Document Type : Research Paper


1 Production Engineering and Metallurgy Dept., University of Technology-Iraq, Alsina’a street, 10066 Baghdad, Iraq.

2 Mechanical Engineering Dept., Sohar University, Oman.


In medical surgery, a customized implant is often required to meet surgical requirements, especially in cases with complicated or traumatic deformities. The emerging techniques of additive manufacturing, e.g., 3D printing, may help provide a quick response to such needs, provided that a valid approach capturing required implant shape data is generated and processed to better suit 3D printing. Different materials, including biocompatible polymer and metal, may suit medical-surgical applications. In this paper, an investigation is conducted to assess 3D printing technology use as part of a full system, from capturing implant shape data to producing the customized implant. The investigation is supported by experimental studies of medical cases. The first case aimed to produce shatter-related finger distal phalanx implants, whereas the second aimed to design and reconstruct a suitable cranial implant for a patient with a left frontoparietal skull lesion. For these cases, the study has adopted a scenario based on CT scans to generate the required implant shape data; hence using DICOM format. The captured data from the two cases are processed using a developed systematic processing approach to generate the final design of the required customized implants. The designs are then converted into suitable manufacturing codes for 3D printed plastic and metal prototypes enabling the assessment of the technique utilizing the facilities of UrukTech Company in Baghdad, Iraq, and Sohar University in Oman. Results show that the developed approach, from data capture to 3D printed implants, has succeeded in addressing the need for customized implants. For instance, the accuracy of the cranial implant was confirmed dimensionally, aiding in restoring structures, appearance, and psychological stability. The design and manufacturing of custom 3D-printed bone implants represent a significant advancement in medical technology and orthopedics, provided that biocompatible materials are used. Therefore, the technique may be adopted in the near future to serve the medical surgery field. The developed approach in this study encompasses several key ideas, contributions, and significant results, including creating patient-specific bone implants by utilizing medical imaging and 3D printing. Hence, the developed approach enables the creation of complex implant geometries that otherwise would be challenging to manufacture.

Graphical Abstract


  • Bone implants were designed, reconstructed, and manufactured from patient medical imaging data.
  • Three models were manufactured at UrukTech in Baghdad and Sohar University in Oman.
  • The 3D-printed final models had a perfect fit.


