Dr. Pradip R. Shetye Leads a Course on Nasoalveolar Molding Appliances

NYU Langone Health's Hansjorg Wyss Department of Plastic Surgery collaborated with the LGS to create models of infant unilateral and bilateral cleft palates for a Nasoalveolar Molding Appliance Therapy hands-on workshop.

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Equipment: Stratasys J850 using Vero and Agilus30 resin; 3D Systems ProJet 7000 HD SLA printer using VisiJet SL Clear resin


More About the Project

Cleft lip and palate¹ occur when the lip and palate tissues do not completely grow together during pregnancy, resulting in an opening on one or both sides of the lip or palate. This ailment is ultimately repaired through surgery within the first 12 months of life, but these surgeries are more streamlined when preceded by very early treatment with a Nasoalveolar Molding (NAM) appliance. Dr. Pradip R. Shetye, craniofacial orthodontist and the director of Langone's NAM Appliance hands-on workshop, explained that when babies with cleft lip and palate are just one-week-old, doctors fit them with customized NAM appliances that help gently mold babies' soft and hard tissues to begin "realigning the displaced lip, nose, [and] gum [three to four months] before surgery."

NAM appliances are customized to each child and can be made conventionally in a dental laboratory or 3D printed at NYU Langone Health's Wyss Department of Plastic Surgery. Like braces, the appliances are worn 24 hours a day, including during feeding, and fit on the roof of the mouth similarly to a traditional removable retainer.² NAM appliances also have nasal stents that reshape the nose while preparing them for surgery.³

Dr. Shetye explained that NYU Wyss has "six to seven babies at any given time undergoing NAM treatment" while 49 percent of the American Cleft Palate-Craniofacial Association (ACPA)-approved cleft centers in the U.S. also offer NAM treatment.⁴ Training more health care providers will further increase the number of cleft teams in North America who can offer NAM therapy. Langone's NAM Appliance Therapy course will teach dentists, physicians, and other medical professionals every part of nasoalveolar molding therapy leading up to surgery—from making and fitting the customized appliances to making incremental adjustments through hands-on training with realistic 3D printed models. To create these learning models, Langone partnered with NYU's LaGuardia Studio (LGS) to produce highly-detailed, 3D printed models of infant faces with unilateral and bilateral cleft lip and palate.

3d printed infant head models

Crafting Lifelike Training Models

LGS created 16 unilateral and 16 bilateral cleft palate models in a process that took more than 48 continuous hours of printing. Printing several copies will allow each participant of the program to work on their own unilateral and bilateral model with individualized attention, ensuring a comprehensive training session. Previously, this sort of training was conducted on rigid, hand-made models that were less visually accurate and did not mimic feel or movement at all. The new LGS models are better proportioned and much more flexible than the previous models, allowing the 3D printed gums and tissues to bend and react more similarly to how a real tissue would.

Combining Langone’s data with LaGuardia’s selection of layering and printing materials resulted in a training experience that is much closer to real procedures. To create the prints, Shelly J. Smith, assistant director of NYU LaGuardia Studio, explained “We worked with Dr. Shetye…to develop and prototype the correct combination of [Stratasys] Vero and Agilus30 resin materials that delivered a flexible, realistic ‘flesh-like’ tactile feel, in addition to the correct coloring, level of infant mouth [and] gum detail, sizing and over print quality.”

These final infant models were created using the Stratasys J850 full-color PolyJet 3D printer. Dr. Shetye explained that the "original models Langone had were rigid like a statue, so these new flexible [models] are much more realistic and …[better] mimic how the tissues will respond to adjustments." In addition to the infant models, LGS also 3D printed dental impressions using the 3D Systems ProJet 7000 HD SLA printer and VisiJet SL Clear resin material, which allows for high-resolution, transparent 3D prints.

Notes:

  1. CDC, Facts about Cleft Lip and Palate
  2. Children’s Hospital of Philadelphia, Nasoalveolar Molding
  3. ACPA Family Services, Resources for Your Cleft Journey, Preparing for Surgery
  4. Cleft and Craniofacial Team Orthodontic Care in the United States, A Survey of the ACPA