In a domain where innovation saves lives, additive manufacturing is now positioned as a major asset for healthcare professionals. Although it still has a few years before its mass adoption (it is adopted by the majority), the first results allowing to create tissues, bones or, custom-made prostheses, are sufficient to apprehend the enormous potential for the public.
To date, the main areas of application that make the most of this technology are: dentistry, orthopedics, medical training, medical research, preparation of surgical procedures, prototyping of medical tools and equipment intended for surgeons, and the design of customized medical equipment.
This paper aims to analyze the contribution of additive manufacturing technology in the medical sector. It will present the integration of this technology in various fields of application in the medical industry, its advantages, but also its limits or points to be improved.
It should be noted that, as part of this dossier, some industry professionals shared their understanding on the subject, as well as their experience with this technology: Dr. Simon Weidert, specialist in orthopedic traumatology, Daniel Crawford CEO of Axial3D and Alexandre Baelde, head of the 3D Print program at Medicrea.
Personalized care and customized prosthesis
Surgery is currently the main field of application for 3D printing health wise. This manufacturing process makes it possible to create customized prostheses that are perfectly adapted to each patient or even implants in biocompatible but durable materials (titanium, plastic).
Where, until now, the "made-to-measure" consisted of modeling a prosthesis by hand, 3D medical imaging combined with a 3D printer makes it possible to create an exact replica of the bone to be replaced. It is mainly the use of a 3D scanner that allows to digitally detail the need of the patient, allowing to create a prosthesis perfectly adapted to its morphology.
This process has an impact on the production cost of the prosthesis as well as the time it takes to make it.
Alexandre Baelde’s point of view, Head of the 3D Print program at Medicrea
Medicrea is a French company specialized in the design and production of medical devices for spinal cord surgery (the spine). At the end of 2014, the company integrated 3D printing technology with the goal of producing customized implants. With additive manufacturing, the company produced modified and standard implants.
Alexandre Baelde explains that their "implants allow to quickly create the fusion between the vertebrae. The idea is to have easy surface properties while properly integrating the mechanical properties”. The manufacture of metal powder (titanium) in SLM machines is used by Medicrea, particularly with the laser deposition technique.
Speaking of the two types of implants made with 3D printing, Alexandre Baelde explains: "For custom-made implants, technology makes it possible to make highly adapted implants. These are the most complex implants, having something modified facilitates "the operative gesture". Implants adapt better to structures because they provide a solution that does not exist and produce an ideal post-operative result.
On the level of more standard ranges, it must be understood that the product offering is based on customization and planning. We have doctors working on algorithms for customization. For planning, however, the surgeon has the choice to adapt it to his needs, to the pathology he wants to treat."
Dr. Simon Weidert's perspective on the cost of prosthesis and production time
Dr. Simon Weidert is a specialist in orthopedic traumatology and works at the University of Munich. He has also founded three companies that have different activities in the medical industry. 3D printing in the medical sector is one of the main matters of his research.
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Dr. Weidert compares the cost and time of conventional orthosis manufacturing with additive manufacturing. Speaking of additive manufacturing, he emphasizes the importance of having good software and knowing how to use it: “If you have to design an orthosis for 30 hours, nobody will pay for it. But with a 3D printer, the model adapts perfectly to the body, to your pain and its fabrication is fast. Consequently, only the software combined with the 3D printer can give you the freedom to design parts and analysis in the frame structure, perfectly adapted to your needs.”
Dr. Weidert mentions his activity in Mecuris, a company specializing in personalized prostheses as an example:
“There are kids being born without a foot. They can lose a foot in an accident. They do not know how to run because the 3D printed prosthetic available on the market does not allow that. It is really bad because no company wants to invest in that.
So, we at Mercuris created a 3D printed prosthetic to enable those children to walk and continue other activities. It may change the life of a person and increase their confidence. This is the biggest advantage of 3DP. A product which is tailor-made to them. à It’s about turning a parametric product into a unique one.”
In 2017, 3D printing became widespread in the dental industry. As the additive industry continues to fully transform and delve into manufacturing applications, the growth path of most existing polymer printing technologies has somewhat declined in historical terms. This has allowed well-established, high-value applications in the health care field to shine and attract the attention of industry stakeholders.
Dentists are increasingly taking advantage of digital workflows and manufacturing processes, having recognized long ago that digital dentistry is the future of the industry. Indeed, 3D printing is well positioned to becoming the first digital process in global dental manufacturing with its flexibility in the efficient and accurate production of everything from dental models to orthodontic aligners to PFM restorations, dental prostheses and many others.
3D printer manufacturers are developing and bringing to the market more and more innovative machines, enabling better dental treatment by bringing the creation of personalized devices closer to the point of service - in the dentist's office. These include EnvisionTec, DWS, Formlabs, Shining 3D, whose machines are the mostly used by the dental professionals.
Prototyping of medical tools and equipment
Whether it be for the manufacturing of prototypes of medical equipment, or molds for the production of mass prostheses, conventional manufacturing methods generally require tools that have an impact on production time and costs. These two factors increase with the complexity of the design (shapes and dimensions).
