## 2 Materials and Methods  
In this study, the NASSS technology implementation framework and the WHO Health Systems Framework were adopted as the analytical tool. These frameworks were selected for their effectiveness in helping researchers pinpoint both the facilitators of and barriers to the implementation of technology [2; 3]. The NASSS framework provides a comprehensive, multidimensional examination of the essential components for successful technology implementation. The present article adopts a forward-looking approach informed by the NASSS framework to predict and identify potential facilitators and barriers to the integration of new medical technologies in conventional clinical settings. This approach is in line with the principles of responsible innovation (RI) which focus on proactive measures to ensure beneficial societal outcomes and navigate the processes needed to achieve these goals [4]. The NASSS framework is structured around seven domains, each representing a complex ecosystem [5]. It is important to consider these domains not separately, but as interconnected parts of a larger sociotechnical system that evolve through mutual interaction over time [6]. Each domain contains various sub-domains that expose different types of complexity in the intended program, highlighting the widespread impact of technologies that can initiate specific actions in different contexts. Domain 1 explores the complexities of health conditions in maxillofacial surgery, highlighting the intricate challenges presented by the coexistence of these conditions with other comorbidities. Moreover, the management of these conditions is significantly affected by sociocultural factors, such as poverty or race and ethnicity, which are vital in determining the condition's impact and the management strategies used in the context of 3D printing in oral and maxillofacial surgery [7; 8]. Domain 2 explores the complexities of 3D printing technology, focusing on its operational effectiveness, reliability, and speed. This technology necessitates the development of new, specific skills for its successful application. Furthermore, the type of data generated by 3D printers, along with the management of these data and related privacy concerns, add further complexity to this domain [9]. Domain 3, titled the value proposition, explores the advantages for both creators (supply side) and users (demand side) including patients, the healthcare system, and payers like taxpayers or insurance companies. The challenge in this area lies in creating a strong business argument for the developers, proving the technology's cost-effectiveness, and confirming its appeal to users [10]. Domain 4, known as the adopter system, involves the healthcare personnel responsible for operating and maintaining 3D printing technology, along with the patients and staff expected to use it. The complexity in this domain arises from resistance among healthcare professionals and patients against adopting new technologies. This reluctance can stem from several factors, including resistance to change, unfamiliarity with the technology, or concerns over its ease of use and effectiveness [4]. Domain 5 relates to the healthcare organizations engaged in the process. The challenges in this area are connected to the organization's capacity to encourage innovation. This involves elements like effective leadership, solid decision-making mechanisms, and competent management of human resources, all vital for motivating staff, facilitating continuous education, and providing support. Moreover, the extent of work needed to bring about change, including activities such as software upkeep and modifications, adds to the complexity of this domain [11]. Domain 6 covers the wider ecosystem, incorporating factors such as the policy landscape, support from regulatory and professional bodies, and public opinion. This domain highlights how external factors influence the adoption and potential deceleration of innovative technologies.