3D Printing in Healthcare: Bridging Innovation and Practical Use

Abstract

Medical 3D printing is rapidly transforming healthcare by enabling personalized, patient-specific solutions that enhance clinical outcomes and streamline surgical procedures. Its applications span from anatomical models for pre-operative planning to custom surgical tools, advanced medical devices, and implants tailored to individual anatomy. These innovations not only improve surgical precision and reduce operative times but also contribute to more efficient resource utilization. Over recent years, academic hospitals have increasingly transitioned from research to clinical implementation, underscoring the technology's real-world viability. Despite this progress, challenges such as limited reimbursement frameworks, regulatory uncertainties, the need for advanced imaging and software tools, and clinical training requirements continue to hinder widespread adoption. Looking ahead, the vision of decentralized, on-site manufacturing-where hospitals produce patient-specific devices and even bioprinted organs-is increasingly within reach. Realizing this potential will require coordinated efforts across research, industry, and healthcare systems to ensure safety, efficacy, and accessibility in routine clinical practice.

Headnote

Abstract: Medical 3D printing is rapidly transforming healthcare by enabling personalized, patient-specific solutions that enhance clinical outcomes and streamline surgical procedures. Its applications span from anatomical models for pre-operative planning to custom surgical tools, advanced medical devices, and implants tailored to individual anatomy. These innovations not only improve surgical precision and reduce operative times but also contribute to more efficient resource utilization. Over recent years, academic hospitals have increasingly transitioned from research to clinical implementation, underscoring the technology's real-world viability. Despite this progress, challenges such as limited reimbursement frameworks, regulatory uncertainties, the need for advanced imaging and software tools, and clinical training requirements continue to hinder widespread adoption. Looking ahead, the vision of decentralized, on-site manufacturing-where hospitals produce patient-specific devices and even bioprinted organs-is increasingly within reach. Realizing this potential will require coordinated efforts across research, industry, and healthcare systems to ensure safety, efficacy, and accessibility in routine clinical practice.

Keywords: additive manufacturing; 3D printing techniques; rapid prototyping, patient-specific medical devices, XR and 3D printing, Bioprinting

1 Introduction

There is a growing demand in the healthcare system for customized, biocompatible, and sterilizable components, as the personalization of care becomes increasingly essential for delivering optimal outcomes. In this context, 3D printing is proving to be a gamechanger, unlocking a wide range of opportunities for research and development. Medical device manufacturers can accelerate innovations, surgeons benefit from more efficient workflows using custom tools, anatomical models and implants, and finally patient receiving the best possible care. There is a growing body of research supporting the use of 3D printed anatomical models in medical training and education. One major advantage of 3D printing over traditional anatomical models is the ability to replicate specific medical conditions for hands-on. The potential of 3D printing for creating patient-specific implants is also particularly compelling. Complex geometries-whether in metal or plastic-can now be precisely and efficiently produced. This leads to better prototypes, lower costs, and faster turnaround times for components. What was once impossible with older production technologies can now be physically realized using a broad range of materials including even materials of biological origin (Javaid et al., 2022).

1.1 Development stages of 3D Printing

The 1980s saw the emergence of additive manufacturing, a new method of industrial production that began to complement and in certain cases even replace subtractive fabrication. Rather than removing unnecessary material from an entire block (subtractive process), 3D objects are created by adding layers of material beginning from nothing. In analogy to a comparable technique used in ink-jet printers for text printing, this method of production has been termed 3D printing. Since then, it is estimated that over 30,000 patents related to 3D printing have been published in the United States alone. From photopolymerization to fusion deposition to bio-printing, various additive technologies have been consistently proposed over time. Simultaneously, numerous open-source software tools supporting the fabrication process have been developed and made available online. These days, almost everyone can afford a desktop 3D printer. As a result, a revolutionary transformation in fabrication techniques - one that both leverages and parallels the current digital revolution - is likely on the horizon. Additive manufacturing involves building up a 3D object layer much like constructing a structure by stacking bricks. This approach was not widely used in industry until recent times. There are several methods for creating three-dimensional objects, which usually involve shaping liquid or powered-based materials into the desired form by solidifying them. A comprehensive list of the different families of additive manufacturing methods can be found in the standard ISO/ASTM 52920:2023. These techniques were frequently used for prototypes in the past often necessary in the research and development of new products. Nowadays these methods are already used for production level across several industries. The advent of computers in the late 20th century, along with the development of advanced computer-aided design (CAD) and computer-aided manufacturing (CAM) software, transformed design, prototyping, and fabrication processes. Numerical control manufacturing was first developed in the 1940s by J.T. Parsons and later by P. Hanratty in 1957. One of the first applications was the aerospace industry, where automated subtractive manufacturing was used to produce components. Since then, both computer technology and software have advanced rapidly. From mainframe computers in the 1970s, minicomputers and workstations in the 1980s, to personal computers in the 1990s, and more recently, smartphones since 2007, computational and communication capabilities have become more affordable and accessible. This democratization of technology provided engineers with greater computing power at lower costs. CAD has particularly revolutionized the design process. With the introduction of 3D solid modelling in the 1970s and Micr°CAD (later Aut°CAD) in 1982, architects and engineers were able to create realistic models of 3D objects of any size. However, when the idea of computer-assisted additive synthesis of three-dimensional objects emerges in the 1980s, the manufacturing revolution had not yet taken place. Prior to the 1980s, additive manufacturing techniques were only used in the electronic industry, primarily for the fabrication of microchips. Several approaches to computerassisted additive manufacturing were proposed in the late 1970s, and early patents were filed. The Massachusetts Institute of Technology developed a 3D printing technology modelled after the inkjet technology created by Canon Co. in 1979. The US patent, marketed by Z Corp., popularized the term "3D printing". In the 1980s, more comprehensive patents were developed. Below are the key milestones in chronological order, based on fabrication techniques (Savini and Savini, 2015):

Stereolitography (STL): Charles Hull developed a process using ultraviolet light to solidify liquid polymers. In August 1984, he patented a method for creating solid objects by layering this material. The production process took months, and his first successful creation was a 5 cm high cup. In 1986, he founded 3D Systems, a company that manufactures and markets fabrication equipment (Savini and Savini, 2015).

Laminated Object Manufacturing (LOM): Toward the end of the 1980s, a new technology was developed involving the use of a laser to cut cross-sections of an object from paper, followed by the melting of a plastic coating on the underside of the paper layer. However, the technique did not gain wide spread success, and companies like Kira (Japan), Solido3D (Israel), and Hclisys (USA) produced these systems. Selective Laser Sintering (SLS): At the University of Texas, C.R. Deckard developed a method, in which a laser is used to melt powder particles. His relevant US patent was granted in 1989. After producing academic machines, the university's spin-off company, DTM Co., began building commercial machines, which led to its acquisition by 3D Systems in 2001 (Savini and Savini, 2015).

Fused Deposition Modeling (FDM): In the late 1980s, C.S. Crump developed a technique based on the layer-by-layer deposition of thermoplastic material using a 3-axis robot. In 1992, he founded Stratasys Inc. and patented this technique. In 2012, Stratasys merged with the Israeli company Objet Ltd. Today, FDM is the most commonly used technique in desktop 3D printing. Until the early 2000s, 3D printers were expensive and primarily used for prototyping in various industries. In 2005, A. Bowyer at the University of Bath launched a project aimed at creating a low-cost, open-source 3D printer that could produce most of its own parts - Rep Rap (Replicating Rapid Prototyping). This printer used Fused Filament Fabrication (FFF), a derivative of FDM, and employed opensource hardware and software, including Arduino-based circuits (Savini and Savini, 2015).

In 2006, Cornell University in the US initiated a similar effort with the Fab@Home printer, which used open-source software and hardware. This 3-axis system with multiple extruders deposited various materials. The goal was to replicate the shift from industrial mainframes to desktop computers, bringing the transition from industrial to home manufacturing. The Rep Rap project inspired the founding of MakerBot Industries in New York City in 2006, which offered DIY kits for hobbyists with even basic technical knowledge. Over time, MakerBot transitioned from open source to closed-source hardware and was acquired by Stratasys in 2013. The real revolution, however, was not just technological - it was the democratization of manufacturing itself. Additive manufacturing became affordable and accessible to anyone, making the beginning of personal manufacturing (Savini and Savini, 2015).

