Doble Aligner Nasoalveolar Molding: A New Approach of Digital Protocol for Cleft Lip and Palate in Newborn Patients

In Spain, a new digital workflow protocol has been developed for patients with cleft lip and palate. This protocol involves several steps, including the creation of a double aligner tray for nasoalveolar molding (2A-NAM) and the utilization of digital intraoral scans for the movement design. The sequential process includes: intraoral scanning (IOS), virtual design (VD), digital impression (DI), 2A-NAM preparation, and analysis of anatomical changes. This process is repeated until the desired outcomes are achieved.

At just 7 days of age, records of the male child were obtained using an iTero® Element 5D intraoral laser scanner. Additionally, an extraoral record was taken to measure the distance from the commissure to the left nostril, which enables the reconstruction of the nasal stent of the tray. The resulting stereolithography (STL) files underwent digital planification using 3D NemoStudio. The degree of approximation, rotation, and inclination of major and minor segments varied for each (M) based on each individual record and the patient's specific condition. Finally, the Form 3+® 3D-printer was used to produce the VD using Formlabs® photopolymer resin. The technician then assembled the device using a Durasoft® PD splint (both hard and soft components), to which tension springs were added using wire and secured with resin. A total of five 2A-NAMs were required to achieve proper segment approximation prior to orthopedic surgery at 4.5 months of age.

By assessing the anatomical predictions provided by digital simulation, clinicians can make proper decisions regarding the approximation of the maxillary segments of the patient.

The predictability of planned approximation movements and the absence of aligner injuries motivate the promotion of the protocol as a reliable method that facilitates pediatric dentistry and orthodontic treatment for any professional, ensuring patient safety.

Rico-Lillo I, García-García VJ, Kasem K, et al. Doble Aligner Nasoalveolar Molding: A New Approach of Digital Protocol for Cleft Lip and Palate in Newborn Patients. Int J Clin Pediatr Dent 2026;19(1):110-119.