Powder Technology 327 (2018) 128–151

Contents lists available at ScienceDirect

Powder Technology

journal homepage: www.elsevier.com/locate/powtec

Review

A review of powder additive manufacturing processes for

metallic biomaterials
W.S.W. Harun a,⁎, M.S.I.N. Kamariah b, N. Muhamad c, S.A.C. Ghani a, F. Ahmad d, Z. Mohamed a
a
Green Research for Advanced Materials Laboratory (GramsLab), Faculty of Mechanical Engineering, Universiti Malaysia Pahang, 26600 Pekan, Pahang, Malaysia
b
Institute of Postgraduate Studies, Universiti Malaysia Pahang, Lebuhraya Tun Razak, 26300 Gambang, Kuantan, Pahang, Malaysia
c
Department of Mechanical and Material Engineering, Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor, Malaysia
d
Department of Mechanical Engineering, Faculty of Engineering, Universiti Teknologi PETRONAS, Perak, Malaysia

a r t i c l e i n f o a b s t r a c t

Article history: Metal additive manufacturing (metal-AM) has undergone a remarkable evolution over the past three decades. It
Received 18 July 2017 was first used solely as an innovative resource of the prototype. Due to the technology maturity which allows
Received in revised form 5 December 2017 combining various manufacturing processes for the production of a bespoke part that applied complex
Accepted 16 December 2017
geometries, additive manufacturing (AM) technology has captured an increasing attention. For the past ten
Available online 23 December 2017
years, it has moved into the mainstream of the industrialised field such as biomedicine. The review covers the re-
Keywords:
cent progress of metal-AM manufacturing technologies, main types of metallic biomaterials, and most common
Metal additive manufacturing biomedical applications. The direction of the future potential of metal-AM in biomedical research and implemen-
Metallic biomaterials tation are further discussed. Selective laser melting (SLM), selective laser sintering (SLS), electron beam melting
Biomedical applications (EBM), and laser engineered net shaping (LENS) are the most common metal-based additive manufacturing pro-
Additive manufacturing cesses employed in the production of the biocompatible parts. The evolution and favourite trend of the metal-AM
Powder metallurgy technologies are highlighted in this review. Additionally, the advancement of metallic biomaterials such as tita-
nium and its alloys, cobalt-based alloys, 316L stainless steel, nickel-titanium, and other metallic biomaterials is
also presented since it leads to the transpired of several new studies in the scope of metal-AM in the medical
field. The rise of metal-AM in the biomedical industry has also been significant, especially in orthopaedics and
dental. The metal-AM is predicted to continue to dominate and further benefit the biomedical industry
development.
© 2017 Elsevier B.V. All rights reserved.

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
2. Metal additive manufacturing (metal-AM) processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
2.1. Advantages of metal-AM and opportunity in biomedical industry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
2.2. Selective laser melting (SLM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
2.3. Electron beam melting (EBM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
2.4. Selective laser sintering (SLS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
2.5. Laser engineered net shaping (LENS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
3. Biomaterials for metal-AM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
3.1. Titanium and its alloy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
3.1.1. Microstructure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
3.1.2. Mechanical and physical properties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
3.1.3. Biocompatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
3.2. Cobalt-based alloy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
3.2.1. Microstructure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
3.2.2. Mechanical and physical properties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
3.2.3. Biocompatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

⁎ Corresponding author.
E-mail address: sharuzi@ump.edu.my (W.S.W. Harun).

https://doi.org/10.1016/j.powtec.2017.12.058
0032-5910/© 2017 Elsevier B.V. All rights reserved.
 W.S.W. Harun et al. / Powder Technology 327 (2018) 128–151 129

3.3. 316L stainless steel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139

3.3.1. Microstructure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
3.3.2. Mechanical and physical properties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
3.3.3. Biocompatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
3.4. Nickel-titanium (nitinol) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
3.4.1. Mechanical and physical properties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
3.4.2. Biocompatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
3.5. Others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
4. An overview of simulation works in metal-AM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
5. Metal-AM in biomedical applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
5.1. Orthopaedics implants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
5.2. Dental application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
5.3. Other metal-AM implants and devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
6. Future trend . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
7. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Acknowledgement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146

1. Introduction Tooling Technologies (United Kingdom), which is known as MTT Tech-

The additive manufacturing (AM) technology is acknowledged as
one of the remarkable recent layer-upon-layer material technologies
that build 3D object products. The method is relatively different from
conventional subtractive and formative manufacturing methods, which
produced thousands of component layers. However, the typical draw-
back of the technology is dealing with each of the layers that potentially
faced failure mode. The thin cross-sectional layer of the component typ-
ically originates from 3-D solid modelling [1–4]. Correspondingly, the
ground has been researched and the use of AM has undergone a remark-
able evolution over the past three decades [5,6]. AM was first believed
solely as an innovative resource prototype and known as rapid
prototyping or solid free-form fabrication [7–9]. However, for the past
ten years, it has moved into the mainstream of the industry such as the
biomedical sector [10–15]. It has now appeared as a universal need in
the manufacturing processes and is believed to hit a tipping point soon.
The inherent ability of technology maturity allows the production of
unique and complex bespoke part which is not achievable by other
manufacturing processes [16–19]. Another benefit of AM includes the
potential to produce faster and more cost-effective products, reduce en-
vironmental impact, lessen resource-intensive, and shorten lead time
[20,21].
At this juncture, AM has become the latest trend of processing tech-
nique in fabricating metal and alloys [1,13,18,22]. The current highlights
of metal-AM categorised by layer type for biomedical applications are di-
vided into two main categories; powder bed and powder-fed systems.
Powder bed fusion system is classified to selective laser melting (SLM), di-
rect metal laser sintered (DMLS), selective laser sintering (SLS), and
electron beam melting (EBM) technologies [23–25]. Meanwhile, the
powder-fed system involves laser metal deposition (LMD), and laser
engineered net shaping (LENS) [26]. The laser process involves the
heating of alloy metal powders that form several melt-pools which con-
solidate through a rapid solidification process [3,25,27,28]. These laser-
based manufacturing techniques have shown their capability to achieve
required material selection and strictly controlled conditions to achieve
further improvement of chemical and mechanical properties, high accu-
racy, and increase the surface roughness through the argon surface plas-
ma treatment (APT) for biomedical application [29].
The transition of AM from plastics to metals arena can be traced back
as early as 1994 when EOS' direct metal laser sintering (DMLS) technol-
ogy launched its metal powder-based prototype for a commercial sys-
tem [30,31]. In 1998, the laser-engineered net shaping (LENS) metal
powder-based system made into a commercial by Optomec based on
the technology was developed at Sandia National Labs [32]. Further-
more, the selective laser melting (SLM) and electron beam melting
(EBM) have been made commercially available since 2005 by MCP
nologies Group and Arcam AB (Sweden) [32,33]. Subsequently, AM
then was adopted as a rising manufacturing method in several indus-
tries in 2011. The most important industries are in healthcare and
medical-related industries around the world. Strikingly, the mass pro-
duction of biomedical devices is one of the earliest to adopt AM technol-
ogy, precisely for hearing aid devices and dental equipment [32,34].
Particularly, metal-AM technology has found extensive applications in
the biomedical area including orthopaedics [13,35,36], dental [37–41],
and cardiovascular [42] [43,44]. For example, orthopaedic implants
should match the anatomical bone defect where the shaping of the im-
plant and assurance of the graft's mechanical stability during the healing
period would take protracted time and become more complicated [15].
Since each patient has various anatomies, the technology opted for the
print implant as well as other particular biomedical applications with var-
ious material properties, external and internal structures, and porosity
[45–51]. The technology includes customising products for tissue scaf-
folds, vessel stent, dental work, and biomedical tools.
The as-cast metals have extensively been used as an implantable
material for biomedical devices. Often, these biomedical implantable
devices possess unique biological-friendly properties to ensure their ca-
pability to respond to complex changes in the human body. In fact, the
metals are referred as the adaptation behavioural material to simulate
cell response and tissue construction to match the mechanical proper-
ties of native tissues, or exhibit suitable surface with favourable tissue
response and also as bio-mimic of the multi-level structures [52–54].
Therefore, although most of the biomedical metals influenced a wide
range of field, only a few possess suitable clinical biocompatibility pro-
cesses. Until now, there are different types of powdered metallic bioma-
terials for metal-AM [11,55–58]. The most common of those are
titanium and its alloys [47,59–79], Co-based alloys [41,80–89], and
stainless steel [3,90–103]. They have also extensively been utilised due
to their excellent mechanical properties. Hence, they only perform a
relatively simple function to support, fix, and protect the biomedical
devices [104,105].
The study presents the review of a recent trend for metal-AM pro-
cessing in the last 17 years (years 2001 to 2017) on the processing of
various powder metals for biomedical applications. The review begins
by outlining the primary attribution of metal-AM in today's technolo-
gies; i.e., SLM, EBM, DMLS, SLS, and LENS followed by the discussion
on evolution metal-AM technology studies focusing on different types
of biocompatible metals. Subsequently, the report describes the emer-
gence of metal-AM technology in diverse biomedical fields. Later, the
possible future trend is presented while exclusively highlighting the
biocompatible powder metals studies and its applications in biomedical
under the light of metal-AM technologies. Finally, the concluding re-
marks underpin the current studies.
130 W.S.W. Harun et al. / Powder Technology 327 (2018) 128–151
2. Metal additive manufacturing (metal-AM) processes
The AM techniques for biomaterials are divided into two main cate-
gories namely, acellular and cellular. Acellular entails processing of bio-
materials without any living cells, whereas cellular involves the living
cells together with biomaterials. Generally, the acellular AM technolo-
gies can be classified into seven techniques according to the American
Society for Testing of Materials (ASTM) Standard namely, 1) binder jet-
ting, 2) directed energy deposition, 3) material extrusion, 4) material
jetting, 5) powder bed fusion, 6) sheet lamination, and 7) vat
photopolymerisation [106]. The individual processes of AM are different
depending on the material and machine technology applied. There are a
few metal-AM processes for powder-based metallic feedstock system,
which can be found in AM technologies of powder bed fusion and di-
rected energy deposition. Powder bed fusion technique uses thermal
energy either a laser or electron beam to fuse particle powder of mate-
rial together at particular areas on a powder bed. This technique high-
lights the advantages including its ability to manufacture small
complex parts but high dimensional accuracy, fabricate without neces-
sary support, and a wide range of powders. Powder bed fusion has con-
tributed as one of those from the first generation that commercialises
the AM processes. There are a few types of powder bed fusion processes
capable in processing biocompatible powder metal, namely selective
laser melting (SLM), electron beam melting (EBM), and selective laser
sintering (SLS).
On the other hand, the direct energy-based techniques adopted a di-
rect source of energy which typically in the form of laser, electrons beam
or plasma arc. As defined in ASTM F2792-12a, directed energy deposi-
tion (DED) is the AM process “in which focused thermal energy is
used to fuse materials by melting as they are being deposited” [106].
The fused material is fed either in the form of powder, filament or
wire. These processes relied on the continuous feeding of the initial ma-
terial before the thermal energy melted and deposited it in a layer-wise
pattern. The geometry part and pattern building in these processes are
controlled by a computer utilising XYZ system. Although these process-
es are applied to ceramic, composite, and polymeric materials, they are
mostly applied to metals. Laser engineered net shaping (LENS) is one of
the AM technologies utilising powder-based metallic biomaterials that
belong to the class of direct laser deposition techniques.
Table 1 presents the categories of metal-AM technologies as men-
tioned in ASTM F2792. These categories are detailed regarding power
sources which are laser and electron beam. Besides that, the table also
shows some of the recent work by metal-AM technologies which
show their capability in processing metals for biomedical. The materials
include the most commonly used metals which are titanium and its al-
loys, cobalt alloy, and 316L stainless steel.
Just like other AM technologies, the metal-AM work in medical ap-
plications utilised the technique of digital imaging; i.e., magnetic reso-
nance imaging (MRI) and computed tomography (CT) [227,228]. The
information collected from MRI or CT scans was converted into three-
dimensional (3D) bio-CAD model with the assistance of computer soft-
ware such as Mimics or such alike. Next, the 3D bio-CAD model was re-
generated into the industrial standard STL (Stereo Lithography) file
format and later imported into metal-AM machine set-up. Notably,
the ease with which 3D medical imaging data can be reconstructed
Table 1
Metal-AM technologies used in processing powder metallic biomaterials.
Categories Metal-AM processes Power sources
Powder-bed fusion Selective Laser Melting (SLM) High-power Laser Beam
Selective Laser Sintering (SLS)
Electron Beam Melting (EBM) Electron Beam
Directed energy Laser Engineered Net Shaping Laser Beam
deposition (LENS)
into solid objects was the reason for medical industries' interest that
led to the development of Metal-AM technologies in the field [229].
The following sub-section briefly discusses how the advantages of
metal-AM found its opportunity in biomedical industries. After that,
the further discussion focuses on metal-AM technologies for powder
bed fusion that includes SLM, EBM, SLS, while the other method is the
directed energy deposition which is LENS. Both technologies focus on
the metal-AM for powder metallic biomaterial processing.
2.1. Advantages of metal-AM and opportunity in biomedical industry
In contrast to conventional manufacturing techniques, metal-AM is a
novel material processing approach for creating prototypes or parts
based on incremental layer-by-layer. This layer-by-layer technique al-
lows an unprecedented freedom in manufacturing complex structures
with precision and control that is not possible through conventional
manufacturing routes. An excellent example is a bone tissue engineer-
ing scaffold, the idea of which is to provide tissue support in-vivo
while mimicking the porous and permeable hierarchical architecture
of bone. It has been proven that mimicking the interconnected porous
network structure with conventional methods is difficult. However,
utilising X-ray micro-computed tomography (X-ray μCT) image coupled
with computer-aided design (CAD) can create design files that can be
processed using reliably AM. Some of the potential advantages [230]
of metal-AM are summarised in Fig. 1:
Metal-AM is a design-specific and material-specific system. There-
fore, the idea of the metal-AM and biocompatible material combination
is very promising, especially towards the specific clinical application of
patient. Furthermore, an essential application of metal-AM in the bio-
medical industry includes helps in surgical operation planning with
the use of accurate anatomic models based on the magnetic resonance
imaging (MRI) or X-ray micro-computed tomography (X-ray μCT),
and development of implants.
For the past ten years, metal-AM has moved into the biomedical field.
Ever since that, extensive research work has been carried out to enhance
various quality characteristics of metal-AM in producing biomedical
products. The reported characteristics are mostly the functions of
metal-AM parameters, especially on the importance of the load bearing
implants to achieve mechanical and fatigue performance together. The
growth trend of research works for the application of metal-AM in bio-
medical applications with two years interval is shown in Fig. 2 which il-
lustrates the soaring trend from the year 2001 to 2017. These data served
as evidence for the increment in the research works of metal-AM in fab-
ricating biomedical products. Apparently, the significant progress in the
year of 2005 averagely dominated the growth contribution. This was
followed by the gradual increase from the year 2011 until 2012, which
ignited the sharp increase in the years of 2015 and 2016 for approxi-
mately 47%. Overall, the increase in the growth trend took about four
years to reach the increment of 12% from the previous growth in the
year 2013. Surprisingly, the value increased triple times in 2014. In the
subsequent two years, the consistency in the rising trend remained
throughout these years where the value rose by up to 23%. The visibility
of the technology was significant during these years which then yielded
an enormous demand for the complete experimental-based information
Raw metallic biomaterials References
Titanium alloy powder, Cobalt alloy powder; 316L stainless [44,81–83,107–178]
steel powder, NiTi powder, Niobium powder, Tantalum powder
Titanium alloy powder, molybdenum powder, 316L stainless [179–185]
steel powder, NiTi powder
Titanium alloy powder, Cobalt alloy powder [59,130,131,163,186–221]
Titanium alloy powder, NiTi powder, Tantalum powder [186,222–226]
 W.S.W. Harun et al. / Powder Technology 327 (2018) 128–151 131

