3D Printing Applications and Extended Realities in Medicine: Systematic Review

Abstract

This study aims to systematically review the integration and clinical applications of 3D printing and extended reality technologies in medicine. This offers an in-depth review of technological advances and their application in different areas of medicine such as surgical planning, medical staff training, new ways of visualization, as well as the integration of tailor-made physical and digital elements. Factors that benefit patient safety and promote innovation through technological intervention. The study conducted a systematic review of the literature using the PRISMA methodology, with a selection of studies published between 2005 and 2023. The process included a comprehensive search in academic databases from which articles were extracted that included topics on 3D printing technologies, extended realities, and applied cases in which efficacy and application in clinical settings were proven. As a result, specific inclusion and exclusion filters were established to ensure relevance to the study’s objective. The selected items were subjected to a detailed analysis, based on which the methodologies used, types of studies, areas of impact, population, and clinical impacts were evaluated. The synthesis of the results was carried out using the quantitative and qualitative approaches. This enabled a comprehensive understanding of current trends and potential future applications of these technologies in the field of medicine. The results indicate that the adoption of 3D printing and technologies such as augmented reality (AR) and mixed reality (MR) facilitates more precise and less invasive interventions. It also improves understanding of complex conditions and pathologies through enhanced and enriched interactions and visualizations. In addition, technologies are consolidated as tools for medical strengthening and training through more realistic simulations. Studies show that by having better understanding, visualization, and interaction with components and technologies, there is a reduction in surgical errors and optimized duration times in the surgeon and patient recovery; finally, the use of these technologies also improves the retention of information in training and education contexts. Furthermore, the study reveals that, although the associated costs may be considerable, the gains in accuracy and operational efficiency justify the investment. Among the challenges posed by the use and integration of 3D printing and augmented or MR is the need to further improve the accurate calibration of the 3D images with physical models, which turns out to be a key aspect for the success of these applications in the clinical context. Implementation of technologies such as 3D printing, AR, MR, and virtual reality in clinical practice has been shown to have great benefits in efficiency and safety in surgical procedures. These technologies profile themselves as solutions that promise to revolutionize approaches to learning, surgical planning, and surgery. This offers customization and accuracy features, significantly reducing error margins. Furthermore, medical training is enriched by more realistic simulations and detailed visualizations. However, the construction of innovative tools that consolidate the characteristics of these technologies requires continuous improvement and investment in training, development, and appropriate infrastructure to overcome the challenges associated with the integration of such technologies into clinical practice. This review provides a comprehensive synthesis of current applications and the transformative impacts of 3D printing technologies and extended realities in medicine. Unlike previous revisions, this study carries out a quantitative analysis of its benefits, supported by recent case studies and statistical data. This leads to valuable insights on future directions of medical technology integration.

Keywords

3D printing medical applications clinical technologies extended realities integration of technologies in medicine

Introduction

Medicine is an area that is constantly evolving, largely due to technological advances and the integration of various technologies. Since the appearance of X-rays in 1896, a key year for the development of radiological diagnostics,¹ research has begun on their specific applications in medical use. Initially, X-rays were used for bone structure analysis. However, the integration and relationship between basic sciences, clinical medicine, and industry has enabled a constant evolution. Thanks to this, we now have tools and procedures such as interventionist radiology, ultrasounds, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission imaging. In this way, the digital image has replaced the traditional medium of contrast with modern agents and the X-ray film, which became the basis and standard for making highly complex diagnostic and surgical planning.

Before carrying out a highly complex surgical procedure, medical specialists perform a series of medical and diagnostic examinations that allow them to understand the patient’s pathology and discern what is the best way to do the different procedures to ensure the success of the surgery and people’s well-being. This is a complex process because it requires the interpretation of a large amount of information, clinical data, diagnostic images, medical history, and a high understanding of anatomy and pathology.² Today the evolution of diagnostic imaging allows to analyze the structures of the body in a noninvasive way. Technologies such as MRI, CT, and ultrasound are crucial in the planning process.³ In addition to these technologies, in the clinical context, 3D printing, augmented reality (AR), and mixed reality (MR) are beginning to be integrated into the planning process as tools that generate value and enrich medical planning, education, and training processes.⁴

These technologies, which are not specific to the clinical sector, have been shown to generate great benefits and contributions. In the case of 3D printing, this has gained great relevance in the medical industry, thanks to its ability to materialize and build different pieces using techniques and materials according to the needs of patients.⁵ Among its features is the ability to reproduce precise and detailed models, used with different intentions such as planning, simulation, and device development to complement clinical practice.³ However, MR and AR are becoming important technologies in the clinical context, thanks to the integration of low-cost ease and less time-consuming digital components into their manufacture or process, which changes the ways medical planning has to integrate patient information into projected or holographic environments.⁶

Such a situation highlights the importance of understanding the complexity of diagnostic imaging interpretation and surgical planning, as the efficiency and accuracy required in these processes are crucial to the success of medical procedures.

