Kamio et al.
3D Printing in Medicine (2018) 4:6
https://doi.org/10.1186/s41205-018-0028-5
RESEARCH Open Access
Utilizing a low-cost desktop 3D printer
to develop a “one-stop 3D printing lab”
for oral and maxillofacial surgery and
dentistry fields
Takashi Kamio1* , Kamichika Hayashi1, Takeshi Onda1, Takashi Takaki1, Takahiko Shibahara1, Takashi Yakushiji2,
Takeo Shibui3 and Hiroshi Kato4
Abstract
Background: In the oral and maxillofacial surgery and dentistry fields, the use of three-dimensional (3D) patient-
specific organ models is increasing, which has increased the cost of obtaining them. We developed an environment in
our facility in which we can design, fabricate, and use 3D models called the “One-stop 3D printing lab”. The lab made it
possible to quickly and inexpensively produce the 3D models that are indispensable for oral and maxillofacial surgery.
We report our 3D model fabrication environment after determining the dimensional accuracy of the models with
different laminating pitches (; layer thickness) after fabricating over 300 3D models. Considerations were made for
further reducing modeling cost and model print time. MDCT imaging was performed using a dry human mandible,
and 3D CAD data were generated from the DICOM image data. 3D models were fabricated with a fused deposition
modeling (FDM) 3D printer MF-2000 (MUTOH) with a laminating pitch of 0.2 mm, 0.3 mm, 0.4 mm, or 0.5 mm. Each 3D
model was then subjected to reverse scanning to evaluate the modeling conditions and deformation during
modeling. For the 3D image processing system, Volume Extractor 3.0 (i-Plants Systems) and POLYGONALmeister V2
(UEL) were used. For the comparative evaluation of CAD data, spGauge 2014.1 (Armonicos) was used.
Results: As the laminating pitch increased, the weight of the 3D model, model print time, and material cost decreased,
and no significant reduction in geometric accuracy was observed.
Conclusions: The amount of modeling material used and preparation cost were reduced by increasing the laminating
pitch. The “One-stop 3D printing lab” made it possible to produce 3D models daily. The use of 3D models in the oral
and maxillofacial surgery and dentistry fields will likely increase, and we expect that low-cost FDM 3D printers that can
produce low-cost 3D models will play a significant role.
Keywords: 3D printing, FDM 3D printer, Oral and maxillofacial surgery, Patient-specific, Accuracy, Education, Training
* Correspondence: kamio@tdc.ac.jp
1
Department of Oral and Maxillofacial Surgery, Tokyo Dental College, 1-2-2
Masago, Mihama-ku, Chiba 261-8502, Japan
Full list of author information is available at the end of the article
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made.
Kamio et al. 3D Printing in Medicine (2018) 4:6 Page 2 of 7
Background
Three-dimensional (3D) patient-specific organ models
made with 3D printing technology are utilized in various
fields [1–4]. In the oral and maxillofacial surgery and den-
tistry fields, 3D models of hard tissues such as teeth and
bones are being utilized for medical education training,
explanation to the patient, operation planning, and simu-
lated surgery using real surgical instruments [5–8]. The
increased use of 3D models has directly led to an increase
in the cost of obtaining them. Reducing the cost of obtain-
ing 3D models is now one of the major concerns. By gen-
eralizing the hardware and software surrounding 3D
printing technology [9, 10], a desktop fused deposition
modeling (FDM) 3D printer which is extremely inexpen-
sive compared with industrial 3D printers, we created an
environment for enabling design, fabrication, and the use
of patient-specific 3D models in our facility entitled the
“One-stop 3D printing lab”. 3D models were produced
quickly and the cost burden was greatly reduced. The
laminating pitch (layer thickness) and fill density (infill
density) control the amount of modeling material used.
While it is expected that an increase in laminating pitch
will lead to a reduction in the modeling cost, there is con-
cern that the precision will be lowered. Fig. 1 The FDM 3D printer, Value3D MagiX MF-2000
In this study, we evaluated the dimensional accuracy of
3D models fabricated with different laminating pitches,
aiming for a further reduction of modeling costs. In same parameters: 120 kV tube voltage, 110 mAs,
addition, based on our experience of fabricating over 300 0.6 mm slice thickness, and 128 mm FOV.
