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Vertical distraction in augmentation of atrophic mandibular ridge
Distraction osteogenesis correct dental malocclusion. And also if necessary minor orthodontic treatments can be done during distraction period. doi:10.1016/j.ijom.2007.08.145
O5.8 Treatment of midface retrusion by maxillary distraction: comparison of rigid intraoral and extraoral distraction systems S. Basa*, S. Yilmaz, A. Varol Marmara University, School of Dentistry, Department of Oral and Maxillofacial Surgery, Turkey Purpose: To compare advantages and disadvantages of intraoral and extraoral midface distraction (DO) systems to treat severe maxillary hypoplasia in cleft (CLP) and trauma patients. Material and methods: Six patients (one female) with age range from 16 to 48 years (mean age 24 years) were treated by high-level LeFort I maxillary DO. The aetiology of maxillary retrusion was CLP in four male patients and previous high-level maxillary fractures in two patients. Three patients underwent transinuisidal maxillary DO; one patient had intraoral DO by a custom-made device. Three CLP patients were treated by a rigid extraoral maxillary DO. Results: No surgical complications were observed. Mean 13 mm maxillary advancement was achieved. Intraoral DO was not successful in one case and was changed to extraoral DO. In CLP patients, maxillae ran on anterior and downward direction, however, this way of movement was not observed in external DO. External devices are simpler to use and allow non-limited 3-D distraction with minimal hardware on maxilla. Conclusion: Rigid external distraction system is a very powerful technique to treat serious maxillary retrusion/hypoplasia. Although intraoral DO systems offer extra comfort in public, maxillary distraction is performed safely with the extraoral armamentarium.
The interceptive management of maxillary hypoplasia in the growing child can be achieved by maxillary distraction. Its successful outcome is hugely dependent on accurate vector planning and transfer during surgery. Manufacturers of all internal maxillary distractor systems recommend the use of software for accurate planning and transfer of vector. Aim: To evaluate the precision of the distraction achieved with the trans-sinusoidal maxillary distractor system using 3D stereolithographic models and conventional laboratory techniques; and to document complications and patient’s perspectives of treatment. Method: Four UCLP patients with severe maxillary hypoplasia with/out anterior open bite were included in this study. The vector planning and transfer was performed using stereolithographic models which facilitated accurate prebending of plates and the fabrication of a customised distractor-locating device. Results: Three of four patients achieved excellent outcomes. One patient had partially achieved the planned movement and required bimaxillary osteotomy to correct the residual deformity. The distractor was capable of accurate fit during surgery and this significantly reduced operating time. There were no complications and patients rated the treatment favourably. Conclusion: The use of stereolithographic models and a customised distractor locating device is a viable, cost-effective method of vector planning and transfer with good accuracy and predictability. doi:10.1016/j.ijom.2007.08.147
O5.10 Midface advancement with the modular internal distractor and rigid external distractor systems—the AFMC Pune experience A. Chakranarayan Department of Oral & Maxillofacial Surgery, Armed Forces Medical College, Pune 411040 India
doi:10.1016/j.ijom.2007.08.146
O5.9 Interceptive management of maxillary hypoplasia in unilateral cleft lip and palate using 3D sterolithographic models and a customised distractor locating device N. Ghazali*, P. Haers, N. Abizadeh, R. Edler The South Thames Cleft Unit, Guy’s Hospital, London, United Kingdom
Midface retrusion is commonly seen in patients with cleft lip/palate and other craniofacial syndromes and maxillofacial trauma. Midface retrusion can be treated either conventionally by various osteotomies or by distraction. The advantage of using distraction is the reduced incidence of relapse and also the possibility of large movements. Patients and methods: Five cases of midface hypoplasia were managed, one patient was managed with conventional Lefort l maxillary advancement,
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two patients with Le fort 1 advancement using the modular internal distractor system (MID), 1 patient with rigid external distractor system (RED) and 1 patient with Lefort 1 advancement involving the orbital floor using both MID and RED. Results: 6 mm advancement done conventionally following Lefort 1 osteotomy in the first case. 12 mm and 14 mm distraction using MID in the second and third cases respectively. 30 mm distraction using RED and 40 mm distraction using MID & RED in the fourth and fifth case. Conclusion: Conventional advancement, where indicated, produces satisfactory results. MID may require design modification to improve utility in complex cases. RED though a little inconvenient for the patient, by far produces the best results. doi:10.1016/j.ijom.2007.08.148
O5.11 Vertical distraction in augmentation of atrophic mandibular ridge N. Desai*, B.S. Parmar Govt. Dental College and Hospital, Ahmedabad, India Objective: To determine the efficacy of an indigenous titanium vertical alveolar distraction device in augmentation of atrophic mandibular alveolar ridge and assess the feasibility of the augmented alveolar ridge with an objective of improving the quality of prosthodontic rehabilitation. Materials and methods: This study was conducted in the Dept. of Oral and Maxillofacial Surgery, Govt. Dental College and Hospital, Ahmedabad. Ten patients were selected for the study based on the following criteria: Patients were selected on the basis of their complaints and clinical findings, both partially and completely edentulous. Patients who had a minimum of 5 mm bucco lingual width of the residual alveolar ridge and a minimum of two teeth adjacent to the edentulous space were selected. Distraction was performed using extraosseous TRACK 1.0 (Tissue Regeneration by Alveolar Callus Distraction Koeln), an indigenous titanium vertical alveolar distractor. Results: Atrophic ridge deficiency in the patients was in the range of 5–7 mm with a mean of 5.7 mm. Distraction was carried out after a latency period of 5 days at a rate of 0.5 mm twice a day for average period of 6 days with consolidation period of 8 weeks. A definite increase in the vertical height of the alveolus was observed in all cases which averaged 5.1 mm. doi:10.1016/j.ijom.2007.08.149
O5.8 Treatment of midface retrusion by maxillary distraction: comparison of rigid intraoral and extraoral distraction systems S. Basa*, S. Yilmaz, A. Varol Marmara University, School of Dentistry, Department of Oral and Maxillofacial Surgery, Turkey Purpose: To compare advantages and disadvantages of intraoral and extraoral midface distraction (DO) systems to treat severe maxillary hypoplasia in cleft (CLP) and trauma patients. Material and methods: Six patients (one female) with age range from 16 to 48 years (mean age 24 years) were treated by high-level LeFort I maxillary DO. The aetiology of maxillary retrusion was CLP in four male patients and previous high-level maxillary fractures in two patients. Three patients underwent transinuisidal maxillary DO; one patient had intraoral DO by a custom-made device. Three CLP patients were treated by a rigid extraoral maxillary DO. Results: No surgical complications were observed. Mean 13 mm maxillary advancement was achieved. Intraoral DO was not successful in one case and was changed to extraoral DO. In CLP patients, maxillae ran on anterior and downward direction, however, this way of movement was not observed in external DO. External devices are simpler to use and allow non-limited 3-D distraction with minimal hardware on maxilla. Conclusion: Rigid external distraction system is a very powerful technique to treat serious maxillary retrusion/hypoplasia. Although intraoral DO systems offer extra comfort in public, maxillary distraction is performed safely with the extraoral armamentarium.
