Design and Fabrication of the Orthodontic Airway Plate Appliance for Neonates with Pierre Robin Sequence Utilizing...

ObjectivePresent the workflow and the use of simulation in designing and fabricating an optimal orthodontic airway plate (OAP) to treat patients with Robin sequence (RS) at a pediatric hospital.DesignNarrative description of the workflow, materials, and steps employed to design the OAP appliance for neonates with RS and upper airway obstruction (UAO). Case report of two patients with varying degrees of complexity of RS treated with this therapy.SettingDental and bioengineering laboratory, neonatal intensive care unit, and acute care units of a United States tertiary pediatric hospital.Patients, ParticipantsSyndromic and non-syndromic neonates with RS and severe tongue-based UAO not stabilized with positioning.InterventionsOAP therapyMain Outcome Measure(s)Delivery of an optimal OAP appliance that effectively displaces the tongue forward and relieves UAO.ResultsThirty months after the implementation of the OAP program at our institution, 26 infants with RS had an OAP fabricated and delivered utilizing our existing workflow. With the inclusion of simulation and 3D-printed bending guides, the mean time for appliance fabrication was 5 days, with seven patients requiring multiple delivery attempts. Two patients had pharyngeal tissue trauma related to device malposition or dislodgement.ConclusionsThe multidisciplinary collaboration involved in developing our institution's workflow with simulation enhanced the safety and efficiency of our OAP program, enabling the successful delivery of this appliance to 26 infants.