Materials Horizons: From Nature to Nanomaterials

Sunpreet Singh
Chander Prakash
Rupinder Singh Editors

3D Printing
in Biomedical
Engineering
Materials Horizons: From Nature
to Nanomaterials

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Cranfield University, Cranfield, UK
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Sunpreet Singh Chander Prakash
• •

Rupinder Singh
Editors

3D Printing in Biomedical
Engineering

123
Editors
Sunpreet Singh Chander Prakash
Department of Mechanical Engineering School of Mechanical Engineering
National University of Singapore Lovely Professional University
Singapore, Singapore Jalandhar, Punjab, India

Rupinder Singh
Department of Mechanical Engineering
National Institute of Technical Teachers
Training & Research
Chandigarh, India

ISSN 2524-5384 ISSN 2524-5392 (electronic)

Materials Horizons: From Nature to Nanomaterials
ISBN 978-981-15-5423-0 ISBN 978-981-15-5424-7 (eBook)
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Preface

The book titled 3D Printing in Biomedical Engineering presents the emerging

biomedical applications by clubbing the various aspects of the science and tech-
nology. Indeed, the content of this book has opened the various scientific horizons
which are proved to be utmost beneficial for uplifting the standards of the
day-to-day practices in biomedical domain. This edited book has been structured to
not only discuss the current and emerging trends of 3D printing in biomedical
sector, but also to provide the basic insights which could help the newcomers to
understand the essential requirements. It has been witnessed while editing the book
content that the prosthetic is the first biomedical area that has been revolutionized
by 3D printing and, thereafter, transformed to more sophisticated products.
Continued innovation has pushed 3D printing into new realms and has proved how
far the technology has come since its invention. From dental products to prosthetics
and tissue engineering, 3D printing is also helping address some of today’s
biomedical challenges. Additive manufacturing process has ability to manufacture
highly complex engineered and customized components for specific biomedical
applications. Furthermore, traditional feedstock materials of 3D printing have also
been transformed in the last decade wherein different types of bio-inks, hydrogels,
proteins, human cells and thereby combinations were used. Extensive research is
being conducted in bioprinting and its potential as a future source for organ
transplants. It is, however, much simpler to print in plastic than living cells.
Noticeably, myriads of innovations of this class of manufacturing (including
material, design and process iterations) are being transforming our day-to-day life in
an extraordinary manner. This book has captured all aforementioned trends of the
3D printing in the area of biomedical science and engineering. With this, we are
highly confident that this contribution will benefit all the readers in different ways.

Singapore, Singapore Sunpreet Singh

Jalandhar, India Chander Prakash
Chandigarh, India Rupinder Singh

v
Contents

1 3D Printing: Challenges and Its Prospect in Futuristic Tissue

Engineering Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Abir Dutta, Trina Roy, Preetam Guha Ray, Ragavi Rajasekaran,
Mamoni Banerjee, Santanu Chattopadhyay, Sanjay Gupta,
and Santanu Dhara
2 Fundamentals of 3D Printing and Its Applications
in Biomedical Engineering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Hasan Kemal Surmen, Faruk Ortes, and Yunus Ziya Arslan
3 Thermal Effects in 3D Printed Parts . . . . . . . . . . . . . . . . . . . . . . . . 43
Prasansha Rastogi, Swaroop Gharde,
and Balasubramanian Kandasubramanian
4 Role of Imaging Data in Additive Manufacturing
for Biomedical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Gurminder Singh and Pulak M. Pandey
5 Additive Manufacturing in Bone Tissue
Engineering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Majid Fazlollahi, Yasaman Pooshidani, and Mahnaz Eskandari
6 FDM 3D Printing in Biomedical and Microfluidic
Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Gabriel Gaal, Vladimir Gaal, Maria Luisa Braunger, Antonio Riul Jr,
and Varlei Rodrigues
7 Integration of FDM and Indirect Rapid Tooling Technique
for Fabrication of Low-Cost Hip Implant Replicas for Batch
Production: A Case Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Jaspreet Singh, Rupinder Singh, and Harwinder Singh

vii
viii Contents

8 Biomaterials and Fabrication Methods of Scaffolds for Tissue

Engineering Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Atul Babbar, Vivek Jain, Dheeraj Gupta, Sunpreet Singh,
Chander Prakash, and Catalin Pruncu
9 Rapid Prototyping Methods in Manufacturing of Biomedical
Implants: A Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Ajith Gopinath, Tobias Waclawczyk, Raman Bedi, Avinash Babu,
Shijo Thomas, and Praise Tom
10 PLA-HAp-CS-Based Biocompatible Scaffolds Prepared Through
Micro-Additive Manufacturing: A Review and Future
Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Nishant Ranjan, Rupinder Singh, I. P. S. Ahuja, Mustafizur Rahman,
and Seeram Ramakrishna
11 Dental Crowns by FDM Assisted Vapour Smoothing
and Silicon Moulding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
R. Singh, Rupinder Singh, and J. S. Dureja
12 Complex Shapes Prosthetics Process: An Application of Fused
Deposition Modeling Technology . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Tan Thang Nguyen, Hoang Vu Nguyen, Minh Phung Dang,
and Thanh-Phong Dao
13 Improvement of Human Gait in Foot Deformities Patients
by 3D Printed Ankle–Foot Orthosis . . . . . . . . . . . . . . . . . . . . . . . . 269
Harish Kumar Banga, Parveen Kalra, R. M. Belokar,
and Rajesh Kumar
14 Influence of Laser Power and Scan Speed During Laser-Assisted
Multi-layer Additive Manufacturing Using Finite Element
Modeling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Sapam Ningthemba Singh, Yadaiah Nirsanametla,
Sohini Chowdhury, and M. Muralidhar
15 Novel and Emerging Materials Used in 3D Printing for Oral
Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
Anoop Kapoor, Priyanka Chopra, Komal Sehgal, Shaveta Sood,
Ashish Jain, and Vishakha Grover
Editors and Contributors

About the Editors

Dr. Sunpreet Singh is post-doc fellow in the School of Mechanical Engineering,

National Univeristy of Singapore, Singapore. He has received Ph.D in Mechanical
Engineering from Guru Nanak Dev Engineering College, Ludhiana, India. His area
of research is additive manufacturing and application of 3D printing for development
of new biomaterials for clinical applications. He has contributed extensively in
additive manufacturing literature with publications appearing in Journal of
Manufacturing Processes, Composite Part: B, Rapid Prototyping Journal, Journal
of Mechanical Science and Technology, Measurement, International Journal of
Advance Manufacturing Technology, and Journal of Cleaner Production. He is
working in joint collaboration with Prof. Seeram Ramakrishna, NUS Nanoscience &
Nanotechnology Initiative and Prof. Rupinder Singh, manufacturing research lab,
GNDEC, Ludhiana. He is also editor of 3 books- “Current Trends in
Bio-manufacturing”; “3D Printing in Biomedical Engineering”; and “Biomaterials in
Orthopaedics and Bone Regeneration - Design and Synthesis”. He is also guest editor
of 3 journals- special issue of “Functional Materials and Advanced Manufacturing”,
Facta Universitatis, series: Mechanical Engineering (Scopus Indexed), Materials
Science Forum (Scopus Indexed), and special issue on “Metrology in Materials and
Advanced Manufacturing”, Measurement and Control (SCI indexed).

Dr. Chander Prakash is Associate Professor at the School of Mechanical

Engineering, Lovely Professional University, Jalandhar, India. He has received
Ph.D in mechanical engineering from Panjab University, Chandigarh, India. His
area of research is biomaterials, rapid prototyping & 3-D printing, advanced
manufacturing, modeling, simulation, and optimization. He has more than 11 years
of teaching experience and 6 years’ of research experience. He has contributed
extensively to the world in the titanium and magnesium based implant literature
with publications appearing in Surface and Coating Technology, Materials and
Manufacturing Processes, Journal of Materials Engineering and Performance,

ix
x Editors and Contributors

Journal of Mechanical Science and Technology, Nanoscience and Nanotechnology

Letters, Proceedings of the Institution of Mechanical Engineers, Part B: Journal of
Engineering Manufacture. He has authored 60 research papers and 10 book
chapters. He is also editor of 3 books: “Current Trends in Bio-manufacturing”; “3D
Printing in Biomedical Engineering”; and “Biomaterials in Orthopaedics and Bone
Regeneration - Design and Synthesis”. He is also guest editor of 3 journals: special
issue of “Functional Materials and Advanced Manufacturing”, Facta Universitatis,
Series: Mechanical Engineering (Scopus Indexed), Materials Science Forum
(Scopus Indexed), and special issue on “Metrology in Materials and Advanced
Manufacturing”, Measurement and Control (SCI indexed).

Prof. Rupinder Singh is Professor in Department of Mechanical Engineering,

National Institute of Technical Teachers Training and Research, Chandigarh, India.
He has received Ph.D in Mechanical Engineering from Thapar Institute of
Engineering & Technology, Patiala, India. His area of research is Non-traditional
machining, Additive manufacturing and development of porous biomaterials using
3D printing and rapid prototyping techniques. He has more than 20 years of
teaching and research experience. He has contributed extensively to the world in
Additive Manufacturing literature with publications appearing in Journal of
Manufacturing Processes, Composite Part: B, Rapid Prototyping Journal, Journal
of Mechanical Science and Technology, Measurement, International Journal of
Advance Manufacturing Technology, and Journal of Cleaner Production. He
authored 21 books and 80 book chapters. He has received research grants from
various funding agencies such as DST-SERB, AICTE.

Contributors

I. P. S. Ahuja Department of Mechanical Engineering, Punjabi University, Patiala,

India
Yunus Ziya Arslan Department of Mechanical Engineering, Faculty of
Engineering, Istanbul University-Cerrahpasa, Avcilar, Istanbul, Turkey
Atul Babbar Department of Mechanical Engineering, Thapar Institute of
Engineering and Technology, Patiala, India
Avinash Babu Christ Deemed to be University, Bengaluru, India
Mamoni Banerjee Rajendra Mishra School of Engineering Entrepreneurship,
Indian Institute of Technology Kharagpur, Kharagpur, India
Harish Kumar Banga Production and Industrial Engineering Department, Punjab
Engineering College (Deemed to Be University), Chandigarh, Punjab, India
Raman Bedi Christ Deemed to be University, Bengaluru, India
Editors and Contributors xi

R. M. Belokar Production and Industrial Engineering Department, Punjab

Engineering College (Deemed to Be University), Chandigarh, Punjab, India
Maria Luisa Braunger Department of Applied Physics, “Gleb Wataghin”
Institute of Physics, University of Campinas (UNICAMP), Campinas, São Paulo,
Brazil
Santanu Chattopadhyay Rubber Technology Centre, Indian Institute of
Technology Kharagpur, Kharagpur, India
Priyanka Chopra Professor, Sri SGT Dental College and Hospital, SGT
University, Gurugram, India
Sohini Chowdhury Department of Mechanical Engineering, North Eastern
Regional Institute of Science and Technology (NERIST), Nirjuli, Arunachal
Pradesh, India
Minh Phung Dang Ho Chi Minh City Industry and Trade College, Ho Chi Minh
City, Vietnam
Thanh-Phong Dao Division of Computational Mechatronics, Faculty of Electrical
& Electronics Engineering, Institute for Computational Science, Ton Duc Thang
University, Ho Chi Minh City, Vietnam
Santanu Dhara School of Medical Science and Technology, Indian Institute of
Technology Kharagpur, Kharagpur, India
J. S. Dureja Mechanical Engineering Department, Punjabi University Patiala,
Patiala, India
Abir Dutta School of Medical Science and Technology, Indian Institute of
Technology Kharagpur, Kharagpur, India
Mahnaz Eskandari Department of Biomedical Engineering, Amirkabir
University of Technology (Tehran Polytechnic), Tehran, Iran
Majid Fazlollahi Mechanical Engineering Department, Amirkabir University of
Technology (Tehran Polytechnic), Tehran, Iran
Gabriel Gaal Department of Applied Physics, “Gleb Wataghin” Institute of
Physics, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
Vladimir Gaal Department of Applied Physics, “Gleb Wataghin” Institute of
Physics, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
Swaroop Gharde Rapid Prototyping Laboratory, Department of Metallurgical and
Materials Engineering, Defence Institute of Advanced Technology (DU), Ministry
of Defence, Girinagar, Pune, India
Ajith Gopinath Christ Deemed to be University, Bengaluru, India
xii Editors and Contributors

Vishakha Grover Associate Professor, Department of Periodontology and Oral

Implantology, Dr. H.S.J. Institute of Dental Sciences, Panjab University,
Chandigarh, India
Dheeraj Gupta Department of Mechanical Engineering, Thapar Institute of
Engineering and Technology, Patiala, India
Sanjay Gupta Department of Mechanical Engineering, Indian Institute of
Technology Kharagpur, Kharagpur, India
Ashish Jain Professor and Head, Department of Periodontology and Oral
Implantology, Dr. H.S.J. Institute of Dental Sciences, Panjab University,
Chandigarh, India
Vivek Jain Department of Mechanical Engineering, Thapar Institute of
Engineering and Technology, Patiala, India
Parveen Kalra Production and Industrial Engineering Department, Punjab
Engineering College (Deemed to Be University), Chandigarh, Punjab, India
Balasubramanian Kandasubramanian Rapid Prototyping Laboratory,
Department of Metallurgical and Materials Engineering, Defence Institute of
Advanced Technology (DU), Ministry of Defence, Girinagar, Pune, India
Anoop Kapoor Professor and Head, Sri Sukhmani Dental College and Hospital,
Dera Bassi, Punjab, India
Rajesh Kumar Production and Industrial Engineering Department, Punjab
Engineering College (Deemed to Be University), Chandigarh, Punjab, India
M. Muralidhar Department of Mechanical Engineering, North Eastern Regional
Institute of Science and Technology (NERIST), Nirjuli, Arunachal Pradesh, India
Hoang Vu Nguyen Ho Chi Minh City Industry and Trade College, Ho Chi Minh
City, Vietnam
Tan Thang Nguyen Ho Chi Minh City Industry and Trade College, Ho Chi Minh
City, Vietnam
Yadaiah Nirsanametla Department of Mechanical Engineering, North Eastern
Regional Institute of Science and Technology (NERIST), Nirjuli, Arunachal
Pradesh, India
Faruk Ortes Department of Mechanical Engineering, Faculty of Engineering,
Istanbul University-Cerrahpasa, Avcilar, Istanbul, Turkey
Pulak M. Pandey Mechanical Engineering Department, Indian Institute of
Technology Delhi, New Delhi, Delhi, India
Yasaman Pooshidani Department of Biomedical Engineering, Amirkabir
University of Technology (Tehran Polytechnic), Tehran, Iran
Editors and Contributors xiii

Chander Prakash Department of Mechanical Engineering, Lovely Professional

University, Phagwara, India
Catalin Pruncu Department of Mechanical Engineering, Imperial College of
London, London, UK
Mustafizur Rahman Department of Mechanical Engineering, Universiti Malaysia
Pahang, Pekan, Malaysia
Ragavi Rajasekaran School of Medical Science and Technology, Indian Institute
of Technology Kharagpur, Kharagpur, India
Seeram Ramakrishna Department of Mechanical Engineering, National
University of Singapore, Sovereign, Singapore
Nishant Ranjan Department of Production Engineering, Guru Nanak Dev
Engineering College, Ludhiana, India;
Department of Mechanical Engineering, Punjabi University, Patiala, India
Prasansha Rastogi Rapid Prototyping Laboratory, Department of Metallurgical
and Materials Engineering, Defence Institute of Advanced Technology (DU),
Ministry of Defence, Girinagar, Pune, India
Preetam Guha Ray School of Medical Science and Technology, Indian Institute
of Technology Kharagpur, Kharagpur, India
Antonio Riul Jr Department of Applied Physics, “Gleb Wataghin” Institute of
Physics, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
Varlei Rodrigues Department of Applied Physics, “Gleb Wataghin” Institute of
Physics, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
Trina Roy School of Medical Science and Technology, Indian Institute of
Technology Kharagpur, Kharagpur, India
Komal Sehgal Associate Professor, Department of Prosthodontics, Dr. H.S.J.
Institute of Dental Sciences, Panjab University, Chandigarh, India
Gurminder Singh Mechanical Engineering Department, Indian Institute of
Technology Delhi, New Delhi, Delhi, India
Harwinder Singh Department of Mechanical Engineering, GNDEC, Ludhiana,
India
Jaspreet Singh School of Mechanical Engineering, Lovely Professional
University, Phagwara, India
R. Singh Punjabi University Patiala, Patiala, India;
GNA University, Phagwara, Punjab, India
xiv Editors and Contributors

Rupinder Singh Department of Mechanical Engineering, National Institute of

Technical Teachers Training and Research, Chandigarh, India;
Department of Production Engineering, Guru Nanak Dev Engineering College,
Ludhiana, India
Sapam Ningthemba Singh Department of Mechanical Engineering, North
Eastern Regional Institute of Science and Technology (NERIST), Nirjuli,
Arunachal Pradesh, India;
Department of Mechanical Engineering, National Institute of Technology Silchar,
Silchar, Assam, India
Sunpreet Singh Department of Mechanical Engineering, Lovely Professional
University, Phagwara, India;
Department of Mechanical Engineering, National University of Singapore,
Singapore, Singapore
Shaveta Sood Assistant Professor, Department of Periodontology and Oral
Implantology, Dr. H.S.J. Institute of Dental Sciences, Panjab University,
Chandigarh, India
Hasan Kemal Surmen Department of Automotive Technology, Vocational
School of Technical Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
Shijo Thomas Christ Deemed to be University, Bengaluru, India
Praise Tom Christ Deemed to be University, Bengaluru, India
Tobias Waclawczyk University of Augsburg, Augsburg, Germany
Chapter 1
3D Printing: Challenges and Its Prospect
in Futuristic Tissue Engineering
Applications

Abir Dutta, Trina Roy, Preetam Guha Ray, Ragavi Rajasekaran,

Mamoni Banerjee, Santanu Chattopadhyay, Sanjay Gupta,
and Santanu Dhara

1.1 Introduction

Recent developments in various critical diseases varying from dermal, muscu-

loskeletal to internal organs and tissues, induced a steep increment in the surgical
intervention of the patients [1]. The current condition in healthcare requires a quick
diagnosis of the medical issue, followed by a pre-surgical analysis and further post-
surgical care for the patients. In spite of a quick diagnosis of the issue in a patient,
the medication in terms of surgery, or pre-surgical analysis, is delayed. There lies
a spectrum of subtle issues which contribute to the delay and further burdening
the patient with overloaded cost and critical conditions. Among many, pre-surgical
analysis of the disease using computed tomography (CT) or magnetic resonance
imaging (MRI) and preparation of the prototype of the implant plays a crucial role
in the successful process from diagnosis to medication. The prototypes were used to
be fabricated by conventional manufacturing processes such as milling, drilling, and

A. Dutta · T. Roy · P. G. Ray · R. Rajasekaran · S. Dhara (B)

School of Medical Science and Technology, Indian Institute of Technology Kharagpur,
Kharagpur, India
e-mail: [email protected]
M. Banerjee
Rajendra Mishra School of Engineering Entrepreneurship, Indian Institute of Technology
Kharagpur, Kharagpur, India
S. Chattopadhyay
Rubber Technology Centre, Indian Institute of Technology Kharagpur, Kharagpur, India
S. Gupta
Department of Mechanical Engineering, Indian Institute of Technology Kharagpur, Kharagpur,
India

© Springer Nature Singapore Pte Ltd. 2020 1

S. Singh et al. (eds.), 3D Printing in Biomedical Engineering,
Materials Horizons: From Nature to Nanomaterials,
https://doi.org/10.1007/978-981-15-5424-7_1
2 A. Dutta et al.

shaping. However, these processes were associated with many limitations. Manu-
facturing time and cost of the prototypes were very high. The failure rates were also
very high due to poor manufacturing strategies. Moreover, the precise shape of the
manufactured constructs was far from the actual contour and shapes of the targeted
tissues and organs. The mass production of the implants was also hindered due to
the long processing time associated with each fabrication unit. These issues raised a
serious concern among the medical professionals to look forward to a type of manu-
facturing process which would decrease the manufacturing time as well as precisely
tailor the actual shape and functionalization of the targeted tissues and implants.
Additive manufacturing is an approach which covers almost all the aforemen-
tioned drawbacks of the conventional manufacturing processes. Conceptually, 3D
structures designed in a computer with the help of computer-aided modeling or
image processing software are fabricated in a layerwise fashion, without any require-
ment of jigs or fixtures. The first 3D printing technology, developed and patented
(US4575330) by C. W. Hull in 1984 [2], was called stereolithography (SLA). In this
methodology, the ultraviolet (UV) lights are focused on the polymer layers according
to the design of the structure, leading to fabrication of the structure by hardening the
polymer layers. The main drawback to this system is the rigidity of the selection of
materials. The only photo-curable-polymers and resins can be used for fabrication
of the structures. In this regard, it is needless to mention that every polymer and
resin are not photo-curable as well as applicable for the fabrication of implants and
tissues. On the contrary, in many of the musculoskeletal disorders, the prototypes are
required to endure high loads, which can be integrated using ceramics and metals as
materials to prepare the implants and tissue analogs. In the year 1991, fused depo-
sition modeling (FDM) was introduced in the manufacturing industry [3, 4]. In this
process, high-density polymers are fed into the process as filament wires from a pool,
and the material is deposited through a heated nozzle on the printing bed in layer
by layer fashion. The process dealt with the issue of precision of the contours of
the structures, but the diversity of materials was left unaddressed. The FDM process
is limited to only thermoplastic materials such as polylactic acid (PLA), polyether-
ether-ketone (PEEK), and acrylonitrile butadiene styrene (ABS) [5–7]. Moreover,
in this process, if the requirement is to fabricate a structure of ceramic or metal
powders, the metal powders have to be integrated with thermoplastic polymer in the
form of a filament [6], else this process cannot be utilized to fabricate structures of
ceramic or metal. However, this modification to use the ceramic or metal powders
would amplify the time and cost of the final product, which is not intended. In the
year 1992, selective laser sintering (SLS) was introduced to facilitate the path toward
the additive manufacturing of the ceramics and metals [8–11].
The laser sintering process consists of a powder bed and a high-energy laser
source. The high-energy laser source is focused on the powder layer to fuse the
powder granules to build the 3D structures. Eventually, by repeating this process
layerwise, the final structure is fabricated. This process builds the structure starting
from the base layer. This is the reason that these processes are also called ‘bottom-up’
approach. The advantage of the laser sintering process is the availability of the final
product with one step. However, there are few subtle, but strong disadvantages of this
1 3D Printing: Challenges and Its Prospect in Futuristic … 3

process. The process is suitable for only the processing of ceramic or metal powders.
The initial cost and maintenance cost of the machine are very high, leading to high
cost of the patient-specific products. Moreover, a significant amount of powder is
wasted while manufacturing using laser sintering. Cell-based printing for organs and
soft tissues is not possible in this process.
Similarly, another additive manufacturing process evolved in the year 1997 known
as laser engineered net shaping (LENS), which is also limited to produce metal and
ceramic prototypes [12–14]. Around the same time as LENS was developed, electron
beam melting (EBM) process was developed. The LENS is operated by high-energy
laser source, whereas EBM is based on the shooting of electron beams on the powder
layers [15]. However, as high energy is involved, both these processes lack the ability
to process live cell constructs. Moreover, these high-energy sintering processes are
limited to fabricate bone implants and grafts, excluding the soft tissue analogs and
further live cell constructs. So, the requirement of a manufacturing process which is
able to process versatile materials, with acceptable limitations, was always needed
from both the medical professionals and engineers.
In the year 2000, an extrusion-based additive manufacturing of polymers and
oligomers was reported by Landers et al. [16, 17]. The basic operation of the proce-
dure [18, 19] can be explained in Fig. 1.1. A compressive load is applied at the
entry section of a die, and the extruded material comes out of the die in the shape
of the cross-section of the exit end. This particular system of additive manufac-
turing utilizing the conventional extrusion process is termed as 3D plotting. 3D
plotting consists of one or a multiple numbers of cylindrical chambers, nozzles of
varying diameters, and pressure control system. The printing bed is preferred to be

Fig. 1.1 Schematic representation of 3D printing process

4 A. Dutta et al.

equipped with a temperature control mechanism for precise and hassle-free printing.
The major advantage of the 3D plotting, compared to other additive manufacturing
processes, is the diversity of materials for printing structures. Precisely, polymers,
ceramics, and metal powders can be printed to prepare prototypes for soft tissues,
organs, musculoskeletal implants, and bone analogs [20]. Another distinct advan-
tage of the 3D plotting is its capability to incorporate tailored porosity within the
structures, which is a major limitation in the conventional manufacturing processes.
Moreover, the various inter-fiber orientations such as +90°/−90° and +45°/−45°
can be incorporated in the structures to increase the porosity, which may facilitate
the communication between the analog and the host tissue.
A comprehensive literature is available to gain an insight into the genesis of
the extrusion-based 3D plotting [21–25]. Polymers and metals have been exten-
sively explored for fabrication of implants and tissue analogs using the 3D plotting.
However, there are few critical issues, associated with this additive manufacturing
process, which are rarely reported. Among several metal powders, steel (SS316),
Co-Cr alloys, and Ti alloys (popularly Ti6Al4V) are extensively used to fabricate
several hard tissue analogs and implants [25].
The crucial part of printing with metal powders is to prepare it in such a form
which would be able to overcome the yield stress of the nozzle and flow, as well
as would sustain its circular shape after deposition on the printing bed. The metal
powders are required to be processed to a homogenized dough by mixing with a
polymer. The inclusion of the polymers also leads to several critical issues which
play an important role in determining the precision of the output structure. The ratio
between the powder and polymer should be optimized to achieve an appropriate green
stage structure after printing. The struts would suffer from waviness or microcracks
if the ratio is not at its optimum composition. Moreover, the metal powder should be
handled within a closed environment, preferably under a glove-box or vacuum hood,
to protect the surfaces of metal particles from getting oxidized. Careful attention
is required to optimize the flow behavior of the dough so that could overcome the
yield stress of the internal wall of the nozzle. In this regard, the characterization of
the rheological properties of the dough is necessary. However, there lies a limita-
tion in the powder percentage in the composition. The range of maximum powder
loading, which yielded to successful printing of circular fibers, was 80–85%. Low
powder loading would result in sagging of the structures, and high powder loading
would result in a high viscosity of the dough, which again adversely affect the printing
parameters. The dough becomes highly viscous in cases of powder loading more than
the allowed percentages, which loses its ability to flow through the nozzle. Inter-fiber
contact is another issue which affects the integrity and mechanical strength of the
printed structures. This issue is solved when the input parameters for slice thick-
ness are prescribed. The optimum slice thickness should be 20% less than the nozzle
diameter of the extrusion printer to achieve appropriate inter-connection between the
fibers of two consecutive layers. However, the percentage of shrinkage, after drying
in a vacuum oven and after the thermal treatment or sintering, should be consid-
ered while printing the green structures. Once the dough is prepared at its optimum
composition, the pressure and printing speed are two major parameters to decide
1 3D Printing: Challenges and Its Prospect in Futuristic … 5

the successful completion of the printing process. The pressure should be optimized
within such a range, so that the deposition of the dough through the circular nozzle
remains intact. Higher pressure leads to more material deposition and lower pressure
leads to discontinuous extrusion of the fibers. However, the printing speed is also
associated complementarily with the pressure range. High pressure ranges require
high printing speed, so that the fast-moving nozzle would drag the over-extruded
fiber in its continuous circular form. Though, high speed and pressure combination
can affect the integrity of the inter-fiber connection. In a nutshell, material processing
(i.e., preparation of the dough, specifically for metal and ceramic printing), printing
pressure and printing speed are the key parameters which decide the final form of an
extrusion-printed structure.

1.2 Case Study

The aforementioned critical issues regarding 3D printing should be associated with

case studies to visualize the discussion. The extrusion printing is chosen to investigate
the pros and cons of metal printing, because of its versatility of selection of matrix
polymers according to the requirements, very less material processing time, low
running cost, and absence of employing specialized operating professional. More-
over, these factors contribute to the reduction of the final cost for the implants and
tissue analogs fabricated using this process.
3D bioplotter manufactured by EnvisionTEC GmBh, Germany, has been used to
fabricate the scaffolds. Titanium slurry was prepared with mixing titanium powders
with a polymer matrix dissolved in 2% acetic acid. The viscosity of the slurry was
optimized for flowability and stability of the particles in the suspended condition
with minimum segregation. The slurry was further optimized in order to achieve
structures without sagging. The green samples (Fig. 1.2) were air dried for half an
hour and vacuum dried for 24 h in an oven (Rivotec, India) at 60 °C. The vacuum-
dried samples were sintered in a controlled atmosphere tube furnace under Argon
(99.9%) gas with a flow rate 50 ml/min followed by air cooling. The samples were

(a) (b) (c)

200 µm 20 µm 200 µm

Fig. 1.2 a Top view of green scaffold, b high magnification view of the morphology of the green
sample with slurry prior to optimization and c fiber-to-fiber connection of dense samples
6 A. Dutta et al.

(a) (b) (c) (d)

200 µm
20 µm 10 µm 2 µm

Fig. 1.3 Morphology of a top view of the lattice structure with optimized slurry, b individual strut,
c evidence of Oswald ripening during sintering, d grain growth of 0°/90° sintered Ti6Al4V scaffolds

(a) (b) (c)

200 µm 10 µm 2 µm

Fig. 1.4 Morphology of a top view, b microstructure after sintering, c grain growth with roughening
and resultant polygonal overlay of 0°/45° sintered Ti6Al4V scaffolds

ready for further characterization. 3D printed green (Fig. 1.2) and sintered samples
(Figs. 1.3 and 1.4) were characterized under SEM (SEM, Zeiss EVO 60) to examine
for powder distribution, scaffold structure, grain growth morphology, fiber diameter,
and inter-fiber spacing.
As titanium powder particles are prone to oxidation, the samples were primarily
processed under controlled atmosphere. When the samples were air dried, the
oxidized surface morphology is shown in Fig. 1.5. EDX (Zeiss EVO 60 scanning
electron microscope with Oxford EDS detector) analysis (Fig. 1.6) was performed
to know the percentage elemental composition present at the surface of the sintered
samples. A very distinctive difference in the microstructure patterns between the
oxidized and non-oxidized samples was found (Figs. 1.4 and 1.5).
Titanium powders are very sensitive to the moisture present in the air. It has
a tendency to get oxidized very rapidly if it is allowed to remain in contact with
the air for more than a few hours. The more oxidized the surface of the powder
particles; the sintered structure will be more brittle. So, the powder processing while
preparing the slurry is a crucial part of the fabrication. The samples were polished
and examined with XRD (BRUKER, DISCOVER D8) analysis (Fig. 1.7) to know
the phase information of titanium formed in the samples. It was revealed that the
lattice structures contained both α and β titanium structures.
1 3D Printing: Challenges and Its Prospect in Futuristic … 7

(a) (b)

20 µm 10 µm

(c) (d)

2 µm 1 µm

Fig. 1.5 Surface morphology of oxidized Ti6Al4V scaffolds under SEM showing a junction
between two struts, b oxidized titanium powder morphology after sintering, c oxidized titanium
particle to particle junction in higher magnification, and d oxidized titanium particle surface structure
Intensity

keV

Fig. 1.6 EDX analysis of the sintered Ti6AL4V 3D printed scaffolds

8 A. Dutta et al.

Fig. 1.7 Results obtained by XRD analysis showing the titanium peaks and corresponding JCPDS
files

1.3 Bioprinting

Bioprinting is a major breakthrough in 3D printing technology integrating live cells,

‘bioinks’ and high-precision robotic dispensing system to form complex biological
structures in vitro. It involves additive manufacturing using layerwise assembly of
living cells and biomaterials to fabricate structures mimicking native organs and
tissues [20]. Bioprinting comprises of essentially three main components—(1) living
cells, (2) bioinks which are mostly in the form of hydrogel or combination of hydrogel
and cell culture medium along with some growth factors [26–29], and (3) robotic
dispensing system in which structures are generated to the CAD file from CT data
or other design software and prints the tissue structures [30, 31].
Different types of bioprinting techniques are available, and based on the mode of
delivery on the target platform, they are classified into three main types—(a) laser-
based bioprinting (b) jetting-based bioprinting, and (c) extrusion-based bioprinting
[27, 30]. Other techniques involve magnetic printing and electrohydrodynamic
printing in recent times.

1.3.1 Laser-Based Bioprinting

This technique is further divided into following two types—laser-guided direct cell
printing and laser-induced cell printing. In laser-guided direct cell printing, the laser
pulse pools cells from the cell suspension based on the difference between the refrac-
tive index of the cells and cell media and guides the cells to the substrate. However,
in the laser-induced cell printing, the laser power is utilized to heat up a donor
1 3D Printing: Challenges and Its Prospect in Futuristic … 9

layer creating pressure change. The pressure change causes ejection of cell-laden
hydrogel or droplet below the absorbing donor layer onto the substrate [32, 33].
Two-photon polymerization (2PP) or direct laser writing is also used to fabricate
cell-laden photo-thermal sensitive hydrogels. In 2PP, the focal point of high-intensity
femtosecond laser source generates two photons which are responsible for creating
localized polymerization reaction within a photopolymer resin [34]. Stereolithog-
raphy is a UV laser-based 3D printing technique which cures photopolymer moving
from one point to another, on the surface of the resin and fabricates a 3D structure
layer by layer [35].

1.3.2 Jetting-Based Bioprinting

The most potent and well-established jetting-based bioprinting is an inkjet-based

bioprinting which is further categorized into two types—piezoelectric- and thermal-
based bioprinting. In piezoelectric-based bioprinting, the shape distortion of piezo-
electric transducer results in an air bubble which expands resulting in pushing the
liquid out of the nozzle. In thermal inkjet bioprinting, a heater is used to heat up
the resistor for expansion of the bubble which results in ejection of the droplet [32,
36]. Inkjet-based bioprinting is explored in in vivo printing [37]. More recently, new
jetting-based bioprinting has been developed in the form of—valve-based jetting
printer and acoustic-based jetting printer. The flow rate of valve-based printing system
is controlled by the opening and closing of the valve resulting in a tunable precise
number of cells and size of droplets [38, 39]. In acoustic bioprinting, the material
is ejected by the generation of the acoustic wave. Heat is generated in this process
which might hinder in the printing of thermoresponsive hydrogel [38, 40].

1.3.3 Extrusion-Based Bioprinting

Extrusion-based bioprinting is one of the popular versatile techniques involving depo-

sition of cells and hydrogels. Extrusion is incorporated by either pneumatic force (air
pressure) or mechanical force (through screw and piston) for extruding cell-laden
hydrogels [33, 41]. In this technique, hydrogels having a wide range of viscosity
(from 30 mPa s to 6 × 107 mPa s) could be printed and from photo-crosslinkable
to thermoresponsive hydrogels could be extruded efficiently yielding higher cell
density structures [42]. Thermoresponsive hydrogels like gelatin, methyl-cellulose,
agarose, pluronic (Lutrol F127), and poly-N-isopropylacrylamide (PNIPAAM) have
been reported for extrusion-based printing with better response [43, 44] (Table 1.1).
10 A. Dutta et al.

Table 1.1 Overview of existing bioprinting technology

Bioprinting technique Advantages Disadvantages
Laser-based bioprinting
Laser-guided direct cell High resolution and cell High printing cost and slow
printing viability, non-clogging of fabrication process
nozzles
Laser-induced cell printing High resolution and cell High printing cost and limited
viability, multi-materials scalability, metallic residuals
fabrication, non-clogging contamination
Stereolithography (SLA) High resolution, higher shape Cell viability affected by laser
Two-photon polymerization holding capacity in vertical 3D source, hydrogel needs to be
(2PP) structure UV-photocrosslinked
Jetting-based bioprinting
Piezo inkjet printing High resolution, faster process Nozzle clogging, lower cell
density, low shape fidelity and
complexity in 3D structure,
limited bioink viscosity,
droplets drying
Thermal inkjet printing High resolution, faster process Lower cell density, low shape
and low cost fidelity, hydrogel properties
affected by heat, non-uniform
droplets
Valve-based printing Medium-to-high resolution, Low shape fidelity in 3D
good cell viability, less structure, time delay
clogging, jetting ability from
droplet to strand
Acoustic printing High resolution, uniform Low shape fidelity in 3D, lower
droplets size, lesser clogging cell density, limited bioink
viscosity
Extrusion-based bioprinting
Pneumatic extrusion printing Versatile process, wide ranges Low resolution, effect of shear
of bioink could be used, high stress on cell viability, time
cell density delay
Mechanic extrusion printing Versatile with wide spectrum of Low resolution, effect of shear
bioinks, high shape sustaining stress on cell viability
ability in 3D structure, high
cell density, direct control of
material flow rate
Recent techniques in bioprinting
Magnetic printing High resolution, support Toxicity of nanomaterials, high
material free, high cell density system cost
Electrohydrodynamic jetting High resolution, precision High voltage and special setup,
control, better cell viability low shape fidelity in 3D form
1 3D Printing: Challenges and Its Prospect in Futuristic … 11

1.3.4 4D Bioprinting

Profound advancement in 3D printing technology has resulted in new research area

of 4D bioprinting technology. Researchers have incorporated stimuli-responsive
dynamic environment which results in shape-morphing effects (SME) to the fabri-
cated scaffolds. The external stimulus is given in the form of temperature, light,
humidity, and using smart biomaterials which converts stimulus changes to produce
dynamic environment [45]. Shape-morphing effects (SME) can be categorized into—
(1) one-way shape morphing, (2) two-way shape morphing, and (3) multi-way shape
morphing [46, 47]. Along with external stimulus application, smart biomaterials
mimicking tissue geometry and physiological functions are being explored exten-
sively, so that the printed tissue/organ can change its shape and form as per native
tissue structure [48–50].

1.3.5 Case Study

The versatility of 3D printing is one of the most prominent features that it is being
explored in various domains ranging from aerospace, concrete printing to electronics,
biomaterials, and tissue engineering applications [25, 32, 51, 52]. However, during
3D printing, certain critical issues could be encountered which might be deviating
from the previously reported information. Herein, we have chosen an FDA approved
synthetic polyester polycaprolactone (PCL) for 3D printing. The low glass transition
temperature (Tg) of 60 °C makes PCL a preferred polymer for melt extrusion 3D
printing [53–56] in tissue engineering applications (Fig. 1.8).
In our study, however, we found quite a deviation from the previously reported
articles. 3D bioplotter manufactured by EnvisionTEC GmBh, Germany, had been
used to print PCL (Molecular weight ~80,000 Da, Sigma Aldrich, USA). The partic-
ular 3D printer comprises low-temperature (LT) head and high-temperature (HT)
head. PCL was loaded into the HT head made of stainless steel cartridges. It was
observed that even after keeping PCL granules at 60 °C for an approximately a long
time, the polymer could not be extruded with precision strands. The pressure was
maintained at 5 bars for extrusion. Following some trials, it was observed that raising
the temperature to about 150–160 °C, and air pressure being kept at 8–9 bars yielded
melt extruded PCL strands with precision structures.
The reason for such deviation could be hypothesized due to the influence of
ambient conditions for 3D printing. While the steel cartridges were heated to 60 °C,
it might have reduced the heat transferred to the PCL pellets owing to the thickness
of the cartridge itself. Moreover, molecular weight being very high, it might have
resulted in highly viscous polymer melts, difficult to be extruded with 5 bars pressure.
Alongside, the distance between the nozzle mouth from where the polymer melt is
being extruded, and the platform to be printed plays a major role in efficient 3D
printing of polymer melts.
12 A. Dutta et al.

Fig. 1.8 a 3D printed PCL tube (longitudinal view), b cross-sectional view of PCL tube, c cross-
sectional view of 3D printed tube (scale bar—1 mm)

1.4 3D Micro/Nanostructures—Directional Propagation

of Cellular Viability

The in vivo periphery of cells in any tissue or organ system constitutes of a complex
three-dimensional (3D), multifunctional microenvironment surrounded by multi-
functional extracellular matrix components along with other cellular populations
or ECM-trapped cellular signaling factors. It is often observed that cells undergo
directional migration or restructure its microenvironment especially when triggered
by the concentration gradient of one or more bioactive signaling molecules [57,
58]. A perfect example of such chemotactic migration of cells is the movement of
immune cells to their specific target site. Furthermore, site-directed migration of
cells take place within tissues in pathological conditions like cancer cell metastasis
or chronic inflammation [59–61]. For example, the malignancy of cancerous condi-
tion is determined by the efficiency of tumor cells to migrate to either distant organs
or neighboring tissues [61, 62]. It is apparent that not only biochemical constitution
of the surrounding environment but the 3D or spatial distribution of ECM proteins
need to be recapitulated in order to decode and understand the interaction between
cellular components in any pathological or immunological conditions [63].
1 3D Printing: Challenges and Its Prospect in Futuristic … 13

An array of various methods had been deployed in the last decade for achieving
structurally stable 3D microstructures trying to mimic the in vivo microenvironment
that has strongly influenced the tissue engineering fraternity. As explained earlier,
these approaches depend on printing technologies like extrusion-based bioprinting
[64, 65], inkjet-based bioprinting [32, 66], digital light processing (DLP)-based
bioprinting [67], laser-induced forward transfer (LIFT)-centered bioprinting [68],
or electrospinning [25, 69]. The biofunctionalization of microenvironment created
based on the above technologies is often executed using either synthetic peptides or
model compounds [70]. However, the above-narrated fabrication procedures either
lack the possibility to construct true 3D free-standing microarchitectures without
sacrificial support or are unable to reach micronanometric feature resolution desired
for the above application. More recently, studies revealed fabrication of micro–
nanostructures containing full-length bioactive proteins had been proposed [71]. The
microfabrication of such structures are often based on light-assisted photopolymer-
ization techniques which include stereolithography (SLA), digital light projection
(DLP), or selective laser sintering (SLS), wherein the concept of 3D microstruc-
tures are often realized by a layerwise approach evolving from series of transverse-
plane images as slices [72]. The above techniques can easily print microstructures
possessing dimensions in the range of few micrometers, although spontaneous appli-
cations of such techniques are limited by the fact that there are only a few materials
that feature biocompatibility and photosensitive properties at the same time. Another
developing technique that is gaining much attention is two-photon polymerization-
based direct laser writing technique (2P-DLW) that possesses the capability to write
structures in the submicrometer range. Direct laser writing is a process, wherein a
photoresist containing a radical photo-initiator and crosslinkable monomer moiety
is polymerized using two- or multi-photon-based technique. Till date, an extensive
array of complex and submicron-sized microstructures has been fabricated using the
above technique (Fig. 1.9). However, only a few 2P-DLW based printable materials
are considered biocompatible and could be used for cell culture activities.
One such material was reported by Accardo et al., wherein direct laser writing of
PEGDA (poly (ethylene glycol)diacrylate) was carried out to prepare a 3D scaffold
for neuronal tissue engineering [73]. PEGDA is an FDA approved biocompatible
hydrogel, and the physical phenomena highlighting the fabrication is similar to the
one narrated above. An appropriate photo-initiator in the form of phenylbis (2,4,6-
trimethylbenzoyl) phosphine oxide was mixed with the hydrogel to facilitate the
writing procedure, as it has a high absorption property in the UV range. The photo-
initiator was considered to provide a very high writing speed, thus aiding in the rapid
fabrication of submicron-sized scaffolds. After fabrication, the architecture was func-
tionalized with poly-L-lysine and laminin to promote cellular adhesion. The porous
architecture of as-fabricated scaffold allowed excellent growth and proliferation of
neuronal cells with ramified neuronal network penetrating the 3D microstructure,
thus forming multiple neuritic extensions possessing a length between 10 and 60 μm
per cell. Moreover, PEGDA hydrogel demonstrated low intrinsic fluorescent emis-
sion [74], thus allowing multi-staining immunofluorescence evaluation of neuronal
cells in the 3D matrix. Further, it was also observed that PEGDA demonstrated
14 A. Dutta et al.

Fig. 1.9 3D microstructures which were printed using 2P-DLW fabrication technique

low stiffness (Y-modulus ~200 kPa) which is comparable or close to that of brain’s
stiffness (Y-modulus ~600 Pa), thus ratifying the excellent growth and prolifera-
tion of neural cells on the 3D architecture. It was apparent to conclude that the 3D
hydrogel-based architecture can be further explored as a futuristic platform for neural
tissue engineering or as a tissue model for studying the interaction between various
biochemical compounds (including potential drugs or neurodegenerative proteins)
and neural cell cultures.
The second approach is to make this 3D microstructure biocompatible which could
be achieved by either functionalizing or coating the same with necessary proteins
which could aid in particular cell proliferation. In a report by Martin Bastmeyer group,
a 3D scaffold was constructed and bifunctionalized with two different extracellular
matrix (ECM) proteins in a spatially resolved manner, as represented in Fig. 1.10,
in an effort to specifically control cell adhesion [63]. A sequential DLW technique
combined with three photoresists were deployed to attain the same. The square-
shaped microstructures consist of four pillars with beams bridging the pillars on the
edges on the top. While other set of beams present in the middle, not only bridge
the pillars but also form square-shaped net-like structure. The beams on the top
were used for the functionalization process, and beams facing each other were only
functionalized with similar proteins. Fibronectin or laminin proteins were used to
functionalize the upper beams of the microstructure in a spatial arrangement while the
bottom ones were left bare. Epithelial A549 and NIH 3T3 fibroblast cell lines were
1 3D Printing: Challenges and Its Prospect in Futuristic … 15

Fig. 1.10 3D microstructures which were printed using 2P-DLW fabrication technique by Martin
Bastmeyer group to fabricate a cell instructive 3D microscaffolds for guided cell propagation

cultured on these dual-functionalized 3D matrices to understand the proliferation of

each cell line in the presence of above two proteins. In case of the epithelial A549
cell line, it was observed that it adhered to both surfaces irrespective of the protein
it constituted; however, the proliferation was restricted only to the functionalized
beams while no migration was observed on the lower beams. This suggested that
the adhesion of A549 cells did not depend on the kind of protein attached, but
proliferation was restricted only to the functionalized surface. Further, NIH 3T3
fibroblast cell line was introduced, and it was observed that owing to the presence of
a different set of integrin proteins, it only adhered and proliferated along the beam
containing the laminin protein. In another set of experiments, epithelial A549 cells
were seeded onto a 3D matrix containing laminin and biotinylated vitronectin as
the two proteins, and it was observed that the cells only proliferated on the beams
containing the laminin protein.
The above experiment proves the epithelial nature of the two cell lines as they
prefer the basal lamina adhesion protein, laminin which is the main component
of natural ECM. It was clear that the group was able to fabricate a cell instruc-
tive 3D microscaffolds capable of guided cell propagation and could be used as an
excellent alternative for investigating cell–matrix or cell–cell interactions. Also, the
as-fabricated powerful platform can be used to evaluate cell response to multiple
extracellular cues in the near future.

1.5 3D Printing as a Tool for Lab-on-Chip

or Microbioreactor Applications

Recently, additive manufacturing has significantly producing Lab-on-chip (LOC)

platform, which impacts on mostly biomedical science field. The microfluidic plat-
form using 3D printing is the only existing technique delivered to create a complete
16 A. Dutta et al.

three-dimensional devices in one step with high portability, a fraction of time, cost,
simple, and relatively required a lesser amount of resources [75]. Such 3D printed
devices supported various medical purposes such as fabricating scaffolds, implants,
LOC based cellular study, diagnostic of toxicity, genomic study, drug screening,
metabolism studies, and microfluidic bioreactor for cell culturing [76, 77]. The widely
used 3D printing approach for creating microfluidic channel are inkjet 3D printing,
stereolithography, two-photon polymerization, and extrusion printing.
Microfluidic bioreactor: Lee et al. presented a comparative study between the widely
used 3D printing such as inkjet and fused deposition modeling technique to fabri-
cate microfluidic device [78]. Several characterizations such as microchannel accu-
racy, surface roughness, surface contact angle, biocompatibility, printer accuracy,
and repeatability have studied. The result proved that inkjet printing showed high
resolution in all the dimension with accuracy and smooth microchannel surface than
FDM. Similarly, Ong et al. designed a microfluidic device using both stereolithog-
raphy (SLA) (Proto Labs, USA) (material polycarbonate mixture) and polyjet [like
Inkjet 3D (Objet260 Connex3 Printer) (Stratasys, USA)] (material photopolymer
VeroClear-RGD810) printing technique to evaluate the multicellular spheroids
immobilization, viability, and functionality in microstructure [77]. A comparative
study showed similar output, but SLA printed microfluidic device was designated
due to its high resolution resulted with clean-cut microstructure array providing
better accuracy and surface smoothness on microchannel (200 μm depth) and culture
chamber (750 μm diameter). The microfluidic device is carried out using a pump-free
perfusion culture system, whereas computational fluid dynamic (CFD) simulation
was employed to calculate the media inlet and outlet flow and culture chambers shear
stress. Therefore, the microstructure array designed in the microchannel was seeded
with cells (parental metastatic OSCC tumor derived from patient and human HepG2
hepatocyte spheroids) showed to immobilize at cell culture chamber supported with
microstructure array and perfusion channel designed maintained good viability and
functionality up to 72 h.
Takenaga et al. fabricated microfluidic chip using 3D printing (Asiga, PicoPlus 27)
(resin-based photopolymer material) and prepared light-addressable potentiometric
sensor (LAPS) as a sensor surface to attain a semiconductor-based new biochip [76].
LAPS which is an electrolyte–insulator–semiconductor structure (EIS) is composed
of bilayers such as Ta2O5 (60 nm) (pH-sensitive layer) and SiO2 (30 nm) above the
p-doped silicon substrate with an Al contact at its back side. With a photocurrent
depending principle, light-emitting diode (LED 4 × 4 infrared) setup has been used
with data acquisition card (DAQ) (from NI—National Instruments) to record the
ion concentration on the LAPS surface, and 3D printed microfluidic channel was
attached above. The LAPS chip and microfluidic channel were assembled using sili-
cone adhesive sealant and photo-resin, and comparative study with Chinese hamster
ovary (CHO) cells was studied. Photo-resin-based adhesion showed cell morphology
and functionality similar to culture flask outstanding with its biocompatibility while
silicon sealant with unhealthy cells.
1 3D Printing: Challenges and Its Prospect in Futuristic … 17

Gowers et al. designed and fabricated robust microfluidic analysis system to

continuously monitor human tissue metabolism level by measuring glucose and
lactate in cyclist at the real time [79]. The 3D printed (ULTRA 3SP) microflu-
idic device incorporated with commercially available clinical microdialysis probe
through a removable biosensor and monitored the glucose and lactate level in real
time. Comina et al. [80] demonstrated the fabrication of LOC on PDMS-glass using
template fabrication by microstereolithography 3D printer with 50 μm resolution
and smooth surface for sealing (PDMS-glass). The process is cost-effective, requires
less time, and fabricated a reusable template with independent multilevel fluidics
with functionalized surface and micromixers for detecting glucose. The function-
alized surface with glucose oxidase (GOx), horseradish peroxidase (HRP), and a
non-colored substrate (Ampliflu Red) as a result were tested with glucose solution
at different concentration (2.5, 5 and 10 mM). The quantitative detection by quicker
resorufin production for 10 mM glucose concentration resulted faster than others
due to the hydrogen peroxide by GOx catalytic reaction and consequently resorufin
consumed by HRP.
Kitson et al. demonstrated milli- and microfluidic reactionware LOC device using
the 3DTouchTM printer with polypropylene (PP) material [81]. The designed reactor
using such inert, robust, cost-effective, and reliable material with one, two, and three
inlets performs organic, inorganic, and material synthesis successfully. Peris et al.
validated 3D printed bioreactor with continuous flow and efficiently immobilizing
the enzyme [82]. The microfluidic is printed using FDM printer with nylon 6; hence,
to immobilize the enzyme, the surface was functionalized using glutaraldehyde after
treating with HCL (5 ml). Additionally, treating with polyethylenimine (PEI) multi-
plied the free amines on the surface. and reaction with glutaraldehyde enhanced the
C=O band resulting with surface functionality. The biocatalytic reactor with contin-
uous flow showed stability for approximately 100 h and good activity of the enzyme
by comparing reaction thru converting (R)-methyl-benzylamine into acetophenone.
The kinetic resolution with the production of 20.5 μmol h−1 mgenz in 20 min was
presented. In future by tailoring, the geometries of microchannel and chamber with
continuous flow could present a rapid testing device with different immobilization.

1.6 Conclusions

In the realm of the current state of art for medical implants as well as for wide
varieties of tissue analogs, 3D extrusion printing technology has provided a comfort-
able, feasible, economically viable, and medically corrigible platform in tissue engi-
neering. Extrusion-based 3D printing has provided a much awaited process which
would enable the researchers to fabricate scaffolds of a wide spectrum of materials
with tailorable mechanical as well as physicochemical properties. On the contrary,
the successful completion of the process is potentially dependent on the material
processing compared to the other additive manufacturing processes. However, in
18 A. Dutta et al.

laser-based and fused deposition modeling, in spite of lacking the flexibility in mate-
rial selection, the final product is produced with very less pre- and post-processing.
However, the current demand of printing tissue analogs or organ with live cells has
swayed off this drawback, because cell-based bioinks are needed significant atten-
tion to pre-processing along with the material selection. Further, future studies are
required with novel biomaterial/bioink printed tissue which could pave the way to
design an artificial tissue that would support, function, and replace the damaged
tissue.

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Green Chem 19(22):5345–5349

Abir Dutta is pursuing doctoral research in Biomaterials and Biomechanics at Advanced Tech-
nology Development Centre, Indian Institute of Technology Kharagpur. He is also working in
School of Medical Science and Technology in the domain of 3D printing of biomaterials.

Ms. Trina Roy is Ph.D. Research Scholar, School of Medical Science and Technology (SMST),
Indian Institute of Technology Kharagpur. Her research area is focused on 3D printing of thermo-
plastic polymers for vascular tissue engineering applications.

Preetam Guha Ray is working as Research Associate at the School of Medical Science and Tech-
nology, Indian Institute of Technology Kharagpur, India. His research interest is focused on fabri-
cation and surface engineering of multimodel platforms and scaffolds for biosensing and tissue
engineering applications.

Ms. Ragavi Rajasekaran is pursuing her doctoral program in Rajendra Mishra School of Engi-
neering Entrepreneurship (RMSoEE), Indian Institute of Technology Kharagpur. She is working
in the areas of stem cell-based tissue regeneration and its in vitro study in micro-environment.

Prof. Mamoni Banerjee is working on product development using phytochemicals and is

currently an Assistant Professor of Rajendra Mishra School of Engineering Entrepreneurship,
Indian Institute of Technology Kharagpur.

Santanu Chattopadhyay is a professor in Rubber Technology Centre, IIT Kharagpur and an

expert in the field of synthesis and characterization of block copolymers by controlled polymeriza-
tion, smart rubber composites, biomaterials, and polymers for health care and energy harvesting.

Prof. Sanjay Gupta Ph.D. (TU Delft), has 20 years of research experience in orthopaedic biome-
chanics and is currently a Professor of Mechanical Engineering, Indian Institute of Technology
Kharagpur.
22 A. Dutta et al.

Prof. Santanu Dhara Ph.D. (IIT Kharagpur), has expertise in biomaterials and tissue engineering
and is currently a Professor of School of Medical Science and Technology, Indian Institute of
Technology Kharagpur.
Chapter 2
Fundamentals of 3D Printing and Its
Applications in Biomedical Engineering

Hasan Kemal Surmen, Faruk Ortes, and Yunus Ziya Arslan

2.1 Introduction

Three-dimensional (3D) printing is a practical manufacturing method that allows

us to transform objects designed in the digital environment into physical objects
using layered manufacturing methods. The terms of rapid prototyping and additive
manufacturing are also used to express the manufacturing process using 3D printers.
Unlike the subtractive manufacturing (machining) approach in which 3D objects are
constructed by successively cutting material away from a solid block of material,
additive manufacturing processes produce parts by adding material one layer at a
time.
In 3D printing technology, parts with complex geometries can be manufactured
using less material compared to conventional manufacturing techniques. There is no
need for molding in 3D printing, and the production of a part with different geometry
can be quickly adapted. Objects designed in a digital environment can be directed
to the production process immediately. Three-dimensional printing, which is very
suitable for the production of objects with free-form surfaces, has been widely used
in the medical sector, especially in the production of patient-specific biomedical
devices [1].
Three-dimensional printing applications are spreading rapidly in many areas of the
medical sector. Nowadays, orthopedic implants, prostheses, orthoses, dental prod-
ucts, anatomical models, customized tablets for personalized medicine, and many

H. K. Surmen
Department of Automotive Technology, Vocational School of Technical Sciences, Istanbul
University-Cerrahpasa, Hadimkoy, Istanbul 34555, Turkey
F. Ortes · Y. Z. Arslan (B)
Department of Mechanical Engineering, Faculty of Engineering, Istanbul University-Cerrahpasa,
Avcilar, Istanbul 34320, Turkey
e-mail: [email protected]

© Springer Nature Singapore Pte Ltd. 2020 23

S. Singh et al. (eds.), 3D Printing in Biomedical Engineering,
Materials Horizons: From Nature to Nanomaterials,
https://doi.org/10.1007/978-981-15-5424-7_2
24 H. K. Surmen et al.

surgical instruments can be produced using 3D printers [2–5]. Three-dimensional

printing allows significant flexibility for the fabrication of biomedical devices,
offering geometric freedom without limitations experienced in traditional manu-
facturing methods. By using the 3D printing method, we are able to print complex-
shaped functional parts with detailed internal features and adjust the material density
to produce lighter biomedical devices with fewer parts.
Since the biomedical devices and implants must be compatible with the patient’s
anatomy, the production of such devices by traditional manufacturing methods is a
challenging task . In addition, because these devices are supposed to be designed for
patient-specific purposes, the design of each item should be independently carried
out for each patient [6]. Three-dimensional printing technology does not require
additional production stages such as production line installation and mold design,
thereby having the advantage of manufacturing the parts immediately, which makes
the 3D printing method very suitable for the production of biomedical devices. Three-
dimensional printing has been one of the widely preferred approaches in the biomed-
ical sector because of its high geometrical accuracy and resolution. In addition, the
ability to print complex body implants by taking into account the magnetic reso-
nance image (MRI) [7] and computed tomography (CT) [8] data further increased
the functionality of this technology.
Three-dimensional bioprinting is another application area of the 3D printing tech-
nology in which the complex 3D living tissues and artificial organs are constructed
[9]. It is possible to produce 3D functional and living tissues using 3D bioprinting
[10]. These printers generally use materials such as hydrogel, silicon, and protein
solutions. The major aim in this field is to produce functional and transplantable
human organs in the near future [11].
Some disadvantages of the 3D printing method are (i) it is not economically
feasible for mass production, (ii) size of the part to be manufactured is limited to the
dimensions of the 3D printer, and (iii) production speed is relatively low. Furthermore,
the variety of materials used in 3D printing is also limited. On the other hand, new
strategies are being developed that allow different types of materials to be used in
the 3D printing technology [12–15]. Thanks to these novel technologies, many types
of metal [16], plastic [17], composite [18], and organic materials [19] can be used in
3D printing.
In biomedical applications, post-processing is of particular importance. For
example, stair-stepped surface, which is a result of layer-by-layer manufacturing,
may lead to undesirable surface conditions for implants required biocompatibility
[20]. In such cases, surface finish operations should be done carefully and precisely.
Moreover, clean and sterile manufacturing environments are required in the manu-
facture of medical products such as implants. In this context, precautions against
contamination should be carefully taken for printing platform and other 3D printer
equipment [21].
In this chapter, the general working principle of 3D printers, commonly used 3D
printing technologies, and types of materials used in 3D printers were addressed.
In addition, scientific studies focusing on 3D printing technology in the biomedical
field have been discussed.
2 Fundamentals of 3D Printing and Its Applications … 25

2.2 Stages of the 3D Printing Process

In the 3D printing process, the 3D model of the target object is divided into layers
in a 3D slicer software by considering the desired surface precision, and the related
G-codes are produced. The data obtained in this stage are digitally transmitted to the
3D printer, and the first layer of the object is created according to these data. The
next layer is built on the previous layer so that all layers are created and the object is
constructed.
In general, a 3D printing process consists of (i) obtaining the 3D model of the
target object in the digital environment, (ii) converting the model file of the desired
object into a digital file format compatible with 3D printer such as STL, (iii) slicing
the model into layers by means of a 3D printer slicer software and producing the
G-codes, (iv) transmission of the G-codes to the 3D printer, and (v) printing the
object (Fig. 2.1).

2.2.1 3D Modeling

In the first step, the 3D printing process requires a 3D model of the object to be
printed. The model can be obtained by using many different computer-aided design
(CAD) programs, as well as a 3D scanning system (optical, MRI, CT, or image-
based). More efficient printing results can be achieved if the design is made by
taking into consideration the technology and sensitivity of the 3D printer. Moreover,

3D Modeling File Conversion 3D Slicer Software

3D Scanning or CAD modelling Adjusting the settings
- CT scan Exporting the - Material - Layer thickness
- MRI scan model file to either - Density - Printing speed
- Laser scan STL, 3MF, or OBJ - Location - Temperature
- Optical scan file format
- Photo scan Slicing &
Generating G-Code

Post-Processing 3D Printing File Transfer

-Painting -Polishing
-Sanding -Gap filling Saving the G-Code to a
Starting to removable driver
-Epoxy coating
3D printing or
-Metal plating
operation printing over a network
-Dipping
-Vapor smoothing

Fig. 2.1 Stages of the manufacturing process by using 3D printing technology

26 H. K. Surmen et al.

the capabilities of the 3D printer should be compatible with the assembly parts
intended for printing at once and the intended clearance between moving parts.

2.2.2 File Conversion

Once the 3D model has been acquired, the model should be converted to a file format
that a slicer software would recognize. The most common file format for 3D printing
is STL. Other formats such as obj and 3MF are also recognized by many software.
The model geometry cannot be changed after conversion of the file format, but the
size and orientation of the model can be modified.

2.2.3 3D Slicer Software

Models saved in an appropriate format are transferred to a 3D slicer software before

3D printing. The purpose of the use of this software is to slice the model into layers
and generate G-codes required to be fed into the 3D printer. The position of the object
on the 3D printer table, layer thickness, type of the material to be used, temperature,
material density, and printing speed can be adjusted using the software. According to
the specified parameters, the model is sliced and G-codes are generated. Moreover,
the construction of the model can be simulated and monitored by means of the slicer
software just like in a computer-aided manufacturing (CAM) program. In this way,
the errors that may occur during 3D printing can be detected and eliminated in a
timely manner. Many open-source and open-access 3D slicer software such as Ulti-
maker Cura (Ultimaker B.V., The Netherlands), CraftWare (Craftunique, Hungary),
and Z-Suite (Zortrax, Poland) are available for users. The resulting G-codes can be
transferred to the printer via a memory card or through a wired/wireless network.

2.2.4 3D Printing

Once the file transfer has been completed, the 3D printer recognizing the G-
codes starts printing after reaching the required temperature value. Before printing,
the printer should be placed on a level surface, calibration operations should be
performed, and the material should be prepared properly for printing. Printing dura-
tion varies according to the technology of the 3D printer, material density, geometry
and size of the model, amount of support to be used, and the desired level of resolution.
In 3D printing, the geometry of the object directly affects the printing time. Since
the software fills the support structures between the object and the printing tray in
the order of the printing process to be carried out successfully, it is important to
position the object appropriately on the printing tray (Fig. 2.2). If the objects are
2 Fundamentals of 3D Printing and Its Applications … 27

Printing time: 2 hours and 30 minutes Printing time: 2 hours and 48 minutes
(a) (b)

Fig. 2.2 Sample representation of the effect of the positioning of objects on the formation of the
support structures. Printing time for the same object located horizontally (a) is less than that for
located laterally (b)

positioned so that the minimum support structure is required, the printing and post-
processing time, which require for isolating the model from the support structures,
can be minimized.

2.2.5 Post-processing

When printing is finished, the part is taken from the 3D printer tray and cleaned
from the support structures. Support structures are two types: standard and dissolv-
able. Standard support structures are removed from the workpiece using suitable
hand tools. Dissolvable support structures are removed by immersing the work-
piece in water or specific solutions developed for the material. After removal of the
support structures, post-processing operations such as painting, polishing, sanding,
gap filling, metal plating, epoxy coating, dipping, and vapor smoothing can be
applied.

