Alveolar Distraction Research Articles

Radiological and histological evaluations of different consolidation periods during alveolar distraction osteogenesis: a clinical study

iterature describes that congenital eye oss can be the most important reason of the icroorbit. This development deficiency rings functional, physical and psychoogical consequences. I will present a ew treatment alternative for the severe icroorbit, in which the conventional treatents are not possible to use. Method:There is a 6/1 years old female ith bilateral cleft lip and palate, and right nophthalmia. She had a severe microorbit nd it was impossible to use conventional herapy in order to stimulate the orbit rowth for the rehabilitation with an ocular rothesis. It was decided to use the orbital istractor, which movements are hree-dimensional: orbit expansion nd posterior–anterior movement by eans of an osteotomy in four segments f the orbit. Results:The activation of the distractor egan at the seventh day, it was achieved posterior–anterior movement of the orbit nd the expansion of the laterals and medils walls. The period of consolidation was 2 days. The placement of the ocular prothsis in cavity was done four and a half onths after the distractor was taken off. Conclusion: The craniofacial skeleton s formed by bones, in three-dimensional orm. It is necessary to look for alternatives f treatment that recover the anatomy with ore aesthetic, functional and permanent esults. The distractor used in this case is a ew alternative, but it needs specific modications of size to favor its comfort during ts use and to prevent the ulcers caused by ressure of the distractor contact on the kin and its movement. Conflict of interest: None declared.

A new device for alveolar bone transportation

We present a retrospective review of a new technique for the transportation of alveolar bone using a Hyrax device modified by the principal author (O.A.V.). There were seven patients (five males and two females), including five patients with cleft palate and lip diagnosis, one patient with a high-speed gunshot wound, and one patient with facial trauma sequel due to mandibular fracture. They were all treated with an alveolar bone transportation technique (ABT) through the use of the modified Hyrax device (VEGAX). Before surgery, distraction osteogenesis of the bifocal type was performed on four patients, and the trifocal type was performed on the other three patients. However, in one case, direct dental anchorage was not used, only orthodontic appliances. In all the cases, new bone formation and gingival tissue around the defect were obtained, posterior to the alveolar distraction process; no complications were observed in any patient. In one case, two teeth involved in the disk of the ABT were extracted, due to a previous condition of periodontal disease. The alveolar bone transport with the VEGAX device is an accessible technique for almost every patient with alveolar defects due to diverse causes. In all the presented cases, predictability and success were demonstrated.

Alveolar distraction osteogenesis for oral rehabilitation in reconstructed jaws

To present a literature review of alveolar distraction osteogenesis (ADO) for reconstructed jaws, with emphasis on indications, critical surgical factors, protocols and complications for oral rehabilitation of reconstructed jaws. The defects in jaw result mostly from malignancy, benign tumor or gunshot injury. Jaw reconstructions were performed mostly by vascularized fibula graft. Alveolar distraction was primarily indicated to correct vertical discrepancy between the reconstructed region and residual ridge in order to achieve adequate height of the transplanted bone prior to implant placement. The vertical bone height gained ranged from 6 to 15 mm. The most common complications reported were infections and distractor malalignment. This review reveals few numbers of case series on this topic. However, ADO in reconstructed jaws can produce consistent evidence of bone regeneration, with stable augmentation results clinically, histologically and radiographically, thus making it a predictable surgical procedure prior to oral implant rehabilitation.

P242. Alveolar distraction in the reconstructed mandible using fibular free flap

P242. Alveolar distraction in the reconstructed mandible using fibular free flap

A New Device for Alveolar Bone Transportation

We present a retrospective review of a new technique for the transportation of alveolar bone using a Hyrax device modified by the principal author (O.A.V.). There were seven patients (five males and two females), including five patients with cleft palate and lip diagnosis, one patient with a high-speed gunshot wound, and one patient with facial trauma sequel due to mandibular fracture. They were all treated with an alveolar bone transportation technique (ABT) through the use of the modified Hyrax device (VEGAX). Before surgery, distraction osteogenesis of the bifocal type was performed on four patients, and the trifocal type was performed on the other three patients. However, in one case, direct dental anchorage was not used, only orthodontic appliances. In all the cases, new bone formation and gingival tissue around the defect were obtained, posterior to the alveolar distraction process; no complications were observed in any patient. In one case, two teeth involved in the disk of the ABT were extracted, due to a previous condition of periodontal disease. The alveolar bone transport with the VEGAX device is an accessible technique for almost every patient with alveolar defects due to diverse causes. In all the presented cases, predictability and success were demonstrated.

