- Email: [email protected]
Implant position correction by distraction osteogenesis
Int. J. Oral Maxillofac. Surg. 2005; 34 (Supplement 1): $ 1 - $ 1 8 1
1 10 ~'-~
IMPLANT POSITION CORRECTION BY DISTRACTION OSTEOGENESIS
M.M. Soares, D. Paiola, F. Guerra, C. Soares. Osteogenesis Institute,
B.T. Suer, "K Gunaydin, K. Ortakoglu, A. Kaya, "KS. Aydintug, I. Mutlu.
Brazil Mal positioned implants are a problem on the prosthetic rehabilitation. The removal of the implant may increase the bone deficiency and requires bone grafts for the installation of a new implant. The purpose of this presentation is to report the result obtained by bone lengthening through an implant-supported custom made distraction device in order to reposition it. On this paper it will be reported the reposition of five anterior maxillary osseointetegrated implants distributed on 3 females and 2 male patients. All the implants were installed and on function for at least one year or more. The patients complained about the aesthetic results obtained. All the implants were on a correct axis showing only vertical malpositions. The average distance for an ideal position was 7.4 mm ranging from 7 to 9.5 mm. For the lengthening, a custom made bridge was built connecting the neighborhood teeth and having a stop for the activation screw. The activation screw was screwed on the internal spiral tap of the implant making it move when the screw is activated. The bridge was fixed to the remaining anterior teeth and under local anesthesia an osteotomy was performed, containing the comprised implant and the surrounding bone in it. The activation screw was positioned connecting the bridge to the implant. The surgical wonld was sutured. After a week of latency the screw was tightened to movement the implant-bone structure until the proper position. After this position was achieved, the screw was locked for the mineralization period. Four months after activation, the bridge was removed and the implants received the prosthodontic final rehabilitation All the implants improved their aesthetic position, showing an average of 6.8 mm of lengthening, on two implants a secondary surgery was required to optimize the soft tissue appearance. Mal positioned implants on selected cases can be repositioned through distraction osteogenesis, at low cost, however, being a very accurate procedure.
•
[ - P - ~ THE EFFECT OF HYPERBARIC OXYGENATION ON OSTEOGENESIS INDUCED BY PERIOSTEAL DISTRACTION IN RABBITS: A PRELIMINARY REPORT
DISTRACTION OSTEOGENESIS IN CORRECTION OF MANDIBULAR RETROGNATHY (A CASE REPORT)
K. Ortakoglu, O. Bengi, M. Sencimen, B.T. Suer, S. Karacay, H.A. Altug.
Department of Oral and Maxillofacial Surgery, Gulhane Military Medical Academy Dental Sciences, Ankara, Turkey The aim of this study was to correct the bird face appearance caused by mandibulary retrognathy using ramus distraction method. In treatment of patient, preoperatively orthodontic leveling of teeth in both arches was applied. Then mandibula was distracted 15 mm to the anterior position. Essentially distraction was planned 11 mm. In addition to this 4 mm distraction was also performed because of the relapse. Finally postoperative orthodontic treatment was performed for supplying association between upper and lower teeth. There was no complication related to the distraction procedure. The distractor resisted successfully for distraction forces. After the consolidation period the new bone was observed radiologically. A one-year postoperative lateral sephalogram was showed that, relapse was 0.5mm. The application of DO to the maxillofacial skeleton has widened the options of treatments for the patients with deficiencies of the maxillofacial structures. With developments of this technique, DO have been applied with osteotomy for lengthening the congenital mandibular deformities such as mandibular retrognathy. The technique of DO is accepted as useful for maxillofacial deformities. Particularly, in anterior positioning of the mandible for 10 or more mm DO is the favorable technique for orthognathic surgery. References [1] Rachmiel A, Aizenbud D, Eleftheriou S, Peled M, Laufer D. Extraoral vs. intraoral distraction osteogenesis in the treatment of hemifacial microsomia.Ann Plast Surg. 2000 Oct;45(4):386-94. [2] Rachmiel A, Manor R, Peled M, Laufer D.Intraoral distraction osteogenesis of the mandible in hemifacial microsomia.J Oral Maxillofac Surg. 2001 Jul;59(7):728-33.