In this context, the present study seeks to answer the following research question: Which are the current main applications of 3D printing and extended realities, and how do they contribute to improving education and clinical practice?

This research aims to document through a systematic search how the incorporation of physical 3D models and data layers in mixed realities can improve or make more efficient the diagnosis of medical specialists. Also, this enables the possibility to explore the potential of these emerging technologies to enrich surgical planning, education, medical training, and the reduction of costs and time required in these processes. In this way, it is intended to contribute to modern medicine, opening new paths for the implementation of advanced technologies in the clinical field, and improving patient care quality.

Materials and Methods

This review uses the PRISMA methodology (Preferred Reporting Items for Systematic reviews and Meta-Analyses) to systematically explore the integration and impact of AR and 3D printing technologies in the medical field. A comprehensive search was conducted in academic databases such as Scopus and ScienceDirect, following a structured four-stage protocol.

At the same time, to map the many indicators and uses in order to create a foundation for comprehending the influence in the different fields and medical specializations, a review was made using the PRISMA methodology (see Fig. 1), which outlines the methodological structure and development in each of the phases. According to the established methodology, the literature search was carried out in databases such as Scopus and ScienceDirect. It is also important to emphasize that a four-stage protocol was designed, which will be described below (see Fig. 1).

FIG. 1.

PRISMA flowchart. Source: Self-made.

Step 1. Identification

A literature search strategy was implemented with preestablished parameters and guidelines to delineate and obtain the best-expected results in the databases. To summarize the search and obtain texts aligned with the objective of the research, the following keywords were defined: 3D printing, AR, virtual reality (VR), MR, medicine, surgery, and training. It should be noted that the search was limited to articles published in a temporary frame from 2005 to 2023, to ensure that the information is relevant to the latest medical practice.

Step 2. Selection

Subsequently, a first filter was established in which the inclusion and exclusion factors were defined. This filter excludes duplicate items, by year, document type, and keywords mentioned earlier. Items that met at least one of the following inclusion criteria were selected: surgical study cases, use of 3D-printed models, MR, VR, AR, organs representation, anatomical parts, training, and digital device development. At the same time, the following exclusion criteria were applied: duplicate studies, nonmedical studies, related to education but in the medical field.

Justification of selected studies

Although the total number of selected articles may seem relatively low compared with the total number of studies available, the selection focused on studies with high methodological rigor and proven clinical applications. This approach allowed for a deeper and more relevant analysis, ensuring that the presented results are significant and reliable within the medical context. The priority was placed on the quality of the selected studies to ensure that the findings accurately reflect the current state of 3D printing and extended reality applications in medicine.

Step 3. Data extraction

After the selection and filtering the documents, the basic information from each article was extracted to identify in depth the type of study, the area of specialization, and the kind of process that was included in the documents. It is important to mention that qualitative and quantitative data were extracted. These data were decisive, as they had to be included or excluded from the study according to their categorization and information.

Step 4. Data synthesis

Finally, after having the articles selected for analysis, the relevant information and data were extracted to make it possible to summarize trends, findings, and conclusions. With the information synthesized, the diagrams and tables presented in the study were constructed.

Results

This section analyzes the key findings obtained from the literature review on the use of AR technologies, consisting of VR, AR, and MR, as well as 3D printing. In addition, it examines how they have impacted the medical field by providing a characterization and the analyzed documents' statistical data. The results are analyzed to determine how these emerging technologies are redefining clinical practice, from surgical planning to medical diagnosis and medical training. The above elements are categorized and presented as follows.

Main information about data provides a detailed timeline search overview, the media in which it was published, the type of documents, the average annual growth of the research topic, the authors, etc. This information is relevant because it allows to build the demographic, geographical characterization, applicability in the context, timeline, and the analyzed topic evolution (see Table 1).

Table 1.

Data Description

Description	Results
Timespan	2038:43:00
Sources (journals, books, etc.)	57
Documents	68
Annual growth rate %	−5.59
Document average age	2.28
Average citations per doc	18.94
References	0
Documents contents
Keywords plus (ID)	814
Author’s keywords (DE)	232
Authors
Authors	427
Authors of single-authored docs	2
Authors collaboration
Single-authored docs	2
Co-authors per doc	7.21
International co-authorships %	26.47
Document types
Article	48
Review	30

Source: self-made.

However, to understand the evolution, according to the data analysis, it can be evidenced that there is an interest in researching topics related to the technologies of 3D printing, AR, VR, MR applied to the context of health. Graph 2: between 2005 and 2023, there is a pattern of rapid development in annual scientific production (see Fig. 2).

FIG. 2.

Annual scientific production. Source: Self-made.

Technologies

In this sense, the interaction between science and technology has undergone a series of revolutionary transformations in medicine. This has been a benchmark of innovation throughout history. Indeed, since the discovery of X-rays (1895), medicine has evolved exponentially through the integration of new technologies and developments associated with the time. This study mainly addressed four technologies, which are AR, VR, MR, and 3D printing. From these categories, the most relevant or highly impactful aspects in the medical field were identified.