Fig. 1. Some potential advantages of metal-AM.

on the metal-AM establishment. Therefore, this led to the dramatic in-
crease in the research improvement from the year 2015 until 2017.
2.2. Selective laser melting (SLM)
Selective laser melting (SLM) is one of the divisions of laser-based
powder bed fusion. It is also known as an advanced form of selective
laser sintering (SLS) which allows full melting of metal powder and pro-
duces a homogenous SLM part [231]. SLM is applied only to pure and
X the most popular metal powder bed fusion technique in producing me-
Metal-AM Utilisation (%)
alloyed metal powders. The direct metal laser sintering (DMLS) on the
other hand is practically used interchangeably with SLM. The original
DMLS process is similar to the SLM where its machine is equipped
with high-powered lasers that entirely melt fine metallic powders
[232].
SLM was developed in 2002 [233]. As one of the ‘non-classic’
manufacturing complex part methods under metal-AM, this technique
has been adopted for the biomedical industry. One of the earliest studies
is in the fabrication of jaw and bone implants for dental and orthopae-
dics applications [129,234]. The present-day shows that SLM has been
tallic biomaterials compared to other metal-AM technique [153]. This

circumstance is aligned with the growth of SLM system concerning

47 new machine development and innovation to make it more productive
and economically attractive [3,27,28,141,235–237]. Furthermore, vast
numbers of SLM systems with different brands and machines are now
25 available in the market as shown in Table 2. One of the earliest metal-
13 AM machines used in the biomedical-related field was MCP Realizer in
9 2005 [129,155]. The new technology development and well-
5
0 0 1 developed innovation for the machine utilisation became significant as
the growth reached the year 2012 [81,82,146,160,166,168]. It included
2001 2003 2005 2007 2009 2011 2013 2015 2017
the in-house production of SLM system for the research involving
Years
in vitro study for bone scaffolds, the biomedical implant with cobalt
Actual Metal-AM Utilisation Projection of Metal-AM Utilisation alloy, and metallic biomaterial of Nickel-Titanium [113,153,161].
The system continued to evolve with more advanced SLM for the fol-
Fig. 2. Trend of metal-AM utilisation in biomedical applications based on the year 2001 to lowing years involving the well-known AM companies from Germany,
2017. France, the United Kingdom, and Belgium [110,119,121,126,128,130,
132 W.S.W. Harun et al. / Powder Technology 327 (2018) 128–151
Table 2
SLM machines used as metal-AM processes for biomedical applications.
Metal-AM process Machines
SLM MCP Realizer (MCP-Hek Group, Kaarst, Germany)
M3 Linear (Concept Laser GmbH, Germany)
SLM system (Bego Medifacturing-System, Bego Medical, Germany)
SLM system (Fraunhofer ILT, Germany)
PM100 (Phenix Systems, France)
In-house developed SLM machine
Realizer SLM 100 (MTT Technologies GmbH, now SLM Solutions GmbH, Lübeck, Germany)
ProX® DMP 320 (3D Systems - Layerwise NV, Leuven, Belgium)
SLM 250HL (SLM Solutions GmbH, Germany)
AM250 (Renishaw, UK)
ProX® DMP 100 (3D Systems - Layerwise NV, Leuven, Belgium)
HRPM-II (Rapid Manufacturing Center, Huazhong University of Science and Technology, China)
Mlab-R (CONCEPTLAER, Germany)
SLM50 (Realizer GmbH, Borchen, Germany)
SLM 125HL (SLM Solutions GmbH, Germany)
Phenix PXM (Phenix Systems, France)
135,145,164]. To take one example, SLM Solutions GmbH from
Germany has carried out an innovation for its SLM series of machines
namely, SLM 125, SLM 280, SLM 500, and SLM 280 2.0. The development
involved the improvement regarding the size of the building envelope
up until 500 × 280 × 365 mm3 and types of laser technology from a sin-
gle fibre laser to Quad IPG fibre laser. These led to the high performances
of build-rate up to 90%. Besides that, innovation has also been conduct-
ed on the substrate plate of SLM 280 2.0 machine, which helped to re-
duce the crack or internal stresses of the fabricated titanium material
based alloys. Another constraint faced by metal-AM technologies was
powder removal process after completion of part fabrication [238].
However, with the new machine development as of SLM 500 with
unique features namely, part removal station (PRS), the excess powder
can be removed ergonomically without any skin contact. The powder,
with a defined grain size, will be transported into a storage container
and is prepared for use again.
2.3. Electron beam melting (EBM)
Electron beam melting (EBM) process was named after the commer-
cial machine developed by a Sweden-based company Arcam AB in the
year 2015. The method is one of the most established powder bed fusion
techniques for metal [33]. Just like SLM, the system consists of rake,
build platform, powder hoppers, and an energy source. However, the
system uses electron beam energy rather than a laser in the processing
method. Due to some inherent characteristics of electron beams, it is es-
sential for EBM to work under a high vacuum. Moreover, a highly reac-
tive condition of some metals and alloys are likely to gather impurities
as they are exposed to air. The vacuum chamber is used to create vacu-
um environment during the process and thus ensures the integrity of
EBM manufactured part [37].
Earlier in the year 2010, research works were dominated more by
EBM in biomedical field compared to other metal-AM techniques [59,
191,199,203,209,214,221,239]. However, recently, the growth of re-
search works on EBM has become more competitive towards the SLM
[131,188–190,192,197,205,207,208,212,215,217–220]. The selection of
the EBM fabrication as the most in-demand replacement components
for biomedical parts is due to the coherence of its energy beam source.
Thus, the high power of electron beam enhanced the capability in fabri-
cating products with lower residual stress but increased surface rough-
ness higher [212]. As a result, the low residual stress is achievable at
high-temperature processes. Apart from that, EBM is capable of
supporting higher fabrication rate in comparisons to its conventional
counterpart such as SLM [109].
Recently, metal-AM has become increasingly mature with SLM and
EBM as the two representatives. The inherent ability of technology ma-
turity gives advantages concerning high build resolution, excellent
Starting year of utilisation References
2005 [129,155]
2007 [156]
2012 [81,82,166,168]
2012 [160]
2012 [146]
2012 [113,153,161]
2013 [126,130,135]
2013 [119,128]
2013 [109,137,141,143]
2014 [110,121,145,164]
2015 [133,134]
2015 [158]
2015 [83,147]
2016 [148]
2016 [112,116,149,172]
2016 [133]
dimensional accuracy, clean build environment, low excess materials,
and near-net-shape capability. These highlighted the potential of SLM
and EBM to directly manufacture customised metallic cellular scaffolds
for orthopaedics implant [157,240,241].
2.4. Selective laser sintering (SLS)
Selective laser sintering (SLS) was the first process in the powder bed
fusion class developed and commercialised [242]. The differences be-
tween SLS and other powder bed fusion techniques are based on the ma-
terial options and powder fusing mechanism. Like SLM, SLS is another
laser-based powder bed fusion technique. However, unlike SLM, the
raw powder during SLS process is partially molten or heated to the
sintering point. Regarding material options, SLS can fabricate thermo-
plastic polymer/ceramic or metal composite powders. In powder-based
metallic material technology, polymer serves as a binder that binds
fused metal particles together at relatively low temperature. Later, the
polymer is removed from the green body through depolymerisation. As
a result, the part produced shows inherently porous structures. Previous
research related to the biomedical field has concentrated on reducing po-
rosity and rapid manufacturing near-full-density parts by a combination
of SLS and post-processing [179–182,185,243].
Most of the typical porous structural application is for the prepara-
tion of metallic foams for bone implants. The cellular structure of metal-
lic foams can be designed to imitate the structure of cancellous bone
while meeting the design specifications concerning porosity level,
shape, size, strength, and biocompatibility of the implants [244–246].
Metallic foam is expected to prepare better interaction with bone. It is
because the porous structure is expected to encourage bone growth
transportation of body fluid through the interconnected array of the
pores of the open cell foam [45]. Thus, this promotes better interlock be-
tween implant and bone which helps to reduce or avoid the defects of
implant loosening [244].
2.5. Laser engineered net shaping (LENS)
LENS technology was initially developed by Sandia National Labora-
tory before commercialised by Optomec Inc. (Albuquerque, NM). It is
acknowledged as one of the usually used AM technology utilising bio-
compatible metal powders that belong to the class of direct laser depo-
sition techniques. Besides fabrication of near net-shaped functional
component, this technique can also be applied for surface modification
of a part. It is a process in which a powder bed does not surround a mol-
ten pool. LENS has a high power laser which is up to 4 kW (solid state or
fibre optic laser). In a LENS process, a mixture of powders is fed through
argon pressurised nozzles. It is delivered to a converging point where it
is also the central point of the laser. The powder then melts and forms a
 W.S.W. Harun et al. / Powder Technology 327 (2018) 128–151
micro-melt pool [247]. The melt pool adheres to the substrate. The
LENS's substrate is fixed, while the overhead laser system moves up-
ward with the deposition of each subsequent layer. The whole build as-
sembly of the LENS system is enclosed in a controlled environment to
avoid any oxidation of build material during deposition.
LENS is believed to have more advantages compared to powder bed
fusion regarding fabrication efficiency, better cooling effect, and parts
