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HyeRan Choo, HyoWon Ahn. Biocreative Alveolar Molding Plate Treatment (BioAMP) for neonatal unilateral cleft lip and palate with excessively wide alveolar cleft and maxillary arch width. Korean J Orthod 2024; 54:69-73. [PMID: 38268462 PMCID: PMC10811360 DOI: 10.4041/kjod23.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/26/2024] Open
Abstract
Since its inception in Europe in the 1950s, alveolar molding treatment for neonates with complete cleft lip and palate has undergone significant evolution in both design and application methodology, demonstrating effectiveness in normalizing the alveolar cleft and nasal shape. However, excessively wide alveolar clefts accompanied by disproportionately wide total maxillary arch pose significant challenges when utilizing conventional alveolar molding methods involving cyclical adding and grinding of acrylic on molding plates. The current report introduces a novel alveolar molding method named Biocreative Alveolar Molding Plate Treatment (BioAMP), which can normalize the maxillary alveolar cleft and arch shape without laborious conventional acrylic procedures. BioAMP sets the target arch form and provides unrestricted space for natural growth of the maxillary alveolar bones while systematically reducing the total maxillary arch width in precise increments. Two exemplary cases are presented as proof-of-concept, showcasing the clinical innovation of BioAMP.
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Affiliation(s)
- HyeRan Choo
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Neonatal and Pediatric Craniofacial Airway Orthodontics, Stanford University School of Medicine, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA, USA
| | - HyoWon Ahn
- Department of Orthodontics, School of Dentistry, Kyung Hee University, Seoul, Korea
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Dursun A, Öztürk K, Şenel FA, Albay S. Intrauterine maxillary development and maxillary dental arch biometry: a fetal cadaver study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:494-498. [PMID: 32828995 DOI: 10.1016/j.jormas.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/17/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION This study's goal was to determine normal maxillary development on fetal cadavers. MATERIALS AND METHODS This study was carried out on 45 fetuses aged between the 17th - 40th weeks of gestation (24 male, 21 female). The distance between the widest left and right points of the maxillary dental arch (MDA) on the transverse plane, the distance of the papilla incisiva (PI) to the widest left and right points of the maxillary dental arch (MDAW), and the PI and posterior nasal spine (PNS) were measured. The average arch forms of the MDA were created according to trimester groups using the MATLAB program. The one-way ANOVA test was used to make a comparison between trimester groups, and ANOVA followed by post hoc analysis using the Bonferroni test was applied for comparisons. Pearson's correlation analysis was used for correlation analysis. RESULTS The data in the present study did not differ between genders. In the comparison between trimester groups, we did not find any difference between the 3rd trimester and full-term groups only in the PI-MDAW measurement. Other parameters increased with age. In the correlation analysis, the measurement values by age showed a strong positive correlation. The MDAW exhibited the best correlation with age (rweek = 0.919). When the average MDA forms created using the MATLAB program were evaluated, it was observed that the PI-MDAW of the average MDA in the 3rd trimester and full-term intersected. CONCLUSIONS This study provides a basis for a better understanding of fetal maxillary growth processes and can be useful to standardize the detection of malformations or intrauterine growth restrictions.
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Affiliation(s)
- Ahmet Dursun
- Department of Anatomy Faculty of Medicine Suleyman Demirel University, 32260, Isparta, Turkey.
| | - Kenan Öztürk
- Department of Anatomy Faculty of Medicine Suleyman Demirel University, 32260, Isparta, Turkey.
| | - Fatih Ahmet Şenel
- Department of Computer Engineering, Engineering Faculty, Suleyman Demirel University, 32260, Isparta, Turkey.
| | - Soner Albay
- Department of Anatomy Faculty of Medicine Suleyman Demirel University, 32260, Isparta, Turkey.
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Xepapadeas AB, Weise C, Frank K, Spintzyk S, Poets CF, Wiechers C, Arand J, Koos B. 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. BMC Oral Health 2020; 20:20. [PMID: 31973720 PMCID: PMC6979345 DOI: 10.1186/s12903-020-1001-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 01/10/2020] [Indexed: 11/27/2022] Open
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.
