- Email: [email protected]
Transport distraction osteogenesis following marginal resection of the mandible
Int. J. Oral Maxillofac. Surg. 2002; 31: 675–676 doi:10.1054/ijom.2002.0249, available online at http://www.idealibrary.com on
Technical Note Distraction Osteogenesis
Transport distraction osteogenesis following marginal resection of the mandible
T. Kondoh, Y. Hamada, K. Kamei, K. Seto First Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tsurumi University, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama, 230-8501, Japan
T. Kondoh, Y. Hamada, K. Kamei, K. Seto: Transport distraction osteogenesis following marginal resection of the mandible. Int. J. Oral Maxillofac. Surg. 2002; 31: 675–676. 2002 the International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Science Ltd. All rights reserved. Abstract. We performed sliding transport distraction osteogenesis (STDO) of an alveolar segment containing an unerupted third molar in the mandible of a 22-year-old man with a benign cementoblastoma. Marginal mandibulectomy including the tumour and the right mandibular second premolar and first and second molars was done. STDO was performed to horizontally reconstruct the alveolar ridge and to restore occlusion with the use of the third molar. After forward horizontal distraction of the alveolar segment, the third molar spontaneously erupted and was gradually moved to the position previously occupied by the second molar.
Introduction Distraction osteogenesis has been used since 1992 in oral and maxillofacial region6. Recently, several clinical studies have employed transport distraction osteogenesis for vertical alveolar augmentation1–3. This application is based on the concept of transverse distraction osteogenesis reported originally by Ilizarov in the dog tibia4. We now describe the use of a new procedure, sliding transport distraction osteogenesis (STDO), for repair of an alveolar defect occurring after marginal mandibulectomy. Case report A 22-year-old man presented with swelling and pain in the right mandibular molar region. A firm osseous swelling was detected on palpation of the buccal 0901-5027/02/060675+02 $35.00/0
alveolar ridge. The swelling extended from the second premolar to the second molar. The right mandibular third molar had not erupted. A panoramic radiograph showed a well-defined radiopaque lesion involving the roots of the right mandibular second premolar, the first and second molars, and an impacted supernumerary tooth. The radiopacity was uneven, and was surrounded by a radiolucent zone of uniform width (Fig. 1). The lesion was excised and diagnosed as a benign cementoblastoma. Marginal mandibulectomy including the tumour and involved teeth was performed under general anaesthesia. Subsequently, an alveolar segment containing the right mandibular unerupted third molar was formed by complete osteotomy, performed with an electric bone saw and thin osteotomes. The lingual periosteum of the segment was
Key words: sliding transport distraction osteogenesis; transport distraction osteogenesis; distraction osteogenesis; unerupted tooth; mandible. Accepted for publication 3 February 2002
Fig. 1. Panoramic radiograph at first visit. Arrowheads indicate the tumorous lesion of the mandible. Arrow indicates the unerupted third molar.
preserved, and the mandibular canal was avoided. A distraction device (20 mm horizontal distraction device: Medicon Co., Ltd, Tuttlingen, Germany) was then fixed securely in the desired position (Fig. 2). All surgical procedures were performed intraorally. The surgical wound was closed with the
2002 the International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Science Ltd. All rights reserved.
676
Kondoh et al.
Fig. 2. Panoramic radiograph immediately after surgical procedures.
remaining gingival mucosa, lined with periosteum. STDO was scheduled to start after a 7-day latency period but was delayed for another 4 days because a haematoma had formed around the distraction device. The device was activated for 24 days at the rate of 0.4 mm twice daily (0.8 mm per day). The total sliding distance of the segment was 19.2 mm (Fig. 3). The device was removed after a 4-month consolidation period. During this period, the third molar had spontaneously erupted in linguoversion. By 1 year after STDO, the third molar had moved to the position previously occupied by the second molar (Figs 4, 5). We are planning to orthodontically correct the third molar with mesial inclination and rotation. The alveolar defect at the second premolar and first molar regions will be repaired by bone grafting and two dental implants. There has been no recurrence of the tumour. Discussion In our patient, tumour ablation resulted in loss of the mandibular alveolar ridge from the second premolar to the second molar. On the other hand, there were no
Fig. 3. Panoramic radiograph after mesially STDO of the alveolar segment which contains the unerupted third molar. The segment has been moved mesially into the second molar region (arrow).