re-fabricating capability [248]. In LENS process, the molten pool is not
surrounded by a powder bed. The deposition of LENS is more accessible
to control through the assistance of powder feeding gas coolant, thus,
helps in increasing its cooling rates [249]. Another unique feature of
LENS is the ability to fabricate parts with high build rate and more sig-
nificant build volumes, unlike the powder bed-based technologies [2].
It is also worth to note that, LENS fabrication process is carried out in a
protective surrounding where the oxygen content is controlled
b10 ppm. It is essential to allow LENS processed materials to preserve
the purity of feedstock powder, as it is highly vital to any fabrication
process for biomedical applications [250].
Additionally, LENS has demonstrated successful fabrication for vari-
eties of biocompatible metals such as Ti-based alloys [224] and Co-
based alloys [225], Nitinol [186], and Tantalum [222]. Aside from capa-
bility of processing different biocompatible materials, the technique
has also been used to fabricate functional gradation implant structures
with different porosity [250], and manufacture multi-material systems
[225]. Recently, many research works were found to show the primary
focus of LENS fabrication for load-bearing implant application [186,219,
222,224–226,251,252]. For example, Balla et al. assessed the interaction
of in vitro cell-material utilising human foetal osteoblast cell line on
LENS processed TiN reinforced Ti6Al4V composite coatings for potential
wear resistant of load bearing implant [226]. Marattukalam et al. did an-
other research to investigate the role of LENS processing parameters on
the microstructure and corrosion properties of NiTi alloy which was
profoundly explored for bone implants [186].
3. Biomaterials for metal-AM
Nowadays, a lot of biomedical devices are fabricated using metal.
Despite numerous types of metallic materials available in industries,
only a few were identified as compatible biologically to the human
body for long-term biomedical applications. One of the principal con-
cerns is regarding the biocompatibility characteristics of these metallic
materials [44,253]. The biocompatibility requirements mainly vary
with specific medical applications. Since utilisation of the metal-AM
techniques is favourable in fabricating biomedical devices, the metal
condition has to be congenial with the list of metal-AM processes. The
biocompatible metals fabricated through metal-AM processes are re-
quired to meet a more stringent qualification and suits. Depending on
whether powder bed fusion and directed energy deposition processes
are used, the biocompatible metal feedstock must be in the form of ei-
ther metal powder or wire for it to fit with their processes.
Commercially metal-AM techniques are rigid in-terms of input pro-
cessing including the characteristics of metal powder to be used [254].
The general rule for the metallic biomaterials to be successfully proc-
essed using powder bed fusion is that the material must also be suitable
for casting and welding processes. Therefore, the commercially avail-
able metal powders are often supplied by the additive manufacturers
such as SLM Solutions and EOS. During metal-AM process, the possibil-
ity of severe part distortion is controlled by support structure during the
building, cooling rate management, and comprehensive laser scanning
strategies design. Ultimately, the metals must necessarily show accept-
able biomedical properties for them to perform successfully. The final
products fabricated through the metal-AM schemes must be capable
of preserving the strength as necessary [255]. For stringent service ap-
plication such as biomedical application, post-processed may be per-
formed after specific metal-AM processes to reduce porosity, improve
133
the microstructure, finish surface, and meet geometrical tolerance
[256].
The set of widely commercially available biocompatible metals
which are processible with metal-AM includes pure Ti, Ti alloys, surgical
grade stainless steel and cobalt-chromium alloys. Fig. 3 illustrates a sub-
stantial usage of raw spherical metal powders of Ti6Al4V alloy, CoCrMo
alloy, and 316L stainless steel for metal-AM processes. Some of the
spherical powders employed were produced from gas atomization
and plasma spheroidisation. However, metal-AM techniques are very
particular with the input processing variables including the quality of
metal powder to be used [254]. It is because to obtain a perfect and
fine spherical powder is necessary for metal-AM processes as they
help to increase the flowability and packing density of the powder.
These qualities not only enhance the reduction of the machine down-
time but also increase the manufacturing processing speed. Conse-
quently, most of the metal powders were monopolised by the AM
machine's manufacturers, which led to the high cost.
The characteristics precisely on the surface, geometrical, mechanical,
and biological characteristics of metal-AM fabricated parts are essential
to be qualified during pre-surgical verification [259]. In the medical
field, implants are required to meet specific desirable mechanical prop-
erties that harmonise with human bones to ease life-long functionality.
Those mechanical properties of human bone; i.e. young modulus, ten-
sile strength, compressive strength and toughness are dependable of
age, gender, location in the body, amount of water as well as disease his-
tory [260]. Till date, the optimisation of metal-AM process parameters
through a design of experiments has been conducted to functionally im-
prove the final medical implants and devices [261]. The biocompatibility
of the materials processed by metal-AM was examined through in-vitro
and in-vivo. The in-vitro characterization of implants and medical de-
vices is the most critical process to analyse before being used. The re-
sults of in-vitro developments are essential in providing the necessary
proof of concept and in perseverance that whether a metal-AM process
or metal is suitable for producing biocompatible structures. Once the
qualification is established in the in-vitro analysis, the metal-AM pro-
cess, feedstock, or fabricated structures proceed towards in-vivo stud-
ies. It would involve implant plantation inside an animal such as rat,
rabbit, and sheep or even directly in the human body [262,263].
3.1. Titanium and its alloy
Titanium and its alloy are one of the highly utilised metals of tradi-
tional biomaterials and remain as the material of choice for the biocom-
patible applications. They also have appeared as the most routine
metallic biomaterial to be processed by metal-AM technologies. Al-
though titanium is more costly compared to other metallic biomaterials
such as cobalt-based alloys and stainless steel, it can be more cost-
effective for a long-term used as a result of its unique characteristics.
The promising on-demand has been foreseen due to their excellent bio-
compatibility and biomechanical properties which make them as a
choice for implantable application [263,264]. They also exhibit excellent
resistance to fatigue loading and corrosion resistance in the physiologi-
cal environment.
Nevertheless, the Ti-based alloys have some disadvantages. The al-
loys show poor tribological performance. The material mechanical inad-
equacy causes this drawback. Most of the Ti-based material application
lies on load-bearing implants such as knee and total hip replacement. A
satisfactory bonding between the human tissue and new implant is a
must for this application. Not only that, the clinical success of Ti-based
materials implants does not depend only on excellent corrosion resis-
tance and favourable tissue reaction but also on their functional design
[178]. Ti-based materials are known material systems for biomedical
implant applications although a few shortcomings still need to be
attended. The metal-AM techniques can offer some solutions ranging
from improving wear performance through surface modification of Ti-
134 W.S.W. Harun et al. / Powder Technology 327 (2018) 128–151

Fig. 3. SEM images showing the raw spherical particle shape of (a) Ti6Al4V alloy [257], (b) CoCrMo alloy powder [258], and (c) 316L stainless steel [3].

based materials or enhancing osseointegration through the structurally
graded part.
3.1.1. Microstructure
Metal-AM of Grade 5 composition ranges for Ti6Al4V was revealed
by Murr et al. [214]. The researchers explored and compared the
Ti6Al4V microstructures of EBM built product with forged (wrought)
products. For EBM products, the microstructures showed homogenous
and primarily acicular α-plate, with Widmanstätten pattern as shown
in Fig. 4. Thijs et al. who conducted the later research also found a sim-
ilar acicular martensitic or the α' phase structure through the SLM pro-
cess [140]. In EBM study accomplished by Murr et al., there was a slight
difference concerning the variance of α-plate microstructure from the
top (~1 cm) to the bottom (~1 cm) of the EBM-ed build. The top average
α-plate thickness as shown in Fig. 4(a) was 2.1 μm, while 1.4 μm is
shown by the bottom of the build in Fig. 4(b). Fig. 4(b) exhibits finer
α-microstructure and more lamellar-like than acicular as it got nearer
the bottom of the build. The lamellar structure consists of (α + β)
phases can also be seen for both the microstructures of SLS Ti6Al4V
and hot isostatic pressing (HIP) Ti6Al4V as shown in Fig. 5(a) and (b)
[265].
Fig. 6 illustrates typical dislocation substructures in the acicular α-
plates of the EBM fabricated samples. In Fig. 6(a), the dislocation densities
measured were slightly higher than 1010 cm−2, while Fig. 6(b) shows es-
timated dislocation density of 5 × 109 cm−2. The dislocation density of
EBM fabricated products showed the range (~109–1010 cm−2) which is
a typical deformation range for metals.
The primarily acicular α-plate microstructures for the EBM fabricat-
ed sample was compared to a wrought Ti6Al4V sample of the following
conditions; 1) forged at 1040 °C, and 2) forged and solution treated 1 h