2.3 Types of 3D Printing Technologies

2.3.1 Stereolithography (SLA)

The SLA technique is based on the principle of curing the photopolymer resin layer,
which is in a liquid state at room temperature, by an ultraviolet laser beam according to
geometric data of the target object [22]. Curing is based on the additive manufacturing
28 H. K. Surmen et al.

approach, which forms the basis of 3D printer technologies. Each layer is obtained
by G-code previously generated using a 3D slicer software. The laser beam scans
the resin layer and performs the curing process. After the first layer is solidified,
the building platform moves up to a layer height, a new resin layer is plastered on
top, and the curing process is repeated. The layers are added to each other, and
the entire object is produced. Thus, 3D objects having very detailed geometries can
be obtained from the liquid resin which is filled in the pool and which does not
have certain geometry. This 3D printing technology, with a high degree of accuracy
and smooth surfaces, is highly suitable for the production of objects with detailed
geometries in many areas. SLA printing technology has proven to be suitable for
the production of 3D ceramic parts with desirable mechanical properties, as well as
the production of 3D polymer parts in the biomedical device sector [23]. By adding
ceramic powder suspensions into the photopolymer and by laser polymerization of
the ceramic-resin mixture, complex shapes can be obtained.

2.3.2 Digital Light Processing (DLP)

DLP and SLA technologies are quite similar. The main difference is the source of
the light to be used. DLP printing technology has a projector located in the bottom
of the resin pool instead of the ultraviolet laser [24]. In the SLA, the laser beam
scans the layer, while the projector in the DLP acts on the entire layer surface at one
time, resulting in faster print speeds. However, SLA is more suitable for the parts
requiring high resolution. In DLP technology, since projected images of each layer
are composed of pixels, small quadratic volumes form at the layer edges. In DLP,
the projector’s resolution is directly related to print quality and print volume.

2.3.3 Binder Jetting

In this technology, a liquid binding agent is used to bond the materials together.
Binder is added on the powder material, and a solid layer is obtained [25]. The printer
platform is lowered by one layer, and the powder material is laid on the previously
formed layer. This process is repeated in a loop, and the production of the object
is completed. Metallic, ceramic, and sand materials can be used in this technology
and are suitable for the production of large parts. Since there is no heating operation
in this technology, dimensional distortions due to thermal effect do not occur. As
in the SLS technology, metal powders serve as support and therefore no support
structures are needed. Binder jetting also allows for the production of colored parts
and offers low cost. The parts printed by metal binder jetting show high porosity,
which adversely affects the mechanical properties of the parts. Compared to other
3D printer methods, binder jetting allows fewer material types to be used, which is
another limitation of this technology.
2 Fundamentals of 3D Printing and Its Applications … 29

2.3.4 Polyjet

Another 3D printing technology used in the production of 3D objects with

photopolymer resin material is polyjet. In addition to being used to produce colored
parts, it is a printing technique with high speed that can print more than one material
at the same time. Thus, parts having different mechanical properties can be manu-
factured in one piece. This technology, which is ideal for the production of parts with
smooth surfaces and detailed geometries, can be considered as a combination of the
2D inkjet and SLA printing technologies. Thanks to polyjet technology, which allows
the use of different materials at the same time, the support materials can be easily
removable, even in a water-soluble form [26]. Thus, removing the support structures
is effortless, and no marks/residuals remain on the surface of the fabricated part at
the end of the removing process.

2.3.5 Fused Deposition Modeling (FDM)

FDM is the most common 3D printer technology for fabricating prototypes and
functional parts among many different desktop-type models [27]. This technology,
also known as fused filament fabrication, generally uses filaments made from PLA
and ABS materials. In the FDM process, one end of the filament is placed in the
nozzle, and it is waited until the printing temperature is reached. The thermoplastic
filament is then extruded and pressed into the printing table. The nozzle moves and
forms the object layer by layer according to the G-codes [28]. The process ends
with removing the support structures as in the most of the 3D printer technologies.
Multicolor printing can be done by multiple-nozzle FDM printers, and the support
structures can be printed using a dissolvable material, which makes removing the
support structures easier. In some parts printed with this technology, layer traces can
be seen on the outer surface of the object (stair effect). Surface roughness can be
reduced by hand sanding at the post-processing stage. Robust and functional parts can
be obtained by this technology. FDM, which has a lower printing speed compared to
SLA, has become very popular thanks to its ease of use, environmental friendliness,
relatively low cost, and high mechanical, thermal, and chemical properties.

2.3.6 Selective Laser Sintering (SLS)

SLS technology is based on the principle of binding the powdered material by

sintering with a laser beam. In SLS technology, the material powders are fused
together without being completely dissolved [29]. The non-sintered powders serve
as a support structure and are removed from the part at the end of the process.
SLS technology allows the use of a wide variety of materials such as metal, nylon,
30 H. K. Surmen et al.

ceramic, and glass. Internal stresses can occur on the parts produced by SLS so that
the stress relief annealing can be made [30]. This technology, which is popular in the
3D printing industry, requires a powerful laser source, which makes it costly. Direct
metal laser sintering technology has been developed with some changes in SLS tech-
nology [31]. With this technology, successful results can be obtained in the fusing
of the materials with micro dimensions and in the production of thin structures.

2.3.7 Selective Laser Melting (SLM)

SLM technology is very similar to SLS technology, but in SLM, a complete melting
process is performed instead of sintering [32]. This technology, which is popular in
the aviation and medical sectors, is not suitable for home users because of its high
cost. Titanium material with high biocompatibility and corrosion resistance that can
be used in SLM technology is suitable for many biomedical applications. Apart
from titanium, metals such as stainless steel and aluminum can also be used in SLM.
However, materials such as plastic, glass, and ceramic used in SLS cannot be used
in SLM. Process control of the SLM in which high-power laser is used is not easy
and requires good temperature control during the process.

2.3.8 Electron Beam Melting (EBM)

EBM technology is based on the principle of fusing metal powders or filaments under
a high-pressure atmosphere by a focused electron beam providing high energy and
temperature [33]. A layer of fused power is obtained according to the geometric
data, and once the current layer has been exposed to the laser, the build platform
lowers. At each step, the top of the layer is covered with metal powders, the fusion
process is repeated, and new layers are obtained. By combining all layers, 3D objects
are obtained. In EBM technology, the vacuum environment prevents collisions of
electrons with the gas molecules, thus providing a positive effect on the process of
reactive metals. At the same time, significant energy consumption is avoided. EBM
is a highly preferred technology in the production of high-strength parts. It is possible
to reduce residual stresses by preheating the material and the print bed and adjust
the porosity of the part by adjusting the beam parameters.

2.3.9 3D Bioprinting

Three-dimensional bioprinting is the adaptation of 3D printing technology to print

the tissues of living cells. Three-dimensional bioprinting is being developed for use
2 Fundamentals of 3D Printing and Its Applications … 31

in tissue and organ transplantation in regenerative medicine applications. Technolo-

gies commonly used for this purpose are thermal inkjet [34], microextrusion [35],
and laser-assisted printing [36]. The type of technology to be selected is determined
according to the material type, cell viability, and surface resolution. Each technology
has different advantages and constraints. The printers with thermal inkjet technology
have low cost, high resolution, and fast printing capability. However, the materials
must be in liquid form. In addition, low printing density is another limitation of
this technology. Printers using microextrusion technology have the ability to deposit
a very high cell density [37]. Also, it is the most common technology used for
scaffold-free tissue spheroid bioprinting. However, the cell viability ratio, which is
inversely proportional to the applied extrusion pressure, is lower than that of inkjet
technology. The studies are underway to increase the printing speed and resolution
in this technology [37]. It is possible to print materials within different viscosity
ranges by laser-assisted printing technology. In addition, the problem of nozzle clog-
ging encountered in other technologies is not seen in this technology. However, this
technology requires rapid gelation kinetics for obtaining high resolution [38].

2.4 Biomedical Applications of 3D Printing Technology

Three-dimensional printing technology has a wide range of application field in the

biomedical engineering such as tissue and organ fabrication [38], implants and
prostheses production [39–41], drug formation in pharmaceutical research [42],
and production of anatomical models for education and training purposes [43].
In this chapter, we focused on the products built by additive manufacturing tech-
nology, especially used in maxillofacial surgery, orthopedic surgery, and human arm
prosthetics.

2.4.1 Applications in Maxillofacial Surgery

In maxillofacial surgery, maxillary and face defects are corrected by employing

various surgical techniques and implants [44, 45]. It has been shown that a series
of midface defects can be corrected by anterolateral thigh flap which is produced
by rapid prototyping [46]. These implants have been reported to provide successful
esthetic outcomes, and reduction in operation time and postoperative complications
[46].
Saijo et al. treated several patients with mandibular deformity using the artificial
bones manufactured by 3D printing technology [47]. They implanted custom-made
inkjet-printed mandibular artificial bones into lower jaw area (Fig. 2.3). The authors
also used rapid prototyping to produce a plaster model for surgery planning. They
concluded that artificial bones had dimensional compatibility in all patients and
partial union occurred between the artificial bones and host bone tissues without
32 H. K. Surmen et al.

Fig. 2.3 Modeling and production of artificial mandibular bone. a The CAD model of the target
area and b inkjet-printed custom-made artificial bone [This figure is reprinted from J Artif Organs.
(2009; 12: 200–205) with permission] [47]

serious adverse reactions. They acquired reduced operational time ensured by the
minimal need for size adjustment and fixing manipulation [47]. Three-dimensional
printing technology is also utilized in the production of intermediate and final splints
for maxillofacial surgeries. Sun et al. studied the computer-assisted surgical planning
and splint fabrication using 3D printing [48]. In order to manufacture the splints,
which can be considered as a surgical guide, 3D mandible models were created using
CT and optical dental scanning data for patients undergone bimaxillary orthognathic
surgery [48]. Splints were used for identifying the final position of the maxilla and
mandible after re-positioning of split maxillofacial bones. The authors reported that
they obtained acceptable accuracy and satisfactory aesthetics outcomes by using 3D
printing techniques to produce intermediate splints [48]. Rapid prototyping is also
used to produce bone implants in the treatment of mandible fractures or defects,
which requires a precise reconstruction. Wang et al. reported a case of a patient
with a square-shaped face and a bunch of symptoms such as the asymmetric face,
collapse of the right face, and deviation in mouth opening, who had undergone
mandibular outer cortex split ostectomy [49]. In the surgical intervention, the authors
used a titanium mesh implant, which was designed based on the patient’s mandibular
anatomy, to replace a part of the mandible including ramus (Fig. 2.4). The implant
was manufactured by means of a rapid prototyping method. After surgery, titanium
implant ensured the complete accordance with the original bone. It was reported
that the 3D printing technology facilitated the intervention for correcting the defects
or fractures of the ramus in the mandible, which is commonly accepted as a critical
complication of mandibular reduction and a challenging task because some surgeons
have trouble in the formation of the original morphologic symmetry [49].
The 3D printing technique is also used to obtain 3D models of the skull or
mandibula with various abnormalities. The models enable to plan surgery in which
2 Fundamentals of 3D Printing and Its Applications … 33

Fig. 2.4 Reconstruction of bone defects by the custom-specific implant. a The CAD model of the
craniofacial structure and implant. b Custom-made implant [49]

pathological or traumatic deformities can be evaluated in 3D space, various treat-

ment scenarios can be assessed, and clinical outputs can be predicted. Design and
manufacture of the implants to be used in surgery can also be modified according to
findings obtained from the models [50, 51].
Mehra et al. reported a series of case studies regarding the use of models in
the correction of maxillofacial deformities [52]. Authors reported that a 16-year-
old female patient had a progressive pathological lesion of the mandible (juvenile
ossifying fibroma). Since there was significant destruction in the original mandible
and its normal anatomic shape, the treatment and surgery decision had been made
benefitting from 3D printing models. The models were also used as base geometries
for bending of fixation plates [52].

2.4.2 Applications in Orthopedic Surgery

Three-dimensional printing technology is a useful tool for orthopedic surgical proce-

dures in which the injuries with multiple bone fragmentation or bone deformities are
treated. It was reported that although FDM or SLS provides reasonable manufacturing
outcomes in terms of material properties, accuracy, and production time, SLA is the
most widely used rapid prototyping technique in the field of orthopedic surgery [53].
Potamianos et al. reported a case study of a patient with a shoulder injury consisted
of a double fracture of the clavicle and scapula [54]. Such an injury required surgical
stabilization with plate and screw fixation. CT data of the bony parts of the shoulder
were processed by fragmentation and segmentation. The solid model of the shoulder
34 H. K. Surmen et al.

was produced by a SLA machine. The reconstructed model showed that the fracture
was not a floating shoulder type, clavicle had a complete transverse fracture, and
scapula remained partially attached (Fig. 2.5). According to the evaluation made
on the anatomical model, the researchers decided that the surgery is not essential,
which enabled the patient was spared an unnecessary surgery [55]. This preoperative
assessment based on the 3D model of shoulder fabricated by 3D printing saved time,
cost, and labor.
Jeong et al. reported a case study of a patient with a midshaft fracture in the
clavicle. Three-dimensional CT scans of both clavicles were obtained, and plastic
models of fractured and intact clavicles were fabricated by a 3D printer [55]. A clav-
icular locking plate was contoured to the plastic model of the contralateral intact
clavicle of the patient. Internal fixation of the fractured clavicle with the plate was
implemented through surgical intervention. The authors reported that 3D printing
techniques allowed for printing the contralateral mirror images and providing accu-
rate prebent plates for a wide range of clavicular shapes besides the advantages of
short surgery time and low cost [55].
Chareancholvanich et al. employed the additive manufacturing technique to
produce an assistive guide for a total knee replacement task [56]. In their clin-
ical study, they performed total knee replacement surgeries for around 80 patients
for the treatment of knee osteoarthritis. A patient-specific splitting guide produced
by rapid prototyping and conventional instrumentation was used in surgery. The
patient-specific guide was designed based on preoperative MRI scans of the patients.
These surgical guides were employed to improve the accuracy of alignment of the

Fig. 2.5 Three-dimensional printed model of the shoulder. Oblique posterior view (a) and medial
view (b) which show the fracture [This figure is reprinted from Proc. Inst. Mech. Eng. (Part H).
(1998; 212: 383–393) with permission] [54]
2 Fundamentals of 3D Printing and Its Applications … 35

total knee replacement. The authors reported that alignment results were satisfac-
tory using the patient-specific guide and accuracy was comparable to that of the
conventional instrumentation [57].
Surgical guide production using additive manufacturing in hip surgery is also
becoming a common technique. Hananouchi et al. tested a surgical guide fabricated
by rapid prototyping for insertion of the cup in total hip arthroplasty [57]. As the
first step of work, the authors obtained CT scans of the pelvis of 24 patients with
osteoarthritis, osteonecrosis, and rheumatoid arthritis and designed the surgical guide
preoperatively. Rapid prototyping was utilized to fabricate the guide. The authors
stated that the cup accuracy sustained throughout the surgery was acceptable using
the 3D printed guide [57].
Additive manufacturing technology is also used in hand surgery. Fuller et al.
presented a step-by-step description for the design of bone reduction clamp which
was manufactured by 3D printing technology [58]. The authors changed the design of
traditional bone reduction forceps so that it provided multiple points of contact at the
fracture site and stabilized the fracture by multiple force vectors. They also considered
the new design as an assembly of a series of smaller parts that could be connected
to each other to reduce the exposure of clamping forces of the tissues. Following a
few adaptations in the design, the authors produced the model by FDM 3D acrylic
printer to obtain a plastic prototype of design. The prototype was tested on bony
practice models and found to be not sufficiently rigid for clinical purposes. Another
prototype, which had three components, was printed using stainless steel and the
components assembled to each other after manufacturing. The authors highlighted
that the main goals of these kinds of attempts were to increase patient safety and
decrease operation time [58].

2.4.3 Applications in Upper Limb Prosthetics

Upper limb prosthetics are artificial devices that are built to regain functions of
missing limbs. These kinds of mechanical devices allow amputated people to handle
and manipulate objects with varying shapes to help the user perform fundamental
daily tasks. The factors including mechanical structure, actuation method, sensing
capability, and control features are the main determinants in the functionality and
performance of prosthetics devices. Novel technologies such as 3D printing and
other additive manufacturing techniques are improving the design and manufac-
turing features of prosthetics [59–61]. Hetherington and his colleagues designed
and produced a prosthetic limb utilizing additive manufacturing technology [62]
(Fig. 2.6). The mechanically operated prosthetic hand was produced by 3D printing
and controlled by muscle activation recorded from electromyography (EMG) sensors.
The actuation of the automated prosthetic hand was stimulated by forearm muscles
[62]. These kinds of assistive devices made by new generation production techniques
are mostly light, affordable, customizable, and replaceable.
36 H. K. Surmen et al.

Fig. 2.6 Three-dimensional

printed EMG-driven
prosthesis developed and
built by SenseTech [This
figure is reprinted from
Senior Theses 255, 2018
with permission] [62]

Another study based on a 3D printing implementation in human arm prosthetics

was carried out by Low et al. [63]. The authors built a soft finger actuator which
was driven by pneumatic means in the order of enabling the user to grasp objects.
The actuators were fabricated by the 3D printing technique. The authors showed that
by using this technique, lightweight actuators could be produced and a compliant
gripping with acceptable stress could be achieved. Arjun et al. employed 3D printing
technique in the manufacturing of a low-cost and functional prosthetic hand to have
the ability to separately manipulate the fingers and grasp a variety of objects [64].
The authors considered that the technique allowed reducing the cost of customizable
parts. According to the study, the prosthesis was able to grasp various structures with
different shapes such as the cube, sphere, and cylinder. The authors also reported
repeatable grip times with low standard deviations [64].
Prosthetics for children require frequent modifications and adaptations due to
constant anthropometric changes. Zuniga et al. developed a 3D printed prosthetic
hand for children with upper limb reductions called “Cyborg Beast” [65]. They
reported that they were able to produce a low-cost prosthetic device that may produce
a significant positive impact on the quality of life of children with upper limb reduc-
tions, especially from low-income, uninsured families. Although such low-cost and
rapidly producible devices show promising outcomes, Ten Kate et al. stated in their
review paper that the lack of evidence with respect to the user acceptance, func-
tionality and durability of the 3D-printed hands are a major drawback of the 3D
printed upper limb prosthetics [66]. Moreover, they claimed that 3D printing is not
2 Fundamentals of 3D Printing and Its Applications … 37

necessarily cheap compared to injection molding, which can be seen as another disad-
vantage of the 3D printed prosthetics. Individualization of the prosthetic designs is
seen as a major advantage of such medical devices.

2.5 Conclusions

Biomedical devices and medical products usually have free-form surfaces and
patient-specific design features. Three-dimensional printing technologies, which
enable the production of objects with complex geometries and do not require the
installation of the production line and mold manufacturing, are an effective approach
for biomedical applications. In the 3D printing sector, continuous progress has been
observed in the area of printer technology, material type, maintenance, software,
and methods. The market value of this developing area is expected to be almost 27
million dollars by 2019 [67].
Three-dimensional printing technology has been effectively used to fabricate
customized implants, anatomical models, and surgical guides. Reduction of oper-
ation time and hospitalization duration, improvement of the surgery planning and
education, allowing for the production of patient-specific complex-shaped devices
consistent with the anatomical structure are some of the merits of the technique.
In clinical applications, high-resolution 3D printers are preferred to print bioma-
terials although high prices of these printers limit the use of this technology [68, 69].
Furthermore, post-processing applied after the printing process negatively affects the
cost and production speed. This is another factor that restricts the use of 3D printing
technology in the medical field.

2.6 Future Research Directions

The decrease in cost and fabrication duration and printing control for remote imple-
mentations might be improved in the near future. Production of the functional human
body tissues would also be improved in future studies. Interaction of living and printed
tissues would affect the developments of the technique. More complex and hetero-
geneous structures produced by improved bio-fabrication method are candidates for
the next applications. In addition, novel design concepts are being developed in order
to reduce post-processing stages, and also, the studies on support structures, which
can be dissolved in aqueous solutions, are continued [70, 71].
The future research attempts are anticipated to focus on acceptable standardization
of testing to enhance the commercialization of the products besides the attempts for
reduction of manufacturing costs of biomedical devices [72, 73]. In addition, in
the biomedical industry, as well as automotive, aerospace, and other manufacturing
areas, the fabricated multi-material components might likely be developed [74]. The
improvement of compatibility between workable materials and printing conditions
38 H. K. Surmen et al.

is another potential future trend in order for the lifelong survival of the printed
devices. Academics and industrial enterprises should also work on the improvement
of feasibility and accuracy of fabrication of the microstructures especially for the
surgical implementations [75].

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technology. Arch Des Res 31:23–35
68. Singh S, Singh G, Prakash C, Ramakrishna S (2020) Current status and future directions of
fused filament fabrication. J Manuf Proc, 55: 288–306
69. Pandey A, Singh G, Singh S, Jha K, Prakash C (2020) 3D printed biodegradable func-
tional temperature-stimuli shape memory polymer for customized scaffoldings. J Mech Behav
Biomed Mater, 103781
70. Kim M-K et al (2018) Ink composition for 3D printing support and 3D printing manufacturing
method using the same. U.S. Patent Application No. 15/745, 736
71. Swanson WJ, Mannella DF, Schloesser RG. Support structure removal system. U.S. Patent
Application No. 10/016, 945
72. Singh S, Singh M, Prakash C, Gupta MK, Mia M, Singh R (2019) Optimization and reliability
analysis to improve surface quality and mechanical characteristics of heat-treated fused filament
fabricated parts. Int J Adv Manuf Technol 1–16
73. Singh S, Prakash C, Ramakrishna S (2019) 3D printing of polyether-ether-ketone for biomedical
applications. Eur Polym J 114:234–248
74. Singh S, Singh N, Gupta M, Prakash C, Singh R (2019) Mechanical feasibility of ABS/HIPS-
based multi-material structures primed by low-cost polymer printer. Rapid Prototyping J
25(1):152–161
75. Poomathi N, Singh S, Prakash C, Patil R, Perumal PT, Barathi VA, Balasubramanian KK,
Ramakrishna S, Maheshwari NU (2018) Bioprinting in ophthalmology: current advances and
future pathways. Rapid Prototyping J 1–20

Dr. Hasan Kemal Surmen is an Assistant Professor in the Vocational School of Technical
Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey. He has received his Ph.D. in Mechan-
ical Engineering Department from Istanbul University, Istanbul, Turkey. His research areas
are computer-aided design and engineering, orthosis design, additive manufacturing, and 3D scan-
ning. He has authored more than 10 journal and conference papers, one book and two chapters.

Faruk Ortes is a Ph.D. candidate and working as Research Assistant in the Department of
Mechanical Engineering, Istanbul University-Cerrahpasa, Turkey. His research interests span
muscle mechanics, computational biomechanics, applied mechanics, finite element analysis, as
well as design and production of surgical instruments. He has authored more than five research
papers in various journals and authored five chapters. He also reviewed many scientific papers
from a wide variety of international journals.

Dr. Yunus Ziya Arslan is working as Associate Professor in the Department of Mechanical Engi-
neering, Istanbul University-Cerrahpasa, Turkey. He received his B.Sc. degree in 2002, M.Sc.
degree in 2005, and Ph.D. degree in 2009 all from the Mechanical Engineering Department,
Istanbul University, Turkey. He spent six months at the Human Performance Laboratory of the
University of Calgary as a visiting Ph.D. student (2008) and one year at the BioMotion Center of
Karlsruhe Institute of Technology as a visiting professor (2018–2019). He is working in the areas
of musculoskeletal biomechanics, computational modeling and simulation of human movement,
computer-aided analysis of movement disorders, mechanical design and production of biomed-
ical devices. He has six patents in his name and authored more than 35 research papers in various
journals and authored eight chapters. He is a reviewer of various international journals.
Chapter 3
Thermal Effects in 3D Printed Parts
Prasansha Rastogi, Swaroop Gharde,
and Balasubramanian Kandasubramanian

3.1 Introduction

Idiosyncrasy, intricacy, precise architecture, and caricatures of nature’s beauty have

always been a subject of curiosity for the world’s ingenious minds and thus pilot
the futuristic growth of technology. Same inquisitiveness by Charles Hulls in 1986
might have led to the invention of printing-based manufacturing of products. It has
marked the onset of revolution in manufacturing tactics and proficiency in intri-
cate designing, on-demand printing, controllable patterning, customize products
in finite time boundary [1, 2]. According to MarketsandMarkets assessment, 3D
printing will burgeon to occupy US $32.78 billion market in forthcoming years
(i.e., by 2023) witnessing 25.76% growth from 2017 [3]. Central to 3D printing
manufacturing lies in its successive layering of materials—powders, liquids, or
solids followed by crosslinking or coalescence steered solidification. Selective laser
melting (SLM), binder jetting, and selective laser sintering (SLS) are the subset
of powders-built entities which are thereupon sintered for densification (Fig. 3.1).
Moreover, stereolithograhy (SLA), multi-material [4] printing, direct ink writing
(DIW), and digital light processing (DLP) are labeled under liquid-feed printing
(Fig. 3.1). However, fused deposition modeling (FDM) is typecast within solid-
supplied printing on account of its filament-feed which then melts by heater coils
around nozzle and raster dispensing follows for three-dimensional product [5, 6]
(Fig. 3.1). Input materials for feed in above-categorized techniques are polylactic
acid (PLA), polyamide (nylon, PA), polycarbonate (PC), polyurethane (PU), acry-
lonitrile butadiene styrene (ABS), polydimethylsiloxane (PDMS), copper (Cu), gold
(Au), aluminum (Al), silver (Ag), polymethyl methacrylate (PMMA), gelatin, lutrol

P. Rastogi · S. Gharde · B. Kandasubramanian (B)

Rapid Prototyping Laboratory, Department of Metallurgical and Materials Engineering, Defence
Institute of Advanced Technology (DU), Ministry of Defence, Girinagar, Pune 411025, India
e-mail: [email protected]

© Springer Nature Singapore Pte Ltd. 2020 43

S. Singh et al. (eds.), 3D Printing in Biomedical Engineering,
Materials Horizons: From Nature to Nanomaterials,
https://doi.org/10.1007/978-981-15-5424-7_3
44 P. Rastogi et al.

Fig. 3.1 Classification of 3D printed technique based on feed material, i.e., solid (filament), liquid
(resin, solution), and powder

F127, chitosan, alginate, fibrinogen, collagen, polyether ether ketone (PEEK), poly-
imide (PI), polyester acrylate, composites and continued [7–17]. Materials utilized
during printing have been subjected to varied parameters whose change in magnitude
alters design output (parameters depicted in Fig. 3.2). Yadav et al. studied the effect
of varied pattern structure (foliated complex cross-lamellar, nacre, and cross-lamellar
on the mechanical properties where lastly defined design (owing to its orientational
morphology) obtained improved toughness and wear rate (1.2 × 10−4 mm3 /N m)
[18]. Kuo et al. had recorded the effect of alteration in reinforcement (steric maleic
anhydride copolymer, carbon black, titanium oxide, methacrylate butadiene styrene)
in starch-ABS composite for enhancement in associated properties (heat distortion T,
impact strength, flexural strength and modulus, thermal resistance, stability, tensile
strength) owing to change in interactions [19]. Geng et al. had differed extrusion
speed and characterized its effect on material after solidification (i.e., low speed →
pressure dropped → improper flow of filament mismatch between feed rate and melt
3 Thermal Effects in 3D Printed Parts 45

Fig. 3.2 Parameters (pre-, during, post-printing) investigated for determining the effect on final
properties of entity

outlet rate → porosity) [20]. Jayanth and Senthil had investigated variation in the
thickness and width of printed sensor on capacitance performance. They reported
proportionality relation between variables and outcome due to dependency of area
in capacitance calculation which was further enhanced with carbon black additions
[21]. These are some few variables that attune the performance of printed entity
related to mechanical, electrical, thermal, and other related features.
3D printing is increasingly infiltrating into daily routine where custom-built
designs have extensively been preferred for end-user utilization. Low T workability,
convoluted (micro-) patterning ease in control over designing, and other variegated
specialities, 3D printing has secured its prominence in electronics industry [22–24].
Utilization is burgeoning toward industry, e.g., in aerospace (aircrafts), consumer
items (hearing aids, visual aids), vehicles, etc., due to materials (composites or alloys
mechanical performance, etc.) [25–27]. The fascination of imitating nature synthet-
ically has always thrilled scientists from all over the world to invest their time and
money in bio-mimicking application from 3D printing due to fine engineering, e.g.,
nacre structure, molluscan construction, crustaceans, bones, fish scales, etc. [28–
32]. Adding to it, biomedical utilization of 3D printing cannot remain untouched and
research is extensively progressing in its every aspects. Multifarious bioink compo-
sition has been experimented for developing scaffolds for tissue engineering (eyes,
heart, brain, cartilage, bones, etc.), drug delivery, transplantation, constructing prox-
imity environment for studying various types of cancer, tumor, and other diseases
(to develop treatment) along with various functions [12, 33–35]. The innovation
46 P. Rastogi et al.

of additive manufacturing has not been restricted to aforesaid but expanding into
other domains of space technology, textiles, jewelry, robotics, sensors, etc. [36, 37].
Though 3D printing bestows customized products, ease of production in small lots,
high resolution, accommodating wide range of materials, multi-hues, multiple mate-
rials, multi-combinations of properties, cost-effective, etc., still the techniques have
been challenged in certain aspects. Photopolymers in SLA have posed a limit in
usability owing to their degrading, brittleness, intolerance toward heat, etc., along
with compulsion of incorporating photosensitive groups for photocuring [7, 10].
FDM restricts to only filaments feeding and also the production defect, i.e., staircase
effect (rough surface), low resolution printing, etc., that can contribute to interfa-
cial weakness, distortion, etc. [38]. In addition, powder-feed techniques, i.e., SLS,
SLM, binder jetting, have to confront densification complication (as adjacent parti-
cles necks down by laser rendering porosity or binder evaporation) along with post-
processing like sintering, heat treatment, etc.; hence, pre-requisition of materials
stability is exhorted [10, 38]. In general, 3D printing equips with user-designed
product but necessitates amelioration in precision, time management (layer-by-layer
print), support structures, and post-processing for further enhancement in its caliber.
This chapter scrutinizes pivotal aspect of 3D printing, i.e., temperature or thermal
outlines practiced over from its cradle to finished product. Since temperature is scaled
as one of the many influential parameters driving the course of printing, therefore,
taking the stimulus of variable, concomitant effects of same has been categorized in
pre-, during, post-printing operation. Furthermore, it also briefly elucidates on some
extended temperature functions, e.g., in recycling, etc. The chapter in addition delves
into fundamental features of temperature in bioprinting which engineer cells onto
scaffolds for variety applications. Optimal magnitude setting of temperature while
formulation, stage control, and post-treatments renders printed structure its efficient
output.

3.2 Thermal Parameters in 3D Printing

Multifarious end-user applications of 3D printing products in either domain are engi-

neered with an aspiration to attain long-lasting and steadfast performance. These
properties are ensured in design, during different stages of printing which consists
of pre-printing stage, printing stage, and post-printing stage. Further, these stages
are governed by distinct parameters which are pivotal for any design and prop-
erty optimization (Fig. 3.3). In myriads of parameters that are specific to material,
printer setup, or during printing operation, temperature has significant influence in
modulating characteristics of printed entity.
3 Thermal Effects in 3D Printed Parts 47

Fig. 3.3 Some sources and requirement of temperature which governs end properties of printed
product

3.2.1 Pre-printing Thermal Characteristics

This section encloses features related to the selection of material, their innate prop-
erties, pre-printing processing, and printing stage conditions which pilot thermal or
temperature attributes.
Considering innate thermal characteristics, e.g., glass transition temperature (T g ),
decomposition T, etc., of material during its selection has profound impact on final
temperature stability of printed entity. As an instance, homogenization of carbon
black, which can relatively endure high magnitudes of T, furnishes thermal stability
in its composite. Temperature pertained to onset and accomplishment of composite
decomposition also experiences proportional enhancement with the filler when
investigated with thermogravimetric analysis (TGA) [7]. Correspondingly, graphene
ascribed to its π-bond delocalization endows conductivity and T stability during
printing of graphene–polylactic acid (Gr-PLA) composite. Studies also revealed that
increasing graphene concentration (conc.) had lowered the resistance path to ~47
 from ~2217 . Therefore, as a resultant minor heating/T upsurge in composite
displayed distortion resistance when voltage up to 20 V was applied manifesting
48 P. Rastogi et al.

its accessibility in electronics mobile for faster heat dissipation [39]. Furthermore,
thermal stability of precursor for energy storage applications in printed batteries can
mitigate flammability-related issues (fire accidents) of conventional non-printed elec-
trolytes or electrodes (cell). In addition, it also augments and maintains ionic conduc-
tivity of gel electrolyte at significantly high-T (vs. conventional) for an extended
period of time while enduring thermal shock which boosts its life predictability [40].
Similarly, powder-state intermixing of copper, iron, or metal in polymer/s bridges
resistive pathways engendering conductivity to composite as a consequence of the
propagation of electrons and vibrations [41]. Another parameter is T g which facili-
tates the selection of T environment for precursor material printing as low T g enables
room-T designing. Moreover, the later also vindicate dimensional stability which
otherwise prompts shrinkage when cooled as a result of water evaporation from
gel network pertaining to its T gradient existence [42]. Geometrical soundness of
printed material is also a function of thermal expansion coefficient (CTE), a measure
of shrinkage or expansion during heat flow. Precursors with large CTE are susceptible
to greater shrinkages while cooling which can engender delaminations, warpages or
distortion printed interest, therefore, intermixing of hard or thermally stable phase
contributes to minimization in CTE-related defects [43, 44]. Wei et al. reported CTE
of graphene composite with ABS and mere ABS to be comparable, i.e., 75 ppm/°C
and 78 ppm/°C, respectively, which otherwise would have seeded thermal stress in
the printed part progressing to distortion [45].
T has also been utilized while formulating materials to be used with respec-
tive printing equipment. Nikzad et al. had employed cryogrinder to produce acrylo-
butadiene-styrene (ABS) powder in which T was lowered to <T g ceasing chain
motion (glassy state—brittle), and subsequently, reduced molecular energy had
favored crushing for later composite extrusion printing [41]. However, freeze-drying
could also be functioned to prevent clustering and yield powder particles owing to
its locking-in and low energy state [44]. Alternatively, ABS could also be blended
with another polymer in pellets form which was dried (40 and 60 °C, respectively)
[46] before being extruded to eliminate water which sources voids and improper
filament in FDM; process is also practiced in general before printing commences
[44]. Thence, T selection is momentous for material drying or other intended func-
tion over it as instance, ABS + PC T endurance limit <110 °C and therefore printing
conductive inks wherein drying T belongs within threshold [47]. Following the selec-
tion of precursor formulation, reinforcement, and drying, it is fed in screw extruder
(SE) [48, 49]) to homogenize its conc. Barrel T is predetermined based on mate-
rial to be extruded out, e.g., polylactic acid (PLA) was intermingled with carbon
black (CB) and carbon nanotube (CNT) separately in batches and filled in extruder.
T of progressing zones ranges between 160 and 175 °C, and the resultant extrudate
was dried again to dehumidify for later extrusion into filament for printing [48].
Correspondingly, filaments of varied polymers or composites can be extruded with
different T range suitable in accord with respective properties for FDM dispensing.
Nevertheless, for SLA where liquid resin layers are laid on platform for UV curing,
a prerequisite for precursor material is viscosity which determines flowability and
also crosslinkability [50]. As extreme magnitudes of viscosities can render SLA
3 Thermal Effects in 3D Printed Parts 49

printing in vain, therefore apposite T can be determined by heating and measuring

its viscosity at intervals. Optimum viscosity for SLA printing ranges <1 Pa s [51] and
requisite heat (or T ) is catered with light intensity, e.g., in modified polycaprolactone
(PCL), T < 46 °C was apt to obtain viscosity around 0.66 Pa s [52]. DLP, which is
bottom-up version of SLA, had similarly processed methacrylated functionalized
polyimide which employed multiple heating and cooling cycles followed by drying
(e.g., at 40 °C) (apposite for photocuring) [53].
SLM printing is exercised majorly in metals, ceramics, and alloys, attributable to
their T tolerance and high-energy melting wherefore implementation is restricted in
polymeric particles, ascertained to their T-related softness [5].
SLS printing entails densification by sintering of powder (polymeric-low melting
T, ceramics, metals and composite-high melting T ) precursor particles, e.g.,
polyamide (PA), polystyrene (PS), polyether ether ketone (as PEEK), copper (Cu),
aluminum (Al), etc. [5]. Precursors are manufactured by atomizing metals or alloys
from their molten state which solidifies with highly pressured unreactive air, water,
or rotary disk along with other processes. While for polymers, Dechet et al. had
employed conc.-T diagram-derived phase separation in liquid medium to precipitate
beads (PA11) which were sintered at 170 °C for the densified product. Mechanism
commenced with precursor solution heated to ~190 °C, stabilized and cooled 0.5–
3 K/min rate to 50 °C and instant when T < solution T (differed with conc.), PA11
precipitated out which were dried before being directed by laser for sintering [54].
In powder production mechanisms, the resultant due to T gradient, laser pene-
tration, or solidification irregularity may have entrapped bubbles, satellite particles-
rough finish, non-uniform size which ensued melting heterogeneity, deprived inter-
face bonding, and truncated mechanical performance [55]. After solidification of
3D printed entities, volumetric shrinkage and residual stress prevail which guide
emergence of delamination, cracks, or other interfacial defects that are accredited
to constraints (previously built layers), T, solvent evaporation, and other parametric
gradients [56].
Optimization of pre-printing parameters in accordance with printing technique is
followed by preheating of precursor materials before being patterned on platform to
acclimatize it to the printing environment and reduce thermal variation (magnitudes),
e.g., PA12 heated to 178 °C for printing with SLS [57].

3.2.2 Thermal Effects During Printing Process

Following the material preparations, temperature characteristics needs to be

controlled in printer setups for stable production in user-controlled design. FDM
dispensing is governed by nozzle-T (which dispenses melt in printable viscosity)
and bed/platform-T (which controls thermal gradient for layer bonding and end
performance). Optimum nozzle-T steers solidification and mechanical behavior, e.g.,
in ABS-carbon fiber composite, the variable was tuned between 200 and 240°C
50 P. Rastogi et al.

in intervals of 10 °C. Experiments employed 220 °C as optimal T because inter-

layer energy was efficient in bonding as opposed to 200 °C which lacked requi-
site energy to bond adjacent layers in full and 240 °C where complete merging
seeds porosity in structure. Therefore, superlative 220 °C peaked in mechanical
strength (tensile and yield), toughness, and modulus (E) [58]. Similarly, ABS–mont-
morillonite was extruded at 190 °C [44], nylon6–graphite, etc., blend at 250 °C
[49], polymethyl methacrylate–graphene, etc., composite at 280 °C [59], and other
formulation with varied filament extrusion T can be produced governed by their
composition and innate characteristics. Emphasis is due to the observation that
alteration of 5 °C could generate perceivable contrast mechanically and qualita-
tively [60]. Composite/polymer dispensing from extruder (FDM) nozzle experi-
ences solidification immediately after being extruded and continued on platform.
Nonetheless, prior to resting of filament on platform, minor amendments in T can
bestow drastic property difference which was portrayed by Gantenbian et al. Authors
had employed liquid crystalline polyesters which are FDM extruded in isotropic
phase with room-T cooling but while in air, ample T gradient engineered core–
shell filament with dimensions determined by nozzle diameter. Circumference of
filament was exposed to room-T and therefore, got ordered in nematic configuration
while central retained the thermal energy and thereby, slow orientation. Furthermore,
authors explained that performance escalation due to core–shell solidification went
substantial when nozzle-T was in close proximation to T melting (polymer). Addition-
ally, post-thermal treatment assisted crosslinking had maneuvered the mechanical
magnitudes (toughening, strength, crack-arresting, modulus, etc.) positively [61].
Idiosyncratically, FDM displays parallelism with acoustoplatic metal direct-write
(AMDW) in the geometry of material feeding as filament. Inter-filament bonding in
AMDW thrives with the application of ultrasonically generated energy; e.g., printed
aluminum (Al) filaments were affixed with 60 kHz frequency horn. Incoming energy
induces huge localized heat which macroscopically contributed to minimal change,
unlike in FDM or ultrasonic processing. As Al experienced merely 5oC divergence
which was attributed to huge disparity between radial and lateral dimensions (aspect
ratio to 0.001) [62–64]. Platform-T in extrusion derived printing not only functions
to lessen the gradient carried amendment but also boosts recrystallization process
(e.g., for PLA and ABS, temperatures were 70 and 80 °C, respectively [65]). Along
with the prior, hot dispensing on formerly printed layers aid in heat and fluid flow
across dimension which corroborates evaporation of moisture which consequently
revitalizes the interface interaction for densification and defect averting [66].
As aforementioned in Sect. 2.1, the viscosity in SLA is pivotal for printing and
later curing commences with UV (majorly) light owing to photoresin incorpora-
tion at room-T [50]. Contrarily, slight modulation in formulation, e.g., hybridizing
Silicone-epoxy-acrylate resin evinced curing from two energy sources, i.e., heat
(epoxy curing) and light (acrylate curing). First step curing by UV flooding had
lifted-up T which further assisted in second step thermal crosslinking at 90 °C
and thus elevated T g (interpenetrating network (IPN) formation) empowering the
thermosets with amplified performance [51, 67]. But, UV curing is also followed
by entity’s geometrical disfigurement (curling or shrinkage) endowed to it by T.
3 Thermal Effects in 3D Printed Parts 51

Fig. 3.4 Illustration of temperature build-up during SLA printing of resin layers owing to
photopolymerization (release of thermal/internal energy). T later at top layers (e.g., 10th layer)
< bottom layer due to temperature increment (heat liberation) from lower but overall T tends to
enlarge with layers and laser scanning time

Photocuring reaction-instigated solidification liberate thermal energy which accrues

with layer thickness (for ~10 layers, T = 31.5 °C, resin T = 24.7 °C) and exposure
time. Though interlayer change (T ) dwindles with thickness, inclusive (overall
entity) T upsurges which induces thermal residual stress and shrinkage [68], thereby
cracking [50] (Fig. 3.4). This T or minimum T before next layer deposition had also
been witnessed in FDM printing, and results were modeled with various design and
dimension (1D, 2D, etc.). Amico et al. demonstrated square and line modeling which
exhibited conduction heat transfer (Eq. 3.1) but only former manifested convection
(Eq. 3.2) owing to geometry and area. Though radiation energy interaction of fila-
ments with circumambient or with their adjacent (owing to geometry) had been
neglected, it could surpass convection when h was quantitatively small [69].

Conduction: Q = V  ∗ ρ ∗ c p ∗ (Tnozzle − Tambient ) (3.1)

Convection: Q = h ∗ (T − Tambient ) (3.2)

where Q = conductive or convective heat, V  = deposition rate (volumetric), ρ =

density, cp = specific heat, h = heat transfer coefficient.
Finite element (FE) analysis outcomes displayed printing speed dependency on
heat transfer and overall T enhancement with deposition of layers. Slower cooling rate
except for (printing speed) 10 and 30 mm/s as lesser speed renders extended contact
of hot source (filament) while higher quantity caused dwindling in time for next
deposition (preventing heat transfer and thermal piling up). In other words, T rejec-
tion from bottom layers increased and therefore T lowered with layers stacking.
Nevertheless, when time gap between depositing adjacent layers was uncontrolled,
delamination (owing to improper bonding), cracking warping, etc., defects were
evidenced, e.g., minimum layer T = ~72–65 °C, maximum T = ~85–103 °C when
in-between layer duration varied from 3280 to 760 s. Additionally, layers ≥ ~20
rendered thermal transfer from sidewalls due to high gradient with central section
of filament and therefore necessitated T optimization or side insulation to mitigate
52 P. Rastogi et al.

warping, cracking, etc. (also vanquished when T toplayer > T g ). Furthermore, experi-
mental (ABS material) and modeled results delineated that platform-T and thermal
conductivity of material influenced the cooling rate for few initial layers as quenching
effect diminished with further built-up [70–72].
SLS in similarity with FDM and other techniques entails bed preheating as
substantial T variation arises while scanning powder layers. Laser scanning on cooled
former layers stems residual stress in sintered layer which continue accruing with
gradual scanning of further layers and contribute to warping and mechanical impair-
ment (modeled for PA12) [57]. Therefore, subsequent layering of powders necessi-
tates above crystallization (T > 300 °C for PEEK) heating to equalize rate of cooling
of underneath sintered layers which also ensured densification and enhanced relative
bending stress (0.15–0.35) [73]. This re-stimulation of sintered metal layers inter-
rupt oxide formation and thence encourages interfacial bonding due to improved
wetting [74]. Additionally, SLS had also aided in sintering of inkjet-printed self-
assembled gold (Au) nanoparticles at 150 °C (melting T of Au due to nano-size-
effect) with Argon laser which made pathways for conduction. Different Au patterns
were spaced with poly 4-vinyl phenol (polymerized at 150 °C) and finally walled
with annealed (120 °C) conductive polythiophene inkjet-printed layer for flexible
electronics applications (Fig. 3.5) [75].

Fig. 3.5 Illustrating conductive patterned gold layer on polymer substrate for flexible organic
electronics application
3 Thermal Effects in 3D Printed Parts 53

SLM printing is impeded by solidification (103 –108 K/s rate of cooling) route
as high-power laser pierce deep-down several layers depreciating T gradient (also
dependent on interaction time) between underneath layers and promotes grain
growth, atoms mobility inducing segregation, undesirable phases, stresses, etc., but
attenuate voids geometry and formation [76]. Shrinkage as in SLM also involves in
SLS due to thermal energy interference but the latter is more sensitive to melting
or crystallization T which may initiate curling, dimensional instability or polymer
flow, thus deviating from efficacious printing [77]. Wudy and Drummer had exper-
imented PA12 with 50 W laser and to evade gradient (ranging to 10 K)-followed
curling damage, build T was fluctuated between 164 and 172 °C which assisted in T
distribution homogeneity and coalescence prevention in end product [78]. Succinctly,
when the metal powder is impinged by laser beam, it coalesces and necks down to
produce metallurgical bond followed by solidification which is governed by flow of
heat energy. This flow pilots microstructural and macrostructural features in cooling
material and the most critical section sustaining this is heat-affected zone (in short
as HAZ—adjacent to region of laser focus). T gradient in these regions administer
solidifying structure (columnar or dendritic) and thereby final properties. In addi-
tion, preponderated difference in T accompanies swift cooling → small grain size
or precipitate size, large residual stress, crack generation, coring phenomenon →
depletion in properties. Therefore, printed metal necessitates post-heat treatment
to avert coring, coarsening (high-T for extended period), segregation and therefore
crack impediment [79].
In addition to other cracks, damages, etc., owing to laser (intrinsic heat) raster
patterning on powder, SLM and SLS evinced heat-affected zone [80]. Ouyang et al.
had formulated iron-based alloy powder for SLM printing and observed that high
laser power (e.g., 350 W) coupled with low scanning speed (e.g., 200 mm/s) nucleated
crystallinity to the solidifying structure in HAZ, i.e., crystallinity fraction ∝ laser
power, but ∝ (scanning speed)−1 . Authors had also verified the reliance with FE-
modeling in which they implied susceptibility of HAZ to heat reflow due to high
laser power and that duration (e.g., 7.29 s at HAZ) if exceed incubation period,
bestowed intermetallic precipitation and crystallization. Further, the formation was
also reasoned that heat reflow had directed the zone to above crystallization T, and
thus, HAZ was governed by cooling time irrespective of cooling rate (which was
~8.07 × 104 °C/s ≫ 11 °C/s for amorphous structure formation) [81]. Not only
HAZ results in structural variation but also challenges mechanical performance and
roots residual stress, distortion, etc. [82]. Analogous to SLM, SLS also employs laser
for sintering phenomenon in metals along with polymers and thus are susceptible to
HAZ which in addition subsist laser characteristic. Time and intensity of input energy
are optimized so as to raise T below decomposition which otherwise can ablate the
polymers, thus deflecting from requisite output. Lasers (e.g., CO2 , Nd:YAG, etc.)
penetrate to a depth and partially or fully melts the interacted material (polymer),
adjacent to it lies HAZ whose width is controlled by incident fluence and other
material innate properties, e.g., thermal conductivity and diffusivity T in HAZ, in
similar to laser interaction zone, elevates to exceed T g , and therefore also steers
crystallinity in polymers which has direct influence on mechanical performance
54 P. Rastogi et al.

[78, 83–86]. Another fact in sintering is boundaries of HAZ, and agglomeration (of
powders appertained to heating) is dependent on again laser energy, e.g., Franco and
Romoli had defined that >0.10 J/mm2 was effective in making a clear distinction
among them. Moreover, they also reported that sinter depth was a factor of melting
and vaporization of polymer material (PA12) but HAZ could elongate deeper based
on energy available [87]. Though laser is also utilized in SLA photocuring, HAZ
ceases to exist appertained to (1) intensity is quite low to lift T to sufficient as resin is
already in semi-molten form (2) UV light is used which prevents any HAZ formation
[83]. In reference to above-mentioned facts, quantifying the gradient in HAZ zone
is complex and therefore necessitates more in-depth study in relation to 3D printing
processes.

3.2.3 Post-printing Thermal Effects

During thermal analysis of printed entity, temperature is pivotal as it determines

product’s feasibility, i.e., with T stiffness diminishes due to high mobility of chains
which abate network formation and also strengthening which prepare the designs for
functional application.
Though FDM furnish printing ease, cost-effectiveness, material efficiency, etc.,
the process is confronted with resolution and surface step-case (visible pathways)
[38]. Roughness of print can be subdued by thermal assistance after complete manu-
facturing of entity, i.e., heating to T (160 °C for PLA) > T g for thermoplastics
melting. In printing of Braille letters, molecular chains-prompted mobilization had
not only smoothens the pattern but also aided in interfacial bonding augmentation
with cellulose paper (reduced viscosity empowered interdiffusion) [88]. Above-
stated staircase-free smooth surface at upraised T also ameliorates reflectivity (but
within limits) owing to its curtailed scattering. These features are showcased by
PLA, T-glase, ABS, moldlay, high impact polystyrene (HIPS), thermoplastic elas-
tomer (TE), etc., as an exemplary in which TE achieves the peak reflectivity at high-T
while HIPS and PLA emanates fumes but T-glase unveils suitability with printing
among all. HIPS exhibits average roughness of 0.523 μm at ~123.5 °C, T-glase
= 0.597 μm at 113.6 °C, ABS = 0.592 μm at 126.6 °C, due to distinct tolerance
of material toward T [89]. Apart from polymers, ceramics are high-T workable
materials and printing of suspensions (ceramics directly added [90] or derived from
polymer [91]) rendered production of green body. This resultant is dehumidified at
T slightly greater (50 °C) than room-T or at room-T (25 °C) to eliminate liquid
(water) content which is ultimately sintered. Extortionate sintering T (≥1300 °C)
in conjunction with the period of holding at the same is significantly controlled and
optimized to circumvent formation of defects. Expulsion of organic molecules with
the application of heat energy ensured densification (can be ~97%) and strength
building but also renders dimensional variation in the form of shrinkage which can
also source pores. In addition, porosity defect is a function of sintering T and thus
can be variegated positively (T ) to lessen the quantity and dimension of pores which
3 Thermal Effects in 3D Printed Parts 55

is accompanied by increased packing density of entity [90–92]. As an instance, Peng

et al. sintered Al2 O3 green body at three distinct T of 1350, 1450, and 1550 °C and
reported that for any printing path followed, porosity curtailed while an upsurge was
recorded in bulk density (1550 °C → 3.71 g/cm3 → 10.8% porosity). Additionally,
authors also witnessed that contraction due to the densification had primly affected
the radial dimension and then height, i.e., diametrically 2.62% and height 0.98%
[90]. In contrary, Li et al. had printed acrylate-modified polyborosilazane polymer
by DLP and obtained SiBCN after pyrolysing at T up to 1500 °C. Pyrolysis at 900,
1200, and 1500 °C individually witnessed increasing percentage of shrinkage, crys-
tallization, and densification, however, later slowed down (density, ρ 900 − ρ 1200 =
11 g/cm3 and ρ 1200 − ρ 1500 = 2 g/cm3 ) due to the ceramic conversion which was
approximately 58% at all T. organics were burnt endowing the design its black color
and thermal stability and oxidation resistance coupled with anticipated mechanical
enhancement (toughness and modulus) [91]. This sintering-assisted densification
had also furnished thermoelectric application in waste to electricity generation with
enhanced Seebeck coefficient for p- (199 μV/K) and n- (145 μV/K)-type materials
at around ~200 °C [93]. In addition to aforementioned pyrolysis and sintering which
aids in functional improvement, mere heat treatment also delivers upgradation. Wang
et al. had inkjet-printed VeroClear material with heat treatment to 150 from 60 °C at
intervals of 30 °C and evidenced >20% increment for either of compressive/tensile
strength, strain, and modulus at highest T of 150 °C. These achieved results were
ascribed to internal energy increase in terms of chain mobility which engenders
conversion efficiency and sites for crosslinking, therefore stiffness [94].
Zhang et al. had designed graphene oxide (GO) aerogel within printed template by
hydrothermal reaction and freeze-drying equipping flowability of graphene in struc-
ture and locked the network, both relied on T optimization. This steep T gradient in
freeze-drying had directionalized and positioned GO sheets to construct conductive
bridge and a porous network. Later decomposition of template at 1000 °C rendered
porous graphene construction water hydrophobicity and organics hydrophilicity
which could be discharged by heating. This facilitated aerogel in remediation of
organics (oils) (e.g., asphalt) by thermal (Joule) energization followed by recovery.
Furthermore, the conductivity of constructs can be modulated with T in a propor-
tional relation as low T → high resistance to electrons flow and conversely for high-
T. Amidst the process, aerogel construction and thermal stability were preserved
conferring multi-applications in electrical heater, absorbent, sensors, and thermal
insulator (Fig. 3.6) [95, 96]. Moreover, GO nanocomposites were also sensitive to
T as annealing at 50 °C could not overcome the wrinkling and dispersion (GO)
barrier which thereby conferred drop in tensile strength with fillers but converse was
discerned with 100 °C.
Corresponding to aforesaid nozzle or nozzle-free maneuvering of precursor
metals, binder jetting employs binding agent (can be water-based), thus fabricating
green body which is accompanied by curing and sintering in steps. In particular, iron,
magnesium, and calcium powders were slightly cured at 200 °C and subsequently
thermally treated at 430, 620, and 1200 °C for binder burnt-out and densification
[97]. In contrast to treatment at elevated T, when quantification progress in freezing
56 P. Rastogi et al.

Fig. 3.6 Representing (1) the processing of graphene porous structure (or graphene lattice, GL)
by decomposition of SLA printed template, (2) inhibiting convection of thermal energy by asphalt
absorbed GL rendering it in application of insulator, (3) thermal stability of GL when tested ~30 min
permitting GL for fireproof conditions, (4) asphalt is absorbed in GL by modulating its viscosity
(by thermal energy) to overcome surface tension and filling the pores which can be discharged
with aid of joule heating, subsequently by fire (which loosen asphalt consequently flowed out) thus
leading to the recovery of GL to be utilized for further recycling (environment remediation, e.g.,
oil leakage, etc.) [95]

ranges, thermal characteristics may differ from its high-T counterpart. For instance,
thermal expansion of FDM printed ABS and polyjet printed PLA dropped down to
around 15,000 and 12,500 μm/m in negative at 4.2 K from to 0 μm/m when tested
in 290 K. Corresponding results were also reported for thermal conductivity which
descended to ~0.04 W/m K from ~0.2 W/m K for both, therefore, advocating the
material for cryogenic utilization [98], e.g., an auxiliary accessory for 77 K operable
magnetic concentrator [99]. Laser intervention (T ) on metallic green body can also
be led to the modification in composition owing to evaporation of highly volatile
metals (if present) which further manages to alter the solidification, mechanical,
microstructural, corrosion, and thermal properties. In addition, inadequate laser raster
and coalescence of powder particles also engender fusion irregularity (contraction
→ cracking) along with rough outer surface [55].
3 Thermal Effects in 3D Printed Parts 57

Fig. 3.7 DSC themogram (at 10 °C/min ramp rate) for T g determination for acrylate-based resin
and graphene oxides composites (green and red) after annealing (1 wt% at varied temperature for
annealing 50 and 100 °C). Black line indicates for resin with T g of 47 °C which climb-up (to 56
and 60 °C) with increasing annealing temperature owing to GO restraint to polymer motion (chain)
and dwindling in flakes (GO) wrinkles for augmented adhesion [101]

Irrespective to printing stage, i.e., pre-, during, or post-printing characteriza-

tion tools like differential scanning microscopy (DSC), thermogravimetric analysis
(TGA), are exercised for explicit understanding of T g and decomposition T. TGA
analyses facilitate detection of thermal stability by weight loss that transpires when
the sample is heated to requisite T (up to 800 °C, etc.) at a specific rate, e.g., 10,
20 °C/min, etc. It is determined within N2 or argon environment by onset weight loss
of 5% following the sharp descend in weight of sample owing to the exclusion of
organic content [100–103]. Dynamic mechanical analysis (DMA) assess loss factor
(given by tanδ) at 1 Hz which is a fraction of loss to storage modulus of the sample
after being heated to predetermined T and the peak ascertains viscous/elastic nature
for onset/offset of deformation [45, 46]. Similarly, DSC studies are performed to
analyze heat absorption/release perceptible through endotherms and exotherms in the
graph. Furthermore, these calculations aid in determination of transition T (melting,
crystallization, T g ), enthalpy, curing reactions, etc., at stable rate, e.g., 5, 10 °C/min
(Fig. 3.7) [101, 104, 105].

3.3 Auxiliary Functions for Extended Application

Tailoring of precursor material during its processing can foster some adjunct features
which transcends principle purpose and broaden the performance window. As an
58 P. Rastogi et al.

instance, ester-hydroxyl transesterification reaction was availed at elevated temper-

ature (around 180 °C) which advocated bond dynamicity for exchange reactions (at
interface) and stress curtailment (T dependency—Eq. 3.3) bestowing reprocessability
to thermosets. These features facilitated repairment and recycling using exchange
reaction; moreover, T g of material was shifted to higher-end conferring increased
modulus (~900 from 7.4 MPa), extended functioning, strength, and stiffness [106].

Ea
ln t = ln to + (3.3)
RT
where t = time of relaxation at T of interest, t o = time of relaxation at infinite T, E a =
energy of activation for transesterification reaction, T = temperature, R = universal
gas constant.
Analogous bond reaction course had been defined by Shi et al. with vitrimer epoxy
through DIW approach where it had been processed over three cycles of printing,
dissolving (ethylene glycol), and again printing (Fig. 3.8) with intact design to the
endmost cycle of print. T had portrayed a pivotal role of attuning viscosity (by
building flow), partial crosslinking (130 °C, strengthening a safeguarding printing
geometry), dissolution of print (180 °C, for recycling), pre-curing (securing print at
60 °C), and post-curing (180 °C). Staircase challenge of printing had been subdued
by coating of same epoxy (surface mending) by T-steered fluidity and curing for
glossy finish in addition to repairing. Authors had also observed the enhancement of
interfacial linkages and fracture energy when T-aided heating persists for an extended
period [107].
Wang et al. had recycled un-scanned PA12 SLS powder (because adjacent laser
sintering had enhanced powder weight and reusing could deteriorate surface integrity)

Fig. 3.8 Thermoset vitrimer epoxy being printed and recycled (3 cycles in addition to original)
(1) and (2) involves formulating and pre-crosslinking followed by (3) DIW printing which is (4)
cured (in 2 steps) which also lead to darkening of color due to oxidation and curing (5) printed
entity being dissolved in polyethylene glycol (PEG) followed by subsequent printing (6) and again
following the loop {(2)–(6)}. However, the content of PEG is higher recycling (e.g., 3rd) > former
(1st or 2nd)
3 Thermal Effects in 3D Printed Parts 59

into FDM processed filament with reinforcements (carbon fiber). PA12 filament was
produced in twin-SE with zones varying 175–190 °C (die T ) → pelletized → dried at
60 °C to be re-extruded (174–199 °C in single-SE) as a composite. Authors printed
the outcome at 240 °C nozzle-T and 90 °C platform-T and observed that though
printed entity had not amplified thermal performance due to short fibers, mechanical
magnitudes of elastic/flexural strength and modulus had outstripped the precursor
[108]. Xu et al. had engineered scaffolds on petroleum jelly-coated substrate with
reusable ink comprising of alloyed steel with kinetically jetting out chitosan–acetic
acid (room-T evaporation) binder endowing a green body which was thereupon
sintered at 1165 °C. Furthermore, acidic solution-aided dissolution of wasted-out
parts for re-formulating in prerequisite ratio and re-printing accompanied by heat
treatment for carbon diffusion-assisted strengthening [109].
Before advancing as final product, post-processing of precursor materials
enhances the utility but is also associated with certain challenges, mitigation of which
can optimize product’s functioning. Printing techniques where post-densification or
sintering is progressed, material shrinks but its non-uniform change bestowed the
entity with numerous cracks and wastage or non-serviceable especially, in medial
where uniform porosity render effective circulation of fluids. With sintering in-
progression, high intensity of laser or presence of humidity on material can encourage
ablation, degradation, or vaporization of material and continuing can impair the
part with unintentional porosity, thus attenuating practical workability and therefore
necessitating optimal tuning of laser power and time of interaction. Yet another is
allied with the employment of support materials in which post-sintering or support
removal can close or destroy (large pore size generates) the interconnection between
pores. Additionally, while erasure of support structures required part can also be
damaged conferring inappropriate surface (or its incomplete removal) and thus
necessity arises in controlling the precision or accuracy of elimination [87, 110, 111].

3.4 Thermal Features in Biomedical Application

Realization of 3D printing in biological has diversified the tactics of treatment and

implantation as scientists or biologists can envision the criticality of design, its
functioning, allied challenges, etc., by modeling/simulation bestowing user-specific
medications. This enticing technology executes its strategy by counterfeiting nature
to trick physiological systems in working, in vitro culturing or proliferating cells
or tissue for organ generations, and scaffold-free therapeutics [1]. Implementation
of material through printing thrives with extrusion, inkjet, laser-assisted, or SLA
to yield scaffolds, organs, or drug carriers for treatment. For efficacious printing
of biomaterials (e.g., hydrogels, etc.), parameters like T, pressure, environment,
time, humidity, biocompatibility along with material properties are indispensable
and therefore necessitate for optimization in cell viability [112]. Printing of cell-
bearing ink, e.g., biodegradable PLA, imposes a challenge as it fluids out at T which
are beyond the tolerance of biological cells [113]. Inkjet printing requisites the
60 P. Rastogi et al.

controlled dispensing of successive drops on predetermined sites for 3D build-up

in z-axis. Two analogues of inkjet printing comprise of thermal and piezoelectric
in which either differs in driving force of dispensing, i.e., T and acoustics energy,
respectively. Outcome of localized invigoration in thermal inkjet is the concomi-
tant increase in bulk-T (~4 to 10 °C) but bestows user with speedy printing [1].
Other alternative is extrusion which is characterized by robotic-driven continuous
dispensing of shear-thinning materials (hydrogels) at physiological T. This technique
is propitious for high density of cell loadings but viability is compromised owing to
stress dispensing at nozzle [1, 114]. Laser-assisted printing avails ink coating (highly
viscous—<30 mPa/s) on laser absorbing layer which effectively sacrifices itself in
bubble form (vaporize due to heat) to propel ink toward the platform in user-defined
pattern controlled by laser position. This process is adapted by virtue of its high cell
viability (no nozzle stress on the ink in contrast to pre-mentioned extrusion) and
intricate/complex printing but confronts expensive manufacturing [114]. Yet another
printing process is SLA, although similar to non-biological applications printing but
is contrasted by the utilization of visible energy as a crosslinking medium due to the
inimical nature of UV [115].
Analogous to above-mentioned pre- and during printing in Sects. 3.2.2 and 3.2.3,
bioprinting also elicits features in T-controlled environment. As an instance, He
et al. constructed alginate–gelatin scaffolds where the viscosity of the mixture was
preserved to optimum (0.3–3 Pa s) at 37 °C by nozzle heating (as gelatin is inordi-
nately sensitive to T, gel at room-T while liquid at 37 °C [116]). This variable magni-
tude also expedited flow, thus mitigating nozzle occlusion; meanwhile, platform-T
was attuned to ~5 °C which ushered in crosslinking of gelatin structure, additionally,
also efficacious diffusion [117]. Tan et al. had also employed freezing platform-T
() for polyvinyl alcohol (PVA) to establish hydrogen bonding-networked structure
which also aided in soft gel engineering (e.g., in brain) [116]. Goyanes et al. had inves-
tigated three different polymeric materials (drug-carried) through FDM printing at
different nozzle-T determined by innate characteristics, e.g., 230 °C for PLA, 170 °C
for PCL, and 220–230 °C for PU. While extruding drug-loaded polymer–salicylic
acid, authors realized degradation of acid as well as drug at T of 170, 190, 60 °C
for either of them due to modified functionality governed by modulated interac-
tions. Moreover, improper solidification, cooling, and nozzle blockage had also been
obtained with drug incorporation and also T selection (heat) [104]. Owing to miscel-
laneous incidents (disease or accidents), quantification in patients is burgeoning every
year followed by anticipation for treatment (implantation). Correspondingly, bone
implantation (craniomaxillofacial) cases in market will also envisage a financial
inclination at 6.9% rate to 2.49 billion USD from 1.79 billion USD by the year
2021 [118]. These are customarily formulated with calcium phosphate (by virtue of
natural presence) at 1400 °C, subsequently quenched and crushed for later printing
[119]. Nevertheless, they (bones) are prone to T sensitivity (due to tissue’s vulnera-
bility toward it) and hence optimized not only to replicate the physiological environ-
ment but also to examine heat emanated during surgical piercing. On that account,
specific heat, thermal diffusivity, and conductivity are reckoned while prototyping
3 Thermal Effects in 3D Printed Parts 61

artificial bones. Tai et al. attained parametric magnitudes which are in approxima-
tion to natural bones as thermal diffusivity = 0.31 and 0.25 mm2 /s, Specific heat
= 1.23 and 1.29 kJ/Kg K, thermal conductivity = 0.65 and 0.59 W/m K for arti-
ficial (VisiJet PXL Core) & bovine bones, respectively [120]. Another exploration
for Bone tissue engineering was appraised by Rasoulianboroujeni et al. with poly
lactic-co-glycolic acid/TiO2 . Print initiated at nozzle-T of 160 °C and results vali-
dated enhancement of T g by 2 °C/10 wt% TiO2 with decomposition/degradation
onset shifted to 269.75 °C/352 °C (by DSC/TGA) (porosity augmentation) owing to
thermal energy sinking (absorption) by TiO2 [121]. In reference to above all litera-
tures, cell proliferation is principally progressed at body T to mimic it for in vitro
evaluation of materials and also as consequence of cell damage at high-T [116,
122]. Rheologically also, numeric of loss modulus and storage modulus in relation
to experimental T was an indicative of viscoelastic or solid-like state accompanied
by spreading phenomenon (proportional with T by virtue of its brisk solidification
at gelling T which aided in the upkeep of geometry) [123].
Thus, formulation prerequisites T (above ambient) mixing which are oftentimes
followed by cooling and storing of precursors of printing at T < 10 °C. The resultant
when printed also demands physiological T for flow-out viscosity and retrenched T
on ink or filament collecting surface for cell vitality. For cells to proliferate and be
viable, the culture approximates at bodily T to simulate its working in vitro as they
are exceedingly susceptible to external environment predominantly, temperature.