Department of Oral and Maxillofacial Surgery, Gulhane Military Medical Academy Dental Sciences, Ankara, Turkey This study was undertaken to evaluate the effects of hyperbaric oxygen (HBO) therapy on the new bone obtained through periosteal distraction in a rabbit model. Two groups, each consisting 6 New Zealand rabbits, were studied. A custom-made periosteal distraction device was rigidly fixed to the lateral surface of the mandible and decortications were performed under the device for all rabbits. In one of the groups (HBO group), 25 sessions of HBO treatment were carried out per day (2.4 ATA 90 min). The other group was not exposed to HBO and this group served as the control group (CG). In the HBO group, HBO treatment was started 2 days after the placement of the device. In both groups periosteal distraction was started 7th day postoperatively. The periosteum was distracted 5 mm over 6 days. And 3 rabbits were sacrificed at the end of the consolidation period (30 days) in each group. Others were sacrificed at the 60th day of the study. Clinical and radiological examinations were performed on all specimens, and the new bone materials between the HBO group and the CG were compared histologically. In both groups, there were serious amounts of new bone in the periosteal distraction gap on the 30th and the 60th days. In the HBO group, new bone formation was greater than it was in the control group. Our results indicate that the HBO accelerates new bone formation in the periosteal distraction site. References [1] Schmidt BL, Kung L, Jones C,Casap N. Induced Osteogenesis by Periosteal Distraction. J Oral Maxillofac Surg 60:1170-1175, 2002. [2] Sawai T, Niimi A,Takanashi H,Ueda M. Histologic Study of the Effect of Hyperbaric Oxygen Therapy on Autogenous Free Bone Grafts. J Oral Maxillofac Surg 54: 975-981, 1996. [ - P - ~ VERTICAL DISTRACTION OSTEOGENESlS OF FIBULA TRANSPLANTS FOR MANDIBULAR RECONSTRUCTION K. Ortakoglu, Y. Gi3naydin, K.M. Okgu, Y.S. Aydintug, B.T. S(3er, R. K6ymen. Department of Oral and Maxillofacial Surgery, Gulhane
Military Medical Academy Dental Sciences, Ankara, Turkey Bone continuity defects in the mandible are caused primarily by ablative surgery for tumors, but they also may result from trauma, infection or osteoradionecrosis. Today, the repairment of long-span mandibular defects with a free fibular flap is a routine procedure. However the bone height of the neo-mandible after reconstruction with a fibular flap is about half that of the dentulous mandible. Therefore, the deficiency in bone height makes implant placement impractical. In our case, since it was necessary to restore the mandibular height, a vertical distraction osteogenesis was performed on the grafted mandible of a young male patient who was referred to our clinic with a reconstructed mandible due to gunshot injury. As a result, the vertical discrepancy between the fibula and the native hemimandible of the patient was corrected. And the placement of dental implants was performed without any complications. In conclusion, we believe that the vertical distraction osteogenesis of free vascularized fibula flaps is a reliable technique that optimizes implant positioning for ideal prosthetic rehabilitation of patients with mandibular defects resulting from gunshot trauma. References [1] Levin L, Carrasco L, Kazami A, Chalian A. Enhancement of the fibula free flap by alveolar distraction for dental implant restoration: report of a case. Facial Plast Surg. 2003 Feb; 19(1): 87-94. [2] Nocini PF, Wangerin K, Albanese M, Kretschmer W, Cortelazzi R.Vertical distraction of a free vascularized fibula flap in a reconstructed hemimandible: case report. J Craniomaxillofac Surg. 2000 Feb; 28(1): 20-4. [-~']
VERTICAL DISTRACTION OSTEOGENESlS OF SCAPULAR BONE FLAP FOR MANDIBULAR RECONSTRUCTION
M. Hirota, K. Fujita. Yokohama City University Graduate School of Medicine Department of Oral and Maxillofacial Surgery, Japan Reconstruction of mandiblar defect following tumor surgery is necessary to functional and esthetic restoration of jaw. Goals for mandibular reconstruction are restoration of bone continuity, osseous bulk and alveolar
1 10 ~'-~
IMPLANT POSITION CORRECTION BY DISTRACTION OSTEOGENESIS
M.M. Soares, D. Paiola, F. Guerra, C. Soares. Osteogenesis Institute,
B.T. Suer, "K Gunaydin, K. Ortakoglu, A. Kaya, "KS. Aydintug, I. Mutlu.
