Application Of Three-dimensional Printing Research Articles

Three-Dimensional Printing Applications in Percutaneous Structural Heart Interventions

Cardiovascular 3-dimensional printing refers to the fabrication of patients' specific cardiac anatomic replicas based on volumetric imaging data sets obtained by echocardiography, computed tomography, or magnetic resonance imaging. It enables advanced visualization and enhanced anatomic and sometimes hemodynamic understanding and also improves procedural planning and allows interventional simulation. Also, it is helpful in communication with patients and trainees. These key advantages have led to its broad use in the field of cardiology ranging from congenital to vascular and valvular disease, particularly in structural heart interventions, where many emerging technologies are being developed and tested. This review summarizes the process of 3-dimensional printing and the workflow from imaging acquisition to model generation and discusses the cardiac applications of 3-dimensional printing focusing on its use in percutaneous structural interventions, where procedural planning now commonly relies on 3-dimensional printed models.

Application of three-dimensional printing combined with surgical navigation and endoscopy in orbital fracture reconstruction

Objective: To evaluate the clinical effect of three-dimensional printing combined with surgical navigation and endoscopy for orbital fracture reconstruction. Methods: A case series study. Twenty-eight patients (28 eyes) with orbital fractures (20 males and 8 females, aged 10-61 years, with simple orbital fractures in 22 patients and composite orbital fractures in 6 patients) were treated with three-dimensional printing combined with surgical navigation and endoscopy for orbital fracture reconstruction at Affiliated Eye Hospital of Nanchang University from July 2016 to June 2018. With the help of three-dimensional printed models and guides, navigation positioning guidance and endoscopic visualization performance, the soft tissue incarcerated in the orbital fracture area was loosened, and the repair material was implanted (video attached). Postoperative follow-up was conducted at 1 week and 3 months. The follow-up observation included the best corrected visual acuity, diplopia, dyskinesia of the eyes, enophthalmos, and orbital volume. The data were analyzed by the paired t-test, Wilcoxon and the Mann-Whitney U rank sum test. Results: The best corrected visual acuity before and 1 week after surgery was 4.714±0.400 and 4.732±0.377, respectively, and the difference was not statistically significant (t=1.724, P=0.096). The enophthalmos before and 1 week after surgery was 2.2 (2.0-5.0) mm and 0.3 (0.0-2.3) mm, respectively, and the difference was significant (Z=-4.604, P<0.01). The orbital volume before and 1 week after surgery was 2 008.10 (6.84-11 200.00) mm(3) and 478.76 (5.01-7 286.00) mm(3), respectively, and the difference was statistically significant (Z=-3.735, P<0.01).The preoperative diplopia degree was 0, Ⅰ, Ⅱ, and Ⅲ in 14, 11, 3, and 0 eyes, while the degree of diplopia 3 months after surgery was 0, Ⅰ, Ⅱ, and Ⅲ in 22, 6, 0, and 0 eyes, respectively. The difference was statistically significant (Z=-2.359, P=0.018). The preoperative dyskinesia degree of the eyes was 0, Ⅰ, Ⅱ, and Ⅲ in 11, 11, 3, and 3 eyes, while the dyskinesia degree of the eyes 3 months after surgery was 0, Ⅰ, Ⅱ, and Ⅲ in 23, 5, 0, and 0 eyes, respectively. The difference was statistically significant (Z=-3.456, P=0.001). No implant infection, displacement, and other serious complications were observed during the follow-up of 3 to 12 months. Conclusions: Three-dimensional printing technology combined with nasal endoscopy and surgical navigation, which is applied in the reconstruction of orbital fracture, can significantly improve the symptoms of diplopia, ocular dyskinesia, and ocular depression. It is a feasible assistant method. (Chin J Ophthalmol, 2019, 55: 658-664).

Applications of three-dimensional printing in orbital diseases and disorders.

