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Sample records for maxillary distraction osteogenesis

  1. A minipig model of maxillary distraction osteogenesis.

    PubMed

    Papadaki, Maria E; Troulis, Maria J; Glowacki, Julie; Kaban, Leonard B

    2010-11-01

    To establish a porcine model for maxillary distraction osteogenesis and to document the sequence of bone formation in the zone of advancement. Female Yucatan minipigs (n = 9) in the mixed dentition stage underwent modified Le Fort I osteotomy through a vestibular incision under general anesthesia. A unidirectional, semiburied Le Fort I distraction device was fixed across the osteotomy. The distraction protocol was 0-day latency, 1-mm/d rate for 12 days, and 24 days of fixation. Maxillary specimens (n = 9) were harvested and divided in half at the end of distraction (n = 6 sides), midfixation (n = 6), and the end of fixation (n = 6). Clinical stability, volume, and radiographic density across the zone of advancement were graded on semiquantitative scales. Specimens were stained with hematoxylin and eosin and examined with light microscopy. Animals tolerated the operation, the distraction and fixation periods. There were no infections and no devices failed. At the end of the distraction period, bone trabeculae were present at the periphery and fibrous tissues, and vessels, preosteoblasts, and osteoblasts were present in the center of the zone of advancement. Islands of chondrocyte-like cells appeared in 1 specimen each at midfixation and the end of fixation. At the end of fixation, clinical stability and radiographic density were graded 3/3 and bone formation was complete across the advancement zone in all specimens. A model for Le Fort I distraction osteogenesis was established. Intramembranous bone formation was the predominant mechanism of healing in the zone of advancement. Latency was not necessary for bone formation in this minipig model. Copyright © 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Le Fort I Maxillary Advancement Using Distraction Osteogenesis

    PubMed Central

    Combs, Patrick D.; Harshbarger, Raymond J.

    2014-01-01

    Treatment of maxillary hypoplasia has traditionally involved conventional Le Fort I osteotomies and advancement. Advancements of greater than 10 mm risk significant relapse. This risk is greater in the cleft lip and palate population, whose anatomy and soft tissue scarring from prior procedures contributes to instability of conventional maxillary advancement. Le Fort I advancement with distraction osteogenesis has emerged as viable, stable treatment modality correction of severe maxillary hypoplasia in cleft, syndromic, and noncleft patients. In this article, the authors provide a review of current data and recommendations concerning Le Fort I advancement with distraction osteogenesis. In addition, they outline their technique for treating severe maxillary hypoplasia with distraction osteogenesis using internal devices. PMID:25383054

  3. Anesthetic concerns of external maxillary distraction osteogenesis.

    PubMed

    Wong, Granger B; Nargozian, Charles; Padwa, Bonnie L

    2004-01-01

    External maxillary distractions present additional anesthetic concerns to the existing complexity of the patient with craniofacial disorder. The distraction hardware is rigidly fixed to the cranium and projects in the frontofacial midline, thus limiting oronasal airway access. A review of 16 patients (10 male, 6 female) having external maxillary distraction was done. Patients with patent tracheostomies were excluded. In all cases, the same type of external distraction device was used (R.E.D., K.L.S. Martin, Jacksonville, FL, USA). Perioperative records were reviewed for medical history; operative diagnosis, presence of airway disease, tracheostomy, laryngoscopy grade, use of fiberoptic bronchoscope, procedure, operative time, use of intraoperative steroid, day of postoperative extubation, and need for reintubation were documented. The study group was subdivided into two diagnostic categories: those with syndromic craniosynostosis (n = 9) and those with cleft lip/palate (CLP) (n = 7). Patients in the craniosynostotic group had grade 1 laryngoscopy views, with the exception of a single patient with Crouzon syndrome who had a grade 3 view. This was the only patient who required fiberoptic intubation. One patient with Apert syndrome required reintubation (48 hours after surgery); successful extubation was done 96 hours later. In the cleft lip/palate group, all patients had grade 1 laryngoscopic views, except one with a grade 3 view; no patient required fiberoptic intubation. Six of the seven patients were extubated immediately after surgery, with one patient extubated the next day. No patient experienced failure of extubation. External maxillary distraction minimally affects anesthetic management provided certain safeguards are observed. The vertical bar can be left attached to the cranial portion of the distractor, or it can be removed for extubation or reintubation. Removal of the vertical bar allows unobstructed direct laryngoscopy. This emphasizes the importance

  4. Stability after Cleft Maxillary Distraction Osteogenesis or Conventional Orthognathic Surgery

    PubMed Central

    Svenstrup, Martin; Pedersen, Thomas Klit; Küseler, Annelise; Jensen, John; Nørholt, Sven Erik

    2015-01-01

    ABSTRACT Objectives To compare stability of maxillary advancements in patients with cleft lip and palate following distraction osteogenesis or orthognathic surgery. Material and Methods Inclusion criteria: 1) cleft lip and palate, 2) advancement > 8 mm. Eleven patients comprised the distraction osteogenesis group (DOG). Seven patients comprised the orthognathic treatment group (CONVG). Skeletal and soft tissue points were traced on lateral cephalograms: T1 (preoperatively), T2 (after surgery), T3 (follow-up). Group differences were analyzed using Students t-test. Results At T1-T2, advancement of 6.98 mm (P = 0.002) was observed in DOG. Horizontal overjet increased 11.62 mm (P = 0.001). A point-nasion-B point (ANB) angle increased 8.82° (P = 0.001). Aesthetic plane to upper lip was reduced 5.44 mm (P = 0.017) and the naso-labial angle increased 16.6° (P = 0.001). Vertical overbite (VOB) increased 2.27 mm (P = 0.021). In T2-T3, no significant changes were observed in DOG. In T1-T2, horizontal overjet increased 8.45 mm (P = 0.02). The ANB angle, 9.33° (P = 0.009) in CONVG. At T2-T3, VOB increased, 2.35 mm (P = 0.046), and the ANB angle reduced, 3.83° (P = 0.003). In T2-T3, no parameters changed in CONVG. At follow-up (T3), VOB increased in CONVG compared with DOG, (P = 0.01). Vertical position of A point differed between the groups (P = 0.04). No significant intergroup differences between soft tissue parameters occurred. Conclusions Distraction osteogenesis resulted in a stable position of the maxilla and movement upwards in vertical plane, however in case of orthognathic treatment sagittal relapse and a continued postoperatively downward movement was registered. PMID:26229581

  5. Perpendicular serial maxillary distraction osteogenesis in cleft lip and palate patients

    PubMed Central

    Ylikontiola, Leena P.; Sándor, George K.; Harila, Virpi

    2015-01-01

    Background: Cleft lip and palate patients often have a retruded maxilla with a severely narrowed deficient maxillary arch. This report aims to describe the management of severe maxillary retrusion and constriction in cleft lip and palate patients using distraction osteogenesis applied in serial sequence in two directions perpendicular to each other. Materials and Methods: Two adult male cleft lip and palate patients were treated with maxillary distraction osteogenesis in two stages. In the first stage, surgically assisted rapid palatal expansion with a tooth-borne device was performed to significantly expand the maxillary arch in the transverse dimension. After the teeth were orthodontically aligned, the horizontal distraction of the maxilla was made by two internal maxillary distraction devices. Results: In the first patient, the maxilla was initially widened by 11 mm and then distracted forward by 20 mm. Despite the breakage of the shaft of one of the two distractors at the end of distraction, a satisfactory occlusion was found at the time of distractor device removal. The maxillary position has remained stable through 8 years of follow-up. In the second patient, the palate was widened by 14 mm and the maxilla was distracted forward by 22 mm. The maxillary position has remained stable through 3 years of follow-up. Conclusion: Sequential serial distraction of maxilla in two planes perpendicular to each other is a safe and stable approach for the treatment of cleft lip and palate patients with severe transverse and anteroposterior discrepancies. PMID:26981462

  6. Perpendicular serial maxillary distraction osteogenesis in cleft lip and palate patients.

    PubMed

    Ylikontiola, Leena P; Sándor, George K; Harila, Virpi

    2015-01-01

    Cleft lip and palate patients often have a retruded maxilla with a severely narrowed deficient maxillary arch. This report aims to describe the management of severe maxillary retrusion and constriction in cleft lip and palate patients using distraction osteogenesis applied in serial sequence in two directions perpendicular to each other. Two adult male cleft lip and palate patients were treated with maxillary distraction osteogenesis in two stages. In the first stage, surgically assisted rapid palatal expansion with a tooth-borne device was performed to significantly expand the maxillary arch in the transverse dimension. After the teeth were orthodontically aligned, the horizontal distraction of the maxilla was made by two internal maxillary distraction devices. In the first patient, the maxilla was initially widened by 11 mm and then distracted forward by 20 mm. Despite the breakage of the shaft of one of the two distractors at the end of distraction, a satisfactory occlusion was found at the time of distractor device removal. The maxillary position has remained stable through 8 years of follow-up. In the second patient, the palate was widened by 14 mm and the maxilla was distracted forward by 22 mm. The maxillary position has remained stable through 3 years of follow-up. Sequential serial distraction of maxilla in two planes perpendicular to each other is a safe and stable approach for the treatment of cleft lip and palate patients with severe transverse and anteroposterior discrepancies.

  7. Minipig model of maxillary distraction osteogenesis: immunohistochemical and histomorphometric analysis of the sequence of osteogenesis.

    PubMed

    Papadaki, Maria E; Kaban, Leonard B; Troulis, Maria J

    2012-11-01

    To document the sequence of bone formation in a minipig model of Le Fort I distraction osteogenesis (DO) using immunohistochemistry and histomorphometry. Female Yucatan minipigs (N = 9) in the mixed-dentition stage underwent bilateral maxillary DO. The distraction protocol was 0 days of latency, with a distraction rate of 1 mm/d for 12 days and 24 days of fixation. Specimens were harvested and divided between the central incisors (18 hemi-maxillae) at the end of DO (n = 6), at mid-fixation (n = 6), and at the end of fixation (n = 6). Sections, including the advancement zone, were stained with hematoxylin-eosin, collagen II, CD34, proliferating cell nuclear antigen, and tartrate-resistant acid phosphatase. Light and fluorescence microscope images (original magnification ×200) were obtained, and percentage of surface area (PSA) of the advancement zone occupied by fibrous tissue, vessels, proliferating cells, osteoid, and bone was determined. An intact maxilla served as the control. At the end of DO, in the advancement zone, the PSA (mean values) of proliferating cells was 33.16%; fibrous tissue, 52%; vessels, 4.35%; and new bone, 5.45%. At the end of fixation, the PSA of proliferating cells decreased to 10.53%, fibrous tissue to 2.3%, and vessels to 1.5% whereas the PSA of new bone increased to 44.9%. The results of this study indicate that the progression of osteogenesis in the maxillary DO wound begins with intense cellular proliferation and vascular fibrous tissue formation and progresses to mature, cancellous bone by the end of fixation. The PSA occupied by mature bone is significantly less than in the control maxilla at the end of fixation. This is consistent with the sequence in the mandibular DO wound. Published by Elsevier Inc.

  8. Distraction osteogenesis.

    PubMed

    Welch, R D; Lewis, D D

    1999-09-01

    Distraction osteogenesis and the use of circular external skeletal fixation has increased the capacity of veterinary surgeons to manage difficult orthopedic conditions including limb-length discrepancies, angular deformity, distal and severely comminuted fractures, and bone defects. This article discusses the historical developments of the Ilizarov method of distraction osteogenesis in veterinary surgery, circular external skeletal instrumentation, and the biological principles. There is also discussion of use of this method for correction of angular deformity and bone transport and complications associated with this technique.

  9. Use of anterior maxillary distraction osteogenesis in two cleft lip and palate patients

    PubMed Central

    Srivastava, Dhirendra; Ghassemi, Alireza; Ghassemi, Mehrangiz; Showkatbakhsh, Rahman; Jamilian, Abdolreza

    2015-01-01

    Distraction osteogenesis (DO) has become a mainstream surgical technique for patients with jaw deformities. The aim of this study was to report the effect of DO done by a hyrax screw incorporated in an acrylic plate in the treatment of two maxillary deficient cases with cleft lip and palate. Two patients, a 24-year-old female and a 29-year-old male who suffered from maxillary deficiency and cleft lip and palate, were treated by DO. After making vertical cuts between the premolars on both sides and horizontal cuts similar to Le Fort 1, a hyrax screw was mounted on an acrylic plate for the slow anteroposterior expansion of maxillary arch. The expansion was achieved by turning the hyrax screw 0.8 mm per day after the latency period. Treatment was discontinued after achieving satisfactory over jet and occlusion. This study showed that anterior maxillary distraction is a reliable technique for correction of midfacial deformity arising out of cleft lip and palate. Incidences of complications are negligible compared to total maxillary distraction. PMID:26668459

  10. Maxillary distraction osteogenesis versus orthognathic surgery for cleft lip and palate patients.

    PubMed

    Kloukos, Dimitrios; Fudalej, Piotr; Sequeira-Byron, Patrick; Katsaros, Christos

    2016-09-30

    Cleft lip and palate is one of the most common birth defects and can cause difficulties with feeding, speech and hearing, as well as psychosocial problems. Treatment of orofacial clefts is prolonged; it typically commences after birth and lasts until the child reaches adulthood or even into adulthood. Residual deformities, functional disturbances, or both, are frequently seen in adults with a repaired cleft. Conventional orthognathic surgery, such as Le Fort I osteotomy, is often performed for the correction of maxillary hypoplasia. An alternative intervention is distraction osteogenesis, which achieves bone lengthening by gradual mechanical distraction. To provide evidence regarding the effects and long-term results of maxillary distraction osteogenesis compared to orthognathic surgery for the treatment of hypoplastic maxilla in people with cleft lip and palate. We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 16 February 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 1), MEDLINE Ovid (1946 to 16 February 2016), Embase Ovid (1980 to 16 February 2016), LILACS BIREME (1982 to 16 February 2016), the US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) (to 16 February 2016), and the World Health Organization (WHO) International Clinical Trials Registry Platform (to 16 February 2016). There were no restrictions regarding language or date of publication in the electronic searches. We performed handsearching of six speciality journals and we checked the reference lists of all trials identified for further studies. We included randomised controlled trials (RCTs) comparing maxillary distraction osteogenesis to conventional Le Fort I osteotomy for the correction of cleft lip and palate maxillary hypoplasia in non-syndromic cleft patients aged 15 years or older. Two review authors assessed studies for eligibility. Two review authors independently

  11. Distraction osteogenesis.

    PubMed

    Sidman, James; Tatum, Sherard Austin

    2014-02-01

    James Sidman, MD, and Sherard A. Tatum, MD, address the following questions for discussion and debate. Is neonatal distraction osteogenesis (DO) better than lip-tongue adhesion or tracheotomy for micrognathic airway compromise? What role does DO have in adult orthognathic surgery situations? In monobloc and Le Fort III procedures, are internal or external devices preferable? What role does DO play in craniofacial microsomia? Is endoscopic DO better than open procedures for synostosis management? How has your technique changed or evolved over the past 5 years and what has doing this technique taught you? Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Maxillomandibular distraction osteogenesis.

    PubMed

    Efunkoya, Akinwale A; Bamgbose, Babatunde O; Adebola, Rafael A; Adeoye, Joshua B; Akpasa, Izegboya O

    2014-09-01

    Distraction osteogenesis (DO) is a biologic process of new bone formation between the surfaces of bone segments that are gradually separated by incremental traction. It consists of 4 primary phases, namely, corticotomy and device placement, a latency period, active distraction, and consolidation. The objectives of the current study were to review DO as it applies to maxillomandibular defects and to share our clinical experience in the cases we have done. A clinical narrative review of the literature was performed to evaluate the use and efficacy of maxillomandibular osteogenesis in maxillomandibular defects. A systematic search of the literature was performed using PubMed, with special interest in the history of DO and its application in dentistry and maxillofacial surgery. medical subject headings terms included surgical procedures, osteogenesis, distraction, and orthodontics. Two cases of maxillomandibular DO managed at the Aminu Kano Teaching Hospital (AKTH), Nigeria, were reported and discussed. Articles involving maxillary and midface distractions, bilateral distraction for airway obstruction, and distraction for hemifacial microstomia were all reviewed. In the first case reported, a unidirectional distractor was used to achieve simultaneous mandibular lengthening and maxillary occlusal correction. Gains of 10 mm in mandibular ramal height and 23 mm in corpus length were achieved in the second reported case, using a bidirectional distractor. The literature search revealed no previous Nigerian reports of maxillomandibular DO. The DO is a viable and available treatment option for reconstructing maxillomandibular discrepancies and accompanying soft and hard tissue deficiencies.

  13. Long-term results of maxillary distraction osteogenesis in nongrowing cleft: 5-years experience using internal device.

    PubMed

    Hirjak, D; Reyneke, J P; Janec, J; Beno, M; Kupcova, I

    2016-01-01

    Patients with cleft lip and palate (CLP) related deformities frequently have maxillary hypoplasia in all dimensions. These patients usually present with class III malocclusions, retruded midfaces and narrow hard palates. The skeletal problems can be treated by means of Le Fort I maxillary procedures. Surgical and orthodontic correction of severe maxillary hypoplasia, as often seen in CLP patients, has however proved to be challenging. The magnitude of the advancement is often hampered and the post operative stability significantly affected by palatal soft tissue scarring. The slow distraction of bone and the histogenic abilities of distraction osteogenesis (DO) have made it an atractive alternative treatment option for the management of maxillary hypoplasia in these patients. This paper presents the treatment results of 15 nongrowing CLP patients with severe maxillary hypoplasia treated by means of intra oral distraction. The mean anterior distraction of the maxillas was 12.7 mm (9-15.0 mm). The long-term cephalometric and clinical evaluation after a minimum of 60 months (mean follow-up 71 months) proved to be stable. The treatment results revealed, that distraction osteogenesis in nongrowing CLP patients with severe maxillary hypoplasia proved to be a predictable and stable option (Tab. 2, Fig. 3, Ref. 26).

  14. Effects of growth on maxillary distraction osteogenesis in cleft lip and palate.

    PubMed

    Doucet, Jean-Charles; Herlin, Christian; Bigorre, Michèle; Bäumler, Caroline; Subsol, Gérard; Captier, Guillaume

    2013-12-01

    The objective was to analyze the effects of growth on the long-term result of maxillary distraction osteogenesis (DO) in cleft lip and palate (CLP). Retrospective study of 24 CLP cases with long-term follow-up operated for maxillary DO using the Polley and Figueroa technique: 10 patients were distracted during growth, while 14 patients were operated after their growth spurt. Preoperative (T0), 6-12 months postoperative (T1), and ≥4 years postoperative (T2) cephalometric radiographs were evaluated. A classical cephalometric analysis was used to assess the treatment stability, and a Procrustes superimposition method was performed to assess local changes in the maxilla and the mandible. At T0, the mean age was of 11.9 ± 1.4 years for growing patient, and 17.9 ± 3.5 years for patient treated after their growth spurt (P < 0.001). Between T0 and T1, a greater increase of the SNA was shown in growing patients (P = 0.036), but the relapse was more important between T1 and T2, with a significant decrease of the SNA (P = 0.002) and ANB (P = 0.032) compared to the patients treated after their growth spurt. Although not significant, growing patients showed greater rotations of their palatal plane and mandibular plane. Maxillary DO in CLP does not correct the growth deficit inherent to the pathology. Overcorrection of at least 20% is advised during growth. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  15. Biomechanical comparison of two intraoperative mobilization techniques for maxillary distraction osteogenesis: Down-fracture versus non-down-fracture

    PubMed Central

    Yang, Lili; Suzuki, Eduardo Yugo; Suzuki, Boonsiva

    2014-01-01

    Purposes: The purpose of this study was to compare the distraction forces and the biomechanical effects between two different intraoperative surgical procedures (down-fracture [DF] and non-DF [NDF]) for maxillary distraction osteogenesis. Materials and Methods: Eight patients were assigned into two groups according to the surgical procedure: DF, n = 6 versus NDF, n = 2. Lateral cephalograms taken preoperatively (T1), immediately after removal of the distraction device (T2), and after at least a 6 months follow-up period (T3) were analyzed. Assessment of distraction forces was performed during the distraction period. The Mann–Whitney U-test was used to compare the difference in the amount of advancement, the maximum distraction force and the amount of relapse. Results: Although a significantly greater amount of maxillary movement was observed in the DF group (median 9.5 mm; minimum-maximum 7.9-14.1 mm) than in the NDF group (median 5.9 mm; minimum-maximum 4.4-7.6 mm), significantly lower maximum distraction forces were observed in the DF (median 16.4 N; minimum-maximum 15.1-24.6 N) than in the NDF (median 32.9 N; minimum-maximum 27.6-38.2 N) group. A significantly greater amount of dental anchorage loss was observed in the NDF group. Moreover, the amount of relapse observed in the NDF group was approximately 3.5 times greater than in the DF group. Conclusions: In this study, it seemed that, the use of the NDF procedure resulted in lower levels of maxillary mobility at the time of the maxillary distraction, consequently requiring greater amounts of force to advance the maxillary bone. Moreover, it also resulted in a reduced amount of maxillary movement, a greater amount of dental anchorage loss and poor treatment stability. PMID:25593865

  16. Orthodontic Considerations for Maxillary Distraction Osteogenesis in Growing Patients with Cleft Lip and Palate Using Internal Distractors

    PubMed Central

    Silveira, Adriana da; Moura, Pollyana Marques de; Harshbarger, Raymond J.

    2014-01-01

    The orthodontist plays a key role in the selection of the optimal treatment for patients followed by a craniofacial team. For patients with cleft lip and palate, the need for multidisciplinary treatment planning and sequentially staged treatment is essential for successful patient outcomes. The technique of Le Fort I distraction osteogenesis of the maxilla using an internal device is potentially a predictable, stable, and convenient option for the correction of severe maxillary hypoplasia. It is an alternative option for treatment of maxillary hypoplasia in growing patients. In this article, the authors describe the orthodontist's approach to the management of cleft patients with severe maxillary deficiency with the use of an internal distraction device. The information is presented with a focus on the clinical aspects of treatment, using case illustrations and appropriate literature. PMID:25383056

  17. Segmental curvilinear distraction osteogenesis.

    PubMed

    Zhou, Libin; Shang, Hongtao; Feng, Zhihong; Liu, Chen; Ye, Wenmin; Ma, Qin; Wu, Wei; Liu, Yanpu

    2012-10-01

    Curvilinear distraction is currently under investigation to reconstruct curved maxillofacial bone defects. However, previous studies have revealed the discrepancy between the contour of the regenerated bone in the distraction gap and the curvilinear pathway of the transport disc. We hypothesize that the discrepancy is because of the conflict of the distraction vector and the strain vector during the consolidation. In curvilinear distraction osteogenesis, the distraction vector varies, while the strain vector during the consolidation phase is fixed-linear, from the beginning to the end of the distraction pathway. Here we bring forward a solution of segmental curvilinear distraction osteogenesis to divide the curvilinear distraction into several segments, with respective consolidation for each distraction gap. If this hypothesis is verified, the segmental distraction curvilinear distraction will benefit the reconstruction of complicated long-range maxillofacial bone defects. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. Reconstruction of a Post Traumatic Anterior Maxillary Defect by Transport Distraction Osteogenesis.

    PubMed

    Rajkumar, K; Neelakandan, R S; Devadoss, Pradeep; Bandyopadhyay, T K

    2017-03-01

    Rehabilitation of segmental defects of maxilla presents a reconstructive challenge to obtain an ideal osseous form and height with adequate soft tissue investment. Though variety of prosthetic and surgical reconstructive options like the use of vascularized and non vascularized bone grafts are available they produce less than optimal results. Bone transport distraction is a reliable procedure in various maxillofacial bony defect reconstruction techniques. We describe herein a technique of maxillary bone transport distraction using an indigenously designed, custom made trifocal transport distractor performed in a post traumatic avulsive defect of the anterior maxilla. Transport distraction was successful for anterior maxillary alveolar bony regeneration, with excellent soft tissue cover and vestibular depth, which also helped close an oroantral/oronasal fistula.

  19. Long-term skeletal stability after maxillary advancement with distraction osteogenesis using a rigid external distraction device in cleft maxillary deformities.

    PubMed

    Figueroa, Alvaro A; Polley, John W; Friede, Hans; Ko, Ellen W

    2004-11-01

    Rigid external distraction is a highly effective technique for correction of maxillary hypoplasia in patients with orofacial clefts. The clinical results after correction of sagittal maxillary deformities in both the adult and pediatric age groups have been stable. The purpose of this retrospective longitudinal cephalometric study was to review the long-term stability of the repositioned maxilla in cleft patients who underwent maxillary advancement with rigid external distraction. Between April 1, 1995, and April 1, 1999, 17 consecutive patients with cleft maxillary hypoplasia underwent maxillary advancement using rigid external distraction. There were 13 male patients and four female patients, with ages ranging from 5.2 to 23.6 years (mean, 12.6 years). After a modified complete high Le Fort I osteotomy and a latency period of 3 to 5 days, patients underwent maxillary advancement with rigid external distraction until proper facial convexity and dental overjet and overbite were obtained. After active distraction, a 3- to 4-week period of rigid retention was undertaken; this was followed by removable elastic retention for 6 to 8 weeks using, during sleep time, an orthodontic protraction face mask. Cephalometric radiographs were obtained preoperatively, after distraction, at 1 year after distraction, and 2 or more years after distraction. The mean follow-up was 3.3 years (minimum, 2.1 years; maximum, 5.3 years). The following measurements were obtained in each cephalogram: three linear horizontal and two linear vertical maxillary measurements, two angular craniomaxillary measurements, and one craniomandibular measurement. Differences between the preoperative and postoperative cephalometric values were analyzed by paired t tests (p < 0.05). The cephalometric analysis demonstrated postoperatively significant advancement of the maxilla. In addition, the mandibular plane angle opened 1.2 degrees after surgery. After the 1- to 3-year follow-up period, the maxilla was

  20. Hard and Soft Tissue Changes Following Maxillary Distraction Osteogenesis and Mandibular Setback with Bilateral Sagittal Split Osteotomy.

    PubMed

    Bawane, Shilpa S; Andrade, Neelam N

    2016-12-01

    (1) To highlight the role of intraoral submerged device in distraction osteogenesis (DO) of patients requiring two jaw surgeries for the correction of severe developmental maxillary hypoplasia (MH) and mandibular prognathism (MP) (2) To analyse the hard and soft tissue changes following maxillary DO and mandibular setback with bilateral sagittal split osteotomy (BSSO) in patients with severe MH and MP requiring two jaw surgeries. During the period Jan 2004 to Dec 2006, five patients with severe developmental MH along with MP were treated. In 1st stage maxillary distraction was done. Distraction started on 6th postoperative day, 1 mm distraction was carried out for 10-15 days on either side. Serial radiographs were taken immediate postoperative period for baseline comparison, post-distraction and at the end of distraction. After a period of 3-4 months of distraction 2nd stage was done. In 2nd stage, mandibular setback was done with BSSO and distractors were removed under general anesthesia. Radiographs were taken immediately and at 4 months post-operatively. Cephalometric tracings were carried out preoperatively, post DO and finally after mandibular setback with BSSO. The mean horizontal movement of maxilla was 11.4 mm at ANS and 9.6 mm at A point. Upper incisor edge was advanced by 8.8 mms. SNA increased by 8.4° and SNB decreased by 4.6°. Nasal projection advanced by 4°. Nasolabial angle normalized in all patients, mean change achieved was 10.8°. Upper lip moved forward by 5.4 mm. Lower lip moved backward by 5.4 mm. Mandible positioned backward by 4 mm at B point. No vertical change occurred in the position of A, ANS and upper incisor edges. Mean increase in skeletal angle of convexity was 26.4°. Concave profile was significantly changed to convex in all patients. Maxillary DO and mandibular setback with BSSO was associated with improved facial balance and esthetics.

  1. New osteotomy for transport of a disc of alveolar bone to close an oronasal fistula during distraction osteogenesis for reconstruction of a maxillary defect: in vitro assessment.

    PubMed

    Feng, Zhihong; Zhao, Jilong; Dong, Yan; Zhao, Yimin

    2010-04-01

    We describe a new osteotomy for transport of a disc of alveolar bone, which can simultaneously close an oronasal fistula with two layers of mucoperiosteum during distraction osteogenesis for reconstruction of a maxillary defect. 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  2. Alternate rapid maxillary expansion-constriction and tooth-borne symphyseal distraction osteogenesis : A case report demonstrating treatment of a patient with severe crowding.

    PubMed

    Gökalp, Hatice

    2016-05-01

    Surgically assisted rapid mandibular expansion is a contemporary treatment alternative to enable genuine skeletal mandibular widening. Mandibular widening via a tooth-borne distractor is a practical and noninvasive clinical approach. Recently, to expand and protract the maxilla, the alternate rapid maxillary expansion-and-constriction procedure was suggested. In this case report, we describe a female patient (12 years 7 months old) having severe maxillary and mandibular crowding who underwent repeated alternate rapid maxillary expansion and constriction in combination with tooth-borne symphyseal distraction osteogenesis.

  3. Distraction Osteogenesis of the Craniofacial Skeleton.

    PubMed

    Yu, Jack C.; Fearon, Jeffrey; Havlik, Robert J.; Buchman, Steve R.; Polley, John W.

    2004-07-01

    LEARNING OBJECTIVES:: After studying this article, the participant should be able to: 1. Review the biomechanical principles and pertinent cellular and molecular biology of distraction osteogenesis of the craniofacial skeleton. 2. Describe the clinical indications and applications of distraction osteogenesis of the craniofacial skeleton. 3. Describe maxillary, mandibular, midface, and calvarial procedures in distraction osteogenesis. 4. Discuss the clinical outcomes and complications of distraction osteogenesis of the craniofacial skeleton.The year 2002 marked the end of the first decade in clinical distraction osteogenesis of the craniofacial skeleton. In this short period, its application has increased exponentially. More than 3000 cases have been performed according to a recent survey, and more than 700 articles have been written on this subject in the MEDLINE database since 1996. It is a powerful surgical tool and enables surgeons to achieve results not previously attainable. Despite all this, distraction osteogenesis is practiced by only a small number of plastic surgeons. This article reviews the biomechanical principles; the pertinent cellular and molecular biology; and the clinical indications, applications, controversies, and complications of distraction osteogenesis of the craniofacial skeleton.

