Combined transversal maxillomandibular distraction osteogenesis, a novel approach in skeletal corrections—a long-term report

Abstract

Intraoral transversal mandibular distraction (TMD) osteogenesis procedures are utilised in many cases of transverse mandibular deficiency with dental crowding of the mandibular anterior teeth. Orthodontics devices regularly cause periodontic disorders and an altered or compromised facial aesthetics. Dental and skeletal positional changes after TMD were studied prior to osteotomies on patients with diverse malocclusions. Le Fort I advancement, transpalatal distraction (TPD) and TMD were performed Distraction appliances were activated 5 days after the osteotomies at a rate of 1 mm/day. The distraction device TMD is removed and replaced by titanium plates and screws 3 to 4 weeks after the surgical procedure. The facial aesthetic modifications after TMD were evaluated with cephalometric analysis, computed tomography scan, three-dimensional analysis and photographic data. We sought to determine the facial aesthetic amelioration and the subsequent degree of mandibular advancement resulting in an adequate realignment of the dental arch. We also note that these changes result in a change in the facial mask both anteroposteriorly and transversally. The combination of TMD with or without repositioning of the maxilla (Le Fort I) and TPD allow good restoration of the facial structure and harmony thus avoiding bilateral sagittal split osteotomies in many cases.