Intraoral Distraction Devices Research Articles

Vertical alveolar ridge distraction using intraoral distraction device after ablative surgery for treatment of gingival squamous cell carcinoma in patient under chemotherapy: a case report

Background: Squamous cell carcinoma is a malignant epithelial neoplasm characterized by variable clinical manifestations. When located in the gingiva, this neoplasm may mimic common inflammatory lesions. This is a case report of gingival Squamous cell carcinoma treated by marginal mandibular resection and then, reconstruction by distraction osteogenesis during chemotherapy. Patient: In a 50-year-old female patient marginal resection was done for treatment of gingival Squamous Cell Carcinoma and an attempt was made to reconstruct the mandible using distraction osteogenesis during contaminant chemotherapy. Result: Reconstruction of the mandible using distraction osteogenesis was successful with no adverse effect of the chemotherapy on the bone for formation by the distraction. Both soft tissue and bone healing were uneventfully. Conclusion: This case indicates that DO and chemotherapy could be performed simultaneously with no complications.

Distraction osteogenesis for management of cleft maxilla with the use of internal distraction device- A case report

Distraction osteogenesis (DO) has been used recently to correct cleft in the maxillary region with predictable and stable results. This case report describes a case with the use of DO for rapid movement of tooth-bone segments in patients with clefts of the maxilla involving palate. Both acceptable skeletal and soft tissue relationships with satisfactory occlusion were achieved. After 12 months of postoperative follow-up, the occlusal results were stable with minimal skeletal relapse. Keywords: Soft tissue, Intraoral distraction device, Distraction osteogenesis.

Rate of tooth movement and dentoskeletal effects of rapid canine retraction by dentoalveolar distraction osteogenesis: A prospective study.

The purpose of this study was to test the null hypothesis that duration of orthodontic treatment can be significantly reduced by accelerating canine retraction using dentoalveolar distraction (DAD). Thirty-six maxillary canines of 19 patients comprised the DAD group, and 28 canines of 14 patients were included in the distalization group (DG). The initial mean ages were 15.8±1.96years for the DAD group and 16.02±2.8years for the DG. A custom-made, rigid, tooth-borne intraoral distraction device was used for the DAD group, and intraoral elastics were applied for canine distalization in the DG. Six skeletal and 11 dental variables were measured for the cephalometric evaluation. Canine retraction was 7.9±1.49mm in 11.8±1.3days and canine distal tipping was 11.48° ± 4.37° after DAD; the canines were distalized 5.29±2.01mm and tipped 13.64° ± 9.54° in 200±57days in the DG. The rates of posterior canine movement were 0.67±0.14mm per day after DAD and 0.03±0.01mm per day in the DG. No significant first molar anchorage loss was observed after DAD, although the DG showed some vertical and sagittal first molar movement. We failed to reject the null hypothesis. DAD can reduce the duration of orthodontic treatment time by accelerating canine retraction in extraction patients without undesirable side effects.

Treatment of Micrognathia by Intraoral Distraction Osteogenesis: A Prospective Study.

