“We know that digital technology in O&P has really been around since the mid-1980s, with carving and things of that nature. And 3D printing didn’t really hit its stride until some of the materials started getting better, but we knew early on that we would be able to reduce waste just by 3D printing our check sockets. That’s what really made the change for us: We saw that it was coming—and we knew that it was going to be part of the future whether we wanted it to or not, so we decided to go ahead and—instead of throwing in the towel, we threw down the hammer,” says Brent Wright CP, BOCO, EastPoint Prosthetics & Orthotics, headquartered in Raleigh, North Carolina, and a partner in Additive America.
What’s New Now
Jeff Erenstone, CPO, owner of Mountain Orthotic & Prosthetic Services, Lake Placid, New York, identifies MotionTech, a Swiss company that claims to have developed the first technology able to 3D print silicone liners.
Combination additive-and-subtractive machines are appearing, as well, and are likely to become pervasive, Erenstone predicts. Additive layering builds up a base, alternating with a milling head that carves away what’s unwanted. The result is a much higher tolerance and higher quality in some materials that have not been regarded as really functional yet.
One example of this type of machine, Diabase Engineering’s H5-400A Rotary 3D printer+CNC Milling unit, is billed as “the ultimate product development platform: Its two-step process enables users to print their own stock and finish with fine milling in one setup—or to mill existing parts and print directly on top, for hard-to-produce designs.”
Garrett Harmon, applications engineering manager, Essentium, Pflugerville, Texas, points out that although it had not previously been possible, 3D printing with Essentium’s new dual-material platform now allows them to print a socket that has a hard shell for firm support, but also has flexible windows in the same socket where delicate tissue may be.
“Over 90 percent of all of our definitive prostheses are 3D printed now,” Wright says. He believes that Additive America has probably delivered the most 3D definitive prostheses in the United States, if not the world.
Cooper Bierscheid, chief futurist, founder, Protosthetics, Fargo, North Dakota, says, “Over the six years Protosthetics has been in business, we’re seeing a lot more players using 3D printing. And that’s really helping the adoption of the technology and getting more people to buy into ‘why not use this tool to help your practice?’ I think everyone’s familiar now with the terminologies and has maybe fit a 3D-printed product in their clinic by now.
“Although we tend to treat additive manufacturing as all the same, there are many types of 3D printing, and each type has a different advantage, so we have evolved our own proprietary design printers, including MJF (multi-jet fusion), which definitely excels at a lot of the shortcomings of FDM (fused deposition modeling) technology—and both have their places. Our FDM printers run a specific material that’s a rigid urethane that just has different material properties than you would see in a nylon material that comes out of an MJF printer.
“Besides mass customization, 3D printing allows for some really complex shapes and intricate designs for prostheses and covers very affordably,” Cooper adds. “We use certain rigid urethane materials—our pectus carinatum brace, and that allows for really low-profile shapes, varying thickness, different flexibilities, and some interesting complexities like the hardware components that are built into it.”
What’s Coming
Charged with recruiting and scheduling the 3D/Additive Manufacturing Track for the 2021 AOPA National Assembly in September, Erenstone shares insights on what’s coming: Presenters discussing diagnostic devices, standards, experts doing amazing things with complex software, and innovative uses of the top-notch printers, along with their case histories. “I see the field just steadily maturing; there are more and more devices being made, so we’re feeling more and more comfortable about what the technology can do.”
“Additive is one of the most disruptive things to happen to the O&P industry in the last 15 years,” Harmon says. “It’s going to completely change the way that devices are not only made but processed: If I need to remake a socket, I can remake the exact same one without consequences. So it’s not only going speed up the manufacturing method, it’s also going to change the footprint of the offices. Because they won’t have to store a bunch of plaster molds, the mold room or tool room becomes more space to fit patients, or more offices for more clinicians. All they need is a room with a couple of printers and some post-processing stations in it.
“It’s a huge change that will affect a lot of things. And those are just the knowns.”
What’s Possible
Harmon notes the potential for individual innovation. “Any clinician may grab an Essentium HSE 3D printer and come up with the next innovative device that’s never existed before, because they’re no longer technology-limited in their manufacturing methods. Because of this new tool they’re able to build whatever they want to and see if it works, unlocking innovations that O&P has never seen before.”
“As 3D printing continues to evolve and the array of available printable materials grows, it may become possible to replace conventional modular device assembly with printing of finished, working devices (i.e., socket and componentry printed in articulation), says Antonio Dias, director of engineering, Hanger Fabrication Network, headquartered in Tempe, Arizona.
Wright sees benefits in patient outcomes. “As devices start getting lighter and lighter—specifically for pediatrics—the more active [patients] are going to be, the faster they’re going to be, and then obviously the more compliance there is going to be. It is a truly a life change, and that’s what really hit home with me: These 3D-printed devices end up being much lighter than their traditionally fabricated counterparts, and it makes a difference, especially for kids.
“3D printing even reduced a petite 16-year-old’s five-pound prosthesis to one pound and six ounces. It made all the difference in the world for her.”
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