  4. Combined maxillary and mandibular midline and mandibular ramus distraction osteogenesis for treatment of a Class II patient with implants as orthodontic anchorage.

    PubMed

    Takahashi, Ichiro; Kawamura, Hiroshi; Takano-Yamamoto, Teruko

    2010-03-01

    This case report describes the treatment of a woman with severe mandibular retrusion and maxillomandibular transverse deficiency. Her malocclusion was characterized by a large overjet, a deep overbite, and a V-shaped dental arch, and she had a skeletal Class II profile. Treatement included combined maxillary and mandibular midline expansion, maxillary downward repositioning, and mandibular ramus lengthening with distraction osteogenesis with implants as orthodontic anchorage. During the postdistraction orthodontic treatment period, some skeletal relapse occurred. Implants provided absolute orthodontic anchorage to overcome the unexpected skeletal changes. Combined orthodontic treatment with implants for anchorage and distraction osteogenesis successfully expanded the maxilla and the mandible and corrected the mandibular deficiency. Two-year follow-up records show a morphologically and functionally stable result.

  5. Skeletal and soft tissue changes and stability in cleft lip and palate patients after distraction osteogenesis using a new intraoral maxillary device.

    PubMed

    Ansari, Edward; Tomat, Catherine; Kadlub, Natacha; Diner, Patrick A; Bellocq, Thomas; Vazquez, Marie-Paule; Picard, Arnaud

    2015-04-01

    The authors have recently reported on the use of an internal maxillary distraction device. In this study, we report on the hard and soft tissue movements achieved with this intraoral distraction device, and the stability changes after distraction osteogenesis for maxillary hypoplasia in patients with cleft lip and palate. Ten male patients with severe hypoplasia of the maxilla, with complete uni- or bilateral cleft lip and palate were included. The mean age of the patients at the time of operation was 11.91 years (±3.41). To evaluate the distraction process and stability, superimpositions on the preoperative lateral cephalograms were performed. The mean follow-up (FU) was 15.42 months (±3.94). Cephalometric measurements at all of the maxillary hard and soft tissue points improved significantly. Maxillary point A was advanced by 8.25 mm (±3.17; P < 0.001). After distraction soft tissue point A' had advanced 7.10 mm (±2.69; P < 0.001). The soft tissue to hard tissue ratio at point A was 0.86:1 after distraction. Maxillary horizontal relapse at point A was 14.1% at FU. Vertical relapse was not significant. This rigid intraoral distraction device can be successfully used in the correction of severe maxillary hypoplasia. The marked aesthetic improvement and low psychological encumbrance make this device viable for the treatment of cleft-related hypoplasia of the maxilla. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  6. Craniofacial distraction osteogenesis.

    PubMed

    Winters, Ryan; Tatum, Sherard A

    2014-11-01

    Distraction osteogenesis (DO) may be the most versatile tool to become available to the craniofacial surgeon in recent years. It can be used in an ever-expanding register of clinical scenarios and offers major advantages over conventional craniofacial techniques in some circumstances. Craniofacial surgery has significant complications, some of which can be mitigated but not eliminated by choosing DO over conventional approaches. Although some DO applications are in their infancy with limited data, this article provides an overview of current uses of this versatile technology. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Distraction Osteogenesis Update: Introduction of Multidirectional Cranial Distraction Osteogenesis

    PubMed Central

    Sunaga, Ataru; Kamochi, Hideaki; Oguma, Hirofumi; Sugawara, Yasushi

    2016-01-01

    In this review, we discuss in detail our current procedure for treating craniosynostosis using multidirectional cranial distraction osteogenesis (MCDO). The MCDO method allows all phenotypes of skull deformity to be reshaped by distraction osteogenesis, except in patients who are 5 months of age or younger and patients with posterior cranial vault problems. We report the results of clinical data of 36 children with craniosynostosis who underwent MCDO between 2005 and 2014 in our institute. This method has the following benefits, such as a high flexibility of reshaping, shorter treatment period and less invasive secondary intervention. We also discuss the other distraction osteogenesis techniques that are used to treat craniosynostosis and compare them with MCDO. The preferred procedure for correction of craniosynostosis may depend on the patient's age, the extent of deformity, and the extent of correction achievable by surgery. We can arrange the combinations of various methods according to the advantage and disadvantage of each technique. PMID:27226854

  8. Distraction Osteogenesis Update: Introduction of Multidirectional Cranial Distraction Osteogenesis.

    PubMed

    Gomi, Akira; Sunaga, Ataru; Kamochi, Hideaki; Oguma, Hirofumi; Sugawara, Yasushi

    2016-05-01

    In this review, we discuss in detail our current procedure for treating craniosynostosis using multidirectional cranial distraction osteogenesis (MCDO). The MCDO method allows all phenotypes of skull deformity to be reshaped by distraction osteogenesis, except in patients who are 5 months of age or younger and patients with posterior cranial vault problems. We report the results of clinical data of 36 children with craniosynostosis who underwent MCDO between 2005 and 2014 in our institute. This method has the following benefits, such as a high flexibility of reshaping, shorter treatment period and less invasive secondary intervention. We also discuss the other distraction osteogenesis techniques that are used to treat craniosynostosis and compare them with MCDO. The preferred procedure for correction of craniosynostosis may depend on the patient's age, the extent of deformity, and the extent of correction achievable by surgery. We can arrange the combinations of various methods according to the advantage and disadvantage of each technique.

  9. Bone regeneration during distraction osteogenesis.

    PubMed

    Amir, Lisa R; Everts, Vincent; Bronckers, Antonius L J J

    2009-07-01

    Bone has the capacity to regenerate in response to injury. During distraction osteogenesis, the renewal of bone is enhanced by gradual stretching of the soft connective tissues in the gap area between two separated bone segments. This procedure has received much clinical attention as a way to correct congenital growth retardation of bone tissue or to generate bone to fill skeletal defects. The process of bone regeneration involves a complex system of biological changes whereby mechanical stress is converted into a cascade of signals that activate cellular behavior resulting in (enhanced) formation of bone. Over the last decade, significant progress has been made in understanding the bone regeneration process during distraction osteogenesis. The mechanical and biological factors that are important for the success of the distraction treatment have been partially characterized and are discussed in this review.

  10. [Distraction osteogenesis in maxillofacial surgery].

    PubMed

    Jansma, J; Becking, A G

    2000-05-01

    With distraction osteogenesis (DOG) formation of new bone is initiated by gradual separation of osteotomized bone fragments. Both external and internal distraction devices are available. Since its first application in craniomaxillofacial surgery in the early nineties, developments in distraction osteogenesis have been tremendous. Important advantages of this technique are: lack of a donorsite and its associated morbidity; increase of the volume of the soft tissue envelop; less surgical trauma compared to conventional craniomaxillofacial procedures; and the usability of the technique in growing individuals. Disadvantages of DOG are: the sofar limited experience and follow-up in craniomaxillofacial surgery; and the unknown influences on growth. The technique will gradually find its niche and the general dentist will therefore be increasingly confronted with its specific indications. In this paper the general principles of DOG and a number of indications in craniomaxillofacial surgery are discussed.

  11. Neonatal Mandibular Distraction Osteogenesis

    PubMed Central

    Flores, Roberto L.

    2014-01-01

    Mandibular distraction has revolutionized the treatment of Robin sequence associated with severe airway obstruction. The distraction technique remains the only intervention that directly corrects mandibular hypoplasia and the retropositioned tongue, providing efficient relief of airway stenosis. Multiple studies have demonstrated the efficacy of distraction in avoiding tracheostomy and decreasing the severity airway obstruction in this patient population. The benefit to avoiding tracheostomy and relieving airway obstruction is superior to that of tongue–lip adhesion. It is, therefore, not surprising that mandibular distraction has become the first-line intervention at many centers for the surgical treatment of Robin sequence. The complication profile associated with mandibular distraction appears low; the most common complication is infection, which can be treated by antibiotics alone. The severity of airway obstruction can be quantified by polysomnogram: This tool has become one of the most widely used objective metrics in the Robin sequence population. Therefore indications for surgery, timing of palatoplasty and long-term assessment of airway function should be performed in conjunction with sleep study analysis. The effects of mandibular lengthening on feeding difficulty in Robin sequence patient remains a topic of controversy. Studies have demonstrated conflicting results: This can be an area of future study. Agreed-upon indications for surgery and definitive protocols of care have yet to be formulized; future research should focus on achieving these goals. Such studies would require agreed-upon terminology for Robin sequence, an increase in comparative and prospective analysis, and the use of quantifiable metrics of clinical results. PMID:25383055

  12. Neonatal mandibular distraction osteogenesis.

    PubMed

    Flores, Roberto L

    2014-11-01

    Mandibular distraction has revolutionized the treatment of Robin sequence associated with severe airway obstruction. The distraction technique remains the only intervention that directly corrects mandibular hypoplasia and the retropositioned tongue, providing efficient relief of airway stenosis. Multiple studies have demonstrated the efficacy of distraction in avoiding tracheostomy and decreasing the severity airway obstruction in this patient population. The benefit to avoiding tracheostomy and relieving airway obstruction is superior to that of tongue-lip adhesion. It is, therefore, not surprising that mandibular distraction has become the first-line intervention at many centers for the surgical treatment of Robin sequence. The complication profile associated with mandibular distraction appears low; the most common complication is infection, which can be treated by antibiotics alone. The severity of airway obstruction can be quantified by polysomnogram: This tool has become one of the most widely used objective metrics in the Robin sequence population. Therefore indications for surgery, timing of palatoplasty and long-term assessment of airway function should be performed in conjunction with sleep study analysis. The effects of mandibular lengthening on feeding difficulty in Robin sequence patient remains a topic of controversy. Studies have demonstrated conflicting results: This can be an area of future study. Agreed-upon indications for surgery and definitive protocols of care have yet to be formulized; future research should focus on achieving these goals. Such studies would require agreed-upon terminology for Robin sequence, an increase in comparative and prospective analysis, and the use of quantifiable metrics of clinical results.

  13. Treatment of postoperative midfacial deformity of chilopalatognathus by distraction osteogenesis with a self-constructed tooth-borne distraction device.

    PubMed

    Zhao, Su-Feng; Tang, En-Yi; Hu, Qin-Gang; Yang, Xu-Dong; Da, Shi-Jin

    2014-05-01

    Distraction osteogenesis has recently evolved a challenging technique to overcome major drawbacks of the traditional orthodontic treatment modalities. The aim of this study was to evaluate the therapeutic efficacy of patients with chilopalatognathus who have premaxillary deficiency through distraction osteogenesis using a self-constructed tooth-borne distraction device. Individual tooth-borne distraction devices were used for advancement of the maxillary anterior segment. Distraction was performed for 26 patients in accordance with the specific requirements of each individual. Cephalometric radiographs were taken before treatment (T1), after distraction (T2), and after consolidation for 8 weeks (T3). Cephalometric analysis revealed that the premaxilla was moved forward and that the length of palatal plane increased. In 2 cases, the distractor did not work during distraction and was removed. Distraction osteogenesis using individual tooth-borne distraction devices in patients with chilopalatognathus could effectively resolve soft tissue insufficiencies and hypoplasia of the maxilla.

  14. Angiogenesis during mandibular distraction osteogenesis.

    PubMed

    Rowe, N M; Mehrara, B J; Luchs, J S; Dudziak, M E; Steinbrech, D S; Illei, P B; Fernandez, G J; Gittes, G K; Longaker, M T

    1999-05-01

    Recruitment of a blood supply is critical for successful bone induction and fracture healing. Despite the clinical success of distraction osteogenesis (DO), an analysis of angiogenesis during membranous bone DO has not been performed. The purpose of this study was to evaluate the temporal and spatial pattern of angiogenesis during mandibular DO. The right hemimandible of adult male rats was osteotomized, and a customized distraction device was applied. Following a 3-day latency period, distraction was begun at a rate of 0.25 mm twice daily for 6 days (3.0 mm total; 12% increase in mandibular length). Three animals each were sacrificed on days 2, 4, and 6 of distraction (D1, D2, and D3 respectively), or after 1, 2, or 4 weeks of consolidation (C1, C2, and C3 respectively). Two experienced pathologists reviewed the regenerate histology, and angiogenesis was assessed by counting the number of blood vessels per intermediate-power field (IPF). Statistical analysis was performed using analysis of variance, with p < or = 0.05 considered significant. Results demonstrate that mandibular DO was associated with an intense vascular response during the early stages of distraction (D1). On average, 31.5+/-7.9 vessels were noted in each IPF examined during this time point. The number of blood vessels in the distraction regenerate decreased significantly during the later distraction time points, with approximately 14.0+/-2.0 and 14.7+/-3.5 blood vessels per IPF in sections obtained after days 4 and 6 of distraction (D2, D3) respectively. However, blood vessels at these time points took on a more mature histological pattern. During the consolidation period, the number of blood vessels noted in the regenerate decreased with 8.0+/-2.6, 9.3+/-2.1, and 4.0+/-2.0 vessels per IPF in sections obtained after 1, 2, or 4 weeks of consolidation (C1, C2, C3) respectively (p < 0.05 compared with vessel counts during the earliest distraction time point). This study demonstrates for the first

  15. Anterior Segmental Distraction Osteogenesis in the Hypoplastic Cleft Maxilla

    PubMed Central

    Rao (Janardhan), Sruthi; Kotrashetti, S. M.; Lingaraj, J. B.; Pinto, P. X.; Keluskar, K. M.; Jain, Siddharth; Sone, Piyush; Rao, Santhosh

    2013-01-01

    Orthognathic surgery and distraction osteogenesis play a prime role in the correction of maxillary hypoplasia in patients with cleft lip and palate (CLP). Advancement of the anterior maxilla alone without interfering with the velopharyngeal sphincter may be advantageous in cleft patients, who more commonly have speech deficits and dental crowding. We present a case series of anterior maxillary segmental distraction for maxillary hypoplasia in 5 CLP patients with a one-year follow-up. A custom-made tooth-borne distraction device with a hyrax screw positioned anteroposteriorly was used. The evaluation comprised of hard and soft tissue analysis and speech assessment. A stable occlusion with positive overjet and correction of dental-crowding without extraction was achieved at one year post-distraction. Facial profile and lip support improved. There was no deterioration in speech. PMID:23984033

  16. The molecular biology of distraction osteogenesis.

    PubMed

    Bouletreau, Pierre J; Warren, Stephen M; Longaker, Michael T

    2002-02-01

    Distraction osteogenesis has become a mainstay in bone tissue engineering and has significantly improved our armamentarium for reconstructive craniomaxillofacial procedures. However, although the biomechanical, histological, and ultrastructural changes associated with distraction osteogenesis have been widely described, the molecular mechanisms governing the formation of new bone in the interfragmental gap of gradually distracted bone segments remain largely unclear. Recently, a rat model of mandibular distraction was described that provides an excellent environment for deciphering the molecular mechanisms that mediate distraction osteogenesis. This article presents the hypotheses and current research that have furthered knowledge of the molecular mechanisms that govern distraction osteogenesis. Recent studies have implicated a growing number of cytokines that are intimately involved in the regulation of bone synthesis and turnover. The gene regulation of numerous cytokines (transforming growth factor-beta1, -beta2, -beta3, bone morphogenetic proteins, insulin-like growth factor-1, fibroblast growth factor-2) and extracellular matrix proteins (osteonectin, osteopontin) during distraction osteogenesis have been best characterized and are discussed in this article. It is believed that understanding the biomolecular mechanisms that mediate membranous distraction osteogenesis may guide the development of targeted strategies designed to improve distraction osteogenesis and accelerate bone healing.

  17. Technical considerations in distraction osteogenesis.

    PubMed

    Suhr, M A A; Kreusch, Th

    2004-01-01

    Five cases are presented to exemplify technical difficulties and complications which may be encountered when performing distraction osteogenesis in the facial skeleton. The procedure should be performed under close supervision by the surgical and orthodontic colleagues. Errors in the choice of vector may be managed by earlier removal of the distractor and subsequent traction on the previously osteotomized segments using orthodontic appliances and principles. Multiple distractors may be inserted in the same jaw and bimaxillary procedures are possible, increasing the likelihood of encountering technical difficulties. Detailed planning and close follow-up, with early recognition and active management of the complications, may be useful in ensuring a successful outcome of this versatile procedure.

  18. [The molecular biology of distraction osteogenesis].

    PubMed

    Boulétreau, P; Longaker, M T

    2004-02-01

    Distraction osteogenesis has become a mainstay in bone engineering and the recent application of this technique to the membranous craniofacial skeleton has significantly improved our armamentarium for reconstructive craniomaxillofacial procedures. However, if the biomechanical, histological and ultrastructural changes associated with distraction osteogenesis have been widely described, the molecular mechanisms governing the formation of new bone in the interfragmental gap of gradually distracted bone segments remain largely unclear. Recently, our laboratory has described a rat mandibular distraction model that provides an excellent environment for deciphering the molecular mechanisms that mediate distraction osteogenesis. In this Article, we present the hypotheses and current research that have furthered our knowledge of the molecular mechanisms that govern distraction osteogenesis. Recent studies have implicated a growing number of cytokines that are intimately involved in the regulation of bone synthesis and turnover. The gene regulation of numerous cytokines (Transforming Growth Factor-B, Bone Morphogenetic Proteins, Insulin-like Growth Factor-1, Fibroblast Growth Factor-2) during distraction osteogenesis have been best characterized and will be discussed in this text. We believe that novel systems like the rat model will facilitate our understanding of the biomolecular mechanisms that mediate membranous distraction osteogenesis and will ultimately guide the development of targeted-strategies designed to accelerate bone healing.

  19. The use of internal maxillary distraction for maxillary hypoplasia: a preliminary report.

    PubMed

    Van Sickels, Joseph E; Madsen, Mathew J; Cunningham, Larry L; Bird, Douglas

    2006-12-01

    Distraction osteogenesis is a useful alternative to advance the maxilla in complicated cases of maxillary hypoplasia. The purpose of this article is to review the workup, experience, and preliminary results with the use of internal distraction osteogenesis for maxillary hypoplasia at one teaching institution. Over a 5-year period, more than 300 patients with craniofacial and dentofacial defects have undergone oral and maxillofacial surgery at our center to correct their skeletal discrepancies. Of these, 10 have had maxillary distraction osteogenesis done with internal distractors. Follow-up of 6 months or more was available for 8 patients. Stereolithographic models were used to bend distractors prior to surgery in 6 patients. Latency prior to the start of distraction was 3 to 7 days and varied with the age of the patient. Distraction occurred at approximately 1 mm per day with an average distraction length of 8.5 mm (range, 6-10 mm). Excellent occlusal results were obtained in 5 patients. Major complications including nonunion and failure to achieve acceptable occlusal results were observed in 3 patients. Minor complications including pain and loosening of the distracter devices were observed in 2 patients, but did not appear to affect the esthetic and functional results. Distraction osteogenesis is a useful alternative to traditional orthognathic surgery to treat maxillary hypoplasia. Internal distractions are attractive to patients, but are more difficult to place and can cause discomfort to patients when trying to achieve an ideal primary vector of distraction. Stereolithographic models can help with placement of the device. Changes in design of distractors may help with patient discomfort.

  20. Ankylosed maxillary incisor with severe root resorption treated with a single-tooth dento-osseous osteotomy, vertical alveolar distraction osteogenesis, and mini-implant anchorage.

    PubMed

    Senışık, Neslihan Ebru; Koçer, Gülperi; Kaya, Bulem Üreyen

    2014-09-01

    Dentoalveolar ankylosis interferes with the vertical growth of the alveolar process, which can lead to an open bite, an unesthetic smile, and occlusal disharmony. This case report presents a new treatment protocol for an ankylosed tooth with severe root resorption using a combined surgical orthodontic management protocol involving a single-tooth dento-osseous osteotomy and vertical alveolar distraction osteogenesis with intraoral elastics and mini-implant anchorage. After distraction and active orthodontic treatment, the patient's anterior open bite was corrected. A Class I dental relationship was achieved, overjet was decreased, and a normal incisor relationship was obtained.

  1. Maxillary Expansion and Midline Correction by Asymmetric Transverse Distraction Osteogenesis in a Patient With Unilateral Cleft Lip/Palate: A Case Report.

    PubMed

    Shintaku, Yuko; Tanikawa, Chihiro; Iida, Seiji; Aikawa, Tomonao; Kogo, Mikihiko; Yamashiro, Takashi

    2015-09-01

    This case report presents the management of a female patient with unilateral cleft lip and palate presenting with skeletal Class III malocclusion and a narrow upper dental arch with a midline deviation. The treatment plan involved asymmetric transverse distraction osteogenesis of the maxilla to make the upper dental midline coincident with the facial midline. After the treatment, a good facial profile and a close intercuspation of teeth were achieved. Occlusion remained stable with normal overjet and overbite after 2-year retention.

  2. [Distraction osteogenesis: principles, history and background].

    PubMed

    Vissink, A; de Baat, C

    2008-06-01

    Distraction osteogenesis is a treatment in which new bone is created in the space which comes to exist between bone fragments that have slowly been driven apart by osteogenesis. This treatment, originally developed in orthopaedic surgery, is also commonly used for correcting deformities in the head and neck. After an initial hype, during which time distraction osteogenesis was used to correct deformities in the maxillofacial skeleton, it is beginning to become clearer for which conditions in the head and neck region distraction osteogenesis is most effective or can be seen as a good alternative for 'classical' surgical treatment. In this special issue, the application of distraction osteogenesis in orthopaedics, pre-prosthetic reconstructive surgery, orthodontics and cleft-surgery are discussed and the mandible, the maxilla and the cranio-facial skeleton are also considered. In addition, the possibility that the consolidation period can be reduced in the case of some treatments, such as bone substitutes and growth factors, by combining them with distraction osteogenesis is also addressed.

  3. Distraction osteogenesis: application to dentofacial orthopedics.

    PubMed

    Yen, S L

    1997-12-01

    Distraction osteogenesis is a surgical-orthopedic method for lengthening bone by separating or distracting a fracture callus. This technique has a long history in limb lengthening and has recently been used to lengthen mandibles and maxillae in human patients. Distraction osteogenesis represents a powerful method of producing unlimited quantities of living bone which can be formed along any plane of space. Because this method uses local host tissue, it offers many advantages over bone grafting. In the author's experience, large (10-22 mm) antero-posterior and vertical corrections of mandibles can be achieved using this technique. The purpose of this article is to review its biological basis and discuss recent clinical applications. This article reviews the history, theory, current management, and limitations of distraction osteogenesis in treating craniofacial anomalies.

  4. Transport dentoalveolar distraction osteogenesis-assisted rapid orthodontic canine retraction.

    PubMed

    Kharkar, Viraj R; Kotrashetti, S M

    2010-05-01

    A recent innovative use of distraction osteogenesis technique in the field of orthodontic tooth movement is the application of the principle of distraction to move individual tooth segments rapidly, thus reducing orthodontic treatment time. Twelve maxillary canine teeth were rapidly retracted using the concept of dentoalveolar distraction osteogenesis. They were evaluated for the time required to complete the retraction, canine tipping, anchorage loss, and root resorption using intraoral radiographs and lateral cephalograms. The vitality of the canine was also evaluated using an electric pulp tester. Canines can be rapidly retracted by dentoalveolar distraction, and subsequently the total orthodontic treatment time can be reduced as described in this technique. The time taken is 12.5 +/- 0.50 days with a minimal amount of tipping and acceptable amount of anchorage loss. All the teeth were vital with no evidence of root resorption. The concept of distraction osteogenesis for rapid orthodontic tooth movement is thought to be promising and feasible for clinical practice. Copyright (c) 2010 Mosby, Inc. All rights reserved.

  5. Vertical Alveolar Ridge Augmentation by Distraction Osteogenesis

    PubMed Central

    Kumar, N. Nanda; Ravindran, C.

    2015-01-01

    Introduction Compromised alveolar ridge in vertical and horizontal dimension is a common finding in patients visiting practitioners for dental prosthesis. Various treatment modalities are available for correction of deficient ridges among which alveolar distraction osteogenesis is one. Aim To study the efficacy of alveolar distraction osteogenesis in augmentation of alveolar ridges deficient in vertical dimension. Materials and Methods Ten patients aged 16 to 46 years with deficient alveolar ridge underwent ridge augmentation in 11 alveolar segments using the distraction osteogenesis method. For each patient a custom made distraction device was fabricated. The device was indigenously manufactured with SS-316 (ISO 3506). Results The vertical bone gain reached more than 10mm without the use of bone transplantation. Certain complications like incorrect vector of distraction, paresthesia, pain and loss of transport segment were encountered during the course of the study. Conclusion Alveolar vertical distraction osteogenesis is a reliable and predictable technique for both hard and soft tissue genesis. Implant placement is feasible with primary stability in neogenerated bone at the level of the distracted areas. PMID:26816991

  6. Vertical Alveolar Ridge Augmentation by Distraction Osteogenesis.

    PubMed

    Mohanty, Rajat; Kumar, N Nanda; Ravindran, C

    2015-12-01

    Compromised alveolar ridge in vertical and horizontal dimension is a common finding in patients visiting practitioners for dental prosthesis. Various treatment modalities are available for correction of deficient ridges among which alveolar distraction osteogenesis is one. To study the efficacy of alveolar distraction osteogenesis in augmentation of alveolar ridges deficient in vertical dimension. Ten patients aged 16 to 46 years with deficient alveolar ridge underwent ridge augmentation in 11 alveolar segments using the distraction osteogenesis method. For each patient a custom made distraction device was fabricated. The device was indigenously manufactured with SS-316 (ISO 3506). The vertical bone gain reached more than 10mm without the use of bone transplantation. Certain complications like incorrect vector of distraction, paresthesia, pain and loss of transport segment were encountered during the course of the study. Alveolar vertical distraction osteogenesis is a reliable and predictable technique for both hard and soft tissue genesis. Implant placement is feasible with primary stability in neogenerated bone at the level of the distracted areas.

  7. Distraction osteogenesis to widen the mandible.

    PubMed

    Bell, W H; Harper, R P; Gonzalez, M; Cherkashin, A M; Samchukov, M L

    1997-02-01

    The purpose of this investigation was to elucidate the biology of distraction osteogenesis during mandibular widening. Midsymphyseal vertical interdental osteotomies were performed in nine Macaca mulatta monkeys. After a latency period a tooth-borne appliance was activated at a rate of 0.5 mm twice a day for 7-10 days. The appliance was then stabilized for a period of 4 or 8 weeks. The distraction gap at the inferior portion of the symphysis was bridged completely by new bony trabeculae. Bone formation in the interdental area was apparently related to the surgical technique. Newly formed bony trabeculae were oriented parallel to the direction of distraction. The location of the osteotomy site with an adequate margin of alveolar bone contiguous with the adjacent teeth was necessary for the induction of the distraction osteogenesis. Disproportional movement between superior and inferior portions of the distracted segments was noted.

  8. Measurement of Distraction Force in Cleft Lip and Palate Patients During Le Fort I Maxillary Advancement With Rigid External Distraction.

    PubMed

    Sawada, Hiromi; Ogawa, Takuya; Kataoka, Keiichi; Baba, Yoshiyuki; Moriyama, Keiji

    2017-03-01

    Maxillary distraction osteogenesis (DO) is a mainstream surgical technique for patients who have severe maxillary hypoplasia associated with craniofacial syndromes and cleft-related deformities. However, limited information about the biomechanical aspects of maxillary DO is available limiting broad utilization and improvements to the procedure. The objective of this study was to analyze force levels during the active distraction process and to investigate the relationship between distraction force and maxillary movement during Le Fort I maxillary DO using a rigid external distraction (RED) system. Microtension gauges were integrated into the distraction wires on each side of the RED system. Six patients with cleft lip and palate aged 12.8 to 23.5 years underwent strain gauge measurements during maxillary advancement with DO using an RED system. Lateral cephalograms were taken to measure maxillary horizontal, vertical, and linear movements after DO. The average linear maxillary movement was 11.2 mm (range 8.5-15.9 mm). The applied forces ranged from 13.4 to 26.8 N. The distance of maxillary movement was proportional to the distraction force. The measurement of distraction forces during DO provides important information with which to establish appropriate protocols. Patients requiring more advancement may require more distraction force. However, other factors such as scarring, patient anatomy, surgical freedom of the osteotomized maxilla, and the like, may affect the required force during DO with the RED system.

  9. Experimental and clinical experience with distraction osteogenesis.

    PubMed

    Aronson, J

    1994-11-01

    G.A. Ilizarov's clinical insights and experimental biology have developed into what is known today as distraction osteogenesis. Initially used for the treatment of fractures and nonunions, his methods have proven successful for limb lengthening and bone transportation. A brief history of the development of distraction osteogenesis, definition of terms, methods, and monitoring techniques are described. The primary mechanism, intramembranous ossification, is direct bone formation in uniform gradients of mineralization from a central fibrous interzone. New bone is produced from the local host surfaces and quickly remodels to the equivalent macro and microstructure. Blood supply at the focus of distraction, dependency on a latency period, different rates, and rhythms of distraction are all tested and discussed. Data from experimental tibial lengthening in more than 125 animals (dogs, rabbits, and rats) show that distraction osteogenesis provides unlimited new bone formation that remodels at daily rates ranging from 200 to 400 microns. In over 100 clinical cases, patients ranging in age from 18 months to 49 years have regenerated bone at an average rate of 213 microns in adults and 385 microns in children. Approximately 10% of these cases required supplemental bone grafts. The article proposes that distraction osteogenesis might be successfully applied in craniofacial surgery.

