Fused deposition modeling of polymethylmethacrylate for use in patient-specific reconstructive surgery

Polymethylmethacrylate (PMMA) is a biocompatible alloplastic material used in craniofacial reconstruction and as bone cement and antibiotic-impregnated spacers in orthopaedics. The polymerization of PMMA in-situ causes tissue necrosis and other complications due to the long surgical times associated with mixing and shaping the PMMA. PMMA is a thermoplastic acrylic resin suitable for extrusion in FDM thus 3D anatomical models can be fabricated prior to surgery directly from medical imaging data. The building parameters required for successful FDM fabrication with medical-grade PMMA filament (1/16"Ø) were developed using an FDM 3000. It was found that a liquefier and envelope temperature of 235°C and 55°C, respectively, as well as increasing the model feed rate by 60%, were necessary to properly and consistently extrude the PMMA filament. Scaffolds with different porosities and fabrication conditions (tip wipe frequency and layer orientation) were produced, and their compressive mechanical properties were examined. Results show that both the tip wipe frequency (1 wipe every layer or 1 wipe every 10 layers) and layer orientation (transverse or axial with respect to the applied compressive load) used to fabricate the scaffolds, as well as the porosity of the scaffold had an effect on the mechanical properties. The samples fabricated with the high tip frequency had a larger compressive strength and modulus (Compressive strength: 16 ± 0.97 vs. 13 ± 0.71 MPa, Modulus: 370 ± 14 vs. 313 ± 29 MPa, for samples fabricated in the transverse orientation with 1 tip wipe per layer or 1 tip wipe per 10 layers, respectively). Also, the samples fabricated in the transverse orientation had a larger compressive strength and modulus than the ones fabricated in the axial orientation (Compressive strength: 16±0.97 vs. 13±0.83 MPa, Modulus: 370±14 vs. 281±22 MPa, for samples fabricated with 1 tip wipe per layer, in the transverse and axial orientation, respectively). Overall, the compressive strain for the samples fabricated with the four different conditions ranged from 8 - 12%. In regards to the porosity of the samples, in general, the stiffness, yield strength and yield strain decreased when the porosity increased (Compressive strength: 12±0.71 - 7±0.95 MPa, Modulus: 248±10 - 165±16 MPa, Strain: 7±1.5 - 5±1% for samples with a porosity ranging from 55 - 70%). The successful FDM fabrication of patient-specific, 3D PMMA implants with varying densities, including the model of a structure to repair a cranial defect and the model of a femur, was demonstrated. This work shows that customized structures with varying porosities to achieve tailored properties can be designed and directly fabricated using FDM and PMMA.