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PubMed2001

[Preliminary study on orthodontic treatment before and after distraction osteogenesis].

OBJECTIVE: To get some guidelines for the orthodontic treatment before and after distraction osteogenesis (DO). METHODS: DO was performed in 4 patients maxilla and two for mandible. The patients were aged from 19 to 25 (average 21.5). We try to sum up the procedures and clinical experiences of pre- and post-surgery orthodontics. RESULTS: The procedures and experiences obtained are the followings: 1. Pre-surgery orthodontics for DO is simplified as alignment of dental arch in a short period. 2. Post-surgery orthodontics for DO is more complicated and peculiar. The main task is to make the opened posterior teeth occlude as soon as possible by light force vertical elastics. At the same time, some cross elastics may be needed for correction of posterior occlusal relationship. 3. Expansion of upper arch may be needed in some patients because of constricted dental arch. 4. Class II or III elastics may be used for prevention of relapse after DO. CONCLUSIONS: DO is a new technique in orthognathic surgery. Post-surgery orthodontics is more complicated and important in the treatment course.

Adult↗
PubMed2004

[Prognosis of three-dimension change at middle facial soft tissue with distraction osteogenesis].

PURPOSE: To evaluate the changes in middle facial soft tissue caused by distraction osteogenesis. METHODS: A three-dimensional finite element model was established based on the simulation of a 13-year-old female with skeletal class III malocclusion. Three approaches of osteotomy, namely Le Fort I, Le Fort II and Le Fort III, were simulated and the maxillary complex was advanced by 5mm in the direction of FH plane, functional occlusal plane and functional occlusal plane with deviation of counter-clockwise 10 degrees, respectively, some premeters indicating the contour of the facial soft tissue were evaluated. RESULTS: The three kinds of osteotomy in which different levels of osteotomied maxillary complex area were advanced. Changing in detail is that the nose tip moved forward 1.25 mm, upper lip moved forward 4.9 mm, and the angle of Cm-Sn-U1 tended to increase after Le Fort I osteotomy; and nose tip moved forward 4.9 mm after Le Fort II osteotomy without increase of the angle of Cm-Sn-U1; besides changes that happened after Le Fort II osteotomy, lower eyelid moved forward 2mm after Le Fort III osteotomy. CONCLUSION: By computer surgery simulation using three-dimensional finite element model, we can obtain not only the amount of the three-dimensional change of the facial soft tissue, but also the three-dimensional effected graphics after operations.

Adolescent↗
PubMed2005

Radiographic evaluation of alveolar distraction osteogenesis: analysis of 60 cases.

PURPOSE: The aim of this study was to evaluate radiographically the effectiveness of alveolar distraction osteogenesis (ADO) technique for vertical reconstruction of atrophy alveolar ridges in partially edentulous patients. MATERIALS AND METHODS: A total of 60 vertical distraction osteogenesis procedures were performed in 55 patients. Two panoramic radiographies were performed in all patients, one the day before the beginning of distraction, and one after consolidation period, 12 weeks postoperatively. The radiographic analysis consisted of obtaining the amount of the vertical bone gain (VBG) in each radiography. For this, we obtained initially the magnification factor (MF) of each panoramic radiography by dividing the real size (RS) of the activation rod among the image size (IS) of the activation rod. After this, to obtain the VGB, we measured initially the length of the distracton preactivation (LD1), which consisted of the distance between the superior portion of the basal plate and the superior portion of the transport plate, multiplying by the MF. Then, we measured the length of the distraction postactivation (LD2), using the same method described before, in radiographies performed 12 weeks postoperatively. The VBG was obtained using the following formula: VBG = LD2 - LD1. The results were applied to descriptive statistical analysis. Complications were also investigated during all of the treatments. RESULTS: The mean alveolar distraction achieved in 60 cases was 6.27 mm (range, 0 to 10.83 mm). According to the region treated, 51.6% were in the posterior mandible (mean VBG, 4.60 mm), 36.66% were in the anterior maxilla (mean VBG, 7.46 mm), 8.33% were in the anterior mandible (mean VBG, 6.73 mm), and 3.33% were in the posterior maxilla (mean VBG, 6.32 mm). The overall rate of complications that compromised the success of the technique was 8.44%. The increased radiopacity of the distracted region could be observed in the 12-week period after surgery. CONCLUSIONS: The ADO technique was demonstrated to be an effective tool to treat vertical defects of the alveolar ridge with a success rate of 91.66%. Our radiographic analysis seems to be an important tool in verifying the technique as well as planning implant placement after ADO.

