目的:尝试建立新生儿腭裂术前矫治器计算机辅助设计与制作的方法.方法:选取5名单侧完全性腭裂新生儿作为受试对象,用MicroCT扫描患者腭裂石膏模型获取患儿腭裂三维原始数据；用逆向工程软件三维重建腭裂数字化模型,在此基础上模拟分割腭裂骨段,将健侧前牙槽突骨段按设计向患侧移动以缩小腭裂裂隙,填充骨段移动后形成的缺隙及腭裂裂隙,确定矫治器边界范围,设计腭裂矫治器实体模型；用快速成型技术将其加工为矫治器树脂模型,采用真空压膜方法制作术前矫治器(PNAM).结果:MicroCT扫描技术以55 μm扫描间隔层厚获得了腭裂模型原始数据,在此基础上利用逆向工程软件三维重建腭裂数字化模型,并按照预定要求完成了术前矫治器的个性化设计.通过快速成型和真空压膜技术可制作适合患者口内安全使用的术前矫治器.利用该方法为患儿进行术前矫治,3月后腭裂裂隙明显缩小.结论:基于多种计算机辅助设计与制造技术,可以为新生儿腭裂患者设计和制作个性化的术前矫治器.%Objective: To develop a new method of manufacture of presurgical nasoalveolar molding(PNAM) appliance using computer-aided design and manufacturing (CAD/CAM) technique for infants with cleft palate. Methods: 5 infant patients with unilateral cleft palate were recruited. The plaster cast of the upper denture and palate was obtained, scanned by micro-CT and transformed into 3D digital model by the reverse engineering software. The unaffected alveolar process was split into two parts; the anterior part was moved towards the affected side to narrow the alveolar cleft gap. The cleft palate gap and the gap behind the anterior part were then filled. The PNAM appliance was designed base on the modified model. PNAM appliances were manufactured by rapid prototyping and vacuum laminating. The PNAM appliances were used in 5 cases for 3 months and the palate models were measured before and after application of the PNAM. Results: The original data of the cleft palate models were obtained via micro-CT scanning with an interval of 55 um, based on which the 3-dimensional models were reconstructed by the reverse engineering software. The PNAM appliances made by CAD/CAM technique matched perfectly with the models and fitted well when worn in the patient s mouth. With this method, the cleft gap of the palate was obviously decreased in the 5 cases. Conclusion: CAD/CAM technologies can be used in the design and manufacture of individual PNAM appliance.
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