ORIGINAL RESEARCH PRESURGICAL NASOALVEOLAR MOLDING IN UNILATERAL CLEFT LIP AND PALATE: EVALUATING ALVEOLAR APPROXIMATION AND MAXILLARY ARCH CHANGES WITH GS-NAM VERSUS CONVENTIONAL NAM TECHNIQUE

Background: Presurgical nasoalveolar molding (NAM) is widely used to improve nasal and alveolar morphology in infants with unilateral cleft lip and palate (UCLP) prior to surgical repair. While conventional NAM has established efficacy, the Grayson–Santiago NAM (GS-NAM) technique proposes enhanced practicality and simplified activation. Comparative evidence of its intraoral effectiveness remains limited. Objective: To compare the effects of GS-NAM and conventional NAM on alveolar alignment and early maxillary growth in infants with complete UCLP over a 3-month presurgical period. Study Design: A prospective, assessor-blinded, randomized controlled trial with 1:1 allocation. Setting: Faculty of Dental Medicine, Al-Azhar University, Cairo, Egypt, and Operation Smile Egypt comprehensive cleft care centers. Participants: Thirty infants with non-syndromic complete UCLP (aged 1–8 weeks) were randomized into two groups: GS-NAM (n=15) and conventional NAM (n=15). An additional 15 healthy non-cleft infants served as a normative control group. Interventions: Both groups received NAM appliances fabricated using digital workflow and 3D printing. The conventional NAM group underwent weekly adjustments with selective grinding and soft-liner addition. The GS-NAM group received adhesive-based stabilization and asymmetric extraoral elastic traction with weekly hard acrylic reduction. Main Outcome Measures: Intraoral parameters were assessed via 3D digital models at baseline (T0) and 3 months (T3), including: posterior alveolar width (PG-PL), middle alveolar width (BG-BL), cleft gap width (ACG-ACL), midline deviation length (Inc-Sagittal), and midline deviation angle ((Mid-Inc)-Sagittal). Results: Both NAM techniques produced significant and comparable reductions in cleft gap width (GS-NAM: 13.34±1.26 mm to 6.28±1.33 mm; conventional NAM: 12.16±1.94 mm to 7.17±2.45 mm; p0.05). Both treatment groups showed growth patterns distinct from healthy controls, with reduced transverse expansion in the canine region. Conclusions: GS-NAM and conventional NAM demonstrate equivalent efficacy in improving alveolar alignment and reducing cleft gap width over a 3-month presurgical period. While both techniques effectively reshape the alveolar arch, they do not replicate the physiological transverse growth observed in non-cleft infants. Clinical selection may therefore prioritize practicality, comfort, and caregiver adherence, as both methods yield comparable orthopedic outcomes.