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PubMed2000

Maxillary distraction osteogenesis: a method with skeletal anchorage.

Maxillary distraction osteogenesis is a challenging technique to treat severe maxillary retrusion. Maxillary advancement by distraction has the advantage to provide new bone in combination with simultaneous expansion of the soft-tissue functional matrix. Cleft lip and palate patients can present with severe maxillary retrusion and Class III malocclusion. Two 13-year-old patients, born with non-syndromic cleft lip and palate, underwent maxillary distraction--one had a bilateral, the other a unilateral complete cleft lip and palate. Maxillary advancement was performed using an external distraction device in combination with titanium miniplates as a skeletal maxillary anchorage. After a complete Lefort I osteotomy with pterygomaxillary disjunction, a latency period of 3 days was respected. On the fourth postoperative day, distraction was initiated at the rate of 1 mm/d. Preoperative clinical photographs, dental casts, lateral cephalograms, and panoramic radiographs were taken. Further lateral cephalograms were obtained after the latency period, after completion of the active period of distraction, at the completion of the consolidation period, and at 6 and 12 months postoperatively. The aesthetic outcome was excellent and skeletal advancement of 8 and 7 mm was measured without dentoalveolar compensations.

Adolescent↗
PubMed2006

Quality and quantity of bone following alveolar distraction osteogenesis in the human mandible.

PURPOSE: The purpose of this prospective study on humans were to evaluate (a) the clinical outcome of alveolar distraction osteogenesis for the correction of vertically deficient edentulous mandibular ridges, (b) the clinical outcome of dental implants placed in the distracted areas, and (c) the quality and quantity of the bone that had formed in the distraction gap. MATERIAL AND METHODS: Seven patients presenting vertically deficient edentulous ridges were treated by means of distraction osteogenesis with an intraoral alveolar distractor. Approximately 3 months after consolidation of the distracted segments, 20 ITI solid screw SLA implants were placed in the distracted areas. Three to 4 months later, abutments were connected and prosthetic loading of the implants started. During implant site preparation, bone biopsies were taken at the implant sites with trephine burrs for histologic and histometric analyses. RESULTS: The mean follow-up after the initial prosthetic loading was 18 months (range 12-24 months). The mean bone gain obtained at the end of distraction was 7 mm (range 5-9 mm). The cumulative success rate of implants 2 years after the onset of prosthetic loading was 95%, whereas the survival rate of implants was 100%. The newly formed bone consisted of woven bone reinforced by parallel-fibered bone with bone marrow spaces between the bone trabeculae. The bone area fraction in the distraction region ranged from 21.6% to 57.8% (38.5+/-11.7%). DISCUSSION AND CONCLUSIONS: Results from this study showed that (a) distraction osteogenesis is a reliable technique for the correction of vertically deficient edentulous ridges, (b) the regenerated bone withstood the functional demands of implant loading, (c) survival and success rates of implants placed in the distracted areas were consistent with those of implants placed in native bone, and (d) there is sufficient bone volume and maturity in the distracted region for primary stability of the implant.

Adult↗
PubMed2006

A case of Paget's disease treated by distraction osteogenesis.

Paget's disease is a localized bone disorder marked by increased turnover usually associated with a deformity of the affected bone. Distraction osteogenesis may be a useful method for correcting the deformity. A 57-year-old woman with Paget's disease had a 3 cm limb-length discrepancy with a 47 degrees procurvatum deformity of the ipsilateral femur. Distraction osteogenesis using a Taylor Spatial Frame was performed, leading to complete correction of the procurvatum deformity and limb-length discrepancy. After improvement of the limb-length discrepancy, the patient felt more comfortable than she had before surgery with less low back pain. This result suggests distraction osteogenesis may be appropriate for the treatment of some severe, complex deformities of the lower limbs in patients with Paget's disease.

Female↗
PubMed2006

[Distraction osteogenesis for treatment of unilateral temporomandibular joint ankylosis and secondary OSAHS in children: report of 4 cases].