  10. Distraction osteogenesis for correction of mandibular abnormalities

    PubMed Central

    Karun, Vinayak; Agarwal, Navneet; Singh, Virendra

    2013-01-01

    Introduction: Management of mandibular deformities is challenging. Distraction osteogenesis is a relatively new technique with promising results. Materials and Methods: We selected 12 patients. The osteotomy site decided was proximal to the antegonial notch. Latency time was five to seven days. Consolidation period was eight weeks in eleven cases and six weeks in one case. Results: In all the patients, appreciable lengthening of mandible was achieved. Discussion: The greatest advantage of distraction osteogenesis is growth of soft tissue along with the growth of hard tissue. This increases post operative stability PMID:24665178

  11. Orthodontic Treatment and Maxillary Anterior Segmental Distraction Osteogenesis of a Subject with Williams–Beuren Syndrome and Isolated Cleft Palate: A Long-Term Follow-Up from the Age of 5 to 24 Years

    PubMed Central

    Shirota, Tatsuo; Adel, Mohamed; Takahashi, Masahiro; Haga, Shugo; Nagahama, Ryo; Nakashima, Misato; Furuhata, Mayu; Kamatani, Takaaki; Maki, Koutaro

    2017-01-01

    Williams–Beuren syndrome (WBS) is a rare multisystem disorder caused by a hemizygous deletion of the elastin gene on chromosome 7q11.23. WBS patients have characteristic skeletal features and dental anomalies accompanied by mental retardation, a friendly outgoing personality, and mild to moderate intellectual disability or learning problems. In this case report, we present the combined orthodontic and surgical treatment of a WBS patient with an isolated cleft palate through a long-term follow-up from the age of 5 to 24 years. During the period of active treatment, comprehensive orthodontic treatment combined with maxillary anterior segmental distraction osteogenesis and prosthetic treatment using dental implants were effective in dramatically improving the patient's malocclusion. The patient's mental abilities and the cooperation shown by the patient and her family were crucial for the success of this complex and long-term treatment course. PMID:28744380

  12. Alveolar distraction osteogenesis for implant site development.

    PubMed

    Batal, Hussam S; Cottrell, David A

    2004-02-01

    Alveolar distraction osteogenesis can be a valuable tool for implant site development. Simultaneous regeneration of hard and soft tissue and an overall decrease in treatment time compared with other methods of site preparation can be an advantage. The authors advocate the concept of "prosthetically driven alveolar distraction." Surgical planning should begin with visualization of the final restoration to determine the volume and position of the soft and hard tissue deficiency. Surgical guides will help the surgeon determine the vector of distraction. Adherence to surgical principles to avoid damage to adjacent vital structures and maintain vascular supply to the transport segment is necessary for success. Bone grafting may be necessary before or after distraction to increase the surgical success of the procedure. Close follow-up is needed to verify the appropriate distraction vector and volume. Patient management and acceptance should be considered in distractor design and placement.

  13. Premaxillary Distraction Osteogenesis Using an Intraoral Appliance for Unilateral Cleft Lip and Palate: Case Report.

    PubMed

    Terbish, Munkhdulam; Choi, Hye-Young; Park, Young-Chel; Yi, Choong Kook; Cha, Jung-Yul

    2015-07-01

    Premaxillary distraction osteogenesis was introduced using intraoral devices to correct maxillary hypoplasia and lengthen the alveolar bone horizontally in a patient with unilateral cleft lip and palate. For premaxillary distraction osteogenesis, Le Fort I osteotomy was performed. Vertical osteotomy lines were located distally of the upper right canine and left first premolar to separate the anterior segment of the maxilla. After a 7-day latency period, distraction was allowed to continue for 20 days at a rate of 0.5 mm/d, followed by a 3-month consolidation period. After consolidation, orthodontic treatment and bilateral intraoral vertical ramus osteotomy were performed for the mandibular setback. The implant and prosthodontic treatments were applied to the alveolar ridge area created by the distraction osteogenesis. The A-point moved 8.0 mm forward during the distraction osteogenesis period, and the recurrence rate was 25% after the retention period. The transverse dimension of the upper arch was expanded during orthodontic treatment. The quality of the alveolar bone created by distraction osteogenesis was acceptable for the prosthodontic implant. Premaxillary distraction osteogenesis and arch expansion is an effective treatment strategy, improving function, aesthetics, and stability for cleft patients with multiple missing teeth.

  14. Dento-Alveolar distraction osteogenesis using rigid intra-oral tooth borne distraction device

    PubMed Central

    Nair, Arvind; Kumar, J Phani; Venkataramana, V; Yuvaraj, A; Reddy, V Sridhar; Kumar, S Kishore

    2014-01-01

    Background: The aim of this clinical prospective study is to apply and evaluate an approach to reduce the overall orthodontic treatment time, by means of dentoalveolar distraction osteogenesis to achieve rapid canine retraction using an indigenously developed intra-oral tooth-borne distraction device. Materials & Methods: This study was carried out in the Department of Orthodontics and Dentofacial Orthopedics. Four patients selected for the purpose of Maxillary and/or Mandibular canine distraction with a rigid custom-made, intra-oral distraction device made of stainless steel and were scheduled for orthodontic treatment with bilateral first premolar extraction and then subsequent bilateral canine teeth distalization. Results: In all the patients the canine teeth moved distally and made contact with the second premolars within 14-16 days range after which they were kept passive, with the appliance for a week of consolidation. The amount of canine retraction was in 7-7.5mms range, in all the patients, in each of the four quadrants studied. Bodily movement, tipping and buccal flaring of the canine teeth were noticed in all the cases. Conclusion: Combination of newer orthodontic appliances and the principles of biomechanics to maintain the control over rapid tooth movement, rapid canine distalization using distraction osteogenesis awaits further development before routine application, of this innovative and exciting approach. How to cite the article: Nair A, Kumar JP, Venkataramana V, Yuvaraj A, Reddy VS, Kumar SK. Dento-Alveolar distraction osteogenesis using rigid intra-oral tooth borne distraction device. J Int Oral Health 2014;6(2):106-13. PMID:24876710

  15. Dento-Alveolar distraction osteogenesis using rigid intra-oral tooth borne distraction device.

    PubMed

    Nair, Arvind; Kumar, J Phani; Venkataramana, V; Yuvaraj, A; Reddy, V Sridhar; Kumar, S Kishore

    2014-04-01

    The aim of this clinical prospective study is to apply and evaluate an approach to reduce the overall orthodontic treatment time, by means of dentoalveolar distraction osteogenesis to achieve rapid canine retraction using an indigenously developed intra-oral tooth-borne distraction device. This study was carried out in the Department of Orthodontics and Dentofacial Orthopedics. Four patients selected for the purpose of Maxillary and/or Mandibular canine distraction with a rigid custom-made, intra-oral distraction device made of stainless steel and were scheduled for orthodontic treatment with bilateral first premolar extraction and then subsequent bilateral canine teeth distalization. In all the patients the canine teeth moved distally and made contact with the second premolars within 14-16 days range after which they were kept passive, with the appliance for a week of consolidation. The amount of canine retraction was in 7-7.5mms range, in all the patients, in each of the four quadrants studied. Bodily movement, tipping and buccal flaring of the canine teeth were noticed in all the cases. Combination of newer orthodontic appliances and the principles of biomechanics to maintain the control over rapid tooth movement, rapid canine distalization using distraction osteogenesis awaits further development before routine application, of this innovative and exciting approach. How to cite the article: Nair A, Kumar JP, Venkataramana V, Yuvaraj A, Reddy VS, Kumar SK. Dento-Alveolar distraction osteogenesis using rigid intra-oral tooth borne distraction device. J Int Oral Health 2014;6(2):106-13.

  16. Skeletal stability after correction of maxillary hypoplasia by the Glasgow extra-oral distraction (GED) device.

    PubMed

    Jayade, C V; Ayoub, A F; Khambay, B S; Walker, F S; Gopalakrishnan, K; Malik, N A; Srivastava, D; Pradhan, R

    2006-08-01

    Maxillary distraction osteogenesis delivers excellent results, particularly in patients with clefts. In the past, devices such as the conventional facemask and the rigid external distraction device have been used to correct maxillary hypoplasia after a Le Fort I osteotomy. We describe a new device, the Glasgow extra-oral distraction device. The extent of skeletal and dental stability of corrections achieved in 10 patients with maxillary hypoplasia associated with clefts was satisfactory. This device costs little, can be produced in developing countries, and provides effective treatment for severe secondary deformity associated with clefts.

  17. Distraction osteogenesis in craniofacial surgery: a review.

    PubMed

    Tavakoli, K; Stewart, K J; Poole, M D

    1998-01-01

    Distraction osteogenesis is a technique of new bone formation by the gradual separation of bony fragments. The method, although initially developed for limb lengthening, is now being applied in the treatment of craniofacial deformities. A number of principles have been established through careful scientific study to guide clinical practice, such as the ideal rate and rhythm of distraction, the need for periosteal preservation during bone division, a "latent period" of neutral fixation before, and a "consolidation period" after distraction. The technique is being applied in craniofacial surgery particularly for mandibular deformities and offers considerable advantages over previous methods such as osteotomy and inlay bone grafting. Donor site morbidity is avoided, the investing soft tissue envelope is concurrently expanded, and the magnitude of the procedure is less. However, the technique is still in its infancy and requires further modification and refinement before widespread acceptance as a treatment in mainstream craniofacial surgery. Problems with cutaneous scarring and socially undesirable external hardware, particularly in the pediatric population, have led to the emergence of intraoral miniature devices, with the ultimate goal of development of a multiplanar internal autodistractor. Furthermore, many principles well established in leg lengthening, such as the rate and rhythm of distraction, need to be reexamined and the parameters redefined with particular reference to the craniofacial skeleton. Distraction osteogenesis has an expanding role in craniofacial surgery.

  18. Distraction osteogenesis and orthognathic surgery for a patient with unilateral cleft lip and palate.

    PubMed

    Kim, Ji Hyun; Lee, Il Hong; Lee, Sang Min; Yang, Byoung Eun; Park, In Young

    2015-03-01

    Maxillary deficiency is a common feature in patients with repaired cleft lip and palate. Orthognathic surgery has been the conventional approach for the management of cleft-related maxillary hypoplasia. However, for patients with a severe maxillary deficiency, orthognathic surgery alone has many disadvantages, such as high relapse rates of 25% to 40%, instability, limited amount of advancement, and a highly invasive surgical technique. As an alternative treatment method, distraction osteogenesis has been used successfully in the distraction of the mandible, the maxilla, the entire midface, and the orbits as well as the cranial bones, with stable outcomes. The type of distraction device, either external or internal, can be chosen based on the surgical goals set for the patient. In this study, we report on the use of a rigid external distraction device for maxillary advancement in a 22-year-old woman with a repaired unilateral cleft lip and palate and severe maxillary hypoplasia. After the distraction osteogenesis, 2-jaw surgery was performed to correct the maxillary yaw deviation and the mandibular prognathism. Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  19. Distraction osteogenesis of costochondral neomandibles: a clinical experience.

    PubMed

    Corcoran, J; Hubli, E H; Salyer, K E

    1997-08-01

    Distraction osteogenesis quickly has become a mainstay in the treatment of craniofacial syndromes with mandibular hypoplasia. We report on a series of eight patients undergoing distraction osteogenesis of neomandibles constructed with costochondral grafts. The length of distraction, resting phase between distraction and device removal, and complication rate were significantly greater in the rib-graft distraction group when compared with our series of native mandibular distraction patients (n = 21 devices). Most complications were minor, including pintrack infection and hardware failure; however, major complications included fibrous union and facial nerve praxia. Secondary procedures have been able to be performed successfully on previously distracted rib grafts as well.

  20. Angiogenesis and mineralization during distraction osteogenesis.

    PubMed Central

    Choi, In Ho; Chung, Chin Youb; Cho, Tae-Joon; Yoo, Won Joon

    2002-01-01

    Distraction osteogenesis is currently a standard method of bone lengthening. It is a viable method for the treatment of short extremities as well as extensive bone defects, because large amounts of bone can be regenerated in the distraction gap. Mechanical stimulation by distraction induces biological responses of skeletal regeneration that is accomplished by a cascade of biologic processes that may include differentiation of pluripotential tissue, angiogenesis, mineralization, and remodeling. There are complex interactions between bone-forming osteoblasts and other cells present within the bone microenvironment, particularly vascular endothelial cells that may be pivotal members of a complex interactive communication network in bone. Regenerate bone forms by three modes of ossification, which include intramembranous, enchondral, and transchondroid ossifications, although intramembraneous bone formation is the predominant mechanism of ossification. In this review we discussed the coupling between angiogenesis and mineralization, the biological and mechanical factors affecting them, the cellular and molecular events occurring during distraction osteogenesis, and the emerging modalities to accelerate regenerate bone healing and remodeling. PMID:12172035

  1. Mandibular widening by intraoral distraction osteogenesis.

    PubMed

    Guerrero, C A; Bell, W H; Contasti, G I; Rodriguez, A M

    1997-12-01

    Transverse mandibular deficiency with crowding of the mandibular anterior teeth is frequently present in patients with Class I and II malocclusions. The hallmarks of treatment by compensating orthodontics, functional appliances or orthopaedic devices are instability, compromised periodontium and compromised facial aesthetics. A new surgical technique has been developed to widen the mandible. The method is based upon gradual osteodistraction following vertical interdental symphyseal osteotomy. Ten patients with transverse mandibular deficiency and significant dental crowding were treated by symphyseal distraction and subsequent non-extraction decompensating orthodontic treatment. Either an intraoral tooth-borne Hyrax appliance or a new custom-made bone-borne osteodistractor was used to gradually widen the mandible. The surgical procedures were accomplished under local anaesthesia and intravenous sedation in an ambulatory surgical setting using an individualized distraction protocol. The appliances were activated 7 days after symphyseal osteotomies, once each day at a rate of 1 mm per day and stabilized for 30-40 days after distraction. After the segments were distracted, non-extraction orthodontic alignment of the mandibular anterior teeth was accomplished. The symphyseal distraction gaps were bridged by new bony regenerate. Distraction osteogenesis provided an efficient surgical alternative to orthognathic surgery for widening the mandible and treatment of transverse mandibular deficiency without extraction of teeth.

  2. Distraction Osteogenesis for Brachymetatarsia by Using Internal Device.

    PubMed

    Kitabata, Reina; Sakamoto, Yoshiaki; Nagasao, Tomohisa; Kishi, Kazuo

    2017-07-01

    Congenital brachymetatarsia most commonly involves the fourth ray and may be combined with metacarpal shortening. Now, many reports demonstrated the usefulness of distraction osteogenesis for lengthening of the metatarsals by using an external distraction device. In this article, we treated shortening fourth metatarsal by bone lengthening using the internal distraction device. This technique has some advantages over the method of external distraction.

  3. Rat mandibular distraction osteogenesis: Part I. Histologic and radiographic analysis.

    PubMed

    Rowe, N M; Mehrara, B J; Dudziak, M E; Steinbreck, D S; Mackool, R J; Gittes, G K; McCarthy, J G; Longaker, M T

    1998-11-01

    The application of distraction osteogenesis to craniofacial surgery has altered the approach and treatment of congenital and acquired craniofacial defects. Although the histologic and ultrastructural changes associated with distraction osteogenesis have been described extensively, relatively little is known about the molecular regulation of this process. The elucidation of the molecular mechanisms of distraction osteogenesis has important clinical implications because it may facilitate the use of recombinant proteins or gene therapy to accelerate bone regeneration. Molecular analysis of distraction osteogenesis has been hindered by the use of large animal models in which only limited genetic information is available. In this study, a rat model of mandibular distraction osteogenesis is described. This report includes a pilot study (n = 50) to develop an appropriate distraction device and to determine the optimal placement of the osteotomy. The study subsequently included 80 animals, 35 of which were distracted at a rate of 0.25 mm per day for 6 days (1.5 mm total) and 35 that were distracted at a rate of 0.25 mm twice per day (3.0 mm total). These animals were killed at various time points (after latency and during the distraction and consolidation periods) and displayed histologic and radiographic findings of membranous bone distraction osteogenesis that were consistent with those in large ,animal and clinical models. In addition, five animals each were acutely lengthened 1.5 mm and 3.0 mm and demonstrated a fibrous nonunion. Furthermore, the utility of this model is demonstrated in the analysis of the molecular mechanisms of distraction osteogenesis by applying the polymerase chain reaction to total cellular RNA isolated from normal and distracted rat mandibles. In conclusion, it is believed that the rat model of distraction osteogenesis has significant advantages over traditional models, including decreased costs and facilitation of molecular analysis.

  4. Transport distraction osteogenesis for maxillomandibular reconstruction: current concepts and applications.

    PubMed

    Neelakandan, R S; Bhargava, Darpan

    2012-09-01

    Reconstruction of the facial skeleton remains a herculean task for a reconstructive surgeon, even with the availability of ample reconstructive options. Transport distraction osteogenesis is a novel reconstructive modality in the armamentarium of a maxillofacial reconstructive surgeon with obvious advantages of osteogenesis and histogenesis from the residual host tissues after tumor ablative surgeries or trauma and also, precludes donor site morbidity. This paper reviews the current concepts, principles involved and applications of transport distraction osteogenesis in maxillomandibular reconstruction.

  5. Submuscular plating after distraction osteogenesis in children.

    PubMed

    Oh, Chang-Wug; Shetty, Gautam M; Song, Hae-Ryong; Kyung, Hee-Soo; Oh, Jong-Keon; Min, Woo-Kie; Lee, Byung-Woo; Park, Byung-Chul

    2008-09-01

    Although distraction osteogenesis has solved limb length discrepancies, many complications are inevitable from long duration of external fixation. Use of intramedullary nails for early removal of fixators has its own challenges especially in pediatric age group. To facilitate early removal of external fixators in children, we tried a novel method of submuscular plating over the distraction callus, which is described, and the results and complications of this technique are presented. In eight children (four girls and four boys), of limb lengthening (four cases) and bone transport (four cases) done in three femurs and five tibiae with external fixators (five Ilizarov ring fixators and three monofixators), submuscular plating was done over the distraction callus. The causes of limb length discrepancy included traumatic and septic growth arrest, congenital pseudoarthrosis of tibia, fibular hemimelia, tumor salvage, and Perthes' disease. The purpose of plating was to remove the external fixator earlier after achieving the target length. Mean age of plating procedure was 11.62 years, and mean amount of distraction was 5.47 cm. In all patients, the distraction callus healed on maintaining its length or correcting into the original alignment. The mean external fixation index was 26.93 days/cm and healing index was 52.01 days/cm. One complication of superficial pin-track infection occurred, which resolved completely with conservative treatment. None of the patients developed deep infection or implant failures. The mean follow-up after plating was 28 months (range, 18-62 months). Submuscular plating over the distraction callus may be a successful method that permits early removal of fixator with fewer complications. This method can be a useful alternative in children or when nailing is difficult.

  6. Biomechanics and orthodontic treatment protocol in maxillofacial distraction osteogenesis.

    PubMed

    Maheshwari, Sandhya; Verma, Sanjeev K; Tariq, Mohd; Prabhat, K C; Kumar, Shailendra

    2011-07-01

    As in the traditional combined surgical and orthodontic procedures, an Orthodontist can plays vital role in treatment planning and the orthodontic treatment of patient undergoing distraction osteogenesis. This role includes predistraction assessment of the craniofacial skeleton and occlusal function, pre-distraction, and post-distraction orthodontic care. Based on clinical evaluation, dental study models, photographic analysis, cephalometric evaluation, and three-dimensional computed tomographic analysis, the Orthodontist, in collaboration with the Surgeon, plans distraction device placement and the predicted vectors of distraction. Finally, as in other forms of orthognathic surgery, the practice of distraction osteogenesis depends on the cooperation and planning between orthodontist and surgeon as a team. Purpose of this paper is to review biomechanics and orthodontic treatment protocol of distraction osteogenesis in the maxillofacial region.

  7. Biomechanics and orthodontic treatment protocol in maxillofacial distraction osteogenesis

    PubMed Central

    Maheshwari, Sandhya; Verma, Sanjeev K.; Tariq, Mohd.; Prabhat, K. C.; Kumar, Shailendra

    2011-01-01

    As in the traditional combined surgical and orthodontic procedures, an Orthodontist can plays vital role in treatment planning and the orthodontic treatment of patient undergoing distraction osteogenesis. This role includes predistraction assessment of the craniofacial skeleton and occlusal function, pre-distraction, and post-distraction orthodontic care. Based on clinical evaluation, dental study models, photographic analysis, cephalometric evaluation, and three-dimensional computed tomographic analysis, the Orthodontist, in collaboration with the Surgeon, plans distraction device placement and the predicted vectors of distraction. Finally, as in other forms of orthognathic surgery, the practice of distraction osteogenesis depends on the cooperation and planning between orthodontist and surgeon as a team. Purpose of this paper is to review biomechanics and orthodontic treatment protocol of distraction osteogenesis in the maxillofacial region. PMID:22639497

  8. Biology of Bone Formation, Fracture Healing, and Distraction Osteogenesis.

    PubMed

    Runyan, Christopher M; Gabrick, Kyle S

    2017-07-01

    Distraction osteogenesis is a bone-regenerative process in which an osteotomy is followed by distraction of the surrounding vascularized bone segments, with formation of new bone within the distraction gap. Distraction osteogenesis is efficacious for reconstructing critical sized bony defects in the appendicular and craniofacial skeleton. To provide opportunity to expand applications of distraction osteogenesis, it is important to have a thorough understanding of the underlying molecular biology and physiology of bone development and fracture healing. To accomplish these objectives a review of the literature was performed using search terms "endochondral ossification, intramembranous ossification, craniofacial skeleton, appendicular skeleton, fracture healing, bone development, and distraction osteogenesis." Bones of the craniofacial and appendicular skeleton have distinct mechanisms of embryonic development. The former develops from growth centers of mesenchymal precursors through intramembranous ossification. The latter forms though endochondral ossification in growth plates. However, both endochondral and intramembranous bone share similar master regulatory transcription factors and downstream growth factors. Fracture healing mirrors the pathway by which these bones developed embryonically. In contrast, bone formed by distraction osteogenesis does so by intramembranous ossification, regardless of whether it occurs within the appendicular or craniofacial skeleton. Understanding molecular pathway differences between bone formation by these mechanisms may allow for optimization and expansion of skeletal reconstruction by distraction osteogenesis.

  9. Cephalometric evaluation of the craniofacial complex in patients treated with an intraoral distraction osteogenesis device

    PubMed Central

    Chow, Angela; Lee, Hao-Fu; Trahar, Mary; Kawamoto, Henry; Vastardis, Heleni; Ting, Kang

    2009-01-01

    Introduction Distraction osteogenesis has gained popularity because of the hypothesized concurrent soft-tissue expansion, which is believed to reduce postoperative relapse. Although many articles describe the immediate success of mandibular distraction, little research has been done on its long-term stability. Our goal was to examine the long-term craniofacial changes after distraction. Methods Four hemifacial microsomic patients treated with unilateral mandibular distraction were recalled. Changes in maxillary width and height, occlusal height, ramus height, mandibular length, and chin position were quantified by using the posteroanterior and 45° lateral oblique cephalographs. Predistraction and postdistraction measurements were taken over a 5-year period. The data were analyzed by using paired t tests and ANOVA. Results Maxillary height, ramus height, mandibular length, and chin point deviation all experienced moderate improvement after distraction. Although the growth patterns between the control side and the treated side were comparable until 2 years after removal of the device, the normal side outgrew the affected side thereafter until 5 years after distraction. Conclusions Because of the greater inherent growth potential of the unaffected side, more overcorrection than originally believed is needed to offset the persistent asymmetry in growing hemifacial microsomia patients who undergo unilateral distraction osteogenesis. PMID:19061798

  10. "Transport distraction osteogenesis for reconstruction of mandibular defects": our experience.

    PubMed

    Nanjappa, Madan; Natashekara, M; Sendil Kumar, C; Kumaraswamy, S V; Keerthi, R; Ashwin, D P; Gopinath, A L

    2011-06-01

    Mandibular defects usually involve a combination of osseous and soft tissue deficiency and are among the most challenging problems in maxillofacial surgery, many options are available for mandibular reconstruction. One of the options discussed in literature recently being distraction osteogenesis. The aims and objectives of the study were to evaluate clinically the technique of distraction osteogenesis to reconstruct mandibular defects, using indigenous transport distractors, and to evaluate the efficacy of Indigenous transport distraction osteogenesis device. A prospective, experimental study was designed to examine the use of transport distraction osteogenesis in the treatment of defects of the mandible. Four patients with defects of the mandible were subjected to distraction osteogenesis with indigenously manufactured distraction device. The regenerate was assessed clinically and radiographically. The results showed that the regenerate was clinically as hard as the adjacent unaffected mandible and radiologic evidence of bone regeneration was observed. The major advantage being regeneration of hard tissue and soft tissue components without the morbidity of donor site, so that functional rehabilitation of the patient is possible. Thus from our study it is shown that transport distraction osteogenesis using indigenous distractors is a reliable yet affordable option for reconstruction of mandibular defects.

  11. Response of ramus following vertical lengthening with distraction osteogenesis.

    PubMed

    Tuzuner-Oncul, Aysegul Mine; Kisnisci, Reha S

    2011-09-01

    Vertical lengthening of the mandibular ramus is considered to be one of the least stable surgical procedures in the management of musculoskeletal maxillofacial deformities. The aim of this study was to evaluate the response of the mandibular ramus following vertical lengthening by means of distraction osteogenesis. This study included eight non-syndromic adult patients with temporomandibular joint ankylosis. The vertical height deficiency of the mandibular ramus and the ramus/condyle unit on the affected side were simultaneously reconstructed by transportation of a bone segment using distraction osteogenesis following gap arthroplasty. Lateral and posteroanterior (PA) cephalograms taken postoperatively before active distraction, at the completion of distraction and 6, 12, 24 months after distraction, were compared to evaluate the changes of the ramus height. In all cases the vertical ramus and ramus/condyle unit height loss were successfully reconstructed by distraction osteogenesis. There was no relapse in the amount of height gained by distraction osteogenesis at the 24 months follow-up review (p>0.05). Acute one stage vertical lengthening of the mandibular ramus is considered to be one of the least stable musculoskeletal procedures with relapse being a significant adverse outcome. In this clinical study gradual vertical lengthening of the ramus through ramus/condyle unit distraction osteogenesis has maintained the initial vertical ramus height gained for 24 months.

  12. Distraction osteogenesis using a longitudinal corticotomy.

    PubMed

    Al-Saati, Ma'ad F; Magnussen, Robert A; Lustig, Sebastien; Testa, Rodolphe; Al-Saati, Gazal; Al-Saati, Faisal

    2012-05-01

    The purpose of this study was to evaluate whether the use of a longitudinal corticotomy (S-Z osteotomy) results in more rapid consolidation following distraction osteogenesis of short tibiae. Sixty-seven lengthening procedures were performed in 51 patients ranging in age from nine to 38 (mean 25) years. Diagnoses included short stature (32 tibiae), postpolio limb deformity (22 tibiae), osteomyelitis (three tibiae), trauma (two tibiae) and other diagnoses (eight tibiae). Forty-five lengthenings were performed via a longitudinal corticotomy, and 22 were performed via a transverse corticotomy. Patients were followed until consolidation of the regenerated bone was noted radiographically (consolidation time). The healing index (consolidation time per centimetre of lengthening) was calculated for each patient and compared between groups. The healing index was significantly lower in the S-Z group (30.8 ± 9.6 days/cm) than in the transverse corticotomy group (46.8 ± 20.2 days/cm) (p < 0.0001). Mean lengthening was 6.6 (range 2.5-12.5) cm in the S-Z group and 5.8 (range 2.0-12.0) cm in the transverse group (p = 0.28). Mean consolidation time was 6.3 ± 2.8 (range 3-16) months in the S-Z group and 8.1 ± 3.8 (range 3-13.5) months in the transverse group (p = 0.03). The S-Z osteotomy safely reduces consolidation time of regenerative bone during distraction osteogenesis in the tibia relative to a transverse corticotomy.

  13. [Improvement of maxillofacial bone distraction osteogenesis: future prospects].

    PubMed

    Wojcik, T; Touzet, S; Ferri, J; Schouman, T; Raoul, G

    2011-09-01

    Distraction osteogenesis is a tissue engineering technique based on Ilizarov's study on long bones. McCarthy transposed it rapidly to facial bones. His results in cranial and maxillofacial surgery are good and reproducible. However, the current protocols are long and the devices used are bulky. Finding new devices and association with other tissue engineering techniques should improve distraction osteogenesis and the patient's comfort. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  14. "Cat's cradle" midfacial fixation in distraction osteogenesis after Le Fort III osteotomy.

    PubMed

    Havlik, Robert J; Seelinger, Michael J; Fashemo, Deji V; Hathaway, Ronald

    2004-11-01

    Distraction osteogenesis has provided a powerful technique for the treatment of severe midfacial hypoplasia. Skeletal fixation is a critical component of successful distraction osteogenesis. This is a report on the development of a new approach to bone fixation for distraction osteogenesis of the midface, based on circumferential suspension of the entire midfacial skeleton using surgical wires placed through the soft palate. This technique offers the advantages of (1) complete control of the attitude of the midface in terms of a precise dispersion of forces that can determine the desired pitch, yaw, and roll of this skeletal complex during the active phase of distraction, (2) being compatible with young children in the deciduous dentition stage because it obviates the need for rigid fixation devices on the maxillary lateral walls in the proximity of numerous dental follicles of the unerupted adult dentition, (3) actually serving as the instrument for posterior maxillary "lift" in cases of skeletal open bite malocclusions (frequently seen in the craniosynostoses), thereby allowing the clinician to determine the final occlusal and palatal planes and simultaneously close the open bite. An illustrative case of a 5(1/2)-year-old girl with Apert syndrome is presented wherein her ventilatory obstruction and ocular proptosis were significantly improved.

