AToAAdditive Tech on Anatomy

Evidence library

Read the papers.
Then send the case.

What each study found, and what it means for the patient in front of you. Every entry links to the source.

Read every number here as a floor

Almost all of this evidence comes from well-resourced centres that already have navigation, intraoperative imaging, subspecialty teams and routine 3D planning. Where those are scarce, a printed model or guide is often the only three-dimensional information in theatre, so the difference it makes should be larger, not smaller. That has not yet been measured in East Africa; our case registry is built to measure it.

Dental and jaw: reconstruction

  • Virtual surgical planning shortened fibula free flap mandible reconstruction by 44.6 minutes, with no difference in complications.
    Systematic review and meta-analysis; 241 planned against 214 conventional patients.
    Barr ML, Haveles CS, Rezzadeh KS, et al. Virtual surgical planning for mandibular reconstruction with the fibula free flap: a systematic review and meta-analysis. Ann Plast Surg. 2020;84(1):117-122. doi:10.1097/SAP.0000000000002006
  • Virtually planned mandible reconstruction halved the gonial angle error against free-hand surgery (3.6° against 7.7°, p < 0.05).
    Meta-analysis of six studies. Intercondylar distance also favoured planning (2.0 mm against 3.9 mm) but did not reach significance.
    Pucci R, Weyh A, Smotherman C, et al. Accuracy of virtual planned surgery versus conventional free-hand surgery for reconstruction of the mandible with osteocutaneous free flaps. Int J Oral Maxillofac Surg. 2020;49(9):1153-1161. doi:10.1016/j.ijom.2020.02.018

Dental and jaw: orthognathic

  • Virtual planning with custom surgical guides consistently reduced the difference between planned and achieved jaw positions; operating time savings were not statistically significant.
    Lee YJ, Oh JH, Kim SG. Virtual surgical plan with custom surgical guide for orthognathic surgery: systematic review and meta-analysis. Maxillofac Plast Reconstr Surg. 2024;46(1):39. doi:10.1186/s40902-024-00449-2
  • Across 5 randomised trials (199 patients), virtual planning gave more symmetrical frontal results, better accuracy in the anterior maxilla and more precise soft tissue prediction than traditional planning.
    Chen Z, Mo S, Fan X, et al. A meta-analysis and systematic review comparing the effectiveness of traditional and virtual surgical planning for orthognathic surgery: based on randomized clinical trials. J Oral Maxillofac Surg. 2021;79(2):471.e1-471.e19. doi:10.1016/j.joms.2020.09.005
  • Narrative review of virtual planning and 3D printing in orthognathic surgery; source of the figures on our orthognathic page (CC BY 4.0).
    Lee YC, Kim SG. Redefining precision and efficiency in orthognathic surgery through virtual surgical planning and 3D printing: a narrative review. Maxillofac Plast Reconstr Surg. 2023;45(1):42. doi:10.1186/s40902-023-00409-2

Dental and jaw: implants

  • Implants placed with static printed guides deviated a mean 1.2 mm at entry, 1.4 mm at the apex and 3.5° in angle.
    20 clinical studies, 2,238 implants in 471 patients. Accuracy is clinically acceptable in most situations, with a recommended 2 mm safety margin; partially edentulous cases were more accurate than fully edentulous ones.
    Tahmaseb A, Wu V, Wismeijer D, et al. The accuracy of static computer-aided implant surgery: a systematic review and meta-analysis. Clin Oral Implants Res. 2018;29 Suppl 16:416-435. doi:10.1111/clr.13346

Orthopaedics: fractures

  • Across 16 randomised trials, 3D-assisted fracture surgery cut operating time, blood loss and fluoroscopy; in tibial plateau fractures by 12.8 minutes, 30.4 mL and 2.1 minutes.
    881 patients; tibial plateau, ankle, calcaneus, elbow and wrist. No difference in complications.
    Mazzola MA, D'Andrea G, Barducci N, et al. Impact of 3D technology on perioperative outcomes of articular and periarticular fractures: a systematic review and meta-analysis of RCT studies. J Orthop. 2026;76:39-48. doi:10.1016/j.jor.2026.03.015
  • 3D printing-assisted fixation of tibial plateau fractures gave shorter operations, less blood loss and faster union than conventional fixation.
    11 RCTs and 6 prospective studies, 736 patients. Functional scores and complications did not differ.
    Xie L, Chen C, Zhang Y, et al. Three-dimensional printing assisted ORIF versus conventional ORIF for tibial plateau fractures: a systematic review and meta-analysis. Int J Surg. 2018;57:35-44. doi:10.1016/j.ijsu.2018.07.012