PURPOSE: To evaluate the efficiency of distraction osteogenensis for treatment of unilateral temporomandibular joint ankylosis and secondary OSAHS in children. METHODS: 4 children with temporomandibular joint ankylosis and secondary OSAHS were retrospectively reviewed for their treatment. There were 2 males and 2 females, ranging from 5 to 13 years in age with the median of 6.5 years. Based on the history of the disease, the clinical manifestations, CT scan and PSG findings, the diagnosis was confirmed to be unilateral temporomandibular joint ankylosis and secondary OSAHS. All the patients were treated by gap arthroplasty to restore mouth opening, combined with mandibular body distraction osteogenesis for treatment of OSAHS. One-stage operation was performed on 3 patients, and two-stage operation on 1 patient. Unilateral and bilateral mandibular distraction osteogenesis was undergone on 2 patients individually. At the end of consolidation period of 3 months, the PSG examination was performed again and the distractor was removed. RESULTS: OSAHS was cured, the average AHI was lowered from 42.7 to 4.9, the average lowest saturation of blood oxygen rose from 74.3% to 89.8%, the average incisor distance reached 25.5mm compared to 6.5mm before surgery and facial deformity was corrected satisfactorily. Following up 38.1 months (13-58 months), no relapse appeared. CONCLUSION: Mandibular body distraction osteogenesis, combined with gap arthroplasty, could be the potential treatment modality for children with unilateral temporomandibular joint ankylosis, secondary OSAHS and facial asymmetry; it is recommended that both procedures be performed at the same time.

Adolescent↗
PubMed2005

Relationships between tissue dilatation and differentiation in distraction osteogenesis.

Mechanical factors modulate the morphogenesis and regeneration of mesenchymally derived tissues via processes mediated by the extracellular matrix (ECM). In distraction osteogenesis, large volumes of new bone are created through discrete applications of tensile displacement across an osteotomy gap. Although many studies have characterized the matrix, cellular and molecular biology of distraction osteogenesis, little is known about relationships between these biological phenomena and the local physical cues generated by distraction. Accordingly, the goal of this study was to characterize the local physical environment created within the osteotomy gap during long bone distraction osteogenesis. Using a computational approach, we quantified spatial and temporal profiles of three previously identified mechanical stimuli for tissue differentiation-pressure, tensile strain and fluid flow-as well as another candidate stimulus-tissue dilatation (volumetric strain). Whereas pressure and fluid velocity throughout the regenerate decayed to less than 31% of initial values within 20 min following distraction, tissue dilatation increased with time, reaching steady state values as high as 43% strain. This dilatation created large reductions and large gradients in cell and ECM densities. When combined with previous findings regarding the effects of strain and of cell and ECM densities on cell migration, proliferation and differentiation, these results indicate two mechanisms by which tissue dilatation may be a key stimulus for bone regeneration: (1) stretching of cells and (2) altering cell and ECM densities. These results are used to suggest experiments that can provide a more mechanistic understanding of the role of tissue dilatation in bone regeneration.

Animals↗
PubMed2003

Volumetric change of the medial pterygoid following distraction osteogenesis of the mandible: an example of the associated soft-tissue changes.

Mandibular distraction osteogenesis lengthens not only the affected skeleton but also the associated muscles of mastication. The purpose of this study was to determine medial pterygoid volume before and after distraction by using computed tomography. Using computed tomographic scans, the volume of the medial pterygoid muscle was determined before and after mandibular distraction in six pediatric patients. In four unilateral distraction patients (average age, 65 months), the average increase of the medial pterygoid muscle on the distracted side of the mandible was 29 percent, and on the contralateral nondistracted side, 10 percent. The average increase in medial pterygoid muscle volume in two bilateral distraction patients (each aged 8 months) was 75 percent. Results of this study demonstrate that distraction osteogenesis of the human mandible not only lengthens deficient bone, but it also increases the volume of the attached musculature.

