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Basics and applications of rapid prototyping medical models

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DOI: 10.1108/RPJ-07-2012-0065

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 Basics and applications of rapid prototyping
medical models
Sushant Negi, Suresh Dhiman and Rajesh Kumar Sharma
Department of Mechanical Engineering, National Institute of Technology (NIT) Hamirpur, Hamirpur, India

Abstract
Purpose – This study aims to provide an overview of rapid prototyping (RP) and shows the potential of this technology in the field of medicine as
reported in various journals and proceedings. This review article also reports three case studies from open literature where RP and associated
technology have been successfully implemented in the medical field.
Design/methodology/approach – Key publications from the past two decades have been reviewed.
Findings – This study concludes that use of RP-built medical model facilitates the three-dimensional visualization of anatomical part, improves the
quality of preoperative planning and assists in the selection of optimal surgical approach and prosthetic implants. Additionally, this technology makes
the previously manual operations much faster, accurate and cheaper. The outcome based on literature review and three case studies strongly
suggests that RP technology might become part of a standard protocol in the medical sector in the near future.
Originality/value – The article is beneficial to study the influence of RP and associated technology in the field of medicine.
Keywords Technology, Rapid prototyping, Model, CAD, Computer tomography (CT), Fabrication
Paper type General review

1. Introduction in which suitable RP system uses CAD data to develop the

physical model. Nowadays, variety of materials (instead of
Rapid prototyping (RP), a layer-by-layer material deposition
normal RP material) and some medical-grade materials are
technique, started during the early 1980s, has significantly
available, which can be used to fabricate RP models on the
improved the ability to fabricate physical models with precise
basis of their use in different medical applications.
geometries using computer-aided designs (CADs) or data
This article covers most commonly available, current RP
from medical imaging technologies (Melchels et al., 2010). RP
techniques and their medical applications. The techniques
is beneficial in the field of medicine, as this technology has the
which have mainly been used for fabricating medical models
ability to fabricate complex-shaped anatomical parts directly
are stereolithography (SLA), selective laser sintering (SLS),
from scanned data such as computerized tomography (CT)
fused deposition modeling (FDM), three-dimensional printing
images. These models provide a better illustration of the
(3DP) and laminated object manufacturing (LOM). This
human anatomy, and are used for precise presurgical planning
review article deals with only these RP techniques with their
and for assistance in the intensive planning of surgical
applications and also reports three case studies from literature
procedures and also for helping surgeons and medical
where RP and associated technology have been successfully
students to rehearse different surgical procedures realistically
used for medical applications.
(Kai et al., 1998; Liu et al., 2006). RP models can also be used
for designing customized implants, prosthesis and function as
a communication tool between surgeons and patients 2. RP techniques
(Dhakshyani et al., 2011). There are currently a number of RP techniques in the market
RP process can be divided into two phases: virtual based on special sintering, layering or deposition methods.
(modeling and simulating) and physical (model fabrication) Each technique has its own limitations and applications in
(da Rosa et al., 2004). Before the fabrication of physical constructing prototype models. Established RP techniques
models, first comes the virtual phase in which a CAD is which are commercially available are summarized in Table I
prepared by using medical imaging technologies such as CT, and precisely discussed below.
magnetic resonance imaging (MRI) and laser digitizing (Ahn
et al., 2006; Wang et al., 2010; Willis et al., 2007). The 2.1 Stereolithography
fabrication of the physical model is the second phase, a process The term stereolithography (SLA) was first introduced in
1986 by Charles W. Hull, who defined it as a method based
on photo-polymerization of liquid monomer resin for
The current issue and full text archive of this journal is available at fabricating solid parts. An SLA device typically consists of a
www.emeraldinsight.com/1355-2546.htm vat filled with liquid resin (acrylic or epoxy resin), a movable
elevator platform inside the vat, an ultraviolet laser and a

Rapid Prototyping Journal

20/3 (2014) 256 –267 Received: 12 July 2012
© Emerald Group Publishing Limited [ISSN 1355-2546] Revised: 14 September 2012
[DOI 10.1108/RPJ-07-2012-0065] Accepted: 11 December 2012

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Table I Features of commercially available RP techniques