To comprehensively review the applications of advanced three-dimensional printing technology in the management of orbital abnormalities. Three-dimensional printing has added value in the preoperative planning and manufacturing of patient-specific implants and surgical guides in the reconstruction of orbital trauma, congenital defects and tumor resection. In view of the costs and time, it is reserved as strategy for large and complex craniofacial cases, in particular those including the bony contour. There is anecdotal evidence of a benefit of three-dimensional printing in the manufacturing of prostheses for the exenterated and anophthalmic socket, and in the fabrication of patient-specific boluses, applicators and shielding devices for orbital radiation therapy. In addition, three-dimensional printed healthy and diseased orbits as phantom tangible models may augment the teaching and learning process of orbital surgery. Three-dimensional printing allows precision treatment tailored to the unique orbital anatomy of the patient. Advancement in technology and further research are required to support its wider use in orbital clinical practice.

Multimaterial printing and characterization for mechanical and surface properties of functionally graded prototype

In this work, an effort has been made for multimaterial three-dimensional printing of functionally graded prototypes of polylactic acid matrix (tensile specimens as per ASTM D638 type IV) followed by characterization of mechanical and surface properties. The work is an extension of previous reported studies on twin-screw extrusion process for the preparation of multimaterial wires as feedstock filaments in possible three-dimensional printing applications. The results of the study suggest that the highest peak strength (46.28 MPa) and break strength (41.65 MPa) was obtained for multimaterial three-dimensional printed samples at infill density 100%, infill angle 45°, and infill speed of 90 mm/s on commercial open source fused deposition modeling setup. Further surface hardness measurements performed on two extreme surfaces (top surface comprising magnetite (Fe3O4)-reinforced polylactic acid and bottom with polylactic acid without any reinforcement) revealed that the hardness for the bottom layer was more than the hardness for the top layer. From fractured surface analysis (using photomicrographs), it has been observed that the three-dimensional printed samples with low infill density resulted into more void formation due to which the performance while mechanical testing was poor in comparison to samples printed with higher infill density. The results are also supported by rendered images of photomicrographs, which revealed that high roughness value of samples printed with low infill density was also one of the reasons for poor mechanical performance of multimaterial three-dimensional printed functionally graded prototypes.

A Systematic Review of the Clinical Value and Applications of Three-Dimensional Printing in Renal Surgery.

The purpose of this systematic review is to collate and analyse the current literature which examines clinical applications of 3D printing for renal disease, alongside cost and time duration factors associated with the printing process. A comprehensive search of the literature was performed across five different databases to identify studies that qualitatively and quantitatively assessed the value of 3D-printed kidney models for renal disease. Twenty-seven studies met the selection criteria for inclusion in the review. Twenty-five were original studies, and two were case reports. Of the 22 studies reporting a qualitative evaluation, the analysis of findings demonstrated the value of the 3D-printed models in areas of clinician and patient education, and pre-surgical simulation for complex cases of renal disease. Of five studies performing a quantitative analysis, the analysis of results displayed a high level of spatial and anatomical accuracy amongst models, with benefits including reducing estimated blood loss and risk of intra-operative complications. Fourteen studies evaluated manufacturing costs and time duration, with costs ranging from USD 1 to 1000 per model, and time duration ranging from 15 min to 9 days. This review shows that the use of customised 3D-printed models is valuable in the education of junior surgeons as well as the enhancement of operative skills for senior surgeons due to a superior visualisation of anatomical networks and pathologic morphology compared to volumetric imaging alone. Furthermore, 3D-printed kidney models may facilitate interdisciplinary communication and decision-making regarding the management of patients undergoing operative treatment for renal disease. It cannot be suggested that a more expensive material constitutes a higher level of user-satisfaction and model accuracy. However, higher costs in the manufacturing of the 3D-printed models reported, on average, a slightly shorter time duration for the 3D-printing process and total manufacturing time.

