3D printing has revolutionized the medical field, offering unprecedented precision and customization in various healthcare applications. As the founder of BoneEasy, a company dedicated to creating individualized 3D-printed implants for maxillofacial reconstruction and dental atrophic rehabilitation, I envision a future where these innovations will further evolve into hybrid devices. These devices will seamlessly blend mechanical structures with biological surfaces, promising enhanced integration and reduced inflammation.

Advancements in 3D Printing for Healthcare

One of the most promising future developments in 3D printing for healthcare is the preparation of titanium implants with a biologically active surface. This involves covering the implant with cells derived from the patient’s own blood, cultured in cell bioreactors. By “cellular baking” these cells onto the implant, we can create a surface that is immunologically compatible with the patient. This approach not only promotes faster integration of the implant but also significantly reduces the risk of inflammation and rejection

The Concept of Hybrid Devices

The concept of hybrid devices—where a 3D-printed structure is enhanced with a biological surface—represents the next frontier in personalized medicine. BoneEasy has pioneered the exploration of this idea through our series of lectures titled “When Mechanics Kiss Bio.” Our goal is to create devices that align more closely with individual biology, offering patients implants that are not only structurally sound but also biologically harmonious.

Research Supporting Hybrid Devices

Recent advances in bioprinting support this vision. Institutes like Wake Forest and Karolinska have made significant strides in the field. For instance, researchers at Wake Forest Institute for Regenerative Medicine have developed techniques to print tissues and organs that demonstrate functional and structural integrity similar to natural tissues. These breakthroughs lay the groundwork for the development of hybrid implants that integrate seamlessly with the human body .

Similarly, the Karolinska Institute has been at the forefront of stem cell research and bioprinting. Their work on printing human cartilage and bone structures using stem cells harvested from the patient holds immense potential for maxillofacial and dental applications. This technology could enable the creation of implants that not only match the physical specifications of the patient but also possess the biological characteristics necessary for optimal integration and function .

Dr. Anthony Atala’s extensive work in bioprinting at the Wake Forest Institute has also been instrumental in advancing the capabilities of 3D printing for medical applications. His research has demonstrated the feasibility of creating complex tissue structures that can function effectively within the human body, paving the way for the development of our hybrid devices .

BoneEasy’s Commitment to Innovation

My team is committed to advancing this integration of mechanics and biology. By utilizing patients’ own cells, we can create implants that are more than just structural replacements—they become part of the patient’s own body. This personalized approach not only improves the physical outcome of reconstructive procedures but also enhances the overall patient experience by reducing recovery times and complications.

Our team, along with some European  Universities work are bolstered by pioneering research in the field. A study published in Nature Biotechnology detailed a 3D bioprinting system capable of producing human-scale tissue constructs with structural integrity, highlighting the potential for large-scale application in human implants . Another recent paper in Nature Communications discussed a mechanical-assisted post-bioprinting strategy for repairing challenging bone defects, further demonstrating the advancements in bioprinting technology .

The Future of Personalized Medical Implants

The future of 3D printing in healthcare, particularly in maxillofacial reconstruction and dental rehabilitation, lies in the development of hybrid devices. By combining 3D-printed structures with biologically active surfaces derived from the patient’s own cells, we can achieve a new level of personalization and integration in medical implants. This vision, supported by ongoing research and development at leading institutes, promises to transform patient outcomes and set new standards in the field of medical implants.

 is excited to be at the forefront of this transformative journey. Our dedication to combining mechanical engineering with biological sciences aims to create implants that are not only structurally robust but also biologically compatible with each patient. This approach ensures that the implants we develop will integrate more effectively, reduce the likelihood of rejection, and promote faster healing.

In conclusion, the convergence of 3D printing and bioprinting technologies heralds a new era in personalized medicine. Hybrid devices represent the pinnacle of this evolution, offering unprecedented benefits in terms of patient compatibility and overall treatment efficacy. As we continue to innovate and refine these technologies, I remain committed to enhancing patient care and improving outcomes through cutting-edge advancements in 3D printing.

References:

• Kang, H.W., Lee, S., Ko, I. et al. A 3D bioprinting system to produce human-scale tissue constructs with structural integrity. Nat Biotechnol 34, 312–319 (2016). https://doi.org/10.1038/nbt.3413
• Yang, J., Chen, Z., Gao, C. et al. A mechanical-assisted post-bioprinting strategy for challenging bone defects repair. Nat Commun 15, 3565 (2024). https://doi.org/10.1038/s41467-024-48023-8
• Murphy, S.V., & Atala, A. (2014). 3D bioprinting of tissues and organs. Nature Biotechnology, 32(8), 773-785. https://doi.org/10.1038/nbt.2958
• Ozbolat, I.T., & Hospodiuk, M. (2016). Current advances and future perspectives in extrusion-based bioprinting. Biomaterials, 76, 321-343. https://doi.org/10.1016/j.biomaterials.2015.10.076
• Gao, G., Schilling, A.F., Hubbell, K., Yonezawa, T., Truong, D., Hong, Y., & Dai, G. (2015). Improved properties of bone and cartilage tissue from 3D printer co-culture of human mesenchymal stem cells and endothelial cells. Biomaterials, 29, 281-290. https://doi.org/10.1016/j.biomaterials.2015.07.042

About the Author:

Rui Coelho

I’ve started as a DDS, jumping almost immediately to maxillofacial surgery, I’ve taught dental implantology at the University from 1993 to 1998, a post-graduate program. From 2011 I’ve dedicated to the Industry as a project manager for some projects including “Digital stratification of dental crowns”. The project was developing a 5-axes 3D printer to make stratification of dental crowns with composites by 3D printing.