Fig. 4. Panoramic radiograph at one year after mesially STDO. The third molar is almost in the normal position for a second molar (arrow). Mature bone structure is seen in the distraction zone (arrowheads).
missing teeth in the maxilla. We planned to restore functional occlusion by using the unerupted third molar as a replacement for the second molar and placing two dental implants for the second premolar and first molar. In terms of long-term maintenance, this planning is considered more practical than using the third molar for the first molar. An impacted tooth can spontaneously erupt even in adult patients if adequate space is available. In our patient, however, the alveolar bone defect after marginal mandibulectomy would interfere with mesial movement of the third molar. We therefore used STDO to mesially shift the alveolar segment containing the unerupted third molar. Consequently, the third molar erupted 4 months after STDO. Our findings suggest that complete osteotomy and STDO of an alveolar segment do not adversely affect tooth eruption. In addition, the preserved periosteum of the alveolar segment must have contributed to the successful outcome of distraction osteo-
Fig. 5. Intraoral view at one year after mesially STDO. The third molar with mesial inclination and slight rotation has erupted and moved into the position previously occupied by the second molar (arrows).
genesis5 and to maintenance of vitality of the third molar. STDO is useful for repair of alveolar defects. This technique can be used in the management of various alveolar defects associated with tumours, cysts, localized periodontitis, and traumata. STDO is particularly suited for the treatment of alveolar defects in the molar region of the mandible with an unerupted or erupted third molar. STDO is contraindicated in the maxillary molar region because of anatomical reasons. Future research should focus on ways to more reliably predict the outcome of alveolar STDO. References 1. C M, T BA. Distraction osteogenesis in maxillofacial surgery using internal devices: Review of five cases. J Oral Maxillofac Surg 1996: 54: 45–53. 2. G A, S G, K H. Distraction implants: a new operative technique for alveolar ridge augmentation. J Craniomaxillofac Surg 1999: 27: 214–221. 3. G A, S G, K H. Distraction implants—a new possibility for augmentative treatment of the edentulous atrophic mandible: case report. Br J Oral Maxillofac Surg 1999: 37: 481–485. 4. I GA. The tension-stress effect on the genesis and growth of tissues: Part I. The influence of stability of fixation and soft-tissue preservation. Clin Orthop 1989: 238: 249–281. 5. K H, Y N, G T, M S, S Y. Bone lengthening in rabbits by callus distraction. The role of periosteum and endosteum. J Bone Joint Surg [Br] 1988: 70-B: 543–549. 6. MC JG, S J, K N, T CH, G BH. Lengthening the human mandible by gradual distraction. Plast Reconstr Surg 1992: 89: 1–8. Address: Toshirou Kondoh, DMD, PhD First Department of Oral and Maxillofacial Surgery School of Dental Medicine Tsurumi University 2-1-3 Tsurumi Tsurumi-ku Yokohama 230-8501 Japan Tel: 81-45-581-1001 Fax: 81-45-582-0459 E-mail: [email protected]
Technical Note Distraction Osteogenesis
Transport distraction osteogenesis following marginal resection of the mandible
T. Kondoh, Y. Hamada, K. Kamei, K. Seto First Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tsurumi University, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama, 230-8501, Japan
T. Kondoh, Y. Hamada, K. Kamei, K. Seto: Transport distraction osteogenesis following marginal resection of the mandible. Int. J. Oral Maxillofac. Surg. 2002; 31: 675–676. 2002 the International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Science Ltd. All rights reserved. Abstract. We performed sliding transport distraction osteogenesis (STDO) of an alveolar segment containing an unerupted third molar in the mandible of a 22-year-old man with a benign cementoblastoma. Marginal mandibulectomy including the tumour and the right mandibular second premolar and first and second molars was done. STDO was performed to horizontally reconstruct the alveolar ridge and to restore occlusion with the use of the third molar. After forward horizontal distraction of the alveolar segment, the third molar spontaneously erupted and was gradually moved to the position previously occupied by the second molar.
Introduction Distraction osteogenesis has been used since 1992 in oral and maxillofacial region6. Recently, several clinical studies have employed transport distraction osteogenesis for vertical alveolar augmentation1–3. This application is based on the concept of transverse distraction osteogenesis reported originally by Ilizarov in the dog tibia4. We now describe the use of a new procedure, sliding transport distraction osteogenesis (STDO), for repair of an alveolar defect occurring after marginal mandibulectomy. Case report A 22-year-old man presented with swelling and pain in the right mandibular molar region. A firm osseous swelling was detected on palpation of the buccal 0901-5027/02/060675+02 $35.00/0
alveolar ridge. The swelling extended from the second premolar to the second molar. The right mandibular third molar had not erupted. A panoramic radiograph showed a well-defined radiopaque lesion involving the roots of the right mandibular second premolar, the first and second molars, and an impacted supernumerary tooth. The radiopacity was uneven, and was surrounded by a radiolucent zone of uniform width (Fig. 1). The lesion was excised and diagnosed as a benign cementoblastoma. Marginal mandibulectomy including the tumour and involved teeth was performed under general anaesthesia. Subsequently, an alveolar segment containing the right mandibular unerupted third molar was formed by complete osteotomy, performed with an electric bone saw and thin osteotomes. The lingual periosteum of the segment was
Key words: sliding transport distraction osteogenesis; transport distraction osteogenesis; distraction osteogenesis; unerupted tooth; mandible. Accepted for publication 3 February 2002
Fig. 1. Panoramic radiograph at first visit. Arrowheads indicate the tumorous lesion of the mandible. Arrow indicates the unerupted third molar.
preserved, and the mandibular canal was avoided. A distraction device (20 mm horizontal distraction device: Medicon Co., Ltd, Tuttlingen, Germany) was then fixed securely in the desired position (Fig. 2). All surgical procedures were performed intraorally. The surgical wound was closed with the
2002 the International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Science Ltd. All rights reserved.
