Transport Distraction Osteogenesis Research Articles

Evaluation of Transport Distraction Osteogenesis in Maxillofacial Region

Evaluation of Transport Distraction Osteogenesis in Maxillofacial Region

Osteoinductive intramedullary implant as an adjunctive therapy for bone transport: A promising approach to accelerate bone defect healing

A recent study published in Nature Communications presents a unique approach using an osteoinductive intramedullary (IM) implant as an adjunctive therapy for bone transport distraction osteogenesis. The study demonstrates that this innovative technique achieves early bony bridging, eliminates pin tract infections, and prevents docking site non-union, offering significant potential for the treatment of large bone defects. The study also highlights an additive effect of the osteoinductive IM implant on distraction osteogenesis for managing bone defect.

Reconstruction Using Transport Distraction Osteogenesis with Indigenous Distractors: A Case Series

Reconstruction Using Transport Distraction Osteogenesis with Indigenous Distractors: A Case Series

Versatility of Transport Distraction Osteogenesis for Reconstruction of Lateral Mandibular Ablative Defects

Versatility of Transport Distraction Osteogenesis for Reconstruction of Lateral Mandibular Ablative Defects

Role of Stem Cells in Transport Distraction Osteogenesis for Reconstruction of Mandibular Defects after Segmental Mandibulectomy

Purpose: to restore the continuity and functions of the mandible after segmental mandibulectomy for mandibular defect reconstruction by using a technique of transport distraction osteogenesis with stem cells injection. Subjects and methods: Clinical study was conducted on eight patients suffering from mandibular deficiency after tumor resection. All steps of manufacturing of the transport distractor, tumor resection and segmental mandibulectomy of transport disc were guided by Stereolithographic (STL) model. Stem cells sample was prepared to be injected along the soft callus at the end of the activation period. Patients were followed up postoperative clinically every week and radiographically by Panoramic x-ray and computed tomography (CT) at immediate postoperatively, then by panoramic x-ray monthly along the periods of distraction and finally by multi slice CT at the end of the consolidation to evaluate the time consuming for treatment. Results: seven cases out of eight cases recorded excellent distraction regenerate and excellent soft tissue coverage and one case out of these eight cases in the control group failed at the first week of activation. Multi slice CT showed a significantly higher value in the mean of the regenerated bone density at the end of the consolidation (1163.76±111.38) in the study group than the control group (747.67±268.6). Conclusion: From our study, stem cells injection in the distraction regenerate for reconstruction of mandibular defect cases achieved short consolidation period and high regenerated bone density.

Role of Stem Cells in Transport Distraction Osteogenesis for Reconstruction of Mandibular Defects after Segmental Mandibulectomy

Purpose: to restore the continuity and functions of the mandible after segmental mandibulectomy for mandibular defect reconstruction by using a technique of transport distraction osteogenesis with stem cells injection. Subjects and methods: Clinical study was conducted on eight patients suffering from mandibular deficiency after tumor resection. All steps of manufacturing of the transport distractor, tumor resection and segmental mandibulectomy of transport disc were guided by Stereolithographic (STL) model. Stem cells sample was prepared to be injected along the soft callus at the end of the activation period. Patients were followed up postoperative clinically every week and radiographically by Panoramic x-ray and computed tomography (CT) at immediate postoperatively, then by panoramic x-ray monthly along the periods of distraction and finally by multi slice CT at the end of the consolidation to evaluate the time consuming for treatment. Results: seven cases out of eight cases recorded excellent distraction regenerate and excellent soft tissue coverage and one case out of these eight cases in the control group failed at the first week of activation. Multi slice CT showed a significantly higher value in the mean of the regenerated bone density at the end of the consolidation (1163.76±111.38) in the study group than the control group (747.67±268.6). Conclusion: From our study, stem cells injection in the distraction regenerate for reconstruction of mandibular defect cases achieved short consolidation period and high regenerated bone density.

