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Ultrastructural and elemental spectrum analysis of distraction osteogenesis reconstruction for cleft palate on rhesus model
556 Free Papers—Poster Presentations steady of distractor in two set directions: parallel to the Y axis or the extension axis. Thereby, to promote intramembranous ossification, speed up bone formation and elevate the quality of bone formation. Results: Distractor set parallel to Y axis performed better than the extension axis. Conclusions: This study provides a theoretical basis for the position of distract equipment and distraction orientations in clinical application. Acknowledgement. This study was supported by Scientific and Technological Development Programme of Jilin Province Scientific and Technological Bureau. NO.20040508 doi:10.1016/j.ijom.2009.03.556
P84 A complication associated with distraction osteogenesis in correction of maxillary hypoplasia: a case report A. Apaydin ∗ , H. Kocaelli, S. Uygun Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
Introduction: Distraction osteogenesis is a surgical procedure for reconstruction of skeletal deformities. It involves controlled displacement of surgically created fractures which results in an increase in bone volume. Distraction osteogenesis has become an alternative method in the treatment of patients with severe maxillary hypoplasia in various bone deformities. Insufficient distraction, occurrence of scarred tissues and defective distraction vectors are among the potential complications of intraoral maxillary distraction osteogenesis. Several minor complications during distraction have been reported, including infection, exposure and displacement of the devices. Case Report: We present a case with a device failure. A two-stage procedure, combining maxillary advancement by distraction technique with mandibular setback surgery, was planned for a 22-year-old patient with severe maxillary retrusion and mandibular prognathism. Initially, osteotomies were performed and maxilla was slightly mobilised after down-fracture. Distractors were previously adopted to the patient’s stereolithographically produced scull model. Within the operation, these were placed on both sides of the maxilla intraorally. During activation period, maxilla was distracted a total of 5 mm with a rate of 2 × 0.5 mm per day. On the sixth day of the distraction, a breakage was
noticed in the right device. Treatment of the case was accomplished by the conventional osteotomy techniques at a final operation. The maxilla was advanced to the desired position producing a good occlusion and an improved facial profile. Conclusion: The surgeons should be aware of such possible technical complications when using these devices and also be prepared to use an alternative method to achieve a successful final outcome of the case. doi:10.1016/j.ijom.2009.03.557
P85 Ultrastructural and elemental spectrum analysis of distraction osteogenesis reconstruction for cleft palate on rhesus model G. Chen ∗ , Y. Liu, Z.Q. Wang, D. Shen, Y.S. Liu, J. Wang Department of Oral and Maxillofacial Surgery, Stomatological Hospital of Tianjin Medical University, Tianjin, China
Background and Objectives: The attempts to tissue defect correction in cleft palate (CP) by means of tissue regeneration was always the challenge to surgeons for the anatomical compromise, and available CP models on small mammals impaired the surgical manipulating. The authors explored the possibility of the reconstruction of tissue integrity with distraction osteogenesis (DO) on surgically established CP model on rhesus, the ultrastructural characteristics and calcium/phosphorous (Ca/P) elemental spectrum of new formed bone were studies. Methods: The CP animal models (23 monkeys) were established surgically. In experimental group (21 monkeys), the palatal tissue defects were repaired by distraction at the rhythm of 0.4 mm twice per day. The specimens retrieved in 1, 2, 4, 6, 8, 12, 24 weeks (3 animals each) after completion of distraction. The scanning electron microscope study and Ca/P elements spectrometric analysis were then performed. Results: Through 1 to 24 weeks after the completion of DO correction of CP, the results of ultrastructural and elements spectrometric analysis of the new bone in the distraction gap indicated that in early stage of osteogenesis, the organic components represented by P/sulphur (S) were relatively high while the Ca was much lower. During the later stage, the S element was obviously decreased, and Ca/P ratio became higher till the normal level as in empty control group.
