Journal or Transactions

[2] Reed Smith (Life science health industry group) 3D Printing of Medical Devices:
When a Novel Technology Meets Traditional Legal Principles OF Jim Beck, Celeste
Letourneau, Kevin Madagan, Todd Maiden, John Schryber, Tracy Quinn, and Gail
Daubert BY Colleen Davies, Lisa Baird, Matthew Jacobson and Farah Tabibkhoei
Editors
[3] 3D Printing & The Medical Industry an in--depth analysis of 3DPS potential
impact on health care By Nancy Bota, Ethan Coppenrath, Danying Li, Michael
Manning

Papers from Conference Proceedings

[4] Organovo develops first commercial 3D bio-printer for manufacturing human


tissue and organs. Organovo. 1 Dec. 2009. <http://www.organovo.com/news1.php>
[5] The International Design Technology Conference, DesTech2015, 29th of June
1st of July 2015, Geelong, Australia
Simplifying Medical Additive Manufacturing: Making the Surgeon the Designer
Ian Gibsona*, Aniruddha Srinathb aDeakin University, Geelong, Victoria 3220,
Australia bCyient Limited, Bengaluru 560100, India
[6] Bone Tissue Engineering using 3D printing By Susmita Bose*, Sahar Vahabzadeh
and Amit Bandyopadhyay W. M. Keck Biomedical Materials Research Lab, School
of Mechanical and Materials Engineering, Washington State University, Pullman,
WA 99164, USA

[7] 12 Things We Can 3D Print in Medicine Right Now By Bertalan Mesk On Thu,
February 26, 2015 3D Printing, Bioprinting, Industry Insights, Lists, Medical &
Dental, Military, Prosthetics, Science8 Comments

Internet
[8]http://www.explainingthefuture.com/3dprinting.html
[9]http://en.wikipedia.org/wiki/3D_printing
[10]http://www.mahalo.com/3d-printers/

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