A Virtual Noninvasive Way of Constructing a Nasoalveolar Molding Plate for Cleft Babies, Using Intraoral Scanners, CAD, and Prosthetic Milling

Abstract

Presurgical nasoalveolar molding (PNAM) is a key step in the early management of cleft babies. It involves making an impression of the alveolar segments and the lip elements, after which an appliance is fabricated and activated to achieve optimal alveolar and nasal positions for a superior surgical result. These appliances are fabricated and activated in babies as young as 10 days, and the molding is ideally carried on till the baby is ready for the primary lip repair. This article outlines in detail a digital method of fabricating the PNAM appliance using a combination of intraoral scans, computer-assisted digital software, and computer-assisted machining, facilitated by milling machines. This process obviates impression making and the subsequent laboratory procedures.

Parental anxiety/incompliance and patients’ complications during COVID-19 pandemic regarding nasoalveolar molding treatment of infants with cleft lip/palate

“… 23 In addition, as mentioned previously, the best time for NAM is the first weeks after birth. 18 It is also stated that maternal estrogen in infant cartilage during the first few weeks of birth helps maintain the high plasticity of cartilage, 39 which makes cartilage more amenable to molding. Therefore, the sooner the NAM treatment starts, the less incompliance, and superior treatment outcomes are expected.…”

Digital impressions from newborns to preschoolers with cleft lip and palate: A two-centers experience

“…Although the use of intraoral scanners has become common in dentistry, their implementation has been lagging for patient care in orofacial malformations due to technical hurdle in reconstruction of intraoral structure without teeth. Only in recent years, their use for infants with cleft lip and palate has been explored increasingly [8][9][10][11][12][13][14] . Digital impression using intraoral scanners allows for contactless acquisition of intraoral as well as lip and nose morphology of the patients as opposed to the traditional technique by physical impressions which accompanies a risk of endangering the airway of the infants with impression material [15][16][17][18] .…”

Chairside versus external laboratory milling in fabricating CAD/CAM surgical and restorative products in dental practice

“…The evolution of milling machines from 3-axis to 6-axis machines is a prime example of how digital innovations are continuously being optimised to create higher quality dental, maxillofacial, and surgical products. 4,5 The rudimentary design of the 3-axis milling machine makes it less than ideal for clinicians wanting accurate products, while the highly efficient 6-axis machine has yet to be introduced to the dental field. Therefore, 4-axis and 5-axis milling machines are considered the most practical options by many clinicians and laboratory technicians.…”