With the spread of artificial intelligence tools, another significant trend is emerging the automation of not only manufacturing but also design.

1.2 The Importance of 3D Printing in Healthcare / Major benefits

In the healthcare industry, advanced 3D printing technologies hold significant potential for improving patient outcomes, accelerating surgical procedures, and enabling the development of innovative medical instruments. Beyond current applications, further high-level innovation is expected to enhance and expand the role of 3D printing in healthcare. Orthopaedic surgeons for instance use 3D printing for surgical planning. According to these clinicians, it reduces both surgery time and the need for fluoroscopy. The technology is also utilized for creating prosthetic molds -such as those for arms and ears -as well as spacers for infants (Precedence Research, 2025). 3D printing enables the creation of prosthetic limbs that are customized to the individual, offering a significant improvement over traditional methods. Amputees often face long wait times and high costs for prostheses through conventional routes. In contrast, 3D printing allows for the production of affordable, high-quality prosthetics in a fraction of the time, providing the same or even enhanced functionality. This cost-effective solution is especially beneficial for children, whose prosthetics quickly become obsolete as they grow. Furthermore, 3D-printed prosthetics are highly personalized, tailored to each person's unique anatomy and needs, which improves both the fit and function of the device. This personalization ultimately enhances the patient's mobility and overall quality of life (Boretti, 2024).

3D printing enables the creation of precise, hygienic, and highly compact surgical instruments designed for use in confined spaces, minimizing unnecessary risk to patients. It allows for the production of highly specialized, tailored tools for specific patients or procedures. This capability is especially crucial for complex surgeries that require instruments with more precision than standard tools can provide. Surgeons can benefit from 3D-printed instruments that are not only ergonomic and lightweight but also comfortable to use, reducing fatigue and discomfort during procedures. This, in turn, can improve surgical outcomes. Additionally, 3D printing can significantly reduce both costs and production lead times, streamlining the supply chain and eliminating the need for large inventories by enabling on-demand manufacturing of surgical tools (Boretti, 2024). In a literature review about the use of 3D printing in the medical setting, researchers found that this technology is well integrated in surgical practice. Applications were ranging from anatomical models for surgical planning, to surgical guides that allow higher precision in interventions such as osteotomies, and implants customized to patient specific anatomies. Several advantages could be highlighted such as shortening of operating room time, improvement in the accuracy of the manufactured parts, reduction in radiation exposure, overall better clinical outcomes and cost-effectiveness (Tack et al., 2016).

2 Fundamentals of 3D Printing

2.1 Techniques and Materials Used in Medical 3D Printing

3D printing, or additive manufacturing, encompasses various techniques, each with unique materials, processes, and applications. Choosing the right method depends on industry needs, such as consumer products, automotive, aerospace, and healthcare (Lodhi et al., 2024).

2.2 Advantages and Limitations of 3D Printing Techniques

Precision in 3D printing refers to the technology's ability to produce highly accurate and detailed objects with minimal deviation from digital models, with SLA and SLS methods offering the highest accuracy. This is crucial for industries like healthcare, aerospace, and consumer goods. Achieving high-resolution prints depends on factors such as material properties, printer calibration, post-processing, and technology selection (see Table 1). By optimizing them, 3D printing can achieve high precision and fine detail (Lodhi et al., 2024).

2.3 3D Bioprinting and biocompatible materials

As noted above, traditional methods for creating biomedical implants and prosthetics relied on subtractive manufacturing, which is often inefficient and limited in design flexibility. In contrast, modern advancements in multi-material and hybrid manufacturing techniques improve implant functionality by better replicating natural tissue properties. A significant breakthrough in biomedical engineering is 3D bioprinting, which combines biological sciences with advanced technology to create functional soft tissue constructs. This method enhances regenerative medicine, disease modeling, and drug research by enabling scalable and reproducible tissue fabrication. However, challenges remain, such as vascularization and cell viability during printing. The bioprinting process involves imaging damaged tissue, designing constructs, selecting materials (such as synthetic polymers or decellularized extracellular matrices), and printing with technologies like inkjet, microextrusion -a variation of traditional extrusion-based 3D printing (like FDM), but at a much finer resolution, often at the micron scale-, or laser-assisted systems. Some tissues require maturation in bioreactors before transplantation (Onu et al., 2025).

Key biocompatible materials used in 3D bioprinting can be categorized into metals, polymers, and composites, along with their properties and applications as follows:

1. Biocompatible Metals

* Titanium (Ti) & Tİ-6A1-4V: Strong, corrosion-resistant, and biocompatible, used in dental and orthopaedic implants.

* C°CrMo (Cobalt-Chromium-Molybdenum): High wear resistance, ideal for knee and hip implants.

* 316L Stainless Steel: Durable and biocompatible, commonly used in surgical instruments and temporary implants.

2. Biocompatible Polymers

* Polyether ether ketone (PEEK): High strength and chemical resistance used in spinal implants and trauma fixation devices.

* Polylactic acid (PLA) & Polyglycolic Acid (PGA): Biodegradable materials used in sutures, drug delivery, and scaffolds.

* Polycaprolactone (PCL): Flexible and slow-degrading, suitable for long-term implants and tissue engineering.

* Polyethylene Glycol (PEG): Hydrophilic, used in bio-inks and hydrogels for drug delivery and bioprinting.

3. Biocompatible Composites

* Hydroxyapatite (HA) & Calcium Phosphate Cements (CPCs): Mimic bone properties, used for bone grafts and regeneration.

* Carbon Fiber-Reinforced Polymers (CFRPs): Lightweight and strong, used in prosthetics and orthopedic implants.

* Silk Fibroin & Chitosan-Based Composites: Biocompatible biopolymers used in wound healing, drug delivery, and tissue engineering.

(Onu et al., 2025)

3 Applications of 3D Printing in Healthcare

From prosthetics and orthotics, to surgical planning models and implantable bioengineered devices, 3D printing is bridging the gap between engineering and personalized care. The integration of imaging, design, and manufacturing workflows allows clinicians and researchers to develop precise, adaptable tools that enhance treatment quality, training, and outcomes. However, the translation of these innovations into clinical practice must navigate complex regulatory pathways to ensure safety, efficacy, and biocompatibility.

3.1 Prosthetics and Orthotics

3D printing has significantly advanced the fields of prosthetics and orthotics by enabling the rapid, cost-effective production of personalized devices that improve patient comfort, functionality, and accessibility. One of the most dynamic areas in this field is the development of anthropomorphic hand prostheses, where anatomical fidelity, mechanical performance, and functional integration are critical. Additive manufacturing allows for the fabrication of complex structures such as articulated phalanges, tendon-driven linkages, and hybrid material interfaces that mimic the compliance and kinematics of the human hand. FDM remains the most widely adopted technique for prototyping due to its affordability and material flexibility, although SLA and SLS are often employed for higher-resolution or load-bearing components. A key requirement in the development of such prostheses is structured validation, which typically progresses from prototyping and qualitative evaluation to standardized quantitative assessments and, finally, clinical application. Validation frameworks, such as those using Yale-CMU-Berkley object sets, the Karpandji test, and fingertip force or torque measurements, provide benchmarks to assess grasp functionality and mechanical fidelity. These should precede clinical trials with amputees to ensure safety, reliability, and functional performance. Several 3Dprinted anthropomorphic hand systems have already progressed to this level, with successful implementation and testing in clinical settings, demonstrating their practical viability. However, significant challenges remain, particularly in the integration of soft materials. Current 3D printing platforms offer limited options for materials with low Shore hardness that can replicate the compliance of skin or muscle. As a result, many systems rely on rigid phalangeal structures that are skeletonized using pins and joints, sometimes morphologically optimized through topology algorithms to achieve desired mechanical behaviors. Emerging directions in the field include 4D printing, which uses stimuli-responsive materials capable of changing shape or function over time, potentially enabling features like self-assembly, passive actuation, or shape adaptation. Another promising path involves hybrid fabrication strategies, such as integrating conductive inks within structural prints to create embedded sensors, thereby producing fully scnsorized prosthetic hands in a single manufacturing workflow. These advances highlight 3D printing's role not only in reproducing the form of the human hand but also in enabling new modes of interaction, sensing, and adaptability (Park et al., 2024).