It is necessary to highlight the development and relevance of the advances in the acquisition and evolution in visualization that have been generated around diagnostic imaging. This is because they are the basis that allows to detect, diagnose, identify, and visualize the anatomy of the human body, conditions, and diseases.⁷

Diagnostic images

In 1895, German physicist Wilhelm Conrad Roentgen discovered X-rays from cathode-ray tubes and the application of 2D radiographical plates. Later, this technology was affected by the computers’ arrival, screens, and machine-mediated interaction systems. The technological innovation marks a milestone in the introduction of the digital interface concept, human–machine interface, and user experience. This event significance lies in the fact that it made the specialist physician a user for the first time, whereas his work previously relied on the technical reading and diagnostic images interpretation.⁸

Various advances have consolidated diagnostic imaging development, from its use in surgical planning and medical diagnosis. At first, they were visualized on printed plates, then they were transformed into digital systems with the emergence of computing systems. Initially, this interaction was given by specialized commands through a line interface. The graphical user interface systems emergence, the mouse, and icons deployment marked a milestone in user experience, which has prevailed relatively for about 30 years in the radiological context. Indeed, studies state that the mouse and keyboard are still essential for detailed visualization tasks.⁹ However, touch technology and tracking sensors have begun to impact the interaction and views with diagnostic images. This provides portability and accessibility with cloud computing systems.¹⁰ Made of the utmost relevance in the surgical context, as it has allowed to find contactless control systems for image visualization and, consequently, reduce the risk of contamination.^11,12 This includes technologies such as AR and MR, which, by their characteristics, become valuable tools because they meet the needs of the user and the environment and improve usability in medical diagnosis and treatment. On this subject, Table 2 summarizes the technological developments associated with the evolution of diagnostic imaging, details, and impact in the health sector (see Table 2).

Table 2.

Technological Development and Impact

Technological development	Details	Health sector impact
X-rays and computed tomography	Initially, they provided 2D images, printed and then displayed on computers.	Base for medical diagnosis; transition from printed to digital images.
Command line interface	Using special commands to operate computers.	Initial use in radiology, but less intuitive for image visualization.
Graphical user interface	Use a mouse and icons to facilitate the operation of computers.	It simplified the visualization and manipulation of images in radiology.
Mouse and keyboard in radiology	The setting hasn’t changed much in 30 years.	Standard in radiology, but alternatives are being explored to improve efficiency.
Study of devices for radiologists	No device is superior to the mouse and keyboard combined.	Mouse and keyboard remain the preferred tools for detailed tasks.
Eye tracking technology	Allows you to move the cursor where you are looking, but you need a mouse for precise tasks.	Potential to improve efficiency in image review, still in development.
Touch screens and tablets	Useful for quick checks but limited for detailed images.	Portability is beneficial; improvements are needed for intensive use in radiology.
Cloud computing	Improved design and cloud computing for more power.	Potential future to make the most suitable tablets for radiology.
3D printing technology	Creation of parts for the construction of anatomical devices and models.	Base for medical diagnosis; transition from digital to printed images. It allows doctors and surgeons to explore and interact with 3D models of organs and systems of the human body.
Virtual reality (VR) technology	Create a completely immersive environment with the use of special viewers.	Surgical training and simulation; detailed anatomical structural visualization for preoperative planning Improves real-time medical imaging during surgical and diagnostic procedures.
Augmented reality (AR)	It overlooks digital information in the real world through devices such as smart glasses or tablets.	Guidance of surgical procedures with overlapping images; assistance in diagnostics and treatments; medical education and training.
Mixed reality (MR)	Combines VR and AR elements to create interactions with virtual and real objects.	Advanced surgical simulations; interactive training; ability to manipulate 3D medical images in real time.
Contactless controls in surgery	Development focused on maintaining surgical room sterility.	Innovation for the visualization of images without the risk of contamination.
Contactless surgery system	New system based on simple movements of the arms.	Example of user-centric design and environment to improve the technology.

Source: Self-made.

However, it is essential to understand the importance and evolution of diagnostic images, as they become the basis for creation with 3D printing, AR, MR, VR. The process begins with the acquisition of patient images, the postprocessing, and the procurement of 3D digital models. Subsequently, the specialists analyze the images and 3D models for different clinical approaches. This is the standard procedure, without the technology’s integration mentioned in the study (see Fig. 3).

FIG. 3.

Route integration path for creation with 3D printing and extended realities. Source: Self-made.

3D printing

Additive manufacturing technology has seen significant growth in the field of medicine, thanks to its features, it is used to generate value in personalized treatments in patients, impacting clinical processes such as advanced preoperative planning. The creation of surgical guides, implants, prostheses, medical devices, and clinical support elements has proven to have applications in the pharmaceutical sector.^13,14 In other words, the process begins with the acquisition of diagnostic images, segmentation, processing, and manufacturing with 3D printing.¹⁵ Due to the ability to build digital models, adding layer-by-layer material, complex structures that are difficult to create with other technologies can be obtained. In this sense, the concept of personalized and patient-centered medicine has managed to consolidate 3D printing with several applications that can be appreciated in Table 3.¹⁶

Table 3.

