Kamio et al. 3D Printing in Medicine (2018) 4:6
https://doi.org/10.1186/s41205-018-0028-5

RESEARCH

Open AccessUtilizing a low-cost desktop 3D printerto develop a “one-stop 3D printing lab”
for oral and maxillofacial surgery anddentistry 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) patientspecific 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 withdifferent laminating pitches (; layer thickness) after fabricating over 300 3D models. Considerations were made forfurther 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 3Dmodel was then subjected to reverse scanning to evaluate the modeling conditions and deformation duringmodeling. 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, andreproduction 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

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 dentistry fields, 3D models of hard tissues such as teeth andbones are being utilized for medical education training,
explanation to the patient, operation planning, and simulated surgery using real surgical instruments [5–8]. The
increased use of 3D models has directly led to an increasein the cost of obtaining them. Reducing the cost of obtaining 3D models is now one of the major concerns. By generalizing the hardware and software surrounding 3D
printing technology [9, 10], a desktop fused deposition
modeling (FDM) 3D printer which is extremely inexpensive compared with industrial 3D printers, we created anenvironment for enabling design, fabrication, and the useof 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 concern that the precision will be lowered.
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
addition, based on our experience of fabricating over 300
3D models, we report on the “One-stop 3D printing lab”
and investigate current problems and future prospects forfurther utilization of low-cost FDM 3D printers.
Methods
The shape error between the CAD model and the printed
3D object was measured to understand the printing characteristics. MDCT scanning was performed on the dry humanmandibular bone, and then 3D CAD data in the STL format file (composed of about 100,000-point clouds) werecreated from the DICOM image data. Medical image processing software was used to create CAD data, and a desktop FDM 3D printer was used to fabricate the 3D model(Fig. 1). 3D models with laminating pitches of 0.2 mm,
0.3 mm, 0.4 mm, or 0.5 mm were created from the original
3D mandibular bone CAD data (Figs. 2a–d and 3a). MDCT
reverse scanning of each fabricated 3D model was performed under the same conditions. The shape error of each
3D model against the 3D CAD model was calculated andthe dimensional accuracy was evaluated.
MDCT scanner and scanning parameters

The dry human mandibular bone was scanned and all
fabricated 3D models were reverse scanned with a
64-slice MDCT (Somatom Definition AS64, Siemens,
Erlangen, Germany) with the following scanning with

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Fig. 1 The FDM 3D printer, Value3D MagiX MF-2000

same parameters: 120 kV tube voltage, 110 mAs,
0.6 mm slice thickness, and 128 mm FOV.

Software and 3D printer used and evaluation procedure

The software and 3D printer used to fabricate the 3Dmodels of the mandibular bone and the software used toevaluate the accuracy were as follows:
1. Creation of 3D CAD data from DICOM image
data. A region of interest was established andbinarization of images was performed with a
medical imaging application (Volume Extractor 3.0,
i-Plants Systems, Iwate, Japan) [11] and an STL
format data editing software (POLYGONALmeister
V2, UEL Corp. Tokyo, Japan) [12] was used for data
volume reduction without shape change.
2. 3D printing. 3D models were fabricated using an
FDM 3D printer (Value3D MagiX MF-2000,
MUTOH Industries Ltd., Tokyo, Japan) based on
the 3D CAD data. All models were fabricated with
PLA (polylactic acid).
3. Accuracy evaluation. To evaluate the differential
image processing between the 3D CAD data andthe printed model and acquire a shape error(difference value), a 3D evaluation software(SpGauge 2014.1, Armonicos Co., Ltd., Shizuoka,
Japan) was used.

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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
positive and negative discrepancies, which are viewed bymeans of a color-mapping. The color-mapping of the partcomparisons were visually inspected to ascertain the specific regions of shape error (Fig. 3a–e). Evaluation of shapeerror (signed and unsigned differences) was carried out according to the method of Treesh et al. [13]. Each 3D CAD
data was compared with the reference 3D CAD data using
a best-fit registration protocol with the 3D evaluation software. Each shape error (signed and unsigned differences)included median, interquartile range, and minimum andmaximum values and were recorded in millimeters.
Statistical analysis

For evaluation of shape error between means, the data
were first checked as to equal variance using the Bartlett

test. If the equal variance was found, a one-way analysis ofvariance was used. If no equal variance was found, theKruskal–Wallis test was employed. Comparisons withineach data and among data were carried out in this way. A
value of P < 0.05 was regarded as statistically significant.
An open-source statistical analysis program, “R Ver3.5.0”
was used for the statistical analysis in this study [14].

