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PubMed1991

Distraction osteogenesis. Applications for mandibular regrowth.

One experimental surgical technique of bone replacement demonstrates the greatest potential for clinical applicability in the near future: the regrowth of bone by distraction (stretching). Distraction osteogenesis defines the technique of growing new bone by stretching existing bones. Although this technique does not represent the ultimate method of mandibular reconstruction, it shows sufficient promise that its eventual use for specific types of mandibular defects probably will occur in the near future.

Animals↗
PubMed2000

Temporal and spatial expression of bone morphogenetic protein-2, -4, and -7 during distraction osteogenesis in rabbits.

The Ilizarov method of limb lengthening makes use of the fact that osteogenesis is induced at an osteotomy site when distraction is applied. It is unknown at present how the mechanical forces created by distraction are translated into biological signals. Because bone morphogenetic proteins (BMPs) are potent inducers of osteogenesis in many experimental systems, they are obvious candidates for playing a role in this process. In this study, we investigated the temporal and spatial expression of BMP-2, -4, and -7 proteins during distraction osteogenesis using immunohistochemistry. An osteotomy was performed on the right tibiae of white New Zealand rabbits. After a delay of 7 days, distraction was started at a rate of 0.25 mm/12 h for 3 weeks, followed by a 3 week consolidation phase. Each week after osteotomy one rabbit was killed for immunohistochemical studies. Staining for BMP-2, -4, and -7 was evident before distraction was applied and was mainly localized to mesenchymal cells and osteoblastic cells in the periosteal region. After distraction was started, the typical fibrous interzone developed between the osteotomy fragments, where both intramembranous and endochondral ossification were noted. In this area, cells resembling fibroblasts and chondrocytes, but not mature osteoblasts, showed intense staining for all three BMPs. This high level of expression was maintained during the entire distraction phase and then gradually disappeared during the consolidation phase. These results are compatible with the hypothesis that BMPs play an important role in the signaling pathways that link the mechanical forces created by distraction to biological responses.

Animals↗
PubMed2000

Temporal and spatial expression of bone morphogenetic protein-2, -4, and -7 during distraction osteogenesis in rabbits.

The Ilizarov method of limb lengthening makes use of the fact that osteogenesis is induced at an osteotomy site when distraction is applied. It is unknown at present how the mechanical forces created by distraction are translated into biological signals. Because bone morphogenetic proteins (BMPs) are potent inducers of osteogenesis in many experimental systems, they are obvious candidates for playing a role in this process. In this study, we investigated the temporal and spatial expression of BMP-2, -4, and -7 proteins during distraction osteogenesis using immunohistochemistry. An osteotomy was performed on the right tibiae of white New Zealand rabbits. After a delay of 7 days, distraction was started at a rate of 0.25 mm/12 h for 3 weeks, followed by a 3 week consolidation phase. Each week after osteotomy one rabbit was killed for immunohistochemical studies. Staining for BMP-2, -4, and -7 was evident before distraction was applied and was mainly localized to mesenchymal cells and osteoblastic cells in the periosteal region. After distraction was started, the typical fibrous interzone developed between the osteotomy fragments, where both intramembranous and endochondral ossification were noted. In this area, cells resembling fibroblasts and chondrocytes, but not mature osteoblasts, showed intense staining for all three BMPs. This high level of expression was maintained during the entire distraction phase and then gradually disappeared during the consolidation phase. These results are compatible with the hypothesis that BMPs play an important role in the signaling pathways that link the mechanical forces created by distraction to biological responses.

Animals↗
PubMed1994

Mechanical forces as predictors of healing during tibial lengthening by distraction osteogenesis.

Direct axial loads were measured weekly during a 15% left tibial lengthening in 21 skeletally mature dogs using three in-line load cells mounted between the rings of an Ilizarov external fixator. The loads increased linearly over time to a maximum at the end of distraction (Week 4). The metaphyseal lengthening sites (mean, 155 N) generated significantly higher loads than diaphyseal sites (mean, 111 N). Stress was calculated by dividing measured load by the computed tomographic-measured cross-sectional area of each distraction osteogenesis site; the metaphyseal and diaphyseal groups demonstrated equal stress at each time point with a maximum of 47 N/cm2 at the end of distraction. Six premature consolidations occurred that demonstrated loads significantly greater than 200 N by Week 2 of distraction. Three nonunions occurred that had significantly lower loads measured by Week 3 of distraction (mean, 60 N or 26 N/cm2).

Animals↗
PubMed2001

[Mandibular advancement: osteotomy or distraction osteogenesis? A case report].