  15. Distraction Osteogenesis for Surgical Treatment of Craniosynostosis: A Systematic Review.

    PubMed

    Mundinger, Gerhard S; Rehim, Shady A; Johnson, Owen; Zhou, Joy; Tong, Anne; Wallner, Christopher; Dorafshar, Amir H

    2016-09-01

    Distraction osteogenesis has been proposed as an alternative to cranial remodeling surgery for craniosynostosis, but technique descriptions and outcome analyses are limited to small case series. This review summarizes operative characteristics and outcomes of distraction osteogenesis and presents data comparing distraction osteogenesis to cranial remodeling surgery. A systematic review of the literature was undertaken. Descriptive analysis, operative technical data, outcomes, or postoperative complications of distraction osteogenesis for craniosynostosis were included. A total of 1325 citations were reviewed, yielding 53 articles and 880 children who underwent distraction osteogenesis for craniosynostosis. Distraction plates were used in 754 patients (86 percent), whereas springs were used for the remaining 126 patients (14 percent). Standard and spring distraction osteogenesis was reported to successfully treat the primary condition 98 percent of the time. Suboptimal results were reported in 11 patients (1.3 percent), and minor complications were reported in 19.5 percent of cases (n = 172).Major complications were rare, occurring in 3.5 percent of cases (n = 31), and included two reported deaths. Absolute operative times and blood loss were marginally greater for cranial remodeling surgery cases, but the differences were not statistically significant. Distraction osteogenesis is an effective cranial vault remodeling technique for treating craniosynostosis. No statistical differences were found with respect to operative time, blood loss, need for transfusion, or intensive care unit resources compared with cranial remodeling surgery. Outcome studies with longer follow-up periods specifically investigating cost, relapse, and reoperation rates are necessary to effectively compare this treatment modality as an alternative to cranial remodeling surgery. Therapeutic, IV.

  16. [Application of multislice helical computed tomography in maxillofacial distraction osteogenesis].

    PubMed

    Niu, Xue-gang; Zhao, Yi-min; Han, Xiao-xian; Hao, Yong; Men, Shen-li

    2008-12-01

    To develop the method and investigate the value of the application of multislice helical computed tomography (CT) in the maxillofacial distraction osteogenesis. Twelve cases of maxillofacial distraction osteogenesis (3 in zygoma, 2 in maxilla, and 7 in mandible) were scanned by the multislice helical CT, then the reconstruction of three dimensional and fault image and the relative measurement were carried out to study the effect of distraction and osteogenesis. The three dimensional image provided clear and high resolution stereoscopic view that the effect of distraction osteogenesis could be evaluated easily and exactly. The fault image could be set up in private computer by Mimics and the measurements, such as distance, thickness and density, could be performed as expected. The effect of 12 cases was satisfied, and the average distracted distance was 16.73 mm. Basing on multislice helical CT scanning, the high resolution image reconstruction and relative measurement data could be obtained which could meet the need of clear and direct observation. Its application in the maxillofacial distraction osteogenesis is expecting and promising.

  17. A low-cost method of craniofacial distraction osteogenesis.

    PubMed

    Greyvensteyn, Gerhardus A; Madaree, Anil

    2016-03-01

    Distraction osteogenesis is an effective treatment modality for the correction of craniofacial deformities. The cost of these devices is significant and may preclude routine use of these distractors in developing countries. Hence, distraction osteogenesis was performed using medical equipment that was readily available in any hospital at minimal cost. From 2008 to 2013, a retrospective study was performed on infants and neonates who underwent primary distraction for craniofacial abnormalities. Midface or mandibular distraction was performed because of respiratory impairment and/or globe exposure. The apparatus used included Steinmann pins, stainless steel wires, attachment bolts, orthopaedic pulleys, string and intravenous bags for weights. For midface distraction, a transzygomatic pin was inserted, and a transmandibular pin or a cerclage wire was inserted into the mandible through the symphysis or body of the mandible and connected to the pulley system. Distraction osteogenesis was performed on five patients - three mandibular distractions (Pierre Robin sequence) and two transfacial distractions (Apert syndrome/Pfeiffer syndrome type III). The mean age, duration of distraction and duration of consolidation at the time of distraction was 60.5 days, 18.6 days and 16.4 days, respectively. The mean length of distraction achieved was 12 mm. Common complications observed were pin loosening, pressure necrosis of the skin and uneven pull. A major disadvantage was the longer hospital stay required. The African method of distraction is effective, easy and cost effective and could be used in third-world hospitals where surgical expertise or expensive distraction sets are not freely available. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  18. Deferoxamine Expedites Consolidation during Mandibular Distraction Osteogenesis

    PubMed Central

    Donneys, Alexis; Deshpande, Sagar S.; Tchanque-Fossuo, Catherine N.; Johnson, Kelsey L.; Blough, Jordan T.; Perosky, Joseph E.; Kozloff, Kenneth M.; Felice, Peter A.; Nelson, Noah S.; Farberg, Aaron S.; Levi, Benjamin; Buchman, Steven R.

    2014-01-01

    Background A limitation of mandibular Distraction Osteogenesis (DO) is the length of time required for consolidation. This drawback subjects patients to possible pin-site infections, as well as a prolonged return to activities of normal daily living. Developing innovative techniques to abridge consolidation periods could be immensely effective in preventing these problematic morbidities. Deferoxamine (DFO) is an angiogenic activator that triggers the HIF-1α pathway through localized iron depletion. We previously established the effectiveness of DFO in enhancing regenerate vascularity at a full consolidation period (28 days) in a murine mandibular DO model. To investigate whether this augmentation in vascularity would function to accelerate consolidation, we progressively shortened consolidation periods prior to μCT imaging and biomechanical testing (BMT). Materials and Methods Three time points (14d, 21d and 28d) were selected and six groups of Sprague-Dawley rats (n=60) were equally divided into control (C) and experimental (E) groups for each time period. Each group underwent external fixator placement, mandibular osteotomy, and a 5.1mm distraction. During distraction, the experimental groups were treated with DFO injections into the regenerate gap. After consolidation, mandibles were imaged and tension tested to failure. ANOVA was conducted between groups, and p < 0.05 was considered statistically significant. Results At 14 days of consolidation the experimental group demonstrated significant increases in Bone Volume Fraction (BVF), Bone Mineral Density (BMD) and Ultimate Load (UL) in comparison to non-treated controls. The benefit of treatment was further substantiated by a striking 100% increase in the number of bony unions at this early time-period (C:4/10 vs. E:8/10). Furthermore, metrics of BVF, BMD, Yield and UL at 14 days with treatment demonstrated comparable metrics to those of the fully consolidated 28d control group. Conclusion Based on these

  19. Cisplatin Inhibits Bone Healing During Distraction Osteogenesis

    PubMed Central

    Stine, Kimo C.; Wahl, Elizabeth C.; Liu, Lichu; Skinner, Robert A.; Schilden, Jaclyn Vander; Bunn, Robert C.; Montgomery, Corey O.; Suva, Larry J.; Aronson, James; Becton, David L.; Nicholas, Richard W.; Swearingen, Christopher J.; Lumpkin, Charles K.

    2014-01-01

    Osteosarcoma (OS) is the most common malignant bone tumor affecting children and adolescents. Many patients are treated with a combination of chemotherapy, resection, and limb salvage protocols. Surgical reconstructions after tumor resection include structural allografts, non-cemented endoprostheses, and distraction osteogenesis (DO), which require direct bone formation. Although cisplatin (CDP) is extensively used for OS chemotherapy, the effects on bone regeneration are not well studied. The effects of CDP on direct bone formation in DO were compared using two dosing regimens and both C57BL/6 (B6) and tumor necrosis factor receptor 1 knockout (TNFR1KO) mice, as CDP toxicity is associated with elevated TNF levels. Detailed evaluation of the five dose CDP regimen (2mg/kg/day), demonstrated significant decreases in new bone formation in the DO gaps of CDP treated versus vehicle treated mice (P<0.001). Further, no significant inhibitory effects from the 5 dose CDP regimen were observed in TNFR1KO mice. The two dose regimen significantly inhibited new bone formation in B6 mice. These results demonstrate that CDP has profound short term negative effects on the process of bone repair in DO. These data provide the mechanistic basis for modeling peri-operative chemotherapy doses and schedules and may provide new opportunities to identify molecules that spare normal cells from the inhibitory effects of CDP. PMID:24259375

  20. Effects of rapid distraction rate on new bone formation during mandibular distraction osteogenesis in goats.

    PubMed

    Long, Jie; Tang, Wei; Fan, Yu-bo; Tian, Wei-dong; Feng, Fan; Liu, Lei; Zheng, Xiao-hui; Jing, Wei; Wu, Ling

    2009-08-01

    Distraction osteogenesis typically requires a long treatment period, which can lead to bone and soft-tissue infection and considerable patient discomfort. Use of a rapid distraction rate in craniofacial distraction osteogenesis to shorten the distraction period is possible owing to the unique characteristics of craniofacial bones, including an abundant blood supply and rapid bone healing compared with long bones. The effects of using a rapid distraction rate in the treatment of craniofacial deformities are currently unclear, however. The objective of this study was to investigate the effects of a rapid distraction rate on new bone formation during mandibular distraction osteogenesis in goats. Sixteen goats were randomly divided into four groups consisting of four goats each. In Groups A, B, and C, the right mandible of each goat was distracted at a rate of 0.8mm/d, 1.6mm/d, and 2.0mm/d, respectively; Group D was the control group and did not undergo distraction. Six weeks after the conclusion of distraction, bone densitometry and three-point bending testing were performed in all groups. The mean bone density value of goats in Group A was significantly higher than those of all the other groups (p<0.05), and the mean bone density value of goats in Group C was significantly lower than those of all the other groups (p<0.05). The mean curve slope, peak stress, bending modulus, and energy to failure values of Groups A, B, and C were all significantly lower than those of the control group (p<0.05). As the distraction rate increased, the curve slope and peak stress values gradually declined (p<0.05). Use of a rapid distraction rate in mandibular distraction osteogenesis may have detrimental effects on the quality of new bone, despite the abundant blood supply of craniofacial bones.

  1. Distraction osteogenesis of the porcine mandible: histomorphometric evaluation of bone.

    PubMed

    Glowacki, Julie; Shusterman, E Mark; Troulis, Maria; Holmes, Ralph; Perrott, David; Kaban, Leonard B

    2004-02-01

    Distraction osteogenesis is a technique for skeletal lengthening that exploits the body's innate capacity for bone formation in response to tension forces on the repair callus. The authors developed a distraction osteogenesis model with a semiburied device in the Yucatan minipig mandible because of similarities between human and porcine mandibular anatomy, temporomandibular function, chewing patterns, and bone turnover rates. The purpose of this study was to measure histomorphometric bone fill after different latency periods, rates of distraction, and duration of neutral fixation in the minipig mandible. In addition, the relationship between histomorphometric bone fill and clinical stability was investigated. Mandibular osteotomies in 20 female Yucatan minipigs weighing 25 to 30 kg were distracted with modified semiburied distraction devices. Variables included 0-day or 4-day latency; 1-mm, 2-mm, or 4-mm daily distraction rates; gap size of 7 or 12 mm; and evaluation after neutral fixation for various lengths of time. Specimens were fixed in 2% paraformaldehyde, pH 7.4, before being embedded in methylmethacrylate. Sections were prepared from the region just below the inferior alveolar canal. The area of new bone formation within the gap was measured and expressed as a percentage of the total area of the distraction gap. Bone fill ranged from 0 to 100 percent. A pilot study with 7-mm advancements showed similar bone fill with 0-day or 4-day latency, but with poor reproducibility. Mandibles that were distracted to 12 mm at 1 mm per day exhibited nearly complete bone fill, either with 0-day latency (average, 93 percent) or 4-day latency (average, 100 percent). Mandibles that had been distracted for 3 days at 4 mm per day showed moderate osteogenesis and clinical stability with increasing time of neutral fixation. Bone fill was significantly correlated with clinical stability (Spearman r = 0.801, p = 0.001). Histological examination showed exuberant periosteal

  2. Simultaneous sinus lifting and alveolar distraction of the atrophic maxillary alveolus for implant placement: a preliminary report.

    PubMed

    Kim, Su-Gwan; Mitsugi, Masaharu; Kim, Byung-Ock

    2005-12-01

    This article describes a procedure for performing simultaneous sinus lifting and alveolar distraction to augment an atrophic maxillary alveolus. This technique is a 1-stage operation that is indicated when the amount of native sinus floor bone is minimal (<5 mm). The technique is contraindicated when there is <2 mm of sinus floor,when a 2-stage operation is needed (sinus lifting, alveolar distraction osteogenesis). Postoperative complications are minimal.

  3. Alveolar ridge augmentation using distraction osteogenesis: a clinical trial

    PubMed Central

    Shukla, Anand; Singh, Saumyendra V; Kumar, Sumit; Mehrotra, Divya; Mohammad, S; Singh, Stuti

    2012-01-01

    Background Severely resorbed ridges present a great challenge to prosthodontic rehabilitation. Available reconstructive options include autologous/alloplastic augmentation with questionable results, or regeneration of new bone under gradual and controlled tension using distraction osteogenesis. This study focused on use of distraction osteogenesis for the treatment of vertically deficient alveolar ridges to assess its feasibility and outcome. Materials and Methods Alveolar distraction osteogenesis (ADO) was studied at 10 different intra-oral, partial or complete edentulous sites. After a latency period of 5 days, distraction was carried out for 6–7 days at the rate of 0.5 mm every 12 hours (1 mm/day). Distractor was removed after a consolidation period of 12 weeks. Results The mean height gained at the 10 intra-oral sites was 4.8 mm with standard deviation of ± 0.056. The mean follow-up period was 2 years. Complications of therapy included hardware failure, wound gape and extra-oral scar. The overall complication rate was 10%. Conclusion Distraction osteogenesis is a promising option to aid uneventful prosthodontic rehabilitation of severe vertically resorbed alveolar ridges. PMID:25756028

  4. Alveolar reconstruction by distraction osteogenesis under unfavorable conditions.

    PubMed

    Kashiwa, Katsuhiko; Kobayashi, Seiichiro; Honda, Takayuki; Nasu, Wakako

    2010-11-01

    We present a patient who underwent alveolar reconstruction using vertical mandibular lengthening by distraction osteogenesis under unfavorable conditions. Part of the alveolar bone in the center of the mandible was resected, together with a squamous cell carcinoma located on the oral floor. We used vertical mandibular lengthening from the region of the remaining mandible inferior to the bony defect to reconstruct the alveolus, combined with a free musculocutaneous flap as a cover. However, the transferred flap underwent complete necrosis and was replaced with another flap on the seventh postoperative day. Radiotherapy at a total dose of 50 Gy was administered from day 75 to day 109 after completion of the distraction, because of suspected residual tumor. Despite the severe conditions, most of the distraction gap became filled with new bone. This case indicates that distraction osteogenesis can be used even in irradiated or poorly vascularized areas, as in our patient.

  5. Metatarsal lengthening by distraction osteogenesis: a report of two cases.

    PubMed

    Saxby, T; Nunley, J A

    1992-01-01

    Two cases of lengthening of metatarsals by distraction osteogenesis are reported. One of these cases is an acquired deformity of the first metatarsal; the other is a congenital short fourth metatarsal. By following the principles set forth by Ilizarov, it was possible to lengthen the metatarsal bones and surrounding soft tissues without open lengthening of tendons or secondary bone grafting of the distraction gap. We believe this method is an improvement over previously described methods of metatarsal lengthening.

  6. Evaluation of the mechanical environment during distraction osteogenesis.

    PubMed

    Waanders, N A; Richards, M; Steen, H; Kuhn, J L; Goldstein, S A; Goulet, J A

    1998-04-01

    Physical forces have been hypothesized to direct the process of bone regeneration during distraction osteogenesis. However, despite significant clinical experience, relatively little is known about how the mechanics of distraction influence bone formation. This study investigated net fixator forces and strains in the distraction callus during bilateral lengthening of tibiae in New Zealand White rabbits. Distractions yielded a classic viscoelastic response with a sharp increase in fixator force, followed immediately by significant relaxation. Tension acting on mesenchymal gap tissue caused by distraction was estimated to reach more than 30 N by the time full lengthening was achieved. Average maximum cyclic strains within the distraction zone during ambulation were estimated to be 14% to 15% and supported by the results of fluoroscopic imaging. Paradigms for fracture healing have hypothesized that such strains are incompatible with new bone formation. The documented clinical success of distraction osteogenesis at stimulating large volumes of new bone suggests that other mechanisms that warrant additional investigation may be at work during distraction.

  7. [The effect of bone morphogenetic protein-2 and osteoprotegerin in trans-sutural distraction osteogenesis].

    PubMed

    Yao, Yusheng; Huang, Hua; Chang, Shimin; Wang, Chengyue; Wang, Guijun

    2012-08-01

    To determine if locally administered bone morphogenetic protein-2 (BMP-2) and osteoprotegerin (OPG) improved osteogenesis and new bone formation by trans-sutural distraction osteogenesis. Twenty four dogs were divided into three groups randomly and received new internal trans-sutural distraction osteogenesis treatment. Five days after operation, infusion apparatus with double-tube was inserted to submucosa near the distracted zone to deliver controlled release agent of recombinant human bone morphogenetic protein-2/poly (lactic-co-glycolic acid)/fibrin sealant (rhBMP-2/PLGA/FS) in group A and group C. Recombinant human osteoprotegerin/fibrin sealant (rhOPG/ FS) was injected three weeks later in group B and group C. Histology staining and bone histomorphometry were used to measure the changes of maxillary bone sutura after distraction for 1, 2, 4 and 6 weeks. New bone formation observed in distracted zone showed a significant increase in group A and C. Transmission electron microscope showed the osteoblast and osteocyte were active with dilated rough endoplasmic reticulum and a large number of chondriosomes and Golgi complex. After distraction for 6 weeks, indexes of osteoblast of group A, B, and C were 38.5 +/- 7.7, 35.7 +/- 6.5, and 41.7 +/- 11.0, indexes of osteoclast (Ioc) were 5.9 +/- 1.0, 1.2 +/- 0.3, and 2.8 +/- 0.4, bone trabecula thicknesses were (38.36 +/- 13.28), (66.20 +/- 9.16), and (51.85 +/- 9.92) microm respectively. Increased bone density and decreased Ioc were found in group B and C. The new elastic distractor is effective in inducing new bone formation. BMP-2 and OPG combination acts synergistically, and leads to significant enhancement of bone formation and remodeling.

  8. Relationships between tissue dilatation and differentiation in distraction osteogenesis.

    PubMed

    Morgan, Elise F; Longaker, Michael T; Carter, Dennis R

    2006-03-01

    Mechanical factors modulate the morphogenesis and regeneration of mesenchymally derived tissues via processes mediated by the extracellular matrix (ECM). In distraction osteogenesis, large volumes of new bone are created through discrete applications of tensile displacement across an osteotomy gap. Although many studies have characterized the matrix, cellular and molecular biology of distraction osteogenesis, little is known about relationships between these biological phenomena and the local physical cues generated by distraction. Accordingly, the goal of this study was to characterize the local physical environment created within the osteotomy gap during long bone distraction osteogenesis. Using a computational approach, we quantified spatial and temporal profiles of three previously identified mechanical stimuli for tissue differentiation-pressure, tensile strain and fluid flow-as well as another candidate stimulus-tissue dilatation (volumetric strain). Whereas pressure and fluid velocity throughout the regenerate decayed to less than 31% of initial values within 20 min following distraction, tissue dilatation increased with time, reaching steady state values as high as 43% strain. This dilatation created large reductions and large gradients in cell and ECM densities. When combined with previous findings regarding the effects of strain and of cell and ECM densities on cell migration, proliferation and differentiation, these results indicate two mechanisms by which tissue dilatation may be a key stimulus for bone regeneration: (1) stretching of cells and (2) altering cell and ECM densities. These results are used to suggest experiments that can provide a more mechanistic understanding of the role of tissue dilatation in bone regeneration.

  9. Reconstruction of a neocondyle using transport distraction osteogenesis.

    PubMed

    Stucki-McCormick, S U; Fox, R M; Mizrahi, R D

    1999-03-01

    The process of slow bone expansion by distraction osteogenesis in conjunction with functional remodeling can also be used for the reconstruction of a neomandible and neocondyle. This is the technique of transport distraction osteogenesis. A transport disc is surgically created adjacent to the area of a discontinuity defect, and the transport disc is advanced by the process of distraction osteogenesis, using the Ilizarov principles. The mandible therefore acts as the bony template for reconstruction such that the neomandible created from the distraction process has the same size and shape as the native mandible covered by gingiva. This allows for enhanced prosthetic reconstruction. A reverse-L osteotomy of the ramus can also be performed to create a transport disc to reconstruct a neocondyle. Because the leading edge of the transport disc becomes enveloped by a fibrocartilagenous cap, the ramal transport disc can be moved superiorly to create a new articulation. Patients are encouraged to open and close their mouths during the distraction process, such that the transport disc remodels to form a neocondyle. This technique was successfully used to treat patients with degenerative joint disease, condylar resorption, and bony ankylosis.

  10. Resorbable Plates Prevent Regression in Pediatric Mandibular Distraction Osteogenesis.

    PubMed

    Richland, Brandon Kikuo; Ellstrom, Christopher; Ahmad, Asim; Jaffurs, Daniel

    2017-05-01

    Mandibular distraction osteogenesis is an important technique to correct the pediatric hypoplastic mandible. Regression of the mandible after distraction continues to be a challenge, with some studies reporting up to 22% to 56% decrease toward predistraction length in the first year. We hypothesize that a resorbable plate placed after removal of the distractor will provide additional stability to newly formed bone, allowing further time for consolidation and minimizing regression. This is a retrospective review of neonatal and pediatric patients between 2010 and 2015 who had mandibular distraction osteogenesis performed by the senior author (D.J.). Five patients, including 1 control and 4 intervention subjects, who had preoperative, postdistraction, and follow-up imaging were evaluated. Mandibular distraction was performed via internal devices (KLS Martin, Jacksonville, Fla) and followed by a consolidation period of 6 to 8 weeks. At the second operation when the distractors were removed, the intervention group had a SonicWeld Resorbx (KLS Martin) resorbable plate placed across the bone regenerate. A digital imaging and communications in medicine viewer was used to create a 3-dimensional reconstruction of each of the computed tomography scans and measurements of the mandible were made in the lateral cephalometric view. We then determined distraction distance, regression distance and percent regression. The average mandible distraction distance was 8.2 mm for the control group, and 9.9 mm for the intervention group (range, 6.7-12 mm). The average distance that the mandible regressed after distraction (regression distance) was 2.7 mm for the control group, and 0.5 mm for the intervention group (range, 0.2-0.9 mm). The average percent regression was 32.9% for the control group, and 5.1% for the intervention group (range 1.8 to 7.5%). The results of this study suggest that resorbable plate placement after removal of distractors helps prevent regression in pediatric

  11. Distraction osteogenesis: role and clinical applications in the maxillofacial region.

    PubMed

    Nuntanaranont, Thongchai

    2008-06-01

    Distraction osteogenesis or callostasis is a technique of new bone formation by gradual separation of bony fragments. The method was first developed for limb lengthening but recently this process was widely applied to the cranio-maxillofacial bones. The application included unlimited bone lengthening and reconstruction of segmental defects. Several designs of extra-oral and intra-oral distraction devices were invented to suit different areas of craniofacial bone. Nevertheless intraoral distractors have several advantages including minimal scarring and being less cumbersome. Clinical cases using distraction osteogenesis as an alternative treatment to conventional surgical procedures for maxillo-mandibular lengthening and reconstruction of alveolar segmental defects after tumour resection before implant installation are presented and discussed.

  12. Satisfaction audit of patients undergoing mandibular distraction osteogenesis with extra-oral distraction appliances.

    PubMed

    Datta, Renu; Utreja, Ashok; Singh, S P; Rattan, Vidya

    2015-06-01

    The aim of this research was to evaluate the level of satisfaction of patients who were undergoing distraction osteogenesis of mandible with extraoral distraction appliance. The prospective study was performed on 13 patients with facio-mandibular deformity reporting to the Oral Health Sciences Center, PGIMER, Chandigarh, India, who required surgical and orthodontic intervention for correction. A standardized multiple choice questionnaire was provided to all patients at 3 stages of treatment i.e. during predistraction, distraction and post distraction period. Predistraction evaluation showed that the main reason for patients to seek treatment was lack of facial esthetics and all of them were sure that there would be a change in their lives after they underwent this treatment procedure. During distraction phase the most common complaint was pain. None of the patients felt that they were suffering during active distraction phase and all felt that they made the right decision. In post distraction phase, all patients were satisfied with the treatment and felt that the treatment was worth it. Twelve out of 13 patients would recommend treatment to others without any hesitation. Our study concludes that distraction osteogenesis of the mandible with extra-oral appliances is acceptable to patients, and improved facial appearance is a positive influence. The appliance and results of the procedure are socially accepted and appreciated.

  13. Anesthesia for maxillary and mandibular osteotomies in osteogenesis imperfecta.

    PubMed Central

    Rodrigo, C.

    1995-01-01

    A 21-yr-old female suffering from osteogenesis imperfecta was anesthetized for correction of maxillary and mandibular deformities that had restricted her chewing. Preoperative assessment revealed a difficult intubation, restrictive lung disease secondary to bony deformities, and multiple repairs of fractures. Management of anesthesia for this operation--which is very rarely carried out in this disorder--is described along with a review of the problems of anesthesia associated with osteogenesis imperfecta. PMID:8934957

  14. Masticatory mechanics of a mandibular distraction osteogenesis site: interfragmentary micromovement.

    PubMed

    Sun, Zongyang; Rafferty, Katherine L; Egbert, Mark A; Herring, Susan W

    2007-08-01

    Micromovement at a fracture or distraction osteogenesis (DO) site may play a significant role in bone formation and healing. Mastication is an important physiological process that can cause substantial micromovement at a mandibular disjunction. The purpose of this study is to characterize and quantify the micromovement caused by mastication. Eighteen pigs, divided into three groups based on duration of consolidation, received a unilateral (right) mandibular angle distraction osteogenesis protocol. Differential variable reluctance transducers (DVRTs) and ultrasound crystals were used to measure the change of gap width as well as interfragmentary movement during mastication. Synchronized chewing video and interfragmentary movement recordings were used to determine the magnitude and direction of micromovement at different phases of the chewing cycle. The magnitude of micromovement did not increase significantly with distraction up to almost 5 mm, but did decrease gradually with consolidation. The average micromovement magnitude during the distraction phase was 0.2-0.3 mm, equaling 50,000-250,000 microstrain (muepsilon) on interfragmentary tissue. The dominant deformation pattern was bending in the sagittal plane. The most common direction of bending at the power stroke of chewing was concave dorsally, i.e., superior shortening and inferior lengthening. These findings elucidate how masticatory mechanics affect a mandibular distraction site, and the measurements may be useful for future simulation studies.

  15. Miniature osmotic actuators for controlled maxillofacial distraction osteogenesis

    NASA Astrophysics Data System (ADS)

    Li, Yu-Hsien; Su, Yu-Chuan

    2010-06-01

    We have successfully demonstrated miniature actuators that are capable of converting chemical potential directly into steady mechanical movements for maxillofacial distraction osteogenesis. Pistons and diaphragms powered by osmosis are employed to provide the desired linear and volumetric displacements for bone distraction and potentially the release of bone morphogenetic proteins, respectively. The cylindrical-shaped miniature actuators are composed of polymeric materials and fabricated by molding and assembly processes. In the prototype demonstration, vapor-permeable thermoplastic polyurethane was employed as the semi-permeable material. 3 cm long actuators with piston and diaphragm radii of 1 mm and 500 µm, respectively, were fabricated and characterized. The maximum distraction force from the piston-type actuator is found to be 6 N while the piston travels at a constant velocity of 32 µm h-1 (or 0.77 mm/day) for about 1 week. Meanwhile, the release rate from the diaphragm-type actuator is measured to be constant, 0.15 µl h-1 (or 3.6 µl/day), throughout the experiment. Moreover, the sizes and output characteristics of the self-regulating actuators could readily be tailored to realize optimal distraction rate, rhythm and osteogenic activity. As such, the demonstrated miniature osmotic actuators could potentially serve as versatile apparatuses for maxillofacial distraction osteogenesis and fulfill the needs of a variety of implantable and biomedical applications.

  16. Masticatory Mechanics of a Mandibular Distraction Osteogenesis Site: Interfragmentary Micromovement

    PubMed Central

    Sun, Zongyang; Rafferty, Katherine L.; Egbert, Mark A.; Herring, Susan W.

    2007-01-01

    Micromovement at a fracture or distraction osteogenesis (DO) site may play an important role in bone formation and healing. Mastication is an important physiological process that can cause substantial micromovement at a mandibular disjunction. The purpose of this study is to characterize and quantify the micromovement caused by mastication. Eighteen pigs, divided into three groups based on duration of consolidation, received a unilateral (right) mandibular angle distraction osteogenesis protocol. Differential variable reluctance transducers (DVRTs) and ultrasound crystals were used to measure the change of gap width as well as interfragmentary movement during mastication. Synchronized chewing video and interfragmentary movement recordings were used to determine the magnitude and direction of micromovement at different phases of the chewing cycle. The magnitude of micromovement did not increase significantly with distraction up to almost 5 mm, but did decrease gradually with consolidation. The average micromovement magnitude during the distraction phase was 0.2-0.3 mm, equaling 50,000-250,000 microstrain (με) on interfragmentary tissue. The dominant deformation pattern was bending in the sagittal plane. The most common direction of bending at the power stroke of chewing was concave dorsally, i.e. superior shortening and inferior lengthening. These findings elucidate how masticatory mechanics affect a mandibular distraction site, and the measurements may be useful for future simulation studies. PMID:17532283

  17. Distraction osteogenesis for ulnar lengthening in Kienbock’s disease

    PubMed Central

    Kawoosa, A. A.; Mir, M. R.; Butt, M. F.