Results
The results are shown in Table 1 and graphically in
Figs. 3b, to e, 4a and b. The mean absolute shape errorsof 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, and0.35 mm, respectively. In the visualization of the shapeerror of each 3D CAD model, it is recognized that slightchanges 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)

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Table 1 Outline of each fabricated 3D model and shape error
evaluation with reference 3D CAD data
Laminating pitch

0.2 mm

0.3 mm

0.4 mm

0.5 mmModel print time

4 h37 m 3 h13 m 2 h33 m 2 h17 m

3D model weight

51 g

50 g

49 g

48 g

Mean absolute shape error
(mm)

0.36

0.36

0.35

0.35

Minimum shape error (mm)

−3.83

−3.83

− 3.78−3.93

Comparison with 3D CAD data

Maximum shape error (mm) 3.47

2.99

3.94

4.07

Standard deviation

0.53

0.56

0.58

0.53

weight of the model. In particular, the tendency was
found in the region of the lower edge and mandibular
angles. As the laminating pitch increased, no significant
reduction in geometric accuracy was observed.

Discussion
Despite the expense, many facilities outsource their 3Dmodeling to external companies because of the workand time required for their creation. If inexpensively fabricating medical 3D models were to become possible,
more needs could likely be met internally. The costs ofthe desktop 3D printer and the modeling materials arelower than those of professional 3D printers for industrial use. To promote the spread of 3D printers in theoral and maxillofacial surgery and dentistry fields, it isessential to accumulate knowledge about the modelingcharacteristics of 3D printers.
Experience using FDM 3D printers

The results of this study show the increase in the lamination pitch means that the amount of filament to be
used is reduced, resulting in shortening of model printtime and reduction of cost. In recent years, 3D printers
ranging from high-end printers for industrial use to
low-end printers for personal use have appeared on themarket. The biggest advantage of using the FDM 3Dprinter is that the purchase price of the equipment islow, maintenance costs are minimal, commonly usedmaterial is easy to obtain and is relatively inexpensive.
Therefore, it is possible to minimize the cost of obtaining 3D models. Many of our fabricated 300 or more 3Dmodels are PLA models with a laminating pitch of
0.3 mm and a fill density of 50%. We think that this setting has a good balance with the anatomical reproducibility we want, cost, and model print time. Models
fabricated with PLA have high affinity with dental instruments and good technical workability, create a cutting feeling similar to actual bone, and can be easily
used to perform the surgical simulation. In addition, it iseasy to fabricate a plurality of models according to the
purpose because of its low modeling cost. The disadvantages are the extrusion head of the printer must continue moving, or material bumps up and depending on
the form of the 3D models, we often experience difficulties in laminating. As can be seen from this result, when
distortion is expected when fabricating 3D models, inconsideration of modeling direction and installation of
support structures, in order to reduce deformation during the 3D CAD design stage (Fig. 5a and b).
“One-stop 3D printing lab” for oral and maxillofacial
surgery and dentistry fields

The “One-stop 3D printing lab” in imitation of the term“One stop shop” that is a business or office where multiple
services are offered, is an environment that can complete
everything from design to fabricating in our facility. Oneof the merits of the one-stop fabrication lab is that it isFig. 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 bottomof the box (lower hinge) represents 25th percentile. Whiskers represent maximum and minimum values

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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 withthe surgeon to determine which parts are critical in the
3D model. Figure 6a–g show our 3D modeling cases. Although the desktop/personal FDM 3D printer is often
classified as low-end, it may be able to meet more expectations and allow for new developments in the oral andmaxillofacial surgery and dentistry fields. However, even if
the desktop/personal FDM 3D printer is introduced, itcannot be used immediately. To reproduce the different

disease states in individual patients to be modeled, it is necessary to first understand the physical properties of themodel, understand modality, master the software operation, and understand the dissections and readings. When
we first began, 3D model creation was not quick and easy,
it took significant time and effort to reduce the labor required and the number of processes in the flow from 3D
CAD data construction to model output. Accumulation of
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 ofmaxillary movement and direction in Le Fort I osteotomy (white-arrow) and bone trimming of mandibular ramus (arrowhead). f Confirmation ofinterferences 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

