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UV source
lens
X-Y stage
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X-Y stage
Glass
Resin
Mirror
Mirror
Oil
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Telescope
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fs laser
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Fig. 4 Stereolithography (SLA) processes; (a) SLA system with dynamic light beam, (b) constrain- surface system, (c) free surface-system, (d) typical two photon polymerization(2PP) sys­tem [112]
Compared with other AM techniques, SLA-fabricated constructs have lower mechanical strength and costly manufacturing procedure and may require more post­fabricating measures [114]. Uncured resin remnants that may be left unwiped from the structure can compromise their biocompatibility [115]. Given that SLA photo­curable materials are not commonly degradable once polymerized, such constructs may not be the most prime candidates in terms of tissue engineering. Designing sup­porting structures for SLA-manufactured 3D constructs must also be accounted for.
5.2 Employed Materials
The rst employed materials for SLA were based on acrylics and epoxies. Thereafter, poly(propylene fumarate) (PPF) [116], trimethylene carbonate (TMC) copolymers [117], and PEG [118] scaffolds were fabricated. Biodegradable constructs com­prised of poly(,-lactide) resins, poly(,-lactide-co-Ɛ-caprolactone) resins, gela­tin, or PCL methacrylate were also employed [119]. Vinyl ester-based resins offer apt biocompatibility and allow development of medically applicable of SLA­manufactured constructs [120].
Unlike FDM, SLA enables employment of polymers, ceramics, and composite materials when the working materials’ capacity for photopolymerization is yield­ing. Composites have higher viscosity compared with polymers. This hampers their common use with FDM and perplex the fabrication procedure.
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H. S. H. Boroojeni et al.
5.3 Clinical Application
Several genioplasty cases have been performed with SLA-fabricated surgical guides. The investigators suggested that SLA-fabricated guides had signicantly improved surgical accuracy [121, 122]. The studies wherein SLA-fabricated genio- plasty guides were used had somewhat the same trajectory. At the designing stages, accurate osteotomy positions and xating screw holes that were to be placed, deter­mined the predened plan of guides. During the operation, once segmentations were made, the repositioning guides were xated onto the mandible. Thereafter, the chin is shifted in accordance to the guide holes and rigidly xated. The cutting guides may be secured via occlusal forces or xation screws. Although there remain certain contentions regarding whether prefabricated guides may reduce the duration of genioplasty surgery, no varied incidence of complications has been reported fol­lowing their use [123].
Nondegradable hydroxy apatite implants for cranial bone contouring or func­tional bone replacement purposes have been fabricated with SLA [124, 125]. Once a HA/photosensitive resin implant is fabricated, the polymeric composition is heat­eradicated and the remnant pure HA sinters. A dimensional accuracy of beyond
0.4mm has been reported with this method [125].
5.4 Digital Light Processing
While the laser beam shifts in rows to form each layer in the traditional SLA tech­nology, the addition of digital micromirror devices (DMD) to SLA systems has altered their approach into digital light processing (DLP) [126, 127]. In DLP, the patterns of each layer are formed upon a single projection. Numerous reective shells are oriented to direct the projection rays onto surface of photosensitive resin with regard to the predesigned patterns. The DLP systems are capable of more ef­cient and rapid manufacturing [128].
6 Selective Laser Sintering (SLS)
With selective laser sintering (SLS) or selective laser melting (SLM), scaffolds are fabricated through prespecied fusion of material powder. A laser beam emits laser in order to precisely melt/sinter the powders and fuse them. Material powder tem­perature is increased beyond their glass transition point [129]. The pathway, in which the laser is emitted, is based upon a STL le input [130]. Upon fusion of each layer, a platform is pushed downward in order for new unexposed powders to be brought above using a mechanical roller. The procedure continues layer by layer until the predesigned object is attained. The irradiated laser fuses the particles, within each individual layer and between overlying layers, as well, to provide an overall structural stability. The unexposed powders remain intact throughout the procedure, leading to adequate support and stability of the printing product. CO2
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Fig. 5 Overview of Fused Deposition Modeling (FDM), Stereolithography (SLA), and Selective Laser Sintering (SLS) methods [131]
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and neodymium-doped yttrium aluminum garnet (Nd:YAG) are the prevalently employed laser types with the SLS trajectory [130] (Fig.5).
Four prominent binding mechanisms exist for SLS and SLM, including solid sintering, liquid sintering, partial melting, and melting [132]. Solid sintering and liquid sintering are mainly used for fabrication of ceramic and combined ceramic­binder constructs.
