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Complication frequencies of conventional grafting technique and alveolar distraction osteogenesis for bone augmentation: Preliminary results
Poster I / Distraction Osteogenesis bone height. Inadequate alveolar process induces disability to mastication. In the report, two cases of segmental distraction osteogengesis of mandible that was reconstructed by microvascular scapular bone flap were presented. Two patients who were received reconstructive surgery using scapular bone and combined flap for resected mandible one half or two year after tumor surgery showed vertical deficient of grafted bone. The deficient of reconstructed bone was almost 10mm. To restore the bone height, segmental vertical distraction osteogenesis of scapular bone was performed under general anesthesia. One case was caused surgical site infection after placement of internal distraction devices. In this case, irrigation for surgical wound was performed until wound condition was improved. After confirmation of disappearance of pus discharge from infection wound, distraction of scapular bone started. Distraction of scapular bone was performed at the rate 0.5 mm/day for 10 days and 1.0 mm/day for 5 days. Four or six month after distraction, dental implant was placed in the scapular bone. Bone specimens were gained with bone trephine bur and histological evaluation of distracted bone was performed. The maturation of distracted bone was stable and enables replacement of dental implants. Although the case, in which surgical site infection occurred, showed a small amount of bone defect in distracted bone, sufficient bone height for dental implants were seen. Microvascular tissue transplants, such as fibular and scapular bone and soft tissue flaps are effective for mandibular reconstruction. In the present cases, the author applied the vertical distraction osteogenesis to scapular flap of reconstructed mandible. In one case, surgical site infection occurred; nevertheless sufficient bone height for dental implant could be seen. Vertical distraction osteogenesis of reconstructed bone considered to be effective procedure for restoration of oral function by dental implants.
[-P'-~ MAXILLARY ANTERIOR SEGMENTAL ADVANCEMENT BY DISTRACTION OSTEOGENESIS IN CLEFT PATIENTS: REPORT OF TWO CASES B. Bas, A. Alkan, M. Ozer, M. Bayram. Department of Oral and Maxillofacial Surgery, Department of Orthodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey Lefort I osteotomy is one of the routine procedure for treatment of maxillary hypoplasia in cleft patients. In recent years, use of rigid external distraction (RED) system has gained popularity for improvement of severe maxillary hypoplasia. However several studies have reported that this technique alters or even worsen symptoms of velopharyngeal insufficiency in cleft patients. For this purpose, advancement of anterior maxillary segment by distraction osteogenesis can be more useful than the others. In this report, we present the use of a tooth-borne type distractor for segmental advancement of the maxilla in two cleft patients. We were not faced with any abnormal responses related to the hard and the soft tissues. Normal overjet and overbite were obtained. The operation and the device were well tolerated by the patients and there were no symptoms of velopharyngeal insufficiency. Advancement of anterior maxillary segment by distraction osteogenesis can be thought as an alternative method that offers many advantages in cleft patients.
111 could be observed in a 3-6 months period after procedure. Seven patients presented major complications like incapacity of planned device activation; epithelium invagination; formation of scar tissue; fracture of transport disc and fracture of transport plate. Fourteen patients (25.45%) arise 24 minor complications, like infection (8 patients), parestesia (06 patients); tipping of transport disk (3 patients); hiperplasia (3 patients); fracture of screw (2 patients), revisions of osteotomies and inadequate lengh (1 patients). Overall complications rate was 36.36%. However, most of complications were minor and did not compromise the implant placement and alveolar distraction technique if a promptly care was take.
References [1] KLUG CN, MILLESI-SCHOBEL GA, MILLESI W, WATZINGER F, EWERS R. Preprosthetic vertical distraction osteogenesis for the mandible using an L-shaped osteotomy and titanium membranes for guided bone regeneration. J Oral Maxillofac Surg. 2001 ; 59(11 ): 1302-1308. [2] MAURETTE O'BRIEN PE, ALLAIS DE MAURETTE ME, MAZZONETTO R. Distracci6n osteogenica alveolar: una alternativa en la reconstrucci6n de rebordes alveolares atr6ficos. Descripci6n de 10 casos. Rev Esp Cirug Oral y Maxilofac. 2004; 26: 41-47. [3] RAGHOEBAR GM, HEYDENRIJK K, VlSSINK A. Vertical distraction of the severely resorbed mandible. The Groningen distraction device. Int J Oral Maxillofac Surg 2000; 29: 416-420.