From an experience in osteogenic distraction techniques acquired since 1993 and facing a case of retromandible, the authors have tried to define the criteria leading them to suggest a distraction rather a classical surgical procedure. The selection of the patient is based upon the age, the significance of the advancement, the asymmetry of the advancement and the former existence of a temporomandibular joint degenerative disease. Monitoring the distraction, in particular with per- and post-distraction orthodontics, remains complicated. The overcorrection and the reduction of recurrences after advancement using distraction remain openly discussed.

Adolescent↗
PubMed1995

Surgically assisted-rapid orthopedic lengthening of the maxilla in primates--relapse following distraction osteogenesis.

A recent study has shown that the maxilla in primates can be successfully lengthened (0.5 mm every other day up to 6.0 mm) by means of surgically assisted-rapid orthopedic movement, using the principles of distraction osteogenesis. The present study was designed to determine if the maxilla can be advanced at a faster rate and if relapse would occur after removal of the orthodontic appliance. Metallic markers were placed in the cranial base and maxilla of two Cynomolgus primates, and cephalometric radiographs were taken. Bilateral horizontal and interdental osteotomies were created between in the first premolars and the canines, and the anterior segment was completely mobilized. An orthodontic appliance was bonded to the teeth and the screw was closed, compressing the osteotomy site. One week postoperatively the appliance was opened four quarter turns every day until the anterior segment was advanced by 10 mm. Cephalometric radiographs were taken at 6, 8, and 12 weeks postadvancement. At 12 weeks, the orthodontic appliance was removed, and at that time and 2, 4, and 6 weeks later, cephalometric radiographs were taken and study models fabricated. At the end of the postretention period, the animals were sacrificed, and the maxillae were evaluated by light microscopy. Results showed that the maxilla can be successfully advanced at a faster rate and for longer distances, and that the advanced maxilla does not relapse during the 6-week postretention period.

Animals↗
PubMed2000

[Suture distraction osteogenesis for closure of cleft palate in the dog: long-term effect and its influence on facial growth].

OBJECTIVE: The purpose of the study was to evaluate the long-term effect and its influence on facial growth of suture distraction osteogenesis for closure of cleft palate. METHOD: 14 Beagle dogs were used in the study. Six of them were in the experimental group, eight served as the control. Direct measurements were taken on dry skulls of the dogs and the data were analysed statistically. RESULTS: The results showed that bony healing at the midline between the two horizontal portions of the palatine bones appeared in all the experimental dogs. There were no significant differences in the variables of facial length and height between the two groups. But the facial width and the distance between the two vertical portions of the palatine bones were significantly less in the experimental dogs than the control. CONCLUSIONS: It is suggested that bony repair of the cleft could be accomplished permanently with the technique of sutural distraction. This technique had no influence on facial length and height growth, but could led to underdevelopment of the width of the face and the respiratory tract of the palatal portion.

Animals↗
PubMed2002

Distraction osteogenesis enhanced by osteoblastlike cells and collagen gel.

Femoral distraction was done in rats to determine whether the injection of osteoblastlike cells with collagen gel into the distracted callus was useful for new bone formation. The cells were obtained from the femoral marrow of Sprague-Dawley rats and cultured for approximately 3 weeks. These rats were divided into four groups. The rats in Group A received injections of physiologic saline, those in Group B received injections of collagen gel, those in Group C received injections of cells, and those in Group D received injections containing a mixture of cells and collagen gel. The distracted areas were harvested and evaluated by histologic analysis, radiography, three-point bending testing, and the weight of femoral ash. Histologic evaluation did not show an immunoreaction between the donor and recipient. Radiographs showed that Group D had the most callus, and the fracture strength in this group as determined by the three-point bending test was higher than in Group A at 2, 4, and 6 weeks after elongation was completed. Group D showed a significant difference in the ash weight of the distracted femurs at 2 weeks. The current study showed that osteoblastlike cells with collagen gel promoted new bone formation in the distracted gap, and shortened the consolidation period.

Analysis of Variance↗
PubMed1996

Mandibular distraction osteogenesis as first step in the early treatment of severe dysgnathia in childhood.

The sole orthodontic treatment of severe dysgnathias in childhood often leads to unsatisfactory results. On the other hand, standard surgical procedures are very difficult and due to their high risks not practicable in early childhood. The distraction osteogenesis enables us to correct hypoplastic mandibles, so that secondary malformations of the midfacial complex can be avoided. During the operation the hypoplastic site of the mandible is osteotomized behind the last visible tooth bud and a bidirectional distractor is inserted. Following the principles of Ilizarov the new callus is lengthened gradually until the required length of the mandible has been achieved. Out of a total sample of 27 patients 3 case reports of young children are presented. The new surgical concept describes new treatment perspectives.