Application of transport distraction osteogenesis in reconstruction of mandibular segmental defects

Application of transport distraction osteogenesis in reconstruction of mandibular segmental defects

Outcomes of Bifocal Transport Distraction Osteogenesis for Repairing Complicated Unilateral Alveolar Cleft

This study aimed to assess the outcomes of bifocal transport distraction osteogenesis (BTDO) for closure of a wide or previously failed unilateral alveolar cleft. Patient in this study had a large alveolar cleft that had not healed with bone grafts. Bone-borne distraction was used under general anesthesia. Intraoperative complications as bleeding and trauma to neighboring teeth were documented. Postoperative complications as wound dehiscence, paresthesia, infection, and bleeding were recorded. Complications including changes in bone segment movement, activation force loss, and occlusal interferences were observed during the activation phase. During the consolidation phase, problems including gingival recession, pulpal vitality, and cosmetic concerns were evaluated. Postoperative, periapical, occlusal, and orthopantomograms were used to evaluate bone gain and bone generation in the distracted area. Ten patients (6 males and 4 females) with unilateral alveolar cleft were included, with mean age of 9.5 ± 2.5 years. Average cleft width was 12.25 ± 2.54 mm. There was no intraoperative or postoperative bleeding. Only 1 patient had a wound dehiscence (10%). All patients had mild postoperative pain and edema in upper lip. Only 1 patient complained of numbness in infraorbital nerve's innervated region. Radiographs revealed bone formation in cleft area and bone healing in distracted chamber. Bifocal transport distraction osteogenesis improves success rate of an alveolar cleft treatment especially a wide or previously failed one. This technique associated with minimal complications when careful planning and cooperation from a patient are combined. It can be recommended when other modalities for alveolar cleft are failed. Patients also tolerate the device well.

Transport Distraction Osteogenesis for Reconstruction of Ramus-Condyle Unit following Release of Temporomandibular Joint ankylosis

Introduction: Temporomandibular joint (TMJ) is a structurally complex joint. TMJ deficiency and deformity can result from different causes. Ankylosis of the TMJ is considered the most common cause leading to severe form of deformity and shortening of the ramus / condyle unit which can affect both, function and esthetic and is difficult to treat. Different surgical procedures have been used to treat this deficiency, with variable degrees of success rates. Distraction osteogenesis is a well-established technique that is used to treat different maxillofacial deformities. A recent use in reconstruction of the deficiency or ramus-condyle unit is developed Aim: The objective of this study was to evaluate the use of transport distraction osteogenesis in restoring the deficient condyle/ramus unit of patients with unilateral or bilateral TMJ ankylosis to correct the resultant deformity. Materials and Methods: Ten patients with TMJ ankylosis underwent Transport condylar ramus distraction osteogenesis to reconstruct the condyle after release and gap arthroplasty. The distractors used were extraoral submerged ones. Results: Five males and five females were included. Their age ranged from 2 to 46 years with an average of 21.2years. The follow-up period ranged from 15 to 60 months with an average of 30.2 months. Successful treatment was achieved in seven cases. Complications were mild in two, moderate in four and severe in three. Conclusions: Transport condylar distraction osteogenesis is a valuable treatment option for TMJ ankylosis. It has a considerable complication rate that must be considered its choice and discussed thoroughly with the patient/guardian.

