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Alveolar distraction osteogenesis for placement of dental implants: The baylor experience
Oral P r e s e n t a t i o n s / 0 2 2 .
CLP II
proper aesthetic position for implant. The healing period adopted was 10 days and the activation was performed on a rate of 5mm per day. The maturation period was extended, the device was removed and the implants installed on an average of 4.5 months after the end of activation. 78 implants were installed and only three failures happened for one implant on the sinus grafted and distracted area and two on the distracted anterior maxilla showing a rate of 95% of osseointegration. The results obtained showed the feasibility of the association of bone grafts on the transport disc to improve the results of distraction osteogenesis on alveolar bone. However more studies must be done in order to understudy the biology and limits of this association.
[ - 0 - - ~ - ~ IMPLANT STABILITY AT SHORTENING THE CONSOLIDATION PERIOD OF ALVEOLAR DISTRACTION OSTEOGENESIS: PRELIMINARY RESULTS B.C. Sener 1 , F. Ugurlu 1 , C). Atar 2, A. Sertg6z 2. 1Marmara University, Faculty of Dentistry Department of Oral&Maxillofacial Surgery, 2Department of Prosthodontics, Istanbul, Turkey Consolidation period of distraction osteogenesis (DO) is similar to conventional bone grafting technique. Implants are used as osteosynthesis materials for fixation of block grafts. Purpose of this prospective study was to compare the implant stability in shortened consolidation period with conventionally advised time duration. Alveolar segmental osteotomy was performed in the mandible followed by placement of 10 mm alveolar distraction devices. Sutures were removed on the 7th day and the devices activated 0.5 mm/day for 20 days. Consolidation period was one month for the study group (n =4) and 3 months for the control group (n=5). Distraction devices were removed during implant placement, and biopsies were taken with trephine burs from the implant sites for histological characterization of the newly formed bone. Two ITI implants to each patient were placed in predetermined sites. Primary stability and osseointegration status of implants at the implantation day, 3rd week, 2nd months postoperatively were tested with Osstell TM. Radigraphically implants were followed-up in between 12 to 26 months (mean = 19 months). All implants were in function at the end of last follow-up. Radiological evaluation showed lifting of the transport segment and mean bone gain obtained by distraction was 9.8 mm (range 9 to 10 mm). Integration of the implants within both the transport segment and the regenerated bone was also observed. Osstell TM values were immediately after operation 52.44 in control group, 49.66 in experimental group. However, 3rd week control showed minimal decrease in Osstell TM values in control group (51.55), while an increase in experimental group (55.33). These values rose up gradually in both groups within following 2 months (control group: 55.33 experimental group: 56.22. Our results showed that one month seems to provide satisfactory consolidation period for the cases in which the segments are fixed via implants during distraction device removal. [-O--~-..5-] OSTEODISTRACTION WITH Q-MULITRACTOR TYPE KARLSRUHE. REPORT OF THE CASE M. Duda, J. Witalinska-Labuzek. Silesia-Med Oral Medicine Clinic, Mieleckiego Str. 6, 40-013 Katowice, Poland Osteodistracton is a biological process consisting of a formation of new bone in the osteotomy gap of gradually distracted bone segments with use of a distractor, which fixates bone segments and facilitates its displacement. The authors describe a case report of an osteodistraction with use of the extraosseous distactor Q-Mulitractor type Karlsruhe. The purpose of the work is to show two unique features of the osteodistractor which we consider useful for the clinicians. The case of osteodistraction of the frontal mandibular region is presented. The patient with the severe bone atrophy was treated using Q-Mulitractor type Karlsruhe in the region 33-43. After successful osteodistraction and consolidation period implantation of 12 two-stage implants and restoration with fixed bridges was performed. We suggest that with use of Q-Mulitractor type Karlsruhe it is possible to avoid the destabilisation of the osteodistractor durig unwristing the distraction screw, which prevents the change of the osteodistraction vector because of the construction of the basal osteodistractors plate, which has a vertical pin. However further clinical researches are needed to confirm the observation. We also found very comfortable for the patient the possibility of hiding (screwing down) the screwing osteodistraction pin after the period of osteodistraction before removing the device, which makes easier for the patient to wear the temporary restoration for 2 - 3 months (consolidation period).