Purpose:Maxillofacial deformities are always psychologically and physically distressing to the patients and is also challenging to the treating surgeons. The term Micrognathia means a “small jaw”. True micrognathia, where the maxilla or the mandibular skeleton does not grow to the full size can be congenital or acquired. Distraction osteogenesis also called as callus distraction or callostasis or osteodistraction or distraction histogenesis is a biological process of regenerating newly formed bone and adjacent soft tissue by a gradual and controlled traction of surgically separated bone segments. The purpose of this prospective study was to assess the versatility of distraction osteogenesis in the treatment of micrognathia.Materials and Methods:Four patients (three males and one female) with micrognathia of mandible were included in this prospective study. The patients were between the age group of 10-20 years. Facial asymmetry was the chief complaint of all the patients. In all the patients following treatment protocol was carried out, Osteotomy and placement of intraoral distraction device under general anaesthesia, latency phase (5-7 days), activation period-rate 1.5 mm per day, consolidation period of 8 weeks, removal of distraction device under local anaesthesia. The parameters assessed were ramus height, body length, hyo mental distance, posterior pharyngeal airway space, chin projection, facial symmetry occlusion, mid line shift pre and post operatively.Results:The mean increase in ramus height achieved was 9.2 + 2.17 mm and the mandibular body length achieved was 10.4+1.67 mm. There was an average increase in hyo-mental distance of 2.75 cm +0.9 cm postoperatively showing a definitive improvement in the airway. The posterior pharyngeal space measured from the lateral cephalogram preoperatively ranged from 3-6 mm and post operatively from 6-9 mm.Intraorally there was a shift in occlusion to class I molar relation in three patients and there was posterior open bite in one patient. Marked correction of facial asymmetry was noticed in all cases both clinically and in PA cephalogram. There was a restoration of dental as well as lip midline and improved lip competence. There was a significant improvement in chin projection and occlusal cant however further chin correction was needed in one case by means of advancement genioplasty.Conclusion:A definite improvement in all parameters such as body length,ramus height,chin projection,occlusal cant was observed in all patients. Moreover the patients were subjectively satisfied with the outcome of the results. Distraction Osteogenesis is definitely a boon to the oral and maxillofacial surgeons in treating large deficiencies of mandible in terms of stability

Skeletal and soft tissue changes and stability in cleft lip and palate patients after distraction osteogenesis using a new intraoral maxillary device

BackgroundThe authors have recently reported on the use of an internal maxillary distraction device. In this study, we report on the hard and soft tissue movements achieved with this intraoral distraction device, and the stability changes after distraction osteogenesis for maxillary hypoplasia in patients with cleft lip and palate. MethodsTen male patients with severe hypoplasia of the maxilla, with complete uni- or bilateral cleft lip and palate were included. The mean age of the patients at the time of operation was 11.91 years (±3.41). To evaluate the distraction process and stability, superimpositions on the preoperative lateral cephalograms were performed. The mean follow-up (FU) was 15.42 months (±3.94). ResultsCephalometric measurements at all of the maxillary hard and soft tissue points improved significantly. Maxillary point A was advanced by 8.25 mm (±3.17; P < 0.001). After distraction soft tissue point A′ had advanced 7.10 mm (±2.69; P < 0.001). The soft tissue to hard tissue ratio at point A was 0.86:1 after distraction. Maxillary horizontal relapse at point A was 14.1% at FU. Vertical relapse was not significant. ConclusionThis rigid intraoral distraction device can be successfully used in the correction of severe maxillary hypoplasia. The marked aesthetic improvement and low psychological encumbrance make this device viable for the treatment of cleft-related hypoplasia of the maxilla.

Periodontal ligament distraction: A simplified approach for rapid canine retraction

Distraction osteogenesis is a method of inducing new bone formation by applying mechanical strains on preexisting bone. The process of osteogenesis in the periodontal ligament during orthodontic tooth movement is similar to the osteogenesis in the midpalatal suture during rapid palatal expansion. A new concept of “distracting the periodontal ligament” is proposed to elicit rapid canine retraction in two weeks. At the time of first premolar extraction, the interseptal bone distal to the canine was undermined with a bone bur, grooving vertically inside the extraction socket along the buccal and lingual sides and extending obliquely toward the socket base. Then, a tooth-borne, custom-made, intraoral distraction device was placed to distract the canine distally into the extraction space. It was activated 0.5 mm/day, immediately after the extraction. Canine was distracted 6.5 mm into the extraction space within two weeks.

