3D-printing for orthopedic treatment of infants with cleft lips and palate deformities

Background: Since its introduction by McNeil in 1954, infant orthopedic treatment of cleft lip and palate deformities has undergone a development into various directions. Depending on the plate design, different improvements of cleft morphology and oral function can be achieved and its application might be restricted to the time before lip surgery or extend for several years. Objective(s): Today 3D printing is assuming an indispensable role in the toolbox of surgery and dentistry. We present a stepwise workflow using this technology to build infant orthopedic plates. Method(s): A silicone impression of the cleft was taken in the awake child. Based on the digitized plaster model (L1 Scanner, Imetric, Switzerland)the plate was digitally designed to a thickness of 2 mm (Meshmixer, Autodesk, US). The plate was printed (Form 2, Formlabs, US)using biocompatible Medical Class IIa resin, which is suitable for long-term intraoral use (Freeprint splint, DETAX, Germany). Post processing consisted of removal of the print support structures, polishing, and fixing a wire, which has an acrylic ovoid alar extension at its end. Finding(s): The 3D printed plate shows equivalent fitting as compared to hand-made acrylic plates; the need for manual adaptation of the plates was minimal. Mean digital planning time was 20 minutes, printing time about 90 minutes. The material costs per plate are approx. 5 CHF, with initial costs for the dental scanner of 10`000 CHF and the 3D-printer of 4`000 CHF. Conclusion(s): The described process of on-the-spot medical 3D-printing represents a simple, fast, and cost-effective new workflow for the manufacturing of infant orthopedic plates, whereas the initial investment for hardware is not negligible. The traditional way is more time-intensive (textgreater 1.5 h longer)and requires a dental technician. However, in order to achieve a completely digitalized workflow, further development of intraoral-3D-scanners is required to improve their soft tissue detection. Copyright textcopyright 2019