A systematic review on the outcome of distraction osteogenesis in TMJ ankylosis

IntroductionTMJ ankylosis (TMJa) management by arthroplasty alone fails to address the deformity and the compromised airway. Distraction osteogenesis (DO) can offer a pragmatic solution to TMJa. The aim of the study was to generate evidence towards the role of DO in TMJa, evaluate its efficiency and develop an algorithm for use of DO in TMJa. Material and methodsThe research question was formulated using the PICOS statement for reporting guidelines in systematic reviews, where the efficiency of DO was evaluated in terms of mouth opening, correction of facial deformity and asymmetry, airway correction, and its long term effects. Results1130 articles reported DO as a treatment modality for TMJ ankylosis, of which 32 prospective studies, 16 retrospective and 2 RCTs were included in the study. DO was used for mandibular distraction in 45 studies and for simultaneous maxillamandibular distraction in only five studies. An algorithm for use of DO in TMJa was developed. ConclusionAlthough DO has proven its application in TMJ ankylosis cases, its best use is for correction of obstructive sleep apnoea. Relapse causing loss of posterior ramal height is a concern after transport DO. Prearthroplastic DO appears to best correct mandibular deformity. A maxillomandibular deformity requires simultaneous maxillomandibular distraction. However, a metanalysis is still awaited for effectiveness of DO in TMJ ankylosis.

Guided Intact Lower Rim for Mandibular Body Transport Distraction Osteogenesis: A Novel Surgical Technique.

Guided Intact Lower Rim for Mandibular Body Transport Distraction Osteogenesis: A Novel Surgical Technique.

Application of a pre-filled tissue expander for preventing soft tissue incarceration during tibial distraction osteogenesis.

Bone transport and distraction osteogenesis has been widely used to treat bone defects after traumatic surgery, but, skin and soft tissue incarceration can be as high as 27.6%. To investigate the efficacy of inserting a tissue expander to prevent soft tissue incarceration. Between January 2016 and December 2018, 12 patients underwent implantation of a tissue expander in the subcutaneous layer in the vicinity of a tibial defect to maintain the soft tissue in position. A certain amount of normal saline was injected into the tissue expander during surgery and was then gradually extracted to shrink the expander during the course of transport distraction osteogenesis. The tissue expander was removed when the two ends of the tibial defect were close enough. In all 12 patients, the expanders remained intact in the subcutaneous layer of the bone defect area during the course of transport distraction osteogenesis. When bone transport was adequate, the expander was removed and the bone transport process was completed. During the whole process, there was no incarceration of skin and soft tissue in the bone defect area. Complications occurred in one patient, who experienced poor wound healing. The pre-filled expander technique can effectively avoid soft tissue incarceration. The authors' primary success with this method indicates that it may be a valuable tool in the management of incarcerated soft tissue.

Evaluating the remodeling of condyles reconstructed by transport distraction osteogenesis in the treatment of temporomandibular joint ankylosis

PurposeThis study aimed to evaluate the remodeling of condyles reconstructed by transport distraction osteogenesis (DO) in patients with temporomandibular joint (TMJ) ankylosis. Patients and methodsTwenty-one patients with 26 affected joints were followed up for 34.1 ± 13.3 months. Patients who had undergone gap arthroplasty and TMJ reconstruction by DO were included. Maximal mouth opening (MMO) and occlusion were recorded. Computed tomography images were obtained preoperatively (T0), upon completing distraction (T1), upon removal of the distraction device (T2), and >2 years postoperatively (T3). The following were measured: mandibular ramus height, distance between gonion and Frankfurt plane (Go–FN), condylar width, and condyle–ramus angulation. ResultsOf the 21 patients, one showed re-ankylosis, while five exhibited anterior open bite. From T1 to T3, the total amount of resorption of ramus height reached up to 8.2 ± 4.6 mm (p < 0.001), in comparison with a total distraction length of 13.8 ± 4.1 mm; the mean resorption rate was 59.4%. Similarly, Go–FN decreased by 6.2 ± 4.0 mm (p < 0.001). ConclusionOur findings indicated that DO combined with gap arthroplasty was an effective method for the treatment of TMJ ankylosis to improve MMO. The reconstructed condyle exhibited a high frequency of resorption in height.

Reconstruction of postsurgical mandibular defect (keratocystic odontogenic tumor) by transport distraction osteogenesis

Reconstruction of postsurgical mandibular defect (keratocystic odontogenic tumor) by transport distraction osteogenesis

Revascularized Fibula Free Flap Reconstruction and Curvilinear Transport Distraction Osteogenesis in Closure of Large Postmaxillectomy Defects: A New Gold Standard?

