The Russian company Zdravprint prints orthoses and is learning to use 3D printers to create artificial bones. Having invested only $150 thousand, the company’s founders expect to reach self-sufficiency in less than a year

Photo: Alexey Zhitomirsky

Published in RBC magazine No. 1 for 2016

The founder of Zdravprint, a graduate of the Faculty of Sociology of Moscow State University, Fyodor Aptekarev, was engaged in video mapping for several years - projecting 3D images onto real objects (often used as part of various shows), until in 2012 he came across 3D printing technology. After experimenting with a personal 3D printer for a year, Aptekarev decided to make a business out of it in March 2013. I started with orthoses - external devices for changing the structural and functional characteristics of the muscles or skeleton of a person. An avid skateboarder, Aptekarev has been a patient in emergency rooms more than once and knew that traditional casting is not always convenient and effective.

According to the estimates of the Federal State Institution CITO named after. N.N. Priorov, about 1.5 million fractures requiring plaster are recorded annually in Russia. In about a third of cases, patients experience inconvenience related to hygiene and itching, as a result of which about 350 thousand of them remove the plaster ahead of time. If, in the case of at least 100 thousand fractures, Zdravprint orthoses are used instead of plaster, the company could receive revenue of several hundred million rubles, Aptekarev calculated.

Unlike plaster, Zdravprint orthoses have a mesh structure, which eliminates the appearance of bedsores, and they look attractive - you can even choose the color, says Aptekarev. The materials closest in functional properties to Zdravprint products are softcast (developed by 3M, USA) and turbocast (T Tare Company, the Netherlands). The first is a polymer plaster (bandages impregnated with resin, which hardens within 10-15 minutes and requires quick application), the second is a low-temperature plastic, which is sold in standard sizes and requires adjustment to each individual patient.

With the idea of comfortable orthoses, in the spring of 2014, Aptekarev, at the invitation of one of his mentors, entered the Yandex Tolstoy Startup Camp acceleration program. Through acquaintances made there, Aptekarev contacted Alexey Tsukanov, who worked in a venture fund managed by Da Vinci Capital. Tsukanov became a co-founder of Zdravprint and headed the company. At the start, the partners invested about $50 thousand of their own funds. The money went towards developing hardware and software. In the spring of 2015, the project raised $100 thousand from the Maxfield Capital venture fund. Now 100% of Zdravprint belongs to Zdravprint Ltd (British Virgin Islands), shares in which are not disclosed.

Orthosis in 20 minutes

Initially, the entrepreneurs planned to conduct a 3D scan of a human limb and then manufacture products based on the model, but this turned out to be too expensive and time-consuming. Then Zdravprint wrote a program that allows you to build a 3D model of a future orthosis using linear parameters (measured with a regular ruler) or from a photograph. They decided to produce products from low-temperature organic plastics (polylactides obtained from corn and milk).

Zdravprint uses a Makerbot Replicator 2 3D printer (one can be purchased on the manufacturer’s official website for €2,140), improving the extrusion mechanism of the serial machine.

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3D perspective

According to research company Gartner Inc., about 224.5 thousand 3D printers will be shipped in 2015 and these deliveries will at least double in each subsequent year. These products are especially in demand in medicine, note Gartner experts, where the knee and hip replacement market alone was estimated at $14.9 billion in 2013 .

The technology of work looks like this: the doctor takes the patient’s measurement and sends it to the head office of Zdravprint. There, using programs that the company has already secured, a 3D model of the future product is built. The orthosis itself can be printed on a 3D printer in Moscow (and delivered to the clinic within a few hours) or in the clinic itself (for example, in Nizhny Novgorod). The doctor will receive a flat orthosis blank, which will need to be heated for several minutes under a stream of warm air and applied to the fracture site.

According to Tsukanov, a model of an orthosis at Zdravprint is now built in a few minutes, and printing a product takes from five minutes (small, for a finger) to 1.5–2 hours (large orthoses for the forearms). An orthosis from Zdravprint, for example, for a finger costs 800–1200 rubles, and an industrially manufactured one from turbocast with installation will cost 8 thousand rubles. Large products from Zdravprint cost 3.5–4 thousand rubles. versus 12 thousand rubles. from turbocast (all prices for products from turbocast are from the website of one of the Moscow clinics; applying plaster under compulsory medical insurance is free).

In November 2015, Zdravprint produced only 100 products worth several hundred thousand rubles, but these numbers have been growing by 50% every month since August 2015, when the project began operating under a paid model, Tsukanov says. If growth rates remain at 30–50% per month, the company will break even in 11 months, he expects.

So far, several medical institutions and private doctors are collaborating with Zdravprint (40 clients in total), and the company’s technology does not allow the production of all types of orthoses. Roman Gorbatov, head of the additive technologies laboratory at the Volga Federal Medical Research Center of the Russian Ministry of Health (PFMITS, Nizhny Novgorod), says that cooperation with Zdravprint began at the company’s initiative. “We liked their technologies because they allow us to work with complex cases, especially in children,” he told RBC, “but it is too early to talk about completely replacing the plaster cast with orthoses.”