3.5 Conclusion

This chapter delineates T and thermal parametric variations and their resultant effect
on overall performance of printed body. Preeminence of T is widespread across
all stages of printing, compositions, material selection, and even after-treatments
to manipulate properties to desired output; in pre-printing stage, T is influential
for homogenization of additives, drying to eliminate humidity interference during
printing which can also engender defects. Second stage employs build platform-
T, laser-generated heat, nozzle-T, etc., that intervene in solidification and cooling
of the material, thereby impacting the interfacial properties. Last stage involves
sintering, various treatments, and other characterization tools which involve ramping
up and down T rate for characterizing decomposition, weight loss, and other for
concluding product’s stability and resistance in external environments. Lastly, this
document explores about the physiological T-driven bioprinting processes to miti-
gate vulnerability of cells and to mimic the bodily nature in vitro. Optimizing the
fundamental features attributes to utmost accomplishment of workable efficiency in
three dimensions and also explores material’s utility in full.
62 P. Rastogi et al.

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Prasansha Rastogi has completed her Master’s in Materials Science and Technology from
Defence Institute of Advanced Technology (DIAT), Pune, India in 2019. For Master’s thesis, she
has worked on 4D printing, which utilized smart materials having property of stimuli responsive-
ness and shape memory. Presently, she is doing PhD on 3D printing of foams, at the University
of Twente, Enschede, The Netherlands.

Mr. Swaroop Gharde is currently working as a Junior Research Fellow (JRF) in DIAT, Pune, and
holds Master’s degree in Computer-Aided Analysis and Design (CAAD) from Manipal Univer-
sity, Jaipur. His research interests include design and analysis of composite structures, 3D printing,
vacuum casting, polymer composite for different applications.

Prof. Balasubramanian Kandasubramanian is highly acclaimed for his contribution towards

the polymer processing and fabrication for various applications including antibacterial, smart
textiles, hydrophobic coatings, ablative materials, fire retardant fabrics waste water treatment,
biomimicking and polymer nanocomposite for defence applications and has 14 Indian patents with
more than 200 papers in peer-reviewed journals. He is the Head of the Department of Metallur-
gical and Materials Engineering, associated with DIAT (DU) from 2010 till date. He was actively
involved in the development of various research laboratory including polymer processing labora-
tory, characterization laboratories (FESEM, HRTEM, SAXS). His contribution towards the waste
water management was acknowledged and perceived by the National Water Academy, Pune, and
Board of Research in Nuclear Science (BRNS), Mumbai. Prof. Balasubramanian K. has been
68 P. Rastogi et al.

recognized by the Royal Society of Chemistry (RSC) for one of the most cited authors of the
year for his erudite work on super-hydrophobicity. They have gleaned the attention of Naval Post-
graduate School California, USA, and Naval Material and Research Laboratory (NMRL), DRDO
Ambernath, Ministry of Defence, India, for the development of hydrophobic, antifungal and anti-
corrosive coating for ship hulls. He is recently awarded with the prestigious award “Technology
Innovation in Petrochemicals and Downstream Plastic Processing Industry” from the Ministry of
Chemical and Fertilizers, Government of India for his contribution in polymer technology.
Chapter 4
Role of Imaging Data in Additive
Manufacturing for Biomedical
Applications

Gurminder Singh and Pulak M. Pandey

4.1 Introduction

Additive manufacturing (AM) has made a significant effect in several application

fields, especially in the biomedical applications. The ability to fabricate customized
or patient-specific scaffolds, prosthesis, or other implants has made a huge impact of
AM in the present era. The combination of digital image processing (DIP) tools and
other computer-aided design (CAD) techniques gives advantage to AM to fabricate
implants, organs, tissues, vascular structures, fixation devices, etc., for transplantation
and also as well for pre-surgery planning. AM has shown time- and cost-saving
potential during surgery in the present time [1]. The fabricated 3D model gives idea
and practice to the doctors to understand the complications of the operation.
Development of image scanning techniques has also rapidly increased the demand
of AM in the medical field. Generally, computerized tomography (CT) or magnetic
resonance imaging (MRI) scanning data is used to make 3D CAD model. There
are also other scanning methods such as ultrasound, laser scanning, and positron
emission tomography which are used to obtain patient data. The data presents exact
density, colour, or other features of the human body parts as of real-time parts. Each
slice of the data is joined to make 3D model by interpolation means. These scanning
methods are discussed in detail in the further sections. The developed 3D models by
image processing are further fabricated by AM techniques.
Generally, AM application has been classified in five different areas as shown in
Fig. 4.1. Medical model fabricated by using AM techniques has made the medical
learning more versatile and provided ease to the medical students. The development

G. Singh · P. M. Pandey (B)

Mechanical Engineering Department, Indian Institute of Technology Delhi, New Delhi, Delhi
110016, India
e-mail: [email protected]
G. Singh
e-mail: [email protected]
© Springer Nature Singapore Pte Ltd. 2020 69
S. Singh et al. (eds.), 3D Printing in Biomedical Engineering,
Materials Horizons: From Nature to Nanomaterials,
https://doi.org/10.1007/978-981-15-5424-7_4
70 G. Singh and P. M. Pandey

Fig. 4.1 Additive

manufacturing application in
the medical field

in AM for the metal printing techniques such as direct metal laser printing (DMLS),
selective laser melting (SLM), and electron beam machining (EBM) provides facility
to fabricate topological optimized implants or prosthesis for load-bearing applica-
tions. These patient-specific fabricated implants fit easily during surgical operations.
AM provided not only the ability to fabricate implants for surgery transplantations; it
also provides facility to fabricate organs or body part structures form the scanned data.
The fabricated part gave information to doctors for better understanding and practice
over the prototypes to reduce the surgery complications and time. Bio-manufacturing
or bio-printing is the upgrowing area in the AM filed. In bio-printing, the organs are
printed with different types of cells using bio-inks [2]. The detail description of the
bio-printing is given in the next sections of the present chapter.
Apart from the above-mentioned major applications, other developments in the
biomedical area due to the AM are summarized in the following points:
• Strength and surface quality enhancements in the implants or prosthetics.
• Production of topological optimized and lightweight implants.
• Reconstruction of soft tissues such as nose and cartilages.
• Development of surgical customized tools.
• Improved overall efficiency and reduced surgery time.

4.2 Motivation for Study

In current era, highly customized and precise implants, prosthetics, scaffolds, etc., are
required for successful and productive medical studies both laboratory or clinically
4 Role of Imaging Data in Additive Manufacturing … 71

Fig. 4.2 Number of

publications year-wise in
medical applications of AM.
Source Scopus

[3–5]. AM is a unique way of manufacturing to fulfil customization and precision

in the medical sector. In the last decade, more than 900 papers have been published
in the medical applications of the AM. Figure 4.2 depicts the yearwise number of
publications of AM in the medical applications. The number of research outcomes
in the present filed is increased rapidly in past five years with establishment and
development in the AM to utilize the digital image processing data for the customized
fabrications.
A study is required to understand the role of digital image processing in AM for
biomedical applications. In the present chapter, specific concentration has been made
to review the different image processing techniques used in the biomedical studies
with the combination of additive manufacturing techniques.

4.3 Image Capturing Techniques in Biomedical Area

There are different image capturing techniques available in the biomedical area to
scan the human body organs, tissues, bones, etc. The generally used techniques
with their principle, applications, advantages, and disadvantages are discussed in the
following subsections.

4.3.1 CT Scan

CT scan (earlier named as computerized axial tomography scan or CAT scan) gives
the inside organ information and to the depth of different density levels of a human
body. The X-ray intensity beam is used to capture different body parts such as shoul-
ders, bones, eyes, spinal cord, heart and also other inner parts. CT scan records
72 G. Singh and P. M. Pandey

Fig. 4.3 a Basic principle of CT scan and b CT image shade variation with density variation [9]

different patterns of densities with the help of multi X-rays and electronic detec-
tors to create images of the tissues or other body organs (ref. Fig. 4.3a). The multi
X-rays pass through the patient at a time from different axis [6]. The bright/dark
image quality depends upon the attenuation of X-rays. The higher attenuation of X-
rays gives brighter or whitish CT image; lower attenuation of X-rays gives darker or
blackish CT image. The variation or shades of CT scan image from lower to higher-
density specimens are shown in Fig. 4.3). The fast scanning provided in this tech-
nology helps to improve patient comfort and easiness. Especially, CT scan provided
visualization of different types of tumours or other small nodules to help doctors to
diagnose, otherwise difficult or cannot be seen by other technologies [7]. CT scan
bypasses the invasive angiography to provide clear 3D images (using different soft-
ware’s) to a surgeon [8]. It provides clear 3D images of the heart to a cardiologist
without using any invasive angiography. The demerits of the scanning technique are
it gives the risk of cancer by high dosage of radiation to the patient.

4.3.2 MRI Scan

In MRI scan (formerly known as nuclear magnetic resonance imaging or NMRI),

powerful magnetic field and radio frequencies are used to capture the detail structures
of the human body like heart, bones, liver, especially soft tissues, etc. The advantage
of an MRI scan is to provide details regarding normal and abnormal tissues [10].
In MRI, radiofrequency signals are generated from hydrogen atoms and absorbed
by the antennas after passing from the human body part [11]. The detected signals
by antennas are further converted into layers segments. Furthermore, the collective
layers present the different views of the scanned organ. The typical flow chart of the
MRI scan processing is shown in Fig. 4.4. As the human body consists of hydrogen
in different forms, it provides information regarding water and fat contents. The
blood circulation information is easy to access using an MRI scanner, which helps
to detect blood clots or blockages in cardiovascular or endovascular surgeries [12].
The technology is an accurate and safest method to detect different types of disease
without any pain to the patient. Also, it provides alternative information about curing
4 Role of Imaging Data in Additive Manufacturing … 73

Fig. 4.4 Flow chart of MRI scan processing [15]

the disease. The advantage of the MRI scan is that it provides typical information
such as swelling or bleeding in the organ, tumours in the brain, and inflammation
of the spine [13, 14]. It easily provides information about blood circulation, which
makes it different from other scanning techniques. The limitations are it involves loud
noises during the scan, and generally, scan is performed in an enclosed chamber.

4.3.3 X-Rays

X-rays are the ray lights like visible rays with a different wavelength. X-rays are
commonly used to capture dense parts of the human body. The rays easily pass
through the low dense tissues such as skin, organs and absorbed by the dense parts
such as bones [9]. The status of the dense parts is captured on X-ray films. These films
are similar to the film of a camera. These types of scanning facility are generally
used by dentists to diagnoses and for different broad variety treatments [16]. The
74 G. Singh and P. M. Pandey

limitation of X-rays is it gives the risk of cancer on the prolonged use, can cause
cell damage, and also can cause mutation disturbance in the DNA. This scanning
information has application to treat malign tumours, identify cracks, infections, and
also bone cancer.

4.3.4 Ultrasound

Sound waves are used to produce inside body pictures in the case of ultrasound.
This kind of scanning images is generally used to diagnose the cause of internal
organs infections, pain, and sometimes swelling [17]. It does not require any ionizing
radiations and is safe and non-invasive. This imaging is also known as sonography
or cardio-graphy. In this technique, an ultrasonic transducer is placed directly on the
patient skin with the help of a gel. The high-frequency ultrasonic sound waves are
transmitted through the skin to create images of the internal part. This is also helpful
to guide bypass surgeries and heart conditions after the heart attack. As it is the safest
capturing technique, the extensive research is going on to address the limitation of
the technique. The ultrasound scanning failed to capture large images and created
difficulty to capture the inside bone structure.

4.3.5 3D Scanning

In this type of scanning, cloud point data is collected to create a three-dimensional

model. A standard reference data is used to format the collected data for the merging
process to make models called as alignment. The structured light is falling on the
object in a series of patterns by a projector, and a camera captures the images of the
object in a cloud data form [18]. The basic difference of the 3D scanning from other
developed scanning technologies is that it captures the outer surface of the body,
whereas other technologies capture internal information such as tissues, different
organs, and bones. For a single scan, 3D scanning takes only a few seconds and
analyses the part quickly as compared to other techniques [19]. Three-dimensional
scanning major application in the medical industry is to ensure the fit of the implant
before surgery.

4.4 Software’s for Data Analysis

The different software packages are available to create a 3D model from the scanned
images by CT or MRI data. These software packages are helpful to make a virtual
surgery simulation platform consisted of anatomical structures, volume, size, and
complex shapes of tissues. Different companies have developed software to data
4 Role of Imaging Data in Additive Manufacturing … 75

analysis from DICOM or other format files. The important steps carried out to obtain
a 3D model from scanned data are briefly discussed in the coming sections. Gener-
ally used or recommended software packages advantages, disadvantages, and cost
analysis are shown in Table 4.1.

Table 4.1 Overview of established software packages used in the medical applications of AM
Software User-friendly Cost Advantages Disadvantages
Mimics +++ $$ • Most reliable and • Highly recommended PC
ISO-based software specifications required
• Provision to analyse the for installation and
3D model with finite working
element study
• Virtual surgery access is
available for surgery
planning
3D doctor + $$$ • FDA (US Food and Drug • Software working
Administration) environment is difficult
approved software for to understand
medical practices • A trained person is
• Can access more than required to use the
2000 sliced data with software
256 MB RAM
• Detailed analysis tools
are available in the parent
package (no additional
charges required for
other modules)
3D slicer + Free • Diffusion tensor data • Not approved for clinical
analysis and visualization uses
available • Subroutine programs
• Image-tracking module required for analysis
available for device
tracking
InVesalius ++ Free • Open-source and free • Must write codes for the
software development
• Required low PC
specifications
OsiriX imaging ++ $$$ • Desktop and mobile • Not advanced in
versions available post-processing functions
• Provision to access or measurement analysis
PET-CT and SPECT-CT
data for 3D and 4D
navigation
Gimias + Free • Movie control provision • Difficult to use
available for better • Required lot of plugins
visualization for different modules
• Open-source framework access
for dynamic analysis
76 G. Singh and P. M. Pandey

4.5 Additive Manufacturing

Additive manufacturing (AM) is a layer-by-layer manufacturing process to fabricate

3D realistic prototypes from a 3D designed model. Generally, models are designed
using CAD software or reverse engineering scanned model or model generated from
medical scanning method CT or MRI scan [20]. AM techniques give the advantage
to fabricate complex shape geometries at a reasonable cost and without the use
of any additional machining or tooling. The complex shapes bones, heart, custom
implants, and prosthetics can be easily fabricated within a few hours. AM is rapidly
advancing in the field of medical to manufacture patient-specific custom implants
[21–23]. AM provides ease to manufacture the customized shapes as per the patient
requirement. There are different types of AM techniques available in the market based
on different types of manufacturing principles. Several types of materials can be used
in different AM techniques. Many authors [24–35] have reviewed the different types
of AM techniques with their merits and demerits in literature. Apart from the present
additive manufacturing techniques (having high capital cost), different rapid tooling
or indirect additive manufacturing methods are also reported in the literature which
required low capital and manufacturing cost [36–46]. Generally used AM techniques
(in the present medical industry) based on different materials are shown in Fig. 4.5.

Fig. 4.5 Classification of AM techniques based on materials used in present medical industry
4 Role of Imaging Data in Additive Manufacturing … 77

4.6 Scan to 3D Model: Steps

The steps used to convert the scanning data to a three-dimensional prototype or

model are shown in Fig. 4.6. The description of the process stepwise is described in
the following sections.

4.6.1 Image Acquisition

Image acquisition is a crucial step in the creation of a 3D model from the scanned
images. Generally, CT and MRI scan data are used for image acquisition as these
files consist of hidden information of the organs such as skin, tissues, and bone. The
scanned data is saved in the DICOM or other compatible format and further used in
the image processing tools for segmentation.

Fig. 4.6 Steps to convert scanning data into a clinically used 3D model
78 G. Singh and P. M. Pandey

4.6.2 Segmentation

In the scanned data, different types of information are stored in a DICOM file. Some
of the data is of interest and some are useless. Therefore, the extraction of useful
data is required from the scanned data. Segmentation steps come into the picture
in the data processing. In segmentation, thresholding of the images is employed to
extract the region of interest. Thresholding is done layer by layer to check the data
in the form of voxel density. The required data is filtered by the selection of the
desired density range. Therefore, the high-density structure such as cortical bone is
easy to exclude or include during thresholding. In the case of thin structures such as
scanning data of cancellous bone, high accuracy and practice experience are required
during thresholding. Otherwise, it resulted in shrinkage of structure dimensions. The
selection of thresholding range is a crucial part of the data segmentation.
Interpolation is included during the segmentation to increase the resolution of
the contour data. Generally, CT-modeller software package is used to interpolate
the threshold sliced data with mathematical interpolation algorithms. Two types of
interpolation techniques (Bi-liner and C-spline) are used to increase the contour
resolution and to minimize the staircase effect. Bi-linear interpolation is used for the
liner or plane surfaces, and on the other side, c-spline is used for the curve or circular
surfaces. After thresholding and interpolation in the segmentation step, further data
is processed to make a CAD model.

4.6.3 Computer-Aided Design

The segmented part developed from the patient CT or MRI data is exported to stere-
olithography (STL) format. The STL file is imported to a computer-aided design
(CAD) package for editing. Further, the file is sliced using recommended slicer soft-
ware for the printer. The sliced data is saved as G-code file for the 3D printing
fabrication. CAD packages give facility to manipulate the STL file such as repair of
triangulation error and any other design feature. Several CAD packages exist in the
market, namely Solid-works, CREO or Pro-E, CATIA, Inventor, Unigraphics, etc.
The different CAD packages have their own demerits and merits that depend upon
the application requirement. The different types of CAD entities such as a circle,
sphere, cylinder, B-spline curves, and surfaces are used to repair and to change
the design feature of the STL file. Many CAD packages consisted of the interface
of finite element analysis (FEA) or other analysis modules for segmented model
design analysis. The analysis modules have used to analyse the material or design
capability by applying different types of stresses as per the application requirement.
These modules provide the ability to check the material and design implant capability
virtually before the 3D printing process. It is done to prevent any failure after the
fabrication of the implant. After the required changes and analyses, the STL file is
used for the 3D printing fabrication.
4 Role of Imaging Data in Additive Manufacturing … 79

4.6.4 3D Printing

The recommended steps for the 3D printing process after obtaining the STL file are
shown in Fig. 4.7. The initial steps for the 3D printing process are too optimized
orientation and slicing of the STL file. The optimized orientation reduced the fabri-
cation time and also supported material requirement for the overhanging parts [47].
Traditionally, the optimized orientation was carried out by optimized algorithms
by minimizing the use of support material and reducing time in a code compiler.
However, with advancement in technology, the optimized orientation modules are
available in the software provided by the AM companies. Support for hanging is
minimized to acquire fine surface finish on the fabricated part. Further, the optimized
oriented part is sliced with the help of slicing algorithms. Slicing step is crucial with
respect to the fabricated part surface finish and the fabricating time also.
The thin layer thickness minimized the cusp height phenomena and improved the
fabricated part surface finish and increased the fabrication time. As the surface finish
is directly related to the fabricated part outer surface, a different combination of
layer thickness can be used to acquire less fabrication time and better surface finish,
known as adaptive slicing [48]. In the developed AM software packages, the different
variation of the layer thickness is available which is selected as the application
requirement. Generally, for medical implant, 50 or 100 µm layer thickness is used
for the fabrication to acquire a high surface finish. Further after slicing, the file is
saved as the G-code (computer-aided manufacturing codes) file. The G-code file is
used to fabricate the extracted part from the scanned data on the 3D printing machine.
Different types of AM techniques are available depending upon the fabricated part
requirements (material, strength, etc.). These techniques are already discussed earlier.
A post-processing step is carried out after the fabrication of the part. Several
types of post-processing techniques such as acetone-vapour treatment shot blasting
process, high-jet power treatment were used in literature to improve the part surface
finish. Finally, the 3D printing part is transferred to the clinical or other application
use.

Fig. 4.7 Three-dimensional printing fabrication process steps

80 G. Singh and P. M. Pandey

4.6.5 Clinical Translation

Three-dimensional implants fabricated by AM techniques help in different treatments

and diagnoses of the diseases. It provides a better understanding between the doctors
and patients for addressing the treatments [49, 50]. The case studies discussing the
use of AM in the clinical trials are given in the next section.

4.7 Case Studies

AM process has shown enormous potential in the biomedical field. The advancement
in scanning techniques and digital image processing tools has provided a unique
way for the solid modelling of patient-specific human organs, bones, tissues, etc.
The extracted model from the scanned data was used with AM processes for the
fabrication with different materials for the applications. The use of AM techniques
has made an impact on both in vitro (carried outside the body) and in vivo (carried
inside the body) medical studies. The significant case studies from the literature are
discussed in the following subsections.

4.7.1 In Vitro

Several researchers [51–53] have reported successful attempts to use AM fabricated

in in vivo studies such as surgical planning and medical education. Different AM
techniques contribution towards different types of disease treatments are summarized
in Table 4.2. Significant contributions from the literature regarding improvement in
in vitro studies are elaborated below.
Wake et al. [49] demonstrated the role of AM using fused deposition modelling
(Stratasys) in the study of kidney tumour of a patient. The 3D model of the kidney
was extracted from the patient MRI scan data. Further, the kidney model was printed
by splitting to view the relationship of the renal tumour to the renal artery. Different
colour materials were used to 3D print to distinguish the parts. The process from
segmentation to 3D printing is shown in Fig. 4.8. It was revealed that the 3D printed
parts gave proper understanding for radiologists and enhanced the patient care.
Bernhard et al. [54] reported the 3D printing of kidney tumour models from
seven patient data. The object base stereolithography technique was used for fabri-
cation with different colours. Patient’s understanding was noted before and after the
model presentation on the visualization scale. It was revealed that the understanding
improvement was noticed in the patients for basic kidney physiology by 16.7%,
kidney anatomy by 50%, tumour characteristics by 39.3%, and the planned surgical
procedure by 44.6% after watching their own personal kidney’s 3D printed models.
The study helps for the better pre-surgical understanding of patients.
4 Role of Imaging Data in Additive Manufacturing … 81

Table 4.2 Contributions of different types of AM techniques in in vitro studies of biomedical

applications
S. No. Application 3D printing Summary References
technique
1 Temporal bone Fused deposition • The prototype was [57]
prototype modelling fabricated for the
educational training
quickly and at a
cheaper cost
• The prototype failed to
replicate bone density
and middle ear
structures
2 Transcatheter aortic Stereolithography • The prototype was [58]
valve prototype for fabricated with a
replacement study dimensional accuracy
of 0.1 mm from the
CAD model generated
from CT scan
• Nine patients designed
were examined and
correctly predicted in
six of nine patients
3 Segmented bone Fused deposition • The CT reconstruction [59]
prototype dimensional modelling parameters such as
analysis surface extraction,
segmentation, and
post-processing
extraction effects were
studied on the
dimensional accuracy
of the 3D model
• The study helps to
fabricate accurate
dimensions prototypes
4 Face bone tissue Extrusion base • The topological study [60]
printing was carried out from
the DICOM files
• The 4% less volume
difference was noted
with surrounding less
than 0.1 mm as
compared to the STL
mode
• Fabricated implant
successfully used in
the surgical planning
(continued)
82 G. Singh and P. M. Pandey

Table 4.2 (continued)

S. No. Application 3D printing Summary References
technique
5 Cadaveric temporal bone Fused deposition • The prototype was [61]
for operation study modelling fabricated for an
operation planning
study
• Drilling was carried
out on a prototype for
operation training
which minimized the
risk during operation
6 Thoracic aorta Polyjet 3D • Rapid vessel [62]
printing prototyping permits
the creation of a
concrete solid replica
of a patient’s vascular
anatomy
7 Orthopaedic product Selective laser • AM reduced the [63]
sintering product development
time and fabricated
patient-specific
surgical accurately
8 Shoulder, hip, knee, Fused deposition • Patient-specific [64]
mandible, radiotherapy modelling models were
face mask, wrist, spine fabricated to give
vertebrae, artery bypass surgeons a better
graft models understanding of the
realistic problem
9 Cranioplasty implant Different method • Reverse engineering [65]
compared and CT data were used
to design
patient-specific
implant by using CAD
techniques
• The technique will be
helped to fabricate
smooth fit implants
10 Femur segment and Selective laser • The study was carried [66]
customized scaffold sintering out to fabricate
patient-specific
scaffolds for the femur
bone
• AM is able to fabricate
topologically ordered
scaffold based on the
CT scan data
(continued)
4 Role of Imaging Data in Additive Manufacturing … 83

Table 4.2 (continued)

S. No. Application 3D printing Summary References
technique
11 Laparoscopic Polyjet 3D • Complex anatomy [67]
splenectomy printing structure was 3D
printed for educational
purposes
• The printer was
successfully able to
reproduce even the
small vessels and the
finest details

Fig. 4.8 Different steps carried out to the 3D print patient kidney with tumour [49]

Young et al. [55] studied the practical aspect of human developmental using AM
technique for biology education. The CT scan data of human embryonic and foetal
for different weeks was used to make 3D CAD models. Further, these models were
fabricated using stereolithography process for education purpose. The extracted CAD
model from 20-week foetal CT scan data and its 3D printed part are shown in Fig. 4.9.
It was noticed that the adopted approach improved the understanding of the students
about human gestational.

Fig. 4.9 a CT scan, b 3D CAD model, and c 3D printed model of 20-week foetus [55]
84 G. Singh and P. M. Pandey

Fig. 4.10 Three-dimensional printed model a with massive cardiac-tumour and b enlarged LV with
an aneurysm [21]

Yang et al. [56] evaluated the role of AM in trimalleolar fracture treatment. Fused
deposition modelling technique was used to fabricate thirty patients’ feet by using
their CT scan data. The effectiveness of the use of 3D printed parts was studied by
the questionnaire among the doctors and the patients. It was revealed that patient
satisfaction from doctor communication was around 9.3 out of 10. The 3D printed
prototypes effectively help the doctors for the operation plan and acted as an effective
tool for physician–patient communication.
Jacobs et al. [21] reported a case study about surgery planning to treat complex
heart disease. Left ventricular aneurysm and the right ventricular tumour were 3D
printed using CT and MRI scan data (ref. Figure 4.10). The surgeon was able to iden-
tify risk structures, assess the ideal resection lines, and determine the residual shape
after a reconstructive procedure. Using a 3D print of the LV aneurysm, reshaping of
the left ventricle ensuring sufficient LV volume was easily accomplished.

4.7.2 In Vivo

The use of AM in in vivo studies has shown a revolutionary change in medical

history. The in vivo studies using AM are difficult to carry out as it directly deals
with living beings. Few studies have been successfully reported in the literature for
clinical implantation of AM fabricated implants. The different AM techniques used
for in vivo studies are summarized in Table 4.3. A significant contribution of AM for
in vivo case studies is elaborated below.
Popov et al. [68] have discussed the fabrication of patient-specific titanium implant
for the foot surgery. The implant design, fabrication using EBM process, and implant
surgery are shown in Fig. 4.11. It was studied that the AM manufactured implants
were easy to fit and handle during the surgery. However, the manufacturing cost
of the customized implants was relatively expensive as compared to the traditional
process.
Khan et al. [69] reported the first in vivo case study of spinal prosthesis implan-
tation fabricated by the 3D titanium printing machine. The customized prosthesis
Table 4.3 Contributions of different types of AM techniques in in vivo studies of biomedical applications
S. No. Application 3D printing technique Summary References
1 Calvarial graft surgical planning and Stereolithography • Physical prototype saved time and cost during [73]
implantation surgery and gave a better idea to doctors for
performing surgery
• The less-dimensional deviation was observed
during implantation
2 Prosthetic sockets implantation Fused deposition modelling • Patient-specific prosthetic socket was [74]
fabricated
• AM reduced the design problem and time for
fabrication and provided better comfort and fit
as compared to the traditional process
3 Hemi-knee joint substitute Stereolithography and rapid tooling • A customized implant designed and [1]
implanted in a dog for trails
• The model was fabricated with a maximum
tolerance of 0.206 mm
• The implanted joint was able to regenerate the
4 Role of Imaging Data in Additive Manufacturing …

damaged knee functions

4 Maxillofacial prosthesis Stereolithography and rapid tooling • Patient-specific prosthesis was designed and [75]
fabricated to match the human mandible
• The implanted prosthesis has shown
remarkable changes in the chewing function
of the patient
(continued)
85
Table 4.3 (continued)
86

S. No. Application 3D printing technique Summary References

5 Chin implant Stereolithography and rapid tooling • Better aesthetic form and fitting of the implant [76]
as compared traditional processing implant
• Reduced the surgery time by pre-planning on
the physical model
• AM implant is accurate and provides easy
insertion of the prosthesis into the defective
site
6 Maxillofacial prosthesis Stereolithography and rapid tooling • Tremendous potential to fabricate lightweight [77]
custom prosthesis
7 Osteotomy treatment for tibial plateau Fused deposition modelling • Three-dimensional printing technology was [78]
fracture helpful to accurately design osteotomy
operation and reduce the risk of postoperative
deformity
• It decreased intraoperative blood loss, shorten
the operation time, and can effectively
improve the treatment effect
8 Treatment of cubitus varus deformity Stereolithography • Twelve male and six female cases were [79]
treated using 3D printed osteotomy
• The correction was confirmed with
radiographs and surgery found successfully
carried out
G. Singh and P. M. Pandey
4 Role of Imaging Data in Additive Manufacturing … 87

Fig. 4.11 a Patient-specific implant design, b fabricated implant using the EBM process, and
c implant surgery [68]

was designed from the CT scan data of a 65-year-old patient. After implantation, the
patient responded uneventful recovery and pain reduction in occipital neuralgia.
Malyala et al. [70] investigated the implantation of the 3D printed basal osseointe-
grated implant for maxillofacial surgery. CAD model was segmented from the acci-
dental patient CT scan data. Then, the implant was designed for repair of denture
jaws. Two-step printing was carried for surgical planning. First, designed implant
and patients damaged jaw were 3D printed using FSM technique, and mock surgery
was performed. After successful mock surgery, FEA analysis was performed in CAD
software to check stress concentration with titanium as an implant material. Laser
sintering technique was used to fabricate customized implant prosthesis with tita-
nium material. The fabricated implants using laser sintering technique and surgery
for implantation are shown in Fig. 4.12. The surgery was performed to implant the
prosthesis and carried out in less time as compared to conventional surgery times.
Mohammed et al. [71] used selective laser melting process to fabricate patient-
specific mandible implant. The titanium material was used for the fabrication of the
implant. The size and geometric precision of the final implant were also evaluated

Fig. 4.12 a Fabricated implant using laser sintering and b implant surgery [70]
88 G. Singh and P. M. Pandey

Fig. 4.13 a Radiograph demonstrating loosening of the glenoid component, b 3D-printed custom-
made metal backing with porous structure filling, and c radiograph of stable glenoid component
[72]

by reference to an FDM fabricated representative model of the patients surrounding

skeletal anatomy and found to be an excellent fit. This device will address many of the
shortcomings of current practice such as complications resulting from mandibular
fractures, missmatching fixation plates, and general plate failures.
Stoffelen et al. [72] reported a case study of glenoid implant surgery on a 56-
year-old woman. The radiograph images were taken to observe the destruction of the
glenoid. The CT scan data was used for the repairing of the bone. It was noticed that
the 22 cm3 bone was a loss from the joint. The porous implant was designed using
CT data and fabricated with titanium material using metal printing technique. The
fabricated part easily fitted to the bone and joint was observed over different time
periods. The radiograph image of defected glenoid, fabricated porous implant, and
radio graph of glenoid after surgery are shown in Fig. 4.13. It was observed that the
functional and radiologic results, in this case, remained excellent even after 2 years
of surgery.
Singh and Pandey [22, 80, 81] designed orthosis to address the problem of club
foot deformity. Patient-specific and adjustable orthosis was designed and fabricated
with help of selective laser sintering and rapid tooling to solve clubfoot problems of
newborn babies. The orthosis was developed rotation of three mutually perpendicular
planes and was subsequently tested on five patients over the duration of one week.
Clinical trials confirmed the reliability of the product to reduce the deformities within
short period of time (Fig. 4.14).

4.8 Conclusions and Future Scope

Additive manufacturing (AM) technology gives an advantage to fabricate 3D

complex shapes directly from the CAD models. In medical applications, AM has
been made a huge impact in different areas such as surgical planning, medical
education and training, fabricating patient-specific implants, surgical tools, pros-
thesis, orthotics, scaffolding, and tissue engineering. The combination of scanning
techniques, such as computerized tomography (CT), magnetic resonance imaging
4 Role of Imaging Data in Additive Manufacturing … 89

Fig. 4.14 a Fabricated and b applied orthosis for correction of clubfoot deformity [81]

(MRI), and ultrasound and image process tools such as MIMICS and 3D doctor,
helps to model the patient-specific implants, organs, surgery models, etc. The scan-
ning techniques and image process techniques have been discussed in detail in the
present chapter. It was revealed that the scanning techniques have shown potential
to capture in-depth images from the outer surface to inner parts of the human body.
Renowned data conversion software’s were discussed and compared on the basis
of cost, advantages, and disadvantages. Few software’s are available freeware and
presently in the development stage with limitations. The important steps for conver-
sion of scanned data to 3D printed parts were also given with step’s description.
Significant contribution of AM in vivo and in vitro case studies has been discussed. It
was revealed that the AM techniques have played an important role in the biomedical
field.
Due to different limitations such as high capital and fabrication cost, AM is diffi-
cult to use in everyday clinical practice yet. In the future, AM will have a better
product customization and fabrication at a low or reasonable cost. The enormous
potential in the technique promises development of new application in the fields of
individual patient care, research activities, etc. It minimized the unkind side effects
and has shown its capability to justify numerous challenges in the biomedical research
and development sector.

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applications. Eur Polym J 114:234–248. https://doi.org/10.1016/j.eurpolymj.2019.02.035
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material structures primed by low-cost polymer printer. Rapid Prototyping J 25:152–161.
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36. Singh G, Pandey PM (2019) Ultrasonic Assisted Pressureless Sintering for rapid manufac-
turing of complex copper components. Mater Lett 236:276–280. https://doi.org/10.1016/j.mat
let.2018.10.123
37. Gill SS, Kaplas M (2009) Comparative study of 3D printing technologies for rapid casting of
aluminium alloy. Mater Manuf Process 24:1405–1411. https://doi.org/10.1080/104269109029
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38. Singh S, Singh R (2015) Wear modelling of Al-Al2 O3 functionally graded material prepared by
FDM assisted investment castings using dimensionless analysis. J Manuf Process 20:507–514.
https://doi.org/10.1016/j.jmapro.2015.01.007
39. Singh JP, Pandey PM (2018) Fabrication and assessment of mechanical properties of open
cell porous regular interconnected metallic structure through rapid manufacturing route. Rapid
Prototyping J 24:138–149. https://doi.org/10.1108/RPJ-04-2015-0043
40. Mun J, Yun BG, Ju J, Chang BM (2015) Indirect additive manufacturing based casting of
a periodic 3D cellular metal - Flow simulation of molten aluminum alloy. J Manuf Process
17:28–40. https://doi.org/10.1016/j.jmapro.2014.11.001
41. Singh G, Pandey PM (2018) Design and analysis of long-stepped horn for ultrasonic assisted
sintering. In: 21st International conference on advances in materials and processing technology
(AMPT). Dublin, Ireland
42. Sharma P, Pandey PM (2018) Morphological and mechanical characterization of topologically
ordered open cell porous iron foam fabricated using 3D printing and pressureless microwave
sintering. Mater Des 160:442–454. https://doi.org/10.1016/j.matdes.2018.09.029
43. Sharma P, Pandey PM (2018) A novel manufacturing route for the fabrication of topologically-
ordered open-cell porous iron scaffold. Mater Lett 222:160–163. https://doi.org/10.1016/j.mat
let.2018.03.206
44. Sharma P, Pandey PM (2018) Rapid manufacturing of biodegradable pure iron scaffold using
amalgamation of three-dimensional printing and pressureless microwave sintering. Proc Inst
Mech Eng Part C J Mech Eng Sci, 0:1–20. https://doi.org/10.1177/0954406218778304
45. Singh G, Pandey PM (2019) Uniform and graded copper open cell ordered foams fabricated
by rapid manufacturing: surface morphology, mechanical properties and energy absorption
capacity. Mater Sci Eng, A 761:138035. https://doi.org/10.1016/j.msea.2019.138035
92 G. Singh and P. M. Pandey

46. Singh G, Pandey PM (2019) Rapid manufacturing of copper components using 3D printing and
ultrasonic assisted pressureless sintering: experimental investigations and process optimization.
J Manuf Process 43:253–269. https://doi.org/10.1016/j.jmapro.2019.05.010
47. Thrimurthulu K, Pandey PM, Reddy NV (2004) Optimum part deposition orientation in fused
deposition modeling. Int J Mach Tools Manuf 44:585–594. https://doi.org/10.1016/j.ijmach
tools.2003.12.004
48. Pandey PM, Reddy NV, Dhande SG (2003) Real time adaptive slicing for fused deposition
modelling. Int J Mach Tools Manuf 43:61–71. https://doi.org/10.1016/S0890-6955(02)001
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rapid prototyping. Rapid Prototyping 9:167–174. https://doi.org/10.1108/13552540310477472
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of lateral tibial plateau fracture. Injury 47:2816–2821. https://doi.org/10.1016/j.injury.2016.
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80. Khas KS, Pandey PM, Ray AR (2013) Rapid manufacturing of a clubfoot model imitating
soft tissue and bones rapid manufacturing of a clubfoot model imitating soft tissue and bones
This paper reports an exploration of fabricating a composite clubfoot model consisting of both
soft and hard ti. Virtual Phys Prototyping 8:187–192. https://doi.org/10.1080/17452759.2013.
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dimensional correction of clubfoot deformity. Clin Biomech 51:67–75. https://doi.org/10.1016/
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94 G. Singh and P. M. Pandey

Dr. Gurminder Singh has completed his PhD from mechanical engineering department of Indian
Institute of Technology Delhi, India. He is currently working in the area of 3D printing combined
with ultrasonic-assisted sintering. He is a young scientist having two patents and five journal
publication. His research interests are 3D printing, material development for biomedical applica-
tions, powder metallurgy, CAD/CAM and mechatronics.

Prof. Pulak Mohan Pandey is professor in the mechanical engineering department of Indian
Institute of Technology Delhi, India. He joined IIT Delhi as a faculty member in 2004 and is
presently serving as Professor. In IIT Delhi, Dr. Pandey diversified his research areas in the field
of micro- and nano-finishing, micro-deposition and also continued working in the area of 3D
printing. He supervised 30 PhDs and more than 34 M.Tech theses in last 10 years and also filed 17
Indian patent applications. He has approximately 154 international journal papers and 45 interna-
tional/national refereed conference papers to his credit. These papers have been cited for more
than 4403 times with h-index as 33. He received Highly Commended Paper Award by Rapid
Prototyping Journal for the paper “Fabrication of three-dimensional open porous regular structure
of PA 2200 for enhanced strength of scaffold using selective laser sintering” published in 2017.
Many of his B.Tech. and M.Tech. supervised projects have been awarded by IIT Delhi. He is recip-
ient of Outstanding Young Faculty Fellowship (IIT Delhi) sponsored by Kusuma Trust, Gibraltar
and J. M. Mahajan outstanding teacher award of IIT Delhi. His students have won Gandhian
Young Technological Innovation Award (GYTI) in 2013, 2015, 2017 and 2018.
Chapter 5
Additive Manufacturing in Bone Tissue
Engineering

Majid Fazlollahi, Yasaman Pooshidani, and Mahnaz Eskandari

5.1 Introduction

The human skeleton helps the body to maintain its form and provides mechanical
backing for the system included inside. It also plays a crucial role in the muscu-
loskeletal system that provides us the ability of movement. Bone is a complex
composite material that differs from other tissues in the body. This composite struc-
ture owes its hardness and strength the hydroxyapatite crystals, and collagen fibers
provide the flexibility of this structure to avoid being fragile. Thanks to its unique
structure, the bone is simultaneously durable and comparatively lightweight. The
bone marrow forms the inner part of the bone. Two primary kinds of bone tissue
surround it: cortical bone as the tough, exterior crust, and trabecular bone as the
spongy center. Having a porosity less than 10%, the compact bone (cortical bone) is
highly dense and also has orthotropic properties due to the rounded osteons. The inner
layer of the bone is spongy bone (cancellous bone) that has a trabecular structure
which contains osteocytes within the lacuna. Spongy bone has a porosity of 50–90%,
which reduces bone weight, while due to the growth of trabecula in the direction of
imposed tension, it has high anisotropic strength so shows a high load-carrying
capacity in the direction of trabeculae.
Four different types of cells form the bone tissue: osteogenic, osteoblast, osteocyte,
and osteoclast, each of which has its own function and characteristics. The primary
cells are osteogenic cells which have not yet been differentiated. These cells turn into

M. Fazlollahi (B)
Mechanical Engineering Department, Amirkabir University of Technology (Tehran Polytechnic),
Tehran, Iran
e-mail: [email protected]
Y. Pooshidani · M. Eskandari
Department of Biomedical Engineering, Amirkabir University of Technology (Tehran
Polytechnic), Tehran, Iran

© Springer Nature Singapore Pte Ltd. 2020 95

S. Singh et al. (eds.), 3D Printing in Biomedical Engineering,
Materials Horizons: From Nature to Nanomaterials,
https://doi.org/10.1007/978-981-15-5424-7_5
96 M. Fazlollahi et al.

osteoblast cells after differentiation. The osteoblast is the main cell for the production
of new bone, and when this cell becomes embedded in the material it has secreted,
it becomes osteocyte, the most prevalent kind of cell observed in bone tissue. The
osteoclast cells function is absorbing the old or damaged bone. The balance between
the osteoblast and osteoclast cells results in the destruction of the old bone and the
formation of a new bone that is essential for proper bone function. Figure 5.1 depicts
the structure, cells, and layers of bone [1]. Also, the function and location of bone
cells can be found in Table 5.1 [1].
Bone damage is a common injury, so much so that about 6 million people suffer
from this injury each year in the USA, of which about 500,000 people need bone
grafts [2]. These numbers indicate that while most bone defects are healed sponta-
neously due to the bone self-healing properties, but still a large number of injuries
require implants and surgery for bone remodeling. The demand for joint and bone
replacement is increasing rapidly [3]. The bone remodeling process can be viewed
as five different stages: resting, activation, resorption, reversal, and formation [4].
Osteoclast cells (for absorbing damage bone) and osteoblast cells (for the production
of new bone) have an essential part in these steps. During the formation of new bones,

Fig. 5.1 Structure of bone; a cortical bone, b cancellous bone [1]

Table 5.1 Bone cells [1]

Cell type Function Location
Osteogenic cells Develop into osteoblasts Deep layers of the periosteum and the
marrow
Osteoblasts Bone formation Growing portions of bone, including
periosteum and endosteum
Osteocytes Maintain mineral concentration of Entrapped in matrix
matrix
Osteoclasts Bone resorption Bone surfaces and at sites of old,
injured, or unneeded bone
5 Additive Manufacturing in Bone Tissue Engineering 97

trabeculae grow along the direction of imposed stress due to the property of mechan-
otransduction while osteocytes act as mechanical sensors to sense this mechanical
stimulation (tension).
Today, still autograft and allograft are employed to treat a large-scale bone defect.
In these methods, the bone is extracted from the part of the body of patient or donor
which is not a load-bearing bone, and it is implanted in the defect site. But in the
recent years, limiting factors such as the lack of donated organs, the transmission of
certain diseases, and the insufficient integration into the damaged bone have made
scientists keen to use bone tissue engineering (BTE) to form a new bone and implant
it in the defective area [5].
BTE involves the employment of bio-scaffolds to create a supportive structure as
a basis for the growth of the new tissue. Scaffolds are porous structures which act as
a temporary template to guide and support osseous regeneration. Cell culture can be
carried out in scaffolds under laboratory conditions, and then the created tissue be
placed in the defect site to continue to grow and incorporate into the body. Scaffolds
can also be planted directly on the defect area, and the tissue is grown using the body’s
own system. For this purpose, BTE scaffolds should provide the desired mechanical
and biological properties. More precisely, a BTE scaffold must have the following
properties [6, 7]:
1. Similar mechanical properties to the adjacent bone
2. Biocompatibility
3. Biodegradability
4. Suitable porosity and geometry for cell infiltration and growth
5. Proper stimulation of cells to growth (osteoconductivity and osteoinductivity).
Various materials are used to make BTE scaffolds depending on the advantages
and disadvantages of each material. Most BTE scaffolds are made of ceramics, but
these materials do not fully meet the mechanical properties requirements due to their
fragility. Natural and synthetic polymers are also used for BTE scaffolds. Although
producing polymeric scaffolds is much easier than other materials processing, most
polymer scaffolds break down rapidly in the body and create an acidic environment
that is hazardous to the body’s tissue. Scaffolds made of metals and alloys show
outstanding mechanical characteristics, but biodegradability remains a major chal-
lenge for them. Therefore, considering the pros and cons, different materials are used
for the construction of scaffolds [8, 9].
The fabricating method is a criterion for designing BTE scaffolds that can affect
all of the scaffold properties. There are several methods for making scaffolds that
can be referred to as freeze-drying, solvent casting, gas forming, thermally induced
phase separation, sol-gel method, and electrospinning. These methods do not provide
satisfying controllability regarding the characteristics of pores such as geometry, size,
and interconnectivity of pores, which results in loss of desired mechanical and fatigue
life properties. Consequently, there was a need for a better method with higher control
capabilities, and additive manufacturing (AM) method was the most suitable option
to fulfill this goal [10].
98 M. Fazlollahi et al.

In the AM or 3D printing method, the scaffold is created layer by layer to create

a three-dimensional structure employing a CAD model [11]. By using this method,
complex structures can be created without the need for molds and tools, which makes
it ideal for producing patient-specific implants. Due to its unique advantages, the
usage of 3D printing in the industry has been dramatically increased during the recent
decade [12, 13]. Powder-bed-based and powder-fed-based 3D printing methods have
been widely studied for the production of BTE scaffolds from metals and alloys. The
results show that these scaffolds have excellent mechanical and biological features,
biocompatibility and also biodegradability (in case of using proper alloy) [14–16].

5.2 AM and Its Application in the Fabricating of BTE

Scaffolds

As mentioned, the AM process requires no tools and mold to produce complex shapes
and also has a very good control capability that makes this technology suitable for
BTE scaffold manufacturing. Using the CAD file and extracting the STL output, the
printer builds the desired structure as a successive layer print. Depending on the mate-
rial or method on which the materials are laid down, scaffolds with different properties
can be made. Therefore, two important parameters in the scaffold production process
are the type of materials and the technology adopted.

5.2.1 Different AM Methods

AM methods are divided into different categories, depending on whether they are
powder-bed, powder-fed, or wire-fed, and also depending on whether their energy
source is laser, electron beam, or plasma arc. Table 5.2 shows seven types of this
technology and their features, which are divided by the American Society for Testing
and Materials (ASTM) [5, 17].
Table 5.3 also compares these methods in a qualitative way [17]. In most of the
new studies on BTE scaffolds, SLM and EBM methods have been used for their high
accuracy and controllability.

5.2.2 Biomaterials

In general, the biomaterials employed in BTE scaffolds are divided into four cate-
gories: ceramics, metals, polymers, and composites, which are a combination of the
three previous types. Depending on the required properties, one of these four types
is selected.
Table 5.2 Different AM methods
AM technology Brief Applicable Advantages Disadvantages Reference
description materials
Powder bed and inkjet 3D • Placing Polymer, ceramic, • Applicable to • Optimization [18, 19]
Printing or binder jetting (3DP) binder on metals (stainless a wide variety is required
metal steel, iron, of materials • Post
particles, cobalt-chromium • No heat source processing is
• Curing the alloy, zirconium, is employed required
binder to tungsten, etc.), through the • Shows
keep the other powders printing undesirable
particles porosity
together,
• Sintering or
consolidating
the bound
particles
• Infiltrating
with a second
5 Additive Manufacturing in Bone Tissue Engineering

metal
(Optional)

(continued)
99
Table 5.2 (continued)
100

AM technology Brief Applicable Advantages Disadvantages Reference

description materials
Selective laser sintering (SLS) • Use of laser Thermoplastics, • Applicable to • Post [20]
to sinter the ceramic a wide variety processing
2D cross powders and of materials required
section layer metal powders • No support
according to (stainless steel, design
the CAD cobalt-chromium required
model alloy, titanium,
• Layer by etc.)
layer
addition of
particles

(continued)
M. Fazlollahi et al.
Table 5.2 (continued)
AM technology Brief Applicable Advantages Disadvantages Reference
description materials
Selective laser melting (SLM) • Similar to the Metal alloys -High • Post [7, 21]
SLS process, powders processing processing is
expect for (Stainless steel, resolution required
melting iron based alloys, • High strength; • High quality
powder titanium, gold, Full dense requirements
instead of silver, etc.), parts for metal
sintering ceramic powders particles and
powder to restricted
adhere piece size
material
together
5 Additive Manufacturing in Bone Tissue Engineering

(continued)
101
Table 5.2 (continued)
102

AM technology Brief Applicable Advantages Disadvantages Reference

description materials
Electron beam melting (EBM) • Like the Metal powders • Full dense • Applicable to [19, 22]
SLM (Titanium alloys, parts a limited
process, but cobalt • Metal does not variety of
electron chromium alloy) oxidize Easily materials
beam under because of • Post
vacuum is vacuum processing
applied to environment required
melt the • No support
metal not a design
laser required

(continued)
M. Fazlollahi et al.
Table 5.2 (continued)
AM technology Brief Applicable Advantages Disadvantages Reference
description materials
Direct metal laser sintering (DMLS) • Depositing a Metal powders -High • High costs • [23]
slight film of (aluminum, processing Not proper for
particles on bronze, resolution the materials
the surface cobalt-chrome, • Full dense with inferior
• Use of laser stainless steel, parts ductility
to sinter the titanium, etc.)
powder
gradually
5 Additive Manufacturing in Bone Tissue Engineering

(continued)
103
Table 5.2 (continued)
104

AM technology Brief Applicable Advantages Disadvantages Reference

description materials
Direct metal deposition (DMD) • A melt pool Ceramics, Metal • Fully dense -Not repeatable [24]
is formed on powders (Iron, meta enough
the titanium, etc.) • Controllable • Post
underneath microstructure processing
material by required
using Laser
• Then the
other particle
(or wire) is
transferred
into the melt
pool

(continued)
M. Fazlollahi et al.
Table 5.2 (continued)
AM technology Brief Applicable Advantages Disadvantages Reference
description materials
Electron beam additive manufacturing (EBAM) • Electron Metals (Titanium • No support • Not [19, 25]
beam melts alloys, cobalt design sufficiently
the metal chromium alloy) required fine texture
layers (as • Prevents metal • Low precision
particles or oxidization
wire) due to vacuum
successively condition
to obtain the
final
configuration
5 Additive Manufacturing in Bone Tissue Engineering
105
106 M. Fazlollahi et al.

Table 5.3 Qualitative comparison of different AM methods [17]

AM Resolution Build Surface Power Build Residual Cost
process speed roughness efficiency volume stress
3DP Poor Fast Poor – Big Low Low
SLS Good Slow Excellent Poor Small High High
SLM Good Slow Excellent Poor Small High High
EBM Moderate Fast Good Good Small Moderate High
DMLS Good Slow Excellent Poor Small Low High
DMD Poor Fast Poor Poor Big High Moderate
EBAM Moderate Moderate Good Good Small Moderate High

5.2.2.1 Ceramics

Calcium phosphate (CaP) ceramics have composition characteristics near to the bone
properties. This feature makes them extremely popular in using as BTE scaffolds
material. For example, hydroxyapatite (HA) powder was one of the first materials
used to make BTE scaffolds through AM. Tricalcium phosphate (TCP) is also highly
regarded due to its better biodegradability than HA. Having good bioactivity bioglass
ceramics are also used in BTE scaffolds, for example 45S5 bioglass. However, they
do have not suitable capacity to withstand loads [26].

5.2.2.2 Metals

Having excellent strength, metallic biomaterials are of great importance in the fabri-
cating of BTE scaffolds, especially with the advent of AM technology that allows
controlling the structure of scaffolds. Ti-based biomaterials have high corrosion and
fatigue resistance and also excellent biocompatibility. Additionally, iron-based alloys
and cobalt-based alloys are highly regarded due to their excellent strength and good
corrosion resistance.

5.2.2.3 Polymers

Polymers are the first materials used by the AM process and are highly regarded for
their excellent processability. Polymers divide into two general classes: natural and
synthetic. One of the most important natural polymers is collagen, which is known
as the “extracellular matrix” (ECM). This polymer has many uses in the AM process
of BTE structures. Other natural polymers like cellulose, chitosan, and starch have
also been scrutinized for this work.
Synthetic polymers have interesting properties, such as physical, chemical, and
mechanical properties that make them attractive. Polycaprolactone (PCL) is one
of the most generally utilized synthetic polymers for making BTE structures. Other
5 Additive Manufacturing in Bone Tissue Engineering 107

synthetic polymers as for example polyglycolic acid (PGA) and polylactic acid (PLA)
are likewise commonly used. Another example is polyether-ether-ketone (PEEK)
in which its mechanical properties is near to bone, as well as excellent chemical
resistance, and radiolucency [27].

5.2.2.4 Composites

The combination of the three types of previous biomaterials can provide the desired
properties, which has directed to the improvement of composite biomaterials for BTE
scaffolds. Ceramic composites, such as biphasic calcium phosphate (BCP), which
combines HA and TCP, have good properties like biocompatibility and biodegrad-
ability which make them ideal for utilization in the BTE scaffolds. Also, additives
such as MgO, ZnO, and SiO2 are promising to improve CaP scaffolds. For example,
studies have shown that adding ZnO and SiO2 particles to TCP can improve bone
growth [28].
The combination of brittle ceramics and flexible polymers can provide extraor-
dinary properties. Collagen–calcium phosphate scaffolds are an example of these
composites which are widely used in AM of BTE. Other polymer–ceramic compos-
ites are also used in BTE scaffolds. For example, PLG A/β-TCP/HA nanocomposite
scaffolds exhibited interesting biocompatibility and drug delivery properties [29].
Metal composites, like titanium alloys with TCP coating, showed an increase in
cell adhesion as well as cell proliferation.

5.3 Architectural Design of BTE Scaffolds

Architecture design affects all properties of the BTE scaffold. The size and shape of
the pores as well as the interconnectivity of porosities have a notable impact on the
growth of the cells. In addition, metal scaffolds have wide variety of applications in
BTE, but as they have more strength compared to the adjacent bones, they cause flaws
like implant loosening and bone resorption. Therefore, fabricating porous structures
can be the golden standard to use metal and alloy scaffolds for BTE. Using the AM
method, the shape and size of pores can be controlled unlike most other methods that
result in a stochastic structure.

5.3.1 Scaffold Library

Designing a suitable unit cell and repeating it as a pattern, will result in a struc-
ture with desired porosity. These unit cells can be truss, polyhedron, or triply peri-
odic minimal surface (TPMS). Design methods for these unit cells are based on
108 M. Fazlollahi et al.

CAD modeling, medical image such as CT and MRI, implicit surface modeling, and
topology optimization.

5.3.1.1 Polyhedron

There are two criteria for designing a unit cell: 1. only by connecting vertices and
edges it can be repeated in three-dimensional space, 2. it should be producible. A unit
cell with many small surfaces would have a complex shape which makes it virtually
impossible to produce. Based on these two criteria, there are 11 types of polyhedron
unit cells [30]. They are, namely the cube, truncated octahedron, cuboctetradron,
truncated cube, rhombiducoctehedron, truncated cuboctahedron, triangular prism,
hexagonal prism, rectangular prism, octagonal prism, and rhombic dodecahedron.
Figure 5.2 shows these 11 types of polyhedron unit cells. These 11 types of cells are
divided into two groups, based on the fact that after being placed together, an empty
space is created between them or not. Figure 5.3 shows an illustration of two types
of assembly of cells. In Fig. 5.4, scaffolds created by repeating these 11 types of unit
cells can be seen. Analytical solutions have been studied extensively for obtaining
mechanical properties related to the various unit cell geometry.

Fig. 5.2 11 polyhedron assembly of cells (scale 50:1). Forward row (L–R): truncated octahedron,
square pyramid, rhombic dodecahedron; middle row (L–R): octagonal prism, square prism, trian-
gular prism, hexagonal prism; back row (L–R): truncated cuboctahedron, rhombicuboctehedron,
truncated cube, cuboctahedron [31]
5 Additive Manufacturing in Bone Tissue Engineering 109

Fig. 5.3 Examples of cells that: a occupy space without leaving holes (three hexagonal prisms),
and b span 3D space by creating holes (four truncated cubes) [30]

Fig. 5.4 11 sample scaffold arrangements (scale 10:1). Forward row(L–R): rhombicuboctehedron,
truncated cuboctetradron, truncated cube, cuboctetradron; Middle row (L–R): rhombic dodeca-
hedron, square pyramid, truncated octahedron; Back row (L–R): square prism, hexagonal prism,
triangular prism, and octagonal prism [31]

5.3.1.2 TPMS

Surface shape also has a critical influence on the growth of bone cells. Studies
show that the concave surface of the scaffold is more useful for cell attachment and
proliferation than the smooth or curved surfaces [32]. But since the natural trabecula
110 M. Fazlollahi et al.

curvature is almost zero, a novel unit cell was developed, called TPMS. The TPMS
shows an unlimited structure in three free directions, with an average curvature of
zero. The TPMS porous structure is made with repeating the unit cells with the least
possible area [33]. There are four types of TPMS, each of which can be expressed
with implicit functions as follows [34]:
Gyroid surface:

F(x, y, z) = cos(x) . sin(y) + cos(y) sin(z)

+ cos(z) . sin(x) + α (1)

Schwarz diamond:

F(x, y, z) = sin(x) sin(y) . sin(z) + sin(x) . cos(y) . cos(z)

+ cos(x) . sin(y) . cos(z) + cos(x) . cos(y) . sin(z) + α (2)

Neovius surface:

F(x, y, z) = 3(cos(x) + cos(y) + cos(z))

+ 4(cos(x) . cos(y) . cos(z)) + α (3)

D-prime surface:

F(x, y, z) = 0.5(sin(x) . sin(y) . sin(z) + cos(x) . cos(y) . cos(z))

− 0.5(cos(2x). cos(2y) + cos(2y) . cos(2z)
+ cos(2z)cos(2x)) + α (4)

x, y, and z are Cartesian coordinates, and α is offset value, which can be used to
control the porosity of the structure. Figure 5.5 shows some examples of TPMS. The

Fig. 5.5 Some examples of the triply periodic minimal surfaces (TPMSs) [36]
5 Additive Manufacturing in Bone Tissue Engineering 111

most popular TPMS structure for BTE scaffolds is gyroid. Comparison of mechan-
ical features of gyroid TPMS with stochastic scaffolds produced through prticle-
leaching with the same porosity percentage showed that scaffold permeability and
tissue growth were significantly higher in gyroid TPMS scaffolds [35]. The gyroid
TPMS scaffolds have two types of morphology, minimal surface network solids, and
minimal surface sheet solids. Albeit sheet solid gyroid structure has better mechanical
properties, and it does not have pores interconnectivity, which is a major drawback for
cells penetration and tissue growth. On the other hand, network solid gyroid structure
has good mechanical characteristics as well as good pores interconnectivity, which
make it suitable for use in BTE scaffolds.

5.3.1.3 Truss

Trusses are also another form of unit cells that are created by connecting the points
with struts. The truss unit cells can be elementary cubic truss, elementary non-cubic
truss, complex truss, or compound truss, which are derived from the combination of
two trusses in a spatial network [37]. Figure 5.6 shows some examples of these truss
unit cells.

5.3.2 Functionally Graded Scaffolds (FGSs)

In order to mimic the mechanical properties, morphology, and physiology of the

human body bone, it is necessary to have scaffolds that have gradient porosity and
even gradient type of unit cell. Simply, a uniform porous structure cannot be suitable
for the regeneration of a large-scale segmental bone damage with complex mechan-
ical and biological function. There are four types of FGS for different applications
[38]:
1. FGS with different strut diameters: Changing the strut diameter can result in
desired changes in the pore size.
2. FGS with different cells sizes: Pore size and strut diameter can be changed by
changing the cell size
3. FGS with various kinds of unit cells: By this method, desired pore size and strut
diameter, in addition to the optimal porosity can be achieved in each section.
4. FGS with different chemical compositions: A porous construction which has
a favorable gradient in mechanical properties can be obtained by changing the
composition of the scaffold through the use of various materials.
Among these structures, varying strut diameter is more widely used because of
its simplicity and lack of flaws, such as mismatching nodes. Figure 5.7 shows these
four strategies.
Also, various kinds of porous structures can be found on the basis of the types of
unit cells in Fig. 5.8.
112 M. Fazlollahi et al.

Fig. 5.6 Some examples of the truss unit cells [37]

5 Additive Manufacturing in Bone Tissue Engineering 113

Fig. 5.7 Schematic picture of different designs of FGS and their qualities [38]

Fig. 5.8 Various designs of scaffolds on the basis of different types of unit cells [17]
114 M. Fazlollahi et al.

5.4 Experimental Studies on the Additively Manufactured

BTE Scaffolds

Since the additively manufactured BTE scaffolds do not match exactly with the
theoretical models and are so complex, many empirical studies have been done to
understand the behavior of these scaffolds in different conditions. The prediction of
mechanical behavior of scaffolds through finite element (FE) simulation is a very
effective tool for studying these scaffolds. Conducting mechanical tests is the most
accurate way to get mechanical properties, failure mechanism, and fatigue behavior
of the BTE scaffolds. Also, many empirical studies concentrate on the mechanical
properties of FGS and comparing them with the uniform structures.