    2006-01-01

    Ulnar lengthening is an accepted modality of treatment to achieve joint levelling in Kienbock’s disease. The conventional method of ulnar lengthening with a plate and bone graft is fraught with complications including graft site morbidity, non-union, hardware removal and difficulty in the achievement of a proper length. We used a Umex distractor to achieve distraction osteogenesis in a group of 12 patients and assessed them over an average follow-up period of 29.5 months. We had one excellent, ten good and one fair result. We conclude that distraction osteogenesis addresses all the complications of coventional lengthening in addition to providing an increase in the local blood supply, which might be beneficial in a disease that is primarily an avascular necrosis. This procedure addresses both the biomechanical and the biological aspects of this disease. PMID:16821009

  18. Mandibular symphyseal distraction osteogenesis: diagnosis and treatment planning considerations.

    PubMed

    Conley, Richard; Legan, Harry

    2003-02-01

    Treatment planning decisions in the transverse dimension have historically been based on the presenting mandibular arch width and form. Distraction osteogenesis (DO), originally developed by Russian orthopedic surgeon Ilizarov, has produced significant results in limb lengthening. Mandibular symphyseal DO was introduced by Guerrero, providing a new paradigm for patients whose treatment alternatives and results were previously limited. Orthodontic and surgical techniques and principles will be shown using completed and current cases.

  19. The histology of distraction osteogenesis using different external fixators.

    PubMed

    Aronson, J; Harrison, B H; Stewart, C L; Harp, J H

    1989-04-01

    The local biology of distraction osteogenesis using Ilizarov and Wagner external fixators was compared in unilateral tibial lengthenings in two groups of eight dogs. Serial roentgenograms with histological correlation revealed some basic similarities as well as distinct differences between the two groups. All dogs fully bridged the experimental gap by intramembranous ossification. Subtle histological changes in the alignment of collagen bundles and subsequent ossification reflected the mechanical configuration of each fixator. The multiplanar, full-pin Ilizarov system delivered concentric load to the site of osteogenesis, inducing perfectly parallel columns of new bone. The uniplanar, one-half pin Wagner system induced angulation of the collagen and subsequent bone columns on the basis of eccentric load to the osteogenic interface. Despite a significant difference in axial rigidity, the Ilizarov and Wagner external fixators induced osteogenesis of equal volume.

  20. Bone resorption and complications in alveolar distraction osteogenesis.

    PubMed

    Ettl, Tobias; Gerlach, Till; Schüsselbauer, Thomas; Gosau, Martin; Reichert, Torsten E; Driemel, Oliver

    2010-10-01

    Distraction osteogenesis presents an alternative procedure for augmentation of atrophic alveolar bone prior to inserting dental implants. The aim of this retrospective study was to evaluate complications of this method with specific focus on bone resorption during the consolidation period and the follow-up period after dental implant insertion into distracted bone. Thirty partially edentulous patients underwent a total of 36 vertical alveolar distractions with an extraosseous distraction system. Eleven devices were placed in the maxilla and 25 in the mandible. Eighty-two dental implants were inserted after a mean consolidation period of 4.5 months. Treatment results were evaluated by means of panoramic radiographs for distraction follow-up and periapical radiographs for implant follow-up. The mean length of the transport segment was 19 mm. The average alveolar height achieved was 6.4 mm with a mean resorption of 1.8 mm (21.1%) at the time of dental implant insertion. Main problems comprised oral displacement of the transport segment (n = 15) and inadequate soft tissue extension (n = 13). Eighty-two dental implants were inserted with an overall survival rate of 95.1% after 45.8 months. For periimplant marginal bone, an average resorption of 3.5 mm was recorded 50.4 months after implant insertion. Although alveolar distraction osteogenesis seems to be an effective tool to treat vertical defects of the alveolar ridge, it is not an uncomplicated procedure. A combination with vestibular augmentation of autogenous bone grafts should be considered. Overcorrection of 20% may compensate bone relapse during the consolidation period of the distracted alveolar bone. Further bone resorption after dental implantation is common.

  1. Inferior alveolar nerve regeneration after bifocal distraction osteogenesis in dogs.

    PubMed

    Isomura, Emiko Tanaka; Shogen, Yosuke; Hamaguchi, Munehiro; Harada, Takeshi; Tanaka, Noriaki; Kogo, Mikihiko

    2013-10-01

    Bifocal distraction osteogenesis has been shown to be a reliable method for reconstructing missing bone segments. However, no reports have been published regarding inferior alveolar nerve regeneration during this procedure. We assumed that the nerve could regenerate with the bone regeneration during bifocal distraction, if the nerve had been saved at a mesial site of the transport disc. In the present study, we investigated that possibility in dogs. Using a bifocal distraction osteogenesis method, we produced a 10-mm mandibular defect, including the nerve defect, and distracted the transport disc at a rate of 1 mm/day in 12 dogs. The nerve was saved at the mesial site of the transport disc. The regenerated nerve was evaluated by a jaw opening reflex examination performed once daily. Histologic examinations with hematoxylin-eosin and immunohistochemical staining with neurofilament and S-100 antibody were also performed on all dogs after death at 3, 6, and 12 months after the first operation. The jaw opening reflex had recovered in all dogs. The average period of recovery was 109.5 ± 24.7 days. On histologic examination, although consecutive nerves were observed in all areas, cellular nerve fascicles were seen, consistent with wallerian degeneration at 3 and 6 months in the nerve connection area on the distal side of the transport disc. Our results have indicated that inferior alveolar nerve regeneration after bifocal distraction osteogenesis is successful in dogs. Although our research is still at the stage of animal experiments, future application in humans can be considered to be possible. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Distraction osteogenesis for correction of post ankylosis mandibular deformities.

    PubMed

    Khan, Ahmed; Fareed, Wamiq Musheer; Tandon, Parul; Zafar, Muhammad Sohail

    2015-07-01

    Temporomandibular joint ankylosis, a debilitating disease mainly affecting children, is characterized by progressive restriction of mouth opening and maxilla-mandibular developmental deformities. Craniofacial distraction osteogenesis has been developed as a standard surgical strategy for rectification of craniofacial deformities. The purpose of this study was to assess mono-planar distraction devices for the correction of various mandibular asymmetries in patients with unilateral temporomandibular joint ankylosis who developed restricted mouth opening and mandibular retrognathia. All patients were treated using one-stage distraction osteogenesis followed by temporalis fascia interpositional arthroplasty under general anesthesia. A significant increase in mandibular ramus and base length was observed. Although an increase in anterior lower facial height was observed, it was not significant statistically. A decrease in posterior lower facial height and corpus was observed. Oblique distraction with angular osteotomy allowed lengthening of both the ramus and corpus, yielding satisfactory results and hence eliminating the need of secondary surgery. In conclusion, univector internal distractors are effective for correction of multi-planar mandibular deficiencies by optimizing its placement through meticulous planning.

  3. Molecular signaling in bone fracture healing and distraction osteogenesis.

    PubMed

    Liu, Z; Luyten, F P; Lammens, J; Dequeker, J

    1999-04-01

    The process of fracture healing has been described in detail in many histological studies. Recent work has focused on the mechanisms by which growth and differentiation factors regulate the fracture healing process. Rapid progress in skeletal cellular and molecular biology has led to the identification of many signaling molecules associated with the formation of skeletal tissues, including members of the transforming growth factor-beta (TGF-beta) superfamily and the insulin-like growth factor (IGF) family. Increasing evidence indicates that they are critical regulators of cellular proliferation, differentiation, extracellular matrix biosynthesis and mineralization. Limb lengthening procedure (distraction osteogenesis) is a relevant model to investigate the in vivo correlation between mechanical stimulation and biological responses as the callus is stretched by a proper rate and rhythm of mechanical strain. This model also provides additional insights into the molecular and cellular events during bone fracture repair. TGF-beta 1 was significantly increased in both the distracted callus and the fracture callus. The increased level of TGF-beta 1, together with a low concentration of calcium and an enhanced level of collagen synthesis, was maintained in the distracted callus as long as mechanical strain was applied. Less mineralization is also associated with a low level of osteocalcin production. These observations provide further insights into the molecular basis for the cellular events during distraction osteogenesis.

  4. Development and evolution of distraction devices: Use of indigenous appliances for Distraction Osteogenesis-An overview

    PubMed Central

    Andrade, Neelam; Gandhewar, Trupti; Kalra, Rinku

    2011-01-01

    An attempt has been made to review various devices as well as the outstanding studies done in the past for understanding the methodology of distraction for regeneration of bone. Lengthening of underdeveloped bones inclusive of the maxillofacial complex has been obtained by distraction osteogenesis by many authors. This could be achieved by the use of various extraoral or intraoral devices. Devices used for distraction osteogenesis must have a minimum of 2 important characteristics – they should be able to transfer distraction forces directly to the bone and secondly, should offer adequate rigidity for osseous consolidation to occur. With advanced technology and biomechanical engineering, preformed intraoral distraction devices are now available worldwide. The introduction of these intraoral bone-bourne devices have eliminated the need for bulky, cumbersome extraoral distraction devices which had problems such as external scars, pin tract infections, nerve or tooth bud injuries and poor patient compliance. The design of completely internalized custom made appliance has opened new vistas in the field of Oral and Maxillofacial Surgery. Indigenous internal devices are also economical and locally available. PMID:23482829

  5. [Rational use of distraction osteogenesis in craniofacial surgery].

    PubMed

    Guerreschi, P; Wolber, A; Bennis, Y; Vinchon, M; Martinot-Duquennoy, V

    2016-10-01

    Distraction osteogenesis, initially developed by Ilizarov for limb, is the tissular extension caused by the progressive space of the osseous pieces following an osteotomy. Distraction is osteogenesic and histogenic. Twenty-five years ago, at the instigation of McCarthy, this technique was used to handle the craniofacial malformations in the various floors of the face : mandibular, mediofacial and cranial. The most wide-spread protocols respect a latency period from 0 to 7 days, a rhythm of distraction from 1 to 2mm a day in 2 at 4 times and a period of consolidation from 4 to 8 weeks. Distraction is the result of the inventiveness of the pioneers then the work to always adapt to the multiple complex clinical situations. The surgeon has to choose between internal or external materials allowing a mono- or multi-vectorial extension, in osseous and/or dental anchoring. The mandibular distraction is very effective for the treatment of the secondary obstructive syndromes in the unilateral or bilateral severe hypomandibular malformations. She also allows desobstruction of the superior airways within the framework of the mediofacial hypoplasies as well as the secondary treatment of the growth defects in cleft lips and palates. Finally, the distraction osteogenesis enhanced reliability of the fronto-facial advancement in early and secondary treatment of craniofaciosynostosis. This is a real support of the facial growth, which has to be included in a plan of global treatment. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  6. Craniofacial Stability in Patients With Crouzon or Apert Syndrome After Le Fort III Distraction Osteogenesis.

    PubMed

    Reitsma, Jacobus H; Ongkosuwito, Edwin M; Buschang, Peter H; Adrichem, Léon N A V; Prahl-Andersen, Birte

    2013-09-01

    Objective : Le Fort III osteotomy with distraction osteogenesis (DO) is used to improve the retruded midface in patients with Crouzon or Apert syndrome. This study aimed to evaluate sagittal and vertical preoperative and postoperative cephalometric changes of DO of the midface in patients with Crouzon or Apert syndrome. Design : Population-based case-control study. Patients and Methods : Records of patients with the syndrome of Crouzon (N = 6) or Apert (N = 7) were compared, before and after Le Fort III DO, with a nonsyndromic untreated control group (N = 486). Main Outcome Measures : Sagittal and vertical cephalometric maxillary landmarks and measurements were used to predict and measure midface advancement and rotation after Le Fort III DO. Cephalograms were taken before surgery (T0), 4 months after surgery at removal of the distraction device (T1), and 1 year after removal of the distraction device (T2). Analysis : Z scores were performed to compare cephalometric measures of syndromic patients with control subjects. Results : Cephalograms of 13 patients with Crouzon syndrome (N = 6) or Apert (N = 7) (age range 8.2 to 19.8 years) were evaluated. Treatment changes (T1-T2) showed statistically significant maxillary advancement, with no significant differences between the patients with the Crouzon or Apert syndrome. Conclusions : DO of the midface in patients with Crouzon or Apert syndrome seems to be stable in the sagittal direction after follow-up. Although Crouzon and Apert differ after DO, anteroposterior craniofacial dimensions were significantly improved and were closer to patterns of normal subjects.

  7. Treatment of Micrognathia by Intraoral Distraction Osteogenesis: A Prospective Study

    PubMed Central

    Baskaran, M.; Arularasan, S. Gidean; Divakar, T. K.; Thirunavukkarasu, Rohini

    2017-01-01

    Purpose: Maxillofacial deformities are always psychologically and physically distressing to the patients and is also challenging to the treating surgeons. The term Micrognathia means a “small jaw”. True micrognathia, where the maxilla or the mandibular skeleton does not grow to the full size can be congenital or acquired. Distraction osteogenesis also called as callus distraction or callostasis or osteodistraction or distraction histogenesis is a biological process of regenerating newly formed bone and adjacent soft tissue by a gradual and controlled traction of surgically separated bone segments. The purpose of this prospective study was to assess the versatility of distraction osteogenesis in the treatment of micrognathia. Materials and Methods: Four patients (three males and one female) with micrognathia of mandible were included in this prospective study. The patients were between the age group of 10-20 years. Facial asymmetry was the chief complaint of all the patients. In all the patients following treatment protocol was carried out, Osteotomy and placement of intraoral distraction device under general anaesthesia, latency phase (5-7 days), activation period-rate 1.5 mm per day, consolidation period of 8 weeks, removal of distraction device under local anaesthesia. The parameters assessed were ramus height, body length, hyo mental distance, posterior pharyngeal airway space, chin projection, facial symmetry occlusion, mid line shift pre and post operatively. Results: The mean increase in ramus height achieved was 9.2 + 2.17 mm and the mandibular body length achieved was 10.4+1.67 mm. There was an average increase in hyo-mental distance of 2.75 cm +0.9 cm postoperatively showing a definitive improvement in the airway. The posterior pharyngeal space measured from the lateral cephalogram preoperatively ranged from 3-6 mm and post operatively from 6-9 mm.Intraorally there was a shift in occlusion to class I molar relation in three patients and there was

  8. Treatment of Micrognathia by Intraoral Distraction Osteogenesis: A Prospective Study.

    PubMed

    Baskaran, M; Arularasan, S Gidean; Divakar, T K; Thirunavukkarasu, Rohini

    2017-01-01

    Maxillofacial deformities are always psychologically and physically distressing to the patients and is also challenging to the treating surgeons. The term Micrognathia means a "small jaw". True micrognathia, where the maxilla or the mandibular skeleton does not grow to the full size can be congenital or acquired. Distraction osteogenesis also called as callus distraction or callostasis or osteodistraction or distraction histogenesis is a biological process of regenerating newly formed bone and adjacent soft tissue by a gradual and controlled traction of surgically separated bone segments. The purpose of this prospective study was to assess the versatility of distraction osteogenesis in the treatment of micrognathia. Four patients (three males and one female) with micrognathia of mandible were included in this prospective study. The patients were between the age group of 10-20 years. Facial asymmetry was the chief complaint of all the patients. In all the patients following treatment protocol was carried out, Osteotomy and placement of intraoral distraction device under general anaesthesia, latency phase (5-7 days), activation period-rate 1.5 mm per day, consolidation period of 8 weeks, removal of distraction device under local anaesthesia. The parameters assessed were ramus height, body length, hyo mental distance, posterior pharyngeal airway space, chin projection, facial symmetry occlusion, mid line shift pre and post operatively. The mean increase in ramus height achieved was 9.2 + 2.17 mm and the mandibular body length achieved was 10.4+1.67 mm. There was an average increase in hyo-mental distance of 2.75 cm +0.9 cm postoperatively showing a definitive improvement in the airway. The posterior pharyngeal space measured from the lateral cephalogram preoperatively ranged from 3-6 mm and post operatively from 6-9 mm.Intraorally there was a shift in occlusion to class I molar relation in three patients and there was posterior open bite in one patient. Marked

  9. Morphofunctional and clinical study on mandibular alveolar distraction osteogenesis.

    PubMed

    Zaffe, Davide; Bertoldi, Carlo; Palumbo, Carla; Consolo, Ugo

    2002-10-01

    Alveolar Distraction Osteogenesis (ADO) is a process which forms new alveolar bone to correct alveolar deformities in ridge height and width. This work aims (a). to verify the predictability of the augmentation of height of atrophic alveolar ridges using an extra-alveolar distraction device and (b). to study the bone processes in order to optimize implanto-prosthetic rehabilitation. ADO was performed on 10 patients with ridge deformities to obtain the required ridge augmentation. Clinical and radiological (OPT and CT with densitometric assay) evaluations were carried out during the following 12 weeks, before implant insertion. Biopsies at 40, 60 and 88 days were studied after general, specific and histochemical staining of slides; microradiographs were analyzed to evaluate the Trabecular Bone Volume. Forty days after the end of distraction, soft callus indicated the start of ossification. Sixty days after the end of distraction, the soft callus was largely converted into a network of trabecular woven bone; osteogenic activity was high and TBV was about 50%. Eighty-eight days after the end of distraction, the amount of bone appeared reduced, with a more ordered structure; bone formation activity and TBV also diminished, whereas osteoclast erosion was active. The densitometric assay shows values increasing from the end of distraction, particularly after implant insertion. Histological results show a regression in bone deposition processes 88 days after the end of distraction culminating in a virtual steady-state after a certain time. The results suggest that early implant insertion may be desirable to avoid bone loss due to mechanical unloading.

  10. Condylar cartilaginous changes after mandibular distraction osteogenesis in rabbits.

    PubMed

    Ahn, Sin-Young; Kim, Su-Gwan

    2011-10-01

    The purpose of this study was to evaluate histologic and immunohistochemical changes in the condylar articular surface in response to distraction osteogenesis (DO) of the mandibular body in rabbits. A unilateral osteotomy of the mandible at the premolar area was performed in 16 rabbits. The animals were divided into 4 groups based on different distraction parameters (rate and rhythm). After a 5-day latency, the mandible was lengthened by 0.5 mm daily for 6 days (group 1); 0.5 mm twice daily for 3 days (group 2); 0.5 mm once daily for 10 days (group 3); or 0.5 mm twice daily for 5 days (group 4). All 4 groups underwent a 14-day consolidation period. Four rabbits were included in the control group. The specimens were stained with hematoxylin-eosin for histologic examination. Immunohistochemical analysis was performed to evaluate the expression of growth factors. None of the groups demonstrated any degenerative changes in the temporomandibular joint (TMJ). On the distraction side in all groups, the histopathological examination revealed a hypertrophic thickening of the cartilage zone. Prominent endochondral ossification and high active osteoblasts were observed in groups 3 and 4. On the nondistraction side, no major changes were observed excluding the appearance of osteoclasts in groups 3 and 4. The immunohistochemical analysis revealed tenascin immunoreactivity in bone marrow mesenchymal cells on the distraction side in group 4. Connexin immunoreactivity did not display a marked change in any of the groups. Osteocalcin was observed on the distraction side in group 2, which suggested that bone formation is increased. Nitric oxide synthase 2 immunoreactivity was observed on the distraction side in group 2, which is associated with stress and inflammation. The results indicated that the hypertrophy of the cartilage zone and endochondral ossification became more pronounced as the extent and rate of distraction increased. Copyright © 2011 Mosby, Inc. All rights reserved.

  11. An Algorithm for Managing Syndromic Craniosynostosis Using Posterior Vault Distraction Osteogenesis.

    PubMed

    Swanson, Jordan W; Samra, Fares; Bauder, Andrew; Mitchell, Brianne T; Taylor, Jesse A; Bartlett, Scott P

    2016-05-01

    The authors hypothesize that early posterior vault distraction osteogenesis safely confers considerable cranial vault remodeling, sufficient to enable fronto-orbital advancement to be delayed to a later age, with improved outcomes. The authors conducted a retrospective cohort study of children with syndromic craniosynostosis treated before (2003 to 2008) or after (2009 to 2014) implementation of posterior vault distraction osteogenesis. Sixty children with syndromic craniosynostosis presented during the study period. Forty met inclusion criteria with care continuity and complete records: 22 before and 18 after implementation of posterior vault distraction osteogenesis. Only 11 patients (61 percent) who underwent initial posterior vault distraction osteogenesis required frontal advancement, at a mean follow-up of 4.0 years of age, compared with 22 patients (100 percent) before implementation of posterior vault distraction osteogenesis. Kaplan-Meier survival analysis indicated significant delay of first fronto-orbital advancement in the posterior vault distraction osteogenesis cohort compared with the pre-posterior vault distraction osteogenesis cohort (p = 0.011). Comparing treatment in the first 5 years of life among posterior vault distraction osteogenesis versus non-posterior vault distraction osteogenesis subcohorts of patients older than 5 years, there were significantly fewer fronto-orbital advancements performed (0.6 versus 1.5 per patient; p = 0.023). Using early posterior vault distraction osteogenesis for patients with syndromic craniosynostosis significantly reduces the average number of fronto-orbital advancement procedures in the first 5 years of life, delays initial fronto-orbital advancement, and is likely to reduce the total number of major craniofacial procedures. Therapeutic, III.

  12. Distraction Osteogenesis Using Bone Matrix Osteotensors in Ectodermal Dysplasia: A Case Report.

    PubMed

    Odin, Guillaume; Petitbois, Renaud; Cotten, Philippe; Philip, Patrick

    2015-10-01

    Ectodermal dysplasia patients require complex oral rehabilitation. Bone matrix Osteotensors activate the patient's own stem cells to promote new bone formation through an autogenous growth factor cascade generated by a targeted flapless bone distraction before implant and/or bone graft therapy. The maxillary and mandibular bone were activated 21 (for type I bone) to 45 days (for type IV bone) before implant and/or bone substitute installation. Purpose-designed Osteotensors initiated massive recruitment of stem cells in the intended bone recipient site, thereby triggering neoangiogenesis and osteogenesis. After new bone formation, root-form implants and Diskimplants were installed. Functional loading was obtained at 48 hours using highly rigid, screw-secured fixed upper and lower full-arch prostheses. At 3 years, all implants appeared clinically and radiologically osseointegrated with an excellent functional and esthetic outcome. Flapless distraction osteogenesis using bone matrix Osteotensors several weeks before surgery improved the initial quality and volume of the recipient bone bed. This minimally invasive approach allows future successful immediate implant-supported complete maxillomandibular fixed rehabilitation without preliminary grafting procedures in patients with an unfavorable initial bone anatomy.

  13. Biomechanical Configurations of Mandibular Transport Distraction Osteogenesis Devices

    PubMed Central

    Zapata, Uriel; Elsalanty, Mohammed E.; Dechow, Paul C.

    2010-01-01

    Mandibular bone transport (MBT) distraction osteogenesis devices are used for achieving reconstruction of mandibular defects in a predictable way, with few complications, less complexity than other alternative surgical procedures, and minimal tissue morbidity. However, selection of appropriate MBT device characteristics is critical for ensuring both their mechanical soundness and their optimal distraction function for each patient's condition. This article assesses six characteristics of currently available MBT devices to characterize their design and function and to classify them in a way that assists the selection of the best device option for each clinical case. In addition, the present work provides a framework for both the biomechanical conception of new devices and the modification of existing ones. PMID:19958167

  14. Alveolar distraction osteogenesis: revive and restore the native bone.

    PubMed

    Sant, Sumedha; Jagtap, Amit

    2009-12-01

    In prosthodontics, knife-edge bony alveolar ridges can cause a problem in their rehabilitation. The distraction osteogenesis process raises the medullary component of the alveolus, allowing the labial plate of the existing natural bone to be displaced. This process involves mobilization, transport, and fixation of a healthy segment of bone adjacent to the deficient site. It entails use of the gradual controlled displacement of surgically created fractures, which results in simultaneous expansion of soft tissue and bone volume. A mechanical device, the alveolar distraction device, is used for this purpose. This modality of treatment can be used in implant dentistry cases for rehabilitation of resorbed ridges. The objective of this overview is to explain this procedure wherein the alveolar housing, including the osseous and soft-tissue components, is enlarged in a single, simultaneous process, which makes creation of an appropriate alveolar morphology possible.

  15. Profile Changes and Stability following Distraction Osteogenesis with Rigid External Distraction in Adult Cleft Lip and Palate Deformities

    PubMed Central

    Painatt, Jaeson M.; Veeraraghavan, Ravi; Puthalath, Ushass; Peter, Sherry; Rao, Latha P.; Kuriakose, Maria

    2017-01-01

    Objectives: The objective of this study is to analyze the hard and soft-tissue profile changes as well as the upper airway changes after distraction osteogenesis (DO) using rigid external distraction device in adult cleft lip and palate (CLP) patients. The study also evaluates the stability of the surgical result. Materials and Methods: Three lateral cephalometric radiographs were taken: Predistraction (T1), postdistraction (T2), and 1 year after distractor removal (T3). The treatment changes (T1 vs. T2) and the stability (T2 vs. T3) were analyzed. The overall treatment changes after 1 year were also evaluated (T1 vs. T3). The lateral cephalograms were digitally analyzed with the help of software named Dolphin. Statistical Analysis Used: Wilcoxon Signed-Ranks test was used, and the probability value (P value) of 0.05 was considered as statistically significant level. Results: Eleven adult patients with CLP were retrospectively analyzed. After distraction, there was a significant mean maxillary advancement of 14 mm (P < 0.01) from a T1 value of 73.54 ± 10.38 to a T2 value of 88.2 ± 10.49. The lower facial height and the incisor exposure were significantly increased. The nasolabial angle had a significant improvement of 24.5° (P < 0.01) from a T1 value of 56.6 ± 21.03 to a T2 value of 81.18 ± 14.4.The upper airway was significantly improved by 3.7 mm (P < 0.01) with a T1 value of 13.5 ± 3.8 to a T2 value of 17.2 ± 3.66. After 1-year follow-up, there was a significant maxillary relapse of 3.20 mm (P < 0.05) from a T2 value of 8.29 ± 6.84 to a T3 value of 5.09 ± 5.59. However, the soft-tissue profile and upper airway remained stable. Conclusion: The clinician should have an understanding of the related hard and soft tissues as well as airway changes which may assist him when planning for maxillary advancement for CLP patients with DO. There were significant improvements immediately after distraction, but during the 1-year follow-up, some relapse was seen. This

  16. Profile Changes and Stability following Distraction Osteogenesis with Rigid External Distraction in Adult Cleft Lip and Palate Deformities.

    PubMed

    Painatt, Jaeson M; Veeraraghavan, Ravi; Puthalath, Ushass; Peter, Sherry; Rao, Latha P; Kuriakose, Maria

    2017-01-01

    The objective of this study is to analyze the hard and soft-tissue profile changes as well as the upper airway changes after distraction osteogenesis (DO) using rigid external distraction device in adult cleft lip and palate (CLP) patients. The study also evaluates the stability of the surgical result. Three lateral cephalometric radiographs were taken: Predistraction (T1), postdistraction (T2), and 1 year after distractor removal (T3). The treatment changes (T1 vs. T2) and the stability (T2 vs. T3) were analyzed. The overall treatment changes after 1 year were also evaluated (T1 vs. T3). The lateral cephalograms were digitally analyzed with the help of software named Dolphin. Wilcoxon Signed-Ranks test was used, and the probability value (P value) of 0.05 was considered as statistically significant level. Eleven adult patients with CLP were retrospectively analyzed. After distraction, there was a significant mean maxillary advancement of 14 mm (P < 0.01) from a T1 value of 73.54 ± 10.38 to a T2 value of 88.2 ± 10.49. The lower facial height and the incisor exposure were significantly increased. The nasolabial angle had a significant improvement of 24.5° (P < 0.01) from a T1 value of 56.6 ± 21.03 to a T2 value of 81.18 ± 14.4.The upper airway was significantly improved by 3.7 mm (P < 0.01) with a T1 value of 13.5 ± 3.8 to a T2 value of 17.2 ± 3.66. After 1-year follow-up, there was a significant maxillary relapse of 3.20 mm (P < 0.05) from a T2 value of 8.29 ± 6.84 to a T3 value of 5.09 ± 5.59. However, the soft-tissue profile and upper airway remained stable. The clinician should have an understanding of the related hard and soft tissues as well as airway changes which may assist him when planning for maxillary advancement for CLP patients with DO. There were significant improvements immediately after distraction, but during the 1-year follow-up, some relapse was seen. This stressed on the need for overcorrection of about 35%-40% for adult CLP patients.

  17. Comparison of local and systemic alendronate on distraction osteogenesis.

    PubMed

    Küçük, Dervişhan; Ay, Sinan; Kara, M Isa; Avunduk, M Cihat; Gümus, Cesur

    2011-12-01

    This study compared the effect of systemic and local administration of alendronate on distraction osteogenesis in rabbit mandibles. Thirty New Zealand white rabbits were allocated to 3 groups: 10 rabbits for systemic alendronate; 9 for local alendronate; and 11 as controls. After a 5 day latency period, distraction was performed at a rate of 0.8mm/day for 9 days via a custom-made distractor. Animals were killed at the end of the consolidation period of 28 days. The distracted mandibles were harvested and evaluated by plain radiography, computed tomography (CT), dual energy X-ray absorptiometry (DEXA), and histomorphometry. Histologically, comparing the systemic and local alendronate groups, there were no statistically significant differences in the bone healing parameters, but each group showed a statistically superior effect over the control group (p<0.05). Quantitative CT evaluation showed a significant difference mean in the density of the regeneration between experimental and control groups. There was a significant increase in mean bone mineral density in the experimental groups compared with the control group. Histologic, CT, and DEXA analysis demonstrated that using systemic and local alendronate may be effective in accelerating new bone formation in the distraction gap in rabbit mandibles. Copyright © 2011 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  18. Midface Distraction Osteogenesis Using a Modified External Device With Elastic Distraction for Crouzon Syndrome.

