Transport Disc Distraction Osteogenesis Research Articles

Evaluation of Success of Transport Disc Distraction Osteogenesis and Costochondral Graft for Ramus Condyle Unit Reconstruction in Pediatric Temporomandibular Joint Ankylosis

The costochondral graft (CCG) is considered the reference standard for pediatric temporomandibular joint reconstruction. It has the disadvantages of unpredictable growth, donor site morbidity, and the need for intermaxillary fixation. It has been reported that transport disk distraction osteogenesis (TDDO) can result in the formation of a neocondyle and disc. We performed a randomized trial to measure and compare clinically relevant outcomes of ramus-condyle unit (RCU) reconstruction using CCG and TDDO for pediatric temporomandibular joint ankylosis (TMJA). In the present randomized controlled trial (block randomization with a variable block size), pediatric patients with unilateral, nonrecurrent TMJA aged 3 to 16years who had presented to our unit from December 2015 to June 2017 were enrolled. Instead of temporalis myofascial flap interposition, a buccal fat pad was used to fill the gap created by osteoarthrectomy. The primary outcome parameter was mouth opening. A mouth opening of at least 25mm at the median follow-up point was considered success. The secondary outcome parameters were occlusion, laterotrusion, protrusion, reankylosis, neocondyle, chin deviation, facial asymmetry, midline shift, and neo-disc formation. Data were analyzed using the independent t test and rank sum test. A total of 24 patients were enrolled in the CCG and TDDO groups (n=12 in each group). Trauma (40.9%) was the most common etiology with a slight male preponderance (59.09%). The mean age was 10.32±2.85years. The average distraction achieved in the TDDO group was 10.42mm. The median follow-up duration was 31.5months (range, 24 to 39months). The mean preoperative maximal incisal opening had improved from 8.5±4.1 and 9.5±7.1mm in the CCG and TDDO groups preoperatively to 35.7±2.7 and 34.4±8.9mm, respectively, at the median follow-up point (P<.005). RCU reconstruction with both modalities resulted in improvement in all the parameters; however, the intergroup comparison showed statistically non-significant differences. No reankylosis or open bite was found. The 3-hour delayed gadolinium-enhanced magnetic resonance imaging scan showed successful neo-disc formation. Similar success can be achieved in RCU reconstruction using either CCG or TDDO for pediatric TMJA. Both techniques have some advantages and disadvantages. RCU reconstruction using CCG or TDDO results in formation of a neocondyle, maintenance of occlusion, and correction of facial asymmetry.

Role of transport disc distraction osteogenesis for ramus condylar unit reconstruction and autogenous fat grafting in management of temporomandibular joint ankylosis

Role of transport disc distraction osteogenesis for ramus condylar unit reconstruction and autogenous fat grafting in management of temporomandibular joint ankylosis

New technique for large mandibular and surrounding soft tissue reconstruction that uses an intraoral three-dimensional distractor for one step transport disc distraction osteogenesis.

New technique for large mandibular and surrounding soft tissue reconstruction that uses an intraoral three-dimensional distractor for one step transport disc distraction osteogenesis.

Reconstruction of Mandibular Segmental Detects Using Transport Disk Distraction Osteogenesis.

Distraction osteogenesis (DO) has become an important alternative for bone defect reconstruction. The study aims to investigate the clinical feasibility and efficiency of transport disc DO (TDDO) for reconstruction of segmental defect of mandible and further dental implant treatment. A serial of 6 patients diagnosed with ameloblastoma or keratocystic odontogenic tumor were included in this study. Computed tomography (CT) scanning and panoramic radiograph were performed for preoperative evaluation and surgery planning. Transport disc DO was applied simultaneously with tumor resection for reconstruction of mandibular defects. The postoperative panoramic radiographs and CT scans were taken for evaluation of the ossification level. Then a second surgery was performed for removal of the distraction apparatus. Bone graft and rigid internal fixation were also used to fill the gap between the transport disc and the stump of the residual ramus. Further dental implant treatment was also finished or in progress. All patients finished the whole treatment period, and no distraction device failure or tumor recurrence occurred. The distraction length ranged from 35 to 48 mm and the whole treatment period of TDDO ranged from 21 to 33 weeks. High degree of ossification was confirmed at the end of treatment by postoperative radiographs and intraoperative observation. Infection occurred in 1 of the 6 patients, and the symptom was controlled by surgical dressing change and flushing. Results of final facial profile in all patients were good. Three patients finished dental implant treatment with good occlusion. Results in this study suggest the clinical feasibility and efficiency of TDDO for reconstruction of segmental defect of mandible and further dental implant treatment.