Child↗
PubMed2004

Novel development for intraoral distraction osteogenesis by individually fabricated traction prostheses.

Modified fixed or removable partial dentures are used for intraoral distraction osteogenesis. These traction prostheses rest on teeth or endosseous implants and direct distraction forces to an endosseous implant in the osteotomy segment. This article explains the fabrication and function of custom-made traction prostheses for 1-, 2- and 3-dimensional distraction osteogenesis.

Dental Abutments↗
PubMed1999

Successful distraction osteogenesis across a growing cranial suture without an osteotomy.

The application of distraction osteogenesis to the membranous bones of the craniofacial skeleton and its effects on cranial volume and overall skull shape have not been fully studied. This pilot study was designed to compare distraction of a cranial suture in the rabbit model with distraction across an osteotomy and to evaluate the response of the suture both grossly and histologically. Additionally, the need for a period of rigid fixation after distraction was evaluated. Calibrated distraction of either the coronal suture or an osteotomy in the midsection of the parietal bone using an internal distractor (Synthes Maxillofacial, Paoli, Pa.) was studied in juvenile and adult New Zealand White rabbits. Skull growth and distraction were followed by serial cephalograms, and bone biopsies of the distracted sites were obtained after death for histologic evaluation. Craniometric analysis of the skulls was also performed. There was significantly greater mean marker separation in the juvenile suture distraction group (6.6 +/- 0.2 mm; n = 3) than in the control group (2.2 +/- 0.2 mm; p < 0.01). Marker separation was also significantly greater across the parietal osteotomy (6.4 +/- 0.1 mm) than in the sham group (no marker separation). Craniometric data demonstrated the ability of the juvenile skull to distribute the change at the coronal suture throughout the skull to maintain symmetry and minimize disproportion. No distraction was obtained across the adult suture. In the juvenile suture distraction group without a period of stable fixation, a relapse of 17 +/- 6 percent was noted after 1 week, an additional 2.3 +/- 0.5 percent after the second week, and no further change in the third postdistraction week (n = 2; p < 0.01). These results show that in this animal model, distraction osteogenesis can be achieved across a growing cranial suture without an osteotomy or suturectomy and that the degree of distraction and new bone formation is comparable to that across an osteotomy. This suggests that cranial expansion can be obtained in a growing animal without using a more invasive cranial osteotomy. Additionally, the first week after distraction seems to be the most critical time period to maintain stable fixation.

Animals↗
PubMed2000

Low-intensity pulsed ultrasound accelerates bone maturation in distraction osteogenesis in rabbits.

We investigated the effects of low-intensity pulsed ultrasound on distraction osteogenesis in a rabbit model. Callotasis of the right tibia was performed in 70 male Japanese white rabbits using mini-external fixators. In the first part of the study in 64 animals using normal distraction (waiting period seven days; distraction rate 0.5 mm/12 hours; distraction period ten days), we evaluated the distraction site by radiography, measurement of the bone mineral density (BMD), mechanical testing, and histology. In the second part in six rabbits using fast distraction (waiting period 0 days; distraction rate 1.5 mm/12 hours; distraction period seven days) the site was evaluated radiologically. Half of the animals (35) had received ultrasound to their right leg (30 mW/cm2) for 20 minutes daily after ceasing distraction (ultrasound group), while rigid fixation only was maintained in the other half (control group). With normal distraction, the hard callus area, as shown by radiography, the BMD, and the findings on mechanical testing, were significantly greater in those receiving ultrasound than in the control group. Histological analysis showed no tissue damage attributable to exposure to ultrasound. With fast distraction, immature bone regeneration was observed radiologically in the control group, while bone maturation was achieved in the ultrasound group. We conclude that ultrasound can accelerate bone maturation in distraction osteogenesis in rabbits, even in states of poor callotasis.