Application Areas

Application areas	Applications of 3D printing in medicine
Medical education	Detailed anatomical models, replicas of organs for formation
Pharmacology	Customized pills, drug release devices
Surgical planning	Customized surgical guides, models for planning
Entertainment	Simulation of procedures, practices in realistic models
Communication with the patient	Physical models to explain diagnostics and procedures
Surgery	Reconstruction of anatomical structures, preoperative planning

Source: Self-made.

Table 3 presents the diversity and scope of 3D printing in the field of medicine, highlighting its versatility and potential in several key areas. In medical education and simulation, 3D printing plays a crucial role in providing detailed anatomical models and organ replicas, improving student learning and understanding.¹⁷ In the field of surgery, this technology enables the creation of customized surgical guides and detailed models for accurate and effective preoperative planning. Implementation of these models allows for reduced costs, time in the surgery, and blood loss in the patient.^13,14,18 In terms of training, 3D printing is used, and its ability to build models with different materials that provide a wide variety of mechanical properties allows the simulators to create procedures and practices in realistic models. All of these are essential for practical training and for the skill acquisition and development of residents and medical students.^19,20

In the field of pharmacology, 3D printing is presented as a tool for the personalization, dosing, and development of devices for the release of drugs. The above is a great tool to customize treatments according to the specific needs of each patient.²¹ The use of these technologies in surgical planning has shown great benefits and has enhanced preoperative planning and its accuracy. Additionally, it has reduced planning time and even managed to change the surgical approach by using 3D-printed models.²² When used in treatments of complex pathologies, 3D-printed models facilitate interdisciplinary communication between the team of surgeons and specialists involved in the operational treatment.¹⁸

Finally, in the field of doctor and patient communication, 3D-printed anatomical models of bodies with complex pathologies become a valuable tool for explaining diagnoses and procedures and improving patient understanding.³ Each of these points out the contribution of 3D printing technology to medicine from two angles. First, it improves clinical processes and outcomes. While, on the other hand, it enriches education and communication in the field of health.

Augmented reality

AR is a technology that allows the user to overlay 3D virtual elements over objects or the real environment. It is a factor that provides an immersive visual experience²³ and is the result of the advances in traditional computer visualization in recent years.²⁴ Additionally, the overlapping of information and 3D digital models makes user interaction with these elements more fluid, easy, and natural. The ability to visualize and interact in the surgical field and clinical environments makes it the biggest advantage that technology has over other navigation and planning technologies. Therefore, it is used in specialties such as neurosurgery,²⁵ cardiology, orthopedics, laparoscopic surgery,²⁶ oral, maxillofacial surgery,²⁷ and spinal surgery.²⁸

However, technology offers great advantages in training and clinical education. The surgical training consists of an approach in which the student, after acquiring the theoretical knowledge of his specialty or area of training, goes through a process of learning by observing and then doing. This means that the student carries out the procedures under the guidance and supervision of the instructor.²⁹ The suggested model and in situ training are expensive, time consuming, and carry a significant risk of process failures for both the institutions and the patients.^29,30 Notwithstanding, AR poses a scenario in which two-way and even remote training can be used, in which the teacher and student can interact in real time.³¹ They can even be adapted to different clinical procedures, which reduces time and risk and has a high potential for reuse.³²

Mixed reality

MR is one of the latest technologies that encompasses extended reality. Like AR, it has the capacity to overlap digital elements in the real environment with the ability to interact with them.^33,34 The features of the technology have allowed it to be adopted in the health sector quickly. This idea and concept were initially introduced by Paul Milgram and Fumio Kishino in 1994.³⁵ The authors raised the concept of the virtuality continuum. This refers to the mixture of the different objects presented in the real environment and emphasizes the type of device used to recreate the different scenes and the degree of immersion.

It should be emphasized that every technology needs a means of being recreated. In the case of AR, devices with a screen and a video camera are used to capture the environment and visualize it on the screen. In the case of MRI, different devices have been presented. However, it was only until early 2016, when Microsoft Corp. released the first commercial MR device known as HoloLens. A wearable device type headset that has several integrated sensors, high-definition cameras, accelerometers, and microphones integrated into a computer.² The device projects a holographic image into the environment through two semitransparent combined lenses, which are placed in front of the user’s eyes to combine the 3D elements with the actual environment.³⁶ Interaction and control of data with gestures and voice make it a great tool for surgeons and students in processes ranging from preoperative planning to clinical surgery³⁷ and professional medical training.^38,39