Introduction:The revascularized fibula free flap (RFFF) is the most popular method of postmaxillectomy reconstruction. This article proves that the use of curvilinear transport distraction osteogenesis (CTDO) is an efficacious way in closing large defects in the maxilla and a superior alternative to the RFFF.Methods and Materials:In a prospective cohort study of six postmaxillectomy patients, CTDO was applied and the new bone (regenerate) was compared with the parent bone from which it had been regenerated. These results were compared with a retrospective group of six participants of similar age and sex who had undergone RFFF reconstruction as an external control. Clinical measurements taken at the depth of the alveolar vestibule were recorded at three different exact points juxtaposed, namely (A) lateral incisor, (B) first premolar, and (C) first molar. These areas of interest were similar to those chosen on the CT scans. Impressions were taken from all the patients and stone casts were made. The width of the alveolar bone was computed based on the measurements made from the stone casts. The stone casts were then used to calculate the width and depth of the soft tissue and bone in the maxilla in the (A), (B), and (C) regions.Results:The regenerate possessed anatomical and physiological characteristics equal to the parent bone. For the CTDO patients, prosthetic rehabilitation of the dentition was supported by dental implants after osseointegration of the latter into the newly created bone and soft tissue.Discussion:The production of the curvilinear bone and soft tissue along a horizontal plane has been demonstrated. The new alveolar bone achieved the correct width and depth to create a physiological vestibule and a functional/esthetic zone for the placement of dental implants. In addition, the shape of the palatal vault was also maintained. The CTDO method is a reliable method of maxillary reconstruction and has a better anatomical and functional outcome than the RFFF.

The Use of Structurally Augmented 3D Printed Cages in Segmental Defects of the Tibial Shaft

Category:Trauma, Emerging TechnologyIntroduction/Purpose:Modern day management of segmental defects of the tibia shaft (SDTS) involve autologous nonvascularized grafts, autologous vascularized contralateral fibula grafts, as well as bone transport distraction osteogenesis, however single stage titanium cages with adjuvant biologics continue to demonstrate advantages. With the development of advanced additive manufacturing further modalities such as complex variable lattice structure and submicron texture may be incorporated into custom fit implants. We aim to further investigate the potential of this technology on osteoinduction, and hypothesize early bone in-growth.Methods:A retrospective analysis was performed on 3 patients undergoing custom cage implantation for SDTS. All three patients were male with an average age of 60, 2 patients were diabetic, and one was a smoker. All three cases were performed in the setting of post-infection salvage. Pertinent demographic and clinical history was retrieved through the medical record.Results:All three cases were uncomplicated in the post-surgical period, and early bone in-growth was demonstrated in successive follow-ups. One case was single-staged and built into a prior total ankle arthroplasty, the next was a deformity correcting intramedullary rod that became infected requiring two-stage salvage with an antibiotic spacer and subsequent custom cage with Intramedullary rod supplementation, and the third case was a two-stage trauma salvage initially using an antibiotic spacer with subsequent custom cage implantation.Conclusion:3D printed custom cages were found to be a safe and efficacious option for management of SDTS, with demonstrated early bone in-growth. Considering the incorporation of advanced additive manufacturing techniques, strong implementations may be present for salvage cases.

Bone Transport Distraction Osteogenesis in the Reconstruction of Pediatric Posttraumatic Calvarial Defects

Reconstruction of posttraumatic calvarial bone defects in pediatric patients is a challenge due to the growing brain and limited autogenous bone supply. Traditional techniques such as split calvarial and particulate bone grafts are associated with prolonged operative time and significant blood loss, which is a major concern in children under the age of 3 years. Bone transport distraction osteogenesis has proven efficacy and safety in the reconstruction of other craniofacial deformities. This procedure is less invasive and requires shorter operative times and hospital stay. We report our experience with 2 cases of bone transport distraction osteogenesis for the reconstruction of large posttraumatic calvarial defects in pediatric patients.