Orthopaedics: spine

  • In spinal deformity surgery, 3D-printed drill guide templates placed more pedicle screws accurately than free-hand (acceptable placement OR 3.66), with 28 minutes less screw placement time and 105 mL less blood loss.
    7 studies, 2,776 screws. No difference in overall operating time or curve correction.
    Liang W, Han B, Hai JJ, et al. 3D-printed drill guide template, a promising tool to improve pedicle screw placement accuracy in spinal deformity surgery: a systematic review and meta-analysis. Eur Spine J. 2021;30(5):1173-1183. doi:10.1007/s00586-021-06739-x
  • Printed spine models are used mainly for planning, education and simulation, and planning models reduced key surgical performance indicators.
    Pearce P, Novak J, Wijesekera A, et al. Properties and implementation of 3-dimensionally printed models in spine surgery: a mixed-methods review with meta-analysis. World Neurosurg. 2023;169:57-72. doi:10.1016/j.wneu.2022.10.083

Cardiac: structural intervention

  • Planning left atrial appendage closure on a 3D print cut device-size disagreement and leaks to about a fifth of the imaging-only rate (RR 0.19; 95% CI 0.09 to 0.37).
    Eight studies, 428 patients, no heterogeneity (I² = 0%). The strongest pooled evidence for cardiac printing so far.
    DeCampos D, Teixeira R, Saleiro C, et al. 3D printing for left atrial appendage closure: a meta-analysis and systematic review. Int J Cardiol. 2022;356:38-43. doi:10.1016/j.ijcard.2022.03.042
  • Tissue-mimicking printed aortic roots predicted the occurrence, severity and location of paravalvular leak after TAVI.
    18 patients; a bulge index on the printed root separated no leak, mild and moderate-to-severe leak (p = 0.001).
    Qian Z, Wang K, Liu S, et al. Quantitative prediction of paravalvular leak in transcatheter aortic valve replacement based on tissue-mimicking 3D printing. JACC Cardiovasc Imaging. 2017;10(7):719-731. doi:10.1016/j.jcmg.2017.04.005
  • Deploying the valve in a printed model of high-risk patients correlated well with clinical coronary obstruction outcomes.
    13 patients at high risk of coronary obstruction during TAVI; proof of concept for pre-procedural simulation.
    Russo JJ, Yuen T, Tan J, et al. Assessment of coronary artery obstruction risk during transcatheter aortic valve replacement utilising 3D-printing. Heart Lung Circ. 2022;31(8):1134-1143. doi:10.1016/j.hlc.2022.01.007
  • Expert consensus on predicting left ventricular outflow obstruction before transcatheter mitral valve replacement from CT.
    The neo-LVOT is a planning problem solved in 3D before the procedure, not during it.
    Reid A, Ben Zekry S, Turaga M, et al. Neo-LVOT and transcatheter mitral valve replacement: expert recommendations. JACC Cardiovasc Imaging. 2021;14(4):854-866. doi:10.1016/j.jcmg.2020.09.027

Cardiac: congenital

  • 3D models changed the surgical decision in 19 of 40 complex congenital cases; in 4, a patient headed for conservative care or single-ventricle palliation got a successful biventricular repair.
    Prospective, 10 international centres. 96% of surgeons said the model improved their understanding and planning. Mean model bias -0.27 mm.
    Valverde I, Gomez-Ciriza G, Hussain T, et al. Three-dimensional printed models for surgical planning of complex congenital heart defects: an international multicentre study. Eur J Cardiothorac Surg. 2017;52(6):1139-1148. doi:10.1093/ejcts/ezx208
  • Appropriateness ratings for 3D printing across 28 paediatric congenital heart lesion categories.
    The RSNA consensus on when a printed model is an appropriate extension of the imaging.
    Ryan JR, Ghosh R, Sturgeon G, et al. Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: pediatric congenital heart disease conditions. 3D Print Med. 2024;10(1):3. doi:10.1186/s41205-023-00199-3
  • Printed models clarify VSD-to-great-artery routing in double outlet right ventricle, the classic case where 2D imaging misleads.
    Includes a virtual method for planning the intracardiac baffle, with printed baffle templates.
    Yoo SJ, van Arsdell GS. 3D printing in surgical management of double outlet right ventricle. Front Pediatr. 2017;5:289. doi:10.3389/fped.2017.00289 · Vigil C, Lasso A, Ghosh RM, et al. Modeling tool for rapid virtual planning of the intracardiac baffle in double-outlet right ventricle. Ann Thorac Surg. 2021;111(6):2078-2083. doi:10.1016/j.athoracsur.2021.02.058
  • Multidisciplinary assessment of printed DORV models in an Indian centre, a resource setting close to ours.
    Garekar S, Bharati A, Chokhandre M, et al. Clinical application and multidisciplinary assessment of three dimensional printing in double outlet right ventricle with remote ventricular septal defect. World J Pediatr Congenit Heart Surg. 2016;7(3):344-350. doi:10.1177/2150135116645604
  • Hands-on surgical training on printed hearts: surgeons practise the operation on the model, and performance can be scored.
    Yoo SJ, Spray T, Austin EH, et al. Hands-on surgical training of congenital heart surgery using 3-dimensional print models. J Thorac Cardiovasc Surg. 2017;153(6):1530-1540. doi:10.1016/j.jtcvs.2016.12.054 · Hussein N, Honjo O, Barron DJ, et al. The incorporation of hands-on surgical training in a congenital heart surgery training curriculum. Ann Thorac Surg. 2021;112(5):1672-1680. doi:10.1016/j.athoracsur.2020.11.018
  • Parents and patients understand the defect better with a model in hand, and it is feasible in routine clinics.
    Biglino G, Capelli C, Wray J, et al. 3D-manufactured patient-specific models of congenital heart defects for communication in clinical practice: feasibility and acceptability. BMJ Open. 2015;5(4):e007165. doi:10.1136/bmjopen-2014-007165