Fig. 4. Optical metallographic images comparing acicular α-plates in the top (~1 cm) section of EBM fabricated samples (a) and the bottom section (~1 cm) (b). Magnification is the same
and shown in (a) [214].
 W.S.W. Harun et al. / Powder Technology 327 (2018) 128–151 135

Fig. 5. Optical images of (a) HIP Ti6Al4V and (b) SLS then HIP Ti6Al4V. The latter commonly shows a lamellar type of microstructure and nearly alike to the former [265].

at 950 °C, air-cooled and then annealed 2 h at 700 °C as shown in
Fig. 7(a) and (b), respectively. Fig. 7(a) shows a primarily acicular α-
plate of the wrought samples, while Fig. 7(b) shows an equiaxed α/β
mixture and some coarse, acicular alpha.
The example of microstructure details of the wrought Ti6Al4V
samples forged at 1040 °C is shown in Fig. 8(a), the α-plates and β
microstructures in Fig. 8(b), and dislocation structure in Fig. 8(c).
The corresponding dislocation density of the wrought samples was
~ 2 × 109 cm− 2, unlike 5 × 109 cm− 2 measured from the EBM fabri-
cated samples as exhibited in Fig. 6(b).
Fig. 9(a) and (b) present the optical microscopic images of EBM
Ti6Al4V at the transverse direction and longitudinal direction, respec-
tively [266]. Fig. 9(a) demonstrates a lamellar microstructure while
Fig. 9(b) shows the directional growth along the build direction. The
higher thermal gradient in the latter is optional to be the most impor-
tant cause for the configuration of this columnar type of microstructure
[265].
Fig. 10 demonstrates the images of optical microscopy of Ti6Al4V
fabricated by LENS in (a) and (b), and EBM in (c) and (d), respectively.
The LENS Ti6Al4V microstructure showed finer structure than the EBM
Ti6Al4V microstructure. It is credited to the larger melting pool related
to EBM system (because of slower cooling rates). Usually, metal-AM
fabricated alloys experience repetitive solid-state phase transforma-
tions. These features initiate complexity which is not created by conven-
tional processes.
3.1.2. Mechanical and physical properties
The surface finish of materials has influenced the properties of
Ti6Al4V. Koike et al. studied the surface roughness effect on the fatigue
life of Ti6Al4V fabricated with SLM and EBM [37]. They used a three-
point bending test with a maximum surface stress of 600 MPa with
stress ratio, R = 0.1. They found that the fatigue life of Ti6Al4V SLM
was higher than Ti6Al4V EBM. Besides, the research conducted by
Simpson et al. [268] revealed that the feature characterization and
build rate were directly connected and allied to surface quality. Typical-
ly, the feature quality decreases if the build rate increases. The sugges-
tion is that the post-process surface finishing is required for critical
fatigue components manufactured by high deposition rate metal-AM
processes.
The surface finish was determined by the process parameters
employed, type of equipment, and build direction [267]. Thus, the static
mechanical properties of the adequately processed metal-AM are com-
parable to conventionally manufactured metal components. The static
strength is related to the density of components and the microstructure
produced through the metal-AM process. As evaluated to the compo-
nents fabricated by the conventional method such as casting, the micro-
structure of metal-AM components was finer. Hence, metal-AM
components exposed a higher static strength than cast and wrought
with the microstructures related much more to the thermodynamic
equilibrium. As titanium and its alloys are appropriate materials for
SLM, EBM, and LENS, the complex inter-relationship among these dif-
ferent metal-AM processes, the employed parameters, resulting proper-
ties and microstructures were comprehensively considered in the prior
study. Besides, Ti6Al4V fabricated by the metal-AM process demon-
strated higher tensile strength than cast or wrought Ti6Al4V. The
shape of microstructure features that reduced the elongation at failure
was consequently the primary concern in the processing of Ti6Al4V by
the metal-AM process [2]. The mechanical properties of Ti6Al4V parts
fabricated by the metal-AM process are demonstrated in Table 3. The
reference values from wrought Ti6Al4V were included for comparison.
Then, Table 4 shows the summary of some microstructural features
that are frequently studied in metal-AM process of titanium alloys and
its influence on the properties. LCF refers to the low cycle fatigue.
Ultimate tensile strength (UTS) and elongation of metal-AM Ti6Al4V
are illustrated in Fig. 11(a) and (b) [265]. The appropriate UTS and elon-
gation values for Ti6Al4V according to ASTM should be minimum at
860 MPa and 10%, respectively. Meanwhile, the dotted lines in Fig. 11
show the benchmark of these values. In comparison, the data proposed

Fig. 6. (a) shows examples of TEM bright-field images of dislocation substructures in the α-plates of the EBM fabricated sample section. (a) exhibits the α-plates with the β boundary zones
(black) microstructures. (b) shows a magnified view of an α-plate region with dislocation substructure [214].
136 W.S.W. Harun et al. / Powder Technology 327 (2018) 128–151
Fig. 7. Optical metallographic images comparing wrought Ti6Al4V microstructures in samples (a) forged at 1040 °C, and (b) forged and solution treated 1 h at 950 °C, air-cooled and then
annealed 2 h at 700 °C. Magnification is the same and shown in (a) [214].
that EBM is capable of presenting a combination of good ductility and
excellent fracture strength which satisfies the ASTM standards.
Ti6Al4V fabricated by SLM leaned to demonstrate the highest fracture
strength between the other processes of metal-AM. However, it has
the lowest value of ductility which is typically below the corresponding
benchmark value (10%). LENS has no adequate data although it is con-
sidered to explain a comparable inclination to that of the SLM caused
by the relationship involving the two processing methods. Due to the
poor density discussed further in [265], Ti6Al4V fabricated by SLS relies
on the post-processing process; for example, hot isostatic pressing
(HIP) to realise good ductility and excellent fracture strength.
A regular unit cell structure was designed to fabricate porous titani-
um parts using SLM [270]. A porosity of 10–95% was tested and the
Fig. 8. Wrought Ti6Al4V microstructures forged at 1040 °C. (a) Optical metallographic
overview. (b) TEM image of acicular α with β boundaries corresponding to area
featured at the arrow in (a). (c) Planar dislocation arrays in α-plate from magnified
view [214].
compression strength was comparable to the naturally occurred range
of 0.5 to 350 MPa. This study demonstrated that the optimised struc-
tures have the capabilities in producing the optimum quality parts for
the bone in-growth application.
Besides that, the fatigue behavior of SLM-ed porous Ti6Al4V ELI
structures has been studied for four different porosity levels;
i.e., porosities between 68 and 84% [119]. The static mechanical proper-
ties of the porous structures were found to be within the reported range
of bone mechanical properties. However, the absolute S\\N curves for
the fatigue tests for these four porous structures are very different.
The porous structures with higher porosities are shown lower than
those with lower porosities.
Stamp et al. carried out a development effort of SLM scanning strat-
egy to meet the mechanical requirement of fabricated porous biomate-
rials [271]. Through manipulation of beam overlap procedure, porous
structures with controlled porosity were produced. A 71% porosity,
440 μm mean pore diameter and 70 MPa compression strength of com-
mercially pure titanium bone in-growth candidate was produced for a
final shape of the orthopaedic component. The results concluded that
SLM beam overlap is a promising method for functional bone in-
growth material manufactures. Another influence of SLM processing pa-
rameters on mechanical properties of titanium fabricated parts was
studied by Pattanayak et al. [150]. SLM processing conditions namely
laser power, scanning speed, and hatching pattern were optimised to
fabricate various porous bodies. The results showed that when the
hatch spacing was less than the laser diameter and the laser power to
scanning speed ratio was larger than 0.5, fully dense plate thinner
than 1.8 mm was acquired. Titanium structures similar to human can-
cellous bone were fabricated. The compressive strength measure was
found to be in the range of 35 to 120 MPa when the porosity was in
the range of 75 to 55%.
3.1.3. Biocompatibility
3.1.3.1. In-vitro. The outcomes from the in-vitro study are important as
they would be the proof of concept as well as to determine whether a
process or material is suitable for fabricating biocompatible structures.
Many studies reported on the positive influence of the rough structure
of implant on cell behavior [272]. A recent breakthrough of metal-AM
in medical engineering has highlighted its potential in implant industry.
Haslauer et al. have documented the assessment of the in-vitro re-
sponse of human cells to solid and porous EBM Ti6Al4V structures and
comparison to commercial Ti6Al4V structures [239]. Cell viability, pro-
liferation, and the release of proinflammatory cytokines IL-6 and IL-8
after being exposed to human adipose-derived adult stem cells (hASC)
to a range of Ti6Al4V discs were evaluated in the in-vitro study. The
findings proved that a porous Ti6Al4V EBM structure increased hASC
proliferation and did not cause the cytokines IL-6 and IL-8 to release
compared to the commercial titanium alloy disc. These findings suggest
 W.S.W. Harun et al. / Powder Technology 327 (2018) 128–151 137

Fig. 9. Optical images of EBM Ti6Al4V from (a) transverse cross-section, and (b) longitudinal cross-section. The build direction is specified in (b) [266].

that porous and unpolished fully dense structures of EBM-processed
would potentially promote cell on-growth and in-growth, and thus ac-
ceptable for orthopaedic implants. Another fabricated bioactive cellular
Ti6Al4V structures by EBM underwent in-vitro test [221]. A chemical
surface modification was performed using HCl and NaOH induced apa-
tite formation during in-vitro bioactivity tests in dynamic simulated
body fluid. Thus, it was believed to enhance the fixation of the implant
in the surrounding bone as well as to improve its long-term stability.
The in-vitro biocompatibility of titanium alloy implants made using
LENS was reported in the following literature [225,273]. The pore size
and its structure had a notable effect on the cell culture results [259].
Xue et al. studied the effects of commercial pure titanium porous struc-
ture on bone cell responses through in-vitro with human osteoblast
cells (OPC1) [273]. The result indicated that LENS fabricated porous tita-
nium exhibited the ability to allow cell in-growth into the pore struc-
tures, where a critical pore size of 200 μm or higher is needed. Bael
et al. studied the effect of pore geometry on the in-vitro biological be-
havior of human periosteum-derived cells seeded on selective laser-
melted Ti6Al4V bone scaffolds [153]. The results concluded that for
SLM-produced Ti6Al4V scaffolds with specific morphological and me-
chanical properties, a functionally graded scaffold which combines
small pores for initial cell attachment and larger non-circular pores to
avoid pore occlusion is suggested. Other biocompatible titanium alloys
fabricated by SLM underwent in-vitro test can be found in the literature
[132,153,234,274].
3.1.3.2. In-vivo. The metal-AM fabricated parts also underwent biocom-
patibility test through in-vivo studies [221,275]. Arabnejad et al. present-
ed two stretch-dominated cell topologies; the Tetrahedron and Octet
truss for porous biocompatible Ti6Al4V fabricated by SLM that can be
used for load-bearing orthopaedic applications [275]. The histology of
the bone in-growth of the implants for both four and eight week time pe-
riods was observed as shown in Fig. 11. New bone formed at the implant-
cortical interface in the fourth week. New bone had grown within the
implant and filled the porous structure adjacent to the cortices in eight
weeks. What is more, bone in-growth was present in the portion of the
implant within the cancellous medullary canal. The backscattered SEM
images in Fig.12 shows the structure of the bone formed in and around
the implants was similar in gross appearance to the native trabecular
bone. At the four-week period, the amount of bone in-growth for Tetra-
hedron and Octet truss implants were 28.6% ± 11.6% and 35.5% ± 1.9%,
respectively. Bone in-growth increased to 41.3% ± 4.3% and 56.9% for
both respective implants at the eight-week period. The Octet truss im-
plant showed more bone in-growth compared to the Tetrahedron

