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Defining biomechanical principles in pre-surgical infant orthopedics in a real cleft finite element model
P Winnand1, M Ooms1, M Heitzer1
1Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany.
Insights
Presurgical infant orthopedics (PSIO) using passive alveolar molding (PAM) offers superior biomechanical efficacy for cleft lip and palate (CLP) treatment. This approach minimizes stress and optimizes force distribution compared to other PSIO methods.
Area of Science:
- Craniofacial surgery
- Biomechanical engineering
- Pediatric dentistry
Background:
- Presurgical infant orthopedics (PSIO) is crucial for cleft lip and palate (CLP) treatment.
- The biomechanical transfer of forces by different PSIO techniques is not well understood.
Purpose of the Study:
- To define the biomechanical principles of competing PSIO techniques.
- To compare the force transfer efficacy of Latham, PAM, and DynaCleft using a finite element model.
Main Methods:
- A real cleft finite element (FE) model was utilized.
- Active intraoral (Latham), passive alveolar molding (PAM), and extraoral (DynaCleft) forces were virtually applied.
- Stress distribution and force transfer were analyzed in the cleft region and midface.
Main Results:
- PAM and Latham exerted significantly less stress in the cleft region than DynaCleft.
- Intraoral molding forces (PAM and Latham) showed localized application without high midface loads.
- PAM demonstrated favorable force flow, and intraoral passive molding exhibited the highest biomechanical efficacy and best load distribution.
Conclusions:
- Intraoral passive molding (PAM) is biomechanically superior for cleft lip and palate treatment.
- PAM offers more favorable load distribution and less stress compared to extraoral methods.
- Further clinical validation is recommended to confirm these biomechanical findings.
Abstract:
Presurgical infant orthopedics (PSIO) is the first step in the treatment of cleft lip and palate (CLP) and is designed to approximate the cleft segments as effectively as possible before surgical reconstruction of the lip and palate. The biomechanical efficacy of different PSIO approaches in transferring molding forces to the CLP is unknown. This study aimed to define the biomechanical principles of competing PSIO techniques in a real cleft finite element (FE) model. Active intraoral (Latham), passive alveolar molding (PAM), and extraoral (DynaCleft) molding forces were virtually applied to a real cleft FE model. In the cleft region, PAM (P < 0.001) and Latham (P < 0.05) exerted significantly less stress than DynaCleft. Intraoral molding forces acted primarily at the site of the force initiation without being accompanied by high loads in the midface. PAM showed a tendency toward a better flow behavior of the molding forces than Latham. Extraoral molding transferred high stresses to the cleft, alveolar ridge, and midface. Intraoral passive molding was ultimately characterized by the highest biomechanical efficacy and showed the most favorable load distribution of all of the PSIO approaches considered in this study. Future research is needed to validate the findings against clinical data.
