A prospective longitudinal study of postnatal dentoalveolar and palatal growth: The anatomical basis for CAD/CAM‐assisted production of cleft‐lip‐palate feeding plates

Abstract

This study describes the dentoalveolar and palatal growth during the first months of life. Knowledge concerning this development is essential to avoid unwanted events such as mucosal ulcerations or restriction of growth when cleft-lip and palate (CLP) patients are treated. The results involve the generation of CAD/CAM CLP-feeding plates. Intraoral impressions from 32 healthy newborns were taken monthly for 5 months, supplemented by measurements of body weight, length, and occipital-frontal head circumference. The casts were digitalized, and two observers manually selected defined anatomical landmarks on virtual 3-D models. The distances between these landmarks were evaluted. Statistical analysis included an inter-rater agreement analysis and the determination of growth. In total, 213 casts were analyzed, with 65 models excluded because of inaccuracies in impression-taking or cast production. Overall longitudinal growth was 20.3%, whereas transversal growth reached a maximum of 21.1%. Vertical growth was 32.4% at the tuberal level. On the basis of these results, a semiautomated series of feeding plates allowing for monthly expansion could be generated. The acquired data serve as a useful reference for other pediatric and orthofacial investigations and treatments. One such application is the automated, fully virtual manufacture of CLP-feeding plates based on only one impression-taking. Our data reveal when caution is needed to prevent ulceration. The series of plates generated can minimize the time-consuming impression-taking and the production of further plaster models. The method of measurement is suitable for documentary purposes. Clin. Anat. 30:846-854, 2017. © 2017 Wiley Periodicals, Inc.

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

“…This might be explained by, first, the good closure of the cleft resulting in a desired reduction of transversal dimensions, and second, the elliptic alignment of the greater segment aiming for a harmonic arch as present in healthy newborns. The total length of 28.7 mm after RapidNAM was even somewhat greater compared with healthy newborns that reached 24.4 mm after 5 months 19 . This finding may oppose the claimed criticism that molding therapy might restrict maxillary growth 25 .…”

“…Since anatomical developments have been derived from healthy newborns, which represent, in our opinion, the desired symmetry, we have considered our own previously stated objections with regard to digitally designed intraoral molding devices, namely that not only closure, but also the alignment is of importance 27 . Since the virtual closure of the cleft was performed by bridging the gap based on a fitted ellipse, the alveolar growth has a type of guiding track into which it can expand 19 . This kind of free-form molding has previously been implemented in intraoral molding 16 .…”

“…The monthly growth rate was determined in an anatomical study of 32 healthy newborns. The algorithm automatically detected the alveolar ridge 19 , 20 . For this reason, a graphical user interface (GUI) was created (Fig.…”

“…The digitalized plaster models pre- and post-molding therapy of both groups were virtually analyzed by using selected landmarks as previously described 19 , 22 . For this purpose, the plaster models of CAD/CAM-molding-treated children were re-measured.…”

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

“…Disadvantages of a digital approach include that it is not yet possible to incorporate elements like screws, which enable the plate to "grow" with the patient or induce a transverse movement of the alveolar segments in cleft palate patients. Recently, however, a correction factor for palatal plate production due to age-related growth was introduced, which would make a screw obsolete [26]. As expansion of the jaw mostly occurs in the transverse plane during the first months of life, pressure marks in the lateral areas of the tuberosity indicate that the plate has become too small.…”