Adult↗
PubMed1999

Distraction osteogenesis of free interpositional membranous bone: experimental design.

The purpose of this study is to explore the possibility of bone formation in distraction osteogenesis of the free interpositional membranous bone. Three canine dogs were used as subjects. Two mandibular osteotomies were made in the mandibular body. The oral soft tissue and periosteum of the segment between the two osteotomies were freed from periosteum and the surrounding soft tissue as a free interpositional bone graft 2 cm wide was created. The free interpositional bone was fixed to the proximal mandibular body with a miniplate. The external fixation device was applied to the proximal mandibular body and the distal mandibular body. Mandibular distractions were performed postoperatively at a rate of 1 mm/day for a total of 10-mm distraction for 10 days. The latency period was 1 week in Dog 1, 2 weeks in Dog 2, and 3 weeks in Dog 3. Three dogs were killed 6 weeks after distraction, and interpositional bone specimens were obtained. In Dogs 1 and 2, the free interpositional bone showed severe resorption and had no new bone formation at the distracted area. However, in Dog 3, new bone developed along the distracted gap. Our study demonstrated the possibility of distraction osteogenesis in the free interpositional membranous bone and suggested that free interpositional membranous bone be allowed, under rigid fixation device, to have enough revascularization from surrounding tissue to have osteogenesis for at least 3 weeks or even more.

Animals↗
PubMed2000

[Vertical distraction osteogenesis of the alveolar process using a tooth-borne device].

Since the communication of McCarthy et al. in 1992, applications for distraction osteogenesis in the maxillofacial complex have increased enormously. The advantages as compared to conventional reconstructive procedures are missing donor-site morbidity for bone graft harvesting, reduced blood loss and also a gradual gain in the soft tissue envelope. Meanwhile, even the vertical lengthening of the alveolar process has become a clinically reliable method. The case presented illustrates the treatment of a 16-year-old patient who suffered a sporting accident at the age of 7 years, leading to ankylosis of the upper middle incisors with subsequent underdevelopment of the frontal alveolar process. After fabrication of a custom-made distraction device, an osteotomy of the tooth-bearing segment in the upper front was performed and the segment was attached to the distraction device. Bone lengthening was started on the seventh postoperative day at a daily rate of 0.5 mm. The distraction was maintained until closure of the open bite was achieved. On the 22nd day, the segment was fixed using an orthodontic arch wire and the distraction device was removed. A retention period of 6 weeks was maintained until sufficient stability was detectable. Now, 1.5 years after the treatment, the situation is stable with a good consolidation of the bone fragments and a physiologically shaped gingivobuccal sulcus. Lengthening of the alveolar process by vertical distraction osteogenesis using a tooth-borne device may be indicated in certain cases. With this technique a second operation can be avoided and there is less risk of laceration of dental roots by fixation screws.

Adolescent↗
PubMed2004

Anesthetic concerns of external maxillary distraction osteogenesis.

