Alveolar Distraction Osteogenesis Research Articles

Installation of dental implants in distracted anterior alveolar bone

Purpose This study was planned to evaluate the success of dental implants installed in distracted alveolar bone using extra-osseous vertical distractor. Patients and methods This is a prospective noncontrolled clinical study that was carried out on eight patients with age range from 20 to 50 years old who complained from vertical alveolar defect in anterior area and underwent vertical alveolar distraction osteogenesis using extra-osseous distractor device followed by implant installation. Results Clinically there was a significant increase in vertical height of alveolar bone after distraction at P value of 0.007. Radiographically, by cone-beam computed tomography there was a significant increase in alveolar bone height and implants installed in distracted anterior alveolar bone were successful. Conclusion Alveolar distraction osteogenesis was a predictable method for restoring alveolar ridge height prior to implant placement. Distraction osteogenesis is ideally suited for recreating missing tissues in the anterior esthetic zone. The bone gain reached at the end of distraction appears to be lasting.

Bone augmentation in dental implants among Indian patients.

It is of interest to compare guided bone regeneration (GBR) with titanium mesh, alveolar distraction osteo-genesis (DO), GBR with auto-genous bone and e-PTFE membranes and onlay bone grafts. This helps to restore vertically lacking alveolar ridges and their capacity to sustain the vertical bone growth acquired both prior to and following implant placement. The parameters such as (i) success and survival of dental implants (ii) peri-implant clinical parameters after prosthetic loading at 1 year, 2 year and 3 year follow up (iii) resorption of alveolar ridge regenerated before placement of dental implants and after placement of dental implants were assessed. Data shows that the distraction osteo-genesis is more predictable for long-term prognosis of vertical bone growth. However, all methods help to repair the vertically resorbed edentulous ridges.

Indications and surgical technique for distraction osteogenesis of the alveolar bone for augmentation prior to insertion of dental implants.

When bone is limited, short, ultra-short, or narrow implants help to restore oral rehabilitation with an acceptable long-term outcome. This becomes more difficult with severe vertical bone loss. Guided bone regeneration, onlay block transplantation, or sandwich osteotomy have been established to build up these defects. The alternative to the alveolar distraction osteogenesis (ADO) has only been established in some centers, with a standardized protocol. On the one hand, ADO is a biological procedure that allows almost a "restitutio ad integrum" when building up hard and soft tissue. On the other hand, there are clear indications, limitations, and complications of the procedure in the literature. In addition to the literature, concept of Tissue Regeneration by Alveolar Callusdistraction Cologne (TRACC), which has been practiced successfully for over two decades, will be presented for different indications.

Vertical Ridge Augmentation Using Distraction Osteogenesis Versus Autogenous Bone Grafting: A Systematic Review and Meta-Analysis.

The aim of this systematic review was to systematically assess the papers comparing the surgical techniques of Alveolar Distraction Osteogenesis(ADO) and Autogenous Bone grafting (ABG) for Vertical Ridge Augmentation in terms of bone gain, bone resorption and incidences of complications. The review was registered on PROSPERO with the ID : CRD42021237671. A broad electronic survey was conducted in the PubMed, Scopus, Web of Science, Cochrane Library, and Virtual Health Library databases of all studies published till 08/03/2022. Four studies fulfilled the criteria to carry out a meta-analysis a in which a total of 58 patients underwent ADO and 43 patients for ABG. A total of 133 implants were placed in the ABG group and 124 in the ADO group. DerSimonian-Laird estimator of variance was used for Random effect meta-analysis. The estimates of an intervention were expressed as the odds ratio (OR) and standard mean difference (SMD) in millimeters. There was statistically significant difference in terms of bone height gain with SMD of - 0.78 (95% 0.04-1.55) in ABG. Bone resorption and complications were statistically insignificant with SMD of 0.52 (95% - 1.59 to 0.56) and OR 0.55 (95% 0.18-1.70), respectively.PROSPERO Registration ID: CRD42021237671.

