by Lander Veulemans

3D printing, a type of additive manufacturing, has been on the rise in the medical world. The process of creating a three-dimensional item by constructing successive layers of raw material has already proven its purpose in orthopedic surgery and related fields in the last 10 years. However, a new technique often entails difficulties in the regulatory approval field.

At Spentys we join the innovative wave of creating 3D printed external orthoses. However, this is not the only trend seen in the additive manufacturing world. The American Food and Drug Administration (FDA) has authorized a lot of other medical devices, for instance instrumentation devices or implants, that were manufactured with the same sort of technology we use at Spentys. Though 3D printing is not relatively new anymore, only a few papers concerning orthopedic applications have been published in recent years. Another notable observation is the challenging process for a company to get a product on the market in a legal way. To address why these phenomena emerge in this field, Spentys focuses on the regulatory framework for 3D printed orthopedic medical devices.

It is not always convenient to initiate clinical investigations of a new medical device. The generation of clinical data can be accompanied by many obstacles. The objective of a clinical investigation or evaluation to assess safety and efficacy on a 3D printed device depends on the purpose and the population for whom it is intended. In certain areas where clinical outcomes are bound to compliance of the patient, 3D printing can improve clinical results. At Spentys, we are convinced that this is partly due to the shift from mass production to mass personalization.

3D printing might be seen as a conventional step forward in the medical world, but using this additive manufacturing technique in the medical industry is a very progressive climbing of the ladder. It may cause issues for regulatory authorities since anyone owning a 3D printer and a blueprint could start manufacturing its own devices. Luckily, the FDA has issued recent guidance for 3D printing of medical devices, removing some regulatory uncertainties, particularly regarding design-,  manufacturing-,  and device testing considerations.

To evaluate rules set by authorities, we must distinguish two classes of medical devices:

Class I medical devices can be created using any production processes, including 3D printing. Manufacturers only need to prove their final product is largely the same as the product that is already on the market. They are considered to be ‘safe’. The main problem here is that these are the only devices that are on the market at the moment. Multiple issues arise with the regulation of patient-specific devices, e.g. custom-made prostheses. Hence, there can be a problem for each personalized device. Future regulations should focus on the individual differences between people and personalized healthcare, rather than similarities. Currently, regulatory bodies try to fix this by setting a maximum and minimum for custom-made devices.

On the other hand, class II medical devices are considered to be a ‘higher risk’ and must undergo a pre-market authorization procedure as there is nothing similar on the market yet. Still, there are too many contradictory regulations from all the bodies, both national and international. This hitch lags the progression of the innovating process which is 3D printing. In addition, all the regulatory authorities try to achieve one main goal: irrespective of your location, the production of a medical device can use one set of standards and be able to meet all country’s regulations. The principal issue is that the ISO (InternationalOrganization for Standardization), ASTM (formerly known as American Society for Testing and Materials), and others make their own unique standards for 3D printing rather than duplicating from traditional manufacturing.

Though there are many contradictory regulations, the FDA continues to study all new technologies to better comprehend it when reviewing the medical products or offering guidance to manufacturers. The role of the FDA is important. It tries to regulate the medical product, conduct research for advancing regulatory science and serve as a response to encourage innovation concomitantly preserving the innovation process.

Today, there are still some obstructions in terms of regulations. It is not a smooth process for a company to launch a new product. The ambivalence between the effort of some authorities to ameliorate a manufacturing process and the unconsidered rules set by others overrules the need for innovation.

References
The Emerging Role of 3D Printing in Arthroplasty andOrthopedics. https://www.ncbi.nlm.nih.gov/pubmed/29572035

Publication trends and knowledge mapping in 3D printing inorthopaedics. https://www.ncbi.nlm.nih.gov/pubmed/30202148

MedTech Marketing – clinical evaluations and trials

3D printing of Medical Devices https://www.fda.gov/medicaldevices/productsandmedicalprocedures/3dprintingofmedicaldevices/default.htm

The 3Rs of 3D Printing: FDA’s Role https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm533992.htm

Impact of additive manufacturing on the orthopedic industry https://www.odtmag.com/issues/2018-03-01/view_features/impact-of-additive-manufacturing-on-the-orthopedic-industry

FDA’s Role in 3D Printing https://www.fda.gov/medicaldevices/productsandmedicalprocedures/3dpri