3D models, we report on the “One-stop 3D printing lab”
and investigate current problems and future prospects for
further utilization of low-cost FDM 3D printers. Software and 3D printer used and evaluation procedure
The software and 3D printer used to fabricate the 3D
Methods models of the mandibular bone and the software used to
The shape error between the CAD model and the printed evaluate the accuracy were as follows:
3D object was measured to understand the printing charac-
teristics. MDCT scanning was performed on the dry human 1. Creation of 3D CAD data from DICOM image
mandibular bone, and then 3D CAD data in the STL for- data. A region of interest was established and
mat file (composed of about 100,000-point clouds) were binarization of images was performed with a
created from the DICOM image data. Medical image pro- medical imaging application (Volume Extractor 3.0,
cessing software was used to create CAD data, and a desk- i-Plants Systems, Iwate, Japan) [11] and an STL
top FDM 3D printer was used to fabricate the 3D model format data editing software (POLYGONALmeister
(Fig. 1). 3D models with laminating pitches of 0.2 mm, V2, UEL Corp. Tokyo, Japan) [12] was used for data
0.3 mm, 0.4 mm, or 0.5 mm were created from the original volume reduction without shape change.
3D mandibular bone CAD data (Figs. 2a–d and 3a). MDCT 2. 3D printing. 3D models were fabricated using an
reverse scanning of each fabricated 3D model was per- FDM 3D printer (Value3D MagiX MF-2000,
formed under the same conditions. The shape error of each MUTOH Industries Ltd., Tokyo, Japan) based on
3D model against the 3D CAD model was calculated and the 3D CAD data. All models were fabricated with
the dimensional accuracy was evaluated. PLA (polylactic acid).
3. Accuracy evaluation. To evaluate the differential
MDCT scanner and scanning parameters image processing between the 3D CAD data and
The dry human mandibular bone was scanned and all the printed model and acquire a shape error
fabricated 3D models were reverse scanned with a (difference value), a 3D evaluation software
64-slice MDCT (Somatom Definition AS64, Siemens, (SpGauge 2014.1, Armonicos Co., Ltd., Shizuoka,
Erlangen, Germany) with the following scanning with Japan) was used.
Kamio et al. 3D Printing in Medicine (2018) 4:6 Page 3 of 7
Fig. 2 3D models with laminating pitches of 0.2 mm (a), 0.3 mm (b), 0.4 mm (c), and 0.5 mm (d)
For all comparisons, the 3D evaluation software rendered test. If the equal variance was found, a one-way analysis of
positive and negative discrepancies, which are viewed by variance was used. If no equal variance was found, the
means of a color-mapping. The color-mapping of the part Kruskal–Wallis test was employed. Comparisons within
comparisons were visually inspected to ascertain the spe- each data and among data were carried out in this way. A
cific regions of shape error (Fig. 3a–e). Evaluation of shape value of P < 0.05 was regarded as statistically significant.
error (signed and unsigned differences) was carried out ac- An open-source statistical analysis program, “R Ver3.5.0”
cording to the method of Treesh et al. [13]. Each 3D CAD was used for the statistical analysis in this study [14].
data was compared with the reference 3D CAD data using
a best-fit registration protocol with the 3D evaluation soft- Results
ware. Each shape error (signed and unsigned differences) The results are shown in Table 1 and graphically in
included median, interquartile range, and minimum and Figs. 3b, to e, 4a and b. The mean absolute shape errors
maximum values and were recorded in millimeters. of the laminating pitches of 0.2 mm, 0.3 mm, 0.4 mm,
and 0.5 mm were 0.36 mm, 0.36 mm, 0.35 mm, and
Statistical analysis 0.35 mm, respectively. In the visualization of the shape
For evaluation of shape error between means, the data error of each 3D CAD model, it is recognized that slight
were first checked as to equal variance using the Bartlett changes in the dimension occurred because of the own
Fig. 3 Visualization of shape error (signed differences) for each 3D CAD model. Warm color shows expansion rather than reference 3D CAD data,
cold color shows shrinkage. a Reference 3D CAD data. b–e Slight changes in dimension were considered to be due to its own weight (arrowheads)
Kamio et al. 3D Printing in Medicine (2018) 4:6 Page 4 of 7
Table 1 Outline of each fabricated 3D model and shape error time and reduction of cost. In recent years, 3D printers
evaluation with reference 3D CAD data ranging from high-end printers for industrial use to
Laminating pitch 0.2 mm 0.3 mm 0.4 mm 0.5 mm low-end printers for personal use have appeared on the
Model print time 4 h37 m 3 h13 m 2 h33 m 2 h17 m market. The biggest advantage of using the FDM 3D
3D model weight 51 g 50 g 49 g 48 g printer is that the purchase price of the equipment is
low, maintenance costs are minimal, commonly used
Comparison with 3D CAD data
material is easy to obtain and is relatively inexpensive.