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Affiliation(s)
- Alexander B Xepapadeas
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr, 2-8, 72076, Tuebingen, Germany.,Section "Medical Materials Science & Technology", University Hospital Tuebingen, Osianderstr, 2-8, 72076, Tuebingen, Germany
| | - Christina Weise
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr, 2-8, 72076, Tuebingen, Germany.
| | - K Frank
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr, 2-8, 72076, Tuebingen, Germany
| | - S Spintzyk
- Section "Medical Materials Science & Technology", University Hospital Tuebingen, Osianderstr, 2-8, 72076, Tuebingen, Germany
| | - C F Poets
- Department of Neonatology, University Hospital Tübingen, Calwerstr, 7, 72076, Tuebingen, Germany
| | - C Wiechers
- Department of Neonatology, University Hospital Tübingen, Calwerstr, 7, 72076, Tuebingen, Germany
| | - J Arand
- Department of Neonatology, University Hospital Tübingen, Calwerstr, 7, 72076, Tuebingen, Germany
| | - B Koos
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr, 2-8, 72076, Tuebingen, Germany
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Schiebl J, Bauer FX, Grill F, Loeffelbein DJ. RapidNAM: Algorithm for the Semi-Automated Generation of Nasoalveolar Molding Device Designs for the Presurgical Treatment of Bilateral Cleft Lip and Palate. IEEE Trans Biomed Eng 2019; 67:1263-1271. [PMID: 31403406 DOI: 10.1109/tbme.2019.2934907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Nasoalveolar molding (NAM) is an accepted presurgical treatment modality for newborns with cleft lip and palate (CLP). However, the therapy is time-consuming and requires high expertise. To facilitate the treatment, we reveal an algorithm for the automated generation of patient individual NAM devices for neonates with bilateral cleft lip and palate (BCLP) and present results of software validation. METHODS The algorithm was implemented utilizing Python 2.7 and Blender 2.78a based on 17 digitized (3D-scanning) impressions of maxillae with BCLP. The algorithm segments alveolar structures, bridges clefts, and generates a series of NAM device designs, destined for 3D-printing for subsequent treatment. The datasets were used for first software tests. For validation, a follow-up study was carried out using six new, independent maxilla models. The generated NAM plate designs were examined regarding their potential clinical usability. Furthermore, a deviation analysis was carried out, which measured the plate models' and upper jaw models' surface deviations. RESULTS Series of NAM devices were generated automatically in 21 out of 23 cases. We calculated an average surface deviation of 0.140 mm (SD: 0.016 mm). Four out of six plate series (follow-up trials) were assessed as probably usable with minor adjustments. CONCLUSION The algorithm generates 3D-printable series of NAM device designs reliably. We expect most of the series to be clinically usable and that the first plates of each series will fit the patients' maxillae. SIGNIFICANCE The proposed algorithm has the potential to reduce the therapist's manual work and therefore time effort/costs related to NAM.
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Hopkins B, Dean K, Appachi S, Drake AF. Craniofacial Interventions in Children. Otolaryngol Clin North Am 2019; 52:903-922. [PMID: 31353139 DOI: 10.1016/j.otc.2019.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Craniofacial interventions are common and the surgical options continue to grow. The issues encountered include micrognathia, macroglossia, midface hypoplasia, hearing loss, facial nerve palsy, hemifacial microsomia, and microtia. In addition, a unifying theme is complex upper airway obstruction. Throughout a child's life the focus of interventions may change from airway management to speech, hearing, and language optimization, and finally to decannulation and procedures aimed at social integration and self-esteem. Otolaryngologists play an important role is this arena and provide high-quality care while continuing to expand what can be done for our patients.
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Affiliation(s)
- Brandon Hopkins
- Pediatric Otolaryngology, Pediatric Center for Airway Voice and Swallowing, Cleveland Clinic, 9500 Euclid Avenue, 7th Floor Crile Building, Cleveland, OH 44195, USA.
