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PubMed1998

Maxillary distraction: aesthetic and functional benefits in cleft lip-palate and prognathic patients during mixed dentition.

In the last few years, distraction techniques have been used successfully to correct the hypoplastic human mandible. In patients with cleft lip and palate, normal growth of the maxilla may be impaired by early cleft repair, and many of them do not respond to orthodontic procedures alone. Maxillary distraction is an alternative technique to correct maxillary hypoplasia during mixed dentition. In the last 3 years, the procedure was performed in 38 patients aged between 6 and 12 years; 18 patients had unilateral cleft lip and palate, 9 patients had bilateral cleft lip and palate, 7 patients had unilateral cleft palate, 2 patients had prognathism, and 2 patients had nasomaxillary dysplasia. Photographs, posteroanterior and lateral cephalograms, and dental models are obtained preoperatively (as well as an orthopantomogram) to locate the tooth buds. A subperiosteal dissection is performed exposing the anterior and lateral aspects of the maxilla, and an incomplete horizontal osteotomy is done above the tooth buds. Using a facial mask and an intraoral fixed appliance system as an anchorage, we initiate on the fifth postoperative day the application of distraction forces. Maxillary advancement between 4 and 12 mm is achieved during 3 to 4 weeks, and a satisfactory class I or II molar relationship is also obtained. A combination of forward and downward distraction forces can be used to achieve simultaneous advancement and elongation of the hypoplasic maxilla. The aesthetic results are excellent, and the nasolabial angle is increased, including a more anterior projection of the upper lip. Nasal breathing is improved as well as the air flow and patency of the nasal airway. Velopharyngeal function remains unchanged after the procedure. The follow-up in this series varied from 6 months to 3 years. No relapses have been observed.

Child↗
PubMed2005

Treatment of femoral nonunions by using cyclic compression and distraction.

UNLABELLED: Eleven patients with femoral diaphyseal nonunions after intramedullary nailing were treated with cyclic compression and distraction with an external fixator over the nail. We evaluated the limitations of this technique and whether patients having this closed procedure could achieve union without additional operative procedures. Patients with hypertrophic nonunions (n = 4) were treated with gradual compression of the nonunion site. Cyclic compression and distraction was done in patients with oligotrophic (n = 2) or atrophic nonunions (n = 5) to stimulate consolidation. The average age of the patients was 32.9 years (range, 21-48 years), and the average followup was 40.5 months (range, 24-64 months). Union was achieved in an average of 5.8 months in all patients after one operation and without additional surgical intervention. However, pain necessitating strong analgesic agents and pin-related complications consisting of osteomyelitis, septic arthritis, and pin breakage in the atrophic nonunion group were a major limitation of this technique. Based on our study, the cyclic compression and distraction technique can be used in hypertrophic and oligotrophic nonunions that have failed one or more prior exchange nailings. However, it might not be an option for treatment of patients with atrophic nonunions unless pin-site problems are resolved. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.

Adult↗
PubMed2003

Augmentation of the narrow traumatized anterior alveolar ridge to facilitate dental implant placement.

Traumatic tooth loss leads to alveolar resorption especially in sagittal direction. This can be due to avulsion of bone substance during the accident itself or due to resorption of the alveolar crest that takes place afterwards. Shortage of bone can prevent proper positioning of dental implants unless the volume of bone is increased before implantation. In the maxillary anterior area, this is also an esthetic problem. Several treatment modalities have been presented to augment the bone. This report reviews the latest literature on bone grafting, bone substitutes, guided bone regeneration, osteocompression and distraction which are potentially useful in the anterior maxilla. A special emphasis is paid to the versatility of using a crestal split osteotomy, by means of chisels and osteotomes to widen the narrow ridge. Three examples are illustrated showing onlay grafting, preservation of alveolar width with alloplastic coral material and lateral widening of a narrow maxillary alveolar ridge, using the crestal splitting technique.

Adult↗
PubMed2005

Effects of alternating current electrical stimulation on lengthening callus.