Creation of Bone and Soft Tissue in Postmaxillectomy Patients Using Curvilinear Transport Distraction Osteogenesis.

Background:Large surgical defects in the maxilla due to trauma or tumor are usually reconstructed with revascularized-free fibula flaps (RFFF). In the past, the use of curvilinear transport distraction osteogenesis (CTDO) has been shown to be an efficacious way in closing large defects in the maxilla, but it had limitations which have now been overcome by the present development. The present distractor is an improvement upon the previous three prototypes and employs the concept of tetrafocal distraction by means of hybridizing the bone with the tooth in the transport disc segment. This article aims to prove that tetrafocal distraction provides a viable alternative to the RFFF.Materials and Method:In a prospective cohort study of six postmaxillectomy patients, the method of CTDO was applied and investigated to ascertain the outcome. The regenerate bone was compared with the parent bone, using a new maxillary transport distractor. A linear bicortical fracture was created in the maxilla in a vertical direction (segmentally) to develop a mobile, vascularized transport disk. This transport disk underwent further subdivision to produce the concept of tetrafocal distraction.Results:After osseointegration of the dental implants, prosthetic rehabilitation of the dentition was successful. The authors report the successful outcome of two of the six cases subjected to CTDO to treat defects ranging from 25 mm (using bifocal distraction) to 80 mm along a curved trajectory (using tetrafocal distraction).Conclusions:The production of curvilinear bone and soft tissue along a horizontal plane has been demonstrated. From a clinical perspective, the new alveolar bone achieved the correct width and height to create a physiological vestibule and an esthetic zone for dental implants. In addition, the shape of the palatal vault is also reconstituted. The tetrafocal method of the CTDO is a reliable method of maxillary reconstruction.

Horizontal alveolar transport distraction osteogenesis followed by implant placement

Alveolar transport distraction osteogenesis (ATDO) is an alternative treatment method to vertical alveolar distraction osteogenesis in cases of large bony defects, especially when the bone is limited in size. ATDO was performed in 10 patients with 12 defects. The mean age of the patients was 39.1years. The average bone length gain was 18.2mm. Implants were inserted following a 3-month consolidation period. Three patients needed additional bone grafting for horizontal widening. Final prosthetic rehabilitation was performed at least 3 months following implant insertion. The mean follow-up period was 63 months and the survival rate of the 25 implants placed was 92%. All failures (n=2) occurred during the early healing period. Although the results are not totally predictable, it can be concluded that ATDO can be effective in the reconstruction of the alveolar crest prior to implant placement.

Customization of Patient Specific Distraction Device using Additive Manufacture Technology

Additive Manufacturing (AM) technology is an engineering technology which has a wide scope in medical field. Individual planning of complex maxillofacial surgical procedures require 3D models for the precise outcome and reduction in the surgical time and thereby complications. AM technology can be used for the manufacture of patient specific models using Computed Tomographic (CT) Scan data for the complex surgical procedures. Design method for personalized Mandibular Transport Distraction device manufacturing by using medical Additive Manufacturing (AM) is presented in this paper. The present work explains the use of AM models for planning of a case of mandibular defect secondary to tumour ablation. The surgical method used to correct the deformity is called Distraction Osteogenesis (DO). It involves new bone formation between fractured bony segments which are separated by gradual, controlled incremental traction. This results in simultaneous expansion of soft tissue and bone volume. The Transport DO procedure of mandible involves creation of a transport segment which is separated from the residual bone to be distracted to the other side of the bone present. The outcome depends on an important principle called as Distraction Vector where the direction and magnitude dictates the outcome. The use of Additive Manufactured models made to plan the Distraction vector precisely and made the operation easier and more accurate. Moreover preoperative preparation reduced the operating time.© 2017 Elsevier Ltd. All rights reserved.Selection and/or Peer-review under responsibility of 7th International Conference of Materials Processing and Characterization.