Fig. 10. Optical microscopic images of Ti6Al4V fabricated by LENS in (a) and (b), and EBM in (c) and (d) [267].
138 W.S.W. Harun et al. / Powder Technology 327 (2018) 128–151

Table 3 molybdenum (CoCrMo), and Ni-free cobalt chromium tungsten

Mechanical properties of Ti6Al4V fabricated by metal-AM processes [269]. (CoCrW) alloys. Extensive research has been carried out on CoCrMo
Process Yield tensile Ultimate tensile Elastic Elongation
alloy in most of the cobalt-based alloy processed by metal-AM methods
strength (MPa) strength (MPa) modulus (GPa) (%) [262]. The access to the mechanical properties, microstructure, biocom-
patibility, and anti-corrosion properties studies have been carried out
SLM ~1000 ~1100 ~120 ~8
EBM 950 1020 120 14 on Co-based materials processed by metal-AM methods for medical ap-
LENS 973 1077 – 11 plications [82,107,113,120,123,134,147,159,165,166,168,174,207,220].
SLS + HIP – 1116.9 – 5
Wrought 883 951 110 14 3.2.1. Microstructure
(reference)
Xin et al. studied the biocompatibility of CoCr alloy fabricated by se-
lective laser melting and traditional casting techniques [166]. The mi-
implant at both time points. The in-vivo clinical experiments using a ca- crostructure of the traditional-cast and SLM samples are shown in Fig.
nine model proved that the structures encouraged bone in-growth and 13(a) and (b), respectively. At 100× magnification, the traditional-cast
can potentially be implemented for efficient structural topologies in samples in Fig. 13(a) exhibit a heterogeneous structure with typical
bone replacement implants. dendritic solidification microstructure consisting of dendrites as can
Bandyopadhyay et al. studied the effect of fabricated porous Ti6Al4V be seen in the light portion, an inter-dendritic region in the dark por-
alloy structures using LENS to enhance biological fixation and achieve tion, and a third part manifesting as dark lines in the light portion. Nev-
long-term in-vivo stability of tailored porosity implants [260]. The in- ertheless, the SLM samples in Fig. 13(b) exhibit a homogeneous and
vivo results showed that the total amount of porosity plays a vital role compact structure. The difference in microstructures may account for
in tissue in-growth. The in-vivo test with male Sprague–Dawley rats different Co ion release characteristics of the two sample types for the
in a 16-week study demonstrated that the open pore volume fraction further in-vitro study conducted in this research.
up to 0.40 of total porosity could accelerate the healing process through
biological fixation. After 16 weeks, the 25% porosity samples which 3.2.2. Mechanical and physical properties
showed the highest amount of Ca++ concentration within the pores, Takaichi et al. studied the microstructure, mechanical properties,
suggesting a faster rate of tissue generation and integration compared and metal elution of CoCrMn alloys fabricated by SLM [159]. The alloy
to samples with lower pore volume, i.e., ~11% and ~3% total porosity. composition was shown in the range of ASTM F-75. The mechanical
properties of SLM fabricated CoCroMO alloys satisfied the type-5 criteria
3.2. Cobalt-based alloy in ISO22764 but the as-cast alloy was lower than that of the criterion as
the alloy used did not contain carbon and nitrogen. It suggested that the
The continuous research of trustworthy biocompatible metal devel- SLM process could contribute to the decrease of the alloying elements
opment has contributed to the invention of biocompatible Co-based for CoCrMo alloys which were developed for the cast alloy. Besides
materials. For several years, Co-based materials have demonstrated du- that, the metal elution from SLM fabricated CoCroMO alloys was smaller
rability and versatility in the application of orthopaedic implant. The ex- compared to the traditional cast alloy. The mechanical properties and
tensive utilisation of these materials in a biomedical application is due metal elution results showed that the SLM process for the CoCrMo
to the properties as one of the hardest biocompatible alloys along with alloy is a promising candidate for use in dental devices.
high wear properties and corrosion resistance. The first used is for den- A researched has been conducted on CoCrMo parts manufactured
tal appliances. However, recently, the application has been widened up from the optimised processing parameters of SLM [156]. The fabricated
to joint and fracture fixation [113]. Numerous biocompatible Co-based CoCrMo parts were found to have minimum porosity and high part den-
materials exist including cobalt chromium (CoCr), cobalt chromium sities of 99.9%. The SLM parts were found to fulfil the mechanical prop-
erty requirements in terms of strength, hardness, and stiffness. The
research concluded that SLM is capable of producing medical or dental
Table 4
CoCrMo parts with efficient production as well as strong economic
Microstructural features and its influence on the properties of titanium alloys [2].
potential.
Microstructural Increases Decreases
features
3.2.3. Biocompatibility
Elongated α Fatigue crack growth LCFa resistance, ductility,
resistance, notched fatigue fatigue initiation resistance 3.2.3.1. In-vitro. Xin et al. performed an in-vitro study to compare the ion
resistance, fracture toughness
Elongated grain Notched fatigue resistance, Fatigue initiation resistance
released by SLM fabricated CoCr alloys and the cast samples of CoCr
shape fatigue crack growth [166]. CoCr alloys fabricated by SLM showed a significant lower Co
resistance, fracture properties ions release to simulate body fluid media compared to cast samples.
Equiaxed α LCF resistance, fatigue Notched fatigue resistance, An exact quantity of metal ions was released in artificial saliva solution
initiation resistance, ductility, fracture toughness, fatigue
over seven days from either traditional-cast or SLM samples seen in
strength crack growth resistance
Grain boundary α Notched fatigue resistance, LCF resistance, ductility, Table 5A. From the result of this study, SLM technique also showed
fatigue crack growth fatigue initiation resistance higher cell proliferation than the traditionally cast treated cell. Hence,
resistance, fracture toughness this indicates a higher biocompatibility of metal part fabricated by
Widmanstatten creep, notched fatigue Strength, LCF resistance, SLM. As the CoCr alloy prepared by SLM showed a better biocompatibil-
α/α-plates resistance, fatigue crack ductility, fatigue initiation
ity than the traditional casting technique, this research concluded that
growth resistance, fracture resistance
toughness SLM technique is considered as an optimal choice for alloy preparation
Coarse prior β Creep, fracture toughness LCF resistance, fatigue for the oral environment.
grains initiation resistance, ductility,
strength
3.2.3.2. In-vivo. Shah et al. also studied the stiffness of CoCr alloys for or-
Colony α Notched fatigue resistance, LCF resistance, ductility,
fracture toughness, fatigue fatigue initiation resistance, thopaedic surgery [262]. To reduce the high stiffness of CoCr alloys to
crack growth resistance strength avoid stress shielding effect, EBM fabricated CoCr alloy implants were
SLM technique considered as an optimal choice for alloy preparation for the oral
fabricated with an interconnected open-pore structure. The implants
environment. were tested in sheep. After six months of submerged healing in sheep,
a
LCF: low cycle fatigue. it was found that the CoCr alloy implants showed bone formation
 W.S.W. Harun et al. / Powder Technology 327 (2018) 128–151
Fig. 11. (a) Ultimate tensile strength (UTS), and (b) elongation of Ti6Al4V processed by metal-AM processes [265].
with gradual in-growth into the porous structures and densification
around the implant. It was also found that CoCr alloys did not alter the
composition of mineralised interfacial tissue. The results attest to the
potential of customised osseointegrated CoCr implants.
3.3. 316L stainless steel
316L stainless steel (316L SS) is one of the commonly investigated
metals in biomedical applications due to its attractive mechanical prop-
erties, corrosion resistance, and biocompatibility. The acceptance of
316L types was also influenced by the acceptable combination of excel-
lent mechanical properties and fair cost. It was first suggested for the
biomaterial application of plates, screws, and nails. It was due to the
lower carbon content of the material that makes it has an equitable ten-
dency of corrosion resistance.
However, the fact remains that there are enormous possibilities for
the 316L stainless steel to corrode inside the body under the high
stressed oxygen-depleted surrounding [276,277]. Nevertheless, 316L
Fig. 12. Backscattered scanning electron micrograph of a transverse (1) Octet truss and
(2) Tetrahedron transcortical implant section at (A) 4 weeks, and (B) 8 weeks. Bone in-
growth is throughout the length of the implant at the 8-week time point [275].
139
stainless steel remains as one of the useful biocompatible material to
be adopted primarily for typically temporary, or use as long-term,
low-cost cemented implants since it is easy to fabricate and be proc-
essed to achieve a certain level of mechanical and corrosion properties
desired, and requires lower cost [278,279].
3.3.1. Microstructure
Metal-AM has been used to fabricate nanostructured materials
adopted in reinforcing secondary phase to improve the performance
of steel alloys for biomedical devices. AlMangour et al. reported the ef-
fect of the nanoscale reinforcement volume content on the microstruc-
tural evolution of the SLM-processed TiB2-reinforced 316L stainless
steel [280]. They found that the SLM-processed nanocomposites were
sensitive to the TiB2 content. They also identified that the grain-
boundary strengthening and grain refinement induced by the rapid so-
lidification process and the formation of heterogeneous nucleation sites
by the TiB2 particles contributed to the strengthening mechanism of the
316L stainless steel samples reinforced with TiB2 and fabricated by SLM.
Fig. 14(A) exhibits metallurgically bonded layers with homogeneous
microstructure and no significant number of interlayer pores. Unlike
pure 316L stainless steel, Fig. 14(B) shows a heterogeneous layer-wise
microstructure with continuous and refined ring-like structures due to
the coherent bonded TiB2 nanoparticles.
Fig. 15 shows the TEM images of the SLM-processed 15 vol% titani-
um carbide (TiC)/316L nanocomposites. The existence of sub-micron-
sized 316L SS grains and retained nano-scale and spherical TiC particles
was observed in both TEM images. The grain size of the nanocomposite
is in the range of ~ 0.5–1 μm. Fig. 15(A) shows the formation of nano-
scale particles with a size of ~200 nm in the 316L SS matrix. It attributed
to the partial melting of the milled TiC particles. Fig. 15(B) shows that
the distribution and morphology after SLM were narrower and more
round when fine starting TiC particles were used instead of the course.
Fig. 15 also reveals the “metal-ceramic” interface of the 316L SS matrix
grain boundary. The 316L SS matrix has wetted the TiC reinforcements,
and spherical precipitates have formed on the TiC side of the interface.
The wetting helps to improve the interfacial bonding throughout the
metallic matrix composite thus responsible for the wear property en-
hancement of the TiC-reinforced 316L SS nanocomposites.
Corrosion of stainless steels is related to manganese sulphide (MnS)
inclusions that provide the local sites for corrosion pits. Until date, even
much research effort has been focused on the role of MnS in corrosion of
regular cast and wrought stainless steel, it elucidated that SLM-
fabricated 316L stainless steel can be fabricated without MnS inclusions
[282]. It is along with no accompanying Cr-depletion in the vicinity of
