Effectiveness and Pitfalls of Intraoral Distraction in Wide Alveolar Clefts: An Experience

Abstract

Statement of the problemRestoration of alveolar cleft defects is both essential and challenging for the craniofacial team. The technique of distraction is useful in large alveolar clefts, especially after the failure of conventional grafting procedures. The study aimed to analyze the effectiveness and problems of an intraoral tooth-borne distraction device. Materials and methodsSince 2015, 16 patients with nonsyndromic clefts were operated on. Because the defect was large, a trifocal distraction appliance was designed wherein the distractor appliance was completely tooth-borne and incorporated 2 hyrax screws. All distraction devices were individualized according to the patients’ situation. The appliance was cemented intraoperatively, and a latent period of 1 week was allowed. The distraction was performed twice daily at the rate of 0.5 mm/day. Methods of data analysisSingle-institution prospective study. ResultsAll patients were treated with distraction strictly following the natural curve of the dental arch. CBCT was taken prior to surgery and after 8 months of the last activation to visualize bone formation. Only 2 patients needed additional bone grafting procedure to fill the residual defect. In these patients, the required bone was small and was harvested intraorally. A failure of gingivoperioplasty (dehiscence) was observed in 1 patient. Outcomes dataAll patients were treated with distraction strictly following the natural curve of the dental arch. The mean width of the alveolar cleft was found between 11 and 17 mm. CBCT was taken after 8 months of the last activation to visualize bone formation. The continuity of bone could be seen in the majority of cases. The area of the residual defect was found to be between 28.24 and 39.24 mm. ConclusionThe intraoral distraction appliance was successful in the closure of a large alveolar cleft with the 2 transport segments docking successfully. Thus, a hyrax expansion screw used as a distractor could bring about controlled bony transport with the desired directional vectors. Its exclusive tooth-borne usage minimizes the invasiveness of the procedure, and the simplicity of the appliance eliminates the need for costly distractors, making such therapy feasible for a greater number of patients. The intraoral distraction appliance can be used successfully for the controlled closure of large alveolar clefts.