Surgical bone augmentation procedures for oral rehabilitation of patients with oligodontia: A review with a systematic approach

Oligodontia is a developmental dental anomaly defined by the absence of 6 or more permanent teeth, excluding the third molars. We performed a review with a systematic approach and proposed a guideline for the choice of the bone augmentation surgery. The different bone augmentation technique terms were searched in the PubMed and Science Direct database. Clinical studies were eligible if they reported on pre-implant surgery in patients with oligodontia. The database search yielded 400 studies after duplicates removed. Thirty studies were finally included, involving 410 patients. Sixty-three sinus lifts were performed in 37 patients with no failure. Thirteen out of 33 patients with iliac bone transplantation and two out of 24 with parietal bone transplantation had resorption, one out of 4 patients who received allogeneic bone block had complete failure. Seventy-eight patients underwent guided bone regeneration, none had bone loss. No failure was found with the alveolar distraction osteogenesis technique. Four out of thirteen patients developed permanent hypoesthesia after inferior alveolar nerve transposition. The cumulative implant survival rate was 94.4% after bone augmentation procedures. Extensive edentulous areas should be grafted with parietal bone, as iliac grafts present a greater risk of resorption. Smaller edentulous areas should be treated by endobuccal harvesting or guided bone regeneration. Osteogenesis distraction and nerve transposition are effective surgeries for medium-to-large mandibular edentulous spaces. The implant survival rate is not significantly different between implants placed in grafted and nongrafted bone, the appropriate choice of bone augmentation technique can reduce the risk of peri‑implant bone resorption.

Alveolar ridge augmentation in mandible by use the modified distractor.

Objective: The aim of the present study was to evaluate the horizontal and the vertical alveolar distraction osteogenesis using modified alveolar distractor.Study design: The sample consisted of 7 patients presenting horizontally and vertically deficient edentulous ridges were treated by distraction osteogenesis with a modified Alveolar distractor. The surgical procedure was carried out with the patient under local anesthesia. After the osteotomy was performed with pizosurgery, the distractor was placed on the segmental bone over the gingiva for 3 months. The rate of distraction was 0.5 mm/twice a day.Results: The mean of horizontal alveolar before using the distractor was 4.70 mm (SD 0.31 mm) The mean of horizontal alveolar after using the distractor was 8.30 mm (Sd 0.59 mm). The mean of actual gain in bone horizontal at the end of the distraction period was 3.58 mm (SD 0.15 mm). The mean of height alveolar before using the distractor was 6.67 mm (SD 0.46 mm) The mean of height alveolar after using the distractor was 12.59 mm (SD 0.52 mm). The mean of actual gain in bone height at the end of the distraction period was 5.92 mm (SD 0.25 mm).Conclusion: It was concluded that the modified alveolar distractor seems to be an effective to treat horizontal and vertical alveolar ridge deficiencies, and distraction osteogenesis can be considered a safe and effective procedure for gaining bone in the horizontal and the vertical dimension of the alveolar.

Alveolar distraction osteogenesis: possible complications and methods of their treatment

The aim of the study. Analysis of emerging complications during the method of alveolar distraction osteogenesis in patients with jaw defects. A retrospective analysis of foreign and domestic literature was carried out. A systematic literary search was carried out in the electronic bibliographic databases Web of Science (for foreign articles) and Elibrary and Dissercat (for domestic). In the period from 2005 to 2019 in the clinic of the Department of Maxillofacial and Plastic Surgery of the Moscow State Medical University. Evdokimov conducted an examination and comprehensive treatment of 490 patients with primary and secondary adentia of the upper and lower jaws, accompanied by a significant deficiency of bone tissue of the alveolar ridge vertically. A comprehensive dental rehabilitation of patients with jaw defects by the method of distraction osteogenesis was carried out. The most common complications are: exposure of the fixation modules of the distraction apparatus - 24% of cases, failure of bone regenerate - 13%, inflammatory phenomena - 13%, displacement of the distraction vector - 43%, paresthesia - 7%. Based on our analysis of the identified complications during the distraction osteogenesis method, it was found that these complications are not critical in the treatment of patients with jaw bone deficiency and do not jeopardize the success of rehabilitation. With diagnosis and timely approach to treatment, complications are avoidable.

