3D Printing, by Luke Blauch

A diagram of a typical 3D printer that hardens special liquid polymer using UV light [1]

How Stereolithography Works

Traditional 3D printing, called stereolithography, was invented in 1984 by Charles Hull. His patented technique utilizes a UV activated liquid polymer which can be hardened under UV light. To create an object, cross-sectional layers of polymer are subsequently hardened one after the other, with printing instructions provided by a 3D computer aided design (CAD). The platform upon which the object is built (see diagram above) is lowered deeper into the liquid polymer after each layer is solidified, allowing for new layers to be constructed on top of old ones, eventually leading to a useful 3D object.

Background

Charles Hull, the inventor of the 3D printer and stereolithography. [2]

3D printing is quickly becoming one of the more favored tools in the tissue engineer's arsenal, for a variety of reasons. Open-source 3D printers are becoming much more commonplace, allowing researchers to make their own modifications to the original design for their research purposes [3]. Additionally, the applications for 3D printers are rapidly expanding; what started as a purely polymeric endeavor has now grown towards printing actual organs. While polymers will continue to be useful for bone replacement, such as in the skull [4], the final goal will be to use the patient's own cells for the transplant. In the area of bone transplantation, some researchers have moved towards 3D printing scaffolds for cells to grow on out of a ceramic base, such as hydroxyapatite, which is then essentially glued together with polymer in the printing process [5].

History

1976 – The Inkjet Printer was invented
1984 – The 3D printer was invented and patented by Charles Hull (US 4575330 A). Technically termed stereolithography, Hull’s invention allows a physical object to be printed from a 3D computer model. [6]
1987 - The term "tissue engineering" was invented 2012 – First successful 3D printing of permeable blood vessels, using an open-source 3D printer [3]

Future Research Goals

There are several obstacles which must be overcome in order for 3D printing to reach its potential for tissue engineering. These include:

• Better integration of vasculature to provide printed cells with healthy levels of nutrients and oxygen, as well as realistic intermolecular transport [7]
• Improving the ability of computer aided design (CAD) to engineer 3D printed tissue or polymer implants specifically for the patient’s body [4, 7]
• Increasing printing resolution so that more precise structures of cells can be created. Also, increasing the range of materials that can be used in a 3D printer [3]

Ongoing Research - Case Studies

3D Printing of Skull – Stieglitz, et al (2014) [4]

a- low-profile titanium microfixation plates. b,c- small gaps between the patient's skull and implant. d- a nonexistant artifact from the CT scan [4]

The doctor uses a CT scan of the patient’s skull before surgery (often taken upon onset of cranial trauma), then after the flap of skull has been removed. Through digital subtraction of the two images, the flap’s shape can be constructed as a mold in a 3D printer. [4]

Skull reconstruction is a common procedure which can become necessary after severe head trauma or bacterial infection. Other times tumors can invade the skull, or complications can arise post cranial surgery. Traditional methods involve molding a polymer to the skull by hand, usually polymethylmethacrylate (PMMA), which often results in a poor, asymmetrical appearance, or a bad fit. To better serve patients, Stieglitz et al have devised a method of creating artificial skulls using a 3D printer, where the blueprint is reverse-engineered from patient CT scans.

Methods

PMMA implants, based on computer-designed molds, were implanted into twenty-eight patients--11 female, 17 male--between 2009 and 2012. The molding of the implant occured during surgery, so that a CT scan of the patient's open skull could be used to engineer the necessary shape (see figure right). Results of the procedure were assessed using a questionare and quantitative geometric analysis of the implant.

Results

Most patients ranked the appearance of the implant to be "good", while two of the twenty-eight found their appearance to be "unfavorable." Overall, most patients said the function of the implant was "good." The quantitative analysis found that the implants had a median quality of 80.

Conclusions

This is a cost-effective and safe method of skull reconstruction. Overall results were good, with few complications arising.

3D Printing of Vasculature for Living Tissue - Miller, et al and Kolesky, et al [3, 7]

Obtaining vasculature in created tissue is one of the greatest challenges facing tissue engineers today. This is because without vasculature, cells on the inside of a tissue are not able to obtain the nutrients they need, and so die quickly [8].
Currently, there are three available methods for vasculature implementation [3]:

• Layer-by-layer assembly
  
  • Tissue layers are assembled separately, then properly aligned and adjoined
  • Slow, and alignment is often imperfect
  • Has very little flexibility to allow for complex designs, and only a few materials and cell types can be used
• Bioprinting
• 3D sacrificial molding

References

1. http://www.biega.com/3d-printing.shtml

2. http://spie.org/x91418.xml

3. Miller, J. S., Stevens, K. R., Yang, M. T., Baker, B. M., Nguyen, D.-H. T., Cohen, D. M., … Chen, C. S. (2012). Rapid casting of patterned vascular networks for perfusable engineered three-dimensional tissues. Nature Materials, 11(9), 768–774. doi:10.1038/nmat3357

4. Stieglitz, L. H., Gerber, N., Schmid, T., Mordasini, P., Fichtner, J., Fung, C., … Beck, J. (2014). Intraoperative fabrication of patient-specific moulded implants for skull reconstruction: single-centre experience of 28 cases. Acta Neurochirurgica, 156(4), 793–803. doi:10.1007/s00701-013-1977-5

5. Seitz, H., Rieder, W., Irsen, S., Leukers, B., & Tille, C. (2005). Three-dimensional printing of porous ceramic scaffolds for bone tissue engineering. Journal of Biomedical Materials Research Part B: Applied Biomaterials, 74B(2), 782–788. doi:10.1002/jbm.b.30291

6. Hull, C. W. (1986, March 11). Apparatus for production of three-dimensional objects by stereolithography. Retrieved from http://www.google.com/patents/US4929402

7. Kolesky, D. B., Truby, R. L., Gladman, A. S., Busbee, T. A., Homan, K. A., & Lewis, J. A. (2014). 3D Bioprinting of Vascularized, Heterogeneous Cell-Laden Tissue Constructs. Advanced Materials, n/a–n/a. doi:10.1002/adma.201305506

8. Radisic, M. et al. Medium perfusion enables engineering of compact and contractile cardiac tissue. Am. J. Physiol. Heart Circ. Physiol. 286, H507-H516 (2004).