5.4.1 FE Modeling to Predict Mechanical Behavior

of Scaffolds

FE simulation is employed to predict the mechanical response of scaffolds in the

human body. It has been determined that FE modeling is an effective impediment
for this purpose. It is possible to predict the properties of whole porous structure by
modeling a unit cell and by using suitable boundary conditions. The FE model has
been developed in two ways: 1. using micro-computed tomography (micro-CT) and
2. using the CAD model (with or without implementing the manufacturing defects).
Micro-CT imaging is a method to create a high-resolution 3D model from the
real sample. This method of imaging can be used to obtain a 3D model of body
organs and bones with micro-scale precision. In this method, after the fabrication of
the scaffold by AM technology, an image is obtained from the scaffold through the
micro-CT. Then, through the FE simulation, the mechanical behavior of scaffold is
studied. Since, there is often some discrepancies between the produced AM parts and
the CAD model, using micro-CT is a promising method to obtain a precise model of
the scaffolds. In previous studies, the results of this simulation method have shown
good compatibility with experimental data [39].
The second method is to use the CAD model for FE modeling. In this method,
due to the differences between the produced sample and the original CAD model,
there is usually no precise results. Figure 5.9 shows some of these irregularities. In
order to solve this problem, manufacturing defects such as structural changes and
cross-sectional changes of struts are also implemented in the model using statistical
methods. The concept of equivalent diameter or Gaussian distribution can be used to
insert the effect of variations in the diameter of struts in the FE model. For example,
in a study on FE modeling of titanium alloy scaffolds, irregularities of the manufac-
turing process, such as changes in the cross section of struts, in addition to material
flaws were inserted in the FE model. The results showed that the implementation of
manufacturing weaknesses in the FE model significantly reduces the error to predict
the mechanical properties [40].
5 Additive Manufacturing in Bone Tissue Engineering 115

Fig. 5.9 Comparison between design and production of scaffolds with different irregular structures:
a, b sections from the same location; c, d unit cells of 2.4 mm × 2.4 mm × 2.4 mm [41]

5.4.2 Failure Mechanisms of Lattice Structures

An examination of the failure mechanisms of the scaffolds at the micro-level indicates

that the manufacturing imperfections are the main reason of the failure. In fact, during
the fabrication process of a porous structure using AM methods, an imperfection is
created in the microstructure of the scaffold, which results in stress concentration
116 M. Fazlollahi et al.

and strain localization under the loading condition and ultimately followed by the
failure of the entire structure [42].
The failure mechanism at the macro-level depends on the unit cell topology. In
the stretch-dominant unit cell, the failure occurs in a layer-by-layer manner. In the
bending-dominant unit cell, shearing at an angle of approximately 45° is the main
mechanism of failure. In some cases, buckling can also be the main mechanism of
failure that indicates a brittle mechanical behavior [42].
In general, the micro-strut orientation has a crucial impact on the mechanical
behavior of scaffolds. When the micro-strut is oriented in the loading direction, the
structure undergoes stretch-dominant loading. The higher the micro-strut angle, the
more the bending-dominant mechanical behavior [43]. In a study conducted on the
scaffolds with cubic and diamond unit cells, it was perceived that in the cubic scaf-
folds, as a structure with a stretch-dominant deformation, more specific mechan-
ical properties are expected than the diamond structure with bending-dominant
deformation [43]. Figure 5.10 shows the results of this study.

Fig. 5.10 Failure mechanism of a diamond lattice structure at 22% volume fraction; continuous
sharing band of 45°, because of breaking diagonal layers, is investigated. Shearing of layers and
the bending failure of tying struts perpendicular to the diagonal plates is obvious; b cubic lattice
structure; stretch in result of deformation in scaling laws shows the layer-by-layer deformation
mechanism [43]
5 Additive Manufacturing in Bone Tissue Engineering 117

5.4.3 Mechanical Properties of Scaffolds

An ideal BTE scaffold should have properties comparable to the properties of the
adjacent bone, as far as possible, to prevent stress shielding. Structure with the desired
mechanical properties can be achieved by changing the porosity, the strut diameter,
and the porosity of the scaffold through AM process, as well as taking into account
the inevitable imperfections, such as material and production process defects. Also,
the unit cell type plays a crucial role in the stress–strain curve of the scaffold. To
obtain this curve, the uniaxial compression tests are usually employed.
The stress–strain curve of the scaffolds vary with different unit cells. Also, rela-
tive density (porosity) has a great influence on this curve. But in general, this chart
contains a linear elastic segment. Then there is a plateau area of stress, and then the
stress–strain curve fluctuations are observed. The final stage is usually accompanied
by the stiffening of the scaffold. Generally, the fluctuations of this graph are reduced
by increasing the relative density of the scaffold [44]. Figure 5.11 shows the variation
of this graph for a unit cell type (cube) by changing the relative density. In Fig. 5.12,
the effect of changing the unit cell type on the stress–strain curve of the porous
scaffold, in a constant relative density, can be observed. Researches have shown that
for different types of unit cells, increasing relative density increases the mechan-
ical properties such as elastic gradient, first maximum stress, plateau stress, yield

Fig. 5.11 Stress-compressive strain curves for samples with cube unit cell and different porosities
[44]
118 M. Fazlollahi et al.

Fig. 5.12 Stress-compressive strain curves for samples with the same porosity (relative density
of 28%) and with different types of unit cells: cube (C), diamond (D), truncated cubeoctahedron
(TCO), rhombic dodecahedron (RD) [44]

stress, and energy absorption [44]. In most cases, a post-processing treatment is also
performed on the additively manufactured scaffolds. Researches have shown that an
appropriate annealing process can increase the ductility of the structure without any
significant change in its strength [41].
Due to the movement of the body, implants in the human body experience cyclic
musculoskeletal loads. Therefore, the evaluation of the fatigue behavior of these
implants is also important. Most of these cyclic bone loads are compression loading.
Figure 5.13 shows the S-N curves for fatigue life of Ti-6Al-4 V and Co-Cr bioma-
terials with two structures of diamond (D) and rhombic dodecahedron (RD). As
can be seen, the scaffolds with more porosities have better fatigue life [42]. In the
fatigue loading, the adjacent area of unit cell nodes is critical places for initiation and
growth of cracks. Studies show that performing appropriate post-processing, such as
hot isostatic pressing, stress relieving, and chemical etching, can increase the fatigue
life of scaffolds by reducing the stress concentration in these nodes [45].
5 Additive Manufacturing in Bone Tissue Engineering 119

Fig. 5.13 S-N curves for fatigue life of Ti-6Al-4 V and Co-Cr biomaterials with two structures
of diamond a and rhombic dodecahedron b normalized S-N curves with respect to the yield stress
(σ y) of the structures c, d it can be seen that biomaterial type affects fatigue life much more than
the type of unit cell e [42]

5.4.4 FGSs

The most important challenge for FGSs is the stress concentration due to a sudden
change in geometry, which often results in structural failure. But if the smooth
gradient of stress can be achieved, significant results would be obtained. One study
showed that the strength of a homogeneous structure increased from 47 MPa up to
90 MPa and the elastic modulus also increased from 2GPa to 3GPa, by changing the
structure to a gradient structure [39].
120 M. Fazlollahi et al.

5.5 In Vitro and In Vivo Studies on the Additively

Manufactured BTE Scaffolds

Many studies have been done in vivo and in vitro to evaluate the mechanical and
biological performance of the scaffold during the service. It has been shown that
cellular activity is considerably affected by the morphology of scaffolds and the
growth factors. For example, in an in vitro study, MG63 cells were used on Ti-6Al-
4 V scaffolds made by the SLM process. The results showed that micro-scale cavities
and ravines on the original surface of scaffolds facilitate the attachment and migration
of osteoblast cells. Due to the combination of large and small pores, increasing of
irregularities facilitated cell proliferation and osteoblast differentiation. Although the
scaffold with less porosity showed more cell density on the first day, but gradually
cell density increased in the scaffold with more porosity, so much so that in the
fifth day more cell density had been observed in the scaffold with more porosity
than other scaffolds, indicating that more porosity is beneficial for cell growth [41].
Figure 5.14 shows the results of fluorescent microscopic images of cell proliferation.
It has also been shown that curvature of the geometric shape can remarkably enhance
cell attachment and also increase the growth of bone cells [46].
In another study, an in vitro study of Ti-6Al-4 V scaffolds made by the
EBM method was performed to evaluate cytocompatibility using human bone
mesenchymal stem cells (hBMSCs). Cell proliferation and osteogenic differenti-
ation was higher in scaffolds with larger pores. In vivo study of these scaffolds
was performed by implantation in a 30-mm segmental defect of goat metatarsus to
examine osseointegration. The results showed good performance of these scaffolds
and proper bone growth [47]. Figure 5.15 shows the samples with inserted scaffold
at different times.
The effect of adding growth factors has also been widely studied. Researchers
placed bioactive gels containing various growth factors in AM scaffolds. In vivo
study showed that the inclusion of colloidal gelatin gel, which is capable of controlled
releasing of BMP-2 and FGF-2, within the additive manufactured titanium scaffold
is a successful approach for the recovery and reconstruction of damaged bones [48].

5.6 Conclusion

Having conspicuous advantages, additive manufacturing technology has attracted

a great deal of attentions in recent years, to implement in the production of bone
tissue engineering scaffolds. Scaffolds fabricated by AM technology have unique
properties which cannot be obtained through other manufacturing methods. In this
chapter, various AM methods used for BTE scaffold production were examined
and the advantages and disadvantages of each method were presented. All of these
methods print layers in a successive way based on the STL output from the CAD
file. Depending on the energy source and whether it is powder-bed, powder-fed, or
5 Additive Manufacturing in Bone Tissue Engineering 121

Fig. 5.14 Viability and proliferation of MG63 cells cultured on the Ti-6Al-4V scaffolds with
different irregularities(0.06,0.25,0.5) and porosities(48.83%,63.51%,74.28%): a, b fluorescence
microscopy images after being cultured for 1 d (live cells are in green color); c, d CCK-8 test results
after being cultured for 1, 3, and 5 d [41]

wire-fed, AM methods are divided into seven categories, among which EBM and
SLM are more used in the construction of BTE scaffolds. Also, various materials
and powders employed in this method such as ceramics, metal, synthetic and natural
polymers, and composites as well as their pros and cons were discussed. Then, the
architecture design of the additively manufactured BTE scaffolds was studied and
the evaluation of their mechanical properties was presented. It was observed that the
unit cells give a pattern for the construction of scaffolds. These cells can be poly-
hedron, TPMS, or truss. It was found that FGS are also very promising structures
for obtaining the desired properties of the scaffold. Depending on the requirements,
the geometry and chemical composition of the FGSs are different in every section
of the scaffolds. Experimental and FEM investigations showed that when the micro-
strut is oriented in the direction of loading, the loading would be stretch-dominant
that results in better mechanical properties. By increasing the micro-strut angle, the
mechanical properties are reduced. The strain curve of the scaffold is changed by
122 M. Fazlollahi et al.

Fig. 5.15 Scaffold used in

the in vivo procedure (height
and diameter of 30 and
10 mm) a tissue regeneration
for 3 months, 6 months, and
12 months b [47]

changing the cell type and porosity. In addition, it was found that more porosity and
appropriate post-processing could increase the fatigue life of the additively manufac-
tured BTE scaffolds. Finally, in vitro and in vivo studies on these scaffolds showed
that the presence of micro-scale cavities and ravines on the scaffold surface improves
the adhesion and migration of osteoblast cells. Furthermore, porosity and addition
of growth factor have a significant effect on cell growth. Consequently, with all
these taken into account, additively manufactured BTE scaffolds offer a promising
approach for the treatment of graft requiring bone defects.

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(2015) Failure mechanisms of additively manufactured porous biomaterials: effects of porosity
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(2014) Fiber-assisted molding (FAM) of surfaces with tunable curvature to guide cell alignment
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47. Li G, Wang L, Pan W, Yang F, Jiang W, Wu X, Kong X, Dai K, Hao Y (2016) In vitro and
in vivo study of additive manufactured porous Ti6Al4V scaffolds for repairing bone defects.
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Mr. Majid Fazlollahi M.Sc. Research Scholar, Mechanical Engineering Department, Amirkabir
University of Technology (Tehran Polytechnic), Tehran, Iran. He has been working on advanced
manufacturing methods and mechanics of materials. His core research area is mechanical behavior
of biomaterials and advance manufacturing methods such as additive manufacturing.

Ms. Yasaman Pooshidani M.Sc. Research Scholar, Biomedical Engineering Department, Amirk-
abir University of Technology (Tehran Polytechnic), Tehran, Iran. She has been working on
biomaterials, tissue engineering, and drug delivery systems. Her core research area is investigating
the scaffolds properties for tissue engineering and in vivo and in vitro studies of scaffolds. Also,
she is working on drug delivery in the retina tissue.

Dr. Mahnaz Eskandari is Assistant Professor in the Biomedical Engineering Department,

Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran. She has received Ph.D.
in Chemical Engineering from Illinois Institute of Technology, Chicago, IL, USA. Her area of
research is retina tissue engineering, neuron tissue engineering, bioink, cancer–laser interaction,
and bioreactor design. She has more than 10 years of teaching and research experience. She has
contributed extensively to the world in tissue engineering literature with publications appearing
in Journal of Materials Science and Engineering: C, Powder Technology, Reactive and Functional
Polymers, BioNanoScience, Biotechnology and bioengineering, etc.
Chapter 6
FDM 3D Printing in Biomedical
and Microfluidic Applications

Gabriel Gaal, Vladimir Gaal, Maria Luisa Braunger, Antonio Riul Jr,
and Varlei Rodrigues

6.1 Introduction

3D printing has attracted great attention due to its unique capacity of customization
and rapid prototyping, consuming less resources and generating less residues than
traditional subtraction techniques. It is a promising additive manufacturing (AM)
technology because it can build 3D parts designed for highly specific prototyping of
complex geometries. Despite the limited construct dimensions and low scalability
achieved by this technique, there have been strong efforts to apply it in science,
technology, education, and sustainable development [1].
3D printing features two main branches: cutting-edge technologies and rapid
prototyping. The first requires trained personnel and complex infrastructures, being
used in specific applications with high added value constructs, such as automobile
industries and aerospace technologies. The second is used for the rapid design and
prototyping of ideas and concepts and does not require experts. Overall, 3D printers
offer user-friendly interfaces to enable a more versatile manufacturing process [2].
Among them, fused deposition modeling (FDM) 3D printers have been widely
exploited as they are cheap, table-top printers. Despite the variety of commer-
cial models, FDM printers have also innumerous open projects available on the
Internet allowing common users to build their own setups. Moreover, this open-
source technology allows constant improvements by the 3D printing community for
FDM, sharing and discussing new ideas and projects.

G. Gaal · V. Gaal · M. L. Braunger · A. Riul Jr · V. Rodrigues (B)

Department of Applied Physics, “Gleb Wataghin” Institute of Physics, University of Campinas
(UNICAMP), Campinas, São Paulo, Brazil
e-mail: [email protected]

© Springer Nature Singapore Pte Ltd. 2020 127

S. Singh et al. (eds.), 3D Printing in Biomedical Engineering,
Materials Horizons: From Nature to Nanomaterials,
https://doi.org/10.1007/978-981-15-5424-7_6
128 G. Gaal et al.

In this chapter, we will describe the FDM printing process, from the 3D digital
model to a final printed prototype, reviewing the main available commercial fila-
ments. Moreover, we will highlight current FDM technology in science, focusing on
chemical and biomedical applications.

6.2 Printing Process

3D printing is an additive manufacturing process used by stereolithography (SLA),

selective laser sintering (SLS), and fused deposition modeling (FDM) [1, 3–5]. Each
one has its own specificity using different materials to fabricate the 3D model, but
they all follow the same layer-by-layer printing process. In particular, the FDM
technique uses thermoplastics having a specific property for an intended application.
In this section, we will detail the FDM printing process, discussing the digital model
design and its digital file format, the slicer software, GCODE basics, and FDM printer
setups.

6.2.1 From Digital Model to GCODE

The AM creation process follows the steps presented on Fig. 6.1. The first delineates
the needs of the project, outlining the filament material, the AM technique, and post-
printing processes, in order to tune up specific properties of the printed part [6, 7].
Then, you have to translate your ideas into 3D computer models using computer-aided
design (CAD) applications. The main CAD softwares are AutoCAD, OpenSCAD,
Autodesk Inventor, and SolidWorks. Each CAD program stores information from the
digital model in a particular native draw file format (DWG, IPT, PRT, among others).
However, the drawing file must be translated into another format containing only the

Fig. 6.1 a Schematic flowchart of prototyping process in FDM printing technique. b Lines to be
printed, generated based on the GCODE instructions
6 FDM 3D Printing in Biomedical and Microfluidic Applications 129

necessary information of the model external surface. This process usually tessellates
the digital model surface into a series of small triangles (facets), with each facet
described by a perpendicular direction (labeling the external side) and three points
representing the vertices (corners) of the triangle [8]. This shell representation of the
3D surface geometry is called STL (“StereoLithography”) format. Another way to
obtain the 3D models in STL format is searching projects in open repositories such
as “thingiverse.com” and “grabcad.com”, usually fed by users.
Next step is to generate a set of instructions that controls the FDM printer, gener-
ally made by softwares called “slicers.” They transform the STL 3D model into a
discreet stack of horizontal planes (Fig. 6.1b), which has an associated set of Cartesian
coordinates indicating the position and the amount of thermoplastic to be deposited,
called GCODE. The GCODE also has the information about the 3D printer configu-
ration, such as speed, temperature, and printer dimensions [1]. Several free softwares
such as Slic3r, KISSlicer, and Cura generate the GCODE.
Finally, it is time to print the prototype and test it. A fundamental step of the
prototyping concept is feedback; it is important that the user looks back into the first
step, “re-think” the model, and proceeds to subsequent steps again.

6.2.2 FDM Printers

Different types of FDM 3D printers, either commercial or open-source projects,

follow the same printing principles. Likewise a pen drawing and dropping ink on
a paper, an extruder is guided on a horizontal plane following a particular coordi-
nate system depositing layers of melted thermoplastics. The extrusion is done by a
stepper motor that pushes the filament into the heated nozzle, depositing it on planes
sequentially stacked to create the object in a layer-by-layer process. Usually, the first
layer is deposited on a heated bed to simplify its adhesion to the bed and to maintain
a fairly smooth temperature gradient along the printed object avoiding warping and
delamination effects.
Traditional printers such as Prusa Mendel, Prusa i3, MakerBot, and Ultimaker use
Cartesian coordinates to define the movement directions of the printing bed and hot
nozzle. Usually, the hot bed moves linearly in one direction (Y-axis) and the extruder
is moved in other linear direction perpendicular to the bed (X-axis), creating a XY
printing plane. The vertical movement is done either moving the extruder upward
or the hot bed downward in order to start the next layer. It is interesting to notice
that there are other Cartesian projects using other sets of linear and perpendicular
coordinate systems, but they are still Cartesian printers. For example, our research
group designed and assembled a homemade FDM printer that uses a positioning
technique known as CoreXY to move the heated nozzles of the printer [9]. This
technique consists of two belt and pulley systems that move the nozzle on two
independent and perpendicular directions. By combining these two movements, it is
possible to attain any position in the deposition plane [10].
130 G. Gaal et al.

In polar printers, the printing bed moves linearly in the radial direction (r-axis)
and rotates along the θ-axis direction. The deposited layers can be stacked either
moving the extruder upward or the printing bed downward [11]. There are also
printers that define the printing movements without a set of perpendicular coordi-
nates. Two interesting examples are the Delta and the SCARA printers that maintain
the printing bed static, moving only the extruder head. The Delta printer consists of
three suspended arms that move up and down independently on rails, allowing the
nozzle positioning in any location [12]. Finally, the Selective Compliance Assembly
Robotic Arm (SCARA) printers use a robotic arm system to move the extruder along
a printing plane [11].
It is important to stress that each printer setup has its own pros and cons. For
example, traditional Cartesian printers have good structural stability, diminishing
errors when the print head moves within the 3D space to give a fine surface finish.
They are also well-established setups, so it is easy to find out technical assistance;
however, they usually have bigger structural parts, so they are less portable, and a
relative lower movement speed, increasing the printing time. On the other hand, polar
printers have small structural parts, allowing to print a bigger built volume within
a smaller space. The main drawback in polar printers is the difficulty to integrate a
heater to the printing bed due to its rotational movements.

6.3 Filaments and Composites

There are numerous commercially available thermoplastic filaments having distinct

properties, such as hardness, toughness, softness, water-soluble, biodegradable,
and/or biocompatible. Moreover, there is a current growing interest in the devel-
opment of composite filaments to add new functionalities such as electrical conduc-
tivity in commercial polymers. In this section, we will list the main properties of the
commercially available raw thermoplastic filaments and their composites.

6.3.1 Raw Filaments

One of the most used filaments is polylactic acid (PLA), which consists of linear
aliphatic polyester chains synthesized from renewable resources such as corn starch,
sugar cane, and potatoes [13], being a sustainable polymer, widely exploited as an
alternative to petroleum-based materials. PLA is biodegradable and biocompatible,
so it can resist low-temperature sterilization processes, an essential requirement for
bio-implantable devices. Moreover, it can be used in all commercial FDM 3D printers
as it has low glass transition temperature (60 °C), melting point at 153 °C, and
extrusion temperatures ranging from 175 to 195 °C. PLA also has a low thermal
expansion coefficient (70 × 10−6 °C−1 ), with no need of a hot bed as it has negligible
warping of printed models [14]. Despite being soluble in most organic solvents, PLA
6 FDM 3D Printing in Biomedical and Microfluidic Applications 131

is chemically resistant in acidic media, allowing reversible and permanent surface

functionalization [15–18].
Likewise PLA, acrylonitrile butadiene styrene (ABS) is also widely used filament
for FDM 3D printing. Moreover, ABS is the most used thermoplastic in commercial
products, such as Lego™ building blocks. It has glass transition temperature around
112 °C and extrusion temperatures ranging from 220 to 240 °C [19]. Additionally,
ABS parts combine toughness and flexibility, exhibiting chemical, heat, and moisture
resistances [20, 21]. However, ABS has a thermal expansion coefficient of 100 ×
10−6 °C−1 , which could lead to warping and delamination of printed parts. So it is
essential to maintain a low-temperature gradient along the printed model by using
a hot bed at high temperature (110 °C) and a good thermal isolation [14]. The bed
adhesion is another drawback, but it can be improved by preparing the hot surface
with glue, thin layer of acetone, or printing on polyimide (Kapton™). Finally, ABS
is not biodegradable neither biocompatible, precluding some applications [15].
Polyethylene terephthalate (PET) is also a petroleum derivative thermoplastic of
the polyester family. It is commonly used in fibers for clothing and vessels for liquid
and food storage. PET is a fairly hard material, but its transparency makes it attractive
for some niche applications [15], and despite its use as printing filament, the most
employed material has been glycol modified PET (PETG). PETG has interesting
thermal properties for FDM printing, such as glass transition temperature of 75 °C,
extrusion temperatures from 230 to 260 °C, and low thermal expansion coefficient
(59 × 10−6 °C−1 ) minimizing warping effects [22].
While PLA, ABS, and PETG are user-friendly and largely used filaments, nylon
(polyamide) is a trick material to be used in FDM printers. Firstly, it has a high extru-
sion temperature (250 °C) and high thermal expansion coefficient (~10 × 10−5 °C−1 )
that leads to large warping effects in the printed object. Generally, the printing bed
is kept at 70 °C, but it does not hamper layer warping with nylon. Additionally, there
is a weak layer adhesion due to the lack of compression during the printing process,
leading to a low overall strength of the printed model [15]. Consequently, efforts
have been made to develop composite Nylon materials to improve the mechanical
and chemical properties of the filaments.
Polyvinyl alcohol (PVA) is a water-soluble polymer that is mostly used as support
material for complex geometries. PVA is extruded at temperatures ranging from 190
to 210 °C, and it does not require heated bed to facilitate the adhesion or to avoid
warping process. Therefore, the printing with this material can be tricky because
PVA has a large water absorption coefficient compared with standard filaments and
that implies in a poor adhesion with other materials due its thermal properties [23].

6.3.2 Composite Filaments

Recently, there is a great interest in the development of printable polymer composites

with added properties. The materials may feature properties different from the raw
polymer filaments, such as high mechanical performance and/or enhanced electrical
132 G. Gaal et al.

and thermal conductivity. The fabrication of polymer composites is promoted by

the incorporation of fiber, particle, or nanomaterial reinforcements into raw polymer
matrices [24, 25].
Particle incorporation is particularly interesting because it enables homogeneous
mixture within the polymer matrix, despite the fact that several properties can be
tuned by particle addition in the filament. Nikzad et al. and Hwang et al. showed
that both storage modulus and thermal conductivity can be improved by adding iron
and copper into ABS matrix. Such composites also reduce the thermal expansion
coefficient reducing warping effects [26, 27]. Perez and Wicker observed that ABS
composites of thermoplastic elastomer particles (TPE) showed a reduced anisotropy
of the tensile strength and modulus when compared with results obtained by Ahn
et al. for raw ABS filaments [28, 29]. ABS filaments can also be reinforced with
BaTiO3 nanoparticles in order to tune its dielectric permittivity as shown by Isakov
et al. [30].
Mechanical, electrical, and thermal properties can also be modified by the incor-
poration of nanomaterials such as graphene, carbon nanotubes, and metallic and
ceramic nanoparticles. For example, TiO2 , carbon nanofiber, and multi-walled carbon
nanotubes showed at least 7.5% increase in the tensile strength of the printed ABS
composite parts compared with raw material [28]. The printed objects become more
brittle and showed reduced elongation at yield [28]. However, the ABS matrix can be
modified with graphene to improve electrical conductivity and thermal stability [31].
Montmorillonite, a nanoclay material, can be added to ABS to tune both tensile and
flexural strength and modulus, thermal stability, and to reduce the thermal expansion
coefficient [32].
Another way to enhance polymer properties is through fiber reinforcement. For
example, glass [33] and carbon [34] fibers have been added into ABS to modify its
mechanical properties. Tekinalp et al. showed that printed parts of ABS-based carbon
fiber composites presented higher fiber orientation along the printing direction [35].
They argue that it can explain why the printed parts exhibited similar mechanical
properties compared to those fabricated by standard compression model techniques,
despite the higher porosity obtained by FDM printing. There are also commer-
cial conductive PLA-based graphene filaments designed to allow 3D printing of
electrically conductive parts considering different FDM printers. Nonetheless, after
printing, the printed parts displayed a higher electrical resistance than the filament
[9, 36].
6 FDM 3D Printing in Biomedical and Microfluidic Applications 133

6.4 Applications

6.4.1 Biomedical

The use of 3D printing in biomedical applications is expected to revolutionize health

care, with applications in customized prosthetics, implants, anatomical models [37–
39], and drug dosage and delivery [40–42]. Despite significant biomedical advances
in 3D printing research, time is required for transformative applications due to safety
and regulatory challenges [43, 44]. A usual criticism of FDM printing technology
is the difficulty to scale it up industrially. However, its differential lies precisely
in the customized production rather than scalability. The biomedical area perfectly
exemplifies the need of customization to attend distinct patients.
It is important to stress that the use of 3D printing technologies in biomedical
applications differs from bioprinting. Bioprinting is a very promising technique
for advancing tissue engineering that uses 3D printing-like techniques to spatially
arrange cells within the construct, mimicking the native tissue in its totality and not
just in the physical and chemical form [45]. 3D bioprinting systems use AM tech-
nologies, such as laser-, inkjet-, or extrusion-based deposition [46, 47]. The last one
originates from FDM printing and uses pneumatic, mechanical, or electromagnetic
driven systems to deposit the desired biomaterial [48]. The cell-laden material is
extruded through a needle and printed as lines forming the 3D structure through a
layer-by-layer process [49]. Despite the bioprinting prominence, we will focus here
on describing the use of regular FDM technique in biomedical applications.
In the last two decades, the literature has a plethora of FDM studies in bone
tissue engineering [50]. Tests usually relies on fabricating scaffolds, which are 3D
structures that can mimic the extracellular matrix properties and provide a template
for cell attachment and stimulate bone tissue formation (Fig. 6.2a) [51]. The use of
FDM has evolved from the manufacture of molds to the fabrication of the scaffold
itself from composite materials. Initially, authors used FDM and a thermoplastic
wax filament (ICW-06) to fabricate molds to produce ceramic scaffolds [52–54]. In
2001, Hutmacher et al. fabricated scaffolds from poly (ε-caprolactone) (PCL), which
is considered a soft- and hard-tissue-compatible bioresorbable material [55]. They
found that PCL scaffolds displayed excellent biocompatibility with human fibroblast
and periosteal cell culture systems. In 2002, Too et al. developed 3D non-random
porous structures of ABS using FDM to determine their suitability for use in the
area of tissue engineering [56]. FDM provided good control and reproducibility of
the desired degree of porosity, a crucial parameter to design scaffolds for biomedical
applications. In 2003, Kalita et al. fabricated composite scaffolds from polypropylene
(PP) polymer and tricalcium phosphate ceramic (Fig. 6.2b) [57]. They showed that
these samples were non-toxic, with excellent cell growth during the first two weeks
of in vitro testing. In 2007, Lam et al. fabricated composite scaffolds from PCL mixed
with β-tricalcium phosphate (β-TCP) and evaluated its degradation rate in alkaline
medium (Fig. 6.2c) [58]. Polymer and ceramic composite scaffolds show enhanced
134 G. Gaal et al.

Fig. 6.2 a Methods of 3D tissue fabrication. Reproduced with permission from [50]. Copyright
2004, Elsevier. b Scaffolds fabricated from composite filaments via FDM showing the obtained
controlled and distinct porosity structures. Reproduced with permission from [57]. Copyright 2003,
Elsevier. c Microscopic and macroscopic views of NaOH-degraded PCL scaffolds from 0 to 5 weeks.
Reproduced with permission from [58]. Copyright 2007, John Wiley & Sons

mechanical properties, biocompatibility, osteoconductivity, and also increased degra-

dation rate [59]. Polyether-ether-ketone (PEEK) is known for its chemical/biological
stability and biocompatibility; however, FDM processing conditions impact thermal,
mechanical, and dimensional products fabricated with PEEK [60]. Taking these
issues into account, Vaezi et al. proposed an extrusion-based additive manufac-
turing technique integrated with compression molding processes in order to fabricate
PEEK/hydroxyapatite composite scaffolds [61]. Recent literature about 3D-printed
scaffolds have shown remarkable results using SLA printing due to its high resolu-
tion; however, the reduced number of available biodegradable/biocompatible resins
hamper some applications [62].
In the past few years, FDM printing has received a lot of attention in pharma-
ceutical research regarding drug dosage and delivery. Most of the recent papers
in the literature use FDM raw thermoplastics mixed with drugs, and the perfor-
mance is evaluated after extrusion with distinct shapes and sizes. In 2015, Water
et al. demonstrated the FDM potential producing a PLA-based drug delivery system
6 FDM 3D Printing in Biomedical and Microfluidic Applications 135

for controlled release products [63]. PLA-based nitrofurantoin (NF) filament was
successfully obtained and extruded with up to 30% drug load in two cases, with
the addition of 5% of hydroxyapatite (HA) and without it, and samples printed in
disc geometries. NF release was dependent on the drug loading as a higher level of
released drug was observed from discs having higher drug loads. In the same year,
Weisman et al. loaded PLA with gentamicin sulfate and also with methotrexate,
creating a new class of bioactive 3D printing filaments [64]. It was found that these
compounds retained their effective antimicrobial and cytostatic properties throughout
the manufacturing process, despite the heat required for FDM printing. Antibacte-
rial effects and a reduction in proliferation of osteosarcoma cells were observed
with all constructs, attesting both technical and clinical viability of these PLA-based
composites.
There is also a demand for versatile and adjustable methods for the fabrication
of oral tablets, with FDM techniques adapted to engineer and control the dosage of
3D-printed tablets. Skowyra et al. produced tablets for drug delivery from PVA-based
filaments loaded with prednisolone, with in vitro drug release extended up to 24 h
from the printed tablets [65]. Goyanes et al. manufactured tablet of distinct geome-
tries from PVA loaded with paracetamol. Distinct tablet geometries were success-
fully printed, such as cube, pyramid, cylinder, sphere, and torus (Fig. 6.3a), some
of them challenging to manufacture by powder compaction. They showed that the
drug release profile depends only on the tablet surface to volume ratio instead of its
surface area, indicating the influence of the geometrical shape on the drug release
profile [66]. Goyanes et al. also loaded PVA with 4-aminosalicylic acid (4-ASA) and
5-aminosalicylic acid (5-ASA), drugs commonly used in the treatment of inflamma-
tory bowel disease. They argued that the printing temperature plays a fundamental
role on the drug degradation and showed that the active 4-ASA (50%) was signifi-
cant degraded after being printed, while 5-ASA samples were feasible [67]. Genina
et al. showed that certain grades of ethylene-vinyl acetate (EVA) copolymers are
suitable to produce 3D-printed drug-loaded implantable prototypes, such as custom-
made intrauterine systems and subcutaneous rods loaded with indomethacin drug
(Fig. 6.3b) [68].
Most of the literature in biomedical applications reports the use of FDM in the
fabrication of scaffolds and drug delivery studies. To illustrate, in 2008, Tek et al.
reported FDM as a rapid prototyping technological tool to create devices frequently
required in neuroscience research [69]. A skull-based housing platform for stroke
electrophysiology studies, a cranial window, and two imaging compatible perfusion
chambers were fabricated from ABS filaments. In 2010, Espalin et al. demonstrated
that customized polymethylmethacrylate (PMMA) structures with varying porosi-
ties can be fabricated by FDM for craniofacial reconstruction and orthopedic spacers
(Fig. 6.4a) [70]. By using PMMA (biocompatible polymer) together with FDM,
medical implants can be directly printed from medical imaging data, thus improving
the current state of art use in medicine. In 2014, Sandler et al. demonstrated the incor-
poration of antimicrobial NF in PLA and subsequent FDM printing of disc structures,
resulting in an inhibition of biofilm colonization [71]. The approach taken is very
promising and can pave the way the manufacture of new functional medical devices
136 G. Gaal et al.

Fig. 6.3 a 3D-printed tablets of distinct geometries fabricated from composite filament (PVA
matrix and paracetamol) by FDM. Reproduced with permission from [66]. Copyright 2015, Else-
vier. b Filaments and 3D-printed intrauterine prototypes of EVA containing distinct amount of
indomethacin. Reproduced with permission from [68]. Copyright 2016, Elsevier

in the future. In 2017, Mohammed et al. investigated the design methodology for
the creation of a whole mandible implant based on the patient’s medical imaging
data [72]. The model was fabricated in ABS for preliminary evaluation of the struc-
tural integrity and dimensional accuracy of the jaw, before the final metal fabrication
process (Fig. 6.4b).
6 FDM 3D Printing in Biomedical and Microfluidic Applications 137

Fig. 6.4 a Skull model in ABS and PMMA placed in the cranial defect. Reproduced with permission
from [70]. Copyright 2010, Emerald Publishing Limited. b Images of the post-processed mandibular
implant and the representative FDM model in ABS of the skull/maxilla model with the final implant.
Reproduced with permission from [72]. Copyright 2017, Knowledge E

6.4.2 Microfluidics

Microfluidic is the technology that controls and manipulates small amounts of liquid
and gas samples for miniaturized analytical tools in both chemical and biochemical
systems, biomedical devices, and systems for fundamental research [73, 74]. Duffy
et al. used polydimethylsiloxane (PDMS), an optically transparent, gas- and vapor-
permeable elastomer, for the fabrication of complex microfluidic devices [75]. It
helped to promote soft lithography, which has then become the most widely adopted
method to produce microfluidic devices. Despite all PDMS advantages in microflu-
idic applications, there are some limitations to implement the material in biomedical
research such as its vapor permeability that hampers cell microenvironment studies
[76–78]. When compared to soft lithography, 3D printing extends the use of mate-
rials beyond PDMS, allowing new possibilities for biomedical research. In addition,
it avoids the use of clean rooms, the need to manufacture masks to prepare molds
and the use of photosensitive materials, enabling low cost and faster prototyping.
The most exploited 3D printing technique for microfluidics is SLA due to
higher channel resolution (50–100 μm) and transparency of the final device when
138 G. Gaal et al.

compared with other techniques. However, SLA is restricted to photocurable poly-

mers, hindering biomedical applications and printing with composite materials [79,
80]. Within this context, FDM offers loads of polymers and composites for microflu-
idic biomedical applications. Despite the lower channel resolution, usually hundreds
of microns, FDM stills more versatile than other AM techniques, enabling the fabri-
cation of sacrificial molds for PDMS casting, development of microfluidic tools, and
fabrication/integration of the final microfluidic device [3, 81].
Gul et al. used a commercial composite PLA filament filled with cooper to print
sacrificial microchannels molds for PDMS casting, using a 3D printing pen [82].
This technique gives more flexibility to draw simple geometries, but it has poor
reproducibility for the fabrication of complex channels. To remove the mold, they
used organic acid solution to produce microchannels of 200 μm in diameter. Goh
and Hashimoto used water-soluble PVA filament to fabricate microchannels molds
and extended the casting materials beyond the PDMS realms, being able to develop
microchannels made of hard polymers (rigid polyurethane, epoxy, and NOA 81), soft
polymers (flexible polyurethane and PDMS), and hydrogels (TG gelatin PEGDA)
[83].
Even though the mold printing extinguishes the need of soft lithography, the
complete fabrication of a microfluidic device is interesting because it allows the
development in a single-step process, reducing the time required for prototyping.
To illustrate, Kitson et al. fabricated within a few hours microreactors for chemical
synthesis [84]. They used PP filament and printed different geometries to synthesize
organic and inorganic compounds as well as gold nanoparticles using 60–270 μL of
reagents. They also exploited 3D geometries of microchannels within the reactors,
which is very difficult to achieve using traditional microfabrication techniques that
usually confines the flow to two dimensions.
Banna et al. 3D-printed an integrated water quality sensing system using ABS
filament and were able to monitor the water pH, conductivity, and temperature [85].
This system was able to operate in flow rates equivalent to the water distribution
system without leakage or sensing failure, showing a promising on-site application.
The 3D printing technology also allowed the design of a modular interface to facilitate
the replacement of sensing units, which were integrated within the printed structures
during the printing process.
Bauer and Kulinsky used ABS to fabricate and tested a modular device fully
automated colorimetric enzyme-linked immunoassay (ELISA) designed to detect
malaria [86]. They integrated arrays of disposable 3D-printed microchannels to an
automated system that controls bioassays steps. This lab-on-a-chip device can be used
for rapid on-site qualitative diagnostics with good response, suitable for low-resource
settings.
In 2014, Krejcova et al. reported a new 3D microfluidic chip fabricated with
PLA and equipped with electrodes for the detection of influenza hemagglutinin [87].
They showed that the electrochemical signal of this system has a great potential for
rapid, sensitive, and specific detection of influenza virus. Authors emphasize that the
microfluidic system can be used also for detection of other specific substances that
are important for diagnosis and control of infectious diseases.
6 FDM 3D Printing in Biomedical and Microfluidic Applications 139

In our research group, we exploited the integration of several materials within the
microchannel during the printing process. We were able to insert macro electrodes
for electrochemical analysis, papers for self-driven flows, membranes, and thin glass
sheets for biological applications. As a proof of concept, coated interdigitated elec-
trodes (IDEs) were integrated to develop a 3D-printed microfluidic electronic tongue
(Fig. 6.5) that was able to distinguish basic tastants [88]. In the same context, Yuen
integrated several membranes within the microchannels to control the flow through
three-dimensional channel geometries [89].

6.5 Summary

3D printing has been shown to be a fundamental tool in science, education, and

biomedical applications, with FDM systems being the most flexible and accessible
3D printing benchtop technique for daily and on-demand use. Among the four main
categories of FDM (Cartesian, Delta, polar, and SCARA), Cartesian printers are the
most used ones once its technology is better established compared to the others. They
also present a good structural stability that plays a crucial role in the final construct.
FDM has a great number of commercial thermoplastic filaments, either raw or
composite, which are key factor to vast number of application. In particular, their use
in pharmaceutical applications is remarkable. According to the literature, in the past
few years, there is an increased use of FDM printing in the fabrication of distinct
drug delivery systems. Besides the possibility of personalized controlled dosage, it is
also a flexible methodology in the shape and size of drug tablets presenting distinct
releases.
Composite filaments have also been applied to 3D print scaffolds for biomedical
application. FDM technique allows the use of composites based on biocompatible
materials, such as PLA or PCL matrices that may be approved to be used in biomed-
ical devices. Recent literature about 3D-printed scaffolds have shown amazing
results using SLA technique due to its high-resolution printed parts; however, there
is a limited number of biodegradable/biocompatible resins; therefore, FDM can
contribute to overcome this matter.
Despite better resolution reached in laser-based techniques such as SLA, FDM
printing is finding its niche in the microfluidic and sensor areas. The open FDM
hardware allows great control over the printing process, and the possibility of easily
embedding extra elements such as electrodes or membranes into microfluidic devices
by simply pausing the printing process greatly widens the range of potential applica-
tions. Moreover, the use of composite materials or co-extrusion to integrate devices
in one step of fabrication is another great characteristic of FDM systems.
In summary, applications using FDM in distinct areas were described herein,
showing that despite some limitations intrinsic to the technique, there are many
advantages and possibilities to be explored yet.
140 G. Gaal et al.

Fig. 6.5 a GCODE visualization of a microchannel, and the chamber where gold IDEs (inset) were
manually inserted at the fourth layer during the printing process. b Printed e-tongues system used
to distinguish the basic tastants. Reproduced with permission from [88]
6 FDM 3D Printing in Biomedical and Microfluidic Applications 141

Acknowledgements Authors are grateful for the financial support by the Brazilian funding
agencies FAPESP (Grant Nos. 2015/14836-9 and 2017/19862-3), CAPES, and CNPq.

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crofluidics 10:044104

Gabriel Gaál is currently a Ph.D. student at the Institute of Physics “Gleb Wataghin” at Univer-
sity of Campinas (Unicamp, Brazil). He graduated in Physics (2015) and obtained his MSc. degree
in Physics (2017) from the University of Campinas (Unicamp, Brazil). He has experience in
application of 3D printing in microfluidics and electronic tongue sensors.

Vladimir Gaál is currently a M.Sc. student at the School of Mechanical Engineering at University
of Campinas (Unicamp, Brazil) focusing on mechanical characterization of 3D printed objects.
He is also researcher assistant of research team of Professor Varlei Rodrigues at the University
of Campinas. He graduated in Physics (2017) at Unicamp, Brazil, and has great expertise in
assembling and maintenance of 3D printers.

Dr. Maria Luisa Braunger is currently a postdoctoral fellow at the Institute of Physics “Gleb
Wataghin” at the University of Campinas (Unicamp, Brazil). She also worked as a visiting scholar
at the University of Pennsylvania (UPenn, USA). She graduated in Physics (2008) and obtained a
MSc. degree in Applied Physics (2011) from São Paulo State University (UNESP), Campus Rio
6 FDM 3D Printing in Biomedical and Microfluidic Applications 145

Claro. She has received double-degree Ph.D. in Materials Science and Technology from UNESP,
Campus Presidente Prudente and in Polymer Chemistry from Université de Pau et des Pays de
l’Adour (UPPA, France).

Prof. Dr. Antonio Riul Jr has M.Sc. in physics from the University of São Paulo (1995), Ph.D.
in Materials Science and Engineering from the University of São Paulo (1998) and postdoctoral
studies at the University of Wales (1998–2000), Embrapa/CNPDIA (2000–2002) and University
of Texas at Dallas (2018–2019). He has experience in Physics and Materials Science, focusing on
ultrathin films, acting on ultrathin films (Langmuir-Blodgett and LbL), conducting polymers and
reduced graphene oxides, “e-tongue” and microfluidic sensors. Currently, he is also working with
multifunctional coatings formed by self-healing and conductive nanocomposites.

Prof. Dr. Varlei Rodrigues is currently Professor at the Institute of Physics “Gleb Wataghin”,
UNICAMP. He has worked on Structural and Electrical Conductance of Metal Atomic Size
Nanowires in his MSc. and Ph.D at the Institute of Physics “Gleb Wataghin”, under the super-
vision of Prof. Dr. Daniel Ugarte. He also have a two years post-doc experience at Ecole Poly-
technique Fédérale de Lausanne, EPFL, Switzerland, under the supervision of Prof. Dr. Christian
Felix and a one year post-doc at Laboratório Nacional de Luz Síncrotron, LNLS, Brazil. He has
experience with scientific instrumentation, metal nanowires fabrication and characterization, elec-
tron microscopy, electrical transport characterization, nanoparticle physics, cluster production and
3D printing. He has authored 40 papers, with 1576 total citations, h-factor 16 and 3 chapters. He
has concluded the supervision of one PhD thesis and three MSc dissertations.
Chapter 7
Integration of FDM and Indirect Rapid
Tooling Technique for Fabrication
of Low-Cost Hip Implant Replicas
for Batch Production: A Case Study

Jaspreet Singh, Rupinder Singh, and Harwinder Singh

7.1 Introduction

Last two to three decades witnessed huge investments by the manufacturing

industries for the improvement of their production technologies in order to develop
the new products [1]. In today’s scenario, requirement of shorter lead time and low
cost for the fabrication of prototypes and customized and tailor-made products in
various industries such as biomedical, automotive, aerospace, etc., comes out to
be a major challenge in order to achieve the competitive benefits. With conventional
manufacturing techniques, the production of such products becomes costly and time-
consuming because of the fabrication of the necessary hard tooling [2]. This requires
the transformation of manufacturing sector from traditional to modern techniques
for the economic growth of the country. Further, development of new product leads
to significant trade-offs between lead time, cost and performance of product [3].
Therefore, different approaches for manufacturing must be adopted to accommodate
the market demands.
Additive manufacturing (AM) processes have the potential to overcome the chal-
lenges of the modern industry [4]. AM processes have found wide applications
in industries such as electronics, automotive, aerospace, biomedical, and ophthal-
mology [5–7]. The polymer-based multi-material structures fabricated by fused fila-
ment fabrication (FFF) technique exhibit variety of applications in aerospace and

J. Singh (B)
School of Mechanical Engineering, Lovely Professional University, Phagwara 144411, India
e-mail: [email protected]
R. Singh
Department of Mechanical Engineering, National Institute of Technical Teachers Training and
Research, Chandigarh 160019, India
H. Singh
Department of Mechanical Engineering, GNDEC, Ludhiana 141006, India

© Springer Nature Singapore Pte Ltd. 2020 147

S. Singh et al. (eds.), 3D Printing in Biomedical Engineering,
Materials Horizons: From Nature to Nanomaterials,
https://doi.org/10.1007/978-981-15-5424-7_7
148 J. Singh et al.

other manufacturing industries [8]. However, the AM processes cannot replace the
traditional manufacturing processes but can enhance the efficiency by fabricating
complex parts with high dimensional accuracy [9]. RP involves fabrication of 3D
models from the CAD file created by using different software. The information stored
in the CAD file is split into slices, and then, the layers are printed one over the other
with the aid of the computer [10]. Fused deposition modelling (FDM) being the
most economical AM technique has been commonly utilized for the manufacturing
of various kinds of industrial parts.
FDM process involves heating of model material like wax, polycarbonate or acry-
lonitrile butadiene styrene (ABS) by the heaters as it passes through the extrusion
head [11]. 3D physical model has been built gradually as the head start depositing
the material layer by layer one over the other [12, 13]. Most of the FDM machines
use different grades of ABS as build material, whereas some uses wax also. FDM
possesses several advantages such as simplicity, flexibility and low operating and
maintenance cost as well as ability to fabricate intricate geometries quite easily [14].
Moreover, the replicas prepared through FDM technique have been already employed
in silicon moulding (SM) and rapid casting applications [15, 16].
Irrespective of several advantages, the FDM fabricated parts exhibit poor
surface characteristics due to layer-by-layer manufacturing (staircase effect) [17,
18]. Researchers employed continuous efforts to improve the surface character-
istics of FDM fabricated components such as process parameter optimization,
utilizing optimum build orientations, advanced mechanical methods including
vapour smoothing, barrel finishing, etc. [19–30]. Dimensional variability caused
due to post-processing of FDM parts restricted its applications in precision casting
processes [31]. Further, in an attempt of improving the overall performance of FDM
fabricated parts, heat treatment involving annealing at different temperature (105,
115 and 125 °C) along with different time duration (20, 25 and 30 min) had been
performed and the results indicated improvement in physical, mechanical and quality
characteristics of FDM parts [32].
Apart from poor surface finish and dimensional deviation, RP techniques are
preferred only for low volume runs due to high process cost and limited material
selection [33, 34]. Also, the processability of high-performance materials such as
polyether-ether-ketone (PEEK) using three-dimensional (3D) printing technologies
exhibits a critical barrier [35]. Rapid tooling (RT) provides solution to the above
challenge by utilizing the RP and then applying it to the manufacturing of various
tools [36, 37]. Direct tooling and indirect tooling are the two variants of RT. In
direct RT, the mould is prepared by adopting any one of the AM techniques and
then utilizing those moulds for producing prototypes of different materials [38]. In
indirect RT, multiple prototypes were prepared from the mould manufactured from
an AM master pattern. Some of the most commonly utilized indirect RT processes
includes epoxy resin tooling, spray metal tooling and room temperature vulcanized
silicon rubber moulding.
Cheah explained an indirect method for the wax patterns production using SM in
order to lower the cost incurred with low quantity production during the IC process
[39]. The various direct (SLA, LOM, SLS, FDM, etc.) and indirect routes utilizing
7 Integration of FDM and Indirect Rapid Tooling Technique … 149

RP processes for rapid production of tooling have been highlighted by the researchers
[38]. Rahmati et al. made investigations on the accuracy of wax patterns (H-shaped)
fabricated by polyurethane (PU) mould and RTV silicone mould and concluded that
good surface finish has been obtained on wax patterns produced by silicone mould,
whereas the patterns fabricated by PU mould shows better accuracy [40]. Thian et al.
utilized vacuum casting process to fabricate micro-moulds and micro-gears using
silicon rubber mould and concluded that the deviation between the master pattern
and fabricated prototypes was too small and the proposed process is highly capable to
produce dimensionally accurate parts [41]. Singh et al. fabricated plastic components
using SM process and reported that the IT grades of the components were consistent
and within the allowable range as per ISO standard DIN16901 and UNI EN 20286-I
(1995) [42].
The literature review reveals that poor surface characteristics and dimensional
deviation are the inherent features of FDM and cannot be eliminated completely.
The pre-processing surface finishing techniques for FDM fabricated replicas stressed
on optimization studies and cannot improve the surface finish beyond the specific
limit. The post-processing finishing techniques are highly effective but the mechan-
ical abrasive action of media distorts the part geometry and affects the dimen-
sional stability especially around the sharp edges and corners. The chemical vapour
smoothing technique has been established recently, and the preliminary studies
performed by some of the researchers indicated good surface quality and dimen-
sional stability of parts after vapour exposure. But, the surface characteristics of
complex FDM parts such as biomedical hip implant undergone vapour smoothing
are yet to be ascertained. Further, RP techniques are utilized preferably only for small
quantity (5–10 pieces) production due to limitations of material availability and high
cost. Silicon moulding (SM) is found to be an established indirect RT technique, and
researchers have successfully fabricated wax patterns by this technique to reduce the
cost of RP. But still SM process needs to be explored more in order manufacture
polyurethanes (PU) replicas for various industrial applications. This research work
focuses on combining the route of FDM-CVS-SM with an aim to fabricate low-cost
hip implant replicas for batch production.

7.2 Methodology and Experimentation

This research work includes two phases. In the first phase, after selecting the bench-
mark component, FDM technique has been utilized to prepare the ABS replicas,
followed by the smoothing process to improve their surface quality and to reduce
the staircase effect. The replicas fabricated at best parameter settings based on the
results of Taguchi’s L18 orthogonal array with regard to dimensional accuracy, shore
hardness and surface quality have been selected as a master pattern for the second
phase. The second phase constitutes an indirect rapid tooling technique named as
silicon moulding (SM) with an aim to create multiple replicas to reduce the cost of
AM for small production runs.
150 J. Singh et al.

Fig. 7.1 Different views of

benchmark component

Hip joint (refer Fig. 7.1) has been selected as a functional prototype in this
research. The hip geometry has complex features and sloping profiles which would
help the precise evaluation of efficacy of vapour smoothing process. The STL file
which acts as an input to FDM machine has been prepared using ‘SolidWorks’ soft-
ware. The joint consists of a ball-and-socket joint. It basically consists of three parts,
i.e. stem, neck and head. The head of hip joint must have excellent surface finish for
proper movement while walking.
In the first phase, the hip replicas were fabricated by ‘uPrint SE’ FDM setup of
Stratasys, USA. FDM printer converts the three-dimensional STL file into slices.
The printer then prints these slices one after another until the entire 3D model is
fabricated. After fabrication, the replicas were subjected to hot chemical vapours
to enhance the surface quality. The chemical vapour smoothing (CVS) apparatus
supplied by Stratasys was utilized for the smoothing purpose. It consists of parallel
cooling and smoothing chamber equipped with refrigerator and heaters, respectively.
The cooling and drying of the parts are accomplished by the cooling chamber (0 °C),
whereas the heating chamber is maintained at 65 °C by the heater present in it. The
process initiates once the volatile smoothing fluid enters into the smoothing chamber
from the reservoir tank. Once hot, the fumes rise up in the chamber and react with
the outer surface of the replicas and thus enhance the surface texture. The smoothing
fluid used in this work is acetone because of its high diffusion rate and low toxicity.
The intensive literature survey and pilot experiments have been performed to
scrutinize the input parameters having significant effect on various characteristics
of fabricated components. Orientation of the parts in the build chamber and layer
thickness were observed to be the factors influencing the characteristics of FDM
replicas significantly. As the layer thickness decreases, the surface finish improves
but the manufacturing time increases as nozzle has to deposit more layers per unit
volume. Thus, there is a trade-off between manufacturing time and surface roughness
which motivated to use the intermediate value of layer thickness. Layer thickness
does not influence the surface roughness much after chemical treatment [43]. So,
7 Integration of FDM and Indirect Rapid Tooling Technique … 151

value of 0.254 mm as layer thickness was finalized to fabricate all the replicas for the
present work. Further, only two levels of orientation (0° and 90°) have been selected
for the final experimentation as 45° of orientation angle requires much higher support
material and build time as compared to other two levels. Although part density does
not affect the surface finish, parts fabricated at different densities may lead to variable
manufacturing time, material usage, mechanical properties and weight. Three levels
of density (solid, high and low) have been taken as input parameters in this research
work.
Further, it has been observed that few researchers studied the effect of different
CVS parameters on the surface quality of FDM fabricated ABS replicas. However,
the studies related to acetone dipping and acetone vapour exposure indicate that
the number of cycle and cycle immersion time were the main contributing factors
affecting the surface characteristics [24, 43, 44]. The methodology recommended by
the manufacturer of vapour smoothing station includes pre-cooling the parts initially
for 15–20 min, followed by vapour exposure in smoothing chamber for 5–25 s and
finally post-cooling the parts for 15–20 min in cooling chamber completes the one
cycle. Also, it has been reported to repeat the cycle three to five times in order to obtain
best results. The replicas are required to be hanged with a cotton string attached to a
rod in smoothing chamber and immediately hanged in cooling chamber after specific
duration of exposure. In the present work, number of cycles of vapour exposure and
cycle time were the two selected CVS process parameters. The selected levels of
different parameters for FDM and CVS process have been shown in Table 7.1.
The process diagram (P-diagram) of combined FDM-CVS process is shown in
Fig. 7.2. The diagram highlights the input factors, output factors and noise factors
of the process, while there are no signal factors as FDM-CVS is not a dynamic
process. The first step is to identify the input factors and outputs parameters. The
present research work includes input parameters as orientation angle, part density,
number of cycles and cycle time. There are some factors which are beyond the control
such as environmental conditions which may affect the cooling and heating rate of
FDM replicas. These are categorized under noise factors which cannot be controlled
but their effect must be minimized using different technique. The experiments were
conducted in randomized order to eliminate errors due to changes in ambient condi-
tions, while measurements were replicated and repeated at least three times using
standard procedures [45]. In this study, factor (A) 1 degree of freedom whereas factors
(B, C, D) each have two degrees of freedom. Thus, the total number of degrees of
freedom for the selected four parameters is 7. Therefore, the most suitable orthog-
onal array with a blend of two-level and three-level factors was distinguished as

Table 7.1 Parameters and their levels

Process Parameters Symbol Levels
1 2 3
FDM Orientation A 0° 90° –
Part density B High Low Solid
CVS No. of cycles C 3 4 5
Cycle time (s) D 4 6 8
152 J. Singh et al.

Fig. 7.2 P-diagram of combined FDM-CVS process

L18 (21 × 37 ) with 17 degrees of freedom. Table 7.2 shows the assigned factors and
their levels to four columns of L18 OA.

Table 7.2 Control log for experimentation

Run order Orientation (°) Part density No. of cycles Cycle time (s)
1 90 Low 4 6
2 90 High 5 8
3 0 Solid 5 6
4 90 High 3 4
5 0 Low 4 4
6 0 Low 3 8
7 0 High 3 6
8 0 Solid 4 4
9 0 Low 5 6
10 90 Solid 3 6
11 90 Solid 4 8
12 0 Solid 3 8
13 90 Solid 5 4
14 90 Low 5 8
15 90 High 4 6
16 90 Low 3 4
17 0 High 4 8
18 0 High 5 4
7 Integration of FDM and Indirect Rapid Tooling Technique … 153

7.3 Results and Discussion

The results of each phase have been discussed in the following sections.

7.3.1 Phase I (FDM-CVS Process)

As regard to the first phase, experiments were performed according to the selected
DOE for so as to analyse the impact of change in input process variables on the surface
quality, dimensional accuracy and hardness of fabricated replicas. The experiments
were performed in random order to minimize the error. The impact of CVS process
on the surface quality has been evaluated by measuring the average surface rough-
ness (Ra ). The three reading of Ra at femur (refer Fig. 7.1) had been recorded for
each replica before and after vapour smoothing. The Digital Durometer (supplied by
Samruddhi Industries) has been employed for measurement of shore D hardness (H d )
of ABS replicas fabricated by FDM as per ASTM D 2240 standard. The indentation
hardness of soft materials thermoplastic elastomers, polymers, vulcanized rubber,
elastomeric and cellulose materials is measured by Durometer on various scales
such as A, B, C, D, O, OO and M. The hardness tester has least count 0.5 H d and
ranges from 0 to 100. The three readings were taken for each replica before and after
vapour smoothing, and average was taken as final reading. Dimensional variations in
ABS replicas before and after vapour smoothing have been measured by coordinate
measuring machine (CMM) adopting ISO 10360-2 (2009) standards. In the present
work, one critical dimension on hip implant (as shown in Fig. 7.1) has been identi-
fied and measured by CMM before and after the smoothing operation with an aim
to estimate the dimensional accuracy in terms of dimensional deviation ‘d’ [46].
The observations of surface roughness in terms of ‘Ra ’ value, shore hardness and
the value of dimensions have been shown in Table 7.3. The observations indicated
that the replicas exhibit better surface finish at 90° orientation with solid interior.
Also, the surface finish of fabricated replicas has been improved dramatically after
the smoothing process. Figure 7.3a, b represents the effect of smoothing operation
on the fabricated hip replica. It has been observed that smoothing operation almost
eliminates the effect of layered fabrication of FDM process called stair step effect.
The scanning electron microscope (SEM) images taken for the same fabricated
replica have been shown in Figs. 7.4 and 7.5, respectively. SEM images show dramatic
improvement in surface quality of the replica after the smoothing operation. It was
due to reflow of the material from peaks to valleys forced by the hot vapours of the
acetone which ultimately results in smoothed surface finish. Also, the ‘Ra ’ value of
all the fabricated replicas after the smoothing operation becomes almost same. The
percentage improvement in surface finish after the CVS process for all the replicas
has been calculated and shown in Table 7.4.
The observations of Table 7.3 indicated that shore hardness of all the replicas
increases slightly after the smoothing operation. The microscopic images taken by
154 J. Singh et al.

Table 7.3 Observations of responses before and after CVS

Run order Observations after FDM Observations after CVS
Ra (µm) SH (H d ) Dimension (mm) Ra (µm) SH (H d ) Dimension (mm)
1 7.368 66 6.038 0.310 70.5 6.024
2 5.751 71 6.019 0.192 75.5 6.007
3 8.472 74.5 6.041 0.301 78 6.017
4 5.495 69.5 6.024 0.249 72.5 6.015
5 8.219 64.5 6.02 0.376 68 6.012
6 8.311 64 6.019 0.386 67 6.013
7 8.658 69.5 6.023 0.325 72 6.012
8 8.586 74 6.031 0.361 76.5 6.019
9 8.32 64 6.012 0.347 69.5 6.01
10 5.006 74.5 6.043 0.194 77.5 6.029
11 5.225 75.5 6.041 0.168 79.5 6.024
12 8.436 73.5 6.036 0.34 75 6.019
13 5.106 75.5 6.043 0.187 79 6.024
14 7.942 66 6.038 0.276 72 6.019
15 5.212 71 6.022 0.204 74.5 6.013
16 7.59 65 6.036 0.355 68 6.026
17 8.547 69.5 6.014 0.286 73.5 6.005
18 8.742 70 6.017 0.335 74 6.008

Fig. 7.3 Specimen a before and b after the smoothing operation

7 Integration of FDM and Indirect Rapid Tooling Technique … 155

Fig. 7.4 SEM image before the smoothing operation

Fig. 7.5 SEM image after the smoothing operation

metallurgical microscope at magnification of 100× before and after smoothing oper-

ation for one of the ABS replicas have been shown in Fig. 7.6. Figure 7.6a clearly
shows existence of air gap between the two layers during the fabrication process of
the replica by the FDM technique. After the smoothing operation, the air gap almost
filled by the flow of material which ultimately reduces the stair-step effect and thus
improves the shore hardness (refer Fig. 7.6b). From the SEM images (refer Fig. 7.7),
the same phenomenon has been noticed.
Positive deviation from the drawing dimension has been observed (refer Table 7.3)
for the selected dimension (6 mm) after the FDM process. Also, it has been observed
that the CVS process reduces the dimension slightly (refer Table 7.3). This was due
to the reflow of material that takes place during the CVS process. Absolute deviation
156 J. Singh et al.

Table 7.4 Final responses along with signal-to-noise ratio

Run order Final responses after CVS process S/N Ratio (dB) for each response
after CVS
Percentage SH (H d ) ‘d’ (mm) Percentage SH ‘d’
improvement in Ra improvement in Ra
1 95.8 70.5 0.024 39.63 36.96 32.40
2 96.7 75.5 0.007 39.71 37.55 43.10
3 96.4 78 0.017 39.68 37.84 35.39
4 95.5 72.5 0.015 39.60 37.20 36.48
5 95.4 68 0.012 39.59 36.65 38.42
6 95.4 67 0.013 39.59 36.52 37.72
7 96.2 72 0.012 39.66 37.15 38.42
8 95.8 76.5 0.019 39.63 37.68 34.42
9 95.8 69.5 0.01 39.63 36.84 40.00
10 96.1 77.5 0.029 39.65 37.78 30.75
11 96.8 79.5 0.024 39.72 38.00 32.40
12 96.0 75 0.019 39.65 37.50 34.42
13 96.3 79 0.024 39.67 37.95 32.40
14 96.5 72 0.019 39.69 37.15 34.42
15 96.1 74.5 0.013 39.65 37.44 37.72
16 95.3 68 0.026 39.58 36.65 31.70
17 96.7 73.5 0.005 39.71 37.33 46.02
18 96.2 74 0.008 39.66 37.38 41.94

Fig. 7.6 Microscope image a before and b after the CVS process
7 Integration of FDM and Indirect Rapid Tooling Technique … 157

Fig. 7.7 SEM image a before and b after the CVS process

between the final dimension and the drawing dimension has been measured and
shown in Table 7.4. Since the main aim is to achieve maximum improvement in
surface finish and shore hardness along with minimum ‘d’, so S/N ratios has been
calculated (refer Table 7.4) on the basis of ‘larger is better’ approach for the ‘Ra ’
value and ‘SH’ using Eq. (1), whereas the same has been calculated based on ‘smaller
is better’ approach for the ‘d’ using Eq. (2). The effect of input parameters on the
mean S/N ratio plots for different responses have been shown in Figs. 7.8, 7.9 and
7.10.
 r 
1 1
S/N = −10 Log (1)
r i=1 Yi2
 r 
1 2
S/N = −10 log Y (2)
r i=1 i

Yi Observed value of the response characteristic

r Number of repetitions.

