Mt Sinai-Dr Edward Reiter Fellowship Program, Craniofacial and Special Care Orthodontics, Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio.
James A. Lehman Jr. MD, Craniofacial Center, Akron Children's Hospital, Akron, Ohio.
Am J Orthod Dentofacial Orthop. 2020 Sep;158(3):452-458. doi: 10.1016/j.ajodo.2020.02.007. Epub 2020 Jul 21.
Nasoalveolar molding (NAM) was introduced over 20 years ago as adjunctive therapy for the correction of cleft lip and palate. In the current study, we propose a new approach using a digital workflow and 3-dimensional printing to fabricate clear aligner NAM devices.
A polyvinyl siloxane (PVS) impression of an infant with a unilateral complete cleft lip and palate (UCLP) is acquired and poured, and the stone model is scanned with an intraoral scanner. The stereolithography file is digitized, and the alveolar segments are digitally segmented and moved to the desired final position. The total distance moved is divided into a sequence of 1-1.5 mm increments, creating a series of digital models. The models are 3-dimensionally printed along with button templates to allow free form positioning of the button on each model. A Vacuform machine (Taglus, Mumbai, India) was used to fabricate a 0.040-in aligner for each stage.
We present 1 case that was treated successfully with this approach. Appointments for the NAM adjustments were primarily to monitor progress and counseling with less time spent adjusting the appliance. The appointment length was reduced by over 30 minutes. Benefits of the aligner are improved fit, more precise increments of activation, reduced chairside time, and potentially minimized number of visits.
NAM custom aligners may provide similar benefits to the traditional approach while reducing the burden of care by reducing the number of visits and appointment duration. Further studies with a sample and longitudinal observations are needed to investigate the benefits of the proposed digital approach.
鼻牙槽塑形术（NAM）作为唇腭裂矫正的辅助治疗方法，于 20 多年前引入。在本研究中，我们提出了一种新的方法，使用数字化工作流程和 3D 打印技术来制作透明牙套 NAM 装置。
对单侧完全性唇腭裂（UCLP）的婴儿进行聚硅氧烷（PVS）印模和翻模，并使用口内扫描仪对石模型进行扫描。对立体光刻文件进行数字化，将牙槽段进行数字分割并移动到所需的最终位置。总移动距离分为 1-1.5mm 的递增序列，创建一系列数字模型。将模型与按钮模板一起进行 3D 打印，以便在每个模型上自由定位按钮。使用 Vacuform 机（Taglus，孟买，印度）为每个阶段制造 0.040 英寸的矫正器。
我们成功地治疗了 1 例患者，采用了这种方法。NAM 调整的预约主要是监测进展和提供咨询，而调整矫治器的时间较少。预约时间减少了 30 多分钟。这种矫正器的优点是更好的贴合度、更精确的激活增量、减少椅旁时间，以及可能减少就诊次数。
NAM 定制牙套可能会提供与传统方法类似的效果，同时减少就诊次数和预约时间，从而减轻护理负担。需要进一步进行样本研究和纵向观察，以研究提出的数字化方法的益处。