Precise Screw Positioning at the Mandibular Angle

Buried intraoral devices for distraction osteogenesis in mandibular deformities have numerous advantages, but success depends on the precise positioning of these devices. Although most centers nowadays use template-guided techniques for precise positioning, computer navigation has been described as a promising technique. Surgical navigation during device placement could become a viable method because it affords certainty in defining a device position. A clinical situation was simulated by means of mounting a mandible model inside a phantom head. Screws were positioned according to a preoperative plan through transoral and transbuccal approaches, with both template-coded and freehand computer navigation. With template-coded navigation, the medium deviation from the planned position was 0.63 mm (range, 0.00-1.24 mm). With commercial freehand surgical computer navigation, the medium deviation was significantly higher at 0.98 mm (range, 0.00-3.13 mm). Computer-assisted surgery can provide a high level of accuracy in the region of the mandibular angle where precision is crucial for buried intraoral distraction devices. However, template-coded guidance does provide a significantly higher level of accuracy and therefore represents the gold standard.

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.

Development and evolution of distraction devices: Use of indigenous appliances for Distraction Osteogenesis-An overview

An attempt has been made to review various devices as well as the outstanding studies done in the past for understanding the methodology of distraction for regeneration of bone. Lengthening of underdeveloped bones inclusive of the maxillofacial complex has been obtained by distraction osteogenesis by many authors. This could be achieved by the use of various extraoral or intraoral devices. Devices used for distraction osteogenesis must have a minimum of 2 important characteristics – they should be able to transfer distraction forces directly to the bone and secondly, should offer adequate rigidity for osseous consolidation to occur. With advanced technology and biomechanical engineering, preformed intraoral distraction devices are now available worldwide. The introduction of these intraoral bone-bourne devices have eliminated the need for bulky, cumbersome extraoral distraction devices which had problems such as external scars, pin tract infections, nerve or tooth bud injuries and poor patient compliance. The design of completely internalized custom made appliance has opened new vistas in the field of Oral and Maxillofacial Surgery. Indigenous internal devices are also economical and locally available.

An Implantable Battery System for a Continuous Automatic Distraction Device for Mandibular Distraction Osteogenesis

Distraction osteogenesis is a method of generating new bone formation by the gradual application of tensile stress across an osteotomy site (a complete cut through the bone). Internal or intraoral distraction devices have become the most common clinical apparatus in craniofacial distraction osteogenesis, although actuating the distraction devices relies upon manual length adjustment under patients’ compliance, introducing inconvenience and potential error in the procedure. To realize a fully implantable automatic distraction device, we propose a device design comprising a continuous miniature motor-driven distractor with a controller and an on-board lithium-ion battery. A benchtop prototype was fabricated to demonstrate the device’s structural design capable of transmitting sufficient loads with sufficient strain accuracy; it is capable of using a battery selection algorithm to determine an appropriate electrochemistry, temperature, sealability, and form factor and a control algorithm and a testing protocol with a laboratory-fabricated control circuit. This new distraction osteogenesis device enables completely automated and continuous distraction by the application of a low strain magnitude with multiple steps potentially leading to enhanced osteogenic activity.

Misjudgments at the Mandibular Angle

Distraction osteogenesis is a well known and frequently described technique in mandibular deformities. Buried intraoral devices have numerous advantages, but success hinges on precise positioning of the implants. Although computer navigation has repeatedly been described for craniofacial applications, research on navigating the mandibular region is scarce. Navigating the device placement for a mandibular distractor could become a viable method for distraction osteogenesis because of the possibility of certainty in achieving a defined device position. A clinical situation was simulated by a mandible model mounted inside a phantom head. The screws were positioned according to a virtual plan through transoral and transbuccal approaches, with and without navigation. Without navigation, the mean deviation from the planned position was 4.9 mm (range, 0.9-10.7 mm), with a clear tendency to position the screws in the easy-to-access regions. With navigation, the mean deviation was significantly lower at 1.5 mm (range, 0.1-3.4 mm). Computer-assisted surgery can provide a high level of accuracy in the region of the mandibular angle, where precision is crucial for buried intraoral distraction devices.

