Medical additive manufacturing (aka medical 3d-printing) has received increasing attention in the past years with research applications in many clinical domains, particularly in surgical disciplines (e.g. orthopedic, oral, cardiovascular). In some domains medical 3d-printing has established itself in daily clinical practice, however the question remains if is it ready for broad clinical use. In this talk a short survey about the state-of-the-field will be presented, followed by examples from several research & development projects at the Medical University of Vienna. The selected projects will highiligh the medical background, the technological options employed as well as the challenges we have been encountering towards a successful establishment of 3d-printing in the clinics.