Alveolar Distraction is a method for reconstructing a deficient or atrophic alveolar bone. Alveolar ridge reconstruction may be indicated for the atrophic alveolar process resulting from maxillofacial trauma, periodontal disease, or post aggressive large cyst or tumor resection. The aim of this paper is to demonstrate the method of reconstruction of the alveolar ridge by Distraction Osteogenesis. A total of 32 patients were treated. An alveolar segmental osteotomy was carried out and the distraction device was mounted. In patients with an extensive alveolar defect two distraction devices were placed in order to better control the vector of elongation in both bone edges. The distraction was started on the fourth post-operative day at a rate of 0.5 mm/day as necessary and according to the length of the distraction device, followed by a consolidation period of 90 days. Subsequently, the devices were removed, and dental implants were placed for osteointegration. The amount of elevation was 8-15mm. All the patients had panoramic x ray before the distraction, during the lengthening, at the end of distraction and after removal of the device. Early mineralization in the distracted area was seen radiographically during the consolidation period that increased after device removal. As a result of alveolar distraction, a segment of mature bone was transported vertically in order to lengthen the crest for better implant anchorage, either for esthetic purposes or for functional prosthetic requirements. A total of 68 implants were introduced. In follow-up at 24 months, failure of only one implant was noted, due to inadequate transported bone stability. In conclusion, distraction osteogenesis is an alternative treatment in moderate to severe alveolar deficiencies for an ideal three-dimensional reconstruction with no need for bone harvesting. This method offers the possibility to place dental implants in a correct position to obtain proper prosthetic results.
Transverse maxillomandibular discrepancies are widespread. Treatment is comprised of orthodontic expansion in patients younger than 15 years or by surgically assisted rapid palatal expansion (SARPE) in skeletally mature patients where the possibility of successful orthodontic maxillary expansion decreases as sutures close and resistance to mechanical forces increases.To present our experience of treating transverse maxillary deficiency using a unique L-shaped osteotomy and to demonstrate stable results.32 patients aged between 19 and 54 years exhibiting transverse maxillary deficiency. L-shaped osteotomy was performed laterally from the pterygoid plate posteriorly to above the roots of the second incisive anteriorly continuing with a vertical osteotomy between the lateral incisive and canine teeth toward the horizontal osteotomy. In 18 patients with dysgnathia, bimaxillary surgery was performed one year following the SARPE procedure.Mean transverse maxillary expansion of 6.2mm at the canine incisal and 6.4mm at the first molar occlusal regions were obtained. One year postoperatively results were relatively stable, 5.8mm and 6.2mm respectively. The SARPE procedure resulted in overcoming the maxillary buttress resistance, expansion of the anterior dental arch and bilateral distraction creating bone on both sides of the premaxilla contributing to better alignment of the anterior teeth and superior stability.We conclude that SARPE is an effective and stable method for addressing severe maxillary transverse discrepancy in adults while the unique osteotomy performed allowed for maintaining proper position of the premaxilla and maxillary midline and allowing for division of the newly created bone bilaterally thus resulting in a more stable outcome.
Background: The purpose of this study was to perform alveolar ridge augmentation by distraction osteogenesis (DO) and to enhance bone regeneration through the use of recombinant human bone morphogenetic protein‐2 (rhBMP‐2), followed by implant placement. Methods: Alveolar segmental osteotomy was performed in the mandible of 10 sheep followed by placement of 1.5 mm alveolar distraction devices. The study group was injected on the fifth day of distraction with a single dose of 10 µg rhBMP‐2. Only distraction was performed in the control group. Results: A mean alveolar augmentation of 12 mm was achieved. After 12 weeks of consolidation, the distraction devices were removed and biopsies were taken for histological and immunohistochemical characterization and morphometry of the newly formed bone. Titanium threaded cylindrical implants were then placed in the newly augmented bone. Radiological evaluation showed lifting of the transport segment and integration of the implants within both the transport segment and the regenerated bone. The histological study demonstrated that the association of DO and BMP resulted in increased trabecular bone size and volume (32.2% ± 0.95% versus 18.6% ± 0.71%; P <1 × 10 –17 after 24 days of lengthening and 63.8% ± 1.89% versus 42.5% ± 1.33%; P <1 × 10 –15 after 12 weeks of consolidation) and increased numbers of proliferating cell nuclear antigen stained cells (0.7 ± 0.04 versus 0.47 ± 0.04; P <1 × 10 –10 ) compared with the DO only group. Conclusions: Alveolar distraction augments atrophic alveolar ridge and creates new bone that permits implant placement. rhBMP‐2 enhances bone quality and may shorten the consolidation period of distraction allowing for earlier implant placement. J Periodontol 2004;75:1524‐1531 .
