Evaluation of the clinical effectiveness of Naso-alveolar molding (NAM) using Grayson method versus computer aided design NAM (CAD/NAM) in infants with bilateral cleft lip and palate : A randomized clinical trial / Noha Ali Elashmawi ; Supervised Mona Salah Fayed , Khaled Hazem Attia , Amr Ragab Elbeialy

Thesis (Ph.D.) - Cairo University - Faculty of Oral and Dental Medicine - Department of Orthodontics

Objective: The aim is to compare between the clinical effectiveness of nasoalveolar molding (NAM) versus the computer aided design NAM (CAD/NAM) in patients with bilateral clefts. Design: The trial is a randomized comparative trial with 1:1 allocation ratio. Participants: Thirty infants with bilateral complete cleft lip and palate were recruited. Interventions: Patients were randomized between NAM and CAD/NAM groups. The treatment steps described by Grayson were followed for the NAM group. In the CAD/NAM group, digitized maxillary models were made to create series of modified virtual models which were used to fabricate the molding plates using three-dimensional printing technology. The nasal stents were then added to the plates following Grayson method. The study lasted for 4 months. Main outcomes: The primary outcome was to evaluate the changes in the intersegment cleft gap. Other outcomes included the analysis of the maxillary arch in transverse, antero-posterior and vertical dimensions as well as the premaxillary deviation and rotation. Chair side time was assessed for both methods. Results: Both modalities decreased the intersegment cleft gap. The CAD/NAM plates caused more reduction in the total arch length by 1.99mm (-3.79 - 0.19, P=0.03) as compared to the NAM treatment. No differences were found between both groups in the transverse and vertical maxillary arch changes. Conclusions: Both interventions were effective in narrowing the cleft gap. Similar maxillary changes were found in both groups. The CAD/NAM modality required less chair side time compared to the NAM treatment

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