Alveolar Distraction Research Articles

Advanced Approaches to Alveolar Widening and Vertical Distraction

Alveolar distraction is being used increasingly for alveolar bone reconstruction in patients with severe mandibular defects. Among other surgical techniques such as augmentation and guided bone regeneration procedures vertical distraction of the mandible is a relatively new reconstructive procedure. Since 1996 promising results with this approach have increased its popularity, this mode of treatment is still in the preliminary stages of development.

Relapse in Alveolar Distraction Osteogenesis: An Indication for Overcorrection

The aim of this study was to indicate the necessity of overcorrection regarding the occurrence of bone height relapse at the end of consolidation period in distracted alveolar bone. Eleven patients with a total of 17 distractions performed and 43 implants placed were included in this study. Bone height was evaluated on computed tomography before the procedure and on orthopantomographic radiographs following distraction and consolidation. Measurement was performed on the aproximal surfaces of implants and on identical points before and after distraction. The mean of distraction performed was 6.08 +/- 1.82 mm at mesial points and 6.18 +/- 1.90 mm at distal points of measurement. The mean of bone relapse following consolidation period was 1.57 +/- 1.82 mm at the mesial and 1.79 +/- 1.68 mm at the distal aspects of implants. Statistical evaluation revealed that alveolar bone distraction should include 20% of overcorrection for both mesial and distal points of measurements plus 0.34 mm for mesial and 0.52 mm for distal points of measurement. Occurrence of relapse found in this study indicates that overcorrection should be included when performing alveolar distraction osteogenesis.

Clinical Assessment Of 40 Patients Subjected To Alveolar Distraction Osteogenesis

Alveolar bone distraction is a technique used to restore vertical defects in the edentulous alveolar ridge. The gradual growth of bone tissue has a predictable result, allowing the placement of an osseointegrated implant in an ideal position. In this study, the effectiveness of the alveolar distraction technique was verified, using an extraosseous device. The bone augmentation average was 9.5 mm in 40 patients, showing a 92.5% success rate.

The application of alveolar distraction osteogenesis following nonresorbable hydroxyapatite grafting in the anterior maxilla: A clinical report

Distraction osteogenesis is a method of increasing bone length through the application of slow, controlled force on bone segments where periosteum and medullary blood supply are maintained. Recently, the procedure has been adapted to alveolar augmentation prior to prosthodontic rehabilitation. This report describes the use of alveolar distraction in the anterior maxilla and presents, to the authors' knowledge, the first reported successful application of the technique following nonresorbable hydroxyapatite grafting.

Evaluación clínica y radiográfica de la técnica de distracción osteogénica en la reconstrucción de rebordes alveolares atróficos en la región anterior del maxilar superior

This study evaluates clinically and radiographically the distraction osteogenesis technique for the reconstruction of atrophic alveolar ridges in the anterior maxilla region, and the possible complications that arise during treatment. Fifteen patients were evaluated, clinically and radiographically, that had been treated with alveolar distraction osteogenesis in the anterior region, using a juxta-osseous distractor. In 13 patients (86.6%) the technique was completely successful, there being an effective bone gain of 7,04 mm. In 1 patient (6.66%) this was partial (2.62 mm) and in 1 patient (6.66%) the technique failed, as there was a gain of just 0,76 mm because of problems during the activation. The complications arising during the alveolar distraction osteogenesis were divided into minor complications that did not compromise the success of the technique, and which were found in 8 patients (53.33%), and major complications that did not permit rehabilitation, which were found in 1 patient (6.66%). The alveolar distraction osteogenesis technique proved to be an effective technique for the reconstruction of atrophic alveolar ridges with a success rate of 93.33%. There were minor complications but the surgeon intervened in time and these were solved.