Investigations of polylactic acid reinforced composite feedstock filaments for multimaterial three-dimensional printing applications

This paper reports properties of four different filaments prepared from (i) virgin polylactic acid, (ii) polylactic acid reinforced with polyvinyl chloride, (iii) polylactic acid reinforced with wood powder, and (iv) polylactic acid with reinforcement of Fe3O4 prepared with twin-screw extrusion for possible multimaterial three-dimensional printing. The results suggest that the melt flow rate of composite increases with the increase in reinforcements except for wood powder, which has shown a negative trend. Mechanical properties were also reduced with the loading but with the increase in the Fe3O4 content, these properties were improved. It has been observed that with reinforcement of polyvinyl chloride from 10 wt% to 25 wt% peak elongation and break elongation were reduced by 47.61% and 50%, respectively. Further, thermal analysis suggests that all samples were stable but for reinforced samples, the integral energy has decreased significantly in successive cycles. The vibration sample magnetometery of samples suggested that magnetic properties were dependent on the content of Fe3O4 present in the composite.

Application of three-dimensional printing for pre-operative planning in hip preservation surgery.

Three-dimensional printing is a valuable modality with broad clinical applications. Hip preservation surgery outcomes are dependent on correction of morphological abnormalities that may be optimally visualized with three-dimensional models. To assess the efficacy of three-dimensional models for patient and trainee education and to determine its benefits during pre-operative planning in hip preservation surgery. Sixteen patients with hip pathology were selected. Computed tomography was utilized to generate three-dimensional models. Customized Likert-style questionnaires were given to 10 hip preservation surgeons, 11 orthopedic surgery residents and 10 patients. All residents strongly agreed or agreed that the three-dimensional hip models helped them to understand patients’ pathology. All but one patient agreed that the models assisted in their understanding of the treatment plan. Surgeons concurred that although they do not routinely order three-dimensional models, their use would improve trainee and patient education, especially when treating atypical osseous pathomorphologies. Three-dimensional models are tools that can help surgeon, trainee and patient understanding and participation in treatment of complex hip disorders. Patients and trainees agree that the prototypes enhanced their educational experience, as the surgeon can directly demonstrate complex morphological abnormalities. Trainees can therefore gain a better understanding of hip pathologies and treatment. As patients better understand their hip disorder, they can more fully participate in shared treatment decision-making.Level of EvidenceLevel IV, Retrospective Case Series

Three Dimensional Printing-Based Strategies for Functional Cartilage Regeneration.

This article primarily reviews the applications of three-dimensional printing in cartilage tissue engineering at different anatomical locations and summarizes their strengths and limitations. In addition, we believe that four-dimensional concept and biological microenvironment should not be ignored for functional cartilage regeneration in the future. Finally, we hope the review provide scientist inspiration with constructing anisotropic tissue-engineered organ or tissue.

Surgical applications of three-dimensional printing in the pelvis and acetabulum: from models and tools to implants.

There are numerous orthopaedic applications of three-dimensional (3D) printing for the pelvis and acetabulum. The authors reviewed recently published articles and summarized their experience. 3D printed anatomical models are particularly useful in pelvic and acetabular fracture surgery for planning, implant templating and for anatomical assessment of pathologies such as CAM-type femoroacetabular impingement and rare deformities. Custom-made metal 3D printed patient-specific implants and instruments are increasingly being studied for pelvic oncologic resection and reconstruction of resected defects as well as for revision hip arthroplasties with favourable results. This article also discusses cost-effectiveness considerations when preparing pelvic 3D printed models from a hospital 3D printing centre.

Clinical application of three-dimensional printing in the treatment of knee varus with high tibial os-teotomy