41
I'-O-'~-] CREST WIDENING BY DISTRACTION; AN ALTERNATIVE TECHNIQUE TO BONE AUGMENTATION Z. Laster, A. Rachmiel, O. Jensen. Poriya Governmental Hospital,
Tiberias, Israel To introduce a new device and technique to widen a narrow alveolar crest prior to implantation. A 4-armed distractor was used to widen a narrow alveolar crest. Under local anesthesia, 3 mucoperiostal incisions were performed; One along the crestal ridge and two vertical cuts at the anterior and posterior buccal aspects. Through these cuts, bone cuts were made using a reciprocating scalpel saw to the depth of half of the crest thickness. The distractor was inserted into the crestal bone cut by tapping on the device. Distraction was begun 7 days post-op by rotating the activating screw 1 a full turn twice a day. Each 1 turn distracted the buccal bone flap by 0.2mm. Further distraction was performed by the patients at home, 21 a turn twice a day. The distractor was removed when adequate width of crest was achieved. Implants were inserted at the same session or 7-14 days later. The study group consisted of 8 patients who suffered from a narrow alveolar crest in the 14-16, 11-21, 32-42, 34-37 and 44-47 regions. The amount of widening ranged from 4 - 6 m m . Distraction periods ranged from 10-16 days. Latency period was 5 - 7 days. 6 implants were inserted immediately after the removal of the distractors in the first 2 cases. 19 implants were inserted 4 - 5 weeks post-op. No complication was observed during the distraction period or with any of the implants. Prosthetic treatment of the implants was completed 3 - 4 months after implantation. No complication was observed 18-24 months after prosthetic treatment. Crest widening by distraction may be a better and faster alternative in the case of a narrow alveolar crest with sufficient crestal height. The technique can be easily used in the private office. A long term and multi center trial is needed. 1 " - 6 " ~ ' ~ ALVEOLAR DISTRACTION OSTEOGENESIS FOR PLACEMENT OF DENTAL IMPLANTS: THE BAYLOR EXPERIENCE EE Franco, R.G. Triplett, S.R. Schow, N. Magro-Ernica. Baylor College of Dentistry, Texas A&M University Health Science Center, Texas, USA This abstract will discuss our experience at Baylor College of Dentistry TAMUS and the indications, contraindications, surgical protocol with osteotomy designs, and complications for alveolar distraction osteogenesis in order to improve alveolar implant site. 25 consecutive cases underwent vertical alveolar distraction using extra osseous bone plate distractor in the buccal area. 18 cases were performed in the mandibular anterior area and 7 cases in the maxillary anterior area. All patients had the same surgical approach and osteotomy design in order to improve vestibular depth and alveolar segment stability in the direction of the bone lengthening. All cases were performed with local anesthesia and intravenous sedation. The distraction phase was started on the 10th postoperative day at a rate of 0.9 mm per day for seven days in average, followed by a consolidation period of 60 days. The device was removed and simultaneous placement of endosseous implants was performed. The follow-up time was 13 to 50 months including clinical and radiological evaluation. 82 endosseous implants were placed with 6 implants failed to integrate due to poor bone quality in the respectively area. 73 implants were restored without complications. Bone loss remodeling was observed in the superior portion of the implant- alveolar crest area after loading the implant with the final restoration. Alveolar distraction osteogenesis is a predictable technique to improve alveolar ridge height for placement of dental implants.
