The world’s first 3D printing technology, it uses a laser to turn liquid resin into hardened plastic, layer by layer. The laser traces a different pattern for each layer to form the shape of the 3D object. This is useful for prototyping, modelling and short-run production.

The technology is similar to SLA, but uses powdered material placed in layers. The material is sintered by laser according to the pattern of the object to be built. It is ideal for building complex geometries and its strength can resemble that of injection-moulded parts, making it a popular choice for functional prototyping, according to Formlabs, a 3D printing technology developer and manufacturer in the US. 

This is the most widely used type of 3D printing among consumers. It melts thermoplastic filament and builds the structure layer by layer. It is suitable for modelling and low-cost prototyping of simple parts. It has less resolution and accuracy than the other two, says Formlabs. 

The 3D printing communities that came together during the pandemic were eager to put their printers to use. They brainstormed what equipment they could print to help the frontliners.

Face shields were the easiest, but there were also groups looking into other equipment. “We were also working on building aero chambers. This is typically used by children who have asthma and cannot use inhalers properly yet. Instead, medication is sprayed into the aero chamber and the child can breathe in the medication through the device at their own pace,” says Wan Cheng Huat, a maker leading one of the movements. 

“The equipment costs RM150 to RM200, but we managed to print it for below RM10. The designs are available online.”

Ahmad Nurfaiz, another movement leader, says there were also teams that printed ventilators. “They used a schematic, which is an open-source design, from the 1970s,” he says. “Some people in the group tried to procure diving masks [and turn these into breathing aid devices] for patients to breathe easily without intubation.”

Wan and Nurfaiz say these products were not used by frontliners, however, because there was no shortage of ventilators or the other equipment last year. In addition, medical devices are under strict regulations, for obvious reasons. 

Doctors were wary about using these devices since they had not been tested, and they were unsure of the conditions in which they were manufactured. For safety reasons, medical devices have to be manufactured in controlled environments to prevent contamination. 

The communities did not start up their printers this year because there was less of a shortage of PPEs, Wan and Nurfaiz say, and the ventilator shortage was not something they could help with. “Ventilators require intubation and it’s used in critical, end-of-life situations. The machine cannot fail. That’s why we will not get approval to use this type of DIY machines,” says Wan.

Similar challenges were observed in the US. Interestingly, the Food and Drug Administration (FDA) published a report assessing the role of additive manufacturing in response to Covid-19 last year. 3D-printing communities in the US made face shields, ear savers (for face masks) and nasal swabs for hospitals. 

Doctors were not confident about using non-FDA-approved equipment, but thanks to the Covid 3D Trust (a collaboration between a few health-related government administrations and the US maker community) and the National Institute of Health’s 3D Print Exchange, some designs were found appropriate for emergency use in clinical settings when fabricated with specific printers and materials. 

Owing to the dire situations, some Spanish hospitals approved the use of 3D-printed ventilators during the pandemic last year. Similarly, at least two hospitals in Italy began using 3D-printed respirator valves. The European Commission issued three guidelines in March 2020 to set out mandatory standards for 3D printers that may be used to produce medical devices.

Malaysia could explore these initiatives. “The ventilators [that we built] were just concept ideas to show that this is possible,” says Wan. 

These developments have showcased the makers’ ability to innovate and manufacture products through a decentralised movement in a short time. It could also prevent overreliance on imports, which could leave the country in a lurch when there are supply chain disruptions. 

In a blog post in February, the Malaysian Investment Development Authority mentioned the need for manufacturers to produce ventilators in the country. The local supply chain has to be established in case of unexpected circumstances, it said. 

“If Malaysian makers are able to do this, we can come up with more of our own designs and products,” says Nurfaiz. 

Kevin Lim, lead engineer of Kon10 Enterprise, has maker blood running through his veins. When he was studying engineering in University Tunku Abdul Rahman (UTAR), he was frustrated by the theory-heavy lectures and decided to form a club to do more hands-on projects. 

Together with his friends, he started doing projects using basic materials and soon saved up to buy a 3D printer. His first project? Printing a finger cast made from biodegradable plastic for his father. 

“He is in the renovation business and accidentally pointed his finger too close to the ventilator. He got a bad fracture on his finger. But he didn’t want to wear a normal cast. So, I designed a 3D-printed flexible cast so he could still maintain pressure on the bone and prevent damage,” says Lim.

His team received their first commercial project from the university to print low-cost, 3D souvenirs. “They wanted to print the famous statue on the UTAR Kampar campus. It’s the one of Einstein playing chess with Confucius.” 

With project requests coming in from the university and industry players, they generated more than RM100,000 in revenue within two years. That is when Lim decided to defer his studies and do this full time in 2019.

“Our clients range from those who run small businesses, such as a company that wanted something to put on their coffee grinder so it didn’t spill, to those that want to produce robots,” says Lim.

Joshua Poh, managing director and founder of Inventadore Industries, has a similar story. The company was founded in 2015 and comprises a collective of local and overseas 3D printing hubs. 

When Poh was a final-year university student 10 years ago, he was on the hunt for a 3D printer. It cost thousands of ringgit and he was not sure whether it was worth it. 

“My late father suggested I invest in a cheap 3D printer, as I had a lot of projects due for my final semester. So, the machine would pay for itself if I convinced my classmates to use my 3D printer for a fee,” says Poh.

He bought a small 3D printer for £1,000 — it would cost less than RM1,000 now, he says — and began printing projects. “Some course mates looked for my services because I charged a small fee and was able to fulfil orders with a short lead time. My first 3D printer paid for itself that summer.”