Brazil Mal positioned implants are a problem on the prosthetic rehabilitation. The removal of the implant may increase the bone deficiency and requires bone grafts for the installation of a new implant. The purpose of this presentation is to report the result obtained by bone lengthening through an implant-supported custom made distraction device in order to reposition it. On this paper it will be reported the reposition of five anterior maxillary osseointetegrated implants distributed on 3 females and 2 male patients. All the implants were installed and on function for at least one year or more. The patients complained about the aesthetic results obtained. All the implants were on a correct axis showing only vertical malpositions. The average distance for an ideal position was 7.4 mm ranging from 7 to 9.5 mm. For the lengthening, a custom made bridge was built connecting the neighborhood teeth and having a stop for the activation screw. The activation screw was screwed on the internal spiral tap of the implant making it move when the screw is activated. The bridge was fixed to the remaining anterior teeth and under local anesthesia an osteotomy was performed, containing the comprised implant and the surrounding bone in it. The activation screw was positioned connecting the bridge to the implant. The surgical wonld was sutured. After a week of latency the screw was tightened to movement the implant-bone structure until the proper position. After this position was achieved, the screw was locked for the mineralization period. Four months after activation, the bridge was removed and the implants received the prosthodontic final rehabilitation All the implants improved their aesthetic position, showing an average of 6.8 mm of lengthening, on two implants a secondary surgery was required to optimize the soft tissue appearance. Mal positioned implants on selected cases can be repositioned through distraction osteogenesis, at low cost, however, being a very accurate procedure.
•
[ - P - ~ THE EFFECT OF HYPERBARIC OXYGENATION ON OSTEOGENESIS INDUCED BY PERIOSTEAL DISTRACTION IN RABBITS: A PRELIMINARY REPORT
DISTRACTION OSTEOGENESIS IN CORRECTION OF MANDIBULAR RETROGNATHY (A CASE REPORT)
K. Ortakoglu, O. Bengi, M. Sencimen, B.T. Suer, S. Karacay, H.A. Altug.
Department of Oral and Maxillofacial Surgery, Gulhane Military Medical Academy Dental Sciences, Ankara, Turkey The aim of this study was to correct the bird face appearance caused by mandibulary retrognathy using ramus distraction method. In treatment of patient, preoperatively orthodontic leveling of teeth in both arches was applied. Then mandibula was distracted 15 mm to the anterior position. Essentially distraction was planned 11 mm. In addition to this 4 mm distraction was also performed because of the relapse. Finally postoperative orthodontic treatment was performed for supplying association between upper and lower teeth. There was no complication related to the distraction procedure. The distractor resisted successfully for distraction forces. After the consolidation period the new bone was observed radiologically. A one-year postoperative lateral sephalogram was showed that, relapse was 0.5mm. The application of DO to the maxillofacial skeleton has widened the options of treatments for the patients with deficiencies of the maxillofacial structures. With developments of this technique, DO have been applied with osteotomy for lengthening the congenital mandibular deformities such as mandibular retrognathy. The technique of DO is accepted as useful for maxillofacial deformities. Particularly, in anterior positioning of the mandible for 10 or more mm DO is the favorable technique for orthognathic surgery. References [1] Rachmiel A, Aizenbud D, Eleftheriou S, Peled M, Laufer D. Extraoral vs. intraoral distraction osteogenesis in the treatment of hemifacial microsomia.Ann Plast Surg. 2000 Oct;45(4):386-94. [2] Rachmiel A, Manor R, Peled M, Laufer D.Intraoral distraction osteogenesis of the mandible in hemifacial microsomia.J Oral Maxillofac Surg. 2001 Jul;59(7):728-33.