Short-term comparison of success-rate between costochondral graft interpositional arthroplasty and transport disc distraction osteogenesis in treatment of children with unilateral temporomandibular joint ankylosis

Short-term comparison of success-rate between costochondral graft interpositional arthroplasty and transport disc distraction osteogenesis in treatment of children with unilateral temporomandibular joint ankylosis

Experience with Mandibular Reconstruction Using Transport-Disc-Distraction Osteogenesis

The goal of transport-disc-distraction osteogenesis (TDDO) is to restore bone continuity by using in-situ bone. It may be useful following trauma, gunshot injuries, or tumor ablation, especially when there may be contraindications at the donor site or for prolonged surgery. To the best of the authors' knowledge, this is the first time TDDO has been used for mandibular reconstruction reporting additional procedures, which include osseointegrated dental implants rehabilitation and orthognathic surgery. A retrospective study is performed analyzing all mandibular reconstruction cases that may be suitable for distraction from January 2006 to December 2011. A thorough description of the documented cases includes details about sex, gender, complications, duration of hospitalization, etiology, size, and location of the defect. Eight cases of mandibular reconstruction were included. Six cases correspond to mandibular ameloblastoma. The remaining two cases were mandibular gunshot comminuted fractures. Range of the defects was from 45 to 60 mm. Length of the transport disc was 15 to 20 mm. Protocolized technique consisted of 5 days of latency period, 19 to 45 days of activation term (average 30 days), and 8 to 12 weeks for consolidation. Mean distraction length achieved was 40.45 mm. We can conclude that TDDO is an alternative to conventional and more invasive procedures, when we face severe segmental mandibular defects reconstruction. It shows the potential to restore a better anatomical bone regeneration, also providing soft tissues and reducing donor-site morbidity. Patients' education and awareness about the proper use of the transport-disc-distraction device is important to optimize functional outcomes.

Repair of segmental bone defects in the maxilla by transport disc distraction osteogenesis: Clinical experience with a new device.

The bones of the maxillary complex are vital for normal oro-nasal function and facial cosmetics. Maxillary tumor excision results in large defects that commonly include segments of the alveolar and palatine processes, compromising eating, speech and facial appearance. Unlike the conventional approach to maxillary defect repair by vascularized bone grafting, transport disc distraction osteogenesis (TDDO) stimulates new bone by separating the healing callus, and stimulates growth of surrounding soft tissues as well. Bone formed in this way closely mimics the parent bone in form and internal structure, producing a superior anatomical, functional and cosmetic result. Historically, TDDO has been successfully used to close small horizontal cleft defects in the maxilla, not exceeding 25 mm. Fujioka et al. reported in 2012 that “no bone transporter corresponding to the (large) size of the oro-antral fistula is marketed. The authors report the successful treatment of 4 cases involving alveolar defects of between 25 mm and 80 mm in length.

Biomechanical Analysis of a Curvilinear Distractor Device for Correcting Mandibular Symphyseal Defects

The local mechanical environment is a determinant of successful transport disc distraction osteogenesis. This study assessed the biomechanics of a curvilinear distractor device for correcting mandibular symphyseal defects. The finite element method was used to analyze an intact mandible, mandibular distractor bodies with different rail thicknesses (4, 6, 8, and 10 mm), and mandibular distractor bodies with rails and auxiliary lingual brackets. Rail thickness was positively correlated with maximum von Mises stress in the distractor and negatively correlated with maximum displacement of the mandibular distractor bodies. The maximum von Mises stress occurred at the junction of the rails and fixed arms. It also exceeded the yield strength of the titanium material. Compared with the maximum displacement of the intact mandible, that of the mandibular distractor bodies was visibly increased. An auxiliary lingual bracket can effectively decrease stress in such devices and displacement of mandibular distractor bodies. Rail fixation alone cannot achieve stability for distraction osteogenesis. Using an auxiliary lingual bracket effectively prevents distractor breakage and exposure.

Mandible reconstruction with transport-disc distraction osteogenesis in children of deciduous dentition

Reconstructing segmental mandibular defects in children of deciduous dentition is a challenge. The authors treated a 23-month-old girl with a segmental mandibular defect secondary to tumour resection. Considering the unpredictable negative impacts of the autogenous bone grafting method on the musculoskeletal system of the donor sites, which was growing rapidly at this age, the authors applied transport disc distraction osteogenesis (TDDO) to reconstruct the mandible discontinuity. To the best of the authors’ knowledge, this is the first time TDDO has been used for mandible reconstruction in such a young patient with deciduous dentition. Aesthetics and function were restored satisfactorily at the end of treatment. The facial appearance and occlusion were stable through the 35 month follow-up, possibly due to the growth of the regenerated bone parallel with the rest of the maxillofacial skeleton. The satisfactory reconstruction also contributed to the patient's physical and psychological development. The success of mandible reconstruction with TDDO in this study casts new light on the management of segmental mandibular defect in children with deciduous dentition.

