Use of optical scanning and 3D printing to fabricate customized appliances for patients with craniofacial disorders

This paper presents a concept and methodology of biocompatible 3D printing in combination with intraoral and extraoral 3D surface scans for individualized appliances in patients with craniofacial disorders. The concept arises from the clinical problem of rapid growth and minimal compliance of infants with such disorder and the urgency to effectively treat the often severe, life-threatening symptoms such as airway obstruction. Methodology and interdisciplinary cooperation are explained in a real case of Pierre Robin sequence – infant with micrognathia and airway obstruction. Interdisciplinary cooperation principles for experts from departments of orthodontics and cleft anomalies, pediatric pneumology and phthisiology as well as pediatric otorhinolaryngology department. Scanning of intraoral structures was performed with iTero® Orthodontic Scanner, face scanning was performed with an app Bellus3d Dental Pro on iPad Pro® 2020 with TrueDepth and scans were processed in Autodesk® Meshmixer™. Examples of digital workflows in 3D design, reverse design, and individualization of Tübingen palatal plate are presented. Also, examples of creation of two-part biocompatible 3D printed appliances based on the merged intraoral and extraoral soft-tissue scan are presented. Clinical feedback evaluation of presented clinical example suggests the need for an update of the intraoral appliance every 10 days in a 6-months old infant to preserve comfort and thus infant compliance with the appliance. Results also confirm that TrueDepth sensor can be utilized with a smartphone app to create face scan that provides sufficiently precise data to design and print viable extraoral parts of orthodontic appliance.