Virtual reality

VR is a technology that allows the visualization of computer-generated 3D images through wearable devices such as headsets. Users can interact with these elements in an immersive experience in a real-time virtual world. Its image visualization features and its ability to create and recreate virtual worlds make it an innovative tool in advanced imaging.⁴⁰ Ideal for diagnostic and training processes, it allows students to have active participation, better guidance, and support.⁴¹ In different clinical areas, the implementation of this technology has shown progress. In radiology, it is being used for planning guidance procedures, which improves the processes of doctor–patient communication to communicate information and medical knowledge associated with pathology. This in turn leads to the development of a process of literacy in health anatomical visualization and complex pathologies.^42,43 In cardiology, technology is used in processes of surgical simulation, preoperative management, surgery planning, and immersive tele-virtuality.⁴⁴

3D printing and MR

In recent years, technological advances have been significant, driving innovative solutions ranging from surgical planning to real-time surgery and medical education. However, it is clear that the synergy between 3D printing and MR represents an innovative fusion where precision and interactivity enhance each other.⁴⁵ This combination of digital elements and physical models creates a new visualization mode that is oriented and customized. This allows doctors to observe and understand the details of the injury, navigate the information of digital and physical modeling, improve the accuracy of localizing the lesion, and potentially reduce the risk in surgery.⁴⁶ Having said that, if the characteristics of MRI and 3D printing technologies are compared with 2D images, it provides proof that the accurate understanding and evaluation of anatomies have a positive impact on surgical planning, a factor that has its main evidence in the well-being of the patient.⁴⁷

The multi-level combination of these technologies incorporates an additional feature to the processes of simulation, surgical planning, and education. It is only through this approach that the idea of accurate real-time haptic feedback that duplicates the pathology’s anatomy in 3D printing and adds data layers to MR to provide users realistic situations can be conceived.⁴⁸ The training takes advantage of these characteristics. In this way, a new concept of modern medical training begins to be consolidated, in which technology reshuffles the way residents learn.⁴⁹ At the same time, the mix provides intraoperative advantages with real-time information and interaction, including experts and surgeons connected through devices that can view procedures in virtual scenarios and support surgical procedures⁴⁸ (see Table 4).

Table 4.

