Combined Orthodontic Temporary Anchorage Devices and Surgical Management of the Alveolar Ridge Augmentation Using Distraction Osteogenesis

Abstract

Distraction osteogenesis is used to increase the vertical and transverse bone volume of the alveolar ridge and requires 3-dimensional vector controls. Temporary anchorage devices (TADs) may be inserted into the transported segment, enabling distraction vector control by exerting orthodontic force. The authors' aim was to describe a combined orthodontic surgical technique involving vertical alveolar distraction using TADs. Four patients who presented with extensive anterior alveolar ridge bone loss combined with the incisors and canines underwent treatment according to a combined surgical orthodontic protocol, including presurgical orthodontic preparation and a preimplantation surgical augmentation stage involving vertical distractor insertion. During the active vertical alveolar distraction process, 3 TADs were inserted. Intraoral orthodontic elastics were attached to the main orthodontic archwire exerting multidirectional forces to control the vertical distraction vector. After 4 to 5 months of vector controlling and active bone molding, the TADs were removed. Anterior alveolar ridge augmentation using distraction osteogenesis was achieved. The application of TADs for better anterior segment curvature enabled dental implant insertion, ideal positioning, and restoration. A combined surgical orthodontic management protocol involving vertical alveolar distraction osteogenesis for augmentation purposes using TADs enables improved alveolar ridge volume and architecture for the preimplantation stage.