Nasoalveolar molding – What lies over the horizon?
Cleft lip and palate (CLP) is the most common congenital craniofacial anomaly. Rehabilitation of CLP
generally requires a team approach. Alveolar and nasal reconstruction for these patients is a challenge
for the reconstructive surgeon and various procedures have been attempted to reduce the cleft gap, so
as to obtain esthetic results postsurgically. The concept of presurgical infant orthopedics (PSIO) for
patients with cleft lip and palate began to gain popularity in the 1950s. Grayson’s technique of
Nasoalveolar molding (NAM) is a nonsurgical way to reshape the gums, lip and nostrils with a plastic
plate before cleft lip and palate surgery which has gained wide acceptance and evidence in cleft
therapy. NAM reduces the severity of the initial cleft alveolar and nasal deformity and may decrease
the number of surgeries the child needs because it makes the cleft less severe. The conventional NAM
appliance consists of a removable alveolar molding plate made of orthodontic acrylic from a dental cast
of the infant's maxilla. With the advent of technological improvements and intra-oral 3D scanning, a
novel method for fabricating nasoalveolar molding appliances using 3-dimensional workflow and clear
aligners has been trending. Though it is trailblazing, the 3D printed aligners lack a crucial element of
biocompatibility, leaving us wondering what lies over the horizon. This drives us into research that are
focusing on producing efficient and biocompatible NAM appliance as well as the possibility of
mimicking native live tissues as in 4D bioprinting. This enhanced approach will reduce the cleft defect
and as well improve the naso-labial esthetics. Our table clinic will showcase the past, present and future
scope of NAM in the field of cleft orthodontics.