3D printing has introduced a transformative approach to the design and fabrication of wrist orthoses, particularly for patients with musculoskeletal or neurologic upper limb conditions. Among these, the most common clinical application is for the treatment of distal radius fractures, where immobilization, comfort, and anatomical conformity are essential for optimal recovery. These orthoses, traditionally produced using lowtemperature thermoplastics (LTTP), are now being increasingly customized through digital workflows involving 3D scanning, computer-aided design, and additive manufacturing. This digital pipeline enables the creation of lightweight, ventilated devices tailored to individual anatomies, improving patient comfort and compliance. Clinical studies have demonstrated measurable benefits of 3D-printed wrist orthoses in various outcome domains. For instance, statistically significant reductions in postoperative pain have been reported, with visual analog scale scores showing improvement in the 3D-printed orthosis group with respect to traditional plaster casts for pain (e.g., 64.19 ± 5.72 vs. 52.75 ± 6.50, P= .01). Patient satisfaction was generally high, with Quebec User Satisfaction Evaluation of Assistive Technology scores consistently >4 out of 5, and functional assessments like the Patient-Rated Wrist Evaluation and Orthotics and Prosthetics User's Survey also indicating favorable outcomes. Complication rates were low; in several studies, no skin irritation, pressure sores, or odor (conditions commonly associated with plaster casting) were reported. Materials commonly used include PLA, Thermoplastic Polyurethane (TPU), and polyamide, which allow precise control over thickness, rigidity, and ventilation. Additionally, digital designs enable easy adjustment and repeat production without rescanning, supporting both clinical efficiency and long-term usability. Despite these advantages, some barriers remain. These include the need for advanced imaging and scanning equipment, specialized software, and clinical training to integrate additive workflows into routine practice. Moreover, the time required for printing and post-processing is still longer than the manual fabrication of LTTP orthoses by trained hand therapists. Nevertheless, 3D printing offers a compelling alternative to conventional fabrication methods, with evidence-based advantages in comfort, customization, and patient-reported outcomes, particularly in the management of distal radius fractures and other upper limb injuries (Pereira et al., 2024; Schwartz & Schofield, 2023).

Three-dimensional printing has emerged as a powerful solution for the design and fabrication of personalized foot orthoses, offering substantial advantages over traditional insole manufacturing techniques. Using patient-specific morphological data obtained via pressure mapping, gait analysis, or foam impressions, custom orthotic insoles can be designed through CAD software and fabricated using materials such as Ethylene-Vinyl Acetate (EVA), PLA, or TPU. These materials allow for precise tuning of mechanical properties, such as elasticity, shock absorption, and support, making them suitable for treating diverse foot conditions including flexible flatfoot, plantar fasciitis, and diabetic foot ulcers. Clinical studies have consistently demonstrated superior outcomes with 3Dprinted insoles compared to prefabricated or conventionally milled counterparts. In a randomized crossover study of diabetic patients, 3D-printed insoles achieved a 40.5 kPa reduction in maximum forefoot pressure, closely matching the performance of virtually optimized milled insoles. In cases of plantar fasciitis, 3D-printed insoles led to a 4.22point reduction in a Visual Analog Scale (VAS) discomfort score, compared to a 3.47point reduction for prefabricated models. Another study involving patients with flexible flat feet found that 3D-printed insoles reduced peak pressures on the first to fourth metatarsals while increasing mid-foot loading, suggesting a favourable redistribution of plantar forces. These patients also reported a 5.49-point average improvement in VAS comfort versus a 2.2-point improvement in the control group. Additionally, studies using multi-parameter insole designs (such as those with reinforced and undercut arch supports) showed enhanced mid-foot support and significantly lower medial forefoot pressures, underlining the ability of 3D printing to produce biomechanically optimized designs. Beyond pressure relief, 3D printing enables design features such as region-specific infill densities, arch reinforcements, and heel cups, which are difficult to achieve through traditional methods. Advanced techniques like direct ink writing and the use of functionally graded materials further allow tailoring of local mechanical responses to the patient's gait profile. Despite some challenges such as material deformation during printing, higher production costs, and the need for regulatory standardization, 3D printing remains a transformative approach. It enhances precision, reproducibility, and design flexibility, paving the way for next-generation orthoses that integrate personalized biomechanics with advanced materials science (Chang & Choo, 2025; Cong & Zhang, 2025).

3.2 Implants and Patient-Specific Medical Devices

3D printing also enables the fabrication of fully implantable, patient-specific medical devices. These personalized implants are engineered to match each patient's unique anatomy, improving surgical precision, biomechanical integration, and long-term clinical outcomes. Three-dimensional printing has revolutionized the design and fabrication of spinal interbody fusion cages, enabling the development of anatomically matched, patient-specific implants that outperform traditional PEEK-based options in both form and function. While PEEK has historically been favoured for its elastic modulus similar to bone, its biological inertness and poor osteointegration have limited long-term fusion success. In contrast, 3D-printed cages made from Tİ6A14V titanium offer high biocompatibility, corrosion resistance, and mechanical strength, while supporting advanced architectural customization via additive manufacturing techniques such as SEM or Electron Beam Melting (EBM). These methods allow for the creation of highly porous scaffolds combining pore sizes of 300 pm (diamond-shaped), 500 pm (square-shaped), and 700 pm (hexagonal). These closely mimic cancellous bone, promote vascularization, and enhance osteoconduction and osteoinduction. Surface micro texturing at the nanoand microscale improves mesenchymal stem cell adhesion, proliferation, and osteogenic differentiation, reducing reliance on autologous bone grafts. Early clinical results have demonstrated that 3D-printed titanium cages can achieve fusion rates comparable or superior to PEEK cages even without graft chambers, while also exhibiting lower subsidence rates due to better endplate conformity and stress distribution. For instance, recent studies reported that porous titanium cages significantly outperform PEEK implants in terms of fusion acceleration, segmental stability, and resistance to high-grade subsidence. Moreover, a large surface footprint design has shown high fusion success with minimal use of costly graft materials (Lewandrowski et al., 2024).

Digital workflows using CT and MRI imaging allow for precise anatomical modeling and preoperative simulation with digital twins. These models facilitate accurate loadbearing analysis and surgical rehearsals, improving intraoperative efficiency and reducing revision rates. Manufacturing timelines can be as short as five days with in-house workflows, and costs, although initially higher, are offset by savings in instrumentation, sterilization, and reduced complications. Altogether, the integration of customizable porosity, optimized mechanical strength, and biologically active surfaces positions 3Dprinted titanium cages as a transformative technology in spinal fusion surgery. These cages not only enhance spinal alignment and intervertebral stability but also offer a scalable path toward truly personalized and cost-effective spinal care (Lewandrowski et ak, 2024).