English

Resorbed alveolar ridges, which can be horizontal or vertical in size, are one of the most prevalent issues addressed by dental experts. One of the therapy options for addressing the weak sections of the alveolar ridges is alveolar distraction osteogenesis. Alveolar distraction osteogenesis is a biological process that includes gradual traction between vascularized bone segments in order to generate new bone. Typically, an osteotomy is done, followed by the placement of an osteodistraction device to manage the separating process. This approach eliminates the need for bone grafts by producing the same quality and shape of bone. Distraction osteogenesis (DO) causes soft tissue to develop as new bone is formed on the deficient ridge. Because this treatment restores bone height, lengthier dental implants can be placed. In this work, we cover ride augmentation and the numerous procedures used to repair a resorbed alveolar ridge. It emphasises the relevance of alveolar distraction osteogenesis and provides a brief history of the procedure based on existing information. To summarise, distraction osteogenesis proved efficient in increasing the alveolar ridge and ensuring dental implant recovery. KEY WORDS Distraction osteogenesis, stages of distraction osteogenesis, advantages and disadvantages of distraction osteogenesis.

Interest and outcomes of alveolar distraction osteogenesis for dental implant rehabilitation following mandibular reconstruction

Introduction: Alveolar distraction osteogenesis (ADO) is one of vertical bone augmentation technique used to restore the vertical bone discrepancy between the transplanted graft and the residual alveolar bone after mandibular reconstruction. The aim of this article is to present the clinical outcomes of ADO applied to reconstructed mandible for three patients. Observation: Three patients underwent alveolar distraction osteogenesis procedure on mandibula reconstructed by fibula free flap (n = 2) or iliac crest free flap (n = 1). The mean bone height increase was 11 mm. 16 implants have been placed in all patients, with a success rate of 100% and a mean follow-up of 25 months. Two complications occurred without compromising the final outcome of the procedure: one fracture of the basal bone and one bony interference, both during activation phase. Commentaries: ADO can be performed on reconstructed mandible with free flap to restore alveolar height. An acceptable implant-to-crown ratio allows an optimal supported implant prosthesis. The particular antecedent of our patients can lead to uncommon complications such as basal bone fracture, but doesn't seem to compromise implant placement with good success rate. Conclusions: ADO performed on reconstructed mandible allows appropriate dental implant rehabilitation, achieving good esthetics and occlusal outcomes.

Dental implantasyondan önce sert doku hazırlığı: dört yıllık retrospektif bir çalışma

Aim: The purpose of this study is to investigate the requirements of hard tissue preparation prior to dental implant placement.Methods: In this retrospective study, the records of 1086 patients who referred to Mustafa Kemal University, Faculty of Dentistry, for dental implant between 2011 and 2015 were investigated. The received frequency of patients’ onlay grafting, autogenous block grafting, socket preservation, guided bone regeneration, open sinus lifting, ridge split osteotomy, alveolar distraction osteogenesis, inferior alveolar nerve repositioning were evaluated in any process of the dental implant. Findings: 3186 dental implants in 1086 patients were included to the study. Among 295 patients, it was observed that the number of men was 144 (48.8%) and number of implants was totally 309 (47.2%) implants, while the number of grafted implants in women of 151 (51.2%) was 346 (52.8%). The numbers of grafting procedures for augmentation are as follows; 286 (43.7%) onlay grafting, 23 (3.5%) socket preservation, 9 (1.4%) guided bone regeneration, 271 (41.3%) open sinus lifting, 62 (9.5%) alveolar ridge splitting, 2 (0.3%) alveolar nerve repositioning and 2 (0.3%) distraction osteogenesis. Conclusion: With ongoing the increasing of developments in dental implant surgery, it will be inevitable that the different grafting procedures can be carried out before and during the implantation.