Adolescent↗
PubMed1994

Noninvasive determination of bone stiffness for distraction osteogenesis by quantitative computed tomography scans.

Apparent density of canine tibial specimens was correlated to measured quantitative computed tomography (QCT) numbers, and a conversion equation was derived. Finite element analysis models of canine tibiae were constructed using spatial coordinates of converted QCT data. Two QCT-derived finite elemental analysis models were constructed for a pair of matched tibiae: one lengthened 15% by distraction osteogenesis and one contralateral control. Two equations relating the modulus of elasticity to apparent density were used. These models were then verified mechanically by measuring strains of the two specimens under applied load. Equation I correlated best with measured strains in the less-dense regenerate bone of the distracted tibia (R2 = 0.914, p = 0.0028, n = 6); Equation II performed best in the denser control tibia (R2 = 0.820, p = 0.0129, n = 6). These results demonstrate that the stiffness of tubular bones, including cortical and heterogenous cancellous structure, can be accurately predicted by a noninvasive QCT scan.

Animals↗
PubMed2001

Metacarpal lengthening by distraction osteogenesis in childhood brachydactyly.

Metacarpal lengthening was performed by callus distraction in six children with brachydactyly. Four of the patients were girls and two were boys, with ages ranging from 10 to 14 years (mean age: 12 years). Four of the patients had brachydactyly resulting from injury to the hand and damage to the epiphysis related to infection, while the other two had congenital brachymetacarpia. Two patients had short thumbs, two had short index fingers, and the remaining two had short ring fingers. General anesthesia with a pneumatic tourniquet was used during surgery for all patients. Distraction was initiated on the sixth day following osteotomy, and distractions of 0.25 mm were carried out at 12-hour intervals. Adequate length was achieved in an average of 37 days (32-44), and adequate union of the bone in an average of 12.2 (11.5-15) weeks. No bone grafting was done. In one patient with congenital brachymetacarpia, it was not possible to achieve the desired length because of bending in the Kirshner wires, but union of the bone occurred without difficulty, and the outcome was satisfactory. Although single-stage metacarpal lengthening by callus distraction is time-consuming, it is a simple procedure without complications, which can be used in children with brachydactyly.

Adolescent↗
PubMed1995

Monobloc craniomaxillofacial distraction osteogenesis in a newborn with severe craniofacial synostosis: a preliminary report.

Severe craniofacial synostosis can be a devastating problem for a newborn infant. Reasons for early surgical intervention include cranial stenosis, hydrocephalus, inadequate globe and corneal protection, compromised airway patency, and feeding problems. In this preliminary report, we describe the management of severe craniofacial synostosis in a newborn infant by means of cranial and midfacial distraction osteogenesis.

Acrocephalosyndactylia↗
PubMed1999

Distraction osteogenesis of the mandible: a ten-year experience.

Mandibular distraction has been performed at the authors' institution for the past 10 years on a variety of craniofacial anomalies. This article reviews the experience with distraction and outlines the authors' treatment algorithms based on patient age and pathology. The roles of distraction versus conventional orthognathic surgery are reviewed. The need for preoperative surgical planning and postoperative orthodontic therapy is emphasized.

Adolescent↗
PubMed1999

Computer-aided surgery in distraction osteogenesis of the maxilla and mandible.

When using unidirectional intraoral distraction devices, it is desirable to be able to determine the final position of the bone fragment after the distraction procedure. However, additional constraining forces from adjacent tissues render the prediction of the distraction direction difficult. We have utilised computer-aided surgery in three patients for intraoperative control of the distraction direction. In one cleft palate patient, suffering from maxillary hypoplasia and anterior open bite, a modified Le Fort I osteotomy and maxillary distraction was performed. Despite a ventrocaudal position of the distraction device, intraoperative computer visualisation showed an unfavourable caudal vector of distraction without any anterior movement. The final result confirmed the direction indicated by the computer. Maxillary advancement remained insufficient. In two patients suffering from mandibular hypoplasia, intraoperative assessment revealed a favourable direction of distraction. The distraction procedure led to a satisfactory result in both cases. Computer-aided surgery is helpful in assessing the vector of distraction intraoperatively, making the result of the distraction procedure more predictable and allowing instant correction by adequate reapplication of the device.

