The nasoalveolar molding technique versus DynaCleft nasal elevator application in infants with unilateral cleft lip and palate.

BACKGROUND: The introduction of presurgical nasoalveolar molding represented a significant departure from traditional molding methods. Developed by Grayson and colleagues in 1993, this technique combines an intraoral molding device with a nasal molding stent. This study aimed to compare the Grayson nasoalveolar molding appliance versus DynaCleft appliance as two methods of presurgical nasoalveolar molding. METHODS: A single-blinded, randomized, parallel-arm clinical trial was conducted. Sixteen infants with complete unilateral cleft lip and palate were enrolled and divided into two groups of eight. Group 1 was treated with a modified Grayson nasoalveolar molding appliance that included a nasal stent, while group 2 was treated with DynaCleft elastic adhesive tape and an external nasal elevator. Standardized digital photographs of each infant were taken at baseline and post-treatment using a professional camera. Nine extraoral anthropometric measurements were obtained from each image using image measurement software. RESULTS: The modified Grayson nasoalveolar appliance demonstrated a more significant improvement compared to DynaCleft in terms of alar length projection (on both sides), columella angle, and nasal tip projection. Symmetry ratios also showed enhancement, with significant improvements observed in nasal width, nasal basal width, and alar length projection (p< 0.05). CONCLUSION: Both the modified Grayson nasoalveolar appliance and DynaCleft appear to be effective presurgical infant orthopedics treatment options, demonstrating improvements in nasolabial aesthetics. The modified Grayson appliance, equipped with a nasal stent, improved nasal symmetry more effectively than DynaCleft, resulting in a straighter columella and a more medially positioned nasal tip.

Immediate Implants in Posterior Extraction Sites: A Case Series Applying the Dual-Zone Therapeutic Concept With a Three-Year Follow-Up.

The study aims to present 11 immediately placed implants in posterior extraction sockets applying the dual-zone therapeutic concept. Five patients with non-restorable molars or premolars were treated with single or multiple immediate implants after atraumatic tooth extraction using a piezotome. The dual-zone therapeutic concept included grafting the jumping gap adjacent to the implant up to the gingival margin with a bovine xenograft. A screw-retained customized healing abutment was used to allow healing, and the implant loading was delayed for four to six months. All the patients were followed up for three years. Surgical complications, implant or prosthesis loss, and peri-implant marginal tissue health were assessed annually. No surgical complications or implant loss were observed during the follow-up visits. Peri-implant marginal tissue health showed excellent results with minimal marginal bone loss. Bone gain was evident in some cases. Using the dual-zone therapeutic concept with immediate implant placement in posterior extraction sockets showed promising results over three years.