Biocreative Alveolar Molding Plate Treatment (BioAMP) for neonatal unilateral cleft lip and palate with excessively wide alveolar cleft and maxillary arch width

Abstract

Since its inception in Europe in the 1950s, alveolar molding treatment for neonates with complete cleft lip and palate has undergone significant evolution in both design and application methodology, demonstrating effectiveness in normalizing the alveolar cleft and nasal shape. However, excessively wide alveolar clefts accompanied by disproportionately wide total maxillary arch pose significant challenges when utilizing conventional alveolar molding methods involving cyclical adding and grinding of acrylic on molding plates. The current report introduces a novel alveolar molding method named Biocreative Alveolar Molding Plate Treatment (BioAMP), which can normalize the maxillary alveolar cleft and arch shape without laborious conventional acrylic procedures. BioAMP sets the target arch form and provides unrestricted space for natural growth of the maxillary alveolar bones while systematically reducing the total maxillary arch width in precise increments. Two exemplary cases are presented as proof-of-concept, showcasing the clinical innovation of BioAMP.

Keywords: Arch form; Cleft lip and palate; Nasoalveolar molding; Neonate.

Figure 1

Biocreative Alveolar Molding Plate (BioAMP) with a constriction screw: Fabrication and implementation protocol. A, Occlusal view of a pre-treatment maxillary arch shape of a neonate with an excessively wide alveolar cleft accompanied by excessive total maxillary arch width. B, Wax-up for a target maxillary arch shape. C, Hard acrylic plate with a constriction screw in place. D, A button and nasal stent wire were installed prior to the delivery of the plate. The palatal plate is split in half to activate the constriction screw. E, Frontal view of the final form of the BioAMP after the nasal stent wire was fitted to the nasal dome inside the nose. The palatal plate remained split prior to activating the constriction screw. F, Occlusal view of the BioAMP after activating the constriction. G, Occlusal view of the BioAMP after the gap between the split halves was re-united using fresh hard acrylic. The total maxillary arch width is now less than before.

Figure 2

Patient 1 was treated with the BioAMP with a constriction screw. The images present the frontal facial view, wormʼs eye view, occlusal view of the maxillary arch, and a stone model of the maxillary arch (arranged from left to right): A, Pre-treatment at the age of 1 week. B, Post-treatment at the age of 2.5 months. The total maxillary arch width decreased from 47 to 42.5 mm, and the interalveolar gap decreased from 16 to 1 mm. Permission to use the photos was granted by the patientʼs parents.

Figure 3

Patient 2 was treated with the BioAMP with a construction screw. The images present the frontal facial view, wormʼs eye view, occlusal view of the maxillary arch, and a stone model of the maxillary arch (arranged from left to right): A, Pre-treatment at the age of 2 weeks. B, Post-treatment at the age of 3 months. The total arch width decreased from 46 to 41 mm, and the interalveolar gap decreased from 15 to 0 mm. Permission to use the photos was granted by the patientʼs parents.