Adolescent↗
PubMedDate not supplied

Complications of distraction osteogenesis in short fourth metatarsals.

This study investigated 47 callus distractions performed in 31 patients who had only shortening of the fourth metatarsals (20 feet in 13 children and 27 feet in 18 adults). The average percentage of lengthening was 35% in children and 30% in adults. The average healing index was 69 days/cm in children and 75 days/cm in adults. In both groups, major complications were stiffness or subluxation of the metatarsophalangeal (MP) joint and minor complications were varus angulation at the distraction site and pin tract infection. The incidence of major complications was 30% (6/20) in children and 48% (13/27) in adults. The results in children were 14 excellent and 6 good; results in adults were 14 excellent, 8 good, 3 fair, and 2 poor, according to American Orthopaedic Foot and Ankle Society (AOFAS) score. The unfavorable results occurred in patients with combined short proximal phalanx who required extra lengthening and led to subluxation of the MP joint. Distraction lengthening is an effective treatment method for short fourth metatarsals, but subluxation or stiffness of the MP joint must be avoided for satisfactory results.

Adolescent↗
PubMed2004

Distraction osteogenesis for the cleft lip and palate patient.

Gradual maxillary distraction by modified osteotomies and external force systems is a procedure with minimal morbidity and few complications. The interaction between surgeons and orthodontists is critical, however. The wide range of possibilities for remodeling a hypoplastic maxilla by distraction allows the potential to simultaneously advance and to elongate the midface, thereby restructuring the skeletal framework with mature new bone. An expansion of all the soft tissues of the face and palate (muscles, nerves, vessels, mucosa, skin) occurs in conjunction with bone elongation. This process ultimately produces excellent functional and aesthetic results in patients with midface deficiency, thus restoring their facial appearance and avoiding many years of facial deformity and associated psychologic sequelae.

Child↗
PubMed1995

Effect of bone cylinder length on distraction osteogenesis in the rabbit tibia.

The viability and osteogenic potential of bone cylinders for bone transport was investigated in one tibia of 18 mature male New Zealand rabbits. The length of the bone cylinder was equal to or twice that of the diameter of the tibia. The cylinder was cut subperiosteally with an externally cooled oscillating saw from a lateral approach, after a specific unilateral external fixator had been applied. To simulate bone transport, one end of the cylinder was fixed to the distal bone stump by a cerclage wire and healing and revascularization was prevented by an interposed expanded polytetrafluoroethylene membrane. The periosteum was re-adapted and sutured, and distraction began 10 days postoperatively at 0.25 mm/12 hours for 22 days. New bone formation in the distraction gap was quantified by dual energy x-ray absorptiometry and by computer-assisted histomorphometry of polyfluorochrome-labeled undecalcified bone sections and corresponding microradiographs. In half of the animals with each size cylinder, osseous bridging occurred, so the findings on distraction osteogenesis are reported only for the remaining nine animals. Generally, centripetal mineralization of the gap with two distinct zones of ripening bone structures and a central radiolucent fibrocartilaginous zone could be distinguished. Neither absorptiometry nor histomorphometry showed significant differences in the overall amount of this new bone formation for the bone cylinders of two different lengths. However, osteogenesis was significantly greater at the proximal end than at the cylinder. New bone was formed predominantly from endosteal sites in the smaller cylinders and from periosteal sites in the larger cylinders. Histologically, there was complete necrosis of both sizes of cylinders, followed by revitalization through newly formed vascular channels.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMedDate not supplied

Anterior maxillary alveolar distraction osteogenesis: a prospective 5-year clinical study.

PURPOSE: Anterior maxillary alveolar vertical distractions were followed for a 5-year period of time. MATERIALS AND METHODS: A total of 30 vertical distractions were done in 28 patients. Two patients had both anterior maxilla and anterior mandibular distractions for a total of 30 distractions. Two distraction techniques were used: an implant device (3i) and an orthodontic screw device (Osteomed) for orthodontic attachment. Both devices enabled some horizontal as well as vertical movement. The average net vertical distraction was 6.5 mm, but the average anterior horizontal movement was less than 2 mm. RESULTS: Eighty-four implants were placed, but 8 implants failed to integrate. DISCUSSION: All failed implants had been placed in poor quality bone that needed bone grafting. The most common restoration was a fixed prosthesis supported by implants; the longest follow-up post loading was 4.4 years. CONCLUSION: This clinical study gives additional evidence in favor of the stability and utility of vertical distraction procedures in the maxillary esthetic alveolar zone.

Alveolar Ridge Augmentation↗