Mean absolute shape error 0.36 0.36 0.35 0.35
Therefore, it is possible to minimize the cost of obtain-
(mm)
ing 3D models. Many of our fabricated 300 or more 3D
Minimum shape error (mm) −3.83 −3.83 − 3.78 −3.93
models are PLA models with a laminating pitch of
Maximum shape error (mm) 3.47 2.99 3.94 4.07 0.3 mm and a fill density of 50%. We think that this set-
Standard deviation 0.53 0.53 0.56 0.58 ting has a good balance with the anatomical reproduci-
bility we want, cost, and model print time. Models
weight of the model. In particular, the tendency was fabricated with PLA have high affinity with dental in-
found in the region of the lower edge and mandibular struments and good technical workability, create a cut-
angles. As the laminating pitch increased, no significant ting feeling similar to actual bone, and can be easily
reduction in geometric accuracy was observed. used to perform the surgical simulation. In addition, it is
easy to fabricate a plurality of models according to the
Discussion purpose because of its low modeling cost. The disadvan-
Despite the expense, many facilities outsource their 3D tages are the extrusion head of the printer must con-
modeling to external companies because of the work tinue moving, or material bumps up and depending on
and time required for their creation. If inexpensively fab- the form of the 3D models, we often experience difficul-
ricating medical 3D models were to become possible, ties in laminating. As can be seen from this result, when
more needs could likely be met internally. The costs of distortion is expected when fabricating 3D models, in
the desktop 3D printer and the modeling materials are consideration of modeling direction and installation of
lower than those of professional 3D printers for indus- support structures, in order to reduce deformation dur-
trial use. To promote the spread of 3D printers in the ing the 3D CAD design stage (Fig. 5a and b).
oral and maxillofacial surgery and dentistry fields, it is
essential to accumulate knowledge about the modeling “One-stop 3D printing lab” for oral and maxillofacial
characteristics of 3D printers. surgery and dentistry fields
The “One-stop 3D printing lab” in imitation of the term
Experience using FDM 3D printers “One stop shop” that is a business or office where multiple
The results of this study show the increase in the lamin- services are offered, is an environment that can complete
ation pitch means that the amount of filament to be everything from design to fabricating in our facility. One
used is reduced, resulting in shortening of model print of the merits of the one-stop fabrication lab is that it is
Fig. 4 a Signed shape error of each 3D CAD model. The solid black line represents median value. Top of the box (upper hinge) represents 75th
percentile, and bottom of the box (lower hinge) represents 25th percentile. Whiskers represent maximum and minimum values. b Absolute unsigned
shape error of each 3D CAD model. The solid black line represents median value. Top of the box (upper hinge) represents 75thpercentile, and bottom
of the box (lower hinge) represents 25th percentile. Whiskers represent maximum and minimum values
Kamio et al. 3D Printing in Medicine (2018) 4:6 Page 5 of 7
Fig. 5 Structures fabricated as support materials (arrowheads). a To increase the contact area with the heating table of 3D printer, a plate-like
support was installed. b To prevent deformation due to its own weight, a columnar support was installed
possible to fabricate the model while communicating with disease states in individual patients to be modeled, it is ne-
the surgeon to determine which parts are critical in the cessary to first understand the physical properties of the
3D model. Figure 6a–g show our 3D modeling cases. Al- model, understand modality, master the software oper-
though the desktop/personal FDM 3D printer is often ation, and understand the dissections and readings. When
classified as low-end, it may be able to meet more expec- we first began, 3D model creation was not quick and easy,
tations and allow for new developments in the oral and it took significant time and effort to reduce the labor re-
maxillofacial surgery and dentistry fields. However, even if quired and the number of processes in the flow from 3D
the desktop/personal FDM 3D printer is introduced, it CAD data construction to model output. Accumulation of
cannot be used immediately. To reproduce the different know-how was a necessary part of the process.