Island Osteoperiosteal Flaps With Interpositional Bone Grafting in Rabbit Tibia: Preliminary Study for Development of New Bone Augmentation Technique

Loss of alveolar vertical height is one of the most challenging conditions in the field of implantology. A few augmentation techniques have been proposed to address this challenge, including guided bone regeneration, alveolar distraction osteogenesis, sandwich osteotomies and autogenous block grafting. This is a pre-clinical study of lengthening the alveolar bone height using a thin osteoperiosteal bone flap, the "island bone flap" or i-flap, to establish vitality, stability and incorporation of the augmentation material after healing. A rabbit tibia model was designed for this study and included 8 rabbits. An osteoperiosteal osteotomy was performed through the periosteum cutting 1 mm of the outer cortex of the bone in order to elevate a bone flap. The bone flap was detached, and remained attached to the periosteum as a free floating osteoperiosteal flap, and the resultant defect was filled with xenograft. The histological analysis demonstrates formation of maturing trabeculae in the site of the i-flap. In cases of trauma to the bone marrow during the surgical procedure, a centripetal gradient of bone remodeling from the surgical site toward the periphery was evident, while the bony component of the i-flap maintained vital. Creating a free floating osteoperiosteal flap, used here with interpositional grafting in a rabbit tibia, appears to heal by both appositional modeling and creeping substitution remodeling. Volumetric augmentation persisted despite exuberant bone turnover in this animal model. This technique holds promise as a possible augmentation bone grafting approach for use in alveolar reconstruction.

Alveolar Regions of the Mandible for the Installation of Immediate-Implant Fixtures and Bone Screws of Alveolar Distractors

The purposes of this study were to elucidate the anatomic relationship between the dental roots and surrounding tissues and to identify the optimal sites at which to install dental surgical devices including immediate-implant fixtures and alveolar distractors. We made 5 types of measurements on horizontal cross sections obtained at 1-mm intervals from 20 Korean mandibles. The following results were obtained: (1) the mandibular facial plate was thinnest at the canine (0.5-0.7 mm) and became thicker toward the molar region; (2) the thicknesses of the facial and lingual cortical bone in the interdental region increased from anterior to posterior and from coronal to apical aspects; (3) in each section, the buccolingual root was narrower than 4 mm at depths greater than 8 and 9 mm in the central and lateral incisors, respectively, and the maximum mesiodistal root widths were 3.0 and 3.3 mm; (4) the interroot distance increased from anterior to posterior and from coronal to apical aspects; and (5) on the sections of the first and second molars, the diameter of the septal bone ranged from 4.2 to 7.9 mm buccolingually and from 1.3 to 3.3 mm mesiodistally. Achieving successful placements of implant fixtures and bone screws requires an accurate understanding of the anatomic structure at the installation site. The reported anatomic data might facilitate successful treatments and provide crucial information for use when planning and performing placements of dental surgical devices.

Repositioning a Prosthetically Unfavorable Implant by Vertical Distraction Osteogenesis

Prosthetically unfavorable implant positions challenge patients and restorative dentists. Surgical correction of malpositioned implants may be an alternative technique for esthetically and biomechanically acceptable prosthetic restorations. This case report describes an alveolar distraction technique used to coronally reposition a dental implant and the 3-year results in the maintenance phase. To our knowledge, long-term follow-up of this method of correction is unprecedented. The present case report describes the repositioning of an apically positioned and fully osseointegrated implant at the right maxillary canine region using an alveolar distraction technique. Distraction was performed at 1 mm per day and ended when the implant moved 6 mm coronally. After a consolidation phase of 8 weeks, an implant-supported fixed prosthetic restoration was performed. Healing was uneventful after removal of the distractor. During the 3-year follow-up, the implant was fully functional with minimal probing depths, negligible signs of inflammation, and no further bone loss. This intervention illustrates the promise of an alveolar distraction osteogenesis procedure for vertical repositioning of apically positioned implants. This technique also provided soft and hard tissue remodeling to obtain an esthetic and stable restoration.