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COMPLICATION FREQUENCIES OF CONVENTIONAL GRAFTING TECHNIQUE AND ALVEOLAR DISTRACTION OSTEOGENESlS FOR BONE AUGMENTATION: PRELIMINARY RESULTS
B.C. Sener, E Ugurlu, S. Degirmenci. Marmara University, Faculty of Dentistry, Department of OMFS, Nisantasi, Istanbul, Turkey Alveolar distraction osteogenesis (ADO) is a promising technique for bone augmentation though its well-documented complication risks and economic disadvantage. Aim of this study was to compare clinical complication rates of ADO and grafting techniques. Forty-seven patients with alveolar bone deficiency underwent reconstruction. (12 with ADO and 35 with conventional grafting method, onlay/inlay= 23/12). Implants were placed after 4.5 to 6 months after grafting and 1 to 3 months after end of ADO activation. Infection was observed in 7 (22.6%) grafted sites while no infection was evident in ADO group. All infection patients had onlay grafts (granule/block=5/3) One patient who underwent inlay augmentation and 1 in ADO group experienced intraoperative fracture of lower jaw. One patient of ADO group had anchor segment fracture in the maxilla. One patient faced with graft particle migration. Thirty-three patients in grafting group required secondary operation for soft tissue reconstruction before or after implant placement. Even the number of patients in ADO group was less than the grafting group; lower complication rate was observed with ADO. Probably the major factor of infection was saliva contamination during or after grafting. Over-size grafting can lead sudden decrease of perfusion at the grafted site due to soft tissue tension and vascular occlusion. According to our preliminary results; we can conclude that grafting has the advantage lower cost but higher complication rate when compared with ADO.
[-P'-~ A RETROSPECTIVE STUDY OF THE POTENTIAL COMPLICATIONS DURING ALVEOLAR DISTRACTION OSTEOGENESIS IN 55 PATIENTS
[P-•
R. Mazzonetto, M.A. Maurette, E Maurette, R.W. Moreira. Piracicaba Dental School University of Campinas, Brazil
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
Evaluate the potential complications that may arise during alveolar distraction osteogenesis. Fifty-five patients were treated with alveolar distraction osteogenesis for correction of vertical alveolar ridge. The complications that arose were categorized in two groups: Minor complications, ones that did not affect the final result, but immediate intervention was imperative; and major complications that lead the technique to failure. Among the minor complications we included: Tipping of bone transport segment, dehiscence, infection, lack of the patient's collaboration, and perforation of the mucosa by the transport segment. Among the majors complications we included: Fracture or resorption of the transport segment, fracture of the device, fracture of the mandible, bone formation defects, dysesthesia of the mental nerve, and inadequate length of distraction. Clinical and radiograph follow-up were performed at 7, 10, 15, 20, 30, 60 and 90 days after operation. The mean alveolar distraction achieved was 6.27mm. The increased radiopacity of distracted area
DISTRACTION OSTEOGENESlS IN CORRECTION OF
MANDIBULAR RETROGNATHY (A CASE REPORT)
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 0.5 mm. 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
[-P'-~ MAXILLARY ANTERIOR SEGMENTAL ADVANCEMENT BY DISTRACTION OSTEOGENESIS IN CLEFT PATIENTS: REPORT OF TWO CASES B. Bas, A. Alkan, M. Ozer, M. Bayram. Department of Oral and Maxillofacial Surgery, Department of Orthodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey Lefort I osteotomy is one of the routine procedure for treatment of maxillary hypoplasia in cleft patients. In recent years, use of rigid external distraction (RED) system has gained popularity for improvement of severe maxillary hypoplasia. However several studies have reported that this technique alters or even worsen symptoms of velopharyngeal insufficiency in cleft patients. For this purpose, advancement of anterior maxillary segment by distraction osteogenesis can be more useful than the others. In this report, we present the use of a tooth-borne type distractor for segmental advancement of the maxilla in two cleft patients. We were not faced with any abnormal responses related to the hard and the soft tissues. Normal overjet and overbite were obtained. The operation and the device were well tolerated by the patients and there were no symptoms of velopharyngeal insufficiency. Advancement of anterior maxillary segment by distraction osteogenesis can be thought as an alternative method that offers many advantages in cleft patients.
