S434: Surgically Assisted Tooth Movement and Transportation of Dentoalveolus by Distraction Osteogenesis

Abstract

Conventional orthodontic treatments rely on biological tooth movement and can only be achieved at a limited rate. Most of the cases imply shortage of space and crowding. In such cases extractions are most often needed for an ideal treatment outcome. Therefore an increased orthodontic treatment period is unavoidable especially when teeth movements require more than minor relocations. The literature is abounding to identify optimal biological teeth movements with minimal deleterious effects on the tissues involved during tooth movement including root, periodontal ligament and alveolar bone. Currently a conventional orthodontic technique is still not feasible to increase the rate of tooth movement in order to meet specific patient needs to have a shorter treatment time. Recently, some reports are described either to eliminate extractions especially in the mandible or to reduce the time necessary for tooth movement incorporating surgery to the treatment protocol. A novel approach utilizing transport distraction osteogenesis in such orthodontic cases that require extraction of first premolars in order to reduce the overall orthodontic treatment time will be presented. The variations of certain biological and biomechanical factors of distraction osteogenesis employed with this technique including osteotomy design, latency and consolidation will be comparatively evaluated. The osteotomy involves designing a partial-thickness bony segment for the transportation of a canine tooth along with surrounding alveolar bone to close the gap resulted from the extraction of first premolar without a discontinuity defect. The period of time required to move teeth by utilizing this technique only ranges in between 9 and 14 days by intraoral teeth anchored distraction device. This integrated approach in the management of orthodontic cases reduces the overall treatment time considerably without any significant complications. Several clinical cases will be discussed highlighting the stages from beginning to the end and the benefits of the approach will be presented. Proper management of alveolar clefts sometimes may be difficult or suboptimal due to pre-existing wide clefts and insufficient availability of keratinized mucosa to cover the area at surgery following bone grafting. Transport distraction osteogenesis of neighbouring tooth to the cleft area can optimize the end result by generating new attached mucosa and obviate the need for flaps and also greatly reduce or may even eliminate bone grafting procedures. Clinical cases will be presented in regard to surgical design, and the outcomes will be discussed in detail.