Cranial reconstruction, or cranioplasty, is frequently performed following decompressive craniectomy or trauma-related bone loss, where the restoration of both structural and aesthetic integrity is critical. The adoption of 3D printing in this field has enabled the production of highly personalized cranial implants using CAD/CAM workflows and patient-specific imaging data. Materials such as titanium and PEEK are most commonly used due to their mechanical strength, biocompatibility, and (in the case of PEEK) radiolucency. Compared to conventional hand-molded polymethylmethacrylate (PMMA) implants, 3D-printed implants offer superior contouring accuracy, reducing intraoperative adjustments and improving surgical outcomes. A recent meta-analysis involving 770 patients reported an overall complication rate of 14.7%, with a notably lower rate in the 3D-printed titanium group (5.8%) compared to standard implants (21.6%). This difference was statistically significant (OR = 0.261, 95% CI [0.12-0.58], p = 0.0009), and with F = 0%, the result showed strong consistency across studies. Infection rates also favored 3D-printed solutions: among 781 patients, the infection rate in the 3D-printed group was 1.7%, compared to 6.6% in controls (OR = 0.327, p = 0.0238). Specifically, for 3D-printed titanium, infection rates were lower (2.4% vs. 9.9%), though not statistically significant (p = 0.0893). Conversely, 3D-printed PEEK implants did not show a significant advantage in either overall complications or infection rate, and in some studies, complication rates were slightly higher than standard controls. These findings support the growing clinical preference for 3D-printed titanium implants, which appear to improve surgical outcomes while maintaining low complication and infection rates. Despite some variability in production techniques and cost (ranging from ~$12 to $3,800 USD), the high anatomical fidelity and reduction in adverse outcomes justify their integration into neurosurgical practice. Further prospective, multicenter studies are needed to standardize protocols and fully establish long-term safety and efficacy across implant types and patient populations (Di Cosmo, 2025).

In the realm of craniomaxillofacial surgery, orbital reconstruction stands out as a particularly delicate and complex challenge due to the functional and aesthetic importance of the region. Recent systematic reviews have highlighted the growing role of 3D printing in managing orbital pathologies, particularly in trauma cases and oncologic resections. Out of 314 initial studies screened under PRISMA guidelines, 12 met the inclusion criteria, focusing primarily on orbital floor and medial wall fractures (50% of studies), benign and malignant tumors (16.6%), and conditions such as Basedow's orbitopathy and hemifacial microsomia (each representing 8.3%). The use of 3D printing in these cases spans from direct manufacturing of patient-specific implants, typically in titanium, PEEK, or porous polyethylene, to the creation of anatomical models for plate molding, surgical planning, and intraoperative navigation. The application of 3D printing significantly enhances preoperative planning, allowing for accurate visualization of the lesion and its spatial relationship with adjacent structures. This facilitates more precise surgical approaches, reducing operative time, minimizing intra- and postoperative complications, and improving functional and aesthetic outcomes. The technology also allows for mirror imaging of the contralateral orbit, enabling high-fidelity reconstruction in unilateral defects and ensuring symmetry. Additionally, surgical templates and guides generated through 3D printing improve the reproducibility and accuracy of osteotomies and implant placements. Beyond the operating room, educational applications were also widely reported, with 3D models serving as valuable tools in the training of residents and students, offering tactile and spatial understanding of orbital pathologies and treatment strategies. Despite its advantages, 3D printing in orbital surgery is not without limitations. The production process remains time-intensive, requiring significant leadtime for virtual surgical planning, printing, post-processing (washing, curing), and potential sterilization steps. Moreover, while 3D printing improves surgical accuracy and predictability, it does not eliminate the risk of complications or the need for secondary interventions. Nevertheless, as digital workflows become more integrated and turnaround times are reduced, 3D printing continues to establish itself as an essential adjunct in orbital trauma reconstruction, oncologic resections, and congenital anomaly repair, offering patient-specific, anatomically tailored solutions that bridge the gap between surgical precision and personalized care (Michelutti et al., 2024).

In the dental and maxillofacial domain, 3D printing plays a transformative role in both restorative and orthognathic procedures, with expanding applications in orthodontics. Patient-specific surgical guides, derived from high-resolution imaging such as cone-beam computed tomography and designed through CAD/CAM workflows, are widely adopted to enhance the accuracy of mini-implant placement, osteotomies, and fixation strategies. In orthognathic surgery, the integration of virtual surgical planning with 3D-printed guides has significantly improved the transfer of digital plans into the operating room. A recent meta-analysis reported that average deviations between planned and postoperative bone positions were consistently under 1 mm, with angular deviations below 2°, underscoring the clinical precision of these workflows (Lee et al., 2024). Beyond surgical accuracy, 3D-printed guides offer advantages in workflow efficiency and patient experience. Digital workflows reduce planning time and streamline clinical procedures, enhancing predictability and decreasing chair time. Patients often report increased confidence in their treatment due to the visual clarity provided by 3D simulations and guides. Furthermore, these guides contribute to improved appliance positioning, faster recovery, and overall patient satisfaction. However, successful implementation demands access to specialized equipment (such as cone beam CT scanners, intraoral scanners, and 3D printers) as well as training in CAD modeling and digital treatment planning. The associated cost of hardware, proprietary software, and biocompatible materials remains a significant barrier for smaller practices. Material selection is critical for both mechanical performance and patient safety. Surgical guides must be printed using biocompatible resins or medical-grade polymers that do not elicit immune responses or cytotoxic effects. Several studies have confirmed the biocompatibility of 3D-printed resins and polymers, showing high levels of cell viability and tissue integration. The sterilization of surgical guides (most commonly through autoclaving) adds another layer of complexity. While autoclave sterilization is highly effective in eliminating pathogens, it can affect the structural and dimensional properties of some printing materials. For example, PLA and Acrylonitrile Butadiene Styrene (ABS) may exhibit warping or stiffness changes after multiple sterilization cycles. Pop et al. (2025) observed increased stiffness in surgical guides following thermal sterilization, highlighting the importance of adjusting autoclave settings to preserve guide integrity (Pop et al., 2025). Moreover, print orientation has been shown to influence the mechanical behavior of dental components. Alghauli et al. demonstrated that changing the orientation of titanium prints can significantly impact surface roughness, tensile strength, and elongation, which are critical parameters for long-term implant performance (Alghauli et al., 2025). Altogether, the use of 3D printing in dental, orthodontic, and maxillofacial surgery offers clear clinical and operational benefits. However, successful integration requires attention to digital workflows, material biocompatibility, sterilization protocols, and clinician training. As these technologies mature and become more accessible, their impact on surgical precision, patient safety, and procedural efficiency is likely to grow (Königshofer et ak, 2021).

Beyond orthopedic and craniofacial applications, 3D printing has also enabled the development of patient-specific implants for airway management, particularly in cases of severe tracheobronchial stenosis or post-transplant anatomical distortion. Standard silicone airway stents are available in various off-the-shelf geometries, but in patients with complex or atypical airway morphologies, such as vanishing bronchus syndrome, standard solutions may lead to poor fit, migration, granulation tissue formation, or infection. To address these limitations, a fully personalized silicone airway stent was designed based on high-resolution CT imaging, which was segmented using Mimics software to generate a 3D model of the patient's respiratory tract. The stenotic region was digitally dilated to twice its original diameter (from 3.5 mm to 7 mm), theoretically reducing airflow resistance sixteen-fold, and a custom stent geometry was designed with a 1.25 mm wall thickness to ensure mechanical stability, press-fit fixation, and dimensional compensation. The final stent was manufactured under cleanroom conditions using MED-4244 medical-grade silicone, injected into a custom mold and cured at 120°C for 16 hours. Post-processing quality checks confirmed geometric accuracy within ±0.2 mm and wall thickness tolerance within ±0.05 mm, with no material defects observed under 20x magnification or during tear-resistance testing. The stent was then sterilized via steam autoclaving, demonstrating the feasibility of producing clinically viable, customized airway devices that overcome the limitations of commercial stents in anatomically challenging case (Königshofer et ak, 2021).