Evaluation of Technologies, Outcomes, and Applications

Technology used	Devices used	Clinical area	Clinical application	Clinical variables identified	Quantitative result	Qualitative result	Associated costs	Limitations and challenges	DOI
Ag	HoloLens	N/A	Planning—augmented reality visualization demonstrates its potential application in clinical environments, where real-time overlapping of patient medical imaging data can help surgeons during procedures.	N/A	The accuracy of the system is quantified and considered satisfactory, with an average DSC of 0.83, indicating a high degree of overlap with the actual segmentations. The average Hausdorff distance, 19.06 mm, provides information about the larger segmentation error distance, which is an important measure of segmentation accuracy. The segmentation process is relatively efficient, taking an average of just over 21 min to complete, which is practical for clinical or research applications. These results suggest that the method is accurate and efficient, making it a potentially valuable tool for analyzing medical images in augmented reality environments.	Could be better prepared and understood if a surgeon is provided with a detailed 3D model of the anatomical region of interest, especially when combined with AR or 3D printing. Moreover, 3D models area is an asset in the education of patients, residents, or medical students as 3D images are more effective in developing spatial of understanding than 2D images.	N/A	Precise 3D modeling is crucial to the success of augmented reality-assisted procedures,	https://doi.org/10.1016/j.wneu.2021.07.099
Ag	Physical setup—display, camera registration	N/A	Planning—integration of images in surgical navigation and displayed in augmented reality	The use of 3D image overlapping, automatic real-time image recording, and instrument tracking was proposed. For surgical superposition, the superimposed 3D image is expected to have the same geometric shape as the original organ.	Submillimeter geometric accuracy was obtained from 3D image calibration. Ensuring that the 3D image closely matches the physical dimensions and the actual shape of the object represented.	The AR device showed satisfactory, informative and intuitive accuracy of image recording and overlapping in a simulated oral and maxillofacial surgery experiment compared with traditional digital planning and visualization systems.	The AR overlay device is described as low-cost, compact, flexible, and easy to configure.	The 3D image calibration is important because it can remove the distortion of 3D images caused by the mismatched rendering parameters. Serious distortion will cause large image overlay error, hampering the clinical delivery of the 3D image overlay device. El sistema se puede utilizar en diversas aplicaciones quirúrgicas, siempre que el registro de imágenes se pueda gestionar de forma eficaz	https://dx-doi-org.web.bisu.edu.cn/10.1016/j.compmedimag.2014.11.003
Ags/I3D	Tablet and software developed by ARTEA researchers	Orthopedia—total elbow arthroplasty (TEA)	Planning and use in total elbow arthroplasty surgery	Increased precision in surgical procedure—using augmented reality and 3D printing to improve the precision of implant placement in TEA. Using AR as guidance and position reference during surgery.	ARTEA shows an average position error and a significantly smaller lateral deviation in the placement of the humeral components compared with non-ARTEA (0.6° ± 0.4° vs. 1.9°± 1.4° in varo-valgo rotation, and other similar comparisons). The results indicate that ARTEA is more accurate than the conventional method in several rotation and translation measurements, the errors in the implant placement target are usually less than 2° in the case of rotation, and of 2 mm in that of translation.	The sample size for the study (n = 8), indicating that the effect is large (d = 0.8) but low (35.6%). It is stated that the results should be considered indicative and not conclusive due to the size of the sample and the power of the study.	N/A	Among the limitations of the study are the small sample size and the level of experience of a single surgeon, which may not represent the typical surgical outcomes. Practical considerations for the clinical application of ARTEA include the cost, simulation, and creation time of the 3DPI, as well as the complexity of using sterile encapsulated tablets during surgery.	https://doi.org/10.1016/j.jse.2021.05.019
Ag/I3D	Augmented reality glasses	Prostate biopsy	Training and simulation—case applied in the creation of a device of prostate biopsy by fusion guided by multiple magnetic resonance, brachytherapy and the insertion of a rectal spacer using synthetic models and augmented reality helmets.	N/A	N/A	Augmented reality allows you to see the shared vision line and visualize each other’s hands with the image of the ultrasound in sight, which improves the training experience. The technology allows surgeons to avoid looking from side to side between the ghost and the monitor, which could reduce procedural errors.	The remote training platform allows the virtual presence of the supervisor with the student, which reduces training costs and potentially accelerates the learning curve for new procedures.	Surgeons’ interest in augmented reality technologies must be investigated and barriers to their use identified.	https://doi.org/10.1016/j.sopen.2022.06.004
Ag/I3D	Tablet and software developed by researchers	Dentistry—maxillofacial	Planning, surgical guides, dentistry—about the use of 3D-printed models	Precision	The use of RA casts promising results to guide the drilling of the endodontic cavity into different teeth. successfully perforated 90 access cavities with an average deviation in the frontal and premolar teeth at the point of entry of 0.51 mm and 0.77 mm at the apical point. The average angular deviation was 0.85° and the average surface overlap was 57%. In the case of molars, the average deviation at the point of entry was 0.63 mm, with an average surface overlap of 82%.	The augmented reality-driven method has proven to be promising for clinical use but requires further development and research for its in vivo validation.	N/A	The AR system is new and requires additional validation before its clinical application and a very good calibration and validation system to ensure accuracy during its use.	https://doi.org/10.1016/j.jdent.2023.104476
MR/I3D	HoloLens	Maxilofacial	Planning—guiding surgeons in peroneal osteotomy using HoloLens, which required the representation of the osteotomial lines on various sides of the bone.	Feasibility and precision of MR in mandibular reconstruction with perone suspension. Deviation in the accuracy of peroneal osteotomy. Angular deviation of the segments of the peron. Distances between angles	The average distance of real peroneal osteotomy compared with virtual peronea osteotomy was 2.11 ± 1.31 mm. The average angular deviation of the peron segments was 2.858 ± 1.978 degrees. The average of the inter-angular angular distances was 7.24 ± 3.42 mm	Surgical MRI navigation systems do not meet the requirements for optimal application in maxillofacial surgery, their accuracy. The practical application in surgery is close to that of today. Surgical navigation systems guided by commonly used images. We argue that all the errors were due to manipulation, image change, and occlusion.	N/A	The technology depended on the surgeon’s ability to subjectively integrate virtual and real objects, which could introduce variability. The overlapping of virtual content could not be carried out quickly, suggesting the need to improve the responsiveness of the MRI system.	https://doi.org/10.1016/j.jormas.2021.01.005
MR/I3D	HoloLens	Surgery—liver	Planning liver surgery	Reduced time in the surgery room, reduced blood loss, increased accuracy	N/A	The 3D printing and holograms in MR, have improved precision in hepatic surgery by enabling volume estimation, delineation of resection lines, and evaluation of tumor margins.	$700 in materials and 10 days of postprocessing	The study presents as a challenge the level of knowledge that should be in postprocessing of 3D images, suitable materials for printing in relation to the model and 3D printing time.	https://doi.org/10.1016/j.hbpd.2021.09.002
MR/I3D	HoloLens	Neurosurgery	Training in neurosurgery	Precision in injury location, visualization, interaction with information, and manipulation such as rotation, change of position, and scale.	N/A	Reduced time in surgery	N/A	The study presents as a challenge to improve the accuracy between the objects of the virtual world and the real world. Improve interaction between physical and virtual in real time.	https://doi.org/10.24920/003564
MR/I3D	HoloLens	Neurosurgery	Training and teaching—Punture operation training-dos grupos el A, entrenado de manera tradicional y el B entrenado con realidad mixta e impresión 3D	Placement of the body—positioning on the model, depth of the puncture, accuracy of the puncture position, overall understanding of the operation.	Group B surpassed group A in model positioning, punctuation, depth, and accuracy, with statistically significant higher scores (p < 0.05). Group B surpassed group A in model positioning, punctuation, depth, and accuracy, with statistically significant higher scores (P 0.05). Group B’s end scores for ventricular and hematoma punctuation were significantly higher than group A’s (p < 0.01). In the questionnaire, group B rated the content, effect, experience, and self-confidence improvement of the training better than group A (p < 0.05). In the questionnaire, group B rated the content, effect, experience, and self-confidence improvement of the training with a higher score than group A. (P 0.05).	The study revealed that there is a significant improvement in the content of the training, the effect of training, experience in the training process, and the improvement of self-confidence. The use of MRI technology and 3D printing models in the training enabled a more immersive experience, allowing them to better understand the operation and related anatomical structures.	N/A,	The limitations raised by the study are associated with the nature of the technology and the context of its application, including possible technical problems related to the MR equipment, the learning curve associated with the use of new technologies, and the cost and time required to produce 3D-printed models.	https://dx-doi-org.web.bisu.edu.cn/10.1212/wnl.0000000000012413
MR/I3D	HoloLens	Surgery—Hepatobiliary_pancreatic	Preoperative planning, intraoperative support, teaching	Easy understanding of surgical information, risk reduction-, personalized medicine	N/A	The surgeons express that the preparation for surgery using technologies, was easier than with the conventional method with 2D screens, even if they have virtual 3D volumetric models.	N/A	Suggests that AR and 3D printing can be future tools for collaboration between institutions, especially for high complexity surgeries but barriers to connection and connectivity must be overcome to improve the experience.	https://dx-doi-org.web.bisu.edu.cn/10.1016/j.cireng.2023.02.004

