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

Using an Active Screwed Nasoalveolar Molding Device for Defect Rehabilitation in Patients With Bilateral Cleft Lip and Palate

The present case series aimed to assess non-surgical elongation of the columella and reduction of cleft gaps in patients with bilateral cleft lip and palate using the active nasoalveolar molding (ANAM) device and tissue expansion principles. The study included six complete bilateral cleft patients aged one month: three males and three females. A nasoalveolar molding technique was applied using an active device (ANAM) with a 3D screw, worn by infants for two months. The activation protocol for screw closure is approximately 0.25 mm (quarter turn) on alternating days, resulting in almost 1 mm per week and 4 mm per month and reaching 8 mm after eight weeks. Evaluation involved measuring lip defect sizes and the nostril gap, columellar length and rotation of premaxilla before and two months after the ANAM period before surgical repair. The results show that the anterior rotation of the premaxilla and the lip and nostril gaps were significantly reduced (p < 0.05), with maximum reduction in the anterior rotation of the premaxilla (mean difference ± SD was 4.22 ± 0.4). Simultaneously, the columellar height was significantly increased with a mean difference ± SD of 2.0 ± 0.4 (p < 0.001). The current case series demonstrated that the ANAM device is a safe and effective technique for decreasing the lip and nostril gaps, repositioning the protruded premaxilla, and elevating the depressed columella. No side effects were recorded in current cases.

Rehabilitation Using Hybrid Technique for Feeding Plate Fabrication in a 3-Month-Old Infant with Cleft Palate Defect Utilising Digital and Conventional Method: A Case Report

ABSTRACT

Cleft palate leads to difficulty in suckling, speech abnormalities, dental problems, hearing loss and middle ear infections. Feeding plate acts as a barrier between the oral and nasal cavities allowing the normal development of jaws and enhanced nutritional supply to the patient. Fabrication of the feeding plate using digital means provide better adaptability due to the engagement of all the possible favourable anatomic undercuts, thereby, providing better retention. This case report discusses the hybrid technique including both the digital and conventional means for fabrication of a feeding plate to obturate the defect between the oral and nasal cavity.

Three-Dimensional Printable Open-Source Cleft Lip and Palate Impression Trays: A Single-Impression Workflow

SUMMARY

Documenting complex three-dimensional (3D) cleft lip and palate malformation with plaster casts based on maxillary impressions is standard care. Presurgical orthopedic treatment also requires an impression. Digital impression-taking in patients with cleft lip and palate is feasible, but procurement costs hinder clinical implementation. Individualized impression trays allow for a precise impression, limiting airway risk. The authors present an open-source impression tray library with scalable impression trays not requiring 3D modeling knowledge. The cleft lip and palate impression tray library is accessible on Open Science Framework. Different shapes are available, and the tray size is selected based on the tuber distance. This allows 3D printing with biocompatible material at the point of care complying with local regulations. The open-source cleft tray library presented offers a hybrid solution for cleft centers, pending the implementation of digital impression.

Prefabricated Trays Stock for Impression of Cleft lip and Palate Orthopedic Appliances: A Three-Dimensional Computational Analysis of Maxillary Jaws

OBJECTIVE

This study aimed to propose digitally designed impression trays, for newborns with cleft lip and palate (CLP) defects, using the computer-assisted design and manufacturing (CAD/CAM) technique, based on measurements of width, length, and height made on processed and scanned plaster models. Thus, we will describe the different software and concepts that can be used for the design of these impression trays.

DESIGN

A total of 59 plaster casts of newborn patients with CLP were collected and then scanned. After that, digital dental casts were three-dimensional (3D) evaluated, using precise anatomical landmarks.

SETTING

The Maxillofacial Prosthodontics Team at the Dental consultation and treatment center in Rabat, Morocco.

PATIENTS AND PARTICIPANTS

The study involved plaster casts of newborns with CLP, who had undergone presurgical neonatal treatment in the Maxillofacial Prosthodontics service in Rabat, Morocco.

INTERVENTIONS

None.

MAIN OUTCOME MEASURE(S)

3D evaluation of 59 scanned plaster casts of newborn patients with CLP.

RESULTS

This work allowed us to obtain digital impression trays for each anatomical variation of orofacial clefts. These trays will limit the problems linked to conventional techniques for making neonatal orthopedic plates. We also emphasized the importance of a multidisciplinary approach involving several professionals in Morocco from various fields and specialties.

CONCLUSION

This original technique is advantageous for the practitioner as well as for the patients and their parents. It allows for precise recording, better adaptation, time-saving, and parental comfort.

Development of impression trays for treating infants with trisomy 21 before their deciduous teeth erupt

The treatment of infants with trisomy 21 (TS21) with a myostimulation plate can improve their development and quality of life. The manufacture of these plates requires an accurate cast of the maxilla, and their efficacy relies on their stability and retention. As such, the quality of the impression is a determining factor. The lack of commercially available stock trays for infants with TS21 creates difficulties, including inadequate impression quality and the risk of inhaling impression material. The present technique simplifies impression making for infants with TS21 from 3 months of age to when their maxillary deciduous teeth erupt by using computer-aided design and computer-aided manufacturing (CAD-CAM) impression trays. Sixty-five stored gypsum maxillary casts from infants with TS21 that had been used to manufacture myostimulation plates were analyzed to select four differently sized representative casts for designing the impression trays. A CAD software program was used to digitally shape four sizes of the impression tray from the selected gypsum casts. Practitioners interested in this approach can download and export the standard tessellation language (STL) files using a quick response (QR) code. The impression trays should be manufactured with the stereolithography additive technique using biocompatible resin. This technique allows practitioners to make accurate maxilla impressions for infants with TS21 by manufacturing their own impression trays using the free-access STL files rather than the cumbersome conventional method.

Recent Methods for Modifying Mechanical Properties of Tissue-Engineered Scaffolds for Clinical Applications

The limited regenerative capacity of the human body, in conjunction with a shortage of healthy autologous tissue, has created an urgent need for alternative grafting materials. A potential solution is a tissue-engineered graft, a construct which supports and integrates with host tissue. One of the key challenges in fabricating a tissue-engineered graft is achieving mechanical compatibility with the graft site; a disparity in these properties can shape the behaviour of the surrounding native tissue, contributing to the likelihood of graft failure. The purpose of this review is to examine the means by which researchers have altered the mechanical properties of tissue-engineered constructs via hybrid material usage, multi-layer scaffold designs, and surface modifications. A subset of these studies which has investigated the function of their constructs in vivo is also presented, followed by an examination of various tissue-engineered designs which have been clinically translated.