Three-dimensional printing is increasingly being integrated into the development of patient-specific aortic stent grafts for endovascular aneurysm repair, addressing the limitations of standardized, off-the-shelf devices. Traditional stent grafts are manufactured in fixed lengths and diameters, often failing to match the highly variable and curved anatomy of the thoracic aorta, particularly in cases with complex branching or rapidly tapering vessel geometries. Improper stent sizing can lead to complications such as leakage, migration, vessel rupture, or treatment failure. To overcome these challenges, a novel Rapid Prototyping Sacrificial Core-Coating Forming method was developed, leveraging 3D printing to produce patient-specific stent graft cores from water-soluble polyvinyl alcohol (PVA). Based on CT-derived 3D models segmented with Mimics and designed in SolidWorks, the inner core reflects the true anatomical curvature and diameter variations of the descending aorta, sampled every 5 mm for precise sizing. This core is then coated with multiple layers of polymer film, and a nitinol stent scaffold selected for its super-elasticity, shape memory, and high tensile strength (1453 MPa) is integrated between film layers via a deposition process. This avoids the drawbacks of traditional hand-stitching, such as low efficiency and risk of film damage. The completed stent demonstrated high dimensional accuracy (tolerance ±0.1 mm) and was validated through in vivo implantation in a mini-pig, showing proper aortic support, minimal inflammatory response, and no migration after 30 days. Histological evaluation confirmed equivalent tissue integrity and mild oedema on both sides of the arch, indicating symmetric support. These results suggest that 3D-printed stent grafts, fabricated via sacrificial molding and deposition, offer a rapid, anatomically accurate, and clinically promising solution for personalized Endovascular Aneurysm Repair (EVAR), particularly in urgent settings where time-sensitive customization is essential (Lei et al., 2020).

3.3 3D-Printed Models for Surgical Planning and Medical Training

Three-dimensional printing has become an invaluable tool in surgical planning and medical training, offering anatomically accurate, patient-specific models that enhance procedural preparation, improve trainee education, and support decision-making across a wide range of clinical disciplines.

In preoperative planning and intraoperative stage in pediatric spinal surgery, where anatomical complexity and the severity of spinal deformities often limit the effectiveness of conventional approaches, three-dimensional printing is a useful support. Leveraging patient-specific imaging data, surgeons can fabricate anatomically accurate spine models and pedicle screw drill guides to improve both visualization and instrumentation. In a recent systematic review of 25 studies, 72% reported on the use of 3D-printed screw guides, and 54.5% evaluated 3D-printed models for preoperative planning, underscoring the breadth of application. Pedicle screw placement accuracy was assessed in 15 studies, encompassing 2,125 screws across 222 patients, and showed an average accuracy of 93.9% with 3D printing. In direct comparisons, 3D-printed drill guides achieved 92.7% accuracy versus 80.8% with freehand techniques (P = .03), confirming a statistically significant improvement. Operative metrics such as blood loss and surgery duration were also positively affected. While the average operative time for freehand screw placement was 290 minutes, it was reduced to 244 minutes with 3D-printed guides, although this difference was not statistically significant (P = .18). Similarly, average blood loss decreased from 724 mL to 481 mL with the use of 3D-printed guides (P = .13). In preoperative planning studies, the use of 3D-printed spine models was associated with an average screw placement accuracy of 89.9%, and in studies comparing 3DP-assisted planning with standard techniques, the screw accuracy improved from 81.8% to 90.2%, alongside reductions in complications, surgical time, and intraoperative blood loss. These improvements were consistently reported in 11 out of 12 studies assessing the planning phase. The most common technology used was SLA, implemented in 72% of studies, followed by SLS (20%) and FDM (12%). Printing materials varied widely, including photopolymers, monomeric resins, and titanium, with printing costs ranging from $11.77 to $3846 USD (average: $788 USD) and production times from 5 to 168 hours (average: ~50 hours). Despite challenges such as cost variability, material heterogeneity, and production time, 3D-printed surgical guides and preoperativc models continue to gain traction for their capacity to improve surgical precision, reduce risk, and facilitate personalized planning in complex pediatric spinal deformity correction procedures (Katiyar et al., 2024).

In the article "3D-printed skull model for enhancing training in external ventricular drainage within medical education", Scheidt et al. (2025) presents the development and evaluation of a realistic, anatomically accurate, and reusable phantom model designed to improve training in External Ventricular Drainage (EVD), a critical neurosurgical procedure used to manage conditions like hydrocephalus or elevated intracranial pressure. The motivation for this work stems from the high rate of misplacements in EVD procedures, with only 56% of catheters typically reaching the correct ventricular position and approximately 22% ending up in nonventricular locations. To address this, the authors developed a modular model composed of three primary components: a ventricular system, a brain parenchyma surrogate, and a skull bone shell. The ventricular system was modeled from patient MRI data, printed using elastic resin, and featured two wall thicknesses (0.5 mm at puncture zones for realistic tactile feedback, and 1 mm for structural stability). The brain was simulated using gelatine with a preservation solution of isopropanol, glycerol, and water, which allowed storage of up to 14 days without microbial contamination. The skull component was fabricated using polyamide (PA 12) through multi-jet fusion, offering mechanical resistance and reusability via a two-shell design. In testing, neurosurgeons reported that catheter insertion through the model replicated clinically realistic resistance and haptics. Despite the generally positive evaluations, some limitations were noted, including difficulties in aligning the physical model with its virtual counterpart and the inadequate simulation of drilling through cranial bone. Nevertheless, the model demonstrated significant potential for neurosurgical education, combining accurate anatomical replication with practical usability. The authors propose future improvements such as interchangeable burr hole caps, alternative materials for greater elasticity, and integration with spatial computing for guided procedures, ultimately positioning this model as a valuable tool for training and skill development in neurosurgery (Scheidt et al., 2025).

The article "Recent advances in 3D printing applications for CNS tumours" by Awuah et al. (2025) highlights the growing role of 3D printing in medical training, particularly in the context of Central Nervous System (CNS) tumours. A significant portion of the paper is dedicated to the educational benefits of 3DP, emphasizing how this technology is revolutionizing neurosurgical training by providing tangible, anatomically precise models that simulate complex brain tumour cases. One of the most impactful uses of 3DP in training is the creation of patient-specific brain models that allow residents and junior surgeons to practice complex procedures such as craniotomies, tumour resections, and skull base approaches. These models arc derived from highresolution imaging data (MRI or CT), which are processed through CAD software and fabricated using materials that mimic the texture and mechanical properties of neural tissues. The article underscores that such realistic tactile feedback and spatial representation are nearly impossible to achieve with traditional 2D imaging or virtual simulations alone. Awuah et al. cite a key study comparing trainees who practiced surgical techniques using 3D-printed CNS tumour models against those using standard 2D images. The results showed a statistically significant improvement in the 3DP-trained group: they performed procedures more confidently, demonstrated greater anatomical understanding, and achieved higher scores on post-training evaluations. Moreover, these trainees reported enhanced engagement, better retention of anatomical relationships, and increased preparedness for real-life surgery. The review also discusses how 3DP enhances interdisciplinary collaboration during training, particularly in tumor board settings or surgical planning meetings. Physical 3D models can be passed around and examined collectively by neurosurgeons, oncologists, radiologists, and residents, promoting a shared understanding of the case and facilitating communication. This hands-on interaction is especially valuable for visualising deep-seated tumours or complex vascular relationships that are difficult to appreciate in 2D or even on-screen 3D renderings. In addition to trainee education, the article points out that 3D-printed CNS tumour models are also useful in patient education, allowing clinicians to explain surgical procedures and risks more clearly. Patients reportedly feel more informed and engaged when viewing a tangible model of their condition. In conclusion, the paper strongly supports the integration of 3D printing into neurosurgical training curricula. By providing realistic, patient-specific, and reusable anatomical models, 3DP not only improves technical skills and confidence among trainees but also fosters more effective interdisciplinary collaboration and patient communication. As the technology becomes more accessible and refined, its role in surgical education is expected to expand, helping to bridge the gap between simulation and live surgery (Awuah et al., 2025).

