Case Report

Year : 2026 | Volume : 17 | Issue : 3 | Page : 68-78

Innovative Application of Direct Printed Shape Memory Aligners for Presurgical Alveolar Molding in a Preterm Infant with Unilateral Cleft Lip and Palate : 4D-AM Appliance: A Case Report

Pritam Mohanty-1, Krishna S-2, Om Prakash Kharbanda-3, Bikash Ranjan Bindhani-2

1-Professor and Head, 2-Postgraduate Resident, 3-Visiting Professor Emeritus, 4-Assistant Professor, Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Sciences, Bhubaneswar, Odisha, India

Address for Correspondence:

Dr Pritam Mohanty, MDS, FCFO

Professor and Head,

Department of Orthodontics and Dentofacial Orthopedics

Institute of Dental Sciences, Bhubaneswar, Odisha, India

Email ID: pritammohanty@soa.ac.in

ABSTRACT

Presurgical nasoalveolar molding (PNAM) is an early intervention employed to reposition the alveolar segments and contour the cleft nasal dome, thereby enhancing surgical outcomes. Recent advances in PNAM include the use of thermoform aligners in newborns with clefts, but with certain limitations. Shape-memory aligners featuring dual-phase structures and stimulus-responsive properties deliver consistent, controlled molding, effectively overcoming the limitations of thermoformed aligners in orthodontic uses. This case demonstrates how direct‑printed shape‑memory aligners can be applied for alveolar molding in a premature infant. The infant had a Veau Class III cleft lip and palate and also a unilateral cleft lip nasal deformity. This particular use of aligners has not been widely reported in the literature. 11 sequential aligner trays were utilized to align the alveolar segments for primary surgical repair. We designated this approach the “4D-AM” appliance, which molds the alveolar segments in all three dimensions (3D), and is effective for a longer duration (4thD - time), owing to the shape-memory effect.

KEYWORDS: 4D-alveolar molding (4D-AM) appliance; Shape-memory aligner for AM; Cleft lip and palate; Case Report; Direct-printed aligner therapy

SOURCE OF FUNDING

Self

CONFLICT OF INTEREST

None

How to cite this article: Pritam Mohanty, Krishna S, Om Prakash Kharbanda, Bikash Ranjan Bindhani. Innovative Application of Direct Printed Shape Memory Aligners for Presurgical Alveolar Molding in a Preterm Infant with Unilateral Cleft Lip and Palate : 4D-AM Appliance: A Case Report.

Int J Orthod Rehabil 2026; 17 (3): 68-78.

Doi: 10.56501/Intjorthodrehabil.173.ijor0143

Review Article

Year : 2026 | Volume : 17 | Issue : 2 | Page : 114-127

A Comparative Evaluation of Efficiency of Orthodontic Treatment with Different Palatal Expanders: Hyrax Type and Haas Type — A Systematic Review

Soumya Ranjan Padhi- 1, Shashank Gaikwad- 2, Parag V. Gangurde- 3, Pritam Mohanty- 4, Debapreeti Mohanty- 5

1- Assistant Professor, Department of Orthodontics and Dentofacial Orthopaedics, Institute of Dental Sciences, SOA, Bhubaneswar, Odisha, India, 2- Professor, 3- Professor and Head, Department of Orthodontics and Dentofacial Orthopaedics, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, Maharashtra, India, 4- Professor and Head, Department of Orthodontics and Dentofacial Orthopaedics, 5- Associate Professor, Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, SOA, Bhubaneswar, Odisha, India.

Address for Correspondence:

Dr. Soumya Ranjan Padhi,

Assistant Professor, Department of Orthodontics and Dentofacial Orthopaedics,

Institute of Dental Sciences, SOA, Bhubaneswar, Odisha, India- 751029,

Email ID- drsoumyaranjanpadhi@gmail.com

ABSTRACT

AIM: To compare the efficiency of Hyrax-type and Haas-type rapid maxillary expanders (RME) in growing patients with transverse maxillary deficiency, with respect to dentoskeletal effects, root resorption, and periodontal outcomes.

METHODS: Electronic databases (PubMed/MEDLINE, Embase, Cochrane Library, Web of Science, Scopus) were searched from inception to November 2022 for English-language studies on growing patients (7–18 years) receiving rapid maxillary expansion (RME). Risk of bias was assessed using ROB 2 (Cochrane Risk of Bias tool, version 2) for RCTs and ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) for non-randomized studies. Findings were synthesized narratively across three outcome domains: skeletal/dental expansion, root resorption, and periodontal effects. PROSPERO Registration: CRD42022336910

RESULTS: Nine studies (N=719 patients; 7 RCTs, 2 non-randomized studies) met inclusion criteria. Both appliances effectively corrected transverse maxillary deficiency, with Hyrax favoring dento-alveolar expansion and Haas favoring skeletal movement, though between-group differences were small. Both produced comparable, non-significant root resorption and similar periodontal bone changes (decreased buccal and increased lingual bone plate thickness). Risk of bias was low to moderate in most studies; two RCTs were high risk.

CONCLUSION: Both Hyrax- and Haas-type expanders are effective for correcting transverse maxillary deficiency, with comparable root resorption and periodontal effects. However, confidence in these findings is limited by the predominantly low-to-moderate, and in two RCTs high, risk of bias among included studies, and definitive conclusions await better-quality evidence.

Substantial clinical and methodological heterogeneity across studies precluded meta-analysis; well-designed RCTs with standardized outcome reporting are needed.
KEYWORDS: Rapid maxillary expansion; RME; Hyrax expander; Haas expander; palatal expansion; systematic review.

CONFLICT OF INTEREST AND FUNDING

Nil

How to cite this article: Soumya Ranjan Padhi, Shashank Gaikwad, Parag V. Gangurde, Pritam Mohanty, Debapreeti Mohanty. A Comparative Evaluation of Efficiency of Orthodontic Treatment with Different Palatal Expanders: Hyrax Type and Haas Type — A Systematic Review.

Int JOrthod Rehabil 2026; 17 (2): 114-127.

Doi: 10.56501/Intjorthodrehabil.172.ijor0048