To fabricate highly accurate 3D models, it is necessary
to understand the modeling characteristics of the 3D
printer used. There are many control parameters thatneed to be set in the 3D printer software. A trial anderror process was required until a stable print protocol
could be constructed. The FDM 3D printer melts materials by heat and laminates layers from the bottom.
Therefore, the object may tilt under its own weight depending on the 3D shape being fabricated, and it may
fall off the forming table in the middle of modeling. Thiswas rectified by adjusting the parameters of the 3D
printer control software and developing creative structural solutions during the 3D CAD data creation.
Future prospects

Surgical simulations using a 3D model have been performed [15–18]. Mavili et al. posited that the limitationsof this technology are manufacturing time and cost [16],but the desktop FDM 3D printer can solve these problems[18]. In addition to major surgery, such as bone dissection
and orthognathic surgery, 3D models are also useful fortreatment planning and simulation of minor surgery suchas surgical endodontic treatment [19]. It has been reported that utilization of a low-end 3D printer advances
the field of dental treatment, and endodontic managementin particular [18–21]. Dramatic evolution of 3D printing
technology is expected to further aid the dentistry field.
To utilize 3D printers in the clinical practice of oral andmaxillofacial surgery and dentistry, it is necessary to consider the stomatognathic field, a subspecialty of the oral
and maxillofacial field. The target organs in oral and maxillofacial surgery are the teeth and jawbones, which are
relatively small compared with other organs. Therefore,
higher spatial resolution modalities will be necessary toobtain detailed information. In addition, the response of
metal artifacts to CT imaging, which are often encountered in daily diagnostic imaging, is also a serious problem. It is often difficult to obtain information on teeth andalveolar crest bones because of metal artifacts and/or
beam hardening, which may lead to an increase in thenumber of image processing steps or a decrease in the accuracy of the modeled objects. The CBCT which has become popular in recent years may be useful from theviewpoint of higher spatial resolution and X-ray exposure[22]. If it becomes possible to obtain high-resolution data,
it will be expected to be able to fabricate more detailed 3Dmodels. However, significant metal artifacts and beamhardening are also recognized in CBCT images. Sometimes it is more than MDCT, we experienced difficulty in
3D modeling. Unfortunately, there are as yet no measuresfor preventing them. For certain dental applications, amethod using a hybrid model that the dental cast can bescanned and then aligned with the CT scan has also beendeveloped [23]. However, the current situation is difficult

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to operate, it is difficult to say easily. Furthermore, utilizing 3D optical devices without metal artifacts is considered to be a potential solution to this challenge [13].

Conclusions
The results obtained using the FDM 3D printer suggested
that adjusting the laminating pitch may lead to further reduction of model print time and cost. It was possible toquickly print a 3D model while greatly reducing the costburden using the low-cost desktop 3D printer in the“One-stop 3D printing lab.”
Abbreviations
3D: Three-dimensional; CAD: Computer-aided design; CBCT: Limited cone-beam
CT; CT: Computed tomography; DICOM: Digital Imaging and COmmunicationsin Medicine (file format); FDM: Fused deposition modeling; FOV: Field of view;
MDCT: Multidetector-row computed tomography; PLA: Polylactic acid;
STL: Stereolithography (file format)
Acknowledgements
We thank Melissa Gibbons, PhD, from Edanz Group (www.edanzediting.com/ac)
for editing a draft of this manuscript.
Availability of data and materials
Readers interested in the data should contact the authors.
Authors’ contributions
TK conceived the study and drafted study outline. TT and HK collected therequisite data. TK, YK, TS, and TT implemented software and carried out theanalyses. TK and HK interpreted the data and drafted the manuscript. All authors
have read and have given final approval of the version to be published and all
authors read and approved the final manuscript.
Competing interests
The authors declare that they have no competing interests.

Publisher’s NoteSpringer Nature remains neutral with regard to jurisdictional claims in publishedmaps and institutional affiliations.
Author details
1
Department of Oral and Maxillofacial Surgery, Tokyo Dental College, 1-2-2
Masago, Mihama-ku, Chiba 261-8502, Japan. 2Oral and Maxillofacial Surgery,
National Hospital Organization Takasaki General Medical Center, 32
Takamatsu, Takasaki, Gunma 371-0829, Japan. 3Department of Oral Medicine,
Oral and Maxillofacial Surgery, Tokyo Dental College Ichikawa General
Hospital, 5-11-13 Sugano, Ichikawa, Chiba 271-8513, Japan. 4Department ofEndodontics, Tokyo Dental College, 1-2-2 Masago, Mihama-ku, Chiba
261-8502, Japan.
Received: 20 April 2018 Accepted: 27 July 2018

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