Alveolar Distraction Osteogenesis Research Articles

A retrospective study of the potential complications during alveolar distraction osteogenesis in 55 patients

A retrospective study of the potential complications during alveolar distraction osteogenesis in 55 patients

Complication frequencies of conventional grafting technique and alveolar distraction osteogenesis for bone augmentation: Preliminary results

Complication frequencies of conventional grafting technique and alveolar distraction osteogenesis for bone augmentation: Preliminary results

Implant stability at shortening the consolidation period of alveolar distraction osteogenesis: Preliminary results

Implant stability at shortening the consolidation period of alveolar distraction osteogenesis: Preliminary results

Evaluation of minipigs as an animal model for alveolar distraction

Objective Alveolar distraction osteogenesis is a relatively novel tissue regeneration technique that remains, in some respects, at an experimental stage. The selection of an experimental animal biomodel is not clearly defined, with reports in the reviewed literature on dogs, sheep, and monkeys. The present objective was to compare 2 experimental biomodels (dog and minipig) using an alveolar distraction protocol with a novel prototype distractor. Study design Three beagle dogs and 3 Göttingen minipigs were evaluated, placing the distractor at the right hemimandible alveolar ridge after previous extraction of premolars. The radiological examination was carried out immediately after the distraction and at 2 weeks of consolidation. Results Satisfactory clinical and radiological results were obtained in 2 of 3 beagle dogs after the previous unilateral extraction of mandibular and maxillary premolars. During the consolidation, a height gain of approximately 5 mm was observed, with the appearance of radiodense bone trabeculae in the distraction chamber. The distraction failed in all of the minipigs. Conclusion The minipig was not an appropriate biomodel for the study of alveolar distraction because the investigators were not able to maintain the seal of the distraction chamber or the stability of the distractor.

Alveolar distraction osteogenesis for the correction of vertically deficient edentulous ridges: A multicenter prospective study on humans

Purpose The purposes of this prospective multicenter study were to evaluate the use of vertical distraction osteogenesis in the correction of vertically deficient alveolar ridges and to evaluate whether the vertical bone gained by distraction osteogenesis was maintained over time when dental implants were placed in the distracted areas. Materials and methods Thirty-seven patients presenting vertically deficient edentulous ridges were treated in 4 different centers by means of distraction osteogenesis with an intraoral alveolar distractor. Two to 3 months after consolidation of the distracted segments, 138 dental implants were placed in the distracted areas. Four to 6 months later, abutments were connected and prosthetic loading of the implants began. Results The mean follow-up after initial prosthetic loading was 34 months (range 15 to 55 months). The mean bone gain obtained by distraction was 9.9 mm (range 4 to 15 mm). The cumulative success rate of the implants 4 years after the onset of prosthetic loading was 94.2%, while the implants' cumulative survival rate was 100%. No statistically significant differences were found between the different centers as far as survival and success rates of implants were concerned. Discussion and conclusion The results of this study appear to demonstrate that distraction osteogenesis is a reliable technique for the correction of vertically deficient edentulous ridges. The regenerated bone appeared to withstand the functional demands of implant loading. The survival and success rates of the implants placed in the distracted areas were consistent with those reported in the literature regarding implants placed in native bone in this patient population.— Reprinted with permission of Quintessence Publishing.

Distraction osteogenesis for dental implants

Distraction osteogenesis (DO) is a useful technique for the reconstruction of deficient alveolar ridges. In addition to recreating bone, soft tissues including keratinized gingiva are created. DO affords the clinician the opportunity to “overgrow” the bone, thus allowing osseous recontouring at the time of device removal and implant placement. The technique of DO can easily be mastered, yet the technique does require attention to detail, especially in device trajectory. Yet pitfalls and complications can be encountered. Mastery of these complications as well as the basic DO technique will be discussed in this course. Additionally, special case presentations such as anterior maxillary DO for esthetic implant reconstruction for patients status post avulsion of anterior teeth and bone, treatment of distal saddle deformities using DO and a posterior hinge, monocortical DO for knife edge ridges, evolving technology including the use of smaller, multi-vector distraction devices, DO for treatment of alveolar clefts as well as the use of DO-PRP sandwich technique and “immediate” DO for special cases will be offered. References Chin M: Distraction osteogenesis for dental implants. Atlas Oral Maxillofac Surg Clin North Am 7: 1999 Jensen OT, Cockrell R, Kuhike L, et al: Anterior maxillary alveolar distraction osteogenesis: A prospective 5-year clinical study. Int J Oral Maxillofac Implants 17: 2002 Gaggi A, Schultes G, Rainer H, et al: The transgingival approach for placement of distraction implants. J Oral Maxillofac Surg 60: 2002

Poster 13: Osteoclastic and osteoblastic response to alveolar distraction osteogenesis in a canine model

Poster 13: Osteoclastic and osteoblastic response to alveolar distraction osteogenesis in a canine model

Poster 8: Potential complications during alveolar distraction osteogenesis

Statement of the Problem: Alveolar atrophy has been a major problem in achieving successful rehabilitation with dental implants. Distraction osteogenesis has been clinically applied to augment the alveolar ridge vertically since 1996.