Objective To evaluate the clinical application of a three-dimensional (3D) printing personalized guide for medial open wedge high tibial osteotomy(MOWHTO) in the treatment of knee varus osteoarthritis. Methods A retrospective study was conducted of the 16 patients with knee varus os-teoarthritis who had been treated at Department of Orthopaedics, Zhengzhou Central Hospital of Zhengzhou University from January 2016 to January 2017. They were 6 men and 10 women, aged from 49 to 65 years (mean, 55.8 years). Bilateral knees were involved in 2 cases and a unilateral knee was involved in 14 cases. Their disease duration ranged from one to 12 years (mean, 5.3 years). A personalized guide for MOWHTO was designed and manufactured by 3D printing for every patient preoperatively. All the patients underwent knee arthroscopy before osteotomy which was assisted by the personalized guide. The femorotibial angle (FTA), medial proximal tibial angle (MPTA), weight bearing line (WBL), posterior tibial slope (PTSA) and the patellofemoral height Insall-Salvati index (IS index) were measured on their X-ray radiographs preoperatively and 6 months postoperatively. The Hospital for Special Surgery (HSS) score and visual analogue scale (VAS) were used to evaluate the outcomes at the final follow-ups. Results All surgeries were successful. The 16 patients were followed up for 6 to 12 months (mean, 9.1 months). The FTA, MPTA, WBL and IS index at postoperative 6 months were significantly improved than the preoperative values (P<0.05). There was no significant difference between postoperative PTSA and preoperative PTSA (P=0.990). The mean VAS scores for the 16 patients at the final follow-ups were 0.8±0.7 points, significantly better than the preoperative ones (4.2±0.9 points) (P<0.05); their mean postoperative HSS scores (89.3±6.7 points) were also significantly improved than the preoperative ones (61.9±10.5 points) (P<0.05). According to the HSS scores at the final follow-ups, the surgical outcomes were excellent in 14 knees, good in 3 and fair in one. Conclusion A 3D printed osteotomy guide can be used to perform precise osteotomy in MOWHTO for knee varus osteoarthritis, leading to effective correction of the alignment of the lower limb and good short-term surgical outcomes. Key words: Knee joint; Osteoarthritis; Abnormalities; Osteotomy; 3D printing technology

Preliminary application of three-dimensional printing in dental education

As one of the rapid prototyping technology, three-dimensional (3D) printing is booming since its birth. 3D printing has already been applied in biomedical engineering, medical mold processing and many healthcare fields, but its application in dental education is still in the exploratory stage. Nowadays, educators are seeking to integrate 3D printing and dental education. On the basis of the advantages of 3D printing, the quality of dental education will be further improved and students' enthusiasm for learning will be stimulated. This article will focus on elaborating the recent advances of 3D printing in dental education and exploring its direction in the field of teaching.

Potentials of three dimensional printing in radiology: A case of a knee injury

Introduction. Images of computed tomography, computed tomography angiography, ultrasonography, magnetic resonance imaging, positron emission tomography are usually stored in Digital Imaging and Communication in Medicine standard formats, which can be used later for processing and making three dimensional models and objects. The three dimensional printing has become increasingly popular in various fields of medicine. The purpose of this article was to present the workflow for three dimensional printing of medical models and to point out potential significance of three dimensional model printing in clinical practice and in training of medical students and residents. This type of approach may open new perspectives in communication and interaction between clinicians, radiologists and patients, in order to achieve better treatment results. Material and Methods. Images of an injured knee in digital imaging and communication in medicine format were used for creation of a three dimensional printed model. Digital imaging and communication in medicine files were without sensitive information on the patient using three dimensional Slicer software, then processed with embodi three dimensional cloud service, further prepared with MeshLab and printed on a Ultimaker 2 printer. Results and Discussion. A three dimensional model of an injured knee was printed and presented. The model was used for the evaluation of tibial fractures. It may be shown to the patient and also to the surgeon in order to be more specific about the treatment procedure. Application of three dimensional printing in medicine was discussed. Conclusion. Medical three dimensional printing is likely to play a more important role in the clinical practice, not only for surgical planning, but also in the education of students and residents in different medical branches. This three dimensional plastic model of an injured knee may serve as a good example of the potentials of the three dimensional printing technology in medicine.

Systematic review of the applications of three-dimensional printing in colorectal surgery.

