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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.
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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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.
3.3.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.
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.
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.
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
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
(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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technologies are essential tools for developing organ printing technologies and
industrial scale bio fabrication process engineering
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.
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
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
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
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
[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
[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/