The interceptive management of maxillary hypoplasia in the growing child can be achieved by maxillary distraction. Its successful outcome is hugely dependent on accurate vector planning and transfer during surgery. Manufacturers of all internal maxillary distractor systems recommend the use of software for accurate planning and transfer of vector. Aim: To evaluate the precision of the distraction achieved with the trans-sinusoidal maxillary distractor system using 3D stereolithographic models and conventional laboratory techniques; and to document complications and patient’s perspectives of treatment. Method: Four UCLP patients with severe maxillary hypoplasia with/out anterior open bite were included in this study. The vector planning and transfer was performed using stereolithographic models which facilitated accurate prebending of plates and the fabrication of a customised distractor-locating device. Results: Three of four patients achieved excellent outcomes. One patient had partially achieved the planned movement and required bimaxillary osteotomy to correct the residual deformity. The distractor was capable of accurate fit during surgery and this significantly reduced operating time. There were no complications and patients rated the treatment favourably. Conclusion: The use of stereolithographic models and a customised distractor locating device is a viable, cost-effective method of vector planning and transfer with good accuracy and predictability. doi:10.1016/j.ijom.2007.08.147
O5.10 Midface advancement with the modular internal distractor and rigid external distractor systems—the AFMC Pune experience A. Chakranarayan Department of Oral & Maxillofacial Surgery, Armed Forces Medical College, Pune 411040 India
doi:10.1016/j.ijom.2007.08.146
O5.9 Interceptive management of maxillary hypoplasia in unilateral cleft lip and palate using 3D sterolithographic models and a customised distractor locating device N. Ghazali*, P. Haers, N. Abizadeh, R. Edler The South Thames Cleft Unit, Guy’s Hospital, London, United Kingdom
Midface retrusion is commonly seen in patients with cleft lip/palate and other craniofacial syndromes and maxillofacial trauma. Midface retrusion can be treated either conventionally by various osteotomies or by distraction. The advantage of using distraction is the reduced incidence of relapse and also the possibility of large movements. Patients and methods: Five cases of midface hypoplasia were managed, one patient was managed with conventional Lefort l maxillary advancement,
1001
two patients with Le fort 1 advancement using the modular internal distractor system (MID), 1 patient with rigid external distractor system (RED) and 1 patient with Lefort 1 advancement involving the orbital floor using both MID and RED. Results: 6 mm advancement done conventionally following Lefort 1 osteotomy in the first case. 12 mm and 14 mm distraction using MID in the second and third cases respectively. 30 mm distraction using RED and 40 mm distraction using MID & RED in the fourth and fifth case. Conclusion: Conventional advancement, where indicated, produces satisfactory results. MID may require design modification to improve utility in complex cases. RED though a little inconvenient for the patient, by far produces the best results. doi:10.1016/j.ijom.2007.08.148
O5.11 Vertical distraction in augmentation of atrophic mandibular ridge N. Desai*, B.S. Parmar Govt. Dental College and Hospital, Ahmedabad, India Objective: To determine the efficacy of an indigenous titanium vertical alveolar distraction device in augmentation of atrophic mandibular alveolar ridge and assess the feasibility of the augmented alveolar ridge with an objective of improving the quality of prosthodontic rehabilitation. Materials and methods: This study was conducted in the Dept. of Oral and Maxillofacial Surgery, Govt. Dental College and Hospital, Ahmedabad. Ten patients were selected for the study based on the following criteria: Patients were selected on the basis of their complaints and clinical findings, both partially and completely edentulous. Patients who had a minimum of 5 mm bucco lingual width of the residual alveolar ridge and a minimum of two teeth adjacent to the edentulous space were selected. Distraction was performed using extraosseous TRACK 1.0 (Tissue Regeneration by Alveolar Callus Distraction Koeln), an indigenous titanium vertical alveolar distractor. Results: Atrophic ridge deficiency in the patients was in the range of 5–7 mm with a mean of 5.7 mm. Distraction was carried out after a latency period of 5 days at a rate of 0.5 mm twice a day for average period of 6 days with consolidation period of 8 weeks. A definite increase in the vertical height of the alveolus was observed in all cases which averaged 5.1 mm. doi:10.1016/j.ijom.2007.08.149