Animals↗
PubMed1999

Mandibular lengthening by distraction osteogenesis in children--a one-year follow-up study.

OBJECTIVE: The present study was undertaken to document whether mandibular length could be increased by distraction osteogenesis in children and what happens to the mandibular position 1 year after the distraction. METHODS: Five patients with hemifacial microsomia (four unilateral, one bilateral) had distraction osteogenesis performed to lengthen the mandible. All patients had cephalometric and panoramic radiographs obtained before and 3, 6, and 12 months after the distraction osteogenesis. RESULTS: The total mandibular length (Co-Gn) on the affected side was increased by 11.2 mm after the distraction and remained stable during a 1-year observation period. However, the increased mandibular length tended to move the chin downward (8 mm) more than forward (2 mm) during the same period. CONCLUSIONS: Distraction osteogensis can be used to lengthen the hypoplastic mandible. However, most of the increased mandibular length moved the chin downward more than forward.

Activator Appliances↗
PubMed2003

Low-intensity ultrasound stimulation in distraction osteogenesis in rabbits.

Low-intensity pulsed ultrasound has been shown to accelerate fracture healing. This experiment investigated its possible role in distraction. Thirty-four New Zealand White rabbits had distraction osteogenesis, followed by low-intensity pulsed ultrasound therapy. Seventeen animals had the ultrasound transducer switched off (controls). Four and 6 weeks postoperatively, tibiae were analyzed using quantitative computed tomography and four-point mechanical testing. Two tibiae from each group had histologic analysis at 4 weeks. No significant differences were identified between regenerates of ultrasound-treated and control groups with respect to bone mineral content, cross-sectional area, and strength. No significant reductions in osteopenia proximal and distal to the regenerate were observed. Histologic observation showed no differences in bone volume fraction, but ultrasound-treated regenerates appeared to have fewer trabeculae of increased thickness, and fewer osteoclasts. The modulation by ultrasound may occur by accelerating endochondral ossification through action on chondrocytes, yet distraction osteogenesis is largely intramembranous. Although ultrasound is proven to be effective in unconstrained systems such as plaster, the current study does not support the role of low-intensity pulsed ultrasound as an adjunct for patients having distraction osteogenesis in a rigid fixator. Additional research is needed to definitively support the use of low-intensity pulsed ultrasound in such situations.

Animals↗
PubMed2006

Monobloc advancement by distraction osteogenesis decreases morbidity and relapse.

BACKGROUND: Treatment of midface hypoplasia and forehead retrusion with monobloc advancement is associated with significant complications, including meningitis, prolonged intubation, and frontal bone flap necrosis. To see whether distraction of the monobloc segment offered decreased morbidity, the authors compared clinical outcomes of patients who underwent conventional monobloc advancement with those of patients who underwent monobloc distraction. METHODS: Group 1 (conventional monobloc; n = 12) underwent traditional monobloc advancement with bone grafting. Group 2 (modified monobloc; n = 11) did not receive ventriculoperitoneal shunts and underwent the above procedures with placement of a pericranial flap and fibrin glue over the midline defect. Group 3 (monobloc distraction; n = 24) underwent advancement of the monobloc segment by distraction osteogenesis using internal distraction devices. Complications included meningitis, cerebrospinal fluid leak, frontal bone flap loss, and wound infection. Preoperative, postoperative, and follow-up lateral cephalograms were used to assess horizontal changes of the forehead, midface, and maxilla. RESULTS: Group 3 (distraction monobloc) had the lowest complication rate (8 percent), followed by groups 2 (modified monobloc; 43 percent) and 1 (conventional monobloc; 61 percent) (p < 0.05). Group 3 achieved greater advancement (12.6 mm) than did group 2 (9.4 mm) or group 1 (9.1 mm) (p < 0.05). Relapse was least in group 3 (8 percent) compared with groups 2 (67 percent) and 1 (45 percent). CONCLUSIONS: Monobloc advancement by distraction osteogenesis had less morbidity and achieved greater advancement with less relapse compared with conventional methods of acute monobloc advancement with bone grafting. Monobloc distraction is superior to conventional methods of acute monobloc advancement and is an alternative to staged fronto-orbital advancement followed by Le Fort III advancement.