Limb lengthening by the callotasis method has been clinically applied to patients who suffered from limb length inequality, micromelia, angular deformation and partial bone defect on long bones. However, this technique was time consuming and led to various complications, such as infection at the pin insertion sites, limitation of the range of motion in adjacent joints, muscular weakness and peripheral neuroparalysis. This study was undertaken to investigate whether alternating current electric (AC) stimulation could shorten the maturation period during callotasis. The tibiae of 20 immature male Japanese white rabbits were osteotomized and fixed with external lengthener (Orthofix M100; Orthofix Srl, Bussolengo, Italy). The experimental schedule lasted 5 weeks consisting of 1 week for the latency period, 2 weeks for distraction and 2 weeks for maturation. Twenty rabbits were equally divided into two groups: the control group and the electrical stimulation (ES) group. The control group was not stimulated with an AC stimulator. The ES group was stimulated for 5 weeks just after osteotomy. The obtained results revealed radiologically, electrophysiologically and histologically that AC stimulation accelerated the maturation of lengthened callus and that it could shorten the time course of callus lengthening.

Animals↗
PubMedDate not supplied

Progressive forearm lengthening with an intramedullary guidewire in children: report of 10 cases.

Indications for forearm lengthening are rare. Between 1994 and 1999, 10 forearm lengthenings were performed in seven children for functional reasons and/or esthetic discomfort. Only one of the two forearm bones was involved in the procedure in all cases. The technique consisted of a transverse osteotomy and progressive distraction after intramedullary nailing. When a bone axis correction was needed, it was performed with a substraction osteotomy in the initial osteotomy site. The distraction device was removed when bone healing was achieved. The authors noted the various complications and assessed the amount of elongation, bone healing, and potential bone axis deviation. Mean follow-up was 4.5 years. Mean elongation was 30.8 mm. Four bone grafts were needed for delayed union. No bone axis deviation was noted. An initial axial correction osteotomy allows an easier lengthening procedure. Use of an intramedullary wire avoids axis deviation. This technique can be helpful in malformative pathologies.

Adolescent↗
PubMedDate not supplied

Consolidation period in alveolar distraction: a pilot histomorphometric study in the mandible of the beagle dog.

PURPOSE: Osteogenic alveolar distraction remains in an experimental stage. The present study aimed to compare histologic and histomorphometric results with 2 different consolidation periods (4 and 8 weeks) to determine which period obtained better bone quality after distraction with a prototype alveolar distractor. MATERIALS AND METHODS: Five beagle dogs were used. Four underwent alveolar distraction in an edentulous segment of the right mandible. After a 7-day latency period, distraction was carried out at a rate of 1 mm/d for 5 days; the consolidation period was 4 weeks in 2 dogs (group 1), and 8 weeks in the other 2 (group 2). The fifth dog was used as control (group 3); it underwent removal of its right premolars but not distraction. Histologic and histomorphometric studies were conducted. RESULTS: One animal from each distraction group was withdrawn from the study because of wound dehiscence that allowed invasion of mucosa into the distraction chamber, which was incompatible with bone regeneration. In the group 1 animal, a predominance of immature woven bone was observed in the distraction chamber, whereas the group 2 animal showed a predominance of immature parallel-fibered bone. The group 1 and 2 animals that remained in the study differed in bone area density in the distraction chamber (36.61% +/- 9.79% versus 58.72% +/- 8.30%), bone perimeter in the distraction chamber (262.89 +/- 10.46 mm versus 201.44 +/- 22.64 mm), total height attained (21.31 +/- 0.32 mm versus 18.37 +/- 0.50 mm), lingual trabecular width (134.00 +/- 15.56 versus 229.50 +/- 29.24), buccal trabecular width (90.00 +/- 4.24 mm versus 154.50 +/- 21.64 mm), lingual osteoid area density (4.08% +/- 0.46% versus 1.61% +/- 0.33%), and buccal osteoid area density (3.75% +/- 1.28% versus 2.09% +/- 0.79%). CONCLUSION: Quantitative and qualitative differences in newly formed bone were observed after 4 and 8 weeks of consolidation. These preliminary results serve as a basis for further experimental research with larger samples and for clinical studies.

Animals↗
PubMed1999

Advancement of the midface using distraction techniques.