| | - Kelly Dean
- Department of Otolaryngology/Head and Neck Surgery, UNC Hospitals, University of North Carolina, 170 Manning Drive, CB# 7070, Chapel Hill, NC 27599-7070, USA
| | - Swathi Appachi
- Cleveland Clinic Head and Neck Institute, Cleveland Clinic, 9500 Euclid Avenue, 7th Floor Crile Building, Cleveland, OH 44195, USA
| | - Amelia F Drake
- Department of Otolaryngology/Head and Neck Surgery, UNC Hospitals, Craniofacial Center, University of North Carolina, 170 Manning Drive, CB# 7070, Chapel Hill, NC 27599-7070, USA
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Riedle H, Burkhardt AE, Seitz V, Pachaly B, Reid RR, Lee JC, Franke JE. Design and fabrication of a generic 3D-printed silicone unilateral cleft lip and palate model. J Plast Reconstr Aesthet Surg 2019; 72:1669-1674. [PMID: 31445940 DOI: 10.1016/j.bjps.2019.06.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/20/2019] [Accepted: 06/22/2019] [Indexed: 11/28/2022]
Abstract
The complexity of plastic surgery procedures often requires visualization of the anatomy in three dimensions and therefore demands the development of new and innovative teaching methods. This work describes the development and manufacture of a 3D silicone cleft lip and palate (CLP) model evaluated by surgical residents on its similarity to the biological model. Thirty unilateral CLP models were created and distributed to residents at two different institutions. The model was based on an adult CT scan that was manipulated to resemble an infant with a complete unilateral CLP. This digital model was directly printed in silicone elastomer pieces and later assembled. The residents rated the model based on its realistic value as well as whether or not they felt it improved their surgical technique. Twenty residents used the model to simulate a CLP repair. The structure of the model was rated as fairly realistic while both the material and assembly of the model require improvement in subsequent manufacturing. Post simulation, residents rated the model highly for how accurately it simulated the surgical procedure. An accurate 3D silicone unilateral cleft lip and palate replica was successfully created for educational purposes. This new approach combines a flexible generic design with automated manufacture.
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Affiliation(s)
- Hannah Riedle
- Institute for Factory Automation and Production Systems, Friedrich-Alexander-Universität Erlangen-Nürnberg, Egerlandstr. 7-9, 91058 Erlangen, Germany.
| | - Andrea E Burkhardt
- Institute for Factory Automation and Production Systems, Friedrich-Alexander-Universität Erlangen-Nürnberg, Egerlandstr. 7-9, 91058 Erlangen, Germany
| | - Vera Seitz
- Wacker Chemie AG, Hanns-Seidel-Platz 4, 81737 Munich, Germany
| | - Bernd Pachaly
- Wacker Chemie AG, Hanns-Seidel-Platz 4, 81737 Munich, Germany
| | - Russell R Reid
- Section of Plastic and Reconstructive Surgery, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL 60637, USA
| | - Justine C Lee
- Division of Plastic and Reconstructive Surgery, University of California Los Angeles, 200 Medical Plaza Driveway 465, Los Angeles, CA 90095, USA
| | - Jörg E Franke
- Institute for Factory Automation and Production Systems, Friedrich-Alexander-Universität Erlangen-Nürnberg, Egerlandstr. 7-9, 91058 Erlangen, Germany
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Grill FD, Rau A, Bauer FX, Hellmundt F, Hilmer B, Roth M, Behr AV, Wolff KD, Loeffelbein DJ, Ritschl LM. The absolute and relative effects of presurgical nasoalveolar moulding in bilateral cleft lip and palate patients compared with nasal growth in healthy newborns. J Craniomaxillofac Surg 2019; 47:1083-1091. [PMID: 30878462 DOI: 10.1016/j.jcms.2019.01.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/16/2019] [Accepted: 01/29/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This study investigated the efficiency of nasoalveolar moulding (NAM) in patients presenting with bilateral cleft lip and palate (BCLP). It focused explicitly on nasal outcome and therefore made comparisons with healthy age-matched infants with normal nasal development. METHODS Nasal impressions from 19 BCLP patients were analysed at the beginning and at the end of NAM treatment. In addition, nasal impressions from 32 healthy newborns were taken monthly for 4 months. The casts were digitalized and analysed, using defined anatomic landmarks, by two independent observers. Initial values were compared with outcome parameters at the end of NAM therapy and with the healthy cohort. RESULTS NAM significantly elongated the columella in BCLP patients, with an increase of 106.5% versus 14.5% in healthy newborns. Nostril height showed significant expansion from 4.2 mm to 5.6 mm on the right side, and from 4.3 mm to 6.2 mm on the left side. CONCLUSION NAM significantly elongated columella length and increased nostril height. The comparison with healthy newborns showed the effectiveness of early cartilage moulding. Detailed knowledge about absolute and relative early nasal growth was gained. However, despite highly effective NAM treatment in BCLP, nasal dimensions will not reach healthy proportions.