Double-step transport distraction osteogenesis in the reconstruction of unilateral large mandibular defects after tumour resection using internal distraction devices

One-step transport disc distraction osteogenesis (TDDO) is an effective method for the restoration of mandibular defects. This study aimed to investigate the feasibility of double-step TDDO in the reconstruction of unilateral mandibular segmental defects after tumour resection using internal distraction devices. Six patients with unilateral mandibular segmental defects were reconstructed successfully with this technique. In the double-step TDDO procedure, the mandibular body was lengthened first and then the mandibular ramus was restored. The distraction movement was set at a rate of 0.4mm twice per day. Dental rehabilitation followed distractor removal. The maximal amount of lengthening was 55mm in the mandibular body and 42mm in the mandibular ramus. The average amount of lengthening was 52mm in the mandibular body and 34mm in the mandibular ramus. The aesthetic and functional results were excellent in all patients. The implants were integrated successfully and dental restoration was satisfactory. In this study, double-step TDDO is a reliable method for reconstruction of mandibular defects after tumour resection, especially for large mandibular defects. This technique is an ideal method for dental rehabilitation, despite the long overall treatment time.

Transport Disc Distraction Osteogenesis for the Reconstruction of a Calvarial Defect

According to previous reports about the experimental study of transport disk distraction osteogenesis (TDDO) for the reconstruction of bone defects, TDDO showed great feasibility of successful bone regeneration. However, those studies had some limitations in their design and analysis of the results, either. In this report, we intended to verify the effect of TDDO in the reconstruction of skull defects with a combined result of distraction osteogenesis and bone graft of transported disk (TD). Six female dogs were operated on and were given a 35×15-mm bilateral skull defect. In the experimental group, TDDO with internal distractors (7×14-mm TD) was performed. On the other side, in the control group, the bone defects were left to heal naturally. The distraction was performed from the postoperative fifth day at a rate of 1 mm/d. The distraction progressed for 14 days, and then the TD was maintained in the middle of the bone defect area. The 40% of the original bone defect area was left the same as the control side. The TD was expected to be survived as a bone graft during the consolidation period. After 3½ months of a consolidation period, the remained bone defects were measured by three-dimensional computed tomography. The solidity of the new bone was compared with the bone tissue of the normal skull bone. In the study group, the new bone formation was estimated to be 62.3% (SD, 25.1%) of the defect area, and in the control group, it was 44.8% (SD, 27.3%). The difference between the 2 groups was significant (P=0.04). The solidity of the newly generated bone by TDDO was not different from the normal skull (P=0.74). In this study, the concept of TDDO and bone graft seemed to promote new bone formation. The role of the TD could include bone regeneration from distraction osteogenesis as well as autogenous bone graft, although it needs more investigation. The relationship between the duration of distraction and the positive role of the TD as an autogenous bone graft in TDDO for better clinical application may be investigated.

Transport Disc Distraction Osteogenesis for the Reconstruction of a Calvarial Defect

Reconstruction of bone defects is possible through distraction osteogenesis using small bone transport discs. The aim of this study was to evaluate the usability of transport disc distraction osteogenesis (TDDO) in the reconstruction of skull defects in an animal experiment. Eleven mongrel female dogs were used. Craniectomy (33 x 15 mm) was performed on both sides of the parietal bone symmetrically. On the experimental site, the 7 x 15-mm transport bone disc was used for TDDO. The control site was left in the defect state. An external distraction device was used. The latency period was 5 days, the rate of distraction was 1 mm/d, and distraction was done for 26 days. After a 6-month consolidation period, a computed tomographic scan was performed. The area of regenerated bone was measured from the computed tomographic scan. The hardness was checked on the regenerated bone and the normal bone. A histologic examination of the regenerated bone was done. Eight cases were included in the evaluation, and 3 cases were excluded because they showed early escape of the distraction device. The mean (SD) area of the regenerated bone was 57.1% (26.3) in the experimental site and 41.8% (21.3) in the control site, which was not a statistically significant difference (P > 0.05). The mean (SD) hardness was 0.50 (0.17) MPa in the experiment site and 0.55 (0.29) MPa in the normal calvarial bone; the difference was not statistically significant (P > 0.05). On histologic examination, membranous ossification was found in the regenerated bone in the experimental site. Transport disc distraction osteogenesis can induce new bone formation with hardness comparable to that of a normal bone. However, the amount of regenerated bone is not sufficient to allow TDDO to be substituted for conventional autogenous bone grafts.

Transport disc distraction osteogenesis in mandibular reconstruction

Transport disc distraction osteogenesis in mandibular reconstruction

PD16 The application of transport disc distraction osteogenesis (TDDO) for mandibular reconstruction after composite mandibulectomy

PD16 The application of transport disc distraction osteogenesis (TDDO) for mandibular reconstruction after composite mandibulectomy

Mandible reconstruction using a 2-phase transport disc distraction osteogenesis: A case report

Mandible reconstruction using a 2-phase transport disc distraction osteogenesis: A case report

PD.138 Preliminary results from a prospectiveefficacy trial of transport disc distraction osteogenesis for the reconstruction of segmental mandibular defects

PD.138 Preliminary results from a prospectiveefficacy trial of transport disc distraction osteogenesis for the reconstruction of segmental mandibular defects