RP technique
(commercially Layer thickness Accuracy Maximum part
available since) Process (␮m) (␮m) dimensions (mm3) Scan speed (mm/s) Cost (£1000)
SLA (1987) Photo-curing 50 ⫾ 100 500 ⫻ 500 ⫻ 584 N/A 150-390
SLS (1991) Sintering of powders 76 ⫾ 51 330 ⫻ 380 ⫻ 425 0.001-0.008 250-365
FDM (1991) Melt extrusion 50-762 ⫾ 127 254 ⫻ 254 ⫻ 254 380 100
3DP (1998) Ink-jet printing 177 ⫾ 127 355 ⫻ 457 ⫻ 355 0.005-0.007 Bureau service only
LOM (1990) Paper lamination 76-203 ⫾ 127 813 ⫻ 559 ⫻ 508 508 (cutting speed) 120-235
Source: Pham and Gault (1998); Mousah (2011)

platform, as shown in Figure 1. In SLA, the surface layer of sintered one, and this layer building process is repeated until
resin is cured selectively by the laser beam following the path the whole part is complete (Hur et al., 2001; Pham and Gault,
defined in the slicing model. After creating one layer, the 1998; Yan and Gu, 1997; Yang et al., 2002). The advantage of
movable platform is lowered into the vat, and then the laser this technique is the ability to use variety of thermoplastic
beam tracing process is repeated. This process continues layer powders, easy postprocessing and no requirement of support
by layer until the part fabrication is completed. The structure. Disadvantages of this method include high costs
advantages of SLA include smooth surface finish and high part and the abrasive surface of sintered models (Petzold et al.,
building accuracy, whereas disadvantages of this process 1999). SLS is capable of using a wide range of materials for
include time-consuming postprocessing and use of expansive model production including polycarbonate, polyvinyl
and toxic material (Chockalingam et al., 2008; Guangshen chloride, acrylonirile butadine styrene (ABS), nylon, resin,
et al., 2009; Wang et al., 1996; Yan and Gu, 1997; Zhou et al., polyster, polypropane, polyurethane and investment casting
2000). SLA is well suited for craniomaxillofacial surgery wax. Moreover, this technique is well suited for manufacturing
(congenital, system-bound growth disorders and facial of dental implants (Traini et al., 2008), scaffolds (Leong et al.,
craniosynostoses) (Bill et al., 1995; Petzold et al., 1999). This 2003) and medical devices (Bertol et al., 2010).
technology (SLA) also has a strong prospective for biomedical
applications, such as to manufacture anatomically shaped 2.3 Fused deposition modeling
implants, tailor-made biomedical devices (hearing aids), and The FDM machine is an XY plotter device which carries an
has proven to facilitate and speed-up the surgical procedures, extrusion head. A plastic filament is fed through a heating
especially in implant placements and complex surgeries element, which heats it to a semi-molten state. The filament is
(Melchels et al., 2010). then fed through a nozzle and deposited onto a platform to
form each layer. The latest FDM system includes two nozzles,
2.2 Selective laser sintering one for the part material and one for the support material, as
The SLS process fabricates parts by fusing powdered represented in Figure 3. The FDM process uses a variety of
materials with a CO2 laser instead of liquid. The powdered modeling materials and colors, such as medical-grade ABS
material is spread by a roller over the work surface and and investment casting wax for model fabrication. FDM
preheated to a temperature slightly lesser than its melting advantages include compact construction of the FDM
point, and then a laser beam traces the cross-section on the machine, the possibility to sterilize these models and good
powder surface to heat up the powder to the sintering geometric accuracy; on the other hand, disadvantages include
temperature so that the powder scanned by the laser gets
bonded, as illustrated in Figure 2. After completing one layer, Figure 2 Schematic of SLS process
the roller spreads another layer of fresh powder over the

Figure 1 Schematic of SLA process

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Figure 3 Schematic of FDM process complex craniofacial malformations (osteotomies and vector
of distraction). 3DP can be performed more quickly (4 hours
for a full skull) and easily, and it is also more cost effective
when compared with other RP techniques (Cohen et al., 2009;
Hoque, 2011).

