Lowering the cost of custom tutors. Revolutionary cranial implants.

The partnership between WASP and the Rizzoli Orthopedic Institute


Tutors for to make First Aid centers more functional, whose cost is drastically reduced, almost entirely eliminated. In the future, cranial implants that almost entirely reproduce the skull’s characteristics, with the goal of facilitating bone regeneration and favoring an extraordinary bio-integration. This is possible through the adoption of world leading 3D printing technology in the medical field.

The use of digital manufacturing in the health sector can radically modify patient care, making it economically accessible to all and implementing personalized therapies. The collaboration between WASP, a leading company in the 3D printing sector, and the Banca delle Cellule e del Tessuto Muscoloscheletrico (Bank of Cells and Muscular-Skeletal Tissue), of the Emilia Romagna Region, based within the Rizzoli Orthopedic Institute, is spawning projects to tear down walls that were considered untouchable until just a short time ago.

The first tutors for First aid produced by 3D printing are ready and will begin the experimental phase at the Rizzoli Institute. They will be used to treat contusions, sprains and even fractures. At first they will be used for the wrist area and they will be made of PLA, with a cost of about 2 euro instead of the current 30 euro. Furthermore they are perforated for transpiration, while also allowing electro-stimulation to favor the healing process. After the wrist the project is set to move on to other body parts, starting from the elbow and the knee.

Another ambitious and revolutionary project is related to the possibility of producing replacements for the cranial bone, directly from the patient’s CT scan data, using 3D printing. These will be 3D dowels of the same size as the missing bone parts, of which they will have to accurately mimic the anatomy and physiology. The goal is to facilitate an unprecedented bone regeneration. We are completing the development, testing and standardization phase. Within a few months we expect that the first prototypes will become available and that the first implants on patients may take place as early as 2016.

The partnership between a research institutions and a local structure is made possible in part through projects financed by the Emilia Romagna Region.


3D printed tutors for First Aid Centres

3D printed tutors are employed in Rizzoli’s First Aid center. Tutors are printed in three different sizes, after that they’re shaped on the patient’s wrist. Massimo Moretti, WASP’s founder, affirms “we’re developing 3D printers with bigger sizes and bigger nozzles. It will be possible – thanks to the addiction of several dimensional parameter or the patient hand’s scan, to print tailored tutors in a very short time: 10-20 minutes. In that way there will be the chance to operate live on the place, depending on the situations”.

To develope tutors we started from a prototype which was studied by PiuLab, an internal laboratory of Politecnico in Milan which collaborate with WASP in research. The choice of using PLA is because it is a thermoplastic material derivative of corn which is extruded at the temperature of 180°, but it is already malleable at 60°. The tutor is printed as it was flat, than it is heated and shaped according to the patient necessity and it is cooled down to keep the prearranged form.

Heal-shaped tutors are not new in the First Aid field. The real news is 3D print, which allows to reduce costs till 90%. Moreover, bandaging the patient is no longer needed. The structure is particulary resistant, malleable for the different needs and pierceable, so it consents transpiration.

Rizzoli’s First Aid centre staff has been indispensable for the developement of the project: we needed the advices of somebody who is near to the patients everyday.

Some revisions were made during construction, just like the integration of three external lines that can be cut with scissors, to make the tutors adaptable to every kind of wrist. These lines are in the palm of the hand under the fingers, around the toe base and in the closure point, in the foreharm. The closure is made by self-adjustable strings. The chance of realizing tailored tutors will make the cut lines no longer needed.

Another evolution is represented by the chance of a double material print, with a normal PLA and an electrical conductive one. This will permit to distribute electrons in the tutor’s structure, in that way it is possible to accomplish a tens, an electro stimulation or to create electromagnetic fields wich accelerate the healing process in case of fracture.



tutori4 (1)


Cranial substitutes

Cranial substitutes which reproduce the original structure in three layers: two which have resistance and stability characteristics, one which facilitates regeneration. The skull cap, as time goes by, will be replaced by the patient bone in a spontaneous and physiological way, through an ossification process. It will be less and less a foreign body. As the director of the Rizzoli’s Cells and Musculo-skeletal tissue Bank, Pier Maria Fornasari, said to the magazine “Tecnica ospedaliera”,“in case of a serious cranial trauma the surgeon is often compelled to remove skull cup to consent to the brain to expand his volume. Once the brain return to the normal size the skull cup has to be refurbished. Until today there were three options: re-use the original cranial bone which can be washed and disinfected; otherwise it can be used an hydrioxopatite cranial box, it is a fragile material which forces the patient to be very careful for the rest of his life; another chance is to implant a plastic cranial box which is not be assorbed. These techniques lack is that they are made by a single layer, our cranial box is made by three layers instead.

The innovative idea is to produce, directly from patient TAC, a substituite of the missing part of the cranial box made by a 3D printer. It isn’t only a substitute which has the perfect sizes of the missing parts but also the complete respect of the human anatomy with the reproduction of the three layers: one is external and rigid like the cortical bone, the one in the middle is made by a spongy tissue and the internalone is rigid cortical bone again.

The research is currently focused about the material choice and the layng down tecnique. For the external parts will be used rigid and resistant materials which can be assorbed by the body, just like caprolactone. For the internal material it will may used hidrioxopatite, the aim is to make the rigeneration process start from here.

The ossification process will be facilitate from a piece of the cortical part, so the zone which is in contact with the scalp, to simplify the insertion of blood-vessel.

There already is a contact with several neurosurgery equipes to launch a partnership and pass to a pre-clinical and clinical sperimentation.

More than a FabLab which prints cranial boxes for all the hospitals the project aim at a process that can be transfered in each clinical structure. In the future, the missing part of the cranial box will be directly printed in the operation room.

The social impact of a project like this is huge. The prothesis that are used today cost thousand of euros and one day it would be possible to produce them just with an hundred euros. It will be possible to operate not only in italians hospitals but in war zone too, where these kind of problem are a daily issue.