MnS that results in superior corrosion resistance relative to the wrought
form. The high solidification rates inherent to metal-AM avoided MnS
formation and an associated Cr-depletion zone, which are known to
be stable pit initiators. The stainless steel pit initiators are also associat-
ed with the presence (including size and number density) of MnS
140 W.S.W. Harun et al. / Powder Technology 327 (2018) 128–151
Fig. 13. Metallographic images of the cast sample (a) and the SLM sample (b) at 100× magnification [166].
inclusions. TEM-EDS line profiles of the inclusions in wrought and as-
printed 316L stainless steel are shown in Fig. 16. Fig. 16(a) shows the
TEM-EDS analysis that revealed the irregular shaped particles at or
near the austenite grain boundaries in the wrought 316L stainless
steel due to the chemically complex MnS inclusions. Furthermore, the
fan-shaped inclusion in Fig. 16(a) indicates enrichment of Mn, S, Al, N,
O, and Ti. Compared to wrought 316L stainless steel, a higher density
of spherical inclusions in the range of 20 to 50 nm was shown by as-
fabricated SLM 316L stainless steel. Such inclusions have been reported
to contain Si and O as confirmed by the current study. However, the
analysis here revealed the significant enrichment of such inclusions
with Mn, Al, and N as shown in Fig. 16(b). Note that both S enrichment
and Cr depletion zones were absent through the oxide/oxynitride inclu-
sions characterised. The absence of Mn-S rich particles in sub-micron to
micron scale of 316L stainless steel was confirmed using SEM analysis.
3.3.2. Mechanical and physical properties
Metal-AM is preferable in processing 316L stainless steel through
the manipulation of processing parameters. Until now, SLM and SLS
techniques have been employed for the processing of 316L stainless
steel to achieve and improve its mechanical properties to meet a partic-
ular requirement for specific biomedical applications. Xie et al. success-
fully fabricated porous 316L SS with EVA resin via indirect SLS process
[182]. They found that the porosity of green body was influenced by
laser energy density while sintering temperature contributed to the
mechanical properties and pore features of sintered samples. The
pores of the as-sintered porous 316L SS were characterised by an aver-
age pore size of 35 to 160 μm and a porosity of 28 to 58%. Moreover, the
elastic modulus and compressive yield strength were 1.58 to 6.64 GPa
and 15.5 to 52.8 MPa, respectively. It unveiled that the pore structural
parameters and mechanical properties of the as-sintered porous 316L
SS can be controlled readily to match those of cancellous bone by SLS
modification of processing parameters and subsequent sintering
temperature.
Table 6 listed examples of common manipulated processing param-
eters of metal-AM machines for 316L stainless steel. These parameters
are believed to give significant effect on the properties of the 316L
Table 5
Metal ion release in artificial saliva solution (A) and Dulbecco's modified Eagle's medium
(B) (μg/cm2), mean (SD), n = 3. Note that ‘dl’ indicates ‘detection limit’.
Co Cr Mo
A
CAST 0.49 (0.13) dl 0.12 (0.015)
SLM 0.12 (0.04) dl 0.015 (0.007)
P b 0.05 – P b 0.05
B
CAST 1.04 (0.38) 0.03 (0) 0.19 (0.06)
SLM 0.09 (0.006) 0.02 (0.006) dl
P b 0.05 P N 0.05 P b 0.05
stainless steel parts. To fabricate 316L stainless steel implant; laser
power, and scanning speed and spacing were manipulated for the
SLM and SLS processes [124,182,183]. These were performed to achieve
the mechanical properties according to types of implants such as human
cortical and cancellous bones.
The studies of mechanical properties based on the human bone
properties are summarised in Table 7. From the table, the tensile
strength of SLM-produced component which was 95 MPa [182] success-
fully met the requirement of the human cortical bone. The same goes to
the elastic modulus or stiffness range gained through the cancellous
bone type fabricated through SLS process, where the value gained was
aligned with the mechanical properties of the femoral head, femoral
condyle, and vertebra which were 2.9, 4.9, and 1.5 GPa, respectively
[283].
Many efforts have made to fabricate metal-AM implants making it as
a desirable candidate for bone substitutes [124,182,183]. Hao et al. in-
vestigated the feasibility and performance of SLM to fabricate a 316L
SS implant directly with hydroxyapatite (HA) composites to create a
sound chemical bond which accommodated in promoting new bone
growth [124]. The result showed that there was an existence of opti-
mum condition to fabricate good quality of 316L SS implant and HA
composite part using SLM duplicate scanning strategy. The fabricated
part exhibited the tensile strength of 95 MPa which was acceptable for
load-bearing application, and the stiffness was adequate to avoid the
stress shielding effect.
SLM has been utilised to process nanostructured materials for the use
as a secondary reinforcing phase to improve the performance of steel al-
loys for engineering applications such as biomedical devices. AlMangour
et al. demonstrated how SLM-processed TiB2-reinforced 316L SS nano-
composites helped to improve the mechanical properties of the nano-
composites materials [280]. The addition of the TiB2 ceramic
reinforcements in the SLM-processed samples was proven to improve
the compressive yield strength, hardness, and wear resistance. The nano-
composite materials exhibited the right combination of compression
yield strength and ductility. The 15 vol% TiB2/316L nanocomposite
showed a remarkably high wear resistance to abrasion despite the exis-
tence of some porosities. It was reported that the TiB2/316L nanocompos-
ite achieved wear resistance ten times higher than that of unreinforced
316L SS at a meagre wear rate of 0.046 × 10−4 mm3/(N·m). The im-
provement of mechanical properties of 316L SS as a base steel by TiB2 ad-
dition was due to the grain refinement and grain boundary strengthening
as mentioned in the previous subchapter of the microstructure.
SLM-processed nanocomposite was investigated using TiC-
reinforced 316L SS nanocomposites [281]. The starting TiC particle size
and volume content of TiC were believed to influence the mechanical
properties of the SLM-processed nanocomposite parts. They found out
that as the volume content and hardness of the TiC increased, while
the coefficient of friction (COF) and wear rate decreased owing to the
combined effects of grain refinement and grain-boundary strengthen-
ing. Nevertheless, unlike coarse starting TiC particles, wear performance
was remarkably enhanced, particularly with fine starting TiC particles at
 W.S.W. Harun et al. / Powder Technology 327 (2018) 128–151
Fig. 14. SEM images showing the characteristics of the cross-sections of the SLM-processed samples of (A) pure 316L, and (B) the 15 vol% TiB2/316L nanocomposite [280].
a 10 to 15% TiC content owing to the increased density and improve-
ment of the reinforcement–matrix wettability.
Anisotrophy and scanning strategies of SLM process for the TiC-
reinforced 316L SS nanocomposites was further explored [286]. Built
densification was strongly influenced by building strategy, where a
cross-hatched scanning strategy showed the highest densification. The
findings demonstrated that the utilisation of laser-scanning strategies
allows tailoring of densification, solidification of microstructure, crystal-
lographic texture, and anisotropy of mechanical properties of the fabri-
cated TiC-reinforced 316L SS nanocomposites. The influence of the
volumetric laser energy density was studied in the literature [287].
67 J/mm3 laser energy density was found to show higher compressive
yield strength as compared to 300 J/mm3 due to grain refinement de-
spite the lower density.
3.3.3. Biocompatibility
3.3.3.1. In-vitro. An in-vitro study has reported that the biocompatibility
of SLM-fabricated 316L SS parts was controlled through adjustment of
scanning speed and the microstructures regarding the quality of grain
and some defects [288]. It was reported that in-vitro cytotoxicity of
316L SS was strongly affected by the scanning speed. However, no sig-
nificant effect on the haemolysis was observed. The SEM image of the
SLM-fabricated 316L SS showed that finer grain and fewer defects led
to better biocompatibility due to the increase of corrosion resistance
and a decrease of toxicity released ions.
PremKumar et al. investigated the role of zinc in niobium oxide coat-
ing on 316L SS for biomedical applications [289]. They found that the
zinc incorporated niobium oxide coating dramatically improved the
Fig. 15. TEM images for 316L SS reinforced with the starting (A) coarse TiC, and (B) fine TiC nanocomposite revealing spherical precipitates at the interface and in increased dislocation
density in the 316L SS matrix [281].
141
surface, corrosion resistance, and mechanical properties of 316L SS.
From the bacterial viability studies, the presence of zinc in niobium
oxide coating on 316L SS was observed to efficiently inhibits the
Staphylococcus aureus and Escherichia coli bacteria. The study implied
that the biocompatibility of 316L SS was enhanced by the zinc in niobi-
um oxide by promoting better osseointegration.
3.4. Nickel-titanium (nitinol)
Recently, Nitinol, which is a form of alloying Nickel and Titanium
(NiTi) has received an increased interest in biomedical applications
[290]. NiTi is also known as Nickel-Titanium shape memory alloys
(NiTi-SMA) [126]. NiTi-SMA represents the distinctive feature of pure
NiTi alloy, which dominated most of the studies of metal-AM specifical-
ly for the implant application. Studies showed that NiTi implants can
change the shape after implantation based on the human body's tem-
perature. Two main advantages are the internal bone fixation quality
improvement and minimally invasive surgery [184]. NiTi presents
super elastic behavior close to the bone with high bone growth through
the interconnection of the pores, capillaries properties, and low modu-
lus of elasticity that also represents tuneable stiffness. NiTi also exhibits
excellent corrosion resistance and biocompatibility. The metal-AM such
as SLM [126,146,291] and LENS [186] were mostly adopted to process
NiTi.
Most studies focused on understanding the effect of metal-AM pro-
cessing parameter variations on the NiTi powder behavior that gives ef-
fects on the physical and mechanical structural properties. These
properties include stiffness, thermally induced shape changes, and the
surface innovation of nano-porosity. With these unique characters of
142 W.S.W. Harun et al. / Powder Technology 327 (2018) 128–151
Fig. 16. TEM-EDS line profiles of the inclusions in a) wrought, and b) as-printed 316L stainless steels [282].
NiTi, it is indeed an exciting candidate in biomedical applications that
include interbody fusion devices, acetabular cups, stents, and hip
endoprosthesis.
3.4.1. Mechanical and physical properties
Shiva et al. reported a novel method of fabricating NiTi parts using a
laser-based metal-AM technique [291]. The laser-based metal-AM
system was employed to fabricate circular rings with different
compositions of Ni and Ti powders; i.e., Ni-45% Ti-55%; Ni-50% Ti-50%;
and Ni-55% Ti-45%. The fabricated rings with the composition of Ni-
50% Ti-50% were found to have the closest properties to that conven-
tionally processed NiTi structure like surface morphology, structure,
and shape memory effects. The EDS results revealed that the difference
between the percentage of Ni and Ti were very close to each other for
Ni-50% Ti-50% and conventionally processed NiTi structures, unlike
the other two samples. From the results, it was apparent that Ni-50%
Ti-50% and the conventionally processed Ni\\Ti structures have many
correlations with their characteristics like surface morphology, struc-