Figure 7.8 indicates that the maximum improvement in ‘Ra ’ value after the
smoothing operation has been observed for replicas prepared at 90° of orientation
angle with solid interiors. It was due to the fact that replicas with solid interior have
negligible gap between the consecutive layers which resulted in uniform flow of
ABS material during the smoothing operation and thus more improvement obtained
in surface finish. Further, more and more improvement has been observed as the
number of cycles of exposure increases due to repeated reflow of the material from
peaks to valleys. With increase in cycle time from 4 to 8 s, the improvement in ‘Ra ’
value increases rapidly. The reason behind this was that more time of CVS exposure
158 J. Singh et al.

Main Effects Plot for SN ratios

Data Means
Orientation Part density Cycles Time
39.68

39.67
Mean of SN ratios

39.66

39.65

39.64

39.63

39.62

39.61
0 90 High Low Solid 3 4 5 4 6 8

Signal-to-noise: Larger is better

Fig. 7.8 Mean S/N ratio plot for improvement in surface roughness

Main Effects Plot for SN ratios

Data Means
Orientation Part density Cycles Time
37.8

37.6
Mean of SN ratios

37.4

37.2

37.0

36.8

0 90 High Low Solid 3 4 5 4 6 8

Signal-to-noise: Larger is better

Fig. 7.9 Mean S/N ratio plot for shore hardness

7 Integration of FDM and Indirect Rapid Tooling Technique … 159

Main Effects Plot for SN ratios

Data Means
Orientation Part density Cycles Time
41

40

39
Mean of SN ratios

38

37

36

35

34

33
0 90 High Low Solid 3 4 5 4 6 8

Signal-to-noise: Smaller is better

Fig. 7.10 Mean S/N ratio plot for dimensional deviation

during each cycle results in proper melting and provides extra time for flow of ABS
material which drastically improves the ‘Ra ’ value. Figure 7.8 indicates that with
regard to maximum improvement in ‘Ra ’ value, A2 , B3 , C3 and D3 are the optimum
parameter levels as they yields the maximum value of S/N ratio.
The part interior style (part density) majorly affects the shore hardness and as the
part density increases, the hardness value improves. It was quite obvious that the gap
between the adjacent layers reduces as the part density changes from low to solid
which ultimately increases the hardness value. Smoothing operation has significant
effect on the shore hardness of fabricated replicas. The hardness value increases
as the number of cycles of CVS process increases. It was mainly because of again
and again reflow of the material which ultimately fills the air gap formed during
layered manufacturing. Also, the increase in cycle time of CVS process improves
the hardness value slightly but its effect was very little. Figure 7.9 indicates that the
optimum parameters with regard to shore hardness were A2 , B3, C3 and D3 .
Table 7.3 indicates FDM process yields slightly oversized replicas. However, after
smoothing process, the selected dimension decreases due to material reflow, and thus,
the smoothing becomes beneficial as it reduces the overall deviation. Figure 17.0
indicates that 0° orientation with high part density results in minimum deviation as
compared to other parametric settings. As the number of cycles increases, more and
more flow of the material occurs during each cycle which ultimately reduces the
overall deviation. But this may affect adversely on the other very small dimensions
of the replicas. Further, with increase in cycle time from 4 to 8 s, the overall deviation
decreases as ABS material gets more time to flow from peaks to valleys. Figure 7.10
160 J. Singh et al.

Table 7.5 Input and output

Parameter Goal Lower range Upper range
parameter constraints
Orientation Within region 0o 90o
Part density Within region High Solid
No. of cycles Within region 3 5
Cycle time Within region 4 8
S/N ratio (Ra ) Maximize 39.58 39.71
S/N ratio (SH) Maximize 36.52 38.00
S/N ratio (d) Maximize 30.75 46.02

indicates that the optimum parameters with regard to dimensional deviation were
A1 , B1, C3 and D3 .

7.3.1.1 Combined Optimization

Based on the results, it has been noticed that the optimum levels of parameters
for all the responses were different. So, combined optimized levels of the selected
parameters have been obtained using Minitab 17 software when all the responses were
considered simultaneously. Equal weight and importance have been assigned to each
input and output parameters. The constraints set and the suggested parametric levels
have been shown in Tables 7.5 and 7.6, respectively. The actual value of responses
has been calculated on the basis of S/N ratio by utilizing Eqs. (1) and (2) and shown
in Table 7.6.
Further, validity and repeatability of results have been checked by performing four
confirmatory experiments at suggested parametric settings as given in Table 7.6. The
observed values regarding the dimensional deviation, shore hardness and improve-
ment in surface finish (refer Table 7.7) indicate close and consistent results which
ensure the repeatability of the combined process.

Table 7.6 Suggested

Parameter Suggested value Actual value
parametric levels
Orientation 0° 0°
Part density High High
No of cycles 5 5
Cycle time 8 8
S/N ratio (Ra ) 39.71 96.71%
S/N ratio (SH) 37.41 74.21 H d
S/N ratio (d) 45.34 0.005 mm
Desirability 0.818 0.818
7 Integration of FDM and Indirect Rapid Tooling Technique … 161

Table 7.7 Results of confirmatory experiments

Exp No. Linear dimension (mm) d (mm) SH (H d ) Percentage improvement in Ra
1 6.007 0.007 75.5 96.2
2 6.006 0.006 74 96.4
3 6.007 0.007 75 96.7
4 6.004 0.004 74 96.3

7.3.2 Phase II (SM Process)

In this research work, the master pattern required for fabricating the silicon mould
is obtained from the results of first phase (FDM-CVS). The replica fabricated at
best parameter settings in first phase (FDM-CVS) on the basis of Taguchi’s L18
orthogonal array results with regard to surface finish, dimensional accuracy and
shore hardness has been selected as a master pattern for the second phase. Four
replicas have been fabricated at best parameter settings to create multiple cavity
silicon mould. The steps involved in silicon mould preparation have been shown in
Fig. 7.11.
Initially after attaching the gating system parts (sprue, riser, runner, etc.) to the
fabricated master patterns, a coloured tape was pasted on the edges of the patterns so
as to form the parting line. Further, in order to prevent the sticking of pouring resigns
with the surface of the patterns, a release agent was sprayed on the surface of master
patterns, and then, they were put in a frame. In the next step, mixture of silicon rubber
(VTV-750) and catalyst (CAT 740) that acts as hardener in the ratio of 10:1 were
prepared and degassed by vacuum casting machine for 15 min in order to remove the
air was poured into the frame. The mould was left for curing for about 16–18 h. After
curing, the frame was opened and silicon mould was removed from it. The mould was
ready for cutting and was cut with the surgical blade from the parting surface referring
the coloured tape for the removal of the master patterns. The release agent was again
applied to the cavities, and the mould was re-assembled. After this, the mould was
ready for vacuum casting (VC) of different polyurethane (PU) materials. In this
research work, multiple replicas were prepared by using Renishaw 6130 and Axson
PX223 PU resigns. The replicas prepared by this process are shown in Fig. 7.12.
Surface texture and dimensional accuracy measured on multiple fabricated replicas
were almost equivalent to those fabricated by traditional moulding techniques. So,
the replicas fabricated by this route can be employed as plastic-based sacrificial
patterns in investment casting applications for batch production and various end-user
applications.
162 J. Singh et al.

Fig. 7.11 Steps of preparing the silicon mould

7.3.3 Cost Comparison

The cost incurred for making the replicas during FDM process and SM process has
been compared for twenty-five runs of silicon mould. Higher the mould life, lesser
will be the mould cost per run. Based on the calculations (refer Table 7.8), 69.3% of
saving in cost has been achieved for fabricating the multiple replicas by employing
SM process as compared to FDM process. This ensures the capability of SM process
to produce cost-effective acceptable replicas for batch production applications.
7 Integration of FDM and Indirect Rapid Tooling Technique … 163

Fig. 7.12 Fabricated

prototypes of PU material

Table 7.8 Cost comparison for replicas fabricated by FDM and SM process
S. No. Process Description Cost (USD)
1 FDM Average cost of making each selected $7
replica
2 SM Cost of making multi-cavity (four) $72
silicon mould
Average mould cost for 25 runs $72/25 = $2.9 per run
Cost of fabricating four PU replicas $5.75
Cost of making each replica including (5.75 + 2.9)/4 = $2.15
mould cost
Percentage saving in cost per replica [(7 − 2.15)/7] × 100 = 69.3%

7.4 Conclusions

• The present book chapter demonstrates the procedure for fabrication of low-cost
hip implant replicas for batch production by combining the FDM, CVS and SM
process.
• The surface quality and shore hardness of fabricated replicas enhanced signifi-
cantly after the CVS process due to reduction of stair step effect and filling of air
gap by reflow of the material.
• FDM process yields slightly oversized dimensions. However, the material reflow
caused during the smoothing process reduces the selected dimension and thus
decreases the overall deviation.
164 J. Singh et al.

• 0° orientation, high part density, five number of cycles and eight seconds of
cycle time were the optimum levels of the selected parameters for combined
optimization.
• Multiple PU replicas were fabricated successfully by SM process to reduce the
overall cost of each replica.
• Percentage saving in cost of 69.3% for fabricating multiple replicas by SM process
ensures the capability of the process to produce cost-effective replicas for batch
production applications.

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31. Pattnaik S, Jha PK, Karunakar DB (2014) A review of rapid prototyping integrated investment
casting processes. Proc Inst Mech Eng Part L J Mater Des Appl 228(4):249–277
32. Singh S, Singh M, Prakash C, Gupta MK, Mia M, Singh R (2019) Optimization and reliability
analysis to improve surface quality and mechanical characteristics of heat-treated fused filament
fabricated parts. Int J Adv Manuf Technol 102:1521–1536
33. Boparai K, Singh R, Singh H (2016) Development of rapid tooling using fused deposition
modeling: a review. Rapid Prototyping J 22(2):281–299
34. Singh J, Singh R, Singh H (2018) Surface roughness prediction using Buckingham’s Pi-theorem
for SS-316L hip implant prepared as rapid investment casting. Mater Today Proc 5(9):18080–
18088
35. Singh S, Prakash C, Ramakrishna S (2019) 3D printing of polyether-ether-ketone for biomedical
applications. Eur Polym J. https://doi.org/10.1016/j.eurpolymj.2019.02.035
36. Rosochwski A, Matuszak A (2000) Rapid tooling: the state of the art. J Mater Process Technol
106:191–198
37. Kruth PJ (1991) Material increases manufacturing by rapid prototyping techniques. CIRP Ann
Manuf Technol 40(2):603–614
38. Pal DK, Ravi B (2007) Rapid tooling route selection and evaluation for sand and investment
casting. Virtual Phys Prototyping J 4:197–207
39. Cheah CM, Chua CK, Lee CW, Feng C, Tonog K (2005) Rapid prototyping and tooling
techniques: a review of applications for rapid investment casting. Int J Adv Manuf Technol
25:308–320
166 J. Singh et al.

40. Rahmati S, Akbari J, Barati E (2007) Dimensional accuracy analysis of wax patterns created
by RTV silicon rubber molding using Taguchi approach. Rapid Prototyping J 13(2):115–122
41. Thian SCH, Tang Y, Tan WK, Fuh JYH, Wong YS, Loh HT, Lu L (2008) The manufacture of
micromould and microparts by vacuum casting. Int J Adv Manuf Technol 38:944–948
42. Sharma V, Singh R (2011) Investigations for modeling the silicon moulding process for plastic
components. Int J Mater Sci Eng 2(1–2)
43. Galantucci LM, Lavecchia F, Percoco G (2010) Quantitative analysis of a chemical treatment
to reduce roughness of parts fabricated using fused deposition modeling. CIRP Ann Manuf
Technol 59(1):247–250
44. Garg A, Bhattacharya A, Batish A (2016) On surface finish and dimensional accuracy of FDM
parts after cold vapor treatment. Mater Manuf Processes 31(4):522–529
45. Montgomery DC (2008) Design and analysis of experiments. Wiley, New Jersey
46. Singh J, Singh R, Singh H (2017) Dimensional accuracy and surface finish of biomedical
implant fabricated as rapid investment casting for small to medium quantity production. J
Manuf Process 25(1):201–211

Dr. Jaspreet Singh is associate professor in the School of Mechanical Engineering, Lovely
Professional University, Jalandhar, India. He has received Ph.D. in Mechanical Engineering from
Guru Nanak Dev Engineering College, Ludhiana, India. His area of research is additive manu-
facturing, rapid investment casting and application of 3D printing for non-structural engineering
applications. He has contributed extensively in additive manufacturing literature with publica-
tions appearing in Journal of Manufacturing Processes, Measurement, Assembly Automation and
Materials Today: Proceedings.

Prof. Rupinder Singh is Professor in the Department of Production Engineering, Guru Nanak
Dev Engineering College, Ludhiana, India. He has received Ph.D. in Mechanical Engineering
from Thapar Institute of Engineering and Technology, Patiala, India. His area of research is non-
traditional machining, additive manufacturing and development of porous biomaterials using 3D
printing and rapid prototyping techniques. He has more than 18 years of teaching and research
experience. He has contributed extensively to the world in additive manufacturing literature
with publications appearing in Journal of Manufacturing Processes, Composite Part B, Rapid
Prototyping Journal, Journal of Mechanical Science and Technology, Measurement, International
Journal of Advance Manufacturing Technology, and Journal of Cleaner Production. He authored
17 books and ~3 chapters. He has received more than 3 crores research grants from various
funding agencies such as DST-SERB, AICTE, CSIR, DAE, IE. He is working with Prof. Seeram
Ramakrishna, NUS Nanoscience and Nanotechnology Initiative and Prof. Fernando Fraternali,
Full Professor of Structural Mechanics, Department of Civil Engineering, University of Salerno.

Prof. Harwinder Singh is professor in Department of Mechanical Engineering, Guru Nanak Dev
Engineering College, Ludhiana, India. He has received Ph.D. in Mechanical Engineering from
Punjabi University, Patiala, India. His area of research is additive manufacturing, rapid tooling
and industrial engineering. He has more than 18 years of teaching and research experience. He has
contributed extensively to the world in additive manufacturing and industrial engineering literature
with publications appearing in Journal of Manufacturing Processes, Rapid Prototyping Journal,
Measurement, International Journal of Advance Manufacturing Technology.
Chapter 8
Biomaterials and Fabrication Methods
of Scaffolds for Tissue Engineering
Applications

Atul Babbar, Vivek Jain, Dheeraj Gupta, Sunpreet Singh, Chander Prakash,
and Catalin Pruncu

8.1 Biomaterials

The definition of biomaterials by American Institute of health is as “any material or

combination of material, it may synthetic or natural in nature, which can use for any
time period in human body, which can replace the tissue or function of the body to
enhance the quality of life of any person” [1]. In the history of artificial implants, the
first material which was used to replace the cranial defects was gold by Egyptians and
Romans. During the period of the 1900s, the placenta was used as a biomaterial [2].
The polymethyl methacrylate (PMMA) was the first polymer which was accepted.
There are basically three categories of the biomaterials based on tissue reactions
[3].
Bio Tolerant Materials: These materials can separate from bone tissue by a layer
of fibrous tissue.
Bioactive Materials: Such material has the property of constructing chemical
bonds with other bone tissue. The collagen phase of the adjacent bone is deposited
on the implant surface.

A. Babbar (B) · V. Jain · D. Gupta

Department of Mechanical Engineering, Thapar Institute of Engineering and Technology, Patiala
147004, India
e-mail: [email protected]
S. Singh · C. Prakash
Department of Mechanical Engineering, Lovely Professional University, Phagwara, India
S. Singh
Department of Mechanical Engineering, National University of Singapore, Singapore, Singapore
C. Pruncu
Department of Mechanical Engineering, Imperial College of London, London, UK

© Springer Nature Singapore Pte Ltd. 2020 167

S. Singh et al. (eds.), 3D Printing in Biomedical Engineering,
Materials Horizons: From Nature to Nanomaterials,
https://doi.org/10.1007/978-981-15-5424-7_8
168 A. Babbar et al.

Bioinert Materials: Under this category, it is possible to have direct contact

with the adjacent bone tissue. No chemical reactions will occur between the implant
material and bone tissues.
The adaptation of the biomaterial depends upon the type of material used, load
applied and most importantly the age of the patient [4]. The surface of the material
can be enhanced by adding appetite sequences to provide a 3D structure to support
the matrix formation [5]. The new technologies are being continuously developed to
support new specifications and applications. Orthopaedic, cardiovascular and drug
delivery materials comprise the largest market of the implant materials and alone
dental implant market costs around 1 U$ billion.

8.1.1 Types of Biomaterials

A biomaterial or implants are defined as any material that is used to exchange or

reconstruction function to body tissue and permanent in contact with body fluids.
The implant materials should be biocompatible and should not elicit an ineffective
response from the body. It should be non-toxic [6]. The biomaterial should have
higher mechanical properties to serve as a replacement of human body tissues. A
biomaterial should be easily machined into different shapes and structure at low cost.
Generally, implant materials can be divided into the following categories [7–10].
• Metals
• Polymers
• Ceramics and composites.

Metals
In the previous decades, most of the common orthopaedic surgeries have been
performed for the implantation of metal implants. Applications of the metallic
implants are in wire, screw and total joint replacement such as hips joint, knees
joint, shoulders, ankles, etc., as shown in Table 8.1. There are some basic metals

Table 8.1 Applications of different metals [19]

S. No. Metal Principle applications
1 316L stainless steel Fracture fixations, surgical instruments
2 Pure titanium and its alloys Bone replacements, fixations, dental implants
3 Nickel and titanium alloys Bone plates, stunts and orthopaedic wires
4 Magnesium Bio gradable plates and screw
5 Gold alloys Dental restorations
6. Silver products Antibacterial agents
8 Biomaterials and Fabrication Methods of Scaffolds for Tissue … 169

Fig. 8.1 Applications of different polymers [20, 22, 23]

which have been used in the metallic implants such as stainless steels, pure tita-
nium and its alloy, gold alloys, silver products, platinum and nickel-titanium alloys
[11–18].

Polymers
There are various types of polymers which have been used in the biomedical field.
The application range of such polymers varies from facial treatments to liver and heart
valves and from dentistry to total knee and hip joints [20, 21]. Figure 8.1 illustrates
the applications of different type of polymers.

Glass and Ceramics

Some glasses and ceramics are mostly used in orthopaedic surgeries due to their
good biocompatibility and mechanical properties. These materials are very hard and
can resist high load capacity inside the human body [24, 25]. In the advance era, the
fabrication and machining of these materials are cost-effective and easily available
[11]. Applications of ceramics and glasses in the human body vary according to
the position of implants [26]. Table 8.2 shows the applications of the biomaterial
ceramics and glass materials.

8.2 Polymer Scaffold in Tissue Engineering

There are various conventional and non-conventional techniques to fabricate the

porous material or polymer scaffold for tissue engineering. The aim of the bone
tissue engineering is to enhance the role of traditional bone repair methods by using
biogradable polymer scaffold to increase the mechanism of the human body to repair
the bone fracture [31]. The polymer scaffold should be designed to match the mechan-
ical and structural properties of the target tissue. The polymer scaffold with similar
170 A. Babbar et al.

Table 8.2 Applications of

S. No. Glass and ceramics Principle applications
different type of glass and
ceramics [27–30] 1 Alumina Joint replacements and dental
implants
2 Zirconia Joint replacement
3 Calcium phosphate Bone repair and surface
coating
4 Bioactive glass Bone replacements
5 Porcelain Dental restorations
6 Carbons Heart valves and dental
implants

properties to native bone has many advantages. Porosity, the structure of pores,
interconnectivity of pores and mechanical characterisation of the scaffold affect the
effectiveness of polymer scaffolds [32]. It has been found that the interconnectivity
and porosity throughout the scaffold required to promote the cell culture, loading
and migration of cells, tissue growth and flow of body fluid [33]. The traditional
fabrication techniques have the drawback of poor permeability and interconnectivity
between the porous. The development of non-conventional methods to fabricate
scaffold leads to control of pore morphology.

8.2.1 Traditional Tissue Repair Methods

Tissue repair is an ultimate method of surgery since ancient time and can be classified
into two foams: (1) tissue grafting and organ transplantation and (2) alloplastic and
synthetic material replacement. When the bone tissue is unable to resist the load of
the body, the damaged tissue is replaced with the artificial material used to fill the
bone injury. Moreover, the damaged bone tissue cannot be taken from the other part
of the body or from other human beings since it can cause transmission infection.

8.2.2 Tissue Engineering

Tissue engineering introduced in the year 1990 to address the drawbacks of tissue
grafting and alloplastic tissue repair techniques [34]. This technique is used to trans-
plant the cells, genes and proteins through the porous structure known as a scaffold.
Tissue engineering aims for regenerating a load-bearing tissue, and hence, scaffold
should resist the mechanical function to aid biological delivery [35, 36]. The fabri-
cation of porous scaffold can help in understanding the role of the scaffold structural
parameters on mechanical characteristics and efficiency [37–39]. The techniques
used to fabricate the scaffold have a major role in the morphology of the scaffold.
8 Biomaterials and Fabrication Methods of Scaffolds for Tissue … 171

Table 8.3 Different casting techniques with unique factors and applications [40–44]
S. No. Method Polymers Unique factors Applications
1 Solvent casting PLLA, PLGA Porous scaffold Bone engineering
control
2 Ice particle leaching PLLA, PLGA Pore structure Tissue engineering
control
3 Gas foaming PLLA, PDLLA Porosity control Drug delivery
4 Solvent evaporation PLGA, PLAGA High density cell Bone repair
culture

There are number of methods to fabricate the scaffold; each one has its advan-
tages and disadvantages. The medical applications of the different polymers in tissue
engineering have been shown in Table 8.3.

8.3 Traditional Scaffold Casting Methods

8.3.1 Solvent Casting

Solvent casting is a method that involves dispersing mineral or organic particles in

a polymer solution [45]. Casting or freeze-drying is then performed as a dispersion
process in order to produce porous scaffold [39]. This basic method has been used
to fabricate scaffolds using various polymers but while the approach is relatively
simple, there are disadvantages such as the use of toxic solvents and residual solvent
that remains in the scaffold and it may harmful for human body [46].

8.3.2 Gas Foaming

Gas foaming is a method used under high pressure. In this process, a polymer solid
disc is formed with the help of compression moulding machine under high tempera-
ture and pressure [47–49]. Subsequently, polymer disc is placed in the high-pressure
CO2 chamber for some days. This time period is provided for creating the pores for
tissue growth due to the infiltration of the gas. This technique is sufficient for a high
degree of porosity in the final scaffold without affecting the bioactivity and the pore
size in the range of 100 µ.
172 A. Babbar et al.

8.3.3 Melt Processing

This method has been introduced to use more than one polymer, mixed together
and exposed to the temperature above the melting point of the two polymers [50].
In this method, both polymers are continuous in the structure and allow for the
interconnected pores network. The process of melting of polymer involves the use of
NaCl, polymer and an extruder. Extruder provides the homogenous and well-blended
mixture. The salt particles present in the mixture can also break down during mixing
and result in the small pore size. Polymer network produced in this way is usually
too small for most tissue engineering applications [51].

8.4 Fabrication of Scaffolds with Additive Manufacturing

The process “additive manufacturing (AM)” adds material in layer formation or

pattern to fabricate the required shape and size instead of material removing [52].
The flow chart of the additive manufacturing procedure is shown in Fig. 8.2. AM is
used in several areas such as prototyping, aerospace, military, buildings and cars 3D
printing, home applications and biomedical engineering. This 3D printing technique
uses software which slices the 3D model into various layers. Each layer performed on
the build platform by the printer; once the first layer is completed, the platform goes
downwards according to layer thickness or equal to layer thickness; and another layer
is fabricated over the previous layer. 3D printing technique significantly decreases
the waste because in 3D printing, the material is placed only in the required location;
the rest will be left as empty space [53–55].
From last few years, scientist and engineers have performed rigorous research
to use 3D printing technology to fabricate artificial body parts and organs. This
technique helps to create artificial implants for the patient’s body the same as the
fabrication of plastic and metal parts. Another application of 3D printing in the
biomedical field is creating body parts out of metal or other material to replace the
damaged and lost limbs. With the help of the advancement of 3D printing, now
the doctor firstly scans the patient’s body and bone structure. The design engineers
help to recreate the artificial part in the laboratory which helps to meet the exact
requirements of the patient.

DESIGN PROCESSING PRODUCTION FINISHING

Fig. 8.2 Flow diagram of the additive manufacturing

8 Biomaterials and Fabrication Methods of Scaffolds for Tissue … 173

8.4.1 Stereolithography

Stereolithography is a process in which an ultraviolet laser is used to fabricate parts

layer by layer. The resin is placed on the machine bed and laser beam strike on it and
melt it. For each layer, the laser strikes on the surface of the resin. The high-voltage
laser light cures and solidifies the pattern as per design traced on the resin and helps
to join with the lower layer [56, 57]. Once the pattern is traced, the elevator platform
descends by a distance equal to the layer thickness of a single layer which generally
varies in the range of 0.05–0.15 mm. Once the single layer is completed, the resin
blade moves over the section of the part to fill fresh material and process is repeated
until the final output created. Once the required part is created, it is immersed in a
chemical bath to remove the support material and excessive resin and subsequently
cured in an oven for some time [58].

8.4.2 Selective Laser Sintering

The selective laser sintering technique is another kind of 3D printing technology.

The form of input material is the major difference between stereolithographic and
selective laser sintering. The small powder form particles are used as input material.
The highly powered carbon dioxide laser is used to perform the manufacturing oper-
ation. The highly powered laser scanned the cross section and melts the material. The
movement in X-axis and Y-axis is controlled by the laser head, and the movement in
Z-axis is controlled by the machine bed (refer to Fig. 8.3). The density of the final
part is based upon the peak power of laser instead of laser time. The powder used
in the chamber is preheated so that it can help to raise the temperature in less time.
This technique can be used for various materials such as polymer, nylon, metals and
alloys [59, 60].

Fig. 8.3 Selective laser

sintering process [61]
174 A. Babbar et al.

Fig. 8.4 Fused deposition

modelling machine (under
CC Licences) [62]

8.4.3 Fused Deposition Modelling

The fused deposition modelling is widely used in production application of each

sector. It is generally based on the additive principle of manufacturing. The input
material is basically used in the form of a plastic filament or metal wire. The extru-
sion nozzle converts the material from solid form to liquid as evidently in Fig. 8.4.
The raw material extrudes from the nozzle in the form of thin filament and deposit
and solidifies over the printer’s platform. Subsequently, another layer extrudes out
from the nozzle and diffuses with the previous layer, and hence, material takes its
final shape with layer-by-layer addition of the material. All operations of the FDM
machine are numerically controlled. The process parameters are decided manually
in the software package. The X-axis and Y-axis movements are controlled by extru-
sion nozzle, and Z directions are controlled by machine bed. The movements are
controlled by Stepper motors or servo motors.

8.5 Process Parameters for Additive Manufacturing

The process parameters play a vital role in the properties of the fabricated sample in
3D printing. It has been observed that the different process parameter has a signif-
icant effect on the behaviour of the final specimen. Some parameters play a major
role, while other parameters play a minor role in the characterisation of 3D-printed
samples, which have been discussed below.
8 Biomaterials and Fabrication Methods of Scaffolds for Tissue … 175

Infill Percentage
The infill percentage of workpiece plays a major role in mechanical characterisation.
In 3D printing, the term “infill” means the structure inside the object that required to
print. Figure 8.5 shows the different infill percentage of 3D specimens. The workpiece
with 100% infilling shows dense structure [63, 64]. The infill percentage of the design
is provided in the software. Print weight, build time, usage material in fabrication
and strength of part are another influencing parameters. The sample with 100% in
filling has great mechanical strength and other properties instead of 5, 10 and 20%.

Infill Pattern
The infill pattern is the way of filling the inside portion of the workpiece. The mechan-
ical properties of any workpiece directly depend upon the infill pattern. When using
any infill pattern, it will decide the mechanical characterisation of that particular
workpiece [53, 66, 67]. Nowadays, various types of infill patterns options are avail-
able in 3D printers as shown in Fig. 8.6; each has some advantages and limitations
between the strength of the material, build time or print time and required material
for fabrication.

Fig. 8.5 Different infill percentage [65]

176 A. Babbar et al.

Fig. 8.6 Different infill patterns [32]

The simplified 3D software provides six different types of patterns with some of
the most popular. The designer can select any one of the infill patterns and fabricate
the workpiece. Followings are the most common uses infill patterns are as follows:
1 Rectilinear
2 Grid
3 Triangular
4 Wiggle
5 Fast honeycomb
6 Full honeycomb.

Layer Thickness
The layer thickness in 3D printing can describe as the height of the individual succes-
sive layer. The 3D printing works on the principle of layer formation, extruder moves
on the bed of the machine and fabricates a single layer as per the design of the sample.
The thickness of the single layer is controlled by the servo motor speed, which is
connected with a printing machine and controlled according to the design of the work-
piece. When the single layer is fabricated, the extruder repeats the same process until
8 Biomaterials and Fabrication Methods of Scaffolds for Tissue … 177

final completion of the job. The build time and surface roughness directly depends
upon the layer thickness [68].

Layer Width
As the name suggests, layer width in 3D printing represents the measure of the width
of a single layer. The width of the single layer can be decided in the software. The
layer height or layer thickness and layer width are co-relative to each other. During
fabrication of parts, layer width and layer thickness are controlled by the servo motor
as per directions are given in the software file.

Printing Speed
The printing speed generally can be classified into three stages such as high speed,
medium speed and low speed. The low speed is around 40–50 mm/s, and high build
time, medium infill speed is generally from 80 to 100 mm/s. The third and last stage
is high infill speed up to 150 mm/s. It has been reported that the build time increases
with decrease in the infill speed. A small part with low quality can print in less than
10 min. However, more time would be required for large size parts and high-quality
standards.

Build Orientation
Build orientation plays an important role in the properties of the building part. Fabri-
cation of the parts with different directions of the orientations may result in the
significant change in the print quality. For example, if a designer fabricates the two
cylinders with a different orientation, the dimensions of the cylinders are 10 mm
outside diameter and 6 mm inside diameter with 20 mm height. The printing of
the first part with its centre axis vertical, and the printer would construct a series
of concentric circle layered on the top of other. The result will be a smooth outer
surface. On the other side, the second part printed with its centre axis horizontally,
the part print as the series of rectangles layered on the top of last one. The surface
of the cylinder which touches the platform will be flat. There will be a difference
between the characterisation of both parts.

Raster Angle
Raster angle is the direction of layer fabrication with respect to the platform axis.
It gives a significant result on the characterisation of the part with different raster
angle. It varies from 0° to 90°.

Temperature
The temperature is the main parameter in 3D printing because melting temperature,
glass transition temperature and bed temperature are different for different materials.
For example, the glass melting temperature of polylactic acid is near to 180 °C and
glass transition temperature near about 60 °C. On the other hand, the glass transition
temperature of ABS near to 105 °C.
178 A. Babbar et al.

8.6 Properties of PLA Polymer

PLA is a biocompatible polymer which has excellent biocompatibility due to which

polymer is mainly suited for biomedical applications. The polymer scaffold can float
into the water because of its low densities. The strength of the PLA polymer is lower
than the metallic implants and decreases with the decreasing density of the material.
There is no side effect of PLA polymer in the human body. The process parameters
chosen for the fabrication of scaffolds have a significant effect on its properties.

Mechanical Properties
When polymer scaffolds are compared to dense polymer structure, the scaffold
behaves differently in testing due to their internal structure. Conventional testing
techniques such as compression test and tensile test are used to measure the tensile and
compressive strength of the scaffolds. The polymer scaffold behaves differently with
different process parameters and the internal structure of the scaffold. Followings
are the different mechanical properties of the dense PLA polymer (Table 8.4).

Thermal Properties
Polylactic acid is a biodegradable and bioactive polymer which is produced from the
renewable energy sources such as cassava roots, chips or stretch and sugarcane. In
2010, polylactic acid had the second biggest consumption volume of any bioplastic
in the world. Followings are some thermal properties of the PLA polymer (Table 8.5).

Biocompatibility
Biocompatibility is a degree to which implant materials result in tissue engineering.
There are several biomedical materials available such as stainless steel, titanium and

Table 8.4 Mechanical

S. No. Properties Range
properties of PLA [69–71]
1 Tensile strength 50–60 MPa
2 Elongation at break 6%
3 Young’s modulus 3.5 GPa
4 Flexural strength 80 MPa
5 Shear module 2.4 GPa
6 Flexural module 4.0 GPa
7 Density 1.25 g/cm2

Table 8.5 Thermal

S. No. Properties Range
properties of PLA [70, 72, 73]
1 Glass transition temperature 60–65 °C
2 Melting temperature 173–178 °C
3 Crystallinity temperature 37 °C
4 Heat resistance temperature 110 °C
8 Biomaterials and Fabrication Methods of Scaffolds for Tissue … 179

Table 8.6 Mechanical properties of different bones [74–77]

S. No. Bones Compressive strength Tensile strength Young’s modulus
(MPa) (MPa) (GPa)
1 Cancellous bone 4–12 N/A 0.02–0.5
2 Cortical bone 130–180 60–120 3–30
3 Cartilage N/A 3.7–10.5 0.7–15.3 (MPa)
4 Ligament N/A 13–46 0.065–0.541
5 Tendon N/A 24–112 0.143–2.31

its alloys. If material has less negative tissue reactions occurs, it means the material
has a more biocompatible nature. For example, gold is the most biocompatible metal
compared to others but it is too soft, ductile and costlier. The biocompatibility of
any metal or material depends upon the weight relative to its mechanical properties.
In the case of metals, the corrosion resistance test is the main way to check the
biocompatibility of any metal, because the corrosion rate of any metal can decide
the response of reaction. Implant material should have corrosion resistant nature.
Adjacent tissues may discolour and can be allergic in the patient’s body due to the
release of elements.

Mechanical Properties of Human Body Tissues

The human body has different kind of bones relative to their properties. Some bones
have great mechanical strength, and some others have very low. The following table
shows the different properties of the different bones (Table 8.6).

8.7 Applications of Polymer Scaffolds in Biomedical

Polymer scaffold is widely used in biomedical engineering. In previous decades,

it was only used in the form of medical devices. The foremost requirement of the
biomedical implants is the choice of the material as per adequacy of the human body.
A material which is used for implant manufacturing should have some properties in
order to have long life usage inside the body without any side effects. Some polymeric
material is widely used for medical purpose in these days such as tissue engineering,
artificial organ and implants, bone repair screws and dentistry. Following are the
main applications of the polymer related biomaterials.

Tissues Scaffolding
Biomaterials play a vital role in tissues scaffolding, working as a three-dimensional
support structure for the regeneration of cells as shown in Fig. 8.7. Polymers are the
most popular biomaterial in tissue growing due to their mechanical similarity with the
bone structure. Most polymers can break into natural products. Biomaterials should
have similar chemical properties as required in the tissues engineering [78].
180 A. Babbar et al.

Fig. 8.7 Regeneration of tissue engineering [79]

Implantation of Medical Devices

In drug delivery control systems, stents are coated with a layer of biodegradable and
bioresorbable materials [80]. The biodegradable polymer is also candidate material
for biodegradable stents due to their suitable properties to control drug release and
good mechanical characteristics to prevent stents from deforming or fracturing [81].
The major advantage of the usage of degradable implants is no need for surgery to
remove the implants after recovery. Nowadays, most of the bone fixation screws,
pins and plates are fabricating from degradable materials.

Joint Prostheses
Joints are necessary inside the body parts for the movement. The hip joint, knee joint
and elbow are some examples of body joints. From the last few decades, the artificial
hip joint and knee joint replacement is most commonly applied in human beings.
The acetabular part and femoral part fixed with each other. The shaft of the femoral
stem is specially tapered.
8 Biomaterials and Fabrication Methods of Scaffolds for Tissue … 181

Dentistry
A vast variety of materials like polymer and metals are used in the dentistry like cavity
filling, fluting, crown and bridge, prosthetic, orthodontic and periodontal treatment of
teeth. The choice of dentistry material is the pivot on its properties such as mechanical
and biomedical properties of tooth structure.

Bone Repair
Bone is a structural compound consists of collagen fibres with hydroxyapatite crystals
[82]. Bone also provides space for some other constituents such as bone cells and
blood vessels. Bone fractures behave in contrasting kind of ways, and it can be
classified into two types: internal fixation and external fixation. The external fixations
are used when no need for surgery or can say that without any opening. On the other
side, internal fixation required surgery for recovery of the fracture [83].

Drug Delivery System

The biodegradable polymers are useful for drug delivery. There are some drawbacks
of the oldest methods of drug delivery like injections or tablets. The most prominent
way to drug delivery is that the drug is held in a polymer membrane or matrix and
diffuses out into the implantation of the tissue. In some cases, the dissolution of the
polymer contributes to the release mechanism. In these days, biodegradable polymers
such as PLA are widely used for drug delivery system [32].

8.8 Conclusion

Tissue engineering (TE) plays a significant role in the biomedical applications. The
scaffolds have a great importance in the TE applications. These biological substitutes
not only improve but also restore the basic tissue function by providing a healthy envi-
ronment. Further, scaffolds assist in tissue’s growth, cell attachment, proliferation
and migration during in vivo and in vitro implantation. Additive manufacturing-
based scaffold fabrication technique has showed its potential for manufacturing the
scaffolds. However, design parameters are critical during the selection of the specific
technique and this decision is made on the basis of cost, simplicity, biocompatibility
and architecture characteristics (framework and porosity). The selection of the suit-
able biomaterial is another critically important parameter for the fabrication of the
scaffolds. The materials processed with the FDM technique are limited owing to the
lack of suitable thermal and viscoelastic properties. The parameters such as printing
speed, infill pattern, infill percentage, build orientation, layer thickness and raster
angle can be either software or user controlled. Development of the new design and
hybrid biomaterial use has extended the applicability of the existing techniques with
the addition of stem cells in the various tissue engineering applications.
182 A. Babbar et al.

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https://doi.org/10.2147/orr.s63437

Mr. Atul Babbar, Ph.D. Research Scholar, Mechanical Engineering Department, Thapar Insti-
tute of Engineering and Technology, Patiala, India. He has been working on osteonecrosis and
neurosurgical bone grinding operations for the treatment of benign and cancerous brain tumors.
His core research area is biomedical machining and working on novel ways of bone machining
for preventing deleterious consequences due to thermogenesis.

Dr. Vivek Jain is currently Associate Professor in the Department of Mechanical Engineering at
the Thapar Institute of Engineering and Technology, Patiala, India. He has 14 years of teaching
and industrial experience. He obtained his Bachelor’s Degree in Mechanical Engineering from
Rajiv Gandhi College of Engineering, Research and Technology, Chandrapur-442 403 (Maha-
rashtra), formally (Chandrapur Engineering College, Chandrapur) India, and Master’s from Guru
Nanak Dev Engineering College, Ludhiana, Punjab. He completed his Doctoral Degrees from the
Indian Institute of Technology Roorkee, India. He has guided two doctoral thesis and 22 M.Tech
dissertations and is currently supervising four doctoral theses and 03 more M.Tech dissertations.
He has published more than 40 articles in journals and conferences. He is a reviewer for various
international/national journals. He has filed three Indian patent. He has completed two internally
funded research projects. Currently, he is Co-Principal Investigator for one SERB-DST funded
project.
186 A. Babbar et al.

Dr. Dheeraj Gupta is currently Associate Professor in the Department of Mechanical Engi-
neering at the Thapar Institute of Engineering and Technology, Patiala, India. He has 10 years of
teaching and research experience. He obtained his Bachelor’s Degree in Mechanical Engineering
from Shri Govindram Seksaria Institute of Technology and Science, Indore, India, and Master’s
and Doctoral Degrees from the Indian Institute of Technology Roorkee, India. He has guided 02
Ph.D. and 17 M.Tech dissertations and is currently supervising four doctoral theses and three more
M.Tech dissertation. He has published more than 70 articles in journals and conferences. He is
a reviewer to various international journals. He has filed two Indian patent. He has completed
two internally funded research projects. Currently, he is Principal Investigator for one SERB-DST
funded project.

Dr. Sunpreet Singh is post-doc fellow in the School of Mechanical Engineering, National
Univeristy of Singapore, Singapore. He has received Ph.D in Mechanical Engineering from Guru
Nanak Dev Engineering College, Ludhiana, India. His area of research is additive manufacturing
and application of 3D printing for development of new biomaterials for clinical applications.
He has contributed extensively in additive manufacturing literature with publications appearing
in Journal of Manufacturing Processes, Composite Part B, Rapid Prototyping Journal, Journal
of Mechanical Science and Technology, Measurement, International Journal of Advance Manu-
facturing Technology, and Journal of Cleaner Production. He authored 10 chapters and mono-
graphs. He is working with joint collaboration with Prof. Seeram Ramakrishna, NUS Nanoscience
and Nanotechnology Initiative and Prof. Rupinder Singh, Manufacturing Research Lab, GNDEC,
Ludhiana.

Dr. Chander Prakash is Associate Professor in the School of Mechanical Engineering, Lovely
Professional University, Jalandhar, India. He has received Ph.D in Mechanical Engineering from
Panjab University, Chandigarh, India. His area of research is biomaterials, rapid prototyping and
3-D printing, advanced manufacturing, modeling, simulation, and optimization. He has more than
11 years of teaching experience and 6 years research experience. He has contributed extensively
to the world in the titanium- and magnesium-based implant literature with publications appearing
in Surface and Coating Technology, Materials and Manufacturing Processes, Journal of Materials
Engineering and Performance, Journal of Mechanical Science and Technology, Nanoscience and
Nanotechnology Letters, Proceedings of the Institution of Mechanical Engineers, Part B: Journal
of Engineering Manufacture. He authored 50 research papers and 10 chapters. He is also Editor of
three books: “Current Trends in Bio-manufacturing”, Springer Series in Advanced Manufacturing,
Springer International Publishing AG, Gewerbestrasse 11, 6330 Cham, Switzerland., Dec. 2018;
“3D Printing in Biomedical Engineering”, Book series Materials Horizons: From Nature to Nano-
materials, Springer International Publishing AG, Gewerbestrasse 11, 6330 Cham, Switzerland.,
August 2019, and “Biomaterials in Orthopaedics and Bone Regeneration—Design and Synthesis”,
Book series Materials Horizons: From Nature to Nanomaterials, Springer International Publishing
AG, Gewerbestrasse 11, 6330 Cham, Switzerland., March 2019. He is also Guest Editor of three
journals: Guest Editor of Special Issue of “Functional Materials and Advanced Manufacturing”,
Facta Universitatis, Series: Mechanical Engineering (Scopus Index), Materials Science Forum
(Scopus Index), and Special Issue on “Metrology in Materials and Advanced Manufacturing”,
Measurement and Control (SCI indexed).

Dr. Catalin Pruncu is a Research Fellow with a keen interest in design mechanics, solid
mechanics, fracture mechanics, tribology, microstructure characterization and finite element
modelling (FEM). Dr. Catalin has good experience in virtual engineering and experimental
testing methodology from fundamental to applied research. Dr. Pruncu really enjoys working in
successful partnerships with different colleagues, especially where he performs research across
disciplines, having the possibility to share ideas and learn from each other.
Chapter 9
Rapid Prototyping Methods
in Manufacturing of Biomedical
Implants: A Review

Ajith Gopinath, Tobias Waclawczyk, Raman Bedi, Avinash Babu,

Shijo Thomas, and Praise Tom

Nomenclature

FDM Fused deposition modeling

CT Computerized tomography
MRI Magnetic resonance imaging
SLA Stereolithography
SLM Selective laser melting
SLS Selective laser sintering
DLP Digital light processing
CAD Computer-aided design
UV Ultra violate
FEA Finite element analysis
RP Rapid prototyping
PP Polypropylene
2D Two dimensional
3D Three dimensional
AM Additive manufacturing.

A. Gopinath (B) · R. Bedi · A. Babu · S. Thomas · P. Tom

Christ Deemed to be University, Bengaluru 560029, India
e-mail: [email protected]
T. Waclawczyk
University of Augsburg, Augsburg 86159, Germany

© Springer Nature Singapore Pte Ltd. 2020 187

S. Singh et al. (eds.), 3D Printing in Biomedical Engineering,
Materials Horizons: From Nature to Nanomaterials,
https://doi.org/10.1007/978-981-15-5424-7_9
188 A. Gopinath et al.

9.1 Introduction

Biomedical implants are a constantly improving market. The biomedical implants,

due to its specificity to each patient and the high degree of accuracy required, must
be of extremely high quality. Constant researches have been happening in this field
for the manufacturing and development of the bio-implants. The methods of manu-
facturing have evolved over centuries, and additive manufacturing is one of the most
advanced and sophisticated methods by which the bio-implants can be manufactured
without compromising on the quality and the properties. Additive manufacturing can
be deployed to manufacture the various functional parts in a much faster way. Additive
manufacturing through intensive research over two decades has found its applica-
tion in energy, aerospace, biomedical, automotive, and other fields. The addition of
material layer by layer finds answer for much complex geometries which could not
be achieved with the conventional processes [1]. The dimensional accuracy obtained
is much higher when compared to the traditional methods of manufacturing. The
technique can be subdivided into different categories based on the state of precursor
material or raw material such as liquid-based, powder-based, and solid-based. Steri-
olithography, selective laser sintering, and 3D printing are some of the widely used
manufacturing techniques [2].
Fused deposition modeling is one of the additive manufacturing techniques in
which the input material is solid. The machine consists of an extrusion head which
heats up the solid wire fed into it and thereby depositing it one over the other in
layers to complete a 3D model. The guide ways facilitate the movement of the
extrusion head in X, Y, and Z axes [3]. Additive manufacturing finds its application in
biomedical field because of the accurate manufacturability of specific parts. The rapid
prototyping techniques have been used during the last two decades to manufacture
biocompatible scaffolds and custom-made medical implants, using polymer-derived
composites, ceramics, and other biocompatible materials (Fig. 9.1).
Recent advancement in the biomedical application has shown the manufacture of
biodegradable composites as the implant material used in tissue engineering. Some
of the advantages of rapid prototyping over the conventional methods of manufacture
are the dimensional accuracy and reproducibility along with the freedom in custom
shaping and sizing which can be used for the manufacture of tuned pores of numerous
scales and forms [4].
Ceramics have also been an area of constant research since its inception centuries
ago. The traditional and engineering ceramics are manufactured in numerous ways;
however, these techniques are laborious and expensive in nature. In many of the
researches, high-density alumina were used as the material for manufacturing the bio-
implants for the joints because of various properties such as bio-inertness, abrasion
resistance, strength, and chemical inertness, whereas bio-implants for spinal fusion
was manufactured with bioglass/glass ceramic because of its superior mechanical
properties, good biocompatibility, and nontoxicity. Additive manufacturing process
has proven to be very flexible since more than one processes can be combined for
the fabrication of finished components with a variety of materials such as zirconia
9 Rapid Prototyping Methods in Manufacturing … 189

Fig. 9.1 Schematic representation of rapid prototyping apparatus, fused deposition modeling
machine (FDM)

and alumina [5]. Additive manufactured bones have to be rough in order to facilitate
better attachment with the tissues [1]. Fracture rate was found to reduce when zirconia
was added to aluminum, thus making monolithic ceramic prosthesis more reliable.
Reduction in wear rate was also observed for the ceramic composite hip implants
when compared to others [6]. Many methodologies were assessed by the authors for
the fabrication of the monolithic ceramic components with multiscale porosity and
varied morphology for different industrial applications [7].
Particulate setting instead of being suspended in liquid resin, pore generation
during bubble formation, and longer curing time are the major problems while fabri-
cating monolithic ceramic materials. Some of the problems can be get rid of by opto-
form process in which a paste is used instead of photopolymer liquid [8]. Polysiloxane
due to its bio-inertness and nontoxic nature have been a preferred material in many
biomedical and cosmetic applications [9]. Additive manufacturing provides more
flexibility in manufacturing and finds numerous applications such as the manufac-
turing of prosthesis and complex automobile components. The manufacturing of
prostheses requires high technical expertise and dimensional accuracy. The fabrica-
tion of the prostheses with conventional casting method is time-consuming and is a
tedious process which is eliminated by the advent of additive manufacturing.

9.2 Methodology of 3D Printing for Bio-Implant

Manufacturing

Biomedical field has seen vast improvements in the area of implant manufacturing
after the advent of rapid prototyping into the sector. The materials used for the
process are also varied in scope of improving the properties of the implant. The
190 A. Gopinath et al.

patient-specific implants can be manufactured with the help of rapid prototyping as

explained in Fig. 9.2. The CT scan/MRI imaging provides the 3D model of the bio-
implant required which is then converted to the STL format with interface software.
Analysis of the 3D cad model can be done to simulate the working of the organ.
However, before the actual printing of the material, a presurgical planning is done
to understand the anatomy of the material in times of complex situations. Even it
can be used to create 3D models of living organs which show details invisible in
CT scan [10–12]. Dimensional deviation and surface roughness are two conflicting
results when the number of layers is considered as the deciding parameter [13]. The
rapid prototyping is even used for the treatment of traumatic injuries and cancerous
injuries in bones [14].

Medical Images

3D segmentation

3D CAD Model

Analysis of implantable
Design Pre-surgical Planning
medical devices

-Meshing and -Measurements on

Rapid Prototyping Process
material assignment anatomy for better
understanding of
SLA
-finite element complex
analysis situations[10][88]
SLM
-prediction of -creating 3D models of
material SLS living organs[11]
properties[9].
FDM -3D models show
details, which are not
INKJET visible on the CT
[12]

Fig. 9.2 Flowchart of the process of bio-implant manufacturing by rapid prototyping

9 Rapid Prototyping Methods in Manufacturing … 191

9.3 Material and Process Parameters for Different Rapid

Prototyping Methods

9.3.1 Steriolithography

Steriolithography is a liquid-based additive manufacturing technique in which the

resin is cured with a UV light source to form the required shape as per the CAD
model. UV curable resin is deployed in VAT tray for this process, and UV light is
made to fall on the thin layer of resin over the loaded tray. The layer cures, and then,
the platform is displaced vertically by a very small distance, in micrometers, so that
another layer of liquid comes above the cured layer of resin, which is then cured by
the UV light. This process continues until a perfect solid shape is obtained. A KUDO
steriolithography machines is shown in Fig. 9.3.
The dimensional accuracy of the solid is attributed to the layer thickness of the
solid manufactured. Similar operations are performed in the other techniques, but
instead the UV light laser is used in selective laser sintering, whereas in 3D printing,
binder is used to bind the powder together which is then postsintered to obtain the
final component [1].
The scientists have reported the fabrication of carbon fiber tows of 10 mm where
the liquid precursor was injected to one end of the tow which was then dried and
pyrolyzed under infrared radiation furnace made with 650 W, JCD-G5.3 halogen.
Specimen was then cooled and returned to injector for next cycle. Next specimens
were made with 8, 16, 40, and 80 cycles of infiltration. In order to avoid crack
formation, specific care was taken. The layers have to be very thin to facilitate flash
pyrolysis. Flash pyrolysis is an advanced method in which each layer is exposed to
infrared radiation for a few seconds which avoids the need of sintering the green
mould [15]. Computed tomographic (CT) data can be converted into a format that
can be used by any 3D printer. Hydroxyapatite cannot be cured by the laser only

Platform
Vat Tray

Post Processing Uv Light Source

Chamber

Fig. 9.3 Steriolithography KUDO 3D printing machine

192 A. Gopinath et al.

the resin, which functioned as a binder. But the 3D modeling software gives the
opportunity of using crosshatch patterns to regulate the porosity inside the implant.
The resin was burnt out afterwards and the result was the hydroxyapatite prosthesis
[16].
A hybrid steriolithography/3D printing process was deployed to fabricate 3D
structures with electronic circuits embedded in it. The process consisted of multiple
starts and stops and multiple intermediate processes. The uncured resin was removed,
and electronic circuits were embedded into it, and further processes were done to
manufacture the complete part [17]. The demonstration of the practical applicability
of the silicone-alginate composite as an implant material was shown by manufac-
turing an electrode. The implantable silicone electrode or myoplant electrode from
Lewis et al. was used as a model, with which myogenic signals can be detected. This
electrode consists of two silicone layers glued together. The implant consisted out
of two composite layers between which two electrode contacts were embedded. The
structure and geometry of the implant were based on an implantable silicone elec-
trode. Myoplant electrodes have already been successfully used to derive myogenic
signals. Indirect rapid prototyping method was used in this case to manufacture the
mould for making the myoplant electrodes [18].
One of the researchers has carried out the morphological characterization of
the transitional structure between bone and cartilage, and the data were used to
fabricate beta tricalcium phosphate scaffold using steriolithography and gel casting.
The scaffold fabricated had 700–900 μm pore size, 50–65% porosity, and 12 MPa
compressive strength [19].
Stereolithography enables to construct plastic models with the exact valvular
design of human aortic and pulmonary homografts. These stereolithographic models
were then used as physiologic patterns to generate scaffolds for the tissue engineering
of heart valves [20] (Table 9.1).
Steriolithography is one of the most commonly available types of rapid proto-
typing. It is comparatively less costly to other rapid manufacturing techniques.
However, the need of postprocessing is inevitable in this kind of manufacturing.
The method is suited for the manufacture of ceramics. This can be achieved by
using alumina/zirconia as fillers in the photosensitive resin and photointiators. Once
the monomers start the polymerization and the final shape is achieved, the part is
subjected to sintering or postprocessing during which the final part of the ceramic
material is obtained devoid of the photopolymers [21–23].

9.4 Fused Deposition Modeling

Fused deposition modeling [FDM] is one of the rapid prototyping processes where
solid starting material is also used along with the liquid precursor (Fig. 9.4). In this
technique, a nozzle is the main component, which is attached on a movable head.
Through this nozzle, the material is fed on to the tray. The material as filament is
fed into the head, which is heated up to a desired temperature. The temperature right
Table 9.1 Process parameters and material specifications chosen for different applications in steriolithography
Application/implant Process parameters Material used Material properties References
Orbital floor prosthesis Section thickness, thickness, Hydroxyapatite Biocompatible and [16]
threshold value, imaging osteoconductive, slow to
plane, and reconstruction biodegrade
algorithm (3)
Osteochondral beta-tricalcium Laser power, scan speed, β-TCP-collagen Biocompatibility, [19]
9 Rapid Prototyping Methods in Manufacturing …

phosphate/collagen scaffold laser spot size mechanical strength

Polymer/alumina composite Orientation, size of access α-Alumina—Filler, (polyethylene glycol Mechanical strength, [21–23]
components holes to relieve the viscous 400 diacrylate, SR344 Cray shrinkage factor
resin stuck inside the Valley)—photosensitive resin,
structure (2-2dimethoxy-2-phenylacetophenone,
Fluka)—Photo Initiator
193
194 A. Gopinath et al.

EXTRUSION

GUIDE WAYS HEAD

TABLE/PLATFORM
CONTROL PANEL

Fig. 9.4 Second-generation maker bot, fused deposition modeling machine

above the melting point melts the material and enables the layer-by-layer deposi-
tion to culminate the final 3D component. Multi nozzles are also used in current
researches to deposit different materials. This enables that, e.g., solids, like scaffolds
can be manufactured along with complex cell constructs with different properties and
characteristics [6, 12]. Considering the specific energy that is used for incompress-
ible melting has FDM printing differences compared to other additive manufacturing
techniques. As a result of which the following equation is essential for the whole
process:
 
dT −   → − 
ρc p + →
v ·∇ T = −∇ −
→ τ · ∇→
q − − v +φ
dt

ρ = density, p = applied pressure, T = temperature, τ = surface force, υ = velocity,

ø = internal energy, q = energy per unit time and volume [24].
Fused deposition modeling even after being one of the most widely used rapid
prototyping methods is used rarely for the manufacture of biomedical implants. This
is due to the fact that plastic materials that are compatible with the machine are
often not biocompatible. The plastic materials have reactions with the living tissues
which can cause problems in the longer run. Hence, this method is usually adapted
to manufacture patterns and molds for manufacturing the original part. However,
with the usage of suitable materials, bio-implants have also been manufactured. The
lower costs of manufacturing and the comparatively simpler process are some of the
advantages of this type of rapid prototyping (Table 9.2).

9.4.1 Selective Laser Melting

Additive manufacturing finds wide application in the field of biomedical as the recent
advancements in the technology facilitates it to manufacture bioscaffolds for tissue
9 Rapid Prototyping Methods in Manufacturing … 195

Table 9.2 Process parameters and material specifications chosen for different applications of fused
deposition modeling
Application Process parameters Material used References
Cranial implants, femur Size of granules, nozzle PMMA (polymethyl [87]
bone design, inlet and exit methacrylate)
Hip joint pattern temperature of material, acrylonitrile butadiene [88]
speed of deposition, layer styrene
orientation, tip wipe
Composite scaffolds frequency, and porosity PP-TCP composite [3, 89]

engineering, artificial organs, orthopedic implants, etc. Ti6Al4V with tailored prop-
erties to mimic that of a bone has been manufactured as well as replacement for
hip was manufactured with Ti material [25–27]. SLM has been used to manufacture
ceramic materials as well as the implant parts with biocompatible alloys of metals.
The use of rapid prototyping provides the versatility in the processes such that the
difficult internal architectures are managed and the reproducibility of the work is
very high. The process can be used both as a direct method of manufacture and
as an indirect method by manufacturing the molds for manufacturing the implant
[10, 28–30].
The CAD model of the part to be manufactured has to be fed into the machine
in STL format. 3D printing and selective laser melting are powder-based additive
manufacturing processes and in 3D printing very thin layer of powder is deposited
on top of the tray and binder is added on top of it. Here, binder plays a very vital
role to solidify the material and the process will be continued till a complete solid
structure is obtained [31].
Flexible geometry and a shorter processing time are the major advantages of 3D
printing over other conventional manufacturing methods. However, the challenges
in this process will be the higher melting point of the ceramics, which is one of the
frequently used biomaterial, when compared to that of the metals and polymers, and
the development of cracks during solidification [6] (Table 9.3).

9.4.2 Inkjet Printing

The inkjet printing technique is based on 2D printing layer by layer. A suspension

which contains the finest particles is printed in the drop form. The main challenge of
the ink development is to reduce the particle size to enable a resolution in the range
of 16–50 μm. By shifting the print heads in the z-axis, layers are created by repeated
printing of drops. A postprocessing procedure is required to obtain properties similar
to those of the pressed material [32, 33]. Common procedures are sintering, cooling
(e.g., by crystallization), or chemical changes (e.g., crosslinked network of polymers
through UV—curing) [34].
196 A. Gopinath et al.

Table 9.3 Process parameters and material specifications chosen for different applications for
selective laser melting
Application/implant Process Material used Material properties References
parameters
High strength oxide Preheating ZrO2 /Al2 O3 powder Good flexural [31, 66]
ceramics temperature of properties
1600 °C,
particle shape
(spherical
shape),
scanning
speed:
200 mm/s.
Laser beam
diameter:
200 mm. Layer
thickness:
50 mm
Dental implants Pore size, strut Ti6Al4V Good [67]
thickness, biocompatibility,
dense core of high corrosion
different resistance, and high
diameters strength-to-weight
ratio
Metal components Surface Ti and Ti alloys, Laser absorptivity [90]
structure of Ni-based superalloys
metallic
powder,
porosity of
powder bed,
vaporization,
and heat loss
Titanium gyroid Particle shape Pure titanium Biocompatibility, [91]
scaffolds and size (CP-Ti) and specific strength,
Ti–6Al–4V (Ti64) corrosion resistance

Inkjet printing has frequently been used in the field of bioengineering, especially
in bioprinting with excellent outcomes of DNA chips [35], protein arrays [36] and
cell patterns [36] or direct printing of enzymes [37]. However, not much researches
have been conducted on the fabrication of biomedical implants [38].
Liravi F et al. was the first research group who introduced a direct additive manu-
facturing of polysiloxane through inkjet printing. Polysiloxane due to its bio-inertness
and nontoxic nature has been a preferred material in many biomedical and cosmetic
applications. Before the first research group began, the unique properties of the mate-
rial have only been used to manufacture casting moulds, which are an ineffective
and knowledge-based process. With the use of additive manufacturing techniques,
the whole process got optimized and reduced the production time radically. The
9 Rapid Prototyping Methods in Manufacturing … 197

Table 9.4 Process parameters and material specifications chosen for different applications for
inkjet printing
Application/implant Process Material used Material properties References
parameters
3D-printed cardiac Layer thickness Rigid plastic Mechanical [39, 74]
model, aortic arch material strength and
reconstruction plasticity
Viable mammalian Nozzle Chinese Hamster Cell generation [92]
cells temperature, Ovary (CHO-B2) capability
volume of print cells, primary
droplet embryonic
motoneurons
Protein Droplet Horseradish Immunologic and [75, 37]
microdeposition diameter peroxidase hybridization
reactions
capability

research group optimized the process parameters by employing design of experi-

ments required for the fabrication of the prostheses. The process parameters which
were considered and optimized for the fabrication of the prostheses were pressure
(P), printing velocity (V ), and working distance (WD) (distance between substrate
and nozzle tip) [9] (Table 9.4).
The applications of 3D inkjet printing are not just limited to the printing of the
implants but it also has helped in simulation training of heart, where the doctors
printed a 3D model for presurgical planning and understood the intricate patient-
specific features and could complete the surgery with better precision [39].

9.4.3 Selective Laser Sintering

Selective laser sintering is a type of additive manufacturing process in which the

powder is sprayed as a thin layer which is then solidified by a laser which is selectively
used to bind the material together at the desired places. After each layer is deposited,
the tray is moved by some nanometers down and another layer of powder is deposited
on top of the already fused solid, which is then again melted and binded together
by the laser. One of the advantages of the selective laser sintering is that it does not
require support structure unlike the other processes like FDM. The raw material itself
will act as the supporting material [40–45] (Table 9.5).
Most of the scientists have used selective laser sintering for printing bioscaffolds.
This is an integral part of tissue engineering. Tissue engineering works by the prin-
ciple of coaxing different cell types into synthesizing new tissue. For this, they are
seeded onto a desirable 3D hydrogel scaffold under specific favorable environment
conditions. Thus, they can even be grown into fully functional organs [46]. The 3D
model can be even subjected to FEA analysis to predict the failure. Material can
 198

Table 9.5 Process parameters and material specifications chosen for different applications for selective laser sintering
Application/implant Process parameters Material used Material properties References
Biopolymer scaffolds Laser power, scan spacing, Poly(3-hydroxybutyrate-co-3-hydroxyvalerate), Favorable surface [70–73]
laser energy density, titanium powder and silica sol, polyamide PA-2200 chemistry for cell
scanning speed attachment and
proliferation,
biocompatibility,
bioactivity,
biodegradability
A. Gopinath et al.
9 Rapid Prototyping Methods in Manufacturing … 199

be assigned to the model and meshing can be done thereby predicting the material
properties [9].
There are many other scientists who have made modifications on the existing
3D printing machines to obtain the desired results. Sahmani et al. [47] tested open
porous nanoclay biocomposite scaffolds fabricated using space holder technique for
bone implants. Because of less mechanical and chemical stability, these scaffolds
cannot be used for load bearing applications, and Liu et al. [48] fabricated a scaffold
based on polysaccharides for the same application. Akash et al. [49] found that the
tensile and flexural strength of a hybrid composite made with silk fiber reinforcement
matches to that of femur bone and hence is a suitable implant material, and Chan et al.
[50] studied various properties of composites reinforced with glass fibers. Hu et al.
[51] studied the mechanical properties and microstructure of composites developed
based on the structure of skin of a fish and observed that addition of Ti increased the
toughness of the composite. Ramesha [52] reviewed plant fiber based biocomposites
and found that the mechanical properties were enhanced when fibers were treated
with different alkaline solutions. Sahmani et al. [53] studied the vibrational effect
on the nanocomposite implant subjected to axial compression in prebuckling and
postbuckling regions, whereas Yang et al. [54] developed bio-implants that can be
used for theranostics for cancer patients.
The applications of rapid prototyping are not just limited to printing implants and
parts but also to health monitoring devices. Sharma et al. [55] used RP method to
produce health monitoring devices which may be inserted inside the human body and
hence can be used for patients with chronic diseases so that the process of recovery
can be closely monitored. Wang et al. [56] attempted to convert 2D biomedical
images to 3D using rapid prototyping technique. Shreepad et al. [57] studied the
structural and mechanical properties of the scaffolds produced using RP technique
and observed that the properties nearly match to those of human bones and teeth.
Whitley et al. [58] presented a clinical report based on the dental implants fabricated
in the laboratory using stereolithographic printing, and Robinson et al. [59] analyzed
the potential of additive manufacturing technique for application in different fields.
More researches have happened, and many authors have compared, analyzed, and
modified rapid prototyping based on applications and methods. One of the additive
manufacturing processes which is called as rapid freeze casting is used to make solids
of ice by the principle of layer by layer manufacturing, where water droplets are
deposited over the already solidified layers of solid [13–16]. Researchers have done
considerable amount of work in developing the method to fabricate ceramic and metal
components with suspended particles of ceramics and metals in the photo-curable
resin [8, 22, 23, 60, 61].
Banoriya et al. [62] reviewed the use of rapid prototyping method in various fields
and gave insight of how it can be used for making scaffolds in biomedical applica-
tions, whereas Kochan et al. [63] highlighted the problems faced relating to rapid
prototyping technique (machine design, rapid tooling, product development, etc.).
Lal et al. [64] reviewed the biocomposites fabricated using 3D printing technique
via rapid prototyping for orthopedic trauma surgery.
200 A. Gopinath et al.

