







































VOLUME 6, ISSUE 2 

 2023 
 

Articles in this special issue has been invited and reviewed by Dr. Silvia Ursula Raschke and Dr. Hossein Gholizadeh. 

 

D E S I G N I N G  T H E  F U T U R E :  3 D  P R I N T I N G ' S  

R E V O L U T I O N  I N  P R O S T H E T I C S  &  O R T H O T I C S  

S T A K E H O L D E R  P E R S P E C T I V E S   

PRINTING 

3D 

PUBLISHER: CANADIAN ONLINE PUBLICATION GROUP   

S P E C I A L  I S S U E  

CPOJ 

ISSN: 2561-987X 

https://jps.library.utoronto.ca/index.php/cpoj/EDitorinchief


 

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Hassan Beygi B, Wong M.S. Contemporary and future development of 3D printing technology in the field of assistive technology, orthotics and prosthetics. 
Canadian Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 2, No.10. https://doi.org/10.33137/cpoj.v6i2.42225 

 

 

STAKEHOLDER PERSPECTIVES 

 

CONTEMPORARY AND FUTURE DEVELOPMENT OF 3D PRINTING TECHNOLOGY IN 

THE FIELD OF ASSISTIVE TECHNOLOGY, ORTHOTICS AND PROSTHETICS 

Hassan Beygi B, Wong M.S.* 

The Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong. 

 

 

 

 

  

 

 

 
 

 

 

INTRODUCTION 

Three-dimensional (3D) printing is an additive 

manufacturing process to make 3D objects. With the 

evolution of this technique since the 1980s, its applications 

are becoming increasingly relevant to users of assistive 

technology, orthotics, and prosthetics services. To be more 

precise, we believe this digital transformation should be 

looked as a subset of more comprehensive technology, 

CAD/CAM (Computer-aided Design / Computer-aided 

Manufacturing). The CAD software assists clinicians in 

capturing the shape of body segment(s) and designing 

purposeful devices for treatment purposes. It achieves this 

by reading a 3D captured shape of body segment from 

advanced 3D scanners and allowing for modifications to be 

made to the limb shape. The CAM facilitates in the 

manufacturing process with reduction of manpower and 

increase of precision. 3D printing is only a part of this digital 

transformation, referring only to the additive manufacturing 

process, which is available in different types and forms, 

including powder, liquid, and solid materials.1  

 

 

 

Clinical and technological advancements are equally 

important in delivering quality assistive technology, 

orthotics, and prosthetics services. Patients should be 

comprehensively assessed before an appropriate 

prescription of assistive technology, orthosis, or prosthesis 

is given. In the fabrication of assistive technology, orthosis, 

or prosthesis, advanced technological developments have 

the potential to offer the end-users an effective and reliable 

service. However, the enhancement of CAD/CAM (3D 

printing) technology should focus on facilitating the relevant 

clinical treatment outcomes. 

3D printing serves as a revolutionary transformation in the 

design and fabrication of orthotic and prosthetic devices, 

reshaping the landscape with an excellent potential to 

improve the lives of people with disabilities. This technology 

could be deployed for use in hybrid manufacturing together 

with subtractive manufacturing or injection molding 

processes to produce a standalone 3D-printed appliance or 

sophisticated system. Depending on the size and 

complexity of the design, it can either produce a whole 

shape through the printing process or print the parts which 

could be assembled to complete the system. 

The materials currently used to design and fabricate 3D 

printed orthotic and prosthetic devices include ABS, Nylon 

(PA 12 and PA 11), PETG, PP, TPU, fiber reinforced 

composites, and silicone resins. There are several 

 
OPEN  ACCESS 

ABSTRACT 

3D printing is considered as a helpful technology that facilitates innovative assistive technology, 

orthotics, and prosthetics development. This technology could likely contribute to positive 

treatment outcomes. It could also mitigate the challenges encountered when using the traditional 

methods. Our team’s research in the application of 3D printing in prosthetics, orthotics and 

biomedical technology has shown beneficial results in its use. This article gives a general 

description on application of CAD/CAM, digitalization and 3d printing in this industry followed by 

short description of two spinal-related projects conducted in our research team. Technological and 

clinical challenges on utilization of this technology have been listed. Finally, this manuscript 

provides recommendation for broader applications and developments of the aforementioned 

technology through interdisciplinary practices. A glimpse into the future of 3D printing in the 

healthcare industry shows that this industry is poised to continue having a significant impact in this 

sector. It should be emphasized that assistive technology, orthotics, and prosthetics require a 

human touch and connection, and no digital tool or technology can replace such requirements. 