ture, and shape memory effects.
3.4.2. Biocompatibility
3.4.2.1. In-vivo. Habijan et al. assessed whether a newly developed po-
rous NiTi produced by SLM was a suitable metal carrier for human mes-
enchymal stem cells (hMSC) through in-vivo study [126]. The hMSC is a
promising cell type for regenerative medicine and tissue engineering
due to its ability to support the regeneration of critical size bone defects.
Loading porous SLM-NiTi implants with autologous hMSC may enhance
bone growth and healing for critical bone defects. SLM-NiTi samples
were fabricated with different porosity and surface structure. Further-
more, hMSC was cultured on NiTi samples for eight days. Two-colour
fluorescence staining was used to analyse cell viability. After eight
days, viable cells were detected in all samples. SEM analysed the cell
morphology and surface topography and found that cell morphology
and surface topology were dependent on the orientation of the samples
Table 6
Works on 316L stainless steel part fabrication with varying processing parameters using SLM and SLS processes.
Metal-AM Processing parameters Material
SLM Laser power 316L stainless steel + hydroxyapatite
Scan speed composite
Scan spacing
SLS Laser power 316L stainless steel
Laser scanning speed
Sintering temperature
SLS Laser power 316L stainless steel
Scan speed
Scan spacing
during SLM production. Aligned laser processing conditions can also be
used to reduce Nickle ion release. The results concluded that both dense
SLM-NiTi and porous SLM-NiTi were suitable carriers for hMSC.
3.5. Others
Most commonly used metals such as sintered titanium, CoCrMo
alloy, and 316L stainless steel in biomedical, tantalum, and niobium
have become subjects of the most extant research by using metal-AM
techniques in the biomedical area [143,158,222,292]. The distinctive
characteristics offered by tantalum includes low modulus of elasticity,
corrosion resistance, excellent osseointegration properties concerning
bioactivity, biocompatibility, tissue in-growth properties, and high sur-
face frictional. One of the studies showed the value of Young's modulus
achieved by porous tantalum between 1.5 and 20 GPa [222].
Moreover, Niobium is another metallic biomaterial that has excel-
lent wear resistant characteristics. However, due to the costly fabrica-
tion and raw material price, the growth of niobium in implant
application is limited. However, metal-AM is an excellent and most suit-
able method to fabricate niobium implant that has an ultra-high pro-
cessing temperature up to 2468 °C and a high affinity for oxygen [158].
4. An overview of simulation works in metal-AM
In this new era, simulation plays a decisive role to enhance the tradi-
tional trial and error approaches for the design and optimisation of com-
ponents and materials [293]. It also improves the capability to quantify
the effects of process variables on the result of component properties. It
also brings benefits regarding understanding the underlying physical
process and allows the accelerated design to cut the qualification cycle
of additive manufactured parts. The present modelling and simulation
tools used to simulate processing materials are extended to model addi-
tive manufacturing parts.
The current modelling and simulation effort related to metal-AM
processes by the U.S. Department of Energy National Nuclear Security
Mechanical properties Application References
Young modulus: 20 GPa Human cortical bone [124]
Tensile strength: 95 MPa
Homogenous strain:
2.7%
Elastic modulus: 1.58–6.64 GPa cancellous bone (femoral head, [182]
Compressive yield strength: 15.5–52.8 MPa femoral condyle, vertebra)
Elastic modulus: 1.58–6.64 GPa human cortical bone [183]
Compressive strength: 21–32 MPa
 W.S.W. Harun et al. / Powder Technology 327 (2018) 128–151
Table 7
Mechanical properties of the human bones.
Bone type Mechanical properties
Stiffness Tensile strength (MPa) Ultimate strain
(GPa) (%)
Human cortical bone 15 60–130 1–5
[284,285]
Stiffness Compressive yield strength
(GPa) (MPa)
Femoral head [283] 2.9 68 N/A
Femoral condyle [283] 4.9 32 N/A
Vertebra [283] 1.5 4.1 N/A
Administration (NNSA) laboratories were reported [293]. The various
modelling development efforts included process, microstructure, and
properties modelling, performance and topology, and process optimisa-
tion. These efforts are essential for computational approach integration
of process-structure-properties-performance to ultimately enable engi-
neering and optimisation to specific performance requirements.
Particle shape and spreading conditions on powder bed characteris-
tics are believed to influence the final product quality. In order to inves-
tigate this, Haeri et al. [4] run a discrete element method (DEM)
simulation on the spreading of a non-spherical particle for AM and dis-
covered that a higher spreader velocity increased the bed surface rough-
ness and void fraction. They also found that a roller type spreader
outperformed a blade spreader in the same operating conditions. Be-
sides that, the elongated particles in a prepared bed exhibited shape
segregation and alignment to the flow.
Further development of the optimised spreaders for powder bed
preparation in AM has been recorded [294]. The new outperformed de-
sign led to higher production rates and lower maintenance costs. A new
technique for multi-sphere approximation (MSA) was also developed
and applied to 3D models of real powder grains to generate realistic par-
ticle shapes for the DEM simulations. Modelling and simulation tool
have also been applied in the biomedical application. Hazlehurst et al.
did an interesting study by comparing the compressive properties of
CoCrMo cellular structures with stiffness characteristics of the human
femur [123]. DMLS fabricated the CoCrMO cellular structure with 25
to 95% range of volume based porosity. The DMLS fabricated square
pore CoCrMo cellular structures were found to have similar stiffness
and strength with femoral cortical and cancellous bone. In the study,
an expression was proposed to predict the effective elastic modulus of
cobalt chrome molybdenum cellular structures with a volumetric po-
rosity of 65% and above. A finite element modelling technique has
been used to demonstrate that structural variation and heterogeneities
associated with the manufacture of cellular structures can significantly
decrease the effective stiffness.
5. Metal-AM in biomedical applications
The rise of metal-AM in the biomedical industry has excellently led
the usage mainly in orthopaedics and dental implants. Metal-AM was
first adopted to manufacture tailored implant or manufacturing
incapability by other manufacturing techniques. Furthermore, tissue
engineering is another multi-discipline area of application. In general,
three-dimensional structures with pores provide support for the cell
to attach, grow, and differentiate into functional tissue or organs.
These architectures can be made using the metal-AM techniques with
different micro- and macroporosity. The additional discussion is pre-
sented in the subsequent subsections.
5.1. Orthopaedics implants
The orthopaedic field is one of the biomedical branches that have re-
ceived the most attention after the evolution of metal-AM technologies.
In fact, the advantages of these new fabrication technologies can be seen
143
mostly in skeletal implant design processes. Its bulk properties define
the central performances of an implant; i.e., compressive strength,
elastic modulus, fracture toughness, hardness, wear resistance, and
bio-corrosion [262]. The common metallic implants used to replace
load-bearing joints are known as the total knee replacement (TKR)
and total hip replacement (THR). There are a few concerns regarding
the osseointegration of metallic implant. The concern of metallic ion re-
lease for implant configuration involving metal-on-metal contact is very
high. It is because the metallic ions from alloys can cause hypertension
and various tissue reactions in individuals.
In metallic implant configuration, it is impossible to avoid the wear
induced damage. Therefore, to reduce the risks to patient's health, at-
tempts can be made to minimise the impact through the implant design
configurations. Moreover, postoperatively, the insertion of dense metal-
lic implants with a high stiffness that shows homogeneous and isotropic
behaviors reduce the load transfer into host bone. The changes in load-
ing surrounding lead to a phenomenon known as stress shielding. It
may cause weakening of adjacent bones or premature implant loosen-
ing. More flexible implants are needed to improve stress shielding
characteristics.
In recent years, the development of metal-AM processes such as
SLM, EBM, and LENS has shown their ability to produce orthopaedic im-
plants with tailored properties which can emulate human bone. The ex-
tent and success of osseointegration depend on the biocompatibility of
the implanted material. Titanium and cobalt-chrome are the principal
metals used in manufacturing orthopaedic implants. Instead of fully
dense implants, metal-AM is capable of manufacturing implants with
customised porosity. The porous structure permits reduction in the
stiffness between the fabricated implants and bones. The condition sub-
sequently induced the reduction in stress shielding effect especially for
loosening and micromotion from implant relative to the bone [210,295].
Besides that, the porosity allows bone in-growth into the porous coated
surface and thus helps to enhance the early stage of osseointegration
[296]. These lead to a better gradual transfer of stresses across human
bone or tissue to the metallic implants and thus improve the life of an
implant in-vivo.
Since metal-AM technologies significantly offer capability in fabricat-
ing unique complex-geometrical structure, many research works have
been conducted to investigate the manufacturing processes of porous
metallic parts. Table 8 below listed some of the previous works on
metal-AM fabricated porous structures and the elastic modulus property.
Table 8 also shows that Ti6Al4V has become the most in-demand metallic
biomaterials used in porous structure fabrication component in ortho-
paedics with EBM, LENS, and SLM. The most metal-AM techniques
utilised were EBM [192,210,221], and SLM [153,297]. It was found that
elastic modulus obtained varied depending on the materials and their
structural design. The type of unit cell fabricated using the method in-
cluded open- and closed-cell structures as shown in Table 8. The
closed-cell shapes included diamond, hatched, and bulked porous [222].
While for open-cell, the unit cell was in the shapes of honeycomb-like,
stochastic foam, and rhombic structures [204]. Balla et al. demonstrated
LENS processing of porous tantalum structures with relative densities be-
tween 45 and 73% [222]. EBM process was also utilised to make stochastic
foam structure of Ti6Al4V with 62 to 92% of volume porosity. Strivas et al.
showed the success of cellular structure in improving osseointegration
with the bone tissues [298]. Similar cellular Ti6Al4V structures with inter-
connected porosity suitable for bone in-growth were manufactured by
EBM [221].
Surface modification and coating was another method proposed by
researchers to address the problem of poor osseointegration between
the human tissues and metallic implant. The commonly investigated
coating for this purpose was the coating of calcium phosphate ceramic.
Direct energy based metal-AM techniques such as LENS have created a
calcium phosphate coating efficiently on metallic implants. The coating
can be either done as a conventional coating on the metallic material or
as a compositionally graded coating [300]. Similar quality of coatings
144 W.S.W. Harun et al. / Powder Technology 327 (2018) 128–151