Rapid Tooth Movement and Orthodontic Treatment Using Dentoalveolar Distraction (DAD)

The purpose of this report is to describe the dentoalveolar distraction (DAD) technique and to present its effects on the surrounding structures by presenting a Class II case. A 15-year-old skeletal and dental Class II female patient with an overjet of 9 mm was treated by DAD osteogenesis. A custom-made, rigid, tooth-borne intraoral distraction device was used for rapid canine retraction. Osteotomies surrounding the canines were made to achieve rapid movement of the canines within the dentoalveolar segment, in compliance with distraction osteogenesis principles. The amount of canine retraction was 7.5 mm in 12 days at a rate of 0.625 mm per day, with no posterior anchorage loss. The canine teeth showed 1.6 mm extrusion and 11 degrees inclination change (distal tipping) during the same period. Orthodontic treatment continued for 6 months with no clinical and radiographic evidence of complications such as root fracture, root resorption, ankylosis, and soft tissue dehiscence. The DAD technique is an innovative method, because it reduces overall orthodontic treatment time by about 50%, with no unfavorable effects on periodontal tissues and surrounding structures and with no need to use any intraoral or extraoral anchorage appliances.

Correction of midface deficiency using intra-oral distraction device

A wide variety of disease processes produce alteration of midfacial skeletal growth, resulting in moderate-to-severe midface deficiency presenting as retrusion associated with Angle's class III malocclusion. Most cases of midface deficiency are seen in patients of cleft lip/palate. The surgical procedure to correct the clefts, undertaken over a long period of time from infancy to the teens tends to take its toll on the soft tissues over the midface. The scarring that is a feature in these conditions results in hampering of normal growth of the midface causing the deformity. Conventional procedures to correct the deformity by surgical advancement have been less than satisfactory in terms of success. This is where the concept of multidimensional growth using distraction proved useful. Today distraction has proved to be a versatile tool in the correction of midface deficiencies due to its various advantages. Six patients of cleft lip/palate were taken up for advancement of the hypoplastic midface using intra-oral distractors with successful and stable results.

Role of distraction osteogenesis in maxillofacial reconstruction

Background and Objectives: Distraction osteogenesis involves creation of unlimited quantities of living bone by gradual movement of two of more bony segments following their surgical separation. This technique was first developed for limb lengthening but recently was widely applied in craniomaxillofacial bone with satisfactory outcome. Several designs of the extra and intraoral distraction devices have been invented to serve for different area of the complex craniofacial bone. Intraoral designed devices seem to posses more advantages than extraoral devices, including minimal scarring, less cumbersome with more patient friendly acceptation.

Distraction osteogenesis in secondary microsurgical mandible reconstruction: Report of seven cases

Fibula, ilium and scapula are the preferred donor areas for vascularised bone grafts. For secondary mandibular reconstruction, however, compromises often have to be made as a result of the poor quality of the covering soft tissue and recipient vessels especially in irradiated patients. Callus distraction osteogenesis is a complementary method for optimising the intermaxillary relationship and the facial profile from an aesthetic point of view. Thirteen distractions were performed in seven patients following microsurgical mandibular reconstruction over a period of 4 years, all by the same surgeon. Intra-oral distraction devices were predominantly applied. After a 7-day healing period, the callus distraction was begun, involving two advisements per day of 0.5mm each. The distraction devices were removed after a consolidation phase of 4-5 months. Ten of the 13 distractions were uneventful with an average bone lengthening of 20mm, retained after a follow-up time of 6-47 months (average 27 months). The intermaxillary relationship and the facial profile were improved in all cases. Distraction plate fractures, screw loosening or absence of new bone formation were the complications encountered in the other three patients. Regarding the high complication rate, a successful outcome cannot be expected with greater certainty. Thus the indication should be stringent when including this procedure within the possible treatment alternatives available to the clinician.

The use of modified rigid intra-oral distraction devices for advancement of severely hypoplastic adult cleft maxilla

Problem: A myriad of internal distractors are available for advancing hypoplastic maxilla. These devices do not address all problems and needs of complicated severely hypoplastic maxilla in adult cleft patients (SHMAC) such as: long advancement span, need for 1:1 advancement, lengthy consolidation, segmented maxilla, sturdiness and cost. Objectives: Outlining indications for using modified rigid internal distractors (MRID) for advancement of SHMAC, and describing basics of MRID. Methods: 16 cleft patients divided into two groups were included, mean age 18.5 years, maxillary deficiency >12mm.