111 could be observed in a 3-6 months period after procedure. Seven patients presented major complications like incapacity of planned device activation; epithelium invagination; formation of scar tissue; fracture of transport disc and fracture of transport plate. Fourteen patients (25.45%) arise 24 minor complications, like infection (8 patients), parestesia (06 patients); tipping of transport disk (3 patients); hiperplasia (3 patients); fracture of screw (2 patients), revisions of osteotomies and inadequate lengh (1 patients). Overall complications rate was 36.36%. However, most of complications were minor and did not compromise the implant placement and alveolar distraction technique if a promptly care was take.
References [1] KLUG CN, MILLESI-SCHOBEL GA, MILLESI W, WATZINGER F, EWERS R. Preprosthetic vertical distraction osteogenesis for the mandible using an L-shaped osteotomy and titanium membranes for guided bone regeneration. J Oral Maxillofac Surg. 2001 ; 59(11 ): 1302-1308. [2] MAURETTE O'BRIEN PE, ALLAIS DE MAURETTE ME, MAZZONETTO R. Distracci6n osteogenica alveolar: una alternativa en la reconstrucci6n de rebordes alveolares atr6ficos. Descripci6n de 10 casos. Rev Esp Cirug Oral y Maxilofac. 2004; 26: 41-47. [3] RAGHOEBAR GM, HEYDENRIJK K, VlSSINK A. Vertical distraction of the severely resorbed mandible. The Groningen distraction device. Int J Oral Maxillofac Surg 2000; 29: 416-420.
•53•
COMPLICATION FREQUENCIES OF CONVENTIONAL GRAFTING TECHNIQUE AND ALVEOLAR DISTRACTION OSTEOGENESlS FOR BONE AUGMENTATION: PRELIMINARY RESULTS
B.C. Sener, E Ugurlu, S. Degirmenci. Marmara University, Faculty of Dentistry, Department of OMFS, Nisantasi, Istanbul, Turkey Alveolar distraction osteogenesis (ADO) is a promising technique for bone augmentation though its well-documented complication risks and economic disadvantage. Aim of this study was to compare clinical complication rates of ADO and grafting techniques. Forty-seven patients with alveolar bone deficiency underwent reconstruction. (12 with ADO and 35 with conventional grafting method, onlay/inlay= 23/12). Implants were placed after 4.5 to 6 months after grafting and 1 to 3 months after end of ADO activation. Infection was observed in 7 (22.6%) grafted sites while no infection was evident in ADO group. All infection patients had onlay grafts (granule/block=5/3) One patient who underwent inlay augmentation and 1 in ADO group experienced intraoperative fracture of lower jaw. One patient of ADO group had anchor segment fracture in the maxilla. One patient faced with graft particle migration. Thirty-three patients in grafting group required secondary operation for soft tissue reconstruction before or after implant placement. Even the number of patients in ADO group was less than the grafting group; lower complication rate was observed with ADO. Probably the major factor of infection was saliva contamination during or after grafting. Over-size grafting can lead sudden decrease of perfusion at the grafted site due to soft tissue tension and vascular occlusion. According to our preliminary results; we can conclude that grafting has the advantage lower cost but higher complication rate when compared with ADO.
[-P'-~ A RETROSPECTIVE STUDY OF THE POTENTIAL COMPLICATIONS DURING ALVEOLAR DISTRACTION OSTEOGENESIS IN 55 PATIENTS
[P-•
R. Mazzonetto, M.A. Maurette, E Maurette, R.W. Moreira. Piracicaba Dental School University of Campinas, Brazil
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
Evaluate the potential complications that may arise during alveolar distraction osteogenesis. Fifty-five patients were treated with alveolar distraction osteogenesis for correction of vertical alveolar ridge. The complications that arose were categorized in two groups: Minor complications, ones that did not affect the final result, but immediate intervention was imperative; and major complications that lead the technique to failure. Among the minor complications we included: Tipping of bone transport segment, dehiscence, infection, lack of the patient's collaboration, and perforation of the mucosa by the transport segment. Among the majors complications we included: Fracture or resorption of the transport segment, fracture of the device, fracture of the mandible, bone formation defects, dysesthesia of the mental nerve, and inadequate length of distraction. Clinical and radiograph follow-up were performed at 7, 10, 15, 20, 30, 60 and 90 days after operation. The mean alveolar distraction achieved was 6.27mm. The increased radiopacity of distracted area
DISTRACTION OSTEOGENESlS IN CORRECTION OF
MANDIBULAR RETROGNATHY (A CASE REPORT)
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 0.5 mm. 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