Fourteen patients underwent Le Fort III midface advancement using distraction techniques. Six have cephalometric documentation extending beyond 1 year postoperatively, and the positions of cephalometric points A and orbitale over time are reported here. Excellent stability of advancement at the occlusal level and some relapse at the level of orbitale are documented. Elimination or diminution of obstructive sleep apnea occurred in all patients so affected, and one of two patients with tracheostomy has been decannulated. Speech effects have been mild or transient. No untoward effects on extraocular muscle function have occurred.

Cephalometry↗
PubMed2002

[Results of the facial skull bone defects and deformations repair by modern methods for plasty and fixation of bone fragments].

Methods of reconstructive maxillofacial operations bringing about the best functional and esthetic results are analyzed. Surgical methods for repair of maxillofacial bone defects and deformations with the use of transplants and different methods of their fixation depending on the tissues at the site of defect (deformation) in patients with acquired and congenital abnormalities of the facial skull have been developed and are used at Central Institute of Dentistry. Osteosynthesis using titanium constructions and compression-distraction devices is acknowledged as an effective method of bone repair operations on the face. It notably reduces the duration of operation and prevents the relapse of the deformation. Analysis was carried out on extensive clinical data (more than 1000 patients), which allowed an objective evaluation of remote results of plastic repair of bones and helped define the indications and contraindications for such operations.

Contraindications↗
PubMedDate not supplied

Limb salvage treatment for congenital deficiency of the tibia.

Nine limb salvage treatments were performed in 7 patients with congenital deficiency of the tibia. All feet showed equinovarus deformity and were centralized in a slightly equinus position by placing the distal end of the fibula into the posterior facet of the calcaneus. Tibiofibular fusion was performed in 4 patients with partial deficiency, and fibular transfer (fibular centralization; Brown procedure) in 5 with complete deficiency of the tibia. Callus distraction lengthening was performed repeatedly for leg-length discrepancy on either the femur or the centralized fibula. Satisfactory functional and cosmetic results were obtained in all limbs with partial deficiency, whereas in limbs with completely deficiency, none of the 5 knees treated by fibular transfer achieved a satisfactory functional result because of insufficient quadriceps strength, progressive knee flexion contracture, and persistent ligamentous instability. Nevertheless, in these 5 cases, all patients were ultimately able to withstand weight-bearing.

Adolescent↗
PubMed1998

[Mandibular distraction using a dynamic osteosynthesis system: MD-DOS. Concepts and surgical technic].

MD-DOS (mandibular distraction with a dynamic osteosynthesis system) is an intra-oral mandibular distractor that can be placed via the oral route, enabling application under local anesthesia. The aim of the article is to describe the technical-surgical aspects of the treatment concept, based on an initial experience of 35 cases. The device is characterised by a single horizontal posterior fixation screw-implant, a vertical hinge that copes with the lateral force vector in the condyles, a telescopic distraction module, and an anterior fixation unit that is fixed with monocortical screws. The main indication was mandibular lengthening in Angle Class II, deep bite cases. The third molars could be removed in the same session. Of importance was the horizontal placement of the posterior fixation unit (PFU), together with the distraction module, in order not to interfere with lateral jaw movements and with the lower sulcus. Equally important was the use of at least one 7.5 mm long osteosynthesis screw together with at least three 5.5 mm screws. Near complete mobilisation of the segments, firmly blocking the posterior fixation unit with the vertical hinge in a perpendicular position, and placing MD-DOS as close as possible to the dental arch, were also important parameters for success.

Anesthesia, Dental↗
PubMed2005

Limb lengthening with the Intramedullary Skeletal Kinetic Distractor (ISKD).

