Three-dimensional (3D) printing is the umbrella term for techniques used to make three-dimensional objects. 3D printing has existed for over 25 years but the technology is in continuous development and its use has increased dramatically in recent years. It is becoming cheaper, higher quality and more accessible. Still, 3D printing technology has yet to become mainstream in the healthcare industry. This is due to three main reasons: 1. The technology was not yet refined enough. 2. Current legislation gets in the way of large-scale deployment, and 3. despite extremely positive research results for 3D-printed implants, for example, large studies are still required to demonstrate the positive business case on the long term. But we have already seen the first breakthroughs delivering on the promise of medical 3D printing.
3D printing is a promising technology
According to some, we are currently living through a new industrial revolution. Despite the 3D printing technology still being in development, potential applications are widespread. Combined with other innovative techniques, such as organ-on-a-chip, tissue engineering, synthetic biology and stem cell technology, 3D printing bears enormous potential to improve healthcare in the direction of regenerative medicine. We are already seeing a major application in surgical intervention support, for example. A complex operation can be prepared by printing copies of a specific organ of a patient, for example. By printing a patient-specific mould, surgeons are able to perform their intervention much more quickly thanks to improved accuracy of bone incisions. This has been saving up to 25 minutes per operation. Plus, printing technology is being deployed to produce food and drugs. And printing possibilities for implants are on the rise as well. We are now able to combine two materials in a single design.
Thanks to advances in the technology, there is now a wider range of materials to choose from. This improves the ability to offer patients bespoke solutions and boosts healthcare quality. In addition, the technology offers an important benefit in terms of sustainability as medical equipment can be printed using less and recycled materials. And as healthcare is increasingly focused on reducing costs, 3D printing offers an interesting alternative.
Meanwhile, a lot of evidence is yet to be collected and technical iterations are required in order to obtain new insights. ‘Traditional’ 3D-printed implants are very robust. But the challenge remains to make these implants sustainable and patient friendly. Ideally, we would want to repair cartilage and bone tissue with the body’s own tissue. Speaking of a ‘lifelong’ solution. The multidisciplinary and international consortium PRosPERos (Printing PERsonalised orthopaedic implantS) is working on ‘smart’ 3D-printed implants to facilitate the growth of a body’s own cells. Based on a patient’s unique characteristics, one can print a custom-made titanium implant. These implants feature a type of openwork, webbed structure. This creates a unique shell at the microscopic level, providing a perfect environment for bone cells to latch onto and grow. The implants can also be fitted with antibacterial coating to prevent infections in the joint. We are currently exploring the use of biodegradable materials in the implant and are making strides with PRosPERos II. The potential of 3D printing goes beyond perfectly fitting patient-specific implants. It also allows us to make implants ‘smarter’ to reduce the risk of complications, accelerate recovery and make healthcare more efficient.
“3D printing allows us to make implants ‘smarter’ and contribute to the efficiency of healthcare.”
Mainstreaming 3D printing will take some additional education
When it comes to 3D printing, the Netherlands has become one of the world’s front runners with Belgium as the absolute global leader. If we want to mainstream this technique in the context of healthcare, we will have to keep up our rigorous investments in its continued development. For the most part, the focus on niche markets such as medical 3D printing is currently accounted for by start-ups like Xilloc. These companies play an important role in the continued innovation, implementation and scale-up of 3D printing in healthcare, demonstrating the added value one by one and revealing interesting new areas of application. Luckily, these start-ups have been driving large corporations to enter the medical 3D printing market as well. It is important, however, to ensure that smaller companies retain the financial ability to bear the high R&D costs associated with the industry. Initiatives such as PRosPERoS are helping to make that happen. This will accelerate the market for medical 3D printing.
Meanwhile, we will have to invest in more than 3D printing technology alone. The quality of raw materials and designs needs to be improved dramatically. Continuous attention must be paid to the education and support of healthcare professionals in order to capitalise on the potential of 3D printing. Modern technologies are currently under-represented in education for healthcare professionals.
“Professionals are sceptical, in part because they are used to the current way of working.”
At the moment, medical engineers are being deployed to bridge the gap between technicians and healthcare professionals. A lot of room for improvement exists in this interaction, for individual companies as well as the healthcare industry itself. Almost all hospitals are experimenting with 3D printing by now, but we need to keep in mind the social purpose and safeguard bioethics. Where do we draw the line when it comes to printing organs or foetuses, for instance? Who owns the resources and the decision-making authority? Developments in this area are progressing very rapidly and most of it is still playing out behind the scenes. As a result, the public will be confronted with the new technology all at once. For that reason, the debate will have to be conducted in the public eye.
The technology is far from mature
In the years ahead, the industry will continue to commit to refining printing technology and combining multiple materials in a single print. In order to improve the alignment of the print with the patient’s needs. Major strides are being made in bioprinting as well; the printing of one or multiple types of living tissue, structures and biomedical implants. But the technology remains imperfect and when it comes to organ printing, it could take another 20 years for the first practical applications to materialise. This is due to the fact that organ printing requires a combination of materials, sound design, smart software and the right structure of printed materials. In contrast, 3D printing of more practical, smaller things such as skin, blood vessels and perhaps even micro-organs like the pancreas and liver, has been developing at lightning speed.
We are in the midst of a movement towards sustainable use of materials which will prevent our warehouses from being filled with unused resources in the future. From a sustainability perspective, it is much smarter to print materials only when you need them. So, will every healthcare organisation own a 3D printer 10-20 years from now? I believe so.