Histomorphometric analysis of bone interphase

Background: Different surgical techniques have been advocated for esthetic rehabilitation of deficient alveolar ridges with implant placement: Guided bone regeneration (GBR), Alveolar distraction osteogenesis, Onlay block graft (autogenous and allograft); However, autogenous block graft still provides with predictable outcome since being the gold standard for regeneration and augmentation. Objective: The aim of the present study was to compare histomorphometrically the bone interphase of augmented site with and without GTR (guided bone regeneration) membrane before implant placement. Material and Methods: In this study, a total of 16 patients with missing incisor with Siberts Class 1 alveolar defects were selected, parasymphysial block graft were harvested and stabilized with miniscrews, DFDBA graft material around the block graft were placed, and 8 were covered with GTR resorbable membrane. Miniscrews were removed after 6 months. Bone core biopsy of interphase were retrieved by 2.9 mm diameter trephine bur and sent for histologic and histomorphometric analysis using histometry software. Results: Data were evaluated using paired sample t-test and Shapiro-Wilk test. Histological evidence of fibrous tissue interphase was observes in specimen without GTR group. Though there were no statistically significant difference between the two groups in terms of amount of new bone 31.47 versus 30.6% (P = 0.5362), while there was a statistically significant difference in percentage of residual grafted material higher in non GTR augmented site (t value= 4.501 P = 0.0003) and marrow space in GTR group with statistical significance (t = 2.887 P = 0.0098). Conclusion: Only few studies have tested histomorphometrically to see the exact uptake of the augmented site, comparing interpositioning of fibrous tissue, newly formed bone at site, residual graft material and marrow space. It is most appropriate to use an evidenced-based approach when a treatment plan is being developed for bone augmentation cases. This study will add to the evidence of use of autogenous block graft with GTR membrane thus providing a connective tissue interphase free augmentation.

Bone Augmentation Techniques for Horizontal and Vertical Alveolar Ridge Deficiency in Oral Implantology.

Bone deficiency is the major obstacle in implant dentistry. Guided bone regeneration (GBR) with particulate bone and barrier membranes has been the primary surgical technique used to regenerate alveolar bone for dental implant therapy. This procedure has been used in implant dentistry for more than 30years and continues to be developed and refined for more predictable surgical outcomes. This article reviews GBR and alternative ride expansion procedures and reviews the use of various particulate graft materials. Alveolar distraction osteogenesis, used as an augmentation technique, is also presented.

Surgical repositioning of infra-occluded dental implants in the orthognathic management of a Class III open-bite patient

Abstract Dental implants placed in the maxillary anterior region have a high risk of aesthetic complications caused by later infra-occlusion and may subsequently require special therapeutic considerations to achieve optimal aesthetic and functional results. Based on the severity, possible treatment options for infra-occluded implants include replacement of the implant restoration, alveolar distraction osteogenesis, repositioning by a segmental osteotomy, or the removal of the implant. The present case report describes the successful application of bi-maxillary orthognathic surgery combined with an anterior segmental osteotomy for the correction of a Class III open-bite malocclusion complicated by severely infra-occluded implants.

Horizontal alveolar transport distraction osteogenesis followed by implant placement

Alveolar transport distraction osteogenesis (ATDO) is an alternative treatment method to vertical alveolar distraction osteogenesis in cases of large bony defects, especially when the bone is limited in size. ATDO was performed in 10 patients with 12 defects. The mean age of the patients was 39.1years. The average bone length gain was 18.2mm. Implants were inserted following a 3-month consolidation period. Three patients needed additional bone grafting for horizontal widening. Final prosthetic rehabilitation was performed at least 3 months following implant insertion. The mean follow-up period was 63 months and the survival rate of the 25 implants placed was 92%. All failures (n=2) occurred during the early healing period. Although the results are not totally predictable, it can be concluded that ATDO can be effective in the reconstruction of the alveolar crest prior to implant placement.