BACKGROUND: External maxillary distractions present additional anesthetic concerns to the existing complexity of the patient with craniofacial disorder. The distraction hardware is rigidly fixed to the cranium and projects in the frontofacial midline, thus limiting oronasal airway access. METHODS: A review of 16 patients (10 male, 6 female) having external maxillary distraction was done. Patients with patent tracheostomies were excluded. In all cases, the same type of external distraction device was used (R.E.D., K.L.S. Martin, Jacksonville, FL, USA). Perioperative records were reviewed for medical history; operative diagnosis, presence of airway disease, tracheostomy, laryngoscopy grade, use of fiberoptic bronchoscope, procedure, operative time, use of intraoperative steroid, day of postoperative extubation, and need for reintubation were documented. RESULTS: The study group was subdivided into two diagnostic categories: those with syndromic craniosynostosis (n = 9) and those with cleft lip/palate (CLP) (n = 7). Patients in the craniosynostotic group had grade 1 laryngoscopy views, with the exception of a single patient with Crouzon syndrome who had a grade 3 view. This was the only patient who required fiberoptic intubation. One patient with Apert syndrome required reintubation (48 hours after surgery); successful extubation was done 96 hours later. In the cleft lip/palate group, all patients had grade 1 laryngoscopic views, except one with a grade 3 view; no patient required fiberoptic intubation. Six of the seven patients were extubated immediately after surgery, with one patient extubated the next day. No patient experienced failure of extubation. CONCLUSIONS: External maxillary distraction minimally affects anesthetic management provided certain safeguards are observed. The vertical bar can be left attached to the cranial portion of the distractor, or it can be removed for extubation or reintubation. Removal of the vertical bar allows unobstructed direct laryngoscopy. This emphasizes the importance for the emergent availability of the appropriate screwdrivers and wire cutters to remove the vertical bar and trained personnel to perform the removal.

Adolescent↗
PubMed2004

Effect of distraction osteogenesis on the severely hypoplastic mandible and inferior alveolar nerve function.

PURPOSE: The purpose of this study was to examine the effect of distraction osteogenesis surgery on the inferior alveolar nerve (IAN) and on the stability of the occlusion in patients undergoing mandibular osteotomy and advancement for correction of severe retrognathia. MATERIALS AND METHODS: Five patients (4 women and 1 man) underwent vertical posterior body osteotomy or bilateral sagittal split ramus osteotomy with the application of a distraction device for advancement of the mandible of 10 to 14 mm. After a period of latency, each mandible was advanced 1 mm per day until the patient achieved a Class I occlusion. Distraction devices were removed after a suitable period of consolidation (4 to 11 months). IAN sensory function was evaluated by 2-point discrimination, response to painful stimulus, and moving brush stroke identification. Testing of the IAN was performed on all patients at 7 different time intervals: preoperative (T0), postsurgery and predistraction (T1), within 7 days after the end of distraction (T2), 3 months after T2 (T3), 6 months after T2 (T4), 9 months after T2 (T5), and 1 year after T2 (T6). The same surgeon performed all IAN testing. RESULTS: There were no instances of malunion or fibrous union. At the 1-year follow-up, all 5 patients showed no relapse of their advancement as assessed by their maintenance of a Class I occlusion. Radiographic analysis was not done to discern skeletal versus dental stability. All 10 IANs were intact after the initial surgery. As time progressed, all 10 nerves showed improvement of function as measured by 2-point discrimination, response to painful stimulus, and moving brush stroke identification. At 1 year postsurgery, all 10 nerves showed function consistent with or very near presurgery levels. CONCLUSION: Stable mandibular advancements of 10 mm and greater can be successfully accomplished by distraction osteogenesis without producing significant damage to the IAN.

Adult↗
PubMed2001

Effect of chemotherapeutic agents on distraction osteogenesis. An experimental investigation in rabbits.

Limb-salvage operations such as vascularised or non-vascularised osseous grafts and allograft and callus distraction methods have replaced amputations because of the increase in the life expectancy of patients with malignant tumours. In this study we aimed to evaluate the effects of chemotherapeutic agents on distraction osteogenesis. For this purpose, 23 rabbits randomly divided into two groups were included in the study. The experimental group and the control group consisted of 12 rabbits and 11 rabbits, respectively. The experimental group were administered chemotherapeutic agents with the protocol identified in the osteogenic sarcoma regimen. All the subjects were corticotomised in the metaphyseal-diaphyseal region, and both groups underwent distraction with a circular ring fixator. X-ray films, bone scintigraphy and histopathological examination were performed three times during the study. No difference between the two groups was observed in radiological, scintigraphical and histopathological studies carried out before the distraction period and following the end of the distraction period. In this study, it was shown that the use of antineoplastic drugs has no significant negative effect on distraction osteogenesis applied for reconstruction in rabbits. We think that it can be an alternative treatment method in humans as well.

