An investigation of three-dimensional scanning of human body surfaces and its use in the design and manufacture of prostheses

The capture of highly accurate data describing the complex surfaces of the human body may prove extremely useful in many medical situations. The data provide a method of measuring and recording changes to the surface of a patient's soft tissue. The data may be applied to computer-controlled manufacturing techniques, such as rapid prototyping (RP). This enables accurate physical replicas of the patient topography to be produced. Such models may be used as an aid in the design and manufacture of prostheses. This paper describes an investigation aimed at identifying problems that may be encountered when scanning patients and describes the application of the resulting data in the design and manufacture of facial prostheses. The results of the experiment are presented together with a discussion of the accuracy and potential advantages afforded by this approach

In vitro comparative study of fibroblastic behaviour on polymethacrylate (PMMA) and lithium disilicate polymer surfaces

Polymethyl methacrylate (PMMA) and lithium disilicate are widely used materials in the dental field. PMMA is mainly used for the manufacture of removable prostheses; however, with the incorporation of CAD-CAM technology, new applications have been introduced for this material, including as a provisional implant attachment. Lithium disilicate is considered the gold standard for definitive attachment material. On the other hand, PMMA has begun to be used in clinics as a provisional attachment until the placement of a definitive one occurs. Although there are clinical studies regarding its use, there are few studies on cell reorganization around this type of material. This is why we carried out an in vitro comparative study using discs of both materials in which human gingival fibroblasts (HGFs) were cultured. After processing them, we analyzed various cellular parameters (cell count, cytoskeleton length, core size and coverage area). We analyzed the surface of the discs together with their composition. The results obtained were mostly not statistically significant, which shows that the qualities of PMMA make it a suitable material as an implant attachment

A review of existing anatomical data capture methods to support the mass customisation of wrist splints

Anatomical data acquisition methods used within medicine exhibit various strengths and weaknesses, particularly with regards to accuracy, resolution, patient comfort and safety. Difficulties with data acquisition of wrist and hand geometry are often underestimated, and a suitable method is yet to be identified and standardised to capture skin surface topography to support the mass customisation of wrist splints. The aim of this investigation is to identify a suitable data acquisition method, capable of digitising collected data of the wrist and hand, for manipulation and conversion into a suitable file format to create customised wrist splints using additive manufacture. Literature suggests that scanning inanimate objects such as plaster casts using multiple three-dimensional laser scanners can provide adequate quality scans with suitable accuracy and resolution, with low cost and low risk to the patient. However, post processing would be required to create a “watertight” digital model suitable for additive manufacture

A pilot study in the application of texture relief for digitally designed facial prostheses

This pilot research aims to identify and assess suitable technologies that may be used to capture, create, and produce fine textures and wrinkles that may be incorporated into computer aided prosthesis design and production techniques. A range of suitable technologies is identified and two methods that may be used in different prosthetic rehabilitation situations are assessed: the creation of three-dimensional relief in a computer aided design environment and the capture of facial anatomy and texture using fringe-projection surface scanning. Patterns were produced using the suitable rapid prototyping processes identified, and these were assessed by a qualified and experienced prosthetist. The suitability of the technologies is commented upon, limitations discussed, and future directions identified

The Design of Artificial Metacarpophalangeal Joints

Artificial finger joints have been developed for the past 30 years, and a number of these prostheses has been applied in medical practice

Characterisation of Implant Supported Soft Tissue Prostheses Produced with 3D Colour Printing Technology