3.4 Integrating Virtual / Augmented Reality and 3D Printing in Surgical Planning

In the article "Innovative approaches to pericardiocentesis training: a comparative study of 3D-printed and virtual reality simulation models" by Rubio-López et al., the authors investigate the efficacy of two simulation modalities-3D-printed mannequins and virtual reality (VR)-in the training of pericardiocentesis, a high-risk but rarely performed emergency procedure. Conducted with 35 final-year medical students, the quasi-experimental study aimed to evaluate procedural performance, cognitive workload, and stress response across the two simulation tools. Each participant was exposed to both training environments in sequence: first a VR session, followed by a short break and then hands-on training with a 3D-printed mannequin. Learning outcomes were assessed through an Objective Structured Clinical Examination (OSCE), while stress was measured via heart rate variability (HRV), and cognitive load via the NASA Task Load Index (NASA-TLX). Quantitative results revealed that the 3D-printed mannequin was superior for tasks requiring fine motor skills and tactile precision, such as material handling (Z = -2.56, ·p· = 0.011), aseptic technique (Z = -2.31, ·p· = 0.021), and drainage placement (Z = -2.34, ·p· = 0.019), each with moderate to large effect sizes. However, VR training scored better in terms of mental workload and perceived effort, with significantly lower mental demand (Z = -2.147, ·p· = 0.032) and effort scores (Z = -2.356, ·p· = 0.018) on the NASA-TLX. Stress analysis through HRV further supported this complementarity: the SD1/SD2 ratio, a marker of autonomic stress regulation, was significantly higher during mannequin use (·/2· = 14.157, ·p· = 0.001), reflecting a stronger physiological stress response likely due to the realism of tactile simulation. The authors conclude that each modality offers distinct advantages: VR supports early-stage cognitive acquisition in a low-stress environment, while 3D-printed models provide realistic, stress-inducing scenarios that enhance technical and psychomotor skills. As such, they advocate for a hybrid, progressive training approach beginning with VR for cognitive scaffolding, followed by 3D-printed mannequin practice for procedural consolidation. This dual strategy may offer a scalable and cost-effective model for enhancing procedural competency in resource-constrained settings (Rubio-López et al., 2025).

In the article "Microsoft HoloLcns 2 vs. tablet-based augmented reality and 3D printing for fronto-orbital reconstruction of craniosynostosis: a case study", Pose-Diezde-la-Lastra et al. (2025) investigated the effectiveness of three different intraoperative guidance methods-AR on a tablet, AR with Microsoft HoloLens 2, and 3D-printed spacers-for accurate bone repositioning during open cranial vault reconstruction (OCVR) in a case of metopic craniosynostosis. The study used both simulation (on 3Dprinted phantoms) and actual surgery on a 14-month-old patient to assess how closely the placed bone fragments (frontal bone and supraorbital bar, SO bar) matched the virtual surgical plan (VSP). Methods included preoperative CT-based 3D modeling and normative cranial shape atlases for VSP, AR applications developed in Unity using Vuforia SDK and MRTK for Android and HoloLens 2, and physical guides fabricated through SLS and SLA 3D printing techniques. In both simulated and real surgical conditions, all three guidance modalities achieved sub-millimetric mean placement errors. In the surgical setting, mean placement errors for the SO bar were 0.5 ± 0.3 mm (tablet), 0.6 ± 0.3 mm (HoloLens 2), and 0.3 ± 0.4 mm (3D-printed spacers), with corresponding translation errors all under 1 mm and rotation errors between 0.8° and 1.1°. For the frontal bone in the simulation scenario, placement errors were similarly low, at 0.6 ± 0.4 mm for both AR methods. No statistically significant differences were found between the methods or between simulation and surgical results, suggesting that 3Dprinted phantoms can validly reproduce surgical outcomes. The study found each technique to have unique advantages: 3D-printed spacers offered a fast, intuitive, and low-tech solution for SO bar placement but lacked 3D positional control for more complex fragments like the frontal bone. AR solutions, while requiring more setup, enabled dynamic, real-time adjustments and visual confirmation of VSP alignment, offering higher flexibility and comprehensiveness. Interestingly, while the tablet provided clearer visualization, the HoloLens 2 allowed hands-free interaction and a shared multiuser AR experience, valuable in collaborative surgical contexts. This work confirms that the integration of AR and 3D printing can enhance surgical accuracy in craniosynostosis procedures. It demonstrates a practical, scalable workflow with validated sub-millimetric accuracy, and suggests future extensions, such as multi-marker AR tracking or hybrid workflows combining AR and physical guides for optimal flexibility and precision (PoseDiez-de-la-Lastra ct al., 2025).

The article "Development and assessment of case-specific physical and augmented reality simulators for intracranial aneurysm clipping" by Civilla et al. presents the design, fabrication, and validation of two complementary simulation platforms for training and planning in neurosurgical aneurysm clipping: a physical 3D-printed simulator and a holographic augmented reality (AR) simulation system. These simulators aim to address the growing demand for case-specific and high-fidelity tools amid a decrease in microsurgical case volume and the increased complexity of referred aneurysms. The physical simulator consists of a 3D-printed skull and silicone aneurysm phantoms with interchangeable housing, perfusion capability, and compatibility with fluorescence-based intraoperative assessment (ICG-VA). The aneurysm sacs were printed in silicone with realistic mechanical properties (e.g., Young's modulus ~1 MPa) and a wall thickness of approximately 0.41 ± 0.11 mm, with dimensional accuracy measured by Micr°CT yielding an average deviation of 0.096 mm from design. A perfusion system using dyed fluids and a low-voltage pump was developed to mimic blood flow and support ICG-VA. This platform enabled residents and specialists to practice clip placement under surgical microscope conditions, using real microsurgical instruments and 64 different clip types. The AR system included two modules: a basic visualization tool for geometric assessment of aneurysm-clip compatibility, and an advanced module integrating a realtime finite element simulation of aneurysm deformation during clipping. This was achieved via the SOFA framework, allowing interactive deformation modeling through a head-mounted HoloLensl device. The system was responsive, with computational rates of 85-245 fps and holographic rendering at 25-50 fps. Validation involved 14 participants (5 specialists and 9 residents), who used the physical simulator and completed structured evaluations. The ICG-VA simulations resulted in Raymond class 1 (complete occlusion) in 68.89% of cases, while postoperative CT confirmed complete occlusion in 73.33% of cases. The simulators showed strong performance in content and construct validity, especially for the physical simulator, with high agreement (Cronbach's alpha a > 0.9 for many subgroups). Usefulness scores were particularly high for clip selection: for the physical model, residents and specialists rated its utility in identifying suitable clips at 4.78 and 5.00, respectively. Usability was also excellent, with mean ratings above 4.5 for both simulator types. Although some limitations were noted-such as the absence of haptic feedback in the holographic model and the lack of additional brain anatomy in the physical one-both simulators were considered effective for training and potentially valuable for preoperative planning. The authors suggest that the integration of additive manufacturing and augmented reality provides a cost-effective, intuitive, and realistic pathway to support neurosurgical education and decision-making (Civilla et al., 2024).

The study by Kimura et al. (2025), titled "Development of anatomically accurate digital organ models for surgical simulation and training," presents an innovative, opensource methodology for generating anatomically precise digital organ models that can be utilized in various surgical training platforms, including 3D-printed, hybrid, and augmented reality (AR)-based simulators. The system integrates the Auto Segmentator extension of 3D Slicer-built upon the deep learning framework nnU-Net-to automatically extract surface models of 104 anatomical structures from DICOM data. These initial models are then refined in Blender using both automated and manual editing to match clinical imaging data more precisely. Python scripts were developed to automate image processing and model alignment, including the generation of JPEG-format multiplanar reconstruction (MPR) images, their synchronized visualization with the organ models in Blender, and interactive slider tools for enhanced usability. The average processing time to go from raw DICOM to aligned models was approximately 7 minutes in Fast mode and 22 minutes in Full-resolution mode, even across data from 12 diverse cases obtained via The Cancer Imaging Archive. Crucially, organs and vessels not fully captured during automatic segmentation-such as the ureter or common bile duct-were reconstructed manually, improving the comprehensiveness of the anatomical datasets. These datasets were used to design surgical training systems that faithfully replicate real anatomical spatial configurations. For instance, a laparoscopic choledochojejunostomy simulator was developed using 3D printing, reproducing port and target organ positioning based on human anatomy. The models were also adapted for hybrid simulators involving porcine organs, ensuring tactile realism, and for AR projections using Apple Reality Composer to superimpose digital anatomy over physical models. This multifaceted pipeline offers an accessible, low-cost, and highly customizable framework for surgical training and simulation, with the potential to democratize the creation of high-fidelity educational tools across healthcare institutions (Kimura et al., 2025).