Source: Self-made.

Discussion

After conducting a systematic analysis of the literature examined, it becomes clear that emerging technologies such as 3D printing, VR, AR, and MR are generating a transformative impact in the various areas of medicine from clinical practice to medical training processes at different levels, optimizing the characteristics and potential of technologies. The rapid development of hardware and software in these technologies enables new applications and solutions to be provided, a factor that expands the range of actions of these technologies in the clinical context. At the same time, the user experience is enriched with new possibilities of interactions and medical applications.⁴⁴

Research shows that there is a growing trend toward the integration of these technologies into the health sector and each has a large number of applications. It is evident that the combination of 3D printing technology with some AR platforms, including MR or AR, has the potential to further revolutionize several areas of medicine and lead to significant and innovative developments. In fact, clinical applications with high levels of personalization and precision are currently being created in surgical planning, medical education, and surgery procedures with solutions that integrate physical elements manufactured with 3D printing enriched with digital components.

Such integration can be applied in any of the medical contexts, for example, in the field of practical processes such as surgeries, planning, training, education, or simulation. The aim, in this sense, is that these technologies can become standard tools that accompany the specialists. This would be done through headset-type visualization devices, a real-time visual guide during procedures accompanied by 3D-printed support tools tailored or with a high degree of personalization.

Table 5 details the specific influence and contribution of each of the technologies on the different clinical variables found throughout the research. This provides a clear overview of the benefits that technology brings, from risk reduction to improved accuracy, patient safety, and information visualization. Similarly, it describes how it impacts medical education and simulation, as well as the way in which complete medical procedures are impacted. Understanding these relationships is crucial to appreciating the potential and impact in medical practice (see Table 5).

Table 5.

Variables and Impact of Technology

Clinical variables	3D printing	Augmented reality	Mixed reality	Virtual reality	Finish
Reducing risk/risk Reductions	Creates precise anatomical models for surgical planning, reducing the risk of errors.	Provides visual guidance during surgeries, minimizing the risk of errors.	Combines AR and VR elements for detailed simulations, reducing risk in procedures.	It provides controlled environments for risk-free practices.	It reduces risk
Simulation/helps to simulate	Makes physical models to simulate procedures and pathologies.	Allows you to visualize procedures and anatomy in a real environment.	Integrates digital visualizations with the real environment for more complete simulations.	Create virtual environments for simulating procedures and diagnostics.	Helps to simulate
Less painful procedures/helps to perform a lesser painful procedure	Manufactures customized medical implants and devices for less invasive procedures.	Precise guidance in procedures minimizing invasiveness.	Combines the advantages of AR and VR for more precise and less invasive procedures.	It trains doctors in techniques that minimize pain and invasiveness.	It helps to perform a lesser painful procedure
Patient safety/improve patient safety	Helps in creating surgical tools specific to each patient.	It provides visual guides for safer procedures.	Provides a mixed environment for safe and realistic practices.	It allows training in safe environments without risk for patients.	Improve patient safety
Procedure accuracy/improve accuracy in the procedure	Create exact models for surgical planning and practice.	It offers real-time visualizations that increase surgical accuracy.	Integrates real-time patient data for more accurate procedures.	Simulates procedures to improve accuracy in real situations.	Improve accuracy in the procedure
Information viewing/visualize appropiate information	It allows the creation of detailed anatomical models for specific studies.	Visualizes medical data and images directly in the doctor’s field of vision.	Provides an integrated view of medical information in a real environment.	It provides an immersive environment for the visualization and analysis of medical data.	Visualize appropriate information
Learning and abilities/improve skills and learning	It facilitates the study of complex cases through physical models.	Used for practical training and procedural visualization.	Provides interactive and realistic learning experiences.	It offers simulations for immersive and practical learning.	Improve skills and learning
Procedure planning	Creates physical representations of the entire surgical procedure.	Allows you to visualize each step of the procedure in the real environment.	Combines reality and digital for a comprehensive understanding of the procedure.	Simulate the entire procedure in a controlled environment.	View the entire treatment procedure
Patient data collection	Used for the creation of prostheses and models based on patient-specific data.	Facilitates real-time patient data visualization and manipulation.	Integrates patient data into a mixed environment for more detailed analysis.	It allows simulation and analysis of cases based on real patient data.	Assist in patient data collection
Surgery	Manufactures tools and models for complex surgeries.	Provides real-time visual assistance for complex procedures.	Allows interaction with virtual elements in a real environment for complicated procedures.	It trains doctors in complex procedures in a secure environment.	Helps perform complicated medical procedures