Implant-Supported Hybrid Prosthesis for Severe Mandibular Defects: A Sequence of Treatments From Alveolar Distraction Osteogenesis to Implant Restoration

Although a variety of treatment methodologies for the physiological reconstruction of mandibular defects exist, the use of these methods has often been fragmented and has focused on partial effects of therapy. This article describes a sequence of treatments for a severe mandibular defect. Two patients with severe hard and soft tissue defects had physiological function restored in 4 steps, including alveolar distraction osteogenesis, implant insertion based on a prosthesis, application of dermal matrix membrane in reconstruction of attachment gingiva, and the use of a hybrid prosthesis designed via computer-aided design and computer-aided manufacturing, to produce an adequate bone tissue volume, an adequate amount of attached gingiva, and a reliable prosthesis. The sequence of treatments successfully achieved physiological reconstruction. Biological complications around the implants and mechanical complications in the implants or prostheses did not occur within a 4-year follow-up period. On the basis of the current 4-year follow-up, this study shows that a treatment sequence can be predictable and effective for severe mandibular defects, which suggests that it could be considered a potential protocol for patients with severe mandibular defects.

Sandwich osteotomy for the reconstruction of deficient alveolar bone

Alveolar bone deficiency is a very common problem encountered by the practitioner when planning dental implants. The severity of the deficiency is variable. Many practitioners perform augmentation using the method they feel comfortable with and do not necessarily use the most appropriate method. This is a retrospective study on 21 patients between the ages of 25 and 63 years exhibiting moderate vertical alveolar bone deficiency and treated by the sandwich technique. Mean vertical bone gain was 7.5mm. Sixty-one dental implants were inserted showing a survival rate of 96.7% with a median of 3.1 years follow-up. Main advantages of the method include minimal relapse, single operation and preservation of the native cortical bone in the occlusal surface. We believe the surgeon should maintain the capability of using different augmentation techniques and utilize them appropriately for different severities of deficiency. We wish to establish a paradigm for using different augmentation methods We recommend using the sandwich technique in the moderate deficient cases as described in this work, using alveolar distraction osteogenesis for the severe cases as described in our previous work, where lack of soft tissue for proper closure is a major limitation, and using guided bone regeneration for minor deficiencies.

Alveolar distraction osteogenesis for dental implant treatments of the vertical bone atrophy: A systematic review.

BackgroundTo determine if alveolar vertical distraction osteogenesis obtains better results compared to other bone regeneration treatments (guided bone regeneration with membranes and / or filling material, or autogenous bone graft) in terms of bone gain, complications, and implant survival and success rates.Material and MethodsAn electronic search was performed in Pubmed (MEDLINE), Cochrane Library and Scopus databases in March 2017. Besides, a manual search was carried out. Inclusion criteria were randomized controlled trials published within the last 10 years with at least 1 year of follow-up after implant placement. No language restriction was applied. Exclusion criteria were studies in patients with bone defects produced by trauma, congenital malformation or oncologic surgical treatment. The methodological quality of the selected studies was evaluated by means of the Cochrane Collaboration’s Tool for assessing risk of bias. The reports were classified into different levels of recommendation according to the “Strength of Recommendation Taxonomy “.ResultsOut of 221 articles, two randomized controlled trials were finally selected for the inclusion in the systematic review. Bone gain and complications were higher with the alveolar vertical distraction osteogenesis compared to the autologous bone graft. There was higher bone resorption with the autologous bone graft. Implant survival and success rates were similar between studies, despite of the used technique.ConclusionsBoth alveolar distraction osteogenesis and autogenous bone graft are effective bone regeneration techniques for the treatment of mandibular vertical bone atrophy. A level B recommendation can be established for the use of alveolar vertical distraction osteogenesis for the treatment of the mandibular vertical bone atrophy. Key words:Distraction osteogenesis, alveolar ridge augmentation, alveolar bone loss.