OBJECTIVE: Callus distraction of the femur or tibia with an intramedullary distractor, which lengthens mechanically through alternating rotations of at least 3 degrees. INDICATIONS: Femoral or tibial shortening between 20 and 80 mm. Angular and rotational deformities can be corrected at the osteotomy site. CONTRAINDICATIONS: Open epiphyses. Small medullary canal (after intramedullary reaming femoral diameter < 14.5 mm, tibial diameter < 12.5 mm). Severe deformities. Insufficient compliance. Osteitis. Soft-tissue infections. SURGICAL TECHNIQUE: Supine position. Femoral shaft osteotomy at the proximal or middle third by multiple drill holes completed with a chisel. For lengthening of the tibia, osteotomy with a Gigli saw is preferred. Control of the rotation by two parallel 3.0-mm Kirschner wires. Correction of angular or rotational deformities. Via stab incision reaming of the medullary canal with a flexible reamer. The femur is overreamed 2.0 mm and the tibia 1.5 mm above the desired implant diameter. Insertion of the Intramedullary Skeletal Kinetic Distractor (ISKD) into the medullary canal and distal locking in freehand technique. Control of the rotation and of the osteotomy gap. Proximal locking with an aiming device. For femoral lengthening 3 days and for tibial lengthening 5 days postoperatively the distraction is begun by increasing mobilization with partial weight bearing, to achieve daily distraction of 1 mm. In case of insufficient distraction, additional rotations are performed by the patient while checking the external monitor that displays the daily and total distraction length. RESULTS: Intramedullary lengthening with the ISKD was performed in four patients having an average age of 29 years (18-36 years). Two femoral shortenings were combined with complex rotational and angular deformities. The average lengthening of three femora and one tibia was 31 mm (26-40 mm). The average intraoperative blood loss was 230 ml (110-320 ml), the mean surgical time 108 min (90-145 min). The average daily distraction amounted to 1.2 mm (0.9-1.8 mm). Full weight bearing was permitted after 10 weeks (7-14 weeks), return to regular work after 11 weeks (7-16 weeks). At follow-up examination of an average of 2.3 years postoperatively the knee range of motion was full. Consolidation was noted 80 days (51-111 days) postoperatively with an average consolidation index of 2.9 days/mm (1.8-4.1 days/mm). No complications were observed. According to the Paley Score all patients had an excellent outcome.

Adolescent↗
PubMed2005

Midface distraction in patients with cleft palate.

Cleft palate patients with a severe maxillary hypoplasia can pose a very challenging problem for the surgeon. Traditional orthodontic surgery methods frequently do not fulfil expectations from the point of view of achieving normal aesthetic proportions of the face. Therefore distraction is nowadays an important technique in the treatment of craniofacial skeletal dysplasias. To treat maxillary hypoplasia, either intraoral midface distractor IMD or rigid external distractor RED can be used. This study presents 16 patients. In five of them, we used the IMD and in 11 of them the RED. In all of the patients we achieved good functional as well as aesthetic results. While using this method, complications were minimal. In this study, we analyse surgical and orthodontic methods as well as the advantages and disadvantages of both surgical methods.

Adolescent↗
PubMed2004

Seesaw modification of the lateral orbital wall in Le Fort III osteotomy.

OBJECTIVE: The traditional treatment for patients with syndromic craniosynostosis and midfacial retrusion has consisted of Le Fort III osteotomy and advancement. Distraction with rigid external systems allows advancement of the midface segment much more than the conventional methods. This excessive advancement resulted in the superiormost margin of the advancement segment becoming prominent. It can be felt easily with palpation and may influence the appearance of the patient negatively. This article presents a procedure osteotomy designed to modify the osteotomy lines at the lateral orbital rims and smooth the step deformity at the lateral canthal region. RESULTS: The seesaw osteotomy produced a smooth contour at the lateral orbital rim. Planned advancement was achieved without difficulty and without adverse long-term effects.

Child↗
PubMed2006

Prediction of biomechanical stability after callus distraction by high resolution scanning acoustic microscopy.

Accurate clinical prediction of the resistance to fracture after callus distraction requires a detailed understanding of structural and elastic properties of the newly formed bone. We investigated 26 sheep that underwent middiaphyseal callus distraction at a rate of 0.5 mm every 12 h for 30 d using a standard unilateral fixator system. The sample population included four groups undergoing different treatments to improve bone healing, including bone grafting and the local application of growth factors. All animals were sacrificed eight weeks after the end of distraction. The fracture forces of the lengthened tibia and the contralateral control tibia from each animal were evaluated by biomechanical (four-point bending) testing. The microstructure and anisotropic acoustic impedance distributions were assessed by quantitative 50-MHz scanning acoustic microscopy. The relationships between resistance to fracture, structural properties and acoustic impedance of the newly formed callus tissue and adjacent cortical tissue were investigated. A significant linear multivariate regression model was developed that predicts the fracture force with a high accuracy (RMSE = 248 N, R(2) = 0.86, p < 0.0001).