676
Kondoh et al.
Fig. 2. Panoramic radiograph immediately after surgical procedures.
remaining gingival mucosa, lined with periosteum. STDO was scheduled to start after a 7-day latency period but was delayed for another 4 days because a haematoma had formed around the distraction device. The device was activated for 24 days at the rate of 0.4 mm twice daily (0.8 mm per day). The total sliding distance of the segment was 19.2 mm (Fig. 3). The device was removed after a 4-month consolidation period. During this period, the third molar had spontaneously erupted in linguoversion. By 1 year after STDO, the third molar had moved to the position previously occupied by the second molar (Figs 4, 5). We are planning to orthodontically correct the third molar with mesial inclination and rotation. The alveolar defect at the second premolar and first molar regions will be repaired by bone grafting and two dental implants. There has been no recurrence of the tumour. Discussion In our patient, tumour ablation resulted in loss of the mandibular alveolar ridge from the second premolar to the second molar. On the other hand, there were no
Fig. 3. Panoramic radiograph after mesially STDO of the alveolar segment which contains the unerupted third molar. The segment has been moved mesially into the second molar region (arrow).
Fig. 4. Panoramic radiograph at one year after mesially STDO. The third molar is almost in the normal position for a second molar (arrow). Mature bone structure is seen in the distraction zone (arrowheads).
missing teeth in the maxilla. We planned to restore functional occlusion by using the unerupted third molar as a replacement for the second molar and placing two dental implants for the second premolar and first molar. In terms of long-term maintenance, this planning is considered more practical than using the third molar for the first molar. An impacted tooth can spontaneously erupt even in adult patients if adequate space is available. In our patient, however, the alveolar bone defect after marginal mandibulectomy would interfere with mesial movement of the third molar. We therefore used STDO to mesially shift the alveolar segment containing the unerupted third molar. Consequently, the third molar erupted 4 months after STDO. Our findings suggest that complete osteotomy and STDO of an alveolar segment do not adversely affect tooth eruption. In addition, the preserved periosteum of the alveolar segment must have contributed to the successful outcome of distraction osteo-
Fig. 5. Intraoral view at one year after mesially STDO. The third molar with mesial inclination and slight rotation has erupted and moved into the position previously occupied by the second molar (arrows).
genesis5 and to maintenance of vitality of the third molar. STDO is useful for repair of alveolar defects. This technique can be used in the management of various alveolar defects associated with tumours, cysts, localized periodontitis, and traumata. STDO is particularly suited for the treatment of alveolar defects in the molar region of the mandible with an unerupted or erupted third molar. STDO is contraindicated in the maxillary molar region because of anatomical reasons. Future research should focus on ways to more reliably predict the outcome of alveolar STDO. References 1. C M, T BA. Distraction osteogenesis in maxillofacial surgery using internal devices: Review of five cases. J Oral Maxillofac Surg 1996: 54: 45–53. 2. G A, S G, K H. Distraction implants: a new operative technique for alveolar ridge augmentation. J Craniomaxillofac Surg 1999: 27: 214–221. 3. G A, S G, K H. Distraction implants—a new possibility for augmentative treatment of the edentulous atrophic mandible: case report. Br J Oral Maxillofac Surg 1999: 37: 481–485. 4. I GA. The tension-stress effect on the genesis and growth of tissues: Part I. The influence of stability of fixation and soft-tissue preservation. Clin Orthop 1989: 238: 249–281. 5. K H, Y N, G T, M S, S Y. Bone lengthening in rabbits by callus distraction. The role of periosteum and endosteum. J Bone Joint Surg [Br] 1988: 70-B: 543–549. 6. MC JG, S J, K N, T CH, G BH. Lengthening the human mandible by gradual distraction. Plast Reconstr Surg 1992: 89: 1–8. Address: Toshirou Kondoh, DMD, PhD First Department of Oral and Maxillofacial Surgery School of Dental Medicine Tsurumi University 2-1-3 Tsurumi Tsurumi-ku Yokohama 230-8501 Japan Tel: 81-45-581-1001 Fax: 81-45-582-0459 E-mail: [email protected]