The Effects of NAM on the Symmetry of the Face and Maxillary Arch in Babies With Unilateral Cleft.

The study aimed to evaluate the effect of nasoalveolar molding (NAM) therapy through reverse engineering, or its absence, to obtain symmetry of the face and maxillary arch. Twenty-six babies with unilateral cleft lip and palate received treatment with NAM, and 12 babies with unilateral cleft lip and palate without presurgical orthopedics (control group). Patients were molded and photographed in 2-stages: the first month of life (T1/pre) and after the use of NAM/before the cheiloplasty (T2/post). In the digital models, the analyses performed were arch perimeter, arch length, and labial frenulum angle. The photographs allowed us to analyze nasal width, mouth width, columella angle, and nostril area. The results demonstrated that there was an increase in arch perimeter and arch length in control and NAM groups in the T2 period in comparison to T1. Labial frenulum angle was reduced in the NAM group compared to the NAM-T1 and control-T2 periods. Treatment with NAM yielded a reduction in nasal width in the period of T2 compared with T1. Columella angle was enhanced after NAM use in T2 and, was different from control group. The nostril area was reduced in the NAM group in T2 compared with control group. Nasoalveolar molding therapy reduced the labial frenulum angle, contributing to a reduction in the extension of the cleft. The NAM protocol improved facial symmetry, mainly through nasal effects, whereas the absence of orthopedic therapy yielded a commitment to the face and maxillary arch symmetry.

Alinhadores NAM com elevador nasal: um estudo clínico em pacientes com fissura labiopalatal / Nasoalveolar molding clear aligner technique with a nasal retractor: a clinical study

A fissura de lábio e palato é a deformidade congênita da face mais comum em humanos e acomete cerca de 1:650 nascimentos no Brasil. O tratamento para esses pacientes tem sido amplamente discutido durante décadas e ainda não existe um consenso ou um protocolo de atendimento padronizado. Com o passar dos anos e a evolução da tecnologia, novas formas de tratamento foram surgindo e hoje é possível realizarmos o tratamento desses pacientes através do planejamento digital (CAD/CAM ­ Projeto e fabricação assistida por computador). A partir do conceito dos alinhadores ortodônticos introduzido por Kesling em 1946 e hoje com toda tecnologia disponível para fabricação digital desses dispositivos é que realizamos o tratamento de 25 bebês fissurados no projeto de extensão denominado NAM ­ Naso-Alveolar Modelador do Departamento de Odontologia Restauradora na Faculdade de Odontologia da Universidade Federal de Minas Gerais, avaliando a eficácia da utilização dos alinhadores NAM no fechamento das fissuras do rebordo alveolar. O tratamento com os alinhadores NAM se mostrou eficiente com a diminuição de pouco mais de 50% do tamanho da fenda anterior e com os pacientes realizando o tratamento à distância reduzindo o número de consultas presenciais. A tecnologia CAD/CAM com os alinhadores NAM tornará acessível a pacientes que residem longe dos centros de deformidades, particularmente em áreas rurais, além da possibilidade de padronização do tratamento no mundo global. Embora ainda em estágios iniciais, os alinhadores NAM representam um tratamento promissor para pacientes portadores de fissuras lábio palatinas.

Cleft lip and palate is the most common facial deformity in humans, afflicting 1:650 births in Brazil. Optimal treatment protocols have been debated over the last several years but no consensus has yet been reached. Recently several technological advancements have made possible to develop new ways to treat cleft lip and palate patients using 3D treatment planning softwares to produce customized appliances for pre-surgical orthopaedic treatment of newborns. This new technique is based on well established Clear Aligners introduced by Kesling in 1946. The current manuscript aims to evaluate the outcomes of 25 babies (15 to 30 days-old) treated with clear aligners to reduce the cleft and the gap between the alveolar segments prior to lip and palate repair surgery. Treatment with NAM aligners proved to be efficient with a reduction of just over 50% in the size of the anterior cleft and with patients undergoing treatment at a distance, reducing the number of face-to-face consultations. CAD/CAM technology with NAM aligners will make it accessible to patients residing far from deformity centers, particularly in rural areas, in addition to the possibility of standardizing treatment in the global world. Although still in early stages, NAM aligners represent a promising treatment for patients with cleft lip and palate.

Accuracy and reliability of craniometric measurements on lateral cephalometry and 3D measurements on CBCT scans.

OBJECTIVE: To compare the accuracy of craniometric measurements made on lateral cephalograms and on cone beam computed tomography (CBCT) images. MATERIALS AND METHODS: Ten fiducial markers were placed on known craniometric landmarks of 25 dry skulls with stable occlusions. CBCT scans and conventional lateral headfilms subsequently were taken of each skull. Direct craniometric measurements were compared with CBCT measurements and with cephalometric measurements using repeated measures analysis of variance (ANOVA). All measurements were repeated within a 1-month interval, and intraclass correlations were calculated. RESULTS: No statistically significant difference was noted between CBCT measurements and direct craniometric measurements (mean difference, 0.1 mm). All cephalometric measurements were significantly different statistically from direct craniometric measurements (mean difference, 5 mm). Significant variations among measurements were noted. Some measurements were larger on the lateral cephalogram and some were smaller, but a pattern could be observed: midsagittal measurements were enlarged uniformly, and Co-Gn was changed only slightly; Co-A was always smaller. CONCLUSION: CBCT craniometric measurements are accurate to a subvoxel size and potentially can be used as a quantitative orthodontic diagnostic tool. Two-dimensional cephalometric norms cannot be readily used for three-dimensional measurements because of differences in measurement accuracy between the two exams.