9.5 Discussion

Figure 9.5 classifies the rapid prototyping methods on the basis of the functionality.
Biomedical implants on the basis of their rigidity have been classified into flexible,
form fit, strength, heat/chemical resistant. This chart has been prepared to categorize
the methods that can be used for the specific needs.
Flexible implants are often manufactured with material jetting and fused deposi-
tion modeling. Material jetting can also be used to manufacture materials with higher
tolerance values. The material which requires lower tolerance is manufactured with
FDM. Based on the strength factor, harder materials are manufactured with binder
jetting and ones with lower strength are contrived with FDM [9]. SLA/SLS is used
to produce heat and chemical resistant parts. Considering the functionality of the
product on the specific application the researcher has to choose his 3D printing tech-
nology based on these parameters. Bio-implants in the body are having different
functions. For instance, a knee cap has to be strong as well as slightly flexible. So
based on the functionality of the implant a suitable 3D printing technology, fused
deposition modeling or selective laser sintering can be the preferred method adopted
for this application.
High strength implants can be manufactured by fused deposition modeling, selec-
tive laser sintering/melting, and inkjet printing. DMLS or direct metal laser melting
is also a kind of selective laser melting where metal components are printed. This is
one of the latest technologies used and is considered to be the future of 3D printing.

Fig. 9.5 Classification of rapid prototyping methods based on functionality of the bio-implants
manufactured
9 Rapid Prototyping Methods in Manufacturing … 201

Table 9.6 compiles and compares different rapid prototyping methods based on
its application, materials used in each process, the resolution of the printing, the cost
incurred for the process, and advantages and disadvantages for the process. Selective
laser sintering is mostly used to manufacture bioscaffolds and dental implants. The
cost of the process is higher when compared to the other processes because of the
involvement of laser and the postprocessing of the product. One of the main advan-
tages of this process is that a wide range of materials can be used for this process.
However, the powdery surface texture is a demerit of the process [44, 29, 65].
Selective laser melting is also comparatively costlier process since a high intensity
laser is required which melts and fuses the powders together. Metal powders and
ceramic powders are the starting material in this process, and 20–100 μm thickness
is possible with this process. High strength oxide ceramics, metal components, and
scaffolds are usually manufactured with this process. Higher cost and postprocessing
are the demerits of this process, whereas the higher strength and the higher complexity
of the components manufactured are an added advantage [31, 66, 67].
Steriolithography is comparatively a less expensive process to manufacture prod-
ucts with good surface finish and accuracy. The lesser cost and the comparative
ease of the process make it a desirable candidate for many researchers. Myoplant
electrodes, orbital floor prosthesis, hemi knee joint mould, cranio-plastic implant,
and surgical drilling templates are some of the biomedical applications where steri-
olithography is used for. The SLA printing has a resolution of 5–50 μm [55, 58, 68,
69]. The scattering of the light and the curing time of each layer is one of the main
challenges in this kind of printing.
Fused deposition modeling uses solid material as the raw material for printing.
The materials used for the process are acrylonitrile butadiene styrene or PLA mate-
rial. This limits its flexibility in the biomedical field. However, the lesser cost of
the process and the simplicity of the machine have resulted in wide acceptance of
the machine among the research field. Mostly, FDM is used to manufacture plastic
components and is mostly suited for automotive and general engineering applica-
tions. In biomedical field, FDM is used to manufacture bioscaffolds mostly which
allows the tissue growth. One of the main advantages for this process is the lower
cost and the higher mechanical strength of the parts produced, whereas the high
temperature required to melt the solid wires is one of the challenges in this type of
prototyping [70–73].
Inkjet printing is one the most advanced forms of 3D printing which is the most
versatile prototyping method when compared to the other methods. This type of
printing can use a variety of starting materials such as polysiloxanes, wax, cells, and
enzymes. This versatility is the biggest advantage of inkjet printing.
In Table 9.6, ‘$’ symbol indicates comparative cost, with $ being least and $$$$
being the maximum. Products with different porosity and plasticity can be printed
with this type of manufacturing method. This method has the following advan-
tages like the highest accuracy, surface finish, and the least time for manufacturing.
However, the cost of the machine, installation, and maintenance is very high. The
layer thickness can be from 16 to 50 μm [9, 37, 39, 74, 75].
 202

Table 9.6 Comparison of rapid prototyping methods on the basis of materials used, resolution, cost, advantages, and disadvantages
RP technology Bio-application Materials Resolution (μm) Approximate cost Advantages Disadvantages References
SLS Bespoke dental CoCr, bioactive 50–100 $$$ Broad range of Powdery surface [29, 44, 65]
implants, bone glass materials available,
scaffold (hip joint, good mechanical
knee) properties
SLA Myoplant Hydroxy-apatite 0.5–50 $$ High accuracy, Limited use for [55, 58, 68, 69]
electrodes, orbital (HA) smooth surface mechanical parts
floor prosthesis, SL Y-C 9300
hemi knee joint “Stereocol”
mould, silicone-alginate
cranio-plastic composite
implant, surgical
drilling templates
FDM Hip joint, Thermoplastic 250–700 $ High mechanical High temperature [13, 93]
composite filament, SS316L, strength, low cost during
scaffolds acrylonitrile printing required
butadiene styrene,
PP-TCP
SLM High strength Metal powders, 20–100 $$$$ Highest Highest price, [31, 66, 67]
oxide ceramics, ceramic powders mechanical postprocessing
dental implants, strength, variety of required
metal component, complex forms
titanium gyroid possible
scaffolds
Inkjet Wax template, Polysiloxane 16–50 $$$ Best surface finish, Limited use for [9, 37, 39, 74, 75]
prosthesis fast printing time, mechanical parts,
most accurate 3D very brittle,
printing method expensive ink
magazine
A. Gopinath et al.
9 Rapid Prototyping Methods in Manufacturing … 203

A lot of research has been carried out in the field of biomedical to manufacture
biomedical implants and scaffolds by additive manufacturing [76–86]. The challenge
in the process is that each patient needs vary from each other and that every single
design has to be unique. The printing of biomedical implants or tissues is still an
important research field around the world. Especially the manufacturing of surfaces is
in actual cases a complex problem. Dental prostheses and dental bridges, shoulders,
knees, hips, and spinal cord implants have different specific surface properties but are
manufactured by additive manufacturing and have also been certified in the market
[66]. Hence, the selection of the type of additive manufacturing process is the most
important step in the manufacturing of the process. The selection should be based
on the above-mentioned criteria and the kind of biomedical application it has to be
used for.

9.6 Summary

Additive manufacturing is the most widely accepted method for bio-implant manu-
facturing in the current market. Various researches in the area of biomedical implant
manufacturing by rapid prototyping were studied, compared, and analyzed. This
research has classified the rapid prototyping methods on the basis of specific param-
eters such as functionality, cost, material used, the maximum resolution of the parts
printed, advantages, disadvantages, and the process parameters used in each process.
The relevance of rapid prototyping method in biomedical implant manufacturing
over other conventional methods like casting and machining is prominent because of
its flexibility and the ease of printing complex shapes. The advantages and disadvan-
tages of various rapid prototyping methods were studied and recorded. An empirical
table was prepared which can be used to identify the most suitable rapid prototyping
method, for the bio-implant manufacturing, based on the parameters considered. SLS,
SLM, SLA, FDM, and INKET are chosen the chosen methods of the current study.
The process parameters and materials used for each method were collected from
different literatures and compiled. In prototyping method with solid as the starting
material, which is FDM, the process parameters that were considered are size of
granules, nozzle design, inlet and exit temperature of material, speed of deposition,
layer orientation, tip wipe frequency, and porosity. Usage of FDM in the field of
biomedical implant manufacturing is limited because of limitations in the usage of
the starting material which are mostly plastic. Steriolithography has an advantage
over FDM in terms of the biomedical implant manufacturing due to the wide variety
of materials that can be used for this process. Ceramic manufacturing is also possible
with SLA with the proper mixture of ceramic powder, photointiators, and monomers.
The postprocessing treatment removes the other material, and finally, it is left with
the ceramic component. The smooth surfaces that can be manufactured from SLA
is one of the specialities of this process. SLS and SLM use similar methodology
of printing where the powders are fused together with laser or by melting them
together. This method has an advantage since a variety of materials can be used for
204 A. Gopinath et al.

this process. However, the increased cost of the machines is a disadvantage of these
processes. Inkjet printing with its highly versatile printing method is one of the most
widely used rapid prototyping methods for biomedical applications. This method
could utilize more starting materials, and the droplet deposition technique allows it
to manufacture complex shapes without much difficulty. However, the increased cost
of the machine is one of the disadvantages of this highly flexible process.

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lactic-acid: potential material for bio-printing applications. In: Biomanufacturing, pp 69–87.
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future pathways. Rapid Prototyp J
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analysis to improve surface quality and mechanical characteristics of heat-treated fused filament
fabricated parts. Int J Adv Manuf Technol 102(5–8):1521–1536
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for fused deposition of advanced multiple ceramics. 6(3):161–174
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manufactured by selective laser melting (SLM) for bone implant applications. Acta Mater
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cells. Biomaterials 26:93–99
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23(5):611–620

Mr. Ajith Gopinath is Assistant Professor in the Department of Mechanical Engineering, Faculty
of Engineering, CHRIST (Deemed to be University), Bengaluru, India. He has done his masters
from VIT University, Chennai, Tamil Nadu, India, with over 6 years of teaching experience. His
area of research is additive manufacturing, fibre-reinforced composites, metallurgy and design,
with over five research publications in reputed journals.

Mr. Tobias Waclawczyk B.Sc., University of Augsburg. His area of research is focused on mate-
rial science and lightweight constructions for aerospace applications. Tobias was fascinated by
additive manufacturing and completely focused his attention on this technology. After completing
his research on additive manufacturing in the medical sector at the Christ University in Bangalore,
India, he moved on to Volkswagen AG, Germany, where he undertook research on the potential
of additive manufacturing in the future of the automotive sector.

Mr. Raman Bedi is an alumnus of Department of Mechanical and Automobile Engineering,

CHRIST (Deemed to be University). He was a Gold Medalist and also received an award for the
Best Outgoing Student of his batch. Being an enthusiast learner, he had a keen interest in the field
of research, having three publications in the field of thermal engineering and one in the field of
manufacturing engineering.

Mr. Avinash Babu is Assistant Professor in Mechanical Engineering, CHRIST (Deemed to be

University), Kengeri, Bangalore, India. He completed Master’s Degree in Machine Design, from
Karunya University, Coimbatore, India. He has 5 years of teaching and research experience.
His area of research is metallic foams, rapid prototyping, and functionally graded materials and
product design. He is currently pursuing Ph.D. in functional graded material.

Dr. Shijo Thomas is Assistant Professor in the Department of Mechanical Engineering, CHRIST
Deemed to be University, Bangalore, India. He has received Bachelor of Engineering in Mechan-
ical Engineering and Masters of Engineering in Manufacturing Engineering from Anna University,
Chennai, India; Masters in Business Administration in Technology Management from Bharathiar
University, Coimbatore, India; and Ph.D. in Mechanical Engineering from Vellore Institute of
Technology, Vellore, India. He has an experience of 6 years in teaching and research. His research
interest includes sintering technology, metal matrix nanocomposites, physical and mechanical
metallurgy and manufacturing of composites. He has contributed extensively in the field of multi-
walled carbon nanotubes (MWCNT)-reinforced aluminum nanocomposites. He is working with
joint collaboration with other universities around the world.

Mr. Praise Tom is an Assistant Professor at CHRIST (Deemed to be) University, Bangalore,
India. He has done his graduation in Mechanical Engineering under Kannur University, Kerala,
India, and post-graduation in CAD/CAM at Vellore Institute of Technology, Chennai, Tamil Nadu,
India. He has enormous teaching experience in the field of materials, finite element methods and
theory of machines. His area of research is nanocomposites, multibody dynamics and vibration
control.
Chapter 10
PLA-HAp-CS-Based Biocompatible
Scaffolds Prepared Through
Micro-Additive Manufacturing:
A Review and Future Applications

Nishant Ranjan, Rupinder Singh, I. P. S. Ahuja, Mustafizur Rahman,

and Seeram Ramakrishna

Abbreviations Used

Nomenclatures

PCL Polycaprolactone
H Hydroxyapatite
P Polylactic acid
PEG Poly (ethylene glycol)
PHMGCL Phenylmagnesium chloride
TCP Tricalcium phosphate
PP Polypropylene
Al2 O3 Alumina
CaP Calcium phosphate
PLLA Poly(L-lactic acid)
DEF Diethyl fumarate
PU Polyurethane

N. Ranjan · R. Singh (B)

Department of Production Engineering, Guru Nanak Dev Engineering College, Ludhiana 141006,
India
e-mail: [email protected]
N. Ranjan · I. P. S. Ahuja
Department of Mechanical Engineering, Punjabi University, Patiala, India
M. Rahman
Department of Mechanical Engineering, Universiti Malaysia Pahang, Pekan, Malaysia
S. Ramakrishna
Department of Mechanical Engineering, National University of Singapore, Sovereign, Singapore

© Springer Nature Singapore Pte Ltd. 2020 209

S. Singh et al. (eds.), 3D Printing in Biomedical Engineering,
Materials Horizons: From Nature to Nanomaterials,
https://doi.org/10.1007/978-981-15-5424-7_10
210 N. Ranjan et al.

PS Polysulfone
PET Polyethylene terephthalate
PA Polyacetal
PMMA Polymethylmethacrylate
PTFE Polytetrafluoroethylene
PEEK Polyetheretherketone
SR Silicone rubber
PE Polyethylene
3DP 3D printing
FSF Feedstock filament
MFI Melt flow index
Tg Glass transition temperature
MT Melting temperature
FFF Fused filament fabrication

10.1 Introduction

The rigid tissues (bones) comprise two structures (cancellous and cortical). The
inward piece of bone (cancellous) is lighter than outer part having 45–88% of volu-
metric porosity. Cortical bone (external layer of bone) is thick and heavy in compar-
ison with inner part of the bone having ≤10% of volumetric porosity. These two
kinds of bone experience dynamic renovating development, separation, and resorp-
tion that are controlled by means of associations among osteocyte, osteoblast, and
osteoclast cells [1]. Bone has self-mending capacities [2], but to recuperate much
of the time, outer intercession is expected to reestablish typical tasks [3, 4]. Nowa-
days, various treatment choices for bone/scaffold repair (like autograft, allograft,
bone tissue building) are common practices [5, 6]. Effective utilization of bone
tissue building can maintain a strategic distance from difficulties identified with other
treatments. Aside from material issues, an unmistakable comprehension of science
including cells, extracellular matrix, and development factors are concerns in bone
tissue structurally and biochemically support of surrounding cells [7]. Scaffolds are
necessary piece of bone tissue regeneration/fabrication platform. These platforms
are 3-D biocompatible structures which can improve and increase cellular matrix
properties (like cell action and protein creation through biochemical and mechan-
ical cooperations) and give a layout to cell connection and animate bone tissue
arrangement in vivo study [3, 5–7].
In the beginning period, bone in-growth occurs at outskirts of platforms with
negative slope in mineralization [4, 5]. Open and interconnected pores enable supple-
ments and particles to encourage cell in-growth, just as waste material evacuation
[4, 6, 8]. Since higher porosity (volumetric) builds surface zone per unit volume, the
biodegradation energy of frameworks can be affected by shifting pore parameters.
Biodegradation through a cell intervened process or substance disintegration is both
10 PLA-HAp-CS-Based Biocompatible Scaffolds … 211

imperative to fix and framework supplanting with new bone with no remainder [8]. A
base pore in the range of 95 and 145 mm is required for fast and healthy bone tissue
regeneration/development [4, 9] notwithstanding improved bone arrangement and
vascularization are accounted for platforms with pore measure bigger than 295 mm
[9–11]. Pore estimate likewise assumes an imperative job in matrix generation and
association [12]. Pore volume additionally controls the porousness of supplements
to the platform and their mechanical properties. Porousness in PCL expanded with
higher pore volume and brought about better bone recovery, vein penetration, and
compressive quality in vivo, when other pore parameters were kept the equivalent
[13]. Aside from natural execution, the underlying mechanical properties and quality
debasement rate should coordinate that of the host tissue for ideal bone mending [14].
The energy of permeable platforms is profoundly influenced by pore size and geom-
etry [15–19]. Permeable bone frameworks can be made by an assortment of tech-
niques. Concoction/gas frothing [20], dissolvable throwing, molecule/salt filtering
[12, 21, 22], and thermally actuated stage separation [23, 24] are portion of those
that have been utilized broadly. Be that as it may, pore size, shape, and its inter-
connectivity cannot be completely controlled in these methodologies. In addition,
platforms with custom fitted porosity for explicit imperfections are hard to produce
with the vast majority of these methodologies [21–24]. Such frameworks can be
structured and created utilizing added substance producing by MAM approaches.
The diverse MAM approach (like 3D printing) and strong freestyle manufacture
(SFF) permit complex shapes creation specifically from a CAD data [1, 25–28]. In
MAM approaches, 3D frameworks are made L–B–L [1, 29–31]. These AM strategies
can be delegated—(a) expulsion (disfigurement+hardening), (b) polymerization, (c)
laser-helped sintering, and (d) coordinate composition-based procedures. Bone/teeth
fix or recovery is a typical and entangled clinical issue in orthopedic/dental medical
procedure. Table 10.1 condenses a portion of the MAM systems toward bone tissue
engineering applications including their points of interest and drawback.
For bone/tissue building; 3DP is useful for just in time manufacturing with
controlled porosity using a CAD data [66–70]. Before the final printing, some
controlled parameters (like powder squeezing thickness, latch drop volume, folio
immersion, powder wettability, etc.) need to be ascertained for final part [69–76].

10.2 Scaffold 3D Printing

Major considerations for scaffold are biocompatibility/biodegradability, pore inter-

connectivity, pore sizes, uniform porosity, and thermo-mechanical properties. It
would likewise be advantageous if framework materials could act as substrates for
connection, expansion, and separation of cells. Besides, as cells multiply and sepa-
rate, the platform must have the capacity to withstand the powers being connected by
the cells. The mechanical and tensile strength of the platform must be stable in order
to withstand everyday action and typical body developments [77]. The commercial
materials, for example, alginate, C, collagen, fibronectin, and hyaluronic corrosive,
212 N. Ranjan et al.

have leeway over manufactured materials as they give more inherently organic capac-
ities. Utilizing normally inferred materials, which regularly establish or possess the
ECM, results in a superior copying of certifiable ECM, and this in this way upgrades
cell connection and controls cell expansion more productively than engineered poly-
mers [78]. The utilization of engineered polymers, for example, PCL and poly(lactic-
co-glycolic acid) (PLGA) for framework, has yielded higher mechanical as well as

Table 10.1 MAM for bone scaffolds/implants

Process specifications Materials Merits (+)/demerits (-) Citations
Inkjet writing/3D → Viscous → PCL +: [32–38]
plotting extrusion-based →H → Mild condition
material based on → Bioactive glasses allows drug and
computer-aided design biomolecules plotting
data −:
→ Strand deposition at → Heating restricts the
fixed rate and pressure biomolecule
incorporation for some
materials
FFF → Strands of heated → PCL/TCP/PP +: [26, 29, 39–45]
polymer/ceramics and → Al2 O3 → Platform/support is
composition of not required
polymers with ceramics
extrusion through
heated nozzle
Robo-casting → Direct writing of → H/P +: [46]
liquid using a nozzle → H/PCL → Independent nozzle
movement in 3D
→ Precise thickness
controlled
→ No need of support
required
SLS → In this process, → PCL/H +: [47–52]
powder bed is to be → H is mixed with → No support required
prepared PDLLA → No post-processing
→ In this process, → PDLLA −:
powder is added layer → PHBV → Resolution control as
by layer → Nano H per diameter of laser
→ Sintering each layer beam
using laser source as per
CAD data
Laser-assisted → Desired material → H/H mixed with +: [53–56]
Bio-printing must be coated on osteoblast cell → Control and perfect
(LAB) ribbon → Zirconium condition for working in
→ Laser pulse energy → Human umbilical biomedical application
techniques are to use for vein endothelial cell → It is best suitable for
deposition controlling. cell, in organic and
organic
→ Best controlled
process
−:
→ Equally distributed
ribbons needed
(continued)
10 PLA-HAp-CS-Based Biocompatible Scaffolds … 213

Table 10.1 (continued)

Process specifications Materials Merits (+)/demerits (-) Citations
SLA → In this process, at → PPF mixed with +: [57–65]
focal point, polymeric DEF → By the help of this
materials are → PPF mixed with process, very difficult
solidifying, and composition of DEF and internal feature is
non-exposed polymeric and H easily obtained
materials remain → PDLLA is mixed −:
unchanged and present with H → This
in liquid form. process/techniques are
→ In this process, mostly applicable for
platform is moving in photopolymers
downward direction and
layer by layer fabricated

Note PCL Polycaprolactone, TCP Trichloropropane, PP Polypropylene, PPF poly(propylene fumarate), DEF Diethyl
fumarate, PDLLA Poly-d, l-lactic acid, PHBV Poly(3-hydroxybutyrate-co-3-hydroxyvalerate)

tensile qualities with higher processability and controllable debasement rates [78,
79]. Be that as it may, these manufactured polymer frameworks have moderately low
organic movement, regarding advancing tissue recovery. Notwithstanding being less
naturally dynamic, the inherent hydrophobicity of engineered polymers, for example,
polyesters, for the most part results in poor cell grip [80], which results in imper-
fect multiplication and separation, at last prompting substandard tissue arrangement
[78]. For 3DP frameworks using grain size and grain measure, disseminations must be
considered to create permeable scaffolds [81], as these components affect miniatur-
ized scale porosity which has been believed to impact cell appropriation, connection,
expansion, and separation [82, 83]. To accomplish bio-mimicry, platforms should be
organically dynamic, have high mechanical qualities, be anything but difficult to
process, and have controllable corruption rates. To make these intricate frameworks,
mixture frameworks involving both manufactured and regular polymers have been
utilized and are probably going to be utilized later on [84–86]. To be a feasible alter-
native for tissue recovery, it is essential to remember that the materials utilized for
3DP of frameworks for tissue designing ought to be printable with a high level of
reproducibility. Such materials ought to likewise be financially savvy and pliable to
frame the ideal morphology of the structure platform.

10.2.1 3DP of Metals as Scaffold

Metals for use in 3DP of scaffolds include Fe, Co, Cr, treated steel, and Ti compound
[86–89]. These are appealing materials for use in the 3DP because of better mechan-
ical properties, which appear like bone [90, 91]. Besides showing high mechan-
ical sound qualities, metals are promising materials for in vivo studies [92, 93].
Further work may be performed to build up the practicality of utilizing certain
metal materials as parts of 3DP frameworks notwithstanding having been effectively
214 N. Ranjan et al.

utilized in 2D platforms. The present confinements include: (1) the 3DP innova-
tion accessible, accordingly restricting the sort of metals that can be utilized and
(2) the poisonous quality of metal particles caused by metal erosion and corruption
inside the body. This consumption produces metal particles that might be harmful
to the body at high fixations, and with the absence of a leeway pathway, a frame-
work intended to catch the metal particles or keep away from fundamental lethality
is essential notwithstanding platform manufacture [82, 94]. Another parameter that
prevents the utilization of metals is long corruption times, which results in practical
tissue conforming to the framework instead of eventually supplanting the platform.
Nevertheless, the utilization of moment or follow measures of metals to expand the
mechanical quality of current platforms has demonstrated some guarantee [95–97].
Nevertheless, biodegradable metals have developed as conspicuous possibility for
3DP of frameworks [98]. Printing of 3D platforms utilizing biodegradable metals
for bone recovery indicates guarantee and ought to be additionally inquired about
utilizing an assortment of metal materials to expand the accessibility of materials for
3DP. Despite the fact that these materials and frameworks might be intended for bone
substitution, they may have numerous different applications for different tissues since
nonmetallic platforms are less hearty and can crumple under the contractile power
connected by cells amid cell connection and expansion [69]. As the accessibility of
biodegradable metals consistently builds, the requirement for, and complexities expe-
dited by, changeless prosthetics and metal new parts can be decreased, subsequently
enabling patients to recover their very own bone in a definitive nonattendance of non-
physiological materials. The research on metals as biomaterials for 3DP platforms is
essential because of the conventional thought of non-biodegradability and restricted
processability [87, 99]. Nevertheless, the execution of biodegradable metal plans
to counter this idea and increment the common sense of utilizing metals in 3DP of
increasingly creative and successful frameworks. Biodegradable metals are an undis-
covered hotspot for 3DP of platforms for tissue designing, as they could give extra
mechanical solidarity to the current frameworks to withstand most compressive and
elastic powers.

10.2.2 Ceramics

Ceramics contain both components (metallic and nonmetallic) and have been utilized
as materials for 3DP inserts/platforms because of their high mechanical and tensile
quality and biocompatibility [3]. Pottery is fit for inserts/platform manufacture for
bone recovery essentially because of their apatite-mineralization capacity [100]. The
‘H’ itself a clay is usually found in human teeth and bones [101], along these lines
making the utilization of ‘H’, or comparative earthenware production, alluring mate-
rials for making platforms with solid mechanical properties like that of common
bone. The ‘H’ has gathered much consideration in the field of regenerative drug and,
overall, is a regularly utilized material for 3DP frameworks. In one investigation, a
quick prototyping system was utilized to make 3DP platforms from ‘H’ with complex
10 PLA-HAp-CS-Based Biocompatible Scaffolds … 215

inner structures with inclines of 45° to take into account cell multiplication within the
structure [102]. The interconnecting channels with pore sizes of 500 μm in the struc-
tured platforms showed the capacity to encourage mouse MC3T3E1 cell expansion,
representing the capability of H-frameworks to recover bone. Another examination
utilized PC helped 3D imprinting in a fast prototyping system to manufacture H
and tricalcium phosphate (TCP) frameworks. The platforms were made utilizing
H and tricalcium phosphate in an L-B-L process pursued by sintering [69]. These
scaffolds were seeded with human osteoblasts that were segregated from human
iliac peak cancellous bone and demonstrated high biocompatibility and low toxicity.
The outcomes give additional proof that H-materials show biocompatibility and the
capacity to aid cell development and suitability. Even more as of late, the ceramics,
CaSiO3 , was utilized to make platforms with higher bone mending limit than that of
tricalcium phosphate frameworks [100]. Another clay material normally utilized for
3DP bone platforms is calcium phosphate [75, 103, 104], which, when joined with
different ceramics, for example, ‘H’ [75] and TCP [104], yields frameworks with pore
sizes of 300 μm that are sufficiently substantial to permit supplement exchange for
cells. These platforms/inserts were likewise manufactured with greater than 97.5%
exactness contrasted with the PC-helped configuration, considering future frame-
works to be ideal for cell connection and multiplication [75]. Different examinations
have likewise demonstrated the printability of calcium phosphate with other mixed
mixes, for example, calcium sulfate, to make a powder composite with a water-based
folio [103]. Utilizing a mix of ceramic materials for 3DP of platforms ought to be
additionally researched to make a material with high accuracy configuration, having
sufficient compressive quality, and the capacity to advance cell multiplication and
separation that can be relevant to both non-stack-bearing and load-bearing orthopedic
applications.

10.2.3 Polymers

Polymers speak to a noteworthy classification of materials with potential for use in

the 3DP of platforms for tissue designing [105]. Hydrogels are appealing biomate-
rials for tissue designing since they have movable mechanical and tensile properties
which are biocompatible and can be hydrated while staying insoluble and keeping
up their 3D structure. Furthermore, the hydrating properties of hydrogels enable
them to imitate those of organic tissue [106, 107]. Both PCL and poly(DL-lactide-
coglycolide) (P–D–L–GA) scaffolds/inserts have been made utilizing MAM. The
utilization of these platforms in the deformities of rabbit tibias exhibited their secu-
rity just as their ability to advance the age of bone tissue [108]. Preference of utilizing
engineered polymer materials, for example, PLGA and PCL, is that the FDA for clin-
ical use [109] has endorsed both these manufactured polymers. Another favorable
position of utilizing PCL polymers and PLGA copolymers is the low harmfulness
of their debasement items, which sustains into metabolic pathways. A burden of
216 N. Ranjan et al.

utilizing PLGA is that it can cause provocative reactions when there is a develop-
ment of acidic oligomers [110]. Aggravation assumes a key job in tissue recovery
[111]; however, it is critical to control or restrain this reaction, as abnormal amounts
of irritation can prompt fibrosis bringing about poor tissue work, or even dismissal of
the embedded platform. In this manner, it is critical to comprehend the fiery impact
of the specific biomaterial(s) utilized and the framework structure used to produce
the ideal tissue. The provocative reaction, mostly mounted by the inborn invulnerable
framework, advances the enrollment of cells (principally neutrophils and monocytes)
to the territory of tissue harm to help with tissue fix and recovery [112]. In one investi-
gation, 3D printed ‘P’ and ‘C’ platforms were contrasted for their capacity with incite
aggravation and subsequently effect on tissue recovery [113]. Through the exami-
nation of macrophage morphology and human monocyte cytokine profiles, it was
presumed that the provocative properties of the platforms/inserts were controlled
by both framework geometry and structure. Another intriguing normal for these
polymers is their rate of biodegradation, which is frequently too quick when PLGA
is utilized and too moderate when PCL is utilized. In a polymer debasement test
performed utilizing frameworks, it was appeared with practically identical conver-
gences of PCL and PLGA, PLGA corrupted by 18% at 14 days and 56% by 28 days
contrasted with PCL whose debasement was 33% at 21 days, and 39% at 28 days
[114, 115]. Long haul mending might be vital in open bone breaks [116, 117]. PCL
is potentially an ideal decision for open cracks because of its slower corruption rate.
A more extended recuperating period is frequently required in open cracks in light of
the fact that the bone has infiltrated the skin which can in many cases lead to diseases
that expansion the ideal opportunity for mending. The moderate corruption rate of
PCL enables the platform to offer help for developing cells for a more extended time-
frame empowering increasingly thick tissue to shape [108]. For shut cracks (broken
bone that has not infiltrated the skin), PLGA could be a potential possibility for
bone recovery. PCL-based copolymers, for example, PCL-PLGA-PLGA [118] and
PCL-PEG-PCL [119], have been combined to control the debasement of PCL for
controlled medication discharge applications. Nevertheless, these copolymers can
possibly be utilized for tissue designing applications too. Other manufactured poly-
mers utilized for framework incorporate PGA, PPF, and PHB. Normal polymers, for
example, proteins and polysaccharides, have additionally been utilized for platform
manufacture, and among these polymers, the most well-known contender for tissue
designing has been collagen type 1 [120]. Collagen platforms stacked with cationic
PEI-pDNA edifices were used by some researchers in bone recovery for rodents
(Fig. 10.1) [121].

10.3 Mechanical Properties of Tissues and Materials

Normally, tissues are gathered into hard and delicate tissue. As a rule, the hard tissues
are stiffer (versatile modulus) and more grounded (rigidity) than delicate tissues
(Table 10.2). Considering the basic or mechanical similarity with tissues, metals, or
10 PLA-HAp-CS-Based Biocompatible Scaffolds … 217

Fig. 10.1 In vivo bone formation in rat calvarial defects implanted with collagen scaffolds [121]

Table 10.2 Tensile strength of hard/soft tissues [60, 61]

Hard tissues with respective tensile strength Dentine 39.3 MPa
Cancellous bone 7.4 MPa
Enamel 10 MPa
CB (TD) 52 MPa
CB (LD) 133 MPa
Soft tissue with respective tensile strength AT (LD) 0.1 MPa
Skin 39.3 MPa
Ligament 7.4 MPa
Articular cartilage 133 MPa
Fibrocartilage 52 MPa
Tendon 10 MPa
AT (TD) 1.1 MPa
Intraocular lens 2.3 MPa

pottery is picked for hard tissue applications (Tables 10.2 and 10.3) and polymers
for the delicate tissue applications (Tables 10.2 and 10.4). One of the serious issues
in orthopedic medical procedure is firmness between the bone and metallic inserts,
which needs to be addressed [122, 123].
The advancement in polymer-based composite biomaterials including non-
appearance of erosion and weakness disappointment of metal compounds and arrival
218 N. Ranjan et al.

Table 10.3 Mechanical properties of ceramic and metallic biomaterials [60, 61]
Material Strength in tensile (MPa)
Metal alloys
Amalgam 58
S.S. 578
Ti-alloy 965
Co-Cr alloy 1076
Ceramics
Hydroxyapatite 50
Alumina 295
Bioglass 42
Zirconia 808

Table 10.4 Mechanical properties of thermoplastic biomaterials [60–65]

Thermoplastics Strength (MPa)
PS 75
PU 35
PET 61
PA 67
PMMA 59
PTFE 27.5
PEEK 139
SR 7.6
PLA 72
PE 35

of metal particles (e.g., Ni or Cr which may cause slackening of the inserts, tolerant
distress, and unfavorably susceptible skin response) has motivated the use of these
materials in commercial biomedical applications. Composite materials have favor-
able results over metal amalgams in adjusting the previously mentioned inadequacies
[124–126].

10.4 Case Study

A case study has been reported on P–H–C-based functional prototype prepared by

MAM. The P–H–C feedstock filament was prepared on DSE. Multifactor optimiza-
tion was performed in two stages (a) FSF preparation on DSE and (b) FFF based
10 PLA-HAp-CS-Based Biocompatible Scaffolds … 219

upon tensile and flexural samples [127]. Initially, different proportions of P–H–C
were selected (Table 10.5).
Based upon Tables 10.5 and 10.6 shows MFI and flow continuity data for FFF.
As observed from Table 10.6, composition/proportion1 is without reinforcement
of H and C in P. This was used for comparison purpose only. So, finally four samples
2, 3, 5, and 6 were used for further investigations of dimensional accuracy and peak
strength (Table 10.7).
As observed from Table 10.7, all four FSF diameters are acceptable; however,
two proportions. 91–8–1 and 90–8–2% were selected for peak strength view point.
To counter-verify the suitability of FSF, thermal stability analysis of four selected
proportions was carried out on DSC (Fig. 10.2). Table 10.8 shows result of thermal
analysis for P–H–C.
As observed from Table 10.8, Tg and MT have no significant variations, so all
filament compositions are acceptable. But, in the case of crystallinity (%), the compo-
sition 80–8–12 is considered better. Finally, based upon Tables 10.7 and 10.8, P–H–C
composition as 91–8–1 is recommended for FFF by giving more focus to mechan-
ical properties. Figure 10.3 shows scanning electron microscopy (SEM) image of

Table 10.5 Material proportion of P–H–C [127]

S. No. Material composition(P–H–C) (by weight%)
1 100–0–0
2 84–4–12
3 80–8–12
4 76–12–12
5 91–8–1
6 90–8–2
7 89–8–3
8 88–8–4

Table 10.6 P–H–C MFI and flowability [127]

S. No. P–H–C (by weight%) MFI (g/10 min) Flow continuity Remarks
1 100–0–0 13.52 Yes AD
2 84–4–12 10.512 Yes AD
3 80–8–12 9.015 Yes AD
4 76–12–12 3.125 No NAD
5 91–8–1 12.352 Yes AD
6 90–8–2 11.575 Yes AD
7 89–8–3 7.474 No NAD
8 88–8–4 4.465 No NAD
Note AD Adequate, NAD Not Adequate
220 N. Ranjan et al.

Table 10.7 Observations for dimensional accuracy and peak strength [127]
S. No. Proportion P–H–C Output properties
Average outside diameter (mm) Peak strength (MPa)
1 84–4–12 1.85 2.10
2 80–8–12 1.78 2.43
3 91–8–1 1.86 3.27
4 90–8–2 1.87 3.23

Fig. 10.2 Thermal analysis of four proportions of P–H–C

Table 10.8 Thermal properties of P–H–C composites [127]

Compositions Tg (o C) Crystallization (%) MT (o C)
91–8–1 56.50 3.13 153.17
90–8–2 57.19 10.505 159.875
84–4–12 56.90 7.37 152.46
80–8–12 57.37 1.20 153.95

P–H–C composition 91–8–1 (a), 3D rendered image using image processing soft-
ware (b), amplitude distribution function (c), surface texture (d), surface waviness
(e), and surface roughness (Ra) profile (f) at cutoff length of 0.04 mm. Further based
upon Fig. 10.3a, Table 10.9 shows statistical analysis of surface features, which are
acceptable as per commercial requirements. The observations are in-line with other
investigators [128–134].
10 PLA-HAp-CS-Based Biocompatible Scaffolds … 221

Fig. 10.3 SEM image of P–H–C composition 91–8–1 (a), 3D rendered image using image
processing software (b), amplitude distribution function (c), surface texture (d), surface waviness
(e), and Ra profile (f)

Table 10.9 Statistical

Roughness average (Ra ) 170.1 nm
analysis of surface features
Root mean square (RMS) roughness (Rq ) 274.3 nm
Maximum height (MH) of roughness (Rt ) 2.83 μm
Maximum roughness valley depth (Rv ) 1.37 μm
Skewness (Rsk ) −1.024
Kurtosis (Rku ) 10.92
Waviness average (Wa ) 338.4 nm

10.5 Conclusion and Future Scope

In this review, P–H–C composite feedstock filament has been explored for MAM.
Some of the important observations are:
P–H–C is suitable composite material for biomedical applications. In order to
prepare FSF with different proportions of P–H–C, experimental study was conducted,
and based upon mechanical, continuous flowability, thermal stability, MFI, and
dimensional analysis, P–H–C as 91–8–1 (by weight) proportion was recommended
in the reported case study.
Series of experimental observations needs to be made to ascertain thermal, rheo-
logical, and mechanical properties for best proportion of reinforcement in PLA matrix
for preparation of scaffolds/functional prototypes via FFF in biomedical applications.
Further for in vivo and in vitro, analysis needs to be conducted for ascertaining the
biocompatibility issues.
222 N. Ranjan et al.

Acknowledgements Financial support by SERB (IMRC/AISTDF/R&D/P-10/2017) was received

for this work.

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filaments for the rapid prototyping of innovative materials and structures. Compos Part B Eng
143:132–140. https://doi.org/10.1016/J.COMPOSITESB.2018.01.032
128. Kumar R, Singh R, Hui D et al (2018) Graphene as biomedical sensing element: State of art
review and potential engineering applications. Compos Part B Eng 134. https://doi.org/10.
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materials with metal powder reinforcement for engineering applications. Compos Part B Eng
101. https://doi.org/10.1016/j.compositesb.2016.06.082
130. Kumar R, Singh R, Ahuja IPS et al (2018) Weldability of thermoplastic materials for friction
stir welding—a state of art review and future applications. Compos Part B Eng 137. https://
doi.org/10.1016/j.compositesb.2017.10.039
131. Kumar R, Singh R, Ahuja IPS et al (2018) Friction welding for the manufacturing of PA6
and ABS structures reinforced with Fe particles. Compos Part B Eng 132:244–257. https://
doi.org/10.1016/j.compositesb.2017.08.018
132. Kumar R, Singh R, Ahuja IPS (2018) Investigations of mechanical, thermal and morphological
properties of FDM fabricated parts for friction welding applications. Meas J Int Meas Confed
120. https://doi.org/10.1016/j.measurement.2018.02.006
133. Kumar R, Singh R (2018) Prospect of graphene for use as sensors in miniaturized and biomed-
ical sensing devices. Ref Modul Mater Sci Mater Eng 1–13. https://doi.org/10.1016/b978-0-
12-803581-8.10334-0
134. Singh R, Kumar R, Kumar S (2017) Polymer waste as fused deposition modeling feed stock
filament for industrial applications. Ref Modul Mater Sci Mater Eng 1–12. https://doi.org/10.
1016/b978-0-12-803581-8.04153-9

Mr. Nishant Ranjan is a PhD research scholar at Punjabi University, Patiala, and is working in
the area of additive manufacturing and feedstock developments. He has authored more than five
research paper.

Prof. Rupinder Singh is Professor in the Department of Production Engineering, Guru Nanak
Dev Engineering College, Ludhiana, India. He has received Ph.D. in Mechanical Engineering
from Thapar Institute of Engineering and Technology, Patiala, India. His area of research is non-
traditional machining, additive manufacturing and development of porous biomaterials using 3D
printing and rapid prototyping techniques. He has more than 18 years of teaching and research
experience. He has contributed extensively to the world in additive manufacturing literature
with publications appearing in Journal of Manufacturing Processes, Composite Part B, Rapid
Prototyping Journal, Journal of Mechanical Science and Technology, Measurement, International
Journal of Advance Manufacturing Technology, and Journal of Cleaner Production. He authored
17 books and ~3 chapters. He has received more than 3 crores research grants from various
10 PLA-HAp-CS-Based Biocompatible Scaffolds … 229

funding agencies such as DST-SERB, AICTE, CSIR, DAE, IE. He is working with Prof. Seeram
Ramakrishna, NUS Nanoscience and Nanotechnology Initiative and Prof. Fernando Fraternali,
Full Professor of Structural Mechanics, Department of Civil Engineering, University of Salerno.

Dr. I. P. S. Ahuja is working as Professor in Mechanical Engineering Department of Punjabi

University, Patiala. His research areas are optimization, machining, industrial engineering, and
manufacturing. He has authored more than 150 research papers. He served as reviewer of various
journals. He guided more than 10 Ph.D. thesis and 20 M.Tech. thesis.

Professor Dr. MD. Mustafizur Rahman is a Consultant, a Researcher currently working with
the Faculty of Mechanical Engineering, University Malaysia Pahang, Malaysia, since April 2007.
Dr. Rahman also served as a Director in the Automotive Engineering Centre, UMP. He received
his Ph.D. degree from the Department of Mechanical and Materials Engineering, Universiti
Kebangsaan Malaysia, Malaysia. His prior work experience includes Lecturer in the Depart-
ment of Mechanical Engineering, Khulna University of Engineering and Technology, Khulna,
Bangladesh, and as an Assistant Professor in the Department of Industrial and Production Engi-
neering, Shahjalal University of Science and Technology, Bangladesh. He served as a head of the
department in the same department. The research work of Dr. Rahman is focused on internal-
combustion engine and alternative fuels, fatigue fracture as well as optimization, finite-element
analysis, artificial intelligence, advanced machining techniques. He has managed to publish more
than 200 papers in international scholarly journals and conferences. He is also the editorial
member of several scientific journals. He has been the technical reviewer for over 25 scientific
journals as well as the member of the technical board for conferences. He is the Fellow of Associ-
ation of Computer, Electronics and Electrical Engineers (ACEEE) and Indian Society of Mechan-
ical Engineers (ISME). He has been supervised 11 Ph.D. and 10 M.Sc. Eng. Candidates and more
than 35 undergraduate dissertations.

Prof. Seeram Ramakrishna is Co-Director, NUS Nanoscience and Nanotechnology Initiative

(NUSNNI). He has received his Ph.D. from the University of Cambridge. He is a global leader in
electrospinning and nanostructured materials. Since 2001, Seeram’s team has contributed signif-
icantly to the scientific knowledge in basic research, advances in the process and the applica-
tions of nanofibers. Professor Seeram Ramakrishna’s research resulted in ~1000 peer-reviewed
articles with ~70,000 citations and ~120 H-index. He authored 5 books and ~25 chapters. He
has been recognized as a Highly Cited Researcher in Materials Science (www.highlycited.com)
for the past four years. Thomson Reuters listed him among the Most Influential Scientific Minds
in the World. NUS Vice-President (research strategy); Dean of Faculty of Engineering; Founding
Director of NUSNNI, and Bioengineering; Founding Chair of Global Engineering Deans Council;
Vice-President of International Federation of Engineering Education Societies; Board member of
Asia Society for Innovation and Policy. EC/FP7 report lists him among the top four researchers of
Singapore. He is recognized as world’s number one in nanofiber technologies. He also generated
intellectual property in the form of 20 patents and licensed technologies to industry and start-ups.
He mentors Singapore-based start-ups, namely (a) BioMers International, (b) Insight BioVentures,
(c) ceEntek, (d) Hyperion Core and (e) Everest Capital. Moreover, he works with companies such
as HP, Schlumberger, BASF, Interplex, GE, Mann Hummel, Kaneka, Mitsubishi, Toray, Unitex,
GSK, AMT, etc., for value capture in Singapore.
Chapter 11
Dental Crowns by FDM Assisted Vapour
Smoothing and Silicon Moulding

R. Singh, Rupinder Singh, and J. S. Dureja

11.1 Introduction

Nowadays, the reduction in product cost and cycle time by using additive manufac-
turing (AM) techniques is well-established fact [1–4]. The AM uses CAD data to
print prototypes (both functional/non functional) that can be used at once as finished
products [5–8]. Due to the advancement in AM, it has become a reality to get the
customized implants as required [9, 10]. These can be produced timely at low cost
because of the versatile nature of the 3D printing. Fused deposition modelling (FDM)
is low-cost commercial AM process [11–13]. The material (filament) used for FDM
is strong in itself but the bonds between the forming layer are much weaker [14,
15]. Due to this, the parts printed during the material extrusion process have poor
surface finish and with a defect of stair-stepping [16, 17]. FDM uses the thermo-
plastic materials to feed into the hot nozzle where it transforms into the semi liquid
state [18–20].
The main problems come when the printed parts are used as patterns for casting
applications [21, 22]. So, there surface needs post-finishing which can be achieved by
a technique called CVS. In CVS technique, the thermoplastic materials are exposed
to chemical vapours (e.g. acetone in case of ABS). The acetone vapours improve the

R. Singh (B)
Punjabi University Patiala, Patiala, India
e-mail: [email protected]
GNA University, Phagwara, Punjab, India
R. Singh
Production Engineering Department, Guru Nanak Dev Engineering College, Ludhiana 141006,
India
e-mail: [email protected]
J. S. Dureja
Mechanical Engineering Department, Punjabi University Patiala, Patiala, India

© Springer Nature Singapore Pte Ltd. 2020 231

S. Singh et al. (eds.), 3D Printing in Biomedical Engineering,
Materials Horizons: From Nature to Nanomaterials,
https://doi.org/10.1007/978-981-15-5424-7_11
232 R. Singh et al.

Ra of the parts by breaking the secondary bonds between the layers of the ABS and
ultimately softening the outer surface [18]. The CVS as post-processing technique
has the potential to reduce the staircase effect [18, 23–25].
Currently, AM technologies are not recommended for medium to large scale
production [26–28] and for developing rapid tooling (RT) [29–31] mainly because
of high input cost, material-related issues, etc. SM is an established prototyping
technique (for batch production) to produce patterns [32] which can be used to
overcome limitations of commercial AM processes. In SM process, a master pattern
is first manufactured. After that, liquid silicone and hardener in suitable proportion
are put in mould box around the pattern. The mould is then left for 12–18 h for
healing [33, 34]. The material is then cut usually from the centre and the master is
detached. The cavity created is fitted with the runner and the gating system. The
mould is then reassembled and suitable materials like wax, PU, etc. are poured as
per requirement [35]. Some researchers have highlighted an indirect approach to the
production of wax patterns using SM to reduce the costs of batch production during
IC process [2]. The numbers of direct and indirect routes (AM assisted with SM) for
the rapid manufacture of IC have been widely reported. [29]. Kai et al. outlined that
AM approach is the better option from design flexibility view point [30].
Singh and Singh developed macro-model for printing of plastic components via
SM in terms of d and concluded that the tolerance grades for the prepared compo-
nents are as per UNI EN 20286-I (1995) standard [32]. Few researchers outlined the
d of wax patterns printed by room temperature vulcanization (RTV) and SM [33].
Also, researchers have recommended that the d of customary IC processes can be
enhanced by replacing usual wax-based patterns with contemporary thermoplastic
patterns [32–35].
The reported literature on AM, FDM, CVS and SM reveals that lot of work was
has been done to improve master patterns by independently optimizing the input
parameters of the FDM and SM processes, but till now, very little has been reported
on comparison of Ra , d and SH of the dental crowns prepared by FDM assisted with
CVS and SM process. In this case study, the functional prototypes as dental crowns
have been prepared independently in two stages. In the first stage, effect of CVS, part
density and orientation in FDM (with ABS thermoplastic) as digital manufacturing
tool on output parameters (Ra , d and SH of dental crowns as functional prototype
from assembly view point) have been investigated. In second stage, SM process has
been used for making replicas of dental crowns (prepared in first stage). The process
parameters selected for SM are: de-moulding time, hardener proportion in weight
percentage and curing temperature. Further, ANOVA has been employed to find out
the significance of process parameter from multifactor optimization point of view.
11 Dental Crowns by FDM Assisted Vapour Smoothing … 233

11.2 Methodology

11.2.1 Stage 1

In this stage, dental crown (see Fig. 11.1) has been selected for case study. This
work was divided into two phases. Samples of ABS material were manufactured in
the first phase (preprocessing phase) on commercial FDM setup “Make: uPrint-SE,
Stratasys USA” by varying the “orientation” and “part density” as input variables.
The prototypes were subjected to the CVS in second stage (post-processing phase).
The CVS process has been carried out with acetone on “Stratasys, USA finishing
touch smoothing station.”
The exposure time of the prototypes to chemical vapors is one of the parameters
chosen in the second phase. The selected levels for two phases of experimentation are
shown in Table 11.1. The hardness and dimensional precision of the specimens have
been measured before and after the CVS process. Two dimensions “A” and “B” (see
Fig. 11.1) have been selected judicially for dimensional accuracy. The dimensions
A and B have been measured before and after the CVS process, but no variation
in average deviation of both dimensions were observed (see Table 11.2). The Ra
value of the specimens was measured before and after the CVS by “Mitutoyo SJ-210

Fig. 11.1 Benchmark

(dental crown)

Table 11.1 Two-phase factors and their levels (stage 1)

Phase 1 Phase 2
Factor Symbol Levels Factor Symbol Levels
Angle of A 1 2 3 Exposure time C 1 2 3
orientation 0° 30° 45° in s (CVS) 10 20 30
Density B Low Medium High
Note Low, medium and high density refers to part density as 25, 50 and 75%. This actually refers
to the closeness of consecutive layers while printing
234 R. Singh et al.

Table 11.2 Dimensions before and after CVS (stage 1)

Dimension Nominal dimension (mm) Nominal dimension (mm) Average deviation (d)
before CVS after CVS
A 13.93 14.04 0.11
B 20.54 20.65 0.11

Fig. 11.2 Flow chart for

stage 1 FDM process parameters
(orientation, part density)
Phase 1

3D printing of ABS replicas

Phase 2

CVS
(Exposure time in sec)

Output parameters
(Dimensional accuracy, shore
hardness, surface roughness)

roughness tester.” For better understanding, flowchart of whole process is shown in

Fig. 11.2.

11.2.1.1 Analysis for Stage 1

Based upon Table 11.1, Taguchi L9 orthogonal array (O.A) was used in both phases 1
and 2 for dimensional accuracy (Table 11.3), shore hardness (Table 11.4) and surface
roughness (Table 11.5). Further based upon Table 11.3, Fig. 11.3 shows S/N ratio
plot for d. As observed from Fig. 11.3, parts printed at 45° orientations with low
density, 30 s exposure time are the best settings for controlling d. Based upon
Table 11.4, Fig. 11.4 shows the S/N ratio plot for SH. As observed from Fig. 11.4,
the parts printed at 30° orientations with low density, 20 s exposure time are the
best settings. Further based upon Table 11.5, Fig. 11.5 shows S/N ratio plot for Ra .
11 Dental Crowns by FDM Assisted Vapour Smoothing … 235

Table 11.3 S/N ratio for d (phases 1 and 2)

S. No. Angle of Part Output from Output from Exposure Output S/N
orientation density phase 1 phase 1 time (s) from ratio
(dimension (dimension CVS (s) phase 2 (dB)
A) mm B) mm (d)
1 0° Low 20.77 13.95 10 0.12 18.41
2 0° Medium 20.83 13.98 20 0.16 15.91
3 0° High 20.64 13.92 30 0.18 14.89
4 30° Low 20.63 13.89 20 0.19 14.42
5 30° Medium 20.63 13.86 30 0.21 13.55
6 30° High 20.56 13.82 10 0.26 11.7
7 45° Low 20.65 14.01 30 0.08 21.93
8 45° Medium 20.54 13.93 10 0.11 19.17
9 45° High 20.61 13.97 20 0.15 16.47
Note For S/N ratio calculation output at phase 2 has been considered for minimum the better type
case

Table 11.4 S/N ratio for shore hardness from phases 1 and 2
S. No. Angle of Part density Output from Exposure time Output from S/N ratio
orientation stage 1 (SH) (s) CVS (s) stage 2 (SH) (dB)
1 0° Low 77 10 72 37.14
2 0° Medium 75 20 69 36.77
3 0° High 76 30 67 36.52
4 30° Low 82 20 79 37.95
5 30° Medium 78 30 73 37.26
6 30° High 81 10 77 37.72
7 45° Low 79 30 74 37.38
8 45° Medium 80 10 73 37.26
9 45° High 83 20 75 37.50
Note For S/N ratio calculation output at phase 2 has been considered for maximum the better type
case

As observed from Fig. 11.5, parts printed at 45° orientations, at high density, 30 s
exposure time are the best settings.
Based on Table 11.3 and Fig. 11.3, variance analysis (ANOVA) was carried out
(see Table 11.6). As observed from Table 11.6, parameters “A” and “B” are signifi-
cantly affecting the d of ABS parts as p values for these are less than 0.05 at 95%
confidence level. Further, the percentage contribution of these parameters is 67.86%
and 28.98%, respectively. Similarly, based upon Table 11.4 and Fig. 11.4, Table 11.7
shows that all three input parameters are significantly affecting the SH of ABS parts
as p values for these are less than 0.05. Further, the percentage contribution of these
236 R. Singh et al.

Table 11.5 S/N ratio for surface roughness from phases 1 and 2
S. No. Angle of Part density Output from Exposure Output from S/N ratio
orientation stage 1 (Ra1 ) time (s) CVS stage 2 (Ra1 ) (dB)
(µm) (s) (µm)
1 0° Low 7.997 10 0.508 5.88
2 0° Medium 8.317 20 0.746 2.54
3 0° High 8.86 30 0.329 9.65
4 30° Low 8.963 20 0.722 2.82
5 30° Medium 8.34 30 0.565 4.95
6 30° High 8.478 10 0.383 8.33
7 45° Low 7.78 30 0.236 12.54
8 45° Medium 6.992 10 0.231 12.72
9 45° High 7.192 20 0.213 13.43
Note For S/N ratio calculation Output at phase 2 has been considered for minimum the better type
case

Fig. 11.3 Main effect plots for mean S/N ratio (d)

parameters is 70.35%, 15.01% and 14.72, respectively. Based upon Table 11.5 and
Fig. 11.5, Table 11.8 shows ANOVA of S/N ratio for Ra . It was observed that all
three parameters significantly affect the Ra of ABS parts as p values for these are
less than 0.05. Further, the percentage contribution of these parameters is 71.69%,
17.54% and 10.38%, respectively.
11 Dental Crowns by FDM Assisted Vapour Smoothing … 237

Fig. 11.4 Main effect plots for mean S/N ratio (SH)

Fig. 11.5 Main effect plots for mean S/N ratio (Ra )

Table 11.6 ANOVA of S/N ratio for d

Parameter DoF SS P Percentage contribution (%)
A 2 53.52 0.005* 67.86
B 2 22.85 0.011* 28.98
C 2 2.225 0.105 2.82
Error 2 0.262 0.33
Total 8 78.86 100
DoF degree of freedom, SS sum of square, P probability, * significant parameters

11.2.1.2 Optimization and Confirmation Experiments for Stage 1

For stage 1, it was observed that significant factors and their percentage contribution
for the three responses were different (see Figs. 11.3, 11.4 and 11.5; Tables 11.6, 11.7,
238 R. Singh et al.

Table 11.7 ANOVA of S/N ratios for SH

Parameter DoF SS P Percentage contribution (%)
A 2 1.090 0.005 70.35
B 2 0.234 0.025 15.01
C 2 0.229 0.025 14.72
Error 2 0.005 0.38
Total 8 1.561 100

Table 11.8 ANOVA of S/N ratio for Ra

Parameter DoF SS P Percentage contribution
A 2 104.39 0.005 71.69
B 2 25.529 0.021 17.54
C 2 15.113 0.034 10.38
Error 2 0.534 0.36
Total 8 145.48 100

11.8). The best parameters for the three answers are different. Therefore, instead of
arbitrarily optimizing the single response, overall process optimization was used.
Table 11.9 shows the constraints set and the optimal values in Minitab software.
Starting in stage 1, the calculated d, Ra and SH corresponding to S/N ratio of
21.33, 12.76 and 37.69 are 0.079 mm, 0.198 µm and 78 SH, respectively. In order
to check the validity of the results suggested by the software, two confirmation tests
with optimum parameter values in Table 11.9 were carried out. The d, Ra and SH
for the two confirmation tests were found to be (0.074, 0.080 mm), (0.182, 0.192 µm)
and (79 SH, 77 SH), respectively.

Table 11.9 Optimum values and constraints with desirability

Parameter Set goal Lower limit Higher limit Weight Importance
Angle of orientation Region constraint 0 45° 1 1
Part density Region constraint Low High 1 1
Exposure time Region constraint 10 s 30 s 1 1
S/N ratio (SH) Maximum 36 37 1 1
S/N ratio (d) Maximum 11 21 1 1
S/N ratio (Ra) Maximum 2 13 1 1
Optimum values (stage 1)
Angle of Density Exposure S/N ratio S/N ratio S/N ratio Desirability
orientation time (d) (SH) (Ra )
45° Low 10 s 21.33 37.69 12.76 0.924
11 Dental Crowns by FDM Assisted Vapour Smoothing … 239

11.2.2 Stage 2

In stage 2, based upon input parametric settings in Table 11.9, one ABS master
pattern has been prepared and CVS cycle has been performed. Again as per Fig. 11.1,
dimension A for silicon moulding process has been selected for further evaluation.
The silicone rubber mixture consisting of “VTV-750” silicone rubber and “CAT
740” catalyst as hardener in a ratio of 10:1 has been prepared. Figure 11.6a–h shows
the different steps involved in SM. After making the mould, it is ready for vacuum
casting (VC). The d and Ra values of the mould cavity have been checked before the
pouring of PP resins and found to be within the acceptable range. For this case study
PP resins “Renishaw 8040” was used. The PP consists of two resins: (A) polymeric
polyol with hydroxyl group as hardener; (B) di-isocyanate compound as softener.
Table 11.10 shows the various properties of Renishaw 8040 (commercially used PP
resin). The replicas prepared by VC are shown in Fig. 11.7.
Table 11.11 shows the parameters of the input and their levels for stage 2.

11.2.2.1 Analysis for Stage 2

In stage 2, shrinkage was observed in all experiments (see Table 11.12). The
maximum average deviation percentage is 1.11%. The value of Ra was observed
for the selected material in the range from 0.4 to 0.9 µm. Since the aim is to achieve
minimum d and Ra , so S/N ratio based on “lower is better” has been calculated.
For SH to be maximum, S/N ratio based on “larger is better” was selected.
ANOVA was performed on calculated S/N ratios for the analysis of results
(Tables 11.13, 11.14 and 11.15). The P-value below 0.05 (Tables 11.13, 11.14 and
11.15) shows significant model terms.
Based upon Tables 11.12, 11.13, 11.14 11.15, Figs. 11.8, 11.9 and 11.10 show
S/N ratio plots for d, Ra and SH. As observed from Fig. 11.8, minimum d was
observed when curing temperature is 60 °C and it increases with increase in curing
temperature. This may be due to the fact that by increasing the temperature, it shrinks
the material more and which causes more deviation. So, it has been observed that
optimum parameter setting that minimizes the d is A3 , B1 and C1 (see Fig. 11.8).
It has been observed that hardener percentage and curing temperature have very
little effect as their percentage contribution is very less as seen from the ANOVA
Table 11.14. De-moulding time (min) affects the Ra significantly as seen from its high
F-value in the ANOVA Table 11.14. The Ra increases with increase in de-moulding
time (min) and minimum Ra is observed when de-moulding time is 90 min. So, it
has been observed that optimum parameter setting that minimizes the Ra is A1 , B1
and C 1 (see Fig. 11.9).
As observed from Table 11.15 and Fig. 11.10, curing temperature affects the SH
significantly. It has been observed that best parameter settings that maximize the SH
is A3 , B2 and C 3.
240 R. Singh et al.

(a) Gate attached to FDM pattern (b) Assembly put in a frame

(c) Mixing rubber, hardener and (d) Cured mould

pouring into the frame

(e) Cut the mould for removing the pattern (f) Mould ready for casting

(g) Pour the material into mould (h) After pouring final component is ready

Fig. 11.6 Steps involved in SM process

11 Dental Crowns by FDM Assisted Vapour Smoothing … 241

Table 11.10 Properties of

Material A B Mixture
Resin 8040
Polyol Isocyanate –
Density @ 25 °C (g/cm3 ) 0.99 1.14 1.08
Viscosity @ 25 °C (cPs) 1200 140 420
Pot life @ 25 °C – – 5 min
De-mould time at 65 °C – – 50–80 min

Fig. 11.7 Fabricated

replicas of PP materials

Table 11.11 Input parameters and their levels (stage 2)

Parameters Symbol Levels
Level 1 Level 2 Level 3
Hardener % A 100:90 110:90 120:90
De-moulding time (min) B 90 min 105 min 120 min
Curing temperature (°C) C 60 °C 70 °C 80 °C

11.2.2.2 Optimization and Confirmation Experiments for Stage 2

From Tables 11.13, 11.14 and 11.15, it has been observed that significant factors
and their percentage contribution for the three responses are different for stage
2. Table 11.16 shows the set constraints and the optimal values for multifactor
optimization.
From stage 2, the calculated d, Ra and SH corresponding to S/N ratio of 14.91,
4.84 and 38.04 are 0.096 mm, 0.295 µm and 83 SH, respectively. In order to verify the
validity of the results suggested by the software, two confirmation tests with optimum
parameter values were carried out. The d, Ra and SH for the two confirmation
tests were found to be (0.091, 0.097 mm), (0.325, 0.342 µm) and (84 SH, 85 SH),
 242

Table 11.12 S/N ratio for the three responses (stage 2)

S. No. Hardener ratio (%) De-moulding time Curing temp (°C) d (mm) Ra (µm) SH S/N ratio for d S/N ratio for Ra S/N ratio for SH
(min)
1 100:90 90 60 0.17 0.492 72 15.39 6.160 37.14
2 100:90 105 70 0.27 0.602 82 11.37 4.408 38.27
3 100:90 120 80 0.19 0.769 79 14.42 2.281 37.95
4 110:90 90 70 0.25 0.741 74 12.04 2.603 37.38
5 110:90 105 80 0.20 0.698 80 13.97 3.122 38.06
6 110:90 120 60 0.18 0.873 67 14.89 1.179 36.52
7 120:90 90 80 0.16 0.716 81 15.91 2.901 38.16
8 120:90 105 60 0.17 0.632 79 15.39 3.985 37.95
9 120:90 120 70 0.23 0.914 77 12.76 0.781 37.72
R. Singh et al.
11 Dental Crowns by FDM Assisted Vapour Smoothing … 243

Table 11.13 ANOVA table for d

Parameter DoF SS P Percentage contribution
A 2 2.0421 0.010 9.82%
B 2 1.1328 0.018 5.44%
C 2 17.5926 0.001 84.62%
Error 2 0.0208 0.10%
Total 8 20.7884 100

Table 11.14 ANOVA table for Ra

Parameter DoF SS P Percentage contribution
A 2 6.9736 0.061 31.90%
B 2 12.0057 0.036 54.93%
C 2 2.4298 0.156 11.11%
Error 2 0.4502 2.05%
Total 8 21.8593 100

Table 11.15 ANOVA table for SH

Parameter DoF SS P Percentage contribution
A 2 0.63980 0.038 24.55%
B 2 0.79207 0.031 30.40%
C 2 1.14813 0.022 44.06%
Error 2 0.02536 0.97%
Total 8 2.60537 100

Main Effects Plot for SN ratios

Data Means
A B C
15.5

15.0
Mean of SN ratios

14.5

14.0

13.5

13.0

12.5

12.0
1 2 3 1 2 3 1 2 3

Signal-to-noise: Smaller is better

Fig. 11.8 Main effect plots of S/N ratios for d

244 R. Singh et al.

Main Effects Plot for SN ratios

Data Means
A B C
4.5

4.0
Mean of SN ratios
3.5

3.0

2.5

2.0

1.5

1.0
1 2 3 1 2 3 1 2 3

Signal-to-noise: Smaller is better

Fig. 11.9 Main effect plots of S/N ratios for Ra

Main Effects Plot for SN ratios

Data Means
A B C
38.1

38.0

37.9
Mean of SN ratios

37.8

37.7

37.6

37.5

37.4

37.3

37.2

1 2 3 1 2 3 1 2 3

Signal-to-noise: Larger is better

Fig. 11.10 Main effect plot of S/N ratios for SH

respectively. The surface roughness profile (Ra) of the two samples manufactured in
optimal parameters is shown in Fig. 11.11.