2.5 Laminated object manufacturing

Helisys introduced the LOM, which creates parts from
laminated sheets of paper, plastic or metal by a laser, as shown
in Figure 5. This technique only requires a cut of the outline
of each layer into a sheet of paper using a laser to match a
cross-section of the model. After each outline has been cut, the
roll of paper is advanced, then a new layer is glued onto the
stack and the same process is repeated until the whole part is
fabricated, and then some trimming, hand finishing and
curing are required. However, material costs are very low.
slow building speed and lower surface quality than SLA (Lee Plastics, composites, ceramics, metals and various organic and
et al., 2005, 2007; Wykes et al., 1999). FDM is well suited for inorganic materials with different chemical and mechanical
the fabrication of bone models, as it uses build materials that properties for a variety of applications can be processed. LOM
produce hard, robust models and also can produce complex is well suited for complex and large parts. The build speed is
shape models, surgical guides and templates (Liu et al., 2006). very fast, but a high effort is needed for decubing, finishing
and sealing the parts (Liu et al., 2006; Noorani, 2006).
2.4 3D printing
Soildscapes introduced 3DP technology that uses dual-ink
2.6 Materials
printer heads to deposit both thermoplastic part material and
In the case of medical applications, the RP models can be
a wax support structure. The devices use a milling operation
fabricated with a variety of materials, and the selection of
after fabricating each layer to create a very thin and precise
material depends on the purpose of fabrication. However,
layer, as presented in Figure 4. Once a layer is deposited, the
some medical applications (surgical tools or medical implants)
piston that supports the powder bed and the part lowers so
require models which have the ability to be sterilized or remain
that the next powder layer can be spread and selectively
compatible with human tissue-like biomaterials. A biomaterial
joined. This layer-by-layer process repeats until the whole part
can be classified as any material used to manufacture devices
is fabricated (Lee et al., 2007; Liu et al., 2006; Noorani,
that replace a part or a function of the body in a safe and
2006). 3DP allows the fabrication of complex geometrical
reliable way. Metallic biomaterials are mainly used in areas of
shapes, e.g. hanging partitions inside cavities, without artificial
high static or cyclic stress and are well suited for medical
support structures. After taking the CT scan, the rendering
implants such as cranial plates and acetabular implants.
of the DICOM data and transformation into standard
Ceramic materials are typically solid inert compounds and are
tessellation language (STL) format takes a maximum of a
used where resistance to wear is of primary importance, such
half an hour, and the printing process and infiltration take
as dental implants and crowns, whereas medical-grade
approximately 4-6 hours (Hoque, 2011). 3DP’s advantages
polymers are used in various medical applications where
over other techniques include good fabrication speed and low
stability, flexibility and controlled porosity are demanded,
materials cost. Disadvantages include surface finish, moderate
such as tissue repair, drug delivery devices and medical
strength, hand-free post processing and availability of
implants (Brennan, 2010). Some categorized biomaterials for
materials (Liu et al., 2006). 3DP technology is a reliable
medical use are shown in Table II.
method for assisting in precise mandibular reconstruction
using bone plates and bone grafts, and these models have also
been used for planning distraction osteogenesis related to 3. RP model fabrication
RP machine needs CAD information to fabricate a physical
Figure 4 Schematic of 3D printing process model, so for that purpose RP process can be divided into two
phases: virtual and physical. As mentioned earlier, first comes
the virtual phase, which consists of using image processing
tools that involve data acquisition and image processing, to
create a virtual model through dynamic and interactive
simulation. The fabrication of the physical model is the second
phase (physical). Data acquisition is the process in which
high-resolution images of human anatomy are captured by
using medical imaging technologies such as CT, MRI and
others. After data acquisition, images are processed by suitable
software tools, then the output (virtual model) is transferred in
the STL file format to the RP system for fabricating a physical
part, called a medical model (Starly et al., 2005). The

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Figure 5 Schematic of LOM process

