Review
Printing Technologies for Medical Applications

https://doi.org/10.1016/j.molmed.2016.01.003Get rights and content

Trends

3D printing is a versatile emerging technology that is finding its way through all aspects of human life, and the unique potential of 3D printers can be exploited in different areas of medicine, such as fundamental research, drug delivery, and testing, as well as in clinical practice.

Nearly all current medical non-biological implants, such as ear prostheses or human mandibular replacements, are manufactured at predetermined sizes and configurations that are widely used for patients. 3D printing allows more accurate personalized manufacturing of devices created to the patient's own specifications; a process which is often aided by 3D imaging software.

Surgical planning with 3D printing is already showing promise. As an example, living-donor liver transplantation surgery for patients with end-stage organ disease is complex and can be life-threatening. The use of 3D printed surgical models has been shown to help shorten operative time and decrease donor risk, thereby boosting surgical outcomes.

Bioprinting is being used to create more accurate non-biologic and biologic research models for research purposes in wide variety of applications, including spatial and temporal trauma in cancer research.

3D printing is being increasingly used for the design and manufacturing of living tissues and organs that may one day be implanted into patients.

Over the past 15 years, printers have been increasingly utilized for biomedical applications in various areas of medicine and tissue engineering. This review discusses the current and future applications of 3D bioprinting. Several 3D printing tools with broad applications from surgical planning to 3D models are being created, such as liver replicas and intermediate splints. Numerous researchers are exploring this technique to pattern cells or fabricate several different tissues and organs, such as blood vessels or cardiac patches. Current investigations in bioprinting applications are yielding further advances. As one of the fastest areas of industry expansion, 3D additive manufacturing will change techniques across biomedical applications, from research and testing models to surgical planning, device manufacturing, and tissue or organ replacement.

Section snippets

The Basics of Bioprinting

Generally, bioprinting includes three sets of steps; pre-bioprinting, bioprinting, and post-bioprinting activities. Pre-bioprinting involves imaging and digital design in addition to material selection [13]. Computed tomography (CT) and magnetic resonance imaging (MRI) are considered the two most common imaging technologies for medically applied bioprinting. After medical imaging, tomographic reconstruction is performed to achieve segmental 2D images for the layer-by-layer fabrication process

Biomedical Printing Applications

Bioprinting has been utilized for drug screening and delivery (Box 2), personalized medicine (Box 3), and fabrication and modeling of living organs for medical applications, as discussed below.

Ears

Congenital deformities such as microtia and anotia in addition to accidents or disease can cause ear damage or loss 22, 23. The most common treatment is to replace the damaged ear with a prosthesis or a sculpted rib cartilage 22, 23, 24. However, these conventional techniques are not ideal. The manufacture of a silicone ear is expensive and involves several hospital visits for customization [24]. Costal cartilage is difficult to design and cut to the appropriate shape [22]. Both options may

Livers

The limited number of cadaveric livers cannot meet the growing need for liver transplantation. Consequently, increasing numbers of patients are undergoing transplantation of a liver lobe from a healthy donor [18]. However, this method is prone to some risks and donors may incur blood loss, injury to surrounding tissues or organs, and even death. Furthermore, it is important to predict the volume of the transplanted liver to avoid large/small-for-size syndromes [36]. 3D imaging, such as CT and

Bioprinting for Cancer Applications

Traditional 2D cultures are restricted in many aspects as in vitro models 16, 59, 60, 61 and have a limited level of complexity. Therefore, a 3D model may be necessary to examine the interactions among cells and their environment (e.g. ECM, mechanical stimulation, other cells) 16, 59, 60. A suitable 3D in vitro replica for cancer research must mimic the invasive behavior of tumors as well as tumor–stromal cell interactions with sophisticated design principles [62]. Hence, cancer studies should

Concluding Remarks

Since the beginning of the 21st century, 2D and 3D printing technologies are dramatically impacting on medicine. Today, printing is being recognized as a versatile manufacturing technology. The patterning capabilities, precise manufacturing, diverse printable materials, extensive choices of substrates, and overall cost-effectiveness of bioprinters are increasing exponentially. Printers have been used largely to pattern cells; to make tissues, organs, and medical devices; to construct surgical

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