Three-dimensional (3D) printing has been recognized as a revolutionary technological innovation that has benefitted numerous disciplines, including medicine. The present systematic review aimed to demonstrate the current applications of 3D printing in colorectal surgery along with the limitations and potential future applications of this innovation. A PRISMA-compliant systematic literature search of studies that applied 3D printing in colorectal surgery in the period from January 1990 to July 2018 was conducted. Electronic databases including PubMed/Medline, Scopus and the Cochrane Library were searched. All full-text original articles were eligible for inclusion. Nine studies including 58 patients with a median age of 60.7 years were reviewed. The studies assessed 3D printing in patients with planned stoma construction, colon cancer with liver metastasis, right colon cancer, rectal cancer, intractable constipation and anal fistula. The applications of 3D printing were classified into three categories: patient education, preoperative planning and evaluation of response of colorectal liver metastasis to chemotherapy. 3D printed models aided in planning resection of colorectal liver metastasis, facilitating D3 lymphadenectomy in complete mesocolic excision, improving the understanding of pelvic anatomy in laparoscopic rectal cancer treatment, guiding electrode implantation in sacral neuromodulation for intractable constipation, and elucidating the morphology of anal fistula tract and anal sphincter muscles. Colorectal surgery may benefit from 3D printing in enhancing patient education before stoma construction, preoperative planning and evaluation of the response of liver metastasis to chemotherapy using 3D ultrasonography.

The Application of Three-Dimensional Printed Finger Splints for Post Hand Burn Patients: A Case Series Investigation.

The application of three-dimensional (3D) printing is growing explosively in the medical field, and is especially widespread in the clinical use of fabricating upper limb orthosis and prosthesis. Advantages of 3D-printed orthosis compared to conventional ones include its lower cost, easier modification, and faster fabrication. Hands are the most common body parts involved with burn victims and one of the main complications of hand burns are finger joint contractures. Applying orthotic devices such as finger splints are a well-established essential element of burn care. In spite of the rapid evolution of the clinical use of 3D printing, to our knowledge, its application to hand burn patients has not yet been reported. In this study, the authors present a series of patients with hand burn injuries whose orthotic needs were fulfilled with the application of 3D-printed finger splints.

A Review of Current Clinical Applications of Three-Dimensional Printing in Spine Surgery.

Three-dimensional (3D) printing is a transformative technology with a potentially wide range of applications in the field of orthopaedic spine surgery. This article aims to review the current applications, limitations, and future developments of 3D printing technology in orthopaedic spine surgery. Current preoperative applications of 3D printing include construction of complex 3D anatomic models for improved visual understanding, preoperative surgical planning, and surgical simulations for resident education. Intraoperatively, 3D printers have been successfully used in surgical guidance systems and in the creation of patient specific implantable devices. Furthermore, 3D printing is revolutionizing the field of regenerative medicine and tissue engineering, allowing construction of biocompatible scaffolds suitable for cell growth and vasculature. Advances in printing technology and evidence of positive clinical outcomes are needed before there is an expansion of 3D printing applied to the clinical setting.

Applications of Three-Dimensional Printing in Cardiovascular Surgery: A Case-Based Review

Applications of Three-Dimensional Printing in Cardiovascular Surgery: A Case-Based Review

Clinical Applications of Three-Dimensional Printing in Cardiovascular Disease

Clinical Applications of Three-Dimensional Printing in Cardiovascular Disease

Current and evolving applications of three-dimensional printing in forensic odontology: A review

In these digitized surroundings, we should not overlook the use of three-dimensional (3D) printing in forensic odontology, for investigative or court purposes, which is still comparatively new. We will use the term “3D printing” as it is widely recognized and will perhaps be the simplest phrase for the odontologist for daily use. Alternative terms are additive manufacturing and rapid prototyping. Today, 3D printing is most commonly used in dentistry for the manufacture of drill guides for dental implants, study models for prosthodontics, orthodontics and surgery, the manufacture of dental, craniomaxillofacial and orthopedic implants, and the fabrication of copings and frameworks for implant and dental restorations. However, we are yet to see forensic odontologists, lawyers, and expert witnesses appreciate embrace the advantages of 3D printing for its use in court of law. This may be due to a perception of it being complicated technology, high cost, or simply a lack of understanding of what can be done with 3D printing. 3D image capture devices minimize the amount of angular distortion, therefore such a system has the potential to create more robust forensic evidence for use in courts and medico-legal cases. The major application of 3D printing in forensic odontology includes bite mark analysis, 3D-computed tomography facial reconstruction, dental age estimation, sex determination, and physical models. The aim of this review article is to outline the use and possible benefits of 3D printing in forensic odontology.