In 2013 I’ve found two companies “Tailoredimplant” and “Boneeasy”, the first was to develop 3D software for surgeons designing bone grafts and the second one a bioprinting company that prints implantable medical devices.

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The world of medical 3D printing gives surgeons tools that they never had before. The new technology translates into less surgical time, minimally invasive procedure, and geometries that were impossible to reproduce until now. Patients indeed benefit a lot from this new solution. However, having the abilities to make new 3D-printed devices doesn’t mean that we should ignore a patient’s safety:

One reason is that 3D-printed implants often do not come from the medical devices industry. The second reason is that the regulatory entities are not ready for the number of new companies appearing in this market.

The European Union considers 3D-printed implants a custom-made medical device under the old 93/42/CE Directive (MDD 93/24/CE). However, the new Medical Device Regulation MDR (EU) 2017/745 states that 3D printed implants are not considered custom made medical devices under the CE mark. It also says that these devices should still follow all the directives according to their risk classification.

Classification of medical devices determines the level of risk of each medical device. The classes are class I, class IIA, class IIB, and classIII. Implantable medical devices are considered class IIB and class III, depending on the time of implantation and if the device will create modifications or release drugs. A bone substitute was considered as class IIB previously, but they were forced to change to class III because they were resorbable, and this would cause changes in the body.

Because of the reasons mentioned before, not having the CE mark doesn’t mean 3D-printed implantable medical devices shouldn’t follow the regulation for Class IIB or class III devices. The scandal involving the PIP silicone implants is very recent, and we don’t want that to happen with 3D-printed medical devices and create distrust from patients to these solutions.

European regulation for medical device follow several ISO’s:

ISO 13485, which specifies requirements for a quality management system (QMS), where an organization with the ability to provide medical devices and related services that consistently meet customer and applicable regulatory requirements. Such organizations can be involved in one or more stages of a 3D-printed implant life-cycle, including design, development, production, storage, distribution, installation, and servicing of a medical device, and more.

ISO 11737-1:2018 sterilization of health care products:

Microbiological methods — Part 1: Determination of a population of microorganisms on products. This specifies requirements and guides the enumeration and microbial characterization of the population of viable microorganisms on or in a health care product, component, raw material, or package.

ISO 11737 – 2009 Sterilization of medical devices — Microbiological methods — Part 2: Tests of sterility performed in the definition, validation, and maintenance of a sterilization process. This document specifies requirements and test methods for materials, preformed sterile barrier systems, sterile barrier systems, and packaging systems that are intended to maintain sterility of terminally sterilized medical devices until the point of use.

ISO 11607- 2019 regulates the packaging for terminally sterilized medical devices part I: requirements for materials, sterile barrier systems and packaging systems, shelf life.

It is common to see some of the 3D-printed implants being sterilized in an autoclave. However, an autoclave is not an authorized sterilization system for an implantable medical device.

Health professionals should know more about patient safety when talking about medical devices to understand some of the complications that could occur after implantation.

3D printed implants open new problems during the manufacturing of medical devices because until now, the product was already certified by the supplier. 3D printing implant companies should develop GMP (good management practices) to avoid contamination of the product. Such GMP includes dedicated machines, clean rooms, and consistent internal analysis to ensure the purity of the core of the device. Cleaning of the surface should be done in dedicated cleanrooms, and analysis should confirm your process has no biological or physical contamination. Finally, using certified blisters and controlled sterilization either by ETO or gamma radiation.

Boneeasy has one ISO 6 cleanroom dedicated to titanium 3D-printing, where we have our metal printers, and the powder is completely processed inside of this room. We have an ISO 6 cleanroom for cleaning the devices. We also have an ISO 4 cleanroom where we do packaging. In addition, we have a quality control process for our metal implants, including spectrophotometry for the core and SEM and EDS for the surface. Testings on bioburden, sterilization, ETO residues, and endotoxins are outsourced to certified laboratories.

In conclusion, 3D-printed implantable medical devices are new options that help surgeons with more accurate surgeries and improve the quality of life of the patients. However, the manufacturers should comply with the regulation, and countries should go further on with more specific rules for 3D-printed custom made medical devices.

About the Author:

Rui Coelho

I’ve started as a DDS, jumping almost immediately to maxillofacial surgery, I’ve taught dental implantology at the University from 1993 to 1998, a post-graduate program. From 2011 I’ve dedicated to the Industry as a project manager for some projects including “Digital stratification of dental crowns”. The project was developing a 5-axes 3D printer to make stratification of dental crowns with composites by 3D printing.

In 2013 I’ve found two companies “Tailoredimplant” and “Boneeasy”, the first was to develop 3D software for surgeons designing bone grafts and the second one a bioprinting company that prints implantable medical devices.

Related Articles:

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