Conclusion: DO correction of CP can get definitely in situ intramembranous new bone formation and eventually quite normal bone structure via consecutive remodelling. doi:10.1016/j.ijom.2009.03.558
P86 Methods to increase callus volume in distraction osteogenesis for implant rehabilitation G. Dergin ∗ , G. Gurler, B. Gürsoy Department of Oral and Maxillofacial Surgery, Marmara University, Istanbul, Turkey
Background and Objectives: Functional and aesthetical rehabilitation of severe maxillary alveolar bone deficiencies with implants can be achieved with distraction osteogenesis. Although this method offers certain advantages over conventional augmentation methods, in some cases it requires secondary bone grafting because of insufficient bone thickness of the transport segment and semilunar excavations seen in distraction zone. In those situations simultaneous application of both distraction osteogenesis with polytetrafluoroethylene (PTFE) membrane and autogenous onlay block bone grafting in the same procedure can be an alternative solution to prevent semilunar excavations seen in distraction zone and increase callus volume for a better implant application. Methods: A 27-year-old male patient underwent multiple operations because of recurrent keratocyst at the region of anterior maxilla. After 2 years of follow-up no recurrence was observed. The defect site was insufficient for implant rehabilitation in both horizontal and vertical planes. For prosthetic rehabilitation with implants augmentation of the defect site at anterior maxilla, alveolar bone distraction osteogenesis was planned with simultaneous application of the onlay ramus graft and PTFE membrane to obtain a suitable bone height and width. Results: No complications were seen except slight oedema and pain in two weeks of follow up period. After 4 months of consolidation period distractor was displaced. No fibrous connective tissue or semilunar excavations was seen in distraction zone. About 10 mm vertical and 8 mm horizontal newly generated bone was evaluated after distraction. Two dental implants (4.1 mm × 12 mm; Straumann® , ITI, Switzerland) were placed to distracted
P84 A complication associated with distraction osteogenesis in correction of maxillary hypoplasia: a case report A. Apaydin ∗ , H. Kocaelli, S. Uygun Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
Introduction: Distraction osteogenesis is a surgical procedure for reconstruction of skeletal deformities. It involves controlled displacement of surgically created fractures which results in an increase in bone volume. Distraction osteogenesis has become an alternative method in the treatment of patients with severe maxillary hypoplasia in various bone deformities. Insufficient distraction, occurrence of scarred tissues and defective distraction vectors are among the potential complications of intraoral maxillary distraction osteogenesis. Several minor complications during distraction have been reported, including infection, exposure and displacement of the devices. Case Report: We present a case with a device failure. A two-stage procedure, combining maxillary advancement by distraction technique with mandibular setback surgery, was planned for a 22-year-old patient with severe maxillary retrusion and mandibular prognathism. Initially, osteotomies were performed and maxilla was slightly mobilised after down-fracture. Distractors were previously adopted to the patient’s stereolithographically produced scull model. Within the operation, these were placed on both sides of the maxilla intraorally. During activation period, maxilla was distracted a total of 5 mm with a rate of 2 × 0.5 mm per day. On the sixth day of the distraction, a breakage was
noticed in the right device. Treatment of the case was accomplished by the conventional osteotomy techniques at a final operation. The maxilla was advanced to the desired position producing a good occlusion and an improved facial profile. Conclusion: The surgeons should be aware of such possible technical complications when using these devices and also be prepared to use an alternative method to achieve a successful final outcome of the case. doi:10.1016/j.ijom.2009.03.557
P85 Ultrastructural and elemental spectrum analysis of distraction osteogenesis reconstruction for cleft palate on rhesus model G. Chen ∗ , Y. Liu, Z.Q. Wang, D. Shen, Y.S. Liu, J. Wang Department of Oral and Maxillofacial Surgery, Stomatological Hospital of Tianjin Medical University, Tianjin, China
Background and Objectives: The attempts to tissue defect correction in cleft palate (CP) by means of tissue regeneration was always the challenge to surgeons for the anatomical compromise, and available CP models on small mammals impaired the surgical manipulating. The authors explored the possibility of the reconstruction of tissue integrity with distraction osteogenesis (DO) on surgically established CP model on rhesus, the ultrastructural characteristics and calcium/phosphorous (Ca/P) elemental spectrum of new formed bone were studies. Methods: The CP animal models (23 monkeys) were established surgically. In experimental group (21 monkeys), the palatal tissue defects were repaired by distraction at the rhythm of 0.4 mm twice per day. The specimens retrieved in 1, 2, 4, 6, 8, 12, 24 weeks (3 animals each) after completion of distraction. The scanning electron microscope study and Ca/P elements spectrometric analysis were then performed. Results: Through 1 to 24 weeks after the completion of DO correction of CP, the results of ultrastructural and elements spectrometric analysis of the new bone in the distraction gap indicated that in early stage of osteogenesis, the organic components represented by P/sulphur (S) were relatively high while the Ca was much lower. During the later stage, the S element was obviously decreased, and Ca/P ratio became higher till the normal level as in empty control group.
Conclusion: DO correction of CP can get definitely in situ intramembranous new bone formation and eventually quite normal bone structure via consecutive remodelling. doi:10.1016/j.ijom.2009.03.558
P86 Methods to increase callus volume in distraction osteogenesis for implant rehabilitation G. Dergin ∗ , G. Gurler, B. Gürsoy Department of Oral and Maxillofacial Surgery, Marmara University, Istanbul, Turkey
Background and Objectives: Functional and aesthetical rehabilitation of severe maxillary alveolar bone deficiencies with implants can be achieved with distraction osteogenesis. Although this method offers certain advantages over conventional augmentation methods, in some cases it requires secondary bone grafting because of insufficient bone thickness of the transport segment and semilunar excavations seen in distraction zone. In those situations simultaneous application of both distraction osteogenesis with polytetrafluoroethylene (PTFE) membrane and autogenous onlay block bone grafting in the same procedure can be an alternative solution to prevent semilunar excavations seen in distraction zone and increase callus volume for a better implant application. Methods: A 27-year-old male patient underwent multiple operations because of recurrent keratocyst at the region of anterior maxilla. After 2 years of follow-up no recurrence was observed. The defect site was insufficient for implant rehabilitation in both horizontal and vertical planes. For prosthetic rehabilitation with implants augmentation of the defect site at anterior maxilla, alveolar bone distraction osteogenesis was planned with simultaneous application of the onlay ramus graft and PTFE membrane to obtain a suitable bone height and width. Results: No complications were seen except slight oedema and pain in two weeks of follow up period. After 4 months of consolidation period distractor was displaced. No fibrous connective tissue or semilunar excavations was seen in distraction zone. About 10 mm vertical and 8 mm horizontal newly generated bone was evaluated after distraction. Two dental implants (4.1 mm × 12 mm; Straumann® , ITI, Switzerland) were placed to distracted