Fig. 6 Fabricated PLA 3D models used clinically with a laminating pitch of 0.3 mm and a fill density of 50%. a Precise reproduction of cystic
lesions and tooth roots in the maxilla. b Used in pre-vending of reconstruction plate. c Used for preoperative evaluation of secondary
reconstruction of the mandible. d Patient-specific 3D jaw bone model of a patient with a jaw deformity. e Model embodies the amount of
maxillary movement and direction in Le Fort I osteotomy (white-arrow) and bone trimming of mandibular ramus (arrowhead). f Confirmation of
interferences between mandibular proximal and distal segments for the mandibular setback in sagittal split ramus osteotomy (arrow). g Fixation
plates in mandibular advancement
Kamio et al. 3D Printing in Medicine (2018) 4:6 Page 6 of 7
To fabricate highly accurate 3D models, it is necessary to operate, it is difficult to say easily. Furthermore, utiliz-
to understand the modeling characteristics of the 3D ing 3D optical devices without metal artifacts is consid-
printer used. There are many control parameters that ered to be a potential solution to this challenge [13].
need to be set in the 3D printer software. A trial and
error process was required until a stable print protocol Conclusions
could be constructed. The FDM 3D printer melts mate- The results obtained using the FDM 3D printer suggested
rials by heat and laminates layers from the bottom. that adjusting the laminating pitch may lead to further re-
Therefore, the object may tilt under its own weight de- duction of model print time and cost. It was possible to
pending on the 3D shape being fabricated, and it may quickly print a 3D model while greatly reducing the cost
fall off the forming table in the middle of modeling. This burden using the low-cost desktop 3D printer in the
was rectified by adjusting the parameters of the 3D “One-stop 3D printing lab.”
printer control software and developing creative struc-
Abbreviations
tural solutions during the 3D CAD data creation. 3D: Three-dimensional; CAD: Computer-aided design; CBCT: Limited cone-beam
CT; CT: Computed tomography; DICOM: Digital Imaging and COmmunications
Future prospects in Medicine (file format); FDM: Fused deposition modeling; FOV: Field of view;
MDCT: Multidetector-row computed tomography; PLA: Polylactic acid;
Surgical simulations using a 3D model have been per- STL: Stereolithography (file format)
formed [15–18]. Mavili et al. posited that the limitations
of this technology are manufacturing time and cost [16], Acknowledgements
We thank Melissa Gibbons, PhD, from Edanz Group (www.edanzediting.com/ac)
but the desktop FDM 3D printer can solve these problems
for editing a draft of this manuscript.
[18]. In addition to major surgery, such as bone dissection
and orthognathic surgery, 3D models are also useful for Availability of data and materials
treatment planning and simulation of minor surgery such Readers interested in the data should contact the authors.
as surgical endodontic treatment [19]. It has been re- Authors’ contributions
ported that utilization of a low-end 3D printer advances TK conceived the study and drafted study outline. TT and HK collected the
the field of dental treatment, and endodontic management requisite data. TK, YK, TS, and TT implemented software and carried out the
analyses. TK and HK interpreted the data and drafted the manuscript. All authors
in particular [18–21]. Dramatic evolution of 3D printing have read and have given final approval of the version to be published and all
technology is expected to further aid the dentistry field. authors read and approved the final manuscript.
To utilize 3D printers in the clinical practice of oral and
Competing interests
maxillofacial surgery and dentistry, it is necessary to con- The authors declare that they have no competing interests.
sider the stomatognathic field, a subspecialty of the oral
and maxillofacial field. The target organs in oral and max-
Publisher’s Note
illofacial surgery are the teeth and jawbones, which are Springer Nature remains neutral with regard to jurisdictional claims in published
relatively small compared with other organs. Therefore, maps and institutional affiliations.
higher spatial resolution modalities will be necessary to
Author details
obtain detailed information. In addition, the response of 1
Department of Oral and Maxillofacial Surgery, Tokyo Dental College, 1-2-2
metal artifacts to CT imaging, which are often encoun- Masago, Mihama-ku, Chiba 261-8502, Japan. 2Oral and Maxillofacial Surgery,
National Hospital Organization Takasaki General Medical Center, 32
tered in daily diagnostic imaging, is also a serious prob-
Takamatsu, Takasaki, Gunma 371-0829, Japan. 3Department of Oral Medicine,
lem. It is often difficult to obtain information on teeth and Oral and Maxillofacial Surgery, Tokyo Dental College Ichikawa General
alveolar crest bones because of metal artifacts and/or Hospital, 5-11-13 Sugano, Ichikawa, Chiba 271-8513, Japan. 4Department of
Endodontics, Tokyo Dental College, 1-2-2 Masago, Mihama-ku, Chiba
beam hardening, which may lead to an increase in the
261-8502, Japan.
number of image processing steps or a decrease in the ac-
curacy of the modeled objects. The CBCT which has be- Received: 20 April 2018 Accepted: 27 July 2018
come popular in recent years may be useful from the
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