11.3 Results and Discussion

After completion of stage 2, the tolerance (IT) grades of the fabricated components
with SM were deduced (see Table 11.17).
Initially, the measured dimensions have been used to evaluate the tolerance unit
“n” that drives from the fundamental tolerance “I”, as per UNI EN 20286-I (1995).
The “i” and “n” were calculated by using Eqs. 1 and 2:
√
i = 0.45 D + 0.001D
3
(1)
11 Dental Crowns by FDM Assisted Vapour Smoothing … 245

Table 11.16 Suggested constraints and optimum values (stage 2)

Parameter Set goal Lower Higher Weight Importance
limit limit
Hardener % Region 100:90 120:90 1 1
constraint
De-moulding time (min) Region 90 min 120 min 1 1
constraint
Curing temperature (°C) Region 60 °C 80 °C 1 1
constraint
S/N ratio (d) Maximum 11.3727 15.9176 1 1
S/N ratio (Ra ) Maximum 0.7811 6.1607 1 1
S/N ratio (SH) Maximum 36.5215 38.2763 1 1
Optimum values (stage 2)
Hardener De-moulding Curing S/N ratio S/N ratio S/N ratio Desirability
% time (min) temperature (d) (Ra) (SH)
(°C)
100:90 90 min 80 °C 14.9139 4.8463 38.0434 0.79930

Evaluation Profile
1.5

1.0

0.5
[μm]

0.0

-0.5

-1.0

-1.5
0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4
[mm]

Evaluation Profile
2.0
1.5
1.0
0.5
[μm]

0.0
-0.5
-1.0
-1.5
0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4
[mm]

Fig. 11.11 Evaluation profile for Ra

246 R. Singh et al.

Table 11.17 IT grade

Exp. No. Nominal dimension Tolerance value “n” IT grade
calculations
(mm)
1 13.87 157.0 IT12
2 13.77 249.3 IT13
3 13.85 175.4 IT12
4 13.79 230.9 IT13
5 13.84 184.7 IT12
6 13.86 166.2 IT12
7 13.88 147.7 IT12
8 13.87 157.0 IT12
9 13.81 212.4 IT13

 
|D N − D M |
n = 1000 (2)
i

Here: “D” is the geometric mean of range of nominal size, DN is the nominal
dimension, DM is the measured dimension. The dimension B (14.04 mm) of the
master manufactured by combined processes of FDM and CVS (Table 11.2) was
taken as nominal dimensions in this work. The standard basic measuring step is 10–
18 mm. In experiment 1, the value of “n” for the selected dimension is calculated as
follow:

D = (10 × 18)1/2 = 13.416 mm

i = 0.45(13.416)1/3 + 0.001(13.416) = 1.0827 µm
n = 1000(14.04 − 13.87)/1.0827 = 157.01

It was observed that the measured dimensions were lower than the nominal dimen-
sions in all experiments. It was due to the shrinkage that occurs when the replicas
are solidified, as the plastic changes state from liquid to solid. This can be compen-
sated by giving the master pattern a shrinkage allowance. Figures 11.12 and 11.13
show SEM of FDM printed and CVS samples, respectively. Figure 11.14 shows
SEM image of SM samples fabricated at optimum parameter settings. The SEM-
based photomicrographs of the samples show that exposing FDM prototypes to CVS
causes re-flow of the ABS material and resulted into the formation of fine layer of
ABS on the surface of the prototypes and thus improve Ra.
Figure 11.12 clearly shows the stair case effect of FDM printed samples, which
have been removed by CVS (Fig. 11.13). As observed from Fig. 11.14, no stair case
effect has been observed at SM stage; hence, excellent reproducibility of replicas is
expected.
11 Dental Crowns by FDM Assisted Vapour Smoothing … 247

Fig. 11.12 SEM image of

FDM fabricated component

Fig. 11.13 SEM image of

after CVS process

Fig. 11.14 SEM image of

sample after SM
248 R. Singh et al.

11.4 Conclusions

Following are the conclusions made from the present study:

• In stage 1, it has been found that the combined optimized setting (predicted from
S/N ratio): 45° orientation, low part density and 10 s exposure time.
• After SM process, shrinkage was reported (for selected dimensions) in stage 2.
The PP material shows good Ra after SM.
• The best parametric settings for all the responses (for 8040 PP material) are:
100:90 hardener percentage, de-moulding time 90 min, curing temperature of
80 °C.
• IT grades for the dimensions of replicas are acceptable as per ISO UNI EN 20286-
I (1995) and DIN 16901. So, the prototypes can be used as end products or master
for IC.

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tional temperature-stimuli shape memory polymer for customized scaffoldings. J Mech Behav
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techniques: a review of applications for rapid investment casting. Int J Adv Manuf Technol
25(3–4):308–320
3. Sood AK, Ohdar RK, Mahapatra SS (2010) Parametric appraisal of fused deposition modelling
process using the gray Taguchi method. Proc Inst Mech Eng Part B J Eng Manuf 44:135–145
4. Chhabra M, Singh R (2011) Rapid casting solutions: a review. Rapid Prototyping J 17(4)
5. Anitha R, Arunach AS, Radhakrishnan P (2001) Critical parameters influencing the quality of
prototypes in fused deposition modelling. J Mater Process Technol 118:385–388
6. Armillotta A (2013) Assessment of surface quality on textured FDM prototypes. Rapid
Prototyping J 12:35–41
7. Kumar R, Singh R, Hui D, Feo L, Fraternali F (2018) Graphene as biomedical sensing element:
state of art review and potential engineering applications. Compos B Eng 134:193–206
8. Bassoli E, Gatto A, Luliano L, Violentte MG (2007) 3D printing technique applied to rapid
casting. Rapid Prototyping J 13:148–155
9. Ma S, Gibson I, Balaji G, Hu QJ (2007) Development of epoxy matrix composites for rapid
tooling applications. J Mater Process Technol 192(193):75–82
10. Chen L, He Y, Yang Y, Niu S, Ren H (2016) The research status and development trend of
additive manufacturing technology. Int J Adv Manuf Technol. https://doi.org/10.1007/s00170-
016-9335-4
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fused filament fabrication. J Manuf Process 55: 288–306
12. Rodriguez JF, Thomas JP, Reynaud JE (2001) Experimental investigations Mechanical
behaviour of acrylonitrile butadiene styrene (ABS) fused deposition materials. Rapid Proto-
typing J 7(3):148–158
13. Bhargav A, Sanjairaj V, Rosa V, Feng LW, Fuh YH (2017) Applications of additive
manufacturing in dentistry: a review. https://doi.org/10.1002/jbm.b.33961
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modelling: a review. Rapid Prototyping J 22(2)
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properties treated with a low cost chemical finishing. J Appl Sci Eng Technol 4:3838–3842
17. Boschetto A, Giordano V, Veniali F (2016) Modelling micro geometrical profiles in fused
deposition process. Int J Adv Manuf Technol 61:945–956
18. Chung S, Park S, Lee I, Jeong H, Cho D (2005) Replication techniques for a metal micro-
component having real 3D shape by micro casting process. Microsys Technol 11:424–428
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surface finish of fused deposition modeled parts. Ann Manuf Technol 58:189–192
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parts after cold vapour treatment. Mater Manuf Process 1–24
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deposition modelling. Virtual Phys Prototyping 141–149
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by RTV silicon rubber molding using Taguchi approach. Rapid Prototyping J 13(2):115–122
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Mr. Ranvir Singh Ph.D. Research Scholar, Mechanical Engineering Department, Punjabi Univer-
sity, Patiala, India. He is working as Assistant Professor at GNA University, Phagwara, India. His
area of research is additive manufacturing, investment casting and metal matrix composites.
250 R. Singh et al.

Prof. Rupinder Singh is Professor in the Department of Production Engineering, Guru Nanak
Dev Engineering College, Ludhiana, India. He has received Ph.D. in Mechanical Engineering
from Thapar Institute of Engineering and Technology, Patiala, India. His area of research is non-
traditional machining, additive manufacturing and development of porous biomaterials using 3D
printing and rapid prototyping techniques. He has more than 18 years of teaching and research
experience. He has contributed extensively to the world in additive manufacturing literature
with publications appearing in Journal of Manufacturing Processes, Composite Part B, Rapid
Prototyping Journal, Journal of Mechanical Science and Technology, Measurement, International
Journal of Advance Manufacturing Technology, and Journal of Cleaner Production. He authored
17 books and ~3 chapters. He has received more than 3 crores research grants from various
funding agencies such as DST-SERB, AICTE, CSIR, DAE, IE. He is working with Prof. Seeram
Ramakrishna, NUS Nanoscience and Nanotechnology Initiative and Prof. Fernando Fraternali,
Full Professor of Structural Mechanics, Department of Civil Engineering, University of Salerno.

Prof. Jasminder Singh Dureja is working as Professor in the Department of Mechanical Engi-
neering, Punjabi University, Patiala, India. He obtained his doctoral degree in Mechanical Engi-
neering, Punjabi University, Patiala, India. He is a life member of ISTE. His areas of interest
are hard tuning, tool wear, condition-based maintenance and monitoring apart from statistical
modeling and optimization, machining of aerospace alloys under minimum quantity lubrication
machining/near dry machining, green manufacturing, etc.
Chapter 12
Complex Shapes Prosthetics Process:
An Application of Fused Deposition
Modeling Technology

Tan Thang Nguyen, Hoang Vu Nguyen, Minh Phung Dang,

and Thanh-Phong Dao

12.1 Introduction

Nowadays, a huge number of existing disabilities devices have been facing a few diffi-
cult problems in modeling, analysis, and fabricatiion, etc. Specifically, in Vietnam, a
developing country, many disabled people have missed lower limbs or upper limbs,
named prosthetics, by causes of US and Vietnam War. This caused physical disability
for human and sociality as well as economic cost for the country. Therefore, there is
a need to develop devices, techniques, and knowledge to disabled people in Vietnam,
a specific case in this study.
It is well-known that 3-D printing technology has been used for bioengineering
and other various fields such as arts, food industry, aerospace, consumer products,
medical and manufacturing. In biomedical engineering, 3-D technique permits a high
cost-effectiveness and increased mass production.
Until now, designers can use computer-aided design (CAD) and rapid prototyping
(RP) in order to facilitate pseudo-prototypes before a real fabrication and manufac-
turing. Nowadays, the fused deposition modeling (FDM) process is an alternatively
effective technique for prosthetics and biomedical engineering. Figure 12.1 illus-
trates a hot thermoplastic extrusion with high accuracy. In the present work, the
FDM process is utilized for creating a virtual model of prosthetics with lower limb.

T. T. Nguyen · H. V. Nguyen · M. P. Dang

Ho Chi Minh City Industry and Trade College, Ho Chi Minh City, Vietnam
T.-P. Dao (B)
Division of Computational Mechatronics, Institute for Computational Science, Ton Duc Thang
University, Ho Chi Minh City, Vietnam
e-mail: [email protected]
Faculty of Electrical & Electronics Engineering, Ton Duc Thang University, Ho Chi Minh City,
Vietnam

© Springer Nature Singapore Pte Ltd. 2020 251

S. Singh et al. (eds.), 3D Printing in Biomedical Engineering,
Materials Horizons: From Nature to Nanomaterials,
https://doi.org/10.1007/978-981-15-5424-7_12
252 T. T. Nguyen et al.

Fig. 12.1 Schematic

diagram of fused deposition
modeling [1]

Considering tissue engineering, in the early 1980s, Hull [1] used a .stl file in a
CAD file so as to communicate to the 3-D printer. Later, there are a lot of companies
such as DTM, Z corporation developed 3-D systems in this period of time [2]. Sean
and Anthony [3] used 3-D printing for making skin, bone, vascular grafts, tracheal
splints, heart tissue, and cartilaginous structures. Nicholas et al. [4] used this process
to prosthetic production.
By using the computer-aided design and manufacturing (CAD/CAM) processes,
a variable impedance prosthetic socket for an amputee was developed by David and
Hugh [5]. In the past, 3-D printer was utilized so as to make lower limb prosthesis [6].
In addition, helical cooling channel (HCC) has been used during the modification
of a prosthetic socket. The HCC process provides benefits through considerations
of reducing thermal effect [7]. Regarding the organ models, a 3-D printing FDM
based on the computed tomography scan was applied in Ref. [8]. However, FDM
organ models are still limited by resolution and printing accuracy compared with
instance stereolithography [9] or nasal casts [10]. In addition, many studies used the
FDM process for medical engineering [11, 12]. Considering material with low cost
and high strength, polymers are proper materials, such as collagen [13], gelatin [14],
alginate [15], hyaluronic acid [16], PVA [17], and polyester-urethanes [18], which
are commonly used for 3-D printing. Besides, some focused on compliant prosthetic
ankle foot by taking advantage of compliant mechanism and flexure hinge [19–22].
Until now, according to Vietnam conditions, there is a lack of study on making 3-D
prosthesis by fused deposition modeling process.
12 Complex Shapes Prosthetics Process … 253

The aim of this chapter is to discuss the strength analysis of parts of the prosthesis
by applying the fused deposition modeling process in Inventor software where socket
is made from 200 mc machine, and calves are made of ABS material.

12.2 ISPO Processing

According to the processing had been transferred by International Society for Pros-
thetics and Orthotics (ISPO), orthopedy doctor will examine and give patient lots
of useful pieces of advice for making decisions to select prosthetic parts, after that,
orthopedy technician will take the measurement of patient and the socket plaster cast
will make by hand. The ISPO’ processing is summarized, as illustrated in Fig. 12.2.
In order to get the exact measurement, the prosthetists often use experiences and
knowledge so as to adjust the pressure with the hands. The goal of this step is to
produce a suitable socket. We need to remove the wrap cast carefully when the
plaster is already set.

12.3 FDM Processing

As illustrated in Fig. 12.3, the first step is consulted by biomechanic doctor. And
then, the CAD models of socket, cavet and connecting parts were built. Next, these
models were exported as files with *.slt file. Finally, those files are fabricated by
FDM machine.
As depicted in Fig. 12.3, the rapid prototyping (RP) based on 3-D modeling in a
software can achieve an efficiency and a high performance at a low cost and time.
This process can be considered as a virtual technique so as to create a physical model
before conducting a real production.

12.3.1 Input Information

This study has created a 3-D metric set, as shown in Fig. 12.4. The purpose of this
study is to overcome the error due to manual measurement through the ISPO measure.
When we acquired the exact parameters, we need to determine the size of the
standard ring, as shown in Fig. 12.5. Since the residual limb is the common standard,
each individual patient needs to revise the correlation between the points of load-
bearing and unbearable on the residual limb, so that the residual limb can hold a dead
end without causing discomfort to the patient.
254 T. T. Nguyen et al.

Fig. 12.2 A schematic

diagram of producing
prosthetics and orthotics by
ISPO

12.3.2 Parts Design

After having all the socket specifications and other city sales, the patient’s offi-
cial socket has been completely designed. Through examination, measurement, and
consultation of doctors, data on the size of the residual limb and other parts are
determined and designed, as shown in Fig. 12.6.
12 Complex Shapes Prosthetics Process … 255

Fig. 12.3 Schematic

diagram of FDM process
256 T. T. Nguyen et al.

Fig. 12.4 3-D metric set

Fig. 12.5 Standard ring from ISPO

After we get the real measurement of all the data, we proceed to assemble semifin-
ished products and sockets together on the software. The mounting condition is the
center of mechanical knee joint rotation on the prosthetic leg which is 2–2.5 cm
higher than that of the knee joint.
12 Complex Shapes Prosthetics Process … 257

Fig. 12.6 All parts design

258 T. T. Nguyen et al.

Table 12.1 ABS properties

Material ABS
Gravity 1.06 g/cm3
Weight 0.7 kg
Surface area 249,175 mm2
Volume 713,442 mm3
Mesh 0.1 mm

12.3.3 Strength Testing

Based on the criteria of mechanical biochemistry, we must ensure that the inner
surface of the socket is suitable for patients, the outer surface of the socket is similar
in shape with the healthy leg to achieve aesthetic and safety factor when using is 1.5,
then the socket has officially been designed to suit patients with a maximum weight
of 113 kg. ABS material was used for fabricate socket and cavet with the properties
shown in Table 12.1. First of all, only one small prototype was designed and analyzed
by Inventor software because of the low cost. The strength testing results show that
the socket has enough strength conditions as shown in Table 12.2. After that, the
prototype was made by FDM mc 200 machines.
The experiment was built with model test equipment shown in Fig. 12.7 and the
theory of testing shown in Table 12.3.
Piston provides F x force to lever arm that installs at the position as shown in
Table 12.3. There are three different positions at vertical, tilt, and angle degrees 16,
−16 to vertical that deal with real situation. The socket was broken at 157 kg that
indicates it suitable to use as shown in Table 12.3.
Finally, the real socket was designed and tested by Inventor software. The testing
results in Table 12.4 show that the real socket has enough strength conditions.

12.3.4 Manufacturing

The rapid prototyping process was performed on FDM 200 mc machine at the labo-
ratory of Ho Chi Minh City University of Technical Education. After processing, the
semifinished products are assembled and fixed, as shown in Fig. 12.8.

12.4 Assemble and Experiment

Parts of prosthetic were assembled by orthopedic technician and experiment by

orthopedic doctor. Finally, the prosthetic leg is tested by the patient as shown in
Fig. 12.9. The patient feels comfortable and the doctor confirms that the prosthetic
leg is full compliance for patients.
12 Complex Shapes Prosthetics Process … 259

Table 12.2 Strength testing results

No. Force diagram F Results
F Max F MAX
M CP
1 130 kg 200 kg

Minimum safety factor: 1.53

2 115 kg 170 kg

Minimum safety factor: 1.54

3 110 kg 165 kg

Minimum safety factor: 1.54

260 T. T. Nguyen et al.

Fig. 12.7 Model test

12.5 Conclusions and Future Works

This chapter presented an application of fused deposition modeling technology for

creating the prosthetics with complex shapes. It could help to produce prototypes
quickly at low cost. The socket and cavet were built by FDM 200 mc machine. And
then, the prosthetic was assembled and succeeds experiment under the supervision
of orthopedic doctor. The purpose of this study was to make a comfortable prosthetic
socket that could bear a human weight up to 113 kg. Besides that, the results are
expected to generate a highly maneuverable socket specification. The results of this
study could be used for another patient easily.
12 Complex Shapes Prosthetics Process … 261

Table 12.3 Results of model test

No. Force diagrams P F Results
1 8 kg/cm2 140 kg Socket safe

2 9 kg/cm2 126 kg Socket safe

3 9 kg/cm2 157 kg Socket broken

Table 12.4 Results of socket test
262

No. Force diagrams F, M F Max , M CP

F Max F Max Safety factor
M CP
1 150 kg 220 kg

Minimum safety factor: 1.45

(continued)
T. T. Nguyen et al.
Table 12.4 (continued)
No. Force diagrams F, M F Max , M CP
F Max F Max Safety factor
M CP
2 113 kg 170 kg
12 Complex Shapes Prosthetics Process …

Minimum Safety factor: 1.48

(continued)
263
Table 12.4 (continued)
264

No. Force diagrams F, M F Max , M CP

F Max F Max Safety factor
M CP
3 160 kg 240 kg

Minimum safety factor: 1.51

(continued)
T. T. Nguyen et al.
Table 12.4 (continued)
No. Force diagrams F, M F Max , M CP
F Max F Max Safety factor
M CP
4 F = 113 kg F = 240 kg
M = 113,000 N mm M = 200,000 N mm
12 Complex Shapes Prosthetics Process …

Minimum safety factor: 1.62

265
266 T. T. Nguyen et al.

Fig. 12.8 Socket fabricate with FDM mc 200 machine

Fig. 12.9 Patient testing with prosthetic leg

Acknowledgements This research is funded by Vietnam National Foundation for Science and
Technology Development (NAFOSTED) under grant number 107.01-2019.14.
12 Complex Shapes Prosthetics Process … 267

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Mr. Tan Thang Nguyen is Lecture in Ho Chi Minh City Industry and Trade College, Ho Chi
Minh City, Vietnam. He received his B.S. degree in mechanical engineering from the Ho Chi Minh
City University of Technology and Education, Vietnam, in 2008. He received his M.S. degree in
mechanical engineering from the National Kaohsiung University of Applied Sciences, Taiwan,
ROC, in 2011. He is currently a Ph.D. student at Ho Chi Minh City University of Technology
and Education, Ho Chi Minh City, Vietnam. His research interests include compliant mechanism,
bio-inspired structure, actuator, rehabilitation, prosthetics, hybrid optimization algorithm, applied
soft computing, design optimization.

Mr. Hoang Vu Nguyen is Lecture in Faculty of Mechanical Engineering, Ho Chi Minh City
Industry and Trade College, Ho Chi Minh City, Vietnam. He received his B.S. and M.S. degree in
mechanical engineering from the Ho Chi Minh City University of Technology, Vietnam, in 1984
and 2000, respectively. His research interests include mechanical design.

Mr. Minh Phung Dang is Lecture in Faculty of Mechanical Engineering, Ho Chi Minh City
Industry and Trade College, Ho Chi Minh City, Vietnam. He received his B.S. and M.S. degree
in mechanical engineering from the Ho Chi Minh City University of Technology and Educa-
tion, Vietnam in 2007 and 2009, respectively. He is currently a Ph.D. student at Ho Chi Minh
City University of Technology and Education, Ho Chi Minh City, Vietnam. His research interests
include compliant mechanism, ultra-precision positioning system, hybrid optimization algorithm,
applied soft computing, design optimization.

Dr. Thanh-Phong Dao is Assistant Professor in the Institute for Computational Science, Ton
Duc Thang University, Ho Chi Minh City, Vietnam. He received his B.S. degree in mechan-
ical engineering from the Ho Chi Minh City University of Technology and Education, Vietnam,
in 2008. He received his M.S. and Ph.D. degree in mechanical engineering from the National
Kaohsiung University of Applied Sciences, Taiwan, ROC, in 2011 and 2015, respectively. He is
currently a researcher at the Institute for Computational Science, Ton Duc Thang University, Ho
Chi Minh City, Vietnam. His research interests include compliant mechanism, bio-inspired struc-
ture, actuator, rehabilitation, prosthetics, hybrid optimization algorithm, applied soft computing,
optimization, design optimization.
Chapter 13
Improvement of Human Gait in Foot
Deformities Patients by 3D Printed
Ankle–Foot Orthosis

Harish Kumar Banga, Parveen Kalra, R. M. Belokar, and Rajesh Kumar

13.1 Introduction

Pre-assembled orthotic gadgets are reasonable and intended to fit a scope of patients.
Because of this restricted plans, it would not give redid solace and usefulness. Be that
as it may, delivering a custom-fit orthosis is an arduous and tedious manual process
achieved just by master orthotist. The technique to make a give can take up a role as
much as four long stretches of manufacture time per unit whenever performed by an
accomplished expert. To make the orthotics in light of the cast, it will take days. The
cast will likewise consume room while putting away and must be kept for a couple
of months, and after, that another cast must be made [1–4].
In present-day focused world, makers need to discharge an as good as ever item
to the market as quick as conceivable to have the capacity to contend in the world-
wide market. The presentation of fast prototyping in the beginning periods of item
improvement has extraordinarily decreased the advancement time span and cost
engaged with model assembling. Quick prototyping (RP) is the way toward creating
a three-dimensional parts or models straightforwardly from CAD illustrations. The
uses of fast prototyping are progressing at quick pace. They have moved from making
models for parts to a few building applications. Among the advancing RP applica-
tions are the making of molds for bite the dust throwing and making of parts to be
utilized in the gathering of items. Regarding medicinal utilize, RP is utilized to make
models utilizing three-dimensional designs from X-beam gear and these models are
utilized to study and plan medical procedure. Techniques are being created to lead
remote medical procedure by virtual reality utilizing RP models. Notwithstanding
the past application, quick prototyping is additionally being utilized to make body

H. K. Banga (B) · P. Kalra · R. M. Belokar · R. Kumar

Production and Industrial Engineering Department, Punjab Engineering College (Deemed to Be
University), Chandigarh, Punjab 160012, India
e-mail: [email protected]

© Springer Nature Singapore Pte Ltd. 2020 269

S. Singh et al. (eds.), 3D Printing in Biomedical Engineering,
Materials Horizons: From Nature to Nanomaterials,
https://doi.org/10.1007/978-981-15-5424-7_13
270 H. K. Banga et al.

parts known as orthotics and prosthetics [5]. This investigation work is focused on
illustrating lower leg–foot orthoses (AFOs) through making sense of and produces
by quick prototyping. An orthosis is described by the International Standards Orga-
nization as a remotely associated device used to adjust the fundamental and useful
qualities of the neuromuscular and skeletal structure. Lower leg–foot orthoses cannot
avoid being orthoses that encompass the lower leg joint and the whole or part of the
foot. AFOs are wanted to control development, correct distortion or conceivably
compensate for deficiency of the leg [6–10]. With our present advancement, we can
quicken the amassing method by using making sense of to assemble 3D CAD data
on the patient’s foot. Remedial reverse engineering is required to use the reverse
engineering advancement to revamp 3D models of the anatomical structures and
biomedical things for plan and amassing of therapeutic things. Making sense of is
generally portrayed as a methodology of separating an inquiry or existing system,
to recognize its fragments and their interrelationships, and investigate how it works
remembering the ultimate objective to update or convey a copy without access to the
arrangement from which it was at first made.
Through figuring out, we can dissect the 3D examined information and outline
the most appropriate orthoses for the patient. The way toward outlining orthoses
utilizing figuring out programming would allow changes in the standard plan to
meet the correct needs of every patient. Moreover, the utilization of 3D scanner
and modernized programming in manufacturing understanding particular orthotic
gadgets can possibly convey exceptional solace because of the precise information
gave through 3D checking. Quick prototyping is the name given to an expansive gath-
ering of related advances which might be used to make physical inquiries especially
from CAD information assets. These systems are stand-out in that they incorporate
and protection substances in layers to define items. Such structures are furthermore
regarded by using the names included substance advent, three-dimensional printing,
and stable unfastened-form advent and layered amassing [11–14]. They provide
purposes of enthusiasm for various programs stood out from standard subtractive
fabricate structures, as an instance, getting ready or turning:
i. Objects may be framed with any geometric multifaceted nature or unpre-
dictability without the requirement for make bigger system setup or last get
together;
ii. Objects may be produced the use of various substances, or as composites, or
substances may even be fluctuated in a controlled manner at any place in a
protest;
iii. Additive creation frameworks lessen the improvement of complicated articles
to a sensible, clean and commonly quick manner. These homes have resulted
of their extensive use as a manner to lessen time to marketplace in production.
Today’s systems are heavily used by engineers to higher understand and speak
their product designs in addition to make speedy tooling to fabricate the ones
products. Surgeons, architects, artists and people from many other disciplines
also robotically use the technology.
13 Improvement of Human Gait in Foot Deformities Patients … 271

13.1.1 Background

Foot drop is a misleadingly dependable requires a likely snared bother. It tends to be

depicted as a basic deficiency of decay leg and toe dorsiflexion. The foot and decrease
leg dorsiflexors incorporate the tibialis the front, the extensor hallucis longus (EHL)
and the extensor digitorum longus (EDL). These solid tissues engage the body to
clean the foot amidst swing stage and control plantar flexion of the foot on back
zone strike [15–18]. Weakness in this storing up of muscle tissue brings about an
equinovarus distortion. This is some of the time insinuated as steppage walk, in gentle
of reality that the patient tends to stroll with a distorted flexion of the hip and knee to
save the feet from getting at the ground in the midst of swing level. In the midst of
walk, the power of foot bottom spot strike outperforms body weight, and the course
of the floor reaction vector goes at the back of the lower leg and acknowledgment
(see the photo underneath knee) (Fig. 13.1).

13.1.1.1 Anatomy

Strands from the dorsal pieces of the ventral rami of L4-S1 are found in the peroneal
nerve, which is encouraged with the tibial nerve to fuse the sciatic nerve. The sciatic
nerve leaves the pelvic pit at the more basic sciatic foramen, essentially unremarkable
showed up diversely in connection to the piriformis. It bifurcates to shape the peroneal
and tibial nerves either in the distal third of the thigh or at the midthigh level.
The lower leg partitioning shallow and gigantic branches. The shallow branch
goes between the two pioneers of the peronei and continues down the lower leg to
lie between the peroneal tendon and the sidelong edge of the gastrocnemius [19–23]
(Fig. 13.2).

Fig. 13.1 Forces acting on

ankle during walking
272 H. K. Banga et al.

Fig. 13.2 Anatomy of ankle nerve system

13.1.1.2 Causes

Foot drop is because of inadequacy or absence of development of the muscle tissue

drew in with lifting the front bit of the foot [24]. The concealed purposes behind foot
drop are moved and may include:
i. Nerve hurt.
The most extreme broadly analyzed purpose behind foot drop is strain of a
nerve in your leg that controls the muscle tissues related with lifting the foot.
This nerve can in like manner be hurt in the midst of hip or knee substitution
clinical way, which may reason foot drop. Nerve root hurt (“crushed nerve”) in
the spine can similarly reason foot drop.
13 Improvement of Human Gait in Foot Deformities Patients … 273

ii. Muscle or nerve issue.

Various types of solid dystrophy, an obtained ailment that causes dynamic
muscle weakness, may add to foot drop. Diverse disarranges, for example, polio
or Charcot-Marie-Tooth issue, in like manner would motive be able to foot drop.
iii. Cerebrum and spinal string inconvenience. Scatters that influence the spinal
string or cerebrum—for instance, amyotrophic parallel sclerosis (ALS), diverse
sclerosis or stroke—may purpose foot drop.

13.1.1.3 Symptoms

Foot drop makes it difficult to support the front bit of your foot, so it might defer
the floor when you walk. To counter this, you can raise your thigh while you walk,
around despite the fact that you have been mountaineering stairs (steppage walk),
to allow your foot to clear the floor. This unconventional walk may likewise make
you smack your foot down onto the floor with each movement you are taking. On
occasion, the skin on the absolute best purpose of your foot and feet can likewise
encounter numb [25–30].
Foot drop often affects just a single foot. Contingent upon the hidden reason, be
that as it can, it is possible for the two feet to be influenced.

13.1.1.4 Definition

Foot drop, from time to time called drop foot, is a general term for burden lifting the
front piece of the foot. On the off chance that you have foot drop, you may drag the
front of your foot on the ground when you walk. Foot drop is not an infection. Or then
again potentially, foot drop implies that a covered neurological, solid or anatomical
issue [31].
A part of the time foot drop is transient. In different cases, foot drop is endless.
In the event that you have foot drop, you may need to wear a prop on your lower leg
and foot to hold your foot in a typical position.

13.1.1.5 Tests and Diagnosis

Foot drop is usually dismembered amidst a physical test. Your lord should watch
you walk and may check a part of your leg muscles for shortcoming. The individual
may in addition check for deadness on your shin and on the most critical motivation
behind your foot and toes. Sometimes, extra testing is recommended [32–35].
274 H. K. Banga et al.

13.1.1.6 Imaging Tests

Foot drop is a part of the time realized by an extra of bone in the spinal channel or
with the guide of a tumor or irritates pushing at the nerve inside the knee or spine.
Imaging tests can help pinpoint these sorts of issues [36].
I. X-bars. Plain X-shafts make use of a low degree of radiation to acknowledge a
delicate tissue mass or a bone harm that would reason your pointers.
II. Ultrasound. This headway uses sound waves to make photographs of inward
systems. It might be associated with check for pimples or tumors that may push
at the nerve.
III. Modernized tomography (CT) filters through. Electronic tomography joins
X-shaft photos taken from an expansive extent of edges to framework pass-
sectional points of view of structures inside the packaging.
IV. Attractive resounding imaging (MRI). This research makes use of radio waves
and a strong engaging field to make isolated sneak peaks. X-bar is expressly
prized in envisioning sensitive tissue disasters that could a nerve.

13.1.1.7 Nerve Tests

Electromyography (EMG) and nerve conduction considers measure electrical action

in the muscles and nerves. These tests can be ungainly; at any rate, they are extremely
helpful in picking the region of the harm along the affected nerve [37].

13.1.1.8 Treatments and Drugs

Treatment for foot drop relies upon the hidden reason. In the event that the simple
motive is successfully dealt with, foot drop may additionally beautify or maybe
vanish [23]. On the off threat that the essential cause cannot be treated, foot drop
might be lasting. Particular remedy for foot drop may encompass:
i. Braces or helps. A prop in your decrease leg and foot or guide that fits into your
shoe can assist maintain your foot in an average function.
ii. Physical remedy. Activities that enhance your leg muscle mass and help you
hold up the scope of motion for your knee and lower leg may also beautify stroll
troubles related with foot drop. Extending practices are especially critical to
keep the improvement of solidness within the foot sole vicinity.
iii. Nerve incitement. In a few instances, empowering the nerve that lifts the foot
enhances foot drop.
iv. Surgery. Contingent on the cause, and in case your foot drop is normally new,
nerve clinical process is probably useful. In the occasion that foot drop is lengthy-
standing, your expert might also advise scientific system that wires decrease leg
or foot bones or a method that exchanges an operating ligament to a change
function (Fig. 13.3).
13 Improvement of Human Gait in Foot Deformities Patients … 275

Fig. 13.3 Use of ankle–foot orthosis for foot drop patients

13.2 Ankle–Foot Orthosis

An AFO can be used for foot drop even as cautious fix is not supported or all through
cautious or neurologic recovery. The specific explanation behind an AFO is to offer
toe dorsiflexion inside the course of the swing territory, normal or flat adequacy at the
lower leg for the range of position, and, if urgent, push off affectation at some stage in
the past due position divide. An AFO is profitable elegant if the foot can advantage
plantigrade limit when the patient is status. Any equinus contracture obstructs its
productive use [38].
The best commonly used AFO in foot drop is created of polypropylene and
increases into a shoe. If its miles slice to fit front to the malleoli, it gives rigid
immobilization. This instrument is used meanwhile as lower leg precariousness or
spasticity is astounding, much the same as the case in sufferers with best motor
neuron sicknesses or stroke [39].
If the AFO suits back to the malleoli (back leaf spring type), plantar flexion at
effect point strike is permitted, and push off returns the foot to free for the swing
segment. This gives dorsiflexion help with times of out of shape or slight spastic
equinovarus mutilation. A shoe-get orthosis that associates explicitly to the heel
counter of the shoe besides may be used. A view through Menotti et al. suggested
that front AFOs are related to decay power expenses of by strolling and favored
276 H. K. Banga et al.

degrees of saw comfort over back AFOs are and thusly may likewise enable people
with foot drop to walk longer divisions while utilizing less genuine undertaking.

13.3 Methodology

13.3.1 Manufacturing Techniques of AFO

The process will be used to create orthotic devices is additive manufacturing.

Computer-assisted design (CAD) systems have also being used to assist in creating
the positive improving consistency and repeatability of this process, but the process
remains slow and complex and it requires considerable input from experienced
craftsmen. Furthermore, in these traditional processes, the possibilities for inno-
vation or product development are limited. With CAD systems, it will be observed
that orthoses rejection ratio has been reduced combined with time reduction up to
50% and cost saving up to 25–50% [26–30] as shown in Fig. 13.4.
A standard AFO was characterized to best understand the performance character-
istics required of a spring ankle–foot orthotic. These characteristics, in combination
with the study of human biomechanics, were used to choose optimum material and
size. The flowchart shown below details the steps in the prototype development
process
Each of the individual work flows shown in Fig. 13.5 above merged to create the
final prototype through use of the best process. Upon completion of the final prototype
comparative testing was done to show the similarities in performance between the
standard AFO and the prototype.

13.3.2 3D Scanning Techniques of Foot Drop Patients

During the scanning process as shown in Fig. 13.6, numerous 3D outputs of the ques-
tion are gained from different bearings and every one of the information is consoli-
dated naturally into a solitary and finish 3D surface model. Normal examining times
extend from a couple to 15 min; the moderately long aggregate filtering time is less
significant, since the full robotization of the procedure gives the administrator flexi-
bility to perform different undertakings amid the checking procedure. Likewise, no
particular specialized know-how in 3D checking is required to play out the proce-
dure. The 3D profiles procured progressively by the laser scanner can be moved into
the reference framework characterized by the receptor. The filtering procedure is
in this way extremely straightforward and natural: the administrator move, totally
unreservedly, the hand-held scanner over the protest, while the obtained 3D profiles
are appeared continuously on the screen.
13 Improvement of Human Gait in Foot Deformities Patients … 277

Fig. 13.4 (i) Traditional

process, (ii) Possible AM
process

The essential system for all quick prototyping strategies can be compressed as
takes after:
i. A CAD show is built and afterward changed over to STL design. The
determination can be set to limit stair venturing.
ii. The RP machine forms the STL document by making cut layers of the model.
iii. The first layer of the physical model is made. The model is then brought
down by the thickness of next layer, and the procedure is then rehashed until
consummation of the model.
iv. The demonstration and any backings are expelled. The surface of the model is
then completed and cleaned.
The phases of 3D scanning as shown in Figs. 13.7 and 13.8 and CAD designing the
production of an AFO, with a reasonable quality of image in terms of its resolution,
before sending it to a 3D printer. Based on the observed result, the project purpose
is feasible but further refinement of the process is necessary at this stage. It was
concluded that using a 3D laser scanner can provide a high quality of image of
scanning for the AFO making purposes comparing to those that used in previous
278 H. K. Banga et al.

Fig. 13.5 Flow of AFO prototype development

Fig. 13.6 Process for scanning object

13 Improvement of Human Gait in Foot Deformities Patients … 279

Fig. 13.7 Flow process of

scanning and 3D printing of
foot drop patients leg

i ii

STL file of Leg

Drop Foot Patient's Leg

iii iv

Prototype
3D Printing Machine Model of Leg

Fig. 13.8 (i) Scanning of foot drop patients leg, (ii) Making STL of leg, (iii) SLS 3D printing
machine, (iv) Prototype model of leg
280 H. K. Banga et al.

studies. The CAD tools were suitable to reduce the size of the original, large scan,
mesh making and offsetting.

13.4 Clinical Gait Anyalsis of Foot Drop Patients

The term gait refers to the pattern of walk of an individual. Gait analysis consists
of the various scientific measurement and analysis linked with locomotion. The gait
measurement techniques used in the Gait Laboratory of the Physical and Rehabilita-
tion Medicine Department at PGIMER Chandigarh are broadly classified into four
types [40–42].
i. Camera motion analysis,
ii. 16 force plate-based force analysis,
iii. Biometrics EMG analysis,
iv. Sway analysis.

i. Three markers on each shank: head of fibula, lateral malleulus, lateral bar (same
way for the bar on the tight, see Fig. 13.9);
ii. One marker on each foot:

Fifth metatarsal joint and emispherical markers: b1 marker on each heel: (only
for standing trial) be careful that the two markers on the fifth metatarsal joint and on
the heel have to stay on the same plane (see Figs. 13.10 and 13.11).

Fig. 13.9 Phases of gait laboratory

13 Improvement of Human Gait in Foot Deformities Patients … 281

Fig. 13.10 Data collection and analysis process for instrumented gait analysis

13.4.1 Gait Analysis of Foot Drop Patients

The trial of foot drop patients in clinical gait laboratory is done as shown in Fig. 13.12.
Which will help to check how much improvement of gait cycle with 3D printed
ankle–foot orthosis?
The clinical gait analysis trial with old and customized design 3D printed ankle–
foot orthosis is performed as shown in Fig. 13.13 to check ankle joint stability in
foot drop patients.

13.5 Significant Findings

The different phases of 3D scanning and CAD designing the production of an AFO,
with a reasonable quality of the image in terms of its resolution, before sending it
to a 3D printer. Based on the observed result, the research purpose is feasible but
further refinement of the process is necessary at this stage.
It was concluded that using a 3D laser scanner can provide a high quality of image
of scanning for the AFO making purposes comparing to those that used in previous
studies. The CAD tools were suitable to reduce the size of the original, large scan,
mesh making and offsetting the mesh in order to make 5 mm thickness for the final
AFO design.
1. In show off AFO layout patients stands as a great deal as blood course circulate
to foot and cannot walk truly are being long past up in competition to inside the
282 H. K. Banga et al.

Fig. 13.11 Subject with the markers positioning on his skin (i) back view, (ii) lateral view,
(iii) frontal view (Figures from Motion and Gait Analysis Laboratory at PGIMER, Chandigarh),
(iv) the method in order to find the Posterior Iliac crests and (v) the positioning of “sacral” marker,
(vi) positioning of the bars
13 Improvement of Human Gait in Foot Deformities Patients … 283

Fig. 13.12 Gait analysis of foot drop patients

midst of complete deal make use of. Another arrangement of AFO for foot drop
patients has been made to conquer this issue and restrained detail displaying and
expand exam has in like way been executed.
2. Utilization of 3D human accessible scanner (Artec Eva) to get accurate
measurements of foot drop patients.
3. New format of AFO is created with the aid of 3D printing technology (SLS)
which is greater time and cost. It examinations the shape and lead of fabric of
modern-day usable AFO and 3D published AFO.
4. By making use of 3D printing (SLS) innovation AFO shape some other fabric
Nylon-Poly Amide (type of Plastic) has been made.
5. Selective laser sintering (SLS) three-dimensional printing having the principle
advantage is that the manufactured fashions are permeable (generally 60% of the
284 H. K. Banga et al.

Fig. 13.13 Gait analysis with old and new ankle–foot orthosis

thickness of normal factors), as an end result weakening their great and ground
wrap up.
6. Considering its heartiness and capability to supply complicated entire elements,
SLS can deliver massive money and time saving blessings for little run compo-
nents that would normally require some collecting with popular assembling. It
is an ideal marriage of usefulness, high-quality and unpredictability.
7. It continues up the focal point of weight line of motion in nonpartisan position
(center of base of help). And furthermore balances out the foot, which as a
consequence decreases the danger of harm and improves stride strength and
adjust.
8. It can lessen plantar weight by redistribution of plantar weight. It moreover
assists to upgrade ordinary probability dispersion of plantar stacking, which is
13 Improvement of Human Gait in Foot Deformities Patients … 285

fundamental importance to decrease carry down furthest point torment amid

taking walks.

13.6 Scope of Future Works

Future works of the design of Artec Eva Studio 12 Professional will focus on opti-
mization of the computerized design process. Improvement of image processing for
the 3D scanned data will be researched so as to simplify current processes. The
mechanical structure of compliant finger joint will be further developed, and algo-
rithms of parameter optimization will be developed. The thumb joint will be designed
and tested. More materials and embedded sensors could be tested and optimized. Soft-
ware interface will be developed. In the future, the AFOs with sensor can provide
accuracy indicate that when do they need to replace the AFOs. Future works on the
development of the AFO test bed will focus on the design of the clamp elements
so as to provide quantitative body weight during the gait. Actual human gait cycle
data and ankle stiffness could be implemented into the control system so as to verify
the functional analysis of the AFO. Further study of the energy return in gait will
be analysis in this AFO test bed. Control system will be developed in the real-time
machine so as to improve the performance.

Declaration of Conflicting Interests No potential conflicts of interest with respect to the research,
authorship and publication of this article as declared by author(s).

Funding
The author(s) received no financial support for the research, authorship and publication of this
article.

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Dr. Harish Kumar Banga did his B.Tech. (Mechanical Engineering) from Government Engi-
neering College, Bathinda, in 2007 and ME (Production Engineering) from PEC University of
Technology, Chandigarh, in 2010 and completed his Ph.D. in the area of additive manufac-
turing with collaboration with orthopedic department of PGIMER Chandigarh in 2018 from
Punjab Engineering College, Chandigarh. Presently, he is Assistant Professor in the Department
of Production and Industrial Engineering, Punjab Engineering College, Chandigarh. His areas of
research rapid prototyping and 3-D printing, ergonomics, human gait analysis and robotics. He
published more than 20 research papers in national and international journals.

Dr. Parveen Kalra did his graduation in Mechanical engineering from PEC university of Tech-
nology, Chandigarh, in 1987 and post-graduation in Industrial Robotics from Memorial Univer-
sity, Canada, in 1989, and obtained his PhD in Mechanical Engineering from Punjab Univer-
sity, Chandigarh, in 1995. Presently, he is Professor in the Department of Production and Indus-
trial Engineering in Punjab Engineering College, Chandigarh. His area of specialization is human
engineering, industrial design, CAD/CAM and robotics. He has published more than 85 research
papers in international and national journals. He is a member of ISTE. He carried out design
analysis and also carried out detail discussion on results to conclude the manuscript.

Dr. Rajendra M. Belokar did his graduation in Production Engineering from Amravati Univer-
sity, Amravati, in 1987. He did post-graduation and Ph.D. from Punjab University, Chandigarh, in
1999 and 2010, respectively. Presently, he is Professor in the Department of Production and Indus-
trial Engineering, Punjab Engineering College, Chandigarh. He published more than 75 research
papers in national and international journals. He published one book, and two books are in press.
He is Sr. Member SME (USA), M.I.E, C. Eng (I), LM-ISTE, Member-INVEST, and Member
APICS (USA).

Dr. Rajesh Kumar is working as an Assistant Professor in the Department of Mechanical Engi-
neering, UIET, Panjab University, Chandigarh. He published more than fifty research papers
in national and international journals. He did his graduation from Punjab Engineering College,
Chandigarh in 1999. He did post-graduation and Ph.D. from PEC University of Technology,
Chandigarh, in 2004 and 2012 respectively. His areas of interest are Finite Element Analysis,
288 H. K. Banga et al.

Additive Manufacturing, CAD/CAM. and Robotics. He has participated and organized many
workshops, seminars, and FDP’s and delivered numerous expert lectures.
Chapter 14
Influence of Laser Power and Scan Speed
During Laser-Assisted Multi-layer
Additive Manufacturing Using Finite
Element Modeling

Sapam Ningthemba Singh, Yadaiah Nirsanametla, Sohini Chowdhury,

and M. Muralidhar

14.1 Introduction

The conventional manufacturing methodologies have long been the dominant method
to produce most of the biomedical products available. These processes are convenient
and easier to operate as compared to unconventional machining and manufacturing
processes. However, most of the biomedical products require complex shape and
high level of user customization. Additive manufacturing (AM) is one of the promi-
nent emerging manufacturing technologies in the era of the Internet of things (IoT),
fast computers, Industry 4.0, which can produce objects and parts that conventional
processes cannot produce or offer more advantages in doing so. AM is the process of
manufacturing objects by joining materials from a 3D design data usually layer upon
layer [1]. Rapid prototyping and 3D printing are the common terms often used along
with AM having similar meanings. But, technically rapid prototyping by definition is
mostly used to produce prototypes, while 3D printing is the collective term applied to
manufacturing processes where the product is directly manufactured from a CAD file
which is usually an STL file. The conventional manufacturing process, also known
as subtractive manufacturing, uses the basic idea of material removal by machining
process from the whole workpiece to make the final product. Unlike conventional
manufacturing processes, AM employs the reverse idea in which materials are added
layer upon layer by reading the 3D model data. With an AM machine, a product can

S. N. Singh · Y. Nirsanametla (B) · S. Chowdhury · M. Muralidhar

Department of Mechanical Engineering, North Eastern Regional Institute of Science and
Technology (NERIST), Nirjuli, Arunachal Pradesh 791109, India
e-mail: [email protected]
S. N. Singh
Department of Mechanical Engineering, National Institute of Technology Silchar, Silchar, Assam
788010, India

© Springer Nature Singapore Pte Ltd. 2020 289

S. Singh et al. (eds.), 3D Printing in Biomedical Engineering,
Materials Horizons: From Nature to Nanomaterials,
https://doi.org/10.1007/978-981-15-5424-7_14
290 S. N. Singh et al.

be manufactured directly from a 3D design data without considering other elements

such as the type of machines, cutting tool and fixtures, which is needed in case of
conventional manufacturing processes. This leads to efficient material utilization,
energy saving and avoiding many other constraints. Hence, creating AM technique
is a more desirable manufacturing process in the mainstream of Industry 4.0.
Though it sounds simple in words, the AM process involves complex thermal and
microstructural properties alteration during material deposition in layers as well as
during interaction between the layers. This may lead to undesirable consequences on
the finished product. Despite the freedom in design, it still needs certain optimization.
There are several other parameters that influence the overall performance and quality
of the finished product manufactured by the AM process. Due to such problems, many
researchers have conducted their research, both experimentally and numerically, on
various fields related to AM. In recent years, most of the research work is being
emphasized on understanding the working principle of AM process, material and heat
interaction and its effects on the mechanical attributes, shape and surface roughness
of the final product. Intensive research on transient thermal distribution, melt-pool
evolution and microstructural characterization of the manufactured parts has been
carried out by several researchers. There are three basic stages during an AM process
[2]:
a. Designing the product model in a CAD software and converting it to a suitable
AM file format such that AM machine can understand and execute the commands.
b. After transferring it to the AM machine, the actual fabrication process is carried
out in an AM machine.
c. In the post-manufacturing operations, heat treatment, surface finishing, etc., are
performed. The above-mentioned AM stages can be visualized more effectively
from Fig. 14.1.

14.1.1 Types of AM Processes

There are seven major categories of AM process, out of which three categories
utilizes laser as the source of power to join the material. Powder bed fusion, Vat
polymerization and directed energy deposition are the laser-based AM methodolo-
gies. Sheet lamination, material jetting, binder jetting and material extrusion utilizes
either electron-beam-based technology or inkjet technology to adhere the layers.
Selective laser melting (SLM), selective laser sintering (SLS) and other types of AM
process are derivatives of the above-mentioned types. Some of the major types of
laser-based AM processes are discussed as follows:
Laser beam melting (LBM): It can manufacture fully dense, geometrically
complex models with the ability to attain mechanical and material properties which
are comparable with respect to the conventional machining processes [3, 4]. For
this reason, LBM is considered as one of the most widely used AM processes. This
should not be confused with the laser beam machining process. A laser source of
solid state, a laser deflection mechanism, a powder feeding mechanism, a base or
14 Influence of Laser Power and Scan Speed … 291

Fig. 14.1 A typical additive manufacturing process

a building platform, and a roller or a scrapper constitute the major elements of a

LBM machine. The laser source is adjusted, deflected and concentrated to the area
of interest, i.e., the material layer by using the laser deflection mechanism. After the
first layer is completed, the built platform is lowered down by the same thickness of
the layer and the process is repeated until the product is completely manufactured. A
heater can also be used to preheat materials and alloys which are having high liquidus
temperature in order to achieve uniform melting of the material (powder). In laser
sintering (LS) technique, the powder is heated to the sintering point. In indirect LS, a
mixture of powder and a binder operation is used thus improving the overall material
built quality and property. A de-binding process is carried out to eliminate the binder
material after the laser scanning. Materials used in LBM can be of pure metals such
as Al, Ti, Cr, Fe, Cu and compounds like Fe-Cu, Cu-Sn, Fe-Sn, nickel cobalt-based
alloys, titanium alloys, stainless steel and tool steel materials.
Laser metal deposition (LMD): It is also called as direct metal deposition (DMD),
direct laser deposition (DLD), laser cladding, direct energy deposition (DED), laser
engineered net shaping (LENS) or laser deposition welding [5, 6]. In this case, the
powder is fed by a nozzle. Basic components of LMD are same as LBM except that
the roller is replaced by a nozzle to supply the powder which can be supplied axially
or laterally using inert gas stream [7, 8]. Wire feeding of materials is another type
of laser-based AM. This type avoids the preprocessing of materials to make it as
powder material. It can be used for larger components but moderate in complexity.
Wire-based laser AM has some unique advantages including lower costs, neat and
clean working environment, low wastage of material and higher metal deposition rate
than other AM methods. In wire deposition process, hot wire deposition or central
wire feeding is used [9].
292 S. N. Singh et al.

Table 14.1 Types of major

Laser beam-based Electron Other AM processes
additive manufacturing
AM beam-based AM
processes
VAT polymerization Electron beam Wire feeding
Powder bed fusion melting Inkjet-based AM
Direct energy Electron beam processes
deposition sintering, etc. Sheet lamination
Laser beam melting Binder jetting
Stereolithography Material extrusion,
SLM, SLS, etc. etc.

Stereolithography (SLA): The AM process of building a part using concentrated

laser scanning on a vat of liquid resin photopolymer in a moving platform is known as
stereolithography (SLA) [10]. After contact with appropriate low wavelength lasers,
each layer is solidified and lowered down by an amount equal to the layer thickness.
The laser is applied again, and the same process continues till the manufacturing is
complete. It is mainly used in prototypes and non-structural parts. SLA boasts of
having the ability to obtain higher dimensional accuracy and smoother surface finish
[11]. SLA cannot process metals, and it incurs more cost as compared to other AM
methods. It requires more support base and has limited availability of resins [12].
Other types of AM process are given in Table 14.1.
The first step of an AM process is to convert the 3D model CAD design to a
file format which the AM machine can understand and execute the commands. AM
file format contains data about the surface of the object usually in G code. The
AM machine then decodes the information and the machining takes place. There
are two main types of AM files: STL file or STereoLithography file and Additive
manufacturing file format (AMF).
STL is a native file format for the AM process. It is also known as Standard Triangle
Language or Standard Tessellation Language which gives the surface geometry of
a 3D model for the AM machine [12]. As the name suggests, STL uses a combi-
nation of multiple triangles to create the surface of the object. A low resolution of
triangles means poor surface finish and distortion in shape. Higher resolution allows
manufacturing of products with a smooth surface finish.
Another file format for the AM is the additive manufacturing file format (AMF)
designed, defined and developed under ISO/ASTM 52915:2016(E) [13]. It is an
extensible markup language (XML)-based file format for AM process. Unlike the
previous STL format, AMF has the provision to provide and encode data about the
color, materials, lattices and constellations which are required during the AM process.
It gives the leverage of embedding more information on the file itself without any
other extra methods or add-ons. It also helps in designing more complex products
such as products having different colors, a mixture of materials, etc. Even though
AMF offers more flexibility and above-mentioned advantages, STL format is more
widely used due to the fact that STL is the first AM file format. However, this trend
is changing as AM machine manufactures start adopting the new AMF format rather
than STL as their main file format.
14 Influence of Laser Power and Scan Speed … 293

The previous and current ways of generating the sliced layer of AM in either STL
or AMF have some problems and defects which result in irregularities and error in the
final shape of the overall model. The sliced layers are produced by cutting the whole
model using a rectangular plane parallel to the support base and then by extruding
the layer to form a small volume of the layer. This method of slicing arises two main
errors or effects commonly known as staircase effect and systematic distortion. The
staircase effect is the result of extruding the slice only by square or rectangular blocks
that results in the staircase-like structure as a whole. The staircase effect is directly
proportional to the thickness of layers. It is usually solved by polishing operation
in the post-processing stage [14]. The systematic distortion is the direct result of
the staircase effect. This is due to the cumulative iteration of staircase effects which
will result in major distortion of the model as a whole. Bottom-up slicing, top-down
slicing and radial geometry extrusion of the 3D model are some measures to reduce
this effect. The new methods are concerned with extruding the model as exactly as
possible such that errors can be reduced in the post-processing operation [14–18].

14.1.2 Process Parameters of the AM Process

The principal process parameters of AM processes are raw material, powder grain
size, laser power, laser diameter, scanning pattern, scanning velocity. Additionally,
point distance, exposure time, layer thickness, scanning and building direction have
major effects on the quality of the parts produced such as surface microstructure,
density, fatigue strength, hardness, stiffness and surface roughness [19]. Void forma-
tion is basically due to the air gap which has a large influence on the final product’s
microstructure. By analyzing the influence of major process parameters and control-
ling them as per requirement, AM process has the ability to obtain a final product
which has better quality when compared with the products fabricated by conven-
tional manufacturing processes. A detailed explanation of some of the main process
parameters is described below:
Laser power: Laser power is the foremost key element in AM process. It is the
heat source on which the whole process depends. Higher laser power means high
energy input, and it takes less time to melt the material. Low laser power means
incomplete melting of the material resulting in poor surface finish, irregularities in
grain structures, etc.
Laser diameter: It is the area of laser influence. Large laser diameter means less
scanning time and hence faster machining time. However, a large spot diameter limits
the resolution accuracy.
Scanning velocity: It is the speed in which the material is scanned by the laser.
A high scanning velocity leads to incomplete melting of the material while slow
scanning velocity refers to over melting of the material.
Scanning pattern: Scanning pattern has a significant impact in the final microstruc-
ture of the product. The temperature difference between the layers and across the
cross-sectional area of the product is different for different scanning patterns. Such a
294 S. N. Singh et al.

difference in temperature results in different microstructural patterns due to different

heating and cooling patterns. Figure 14.2 represents the different laser scanning
patterns such as x-unidirectional, y-unidirectional, x-bi-directional, y-bi-directional
and island pattern. Moreover, research in the area of scanning pattern and its influ-
ence on the final mechanical properties and object’s structure is needed. The current
existing scanning modes are also lacking information about when to use, to which
material it suits, which pattern is best for a particular material, etc. Extensive research
in this area will help to increase the effective use of AM processes thus avoiding
material defect and low-quality final products. In addition, the combined effect of
scanning pattern, scanning orientation and time delay between the successive scan
also plays a significant role in the final strength of the product.
Layer thickness: Thicker layer is directly associated with the power requirement
to melt through it. On the contrary, thin layer implies less power requirement to melt
the material. However, manufacturing a whole product with thin layers means longer
manufacturing time of the product. Even though thicker layers are desirable, there
are constraints on maximum power supply in AM machine. Hence, it is inevitable to

Fig. 14.2 Different laser scanning patterns: a x-unidirectional, b y-unidirectional, c x-bi-directional,

d y-bi-directional and e island pattern
14 Influence of Laser Power and Scan Speed … 295

compromise the manufacturing time due to machine limitations with regard to layer
thickness.
Powder size: For AM process based on the powder materials, powder size also has
an impact on the final quality of the product. Larger powder grain size requires higher
energy input, and there are possibilities that grains are left without proper melting.
The voids left in between the powder materials are different for different powder sizes
which will result in different final mechanical characteristics and microstructures of
the product.
All of the above parameters are inter-dependent. For example, high laser power
does not mean that the powder materials will always properly melt. If the scan-
ning velocity of the laser is high combined with large powder size, then it will
result in a poor material quality. Hence, selection of an optimum process parame-
ters is necessary to have a quality product. All the process parameters and different
nature of operations will lead to different porosities in the final product along with
unique microstructural characteristics and tensile strength. Inspecting such proper-
ties, learning how to overcome the defects and avoiding low porosity of metals,
increasing the tensile strength without compromising the manufacturing time and
power requirements will increase the efficiency of AM processes. Some additional
factors influencing the final product of a part manufactured by AM process are
presented in Fig. 14.3.
There are some design and practical limitations of AM method. The difference
in final microstructures in between the layers is bound to occur even if it is very
minimal due to its nature of the operation and difference in cumulative heat transfer
as the number of layer increases. Another limiting factor is the size of the product an

Fig. 14.3 Different types of influencing factors during an AM process

296 S. N. Singh et al.

AM machine can offer. Any attempt to change the current system will need a very
detailed change in terms of heat transfer and distribution in a product and its influence
on the final mechanical properties and microstructural attributes in the final product.
Hence, both experimental and numerical analyses are needed for any improvement
in the AM machine and to have an economically viable commercial manufacturing
method. For a laser-based AM process, controlling melt-pool size and evolution of
melt-pool is very important to control and maintain the final mechanical properties,
but it is not limited to thermal strain, surface roughness, microstructure and strength.
Out of the above-mentioned process parameters, beam power and scanning velocity
are the two major elements. Therefore, it is very important to analyze the evolution
of melt-pool shape and dimensions under different processing conditions and their
effects.
Analyzing each and every process parameter will consume huge amount of
computational work, and it will take considerably large duration. Finite element
analysis is one of the most popular approaches to compute complex problems and
analyze heat flow, stress, failure, etc. In order to understand how finite element
modeling provides results with a high level of accuracy, it is very important to study
some of the research that has been carried out by previous researchers.

14.1.3 Numerical and Experimental Investigations of the AM

Process

Both numerical and experimental analyses have important significances in order

to achieve an efficient fabrication process. Data established from experiments can
be used to validate and verify the numerical models and analysis. With the ever-
increasing computing power and its technology, the applications of numerical anal-
ysis and its effect on engineering fields have been increasing tremendously. Exper-
imental data can also be used to develop new thermal models. The FE models can
be analyzed for studying the insights of physics involved during AM process which
cannot be comprehended through experiments. This in turn will also provide an aid
to optimize certain process parameters based on desired requirements. Hence, adjust-
ment of process parameters is a prime necessity in case any alteration in the product is
required. Numerical modeling and optimization techniques are very helpful in these
scenarios so that the highest possible efficiency can be delivered without compro-
mising the quality of the product. Every set of data cannot be recorded in an experi-
ment due to practical and technological limits such as measuring temperature using
infrared cameras and thermocouples at preferred locations in the sample during fabri-
cation process, inspecting mechanical and microstructural attributes. However, few
experimental data can be used to verify the results of the numerical analysis. If the
result is within the acceptable limit, the numerical model is determined to be correct
and acceptable and it can used be for all experimental trials. On account of modern
personal computers and supercomputers, the model data of every simulation step can
14 Influence of Laser Power and Scan Speed … 297

be retrieved easily. Thus, numerical modeling and analysis help in predicting limits,
simulating certain conditions, calculating costs and duration at a very high accuracy
level. This is why both numerical analysis and experimental analysis are important
and should work together to compliment to each other.
Numerical investigation of laser-based AM process
Modeling and analyzing the fabrication of an object by an AM process accurately
help in determining the exact nature of heat transmission and stress distributions
involved in the particular process. For FEM process defining the model geometry,
discretization, boundary conditions, application of loads are very important and key
steps to comprehend the AM process. Yuze et al. showed a generic analytical model
of a laser additive manufacturing process (LAM) [20]. The moving laser heat source
was assumed as Gaussian distribution and Rosenthal’s 3D model. Also, the 3D melt-
pool geometry considered the Brewster effect. A single-layer laser melting of SS
grade 316L powder with AISI 316L as the base material was simulated to analyze
the influence of various process elements such as laser intensity, scanning velocity,
spot diameter on the melt-pool size, thermo-mechanical properties [21]. The analysis
helped in finding the quality of the built part, thermal distribution and distortion.
However, analyzing a single-layer deposition does not represent the nature of the
fabrication process where multiple layers and multiple tracks are involved. Hence, a
more complex analysis consisting of multi-layers will give more accurate results.
Most of the numerical analysis performed in the past did not consider the factors
such as the air content, sulfur content on the metals. Gan et al. have examined
the effect of surface-active elements during laser additive manufacturing process.
Also, the authors have analyzed the mass transport of sulfur in sulfur-containing
metal during the process [22]. It was determined that the sulfur distribution is
time-dependent, non-uniform and decreases along centerline of the top surface. A
numerical simulation of LAM of Inconel 718 components and Ti-641-4V materials
was carried out to determine residual stress and distortion distribution [23]. It was
observed that Ti-641-4V suffers more residual stress than Inconel 718 material. The
residual stress decreases with decreasing layer thickness as more time is exposed to
the melt-pool. Further, residual stress was reduced by another 20% when the laser
power source was doubled; however, the distortion level was enhanced by 2.5 times.
Moreover, in extreme conditions, when stress changes from tensile to compressive
state the layers were seem to segregate from each other. The parts fabricated by AM
process are susceptible to defects and distortions due to non-uniformity in the mate-
rial deposition in the layers. The distortion and defects can be minimized by using
thermal strain parameters [24]. Lower thermal strain can be obtained if the heat input
is maintained at a minimum level where interlayer bonding is possible.
However, low laser power with high scan speed have short exposure to heat and
shorter duration for melting of metals, and thus, it has very low weldability [25]. The
temperature gradient along the depth increases as the laser intensity increases but
reduces with increasing scanning velocity. It is evident that an optimum condition
of laser intensity, scanning velocity, laser diameter is needed for an AM process in
order to have good weldability and low residual stresses.
298 S. N. Singh et al.