The pace of laser beam dictates scaffold porosity, powder layer thickness, laser power, and the power transferred to material powders [133], indirectly impacting the extent to which powders are fused. When no fusion has occurred, the highest porosity rate is achieved, whereas thorough melting of adjacent powders, for instance, in SLM, renders the least rates of porosity [134].
6.1 Prominent Features
SLS holds the advantage of an obviated necessity of printing supporting structures, over SLA.This has been due to the stability that nonirradiated powders provide for the gradually printed structure within them. Absence of supporting structures results in skipping the post-fabrication trimming phase and leaves the removal of unaf­fected powders as the only post-fabrication manipulation [135]. However, SLS offers compromised accuracy in comparison to SLA while still being among precise
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AM methods with a relatively more control over microstructural properties of the fabricated constructs [17, 114]. Compared with SLS, SLM provides higher func­tional accuracy [136]. SLS is weighed down due to difcult removal of powders and high manufacturing temperatures. Popov etal. [137] proposed that through employ­ing polymer particles coated with biocompatible carbon, the melting phenomena can be conned to the outer coat solely, and the inner material is left untreated. Their modications of SLS, known as selective laser sintering by surface, are can­didate for developing growth factor-containing constructs.
H. S. H. Boroojeni et al.
6.2 Employed Materials
SLS systems can employ polymers, ceramics, metals, and composites for scaffold fabrication. Of note, polymers and ceramics may evoke diverse reactions within identical SLS setups. This has resulted in the necessity for production of polymer­ceramic composite granules prior to fabrication of composite scaffolds with SLS printing [135]. For polymeric scaffolds, the printing environment is heated until the temperature reaches just below the polymer’s melting point, and the reservoir cham­ber is packed with nitrogen and argon gases [13]. PCL, PLA, PHBV, and PEEK have been employed for scaffold fabrication with SLS [113]. Ceramic HA, TCP, and BG scaffolds have also been attained [138].
6.3 Clinical Application
The appropriate accuracy of SLS has made it a prime candidate for fabrication of surgical models for training and treatment planning [25]. However, its time­consuming procedure and untting haptic feedback bear inconveniences [25]. Considering that SLS and SLM offer apt accuracy and compatibility in terms of manipulating metallic materials, their most common clinical application, compared to other AM methods, is justiable. Titanium implants made via SLM have been implanted for reconstructive purposes in a patient undergone complete maxillec­tomy, rhinectomy, and resection of upper lip and cheeks [139].
Three-dimensional printed titanium implants have been implanted in the orbital wall [140, 141], cranial [142], and mandibular [143] regions for reconstructive pur­poses. Presurgically prepared titanium meshes can be used in mandibular recon­struction. Site- and patient-specically printed membranes contribute to decreased operation time and the number of required xating screws [144]. Titanium meshes are also utilized in prosthetically driven bone regeneration treatment modalities.
Through three-dimensional printing, dental implants can also be fabricated. Accordingly, Tunchel etal. [145] fabricated a titanium implant, with a 94.5% of success rate over 3years of follow-up. SLM-fabricated dental implants with gradi­ent porous structures in the desired axis can also be produced for simultaneous improved osteointegration and preserved structural consistency.
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Bioresorbable implants have been developed using SLS.Rasperini etal. [146] were rst to fabricate patient-specic periodontal implants composed of PCL-HA.Their patient had large labial soft and hard tissue defects, which showed feasible regenerative outcomes over 2years of follow-up.
6.4 Direct Metal Laser Sintering (DMLS)
While with SLM, fusion is attained through thorough melting of the material pow­der, DMLS aims to heat metal powders up to the point wherein particles are fused. Single element metals, including titanium, are worked with SLM. Unlike SLM, DMLS allows working with metal alloys, leading to a potentially more exible metallic material selection [147]. With DMLS, structural support during the proce­dure is warranted, which can be attained through supporting structures.
6.5 Electron Beam Melting (EBM)
In EBM, upon spreading of the metal powders on a preheated platform, a concen­trated electron beam fuses the metallic powders. Tungsten laments are most com­monly selected as electron-emitting compartments [148]. The fabricated constructs are solidied via subsequent cooling. EBM provides higher printing speeds com­pared with SLM and DMLS.This is consequent to the higher energy density that is provided by electron beams compared to lasers [147]. With EBM, conductive met­als are solely employed. In order to avert gas contamination-related complications, EBM is often conducted under vacuums [148].
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