    PubMed

    Tong, Haizhou; Liu, Lei; Tang, Xiaojun; Song, Tao; Yin, Ningbei; Zhang, Zhiyong; Zhao, Zhenmin

    2017-09-01

    Midface distraction osteogenesis has been popularized for the correction of midface hypoplasia associated with exophthalmos and obstructive sleep apnea in patients with Crouzon syndrome. The purpose of this study was to present the method of utilizing the modified external device with elastic distraction for the midface advancement in Crouzon syndrome, and the clinical outcomes and skeletal changes were analyzed. Five consecutive patients with Crouzon syndrome underwent Le Fort III osteotomy with midface advancement using a modified external device with elastic distraction. The distraction system consists of a rigid external distractor, nickel-titanium shape memory alloy spring, and bone-borne traction hooks. The midface advancement was initiated with the bony anchorage around the nasomaxillary buttress at the level between occlusal plane and infraorbital margin. The device was activated at a rate of 1 to 1.5 mm per day by the length of spring. The skeletal changes were analyzed by cephalometric and computed tomographic measurement. All the patients achieved improvements in midface appearance, obstructive sleep apnea, exophthalmos, and occlusion. No complications occurred during this procedure. After the distraction, 1 patient developed an open bite that was corrected by a definitive orthognathic surgery. Cephalometric and computed tomographic measurement analysis showed a differential advancement of midface with more at the occlusal level than the orbital level. In addition, midface suture and bone remodeling was also observed in growing patient. Our modified external device with elastic distraction offers an alternative method to achieve midface advancement in patients with Crouzon syndrome.

  19. Posterior Cranial Vault Distraction Osteogenesis: Evolution of Technique

    PubMed Central

    Ong, Juling; Harshbarger, Raymond J.; Kelley, Patrick; George, Timothy

    2014-01-01

    The rapid growth of the brain in the first few years of life drives the expansion of the cranial vault. This expansion occurs primarily at the cranial sutures; premature fusion of these results in growth restriction perpendicular to the axis of the suture. The result of this is physical deformation of the cranial and facial skeleton, as well as the distortion of the underling brain and its physiology. These patients can present with symptoms of raised intracranial pressure, neurodevelopmental delay, as well as the morphological features of craniosynostosis. Acquired conditions such as the slit ventricle syndrome may also result in cephalocranial disproportion with these clinical features. Traditional vault remodeling surgery is able to correct the physical abnormalities as well as correcting cephalocranial disproportion. Its limitations include the degree of scalp expansion achievable as well as resulting defects in the bone. The use of distraction osteogenesis of the cranial vault permits a controlled expansion in a predetermined vector in a gradual manner. When used in the calvarium, this combines the benefits of tissue expansion on the scalp, as well as stimulating the production of new bone, reducing the defects resulting from expansion. In this review, the authors describe some of the surgical considerations important to the use of this technique. This includes the relevant anatomy and technical aspects illustrated with the use of clinical cases. Finally, they present a summary of their experience and discuss the complications associated with cranial vault distraction osteogenesis. PMID:25383052

  20. Bilateral Continuous Automated Distraction Osteogenesis: Proof of Principle.

    PubMed

    Peacock, Zachary S; Tricomi, Brad J; Faquin, William C; Magill, John C; Murphy, Brian A; Kaban, Leonard B; Troulis, Maria J

    2015-11-01

    The purpose of this study was to demonstrate that automated, continuous, curvilinear distraction osteogenesis (DO) in a minipig model is effective when performed bilaterally, at rates up to 3 mm/day, to achieve clinically relevant lengthening. A Yucatan minipig in the mixed dentition phase underwent bilaterally, at a continuous DO at a rate of 2 mm/day at the center of rotation; 1.0 and 3.0 mm/day at the superior and inferior regions, respectively. The distraction period was 13 days with no latency period. Vector and rate of distraction were remotely monitored without radiographs, using the device sensor. After fixation and euthanasia, the mandible and digastric muscles were harvested. The ex vivo appearance, stability, and radiodensity of the regenerate were evaluated using a semiquantitative scale. Percent surface area (PSA) occupied by bone, fibrous tissue, cartilage, and hematoma were calculated using histomorphometrics. The effects of DO on the digastric muscles and mandibular condyles were assessed via microscopy, and degenerative changes were quantified. The animal was distracted to 21 mm and 24 mm on the right and left sides, respectively. Clinical appearance, stability, and radiodensity were scored as "3" bilaterally indicating osseous union. The total PSA occupied by bone (right = 75.53 ± 2.19%; left PSA = 73.11 ± 2.18%) approached that of an unoperated mandible (84.67 ± 0.86%). Digastric muscles and condyles showed negligible degenerative or abnormal histologic changes. This proof of principle study is the first report of osseous healing with no ill-effect on associated soft tissue and the mandibular condyle using bilateral, automated, continuous, and curvilinear DO at rates up to 3 mm/day. The model approximates potential human application of continuous automated distraction with a semiburied device.

  1. Repair of segmental bone defects in the maxilla by transport disc distraction osteogenesis: Clinical experience with a new device.

    PubMed

    Boonzaier, James; Vicatos, George; Hendricks, Rushdi

    2015-01-01

    The bones of the maxillary complex are vital for normal oro-nasal function and facial cosmetics. Maxillary tumor excision results in large defects that commonly include segments of the alveolar and palatine processes, compromising eating, speech and facial appearance. Unlike the conventional approach to maxillary defect repair by vascularized bone grafting, transport disc distraction osteogenesis (TDDO) stimulates new bone by separating the healing callus, and stimulates growth of surrounding soft tissues as well. Bone formed in this way closely mimics the parent bone in form and internal structure, producing a superior anatomical, functional and cosmetic result. Historically, TDDO has been successfully used to close small horizontal cleft defects in the maxilla, not exceeding 25 mm. Fujioka et al. reported in 2012 that "no bone transporter corresponding to the (large) size of the oro-antral fistula is marketed. The authors report the successful treatment of 4 cases involving alveolar defects of between 25 mm and 80 mm in length.

  2. Long-term stability of LeFort III distraction osteogenesis with a rigid external distraction device in a patient with Crouzon syndrome.

    PubMed

    Kuroda, Shingo; Watanabe, Keiichiro; Ishimoto, Kyoko; Nakanishi, Hideki; Moriyama, Keiji; Tanaka, Eiji

    2011-10-01

    A 6-year-old boy, diagnosed with Crouzon syndrome, had moderate exorbitism, a concave profile, an anterior crossbite of -4.0 mm, and a skeletal Class III jaw-base relationship caused by midfacial hypoplasia. At age 8 years 9 months, a LeFort III osteotomy was performed, and distraction osteogenesis was immediately started with the rigid external distractor system. The midface was advanced approximately 10.0 mm for 6 days, including overcorrection. After the distraction, a reverse headgear was used for 6 years to prevent relapse and to accelerate expected growth. At age 16 years 5 months, after extraction of the maxillary first premolars and mandibular third molars, 0.022-in preadjusted edgewise brackets were placed to treat the edge-to-edge incisor relationship and minor crowding. After 13 months of treatment, the facial profile was significantly improved, and an acceptable occlusion was achieved. During the 9-year observation period after the distraction, acceptable facial growth occurred, and no relapse of the maxillary advancement was observed. However, syndrome-specific growth and methodologically induced relapse should be considered when planning a LeFort III distraction in children for the treatment of Crouzon syndrome. Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  3. Distraction osteogenesis of the mandible with an internal bioresorbable device.

    PubMed

    Margulis, Alexander; Patel, Pravin K; Daw, Joseph L; Bauer, Bruce S

    2003-09-01

    Lengthening of the mandible by distraction osteogenesis has been shown to be an effective treatment of hypoplastic mandibles. Use of an internal technique with a bioresorbable distraction device is presented. Mandibular lengthening was performed in seven patients aged 3.2 to 7 years. Six of the patients were diagnosed with craniofacial microsomia, anthe buccal aspect of the mandible, and distraction was started on the second postoperative day at the rate of d one was diagnosed with Nager syndrome. An internal bioresorbable device was placed along 1 mm/d and continued for 17 to 20 days. The distractor screw was maintained for retention for an additional 6 weeks and was then removed. All the patients showed clinical improvement. The postdistraction craniofacial computed tomography scans demonstrated elongation of the mandible with increase in the bony mass. The complications included device failure in one patient. The advantage of this method compared with the internal metal device is that it does not necessitate an additional procedure for device removal.

  4. [Orthodontics and vertical distraction osteogenesis of the maxilla].

    PubMed

    Breuning, K H; de Lange, M; van Strijen, P J; Perdijk, F B T; Bolouri, S

    2008-10-01

    A female patient (age 26) visited the orthodontist for correction of the reduced exposure of the upper incisors during laughing. She also reported crowding of the lower incisors and an association between lisping and her open bite. The diagnosis in this case: a Class III malocclusion case with incisor crowding and an open bite. Because her main complaint was reduced upper incisor exposure while talking and laughing, which would not be corrected with orthodontic appliances only, the position of the maxilla was corrected during orthodontic treatment by means of vertical intra-oral maxillary distraction. An acceptable and relatively stable result was achieved.

  5. Posterior Cranial Vault Distraction Osteogenesis with Barrel Stave Osteotomy in the Treatment of Craniosynostosis

    PubMed Central

    KOMURO, Yuzo; SHIMIZU, Azusa; SHIMOJI, Kazuaki; MIYAJIMA, Masakazu; ARAI, Hajime

    2015-01-01

    Twenty years have passed since distraction osteogenesis was introduced into the field of craniomaxillofacial surgery, with distraction osteogenesis gradually consolidating its position for midface advancement in syndromic craniosynostosis. On the other hand, no consensus has been reached regarding its adaptation to calvarial bone. We reported that distraction osteogenesis was useful in posterior cranial vault expansion, and subsequently, similar reports have been successively observed worldwide. In posterior cranial vault distraction, intracranial capacity could be greatly expanded due to its simultaneous expansion with the scalp, with little risk of relapse because new bone is regenerated in the distraction gap. The possibility was suggested that the standard of first carrying out fronto-orbital advancement (FOA) for brachycephaly observed in syndromic craniosynostosis will greatly change posterior cranial vault distraction. PMID:26226978

  6. Experimental healing of distraction osteogenesis comparing metaphyseal with diaphyseal sites.

    PubMed

    Aronson, J; Shen, X

    1994-04-01

    Distraction osteogenesis was performed on 32 adult dogs to compare bone healing at metaphyseal and diaphyseal sites. Sixteen dogs underwent proximal metaphyseal corticotomy and 16 dogs underwent middiaphyseal corticotomy of the left tibiae for gradual lengthening. Each major group was then divided into four subgroups of four dogs each on the basis of zero-, seven-, 14- and 21-day latency periods. The standard radiograph, quantitative computer tomography density, and bone-healing index were used to evaluate new bone formation and consolidation. A distraction rate of 1 mm per day for four weeks created an average elongation of 23.9 +/- 3.7 mm in the metaphyseal groups and 23.8 +/- 2.0 mm in the diaphyseal groups, excluding nine premature consolidations. In the 16 metaphyseal lengthenings, there were six premature consolidations (37.5%): four with a 21-day latency, two with a 14-day latency, and one nonunion (6.2%). In the 16 diaphyseal lengthenings, three fused prematurely (18.7%), two with a 21-day latency and one incomplete corticotomy with a seven-day latency. Three lengthenings of the diaphyseal group resulted in nonunion (18.7%). All animals, metaphyseal and diaphyseal, successfully bridged the distraction gap after a zero-day latency. The bone-healing index showed that new bone consolidation was best with a zero-day latency in metaphyseal (22 +/- 7.6 days/cm) and diaphyseal lengthening (26.5 +/- 6.5 days/cm). Comparing the minimum quantitative computer tomography density ratio of the experimental side with the contralateral side indicated a significant difference at the end of distraction (p = 0.001), at fixator removal (p = 0.001), and when the dogs were killed (p = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)

  7. Experience with Mandibular Reconstruction Using Transport-Disc-Distraction Osteogenesis

    PubMed Central

    Pingarrón-Martín, Lorena; Otero, T. González; Gallo, L.J. Arias

    2014-01-01

    The goal of transport-disc-distraction osteogenesis (TDDO) is to restore bone continuity by using in-situ bone. It may be useful following trauma, gunshot injuries, or tumor ablation, especially when there may be contraindications at the donor site or for prolonged surgery. To the best of the authors' knowledge, this is the first time TDDO has been used for mandibular reconstruction reporting additional procedures, which include osseointegrated dental implants rehabilitation and orthognathic surgery. A retrospective study is performed analyzing all mandibular reconstruction cases that may be suitable for distraction from January 2006 to December 2011. A thorough description of the documented cases includes details about sex, gender, complications, duration of hospitalization, etiology, size, and location of the defect. Eight cases of mandibular reconstruction were included. Six cases correspond to mandibular ameloblastoma. The remaining two cases were mandibular gunshot comminuted fractures. Range of the defects was from 45 to 60 mm. Length of the transport disc was 15 to 20 mm. Protocolized technique consisted of 5 days of latency period, 19 to 45 days of activation term (average 30 days), and 8 to 12 weeks for consolidation. Mean distraction length achieved was 40.45 mm. We can conclude that TDDO is an alternative to conventional and more invasive procedures, when we face severe segmental mandibular defects reconstruction. It shows the potential to restore a better anatomical bone regeneration, also providing soft tissues and reducing donor-site morbidity. Patients' education and awareness about the proper use of the transport-disc-distraction device is important to optimize functional outcomes. PMID:26000082

  8. Distraction osteogenesis of the palate: an experimental model.

    PubMed

    Menezes, John M; Stutman, Ross L; Murphy, Patrick S; Stephenson, Linda L; Zamboni, William A

    2009-09-01

    Although most cleft palates can be closed with conventional mucoperiosteal flap techniques, the occasional wide cleft or difficult fistula has few options for an early 1-stage reconstruction. Distraction osteogenesis (DO) has the potential to close the palate with both hard and soft tissues as well as mitigating the possibility of future oronasal fistula. A right unilateral 5-mm cleft was surgically created in 15 New Zealand white rabbits. In group 1 (N = 5), no further repair was performed (NR); in group 2 (N = 5), mucoperiosteal flaps were used to close the cleft for a soft-tissue-only repair (STR); in group 3 (N = 5), a unilateral osteotomy in the palate on the noncleft side allowed distraction of the palatal shelf across the cleft until closed (DO). Clinical examination, Micro-computed tomography bone density, direct cephalometry, and histology were evaluated at 8 weeks after the completion of distraction. Bone mineral density (BMD; mg/mL) data were obtained from micro-computed tomography scans of both the cleft and noncleft sides for each rabbit, and a ratio was obtained [(BMDc/BMDnc) x100]; NR = 1.38, STR = 44.27, DO = 88.36, P = 0.007. Facial measurements revealed no growth disturbances as a result of DO. Histologic evaluation revealed increased organization of new bone in DO group compared with NR and STR. Clinically, DO group rabbits did not show any increase in feeding disturbances, infection, or wound healing. The success of membranous facial bone distraction has been applied to a new model for palatal repair with the potential to ameliorate the problems associated with soft-tissue-only repair.

  9. Stem Cells Rejuvenate Radiation-Impaired Vasculogenesis in Murine Distraction Osteogenesis

    PubMed Central

    Deshpande, Sagar S.; Gallagher, Kathleen K.; Donneys, Alexis; Nelson, Noah S.; Guys, Nicholas P.; Felice, Peter A.; Page, Erin E.; Sun, Hongli; Krebsbach, Paul H.; Buchman, Steven R.

    2015-01-01

    Background Radiotherapy is known to be detrimental to bone and soft-tissue repair. Bone marrow stromal cells have been shown to enhance bone regeneration during distraction osteogenesis following radiation therapy. The authors posit that transplanted bone marrow stromal cells will significantly augment the mandibular vascularity devastated by radiation therapy. Methods Nineteen male Lewis rats were split randomly into three groups: distraction osteogenesis only (n = 5), radiation therapy plus distraction osteogenesis (n = 7), and radiation therapy plus distraction osteogenesis with intraoperative placement of 2 million bone marrow stromal cells (n = 7). A mandibular osteotomy was performed, and an external fixator device was installed. From postoperative days 4 through 12, rats underwent a gradual 5.1-mm distraction followed by a 28-day consolidation period. On postoperative day 40, Microfil was perfused into the vasculature and imaging commenced. Vascular radiomorphometric values were calculated for regions of interest. An analysis of variance with post hoc Tukey or Games-Howell tests was used, dependent on data homogeneity. Results Stereologic analysis indicated significant remediation in vasculature in the bone marrow stromal cell group compared with the radiation therapy/distraction osteogenesis group. Each of five metrics idicated significant improvements from radiation therapy/distraction osteogenesis to the bone marrow stromal cell group, with no difference between the bone marrow stromal cell group and the distraction osteogenesis group. Conclusions Bone marrow stromal cells used together with distraction osteogenesis can rejuvenate radiation-impaired vasculogenesis in the mandible, reversing radiation therapy–induced isotropy and creating a robust vascular network. Bone marrow stromal cells may offer clinicians an alternative reconstructive modality that could improve the lifestyle of patients with hypovascular bone. PMID:25415276

  10. Periosteal Distraction Osteogenesis: An Effective Method for Bone Regeneration

    PubMed Central

    Zhao, Danyang; Wang, Yu

    2016-01-01

    The treatment of bone defects is challenging and controversial. As a new technology, periosteal distraction osteogenesis (PDO) uses the osteogenicity of periosteum, which creates an artificial space between the bone surface and periosteum to generate new bone by gradually expanding the periosteum with no need for corticotomy. Using the newly formed bone of PDO to treat bone defects is effective, which can not only avoid the occurrence of immune-related complications, but also solve the problem of insufficient donor. This review elucidates the availability of PDO in the aspects of mechanisms, devices, strategies, and measures. Moreover, we also focus on the future prospects of PDO and hope that PDO will be applied to the clinical treatment of bone defects in the future. PMID:28078283

  11. Automated Continuous Distraction Osteogenesis May Allow Faster Distraction Rates: A Preliminary Study

    PubMed Central

    Peacock, Zachary S.; Tricomi, Brad; Murphy, Brian; Magill, John; Kaban, Leonard B.; Troulis, Maria

    2013-01-01

    Purpose To determine if automated continuous distraction osteogenesis at rates > 1mm/day would result in clinical and radiographic bone formation in a minipig model. Materials and Methods An automated, continuous, curvilinear distraction device was placed across a mandibular osteotomy in 10 minipigs. After 12 mm of distraction and 24 days fixation, animals were sacrificed and bone healing evaluated. The continuous distraction rates were 1.5 (n=5) and 3 mm/day (n=5). A semiquantitative scale was used to assess ex-vivo clinical appearance of the distraction gap (3= osteotomy not visible; 2= <50%; 1= >50%; 0= 100% visible); stability (3 = no mobility; 2 and 1 = mobility in 2 or 1 plane respectively; 0= mobility in 3 planes); radiographic density (4 = 100% gap opaque, 3= >75%, 2 = 50% – 75%, 1= <50%, or 0 = radiolucent). Groups of 4 minipigs distracted discontinuously at 1, 2, and 4 mm/day served as controls. Results The continuous DO 1.5 mm/day group had significantly higher scores for appearance and radiographic density compared to the discontinuous 4 mm/day group. The continuous DO 3mm/day group had significantly higher scores for appearance and radiographic density compared to the discontinuous 4 mm/day group, and higher stability compared to the discontinuous 2 and 4 mm/day groups. Conclusions Results of this preliminary study indicate that continuous DO at rates of 1.5 and 3.0 mm/day produces better bone formation when compared to discontinuous DO at rates faster than 1mm/day. PMID:23499159

  12. Plate-guided distraction osteogenesis to recreate two-thirds of the mandible including symphysis.

    PubMed

    Mohammed-Ali, Ricardo I; Henry, Alastair M; Khurram, Syed A; Yousefpour, Afshin

    2012-12-01

    We report a case of plate-guided distraction osteogenesis to reconstruct a large mandibular defect caused by recurrence of an ameloblastoma in a 17-year-old male patient who had previously had reconstruction using a fibula bone graft.

  13. Parathyroid Hormone Therapy Mollifies Radiation-Induced Biomechanical Degradation in Murine Distraction Osteogenesis

    PubMed Central

    Deshpande, Sagar S.; Gallagher, Katherine K.; Donneys, Alexis; Tchanque-Fossuo, Catherine N.; Sarhaddi, Deniz; Nelson, Noah S.; Chepeha, Douglas B.; Buchman, Steven R.

    2015-01-01

    Objective Descriptions of mandibular distraction osteogenesis for tissue replacement after oncologic resection or for defects caused by osteoradionecrosis have been limited. Previous work demonstrated radiation decreases union formation, cellularity and mineral density in mandibular distraction osteogenesis. The authors posit that intermittent systemic administration of parathyroid hormone will serve as a stimulant to cellular function, reversing radiation-induced damage and enhancing bone regeneration. Methods Twenty male Lewis rats were randomly assigned to three groups: group 1 (radiation and distraction osteogenesis, n = 7) and group 2 (radiation, distraction osteogenesis, and parathyroid hormone, n = 5) received a human-equivalent dose of 35 Gy of radiation (human bioequivalent, 70 Gy) fractionated over 5 days. All groups, including group 3 (distraction osteogenesis, n = 8), underwent a left unilateral mandibular osteotomy with bilateral external fixator placement. Distraction osteogenesis was performed at a rate of 0.3 mm every 12 hours to reach a gap of 5.1 mm. Group 2 was injected with parathyroid hormone (60 μg/kg) subcutaneously daily for 3 weeks after the start of distraction osteogenesis. On postoperative day 40, all left hemimandibles were harvested. Biomechanical response parameters were generated. Statistical significance was considered at p ≤ 0.05. Results Parathyroid hormone–treated mandibles had significantly higher failure load and higher yield than did untreated mandibles. However, these values were still significantly lower than those of nonirradiated mandibles. Conclusions The authors have successfully demonstrated the therapeutic efficacy of parathyroid hormone to stimulate and enhance bone regeneration in their irradiated murine mandibular model of distraction osteogenesis. Anabolic regimens of parathyroid hormone, a U.S. Food and Drug Administration–approved drug on formulary, significantly improve outcomes in a model of

  14. Parathyroid hormone therapy mollifies radiation-induced biomechanical degradation in murine distraction osteogenesis.

    PubMed

    Deshpande, Sagar S; Gallagher, Katherine K; Donneys, Alexis; Tchanque-Fossuo, Catherine N; Sarhaddi, Deniz; Nelson, Noah S; Chepeha, Douglas B; Buchman, Steven R

    2013-07-01

    Descriptions of mandibular distraction osteogenesis for tissue replacement after oncologic resection or for defects caused by osteoradionecrosis have been limited. Previous work demonstrated radiation decreases union formation, cellularity and mineral density in mandibular distraction osteogenesis. The authors posit that intermittent systemic administration of parathyroid hormone will serve as a stimulant to cellular function, reversing radiation-induced damage and enhancing bone regeneration. Twenty male Lewis rats were randomly assigned to three groups: group 1 (radiation and distraction osteogenesis, n = 7) and group 2 (radiation, distraction osteogenesis, and parathyroid hormone, n = 5) received a human-equivalent dose of 35 Gy of radiation (human bioequivalent, 70 Gy) fractionated over 5 days. All groups, including group 3 (distraction osteogenesis, n = 8), underwent a left unilateral mandibular osteotomy with bilateral external fixator placement. Distraction osteogenesis was performed at a rate of 0.3 mm every 12 hours to reach a gap of 5.1 mm. Group 2 was injected with parathyroid hormone (60 µg/kg) subcutaneously daily for 3 weeks after the start of distraction osteogenesis. On postoperative day 40, all left hemimandibles were harvested. Biomechanical response parameters were generated. Statistical significance was considered at p ≤ 0.05. Parathyroid hormone-treated mandibles had significantly higher failure load and higher yield than did untreated mandibles. However, these values were still significantly lower than those of nonirradiated mandibles. The authors have successfully demonstrated the therapeutic efficacy of parathyroid hormone to stimulate and enhance bone regeneration in their irradiated murine mandibular model of distraction osteogenesis. Anabolic regimens of parathyroid hormone, a U.S. Food and Drug Administration-approved drug on formulary, significantly improve outcomes in a model of postoncologic craniofacial reconstruction.

  15. Rat mandibular distraction osteogenesis: latency, rate, and rhythm determine the adaptive response.

    PubMed

    Paccione, M F; Mehrara, B J; Warren, S M; Greenwald, J A; Spector, J A; Luchs, J S; Longaker, M T

    2001-03-01

    Distraction osteogenesis is a well-established technique of endogenous tissue engineering. The biomechanical factors thought to affect the quality of the distraction regenerate include the latency, rate, rhythm, and consolidation period. In an effort to understand the impact of these parameters on regenerate bone formation, this study was designed to decipher the most adaptive response in a rat model of mandibular distraction osteogenesis. Ninety-six adult Sprague-Dawley rats were divided into 16 subgroups (n = 6 per subgroup) based on variations in the distraction parameters (i.e., latency, rate, and rhythm). After a 28-day consolidation period, the mandibles were harvested, decalcified, and sectioned. A standardized histologic ranking system was used to evaluate the effect of each protocol on the adaptive response of the regenerate bone. In this study, we have demonstrated that the latency period dramatically affects the success of distraction osteogenesis. Furthermore, distraction rates up to 0.50 mm per day stimulated excellent regenerate bone formation, whereas greater distraction rates produced a fibrous union. Finally, higher frequency distraction (i.e., increased rhythm) appeared to accelerate regenerate bone formation. We believe that defining the critical parameters of this model will improve future analysis of gene expression during rat mandibular distraction osteogenesis and may facilitate the development of biologically based strategies designed to enhance regenerate bone formation.

  16. The Molecular and Cellular Events That Take Place during Craniofacial Distraction Osteogenesis.

    PubMed

    Rachmiel, Adi; Leiser, Yoav

    2014-01-01

    Gradual bone lengthening using distraction osteogenesis principles is the gold standard for the treatment of hypoplastic facial bones. However, the long treatment time is a major disadvantage of the lengthening procedures. The aim of this study is to review the current literature and summarize the cellular and molecular events occurring during membranous craniofacial distraction osteogenesis. Mechanical stimulation by distraction induces biological responses of skeletal regeneration that is accomplished by a cascade of biological processes that may include differentiation of pluripotential tissue, angiogenesis, osteogenesis, mineralization, and remodeling. There are complex interactions between bone-forming osteoblasts and other cells present within the bone microenvironment, particularly vascular endothelial cells that may be pivotal members of a complex interactive communication network in bone. Studies have implicated number of cytokines that are intimately involved in the regulation of bone synthesis and turnover. The gene regulation of numerous cytokines (transforming growth factor-β, bone morphogenetic proteins, insulin-like growth factor-1, and fibroblast growth factor-2) and extracellular matrix proteins (osteonectin, osteopontin) during distraction osteogenesis has been best characterized and discussed. Understanding the biomolecular mechanisms that mediate membranous distraction osteogenesis may guide the development of targeted strategies designed to improve distraction osteogenesis and accelerate bone regeneration that may lead to shorten the treatment duration.

  17. The Molecular and Cellular Events That Take Place during Craniofacial Distraction Osteogenesis

    PubMed Central

    Rachmiel, Adi

    2014-01-01

    Summary: Gradual bone lengthening using distraction osteogenesis principles is the gold standard for the treatment of hypoplastic facial bones. However, the long treatment time is a major disadvantage of the lengthening procedures. The aim of this study is to review the current literature and summarize the cellular and molecular events occurring during membranous craniofacial distraction osteogenesis. Mechanical stimulation by distraction induces biological responses of skeletal regeneration that is accomplished by a cascade of biological processes that may include differentiation of pluripotential tissue, angiogenesis, osteogenesis, mineralization, and remodeling. There are complex interactions between bone-forming osteoblasts and other cells present within the bone microenvironment, particularly vascular endothelial cells that may be pivotal members of a complex interactive communication network in bone. Studies have implicated number of cytokines that are intimately involved in the regulation of bone synthesis and turnover. The gene regulation of numerous cytokines (transforming growth factor-β, bone morphogenetic proteins, insulin-like growth factor-1, and fibroblast growth factor-2) and extracellular matrix proteins (osteonectin, osteopontin) during distraction osteogenesis has been best characterized and discussed. Understanding the biomolecular mechanisms that mediate membranous distraction osteogenesis may guide the development of targeted strategies designed to improve distraction osteogenesis and accelerate bone regeneration that may lead to shorten the treatment duration. PMID:25289295

  18. Distraction osteogenesis as a treatment of obstructive sleep apnea syndrome

    PubMed Central

    Tsui, Wai Kin; Yang, Yanqi; Cheung, Lim Kwong; Leung, Yiu Yan

    2016-01-01

    Abstract Background: To conduct a systematic review to answer the clinical question “What are the effectiveness of mandibular distraction osteogenesis (MDO) and its complications to treat patients with obstructive sleep apnea syndrome (OSAS)?”. Methods: A systematic search including a computer search with specific keywords, reference list search, and manual search were done. Relevant articles on MDO were assessed and selected in 3 rounds for final review based on 5 predefined inclusion criteria and followed by a round of critical appraisal. Different types of distraction and their treatment outcomes of OSAS were recorded with standardized form and analyzed. Results: Twelve articles were included in the final review. A total of 256 patients aged 7 days to 60 years were treated with either external or internal MDO, with a mean follow-up period of 6 to 37 months. The average distraction distance of 12 to 29 mm was achieved with various distraction protocols. The success rate for adult patients was 100%, and cure rates were ranged from 82% to 100%. The definition of success or cure for OSAS in children or infants was not defined. Therefore, there were no clearly reported success or cure rates for children/infants in the included studies. However, all studies reported that these patients showed significant improvement in OSAS, with many of them who avoided tracheostomy or had the tracheostomy decannulated. The complication rates were ranged from 0% to 21.4%, with most being from local wound infections or neurosensory disturbances. Conclusion: This systematic review showed that MDO was effective in resolving OSAS in adults with retrognathic mandible. MDO also showed promising results in infants or children with OSAS. From the results of this systematic review, we recommend to define the criteria of success or cure for OSAS surgery in children and infants. We also recommend setting up randomized controlled trials to compare MDO with traditional maxillomandibular

  19. Mandibular Distraction Osteogenesis in Low-Weight Neonates with Robin Sequence: Is It Safe?

    PubMed

    Tahiri, Youssef; Greathouse, S Travis; Tholpady, Sunil S; Havlik, Robert; Sood, Rajiv; Flores, Roberto L

    2015-11-01

    The aim of this study was to evaluate the efficacy, safety profile, and complications associated with mandibular distraction osteogenesis performed in infants weighing less than 4 kg with Robin sequence. An 11-year retrospective review of all infants (younger than 6 months) with mandibular distraction osteogenesis-treated Robin sequence was performed. Patients weighing less than 4 kg (experimental) and 4 kg or more (control) who underwent mandibular distraction osteogenesis were compared. Demographics, medical comorbidities, improvement in apnea/hypopnea index, need for tracheostomy, repeated distraction, and complications were evaluated. One hundred twenty-one patients underwent mandibular distraction osteogenesis. Eighty-one patients weighed less than 4 kg and 40 weighed 4 kg or more. The mean follow-up was 2.8 years in patients weighing less than 4 kg and 3.0 years in the control group. Mean age and weight at the time of distraction were 23 days and 3.1 kg, respectively, in the study group; and 2.7 years and 11 kg, respectively, in the control group. There was no significant difference in success of mandibular distraction osteogenesis to treat airway obstruction in the group weighing less than 4 kg compared with the control group (92.6 percent versus 88.9 percent; p = 0.49). The most common complication in each group was surgical-site infection (9.9 percent and 20.0 percent; p = 0.15). Overall complication rates were similar between the two groups (17.3 percent versus 25.0 percent; p = 0.34). The rates of repeated distraction were similar between the two groups (6.3 percent and 13.5 percent; p = 0.28). Mandibular distraction osteogenesis is a safe and effective treatment modality for infants weighing less than 4 kg with severe airway obstruction. The efficacy, safety, and complication profiles are not significantly different from those of larger patients. Therapeutic, III.

