Evaluation of the Usability of a Low-Cost 3D Printer in a Tissue Engineering Approach for External Ear Reconstruction

Abstract

The use of alloplastic materials instead of autologous cartilage grafts offers a new perspective in craniofacial reconstructive surgery. Particularly for regenerative approaches, customized implants enable the surgeon to restore the cartilaginous framework of the ear without donor site morbidity. However, high development and production costs of commercially available implants impede clinical translation. For this reason, the usability of a low-cost 3D printer (Ultimaker 2+) as an inhouse-production tool for cheap surgical implants was investigated. The open software architecture of the 3D printer was modified in order to enable printing of biocompatible and biologically degradable polycaprolactone (PCL). Firstly, the printing accuracy and limitations of a PCL implant were compared to reference materials acrylonitrile butadiene styrene (ABS) and polylactic acid (PLA). Then the self-made PCL-scaffold was seeded with adipose-tissue derived stem cells (ASCs), and biocompatibility was compared to a commercially available PCL-scaffold using a cell viability staining (FDA/PI) and a dsDNA quantification assay (PicoGreen). Secondly, porous and solid patient-customized ear constructs were manufactured from mirrored CT-imagining data using a computer-assisted design (CAD) and computer-assisted manufacturing (CAM) approach to evaluate printing accuracy and reproducibility. The results show that printing of a porous PCL scaffolds was possible, with an accuracy equivalent to the reference materials at an edge length of 10 mm and a pore size of 0.67 mm. Cell viability, adhesion, and proliferation of the ASCs were equivalent on self-made and the commercially available PCL-scaffolds. Patient-customized ear constructs could be produced well in solid form and with limited accuracy in porous form from all three thermoplastic materials. Printing dimensions and quality of the modified low-cost 3D printer are sufficient for selected tissue engineering applications, and the manufacturing of personalized ear models for surgical simulation at manufacturing costs of EUR 0.04 per cell culture scaffold and EUR 0.90 (0.56) per solid (porous) ear construct made from PCL. Therefore, in-house production of PCL-based tissue engineering scaffolds and surgical implants should be further investigated to facilitate the use of new materials and 3D printing in daily clinical routine.

Barriers of Three-Dimensional Printing in Craniofacial Plastic Surgery Practice: A Pilot Study and Literature Review

“…14 Specifically, multiple manuscripts have demonstrated the feasibility of free open-source software, the comparability of low-cost commercial desktop printers for industrial devices, and the biocompatibility of low-cost materials. 16,[18][19][20][21][22]27,29,32 In terms of free open-source software, the included studies underscored its effectiveness in time-saving and rapid prototyping of models. 22,24,27,28 These models were particularly studied in craniofacial reconstruction, revealing lower costs and comparable relative errors compared with current industry standards.…”

“…One supplementary scoping review revealed further potential cost-benefits of incorporating 3D modeling in practice, along with various cost-reducing techniques 14 . Specifically, multiple manuscripts have demonstrated the feasibility of free open-source software, the comparability of low-cost commercial desktop printers for industrial devices, and the biocompatibility of low-cost materials 16,18–22,27,29,32 . In terms of free open-source software, the included studies underscored its effectiveness in time-saving and rapid prototyping of models 22,24,27,28 .…”

Label-Free Physical Techniques and Methodologies for Proteins Detection in Microfluidic Biosensor Structures

“…Thus, it is possible to use low-melting and at the same time very inexpensive polylactic acid (PLA) for rigid and simple structures without great technical demands. Even with low-priced printers, it is possible to process PLA [ 85 ]. If the technical requirements increase due to lower water absorption and temperature resistance, acrylonitrile butadiene styrene (ABS), or polycarbonate (PC), are used.…”

Cost-effective 3D scanning and printing technologies for outer ear reconstruction: current status

“…In a workflow process, 3D printers are the most expensive part, thus making printing more economical and easier is important. Patient-customized ears were constructed in solid form and with limited accuracy in porous form by means of a modified low-cost desktop printer [ 109 ]. The dimensions and quality were sufficient for the selected tissue engineering applications.…”