A Case of Dental Implant Treatment with Alveolar Distraction Osteogenesis in the Grafted Alveolar Cleft

A Case of Dental Implant Treatment with Alveolar Distraction Osteogenesis in the Grafted Alveolar Cleft

20 years of alveolar distraction: A systematic review of the literature.

BackgroundThe Vertical Alveolar Distraction Osteogenesis (VADO) technique is an excellent solution for bone and soft tissue neoformation in areas in which there has been significant bone atrophy that hinders normal rehabilitation using dental implants. The goal of this systematic review is to analyze the most relevant articles published on VADO in the literature over the past 20 years.Material and MethodsThe review was performed by using the keywords: “alveolar ridge”, “distraction ostegenesis” and “dental implant”. This search produced a total result of 240 articles. The clinical studies and cases reported in humans amounted to 113 articles, 18 articles referred to studies developed on animals and 33 review articles. The presentation of this systematic analysis follows the criteria described in the PRISMA declaration.Results22 articles complied with the inclusion criteria and 7 articles more were added manually, reaching a total sample of 29 studies. Following the analysis of the studies, they were classified into 18 high-quality, 10 mediumquality and 1 low-quality study. Only 4 studies achieved a maximum score of 9 (according to NewCastle Ottawa Scale, NOS).Conclusions VADO is a technique with greater potential in vertical gain. The performance of dental implants has a success and survival rate similar to dental implants placed on bones that are not subject to increase techniques. Key words:Vertical distraction osteogenesis, alveolar ridge, distraction osteogenesis, dental implant.

Is Bone Morphogenetic Protein-2 as Effective as Alveolar Distraction Osteogenesis for Vertical Bone Regeneration?

The aim of this study was to assess the clinical effectiveness of alveolar distraction osteogenesis (ADO) versus recombinant human bone morphogenetic protein-2 (rh-BMP-2) for vertical ridge augmentation. Few data have been published on vertical bone regeneration using rh-BMP-2. The authors implemented a retrospective cohort study and enrolled a sample composed of patients with deficient alveolar vertical bone height. The primary predictor variable was vertical augmentation with BMP-2 and a titanium mesh or ADO. The primary outcome variable was gain in vertical bone height (millimeters) measured using computed tomography. The secondary outcome variable was postoperative complications, namely need for further grafting before or simultaneous with implant placement, soft tissue dehiscence, paresthesia, infection, implant failure, and pain. Other outcomes included implant stability at time of placement and follow-up (implant stability quotient by resonance frequency analysis), surgical time (minutes), and total treatment time until implant placement (weeks). Other study variables included location of reconstruction (maxilla or mandible). Appropriate bivariate statistics were computed and statistical significance was set a P value less than .05. The retrospective review yielded 21 patients in the BMP group and 19 in the ADO group. For the BMP-2 group, the average vertical bone gain was 2.96±1.8mm overall (maxilla, mean 3.6±3.1mm; mandible, mean 2.32±1.8mm). For the ADO group, this gain was 4±1.69mm overall (maxilla, mean 2.8±1.94mm; mandible, mean 5.2±4.67mm). For complications, group BMP showed a statistically minor tendency for more postoperative problems, such as wound dehiscence. For implant survival, group BMP showed a 92.2% survival rate versus 96.3% in group ADO at 3 to 45months after delivery of the prosthesis (average, 22months). The 2 techniques showed similar values in absolute vertical bone gain. Group ADO showed a slightly better outcome in outright vertical regenerative potential, albeit with a more frequent need for regrafting before and simultaneous with implant placement. Group BMP showed a lesser need for regrafting, despite having a higher postoperative complication rate.