  20. Locally applied nerve growth factor enhances bone consolidation in a rabbit model of mandibular distraction osteogenesis.

    PubMed

    Wang, Lei; Zhou, Shuxia; Liu, Baolin; Lei, Delin; Zhao, Yinghua; Lu, Chao; Tan, Aixing

    2006-12-01

    Distraction osteogenesis is widely used in treating deformities, defects, and fractures of both long bones and craniofacial bones. Demands for acceleration of bone consolidation are increased in distraction osteogenesis. Nerve growth factor (NGF) can enhance innervation and bone regeneration in a fracture model and stimulate differentiation of osteoblastic cells. In this study, we tested the ability of locally applied NGF to enhance bone regeneration in a rabbit model of mandibular distraction osteogenesis. Twenty rabbits underwent bilateral distraction osteogenesis with a rate of 0.5 mm per 12 h. Two times 0.04 mg human NGFbeta (hNGFbeta) in buffer was injected into the callus after distraction. The contralateral side received placebo injections. Rabbits were euthanized at consolidation times of 14 and 28 days. Specimens were subjected to radiography, callus dimensions measurement, mechanical testing, and bone histological and histomorphometric analysis. The maximum load, bone volume/total volume, mineral apposition rate of the 1st to 11th day, and mineralized bone percentage were significantly higher in the hNGFbeta side at 14 and 28 days (p<0.05). The data indicate that locally applied hNGFbeta can accelerate callus maturation and may be an option to shorten the consolidation period in distraction osteogenesis.

  1. VEGF facilitates periosteal distraction-induced osteogenesis in rabbits: a micro-computerized tomography study.

    PubMed

    Casap, Nardy; Venezia, Nuphar Blau; Wilensky, Asaf; Samuni, Yuval

    2008-02-01

    Distraction osteogenesis is routinely used for reconstruction of bone. Conversely, it was hypothesized that mechanical traction of the periosteum would induce bone formation, and hence the use of periosteal distraction for induction of osteogenesis has been proposed. Further, it was postulated that intracallus administration of vascular endothelial growth factor (VEGF) would facilitate osteogenesis. To investigate this hypothesis, formation of newly synthesized bone was evaluated using micro-computerized tomography (microCT) and histomorphometry. Periosteal distractors were placed subperiosteally in one side of the mandible of rabbits, whereas the contralateral served as control. One group of animals received VEGF into the forming callus. Formation of bone was measured using microCT and histological analysis. The results demonstrate formation of new bone following periosteal distraction. Addition of VEGF to the distraction site increased bone synthesis. microCT and histological analysis validate the hypothesis that mechanical distraction of the periosteum induces osteogenesis and that VEGF has a positive effect on osteogenesis. Periosteal distraction is emerging as a reliable technique for bone regeneration.

  2. Distraction Osteogenesis of Multiple Ribs for the Treatment of Acquired Thoracic Dystrophy.

    PubMed

    Piper, Merisa L; Delrosario, Lawrence; Hoffman, William Y

    2016-03-01

    Acquired thoracic dystrophy is a complication associated with early open repair of pectus excavatum resulting from extensive cartilage resection. The condition can cause serious functional and physiologic impairments, including cardiac compression and restrictive pulmonary function. We describe a 17-year-old boy with acquired thoracic dystrophy after Ravitch repair of pectus excavatum during infancy, whom we treated with distraction osteogenesis. The patient had a marked deformity of the chest wall and general hypoplasia of the central portion of the ribcage, with resultant symptomatic dyspnea on exertion and reduced pulmonary function. After osteotomies and distraction osteogenesis of bilateral ribs 4-8 using customized distraction devices, he had improved thoracic contour, resolution of dyspnea, and decreased restrictive pulmonary symptoms. This case suggests that distraction osteogenesis, already used extensively in craniomaxillofacial and orthopedic surgery, may be a novel method for management of this condition.

  3. Oral and dental restoration of wide alveolar cleft using distraction osteogenesis and temporary anchorage devices.

    PubMed

    Rachmiel, Adi; Emodi, Omri; Gutmacher, Zvi; Blumenfeld, Israel; Aizenbud, Dror

    2013-12-01

    Closure of large alveolar clefts and restoration by a fixed bridge supported by implants is a challenge in cleft alveolus treatment. A major aesthetic concern with distraction osteogenesis is obtaining a predictable position of the implant in relation to the newly generated bony alveolar ridge. We describe the treatment of a large cleft alveolus and palate reconstruction by distraction osteogenesis utilizing temporary anchorage devices (TADs) followed by a fixed implant-supported bridge. The method consists of segmental bone transport by distraction osteogenesis using a bone-borne distractor to minimize the alveolar cleft, followed by closure of the residual small defect by bone grafting three months later. During the active transport distraction, TADs were used exerting multidirectional forces to control the distraction vector forward and laterally for better interarch relation. A vertical alveolar distraction of the newly reconstructed bone of 15 mm facilitated optimal implant placement. The endosseous implants were osteointegrated and supported a fixed dental prosthesis. In conclusion, the large cleft alveolus defect was repaired in three dimensions by distraction osteogenesis assisted by TADs, and the soft tissues expanded simultaneously. Endosseous implants were introduced in the newly reconstructed bone for a fixed dental prosthesis enabling, rehabilitation of aesthetics, eating and speaking. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  4. The effect of human amniotic fluid on mandibular distraction osteogenesis.

    PubMed

    Gokce, S M; Karacayli, U; Nalcaci, R; Avunduk, M C; Özgöçmen, M; Karasahin, E; Gokce, H S

    2015-03-01

    The aim of this study was to evaluate the effects of local administration of human amniotic fluid (HAF) on newly formed bone obtained by mandibular distraction osteogenesis (DO) with histomorphometry. A unilateral mandibular osteotomy at the left corpus was performed in 32 adult male rabbits. After a 5-day latency period, the left mandibles were lengthened by mandibular DO over 5 days, at a rate of 1mm/day, via a custom-made distractor. After the distraction, the rabbits were divided randomly into four groups: 0.3 ml HAF was injected into the distraction gap followed by 21 (group 1) or 45 (group 2) days of consolidation; or 0.3 ml normal saline (NS) was administered followed by 21 (group 3) or 45 (group 4) days of consolidation. Mandibles were removed at the end of the consolidation period and investigated histomorphometrically. The newly formed bone area (NFBA) and number of fibroblasts increased significantly in the HAF groups compared to the NS groups (NFBA: group 1 vs. group 3, P<0.05; group 2 vs. group 4, P<0.01; fibroblasts: group 1 vs. group 3, and group 2 vs. group 4, P<0.05), and also in both 45-day consolidation groups compared to the 21-day consolidation groups (NFBA: group 1 vs. group 2, and group 3 vs. group 4, P<0.001; fibroblasts: group 1 vs. group 2, and group 3 vs. group 4, P<0.01). Additionally, the numbers of osteoblasts and capillaries were increased significantly at 45 days of consolidation compared to 21 days in both the HAF and NS groups (osteoblasts: group 1 vs. group 2, P<0.01; group 3 vs. group 4, P<0.05; capillaries: group 1 vs. group 2, and group 3 vs. group 4, P<0.01). Histomorphometric analysis demonstrated that local HAF administration effectively accelerated bone formation. Thus, a HAF injection procedure could improve new bone formation around the bone in maxillofacial operations such as DO. Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  5. Propolis accelerates the consolidation phase in distraction osteogenesis.

    PubMed

    Bereket, Cihan; Özan, Fatih; Şener, İsmail; Tek, Mustafa; Altunkaynak, Berrin Zuhal; Semirgin, Sibel Uçak; Şenel, Erman; Özdemir, Muhsin

    2014-09-01

    We evaluated the effect of propolis on new bone formation after distraction osteogenesis (DO). This study examined 3 groups: control group, P100, and P200. Rabbits underwent DO of the left mandible after an osteotomy between the first molar and the mental foramen. Bone mineral content and bone mineral density were evaluated using dual-energy x-ray absorption 1 and 4 weeks after the procedure. The volume of connective tissue and new bone and the number of capillaries were measured using stereologic analysis after the subjects were killed. Dual-energy x-ray absorption showed that the bone mineral content and bone mineral density were higher in the groups treated with propolis by week 4, and these parameters were higher in the P200 group. Stereologic analysis showed no significant differences in connective tissue volume and number of capillaries among the groups. New bone volume was lowest in the P200 group. We concluded that propolis accelerates bone formation and may shorten the consolidation phase with DO.

  6. Biomechanics of the canine mandible during bone transport distraction osteogenesis.

    PubMed

    Zapata, Uriel; Dechow, Paul C; Watanabe, Ikuya; Elsalanty, Mohammed E; Opperman, Lynne A

    2014-11-01

    This study compared biomechanical patterns between finite element models (FEMs) and a fresh dog mandible tested under molar and incisal physiological loads in order to clarify the effect of the bone transport distraction osteogenesis (BTDO) surgical process. Three FEMs of dog mandibles were built in order to evaluate the effects of BTDO. The first model evaluated the mandibular response under two physiological loads resembling bite processes. In the second model, a 5.0 cm bone defect was bridged with a bone transport reconstruction plate (BTRP). In the third model, new regenerated bony tissue was incorporated within the defect to mimic the surgical process without the presence of the device. Complementarily, a mandible of a male American foxhound dog was mechanically tested in the laboratory both in the presence and absence of a BTRP, and mechanical responses were measured by attaching rosettes to the bone surface of the mandible to validate the FEM predictions. The relationship between real and predicted values indicates that the stress patterns calculated using FEM are a valid predictor of the biomechanics of the BTDO procedures. The present study provides an interesting correlation between the stiffness of the device and the biomechanical response of the mandible affected for bone transport.

  7. Bone Regeneration Is Promoted by Orally Administered Bovine Lactoferrin in a Rabbit Tibial Distraction Osteogenesis Model.

    PubMed

    Li, Wenyang; Zhu, Songsong; Hu, Jing

    2015-07-01

    Lactoferrin, an iron-binding glycoprotein which belongs to the transferrin family, has been shown to promote bone growth. However, reports regarding effects of lactoferrin on bone regeneration during distraction osteogenesis are limited. Our study was designed to investigate the effect of bovine lactoferrin treatment on bone formation of the distracted callus. We asked whether bovine lactoferrin enhances bone formation of the distraction callus as determined by (1) radiographic and histologic appearances; (2) dual-energy x-ray absorptiometry (DXA) analysis of bone mineral composition and bone mineral density; (3) micro-CT measures of trabecular architecture; and (4) biomechanical strength of the healing bone. Additionally, serology, reverse transcription (RT)-PCR, and immunohistochemistry were used to explore the possible mechanisms of bovine lactoferrin use on bone formation during distraction osteogenesis. Unilateral tibial osteodistraction was performed on 80 New Zealand White rabbits with a distraction rate of 1 mm per day for 10 days. Animals then were divided randomly into two groups: (1) vehicle and (2) bovine lactoferrin. At 4 and 8 weeks after completion of distraction, the animals were sacrificed. Lengthened tibias and serum samples were obtained and subjected to radiologic, DXA, micro-CT, histologic, and biomechanical examinations, and serum, RT-PCR and immunohistochemical analyses. Radiologic, DXA, micro-CT, histologic, and biomechanical examinations indicated that bovine lactoferrin treatment not only accelerated bone formation at early stages of distraction osteogenesis but also promoted bone consolidation at late stages. The ultimate force of the distracted calluses was increased by 37% (118.8 ± 6.65 N in the lactoferrin group and 86.5 ± 5.47 N in the vehicle group; p < 0.001) and 84% (384.8 ± 18.4 N in the lactoferrin group and 209.0 ± 15.2 N in the vehicle group; p < 0.001) at 4 and 8 weeks, respectively. Moreover, serum analysis showed that

  8. Anterior maxillary segmental distraction for correction of maxillary hypoplasia and dental crowding in cleft palate patients: a preliminary report.

    PubMed

    Wang, X-X; Wang, X; Li, Z-L; Yi, B; Liang, C; Jia, Y-L; Zou, B-S

    2009-12-01

    To evaluate the feasibility of anterior maxillary segmental distraction (AMSD) to correct maxillary hypoplasia and severe dental crowding in cleft lip and palate (CLP) patients, 7 patients (average age 16.4 years) with maxillary hypoplasia, shortened maxillary dental arch length and severe anterior dental crowding secondary to CLP were selected for this study. After anterior maxillary segmental osteotomy, 3 patients were treated using bilateral internal distraction devices, and 4 patients were treated using rigid external distraction devices. Photographs and radiographs were taken to review the improvement in facial profile and occlusion after distraction. An average 10.25 mm anterior maxillary advancement was obtained in all patients after 10-23 days of distraction and 9-16 weeks of consolidation. The sella-nasion-point A (SNA) angle increased from 69.5 degrees to 79.6 degrees. Midface convexity was greatly improved and velopharyngeal competence was preserved. The maxillary dental arch length was greatly increased by 10.1 mm (P<0.01). Dental crowding and malocclusion were corrected by orthodontic treatment. These results show that AMSD can effectively correct the hypoplastic maxilla and severe dental crowding associated with CLP by increasing the midface convexity and dental arch length while preserving velopharyngeal function, and dental crowding can be corrected without requiring tooth extraction.

  9. Maxillary distraction versus orthognathic surgery in cleft lip and palate patients: effects on speech and velopharyngeal function.

    PubMed

    Chua, H D P; Whitehill, T L; Samman, N; Cheung, L K

    2010-07-01

    This clinical randomized controlled trial was performed to compare the effects of distraction osteogenesis (DO) and conventional orthognathic surgery (CO) on velopharyngeal function and speech outcomes in cleft lip and palate (CLP) patients. Twenty-one CLP patients who required maxillary advancement ranging from 4 to 10 mm were recruited and randomly assigned to either CO or DO. Evaluation of resonance and nasal emission, nasoendoscopic velopharyngeal assessment and nasometry were performed preoperatively and at a minimum of two postoperative times: 3-8 months (mean 4 months) and 12-29 months (mean 17 months). Results showed no significant differences in speech and velopharyngeal function changes between the two groups. No correlation was found between the amount of advancement and the outcome measures. It was concluded that DO has no advantage over CO for the purpose of preventing velopharyngeal incompetence and speech disturbance in moderate cleft maxillary advancement.

  10. Controlling the vector of distraction osteogenesis in the management of obstructive sleep apnea.

    PubMed

    Shilo, Dekel; Emodi, Omri; Aizenbud, Dror; Rachmiel, Adi

    2016-01-01

    Obstructive sleep apnea (OSA) in individuals with craniofacial anomalies can compromise airway and is a serious life-threatening condition. In many cases, tracheostomy is carried out as the treatment of choice. Distraction osteogenesis of the mandible as a treatment modality for OSA is very useful and may spare the need for tracheostomy or allow decannulation, yet controlling the vector of distraction is still a major challenge. We present a method for controlling the vector of distraction. Eight patients with severe respiratory distress secondary to a micrognathic mandible were treated by mandibular distraction osteogenesis using either external or internal devices. Temporary anchorage devices (TADs) and orthodontic elastics were used to control the vector of distraction. Cephalometric X-rays, computed tomography, and polysomnographic sleep studies were used to analyze the results. A mean distraction of 22 mm using the internal devices and a mean of 30 mm using the external devices were achieved. Increase in the pharyngeal airway and hyoid bone advancement was also observed. Anterior-posterior advancement of the mandible was noted with no clockwise rotation. Most importantly, clinical improvement in symptoms of OSA, respiratory distress, and feeding was noted. We describe a method for controlling the vector of distraction used as a treatment for OSA. In these cases, TADs were used as an anchorage unit to control the vector of distraction. Our results show excellent clinical and radiographical results. TADs are a simple and nonexpensive method to control the vector of distraction.

  11. Controlling the vector of distraction osteogenesis in the management of obstructive sleep apnea

    PubMed Central

    Shilo, Dekel; Emodi, Omri; Aizenbud, Dror; Rachmiel, Adi

    2016-01-01

    Background: Obstructive sleep apnea (OSA) in individuals with craniofacial anomalies can compromise airway and is a serious life-threatening condition. In many cases, tracheostomy is carried out as the treatment of choice. Distraction osteogenesis of the mandible as a treatment modality for OSA is very useful and may spare the need for tracheostomy or allow decannulation, yet controlling the vector of distraction is still a major challenge. We present a method for controlling the vector of distraction. Materials and Methods: Eight patients with severe respiratory distress secondary to a micrognathic mandible were treated by mandibular distraction osteogenesis using either external or internal devices. Temporary anchorage devices (TADs) and orthodontic elastics were used to control the vector of distraction. Cephalometric X-rays, computed tomography, and polysomnographic sleep studies were used to analyze the results. Results: A mean distraction of 22 mm using the internal devices and a mean of 30 mm using the external devices were achieved. Increase in the pharyngeal airway and hyoid bone advancement was also observed. Anterior-posterior advancement of the mandible was noted with no clockwise rotation. Most importantly, clinical improvement in symptoms of OSA, respiratory distress, and feeding was noted. Conclusions: We describe a method for controlling the vector of distraction used as a treatment for OSA. In these cases, TADs were used as an anchorage unit to control the vector of distraction. Our results show excellent clinical and radiographical results. TADs are a simple and nonexpensive method to control the vector of distraction. PMID:28299260

  12. Osteoporosis influences the early period of the healing after distraction osteogenesis in a rat osteoporotic model.

    PubMed

    Tatehara, Seiko; Miyamoto, Youji; Takechi, Masaaki; Momota, Yukihiro; Yuasa, Tetsuya

    2011-01-01

    Despite the clinical adoption of distraction osteogenesis (DO), studies examining the bone healing process at the distraction gap in osteoporotic bone are limited. We examined the effect of osteoporosis in the ovariectomized rat on DO. Mid-diaphyseal osteotomies were performed on the femurs of ovariectomized (OVX) rats. External distractors were placed on these rats and also on sham-ovariectomized rats. After a 7-day latency period, distraction was carried out at a rate of 0.5mm/day for 10 days. The bone volume (BV) of the distraction gap was measured by Micro-focused X-ray computed tomography (micro-CT) at 0, 2, and 4 weeks after completion of the distraction, and the distraction gap was examined histologically. The BV of the distraction gap in the OVX group was significantly lower than that in the sham group at 2 and 4 weeks after completion of distraction (p<0.01). On histological examination, the distraction gap in the OVX group was filled with scattered smaller bone trabeculae than those seen in the sham group at 4 weeks after completion of distraction. Osteoclast numbers at the distraction gap in the OVX group were significantly increased when compared to the sham group (p<0.01). Bone turnover with osteoclast predominance in ovariectomized rats is likely to be the cause of a reduction in new bone formation at the distraction gap. Copyright © 2010 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  13. Regenerate Healing Outcomes in Unilateral Mandibular Distraction Osteogenesis Using Quantitative Histomorphometry

    PubMed Central

    Schwarz, Daniel A.; Arman, Krikor G.; Kakwan, Mehreen S.; Jamali, Ameen M.; Elmeligy, Ayman A.; Buchman, Steven R.

    2015-01-01

    Background The authors’ goal was to ascertain regenerate bone-healing metrics using quantitative histomorphometry at a single consolidation period. Methods Rats underwent either mandibular distraction osteogenesis (n=7) or partially reduced fractures (n=7); their contralateral mandibles were used as controls (n=11). External fixators were secured and unilateral osteotomies performed, followed by either mandibular distraction osteogenesis (4 days’ latency, then 0.3 mm every 12 hours for 8 days; 5.1 mm) or partially reduced fractures (fixed immediately postoperatively; 2.1 mm); both groups underwent 4 weeks of consolidation. After tissue processing, bone volume/tissue volume ratio, osteoid volume/tissue volume ratio, and osteocyte count per high-power field were analyzed by means of quantitative histomorphometry. Results Contralateral mandibles had statistically greater bone volume/tissue volume ratio and osteocyte count per high-power field compared with both mandibular distraction osteogenesis and partially reduced fractures by almost 50 percent, whereas osteoid volume/tissue volume ratio was statistically greater in both mandibular distraction osteogenesis specimens and partially reduced fractures compared with contralateral mandibles. No statistical difference in bone volume/tissue volume ratio, osteoid volume/tissue volume ratio, or osteocyte count per high-power field was found between mandibular distraction osteogenesis specimens and partially reduced fractures. Conclusions The authors’ findings demonstrate significantly decreased bone quantity and maturity in mandibular distraction osteogenesis specimens and partially reduced fractures compared with contralateral mandibles using the clinically analogous protocols. If these results are extrapolated clinically, treatment strategies may require modification to ensure reliable, predictable, and improved outcomes. PMID:20463629

  14. Alveolar vertical distraction osteogenesis: historical and biologic review and case presentation.

    PubMed

    Emtiaz, Shahram; Noroozi, Sohrab; Caramês, João; Fonseca, Luís

    2006-12-01

    Dental rehabilitation of partially or totally edentulous patients with dental implants has become common practice in the last few decades, with reliable long-term results. However, local conditions of edentulous alveolar ridges may be unfavorable for implant placement. Vertically deficient alveolar ridges, in particular, may have insufficient bone volume to hold implants of adequate dimensions, making implant placement difficult or impossible. To correct this situation, a variety of surgical procedures have been proposed, including onlay bone grafts, vertical guided bone regeneration, and alveolar distraction osteogenesis. Distraction osteogenesis is a biologic process of new bone formation between the surfaces of bone segments that are gradually separated by incremental traction. This process is initiated when a traction force is applied to the bone segments and continues as long as the callus tissues are stretched. This traction force, in turn, generates tension within the tissues that connect the bone segments, which stimulates new bone formation parallel to the vector of distraction. The aim of this article is to provide clinicians with the historical background of and biologic basis for the concept of distraction osteogenesis, which can be traced back to the 1800s. Finally, a clinical case is presented to demonstrate a step-by-step application of alveolar distraction osteogenesis as a treatment protocol in a partially edentulous ridge for improvement of esthetics.

  15. Innovation in anterior mandibular alveolar distraction osteogenesis: introduction of a new bone-borne distraction device and first clinical results.

    PubMed

    Obwegeser, Joachim Anton; Metzler, Philipp; Jacobsen, Christine; Zemann, Wolfgang

    2012-12-01

    Segmental distraction osteogenesis of the anterior mandibular alveolar process (frontblock) is a sufficient method to avoid extractions in patients with dental crowding and to decompensate retroalveolism. Up to now dental-borne devices were used, but limitate the indications for front-block distraction. A new bone-borne distraction device for mandibular alveolar front-block movement is introduced in this study. The distractor allows sufficient segmental transport without loading on the teeth. Clinical evaluations of 7 patients have been performed including the feasibility and predictability of the distraction, postoperative pain and patients' discomfort. The results indicate that this technique is a promising strategy in the correction of dental crowding, correcting the curve of Spee and to decompensate mandibular retroalveolism even in patients with impaired periodontal health and a thin mandibular symphysis. Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  16. Placement of implants in distraction osteogenesis: a pilot study in dogs.

    PubMed

    Nosaka, Y; Tsunokuma, M; Hayashi, H; Kakudo, K

    2000-01-01

    This study investigated the possibility of achieving osseointegration of implants placed in a distracted site during the consolidation period. Four healthy male mongrel dogs were used in this experiment. A subperiosteal corticotomy around the mandible was performed between the left mandibular premolar and first molar. After a 7-day latency period for soft tissue healing, the distraction was performed at the rate of 1 mm per day for 14 consecutive days to allow for 14 mm of elongation, using an extraoral distraction device. Three weeks after the completion of distraction, screw-type implants were placed in the distracted site. Twenty-four weeks after placement of the implants, they were stable, and osseointegration had been achieved physically, radiographically, and histologically. These results suggest the possibility of shortening the period of implant treatment by using the distraction osteogenesis technique.

  17. Feasibility of magnetic activation of a maxillofacial distraction osteogenesis, design of a new device.

    PubMed

    Boisson, J; Strozyk, H; Diner, P; Picard, A; Kadlub, N

    2016-06-01

    Distraction osteogenesis is a technique of bone lengthening which uses the bone's natural healing process. Current devices for craniofacial distraction require a transmucosal or transcutaneous activator and are associated with numerous complications. The aim of this study was to evaluate the feasibility of a rodless magnetic activation device that could be used in craniofacial distraction. The method is based on the torque applied between two unaligned permanent magnets. This torque depends on magnet size, shape, composition, magnetization and distance between the two magnets. Using a configuration close to that which would be applied in actual distraction osteogenesis (in terms of the distance between the two magnets), we performed an analytical study and evaluated the results. We observed good agreement between the model and the experimental results, finding that the transmitted force value is comparable to the force required in mandibular distraction. Thus, we proposed a design of a new distracting device consisting of a cylindrical permanent magnet diametrically magnetized and fixed to an endless screw along its main axis. Activation of the distraction motion is achieved through interaction of the first magnet with a second cylindrical magnet whose magnetization is orthogonal to its main axis and to the device's endless screw. This preliminary study demonstrates that magnetic activation for mandibular osteogenic distraction is feasible and that device size is not a constraint. We propose a prototypic device. Copyright © 2016. Published by Elsevier Ltd.

  18. Prosthetic rehabilitation of edentulous ridges following alveolar distraction osteogenesis: clinical report of three cases.

    PubMed

    Ergun, Gulfem; Nagas, Isil Cekic; Yilmaz, Dervis; Ozturk, Mustafa

    2011-03-01

    Patients with complete edentulism who have insufficient bone for endosseous dental implant treatment present a challenge for dental practitioners. Distraction osteogenesis of the edentulous alveolar ridges is a process for augmentation of atrophic alveolar bone before dental implant placement. This clinical report describes the use of distraction osteogenesis and rehabilitation of patients with a fixed or removable implant-supported prosthesis to treat mandibular defects. Two female patients with segmental alveolar atrophy at the posterior regions of mandible and one female patient with defect at the anterior region of mandible were treated using distraction devices. However, lingual tipping of the distraction vector occurred during the distraction phase in patient 1. The morphology of the alveolar bone was also analyzed in relation to the planned implant position. After a consolidation period of 12 weeks on average, radiologic observation suggested that there was sufficient bone formation for implant installation. In all patients, implant-supported fixed or removable prosthetic oral rehabilitation was successfully performed, and the clinical and radiologic findings were satisfactory. After 4 years of follow-up, no functional or esthetic difficulties with the implants and restorations were noted. These case reports suggest that although alveolar distraction osteogenesis seems to be an effective technique for augmenting atrophic alveolar bone for creating bone and soft tissue, complications may occur after surgical procedures.

  19. Effect of oil-based calcium hydroxide (Osteoinductal) on distraction osteogenesis in rabbit mandible.

    PubMed

    Polat, Hidayet Burak; Yeler, Hasan; Gumus, Cesur; Bulut, Huseyin Eray; Kucuk, Dervishan

    2009-06-01

    The objective of this study was to evaluate the effects of oil-based calcium hydroxide on mandibular lengthening during distraction osteogenesis. Twenty-four New Zealand white rabbits underwent unilateral mandibular osteotomy. The rabbits were divided into 4 groups containing 6 each: groups 1 and 3 were control groups and groups 2 and 4 were test groups. Oil-based calcium hydroxide suspension was applied to test groups' corticotomy gap after osteotomy during operation. No treatment was applied to the control groups. After 5 days' latency period, distraction was commenced at a rate of 0.8 mm/day for 10 days via custom-made distractor. Groups 1 and 2 were killed 14 days after distraction and groups 3 and 4 were killed 28 days after distraction. Quantitative computerized tomography evaluation did not demonstrate a difference mean the density and the area of the regeneration between groups 1 and 3, but there was a significant difference groups 2 and 4. Histomorphometric evaluation demonstrated that there was a significant difference between test and control groups in new bone volume formation during distraction osteogenesis. Application of oil-based calcium hydroxide paste during the osteotomy phase of distraction osteogenesis increased regeneration and new bone volume formation.