A Simple Technique for Increasing the Length of the Distracted Area: Technical Note

Intraoral distraction osteogenesis is a relatively new procedure for lengthening of the jaws and alveolar bone.1,2 In this procedure the newly formed bone is maintained in a more physiologic way.3 Alveolar distraction osteogenesis (ADO) shows various advantages in rehabilitation of alveolar bone defects resulting from congenital or acquired bone deficiencies.1,2

Treatment of Class II open bite complicated by an ankylosed maxillary central incisor

Ankylosed teeth in growing patients cause troublesome dentoalveolar problems and require special therapeutic care for accomplishing long-term esthetic and functional results. The various treatment modalities for ankylosed teeth include reconstruction after extraction, surgical extrusive luxation, individual segmental osteotomy or corticotomy, and alveolar distraction osteogenesis. This report describes a case of a 13-year-old boy with anterior open bite complicated by an ankylosed maxillary central incisor that was managed by corticotomy-facilitated orthodontic treatment.

Evaluation of augmented alveolar bone with vertical alveolar distraction osteogenesis and implant installation

Introduction: The purpose of this study was to evaluate the clinical result of vertical alveolar distraction, especially the distracted alveolar bone and installed implants. Materials and Methods: Twenty-one patients who have been received the vertical alveolar distraction and implant installation on 22 areas (3 maxilla and 19 mandible) using intraoral alveolar distraction device were examined. After consolidation period of 3-4 months, distraction devices were removed and 91 implants were installed in the distracted alveolar bone. The distracted bone and implants were evaluated clinically and radiographically. Results: Mean height of distracted alveolar bone was 7.5±3.2 mm (range: 2.5-15.0 mm). Mean follow-up period after completion of the distraction was 3.1 years (range: 1.4-11.5 years). Mean resorption of distracted alveolar bone was 1.6±1.8 mm. The success and survival rates of implants was 95.3% and 100%, respectively.. Conclusion: Results of this study indicate that vertical alveolar distraction procedure is a useful and stable method for alveolar ridge augmentation and implantation.

Rehabilitation of recurrent unicystic ameloblastoma using distraction osteogenesis and dental implants

Ameloblastoma is a true neoplasm of odontogenic epithelial origin. Surgical resection of the ameloblastoma is well-documented and an accepted treatment modality. Vertical distraction of the alveolar process is an efficient method for augmentation. This method of providing additional bone and soft tissue for implant placement is becoming more common. This clinical report describes the use of distraction osteogenesis and fixed implant supported prosthesis to treat a post-surgical alveolar defect as a result of the resection of a unicystic ameloblastoma in the anterior mandibular region. As a result of alveolar distraction a segment of mature bone was transported vertically in order to lengthen the crest, for better implant anchorage. Further clinical and experimental studies of the technique with long-term follow-up are needed, to confirm bone and implant stability, as it relates to alveolar height.

Alveolar osseous distraction by the combined use of modified miniplates and an orthodontic appliance. A technical note

An original alveolar osseous distraction method using a Hyrax orthodontic device connected to two miniplates modified as a skeletal orthodontic anchorage (Bollard™ type) is reported and illustrated by three cases. In all three cases with alveolar bone insufficiency, the alveolar osseous distraction allowed for dental implant positioning and fixed dental prosthetic rehabilitation.

Rehabilitation of Maxillary Anterior Esthetics by Alveolar Distraction Osteogenesis With Immediate Implant Placement: A Case Report

Esthetic reconstruction of severe soft and hard tissue deficiencies is the utmost challenge in implant dentistry. To prevent postoperative bone resorption and to control the amount of hard and soft tissue volume, distraction osteogenesis followed by immediate implant placement has been proven to be a promising combined technique. The aim of this report is to introduce a treatment strategy to maintain anterior esthetics and to control hard and soft tissue volume in a case, treated with the combined technique of vertical alveolar distraction and immediate implant placement. An osteotomy was performed by the use of an oscillating saw. Cut alveolar segment was mobilized, and a distractor device was inserted in between the segments. During the activation and consolidation periods of distraction, anterior esthetics was provided with removable acrylic provisional crowns placed on the distractor's rod. In 2 weeks of distraction period, vertically 10 mm of new bony segment was obtained, and 2 weeks after the removal of distractor, maxillary incisors were extracted. Four dental implants were placed according to the immediate placement protocol. In osseointegration period, provisional restorations were fabricated on abutments to form harmonious gingival contours and to maintain maxillary anterior esthetics until the fabrication of final restorations.

