Kieferorthopädische Behandlungsoptionen im digitalen Workflow bei Neugeborenen und Säuglingen

Zusammenfassung

Kieferorthopädische Behandlungen für Neugeborene und Säuglinge mit kraniofazialen Fehlbildungen können bereits kurz nach der Geburt beginnen. An der Poliklinik für Kieferorthopädie des Universitätsklinikums Tübingen werden konventionelle Alginatabformung bei diesen jungen Patienten seit 2018 durch intraorale Scans (IOS) ersetzt. Die digitale Abformung ermöglicht den Einsatz moderner Technologien wie Computer-Aided Design (CAD) und Computer-Aided Manufacturing (CAM), insbesondere 3D-Druck, zur präzisen Herstellung kieferorthopädischer Apparaturen. Diese werden bei Fehlbildungen wie Lippen-Kiefer-Gaumen-Spalten (LKG-S), der Robin-Sequenz (RS) und Trisomie 21 (TS21) eingesetzt, um zugrundeliegende Symptomatiken zu therapieren. Dabei fördern die Apparaturen Atmung, Nahrungsaufnahme und die kraniofaziale Entwicklung. Der digitale Workflow bietet eine risikoarme, effiziente Versorgung und stellt einen bedeutenden Fortschritt in der kieferorthopädischen Behandlung von Neugeborenen und Säuglingen mit kraniofazialen Fehlbildungen dar.

Abstract

Orthodontic treatment of newborns and infants with craniofacial anomalies can begin shortly after birth. At the Department of Orthodontics of the University Hospital Tübingen, conventional alginate impressions are replaced by intraoral scans for these young patients since 2018. Digital impressions enable the use of modern technologies such as Computer-Aided Design and Computer-Aided Manufacturing, particularly 3D printing, to precisely fabricate orthodontic appliances. These appliances are used to address conditions such as cleft lip and/or palate, Robin Sequence, and Trisomy 21 by treating underlying symptoms. They can promote breathing, feeding, and craniofacial development. The digital workflow provides a low-risk, efficient treatment approach and represents a significant advancement in the orthodontic care of newborns and infants with craniofacial anomalies.

Schlüsselwörter

Lippen-Kiefer-Gaumen-Spalte - Trisomie 21 - Robin-Sequenz - Intraoralscan - CAD/CAM - 3D-Druck

Keywords

Cleft lip and palate - trisomy 21 - Robin sequence - intraoral scan - CAD/CAM - 3D printing

Publication History

Article published online:
12 June 2025

• Literatur

• 1 Weise C, Frank K, Wiechers C.. et al. Intraoral scanning of neonates and infants with craniofacial disorders: feasibility, scanning duration, and clinical experience. European Journal of Orthodontics 2022; 44: 279-286
• 2 Weismann C, Xepapadeas AB, Bockstedte M.. et al. Complete Digital Workflow for Manufacturing Presurgical Orthodontic Palatal Plates in Newborns and Infants with Cleft Lip and/or Palate. Journal of Functional Biomaterials 2024; 15: 301
• 3 Xepapadeas A, Weise C, Frank K.. et al. Technical note on introducing a digital workflow for newborns with craniofacial anomalies based on intraoral scans-part I: 3D printed and milled palatal stimulation plate for trisomy 21. BMC oral health 2020; 20: 1-8
• 4 Bacher M, Sautermeister J, Urschitz MS.. et al. An oral appliance with velar extension for treatment of obstructive sleep apnea in infants with Pierre Robin sequence. The Cleft palate-craniofacial journal 2011; 48: 331-336
• 5 Buchenau W, Urschitz MS, Sautermeister J.. et al. A randomized clinical trial of a new orthodontic appliance to improve upper airway obstruction in infants with Pierre Robin sequence. The Journal of pediatrics 2007; 151: 145-149
• 6 Effert J, Uhlig S, Wiechers C.. et al. Prospective evaluation of children with Robin sequence following Tübingen Palatal plate therapy. Journal of clinical medicine 2023; 12: 448
• 7 Effert J, Wiechers C, Kreutzer K.. et al. Retrospective evaluation of the orthodontic treatment needs in primary school children with Robin sequence following Tübingen palatal plate therapy in infancy. Journal of Cranio-Maxillofacial Surgery 2023; 51: 528-535
• 8 Poets CF, Koos B, Reinert S.. et al. The Tübingen palatal plate approach to Robin sequence: summary of current evidence. Journal of Cranio-Maxillofacial Surgery 2019; 47: 1699-1705
• 9 Vatlach S, Maas C, Poets CF. Birth prevalence and initial treatment of Robin sequence in Germany: a prospective epidemiologic study. Orphanet journal of rare diseases 2014; 9: 1-5
• 10 Wiechers C, Arand J, Koos B.. et al. Evidence and practical aspects of treatment with the Tübingen palatal plate. Seminars in Fetal and Neonatal Medicine. 2021
• 11 Wiechers C, Buchenau W, Arand J.. et al. Mandibular growth in infants with Robin sequence treated with the Tübingen palatal plate. Head & face medicine 2019; 15: 1-8
• 12 Aretxabaleta M, Xepapadeas AB, Poets CF. et al. Comparison of additive and subtractive CAD/CAM materials for their potential use as Tübingen Palatal Plate: An in-vitro study on flexural strength. Additive Manufacturing 2021; 37: 101693
• 13 Xepapadeas A, Weise C, Frank K. et al. Technical note on introducing a digital workflow for newborns with craniofacial anomalies based on intraoral scans - part II: 3D printed Tübingen palatal plate prototype for newborns with Robin sequence. BMC oral health 2020; 20
• 14 Aretxabaleta M, Xepapadeas AB, Poets CF. et al. Fracture load of an Orthodontic appliance for Robin Sequence Treatment in a digital workflow. Materials 2021; 14: 344
• 15 Aretxabaleta M, Roehler A, Poets CF. et al. Automation of Measurements for Personalized Medical Appliances by Means of CAD Software—Application in Robin Sequence Orthodontic Appliances. Bioengineering 2022; 9: 773
• 16 Aretxabaleta M, Unkovskiy A, Koos B.. et al. Accuracy evaluation of additively and subtractively fabricated palatal plate orthodontic appliances for newborns and infants–an in vitro study. Materials 2021; 14: 4103
• 17 Castillo-Morales R. Orofaziale Regulation beim Down Syndrome durch Gaumenplatte. Sazialpadiatrie 1982; 4: 10-17
• 18 Limbrock G, Castillo-Morales R, Hoyer H.. et al. The Castillo-Morales approach to orofacial pathology in Down syndrome. The International journal of orofacial myology: official publication of the International Association of Orofacial Myology 1993; 19: 30-37
• 19 Wiechers C, Sowula J, Kreutzer K.. et al. Prospective cohort study on facial profile changes in infants with Robin sequence and healthy controls. World Journal of Pediatrics 2024; 1-9
• 20 Castillo-Morales R, Brondo J, Hoyer H.. et al. Die Behandlung von Kau-, Schluck-und Sprechstörungen bei behinderten Kindern mit der orofazialen Regulationstherapie nach Castillo-Morales: Aufgabe für Pädiater und. Zahnarzt. Zahnärztl Mitt 1985; 75: 935-942
• 21 Deutsche Gesellschaft für Kinder- und Jugendmedizin (DGKJ) und der beteiligten Fachgesellschaften, B. u. w. O. (aktueller Stand 07/2016). Down-Syndrom im Kindes- und Jugendalter – S2k-Leitlinie Down-Syndrom.