Three dimensional evaluation of transversal, sagittal and vertical alveolar changes after nasoalveolar molding

The aims of this study were to evaluate transversal, sagittal and vertical alveolar changes of infants with complete unilateral cleft lip and palate (CUCLP) during nasoalveolar molding (NAM) using 3D digital models and compare their post-NAM maxillary arch form and dimensions with that of healthy infants. Twenty-six CUCLP patients treated with NAM (mean age at pre-NAM: 14,20±8,09 days, mean age at postNAM: 118,16±10,06 days) composed the treatment group, and the control group consisted of 26 non-CLP infants (mean age: 115,81±8,71 days). Transversal, sagittal, vertical linear and angular measurements along with volumetric and surface area measurements were carried out on 3D digital images of intraoral models. Post-NAM arch forms were compared with the control group. During NAM therapy, cleft widths were decreased (p<0,001). While significant decrease in anterior alveolar arch width was seen (p<0.01), posterior arch width did not change (p>0.05). Anterior and total maxillary arch depths were significantly decreased (p<0.01) whereas lesser segment's arch depth was increased (p<0.001). Rotation of the greater segment decreased (p<0.001). Anterior vertical deviation of the alveolar segments did not change (p>0.05). Alveolar crest lengths, posterior volumetric and surface area measurements and total arch perimeters of both segments were increased (p<0.05). Comparison of post-NAM measurements of CLP and the measurements of the control group revealed that there was no significant difference regarding anterior arch width (p>0.05), but posterior arch width and vertical deviation was greater in NAM group (p<0.05). Alveolar crest lengths, volumetric and surface area measurements, anterior and total maxillary arch depths of NAM group were lower than that of control group. When compatibility of post-treatment arch forms of CLP babies was compared with normal arch forms, the arch forms of 11.5% of the cases were highly, 69.3% were moderately and 19.2% of the cases were weakly compatible. Anteroposterior and transversal alveolar dimensions as well as the cleft width decreased significantly because of alveolar molding effect whereas vertical dimensions were maintained after NAM. Midline deviation was corrected by means of medial movement of the greater segment. Increases in volume and surface area were seen at the posterior alveolar segments due to growth. Sagittal and vertical growth deficiency and volumetric indeficiency was observed in alveolar structures compared to control group. Arch forms approximated to normal forms, however, they showed wide individual variations.