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Affiliation(s)
- Florian D Grill
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Germany
| | - Andrea Rau
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-University Nürnberg-Erlangen, Germany
| | - Franz X Bauer
- Institute of Medical and Polymer Engineering, Technische Universität München, Germany
| | - Fiona Hellmundt
- Institute of Medical and Polymer Engineering, Technische Universität München, Germany
| | - Bettina Hilmer
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Germany
| | - Maximilian Roth
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Germany
| | - Alexandra V Behr
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Germany; Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-University Nürnberg-Erlangen, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Germany
| | - Denys J Loeffelbein
- Department of Oral and Maxillofacial Surgery, Helios Klinikum München West, München, Germany
| | - Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Germany.
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Grill FD, Behr AV, Rau A, Ritschl LM, Roth M, Bauer FX, Wolff KD, Esser T, Loeffelbein DJ. Prenatal intrauterine maxillary development - An evaluation with three-dimensional ultrasound. J Craniomaxillofac Surg 2019; 47:1077-1082. [PMID: 30885526 DOI: 10.1016/j.jcms.2019.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 01/23/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of this prospective study was to investigate normal fetal maxillary development with volume ultrasound during the prenatal phase, for a better estimation of maxillary growth processes. METHODS Some 210 3D volumes were obtained in two measurement series from 38 healthy women (gestational age: 19+2 to 31+4 weeks) using a GE Voluson™ E10 ultrasound system. Maxillary length and width were determined in the axial and sagittal planes. Clearly defined, reproducible landmarks were used for measurements. The results were correlated with gestational age and compared with previously reported studies. RESULTS Total maxillary length ranged from 10.30 to 24.75 mm, total maxillary width from 13.65 to 37.30 mm in an observation period during the second trimester, with high reproducibility for all landmarks. All evaluation results showed steep growth with exponential character. Length growth was determined to be more dominant than width growth. Intra-rater correlation was evaluated to be almost perfect (ICC (3) > 0.8). CONCLUSION This study presents measurements of physiological fetal maxillary development. The defined landmarks proved to be representative for further investigations. This study serves as a baseline for a better understanding of fetal maxillary growth processes, and may be useful for standardising detection of malformations or intrauterine growth restrictions.
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Affiliation(s)
- Florian D Grill
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Germany
| | - Alexandra V Behr
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Germany.
| | - Andrea Rau
- Department of Oral and Maxillofacial Surgery, Friedrich Alexander Universität Erlangen-Nürnberg, Germany
| | - Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Germany
| | - Maximilian Roth
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Germany
| | - Franz X Bauer
- Institute of Medical and Polymer Engineering, Technische Universität München, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Germany
| | | | - Denys J Loeffelbein
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Germany; Helios Klinik München West, Germany
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Grill FD, Ritschl LM, Bauer FX, Rau A, Gau D, Roth M, Eblenkamp M, Wolff KD, Loeffelbein DJ. 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. Sci Rep 2018; 8:11845. [PMID: 30087378 PMCID: PMC6081393 DOI: 10.1038/s41598-018-29959-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 07/17/2018] [Indexed: 12/01/2022] Open
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.
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Affiliation(s)
- Florian D Grill
- Department of Oral and Maxillofacial Surgery, Technische Universität München, München, Germany.
| | - Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, Technische Universität München, München, Germany
| | - Franz X Bauer
- Institute of Medical and Polymer Engineering, Technische Universität München, München, Germany
| | - Andrea Rau
- Department of Oral and Maxillofacial Surgery, Friedrich Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Dominik Gau
- Institute of Medical and Polymer Engineering, Technische Universität München, München, Germany
| | - Maximilian Roth
- Department of Oral and Maxillofacial Surgery, Technische Universität München, München, Germany
| | - Markus Eblenkamp
- Institute of Medical and Polymer Engineering, Technische Universität München, München, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Technische Universität München, München, Germany
| | - Denys J Loeffelbein
- Department of Oral and Maxillofacial Surgery, Technische Universität München, München, Germany.,Department of Oral and Maxillofacial Surgery, Helios Hospital Munich West, Teaching Hospital of Ludwig-Maximilians-Universiität München, München, Germany
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