Source: Self-made.

The integration of technologies itself presents significant improvements around the precision of surgical procedures and a more interactive approach that has demonstrated greater efficiency in medical education processes. However, there are limitations that need to be examined, some aspects revolving around costs. These can be high due to VR, AR, and MR applications development times, long 3D printing times, required infrastructure investment, specialized training, and learning curve on the part of medical personnel.

Although this research does not focus on privacy-related issues, safe handling of patient data, from an ethical and regulatory point of view, is an opportunity for future research to establish clear guidelines on how to handle and protect patient data in these new, advanced clinical and technological contexts.

The inclusion of case studies and applied examples showing the impact of technologies has enabled us to establish a valuable perspective on the potential and practical challenges. In the future, the direct impact of technologies on the patient, and not just on clinical outcomes, must be reviewed in depth. Aspects such as evidence and patient improvement processes or reduced complication rates would be significant indicators of the practical value of technologies in the clinical environment.

Emerging trends in these technologies suggest a landscape in constant evolution. This opens up the possibility of new uses in medicine in the formation of new promising areas in which the needs, experiences, practical challenges, the human dimension understood from patients and medical staff are considered, to integrate them in discussion with 3D printing, VR, MR, and AR technologies.

Table 6 shows the relationship of the technologies to the factors mentioned earlier. The information presented in this table enables a deeper understanding of the practical and strategic implications of its use in clinical settings. Opportunities, crucial challenges, and critical considerations are also presented (see Table 6).

Table 6.

Evaluation Technologies in Medicine

Factors	3D printing	AR	MR	VR
Infrastructure costs	Medium to high	Medium to high	High	Medium to high
Personal training	Required	Required	Required	Required
Privacy and data security	Moderate	Critical	Critical	Critical
Ethical and regulatory aspects	Important	Important	Important	Important
Case studies and practical examples	Available	Available	Available	Available
Impact on patient care	Significant	Significant	Significant	Significant
Trend growth	In evolution	In evolution	In evolution	In evolution
Doctors and patients perspectives	Valuable	Valuable	Valuable	Valuable

Source: Self-made.

Conclusions

Finally, the study has shown that emerging technologies and advances in materials for 3D printing and the constant development in software and hardware for VR, AR, and MR technologies are exerting a valuable transformative impact in the different areas of medicine. Trends are seen as innovations that come together to form useful instruments for improving surgical procedure accuracy, the effectiveness of medical training, and the planning and implementation of specific treatments. In addition, the study also identified challenges, some limitations, and the need for specialized training for the effective use of technologies and the creation of solutions to them.

Optimizing the characteristics of the technologies, being able to extract, generate, and design 3D anatomical models, materialize them with additive manufacturing, and complement them with guided instructions and patient information with AR technologies increase the possibility of clinical applications and allows the experience of the health professional or patient to be enriched and differentiated. Society is moving toward a future in which medicine and digital technologies are increasingly intertwined, as evidenced by the results of this systematic review, which highlights the rapid adoption of 3D, AR, MR, and VR printing technologies. These, although not inherent in the health sector, put at their disposal a potential fully focused efforts on improving the processes of medical practice through continuous adaptation, testing, and transformation toward a more accurate, advanced, and safe medicine for the patient.

Considerations and Limitations

Throughout this study, several key methodological considerations were addressed to ensure the validity and relevance of the results. However, it is important to highlight some inherent limitations of the approach adopted. First, the selection of studies was limited to a relatively small number due to the application of strict inclusion criteria, focusing on studies with proven clinical applications and high methodological quality. While this approach allowed for a deep and relevant analysis, it is possible that some emerging applications in less documented areas were not included. Additionally, the review focused mainly on articles published between 2005 and 2023, which may have excluded recent or ongoing research that could provide new perspectives on the applications of 3D printing and extended realities in the clinical field.

Last, although the study provides a comprehensive overview of the technologies evaluated, longitudinal studies that analyze the long-term impact of these technologies in medical practice were not included. Future studies could focus on evaluating these technologies in a wider range of medical specialties and their large-scale implementation in different clinical contexts.

Footnotes

Author Disclosure Statement

No competing financial interests exist.

Funding Information

No funding was received for this article.

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