IADR Abstract Archives
iDNAM: Advancements in Craniofacial Cleft Care through CAD/CAM
Objectives: In recent years, the use of Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) to produce Nasoalveolar molding (NAM) appliances has emerged as a new paradigm for presurgical infant orthopedics. This technique can simplify the NAM procedure, save time, and allow for reproducibility which will eliminate the limitations of the conventional method. However, using new technology also entails expensive CAD software, and technological skill. Besides, a nasal stent is still manually incorporated into the NAM plate, depending on the treatment modality. The purpose of this study is to introduce an individualized Digital NAM (iDNAM), a complete digital workflow of NAM therapy, and to evaluate the changes in alveolar ridges and nasolabial morphology after treatment with iDNAM.
Methods: Seven infants with complete UCLP underwent PSIO therapy using iDNAMs. Intraoral and extraoral scans were performed to create a virtual maxillary model and a 3D facial scan. Maxillary segmentation, alveolar ridge approximation, and plates design were done virtually. A nasal extension was then digitally incorporated into the second plate, along with a novel method for nasal activation. Alveolar ridges and nasolabial soft tissue outcomes were measured in 3-dimension at initial (T1) and pre-surgical (T2) time points, enabling a comparative analysis to assess the efficacy of iDNAM.
Results: Two iDNAM plates were used as part of the treatment protocol. The changes in the alveolar ridge were as follows. The mean alveolar cleft gap reduction was 8.28 ± 1.22 mm. Length of the greater segment and lesser segment, and posterior arch width increased by a mean of 1.14 ± 1.49 mm, 3.48 ± 1.36 mm, and 2.72 ± 2.59 mm, respectively, while intercanine width decreased by 1.59 ± 1.92 mm. Nostril height on the cleft side, columellar length, and nose projection increased by a mean of 1.84 ± 0.59 mm, 2.60 ± 0.33 mm, and 2.42 ± 0.96 mm, respectively, while nostril width on the cleft side was reduced by 0.93 ± 3.67 mm. The mean improvement in nasal base-columellar angle was 19.86 ± 8.85 degrees.
Conclusions: iDNAM effectively reduced the alveolar cleft gap and improved nasal morphology in patients with complete UCLP. iDNAM offers a complete digital workflow in NAM therapy with minimal number of CAD/CAM NAM plates and digitally incorporated nasal stent.
Methods: Seven infants with complete UCLP underwent PSIO therapy using iDNAMs. Intraoral and extraoral scans were performed to create a virtual maxillary model and a 3D facial scan. Maxillary segmentation, alveolar ridge approximation, and plates design were done virtually. A nasal extension was then digitally incorporated into the second plate, along with a novel method for nasal activation. Alveolar ridges and nasolabial soft tissue outcomes were measured in 3-dimension at initial (T1) and pre-surgical (T2) time points, enabling a comparative analysis to assess the efficacy of iDNAM.
Results: Two iDNAM plates were used as part of the treatment protocol. The changes in the alveolar ridge were as follows. The mean alveolar cleft gap reduction was 8.28 ± 1.22 mm. Length of the greater segment and lesser segment, and posterior arch width increased by a mean of 1.14 ± 1.49 mm, 3.48 ± 1.36 mm, and 2.72 ± 2.59 mm, respectively, while intercanine width decreased by 1.59 ± 1.92 mm. Nostril height on the cleft side, columellar length, and nose projection increased by a mean of 1.84 ± 0.59 mm, 2.60 ± 0.33 mm, and 2.42 ± 0.96 mm, respectively, while nostril width on the cleft side was reduced by 0.93 ± 3.67 mm. The mean improvement in nasal base-columellar angle was 19.86 ± 8.85 degrees.
Conclusions: iDNAM effectively reduced the alveolar cleft gap and improved nasal morphology in patients with complete UCLP. iDNAM offers a complete digital workflow in NAM therapy with minimal number of CAD/CAM NAM plates and digitally incorporated nasal stent.