| Summary: | Abstract Background Three-dimensional (3D) printing is a novel innovation in the field of craniomaxillofacial surgery, however, a lack of evidence exists related to the comparison of the trueness of skull models fabricated using different technology-based printers belonging to different cost segments. Methods A study was performed to investigate the trueness of cone-beam computed tomography-derived skull models fabricated using different technology based on low-, medium-, and high-cost 3D printers. Following the segmentation of a patient’s skull, the model was printed by: (i) a low-cost fused filament fabrication printer; (ii) a medium-cost stereolithography printer; and (iii) a high-cost material jetting printer. The fabricated models were later scanned by industrial computed tomography and superimposed onto the original reference virtual model by applying surface-based registration. A part comparison color-coded analysis was conducted for assessing the difference between the reference and scanned models. A one-way analysis of variance (ANOVA) with Bonferroni correction was applied for statistical analysis. Results The model printed with the low-cost fused filament fabrication printer showed the highest mean absolute error ( $$1.33\pm 0.24 \text{mm}$$ 1.33 ± 0.24 mm ), whereas both medium-cost stereolithography-based and the high-cost material jetting models had an overall similar dimensional error of $$0.07\pm 0.03 \text{mm}$$ 0.07 ± 0.03 mm and $$0.07\pm 0.01 \text{mm}$$ 0.07 ± 0.01 mm , respectively. Overall, the models printed with medium- and high-cost printers showed a significantly ( $$p<0.01$$ p < 0.01 ) lower error compared to the low-cost printer. Conclusions Both stereolithography and material jetting based printers, belonging to the medium- and high-cost market segment, were able to replicate the skeletal anatomy with optimal trueness, which might be suitable for patient-specific treatment planning tasks in craniomaxillofacial surgery. In contrast, the low-cost fused filament fabrication printer could serve as a cost-effective alternative for anatomical education, and/or patient communication.
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