Mumbai: A team of Indian plastic surgeons hopes to soon operate on and restore to its original shape the deformed skull of a three-year-old girl—with a bit of help from a three-dimensional (3D) printer.

The child suffers from craniosynostosis, a condition in which joints between skull bones fuse in an abnormal sequence to alter the normal shape of the skull, restricting brain growth, affecting the sense of smell, and in extreme cases, affecting the nerves or even leading to mental retardation.

The operation will be performed by surgeons at the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) in Puducherry.

“We would have completed the operation by now, but the girl has contracted a respiratory infection, because of which we cannot give her anaesthesia," explained Dinesh Kumar S., associate professor at JIPMER, who will be leading the team.

Typically, plastic surgeons rely on two-dimensional (2D) images to restore the face or skull.

“This implies that we have to do most of the visualization in the mind, which takes a lot of experience," said Kumar.

This time, though, Kumar and his team will have access to an exact sterilized replica of the child’s skull made on a 3D printer.

“The replica will ensure that not many things are left to chance on the operating table. With the replica of the child’s skull, we know where the holes in the skull are, and it will help us cut the bones with precision to get optimal results," said Kumar.

To get the replica of the child’s skull, Kumar had to convert the CT (computed tomography) scan data into a 3D file and send it to a Mumbai-based 3D printer maker, Divide By Zero Technologies.

“We used our Accucraft i250+ 3D printer to extract the replica," said Swapnil Sansare, chief executive of Divide By Zero. “It took us nine hours to print the skull."

The 28-year-old entrepreneur manufactures the 3D printers that sell for anywhere between 90,000 and 1.4 lakh. He pointed out that since most 3D printers in India use thermoplastic as the input material, “the layers remain visible".

Sansare plans to use selective laser sintering (SLS) 3D printers. SLS is an additive manufacturing technique that uses a laser as the power source to sinter powdered material, which is typically metal. Sintering is the process of forming a solid mass of material by heat and pressure, without fully melting the material.

“SLS yields better results and you can get an almost life-like replica," said Sansare.

3D printers typically fabricate complex objects by depositing materials, layer by layer.

The most common household 3D printing process involves a “print head", which allows for any material to be extruded or squirted through a nozzle.

Others use a laser beam or glue to selectively fuse powdered plastic, metal or ceramic in layers.

A user selects an electronic design blueprint and loads the raw materials into the 3D printer. The machine does the rest. A solid 3D object is printed using a 3D printer directly using CAD (computer-aided design) data.

The additive processes include SLS, direct metal laser sintering, fused deposition modelling, stereolithography and laminated object manufacturing. All of them differ in the way layers are deposited to create the 3D objects.

While a 3D printed replica of the skull may be an advancement of 3D printing in India, the world is moving ahead. Fabbers, or personal manufacturing machines—3D printers come under this category—now not only make jewellery and toothbrushes, but also football boots, racing-car parts, custom-designed cakes, guns, planes and even houses.

The application of 3D printing technology is perceptible in surgical fields, and has been used to prepare models based on imaging design to perform mock procedures for complicated surgeries, said surgeon Kumar, adding that 3D printing has also been used “to prepare custom-made prosthesis and in dentistry to obtain quick and accurate dental models".

Globally, though, the advances in 3D printing are also raising ethical issues.

According to a 29 January report by research firm Gartner Inc., 3D printing of non-living medical devices such as prosthetic limbs, combined with a burgeoning population and insufficient levels of healthcare in emerging markets, is likely to cause an explosion in demand for the technology by 2015.

However, the technology of 3D bioprinting, or the medical application of 3D printing to produce living tissue and organs, is advancing so quickly that it will spark a major ethical debate on its use by 2016, the report said.

In India, the 3D printer market is nascent, according to 3D printer makers who also provide 3D printing services and DIY (do-it-yourself) kits that can be merged with imported products and labelled “Made in India".

Over 14,800 units of 3D printers will be shipped in 2017 in emerging Asia-Pacific markets, according to a 10 October 2013 report by Gartner.

3D printer makers in India include young entrepreneurs like 15-year-old Angad Daryani, who plans to introduce his SharkBot range of printers for just around 20,000; 22-year-old Mumbai-based Karan Chaphekar, who has been building and selling machines based on the open-source RepRap concept since 2010 till he set up his own company, KCbots, in 2013; Nitin Gandhi, the 23-year-old founder of Chandigarh-based LBD Makers; and 30-year-old Arvind Nadig, co-founder of Bangalore-based Brahma3.

There are bigger industrial-use 3D printer makers, too, like Stratasys Ltd (Altem Technologies Pvt. Ltd are its resellers in India), whose 3D printers could cost up to 3 crore, depending on the volume of manufacturing to be done, and the quality of material provided.

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