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Villapún, et al.
polymer printers are generally more affordable and have when applied in orthopedic implants [22,23] . Further novel
been adopted early in health-care settings, which coupled functionalities such as sustained drug delivery , MRI
[24]
with the rising of numerous 3D startups has led to an artifact reduction , and bone modulus matching have
[26]
[25]
interest in reasonably prized, user friendly, and compact all been proven feasible by AM in fundamental research.
machines (i.e., FabPro™ 1000, Figure 2™, J35 Pro Biomedical research has also begun to investigate how
Compact or Formiga P110 Velocis) [16-18] . Nonetheless, it the often-overlooked AM surface interacts with both
is still clear that system manufacturer advancements tend cells and bacteria [27,28] in as-fabricated and surface treated
to favor engagement with larger scale industries such as conditions. Hence, where AM system manufacturers
automotive or aerospace yet align less closely with the have made little notable advance in this region, academic
medical device market. Conversely, medical implants and interest indicates that the interface between part and
devices are a good fit with the benefits of AM in general, patient is critical in the device’s effectiveness.
often needing to be patient specific and with biologically It could broadly be suggested that the advances
complementary geometries. In particular, the dental made by system manufacturers and the direction of
industry has embraced metal AM in the production of biomedical research for AM metal implants has some
customized implants . Likewise, the highly customized shared goals but differ in key regions. The drive for
[19]
nature of maxillofacial implants has been enabled by part quality, 1 time-right, and process monitoring are
st
AM and the ability to form complex integrated lattice areas that manufacturers have been working toward
[20]
geometries has led to AM implants for spinal interbody and are necessary for medical implants to satisfy
fusion procedures . regulatory standards. However, the scale-up efforts
[21]
From a research perspective, the medical sector of manufacturers are not necessarily a priority in the
has also embraced the unique capabilities of AM. medical implant market, particularly when considering
Engineered porosity and lattice structures have been patient customization. Health-care applications of AM
shown to enhance osseointegration and implant stability are highly focused on the ease of modification to meet
specific requirements in a case by case scenario , further
[29]
suggesting a disconnection between stakeholders. This is
A
compounded by the complexity inherent to the supply
chain in medical device development. Instead of a direct
relationship between supplier and customer, bespoke
implants require inputs from designers, manufacturers,
clinicians, and then the end user (i.e., patient) to be
brought together while accounting for new technological
developments by researchers. Thus, to fully realize the
potential of AM in healthcare, it is paramount to ensure
a clear alignment between all contributors to the supply
B chain.
Most available reviews have focused on the
present and future uptake of AM based on their ability
to produce complex geometries, rapid lead times, the
flexibility of the design process, and the potential to
create already assembled, movable parts [29-32] . However,
limited attention has been focused on understanding
mismatches between AM specialists in different
C application areas. To this backdrop, the following
survey was undertaken to better clarify how AM is
being used by various stakeholders in healthcare, the
barriers to further uptake, and the perceived strengths
and weaknesses. Through these findings, it is hoped that
system manufacturers, device designers, researchers,
and health-care experts may better collaborate and meet
the demands of end users.
Figure 2. Classification of (A) main motivators behind system 2. Methods
selection, (B) reasons that constrain 3D printing, and (C) most
important features considered for the success of a printed part with A questionnaire covering current affiliations, expertise,
0 being not at all and 5 being very significantly. AM use, positioning, and vision (Questionnaire provided

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