Acoustic Impedance Tests↗
PubMedDate not supplied

Immediate loading of dental implants placed in distracted bone: a case report.

A 40-year-old female patient presented for rehabilitation of an edentulous mandible with endosseous implants. Radiologic examination showed evidence of moderate atrophy in the intraforaminal area and an even more pronounced level of bone resorption in the posterior mandible. The patient desired a fixed rehabilitation with re-establishment of the posterior occlusal plane. From an esthetic standpoint, it was necessary to provide a restoration with crowns the same height as the original teeth while avoiding an unfavorable biomechanical situation. Vertical distraction of the complete mandible was performed using a Martin distractor according to the Hoffmeister technique. At the end of the period of activation and consolidation, the distractor was removed and 8 Frialit-2 Synchro-type implants were placed in predetermined sites and immediately loaded with a cemented transitional prosthesis. Ten months later the definitive restoration was delivered. The absence of any pathologic symptoms or negative radiologic findings 12 months after the surgery suggests a satisfactory result in the short term.

Adult↗
PubMed2003

Rigid external distraction of the midface with direct wiring of the distraction unit in patients with craniofacial dysplasia.

The development of craniofacial distraction techniques represents a significant advancement in the management of craniofacial dysplasias. For distraction of the midface after Le Fort III osteotomy, two levels of anchorage to the moving segments are necessary. In this report, the authors connected the distraction forces directly to the infraorbital rims, using a surgical wire for superior anchorage. They performed this technique in four patients with craniofacial dysplasia for the management of severe maxillary hypoplasia using RED II system. This configuration not only simplified the placement of the system but also made the removal of the device much easier. The authors did not have any problems with the wire traction unit, such as wire breakdown or bony tunnel disruption. It is a cheap, simple, and effective configuration that can be easily performed without any complication.

Bone Wires↗
PubMedDate not supplied

Callotasis lengthening in patients with brachymetacarpia.

Callotasis lengthening is an established method, but few cases of metacarpal lengthening have been reported. The authors performed callotasis lengthening to treat brachymetacarpia in six digits in three patients. The patient age at the time of distraction ranged from 10 to 19 years. The period of application of an external fixator averaged 13.9 weeks (range 10-19 weeks). All the metacarpals achieved the target length, and all patients were satisfied with the esthetic improvement. The length of the metacarpal distraction averaged 15.2 mm (range 10-18 mm). Complete consolidation of the transport gap was achieved for five of six digits. One digit that had a history of previous lengthening required bone graft. The average healing index was 62.3 days/cm. There were no serious complications. In four digits, the range of flexion of the metacarpophalangeal joint was increased after lengthening, and this enabled the patient to use the digit easily in a palmar grasp. Brachymetacarpia is an appropriate indication for callotasis lengthening in congenital deformities of the upper extremities.

Adolescent↗
PubMed2006

Mechanical behavior of an osteotomized mandible with distraction orthodontic devices.

This work analyzes the mechanical behavior of a human mandible when distraction orthodontic devices are used for correcting problems of dental overcrowding and/or arch shrinkage. The mandible 3D model is reconstructed from CT scan data and meshed into finite elements. The distractor is also modeled. FEM analysis included geometric non-linearity. Displacement field of healthy and osteotomized mandibles are compared. Progressive expansion of the distractor and effects of mastication are also analyzed. Finally, we compare two distraction protocols PROT1 and PROT2 where device is, respectively, expanded by 0.6 or 1.2mm/day. The global displacement is 6mm according to clinical recommendations. It came out that mastication forces generate displacements compatible with bone remodeling. However, parasitic rotations of the mandible arms due to mastication may counteract arch expansion induced by the device. Stress concentrations occurred where the device is fixed: stress peaks stay however below yield limit. Finally, PROT2 reduced by about 10% stresses in mandible and reproduces better than PROT1 the displacement field imposed by the device.

Biomechanical Phenomena↗