Alveolar distraction: analysis of 10 cases.

The purpose of this study was to evaluate intraoperative and postoperative complications of alveolar distraction and outcome. Ten patients with alveolar ridge deficiencies were treated with alveolar distraction osteogenesis by means of intraosseous distractors (Lead system, Stryker Leibenger, Kalamazoo, Mich). The deficiencies were caused by atrophy after periodontal disease or atrophy after tooth extraction (n = 6), benign tumor resection (n = 2), trauma (n = l), or oligodontia in a case of ectodermal dysplasia (n = l). The location of the defects was the anterior mandible (7), posterior mandible (1), and anterior maxilla (2). The mean follow-up was 1.8 years, with a range of 10 months to 3 years. The mean alveolar distraction achieved in 10 cases was 8.7 mm (5-15 mm). The intraoperative and postoperative problems encountered were lingual (n = 3) and palatal (n = 2) displacement of the distracted segment, fracture of the distracted segment in a very thin alveolar bone (n = 1), and intraoperative bleeding (n = 1). Overall complication rate was 70%. However, most of the complications were minor and eliminated easily. Implant success rate was 85%.

Morphofunctional and clinical study on mandibular alveolar distraction osteogenesis.

Alveolar Distraction Osteogenesis (ADO) is a process which forms new alveolar bone to correct alveolar deformities in ridge height and width. This work aims (a). to verify the predictability of the augmentation of height of atrophic alveolar ridges using an extra-alveolar distraction device and (b). to study the bone processes in order to optimize implanto-prosthetic rehabilitation. ADO was performed on 10 patients with ridge deformities to obtain the required ridge augmentation. Clinical and radiological (OPT and CT with densitometric assay) evaluations were carried out during the following 12 weeks, before implant insertion. Biopsies at 40, 60 and 88 days were studied after general, specific and histochemical staining of slides; microradiographs were analyzed to evaluate the Trabecular Bone Volume. Forty days after the end of distraction, soft callus indicated the start of ossification. Sixty days after the end of distraction, the soft callus was largely converted into a network of trabecular woven bone; osteogenic activity was high and TBV was about 50%. Eighty-eight days after the end of distraction, the amount of bone appeared reduced, with a more ordered structure; bone formation activity and TBV also diminished, whereas osteoclast erosion was active. The densitometric assay shows values increasing from the end of distraction, particularly after implant insertion. Histological results show a regression in bone deposition processes 88 days after the end of distraction culminating in a virtual steady-state after a certain time. The results suggest that early implant insertion may be desirable to avoid bone loss due to mechanical unloading.

Minor complications arising in alveolar distraction osteogenesis

Purpose: This study evaluates complications that arise during mandibular alveolar distraction osteogenesis and suggests treatments. Methods: We monitored complications that arose during alveolar distraction osteogenesis in 5 patients who underwent a total of 7 distractions, in all cases using an intraosseous distractor (Lead System, Leibinger, Germany). We report our responses to each type of complication. Results: All 7 distractions were followed by the placement of 2 implants. The restoration was ideal in 4 of the 7 cases and functional but not ideal in the remaining 3. In all 7 distractions, we observed complications, although many were minor complications readily avoided by the use of appropriate technique. The complications were, first, intraoperative complications, namely 1) fracture of the transport segment (1 of 7 cases; Response: appropriate preventative measures), 2) difficulties in finishing the osteotomy on the lingual side (7 of 7 cases; Response: use of fine chisels made from cement spatulas), and 3) excessive length of the threaded rod (1 of 7 cases; Response: cut the rod). Second, complications arose during distraction: 1) incorrect direction of distraction (2 of 7 cases; no corrective measures necessary in the present cases), 2) perforation of the mucosa by the transport segment (2 of 7 cases; response: smooth the crest of the segment with a bone rongeur), and 3) suture dehiscence (1 of 7 cases; no significant implications). Third, there were postdistraction complications, namely bone formation defects (4 of 7 cases; response: guided bone regeneration). Conclusions: A number of complications may arise during alveolar distraction osteogenesis. Most of these complications can be considered minor and are readily avoided or resolved by the use of appropriate procedures. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:496-501, 2002

Discussion

Klug et al report on an innovative technique for application of titanium membranes in conjunction with mandibular alveolar distraction osteogenesis documented by histology and computed tomography (CT) scans in humans. Alveolar distraction techniques have gained wider acceptance and increased clinical applications with the advantages of avoidance of bone grafting and potential donor site morbidity.

Distraction alvéolaire des secteurs postérieurs mandibulaires : à propos d'un cas clinique

When it is necessary to increase the vertical height of the residual alveolar ridge, alveolar distraction osteogenesis has numerous advantages compared to other preprosthetic surgical procedures. It is frequently used for this purpose in the anterior region because of the obvious accessibility. The authors present a clinical case of edentulous posterior mandible, with insufficient vertical alveolar bone height, treated by alveolar distraction osteogenesis leading to three titanium fixtures. They explain their choice and discuss the preliminary results.