0 2 2 . CLP II
1"-6"~-~ MIDFACE DISTRACTION WITH AN INTRAORAL DEVICE IN CLEFT PALATE PATIENTS A. Baumann, K. Sinko. University Hospital of Cranio-Maxillofacial and
Oral Surgery, Medical University of Vienna, Vienna, Austria Maxillary hypoplasia has often to be corrected in patients with cleft palate deformities to restore normal jaw function and improve facial
CLP II
proper aesthetic position for implant. The healing period adopted was 10 days and the activation was performed on a rate of 5mm per day. The maturation period was extended, the device was removed and the implants installed on an average of 4.5 months after the end of activation. 78 implants were installed and only three failures happened for one implant on the sinus grafted and distracted area and two on the distracted anterior maxilla showing a rate of 95% of osseointegration. The results obtained showed the feasibility of the association of bone grafts on the transport disc to improve the results of distraction osteogenesis on alveolar bone. However more studies must be done in order to understudy the biology and limits of this association.
[ - 0 - - ~ - ~ IMPLANT STABILITY AT SHORTENING THE CONSOLIDATION PERIOD OF ALVEOLAR DISTRACTION OSTEOGENESIS: PRELIMINARY RESULTS B.C. Sener 1 , F. Ugurlu 1 , C). Atar 2, A. Sertg6z 2. 1Marmara University, Faculty of Dentistry Department of Oral&Maxillofacial Surgery, 2Department of Prosthodontics, Istanbul, Turkey Consolidation period of distraction osteogenesis (DO) is similar to conventional bone grafting technique. Implants are used as osteosynthesis materials for fixation of block grafts. Purpose of this prospective study was to compare the implant stability in shortened consolidation period with conventionally advised time duration. Alveolar segmental osteotomy was performed in the mandible followed by placement of 10 mm alveolar distraction devices. Sutures were removed on the 7th day and the devices activated 0.5 mm/day for 20 days. Consolidation period was one month for the study group (n =4) and 3 months for the control group (n=5). Distraction devices were removed during implant placement, and biopsies were taken with trephine burs from the implant sites for histological characterization of the newly formed bone. Two ITI implants to each patient were placed in predetermined sites. Primary stability and osseointegration status of implants at the implantation day, 3rd week, 2nd months postoperatively were tested with Osstell TM. Radigraphically implants were followed-up in between 12 to 26 months (mean = 19 months). All implants were in function at the end of last follow-up. Radiological evaluation showed lifting of the transport segment and mean bone gain obtained by distraction was 9.8 mm (range 9 to 10 mm). Integration of the implants within both the transport segment and the regenerated bone was also observed. Osstell TM values were immediately after operation 52.44 in control group, 49.66 in experimental group. However, 3rd week control showed minimal decrease in Osstell TM values in control group (51.55), while an increase in experimental group (55.33). These values rose up gradually in both groups within following 2 months (control group: 55.33 experimental group: 56.22. Our results showed that one month seems to provide satisfactory consolidation period for the cases in which the segments are fixed via implants during distraction device removal. [-O--~-..5-] OSTEODISTRACTION WITH Q-MULITRACTOR TYPE KARLSRUHE. REPORT OF THE CASE M. Duda, J. Witalinska-Labuzek. Silesia-Med Oral Medicine Clinic, Mieleckiego Str. 6, 40-013 Katowice, Poland Osteodistracton is a biological process consisting of a formation of new bone in the osteotomy gap of gradually distracted bone segments with use of a distractor, which fixates bone segments and facilitates its displacement. The authors describe a case report of an osteodistraction with use of the extraosseous distactor Q-Mulitractor type Karlsruhe. The purpose of the work is to show two unique features of the osteodistractor which we consider useful for the clinicians. The case of osteodistraction of the frontal mandibular region is presented. The patient with the severe bone atrophy was treated using Q-Mulitractor type Karlsruhe in the region 33-43. After successful osteodistraction and consolidation period implantation of 12 two-stage implants and restoration with fixed bridges was performed. We suggest that with use of Q-Mulitractor type Karlsruhe it is possible to avoid the destabilisation of the osteodistractor durig unwristing the distraction screw, which prevents the change of the osteodistraction vector because of the construction of the basal osteodistractors plate, which has a vertical pin. However further clinical researches are needed to confirm the observation. We also found very comfortable for the patient the possibility of hiding (screwing down) the screwing osteodistraction pin after the period of osteodistraction before removing the device, which makes easier for the patient to wear the temporary restoration for 2 - 3 months (consolidation period).