The director of the Ortho-Cosmos rehabilitation and orthopedic center, Stepan Golovin, says that as a pilot project, Zdravprint produced cosmetic orthoses for prostheses, but so far the cooperation has not continued. “They made a bright product that our customers liked, but there were operational problems,” explains Golovin. “We make mouth guards ourselves, but Zdravprint’s technologies help us do this effectively,” says Irina Dmitrienko, medical director of the 3D Smile laboratory, which specializes in the production of transparent mouth guards for correcting bites and straightening teeth. “For us, they combine CT scan data and 3D models of the patient’s teeth so that we can correctly calculate the forces to move the teeth.” True, 3D scanners are not yet available to most dentists, and the use of 3D printing makes services more expensive, she admits.

3D growth

3D printing in healthcare is still a relatively small market: in 2014, its volume was, according to Visiongain, $ 825 million . But by 2019 it will almost quadruple - to $2.9 billion . Another analytical company, IndustyARC, believes that in 2014 the market volume was $487 million , and this figure was a record, and until 2020 it will increase by 18.3% annually while the price of technology and materials decreases.

3D printing technologies will develop most actively for the manufacture of orthopedic, cranial and maxillofacial implants, Visiongain analysts expect.

Not only orthoses

Back in 2011, a patient in the Netherlands received a 3D printed lower jaw transplant. And in 2013, Oxford Performance Materials reported that the US Food and Drug Administration had approved a 3D-printed polymer skull implant (the agency later approved facial and spinal implants as well).

“Now we use metal powder for printing. To print organic skin and bones, you will need organic material as the “ink.” Technically this is possible, but there is still a long way to go,” the BBC quoted Ruben Vautle, an engineer at LayerWise, which made the jaw implant, in 2011. In 2015, a group of Chinese scientists from the Southern Medical University in Guangzhou announced that they were ready to begin testing organic bones, 3D printed from bone powder and bio-glue, on animals. Scientists are experimenting with creating goat and rabbit bones, but have not yet been able to obtain samples larger than 15 cm. If the tests are successful, 3D-printed bones could be available in five to six years, writes the industry website 3ders.org, citing the Chinese President Huang Wenhua University.

Zdravprint is also experimenting in this area, although so far with printing forms to create implants from a biopolymer, and not the bones themselves. In August 2015, a large bone implant was manufactured at PFMIC using Zdravprint technologies and a 3D printer. Using the company's technologies, a 3D model of the bone was created, and a matrix (tub) was printed on a 3D printer, allowing the bone to be cast from a biopolymer.

“Classical” technology involves the use of titanium plates or meshes, which are manually coated with bone cement. But making a plate takes from several weeks to six months and costs 60–80 thousand rubles. But bone cement is liquid and spreads, so it does not allow large bone defects to be eliminated, explains Tsukanov. According to the technology of PFMITs and Zdravprint, the bone is first cast and then inserted into the desired place, avoiding problems with cement, he explains. With Zdravprint technology, creating a matrix for casting bone took no more than 48 hours from the moment of receiving the tomography data and the doctor’s description and cost a little more than 15 thousand rubles, says Tsukanov. Gorbatov names another advantage of the new technology - accuracy of 100 microns. According to him, this cannot be obtained using the traditional method.

Since August, Zdravprint has already completed eight similar orders using 3D printing, reports Tsukanov. “In Russia, 945 thousand people are awaiting surgery to remove bone tumors, and 2 million people have post-operative defects of the skull,” Gorbatov describes the prospects.

Great prospects

3D printing is already actively used for medical purposes in Europe and the USA, says Dmitry Fadin, a member of the Invitro strategy committee, who advises Zdravprint. Two main directions are preparation for complex operations, when future manipulations are practiced on a 3D model, and making impressions of the jaw in dental laboratories.

“We actively use 3D technologies during surgical operations,” says Nikolai Zagorodniy, Doctor of Medical Sciences, head of the Department of Traumatology and Orthopedics at the Faculty of Medicine of the RUDN University. “Very often there are complex cases in which you cannot rely only on MRI and X-ray images, but you need to see the physical object.”

Fadin considers the main problem of the Zdravprint project to be the conservatism of the medical environment. “As far as I know, their work with doctors is moving very slowly. Most doctors are only willing to use new technologies when they become industry standard, he notes. “The creators of Zdravprint need to be patient and constantly work to convince doctors of the effectiveness of their solutions.”

Aptekarev admits there are difficulties, but is confident that in three years Zdravprint’s technologies will become the standard of the medical market. “I believe in bioprinting as part of the technology to create organs suitable for transplantation,” he says. “And I am confident that 3D printing has the potential to revolutionize many areas of life.”

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