Marit Bockstedte

Robin sequence (RS) is a rare congenital anomaly characterized by micrognathia, glossoptosis, and upper airway obstruction (UAO), often accompanied by a cleft palate. The Tübingen Palatal Plate (TPP), also referred to as the pre-epiglottic baton plate (PEBP), offers a non-surgical, functional orthodontic solution that improves airway patency and feeding by advancing the tongue base. This paper outlines the semi-digital clinical and technical workflow used for TPP treatment at Tübingen University Hospital. The protocol combines intraoral scanning (IOS), computer-aided design and manufacturing (CAD/CAM), and manual refinement for patient-specific appliance production. Practical steps, modifications for special cases and follow-up procedures are detailed, aiming to support clinical implementation at other centres. Based on the published literature and over three decades of experience, the protocol emphasizes safety, quality control, and interdisciplinary collaboration, with practical guidance provided to support implementation in other centres. The potential of digital workflows for data sharing, training, and multicenter collaboration is highlighted, while challenges such as the need for specialized expertise and technical resources are acknowledged. This guideline provides the first comprehensive and reproducible description of the Tübingen approach and aims to facilitate wider adoption of TPP therapy for infants with RS.

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.

Deciding on the implementation or modification of steps in daily clinical care is a nuanced process that demands careful evaluation. This is crucial not only for selecting the most appropriate solution but also for achieving the best treatment outcome. Thus, implementing a workflow for treating cleft lip and/or palate patients with a presurgical orthodontic cleft-covering plate needs to consider objective factors, prioritized from most to least important: safety and quality level, user-friendliness, feasibility, and, finally, efficiency and cost. The goal of this workflow is to integrate CAD/CAM technologies into daily clinical routine to enhance technical and clinical efficiency, reduce the burden of cleft care, and simplify the implementation of these technologies in other facilities. To achieve this, a methodology based on intraoral scanning and additive manufacturing is employed to produce patient-specific passive palatal plates. The approach describes possible pitfalls and their resolution within the routine of a cleft centre, along with an exemplary case scenario. Comparative analysis between the digital workflow and the conventional process demonstrated the digital approach to be safer, higher in quality, more user-friendly, feasible, and cost- and time-effective than the conventional process.

The objective of this study was to present a methodology and manufacturing workflow for non-invasive ventilation interfaces (NIV) for neonates and small infants. It aimed to procure a fast and feasible solution for personalized NIV produced in-house with the aim of improving fit and comfort for the patient. Three-dimensional scans were obtained by means of an intraoral (Trios 3) and a facial scanner (3dMd Flex System). Fusion 360 3D-modelling software was employed to automatize the design of the masks and their respective casting molds. These molds were additively manufactured by stereolithography (SLA) and fused filament fabrication (FFF) technologies. Silicone was poured into the molds to produce the medical device. In this way, patient individualized oronasal and nasal masks were produced. An automated design workflow and use of additive manufacturing enabled a fast and feasible procedure. Despite the cost for individualization likely being higher than for standard masks, a user-friendly workflow for in-house manufacturing of these medical appliances proved to have potential for improving NIV in neonates and infants, as well as increasing comfort.