Cardiac: tumours

  • Printed tumour models, with the mass made transparent, guided maximal debulking in two infants while protecting the coronary arteries.
    Riggs KW, Dsouza G, Broderick JT, et al. 3D-printed models optimize preoperative planning for pediatric cardiac tumor debulking. Transl Pediatr. 2018;7(3):196-202. doi:10.21037/tp.2018.06.01
  • 3D models defined size, location and extension of large malignant cardiac tumours more precisely for resection planning.
    Al Jabbari O, Abu Saleh WK, Patel AP, et al. Use of three-dimensional models to assist in the resection of malignant cardiac tumors. J Card Surg. 2016;31(9):581-583. doi:10.1111/jocs.12812
  • 3D technologies used to plan the management of complex paracardiac tumours.
    Pérez-Cualtán CE, Vargas-Acevedo C, Sánchez-Posada J, et al. Surgical planning aided with 3D technologies for management of complex paracardiac tumors. J Cardiothorac Surg. 2024;19(1):548. doi:10.1186/s13019-024-03096-w

Cardiac: cardiomyopathy and heart failure

  • Septal myectomy rehearsed on a tissue-like print before surgery; the resected volume on the print matched the patient's specimen.
    Hermsen JL, Burke TM, Seslar SP, et al. Scan, plan, print, practice, perform: development and use of a patient-specific 3-dimensional printed model in adult cardiac surgery. J Thorac Cardiovasc Surg. 2017;153(1):132-140. doi:10.1016/j.jtcvs.2016.08.007 · Hermsen JL, Yang R, Burke TM, et al. Development of a 3-D printing-based cardiac surgical simulation curriculum to teach septal myectomy. J Thorac Cardiovasc Surg. 2018;156(3):1139-1148. doi:10.1016/j.jtcvs.2017.09.136
  • In advanced heart failure, 3D planning guided four complex assist-device implants and redirected two very high-risk patients to transplant.
    Stepanenko A, Perez LM, Ferre JC, et al. 3D virtual modelling, 3D printing and extended reality for planning of implant procedure of short-term and long-term mechanical circulatory support devices and heart transplantation. Front Cardiovasc Med. 2023;10:1191705. doi:10.3389/fcvm.2023.1191705
  • Cardio-oncology context: the first ESC guideline for the specialty, and the HFA-ICOS baseline risk tool.
    Lyon AR, López-Fernández T, Couch LS, et al. 2022 ESC Guidelines on cardio-oncology. Eur Heart J. 2022;43(41):4229-4361. doi:10.1093/eurheartj/ehac244 · Lyon AR, Dent S, Stanway S, et al. Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies. Eur J Heart Fail. 2020;22(11):1945-1960. doi:10.1002/ejhf.1920
  • RSNA appropriateness criteria for adult cardiac 3D printing, from valve disease to cardiac neoplasm and mechanical circulatory support.
    Ali A, Ballard DH, Althobaity W, et al. Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: adult cardiac conditions. 3D Print Med. 2020;6(1):24. doi:10.1186/s41205-020-00078-1