Analysis of complications following alveolar distraction osteogenesis and implant placement in the partially edentulous mandible

The purpose of this retrospective study was to evaluate complications before, during, and after vertical alveolar distraction osteogenesis and to assess the survival rate of dental implants placed in distracted bone. In a consecutive series, 37 patients with 45 alveolar ridge deficiencies of the partially edentulous mandible were treated with 14 intraosseous and 31 subperiosteal distraction devices. Seventy-two dental implants could be placed at the time of distractor removal and 21 implants at a second stage. Complications associated with the distraction procedure affected 75.7% of patients. The majority of complications were of minor nature with the exception of fractures of basal bone (n = 3), fracture of transport segment (n = 1), breakage of distractor (n = 1), and severe mechanical problems (n = 3). Eleven secondary grafting procedures were necessary to allow the placement of dental implants. Implant survival was 95.7% (mean postloading follow-up: 35.7 months). Vertical alveolar distraction osteogenesis is not an uncomplicated procedure; however, long-term survival of dental implants inserted into distracted areas is satisfactory.

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

Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device

When teeth are replanted after being avulsed, the repair process sometimes results in ankylosis. In a growing child, the ankylosed tooth fails to move along with the remaining alveolar process during vertical growth, resulting in a tooth that gradually appears more and more impacted and requires several reconstructive procedures to correct. Ankylosed teeth can, however, serve as anchorage for orthodontic correction of a malocclusion and as a point of force application for a dentoalveolar segment during alveolar distraction osteogenesis. This case report describes the treatment of a 13-year-old girl whose maxillary left central incisor had been avulsed and replanted 5 years earlier. The tooth had become ankylosed, and it was used to provide "free anchorage" during distalization of the maxillary dentition. The underdeveloped alveolar process adjacent to the ankylosed tooth was reconstructed by dento-osseous segment distraction osteogenesis, by using the ankylosed tooth as the point of force application.

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

Use of an alveolar distraction device for repositioning the maxillary segment to correct asymmetry of the maxillomandibular complex

Use of an alveolar distraction device for repositioning the maxillary segment to correct asymmetry of the maxillomandibular complex

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.

Horizontal alveolar distraction of the narrow maxillary ridge for implant placement

The purpose of this report was to describe a surgical technique for performing horizontal alveolar distraction of the knife-edge maxillary ridge. The patient was a 17-year-old woman with atrophy of the alveolar rim in the anterior upper jaw, which had inadequate width for implant placement. The transport segment was constructed by the osteotomy of the labial cortex of the alveolus. A transport plate of a distractor (LEAD system; Stryker Leibinger, Kalamazoo, MI) was placed on the transport segment. The distraction rod was inserted horizontally, and put in contact with the palatal cortex at the top. A base plate was not placed. The alveolar distraction was successfully performed to gain 6.0 mm in width and 0.5 mm in height, allowing placement of three 14-mm implants. All the implants were integrated so as to support the prosthesis. Alveolar distraction can be useful for augmenting the narrow ridge horizontally and placement of implants.

Enhancement of Bone Formation by Bone Morphogenetic Protein‐2 During Alveolar Distraction: An Experimental Study in Sheep

The purpose of this study was to perform alveolar ridge augmentation by distraction osteogenesis (DO) and to enhance bone regeneration through the use of recombinant human bone morphogenetic protein-2 (rhBMP-2), followed by implant placement. Alveolar segmental osteotomy was performed in the mandible of 10 sheep followed by placement of 1.5 mm alveolar distraction devices. The study group was injected on the fifth day of distraction with a single dose of 10 microg rhBMP-2. Only distraction was performed in the control group. A mean alveolar augmentation of 12 mm was achieved. After 12 weeks of consolidation, the distraction devices were removed and biopsies were taken for histological and immunohistochemical characterization and morphometry of the newly formed bone. Titanium threaded cylindrical implants were then placed in the newly augmented bone. Radiological evaluation showed lifting of the transport segment and integration of the implants within both the transport segment and the regenerated bone. The histological study demonstrated that the association of DO and BMP resulted in increased trabecular bone size and volume (32.2%+/-0.95% versus 18.6%+/-0.71%; P <1 x 10(-17) after 24 days of lengthening and 63.8%+/-1.89% versus 42.5%+/-1.33%; P<1 x 10(-15) after 12 weeks of consolidation) and increased numbers of proliferating cell nuclear antigen stained cells (0.7+/-0.04 versus 0.47+/-0.04; P<1 x 10(-10)) compared with the DO only group. Alveolar distraction augments atrophic alveolar ridge and creates new bone that permits implant placement. rhBMP-2 enhances bone quality and may shorten the consolidation period of distraction allowing for earlier implant placement.