Animals↗
PubMed2005

Posterior mandibular alveolar distraction osteogenesis utilizing an extraosseous distractor: a prospective study.

BACKGROUND: The aim of this clinical study was to evaluate bone elongation and the effectiveness of distraction osteogenesis when utilizing an extraosseous distractor to treat cases of atrophic posterior mandible. METHODS: Fourteen surgical sites were evaluated in 10 healthy, non-smoking, female patients, with varying degrees of atrophic posterior mandible, who underwent surgery by alveolar bone distraction. The patients presented between 6 and 10 mm above the mandibular, inferior alveolar nerve. Panoramic radiographs were taken before surgery and at the beginning and end of the consolidation period. The extraosseous distractor was fixed to both the basal and the osteotomized bone. After a 7-day latency period, the patients rotated the distractor rod three times a day for 3 to 10 days (1 mm per day). The mobile segment was held in place for 8 to 12 weeks for bone consolidation. RESULTS: The results revealed a distraction range of 2.32 to 8.11 mm (mean distraction +/- standard deviation, 5.12 +/- 1.67 mm), which was less than the real, measured distance between the upper and lower miniplates of the distractor (5.58 +/- 1.62 mm). The bone segments showed between 0.03 and 2.53 mm (mean, 0.88 +/- 0.59 mm) resorption above the upper miniplate. The efficacy of the extraosseous distractor was calculated as between 30.41% and 94.58% (73.45% +/- 20.32%). CONCLUSIONS: Bone regeneration was obtained in all cases; however, when planning alveolar bone distraction using the extraosseous distractor, greater distraction should be performed to compensate for the inclination of the distractor rod and possible bone loss. This adjustment should increase the efficacy of distraction osteogenesis.

Adult↗
PubMed2001

[Vertical alveolar distraction osteogenesis of the posterior edentulous mandible: a case report].

When it is necessary to increase the vertical height of the residual alveolar ridge, alveolar distraction osteogenesis has numerous advantages compared to other preprosthetic surgical procedures. It is frequently used for this purpose in the anterior region because of the obvious accessibility. The authors present a clinical case of edentulous posterior mandible, with insufficient vertical alveolar bone height, treated by alveolar distraction osteogenesis leading to three titanium fixtures. They explain their choice and discuss the preliminary results.

Alveolar Process↗
PubMed1998

Expression of BMP-4 mRNA during distraction osteogenesis in rabbits.

We characterized the presence and localization of bone morphogenetic protein 4 (BMP-4) mRNA in the regenerating tissues produced by distraction osteogenesis following tibial osteotomy in the rabbit. The findings are consistent with previous reports on the localization of BMP-4 mRNA expression during fracture repair. The BMP-4 gene is expressed by less differentiated osteoprogenitor cells (fibroblastic mesenchymal cells and preosteoblasts), and not by fully differentiated osteoblasts. BMP-4 gene expression is localized in callus-forming tissue (muscle, periosteum) during callus formation. Our observations suggest that the BMP-4 gene product is one of the local contributing factors in regulating bone and cartilage formation in distraction osteogenesis.

Animals↗
PubMed1998

Evaluation of inferior alveolar nerve function during distraction osteogenesis in the dog.

PURPOSE: A series of electrophysiologic studies were performed in a canine model to evaluate inferior alveolar nerve (IAN) function during distraction osteogenesis of the mandible. MATERIALS AND METHODS: Fourteen dogs, including two controls, were used in the study. Twelve dogs underwent a 10-mm bilateral mandibular lengthening with an intraoral bone-borne appliance and midbody osteotomy. By using sensory nerve action potentials, IAN function was assessed before and immediately after surgery, before and at the completion of distraction, and before necropsy after 4, 6, or 8 weeks of fixation. RESULTS: Twelve of the 24 nerves showed a complete loss of evoked potential after surgery without recovery at any point throughout the study. Acute nerve injury caused by either the osteotomy or screw encroachment was identified at necropsy. The other 12 nerves showed reproducible responses after surgery. Eight of these nerves had significant amplitude attenuation of the evoked potentials, which was identified at necropsy as a result of acute injury. The remaining four nerves did not show significant evoked potential abnormalities and appeared to be grossly normal at necropsy. During distraction, the amplitude of evoked potentials in all 12 nerves remained at the postoperative level, whereas latency showed a significant delay. In 7 of these 12 nerves, various degrees of evoked potential recovery were identified at the completion of the study. CONCLUSIONS: The high incidence of acute IAN injury in the current study was primarily related to device construction and osteotomy technique. If acute nerve injury is avoided at surgery, distraction osteogenesis with 10 mm mandibular lengthening appears to produce minimal deleterious effect on IAN function.

