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The aim of this retrospective study was to analyse the outcome of alveolar distraction osteogenesis for the correction of vertical defects in a large series of 55 cases. The existing bone deficiencies were secondary to atrophy after periodontal disease or tooth extraction. The overall success rate of this technique was 89.1%. The complications pres...
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Context 1
... 14 patients (25.45%) there were 27 minor complications including infection (8/55), paresthesia (6/55) (posterior mandible), tipping of transport disk (3/55) (Fig. 4), hyperplasia (3/55) (anterior maxillary region; Fig. 5), fracture of the screw (2/55), incomplete osteotomy requiring revision (1/55), and inadequate height (wrong device) (1/55). The frequency of minor complications was 8/27 in the anterior maxillary region, 1/27 in the anterior mandibular region and 15/27 in the posterior mandibular region (Table ...
Context 2
... 14 patients (25.45%) there were 27 minor complications including infection (8/55), paresthesia (6/55) (posterior mandible), tipping of transport disk (3/55) (Fig. 4), hyperplasia (3/55) (anterior maxillary region; Fig. 5), fracture of the screw (2/55), incomplete osteotomy requiring revision (1/55), and inadequate height (wrong device) (1/55). The frequency of minor complications was 8/27 in the anterior maxillary region, 1/27 in the anterior mandibular region and 15/27 in the posterior mandibular region (Table ...
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Background:
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Background:
To perform a morphologic classification based on the results of bone augmentation after a distraction osteogenesis.
Material and methods:
Thirty-four (34) patients (24 women and 10 men; mean age, 47.1 years (SD=9.5); age range, 23 to 62 years) underwent a total of 42 alveolar ridge distractions before the placement of a total of 89 d...
Purpose:
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Materials and methods:
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Citations
... In the intra-oral DO methods, the distractor is placed inside the body-on the defected bone-to move the BS towards the desired position. Different complications and limitations are associated with the application of both manual and automatic distractors, including the size of the distractor, breakage of the distractor, tissue damage, scar formation, and pain [23][24][25][26][27]. The application of extra-oral distractors is associated with more complications and side effects compared to intra-oral distractors, including scar formation, size, visibility, infections, edema, and patients' psychological problems [28][29][30][31]. ...
The application of Distraction Osteogenesis (DO) techniques in the reconstruction of skeletal deficiencies is a relatively new topic in the fields of oral and maxillofacial surgeries. In many reconstruction applications, using DO is the preferred technique, as opposed to conventional reconstruction techniques, as there are more advantages and fewer side effects when it is used. The first generation of DO devices is made up of manual distractors that can apply an intermittent distraction force to the bone segment during the distraction process. Manual DO techniques have shown the functionality of the DO technique. Further research has recently been performed on the development of automatic devices for generating a controlled continuous force. However, the existing automatic techniques have limitations, and are yet to be used in reconstruction applications in humans. There is still a gap between the developed techniques and an ideal distractor to be used in mandibular reconstruction surgeries. In this research, a two-axis continuous distractor is proposed for use in mandibular reconstruction applications. The proposed distractor can generate two continuous distraction forces that can be applied to two independent distraction vectors. The proposed device can perform the standard distraction process using the predetermined distraction factors. The control system has a high positioning accuracy and resolution in controlling the position of the intra-oral end effectors while applying two continuous forces for moving the bone segment. The proposed two-axis continuous distractor meets the current requirements, and can be used as an ideal continuous DO device for different mandibular reconstruction applications.
... The success of this treatment method, as well as the high-quality newly formed tissue in DO of the facial skeleton, have been demonstrated [9] . However, there are still limitations and complications in the application of the DO technique in human MRA [17][18][19] . Different efforts have been undertaken to shorten the treatment time and reduce complications and related physical/psychological side effects [20] . ...