Indeed, multi-disciplinary collaboration is the key to the success of applications of 3D printing. 

CITATION 

Hassan Beygi B, Wong M.S. Contemporary 

and future development of 3D printing 

technology in the field of assistive 

technology, orthotics and prosthetics. 

Canadian Prosthetics & Orthotics Journal. 

2023; Volume 6, Issue 2, No.10. 

https://doi.org/10.33137/cpoj.v6i2.42225 

KEYWORDS 

3D Printing, Orthotics, Prosthetics, 

Adolescent Idiopathic Scoliosis, 

Rehabilitation, Digitalization, CAD/CAM, 

Technology, Additive Manufacturing  

* CORRESPONDING AUTHOR: 

M.S. WONG, PhD 

The Department of Biomedical Engineering, The Hong Kong Polytechnic 
University, Hong Kong. 

E-Mail: m.s.wong@polyu.edu.hk 

ORCID ID: https://orcid.org/0000-0002-4157-9528 

Journal Homepage: https://jps.library.utoronto.ca/index.php/cpoj/index 

Volume 6, Issue 2, Article No.10, 2023 

 

 

Special Issue 

https://doi.org/10.33137/cpoj.v6i2.42225
https://doi.org/10.33137/cpoj.v6i2.42225
mailto:m.s.wong@polyu.edu.hk
https://orcid.org/0000-0002-4157-9528
https://jps.library.utoronto.ca/index.php/cpoj/index


 

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Hassan Beygi B, Wong M.S. Contemporary and future development of 3D printing technology in the field of assistive technology, orthotics and prosthetics. 
Canadian Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 2, No.10. https://doi.org/10.33137/cpoj.v6i2.42225 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X CONTEMPORARY AND FUTURE DEVELOPMENT OF 3D PRINTING TECHNOLOGY  

Hassan Beygi B, and Wong M.S., 2023 (Special Issue) 

advantages to using 3D printing, including, but not limited 

to:2-7  

• Material savings with less waste (plaster or foam blanks) 

therefore being more environmentally friendly. 

• Elimination of storage of hard copy models, which saves 

space.  

• Reduction of production time, labor-intensive manual 

work, and cost. For example, the lower-cost 3D printed 

prosthetics compared to expensive antiquated 

traditional prosthetics in which artisanal approaches are 

deployed.  

• Solutions of customization and personalization as 

complicated designs could be easily implemented, a fact 

that can not be achieved with traditional manufacturing 

(thermoforming and lamination). For example, 

integrating unique patterns, personalized textures, 

variations in thickness across different areas, and 

incorporating built-in reinforcement profiles into the 

designs enhances the durability and breathability of the 

device. This approach likely promotes the use of 

prescribed orthotic or prosthetic devices among 

patients.  

• Decrease of weight, as compared to traditional 

manufacturing, in which the plastic sheets or laminated 

layers were made as solid components, the 

implementation of hollow inside the layers by optimizing 

the infill to strike a balance between weight, strength, 

and printing time of the orthotic and prosthetic 

components. Furthermore, a lattice structure could be 

implemented to decrease the weight and provide shock 

absorption properties, for example, in insoles. 

• Extending the reach of 3D-printed orthotic and 

prosthetic devices to remote areas as well as less 

developed countries.  

• Ease of addressing the continued growth of the children. 

The above-mentioned advantages could facilitate a wide 

range of devices and applications in the orthotics, 

prosthetics and assistive technology including: 

• Inner and outer sockets for lower limb and upper limb 

loss, as well as cosmetic covers and hand prostheses 

• Wheelchair accessories, including cup holders, custom 

wheelchair seats, adaptive utensils with enlarged grips, 

or customized shapes to help people with motor 

disabilities enhance feed. 

• Customized AFOs, cranial remodeling helmets, insoles 

and footwear, hand splints, and spinal orthoses. 

• Customized seating and positioning systems enhance 

the sitting posture of people with disabilities to decrease 

the chance of pressure sores. 

OUR TEAM’S EXPERIENCES IN THIS AREA  

In considering the numerous advantages, our team has 

carried out research exploring the treatment effectiveness 

of the CAD/CAM method as compared to manual plaster 

casting method in managing adolescent idiopathic scoliosis.  