Main Subjects

  1. M. Thakar, Sh. S. Parkhe, A. Jain, Khongdet Phasinam, G. Murugesan, Randy Joy Magno Ventayen, 3d Printing: Basic principles and applications, Mater. Today Proc., 51 (2022) 842-849.
  2. Metal 3D Printing: A Definitive Guide (2021), Metal 3D Printing: A Definitive Guide (2021) - AMFG
  3. Šljivić, Milan, et al., 3D printing and 3D bioprinting to use for medical applications, Contemp. Mater (2019) 82-92.
  4. Wiberg, J. Persson, and J. Ölvander. Design for additive manufacturing–a review of available design methods and software, Rapid Prototyping J., 25 (2019) .
  5. Leal, André Giacomelli, et al., Clinical Applications of Additive Manufacturing Models in Neurosurgery: a Systematic Review, Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery, 40 (2021) e349-e360.
  6. Vignesh, G. Ranjith Kumar, M. Sathishkumar, M. Manikandan, G. Rajyalakshmi, R. Ramanujam & N. Arivazhagan., Development of biomedical implants through additive manufacturing: A review, J. Mater. Eng. Perform., 30 (2021) 4735-4744.
  7. Salmi, Additive manufacturing processes in medical applications, Mater., 14 (2021) 191.
  8. Fricia, F. Nicolosi, M. Ganau, H. Cebula, J. Todeschi , M. des Neiges Santin, B. Nannavecchia, C. Morselli, S. Chibbaro, Cranioplasty with porous hydroxyapatite custom-made bone flap: Results from a multicenter study enrolling 149 patients over 15 years, World Neurosurg, 121 (2019) 160-165.
  9. Moiduddin et al., Fabrication and analysis of a Ti6Al4V implant for cranial restoration, Applied Sciences 9.12 (2019) 2513.
  10. I. Khalid et al., Materials used in cranial reconstruction: a systematic review and meta-analysis, World Neurosurgery 164 (2022) e945-e963.
  11. Abdelaal et al., 411 Additive manufacturing of custom-made hip implants, The Proceedings of Manufacturing Systems Division Conference 2013. The Japan Society of Mechanical Engineers, 2013.
  12. J. Janssen et al., Quantitative 3-dimensional CT analyses of fractures of the middle phalanx base, HAND, 10 (2015) 210-214.
  13. Palmquist et al., Complex geometry and integrated macro-porosity: Clinical applications of electron beam melting to fabricate bespoke bone-anchored implants,   Acta Biomater., 156 (2022) 125-145.
  14. Sudario, Gabriel, Alisa Wray, and Robin Janson., Make and Break Your Own Hand: A Review of Hand Anatomy and Common Injuries, J. Educ. Teach. Emerg. Med., 5 (2020)
  15. Kim, Cuc Nguyen Thi, et al., Design and mechanical evaluation of a large cranial implant and fixation parts, Interdiscip. Neurosurg., 31 (2023) 101676.
  16. M M. Marreiros et al., Custom implant design for large cranial defects, Int. J. Comput. Assisted Radiol. Surg., 11 (2016) 2217-2230.
  17. Castelan et al., Design of custom-made cranial implant using 3D technologies and incremental sheet forming process, Inegi-Feup, Porto (2015) 26-30.
  18. Ab. Nasr et al., Developing a methodology for analysis and manufacturing of proximal interphalangeal (PIP) joint using rapid prototyping technique,  Rapid Prototyp. J., (2015).
  19. Beltrami, Custom 3D-printed finger proximal phalanx as salvage of limb function after aggressive recurrence of giant cell tumour, Case Rep., 2018 (2018) bcr-2018.
  20. Beltrán-Fernández, Juan Alfonso, et al., Manufacturing of a Human’s Hand Prosthesis with Electronic Movable Phalanges Based on a CT Image: An Amputation Case, Eng. Design Appl. II. Springer, Cham., 113 (2020) 355-396.
  21. Janson , 3D printable hand bone anatomy model. Accessed April 4, 2019.
  22. Mishra et al., Virtual preoperative planning and 3D printing are valuable for the management of complex orthopaedic trauma., Chinese J. Traumatol., 22 (2019) 350-355.
  23. Durand‐Hill, Matthieu, et al., Can custom 3D printed implants successfully reconstruct massive acetabular defects? A 3D‐CT assessment, J. Orthop. Res., 38 (2020) 2640-2648.
  24. Benady et al., A review of 3D printing in orthopedic oncology, J. 3D print. med., 6 (2022).
  25. Shen, Zhen, et al., The process of 3D printed skull models for anatomy education, Comput. Assist. Surg., 24.sup1 (2019) 121-130.
  26. S. Food and Drug Administration, 3D Printing of Medical Devices, last modified March 26, 2020,
  27. SME, Additive Manufacturing Glossary, accessed July 17, 2020,
  28. Zolfagharian et al., Patient-specific 3D-printed Splint for Mallet Finger Injury.,  Int. J. Bioprinting, 6 (2020).
  29. Cuellar, Juan Sebastian, et al., Design of a 3D-printed hand prosthesis featuring articulated bio-inspired fingers, Proceedings of the Institution of Mechanical Engineers, Part H: J. Eng. Med., 235 (2021) 336-345.
  30. Zamborsky, M. Kilian, P.Jacko, M. Bernadic, R. Hudak, Perspectives of 3D printing technology in orthopaedic surgery. Bratisl. Lek. Listy., 120 (2019) 498-504.
  31. Zheng, J.  Huang , J.  Lin, Yang D, Xu T, Chen D, et al, 3D Bioprinting in Orthopedics Translational Research, J. Biomater Sci. Polym. Ed., 30 (2019) 1172-87.
  32. Feng, WW. Cai, Zhou PE, Luo JX, He HF, Peng LF. Design and Implementation of a Three-Dimensional Model for Medical Image of Bone Defect, IOP Conf. Ser. Mater. Sci. Eng., 563 (2019) 042004.
  33. Bedo, Munteanu SI, Popescu I, Chiriac A, Pop MA, Milosan I, et al., Method For Translating 3D Bone Defects Into Personalized Implants Made by Additive Manufacturing. Mater. Today Proc. 19 (2019) 1032-1040.
  34. A. Zadpoor, Mechanical Performance of Additively Manufactured Meta-Biomaterials. Acta Biomater., 85 (2019) 41-59.
  35. A. Zadpoor, Meta-biomaterials, Biomater. Sci., 8 (2020) 18-38. Back to cited text no. 24
  36. Haleem, M. Javaid, RH. Khan, R. Suman, 3D Printing Applications in Bone Tissue Engineering. J. Clin. Orthop Trauma 11 (2020) 118-124.
  37. Policicchio, G. Casu, G. Dipellegrini, A. Doda, G. Muggianu, &R. Boccaletti, (2020). Comparison of two different titanium cranioplasty methods: Custom-made titanium prostheses versus precurved titanium mesh. Surg. Neurol. Int.,
  38. Fiaschi, M. Pavanello, A. Imperato,V. Dallolio, A. Accogli, V. Capra et al., Surgical results of cranioplasty with a polymethylmethacrylate customized cranial implant in pediatric patients: A single-center experience. J. Neurosurg Pediatr, 17 (2016) 705-710.
  39. Honeybul, DA. Morrison, KM. Ho, CR. Lind, E. Geelhoed, A randomized controlled trial comparing autologous cranioplasty with custom-made titanium cranioplasty. J. Neurosurg, 126 (2017) 81-90.
  40. C. Hieu et al., Design For Medical Rapid Prototyping Of Cranioplasty Implants, Rapid Prototyping J., 9 (2003) 175-186.