Distraction Osteogenesis (DO) is an emerging limb lengthening method for the reconstruction of the hard tissue and the surrounding soft tissue, in different human body zones. DO plays an important role in treating bone defects in Maxillofacial Reconstruction Applications (MRA) due to reduced side effects and better formed bone tissue compared to conventional reconstruction methods i.e. autologous bone graft, and alloplast implantation. Recently, varying techniques have been evaluated to enhance the characteristics of the newly formed tissues and process parameters. Promising results have been shown in assisting DO treatments while benefiting bone formation mechanisms by using physical stimulation techniques, including photonic, electromagnetic, electrical, and mechanical stimulation technique. Using assisted DO techniques has provided superior results in the outcome of the DO procedure compared to a standard DO procedure. However, DO methods, as well as assisting technologies applied during the DO procedure, are still emerging. Studies and experiments on developed solutions related to this field have been limited to animal and clinical trials. In this review paper, recent advances in physical stimulation techniques and their effects on the outcome of the DO treatment in MRA are surveyed. By studying the effects of using assisting techniques during the DO treatment, enabling an ideal assisted DO technique in MRA can be possible. Although mentioned techniques have shown constructive effects during the DO procedure, there is still a need for more research and investigation to be done to fully understand the effects of assisting techniques and advanced technologies for use in an ultimate DO procedure in MRA.
... In the present study, the osteotomised bone had a width and a minimum height of 5 mm, which coincides those recorded by most authors (15,27,28). Concavity of the lateral alveolar crest is a phenomenon called hourglass deformity, which is quite common (18). Several techniques have been proposed to prevent this problem from occurring, including the stimulation of callus and the placement of barrier membranes on the surface of the bone during distraction, with an effect similar to that of GBR. ...
... In the present study, GBR was required in 57% of all of the distracted cases. In other studies, such as the one conducted by Mazzonetto et al.(18), 38% of patients required autogenous bone graft, of which 81% were placed in the maxillary anterior region, 14% in the posterior mandibular region and 5% in the anterior mandible region. Other authors have verified that in approximately 20% of distractions a new VRA process is required, or alternatively they must resort to other surgical techniques to increase bone. ...
Background:
To perform a morphologic classification based on the results of bone augmentation after a distraction osteogenesis.
Material and methods:
Thirty-four (34) patients (24 women and 10 men; mean age, 47.1 years (SD=9.5); age range, 23 to 62 years) underwent a total of 42 alveolar ridge distractions before the placement of a total of 89 dental implants. Ridge bone morphology was evaluated as the main ordinal variable. Chi-squared, Kruskal-Wallis and ANOVA one-way test were used.
Results:
Category I (30.95%): consisted of wide alveolar rim and no bone defects Category II (28.57%): wide alveolar rim, lateral bone surface concavity. Category III (23.81%): narrow alveolar rim, lateral bone surface concavity. Category IV (2.38 %): distraction transport segment forming a bridge, without bone formed beneath and requiring guided bone regeneration. Category V (9.52%): return of the transport segment to its initial position due to the reverse rotation of the distractor screw. Category VI (4.76 %): distraction transport segment completely lost. Subcategory D (28.57%), consisted of lingual deviation of the distraction axis, occurring in any of the categories I to IV. More men (76.9 %) presented with category I (p<0.001). The use of the chisel resulted mainly in categories I and II (69.4 %) (p<0.001). GBR was only required in 23.1 % of the cases in Category I (p=0.011). The bone height achieved decreases as the category increases, due to the accompanying osteogenic limitations (p<0.001). The implants placed in category I were longer 11.5 ± 0.9 mm (CI95% 10.9-11.9 mm) compared to those placed in category III with a length of 10.4 ± 1.5 mm (CI95% 9.5-11.4 mm) (p=0.035).
Conclusions:
The alveolar ridge after distraction osteogenesis could be divided into six morphologic categories which provide a useful basis for decision-making regarding implant placement.
... These techniques poorly predict movement in the sagittal direction and can lead to incorrect distraction vectors. 22 The piezoelectric surgery is a technique that provides precise bone cutting and increased tactile control since the application of excessive force is not needed as with conventional drills. 23 The vibrating tip also drives the irrigation solution through a cavitation phenomenon which allows for better visibility and a clean operating field. ...