In the first study, the clinical parameters of Cobb angle and 

apical vertebral rotation were evaluated at the pre-orthosis 

and the initial in-orthosis visits of 40 subjects. The mean 

decrease of Cobb angle was almost 10% higher for the 

CAD/CAM method. The mean rectification time of the 

CAD/CAM method was shorter than that of the conventional 

manual plaster modification. Our conclusion was that the 

CAD/CAM method can provide similar clinical results in the 

initial stage of the treatment compared to the manual 

method while saving time in rectification by 108.3 minutes 

(63.5%).8-9 

In the second study, our team conducted a prospective 

randomized controlled trial to compare 1) clinical 

effectiveness and 2) quality of life between 3-D printed 

spinal orthoses and conventional orthoses. The 

conventional orthoses were made using vacuum forming 

technique to drape the heated plastic sheet on a positive 

trunk model. The study was limited to adolescent idiopathic 

scoliosis (AIS). Thirty females with AIS who met the 

inclusion criteria (age 10-14, Cobb angle 20-40°, Risser 

sign “skeletal maturity” 0-2, and less than one year after the 

first menses) were recruited. Patients were excluded if they 

suffered from musculoskeletal or developmental disease 

that prevented them to be complied with the treatment 

protocol. Those recruited were randomly allocated to either 

3D printing or conventional group. 3D printing technology 

was used to design and fabricate orthoses to manage AIS, 

aiming to improve in-orthosis correction and patient 

compliance. 3D printed orthoses were made with 2.5 mm 

thick Nylon 12 (PA-12) using the Stratasys machine and 

FDM technique. The result showed that the patients 

wearing the 3D-printed orthoses experienced better clinical 

outcomes than those in the control group (conventional 

orthotic design) in terms of quality of life (QoL) measured by 

questionnaire as well as similar immediate in-orthosis 

correction. Cobb angle in 3D printing orthosis group 

decreased from 31.7°±6.0 in the baseline to 19.4°±3.9 in 

immediate in-orthosis condition. In the conventional orthosis 

fabrication group, the Cobb angle of 29.8°±4.4 in the 

baseline showed a decrease to reach to in-orthosis Cobb 

angle of 16.5°±6.8.10 It is proposed for future studies to 

consider reinforcement in strategic force application regions 

of the spinal orthosis using variant thickness in the different 

areas as well as exploring other materials and printing 

technologies that could be used for spinal bracing, e.g., 

polypropylene filament (PP) which has been deployed in 

some clinics recently.    

Our experiences and findings in this study have led us to 

believe this technology has wider applications than 

traditional orthotic and prosthetic practice. For example, it 

can be deployed in assistive technology for animals who 

have lost limbs, fractures, or deformed limbs can access 

better medical care through 3D printing technology with 

https://doi.org/10.33137/cpoj.v6i2.42225


 

3 

Hassan Beygi B, Wong M.S. Contemporary and future development of 3D printing technology in the field of assistive technology, orthotics and prosthetics. 
Canadian Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 2, No.10. https://doi.org/10.33137/cpoj.v6i2.42225 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X CONTEMPORARY AND FUTURE DEVELOPMENT OF 3D PRINTING TECHNOLOGY  

Hassan Beygi B, and Wong M.S., 2023 (Special Issue) 

customized artificial limbs, braces, pads, beaks, etc., which 

could increase their quality of life and longevity.  

Another example of potential application of this technology 

is work we have done beyond the recently defined scopes 

of services for orthotists and prosthetists now deployed in 

Hong Kong for several years, is the provision of patient-

specific surgical guides for intra-operative application and 

anatomical models to assist doctors in pre-operative 

planning through the application of 3D printing technology.  

Irrespective of application, one of our findings across these 

various fields is that innovative technology application in the 

clinical setting could be only helpful and valuable when a 

team of experts with different backgrounds work together 

and supplement each other in both the development and 

application stages. The application of CAD/CAM (3D 

printing) technology could range from simple to complex 

assistive technology, orthosis, or prosthesis in which a wide 

range of clinical and technological knowledge, skills, and 

experiences is envisaged and needed. This can only be 

done with close collaboration among professionals from 

different disciplines. 

In working together interdisciplinarity, we have identified two 

general areas of importance that need to be considered by 

other researchers working on this 1) the technological 

challenges and 2) the clinical challenges. 

TECHNOLOGICAL CHALLENGES  

There are several technological challenges, such as the 

selection of appropriate printing method, i.e., FDM (Fused 

Deposition Modeling), SLS (Selective Laser Sintering), SAF 

(Selective Absorption Fusion), SLA (stereolithography) or 

MJF (Multi Jet Fusion) for the specific clinical purpose(s) as 

we also faced with some of them upon our clinical studies. 