3.5 Bioprinting and Tissue Engineering

Bioprinting is at the frontier between traditionally engineered implants and regenerative medicine. Here the printed parts not only restore the morphology and/or functionality of a tissue, but support the regrowth/regeneration of native tissue.

Coaxial and triaxial bioprinting have emerged as powerful techniques within the field of bioprinting, offering transformative capabilities for the fabrication of vascularized and architecturally complex tissue constructs. Unlike monoaxial extrusion, these methods employ multi-channel nozzles that enable the simultaneous deposition of multiple bioinks, allowing for precise control over spatial organization, hierarchical layering, and cell distribution. This is particularly advantageous for creating core-shell or multilayered structures that mimic native vasculature or other tubular tissues. One of the most impactful applications is the generation of perfusable vascular networks, essential for nutrient exchange in thick tissues. Studies have demonstrated that constructs printed with coaxial nozzles, using bioinks such as Gelatine Methacrylate (GelMA), alginate, and endothelial-cell-laden hydrogels, support stable vascular channel formation, high cell viability, and functional perfusion. For instance, Zhang et al. and Shao et al. used coaxial printing to fabricate constructs with hollow channels that facilitated endothelial lining and tissue vascularization, while Hong et al. achieved sustained cell survival and tissue maturation in vitro through encapsulation of fibroblasts and Human Umbilical Vein Endothelial Cells (HUVECs) in coaxial constructs. Triaxial systems further extend these capabilities by enabling the printing of three-layered vascular constructs, achieving enhanced mechanical properties, tissue complexity, and cellular diversity. These approaches have been successfully applied to fabricate vascularized muscle, bone, kidney tubules, skin, and salivary gland constructs, with promising in vivo results including functional regeneration and integration. Moreover, coaxial printing has been leveraged to model disease states such as multiple myeloma and renal dysfunction, and for drug testing applications. Recent advancements like coaxial sacrificial writing into functional tissues (со-SWIFT) and integration with computational fluid dynamics (CFD) have further improved structural fidelity, bioink performance, and scalability. Collectively, coaxial and triaxial bioprinting represent a significant leap forward in the engineering of viable, functional tissues, offering clinically relevant solutions for regenerative medicine, personalized implants, and complex in vitro models (Banigo et al., 2025).

Three-dimensional bioprinting is emerging as a transformative technology in regenerative and reconstructive surgery, with particular promise in the craniomaxillo facial field, where extensive tissue loss from trauma, tumor resection, or congenital defects poses complex surgical challenges. While current clinical practice often relies on autologous flaps (such as fibular or scapular bone flaps) for reconstructing mandibular or midfacial defects, these approaches entail significant donor-site morbidity and long rehabilitation periods. Bioprinting offers the potential to fabricate anatomically precise constructs using patient-derived cells and bioactive materials, thus enabling personalized, biologically integrated solutions for bone, cartilage, mucosa, skin, and even dentin-pulp tissue reconstruction. In the context of bone regeneration, particularly for segmental mandibular defects, extrusion-based bioprinting techniques employing hydrogels such as alginate, GelMA, PEG, and PCL have demonstrated early success in preclinical studies. These constructs aim to replicate native bone by combining osteoconductive matrices with osteoblasts and endothelial cells to promote vascularization and mineralization. Notably, the generation of vascularized bone remains a major bottleneck: the creation of functional capillary networks (<200 pm) requires a resolution that current laser bioprinters (typically ~20 pm) cannot yet deliver, limiting in vivo integration and tissue survival. In soft tissue engineering, bioprinted intraoral mucosa, gingiva, and skin substitutes have shown promise using autologous fibroblasts and kératinocytes embedded in biocompatible matrices. Constructs mimicking the layered structure of skin and mucosa have been successfully fabricated via extrusion, droplet-based, and light-based bioprinting techniques, some of which incorporate endothelial cells to support pre-vascularization. Similarly, bioprinted cartilage tissue- such as nasal or auricular cartilage-has been explored using adipose-derived stromal cells within PEG- or PCL-based hydrogels, offering potential for aesthetic and functional restoration in facial reconstruction. Bioprinting is also showing potential in dental tissue regeneration, particularly the dentin-pulp complex, with studies using stem cells from dental pulp and periodontal ligament, bioinks like GelMA, and digital light processing (DLP) methods to recreate vascularized, innervated dental structures. Moreover, bioprinting platforms enable in vitro models for neoplastic disease research and drug screening, contributing to precision medicine approaches in head and neck oncology. Despite its promise, bioprinting in the craniomaxillofacial region faces significant hurdles, including vascularization limitations, material biocompatibility, resolution constraints, and post-printing maturation requirements. Additionally, sterilization, regulatory compliance, and costs of biomaterials and equipment remain barriers to widespread clinical adoption. Still, advances in bioink formulations, bioreactor systems for maturation, and integration of vascularized architectures continue to push the boundaries of what is achievable. With sustained multidisciplinary research and innovation, 3D bioprinting is poised to redefine reconstructive paradigms in the head and neck region (Michelutti et al., 2025).

4 Challenges

4.1 Challenges in the Adoption of 3D Printing in Healthcare: Insights from Sweden

The integration of 3D printing in healthcare presents significant opportunities for innovation, including improved surgical planning, customized medical devices, and enhanced medical education. However, its widespread adoption faces challenges. To better understand these obstacles, a qualitative study was conducted 2022-2023 across seven life science regions in Sweden, all of which include university hospitals. The study explored the current state of 3D printing, its perceived effects, and the barriers hindering its adoption (Sag et al., 2024).

Findings revealed that while all seven regions utilized 3D printing in some capacity- particularly in surgical planning and clinical applications such as dentistry, orthopedics, and maxillofacial surgery-none had an official adoption strategy. The primary barriers identified were organizational, environmental, and technological in nature. Organizational challenges, such as high costs and a lack of centralized decision-making, were the most significant. Environmental barriers included a complex and sometimes ambiguous regulatory framework, creating uncertainty in compliance. Technological barriers were less frequently cited but still posed challenges to broader implementation (Sag et al., 2024).

These findings underscore the need for structured adoption strategies, clearer regulatory guidelines, and financial planning to support the sustainable integration of 3D printing in healthcare. Understanding these barriers can help inform policy decisions and facilitate the development of solutions that enhance the practical use of 3D printing in medical settings (Sag et ak, 2024).

4.2 Regulations and Approval Processes

One of the major challenges hindering the widespread adoption of 3D printing in healthcare is the complexity of the regulatory frameworks. In the EU, medical 3D printing is subject to various legal requirements, including pre-market approval, postmarket liability, intellectual property rights, and data protection regulations. However, a recent study, Core Legal Challenges for Medical 3D Printing in the EU (2024), highlights that existing legal frameworks often create uncertainty and limit innovation in this field. The study notes that the EU Medical Device Regulation (MDR), which replaced the previous Medical Device Directive, introduced more extensive regulatory requirements but failed to adequately address emerging medical technologies such as personalized medical devices, medical models, and point-of-care production. As a result, the MDR was already considered outdated upon its introduction, leaving significant gaps in the regulation of 3D printing in healthcare. Additionally, the study points out that the General Data Protection Regulation (GDPR) places strict requirements on handling patientspecific data, a fundamental aspect of medical 3D printing. Ensuring compliance with GDPR can be particularly challenging in clinical settings, adding legal and administrative burdens that may discourage adoption. Another key challenge discussed in the study is the uncertainty surrounding liability and intellectual property rights. The lack of clear legal guidance on responsibility for 3D-printed medical devices raises concerns for manufacturers, clinicians, and healthcare institutions, further complicating regulatory approval and implementation. This study argues that the EU's overall approach to medical 3D printing reflects a cautious and highly regulated stance that prioritizes minimizing risks but may inadvertently stifle innovation. While patient safety remains a critical concern, the study emphasizes that excessive regulation and legal uncertainty could slow the development and adoption of potentially life-saving 3D printing applications. It also suggests that more adaptive and flexible legislation could foster innovation while maintaining high safety standards. The study further highlights that medical innovation is progressing rapidly in regions with more flexible regulatory environments, potentially putting pressure on EU regulators to reconsider their approach. The authors suggest that balancing patient protection with technological advancement will be crucial for ensuring that medical 3D printing reaches its full potential within the EU (Mehrzad et ak, 2023).

