A semi-automated virtual workflow solution for the design and production of intraoral molding plates using additive manufacturing: the first clinical results of a pilot-study

Abstract

Computer-aided design and computer-aided manufacturing (CAD/CAM) technology has been implemented in the treatment of cleft lip and palates (CLP) by several research groups. This pilot study presents a technique that combines intraoral molding with a semi-automated plate generation and 3D-printing. The clinical results of two intraoral molding approaches are compared. This is the first clinical investigation of semi-automated intraoral molding. Our study included newborns with unilateral CLP. Plaster models were digitalized and measured by two independent observers. Two methods of CAD/CAM-assisted intraoral molding were compared: (i) stepwise manual design of molding plates (conventional CAD/CAM-intraoral molding) and (ii) a semi-automated approach with an automated detection of alveolar ridges (called RapidNAM) assisted by a graphical user interface (GUI). Both approaches significantly narrowed the clefts and resulted in a harmonic alveolar crest alignment. The GUI was easy to use and generated intraoral molding devices within minutes. The presented design solution is an efficient technical refinement with good clinical results. The semi-automated plate generation with a feasible GUI is fast but allows individual adaptations. This promising technique might facilitate and foster the more widespread use of CAD/CAM-technology in intraoral molding therapy.

Simultaneous, radiation-free registration of the dentoalveolar position and the face by combining 3D photography with a portable scanner and impression-taking

“…We wanted to compare the standard geometry to the cross geometry, because automated registration and positioning of the geometry is wanted in a further step in our diagnostics and treatment planning for children with cleft lip and palate. A cross-like geometry has shown best results in this automated step (data not published) and would have been the missing link for fully automated generation of CAD/CAM-assisted appliances for nasoalveolar moulding (NAM) therapy as described earlier [37, 38]. Furthermore, a cross-like geometry seems to be more suitable for the alignment due to definite edges which can be used for reference marker positioning.…”

Evaluation of a Digital Protocol for Pre-Surgical Orthopedic Treatment of Cleft Lip and Palate in Newborn Patients: A Pilot Study

“…The following landmarks (Figure 3) were selected on both pre-and post-molding therapy models: the most anterior point on the greater segment (A), the center of the papilla incisiva (P), the points that have the shortest connection line passing over the anterior cleft (SA and SA'), the tuberal areas (T and T'), the dissecting point on the connecting line between tuberal areas (MT), the points that have the shortest distance passing over the cleft posterior on the hard palate (SD and SD') ( Figure 3). Then, they measured A-MT, SA-SA', T-T', and SD-SD' segments' length and calculated the difference between pre-and post-molding therapy models, obtaining the outcome measures for statistical analysis [35]. Nasal symmetry and nasal tip projection were evaluated postoperatively.…”

NAM—help or burden? Intercultural evaluation of parental stress caused by nasoalveolar molding: a retrospective multi-center study

“…Since treatment compliance and motivation is of utmost importance and cannot be provided by the small patients themselves, their caregivers are responsible for the daily handling of the NAM plate. Due to obvious infrastructural issues [ 14 ] such as frequent and time-consuming appointments or associated higher treatment costs, several promising attempts have been reported to simplify the techniques, lower the costs, and shorten appointments or lower their frequency [ 15 – 17 ]. However, many different aspects can contribute to psychological burden during the time of the treatment, some of which are based on cultural- and gender-related perspectives.…”