Technical note on introducing a digital workflow for newborns with craniofacial anomalies based on intraoral scans - part I: 3D printed and milled palatal stimulation plate for trisomy 21

Abstract

Background: Advanced digital workflows in orthodontics and dentistry often require a combination of different software solutions to create patient appliances, which may be a complex and time-consuming process. The main objective of this technical note is to discuss treatment of craniofacial anomalies using digital technologies. We present a fully digital, linear workflow for manufacturing palatal plates for infants with craniofacial anomalies based on intraoral scanning. Switching to intraoral scanning in infant care is advantageous as taking conventional impressions carries the risk of impression material aspiration and/or infections caused by material remaining in the oronasal cavity. Material and methods: The fully digital linear workflow presented in this technical note can be used to design and manufacture palatal plates for cleft palate patients as well as infants with functional disorders. We describe the workflow implemented in an infant with trisomy 21. The maxilla was registered using a digital scanner and a stimulation plate was created using dental CAD software and an individual impression tray module on a virtual model. Plates were manufactured using both additive and subtractive methods. Methacrylate based light curing resin and Poly-Ether-Ether-Ketone were the materials used. Results: The palatal area was successfully scanned to create a virtual model. The plates fitted well onto the palatal area. Manual post-processing was necessary to optimize a functional ridge along the vestibular fold and remove support structures from the additively manufactured plate as well as the milled plate produced from a blank. The additively manufactured plate fitted better than the milled one. Conclusion: Implementing a fully digital linear workflow into clinical routine for treatment of neonates and infants with craniofacial disorders is feasible. The software solution presented here is suitable for this purpose and does not require additional software for the design. This is the key advantage of this workflow, which makes digital treatment accessible to all clinicians who want to deal with digital technology. Whether additive or subtractive manufacturing is preferred depends on the appliance material of choice and influences the fit of the appliance.

Fracture Load of an Orthodontic Appliance for Robin Sequence Treatment in a Digital Workflow

“…The process starts by obtaining information about the patient’s palate using an intraoral scanner. These data are then used to create different patient-specific prototypes by CAD software, where parameters such as spur angle and position are changed [ 5 , 9 ]. Afterward, these prototypes are printed with a direct light projection (DLP) printer (Solflex 170, Way2Production, Vienna, Austria) and a Medical Device Regulatory (MDR) class IIa splint material (V-Print splint, VOCO, Cuxhaven, Germany) [ 5 ].…”

Effectiveness of the novel impression tray “cleftray” for infants with cleft lip and palate: a randomized controlled clinical trial

“…However, these techniques present numerous disadvantages including aspiration of material, airway obstruction due to excessive material, distortion from difficulty in removal of the impression, and failure to record minute details and extend the CLP. Additionally, this technique is complex and involves prolonged chairside time 10 , 11 .…”

Accuracy Evaluation of Additively and Subtractively Fabricated Palatal Plate Orthodontic Appliances for Newborns and Infants – An In-vitro Study

“…The cleft covering plate aims to cover the cleft and provide guidance for the alveolar segments to come closer together [6]. The stimulation plate aids in addressing speech impairment, feeding problems and breathing difficulties related to hypotonic tongue musculature [7][8][9][10]. The TPP aids in relieving the upper airway obstruction present in RS patients, by pushing the base of the tongue forward.…”

“…Orthodontic treatment of these patients starts with an impression of the upper jaw, as soon as possible after birth. For that purpose, intraoral scanning was found to be a safe and valid alternative to conventional alginate impressions [7,12], while removing the inherent risk of respiratory obstruction [13]. Additionally, it reduces patient discomfort and nausea sensation [14], while maintaining the accuracy of the conventional impression [15].…”

“…Additionally, it reduces patient discomfort and nausea sensation [14], while maintaining the accuracy of the conventional impression [15]. A digital workflow for direct appliance manufacturing has already been established for each palatal plate case [7,12]. Besides making a physical model obsolete, it decreases hands-on time [11,14] and enables digital archiving [3,16].…”