Department of Oral and Maxillofacial Surgery, Gulhane Military Medical Academy Dental Sciences, Ankara, Turkey This study was undertaken to evaluate the effects of hyperbaric oxygen (HBO) therapy on the new bone obtained through periosteal distraction in a rabbit model. Two groups, each consisting 6 New Zealand rabbits, were studied. A custom-made periosteal distraction device was rigidly fixed to the lateral surface of the mandible and decortications were performed under the device for all rabbits. In one of the groups (HBO group), 25 sessions of HBO treatment were carried out per day (2.4 ATA 90 min). The other group was not exposed to HBO and this group served as the control group (CG). In the HBO group, HBO treatment was started 2 days after the placement of the device. In both groups periosteal distraction was started 7th day postoperatively. The periosteum was distracted 5 mm over 6 days. And 3 rabbits were sacrificed at the end of the consolidation period (30 days) in each group. Others were sacrificed at the 60th day of the study. Clinical and radiological examinations were performed on all specimens, and the new bone materials between the HBO group and the CG were compared histologically. In both groups, there were serious amounts of new bone in the periosteal distraction gap on the 30th and the 60th days. In the HBO group, new bone formation was greater than it was in the control group. Our results indicate that the HBO accelerates new bone formation in the periosteal distraction site. References [1] Schmidt BL, Kung L, Jones C,Casap N. Induced Osteogenesis by Periosteal Distraction. J Oral Maxillofac Surg 60:1170-1175, 2002. [2] Sawai T, Niimi A,Takanashi H,Ueda M. Histologic Study of the Effect of Hyperbaric Oxygen Therapy on Autogenous Free Bone Grafts. J Oral Maxillofac Surg 54: 975-981, 1996. [ - P - ~ VERTICAL DISTRACTION OSTEOGENESlS OF FIBULA TRANSPLANTS FOR MANDIBULAR RECONSTRUCTION K. Ortakoglu, Y. Gi3naydin, K.M. Okgu, Y.S. Aydintug, B.T. S(3er, R. K6ymen. Department of Oral and Maxillofacial Surgery, Gulhane
Military Medical Academy Dental Sciences, Ankara, Turkey Bone continuity defects in the mandible are caused primarily by ablative surgery for tumors, but they also may result from trauma, infection or osteoradionecrosis. Today, the repairment of long-span mandibular defects with a free fibular flap is a routine procedure. However the bone height of the neo-mandible after reconstruction with a fibular flap is about half that of the dentulous mandible. Therefore, the deficiency in bone height makes implant placement impractical. In our case, since it was necessary to restore the mandibular height, a vertical distraction osteogenesis was performed on the grafted mandible of a young male patient who was referred to our clinic with a reconstructed mandible due to gunshot injury. As a result, the vertical discrepancy between the fibula and the native hemimandible of the patient was corrected. And the placement of dental implants was performed without any complications. In conclusion, we believe that the vertical distraction osteogenesis of free vascularized fibula flaps is a reliable technique that optimizes implant positioning for ideal prosthetic rehabilitation of patients with mandibular defects resulting from gunshot trauma. References [1] Levin L, Carrasco L, Kazami A, Chalian A. Enhancement of the fibula free flap by alveolar distraction for dental implant restoration: report of a case. Facial Plast Surg. 2003 Feb; 19(1): 87-94. [2] Nocini PF, Wangerin K, Albanese M, Kretschmer W, Cortelazzi R.Vertical distraction of a free vascularized fibula flap in a reconstructed hemimandible: case report. J Craniomaxillofac Surg. 2000 Feb; 28(1): 20-4. [-~']
VERTICAL DISTRACTION OSTEOGENESlS OF SCAPULAR BONE FLAP FOR MANDIBULAR RECONSTRUCTION
M. Hirota, K. Fujita. Yokohama City University Graduate School of Medicine Department of Oral and Maxillofacial Surgery, Japan Reconstruction of mandiblar defect following tumor surgery is necessary to functional and esthetic restoration of jaw. Goals for mandibular reconstruction are restoration of bone continuity, osseous bulk and alveolar