Distraction osteogenesis /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMY
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The treatment of

cranio-maxillofacial deformities poses a great
challenge to the modern maxillofacial surgeons and
dentofacial orthopeditians…


Treatment modalities available are either Functional
appliances in the growing years or Orthognathic
surgery.


The latest technique for combating the same is a
procedure termed

“Distraction Osteogenesis”




Preferences over orthognathic surgery



Biological basis of DO



Various devices for DO



Indications & contraindications of DO



Disadvantages of DO



Surgical applications of DO



Unsolved issues of DO



Future directions of DO



Complications of DO



Limitations of DO

Distraction Osteogenesis is a biological process of new
bone formation between surfaces of bone segments
gradually separated by incremental traction.

Cope – AJO, 1999




Ilizarov Effects



Ilizarov principles of DO



Sequential periods of DO
- corticotomy
- latency
- distraction
- consolidation





Tension – stress effect
Influence of blood supply & mechanical load




Osteotomy of the bone site with minimal periosteal stripping.



Latency period: 3, 5, or 7 days, depending on the surgical site.



Distraction rate: 1.0 mm per day (0.5–2.0 mm)



Distraction rhythm: continuous force application is best, yet
device activation bid is more practical and allows for better
patient compliance



Consolidation: until a cortical outline can be seen radiographically
across the distraction gap, usually 6 weeks


 Sequences

osteotomy

of DO

latency
distraction

consolidation

 Extraoral

- Unidirectional


 Bidirectional

 Multidirectional


 Intraoral


1.

Wangerin's vertical mandibular distraction
device
(Medicon eG, Tuttlingen, Germany) before (left)




2.

Tooth-borne ROD distraction device
(Oral Osteodistraction, L.P.,
Buffalo Grove, IL, USA)
disassembled (left) and assembled
(right).


 3.

DynaForm Intraoral Distractor
(Stryker Leibinger, Kalamazoo,
MI, USA) with two types of arm


 4.

Diner and Vazquez's mandibular body (left)
and mandibular ramus (right) distractors
(Stryker Leibinger, Kalamazoo, MI, USA).



Age



Greater advancements



Histeogenesis



No Need of bone grafts



Less surgical dissection



Can be done for transverse discripancies



Healing by primary intention



Minimal skeletal relapse




Time consuming



Socially not acceptable



Proper monitoring and maintenance of the device is required.


 Severe retrognathia associated with a syndrome especially in

infants and children who are not candidates for traditional
osteotomies.


Unilateral hypoplasia of the mandible (eg, hemifacial
microsomia).



Nonsyndromic mandibular hypoplasia associated with a dental
malocclusion



Mandibular transverse deficiency associated with a dental
malocclusion and dental crowding.




Mandibular hypoplasia due to trauma and/or ankylosis of the
temporomandibular joint



Mandibular continuity defects resulting from excision of tumors
and/or aggressive developmental cysts



Shortened vertical height of the alveolar bone


 Patients who are unable or unwilling to comply with the

distraction schedule are not ideal candidates for this procedure.


Mandibular distraction osteogenesis has been performed on
infants as young as nine days old, but more difficulty is
encountered when dealing with small fragile bones in the
placement of the distraction device.



Adequate bone stock must be available to accept the device and
to provide adequate surface area of the osteotomy sites for
regeneration.




Distraction osteogenesis of the mandible may be used on
patients who have received prior radiation treatment.
However, this procedure must be performed with caution
because these patients are more likely to develop
complications and to experience delays in wound healing.



In older patients, the decreased number of mesenchymal
stem cells may impair bone healing at the distraction site.




Preoperative planning & Diagnosis
- radiographs
- cephalometric analysis
- stereolithographic models



Treatment




Areas of applications –
- Maxilla
- Mandible

ramus, body, symphysis

- Obstructive sleep apnoea
- TMJ

- Alveolar region
- Clefts


 Mandibular

lengthening & widening


 In

the region of symphysis




Presence of Scar tissue



Soft tissue abnormalities



Difficulty in mobilizing maxilla



Difficulty in control of bone segments



Associated 3D deformity, Nasal deformity



Presence of serve dental arch abnormality



Maxilla – mandibular skeletal & dental relationship



Oral hygiene status



Quality & Quantity of bone



General Medical condition



Regenerate malformation



Axial deviation



Soft tissue over stretching



Blood vessels



Peripheral nerves



Skeletal muscles



Cystic degeneration




Bone necrosis



Buckling or bending



Pin loosening



Scar formation



Infection



Pain




Does not correct underlying growth disturbances.



Second procedures may still be required.



Mineral content & radio density of the generated tissue is less
than normal



Functional level is also less



Distractor devices are too bulky – refinement is required.



Clinical experience and expertise is still limited.



Hospitalization and associated complications are unavoidable.



Certain degree of Relapse still takes place.



Effects of distraction on growth



Limits of DO



Effects of distraction on eruption and movement of teeth



Long term stability of regenerate bone




Refinements in the distraction protocol



Improvements in distraction devices



Enhancement of regenerate maturation




Distraction osteogenesis has proven to be an extremely versatile
and superior method for the correction of dentofacial
deficiencies as well as deficiencies in other parts of the body. But,

a detailed study needs to be carried out to establish the critical
parameters.
In all, craniofacial distraction osteogenesis may perhaps be
the answer, the solution to bring out smiles in those affected by
various malformations.




Acta Stomat Croat 2002; 103-105



American Journal of Orthodontics and Dentofacial Orthopedics.
Volume 116, Number 3



American Journal of Orthodontics and Dentofacial Orthopedics.
Volume 115, Number 1



MJAFI 2005; 61 : 345-347



J Oral Maxillofac Surg 60:496-501, 2002



Distraction Osteogenesis of The Facial Skeleton By Bell &
Guerrero

Distraction osteogenesis /certified fixed orthodontic courses by Indian dental academy

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