Action Potentials↗
PubMed2003

Correction of shortening and/or angular deformities by distraction osteogenesis using AO-tubular fixator.

Eighteen patients (20 bony segments) who had shortening and/or angular deformities were treated by distraction osteogenesis using AO-tubular external fixator. The mean angular correction was 18.9 degrees (range, 8-40 degrees). Of the group in whom shortening and angulation was corrected, the mean length gained was 4.2 cm (3-6 cm). The mean treatment time was 4.9 months (range, 2-13 months) and the mean follow-up was 12 months after removal of the fixator (range, 3-30 months). Delayed union with loosening of the fixator occurred in one patient which resulted in residual shortening of 1.5 cm. The author's technique of distraction osteogenesis using AO-tubular fixator with the new distraction rate of 1 mm/48 h (1 mm/step) could adequately correct shortening and/or angular deformities. No extra equipment was needed other than the readily-available AO-tubular fixation systems. No serious complications such as neurovascular injury were encountered.

Adolescent↗
PubMed1999

[Dental assisted distraction osteogenesis of the mandible. Results of an animal experimental study and initial clinical application].

In recent years lengthening of the human mandible by distraction osteogenesis has become an accepted treatment for correction of severe mandibular disto-basal discrepancies. Using extra-oral and intra-oral distraction devices the technique of osseous anchorage is usually preferred. To avoid the disadvantages of this method it is the aim of many research groups to develop a tooth-borne distraction. In the present animal study, six minipigs were treated with a new solely dentally fixed orthodontic device for mandibular distraction osteogenesis. Following bilateral osteotomy in the dentigerous area of the mandibular body and a latent period of 2-7 days, a mandibular lengthening of 9 mm was reached within a period of 9 days. This situation was retained using the distraction device for 6 weeks. After the removal of the apparatus, there followed a period of another 6 weeks of consolidation. The callus and bone formation and potential dental, periodontal and nerval reactions were radiologically examined and histological examination was performed at the end of the experiment. At 12 weeks after the mandibular lengthening, the osteogenesis in the distraction areas was complete. No destructive processes were recognizable, either at the roots or at the periodontium of the teeth near the osteotomy gap. The mandibular nerve at the osteotomy site remained intact. The results justified transferring this procedure to humans. The clinical application of the device is presented.

Adult↗
PubMed2005

Efficacy of rhBMP-2 during distraction osteogenesis.

BACKGROUND: Osteoinductive ability of bone morphogenetic protein-2 (BMP-2) has been studied in recent reports. In this study, we evaluated the efficacy of BMP-2 during distraction osteogenesis. METHODS: A group of 24 Japanese white rabbits were divided into four groups randomly and underwent lengthening of the right femur. Distraction was performed for 2 weeks (1.0 mm/day). Group A began distraction following a 7-day waiting period after surgery. For all other groups (B-D), distraction was started immediately after surgery. Groups A and B did not undergo any surgical intervention at the osteotomy site, as a control. The delivery system for rhBMP-2 used a polymer-coated gelatin sponge (PGS). Buffer/PGS was implanted into the osteotomy site in group C, and group D received rhBMP-2/PGS. Callus was evaluated radiographically at 1, 2, 4, and 6 weeks after the surgery, and all rabbits were killed at 6 weeks. One rabbit from each group was examined histologically; the remaining five rabbits underwent biomechanical testing. RESULTS: A significant increase in callus formation was evident in group D compared with that in other groups. In group D, regenerative changes were evident during the earlier phase. Formation of bone cortex and bone marrow cavity was almost complete in group D, and the cortex was thicker than that in the other groups. Torsional strength values (10(-2) Nm) of each group were as follows: A, 118.7 +/- 52.4; B, 160.0 +/- 40.7; C, 106.8 +/- 8.1; D, 266.1 +/- 93.1. Stiffness values (10(-3) Nm/degree) were as follows: A, 390.2 +/- 137.2; B, 391.8 +/- 158.4; C, 183.1 +/- 78.5; D, 624.4 +/- 214.2. Group D exhibited the highest values for both torsional strength and stiffness. CONCLUSIONS: Acceleration of the regenerative changes during the early phase occurred in the BMP-2-treated group. The efficacy of BMP-2 in distraction osteogenesis was recognized radiographically, histologically, and by biomechanical testing (torsional strength and stiffness).

