Interdental Distraction Osteogenesis Research Articles

Comprehensive interdisciplinary treatment of patient with unilateral cleft palate and oroantral fistula using archwise Interdental distraction osteogenesis: A case report with 1-year follow-up

A unilateral cleft palate with a wide oroantral fistula necessitates meticulous treatment planning and precise execution to mitigate the risk of relapse. It is arduous to address substantial gaps through conventional surgeries using buccal, labial mucosal flaps, or tongue flaps and is associated with heightened failure rates. In recent years, the introduction of interdental distraction osteogenesis (DO) has facilitated successful interventions in mending extensive cleft defects. In this case report, an adult patient with unilateral cleft palate and oronasal fistula has been successfully managed with orthodontic treatment and interdental DO using a custom-made device. The patient received successful treatment through orthodontic treatment and interdental DO utilizing a custom-made device abiding by Ilizarov’s principles. The size of the oroantral fistula was reduced significantly with a successful approximation of the segments. Subsequently, prosthetic replacement of the distracted segment was performed to restore esthetics. Follow-up images and radiographs showcase the stability and integrity of the arches. The epilogue of this case report is that the implementation of transport distraction can be accounted as an effective treatment approach when meticulously planned and followed through. By integrating early detection, multidisciplinary interventions, and ongoing support, healthcare professionals can significantly enhance outcomes and empower individuals to lead fulfilling lives despite their condition.

Interdental Distraction Osteogenesis in Unilateral Cleft Lip and Palate Patient with Wide Alveolar Cleft

Alveolar bone grafting is routinely performed in repair of alveolar clefts. When the alveolar cleft is wider than 11 mm, however, the survival rate of the bone graft and prognosis are poor. Here, we describe successful orthodontic treatment using interdental distraction osteogenesis (IDO) with a tooth-tooth type distractor to reduce the width of the alveolar cleft in a patient with unilateral cleft lip and palate. The patient was a 12-year-old girl with unilateral cleft lip and palate, maxillary dentition midline deviation, congenitally missing maxillary lateral incisors, a palatally-displaced right upper first premolar, a wide alveolar cleft (20 mm), and mandibular prognathism due to maxillary hypoplasia. Treatment comprised a combination of orthodontic treatment and IDO. After treatment, appropriate occlusion, space closure in the maxillary arch, coincidence of the maxillary and facial midlines, and incorporation of the right maxillary first premolar into the arch were obtained. These results suggest that IDO is effective in treating cleft lip and palate patients with a wide alveolar cleft.

A simplified technique for bridging wide alveolar cleft defects

Wider alveolar clefts/fistulae and maxillary dentoalveolar defects pose problems in achieving complete closure because of the requirement of a greater volume of bone as a graft. Segmented osteotomies have been used successfully for the repositioning of minor segments; however, in major segmented movements, the closing of the flap and the blood supply of the osteotomized segment may be compromised. Interdental distraction osteogenesis has overcome this problem by creating a segment of new alveolar bone and complete approximation of wider alveolar defects. This case report shows an effective and efficient way of distraction using a modified Hyrax appliance.

Treatment algorithm for bilateral alveolar cleft based on the position of the premaxilla and the width of the alveolar gap

The efficacy of conventional secondary bone grafting is limited in instances of a bilateral alveolar cleft with a wide cleft gap and malpositioning of the premaxilla. The purpose of this study is to suggest a systematic algorithm to guide individualised treatment of a bilateral alveolar cleft according to the position of the premaxilla and the width of the alveolar gap. A total of 51 patients with bilateral alveolar clefts were investigated between January 2000 and February 2008. The average age was 9.2 years, and the mean follow-up period was 47 months. Conventional alveolar bone grafting (ABG) was performed for patients with both a narrow cleft gap and acceptable position of the premaxilla. Patients with both a wide cleft gap and acceptable premaxilla position were initially managed by interdental distraction osteogenesis. Premaxilla repositioning was indicated in patients with both sagittally and/or vertically unfavoured positioning of the premaxilla. The extent of bone resorption following bone grafting was evaluated using the Abyhölm criteria. Of 102 grafts, 98 grafts (96.1%) showed satisfactory bony take (Grade I-II). Only four grafts (3.9%) exhibited a poor outcome, with more than 50% bony resorption (Grade III-IV). The average hospital stay was 5.7 days and no serious complications were observed. Our approach resulted in satisfactory surgical outcomes. This suggests the feasibility of a standardised approach for the correction of a bilateral alveolar cleft. Our algorithm should be helpful for systematic and coordinated team approaches to rectify bilateral alveolar clefts.