Table II Categorized biomaterials for medical applications (Milovanovic and Trajanovic, 2007). Most commonly, CT,
Metals Ceramics Polymers MRI and laser digitizing techniques are used for this purpose,
others are cone beam tomography, X-ray, ultrasound and
316L stainless steel Alumina Ultra-high molecular weight others (Abbott et al., 1998; Chang et al., 1991; Lambrecht
polyethylene et al., 2009; Liu et al., 2006; Meakin et al., 2004; Schievano
Titanium alloys Zirconia Polyurethane
et al., 2010). It provides important scanned data of anatomical
Cobalt chromium Carbon
structure for diagnostic reasons, and same data can be used to
alloys
obtain geometrical information of the body structures for 3D
Ti6Al4V Hydroxyapatite
modeling. Some of the most commonly used medical imaging
Calcium phosphate techniques are described in the following section.
Source: Brennan (2010); Mour (2010); Vail et al. (1999)
3.1.1 Computerized tomography
CT is a medical imaging technique that uses computer-
complete process of medical model fabrication is illustrated in processed X-rays to scan a slice of tissue from multiple
Figure 6. directions for generating tomography images of specific areas
of the body. The absorption of different tissues is calculated
3.1 Data acquisition and displayed according to grey-scale values on a screen. The
Data acquisition is a process of capturing the three- resolution of CT data can be increased by decreasing the slice
dimensional (3D) shape of an existing part by using contact thickness, producing more slices along the same scanned
and non-contact measuring devices; only non-contact region, and resolution of approximately 1 mm can be achieved
methods (medical imaging technologies) are considered here. in most practical cases. It is very suitable for hard tissues and
Medical imaging technologies are generally used to visualize bony structures such as cortical and trabecular bones, which
the configurations of bones, organs and tissues, but they also are assessed less with MRI technique (Liu et al., 2006).
have the ability to export scanned image data and additional Nowadays, the speed at which CT scans are obtained has
information in commonly known medical file format, such as increased much more – the new system of CT scanners can
digital imaging and communications in medicine (DICOM) create a slice in about a second (Noorani, 2006). The
(Berce et al., 2005; Rengier et al., 2010), and finally make it technology known as spiral CT allows for shorter scanning
possible to convert scanned image data from DICOM to STL time and small slice intervals with respect to old scanners
file format, which is a universally accepted RP file format (Hoque, 2011).

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Figure 6 General process of RP model production for medical applications

3.1.2 Magnetic resonance imaging 3.2 Image processing

MRI makes use of the property of nuclear magnetic resonance Images of the body are taken in thin cross-sectional “slices”
to image nuclei of atoms inside the body for detecting different which can then be layered by using commercial available
tissue characteristics, especially soft tissues. MRI technique software like MIMICS, 3D Doctor and Voxim to create a 3D
does not use X-ray radiation, and it has the ability to provide model of anatomical parts. These software systems performs
scans of nearly any planar orientation without surgical the necessary segmentation of the anatomy through
intervention. MRI is safe for most patients, but those who sophisticated 3D selection and editing tools and provides the
have implanted medical devices such as heart pacemakers, interface between scanned data of CT, MRI or technical
cochlear implants may not be able to have an MRI (Noorani, scanners and RP systems (Noorani, 2006). These software
2006). An MRI scanner uses a strong magnetic field, which systems allow modification of the images by defining various
causes protons to align parallel or anti-parallel to it and tissue densities for display, to select the regions of interest
measure the density of a specific nucleus, normally hydrogen from the general information available from the scanner. It
nucleus. The speed at which protons lose their magnetic enables the surgeons and radiologists to control and select the
energy is different in different tissues; therefore, it allows correct segmentation of CTs or MRIs. After completing the
detailed representation of the region of interest. MRI segmentation and visualization, the data are converted to STL
provides good contrast between the different soft tissues of format. This format is compatible with most commonly used
the body, which makes it especially useful in imaging the RP machines (Gibson et al., 2006; Liu et al., 2006; Tukuru
brain, muscles and central nervous system with respect to et al., 2008).
other medical imaging techniques such as CT or X-rays.
MRI slice thickness is limited to 0.5 mm at the highest
3.3 Model fabrication
resolution, and measurement system is volumetric (Hoque,
This step includes choosing the right RP technique according
2011; Liu et al., 2006).
to the demand of medical application. As we know, every RP
3.1.3 Laser digitizing system has its strength and weaknesses, and so a suitable RP
Laser digitizing is a medical imaging technique that uses a system or technique needs to be chosen to fulfill various
laser probe which emits a diode-based laser beam, which requirements of a medical application like accuracy, surface
forms profiles on the surface of the anatomy being scanned. finish, cost, visual appearance of internal structures, number
Each profile is collected as a polyline entity, and the of desired colors in the model, strength, availability of
combination of profiles yields a 3D volume (Hoque, 2011). materials and mechanical properties. Then finally, 3D virtual
This technique allows acquisition only of external data, such model in STL file format is transferred to the RP system and
as in dental applications where only external data are required, building starts. After the fabrication of model, it needs to be
whereas CT and MRI comprise both internal and external evaluated and validated by the team and, in particular, by
data. By obtaining only external data, it reduces the scanning surgeons, so as to ensure that it is accurate and serves the
time, file size and processing time to convert scanned data to purpose (Milovanovic and Trajanovic, 2007). Furthermore,
CAD data. This method also has the advantage of not depending on the use of the model, it can be sterilized for
emitting any radiation (Liu et al., 2006). assistance in an operating theater (Petzold et al., 1999).