Obstructive sleep apnea (OSA) is often associated with congenital craniofacial malformations such as Pierre-Robin Syndrome, Hemifacial Microsomia, Treacher Collins Syndrome resulting in decreased pharyngeal airway, which, in severe cases, leads to tracheostomy dependence. Some pediatric patients had tracheostomies done and others with severe respiratory distress were considered tracheostomy candidates.Twelve patients with severe respiratory distress without tracheostomy and ten patients with tracheostomy were treated by mandibular distraction osteogenesis using either external or internal devices. The expansion of mandibular framework was analyzed using bony cephalometric landmarks and computed tomography (CT).The results demonstrated average mandibular elongation of 29 mm on each side using the external devices and 22 mm using the internal devices, and an increase in mandibular volume and pharyngeal airway. The group of patients with tracheostomies were decannulated and in the patients with respiratory distress there was improved airway with improvement of signs and symptoms of OSA with elimination of oxygen requirement.Mandibular distraction is a useful method in younger children with OSA expanding the mandible and concomitantly advancing the base of tongue and hyoid bone increasing the pharyngeal airway. The external devices permit greater distraction length, the removal is simple but the devices are uncomfortable for the patients. On the other hand, the internal devices are more comfortable for patients but permit shorter distraction length and require a second operation for removal.
This book highlights a new possibility of dental treatment for some pathological conditions considered untreatable with conventional methods by the use of low-intensity pulsed ultrasound (LIPUS).The book is divided in 11 chapters.A series of information on LIPUS aspects, how to act and the biological mechanisms on dentofacial bioengineering are presented.The role of LIPUS for bone healing, skeletal muscles, periodontal tissue regeneration, temporomandibular joints and salivary glands is convincingly explained in a number of chapters.LIPUS application in orthodontics, dentofacial region, shockwave therapy in orthodontics, and pulp cell differentiation and future directions are the subjects of other chapters.The authors, presenting and illustrating the latest discoveries and uses of ultrasound in dentistry, manage to attain their aim and write a particularly useful book for dental surgeons, orthodontists, periodontologists, and other practitioners.
To cite this article: Hazan‐Molina H, Molina‐Hazan V, Schendel SA, Aizenbud D: Reliability of panoramic radiographs for the assessment of mandibular elongation after distraction osteogenesis procedures Orthod Craniofac Res 2011; 14 :25–32 Structured Abstract Authors – Hazan‐Molina H, Molina‐Hazan V, Schendel SA, Aizenbud D Objectives – To determine whether panoramic radiographs could be used for evaluation of changes in the vertical and horizontal dimensions following internal curvilinear mandibular distraction osteogenesis. Study Design – A retrospective cohort study included 25 patients who underwent bilateral mandibular distraction surgery. Three panoramic radiographs and lateral cephalograms from each patient were available: before distraction, immediately upon termination of the distraction process, and at the end of the follow‐up period. The radiographs were traced by plotting Condylion, Gonion, and Menton. The linear distances between Condylion and Gonion and between Gonion and Menton were measured on each side, and the correlation was calculated. Results – No significant differences were found between the values of the linear measurements determined by lateral cephalograms and panoramic radiographs ( p ≥ 0.079), excluding one measurement. The correlation test for these radiographs showed very high, positive and statistically significant correlations, for both sides of the internal mandibular distraction ( r > 0.77, p ≤ 0.0001), apart from three measurements. Conclusion – Panoramic radiographs, with mandibular length (Co–Go and Go–Me) measurements, can be used as an alternative to lateral cephalograms, i.e. as a reliable tool for assessing vertical and horizontal dimensional changes resulting from internal mandibular distraction achieved by a curvilinear distractor.