The numbers of patients needing facial prostheses has increased in the last few decades due to improving cancer survival rates. The many limitations of the handmade prostheses together with rapid expansion of prototyping in all directions, particularly in producing human anatomically accurate parts, have raised the question of how to employ this technology for rapid manufacturing of facial soft tissue prostheses. The idea started to grow and the project was implemented based on CAD/CAM principles – additive manufacturing technology, by employing layered fabrication of facial prostheses from starch powder and a water based binder and infiltrated with a silicone polymer (SPIS). The project aimed to produce a facial prosthesis by using 3D colour printing, which would match the patient’s skin shade and have the desirable mechanical properties, through a relatively low cost process that would be accessible to the global patient community. This was achieved by providing a simple system for data capture, design and reproducible method of manufacture with a clinically acceptable material. The prosthesis produced has several advantages and few limitations when compared to existing products/prostheses made from silicone polymer (SP). The mechanical properties and durability were not as good as those of the SP made prosthesis but they were acceptable, although the ideal properties have yet to be identified. Colour reproduction and colour matching were more than acceptable, although the colour of the SPIS parts was less stable than the SP colour under natural and accelerated weathering conditions. However, it is acknowledged that neither of the two methods used represent the natural life use on patients and the deficiencies demonstrated in terms of mechanical properties and colour instability were partially inherent in the methodology used, as the project was still at the developmental stage and it was not possible to apply real life tests on patients. Moreover, deficiencies in mechanical and optical properties were probably caused by the starch present, which was used as a scaffold for the SP. Furthermore, a suitable retention system utilising existing components was designed and added to the prosthesis. This enabled the prosthesis to be retained by implants with no need for the addition of adhesive. This would also help to prolong the durability and life span of the prosthesis. The capability of the printer to produce skin shades was determined and it was found that all the skin colours measured fall within the range of the 3D colour printer and thereby the printer was able to produce all the colours required. Biocompatibility was also acceptable, with a very low rate of toxicity. However, no material is 100% safe and each material has a certain range of toxicity at certain concentrations. At this stage of the project, it can be confirmed that facial prostheses were successfully manufactured by using 3D colour printing to match the patient’s skin shade, using biocompatible materials and having the desirable mechanical properties. Furthermore, the technology used enabled prostheses to be produced in a shorter time frame and at a lower cost than conventional SP prostheses. They are also very lightweight, easier to use and possibly more comfortable for the patients. Moreover, this technology has the capability of producing multiple prostheses at the time of manufacture at reduced extra cost, whilst the data can be saved and can be utilised/modified for producing further copies in the future without having to going through all the steps involved with handmade prostheses. Based on the mechanical properties and colour measurements the prostheses will have a finite service life and the recommendation is that these prostheses will need replacing every 6 to 12 months, depending on how the patient handles and maintains the prostheses and whether the prosthesis is being used as an interim or definitive prosthesis. This was largely comparable to existing prostheses but without the time and cost implications for replacement. However, it is acknowledged that further investigations and clinical case studies are required to investigate the “real life” effect on the prostheses and to get feedback from the patients in order to make appropriate improvements to the mechanical properties and the durability of the prosthesis

Development of AM technologies for metals in the sector of medical implants

Additive manufacturing (AM) processes have undergone significant progress in recent years, having been implemented in sectors as diverse as automotive, aerospace, electrical component manufacturing, etc. In the medical sector, different devices are printed, such as implants, surgical guides, scaffolds, tissue engineering, etc. Although nowadays some implants are made of plastics or ceramics, metals have been traditionally employed in their manufacture. However, metallic implants obtained by traditional methods such as machining have the drawbacks that they are manufactured in standard sizes, and that it is difficult to obtain porous structures that favor fixation of the prostheses by means of osseointegration. The present paper presents an overview of the use of AM technologies to manufacture metallic implants. First, the different technologies used for metals are presented, focusing on the main advantages and drawbacks of each one of them. Considered technologies are binder jetting (BJ), selective laser melting (SLM), electron beam melting (EBM), direct energy deposition (DED), and material extrusion by fused filament fabrication (FFF) with metal filled polymers. Then, different metals used in the medical sector are listed, and their properties are summarized, with the focus on Ti and CoCr alloys. They are divided into two groups, namely ferrous and non-ferrous alloys. Finally, the state-of-art about the manufacture of metallic implants with AM technologies is summarized. The present paper will help to explain the latest progress in the application of AM processes to the manufacture of implantsPostprint (published version

Metrology for Bio Systems

The current paper addresses the advent of next generation bio system focussed Micro Nano Manufacturing Technologies (MNMT). These products and processes have placed significant new emphasis on specification and quality control systems, especially if these product and processes are to achieve economic scale up. Bio technology products and processes are a core element of MNMT and structured surfaces can be a key element in enabling bio system function. There examples of the application of such surfaces in bio systems for functions such as diverse as anti fouling and oseointegration. However a deficit exists in terms of metrology for bio structured surfaces and identifying suitable measurands and instrumentation remains a challenge for production engineers. Functional modelling would seem to point towards a better way of specifying metrology however for bio systems these are rare and often extensive function testing and clinical trials are used to inform the metrology selection. In the present paper the development of MNMT bio systems is discussed in the metrology context and several examples of developing metrology challenges. Four such bio related systems are discussed the solutions are outlined. The case studies cover traditional prosthetic implants, micro fluidic devices, cellular attachment and manufacture of cellular scaffolds

Colour Image Reproduction for 3D Printing Facial Prostheses

In this chapter, using colour 3D printing technology, a 3D colour image reproduction system is detailed for the semi-automated and accurate additive manufacturing of facial soft tissue prostheses. A protocol for 3D colour image reproduction was designed based on the six steps of processing. For this specific application, protocols for each sub‐process required development and details of each technique applied are discussed. The quality of facial prostheses was evaluated through objective measurement and subjective assessment. The results demonstrated that the proposed colour reproduction system can be effectively used to produce accurate skin colour with fine textures over a 3D shape, with significant savings in both time and cost when compared to traditional techniques