A common complication of tooth replantation after traumatic avulsion is tooth ankylosis causing dental malpositioning, partial loss of function, tipping of adjacent teeth and worsening of aesthetics. The aim of this study is to evaluate the effects of a repositioning procedure of such ankylosed permanent front teeth by a distraction osteogenesis procedure. Five patients (mean age 13.4 years), with an ankylosed permanent front tooth in the anterior area, were enrolled in the present study. After the pre-operatory orthodontic preparation, each selected site was treated with single-tooth dento-alveolar block osteotomy surgery performed with a piezoelectric surgery device with ultrasonic cuts on the buccal side. Subsequently, a custom distraction device, made by a resin splint and a sector expansion screw, was set in such a way it delivered a force with direction and sense towards the planned position of the tooth as well as the osteotomy's incision. After a latency period of 14 days, the distraction of the dento-alveolar block was started with a rate of distraction of 0.8 mm per day. The average shift obtained by the ankylosed teeth was 7.8 ± 0.75 mm (±SD), and the ankylosed tooth was regularly positioned into the occlusion in 20.4 ± 1.85 days (±SD), with a slight relapse (±0.5 mm) observed after 1 year. This study indicates that a therapeutic approach combining piezoelectric surgery and orthodontic therapy may be useful for the treatment of ankylosed permanent teeth in the frontal area with a long-term follow-up over 5 years.
... The rate of published complications in DO can vary from 27.7-40% [29]. From literature review, average percentage of complications for alveolar DO was 36.3% [32], mandibular DO ranges from 20.5% to 35.6% [33] and cumulative percentage at craniofacial region was found to be 35.6 percent [26]. Percentage of the abovementioned complications are listed in Table 4. ...
... En el área de implantología oral, la instalación de un implante dental, requiere condiciones basales adecuadas, que permitan la colocación de un implante de longitud y diámetro óptimos según las estimaciones preoperatorias, asegurando el pronóstico del tratamiento realizado (Mazzonetto et al., 2007). La DO se presenta como una alternativa útil, viable y versátil, que permite tanto el aumento óseo como el de tejidos blandos (Mazzonetto et al.), con lo que se puede establecer el mejoramiento tridimensional para la instalación de implantes dentales. ...
Distraction osteogenesis (DO) is a surgical technique used in the treatment of facial deformities and malformations and also in the treatment of alveolar bone deficiencies. The aim of this paper is to show the case of a patient with partial edentulism in the symphysis area with a severe vertical and horizontal bone deficiency caused by mandibular trauma. At the initial analysis, the patient related a recent history of fracture in symphysis and right angle of the mandible. Treatment had not been entirely succesfull, therefore, after studying the options, we opted for a treatment at different stages: Stage 1, surgery for osteo shynthesis removal, soft tissue preparation and replacement of the posterior margin of mandibular symphysis; stage 2, distraction osteogenesis, performed 3 months after the first intervention and stage 3, distractor device removal and dental implant installation, performed 6 months after the second intervention. We discuss some factors involved in the treatment success.
... These studies have reported a wide array of complication rates, ranging from 30 to 100%. 22,[24][25][26] Though frequent, they are rarely of a serious nature and most are related to a lack of experience and observed during the learning curve. ...
Rehabilitation of posttraumatic composite defects of anterior mandible following comminution type high-energy injury often presents a reconstructive challenge. Obtaining ideal osseous and soft tissue contours in these cases is a demanding task. We discuss a case of a young man, involved in a road-side accident leading to multiple fractures in his mandible with comminution of anterior alveolar ridge. We were able to achieve excellent results by planning and treating him in five sequential stages. First, the need for rigid internal fixation was addressed followed by bone augmentation with the dynamic osteodistraction method, dental implants, and prosthesis delivery. Satisfactory aesthetics and functions were noted at a 7-year follow-up evaluation of the patient justifying the multistaged rehabilitation treatment rendered.
... Furthermore, distractors have a unidirectional impact with heavy strengths (distraction rate of 0.5 to 1 mm/d); these techniques poorly predict movement in the sagittal direction and can lead to incorrect distraction vectors. 19,20 In OBS the osteotomy is limited to the buccal side of the alveolar bone. Vascularization is ensured by the presence of the palatal bone and the attached soft tissues. ...