Interdental distraction osteogenesis for the management of alveolar clefts: archwise distraction

Bone grafting is a successful protocol for cleft repair but it is very challenging to close large gaps using local gingival tissue. In the last decade, interdental distraction osteogenesis has been introduced as a successful treatment protocol for repairing such large clefts. In this article a new method for closing the alveolar cleft is introduced and one case is presented. A tooth supported distractor which was specially designed to be inserted on to the main arch wire was used for the distraction. The aim was to distract the tooth segments through the curve of the dental arch and achieve complete closure of the gaps. The distractor introduced had several advantages: it is simple to apply, activate and remove; there is no need for a second operation; it is an outpatient procedure. In the case reported, a very large gap was successfully closed using this protocol whilst maintaining the ideal arch form and generating new bone behind the distracted segments.

Application of Interdental Distraction Osteogenesis to Unilateral Cleft Lip and Palate Patients

Distraction osteogenesis is widely used for the treatment of craniofacial deformities. In patients with cleft lip and palate, distraction osteogenesis can be employed to repair the alveolar cleft. In this report, we describe the management of three cases of unilateral cleft lip and palate by interdental distraction osteogenesis. Interdental distraction osteogenesis of the maxillary bone was performed to reduce the width of the alveolar cleft in these patients in conjunction with orthodontic treatment. Tooth-tooth type distraction devices were fabricated and delivered at the same time as osteotomy. Distraction was continued until the midline of the dentition coincided with the facial midline, and until the width of the alveolar cleft was reduced to the width of lateral incisor or had closed. One month after distraction was complete, orthodontic treatment with an edgewise appliance was initiated, and neighboring teeth were moved into the newly created bone. A favorable treatment outcome was achieved in all three cases.

Application of Interdental Distraction Osteogenesis to Bilateral Cleft Lip and Palate with a Large Palatal Fistula

Application of Interdental Distraction Osteogenesis to Bilateral Cleft Lip and Palate with a Large Palatal Fistula

Intraoral Distraction of Segmental Osteotomies and Miniscrews in Management of Alveolar Cleft

Management of a wide alveolar cleft and alveolar bone graft failure is among the most difficult tasks for both surgeon and orthodontist. This article aims to introduce the techniques of intraoral distraction of segmental osteotomy for solving a wide alveolar cleft, and orthodontic management with miniscrews for solving alveolar bone graft failure; and also to evaluate the feasibility and clinical results of moving teeth into alveolar clefts. Interdental distraction osteogenesis was performed to minimize the alveolar cleft before alveolar bone grafting in 21 patients whose alveolar cleft was wider than a maxillary canine. All clefts were successfully approximated, and the 4- to 5-year results were shown to be stable. In addition, orthodontic protraction of the buccal teeth by using miniscrews as a temporary anchorage device was performed in 13 cases to minimize and/or eliminate the residual bony bridge or alveolar cleft after the previous failure of an alveolar bone graft. The buccal teeth were protracted with intermittent light continuous force. The results revealed that the residual bony bridges or alveolar clefts were minimized and that the space of the cleft was completely closed. The periodontal apparatus of the teeth that were moved into the residual bony bridge or alveolar cleft remained similar before and after the treatment. The orthodontic tooth movement into a residual alveolar cleft is clinically feasible in certain circumstances. However, the long-term status of the periodontal apparatus of the teeth that were moved into the alveolar cleft should be monitored.

Pretreatment of Distraction Docking Sites With Bone Morphogenetic Protein (rhBMP-2)

Interdental distraction osteogenesis (IDO) of the maxilla is used for reconstruction of missing bone segments related to cleft lip and palate or trauma. In the past, when faced with significant large gap deformities in the maxilla, the reconstructive surgeon would have a difficult time repairing the defect due to many factors. In children, there might be inadequate bone to harvest. Greater volume of bone is generally necessary to fill larger defects. If a grafting procedure should fail, the availability of bone harvesting sites diminishes for future surgeries and alternative locations may be necessary (eg, harvesting bone from the posterior hip or cranium).

Use of interdental distraction osteogenesis for orthodontic tooth alignment and correction of maxillary hypoplasia: a case report

The principle of distraction osteogenesis can be applied to the dentoalveolar region. Reported applications include vertical height augmentation of the alveolus and creation of new edentulous alveolar ridge. The newly created ridge can be used for rapid orthodontic movement, to facilitate closure of wide alveolar cleft and reconstruction. The application of interdental distraction osteogenesis to the management of a case of maxillary hypoplasia with severe dental crowding in repaired cleft palate is presented to illustrate the feasibility of utilizing the principle of interdental distraction osteogenesis to create new bone for tooth alignment and simultaneous correction of maxillary hypoplasia.

Interdental Distraction Osteogenesis and Rapid Orthodontic Tooth Movement: A Novel Approach to Approximate a Wide Alveolar Cleft or Bony Defect

Interdental Distraction Osteogenesis and Rapid Orthodontic Tooth Movement: A Novel Approach to Approximate a Wide Alveolar Cleft or Bony Defect