Jeanne Nervina’s Revolutionary Idea

Ann Arbor, MI — November 9, 2011 — You never know where a new idea that could help dental patients will come from.  Just ask Dr. Jeanne Nervina, an assistant professor of dentistry in the School’s Department of Orthodontics and Pediatric Dentistry.

"I was reading a story on a University of Michigan Web site about millimeter-scale computing, which many believe will be the new frontier in electronics,” she said.  “The story captured my attention.  But the photo did too.”  The length and width of the microprocessor were virtually identical to the dimensions of the letter “N” in the word “ONE,” approximately one by two millimeters.  “I thought, ‘This could be it, a way to help cleft lip and palate patients’,” she said.

If her idea becomes reality, Nervina’s initiative could help cleft palate patients in ways that might make conventional methods of treatment obsolete.

Why This Would be Different

Children with cleft lip and palate have deficient palates and upper jaws as a consequence of the original defect or multiple surgeries.  Orthodontic and surgical treatments help mold the palate to the correct size and shape so these patients have a more normal appearance and can eat and speak better.  A palatal expander is used to help achieve these objectives.

Using a microprocessor to develop a “smart” palatal expander would represent a colossal shift in treatment because expanders that have long been used to help cleft palate patients develop the palate in only one direction — left to right.  The microprocessor Nervina envisions would measure data about the forces affecting palatal development in all directions: left and right, up and down, and backwards and forwards. 

Nervina received funding from the U.S. Food and Drug Administration to conduct pioneering research that could ultimately lead to the development of a device where low power circuits sense the magnitude and direction of forces and transmit patient-specific data to orthodontists.  “The biology of each child is different, so you would get very individualized results from each child who would have one of these implanted,” she said.

Funding to Pursue the Idea

The novel idea of using microtechnology to help solve a problem in cleft palate patients led to Nervina becoming one of three individuals from the University of Michigan, and one of 40 nationwide, to receive FDA funding.  This fall, she and the two others from U-M were awarded a two-year, $2.2 million grant to pursue their initiatives.  Developing medical devices for children has been a priority for the FDA in recent years.

Nervina envisions the microprocessor being implanted and wireless.  “The palatal expander will have pressure sensors and wireless data relay capability.  That will enable orthodontists to monitor changes in real time.  She envisions orthodontists using a hand-held device to place it near a patient’s mouth and downloading signals from inside the device.  “That would enable an orthodontist to measure the degree of stresses, where they occur, and then adjust the expander to create the best possible result,” she said.

As principal investigator for the cleft palate technology project, Nervina will work with the U-M Medical Innovation Center and the Pediatric Device Medical Institute in Roanoke, Virginia.  The Institute is a consortium of children’s hospitals that includes U-M’s C.S. Mott Children’s Hospital. 

Time and Smiles

There are two other important reasons Nervina is working to make the device a reality — time and smiles.

“When they’re not in a hospital undergoing surgery, children born with a cleft lip and palate spend their childhood and teens going from one doctor’s appointment to another,” Nervina said.  “For children who don’t live close to a medical center, their families often spend hours traveling long distances for appointments, including orthodontic treatments, sometimes once every two weeks,” she added.  “It’s all very time consuming since this routine for cleft lip and palate patients begins when they are between seven and nine years old and continues until they are in their late teens or early twenties.”

Nervina said because cleft palate children “are often self-conscious, they don’t smile very often.  I can’t imagine going through life not smiling.  I want to do anything I can to help them regain their smile and feel better about themselves.”

Nervina will be collaborating with Dr. Sunil Kapila, chair of the Department of Orthodontics and Pediatric Dentistry; David Blaauw, professor of electrical and computer science at the College of Engineering; and Yogesh Gianchandani, professor and director of Integrated Microsystems at the College of Engineering.

Enthused with Nervina’s initiative, Kapila said “the smart expander has tremendous potential to improve the quality of treatment outcomes for patients with cleft lip and palate.”