Simultaneous Maxillomandibular Distraction Osteogenesis Using a Subcutaneous Device for a Bilateral Cleft Lip and Palate Patient

This report describes a 26-year-old man with repaired bilateral cleft lip and palate treated by simultaneous maxillomandibular distraction osteogenesis using submucosal intraoral distraction devices for skeletal and soft tissue restoration.

Mandibular reconstruction using intraoral trifocal bone transport: Report of a case

On the mandibular reconstruction after tumor resection, it is easy to achieve esthetic and functional results when mandibular defect is relative small, however, it is difficult to reconstruct adequately larger defected mandible. Recently, with progress of devices, distraction osteogenesis that is the method of tissue regeneration is used as mandibular reconstruction. A 19-year-old male patient presented complaining of right lower jaw swelling. Biopsy suspected a multiple-cystic ameloblastoma in mandible. Under the general anesthesia, a mandibulectomy was performed from the right side ramus to the left side incisor. A mandibular reconstruction plate was attached to the proximal and distal bone segments. 2 types of intraoral distraction devices were placed inside the plate. These devices had 25 mm and 60 mm distraction length. After 9 days of latency, trifocal bone transport was started by 0.5 mm 2 times activation per day. After consolidation for 23 weeks, reconstruction plate and distraction devices were removed. 2.5 m x 2.0 cm iliac bone and cancellous bone were placed in the docking site with platelet rich plasma. The mandibular defect (85 mm) was reconstructed adequately using intraoral distraction osteogenesis trifocal bone transport technique. Symmetric facial balance was achieved. Now there is no recurrence and dental implants were placed on new bone.

Stereolithographic Models for Simulation and Transfer of Vector in Vertical Distraction of the Mandibular Ramus: A Technical Note

Mandibular distraction osteogenesis is, despite impressive results, compromised as a treatment modality by difficulties with vector control independent of whether intra- or extraoral devices are used. Resistance of the masticatory muscles and the remaining soft tissue envelope toward elongation and incorrect planning and transfer of the vector cause lack of vector control. To ensure predictability in correct placement of intraoral distraction devices and thereby treatment outcome, a combined planning, simulation, and transfer method was developed. The purpose of the simulation and transfer technique is to duplicate the planned and simulated position and orientation of the distraction device during surgery. The preoperative plan is based on frontal and lateral head films, and the planned position and orientation of the distraction apparatus was applied on the stereolithographic model. The model was cut according to the planned osteotomy, and the distraction was simulated on the stereolithographic model. Based on plaster models transferred to the stereolithographic model, an individual guiding splint was fabricated to reproduce the planned and simulated distraction treatment in the patient. The details of the simulation and transfer technique are presented and discussed in two cases.

Unilateral Mandibular Ramus Elongation by Intraoral Distraction Osteogenesis

Successful correction of facial asymmetry by mandibular distraction osteogenesis relies on mastering vector control. Lack of necessary vector control continues to compromise the treatment modality. The purpose of this study was to describe a new simplified method for vector transfer and to evaluate this method according to the outcome and the efficacy of distraction osteogenesis in the correction of unilateral mandibular hypoplasia and asymmetry. Twenty-seven patients with unilateral hypoplasia of the mandibular ramus underwent unilateral mandibular distraction osteogenesis with intraoral distraction devices. Posterior-anterior and lateral cephalograms were analyzed by digitalization. Changes in sagittal, vertical, and transversal linear and angular dimensions after the distraction treatment were evaluated by measurements performed on headfilms taken before and after surgery. Means and variances were calculated for selected cephalometric variables for each time point. The differences between the control and the treatment side were calculated, statistically described, and compared with a paired Student t test. Correction of the mandibular asymmetry, chin position, and the canting of the occlusal plane was obtained in all patients clinically, as well as radiographically, by the use of intraoral unidirectional distraction osteogenesis.