Different treatments have been proposed to manage the consequences of ankylosed teeth. This clinical report, which includes several different clinical conditions, describes the Orthodontic Bone Stretching procedure (OBS) that can be used to relocate ankylosed teeth. The OBS technique involves only partial osteotomies, without the mobilization or repositioning of the alveolar segment, combined with orthodontic forces. The applied force facilitates tooth movement to the occlusal plane and can modify the axis of the ankylosed tooth. This relocation is possible because of a bone stretching phenomenon in the surgical area. In all of the cases, relocating ankylosed teeth is successfully performed and gingival margins are corrected to improve the aesthetic results.
... -Mandibular fracture (1) -Hematoma in the floor of the mouth or in the chin region (2) -Infection (3) -Perforation of the mucosa (4) -Incorrect vector of distraction (45) -Mandibular farcture (8) -Paresthesia (13) -Lost implants (9) 99 Wolvius et al. 2007 (13) -Mandibular fracture (1) -Incorrect vector of distraction (10) -Lost implants (1) -Poor bone formation (10 height; 5 width) 63 Mazzonetto et al. 2007 (14) -Difficulty incompleting the osteotomy on the lingual side (1) -Paresthesia (6) -Infection (8) -Hyperplasia (3) -Fracture of screw (1) -Lack of device activation (3) -Incorrect vector of distraction (3) -Epithelium invagination ( ...
To review the literature that analyses the types and frequency of complications associated with the use of extraosseous alveolar distraction from 2007 to 2013.
Review of the literature in PubMed, using these keywords; alveolar ridge, alveolar distraction osteogenesis, complication, literature review. Inclusion criteria were: articles published between 2007 and 2013 that included the distraction protocol, the complications encountered and the time when they occurred.
According to the above criteria, 12 articles were included in this review, where 334 extraosseous distractors were placed and 395 complications were encountered, of which 19 (4.81%) were intraoperative, 261 (66.07%) postoperative and 115 (29.11 %) were postdistraction. The most common complication was the incorrect distraction vector found in 105 cases (26.58%), in 23 cases (5.82%) there were severe complications, of which 14 (3.54%) were mandibular fracture and 9 (2.27%) were fractures of the distractor elements.
According to this review, although alveolar distraction is a safe and predictable technique, it can cause complications; however, they are usually minor and easily resolved without affecting the treatment outcome.
... These defects are common in patients who have suffered severe trauma, tumor resections or congenital deformities. 1,2 The gold standard treatment is the autogenous bone graft, but the main complications are: morbidity at the site of the second surgery and the limited amount of bone available. [2][3][4] Recently the use of minimal invasive techniques has been reported to show decreased morbidity at the primary operative site. ...
... 1,2 The gold standard treatment is the autogenous bone graft, but the main complications are: morbidity at the site of the second surgery and the limited amount of bone available. [2][3][4] Recently the use of minimal invasive techniques has been reported to show decreased morbidity at the primary operative site. Many materials have been tested to avoid the graft donation surgery; the most common material used in reconstructions is calcium phosphate cement (BoneSource ® ), a mixture of tetracalcium phosphate (TTCP) and dicalcium phosphate anhydride (DCPA). ...
Objective: To compare the use of Bone Marrow adult Stem Cells (BMSCs), differentiated in vitro into osteoblasts, associated to calcium phosphate versus autogenous bone graft, in the repair process of critical size bone defects.
Materials and method: On 36 Wistar adult rats, bilateral full-thickness defects on parietal bone were created. The defects were either repaired with calcium phosphate (group I), calcium phosphate + (BMSCs) (group II) or autogenous bone graft (group III), and the opposite side with blood clot (Control Group). In all cases a collagen membrane was used. The animals were sacrificed at 30 and 60 days, and all specimens were collected for further histological and histomorfometric study.
Results: At 30 days, group III (autogenous bone graft) evidences a statistical difference on bone formation when compared to the experimental and control groups (p ≤ 0.05). At 60 days group II (BS + BMSCs) and group III (autogenous bone) showed a similar bone formation and has only a statistical difference when compared to group I (BS) and control group.
Conclusion: The use of calcium phosphate in conjunction with BMSCs resulted in a similar behavior in the process of bone repair in critical size defects, when compared with autogenous bone graft.