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4. Use of RP models in medical applications a reasonable cost (Balazic and Kopac, 2007). This
technology allows the physicians to create accurate implants
RP has been recently introduced in the field of medicine when
for their patients rather than the use of standard-sized
compared to its long-standing use in various engineering
implants, such as dental implants, hip sockets, knee joints
applications, and so numerous researchers have reported the
and spinal implants, which could greatly benefit the patients
influence of RP technology in various areas of medical field.
(Milovanovic and Trajanovic, 2007). Using RP, surgical
Some of the areas in which RP technology has been
implants have become more precise, surgery time and risk
successfully used are discussed below.
of surgical complication has been significantly reduced and
to make customized implants it is an alternative to standard
4.1 Surgical planning
implants (Liu et al., 2006; Noorani, 2006).
RP has proven to be beneficial to surgical planning, as the
these models provide the physician and surgical team a visual 4.5 Scaffoldings and tissue engineering
aid that can be used to better plan a surgery, to study the bone RP techniques are very much suitable for generating implants
structure of patient before the surgery, to decrease surgery with special geometrical characteristics, such as scaffolds for
time and risk during surgery as well as costs, to predict the restoration of tissues, and serve as an alternative to
problem cause during operation and to facilitate the diagnostic conventional scaffold fabrication methods (Hutmacher et al.,
quality. These RP models can be used to rehearse complex 2004). Scaffolds are porous supporting structures, serve as an
procedures and to better understand the complex anomaly; adhesion substrate for the cells and provide temporary
therefore, these models are especially beneficial in surgeries mechanical support and guidance to the growing tissue in
where there are anatomical abnormalities and deformities (Kai damaged or defective bones of the patient (Kim and Mooney,
et al., 1998; Liu et al., 2006). Some studies in heart surgery 1998; Yeong et al., 2004). RP techniques like SLS, 3DP and
(Sodian et al., 2007), spine surgery (Guarino et al., 2007; FDM have proved to be suitable for fabricating controlled
Mizutani et al., 2008; Paiva, 2007), craniofacial and porous structures through the use of biomaterials and it has
maxillofacial surgery (Faber et al., 2006; Maravelakis et al., significantly contributed in the field of scaffolding and tissue
2008; Mehra et al., 2011; Peltola et al., 2012; Poukens engineering. RP technology has increased the ability to create
et al., 2003; Zenha et al., 2011) and hip surgery (Dhakshyani complex geometries, customized products and provide high
et al., 2012; Monahan and Shimada, 2007) have shown the accuracy features, as well as enhance the possibilities to
potential and benefit of RP models in the field of surgery and control pore size and distribution of pores within the scaffold
reported a significant improvement in diagnosis. In addition, (Peltola et al., 2008).
surgeons estimated that the use of RP models reduced
operating time by a mean of 17.63 per cent (D’urso et al., 4.6 Prosthetics and orthotics
1999). RP has proven to be beneficial to the fields of prosthetics and
orthotics, as it starts with specific patient anatomy. The
4.2 Medical education and training patient’s specific alignment characteristics are included in the
RP models provide a better demonstration of external and model, allowing for development of a biomechanically correct
internal structures of human anatomy, and they can be made geometry that improves the fit, comfort and stability (Noorani,
in many colors so these models can be used as teaching aids in 2006). There are always patients outside the standard range,
research, medical education and in museums for educational between sizes or with special requirements caused by disease
and display purposes. RP models can be distributed in kits to or genetics. With the aid of RP, it becomes possible to
schools and museums for a better illustration of anatomy manufacture a custom prosthesis that precisely fits a patient at
and medical training purposes. Furthermore, these models reasonable cost; e.g. patterns for dental crowns and implant
can be used by medical students or young doctors to better structures can be fabricated using an RP machine (Liu et al.,
understand the problems or surgical procedures without 2006).
causing discomfort to the patient (Liu et al., 2006; Mori et al.,
2009; Nyaluke et al., 1995). 4.7 Mechanical bone replicas
RP can be used for the fabrication of mechanical bone
4.3 Design and development of medical devices and replicas. With the aid of RP, it becomes easy to replicate the
instrumentation material variations and mechanical characteristics within a
Another application of RP is in fabricating medical devices bone. A composite structure built with a lattice structure of
and instrumentations. RP techniques can be used to design, SLA can create two distinct regions that have properties
develop and manufacture medical devices and instruments. It similar to cortical and trabecular bones. These replicas of
includes dental devices, hearing aids and surgical aid tools bones can be used to observe the bone strength under different
(Noort, 2012). conditions. Additionally, it can be beneficial to recreate
events, and the stresses, fractures and other changes in the
4.4 Customized implant design bone can be observed, which would definitely help the doctors
RP technology is very much able to fabricate customized and researchers (Noorani, 2006; www.rpc.msoe.edu/medical).
implants and fixtures due to the inherent strength of this
technology to fabricate complex geometry within a very short 4.8 Forensics
time. The combination of medical imaging technologies, RP RP can be a beneficial tool in criminal investigation, especially
and CAD packages makes it possible to manufacture in homicide cases, where it is very important to reconstruct the
customized implants and fixtures that precisely fit a patient at crime scene for investigation. RP models can be kept as

