November 14, 2013 12:02 pm

3D printing is new face of medicine

Prosthetic 3d printing

Inside the pistachio-coloured walls of a London hospital, 16 fake eyeballs sit gleaming on a shelf next to a collection of noses. A man holds up a slice of green silicone in the shape of an ear.

“It’s a very early sample,” says Tom Fripp, managing director of Sheffield-based design consultancy Fripp Design and Research. The company is the first to directly print an object in medical grade silicone, a substance whose pliable texture is well-suited to soft tissue prosthetics.

In the next room London dentist and implant manufacturer Andrew Dawood shows a 3D printed copy of the vascular system of conjoined twins. They were separated in 2011 after doctors used Mr Dawood’s model to practice the surgery beforehand, improving the odds of success and reducing the risky time the patients spent under the knife.

The hospital where the medical products were on display was an ersatz affair at a November trade show. But their makers were serious about the importance of 3D printing – a group of novel production methods, also known as “additive manufacturing”, which build up objects layer by layer, instead of more traditional approaches such as carving them out from chunks of material.

“Whenever you have relatively small volumes of high value parts, that’s when it begins to make sense to use additive manufacturing,” says industry analyst Terry Wohlers, commenting on the medical sector.

The technology lends itself to customisation, and its evangelists claim it will lead to printing drugs and even organs. But British medical businesses, from dentistry to orthopaedics, are already using 3D printing to design highly personalised products.

Improvements in digital imaging have prompted the latest wave of 3D medical manufacturing innovation, says Thierry Rayna, a technology and economics expert at ESG Management School in Paris.

Mr Fripp’s consultancy is conducting early patient trials for nose prosthetics designed from patient scans. They are made from a hybrid process, different to that of the ear, in which silicone is forced into a 3D printed starch scaffold under pressure.

This cuts down production time from six weeks for a handmade version to 48 hours for a printed one. At £1,500, the first item costs as much as a standard prosthesis but falls to about a tenth of the cost for reprints from the digital file – a handy saving if the nose is damaged or if the patient’s skin-tone changes with a summer tan.

“We’re batch manufacturing bespoke products,” says Mr Fripp. The consultancy is also developing eyes that it hopes to be able to sell for about £30 in a year’s time.

The value of 3D printing in the global medical market is quite small – currently about $215m in material and machine sales, according to estimates from UK-based industry consultancy Econolyst.

But with the rise of a richer middle class in the developing world and ageing populations in the west, the market is predicted to grow to a $1bn industry within 10 years.

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Britain has the opportunity to be a market leader in the 3D printed medical products and services, according to Mr Wohlers, thanks to its investment in additive research and development. Mr Rayna credits the NHS network of “semi-public, semi-private trusts and hospitals” as acting like “venture capitalists” and making the British scene “quite dynamic”.

LSE-listed engineering company Renishaw PLC has increased its focus on the healthcare sector. It acquired German metal additive company Laser Bearbeitungs Center GmbH this year, which improved its capabilities in machines for custom medical implant manufacture.

But the “little guys with an edge” also play an important role, says Phil Reeves of Econolyst, as they tend to be more willing to adopt new technology than risk-averse big companies. He points to dentistry and orthopaedics as two growth areas.

For complex shapes such as the pelvis and shoulder, Stanmore Implants in Elstree uses 3D printing to make reconstructions to replace pieces of bone removed due to cancer. Such implants can be made to last longer and have surfaces that mesh better with bone than those manufactured by other methods, says Mr Reeves.

In dentistry the opportunity lies in the huge demand for items such as caps, crowns and bridges – each of which “is a one-off Fabergé egg”, says Edward Attenborough, managing director of Nottingham-based Attenborough Dental, a 100-year-old company that is now one of the largest dental labs in Europe.

It collects digital scans of patients’ mouths from 150 satellite labs around the UK and fabricates components using additive manufacturing, among other processes – although Mr Attenborough expects 3D printing to grow as a proportion of revenue. The technology allows his team to make items more accurately, automate some of the lower-skilled processes and focus on “higher added-value in hand-finishing and veneering”.

But there are barriers to the spread of the technology. Few machines manufacture in more than one material, and capturing all the data necessary to make products is complex and costly.

Customised medicine also raises the legal risk for doctors, says Maurits Westerik, a lawyer in the Netherlands working in technology and intellectual property.

“You’ve got the manufacturer, the medical professional in charge of printing, customisation and implantation, and the patient,” says Mr Westerik. “In that lovely triangle, somebody’s going to have to be responsible.”

He knows of a case in western Europe in which a patient with an allegedly faulty 3D printed orthopaedic implant is seeking compensation from the manufacturer of the printing machine – who in turns blames the hospital where it was used.

It may be some time before bespoke bones, eyes and ears are rolling off 3D production lines en masse.

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