Adolescent↗
PubMed1999

[Establishment of the animal models of mandibular distraction osteogenesis].

OBJECTIVE: To establish the animal models of mandibular distraction osteogenesis in rabbits and study its osteogenetic mechanism. METHODS: The right mandibles just anterior to the first molars of 12 rabbits were performed osteotomies, and the mandibles were positioned with distractors. The left mandibles were control group without operation. After 1 week, the distractors were stretched 0.9 mm every day for 10 days progressively. One day, 2, 4, 8 weeks after distraction, the mandibles were studied with gross measurement, X-ray, and histological examination. RESULTS: The right mandible were lengthened 8.3 mm on average without bone nonunion and deformity healing. It was observed that the gaps between the distracted bone edges were first occupied by fibrous tissue. Two weeks after distraction, it was found that the gaps were bridged by callus in X-ray, the new bone and the normal bone could not be differentiated clearly after 8 weeks. In histological sections, there were collagen bundles in early distraction, then those collagen bundles were calcificated and become trabeculaes. No Cartilage was found during distraction. CONCLUSION: It suggests that the rabbit mandible can be lengthened by distraction osteogenesis, and the new bone is formed by intramembranous ossification.

Animals↗
PubMed2003

The use of rapid prototyping in the preoperative planning of distraction osteogenesis of the cranio-maxillofacial skeleton.

OBJECTIVE: In cranio-maxillofacial surgery, the principle of distraction osteogenesis (DO) can be used for the reconstruction of the deformed skull, midface complex, mandible and alveolar ridge. Optimal results can only be obtained with accurate planning of the osteotomies and accurate positioning of the distraction device. In addition, the surgical planning must be transferred very precisely to the patient in the operating theater. The clinical accuracy and utility of stereolithographic models in cranio-maxillofacial distraction osteogenesis of the midface, mandible and alveolar ridge will be demonstrated. MATERIALS AND METHODS: Thirteen patients were treated by DO in the cranio-maxillofacial skeleton. Five patients suffered from midface retrusion and were treated by a LeFort III advancement. One patient suffered from an aseptic necrosis of the condylar process of the mandible and had a reconstruction of the condylar process by DO. Seven patients underwent an osteotomy of the alveolar ridge of the mandible with subsequent placement of distraction screws and implants because of advanced atrophy of the mandible. Following preoperative acquisition and conversion of the CT-scan data, a model was fabricated by stereolithography (SLA). Simulation of the osteotomies and placement of distraction devices was performed on these models, then surgical guides were used to transfer the surgical planning to the patient in the operating theater. Pre- and postoperative facial photographs and X-rays were compared to evaluate the accuracy of the transfer procedure. RESULTS: In all cases, matching of pre- and postoperative facial photographs and X-rays showed reconstruction of the bony structures to be as accurate as planned on the SLA models. Transfer of the surgical plan by means of custom-made surgical guides was optimal in all cases. CONCLUSION: Preoperative planning of distraction osteogenesis of the cranio-maxillofacial skeleton and transfer to the operating theater by custom-made surgical guides remains the standard procedure for the planning of complex distraction cases. However, improvements in surgical simulation software and accurate virtual-reality surgery will probably make the use of these models redundant in the future.

Adolescent↗
PubMed2006

Maxillary distraction osteogenesis using Le Fort I osteotomy without intraoperative down-fracture.