41
I'-O-'~-] CREST WIDENING BY DISTRACTION; AN ALTERNATIVE TECHNIQUE TO BONE AUGMENTATION Z. Laster, A. Rachmiel, O. Jensen. Poriya Governmental Hospital,
Tiberias, Israel To introduce a new device and technique to widen a narrow alveolar crest prior to implantation. A 4-armed distractor was used to widen a narrow alveolar crest. Under local anesthesia, 3 mucoperiostal incisions were performed; One along the crestal ridge and two vertical cuts at the anterior and posterior buccal aspects. Through these cuts, bone cuts were made using a reciprocating scalpel saw to the depth of half of the crest thickness. The distractor was inserted into the crestal bone cut by tapping on the device. Distraction was begun 7 days post-op by rotating the activating screw 1 a full turn twice a day. Each 1 turn distracted the buccal bone flap by 0.2mm. Further distraction was performed by the patients at home, 21 a turn twice a day. The distractor was removed when adequate width of crest was achieved. Implants were inserted at the same session or 7-14 days later. The study group consisted of 8 patients who suffered from a narrow alveolar crest in the 14-16, 11-21, 32-42, 34-37 and 44-47 regions. The amount of widening ranged from 4 - 6 m m . Distraction periods ranged from 10-16 days. Latency period was 5 - 7 days. 6 implants were inserted immediately after the removal of the distractors in the first 2 cases. 19 implants were inserted 4 - 5 weeks post-op. No complication was observed during the distraction period or with any of the implants. Prosthetic treatment of the implants was completed 3 - 4 months after implantation. No complication was observed 18-24 months after prosthetic treatment. Crest widening by distraction may be a better and faster alternative in the case of a narrow alveolar crest with sufficient crestal height. The technique can be easily used in the private office. A long term and multi center trial is needed. 1 " - 6 " ~ ' ~ ALVEOLAR DISTRACTION OSTEOGENESIS FOR PLACEMENT OF DENTAL IMPLANTS: THE BAYLOR EXPERIENCE EE Franco, R.G. Triplett, S.R. Schow, N. Magro-Ernica. Baylor College of Dentistry, Texas A&M University Health Science Center, Texas, USA This abstract will discuss our experience at Baylor College of Dentistry TAMUS and the indications, contraindications, surgical protocol with osteotomy designs, and complications for alveolar distraction osteogenesis in order to improve alveolar implant site. 25 consecutive cases underwent vertical alveolar distraction using extra osseous bone plate distractor in the buccal area. 18 cases were performed in the mandibular anterior area and 7 cases in the maxillary anterior area. All patients had the same surgical approach and osteotomy design in order to improve vestibular depth and alveolar segment stability in the direction of the bone lengthening. All cases were performed with local anesthesia and intravenous sedation. The distraction phase was started on the 10th postoperative day at a rate of 0.9 mm per day for seven days in average, followed by a consolidation period of 60 days. The device was removed and simultaneous placement of endosseous implants was performed. The follow-up time was 13 to 50 months including clinical and radiological evaluation. 82 endosseous implants were placed with 6 implants failed to integrate due to poor bone quality in the respectively area. 73 implants were restored without complications. Bone loss remodeling was observed in the superior portion of the implant- alveolar crest area after loading the implant with the final restoration. Alveolar distraction osteogenesis is a predictable technique to improve alveolar ridge height for placement of dental implants.
0 2 2 . CLP II
1"-6"~-~ MIDFACE DISTRACTION WITH AN INTRAORAL DEVICE IN CLEFT PALATE PATIENTS A. Baumann, K. Sinko. University Hospital of Cranio-Maxillofacial and
Oral Surgery, Medical University of Vienna, Vienna, Austria Maxillary hypoplasia has often to be corrected in patients with cleft palate deformities to restore normal jaw function and improve facial