Cost, value and standards

  • In-house planning for mandibular reconstruction took significantly less time and cost significantly less than a commercial planning service, with no difference in bone healing or wound complications; commercial plans were more precise on some measurements.
    Block OM, Khromov T, Hoene G, et al. In-house virtual surgical planning and guided mandibular reconstruction is less precise, but more economical and time-efficient than commercial procedures. Head Neck. 2024;46(4):871-883. doi:10.1002/hed.27642
  • An in-house planning and guide workflow for free flap jaw reconstruction reproduced the plan with no significant deviation, with 95% flap success and low cost.
    Moe J, Foss J, Herster R, et al. An in-house computer-aided design and computer-aided manufacturing workflow for maxillofacial free flap reconstruction is associated with a low cost and high accuracy. J Oral Maxillofac Surg. 2021;79(1):227-236. doi:10.1016/j.joms.2020.07.216
  • Virtual planning for head and neck reconstruction shortened median hospital stay from 13 to 10 days and operating time, at a similar total cost, even using a commercial planning provider.
    138 patients.
    Mazzola F, Smithers F, Cheng K, et al. Time and cost-analysis of virtual surgical planning for head and neck reconstruction: a matched pair analysis. Oral Oncol. 2020;100:104491. doi:10.1016/j.oraloncology.2019.104491
  • A review of 3D printing in cardiothoracic surgery in Africa: the potential uses, and the cost, training and infrastructure barriers to adopting it.
    Effiom VB, Biswas K, Chandran BVS, et al. Potential uses and challenges of three-dimensional printing in cardiothoracic surgery in Africa: a narrative review. Braz J Cardiovasc Surg. 2025;40(6):e20240301. doi:10.21470/1678-9741-2024-0301
  • Printed anatomical models saved a mean 62 minutes of theatre time and printed guides 23 minutes; a lab breaks even at about 63 models or guides a year.
    Built on US theatre costs of about USD 62 a minute. The time saved travels; the dollar figure needs local costing.
    Ballard DH, Mills P, Duszak R, et al. Medical 3D printing cost-savings in orthopedic and maxillofacial surgery: cost analysis of operating room time saved with 3D printed anatomic models and surgical guides. Acad Radiol. 2020;27(8):1103-1113. doi:10.1016/j.acra.2019.08.011
  • Since 2019 the American Medical Association has had CPT Category III codes (0559T to 0562T) for 3D printed anatomical models and guides.
    A precedent for how a health system can recognise and track this work.
    American Medical Association. CPT Category III codes, long descriptors. ama-assn.org

Kenya: policy, payment and regulation

  • SHA reimburses specialised surgery as fixed packages, for example KES 224,000 for mandibulectomy or maxillectomy with a microvascular bone graft, KES 358,400 with neck dissection and a microvascular free flap, KES 308,000 for orthognathic surgery and KES 291,200 for scoliosis correction. There is no separate tariff line for 3D planning or printing.
    Under a fixed package, theatre time and length of stay saved by planning are retained by the hospital. The surgical package allows one specialised procedure per household per year.
    Tariffs for Healthcare Services, Social Health Insurance Act 2023, Legal Notice 56 of 2025, as amended to 8 May 2026. kenyalaw.org
  • The Ministry of Health gazetted 36 specialised services not available in Kenya, with treatment abroad funded up to KES 500,000 per beneficiary; the reasons given include a lack of implant availability and limited prosthesis access.
    The Benefits Package and Tariffs Advisory Panel will keep assessing which services should be added or removed.
    Gazette Notice No. 13369, 18 September 2025, under the Social Health Insurance Regulations, 2024. Reported in People Daily, 20 September 2025.
  • Personal health information may only be shared with anyone outside Kenya for the purposes of health tourism; the Digital Health Agency is custodian of all health data in Kenya.
    Digital Health Act, 2023 (No. 15 of 2023), section 47. Digital Health (Health Information Management Procedures) Regulations, 2025, regulation 5. kenyalaw.org
  • Health data is sensitive personal data, and processing it requires a lawful basis and safeguards.
    Data Protection Act, 2019 (No. 24 of 2019). kenyalaw.org
  • Kenya imported KES 92.9 billion of health products in 2022 and exported KES 12.2 billion. The national strategy aims to raise use of local manufacturing capacity by 70%, and public procurement gives local goods a 6 to 20% margin of preference.
    Ministry of Health. Kenya Health Products and Technologies Local Manufacturing Strategy 2026 to 2030. Published June 2026
  • Custom-made medical devices can be exempted from registration and establishment licensing, after notification to the Pharmacy and Poisons Board.
    Pharmacy and Poisons Board. Guidelines for Registration of Medical Devices including In-Vitro Diagnostics, section 2.14. pharmacyboardkenya.org

Model sources on this site

  • Adult heart, scan 100: STACOM 2025 open cardiac CT dataset featuring the left atrial appendage (labels MIT licence; CT from ImageCAS).
    Hansen B, Pedersen J, Kofoed KF, Camara O, Paulsen RR, Sørensen K. A public cardiac CT dataset featuring the left atrial appendage. STACOM, MICCAI Workshop, Springer 2025. arXiv:2510.06090
  • Neonatal pulmonary atresia, VSD and MAPCAs: NIH 3D Heart Library, Case Model 24, by Matthew Bramlet (public domain).
    3d.nih.gov/entries/3DPX-007808
  • Ameloblastoma fibula free flap case, intraoral scan arches and severe kyphosis: clinical cases from 2026, shown with identifying details removed.
  • Tibial plateau fracture: NIH 3D, "Knee - proximal tibia fracture" (public domain).
    3d.nih.gov/entries/3DPX-000820