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evidence in criminal investigation and will help investigators 1 tomography images of deficient and contralateral ears
find answers to some questions. In many cases, the ability to with the help of finer CT scanning (0.63-mm slice
reconstruct scenes and events accurately would help forensic thickness);
experts to understand and solve the cases more quickly. These 2 reconstruction of the corresponding 3D models in which
models are accurate enough to see the effects of wounds and the correct geometry and position of the prosthesis were
allow for accurate predictions of the forces, implements and ensured by stacking the CT scan images of the
other key events can be determined using these models. contralateral normal ear in reverse order, and joining them
Especially, in the case of a surviving victim with a difficult- using medical modeling software, MIMICS (Materialise,
to-access wound, e.g. for the skull, a model can be used for Belgium);
detailed analysis. Using RP models, scenes can be re-created 3 design of the final model of missing ear (prosthesis) was
in the court room, and it can help prosecutors to throw some obtained by subtracting the CAD model of the remnant
light on what really happened (Liu et al., 2006; www. portion of the defective ear from the CAD model of the
rpc.msoe.edu/medical). mirrored contralateral ear using a haptic CAD system
(FreeForm, SensAble Technologies, USA);
4.9 Anthropology 4 fabrication of prosthesis master using a suitable RP system
This is an another application where RP technology can be (FDM), the dimensions of fabricated model was
very beneficial to anthropologists because replication of measured as per the standards (standard auricular
delicate bones, teeth and other artifacts can be made so that morphological measurement) and compared with the
molding, measuring and dissecting of the remains can be original CAD model to determine the accuracy
performed without causing harm to the original finding. (dimensional error) then finally;
Especially in cases where only one or two specimens exist, 5 the fabrication of the final prosthesis using a mould
research can be done on built models without harming the made from the master (FDM model) in which
original or rare specimen. The models that are built can also medical-grade silicone rubber of the appropriate color
be used to show changes in evolution that have taken place was packed into the mold to fabricate the final ear
over vast periods (Noorani, 2006; www.rpc.msoe.edu/medical). prosthesis.
The final fabricated prosthesis was also measured as per
5. Case reports standards, and percentage difference was calculated with
In this section, three case reports from open literature have respect to the CAD model and then successfully fitted to the
been considered for discussion, which present different deficient side of the patient using medical-grade adhesive. The
specific applications of RP in the field of medicine. prosthesis may change its color or deteriorate over time, and
may require replacement in future. This can be facilitated by
Case 1: Customized prosthesis implant the availability of the digital model of the prosthesis. The
Researchers (Subburaj et al., 2007) in the Department of postoperative appearance showed the excellent result in terms
Mechanical Engineering [Indian Institute Of Technology (IIT), of aesthetics. Researchers concluded that the use of RP and
Mumbai] and Department of Prosthodontics (Government associated technology provided a high degree of accuracy in
Dental College and Hospital, Mumbai) considered a patient terms of shape, size and position of the prosthesis. It enabled
(male, 19 years) with congenital absence of the right ear for accurate reproduction of customized prosthesis without
investigation, as presented in Figure 7. The purpose was to use requiring sculpting skills and was much faster than the
CAD and RP technologies for the rapid development of conventional (manual) method.
auricular prosthesis and demonstrated a real-life case study.
The anatomic morphology of the prosthesis, matching the Case 2: Preoperative planning
morphology of the contralateral ear, was obtained by following Report of two cases (female patients of age 23 and 18 years
these five steps: with cubitus deformity) as shown in Figure 8 are presented by