Moreover, bio-implants have the problem of stress shielding that causes the
implant to prematurely loosen and reduce the lifespan of the implant. Additively
manufactured bio-implants have the ability to manufacture customized bio-implants
to reduce the stress shielding [26]. A computer model was developed to simu-
late and estimate the effective elastic modulus of biomaterials with high-volume
porosity [27]. Employing multiple lasers to improve manufacturing lead time (MLT)
is another concept in the AM. A simulated study of multi-laser powder bed fusion
(ML-PBF) on Ti-6Al-4V demonstrated that scanning time is reduced by almost 75%
by employing four lasers [28]. The residual stress was reduced by employing island
division schemes, but it resulted in non-uniform and anisotropic stress distribution.
Hence, to obtain a uniform residual stress distribution, a proper model geometry,
defining accurate laser orientation and a synchronized process, is required.
The microstructure of an additively manufactured object depends on chemical
composition of the powder dilution, part orientation, melting rate, solidification rate
and maximum temperature attained. The melt-pool can be fully melted or semi-
melted solid compositions depending on the initial material temperature, laser power
input, scanning velocity, layer thickness and temperature distribution across the
whole deposited material. The nature of melt-pool governs different microstructure
and morphology of the built surface [29–32]. Although most of the AM processes take
place in an inert gas environment, there is little effect on the final product. However,
the application of inert gases has effects on porosity, grain size and compression
strength in final material [33]. The effect of cooling rate was analyzed by Ali et al.
[34]. The authors showed that the cooling rate and chemical composition constitute
the major factors affecting the microstructure of the final object. It was also found
that the cooling rate can be adjusted to obtain specific carbide morphologies in the
build clad. A cooling rate of 1500 K/s is required to form dendritic structures of
higher percentage in Fe materials. However, very slow solidification rate resulted
in floatation of TiC particles for a Fe–Ti-C system [29, 32, 35]. Furthermore, lesser
percentage content of TiC beneath the Fe–Ti-C surface resulted in low wear resistance
and excellent hardness property [32].
A simulation model with the combination of FEM and stochastic analysis was
developed to understand the microstructural evolution of an Nb-bearing in AM
process. The model can analyze the growth of dendrite, nucleation, formation
of Laves phase particles and segregation of Niobium (Nb) during the solidifica-
tion process [35]. The extensive study was conducted to understand the resultant
microstructure and solidification conditions. Laves phase formation is evolved for
a small equally distanced dendrite arm with high cooling rate coupled with low-
temperature gradient. Furthermore, Laves particles of larger width are not desirable
since, it reduces mechanical strength in an object [36–39]. It was also found that
long chain morphology is present for high laser intensity, while discrete Laves phase
particles are present for low laser power intensity. Lowering the required minimum
input energy level to a required minimum is desirable to prevent the formation of
Laves phase particles. Presence of large Laves phase particles causes hot cracking
[40, 41].
14 Influence of Laser Power and Scan Speed … 299

Zinoviev et al. developed a 2D numerical model to simulate the evolution of grain

structure in a LAM process. Using the Goldak heat source and cellular automata
method, grain growth was evaluated [42]. A cellular automata model was used to
examine morphological changes in SS 316 steel. The proposed model was adopted
to test the grain growth [41, 43]. Before incorporating these simulation results
directly into practical applications, the model should be calibrated and verified with
some experimental data. Hence, it is necessary to analyze the experiment process
extensively.
Experimental investigations of laser-based AM process
With several years of experimental research in laser-based AM processes, improve-
ments in terms of metal deposition rate, energy consumption, a decrease in surface
roughness and other parameters have been observed. However, the basic constraints
in AM process, i.e., lack of better surface finish, different mechanical properties
within the manufactured product and slow manufacturing speed are still prominent.
Hence, there is still much research required to perform in order to set the level as
par with the conventional machining process. In this subsection, some research and
attempts to develop a new and improved laser-based AM processes are discussed
along with their advantages and limitations in terms of feasibility and economics.
Most of the experimental works concentrate on method feasibility and the influ-
ence of various process parameters on the final product. The effects of laser beam
parameters such as the pulse width, laser power, frequency and angle of the laser
on the performance of beam and forming of materials during a single or multi-layer
process are [44]:
(a) A compressed plasma arc effect can be observed due to laser power, pulse width,
laser angle and frequency.
(b) The plasma arc decreases with the increase in laser power. With the increase
in laser power, energy absorbed is increased and then improves ionization and
magnetic effects which results in the decrease of the plasma arc. The same
phenomenon of decreasing plasma arc influence can be observed in case of
increased pulse width.
(c) The number of repeating pulses applied in a single time unit is called the pulse
repetition frequency (PRF). The plasma arc increases after PRF of 50 Hz. This
shows that the plasma arc initially decreases up to a certain frequency and
then enhances. This is because the average power density increases and due to
continuous iteration of power supply overall temperature increases.
(d) The deposition width of plasma and hybrid laser is smaller than pure plasma
arc. However, a higher height and a better quality of surface is achieved.
Liu et al. conducted an experiment on a Cu matrix in a Fe-Cu-Ni-C alloy. The
basic idea is that the property of an alloy can be easily changed by changing the
percentage of its constituent elements. The experiment is conducted in such a way that
the material components are changed when the alloy is subjected to indirect selective
laser sintering [45]. Some of the AM processes use powder materials. These powders
can be supplied either by powder movers or nozzles. Powder supplied by nozzles is
300 S. N. Singh et al.

assumed to follow Gaussian distribution [46]. Small focal distance and focus radius
lead to bigger powder concentration. The maximum concentration can be obtained
at a nozzle cone angle of 60°. For some high melting point materials such as W-Ni-
Fe, preheating of the material with high scanning energy, a small gap between each
scan and low scan speed help to obtain better quality products [47]. SLM of AISI
316L austenitic stainless steel has 99.9% density, 30% more elongation rate when
evaluated with SLM of wrought iron [48]. However, the resilience test revealed a
lower value than wrought iron while the same hardness magnitude was obtained.
New methods and new materials are being tested for its feasibility by AM
processes. Use of metallic cellular materials is an emerging concept in AM industry.
Cellular metallic materials are the materials with structures and properties similar
to cellular materials like materials having gaseous voids in it is one such example
[49]. These materials can be formed by stirring foaming agents, pressure infiltration
of a ceramic mold, vapor phase or electrodeposition onto a polymer foam and high-
pressure inert gas expansion trapped in pores [50]. Use of metallic cellular materials
for AM process was achieved by Williams et al. [50]. The previous approach by
Hattiangadi et al. [51] and Chiras et al. [52] resulted in porous parts [53], and the
authors were unable to manufacture unsupported parts and free-standing structures
[54]. SLM and EBM methods have been successfully used to manufacture fully
dense parts. Current and future research should include manufacturing of fully dense
cellular materials with mechanical properties that are tantamount to that of conven-
tional processes. Emphasis should be given in improving the ability to use different
coating materials and reduction of costs. Overall reduction of cost is possible only
when there is mass adoption of AM machines. However, for the AM machines to
adopt in industries, it must have efficient and accurate operations in terms of surface
finish, flexibility in the control system and flexibility in machinability of different
materials. Hence, further research efforts should concentrate on the field of effi-
cient operation, improvement in the material finish and quality. For this to achieve,
a better understanding of the melt-pool evolution and nature of temperature change
is required.

14.1.4 Advances of the AM Process in Biomaterials

and Biomedical Devices

It is fair enough to say that the AM is far away to reach the stage to finally deploy and
adapt to the mainstream manufacturing industry on a very wide scale. This is because
of the limitations and problems mentioned above such as poor surface quality, high-
temperature gradient, change in the microstructure and slow manufacturing time.
But, it is also safe to say that the technology has developed dramatically to the
extent that some of the AM types such as SLM, stereolithography are employed
by some major companies either in beta stages or in industrial productions. In this
section, the latest technological breakthroughs achieved by the research communities
14 Influence of Laser Power and Scan Speed … 301

and their possible effects on the whole industry are discussed. The use of additive
manufacturing in biomedical research to a level where tissue engineering can be
achieved via additive manufacturing is a promising field. All such advances are the
results of years of painstaking research contributed to AM from various sections.
Some of the latest advances that are being discussed in this section may not be the
best as compared to other manufacturing processes. But, every industry in the past
has years of research and development to reach the very best. AM is on its transition
from a process of research interest to large-scale industrial implementation.
An important field that garnered attention is the application of AM in biomedical
research and industries. Though conventional machining processes are being used to
manufacture bio-implants, AM process has certain advantages that it is very much
suitable for customized models. This can be further explained that every problem
or model of an implant is different for each patient. So, conventional machining
processes have to modify the manufacturing systems including supply system, tool
accuracy and machine size that is required for each implant requirements. This
gives an edge for the AM process over the conventional machining processes in the
field of biomedical implants. Other advantages include on-demand manufacturing,
remote manufacturing from remote areas and smaller footprints for the manufacturing
facility [55].
In early stages, even though AM was used to manufacture bio-implants, it was
mainly used for model production, testing but not for a real replacement of an implant
[56]. As the technology advances, the AM is being used to create implants, prostheses
and drug delivery systems which are becoming a major advancement in the fields
of biotechnology, pharmaceuticals, health care, etc. [57]. In tissue engineering tech-
nology, bioprinting with the help of additive manufacturing is gaining attraction and
paving way to print actual live organs. Jetting, extrusion and laser-based bioprinting
AM processes are most commonly used in bioprinting. However, the variation of cell
properties and biological functions due to variation in material and layer deposition,
cell damaged by laser requires intensive care from the process starting to ending.
Also, it leads to major dimensional inaccuracies due to extrusion-based prints. It is
now possible to print exact model of patient’s eye anatomy which will allow the
surgeons [58]. Bio-inert is often associated with bio-implants because bio-implants
often fail or lack the ability to interact and associate with the cells as well as tissues
causing many problems [59]. Another challenge is that metallic implants are bound
to have corrosion even in alloys because of the nature and chemicals present in the
human body [60]. For ceramics used in biomedical, the lack of sintering due to low
temperature is the main problem. Higher energy input with better penetration ability
will help to solve this problem. Biodegradable polymers are most widely used for
internal bio-implants due to the ability to adapt to the internal biosystems and to
interact with the biomaterial by the body. However, these polymers tend to release
acids due to reactions with the living body systems, excessive release of these acids
may cause local inflammation, and delay in healing process which are the main draw-
back in biodegradable material as of now [61]. However, it is expected to have new
improved materials in the years to come with the much ongoing research.
302 S. N. Singh et al.

Significant improvement can be seen in making drug delivery systems. The main
problem was the inability to process the materials used in drug delivery systems
[62, 63]. Another problem is the inability to sinter the material after the drugs are
loaded [55]. The same problem was associated with bone implants and dental works.
Much improvement has been made in making the powder material more homogenous
and more uniform in powder material size, laser power concentration and higher-
resolution feedback systems. With these improvements, AM has progressed over
the last decade to a level where certain parts of biomedical parts can be manufac-
tured with the same or even better quality as conventional manufacturing processes.
Calcium phosphates, silicates, alumina, porcelain and zirconia are mainly used in
these applications.
Some other applications include skin coating, plates for bone, optical applica-
tions and cartilage repair. In these applications, biodegradable polymers such as
polyglycolic acid (PGA), polylactic acid (PLA), polydioxanone (PDS), polyethy-
lene glycol/oxide are mainly employed [64–66]. Recent research has paved the way
to manufacture materials such as polyether ether ketone (PEEK), polycaprolactone
(PCL), functionalized polyurethanes, polypropylene fumarate (PPF) [67–69]. PEEK
has applications in orthopedic implants, scaffolds, artificial organs, surgical guides,
prostheses, drug vessels, etc. Out of the commonly available and widely used AM
processes are fused deposition modeling and selective laser sintering. The major
challenges of PEEK for biomedical applications are low integration to bone, high
wear rate, inherent printing issues related to AM [70]. The main obstacle in cell
adaptation for metallic bio-implants is low wettability due to high surface energy,
smooth surfaces and low porosity. The inherent disadvantages of AM process such
as high surface roughness, porosity in the melt-pool turn out to be very effective
in case of bio-implants. For example, high elastic modulus is not desirable due to
stress shielding. But an additively manufactured part with inherent high porosity will
reduce the high elastic modulus, and it will also help in better bone and cell growth
around the implant [71]. A SLM manufactured sample of SS 316L has a fatigue
limits of 108 MPa which is lower than a turned surface which showed 267 MPa
[72]. Similarly, for Ti-6Al-4V the fatigue limit was determined as 267 MPa using
SLM, while the same material was determined as 500 MPa for a polished surface
[73]. The current and future research is directed toward the development of the
AM process that has the ability to process multi-materials simultaneously without
changing chemically and produce the same quality product multiple times from the
same machine. Acrylonitrile butadiene styrene (ABS) and high-impact polystyrene
(HIPS) are different materials in terms of impact strength. Multi-material fabrication
of these two materials can provide enhanced properties like high impact strength
in certain section by maintaining the tensile strength and lightness. A study carried
out by Sunpreet et al. showed the possibility of fused fabrication of these two mate-
rials with promising results [74]. Tailoring of final mechanical properties requires
post-processing of the product like annealing. It was found that annealing of ABS
material reduced the porosity and interlayer gap, but brittle fracture be present at
cross sections [75]. However, annealing time has negligible effect. With the rise of
nanotechnology and nanorobots, the need of AM machines to have the ability to
14 Influence of Laser Power and Scan Speed … 303

manufacture very small parts in micro- and nanoscale is of paramount importance so

that such AM-based nanoproducts can be manufactured and deployed in real-world
scenario.
Significant efforts have been put to improve the resolution of AM machines for
biomaterials without affecting its composition and without letting it react while
processing the materials. Continuous liquid interface production (CLIP) is the
process where oxygen is used as a barrier to avoid photoinitiation process causing
polymerization continuously upward [76]. Recent development includes the ability
to print liquid metal droplets using 3D inkjet printing which allows the metals to
reduce to nanoparticles and print it through piezoelectric dispensing heads [77, 78].
Laser-induced forward transfer (LIFT) is another method that allows reducing the
resolution of the machine [79]. The major applications include wearable devices,
electrodes for monitoring in the pacemaker and signal transmission in intracochlear
devices. Live cell or tissue printing was achieved by Phamduy et al. using laser direct
write (LDW) where a cancer cell was printed onto a live rat to study the stages and
evolution of cancer and angiogenesis in the rat when the cancer cell is printed in it
[80–83]. This is one of the major steps which may eventually lead to a full live organ
printing in the future.
An effort to reduce the MLT is to increase the layer thickness. But, the layer
thickness cannot be increased more than a certain limit to avoid incomplete melting.
The layer thickness should be limited to a range where the current laser capability
can process. A FEM analysis of a high layer thickness laser-based AM process is
developed in this study to investigate the effect of laser power and scanning velocity
on the melt-pool and time-temperature distribution.

14.2 Mathematical Background

Selective laser melting offers the ability to process parts by applying a concen-
trated laser source onto a layer made of powder. By repeated procedure of melting
phenomena the whole part is generated. During this process, the layers undergoes
repeated phase transformation due to difference in heat applied from the laser source.
Transient thermal distribution, uniform and non-uniform grain growth are occurred
during the process. Some of the thermal energy is lost either due to convection or
radiation. This process can be understood mathematically as discussed further in the
following subsections.
Governing equations and boundary conditions
Initially, transient thermal analysis is performed to determine the time–temperature
history at each specific points of the deposited material over the layers as well as
substrate. The transient heat conduction equation for a three-dimensional heat flux
can be represented as [84]
   
∂2T ∂2T ∂2T ∂T ∂T
k + + 2 + Q̇ = ρc p +v , (14.1)
∂x 2 ∂y 2 ∂z ∂t ∂y
304 S. N. Singh et al.

where k is the thermal conductivity, ρ is the density of the material, C p is the specific
heat, ν is the velocity vector, T is the temperature variable (K), ∇ is gradient operator,
k is the thermal conductivity, Q̇ is the rate of internal heat generation per unit volume.
The initial temperature distribution at time t = 0 is defined as:

T (x, y, z)|t=0 = T0 , (14.2)

where T 0 represents the ambient temperature which is considered 298 K.

The latent heat of conduction within the melt-pool is the main domain where
most of thermal transmission takes place besides convection and radiation thermal
losses from all the surfaces. The natural boundary condition can be represented
mathematically which involves Newton’s Law of Cooling and gray-surface body
behavior [85–91]:

∂T
k − q + qc + qr = 0, (14.3)
∂n
where qr and qc are the heat loss due to radiation and convection and radiation and
q is the input heat flux. Convective and radiation heat loss can be expressed as:

qc = h(T − T0 ) (14.4)

qr = σ (T 4 − T04 ) (14.5)

where h is the coefficient for heat convection, σ is the Stefan–Boltzmann constant,

 is the melt-pool emissivity, T 0 is the initial temperature and T is the instantaneous
temperature at that given time.
Heat source model
The Gaussian heat distribution model is the most common model used in the laser
additive manufacturing process since; heat distribution follows Gaussian distribution.
Gaussian distributed ‘disk’ heat source model is used to simulate the distribution of
laser heat source onto the powder layers from the laser source. It can be represented
as [84].
 
3η P −3(x 2 + y 2 )
q= exp , (14.6)
πr 2 r2

where q is heat flux rate, η is the laser absorption coefficient, P is the laser power,
r is the effective laser beam radius, x and y are the respective positions of the laser
beam at the given time. For the heat source to move, velocity and time have to give
along the axis of movement.
14 Influence of Laser Power and Scan Speed … 305

Table 14.2 Temperature-dependent material properties of Inconel 718 [92, 93]

Temperature (K) Thermal conductivity (W/m K) Temperature (K) Specific heat (J/kg K)
378 14.7 560 480
485 15.7 667 491
579 17.8 767 511
677 18.3 866 537
781 19.7 968 570
881 21.2 1071 612
981 22.9 1173 655
1080 23.7 1271 707
1187 27.7
1277 30.4

14.3 Finite Element Modeling

The FEM of a laser-based AM process for Inconel 718 is taken. The results include the
temperature distribution and melt-pool geometry at different layers under different
operating conditions. It also deals with details of the material composition and the
temperature-dependent material properties. The influence of process parameters on
the melt-pool shape and temperature distribution is also discussed.

14.3.1 Material Properties

An FE-based model is developed based on necessary boundary conditions and mate-

rial properties such as temperature-dependent material properties, correct mesh size,
process parameters. Inconel 718 is considered in this study for analyzing the evolu-
tion of melt-pool and transient temperature distribution during SLM process. Two
key parameters are considered, i.e., laser power and laser scanning velocity. Specific
heat capacity and thermal conductivity are the main temperature-dependent proper-
ties that affect the heat transfer during the SLM process along with density and emis-
sivity even though its effect is low. Specific heat, density and thermal conductivity
of Inconel 718 materials are presented in Table 14.2. Also, temperature-independent
material properties are presented in Table 14.3.

14.3.2 FE Model

An FE-based transient thermal model is developed for transient thermal analysis

using the ANSYS parametric design language (APDL). The SOLID70 element is
306 S. N. Singh et al.

Table 14.3 Material properties that taken into consideration for simulation [93]
Property Value Unit
Density 8190 kg m−3
Ambient temperature 300 K
Thermal conductivity 11.4 W m−1 K−1
Specific heat capacity 435 J kg−1 K−1
Melting point 1609–1700 K
Latent heat 152 × 103 J/kg−1
Coefficient of thermal expansion 1.3 × 10−5 K−1

used in the FE thermal analysis. It has eight nodes and a single degree of freedom
(temperature) at each node. It is used because the model consists only of straight
surfaces. SOLID90 should be used which has 20 nodes and a single DOF at each node
if the model has curve boundaries. If the analysis continues for structural analysis,
the element should be replaced with SOLID45. Figure 14.4 shows the FE model
for Inconel 718. The substrate size is 10 mm × 31 mm × 4 mm with a layer size
of 1 mm × 31 mm × 0.5 mm. Figure 14.4b presents the meshed FE model along
with a magnified view. The process parameters considered in this study are given in
Table 14.4. Element’s death and birth feature is implemented to mimic the adding
layers during the manufacturing.

Fig. 14.4 a Schematic of multi-layer model and b the FE model

Table 14.4 Process variables employed for Inconel 718

Data set no. 1 2 3 4 5 6
Speed (mm/s) 150 150 200 200 300 300
Power (W) 200 250 200 250 200 250
14 Influence of Laser Power and Scan Speed … 307

14.4 Results and Discussions

This section discusses the response of process parameters in terms of temperature

distribution and melt-pool dimensions. The effects of laser power as well as the laser
scanning velocity are also discussed in detail. The results show that for the current
dimensions and high layer thickness, complete melting and sintering of layers are
observed.

14.4.1 Melt-Pool Evolution and Temperature Distribution

When the laser power is applied along the direction of laser scanning, the temperature
is highest at the centerpoint of the laser source. As the laser moves along a layer,
the size of the melt-pool length increases. Moreover, the length of the melt-pool
also increases as the number of layer increases as shown in Fig. 14.5. Figure 14.5
represents the laser movement at different locations when the laser power is 200 W
and scanning velocity is 150 mm s−1 . Figure 14.5a shows the movement of laser
power in the first layer, (b) at a distance of 7.75 mm from the origin in the second
layer, (c) at the middle of third layer, (d) at a distance of 23.25 mm from the origin
in fourth layer, (e) at the end of fifth layer and (f) the cooling process after the laser
scanning is over.

Fig. 14.5 3D transient view of laser scanning during a laser AM process of 5 layers for P = 200 W
and v = 150 mm s−1
308 S. N. Singh et al.

Fig. 14.6 Cross-sectional

view of the evolution of
melt-pool of five layers
during laser AM when P =
200 W and v = 200 mm s−1

The cross-sectional view of the melt-pool at the end of each layer for five layers
is shown in Fig. 14.6. Both the width and depth of the melt-pool increase as the
number of layers increases. The shape of the melt-pool also changes from a semi-
hemispherical to a nearly flat shape as the layer changes from the first layer to fifth
layer. As the layer width is only 1 mm, therefore, after deposition of second layer
the melt-pool width is determined as 1 mm and is expected to keep increasing even
if the layer width is more than 1 mm. The zone in red color represents melted region,
while yellow region represents the sintered zone. These two zones represent where
the actual manufacturing takes place, while others show the temperature range in
different parts of the layers as well as in substrate.
At 200 W laser power and 200 mm s−1 scanning velocity (Fig. 14.6), the width
of the melt-pool increases from ~0.75 mm to ~0.97 mm for first layer and second
layer and then it increases to ~1 mm for the third layer, and thereafter, it remains
constant with further increase in layers. While the depth of the melt-pool increases,
the number of layer increases. The depth of melt-pool is ~0.33 mm, ~0.39 mm,
~0.49 mm, ~0.53 mm and ~0.58 mm for first, second, third, fourth and fifth layers,
respectively. From the fourth layer, the shape of the melt-pool merely changes even
though the depth increases at layer width of 1 mm.
Figure 14.7 represents the time–temperature history of each layer when laser
power and scanning velocity is at 200 W and 200 mm s−1 . The maximum temperature
achieved for first, second, third, fourth and fifth layers are 2282 K, 2479 K, 2644 K,
2762 K and 2873 K, respectively. The rapid temperature reduction is due to cooling
when the manufacturing process is over. Figure 14.7b shows a magnified view of
the time–temperature variation for each layer. It is observed that there are five major
temperature peaks for the first layer, four major temperature peaks for the second
layer and so on. This is due to the laser power directly applied five times above the
point for the first layer, four times for the second layer and so on. The temperature
obtained is well beyond the melting point.
14 Influence of Laser Power and Scan Speed … 309

Fig. 14.7 Time–temperature history a when laser power 200 W and scan speed 200 mm s−1 and
b zoom view of (a) from 0 to 1.2 s

14.4.2 Influence of Laser Beam Power on Melt-Pool

and Temperature Distribution

With increasing laser power from 200 to 250 W and at constant scanning velocity
of 300 mm s−1 the temperature, melt-pool width and depth increases. The width of
the melt-pool increases from ~0.4 mm for 200 W to ~0.65 mm for 250 W at the end
of the first layer. Similarly, from ~0.67 mm for 200 W to ~1 mm for 250 W at the
end third layer. However, at the two different laser powers, the melt-pool width is
determined as ~1 mm at the end of the fifth layer. The depth of the melt-pool varies
from ~0.088 mm for 200 W to ~0.22 mm for 250 W at the end of the first layer,
~0.27 mm for 200 W to ~0.44 mm for 250 W at the end third layer and ~0.41 mm
for 200 W to ~0.52 mm for 250 W at the end of fifth layer as shown in Fig. 14.8.
Figure 14.9 depicts the maximum temperature attained at the center of the first layer

Fig. 14.8 Evolution of melt-pool geometry when laser power varies from 200 to 250 W keeping
the scanning velocity at 300 mm s−1
310 S. N. Singh et al.

Fig. 14.9 Time–temperature history at the center of first layer when a laser power is 200 and 250 W,
and scan speed is 300 mm s−1 and b zoom view of (a) from 0 to 1.2 s

which is 1833 K for 200 W and 2171 K for 250 W at constant scanning velocity of
300 mm s−1 . This reflects that the temperatures increase with increasing laser power.

14.4.3 Influence of Scanning Velocity on Melt-Pool

and Temperature Distribution

When the scanning velocity increases at constant laser power, the melt-pool depth
and width decrease. It is due to the decreasing temperature as the laser power moves
faster. Figure 14.10 represents the evolution of melt-pool shape for first, third and
fifth layers for a scanning velocity of 200 and 300 mm s−1 a constant laser power
of 250 W. The melt-pool width for the third layer is more than 1 mm for both the
scanning velocities. The melt-pool depth decreases from ~0.55 mm for 200 mm s−1
to ~0.42 mm for 300 mm s−1 in the third layer. Figure 14.11 shows the decreasing

Fig. 14.10 Evolution of melt-pool for first, third and fifth layers when scanning velocity varies
from 200 to 300 mm s−1 keeping laser power at 250 W
14 Influence of Laser Power and Scan Speed … 311

Fig. 14.11 Temperature variation of the third layer when a laser power is 250 W and scanning
speed 200 and 300 mm s−1 and b zoomed view of (a) from 0 to 1.2 s

temperature when scanning velocity increases at the start of the third layer. For the
third layer, temperature decreases from 3418 K to 2689 K as laser scanning velocity
increases from 200 to 300 mm s−1 as shown in Fig. 14.11.

14.5 Conclusions

The fundamental concepts of additive manufacturing technologies along with

different classifications and significant process parameters are described in the
present chapter. Also, in order to understand quantitatively the influence of laser
power and scan speed with respect to time–temperature history and melt-pool devel-
opment, a FE-based three-dimensional heat transfer process model developed during
a five-layer laser-based additive manufacturing. It is observed that the temperature
of subsequent layers increases with increasing layer numbers. In the first layer, the
substrate played an important part in conducting the heat away from the layers. The
results also showed that for low power or high speed, there is no significant effect on
the first layer when the laser passes on the fifth layer. For low laser power, incomplete
melting of powder materials takes place. However, if the power is high and scanning
velocity is low, the layers are properly melted and sintered. It is also found that the
dimensions of the melt-pool and temperature enhance with increasing laser power
and constant scanning velocity. However, the melt-pool dimensions and temperature
decrease when the scanning velocity increases keeping the laser power at constant.
The present proposed model can predict the temperature distribution and evolution
of melt-pool under different process parameters for a high layer thickness. It is very
helpful in controlling the process parameters. A more realistic model is developed
for a multi-layer, multi-track AM process.

Acknowledgements This work was supported by TEQIP II grant at the North Eastern Regional
Institute of Science and Technology, Itanagar, Arunachal Pradesh, India.
312 S. N. Singh et al.

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Mr. Sapam Ningthemba Singh is a Ph.D. research scholar at the Department of Mechanical
Engineering, National Institute of Technology Silchar, Assam, India. He completed his M.Tech
and B.Tech from NERIST. His research interest includes additive manufacturing, additive manu-
facturing in biomedical applications, finite element method. He is currently working on the perfor-
mance enhancement of polymer materials to enhance biocompatibility using 3D printing.

Dr. Nirsanametla Yadaiah is Assistant Professor in the Department of Mechanical Engineering,

North Eastern Regional Institute of Science and Technology (NERIST), Nirjuli, Arunachal
Pradesh, India. He has received Ph.D. in Mechanical Engineering from Indian Institute of Tech-
nology Guwahati, India. His area of research is Computational Welding Mechanics, Additive
Manufacturing, Laser Based Manufacturing Processes and macro-/micro-scale fusion welding
processes. He has authored more than 10 journal papers, 1 book, 3 book chapters and many
international conferences.

Ms. Sohini Chowdhury is a Ph.D. research scholar at the Department of Mechanical Engi-
neering, North Eastern Regional Institute of Science and Technology (NERIST). Her research area
include laser based manufacturing processes, additive manufacturing and computational welding
mechanics.

Dr. Manapuram Muralidhar is a Professor at the Department of Mechanical Engineering, North

Eastern Regional Institute of Science and Technology. He received his Ph.D. from Indian Insti-
tute of Technology Kharagpur in 2007. He has more than 28 years of teaching experience and
8 years of experience as Deputy/Assistant/Junior Manager at Vizag Steel Plant, Visakhapatnam,
Andra Pradresh, India. His research area is focused on additive manufacturing, Intelligent Manu-
facturing, Foundry, Forming, Welding, and Production Management. He has conducted many
sponsored projects from the funding agencies such as DST, MHRD, MoMSME. He is a member
of the professional bodies such as LISTE, LISME, LIIW, SMIRED, MAMM, MIMA, MIIF. He
was conferred the prestigious award of Rajiv Gandhi Excellence Award by the India International
Friendship Society in 2010 for his contribution and achievements. He has guided many Ph.D.
students as well as Masters and Graduate students.
Chapter 15
Novel and Emerging Materials Used
in 3D Printing for Oral Health Care

Anoop Kapoor, Priyanka Chopra, Komal Sehgal, Shaveta Sood, Ashish Jain,
and Vishakha Grover

Abbreviations Used

Nomenclatures

3DP 3D printing
AM Additive manufacturing

A. Kapoor
Professor and Head, Sri Sukhmani Dental College and Hospital, Dera Bassi, Punjab, India
e-mail: [email protected]
P. Chopra
Professor, Sri SGT Dental College and Hospital, SGT University, Gurugram, India
e-mail: [email protected]
K. Sehgal
Associate Professor, Department of Prosthodontics, Dr. H.S.J. Institute of Dental Sciences, Panjab
University, Chandigarh, India
e-mail: [email protected]
S. Sood
Assistant Professor, Department of Periodontology and Oral Implantology, Dr. H.S.J. Institute of
Dental Sciences, Panjab University, Chandigarh, India
e-mail: [email protected]
A. Jain
Professor and Head, Department of Periodontology and Oral Implantology, Dr. H.S.J. Institute of
Dental Sciences, Panjab University, Chandigarh, India
e-mail: [email protected]
V. Grover (B)
Associate Professor, Department of Periodontology and Oral Implantology, Dr. H.S.J. Institute of
Dental Sciences, Panjab University, Chandigarh, India
e-mail: [email protected]

© Springer Nature Singapore Pte Ltd. 2020 317

S. Singh et al. (eds.), 3D Printing in Biomedical Engineering,
Materials Horizons: From Nature to Nanomaterials,
https://doi.org/10.1007/978-981-15-5424-7_15
318 A. Kapoor et al.

FGM Functionally graded materials

FDM Fused deposition modeling
SL Stereolithography
SLS Selective laser sintering
PLA Polylactic acid
PLGA Polylactic glycolic acid
ABS Acrylonitrile Butadiene Styrene
HIPS High-Impact Polystyrene
TPU Thermoplastic Polyurethane
PET Polyethylene Terephthalate
PC Polycarbonate
SFF Solid Freeform Fabrication
DNA Deoxyribonucleic acid
PVC Polyvinyl chloride
HA Hydroxyapatite
TCP Tricalcium phosphate
PPF Polypropylene fumarate
PCL Polycaprolactone
PEG-DMA Polyethylene glycol methacrylate
PEG-DA Polyethylene glycol diacrylate
PEP-DEF Poly(propylene fumarate) with diethyl fumarate
PVA Polyvinyl alcohol
PHBV Poly(3-hydroxybutyric acid-co-3-hydroxy valeric acid)
CHAp Carbonated hydroxyapatite
BSA bovine serum albumin
PEEK Polyether ether ketone
SLM Selective laser melting
EBM Electron beam melting
SMAs Shape memory alloys
SMPs Shape memory polymers
NiTi Nickel-titanium

15.1 3D Printing: The Technique and Oral Health

3D printing or additive manufacturing is the most recent revolution witnessed in

the field of health care. The technology is basically distinct from the conventional
processes of manufacturing, in a way that a desired product (3D structure) can be
designed and shaped using a digital model and is formed by ‘layer-by-layer’ deposi-
tion of material, which is digitally controlled and operated. 3D printing is also known
as additive manufacturing (AM), rapid prototyping, layered manufacturing or solid
freeform fabrication [1]. The four most integral components of the process are:
15 Novel and Emerging Materials Used in 3D Printing … 319

• A digital model of the object,

• Material/s manageable in the minimal forms,
• A deposition system of fabrication materials,
• A digital control system for layer-by-layer apposition.
Medical applications of additive manufacturing include preoperative models,
educational anatomic models, splints, templates, external fixators for orthopedics,
medical instruments, and biomaterial printing [2, 3]. The upbeat of additive manu-
facturing technology in this sector largely leans on its ability to create orthotics,
prosthetics, and personalized implants, thus limiting much of disability associated
with missing body parts. This is all the more relevant for the field of dentistry or
oral health care as the essence of dentistry has been talked of as an art and science
focused on recreating the morphology, anatomy, and function as close possible to
the lost parts of teeth, alveolar bone, and other oral structures. It has largely changed
the face of dentistry with its salient features digitization, customization, precision,
and time and cost-effectiveness [4].
Certain salient potential advantages [5, 6] of additive manufacturing, which make
it a next-gen technologic breakthrough for dentistry, are:
1. The direct conversion of design to product.
2. Greater precision and customization with no additional tooling,
3. Functional designing of intricate biologic tissues,
4. Flexible (hollow or lattice structures) for intraoral use,
5. Minimal material wastage,
6. Less manufacturing time,
7. Cost-effectiveness,
8. Feasibility of chairside construction as well as excellent scalability.
The technique provides an immense opportunity for translation into useful health
care products, particularly, dentistry. Commercial success will also depend on adher-
ence and meeting up of some accepted predefined standards regarding properties
of existing materials for the similar clinical situations [7] with a cost-effective
production process [1].

15.2 Applications of 3D Printing in Oral Health Care:

Material Perspectives

Dental therapeutic procedures help the patients to achieve optimal health, function,
aesthetics, and comfort by restoring the natural oral anatomy and morphology of oral
tissues lost/damaged by disease [8]. With the continuous advancements in knowl-
edge and technology, 3D printed appliances have found a broad range of applications
in oral health care. Mechanical solutions were the earliest usage in the dental field
as many 3D printed inlay/onlay restorations, educational models; surgical templates
made up of thermoplastic materials came into being. Thermoplastic materials could
320 A. Kapoor et al.

be worked with most of the first generation AM processes, viz. stereolithography.

Largely polymer materials were used for these kinds of applications owing to their
convenient working parameters and reasonable mechanical and chemical proper-
ties. Few high strength, bioinert/biocompatible metals, e.g., titanium and titanium
alloys, cobalt-chromium, aluminum alloys, etc., also have been utilized for applica-
tions like dental implants, crown and bridge, and dentures prosthesis frameworks.
Ceramics is the third category of materials, which have been utilized for some limited
applications in oral health care. Keeping the application range in view, even the
use of multiple materials in one product, to enhance the clinical performance was
attempted and composite materials were developed for 3D printing. With the contin-
uous upsurge in material sciences, some of the materials in combination with the
printing technique were harnessed for imparting some biologic functionality in terms
of ability to harbor and sustain living/vital cells, nerves and blood vessels, etc., or
allow their growth via providing specific microstructure in the printed part. These
upgrades led to the use of 3D printed components in tissue engineering by acting
as biologic tissue scaffolds. To optimize the biologic applications, it was important
to understand the functionality of vital living tissues, for which these customized
parts were going to be the replacements. This directed toward the second generation
of composites, i.e., functionally graded materials (FGM), which could simulate the
functional biologic structural form of the lost/damaged body part by a much gradual
and homogenous shift in the properties of combined materials used in a product. Most
recently, technologic advances have made it possible to utilize biologic components
and inserts, biomimicking scaffold materials to be printed as composite (bioprinting)
via integrated printing approaches with newer versions of printing devices.
The field of biomaterial and biomanufacturing is expanding vastly with exponen-
tial research in this arena to bring the best usage to the end user, i.e., patient. Rapid
advances in the material sciences are trying to keep pace with the novel technologies
and equipment used for 3D printing, thus making the novel and diverse applications
feasible. How well the 3D printed ‘object’ serves its intended use in the oral cavity
determines its eventual usefulness for clinical application. The durability and func-
tional integration to adjacent oral tissues is vital for the longevity of oral and overall
health. Materials used for 3D printing work in integration with the AM process and
the focused application. All three factors are significant and complement, coordinate
each other to develop a value application. Broadly speaking, there are three major
contemporary domains of applications of 3D printing in oral health care from the
standpoint of materials (Fig. 15.1). Accordingly, the paper shall provide an update
of relevant materials used in 3D printing under three sections:
1. Contemporary materials used for 3D printing,
2. Material updates from tissue engineering perspectives,
3. Emerging materials for novel applications.
15 Novel and Emerging Materials Used in 3D Printing … 321

Tissue engineering
Mechanical Mechanical Biological solutions for
scaffolds (bio
applications for applications for tissue/organ
compatible and
dentistry ( Intra oral dentistry( Extra oral replacements(Intraoral
bioactive for tissue
use) use) use)
reconstruction)

Crown and Bioresponsive

bridge work Scaffolds for solutions(
Investment
bone composite
castings
Restorations for regeneration restorative
caries teeth solutions)

Implant surgical
guides Educational or Biofunctional
preoperative applications as
Dental implants
diagnostic / artificail tissue
Orthodontic
models or organs
aligners

Fig. 15.1 Major domains of 3D printed applications in oral health care from a materials perspective
standpoint

15.2.1 Contemporary Materials Used in 3D Printing for Oral

Health Care

Different AM processes allow for a large range of raw materials to be used for fabrica-
tion of structures, due to a diversity of methods used. The majority of the raw materials
used for dental and medical purposes may be grouped into binder/powder material
combinations include polymers (including resins and thermoplastics), ceramics, and
metals. Among these materials, polymers have been most extensively utilized for
3D printing [9–11]. However, different types of materials including metals [12–15],
ceramics [16–19], and nowadays, different combinations of these as composites,
hybrid, or functionally graded materials (FGM) are being successfully utilized in 3D
shapes and structures using AM. A very brief update of the most basic aspects of
very commonly used contemporary materials has been provided in this section.

15.2.1.1 Polymers

Mostly, thermoplastic polymers have been utilized within versatile industrial appli-
cations. Having a low coefficient of thermal expansion and low glass transition
temperature and melting point, the material becomes workable for the intended use.
However, strong secondary bonding is necessary for obtaining good final strength as
3D printing procedure is by layer to layer addition. In dental applications also, these
materials have been widely used particularly for making models and templates, etc.
322 A. Kapoor et al.

Polylactic Acid (PLA)

Polylactic acid, a biodegradable polymer is most commonly used polymer as an

FDM material. Some variants may have opted for intraoral use as the degradation
products, e.g., lactic acid can be metabolized by the body. Another advantage of the
material is that it needs no ventilation system during the manufacturing process, as
no dissemination of any toxic gases or vapors is accompanying. However, PLA has
low impact strength and temperature stability, limiting its use as a structural material.
The melting temperature of PLA is around 175 °C, but it is workable for flow at a
little higher temperature, i.e., 215 °C. The crystalline structure of the material and
the presence of methyl (CH3 ) group make it strong, yet a brittle material.

Acrylonitrile Butadiene Styrene (ABS) Plastic

Acrylonitrile butadiene styrene is another common 3D printing filament material,

which is used in dentistry. The material is available in different grades as a different
proportion of the three monomers are used for making the final polymer. Though
all are known as ABS materials, it provides an abundant variety for customization
of the applicability in diverse clinical situations owing to different polymerization
processes, chain lengths in structure and crystallization. Issues of toxic gas production
during processing need a well-ventilated place for the safe use of this material.
The material is amenable to produce smooth surfaces, which have popularized it
immensely. The surface disinfection of ABS plastic is done with organic solvents as
material properties are not affected by the same. Acetone is a preferred choice for
disinfection of ABS plastics. The major disadvantage associated with ABS is its high
glass transition temperature, which is responsible for dimensional instability and
limits its application. The three components polystyrene, butadiene, acrylonitriles
impart a specific set of properties as an amorphous and stiff structure, toughness, and
resistance to environmental degradation, respectively.
High-impact polystyrene (HIPS) is composed of styrene and butadiene monomers
and does not have a nitrile group similar to ABS. This distinct composition provides
better impact resistance. The material can be dissolved in the differential solvents,
then the solvents used for routinely used materials, e.g., ABS, and allow its use as a
support material for other printing processes.
HIPS can be usually dissolved in terpene chemicals liked-limonene and even
in some biodegradable solvent combinations, e.g., acetone. Most of the properties
profile is similar to ABS, as they largely share a similar composition.

Thermoplastic Polyurethane (TPU) Elastomer

Thermoplastic polyurethane is a flexible material, composite of long nonpolar regions

and short polar regions. Differential polarity provides a combination of flexibility
and a composed set structure. This co-polymeric molecular arrangement simulates a
15 Novel and Emerging Materials Used in 3D Printing … 323

spring, which is responsible for an elastomeric, rubbery, consistency of the material.

The material is applied widely as has a workable melting temperature range (around
230 °C) and shows resistance to abrasion and organic solvents.

Polyethylene Terephthalate (PET) Plastic

Polyethylene terephthalate is another common, particularly, in fabric and bottle

industry. The appearance of the material varies with the cooling conditions, as on
rapid cooling, it becomes amorphous and appears transparent. The surface of the
printed PET is carefully treated with fumed acetone to enhance smoothness. The
material can be dissolved by organic solvents such as acetone and gasoline, etc.
A distinct advantage offered by the material is good moisture resistance, which
makes the material amenable to easy storage and workability. Temperature range for
workability is same, i.e., 230 °C, as for rest of FDM printable materials.

Nylon

The characteristics of the class are the presence of at least one monomer with
carboxylic acid groups at its ends and another with amines at its ends. These are
polyamide compounds with an amide group –(C=O)–(NH)– at the place of monomer
units joining in the chain. Owing to the immense variability in the molecular structure,
this class of polymers offers an enormous range of properties. High toughness and
stiffness, flexibility, resistance to fatigue, heat and wear and strong adhesion between
Z-layers are few to mention to make them a material of immense application. Major
issues with nylon are high cost, dimensional instability, and easy moisture contami-
nation. Gasoline, acetone, and benzene like solvents do not affect nylon, but it can be
degraded with acids. Workable temperature range for the material is higher than the
usual thermoplastic materials (240–270 °C) depending on the specific formulation.
Nylons exhibit a high degree of crystallinity owing to the aliphatic backbone
and polar amide groups, whereas the amorphous regions have good mobility which
provides the material good flexibility, in addition to high strength.

Polycarbonate (PC)

Polycarbonates which are amenable to 3D printing are largely polymeric forms

of bisphenol A. As only one defined repeat unit, i.e., polycarbonate (PC) is basic
backbone structure of the compound, and the properties are affected by the differ-
ential lengths of chains rather than compositional differences. Salient merits are
its high strength and very high Z-layer adhesion, good impact resistance and
toughness, immense deformability, high-temperature stability, smooth texture, and
optical clarity. A high temperature, viz. 315 °C is needed for extrusion, so specific
printer devices are required for polycarbonates. The surface of the material is easily
324 A. Kapoor et al.

scratched. It can be solvated by petroleum chemicals like gasoline and kerosene but is
resistant to most acids. Exceptionally, acetone embrittles the material. Polycarbonate
has a highly amorphous microstructure due to the pendant groups and aromatic rings.
These features are also responsible for PC’s high strength, optical transparency, and
high T g and processing temperatures. The material discolors over a period of time
from initial transparent appearance to yellowish tinge, due to oxidation of aromatic
rings [20].

15.2.1.2 Ceramics

Few aluminas reinforced and zirconia-based ceramic materials have been utilized
for fabrication of dental prosthesis, especially for crown and bridgework by AM
process. Still there exist many issues like anisotropic shrinkage and staircase effect
in the final product (owing to layering) for this category of materials pose a concern
for their widest scope of application. Most of the current 3D printing methods need
an elaborate workflow in terms of pre- and post-processing treatment for ceramics,
which limits their expansion from prototype to a final manufacturing stage. FDM
and the use of a jetted binder to bind specially coated ceramic powders together need
additional sintering procedures after an initial reaction to achieve the full strength of
the material [21]. Use of SLS technology to produce ceramics involves either ceramic
powder or a pre-sintered ceramic. To date, however, direct SLS of ceramic powder
has only yielded porous structures difficult to post-process to high density, so it has
been mainly used to produce modified glass-ceramics for the fabrication of bioactive
tissue scaffolds [22] (discussed in detail in the next section). With recent innovations,
many composite materials are becoming more and more workable. However, powder-
bed inkjet 3D printing and vacuum infiltration have been found to produce a dense
alumina-reinforced-ceramic structure with high density and satisfactory strength [23,
24]. Crude zirconia prostheses have also been produced using a similar method
[21, 25].

15.2.1.3 Metals

Titanium, Co-Cr, and nickel alloys have been utilized primarily in the field of
dentistry. Nowadays, the use of nickel-containing alloys is almost obsolete in dental
prostheses due to the risk of nickel allergy. However, research on titanium structures
fabricated using additive techniques has documented a favorable yield strength, ulti-
mate tensile strength, and ductility, albeit with some surface roughness [26]. Tita-
nium is much widely used as this has biocompatible, bioinert properties to be used
for intraoral use, especially as implantable devices. Many clinical studies have docu-
mented the successful workability of such implants [27, 28]. In fact, intrinsic surface
roughness, osseointegration and functional integration of these implants with adja-
cent living tissues is a salient advantage [29, 30]. Many well-designed studies on the
properties of titanium alloy (particularly Ti6Al4V) fabricated using SLS have also
15 Novel and Emerging Materials Used in 3D Printing … 325

been documented [26]. With novel methods such as DMLS technology, where there
is a passive fabrication of the material without energy and minimal material wastage,
other precious metals such as Co-Cr have also been workable. This has expanded the
range of materials for 3D printing, yet remains an expensive option only [25, 31, 32].

15.2.2 Material Updates from Tissue Engineering

Perspectives

In recent years, tissue engineering has gained a prime place in the regenerative
therapeutic choices. Dentistry has also witnessed a similar surge in regenerative
approaches based on tissue engineering principles applied to restore the lost bone
around teeth as well as for maxillofacial prosthesis. The pivotal functional triad for
successful regeneration involves the formative cells, signal molecules, and biologic
scaffolds to keep these in place and provide the environment to recapitulate the
development of the tissues as happened during the embryonic stage. The structure
of the scaffolds is critical to simulate biologic environment for cellular infiltration
and proliferation, space creation for the growth of extracellular matrix, biochem-
ical signals to guide the populating cells for healing, and physical networking of
different components, including nutrient transport, and cell–matrix interactions [33–
35]. Additive manufacturing allows the development of complex 3D printed parts
to replace the patient or organ-specific anatomic part (macrostructure), with the
microstructure simulating tissue architecture in terms of porosity and spatial orien-
tation compatible for in the growth of new cells and associated vascular and extra-
cellular substances. The selection of biomaterials for such applications is very chal-
lenging as each material has different physical and chemical properties, processing
methods and FDA approval. Generally speaking, polymers, ceramics, and metals all
have been tried, alone as well as in combinations, in tissue engineering. The selec-
tion of the fabrication technique depends upon that which material is being worked
upon, characteristics of the printing machine and the specific requirements of the
final scaffold in terms of physical strength and chemical behavior.
Various SFF techniques were introduced to build objects with controlled macro as
well as microstructures for biomedical tissue engineering applications. The freedom
in form, coupled with a suitable material choice allows a controlled development
of a product adhering to tissue engineering triad by directing the cells, signals, and
scaffolding substrates in a desired orientation simultaneously fabrication. These tech-
nologies used in conjunction with case-based imaging data enabled the aseptic and
customized manufacturing of tissue engineering grafts according to individual clin-
ical situation. Multi-functional scaffolds for tissue engineering meeting the specific
requirements can be developed based on best simulating models of the patient’s
defect [36]. Precision injection molding technique is another innovative addition,
which can utilize most of the existing thermoplastic materials without pretreatment
to make a customizable patient device as it offers a mold-free printing [37].
326 A. Kapoor et al.

In particular, 3DP offers a huge choice of printable material to be worked with and
many biological agents such as peptides, proteins, polysaccharides, DNA plasmids,
and living cells have been utilized in combination with existing materials. FDM, on
the other hand, utilizes materials based on heat transfer and flow behavior. Materials
with low melting temperatures such as nylon, ABS, and investment casting wax have
been utilized most often. PLGA also have been utilized, but high glass transition (40–
60 °C) of the material limits its application via FDM [38, 39]. Combinations of the
materials are also utilized in FDM, e.g., poly (ethylene glycol) terephthalate/poly
(butylene terephthalate) or polypropylene/TCP [40, 41], PCL/HA or PCL/TCP [42].
Acrylics and epoxies are mostly utilized with stereolithographic techniques, but as
during photopolymerization, very few materials retain their dimensional stability.
So, the choice of materials is quite limited for tissue engineering. Complex 3D scaf-
folds have been developed by utilizing photocrosslinkable poly (propylene fumarate)
(PPF) and investigated in animal studies [43, 44]. Resins with and without bioce-
ramic dispersions have also been processed by SLA for similar applications. SLS
mostly utilized PCL and a combination of materials (PEEK + HA) [45–47]. An
elaborate technical workflow is needed for biomaterial fabrication, as the coated
particles are to sinter together with the elimination of the coating during the process
and even post-processing aimed at enhancing the strength of the printed parts is
required [48]. Another combination of (PVA) and (HA) was also used for biologic
applications [49]. SLS techniques coupled with computational design data utiliza-
tion have allowed the fabrication of complex tissue engineering matrices with desired
micro and macro three-dimensional structural organization. PCL scaffolds for tissue
engineering applications were first developed by Williams et al. [50]. Lately, FDA
has provided approval for the use of SLS to process medical-grade polyether ether
ketone (PEEK) for construction of personalized craniofacial implants. More recently,
first patient-specific, implantable titanium mandible that accepts dental implants have
been developed with SLM [51]. The key strength of SLS/SLM/EBM technique is
the ability to direct translation of implant designs into metallic implants capable of
allowing vital bone in growth and regeneration.
3D plotting/direct-write bioprinting is the technique exclusively meant for natural
polymers for various biologic applications. Two approaches for fabrication have been
commonly utilized, viz. extruding heated natural polymers (agar or gelatin) into a
cooler environment (gelatin or silicone oil) so as to solidify quickly [52, 53] or
into a liquid medium containing reactants for cross-linking (gelatin into calcium
reservoir) for microvasculature build up [54]. TCP, on the other hand, is lyophilized
to remove the liquid after extrusion from a syringe [55, 56]. Recent advances in
materials utilized with specific AM techniques have been summarized in Table 15.1
for a quick review.
15 Novel and Emerging Materials Used in 3D Printing … 327

Table 15.1 Recent material and technology advances in different additive manufacturing processes
for tissue engineering applications
3D Printing Fused deposition Stereolithography Selective laser 3d
modelling sintering plotting/direct
write
bioprinting
Calcium PVC PEG-DMA and PCL & HA PLGA
polyphosphate PEG-DA with
&PVA fluorescently labeled
dextran,
fluorescently labeled
bioactive PEG or
bioactive PEG
HA and TCP Nylon PCL (three-armed PCL and TCP
hydroxyl-terminated) β-TCP with
or poly (d,l-lactide) collagen
coating
TCP, (Mg3 (PO4 )2 ) ABS Photo-curable poly Ca-P/PHBV Collagen &
(d,l-lactide) (PLA) chitosan
resin without the use
of reactive
diluents
TCP with SrO and Investment casting Acrylate or CHAp/PLLA Chitosan
MgO doping wax methacrylate
HA and PPF-DEF PVA Collagen
apatite–Wollastonite alginate silica
Glass ceramic with PCL PPF-DEF with BSA Composites
water-based binder BMP-2 loaded encapsulated coated with
PLGA microspheres in HA
Ca-P/PHBV
microparticles
Calcium phosphate PLGA PPF-DEF or Soy protein
with collagen in PPF-DEF with HA
binder
PLGA Polypropylene/TCP Poly(trimethylene Agarose with
Carbonate) gelatin
Farringtonite PCL/HA, PCL/TCP
powder
Source Adapted from [56]

15.2.3 Emerging Materials for Novel Applications

This section summarizes the new materials that can be specifically 3D printed for
a defined application. It is an emerging field aimed at optimizing the material for
an application by a 3D fabrication process, with retained or enhanced original prop-
erties of the material [57]. Though there are diverse novel materials coming up, in
context of oral health care, only advanced materials with biologic applicability will
328 A. Kapoor et al.

be discussed: (1) Smart materials; (2) Ceramic materials; (3) Electronic materials;
(4) Biomaterials; (5) Composite materials.

15.2.3.1 Smart Materials

These are defined as those materials, which are able to change their internal geometry
under the effect of external stimuli [58–60]. Due to this inherent ability of the material,
the 3D fabricated portions can develop in a planned way over a period of time during
the intended application [61–63]. A new term called ‘4D printing’ has emerged out of
such material usage [63]. ‘Smart’ behavior such as environment sensing, actuating
on its own, and shape changing are essential requirements to be termed as a 4D
printed product, in addition to being a component of vital tissue [64–66]. They are
classified according to the number of materials used for printing. Much research
has been carried out regarding enhanced smart nanocomposites [67], shape memory
alloys (SMA) [68–70], 3D printing of shape memory polymers (SMPs), actuators
for soft robotics [71], self-evolving structures [72], anti-counterfeiting system [73],
active origami and controlled sequential folding [61, 74, 75]. Nickel-titanium (NiTi)
SMA is a unique class of materials that can exhibit both SME (thermal memory)
and superelasticity (mechanical memory) [69, 70]. It has been extensively utilized
in biomedical implants and root canal instrumentation in dentistry [76, 77]. NiTi
exhibits excellent parameters such as shape recovery and stress associated with it,
high superelastic strain [78]. However, it is a difficult material in terms of processing
via traditional methods [68, 77]. NiTi parts have been documented to be produced
by SLM (SLM NiTi) also by Meier et al. [68], which could reduce the number of
manufacturing cycles and associated processes as machining and thermomechanical
treatments [66, 68, 79].

15.2.3.2 Composites

Composite materials, i.e., approach to use more than one material in one product
attained great attention from researchers due to the diversity added to a range of
application. Production of tailor-made gradient multi-phase materials is one of the
salient features of AM processes. As a result of composites, different properties could
be achieved within one single integrated part [80]. Furthermore, in making a compo-
nent with composite materials, the required properties of included materials can be
combined while compensating for some of their restrictions [81] Such materials
were focused on to improve the clinical performance in terms of better mechanical
properties including resistance to corrosion and wear, design flexibility. Usually, first-
generation composites were made by a hybrid process in which the combination of
different materials can be performed before or after AM as a previous or subsequent
stage of production of a component. But the problem encountered was an abrupt
change in the properties, where two different materials contacted, which increased
15 Novel and Emerging Materials Used in 3D Printing … 329

the susceptibility of component failure by the layer dislodgement. This paved the
way for the development of functionally graded materials.

15.2.3.3 Functionally Graded Materials (FGMs)

These are the second generation of composite materials, categorized based on their
graded structure. An FGM typically consists of a composite material with variant
properties across the structure to optimize the material performance based on the
differential distributed specific property. The differential grade may exist for any
aspects, viz. physical or chemical composition and associated parameters from layer
to layer. The change over in the material properties across the junction of the materials
used is turned subtle and gentle, so as to avoid the delamination across the layers of
product. Thus, these materials exhibit superior mechanical properties when compared
to basic (monolithic) and composite materials. Such materials were so much needed
in order to replace the oral tissues as in nature most of living tissues such as bones,
teeth, human skin are functionally graded to perform the specialized functions in the
human body [80].
Earliest materials included at least one metal phase in an FGM, but lately, ceramic-
ceramic and glass-ceramic systems are being worked at [82]. Ceramic materials are
inherently designed to withstand high temperatures, corrosive liquids and gases,
abrasion, and mechanical and thermal-induced stresses, so serve as value additions
to the FGM for biologic applicability. Functionally graded ceramic compositions can
be classified into:
1. Ceramic/metal—(Ti-TiB2) (Ni/Al2 O3 ) FGC—used as an armor material
[83, 84].
2. Ceramic/ceramic and glass/ceramic—Alumina/zirconia—biomedical applica-
tions,
• Mullite/alumina—as a protective coating in chemically susceptible environ-
ments [85, 86].
• Zirconia-mullite/alumina FGCs—refractory materials in high temperature.

3. Ceramic/polymer
Boron carbide/polymer—ceramic filters supports, artificial bones.
A nine-layer laminated and functionally graded HA/yttria-stabilized zirconia (Y-
TZP) for orthopedic applications was developed. In addition, Zhou C presented a
novel FGC with both micro-grain and nano-grain HA crystals meeting the mechan-
ical and biological requisites of bone implants [87–89]. Other functionally graded
ceramics that are used in biomedical applications are ZrO2 /AISI316L as artificial
joints and hip prostheses, and ZrO2 /Al2 O3 FGCs as teeth implants [90].
330 A. Kapoor et al.

15.2.3.4 Biomaterials

Bioprinting technique is usually referred to as a hybrid process that allows printing

of tailored structures including multiple cells and biomaterials in a single part [91,
92]. IJP, extrusion-based printing and laser-aided printing are the most common
methods used for bioprinting applications. Bioprinting allows for the production of
a wide variety of practical biomedical tissues with different shapes and material
compositions [57, 81, 93–95]. Bioprinting can be defined as ‘the use of material
transfer processes for patterning and assembling biologically relevant materials—
molecules, cells, tissues, and biodegradable biomaterials—with a prescribed organi-
zation to accomplish one or more biological functions [96].’ The main advantages of
bioprinting include large scale production of tissue engineering scaffolds with a great
accuracy and highly dense cellular structures [96, 97]. The development of bioma-
terials for tissue engineering has added a new dimension to the existing periodontal
regenerative therapies aimed at reconstruction of bone around teeth. Ceramics and
polymers are extensively worked on for enhancing the outcomes of regenerative ther-
apies. Calcium phosphate (e.g., tricalcium phosphate and hydroxyapatite), calcium
sulfate and bioactive glass, etc., both in natural and synthetic forms have been utilized
as scaffold materials. The natural polymers include modified polysaccharide (e.g.,
chitosan) and polypeptides (collagen and gelatin), whereas poly (glycolic acid), poly
(L-lactic acid)] are the main synthetic polymers. Generally, all these materials have
osteogenic, osteoconductive, and osteoinductive properties to act as tissue scaffolds.
Polymers have been more used as a barrier material in guided tissue regeneration
(GTR). They intend to guide the healing tissue for more regeneration by excluding
epithelial growth in the bone defects [98]. Synthetic polymers such as PLGA and PLA
are the materials of choice as these offer the many essential requisites of biocompat-
ibility, biodegradability, ample availability, and cost-effectiveness. A large number
of determinants such as composition, structural organization, impending stresses,
and residual monomer content affect the degradation rate of the biomaterials [99].
Bioprinting is a new emerging technology and PLA along with its combinations
with other biomaterials (such as glass, ceramics, metals, fibers, and polymers offer
great opportunities to fabricate living biological 3D structures such as tissues, organs,
nutrients, and cells [97, 100].

15.3 Conclusion and Critical Issues Concerning the Use

of Materials for Additive Manufacturing

As their exist discrete differences in the workflow and manufacturing process in

different techniques of 3D printing, the characteristics of a specific material are to be
optimized in terms of its suitability to be used with a particular technique and provide
a workable product form for the intended use. Materials used in AM require careful
pre- and post-processing. In addition to the inherent chemical constitution, many
15 Novel and Emerging Materials Used in 3D Printing … 331

physical and chemical properties are important considerations. Extrinsic properties

that require special considerations are the process of manufacturing of feed, shape,
and surface of the feed, colloidal properties and flow through the feeding system at
the feeding conditions. The state of the art 3D printing, especially for the production
of implantable biomedical devices, is very restricted by the limited choice of print-
able materials. Therefore, novel alternative machining and processing methods are
necessarily need to researched and brought in place for materials difficult to be work-
able with contemporary techniques. 3D printing is particularly advantageous for the
production of customized complex devices that are generally not so cost-effective,
when conventional manufacturing methods such as injection molding are utilized.
With the ongoing advancements, industrial 3D printers can now reach extremely
small build layers such as 16 μm layer thickness for SLA (Polyjet, Stratasys), 178 μm
layer thickness for FDM (Fortus 900mc, Stratasys), 80 μm layer thickness for SLS
(sPro 230HS, 3D systems) and 75 μm resolution for SLA (3D systems). These
systems, are yet not, really optimized for biomaterials of interest for in vitro and
in vivo applications. Though some new macromers with biodegradable moieties
have been developed, but FDA approval and other regulatory demands are pending,
before the clinical applications. FDM, SLS, and 3DP are able to use polymers such
as PLGA, PLLA, and PCL without chemical modification which will help expedite
future FDA approval for biomedical devices. Although macro and microarchitec-
ture have showed immense growth in past some time, but additional efforts are
needed to develop nanoarchitecture biomolecules. Improvised strategies to incor-
porate biochemical molecules directly into scaffolds for prolonged release will be
needed. A better understanding of the degradation kinetics and byproducts of the
materials is required to tackle the issues related to mass transport limitations within
thick scaffolds. Novel methods to control the release of acidic degradation products
and their associated adverse effects during 3D printing process to seeded cells and/or
the surrounding wound healing area for better clinical outcomes should be developed
[1, 56, 66, 96].

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Dr. Anoop Kapoor is Professor and Head, Sri Sukhmani Dental College and Hospital, Dera
Bassi, Punjab, India. He is working on the area of application of 3D Printing in dentistry.
336 A. Kapoor et al.

Dr. Priyanka Chopra is Professor, Sri SGT Dental College and Hospital, SGT University Guru-
gram. She is working on the area of application of 3D Printing in dentistry.

Dr. Komal Sehgal is working as Asssociate professor in the Department of Prosthodontics, Dr.
H.S.J. Institute of Dental Sciences, Panjab University Chandigarh. She is working on the area of
application of 3D Printing in dentistry.

Dr. Shaveta Sood is working as Assistant Professor in the Department of Periodontology and
Oral Implantology, Dr. H.S.J. Institute of Dental Sciences, Panjab University Chandigarh. She is
working on the area of application of 3D Printing in dentistry.

Dr. Ashish Jain is Professor and Head, Department of Periodontology and Oral Implantology, Dr.
H.S.J. Institute of Dental Sciences, Panjab University Chandigarh. He is working on the area of
application of 3D Printing in dentistry.

Dr. Vishakha Grover is working as Associate Professor, Department of Periodontology and

Oral Implantology, Dr. H.S.J. Institute of Dental Sciences, Panjab University Chandigarh. She is
working on the area of application of 3D Printing in dentistry.