The efficiency and flexibility of 3D printing technologies complements conventional manufacturing, allowing medical device manufacturers to push the boundaries of innovation, to realize more design and tooling revisions in a short amount of time, while reducing costs, simplifying operations and speeding up delays of commercialization.
Dr. Simon Weidert’s outlook
Since some professionals do not always have the time or the skills to do this, Dr. Weidert and his team are preparing 3D technologies and equipment needed to help them. They notably have the opportunity to customize their software according to the needs of the medical sector.
3D printing combined with medical imaging can be invaluable in that it provides surgeons with the exact copy of the organ to operate on. This gives the medical profession the possibility to visualize the parts of the body in advance to prepare the operations or train teams.
Daniel Crawford’s, CEO of Axial3D, viewpoint on surgical guides
Axial3D is a company that specializes in medical 3D Printing applications. Daniel Crawford explains that Axial3D helps to pre-plan an operation by preparing any equipment that a surgeon will need before going to surgery. This saves time in surgery and therefore improves patient care, i.e., bleeding or risk of infection.
Daniel Crawford’s, CEO of Axial3D, viewpoint on surgical guides
Axial3D is a company specialized in printing medical applications in 3D. Daniel Crawford explains that Axial3D helps to pre-plan an operation by preparing any equipment that a surgeon will need before going to surgery. This saves time in surgery and therefore improves patient care, i.e., bleeding or risk of infection.
For Daniel Crawford, improving patient care begins with improving the work of a physician:
“ - First and foremost, improving the pre- planning of the patient’s surgery. So, for the orthopedics, the surgeon can actually take existing plates and screws from shelves and pre-band them. Everything that we prep is 1:1 (1 to 1) scale.
- They are working on the exact anatomy that they are going to be operating on so this in turn reduces the amount of time the patient is under the knife, which then reduces the quantity of the bleeding and chance of infection of the patient.
- It also improves the way a lot of surgeons can be trained. So, registered surgeons who are typically operating on patients or are developing their skills base only get to do these types of operations in the theatre but if we give them the opportunity to actually dry-run the procedures before they go in and operate, it improves the patients care greatly.”
Example of a patient case:
To illustrate this, Daniel Crawford tells the story of an 8-year-old boy patient at the Royal Victoria Hospital in Belfast. He was unable to move his arm and this affected his ability to write, play sports and carry out his daily activities. Traditionally, in order to treat this, it would have been necessary to remove bones (the radius and the ulna) before undertaking other procedures that would have taken 3 to 4 hours.
However, once the CT scans were taken and the 3D printed models were prepared for the surgeon, the doctors could see that it was not the deformity that was causing the problem, but a soft tissue deformity that was causing the problem. A necessary execution of "keyhole surgery" took place– a surgery, which would have lasted about 4 hours, took doctors 30 minutes to complete.
“There was less bleeding, less chance of infection and I also heard that the patient was able to leave the hospital on the same day which wouldn’t have been possible without the use of the 3D printed model,” Daniel Crawford confirms.
Clinical training is the field of application that can best leverage the benefits of additive manufacturing technology. As the human body is complex and highly variable, even the most sophisticated medical mannequins represent only an ordinary anatomy. The various options used by trainers have limitations in their ability to fully and consistently represent a particular concept or pathology.
Without clinically relevant models, physicians and students are deprived of the benefits of hands-on experience. The training is longer and requires hours of learning before they can acquire the skills and knowledge needed to perform quality clinical work. 3D multi-material printing allows for the creation of accurate, versatile models at a reduced cost, thus facilitating the work of the medical profession.
Some medical societies are specialized in these trainings. Dr. Simon Weidert explains that in Medability, 3D printing and technologies are used to allow surgeons to better prepare themselves before entering the operating room. "We provide quality training everywhere and provide rapid skills acquisition. (Simulator - training - operation), "says the doctor.
In addition, other 3D printing specialists, such as Stratasys, offer templates that include all the features needed to convey key concepts, including the most subtle visual and tactile details.
Advantages & Limitations
Based on our research and the opinions of the professionals who participated in this dossier, we note the advantages and limitations regarding the use of 3D printing in the medical sector:
Areas for improvement
3D printing’s usefulness in complex surgery
The availability of 3D technology: mastery of the software and its use with the correct printer
In reconstructive surgery, you really take into account many questions that could have been during the operation (at the level of the preparation of a surgical procedure).
Pay attention to regulations in the medical 3D printing sector: all is not yet allowed
At the production level series – the freedom of form, possibility of doing more technical things, possibility of making small series of parts.
For projects under development – possibility to make prototypes. We have more agility in the way we work and we go quickly in the design phases
Mastery of the material is essential and so is the acquisition of new skills.
Training and time saving in the preparation of surgeons
It is still a technology that many health professionals do not know and many people do not have the resources to learn how to produce a 3D model.
3D printing in the health sector illustrates a very positive evolution in the improvement of the patient's care, nonetheless the limitations show that the technology is not yet enough present in the hospital environment. It is therefore necessary to make health professionals aware of its potential in the treatment of patients.
Additionally, if the technology is still in its infancy stage in the medical sector, we must not lose sight of the regulations (that govern this) and the new skills that it implies.
This dossier has originally been published in the April Issue of 3D Adept Mag (2018).
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