5 Market size

The size of the global healthcare 3D printing market was estimated at USD 8.52 billion in 2023, and it is expected to expand at a CAGR (Compound Annual Growth Rate) of 18.5% between 2024 and 2030. The trend toward personalized 3D printing, growing medical uses, and technology developments are all responsible for this increase. Its expansion is also being aided by elements including high production precision, increased need for patient-specific implants, and public-private investment. The market is also being driven by strategic initiatives from major competitors and the increasing adoption of 3D printing across North America. With a revenue share of 36.7% in 2023, the dental application segment led the market. The rising use of 3D printing in dentistry, which improves the design of customized dental prosthesis and transforms conventional production techniques, is what is driving this expansion. One of the key advantages of 3D printing in prosthetics is its potential to save physicians time, money, and effort by enabling the efficient preparation, scanning, and printing of patients' teeth in therapeutically relevant situations. Tissue engineering is expected to grow at a CAGR of 15.0%. 3D printing offers the ability to produce scaffolds that are precisely tailored to the structure and form of injured tissues. In order to facilitate cell development and tissue regeneration, scaffolds with optimal porosity, pore structure and biomaterial composition can be precisely engineered. The adoption of 3D printing in tissue engineering is also being driven by the growing demand for personalized medical care and the broader shift toward regenerative medicine. With the highest revenue share of 38.0% in 2023, the North American healthcare 3D printing market led globally. This growth is primarily fuelled by patent expirations, an expanding range of medical applications, and increasing demand for customized additive manufacturing. The widespread use of 3D printing to produce essential medical equipment during the COVID-19 pandemic also accelerated adoption. Moreover, demand from healthcare professionals continues to rise due to 3D printing's ability to produce highly accurate anatomical models that support surgical planning. Capturing a dominant 86.5% share of the North American market, the United States healthcare 3D printing sector saw significant growth in 2023. This expansion is driven by the presence of advanced medical institutions and research centres that actively employ 3D printing technologies for surgical planning, patient-specific modelling, and the development of medical devices (Precedence Research, 2025).

Looking ahead, the Asia Pacific healthcare 3D printing market is projected to grow at a CAGR of 19.8% over the forecast period. Market expansion is supported by rising demand for personalized 3D-printed medical tools and devices, increased use of precision medicine, and patent expirations that open the door to more competition. The region also saw increased adoption of 3D printing during the COVID-19 pandemic for the local production of essential medical supplies. However, broader adoption remains challenged by the high cost of additive manufacturing and a shortage of skilled professionals. Japan led the Asia Pacific market with a 30.1% revenue share in 2023. This growth is attributed to ongoing innovation and the expanding use of 3D printing in pharmaceutical and medical applications, driven by the nation's continued investment in research and development. Thailand's healthcare 3D printing market is expected to grow at a remarkable CAGR of 22.1% during the forecast period. Adoption is being fuelled by the increasing use of 3D printing techniques in surgeries and treatments, as well as in producing prosthetics, customized implants, and medical models tailored to individual patients. Europe's healthcare 3D printing industry is anticipated to grow rapidly, supported by improved infrastructure and favorable reimbursement policies. The expansion of applications across healthcare-particularly in dentistry, surgery, and cosmetic procedures-along with the availability of cutting-edge 3D printing technology, are key drivers of growth (Precedence Research, 2025).

With a dominant 25.7% market share in 2023, the German healthcare 3D printing market dominated the European market. The industry provides plenty of chances to invest in the customisation capabilities of 3D printing. Additionally, the conditions are right for investors to investigate the possibilities of biocompatible materials made for scaffolds, implants, and tissues that can be 3D printed. Major players in the healthcare 3D printing industry include 3D Systems, Inc., EnvisionTEC US LLC, regenHU, Allevi, Inc., EOS GmbH, Materialise, Stratasys, Nanoscribe GmbH & Co. KG, and Fathom Manufacturing. These companies continue to focus on expansion and competitive differentiation, with leading players executing a range of strategic initiatives. EnvisionTEC US LLC, in particular, offers a wide array of 3D printing equipment, backed by its expertise in mass production (Precedence Research, 2025).

6 Future Perspectives and Innovations

The COVID-19 pandemic highlighted the potential of 3D printing in the medical field, as the technology was employed to produce essential medical supplies, ventilator components, and personal protective equipment overcoming bottlenecks from disrupted supply chains. This experience significantly boosted awareness and adoption of 3D printing in healthcare, with an increasing number of applications being explored. Many of the core uses of 3D printing in medicine are closely tied to ongoing technological advancements, and this number is expected to grow in the coming years. A search for the term "3D printing medicine" in PubMed shows fewer than three publications per year before 2006. Since then, interest has surged, with the number of publications reaching 1,667 in 2022 (Boretti, 2024) and keeping steadily growing every year (Boretti, 2024).

The combined use of 3D printing and artificial intelligence (AI) holds promise in areas such as personalized medicine, medical education and training, predictive analytics, orthotics, prosthetics, and customized medical equipment. AI plays a key role in optimizing the design and functionality of these products. Additionally, 3D printing may enable the creation of dynamic structures that respond to changes in a patient's body or environment-by printing items capable of altering their shape or behavior over time in response to specific stimuli. This concept, known as 4D printing, opens the door to innovations such as self-assembling implants, adaptive drug delivery systems, shapeshifting tissue engineering scaffolds, personalized orthotics that adjust to user needs, and surgical instruments that adapt during procedures. Furthermore, integrating 3D printing with the Internet of Things (loT) may unlock new possibilities in personalized healthcare. For example, IoT-enabled 3D printing can be used to create customized prosthetics and orthotics with embedded sensors, smart pills for real-time monitoring, tailored drug delivery systems with IoT-based tracking, wearable devices for remote patient monitoring, and tools for surgical planning, data collection, and feedback. While the medical industry has yet to fully harness the potential of 3D printing, its integration with cutting-edge technologies like AI, 4D printing, and loT may significantly expand its future applications (Boretti, 2024).

7 Conclusion

No longer limited to prototyping, additive manufacturing now supports the creation of complex geometries, lightweight structures, and custom-fit medical devices-from prosthetics, orthoses, implants to surgical models. These developments have already demonstrated clear benefits in terms of surgical precision, reduced operative times, and enhanced clinical outcomes.

Looking ahead, the potential of 3D printing extends even further with emerging technologies such as 4D printing, hybrid fabrication processes, and sensorized devices. These innovations are unlocking new levels of adaptability, functionality, and user interaction, exemplified by the development of prosthetic hands with embedded sensing capabilities manufactured in a single workflow. Furthermore, cutting-edge research into the integration of stem cells, 4D-printed responsive materials, and organ-on-a-chip platforms signals a future in which 3D printing may support regenerative medicine and biofunctional diagnostics (Onu et al., 2025).

A visionary but increasingly realistic scenario is the decentralization of medical device production: every hospital equipped with its own 3D printer, capable of fabricating patient-specific components and even bioprinted organs on demand (Javaid et al., 2022). This paradigm could reshape surgical planning, emergency care, and chronic condition management by enabling real-time, localized manufacturing.

Nevertheless, several barriers remain. These include the need for advanced imaging, specialized software, skilled personnel, and standardized regulatory pathways to ensure safety, biocompatibility, and reproducibility. The time-intensive nature of printing and post-processing also continues to limit rapid deployment in clinical settings.

Despite these challenges, the trajectory of innovation suggests a future where additive manufacturing becomes an integral component of medical care. Continued interdisciplinary collaboration and regulatory evolution will be critical to fully realize this potential and to bring next-generation medical technologies from the lab to the bedside.

References

References and Notes

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