Figure 7 A patient (male, 19 years) with congenital absence of the right ear

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Figure 8 A patient (female, 18 years) with cubitus varus of left elbow

a group of researchers (Mahaisavariya et al., 2006) in which Figure 9 (a) STL design file for the porous scaffold; (b) PCL scaffold
they reported some work on surgical planning of corrective fabricated by SLS
osteotomy for cubitus varus using RP models. First of all, a
CT scan was performed on both the deformed and the normal
elbow using a Philip spiral CT scanner (Thomoscan, AV), CT
scan acquisition was performed with 2-mm slice thickness and
reconstruction was performed with 1-mm slice thickness;
these scanned data were used to construct a 3D CAD model
using medical imaging and digital CAD software (MIMICS
and Magics RP; Materialise, NV Belgium), and surgical
planning of corrective osteotomy was virtually planned and
simulated in the 3D CAD model. The proper location of
osteotomy, the amount of wedging bone and the tilting of the
plane for osteotomy cut were measured by performing 3D
which is seeded with cells or nutrients and provides necessary
evaluation of the deformed and mirrored normal humerus on
support and shape to growing tissue (Armillotta and Pelzer,
screen. After calculating and determining the optimal
2008). Researchers (Williams et al., 2005) at the University of
configuration, the data of deformed and normal humerus were
Michigan have explored the potential of SLS (an RP
used to fabricate RP models using 3D printing machine (Z
technique) to fabricate polycaprolactone (PCL) scaffolds, as
Corp Inc.). These RP models were used by surgeons to
presented in Figure 9. PCL is a bioresorbable polymer
rehearse the osteotomy before a real surgery. Both patients
which has sufficient mechanical properties for bone tissue
were successfully operated as per the preoperative planning on
engineering applications. Furthermore, researchers evaluated
the RP models, and showed excellent postoperative results in
the biological properties of these SLS-manufactured scaffolds
terms of cosmetic and functional result. This case study clearly
by seeding with bone morphogenetic protein-7-transduced
shows that RP and associated technology (CT) can facilitate
human fibroblasts and evaluated the growth of generated
surgeons in preoperative planning for certain complex cases
tissue. They found that SLS-fabricated scaffolds matched the
like osteotomy of complex deformity of hip, pelvis and
design well, had mechanical strength within the range of
spine, and allows the surgeons to choose proper
trabecular bone and supported the growth of tissue. It is
configuration and the most appropriate location of
concluded that PCL scaffolds fabricated by SLS have great
osteotomy according to individual patient need.
potential for the replacement of skelton tissue in the field of
tissue engineering.
Case 3: Tissue engineering
RP has been used as an alternative to conventional scaffold
fabrication methods within the tissue engineering field. Tissue 6. Conclusions
engineering is the process of growing the relevant cell(s) in RP is making a significant effect in the field of medicine with
vitro into required 3D organ or tissue (Ciocca et al., 2009; a variety of medical applications, and its potential has also
Sachlos and Czernuszka, 2003). This method has been used been demonstrated in several studies (Dhakshyani et al., 2012;
for the repair of damaged tissue and organs. The main element Esses et al., 2011; Mao et al., 2010; Sanghera et al., 2001). A
for cell structure is scaffold, a prefabricated porous structure prospective trial (45 patients with craniofacial, maxillofacial

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Sushant Negi, Suresh Dhiman and Rajesh Kumar Sharma Volume 20 · Number 3 · 2014 · 256 –267