Piezosurgery

Piezosurgery is a new innovating technique used to perform safe and effective osteotomies using piezoelectric ultrasonic vibrations. It was conceived by Tomaso Vercellotti, MD, DDS, and it was first reported for preprosthetic surgery, as alveolar crest expansion, sinus grafting, and, more recently, alveolar distraction. The purpose of this report was to introduce and justify the use of Piezosurgery to perform osteotomies during mandibular distraction in cases of hemifacial microsomia.

Treatment of Patient With Papillon-Lefevre Syndrome With Short Dental Implants: A Case Report

Papillon-Lefevre syndrome (PLS) is an autosomal recessive disorder. Main features of PLS are hyperkeratosis of palms and soles concomitant with premature loss of primary and permanent dentition due to progressive periodontitis. Dental management of patients with PLS is usually challenging because of early excessive loss of alveolar bone support. We describe dental rehabilitation of a 34-year-old patient with PLS with severely atrophic mandible by means of 2 short (6 mm) dental implants between 2 mental foramina supporting an implant retained complete denture. After 1 year of follow-up period, the patient was doing well and there was no sign of bone resorption. In patients with PLS, dental osseointegrated implants (even with shorter lengths) can be safely used for atrophic mandibles instead of invasive preprosthetic applications such as bone augmentation, nerve lateralization, or alveolar distraction to avoid possible complications.

Miniscrew-anchored alveolar distraction for the treatment of the ankylosed maxillary central incisor

Miniscrew-anchored alveolar distraction for the treatment of the ankylosed maxillary central incisor

Prosthetic Rehabilitation of Edentulous Ridges Following Alveolar Distraction Osteogenesis: Clinical Report of Three Cases

Patients with complete edentulism who have insufficient bone for endosseous dental implant treatment present a challenge for dental practitioners. Distraction osteogenesis of the edentulous alveolar ridges is a process for augmentation of atrophic alveolar bone before dental implant placement. This clinical report describes the use of distraction osteogenesis and rehabilitation of patients with a fixed or removable implant-supported prosthesis to treat mandibular defects. Two female patients with segmental alveolar atrophy at the posterior regions of mandible and one female patient with defect at the anterior region of mandible were treated using distraction devices. However, lingual tipping of the distraction vector occurred during the distraction phase in patient 1. The morphology of the alveolar bone was also analyzed in relation to the planned implant position. After a consolidation period of 12weeks on average, radiologic observation suggested that there was sufficient bone formation for implant installation. In all patients, implant-supported fixed or removable prosthetic oral rehabilitation was successfully performed, and the clinical and radiologic findings were satisfactory. After 4years of follow-up, no functional or esthetic difficulties with the implants and restorations were noted. These case reports suggest that although alveolar distraction osteogenesis seems to be an effective technique for augmenting atrophic alveolar bone for creating bone and soft tissue, complications may occur after surgical procedures.

Tooth-borne distraction of the lower anterior subapical segment for correction of class II malocclusion, subsequent to genioplasty

Alveolar distraction is mainly used to increase height and width of the alveolar crest. This technique, however, is not typically used for lengthening the perimeter of the dental arch or improving teeth axes. We applied alveolar distraction in a tooth-borne manner in the second stage of our original method and obtained favorable results. We therefore present an outline of this method. Genioplasty was first performed to create an infrastructure for sequential advancement of the subapical alveolar segment. After bone union, anterior subapical alveolar osteotomy was performed. The stump of the osteotomized dentate segment was moved forward without changing the incisal edge position, and a box-type bioabsorbable plate with four holes was fixed only onto the dentate segment using two screws. After a latency period, two distraction devices were placed bilaterally to the brackets and activated at 1.0 mm/day. After reaching the desired position, the distractor was immobilized, and then replaced by resin temporary teeth to retain the created space. After the consolidation period, orthodontic treatment was restarted and teeth moved into the newly created space. Bimaxillary surgery was performed after completing pre-surgical orthodontic treatment. Finally, both desirable occlusion and functional masticatory function were obtained. This tooth-borne distraction system is one applicable method for patients with skeletal class II and crowding of lower anterior teeth, achieving good results particularly in combination with our original method.

Maxillomandibular Fixation Screws for Early Removal of Hardware and Correction of Lingual Tilting in Alveolar Distraction Osteogenesis

Alveolar distraction osteogenesis is a well-known technique used for the management of deficient alveolar ridges. Vector control of the transport segment is the main problem during distraction. This article describes a new technique for early removal of distractor and correction of tilted transport segment in partially edentulous patients.