الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
This comparative clinical trial was conducted to assess the efficacy of two orthopedic appliances, fabricated by CAD/CAM additive manufacturing, by using virtual planning in infants with complete BCLP.
Twenty infants with complete BCLP were selected from the Maxillofacial Department, Faculty of Dentistry, Alexandria University. The age of the infants selected for this study was from newborn to 1 month old, and the infants were free from any systemic syndromes or other congenital defects. The infants were divided randomly and allocated into two groups: NAM group and the two-piece appliance group.
Tensile tests were performed using 3 different sizes of orthodontic elastics used in this study. The tests were completed on six new and six used elastics from each of the three different sizes to be used as a guide for the treatment procedure using the two-piece appliance.
The casts, obtained from maxillary impressions from the infants, were scanned using a 3D laser scanner. The appliances were designed and manufactured using CAD/CAM additive manufacturing. Virtual planning was completed on the initial cast obtained during the first visit according to instructions from the Maxillofacial surgeon. The appliances were delivered. Sixty days after the beginning of the NAM treatment, another impression was obtained for ensuring that the premaxilla was retracted to its main position before placement of the nasal stents in the NAM group.
Casts were obtained from impressions four months after the beginning of the treatment. Evaluation was completed in three phases. Phase I involved quantitative 3D maxillary geometric analysis before treatment and after four months. Phase II involved comparison of the treatment outcome with the corresponding virtual plan, and phase III involved nasal anthropometric analysis using nasal measurements obtained using a digital caliper and a protractor before treatment, after four months and 10 days after surgery.
The main achieved treatment outcomes in the maxillary geometry by both appliances were: alignment of the alveolar segments and the premaxilla without their collapse, a significant reduction in the right and left cleft width, correction of the midline deviation of the premaxilla, and a significant decrease in the sagittal arch length and premaxilla protrusion. However, the two-piece appliance achieved a greater percentage decrease in the cleft widths that were closer to the virtual plan compared to the NAM appliance.
Regarding the vertical growth at the incisor and bilateral canine regions, NAM resulted in inhibition of growth with a significant decrease at the bilateral canine regions. On the contrary, the two-piece appliance allowed for vertical growth.
The main achieved treatment outcomes in nasal anthropometry by both appliances were: a significant increase in the columellar length, a significant decrease in the bi-alar width and a significant decrease in the columellar deviation. However, the NAM appliance with the nasal stents resulted in twice the percentage increase in
Chapter (6) Summary , Conclusions & Recommendations
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columellar length. In addition, the presurgical nasal morphology was improved with the NAM appliance by a significant increase in the nostril heights and a significant decrease in the nostril widths, in addition to significant improvement in the nasal tip projection. However, the two-piece appliance did not achieve a significant change in the nostril height, width and nasal tip.
from this study, the following can be concluded:
The use of CAD/CAM to manufacture the presurgical orthopedic appliances has simplified the process of designing and fabricating the appliances with high accuracy and precise dimensions, which reduced the chairside clinical adjustments.
The use of virtual planning played an important role in the evaluation of the treatment outcomes of the presurgical orthopedic appliances used for infants with complete BCLP. However, the software used in this study for virtual planning was unable to predict the transverse and vertical growth of the alveolar segments.
Both the NAM and the two-piece appliances improved the maxillary geometry. However, the two-piece appliance mostly achieved results in maxillary geometry that were closer to the virtual plan compared to the NAM appliance.
A limitation of the NAM appliance was inhibition of the vertical growth of the alveolar segments.
Both appliances achieved non-surgical elongation of the columella and improvement in the columellar deviation. However, nasal molding in the NAM appliance resulted in a significant improvement in the presurgical nasal morphology and nasal esthetics before and after surgery.
The two appliances resulted in the completion of the lip repair surgery in one stage. Narrowing of the lip and alveolar segments, nasal shaping and columellar elongation before surgery, helped to reduce tissue tension and improve surgical outcomes.
The success of the treatment procedures required high levels of compliance and participation of the infants’ parents.