Table 8
Previous works on porous structures fabricated by metal-AM methods for orthopaedics.

Year Material Metal-AM Type of unit cell Porosity (%) Elastic modulus (GPa) References

Open-cell Closed-cell

2008 Ti6Al4V EBM – Diamond 80.5 0.9–1.6 [221]

Hatched 61.3 3.9–12.9
2009 Ti6Al4V EBM Honeycomb-like structure – 66.3 ± 2.1 2.5 ± 0.5 [210]
2010 Ti6Al4V EBM Solid cellular foam – 55–82 0.5–9.9 [199]
Hollow cellular foam

55–89 0.3–9.8
2010 Tantalum LENS Bulk porous 27–55 1.5–20 [222]
2010 Ti6Al4V EBM Reticulated mesh – N/A 0.48–1.35 [207]
CoCrMo 0.25–0.70
Stochastic foams – N/A 0.92–6.15
0.49–3.68
2012 Ti6Al4V SLM Triangle – N/A 0.45 ± 0 [153]
Hexagonal 04–11.3 ± 2.7
Rectangular
2012 Ti6Al4V EBM Stochastic foam – 62–92 0.2–6.3 [212]
Reticulated mesh
2013 Ti6Al4V ELI SLM Dodecahedron – 68–84 0.55–3.49 [119]
2013 CoCrMo SLM Cellular – 25–95 1.06–28.59 [107]
2014 Ti6Al4V EBM Rhombic Dodecahedron – N/A 5.67–14.05 [204]
2015 Titanium SLM Dodecahedron – 66–82 2.61 ± 0.05 [299]
2016 Ti6Al4V SLM Spider-web – N/A 11.9 [117]
2016 Ti6Al4V SLM – 68 7.72 ± 0.04 [138]
2016 Ti6Al4V ELI EBM Cubic – N/A 6.3 to 14.9 [206]
G7
Rhombic
Dodecahedron

was processed by techniques such as thin film techniques and plasma
sprays. However, a new dimension can be given by metal-AM methods
to this old concept of bioceramic coating.
Most traditional coating processes use a line of sight techniques,
which give challenges to produce coatings on contours and curved sur-
faces. The problem can be solved using metal-AM techniques such as
LENS since it allows coatings on complex structures and geometries. Be-
sides, not only a bioceramic coating can be processed on metallic im-
plants but also a porous bioceramic coating as well. Hence, not only
biocompatibility of implant increased but also a better quality of
osseointegration can be achieved compared to a dense or porous implant
or a full-dense bioceramic coating. Metal-AM processes were exploited
in the following way. The metallic implants and bioceramic coating can
be processed simultaneously through additive manufacturing route.
The deciding factors for this would be the complexity of the design of
the implant. Besides processing the dense and porous bioceramic coat-
ings, novel metal-ceramic composites can also be processed by metal-
AM as new materials for load-bearing applications [301,302].
Many efforts have been made to fabricate metal-AM implants and
consider it as a desirable candidate for bone substitutes [124,182,183].
Consequently, the influence of coating on the stress shielding effects
caused by the mismatch of stiffness between the foreign implant sur-
faces and host bone can be prevented. For instance, one of the consid-
ered bioactive material to coat on the metallic implant surface is
hydroxyapatite. The metal implant coating creates a strong chemical
bond which helps in promoting new bone growth [302]. Therefore,
the hydroxyapatite coating is believed to help improve the weaknesses
of 316L stainless steel metallic biomaterial and its mechanical proper-
ties. The findings showed the utilisation of 316L stainless steel and hy-
droxyapatite composite in fabricating parts through SLM for human
cortical bone [124].
5.2. Dental application
In order to use a material for a dental implant, several requirements
must be met. The most crucial consideration includes the mechanical per-
formances and surface properties of the dental implants. Vandenbroucke
et al. developed a procedure to fabricate frameworks for complex dental
parts using SLM [156]. The mechanical and corrosion properties of
Ti6Al4V and CoCrMo were accessed to ensure that they meet the biocom-
patibility for dental implants. The metal-AM was found to be capable of
fabricating parts for dental usage.
The most widely used biocompatible material for dental materials is
cobalt-chromium based alloys [303]. Usually, the alloys need to fulfil the
requirement of having an ultimate yield stresses comparable or higher
than the ISO 22674:2006 standard which was 500 MPa [147]. Another
work proved that the mechanical property performances of metal-AM
cobalt-chromium based dental alloys has widely been exercised and
conducted in public health. The material of choice for cobalt-chromium
based alloys include CoCrMo, CoCr, CoCrCu, and CoCrW. Some examples
of other alloys used in this application are Ti6Al4V, and Ti–36Nb–2Ta–
3Zr–0.35O [304]. One of the examples is known that the metallic ions
released form alloys may result in unpleasant diverse hypersensitivity
or tissue reactions in individuals. Hence, it is vital for any alloys intro-
duced to oral environment to have low metallic ions release to allow
risk reduction to patient's health. In an in-vitro study conducted by
Xin et al., they found that lower Co ion was released from the SLM-
prepared samples in simulated saliva and cell culture media compared
to alloy cast traditionally. Thus, SLM was shown to exhibit higher cell
proliferation than the traditionally cast-alloys. They concluded that
CoCr alloys manufactured via SLM exhibit lower biological risks com-
pared to casted samples [166].
5.3. Other metal-AM implants and devices
Different types of biomedical applications employed the metal-AM
processes, where orthopaedics is the domination as shown in Table 9.
The earliest application was first introduced in 2005 with SLM utilised
in the fabrication of lower jaw structure, lumbar vertebra, and tubular
femoral bone shown in figure (a) in Table 9 [129]. MCP Realizer ma-
chine of SLM process was adopted to fabricate 316L stainless steel
lower jaw structure and lumbar vertebra and a pure titanium tubular
femoral bone. Other SLM fabricated implants included Ti6Al4V human
mandible implant as shown in figure (b) in Table 9 [178] while
 W.S.W. Harun et al. / Powder Technology 327 (2018) 128–151 145

customised Ti64 ELI frontoparietal-temporal bone that fit precisely the The component underwent a kinematic test carried out on a cadaver
patient's cranial defect for craniomaxillofacial surgery is shown in figure leg. It was revealed that the tailor-fit articular surfaces reproduced nat-
(c) in Table 9 [44]. Besides, figure (d) in Table 9 shows the talar compo- ural joint motion well, thus supported the necessity of SLM for patient
nent for the CoCrMO endoprosthetic ankle devices fabricated by SLM. personalisation in total ankle replacement. Until then, SLM process has

Table 9
List of implants and devices fabricated by metal-AM processes.

Metal-AM processes Fabricated implants and devices Applications References

SLM Lower jaw [126,129,156,172,178,305,307]

Lumbar vertebra
Tubular femoral bone
Oral screw-retained implant
Stents
Shape memory staples
(a) (From left) lower jaw, lumbar vertebra and tubular femoral bone [129] Interbody fusion devices
Hip endoprosthesis
Acetabular cups
Mandible implant
Frontoparietal-temporal bone

(b) Mandible implant [178]

(c) Frontoparietal-temporal bone [44]

(d) Talar component [80]

EBM Cortical bone [25,59,191]

Load-bearing

(e) Skull plate [191]

Femoral knee implant [25]

SLS Acetabular cup [183]

Medical devices [308]

LENS Load-bearing [222]

Hip stems [10]

146 W.S.W. Harun et al. / Powder Technology 327 (2018) 128–151
been studied for the following applications such as the oral screw-
retained implant, hip endoprosthesis, acetabular cups, and biomedical
devices [126,156,172,178,305].
Besides that, EBM technology has also shown its ability to fabricate a
titanium cranial implant for osteoma treatment; i.e., a treatment for a
benign tumour composed of bone tissue or a hard tumour of the
bone-like structure. Figure (e) in Table 9 depicts the EBM fabricated
skull plate [191]. The surface of the EBM implant was smoothened,
shaped, and cleaned via sandblasting process. Meanwhile, figure (f) in
Table 9 shows the Co-29Cr-6Mo alloy femoral knee implant made
with lattice structure using EBM process [25]. In order to meet the
site-specific demands of the specific implant, the mechanical properties
of the implant were tailored via controlling the lattice structure design.
It illustrated the uniqueness of metal-AM implant components in fabri-
cating complex geometrical structures and meeting specific mechanical
characterization [306].
6. Future trend
Metal-AM technologies are predicted to continue their growth trend
for the upcoming years. In the year 2012, 16.4% of the total system-
related revenue of the AM was contributed by biomedical applications
[309]. The principal reason for this is none other than the abilities of
metal-AM to align with the in-demand of medical device components
and technologies. Relatively, most of the medical devices such as dental
crowns and surgical implants require miniaturisations and hence suit
the envelope size production provided by metal-AM technologies. Fur-
thermore, the technologies are indeed capable of meeting the clinical ef-
ficacy where the bespoke products successfully matched individual
patients with excellent properties.
In the year 2017, most of the metal-AM processes are very compet-
itive with each other in the biomedical arena. Nevertheless, SLM and
EBM systems are believed to lead the opportunity due to their ability
in yielding precise control over internal pore structures and complex
shapes as required in biomedical application [212,275,310]. On the
other hand, in the metal-AM industry itself, metal-AM companies are
also competing to introduce advanced machines that allow the manu-
facturer to process metal products cheaply and quickly. Recently, the ef-
fort to establish new generation metal-processing technologies of
metal-AM has also been carried out by Desktop Metal [311]. This effort
is believed to be a game changer, which directly or indirectly influences
the future advancement of the biomedical industry.
Regarding the biomaterial preferences used by metal-AM tech-
niques, titanium, and its alloys continued to serve and dominate due
to their excellent characteristics [150]. At the same time, NiTi shape
memory is another interesting metallic biomaterial that possesses an
excellent growth trend in the metal-AM industry. On separate notes,
electron and laser melting methods provide comfortable choices for
metal-AM fabrication especially in orthopaedics and dental implants
that should match with the body, and be faster and cost-effective.
More works will continue to develop in these applications concerning
implant structural design and process development. Another biomedi-
cal field which is craniofacial is also expected to continue to grow.
7. Conclusion
The evolution of metal-AM processes has highlighted the role of SLM
and EBM techniques which are mostly utilised in fabricating parts in this
application with SLM as the most popular metal-AM technology follow-
ed by EBM, DMLS, SLS, and LENS. It is due to the growth of SLM system
regarding the new machine development and innovation to make it
more productive and economically attractive. In the field of biomedical
applications such as medical implants, metallic biomaterials fabricated
through metal-AM are required to meet a more stringent qualification
and suit the metal-AM processes. From the review, it showed that the
titanium and cobalt-based alloys have been utilised as the most metal
choice in biomaterials processed by metal-AM technologies. Other bio-
compatible metals include 316L stainless steel and Nitinol. Besides, NiTi
seems to be another future growing metallic biomaterial for it has an
unusual super-elastic characteristic that suits implant application. Nev-
ertheless, the emergence of metal-AM technology in various biomedical
fields has led to the significant usage in orthopaedics and dental appli-
ances. The studies on orthopaedics, dental, and other biomedical field
are believed to gain benefits from the metal-AM for its biomedical in-
dustry development. Ultimately, metal-AM technologies are predicted
to continue their growth trend for the upcoming years. The fundamen-
tal reason is none other than the abilities of the metal-AM processes to
align with the in-demand of medical technologies device components.
Acknowledgement
Universiti Malaysia Pahang (www.ump.edu.my) fully supports
the facilities and resources for this research. The authors would like to
acknowledge the support of the internal grants of Universiti
Malaysia Pahang RDU140354, RDU160337, RDU150337, RDU160354,
GRS1503115, GRS1503145, PGRS170388, and the support of Research
Acculturation Collaborative Effort (RACE) RDU151314, Research Accul-
turation Grant Scheme (RAGS) RDU151404 provided by the Ministry of
Higher Education, Malaysia. The project was also supported by an inter-
national grant namely the Qatar National Research Fund (QNRF)
NPRP8­876­2­375 (UIC161504).
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