The aim of this study is to present a technique for maxillary distraction osteogenesis using Le Fort I osteotomy without down-fracture. Six cleft-related patients suffering from severe midfacial deficiency were treated with maxillary distraction osteogenesis. The RED II system was chosen as the extraoral device and the Leipzig retention plate system to anchor the maxillary segment. Maxillary distraction osteogenesis was successful in all cases. Cephalometric and clinical evaluation after an average follow-up period of 1 year showed stable results with respect to skeletal and dental relationships. The SNA angle increased from 72.3 degrees to 81.4 degrees and the ANB angle increased by 11.0 degrees immediately after removing the distraction device. After 1 year, the sagittal bone gain remained and the SNA angle had decreased by 0.8 degrees . This technique seems to minimize the risk of the surgical procedure and shorten the operation time. It may become an alternative method for the treatment of patients with severe midfacial hypoplasia.

Adolescent↗
PubMed2005

Mandibular distraction osteogenesis for endosseous dental implants.

Patients with complete or partial edentulism who have insufficient bone for endosseous dental implant treatment present a challenge for the dental practitioner. Alveolar distraction osteogenesis is a technique for creating bone and soft tissue, without the need for bone grafting and its potential complications. In this article, alveolar distraction osteogenesis is compared with traditional bone grafting techniques. A case is presented to illustrate successful bilateral mandibular vertical distraction osteogenesis with creation of adequate bone volume for endosseous implant-supported dental restoration.

Alveolar Bone Loss↗
PubMed1998

Mandibular distraction osteogenesis in the treatment of upper airway obstruction in children with craniofacial deformities.

Over the past 3 years, 16 patients (12 males, 4 females) have undergone mandibular distraction osteogenesis in conjunction with soft-tissue procedures to treat medically refractory obstructive sleep apnea. Thirty distraction devices were placed for bilateral distraction in 14 children and unilateral distraction in 2. The mean age of treatment was 4 years and 8 months (range 14 weeks to 12 years and 8 months). Eight of the patients had failed conventional medical and surgical treatment of obstructive sleep apnea and were considered tracheostomy candidates, whereas the remaining eight had tracheostomies placed shortly after birth for upper airway obstruction. These eight children could not be decannulated by standard protocols. The average distraction distance was 25 mm (range 18 to 35 mm). To date, seven of the eight patients with tracheostomies have been decannulated, and one is still in progress. Clinical improvement in the signs and symptoms of sleep apnea and reduction or elimination of preoperative oxygen requirements occurred in seven of the eight children with medically refractory sleep apnea. Twelve-channel polysomnograms were obtained preoperatively and postoperatively in each of the eight patients without tracheostomies. Respiratory disturbance index decreased from a mean of 7.1 to 1.7 after surgery. Lowest oxygen saturation rose from a mean of 0.70 to 0.89 after surgery. Application of mandibular distraction osteogenesis is an important component in the treatment of obstructive sleep apnea and permits mandibular advancement in the younger child. As more experience is gained with distraction osteogenesis in the treatment of children with obstructive sleep apnea, the role of distraction will become better defined.

Airway Obstruction↗
PubMed1999

Decreased expression of osteocalcin and osteonectin in relation to high strains and decreased mineralization in mandibular distraction osteogenesis.

In a rabbit model of mandibular distraction osteogenesis, high strains resulted in a substantial reduction in the expression rate of the two osteogenic marker proteins, osteocalcin and osteonectin. In non-distracted samples and mandibles exposed to 2000 microstrains, staining for osteocalcin in the osteotomized area was detected in osteoblasts and diffusely dispersed in the mineralized matrix of the surrounding bone. However, in osteotomized mandibles distracted at strains above physiological levels (200,000 and 300,000 mustrains, respectively) the majority of osteoblast-like cells failed to express immunodetectable amounts of osteocalcin. Similarly, in the extracellular matrix of the distraction area the expression of osteonectin decreased by applying higher strains. Ultrastructural analyses of mandibular samples exposed to hyperphysiological strains revealed that the reduced expression rate of osteocalcin and osteonectin was paralleled by a significant loss of crystal formation, suggesting a functional role of both proteins related to mechanical loading.

Animals↗