and skull base cervical spinal pathology were selected) with the Journal of Oral and Maxillofacial Surgery, Vol. 24 No. 1,
objective of assessing the utility of 3D models in complex pp. 98-103.
surgery performed by researchers (D’urso et al., 1999) Brennan, J. (2010), “Production of anatomical models from
concluded that these models significantly improved the quality CT scan data”, Masters Dissertation, De Montfort
of preoperative planning and diagnosis, reduced operative University, Leicester.
time and risk, enhanced team communication and assisted the Chang, L.W., Chen, H.W. and Ho, J.R. (1991),
patients to better understand their pathology. Another study “Reconstruction of 3D medical images: a nonlinear
of 47 complex mandibular reconstruction cases (between interpolation technique for reconstruction of 3D medical
2003 and 2009) concluded that 95.7 per cent of the patients images”, Graphical Models and Image Processing, Vol. 53
were found to have at least a satisfactory result and the No. 4, pp. 382-391.
majority (38 out of 47) of patients were in good and very good Chockalingam, K., Jawahara, N., Chandrasekarb, U. and
end result categories (Zenha et al., 2011). Additionally, this Ramanathana, K.N. (2008), “Establishment of process
technology makes the previously manual operations much model for part strength in stereolithography”, Journal of
faster, accurate and cheaper (Noort, 2012). The outcome Materials Processing Technology, Vol. 208 No. 1-3,
based on literature review and three case studies strongly pp. 348-365.
suggests that RP technology might become part of standard Chua, C.K., Leong, K.F. and Lim, C.S. (2003), Rapid
protocol in medical sector in the near future. However, Prototyping: Principles and Applications, World Scientific
presently this technology cannot be used in daily clinical Publishing Company, Toh Tuck Link.
practices due to some issues such as suitable material, time Ciocca, L., Crescenzio, F.D., Fantini, M. and Scotti, R.
and high cost of the procedure. Therefore, these issues restrict (2009), “CAD/CAM and rapid prototyped scaffold
the utilization of RP in complex cases where considerable cost construction for bone regenerative medicine and surgical
savings and quality benefits are generally expected (Giannatsis transfer of virtual planning: a pilot study”, Computerized
and Dedoussis, 2009). Furthermore, this technology can be Medical Imaging and Graphics, Vol. 33 No. 1, pp. 58-62.
used as an alternative to conventional fabrication methods Cohen, A., Laviv, A., Berman, P., Nashef, R. and Abu, T.J.
within the field of tissue engineering (Leong et al., 2003), (2009), “Mandibular reconstruction using stereolithographic
customize implants (Noort, 2012; Traini et al., 2008) and 3-dimensional printing modeling technology”, Oral Surgery,
medical devices (Bertol et al., 2010). Further research is Oral Medicine, Oral Pathology, Oral Radiology, and
required to reduce the overall cost (virtual planning and Endodontology, Vol. 108 No. 5, pp. 661-666.
fabrication cost) of RP technology, for the development of da Rosa, E.L., Oleskovicz, C.F. and Aragao, B.N. (2004),
suitable biomaterials and for the development of RP systems “Rapid prototyping in maxillofacial surgery and
designed specifically for medical applications. traumatology: case report”, Brazilian Dental Journal,
Vol. 15 No. 3, pp. 243-247.
Dhakshyani, R., Nukman, Y. and Abu Osman, A.N. (2012),
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About the authors
using CAD and rapid prototyping technologies”,
International Journal of Oral and Maxillofacial Surgery, Sushant Negi is doing his PhD in Designing under the
Vol. 36 No. 10, pp. 938-943. supervision of Dr Suresh Dhiman and Dr Rajesh Kumar
Traini, T., Manganob, C., Sammonsc, R.L., Manganod, F., Sharma from National Institute of Technology (NIT),
Macchib, A. and Piattelli, A. (2008), “Direct laser metal Hamirpur, Himachal Pradesh (HP), India. He holds a

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 Basics and applications of rapid prototyping medical models Rapid Prototyping Journal
Sushant Negi, Suresh Dhiman and Rajesh Kumar Sharma Volume 20 · Number 3 · 2014 · 256 –267

Bachelor degree in Mechanical Engineering from Punjab experience in the field of manufacturing. He is presently
Technical University Jalandhar, India (2009) and a Master’s working as an Assistant Professor in the Mechanical
degree in CAD/CAM from NIT Hamirpur, India (2011). His Engineering Department at NIT, Hamirpur (HP), India.
areas of interests include rapid prototyping, design, and He has publications in international/national journals and
tribology. conferences to his credit in the area of optimization of
machining parameters, development and characterization
Suresh Dhiman completed a four-year Post Diploma in of metal-matrix composites and RP. Suresh Dhiman is the
Mechanical Engineering from the YMCA Institute of corresponding author and can be contacted at: sudhi_
Engineering, Faridabad, Haryana (India), in 1986, graduation [email protected]
in Mechanical Engineering from the Institution of Engineers
(I), Kolkata, in 1996, post graduation (MTech) in Production Rajesh Kumar Sharma is an Associate Professor in the
Engineering from the Guru Nanak Dev Engineering Department of Mechanical Engineering at NIT, Hamirpur
College, Ludhiana (Punjab), in 2001 and PhD in (HP), India. He completed his doctoral work from IIT Delhi
Mechanical Engineering from NIT, Kurukshetra, Haryana, in 2008. His areas of interest include noise control, design and
India, in 2008. He possesses ten years of industrial tribology.

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