Citation: Czy
˙
zewski, W.; Jachimczyk,
J.; Hoffman, Z.; Szymoniuk, M.; Litak,
J.; Maciejewski, M.; Kura, K.; Rola, R.;
Torres, K. Low-Cost Cranioplasty—A
Systematic Review of 3D Printing in
Medicine. Materials 2022, 15, 4731.
https://doi.org/10.3390/ma15144731
Academic Editor: Antonino Recca
Received: 13 May 2022
Accepted: 2 July 2022
Published: 6 July 2022
Publisher’s Note: MDPI stays neutral
with regard to jurisdictional claims in
published maps and institutional affil-
iations.
Copyright: © 2022 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
Review
Low-Cost Cranioplasty—A Systematic Review of 3D Printing
in Medicine
Wojciech Czy
˙
zewski
1,2
, Jakub Jachimczyk
3
, Zofia Hoffman
3,
* , Michał Szymoniuk
4
, Jakub Litak
2,5
,
Marcin Maciejewski
6
, Krzysztof Kura
2
, Radosław Rola
2
and Kamil Torres
1
1
Department of Didactics and Medical Simulation, Medical University of Lublin, 20-093 Lublin, Poland;
wojciech.w.czyzewski@gmail.com (W.C.); kamiltorres@wp.pl (K.T.)
2
Department of Neurosurgery and Pediatric Neurosurgery in Lublin, 20-090 Lublin, Poland;
jakub.litak@gmail.com (J.L.); krzysztof_kura@wp.pl (K.K.); rola.radoslaw@gmail.com (R.R.)
3
Student Scientific Society, Medical University of Lublin, 20-059 Lublin, Poland;
jakub.jachimczyk@protonmail.ch
4
Student Scientific Association of Neurosurgery, Department of Neurosurgery and Pediatric Neurosurgery,
Medical University of Lublin, 20-090 Lublin, Poland; michmatsz@gmail.com
5
Department of Clinical Immunology, Medical University of Lublin, 20-093 Lublin, Poland
6
Department of Electronics and Information Technology, Faculty of Electrical Engineering and Computer
Science, Lublin University of Technology, 20-618 Lublin, Poland; m.maciejewski@pollub.pl
* Correspondence: zofhof@gmail.com
Abstract:
The high cost of biofabricated titanium mesh plates can make them out of reach for
hospitals in low-income countries. To increase the availability of cranioplasty, the authors of this work
investigated the production of polymer-based endoprostheses. Recently, cheap, popular desktop
3D printers have generated sufficient opportunities to provide patients with on-demand and on-site
help. This study also examines the technologies of 3D printing, including SLM, SLS, FFF, DLP, and
SLA. The authors focused their interest on the materials in fabrication, which include PLA, ABS,
PET-G, PEEK, and PMMA. Three-dimensional printed prostheses are modeled using widely available
CAD software with the help of patient-specific DICOM files. Even though the topic is insufficiently
researched, it can be perceived as a relatively safe procedure with a minimal complication rate.
There have also been some initial studies on the costs and legal regulations. Early case studies
provide information on dozens of patients living with self-made prostheses and who are experiencing
significant improvements in their quality of life. Budget 3D-printed endoprostheses are reliable
and are reported to be significantly cheaper than the popular counterparts manufactured from
polypropylene polyester.
Keywords:
cranioplasty; 3D cranioplasty; additive manufacturing; PMMA; PEEK; PLA; ABS; PET-G
1. Introduction
The human skull is one of the most complex regions of the human body in terms
of maintaining visually pleasing results. In the case of a post-traumatic or postoperative
defect, cranioplasty requires constant medical development to provide a decent quality of
life to affected patients by producing personalized endoprostheses [
1
]. Although widely
adapted titanium endoprostheses often provide satisfactory results, they tend to be too
expensive for low-income patients. Despite high biocompatibility, titanium leads to a
significant artifact in CT and MRI imaging. Prostheses made of polypropylene–polyester
are often used in cranioplasty, for which prices in the case of standard products (regular,
oval shape) do not exceed USD 500 [
2
]. However, if there is a necessity to use a personalized
prosthesis, the cost escalates to nearly USD 2000. In recent years, FDM- (fused deposition
modeling) and SLA- (stereolithography) 3D-printing have become increasingly popular [
3
].
These methods provide a terrific opportunity for medicine to bring widely available so-
lutions with inexpensive planning, prototyping, guiding, and even creating on-demand
Materials 2022, 15, 4731. https://doi.org/10.3390/ma15144731 https://www.mdpi.com/journal/materials