He turned it into a business with a classmate. Soon, they invested in advanced machines and began serving industrial and creative sector clients, providing design, 3D modelling and prototyping services. Since then, they have counted big brands such as Coca-Cola Malaysia, Royal Selangor International and Top Glove among their clients. 

When Lim joined the Shell Eco-marathon competition in Singapore a few years ago, he saw contestants from Nanyang Technological University Singapore use 3D printers to manufacture a whole electric car. 

He was so impressed and convinced that the local automotive industry could benefit from this technology. A car is made up of thousands of parts. If it has fewer parts, it could be a lot lighter, easier to assemble and cheaper, says Lim. Architecture is another industry that he believes can benefit from 3D printing. 

Meanwhile, Poh is excited about being able to 3D-print dentures in ceramics using Inventadore’s modified SLA machine. “We do not offer this service yet, as the Malaysian market is very price-conscious. At the moment, raw SLA ceramic material can cost up to five figures in ringgit per litre,” he says.

Evidently, cost is still a hurdle to the widespread adoption of 3D printing in industries. Another huge challenge is the lack of awareness among industry players. 

“I would say that large industries are still not convinced to use 3D printing for industrial materials because they would question the reliability,” says Lim.

“It’s also a challenge that we can’t certify that we are professionals in 3D printing because there is no certification like the ISO standards. It’s still too new in Malaysia.”

Educating clients and the younger generation is key. As such, Inventadore partnered with Wisdom Spring International School to set up an education programme that teaches students art and design. Lim also hopes competitions can be held so companies can showcase to industries what can be done with 3D printing technology.

In 2015, associate professor Dr Mohd Nazimi Abd Jabar became the first doctor in Malaysia to conduct a facial implant surgery using 3D printing.

Dr Mohd Nazimi, the chief of oral and maxillofacial services at the UKM Medical Centre, had a patient whose frontal bone and upper part of the left orbital rim (parts of the face) were deformed because of an accident. 

He approached OBL, an international company well known for 3D printing in healthcare, for help. Together, they simulated the surgery in 3D and made a custom implant for the bone using 3D printers. 

He has since done more surgeries using this method in collaboration with 3D Gens, a local 3D printing company that uses 3D printers to manufacture metal implants based on detailed digital designs.

“It was very expensive to do this. Even getting the insurance company to cover the procedure was difficult. But we managed to do it and, until today, the patients are still doing all right,” says Dr Mohd Nazimi. 

In the healthcare industry, 3D printing is a tool under the umbrella of computer-assisted surgery, where technology is used to increase the precision of procedures, reduce errors and support personalised healthcare.

3D printing can be used to make customised implants for patients based on scans of their body parts. Custom 3D-printed prosthetics made from metal or plastic are already available. 

“For instance, if I have to cut the patient’s jaw by half, I can use scan data from the other half of the jaw [and replicate it through 3D printing]. For patients who lose their noses [because of cancer], we can scan the real nose of the patient before the surgery and 3D print an exact replica of the nose,” says Dr Mohd Nazimi. 

A more customised solution could prevent the need for repeated surgeries. It is also critical for areas of the body where a second surgery could be damaging. 

“Repeated surgeries are expensive … In addition, injuries such as orbital fractures are small but it’s [important to deal with them properly] because it will be difficult to do a second surgery. It’s a very confined area that is difficult to see. That’s why the first surgery has to be precise,” he says.

This technology is also useful in producing realistic 3D models for surgical planning and training. For instance, 3D anatomy models are printed based on a patient’s MRI scan so that surgeons can plan and practise a complex surgical operation beforehand. 

“While it used to be dangerous to separate Siamese twins, it’s less so now. Neurosurgeons can 3D print models of the babies’ skulls and know where the big blood vessels are, for instance,” says Dr Mohd Nazimi.

“That’s why I embarked on this journey, even though it isn’t easy. But this is the trend now, where we are talking about the Industrial Revolution 4.0. All these developments can improve surgical outcomes for patients.”

The manufacturing of medical devices has to be done in sterile conditions and meet regulatory requirements. A printer used for other objects, for instance, cannot be used to print medical implants.

The design of implants are highly detailed. “For temporary implants, it’s not as difficult. For those that we implant permanently into the patient, however, the design has to be perfect,” says Dr Mohd Nazimi. 

Owing to the novelty and complexity of 3D-printed medical implants, it has not been easy for him. It is also an uphill task for those who use 3D printing — who are usually engineers by training — to communicate with the doctors.

“We have to worry about how we can transfer data without revealing the patient’s identity. There are many safety issues to consider and regulations to follow. We also need approval from insurers and others,” he says. 

As there is a lack of local talent that can work with him to design these implants,

Dr Mohd Nazimi currently works with a company in Thailand for this purpose. 

Most importantly, however, 3D printing of implants is still very costly. An off-the-shelf implant costs three times less than a 3D-printed one, he says. It also costs quite a bit to get the implants approved by the authorities. 

“This kind of service is very routine in countries such as Germany. I’m hoping to bring it here even for primary repair surgeries, so we can assemble the implant quickly in a week or two and more patients can benefit from this technology,” he says.

He thought of creating a special interest group with experts from various specialties and a foundation to help patients who need this kind of surgical protocols.

More collaboration between players in the medical industry would be helpful too. Surgeons must be able to access data quickly, even if it is across states. Dedicated 3D printers should also be available at some central locations and easily accessible. 

“It seems to be exclusive, but it isn’t. It’s the patient’s right to get the best,” Dr Mohd Nazimi says.