Considering the product allowance in terms of dimension, 

material, or bonding properties is essential. Some vital 

physical and mechanical properties tests for suitability of 

clinical applications should be included, such as tensile, 

bending, and opening-closing tests, as well as body heat 

and humidity tests within the laboratory. 

The settings of 3D printing machines are versatile. For FDM, 

it includes the speed of 3D printing, the size and 

temperature of the nozzle, and the bed temperature, which 

may all affect the adhesion/bonding of the materials. On the 

other hand, the limited number of materials in SLS 

technology, as well as powder quality, distribution, and 

density, play a vital role in the quality of 3D printed products. 

Therefore, sometimes, the design needs to proceed using a 

trial-and-error process to obtain the desired orthotic or 

prosthetic component. 

Another challenge is the limited selection of materials, as 

the material and the final orthotic or prosthetic device should 

pass a biocompatibility test to be considered medical-grade 

3D printing materials. Materials must meet ISO standards 

regarding toxicity, skin irritation, and sensitization. The 

biggest challenge arises from assessing how materials 

react with the skin over the long term, as orthotic or 

prosthetic devices maintain direct contact with the skin. 

Improvement of the surface finishing and durability of 3D 

printed prosthetics is another crucial element as FDM 

technology leaves distinct layer lines, and SLS and MJF 

make a matte surface. Post-process surface finishing is 

either physical smoothing, like sandblasting, or chemical 

smoothing, such as vapor smoothing through vaporized 

solvents. 

Flexible printing materials are in demand in the O&P 

industry, and the most acceptable material up to this point 

of time tends to be TPU. However, it faces considerable 

difficulty because of its durability issue. As such, the vapor 

smoothing improves durability. To address bacteria 

proliferation, particularly on surfaces directly in contact with 

skin, such as liners, surface finishing could protect any liquid 

intake. Nonetheless, this needs further improvement and 

accessibility to clinics and laboratories worldwide.  

Finally, it is worth noting that in the application of additive 

manufacturing, several CAD and 3D printing software 

requite a continued internet connection to identify license 

eligibility. While this requirement is understandable, 

alternative methods must be considered, as offline 

platforms are vital for those working in remote areas and 

providing orthotic and prosthetic services. Application of 

generic Mesh modification software in particular freeware 

versions could be kept into account. 

CLINICAL CHALLENGES 

There are a number of clinical challenges, such as material 

allergies, the effect of body temperature and humidity on the 

materials used, and short-term and long-term clinical 

studies on acceptance and efficacy. As an analogy to the 

conventionally used thermoplastics, the 3D printed 

materials should be easily handled, including machining, 

grinding, and possibly modifying the 3D printed devices 

using the heat gun. 

One of the biggest challenges lies in the mindset of 

clinicians and technicians, who may be hesitant to partially 

transition from conventional methods to embracing 

digitalized 3D printing. Overcoming this reluctance requires 

them to be open to learning and adapting themselves to 

become proficient digital practitioners. Therefore, the re-

education of practitioners should be taken into 

consideration, as it would require the acquisition of new 

skills. Nonetheless, it is essential to acknowledge that the 

expertise and creativity of clinicians and designers in 

utilizing digital tools within 3D design applications are 

critical. These skills can be transformed from traditional 

methods and effectively implemented in digital formats. It 

also reminds us the necessity to incorporate more 

https://doi.org/10.33137/cpoj.v6i2.42225


 

4 

Hassan Beygi B, Wong M.S. Contemporary and future development of 3D printing technology in the field of assistive technology, orthotics and prosthetics. 
Canadian Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 2, No.10. https://doi.org/10.33137/cpoj.v6i2.42225 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X CONTEMPORARY AND FUTURE DEVELOPMENT OF 3D PRINTING TECHNOLOGY  

Hassan Beygi B, and Wong M.S., 2023 (Special Issue) 

components into the curriculum in different universities to 

synchronize with the rapid advancement in digital 

technologies. This will prepare students to be already 

comfortable and proficient with such technology once they 

start the clinical services. 

FUTURE OUTLOOK OF 3D PRINTING LANDSCAPE 

The market is expected to become more populated with 

machine learning and AI (artificial intelligence) models and 

semi-automated designs through advancements in 

software, 3D scanning, and digitalized 3D printing workflow. 

While it is imperative for clinicians to get familiar with digital 

design, a semi-automated, repeatable workflow will help 

clinicians spend more time improving the designs, rather 

than grappling with digital tools to replicate traditional 

designs. 

