Gong Xin, Dang Renxing, Xu Ting, Yu Quan, Zheng Jiawei
Department of Orthodontics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology.
Shanghai Jiao Tong University School of Medicine.
J Craniofac Surg. 2020 Mar/Apr;31(2):367-371. doi: 10.1097/SCS.0000000000006258.
The aim of this pilot study was to illustrate the feasibility of a full digital workflow to design and manufacturing a consecutive series of customized nasoalveolar molding (NAM) appliances in advance for presurgical unilateral and bilateral cleft lip and palate (CLP) treatment.
The full digital workflow consisted of acquisition of 3D image data of an infant's maxilla by using intraoral scanner (TRIOS; 3Shape, Copenhagen, Denmark); the initial data were imported into an appropriate computer-aided design (CAD) software environment, the digital model was virtual modified to achieve a harmonic alveolar arch, and generated a consecutive of digital models of each movement stage; the digital model of NAM appliance was designed based on the virtual modified model; bio-compatible material MED610 was used to manufacturing the real NAM appliances by 3D printing. A consecutive series of NAM appliances was delivered to CLP infant before lip surgery.
Intraoral scanning was harmless and safer than conventional impression technique for CLP infants. The CAD/3D printing procedures allowed a series of NAM appliances to be designed and manufactured in advance. The clinical results showed that this full digital workflow was efficient, viable and able to estimate the treatment objective. By the end of presurgical NAM treatment, the malposition alveolar segments had been aligned normally, the surrounding soft tissues repositioned.
The full digital workflow presented has provided the potential for presurgical NAM treatment of infants with cleft lip and palate. Intraoral scanning served as a starting point, so subsequent virtual treatment planning and CAD/3D printing procedures could realize the full digital workflow, a whole series of customized NAM appliances was manufactured in advance. This method brings the benefits of safety, affectivity and time-saving.
本前瞻性研究旨在说明一种全数字化工作流程的可行性，该流程可预先设计并制造一系列连续的定制鼻牙槽成型（NAM）矫治器，用于术前单侧和双侧唇腭裂（CLP）治疗。
全数字化工作流程包括使用口腔内扫描仪（TRIOS；3Shape，丹麦哥本哈根）获取婴儿上颌骨的三维图像数据；将初始数据导入适当的计算机辅助设计（CAD）软件环境，对数字模型进行虚拟修改以获得和谐的牙槽弓，并生成每个移动阶段的连续数字模型；基于虚拟修改后的模型设计NAM矫治器的数字模型；使用生物相容性材料MED610通过3D打印制造真实的NAM矫治器。在唇裂手术前，将一系列连续的NAM矫治器交付给CLP婴儿。
对于CLP婴儿，口腔内扫描比传统印模技术更安全无害。CAD/3D打印程序允许预先设计和制造一系列NAM矫治器。临床结果表明，这种全数字化工作流程高效、可行且能够评估治疗目标。在术前NAM治疗结束时，错位的牙槽段已正常对齐，周围软组织也已重新定位。
所呈现的全数字化工作流程为唇腭裂婴儿的术前NAM治疗提供了潜力。口腔内扫描作为起点，随后的虚拟治疗计划和CAD/3D打印程序可实现全数字化工作流程，预先制造出一整套定制的NAM矫治器。这种方法具有安全、有效和省时的优点。