Horizontal alveolar distraction: A surgical technique with the transport segment pedicled to the mucoperiosteum

The study goal was to describe a surgical technique for performing horizontal alveolar distraction with the aim of increasing the width of alveolar ridges that are too narrow for dental implant placement. A transport segment is cut from the vestibular side of the ridge, using osteotomes, and maintaining extensive attachment to the mucoperiosteum. The distraction screw is placed through the vestibular mucosa and the transport segment, in vestibular-palatal direction. Distraction is then performed to increase ridge width. We successfully applied this technique in a patient who required 2 dental implants at adjacent sites in the upper jaw but whose alveolar ridge was too narrow for direct implantation. With horizontal distraction, ridge width was successfully increased, allowing placement of the 2 implants (diameter, 3.3 and 4.1 mm). This technique shows promise for patients requiring implants in a narrow alveolar ridge. Depending on each patients specific requirements, we suggest that it be taken into account as a possible alternative to existing techniques.

The “FAD” (Floating Alveolar Device): A bidirectional distraction system for distraction osteogenesis of the alveolar process

The following study illustrates preoperative and perioperative vector management in alveolar distraction using a new distraction system--the "Floating Alveolar Device" (FAD). The FAD is a bidirectional alveolar distractor that allows augmentation of an atrophic alveolar process in several planes, assures easy intraoperative positioning of the planned vector of distraction, and provides correction of the horizontal position of the transported segment during and after vertical distraction. The FAD is composed entirely of stainless steel and has the following basic components: an upper member, a distraction rod, a lower base plate supporting the vertical force of the distraction rod, a jointed hinge that connects the upper and the lower members, and a tightening rod that provides blocking of the hinge. The clinician can manipulate and adjust the tightening rods, allowing a change in the angle of the hinge, thereby altering the transverse dimension of the vector of distraction. A total of 4 patients aged to 19 to 40 years underwent bidirectional alveolar distraction. All procedures were performed in the mandible. In all treated patients, planned distraction height and direction were achieved. In all cases it was possible to place implants at the planned time. The most common complication, axial displacement, is easily eliminated by moving the bone with the "floating" rod of the FAD during or immediately after the distraction period, according to the principles of the floating bone concept.

Referral patterns in implant dentistry

omy to more predictably correct these defects. Five consecutive cases of maxillary alveolar distraction (AD) were compared to 5 consecutive osteotomy cases (SO). Parameters studied were the total distraction length desired and achieved, reconstitution of tissue height, favorable vector control, need for additional bone grafting, need for soft tissue grafting, total treatment time. Results: The sandwich alveolar bone graft technique was developed and applied in 5 sites, 5 patients. The surgical technique involves an alveolar osteotomy, for vertical displacement of the inferior fragment and placement of an interpositional autologous mandibular graft. A primary cortical mandibular ramus graft served as the donor site. Key surgical features included elevation of bone to the bone level of adjacent teeth, mobilization of the alveolar segment and retention of the adhering overlying gingival. Mobilization of the distal segment and malleting the graft into place were important for stability. From 5 to 8 mm of desired bony height for SO and 10 to 14 mm for AD were measured using periapical radiographs. Prolonged total treatment time, greater distraction lengths, reduced maintenance of tissue height, and increased need for additional bone grafting as a labial onlay were noted for AD, for equivalent intervals of 6-8 months later. The loss of tissue height could be accommodated for by modification of incision design for implant placement. The disparate distracted lengths may have accounted for the need for additional bone grafting and unfavorable vector control for AD. The recuperation following SO was similar requiring a 2to 5-day postoperative disability period, but there were fewer postoperative visits. AD required a procedure to eliminate the distraction device. Dehiscence over the distraction device could lead to unfavorable esthetic scarring. In contrast, to AD, there was no incidence of dehiscence or delayed labial grafting with SO Conclusion: Advantages of the technique noted include: accurate reliable reconstruction of the alveolus, elimination of additional bony reconstructive procedures, no relapse in the short term, and safer use of an acrylic interim denture for esthetic purposes. On the basis of this pilot study it appears that for vertical lengths of 5-8 mm, SO seems a more predictable procedure simply based on the number of postoperative visits and reduced total treatment time.

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