Application of three-dimensional printing in the operation of distal tibia fracture involving epiphyseal plate injury for teenagers

To investigate the application value of three-dimensional (3-D) printing technology in the operation of distal tibia fracture involving epiphyseal plate injury for teenagers. The retrospective analysis was conducted on the clinical data of 16 cases of children patients with distal tibia fracture involving epiphyseal plate injury undergoing the operation by using of 3-D printing technology between January 2014 and December 2015. There were 12 males and 4 females with an age of 9-14 years (mean, 12.8 years). The causes of injury included traffic accident injury in 9 cases, heavy pound injury in 3 cases, and sport injury in 4 cases. The time from injury to operation was 3-92 hours (mean, 25.8 hours). According to Salter-Harris typing standard, the typing for epiphyseal injury was classified as type Ⅱ in 11 cases, type Ⅲ in 4 cases, and type Ⅳ in 1 case. The thin slice CT scan on the affected limb was performed before operation, and the Mimics14.0 medical software was applied for the design and the 1∶1 fracture model was printed by the 3-D printer; the stimulation of operative reduction was made in the fracture model, and bone plate, Kirschner wire, and hollow screw with the appropriate size were chosen, then the complete operative approach and method were designed and the internal fixator regimen was chosen, then the practical operation was performed based on the preoperative design regimen. The operation time was 40-68 minutes (mean, 59.1 minutes); the intraoperative blood loss was 5-102 mL (mean, 35 mL); the intraoperative fluoroscopy times was 2-6 times (mean, 2.8 times). All the patiens were followed up 12-24 months (mean, 15 months). The fracture of 15 cases reached anatomic reduction, and 1 cases had no anatomic reduction with the displaced end less than 1 mm. All the fractures reached bony union with the healing time of 2-4 months (mean, 2.6 months). There was no deep vein thrombosis, premature epiphyseal closure and oblique, or uneven ankle surface occurred, and there was no complication such as osteomyelitis, varus or valgus of ankle joint, joint stiffness, traumatic arthritis. Helfet scores of ankle function were measured at 12 months after operation, the results were excellent in 15 cases and good in 1 case. The angulation of introversion and extroversion for the affected limb was (6.56±2.48)°, and the growth length was (4.44±2.31) mm, and there was no significant difference ( t=0.086, P=0.932; t=0.392, P=0.697) when compared with the uninjured side [(6.50±1.51)°, (4.69±1.08) mm]. As the assistive technology, 3-D printing technology has a certain clinical application value in improving the effectiveness of distal tibia fracture involving epiphyseal plate injury.

Biomaterials for bone defect repair and bone regeneration

The treatment of large jaw bone defects remains an urgent clinical problem to be solved. With the development of biomaterials, stem cells and bone tissue engineering, new ideas and hopes for the regeneration of jaw have been offered. In addition to meeting the basic requirements of bone repair materials, scaffolds for the regeneration of large jaw bones require the ability of stem cells to participate in bone regeneration. Methods like optimization of scaffolds composition, design of porous structure and combination of gel and microsphere technology can enhance stem cell delivery in vivo, and the osteogenic differentiation of stem cells can be stimulated through controlled release of drugs, preparation of surface micron/nano topography and modifications of ionic components. Moreover, application of three-dimensional printing and channel structure in large-scale scaffolds fabrication present promising strategies for customized, accurate bone reconstruction and vascularization. It is only through synergistic optimization in all aspects that it is possible to obtain scaffold materials suitable for regeneration of large jaw bones. This article focuses on biological materials regulation, stem cell delivery, survival and differentiation, and their role in bone regeneration.