More 3D printing machines will be anticipated into the 

orthotic and prosthetic market while 3D printing hardware, 

software, and materials will evolve concurrently. 

The development of new materials will provide further 

options in the selection of preferred materials for orthotic 

and prosthetic devices. The new materials could also 

address the need for durability, for example, in a remote, 

hot, and humid climate where the maintenance and frequent 

follow-up to the fitted devices may not be feasible. The 

application of pellet 3D printing could be considered as one 

of the solutions since there are a variety of thermoplastic 

materials in the form of pellets compared to the currently 

limited options for the filaments in the market. 

The application of metal 3D printing may get widespread, 

particularly for custom-made prosthetic and orthotic 

components for athletes or activity-specific devices. 

Currently, these components are mainly manufactured 

using subtractive manufacturing, including CNC and laser 

cutting. However, once the metal 3D printing machines 

become more affordable, they could help clinicians design 

and manufacture the specific components tailor-made for 

the individual amputees.  

Color printing is another domain that can be further 

practiced. It remarkably improves the adherence of children 

with disabilities/deformities to the prescribed 

orthotic/prosthetic appliances thanks to its enhanced 

aesthetic. Like metal 3D printing, this is pending the 

development of more cost-effective machines in the near 

future. 

In summary, 3D printing would become a helpful technology 

that facilitates innovative assistive technology, orthotics, 

and prosthetics development. This technology could likely 

contribute to positive treatment outcomes. It could also 

mitigate the challenges encountered when using the 

traditional methods. However, it should be emphasized that 

assistive technology, orthotics, and prosthetics require a 

human touch and connection, and no digital tool or 

technology can replace such requirements. Indeed, multi-

disciplinary collaboration is the key to the success of 

applications of 3D printing. 

CALL TO ACTION 

Close collaboration among different disciplines is the 

essential prerequisite for the successful application of such 

technology into the clinical setting. Moreover, a number of 

relevant clinical and technical research studies should be 

conducted before the CAD/CAM (3D printing) technology 

can be established and formulated as an evidence-based 

patient-centered practice in the field of assistive technology, 

orthotics, and prosthetics. The patient's safety should be 

listed as a priority in the implementation of this technology.  

ACKNOWLEDGEMENTS 

The authors would like to acknowledge the content of 

www.3dheals.com and www.3dprintingindustry.com, where the 

webinars, interviews, and news related to the O&P practice were 

helpful in providing further input to parts of this manuscript. These 

platforms could be considered as two useful sources to support the 

updates in the application of 3D printing in this industry. 

DECLARATION OF CONFLICTING INTERESTS 

Authors declare that there is no financial or personal relationship 

with organizations or individuals that might have influenced our 

research. 

AUTHORS CONTRIBUTION 

Both authors contributed equally to the research and the writing of 

this manuscript. 

SOURCES OF SUPPORT 

None. 

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JJJ, Willemsen F, Janzing HMJ, et al. Personalized 3D-printed 

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Hassan Beygi B, Wong M.S. Contemporary and future development of 3D printing technology in the field of assistive technology, orthotics and prosthetics. 
Canadian Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 2, No.10. https://doi.org/10.33137/cpoj.v6i2.42225 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X CONTEMPORARY AND FUTURE DEVELOPMENT OF 3D PRINTING TECHNOLOGY  

Hassan Beygi B, and Wong M.S., 2023 (Special Issue) 

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BRS.0000000000004202 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AUTHORS SCIENTIFIC BIOGRAPHY 

Professor M.S. Wong is a specialist in 

Prosthetics and Orthotics of the Department 

of Biomedical Engineering, The Hong Kong 

Polytechnic University. With his clinical and 

engineering training background, he has the 

educational vision of nurturing students with 

state-of-the-art professional knowledge and 

skills as well as all-rounded attributes, 

especially in positive attitude to tackle the 

uncertainties and challenges from this ever-

changing world, and in social responsibility to serve the less-

privileged people. His main research interests are scoliosis, spinal 

orthotics, prevention of fragility fractures, gait and posture analysis, 

CAD/CAM in prosthetics and orthotics, and prosthetics and 

orthotics outcome evaluations.  

Dr. Babak Hassan Beygi is a prosthetist 

& orthotist targeting on enhancement of 

the clinical outcomes of applied orthotic 

and prosthetic appliances with his 

research and clinical background. His 

main interests include the conservative 

treatment of spinal deformities as well as 

application of CAD/CAM technology in 

orthotics & prosthetics. 

 

 

 

 

 

https://doi.org/10.33137/cpoj.v6i2.42225