Animals↗
PubMed2004

[Dental tours de force 5. Bimaxillary transverse distraction osteogenesis].

A narrow anterior apical base in both jaws can cause pronounced crowding, which can be corrected by extraction therapy (as a rule extraction of four premolars) or by transverse distraction osteogenesis therapy (as a rule bimaxillary), followed by orthodontic treatment. A case is reported of bimaxillary transverse distraction osteogenesis in an eleven-year old female patient. Alignment was performed with fixed orthodontic appliances. Correction of the skeletal Class II relationship was done with a functional appliance. The active treatment time was eighteen months.

Child↗
PubMed2002

Clinical application of injectable calcium sulfate on early bony consolidation in distraction osteogenesis for the treatment of craniofacial microsomia.

The purpose of this project was to study the effect of calcium sulfate on early bony consolidation in distraction osteogenesis. A total of eight patients with craniofacial microsomia were treated between April 2000 and February 2001. The age of the patients ranged from 2 to 40 years, and all were male. The follow-up period was 1 to 15 months. The operative procedure in adults was based on Ortiz Monasterio's simultaneous mandibular and maxillary distraction technique. In children, osteotomy of the mandible was performed for distraction. On the fifth day after the operation, distraction was performed at a rate of 1 mm/d in three adults. In children, distraction was performed at a rate of 1 mm/d in one patient and 2 mm/d in four patients without a latent period. On the day of completion of distraction, calcium sulfate was implanted into the distracted zone. Radiographs showed bony consolidation at 4 weeks in one child at a rate of 1 mm/d, at 5 to 7 weeks in four children at a rate of 2 mm/d, and at 5 weeks in three adults after implantation of the calcium sulfate. In conclusion, these findings suggest that calcium sulfate is effective for early bony consolidation in distraction osteogenesis and that it would shorten the whole treatment period.

Adolescent↗
PubMed2001

[Distraction osteogenesis for the premaxillary reconstruction. Report of 3 cases].

Reconstructing the premaxillary is well-known for being difficult and usually requires a bone implant, in grafts or flaps. This technique has a high morbidity rate and its middle or long term results remain uncertain. Thanks to their experience and to the results they achieved in mandible and maxillary osteogenic distraction, the authors suggest applying the principle of distraction osteogenesis to the premaxillary reconstruction. Three patients have been treated: first, two hypoplasias of the premaxillary, sequelae of a cleft palate and of a former traumatic loss of teeth; secondly one premaxillary defect following a gunshot wound. The first two were women, the other one was man, all adults. For premaxillary distraction, an intraoral extramucosa device is made-up for each individual case before the surgical operation itself and after an orthognathic analysis. The surgical operation consists in a classical segmental maxillary osteotomy which respects the palatal periosteum, and also in fitting a distractor device with transmucosa screws into the palatal bone. In each of the three cases, with a follow-up from 24 to four months, the reconstruction of the premaxillary by distraction osteogenesis is considered satisfactory and stable as regards both bone and soft tissues. This achieves particularly a very good expansion of the fibrous mucosa of the palate which makes it possible to re-insert false teeth, with or without implants into the bone. The principle of distraction osteogenesis applied to premaxillary reconstruction has shown, in our cases, very good functional and aesthetic results. Yet the techniques we used are simple and have a low morbidity rate; secondly the distraction device is easy to design and little expansive.

Adult↗