  20. A Osteogenesis Distraction Device Enabling Control of Vertical Direction for Syndromic Craniosynostosis

    PubMed Central

    Fukawa, Toshihiko; Hirakawa, Takashi; Maegawa, Jiro

    2014-01-01

    Background: We have developed a hybrid facial osteogenesis distraction system that combines the advantages of external and internal distraction devices to enable control of both the distraction distance and vector. However, when the advanced maxilla has excessive clockwise rotation and shifts more downward vertically than planned, it might be impossible to pull it up to correct it. We invented devices attached to external distraction systems that can control the vertical vector of distraction to resolve this problem. The purpose of this article is to describe the result of utilizing the distraction system for syndromic craniosynostosis. Methods: In addition to a previously reported hybrid facial distraction system, the devices for controlling the vertical direction of the advanced maxilla were attached to the external distraction device. The vertical direction of the advanced maxilla can be controlled by adjustment of the spindle units. This system was used for 2 patients with Crouzon and Apert syndrome. Results: The system enabled control of the vertical distance, with no complications during the procedures. As a result, the maxilla could be advanced into the planned position including overcorrection without excessive clockwise rotation of distraction. Conclusion: Our system can alter the cases and bring them into the planned position, by controlling the vertical vector of distraction. We believe that this system might be effective in infants with syndromic craniosynostosis as it involves 2 osteotomies and horizontal and vertical direction of elongation can be controlled. PMID:25289307

  1. Correction of Length Discrepancy of Radius and Ulna with Distraction Osteogenesis: Three Cases

    PubMed Central

    Koca, Kenan; Akpancar, Serkan; Yıldız, Cemil

    2015-01-01

    Objectives. The aim of the study was to investigate the results of patients with isolated length discrepancy between ulna and radius who underwent distraction osteogenesis with unilateral external fixator. Material and Methods. A patient with ulna shortening due to multiple enchondromatosis, a patient with ulna shortening due to ulnar club hand, and a patient with radial shortening due to radial club hand were included in the study. The patients underwent ulna and radial distraction osteogenesis with unilateral external fixator. Range of wrist and forearm motion, deformities, and length discrepancy of ulna and radius were compared at preoperative and postoperative. Results. Duration of external fixation and followup were 2.6 and 23.3 months, respectively. Mean distraction osteogenesis was 1.66 cm. No patient reached the length of normal side. Range of rotation of forearm was increased by 15°. Range of ulnar-radial deviation was increased by 21.6°. Deformity of 15° at patient with multiple enchondromatosis was corrected. Conclusion. Isolated ulna or radius shortening may reduce with distraction osteogenesis by unilateral external fixator to prevent serious deformity. PMID:26347840

  2. Treatment of upper airway obstruction in infants with micrognathia using mandibular distraction osteogenesis.

    PubMed

    Zim, Shane

    2007-05-01

    Mandibular distraction osteogenesis has become an accepted alternative treatment for infants and children with upper airway obstruction associated with micrognathia. Several reports exist that purport the efficacy of mandibular distraction in these patients, such as preventing tracheostomy or facilitating tracheostomy removal. However, the majority of these studies are retrospective reviews with small cohorts and relatively short-term follow-up. Consequently, the ideal indications, pre- and postoperative evaluation, timing, and treatment are subject to controversy and not currently well established. Significantly less attention has been given to short- and long-term complications of mandibular distraction, such as effects on the developing tooth buds, impact on future mandibular development, and temporomandibular joint abnormalities. This article reviews the basic principles of distraction osteogenesis, summarizes the outcomes of recent literature involving pediatric mandibular distraction including this author's experience, and discusses the known and potential adverse sequelae of mandibular distraction. Before a clearly defined role of mandibular distraction in the treatment of infants with micrognathia-associated upper airway obstruction can be established, additional prospective studies are necessary to delineate its benefits and limitations.

  3. Alveolar distraction osteogenesis in the human mandible: a clinical and histomorphometric study.

    PubMed

    Sezer, Bahar; Koyuncu, Banu Özveri; Günbay, Tayfun; Sezak, Murat

    2012-08-01

    To identify the quality of newly formed bone in the distraction region and to determine the percentage of mineralized bone formed in the distraction area. Ten patients with vertically deficient mandibular alveolar ridges were treated by means of distraction osteogenesis. Four months after consolidation of distracted segments, a total of 40 dental implants were inserted in native bone and distracted bone. Bone biopsies were taken at the implant sites with trephine burrs for histological and histometric analyses. Four months after implant placement, abutments were connected, and prosthetic loading of the implants was started. The mean bone gain at the end of distraction was 7.2 ± 0.8 mm. The cumulative success rate of implants 3 years after the onset of prosthetic loading was 100%. The newly formed bone consisted of woven bone reinforced by parallel-fibered bone with bone marrow spaces and the percentage of mineralized bone ranged from 50.56% to 76.88%. Alveolar distraction osteogenesis is able to produce adequate mature bone for the correction of mandibular bone deficits before dental implant insertion.

  4. Repair of segmental bone defects in the maxilla by transport disc distraction osteogenesis: Clinical experience with a new device

    PubMed Central

    Boonzaier, James; Vicatos, George; Hendricks, Rushdi

    2015-01-01

    The bones of the maxillary complex are vital for normal oro-nasal function and facial cosmetics. Maxillary tumor excision results in large defects that commonly include segments of the alveolar and palatine processes, compromising eating, speech and facial appearance. Unlike the conventional approach to maxillary defect repair by vascularized bone grafting, transport disc distraction osteogenesis (TDDO) stimulates new bone by separating the healing callus, and stimulates growth of surrounding soft tissues as well. Bone formed in this way closely mimics the parent bone in form and internal structure, producing a superior anatomical, functional and cosmetic result. Historically, TDDO has been successfully used to close small horizontal cleft defects in the maxilla, not exceeding 25 mm. Fujioka et al. reported in 2012 that “no bone transporter corresponding to the (large) size of the oro-antral fistula is marketed. The authors report the successful treatment of 4 cases involving alveolar defects of between 25 mm and 80 mm in length. PMID:26389041

  5. [Bone fracture and the healing mechanisms. The mechanical stress for fracture healing in view of distraction osteogenesis].

    PubMed

    Yukata, Kiminori; Takahashi, Mitsuhiko; Yasui, Natsuo

    2009-05-01

    It is generally accepted that moderate mechanical stress influences the course of fracture healing. A flexible fixation of the fractured site can induce fracture callus formation, whereas an unstable fixation can lead to a nonunion. The relationship between mechanical stress and the process of bone regeneration or healing remains incompletely understood. Distraction osteogenesis is a surgical technique that, using appropriate mechanical tension-stress, does not break the callus but rather it stimulates and maintains osteogenesis. The common principles of distraction osteogenesis are osteotomy and slow progressive distraction by an external fixation device. Interest in bone regeneration associated with mechanical stress might lead to better understanding of the fracture healing process.

  6. The influence of expansion rates on mandibular distraction osteogenesis: a computational analysis.

    PubMed

    Boccaccio, A; Pappalettere, C; Kelly, D J

    2007-11-01

    Mandibular distraction osteogenesis is a clinical procedure used for modifying the mandibular geometry when problems of dental overcrowding and arch shrinkage occur. The objective of this study is to use a computational model of tissue differentiation to examine the influence of the rate of distraction on bone re-growth within the fracture callus of a human mandible submitted to symphyseal distraction osteogenesis. A 3D model of the mandible is reconstructed from CT scan data and meshed into finite elements. Two different mastication loadings have been investigated: a 'full' mastication load and a 'reduced' mastication load where the action of each muscle was reduced by 70%. Four different distraction rates were analyzed: 0.6, 1.2, 2, and 3 mm/day, allowing a total displacement of 6 mm. In the early stages of the distraction process it is predicted that there is a decrease in the amount of bone tissue forming within the center of the fracture gap for all distraction rates. After the initial phases of expansion, the bone tissue within the callus increases for the slower rate of distraction or continues to decrease at the faster rates of distraction. At the end of the simulated maturation period, 47% of the distracted callus was predicted to consist of bone tissue for a distraction rate of 0.6 mm/day, decreasing to 22% for a distraction rate of 3 mm/day. Significantly higher amounts of bone formation were predicted for all distraction rates for the case of reduced mastication loading. Disparities between the model predictions and what is observed in vivo were found. For instance, during the latency period, the distraction period and beyond, the model is predicting larger than expected amounts of cartilage tissue formation within the callus. This and other limitations of the proposed model are discussed and possible specific explanations for these disparities are provided in the paper. The model predicts a distraction rate of around 1.2 mm/day to be optimal as higher

  7. Ilizarov distraction osteogenesis over the preexisting nail for treatment of nonunited femurs with significant shortening.

    PubMed

    Azzam, Wael; El-Sayed, Mohamed

    2016-04-01

    Nonunion of the femur with significant shortening with retained intramedullary nail (IMN) is a challenging orthopedic problem. We investigated whether the application of Ilizarov distraction osteogenesis over the preexisting nail can simultaneously achieve union and correct shortening. Thirteen patients with femoral diaphyseal nonunion associated with significant shortening with retained IMN were retrospectively reviewed. All patients were treated by distraction osteogenesis using a circular external fixator over the preexisting nail. The fixator was used to compress or distract the nonunion site and to gradually distract a separate osteotomy to restore limb length. The osteotomy was done percutaneously using the Gigli saw with the nail in situ. The applied surgical technique was bifocal compression distraction in 11 cases, bifocal distraction in one case, and monofocal distraction in one case. Bone healing was achieved in 11 cases (84.6 %) at both the nonunion and the lengthening sites. The mean length gained was 4 cm (range, 3-6 cm). The mean time to fracture union was 4.9 months (range, 4-6 months). The mean knee flexion improved from 86.5° (range, 40°-135°) preoperatively to 109.6° (range, 60°-125°) at final follow-up (p < 0.05). The mean limb-length discrepancy improved from 4.7 cm (range, 3-7.5) preoperatively to 0.7 cm (range, 0-3) at final follow-up (p < 0.001). Ten out of 13 patients had a total of 14 complications, with a mean of 1.1 complications per patient. Distraction osteogenesis over the preexisting nail can be a good alternative to treat difficult femoral diaphyseal nonunions associated with significant shortening.

  8. Bilateral Distraction Osteogenesis of Vascularized Iliac Crest Free Flaps Used in Mandibular Reconstruction

    PubMed Central

    Subramaniam, Shiva S.; Vujcich, Nathan J.; Nastri, Alf L.

    2016-01-01

    Summary: Vascularized free flaps have become the gold standard in reconstructing large segmental mandibular defects; however, even when bony union and soft-tissue coverage is achieved, insufficient bone stock and altered facial contour can create functional and cosmetic problems for the patient. There have been limited case reports on the use of secondary distraction osteogenesis to address these issues. The authors report a case of bilateral mandibular distraction of deep circumflex iliac artery free flaps, used for mandibular reconstruction after total mandibulectomy for treatment of osteosarcoma. Performed for reasons of retrognathia and facilitation of dental prosthetic rehabilitation, this is the first case of bilateral horizontal distraction osteogenesis of deep circumflex iliac artery free flaps reported in the literature. PMID:27257565

  9. Vertical distraction osteogenesis in the human mandible: a prospective morphometric study.

    PubMed

    Amir, Lisa R; Becking, Alfred G; Jovanovic, Andreas; Perdijk, Frits B T; Everts, Vincent; Bronckers, Antonius L J J

    2006-08-01

    Vertical distraction osteogenesis has received considerable interest as a way to augment bone prior to implant placement. However, very little is known regarding the appropriate distraction protocols in the human mandible. In this study, we evaluate the effect of the distraction rate and the duration of neutrofixation on bone formation and closure of the gap in the human mandible. Vertical distraction was performed in the atrophic mandible of 16 edentulous patients, aged 62+/-6 years. The bone was distracted for approximately 10 mm at a rate of either 0.5 or 1 mm/day. Bone biopsies were taken after 7-20 weeks of neutrofixation. Histological analysis demonstrated newly formed bone in the distraction gap in all biopsies. The bone was predominantly of the woven type. After 10 weeks of neutrofixation, the gap was bridged by new bone in two out of three intact samples in the 0.5 mm/day group, but not in two intact samples of the 1 mm/day group. Histomorphometry revealed longer bone trabeculae (P=0.02) and a somewhat increased bone volume in the area where new bone formation started (P=0.07) in the group of patients having the 0.5 mm/day of distraction rate than in the 1 mm/day group. We conclude that in elderly patients, a distraction rate of 0.5 mm/day results in faster osteogenesis in the distraction gap than a rate of 1 mm/day. A minimum of 10 weeks of neutrofixation seems to be needed to close a 10 mm gap after cessation of distraction.

  10. Outcome of early rigid fixation and removal of rigid external distraction system after distraction osteogenesis of the midface.

    PubMed

    Yun, In Sik; Park, Be-Young Yun

    2011-03-01

    After distraction osteogenesis of the midface using a rigid external distraction (RED) system, there is a high possibility that a relapse might occur due to an incomplete fixation during the consolidation period, and it is uncomfortable for the patients to wear a head frame for 2 to 3 months. There are also risks of trauma that are developing. To overcome these problems, we suggest the protocol of early rigid fixation, with excellent treatment outcomes and a review of literatures. Of 9 patients, Le Fort III osteotomy was completed in 2 patients with Crouzon disease, and a Le Fort I osteotomy was completed in 7 patients with a cleft lip and palate. Immediately after the distraction with RED was completed, the fixation was done using a miniplate. This was followed by the early removal of the RED system. In patients who underwent the current procedure, an analysis was performed for the degree and the duration of distraction and the period of use of the RED system. Then, the presence of relapse was examined. The mean degree of bone distraction was found to be 18.05 mm (range, 9-31.5 mm). The mean period of wearing RED system was 29.78 days (range, 21-43 days). Thereafter, the mean follow-up period was 13 months (range, 6 months to 3 years). The degree of accumulated relapse was found to be 1.7 mm (10%) on postoperative year 1, 2.4 mm (13.3%) on postoperative year 2, and 2.3 mm (14.6%) on postoperative year 3. With the concept of early rigid fixation, we were able to eliminate the disadvantages of distraction osteogenesis such as the long period of wearing a head frame, the delay of returning to society, and the inconvenience of patients. Moreover, early rigid fixation could decrease the need of overcorrection and the amount of relapses.

  11. The expression of endogenous hydrogen sulfide signal during distraction osteogenesis in a rabbit model.

    PubMed

    Jiang, X-W; Zhang, Y; Cheng, Y-Z; Fan, X-S; Deng, X; Peng, H-Y

    2017-08-14

    The hydrogen sulfide (H2S) signal system plays an important role in bone metabolism. However, the role of endogenous H2S during distraction osteogenesis (DO) remains unclear. Sixty-two male New Zealand White rabbits were subjected to right mandibular DO. Before distraction, the animals were divided randomly into two groups: group A, 0.5mm twice/day for 10 days; group B, 1.25mm twice/day for 4 days. Plasma and distraction gap tissue were harvested to determine the H2S signal. The osteogenesis effect was also evaluated. The newly regenerated bone in group A presented a higher level of mineralization and biomechanical strength than that in group B. The bone mineralization density in group A was 1.95-fold that in group B (P=0.028), while the biomechanical strength in group A was 1.26-fold that in group B (P=0.042) at the end of the experiment. The H2S signal was detected during the whole process of DO. The relative plasma H2S concentrations in group A were noticeably higher than those in group B at the middle of distraction (P<0.001), at the end of the distraction (P=0.034), and 2 weeks after the end of distraction (P=0.002). The results suggest that the endogenous H2S signal system plays a major role during DO. Copyright © 2017. Published by Elsevier Ltd.

  12. CYP24A1-deficiency does not affect bone regeneration in distraction osteogenesis.

    PubMed

    Husseini, Abdallah; St-Arnaud, René

    2017-10-01

    The putative biological activity of 24,25-(OH)2D remains unclear. Previous studies showed an increase in the circulating levels of this metabolite following fracture in chicks. Our laboratory has generated a mouse model deficient for the Cyp24a1 gene for studying the role of 24,25-(OH)2D. We set out to study the role of CYP24A1 and 24,25-(OH)2D in intramembranous bone formation during distraction osteogenesis in wild-type and Cyp24a1-deficient mice. Distraction osteogenesis was applied to mouse tibiae using a miniature external fixator apparatus. Histomorphometric parameters and gene expression differences between the mutant mice and the wild-type controls were measured using micro computed tomography and reverse-transcription quantitative PCR.There were no statistically significant differences between genotypes when bone volume/tissue volume ratios were calculated at mid distraction, end of distraction, mid consolidation, or end of consolidation. We measured reduced expression of the Col10a1 gene in the mutant vs. wild-type mice at mid distraction (0.4±0.1 vs. 1.0±0.2 respectively, p=0.01). Similarly, we measured a significantly lower expression of the osteogenic marker Atf4 in mutant vs. wild-type mice at end of distraction (0.7±0.1 vs. 1.0±0.1 respectively, p=0.01) and at mid consolidation (0.6±0.1 vs. 1.0±0.1 respectively, p=0.0003). These results suggest moderate and restricted differences in chondrogenesis and osteogenesis that did not affect the volume of bone produced following distraction. We conclude that CYP24A1 activity is not essential for intramembranous bone formation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Combined micro computed tomography and histology study of bone augmentation and distraction osteogenesis

    NASA Astrophysics Data System (ADS)

    Ilgenstein, Bernd; Deyhle, Hans; Jaquiery, Claude; Kunz, Christoph; Stalder, Anja; Stübinger, Stefan; Jundt, Gernot; Beckmann, Felix; Müller, Bert; Hieber, Simone E.

    2012-10-01

    Bone augmentation is a vital part of surgical interventions of the oral and maxillofacial area including dental implantology. Prior to implant placement, sufficient bone volume is needed to reduce the risk of peri-implantitis. While augmentation using harvested autologous bone is still considered as gold standard, many surgeons prefer bone substitutes to reduce operation time and to avoid donor site morbidity. To assess the osteogenic efficacy of commercially available augmentation materials we analyzed drill cores extracted before implant insertion. In younger patients, distraction osteogenesis is successfully applied to correct craniofacial deformities through targeted bone formation. To study the influence of mesenchymal stem cells on bone regeneration during distraction osteogenesis, human mesenchymal stem cells were injected into the distraction gap of nude rat mandibles immediately after osteotomy. The distraction was performed over eleven days to reach a distraction gap of 6 mm. Both the rat mandibles and the drill cores were scanned using synchrotron radiation-based micro computed tomography. The three-dimensional data were manually registered and compared with corresponding two-dimensional histological sections to assess bone regeneration and its morphology. The analysis of the rat mandibles indicates that bone formation is enhanced by mesenchymal stem cells injected before distraction. The bone substitutes yielded a wide range of bone volume and degree of resorption. The volume fraction of the newly formed bone was determined to 34.4% in the computed tomography dataset for the augmentation material Geistlich Bio-Oss®. The combination of computed tomography and histology allowed a complementary assessment for both bone augmentation and distraction osteogenesis.

  14. Anterior maxillary segmental distraction in the treatment of severe maxillary hypoplasia secondary to cleft lip and palate

    PubMed Central

    Li, Hongliang; Dai, Jiewen; Si, Jiawen; Zhang, Jianfei; Wang, Minjiao; Shen, Steve Guofang; Yu, Hongbo

    2015-01-01

    Anterior maxillary segmental distraction (AMSD) is an effective surgical procedure in the treatment of maxillary hypoplasia secondary to cleft lip and palate. Its unique advantage of preserving velopharyngeal function makes this procedure widely applied. In this study, the application of AMSD was described and its long-term stability was explored. Eight patients with severe maxillary hypoplasia secondary to CLP were included in this study. They were treated with AMSD using rigid external distraction (RED) device. Cephalometric analysis was performed twice at three time points for evaluation: before surgery (T1), after distraction (T2), and 2 years after treatment (T3). One-way analysis of variance was used to assess the differences statistically. All the distractions completed smoothly, and maxilla was distracted efficiently. The value of SNA, NA-FH, Ptm-A, U1-PP, overjet and PP (ANS-PNS) increased significantly after the AMSD procedure (P < 0.05), with the mean overjet increased by 14.28 mm. However, comparison of cephalometric analysis between T2 and T3 showed no significant difference (P > 0.05). Changes of palatopharyngeal depth and soft palatal length were insignificant. AMSD with RED device provided an effective way to correct maxillary hypoplasia secondary to CLP, extended the palatal and arch length, avoided damage on velopharyngeal closure function and reduced the relapse rate. It is a promising and valuable technique in this potentially complicated procedure. PMID:26629107

  15. Comprehensive Review of Adipose Stem Cells and Their Implication in Distraction Osteogenesis and Bone Regeneration

    PubMed Central

    Morcos, Mina W.; Al-Jallad, Hadil; Hamdy, Reggie

    2015-01-01

    Bone is one of the most dynamic tissues in the human body that can heal following injury without leaving a scar. However, in instances of extensive bone loss, this intrinsic capacity of bone to heal may not be sufficient and external intervention becomes necessary. Several techniques are available to address this problem, including autogenous bone grafts and allografts. However, all these techniques have their own limitations. An alternative method is the technique of distraction osteogenesis, where gradual and controlled distraction of two bony segments after osteotomy leads to induction of new bone formation. Although distraction osteogenesis usually gives satisfactory results, its major limitation is the prolonged duration of time required before the external fixator is removed, which may lead to numerous complications. Numerous methods to accelerate bone formation in the context of distraction osteogenesis have been reported. A viable alternative to autogenous bone grafts for a source of osteogenic cells is mesenchymal stem cells from bone marrow. However, there are certain problems with bone marrow aspirate. Hence, scientists have investigated other sources for mesenchymal stem cells, specifically adipose tissue, which has been shown to be an excellent source of mesenchymal stem cells. In this paper, the potential use of adipose stem cells to stimulate bone formation is discussed. PMID:26448947

  16. Long-term skeletodental stability of mandibular symphyseal distraction osteogenesis: Tooth-borne vs hybrid distraction appliances.

    PubMed

    Durham, Julia N; King, John W; Robinson, Quinton C; Trojan, Terry M

    2017-03-01

    To evaluate and compare the long-term skeletodental stability of mandibular symphyseal distraction osteogenesis (MSDO) achieved with the use of tooth-borne vs. hybrid distraction appliances. Posttreatment and follow-up orthodontic records were collected for 33 patients. The 14 patients who underwent distraction with a tooth-borne appliance had a mean follow-up of 5.08 years. The 19 patients who underwent distraction with a hybrid appliance had a mean follow-up of 6.07 years. Records included intraoral photographs, study models, postero-anterior cephalometric radiographs, and lateral cephalometric radiographs. Total changes of 16 measurements were analyzed to compare patients who underwent the tooth-borne vs. the hybrid distraction. Both groups shared several similar and significant (P < .05) changes from posttreatment to follow-up records. Cast analysis showed a decrease in intercanine width and arch length and an increase in irregularity index. The postero-anterior cephalometric radiograph showed an increase in the width of the interincisal apices. The lateral cephalometric radiograph showed a decrease in the MP-L1 angle. The only statistically significant difference between the two appliances was the intercentral incisor contact point. Changes found are consistent with those found in untreated and orthodontically treated individuals over time. The long-term changes in the current patient sample can be determined to be expected and acceptable. MSDO is a viable treatment option with the use of either a hybrid or tooth-borne appliance.

  17. Management of post midface distraction occlusal discrepancy using temporary anchorage devices in a cleft patient

    PubMed Central

    Koteswara Prasad, N. K.; Hussain, Syed Altaf; Chitharanjan, Arun B.; Murthy, Jyotsna

    2015-01-01

    Open bite deformity following a successful midface advancement by distraction osteogenesis is a common complication. Temporary anchorage devices can be deployed during the distraction and post-distraction settling phases for restoring the occlusion even in severe cases. The following report describes the management of severe anterior open bite following maxillary distraction. PMID:25991895

  18. Immunohistochemical analysis of reconstructed sheep mandibles: transport distraction osteogenesis versus autogenous bone grafting.

    PubMed

    Çakır-Özkan, Nilüfer; Eyibilen, Ahmet; Özkan, Fatih; Gülbahar, Mustafa Yavuz; Kabak, Yonca Betül

    2011-04-01

    Although many studies have been conducted that related to growth factor expression in mandibular distraction osteogenesis, to our knowledge, no study comparing the immunohistochemical outcomes of autologous bone grafting (ABG) and transport distraction osteogenesis has been conducted up to now. The aim of this study was to histologically and immunohistochemically analyze newly formed bone in the resected mandible reconstructed by transport distraction osteogenesis and iliac crest bone grafting in a sheep model. Mandibular discontinuity defects created in the jaws of sheep were reconstructed by distraction osteogenesis (n = 7) and bone grafting (n = 7) and allowed to heal for 3 mos. The animals were then sacrificed and their jaws resected and prepared for decalcification. Histological and immunohistochemical examinations of transforming growth factor-beta 1 (TGF-β1) and bone morphogenetic protein (BMP) -2, -4 were performed in the newly formed bone in the defect area. Positive staining for BMP-2, -4, and TGF-β was observed in the cells and matrix components. BMP is present in both processes, but the expression of BMP-2, -4, and TGF-β in the distraction regenerate is stronger when compared with bone graft healing. The only limitation of the present study was that it evaluated the role of BMP-2, -4, and TGF-β expressions in bone repair process at 3 mo postoperatively. Determination of growth factor expression at more than 1 time point would be ideal in elucidating the role of these factors during bone healing. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  19. Effect of Low-Intensity Pulsed Ultrasound on Distraction Osteogenesis Treatment Time: A Meta-analysis of Randomized Clinical Trials.

    PubMed

    Raza, Hasnain; Saltaji, Humam; Kaur, Harmanpreet; Flores-Mir, Carlos; El-Bialy, Tarek

    2016-02-01

    The objectives of this systematic review with a meta-analysis were to critically analyze the available scientific literature regarding the effects of low-intensity pulsed ultrasound (US) on stimulating bone regeneration and bone maturation during distraction osteogenesis in humans and to determine whether the stimulatory effect of low-intensity pulsed US can effectively reduce the associated treatment time. Studies were considered for inclusion if they were randomized clinical trials that examined the effect of low-intensity pulsed US on distraction osteogenesis compared to conventional distraction osteogenesis. The primary outcome was reduced treatment time. Study selection, risk of bias assessment, and data extraction were performed in duplicate. A random-effects meta-analysis model was used when more than 3 trials were eligible for a quantitative analysis and considering the expected differences in interventions and measurement tools. Five randomized clinical trials, with a moderate to high risk of bias, met the eligibility criteria. Four trials examining tibial distraction osteogenesis in 118 patients were combined in a meta-analysis. A statistically significant difference for reduced treatment time between distraction osteogenesis with low-intensity pulsed US and standard distraction osteogenesis was evident (mean difference, -15.236 d/cm; random-effects 95% confidence interval, -19.902 to -10.569 d/cm; P < .0001). As for the mandible, only 1 clinical trial was available, which showed no significant effect of low-intensity pulsed US therapy on distraction osteogenesis. Current available evidence suggests that low-intensity pulsed US therapy may provide a reduction in the overall treatment time for tibial distraction osteogenesis. However, this conclusion should be considered with caution, given the moderate to high risk of bias in the included randomized clinical trials. © 2016 by the American Institute of Ultrasound in Medicine.

  20. Gastrostomy Placement Rates in Infants with Pierre Robin Sequence: A Comparison of Tongue-Lip Adhesion and Mandibular Distraction Osteogenesis.

    PubMed

    Susarla, Srinivas M; Mundinger, Gerhard S; Chang, Christopher C; Swanson, Edward W; Lough, Denver; Rottgers, S Alex; Redett, Richard J; Kumar, Anand R

    2017-01-01

    This study was conducted to compare the gastrostomy rates in infants with Pierre Robin sequence treated with tongue-lip adhesion or mandibular distraction osteogenesis. This was a retrospective study of symptomatic plastic and reconstructive surgery patients treated over an 8-year period. The primary predictor variable was surgical intervention (tongue-lip adhesion or distraction osteogenesis). Secondary predictor variables were categorized as demographic and clinical factors. The primary outcome was the need for gastrostomy tube placement. Secondary outcomes were complication rates, costs, and length of stay. Thirty-one tongue-lip adhesion and 30 distraction osteogenesis patients were included in the study. The groups were statistically comparable with regard to demographic and clinical factors (p > 0.18). Gastrostomy rates were higher in patients who underwent tongue-lip adhesion (48 percent) versus those who underwent distraction osteogenesis (16.7 percent; p = 0.008). In an adjusted model, subjects undergoing tongue-lip adhesion were more likely to require gastrostomy tube for nutritional support (OR, 6.5; 95 percent CI, 1.7 to 25.2; p = 0.007). There were two major complications in the tongue-lip adhesion group and none in the distraction osteogenesis group. There were three minor complications in the tongue-lip adhesion group and five in the distraction osteogenesis group. Total operating room costs were higher for distraction osteogenesis (p = 0.05), and total hospital costs and length of stay were higher for tongue-lip adhesion (p < 0.05). Among infants with symptomatic Pierre Robin sequence, treatment by distraction osteogenesis is associated with a lower risk for gastrostomy placement for nutritional support. Hospital costs are higher for tongue-lip adhesion. Therapeutic, III.

  1. Nerve Regeneration and Functional Recovery With Neurorrhaphy Performed at the Early Distraction Osteogenesis: An Experimental Study.

    PubMed

    Kim, Byung Jun; Cho, Jeong Mok; Kwon, Sung Tack

    2017-07-01

    Distraction osteogenesis is widely used in many clinical situations, but distraction in cases accompanying nerve injury has been avoided due to concern of unfavorable effect on nerve regeneration by traction. This study evaluated the feasibility of early distraction lengthening after neurorrhaphy. Thirty-six rats were evenly distributed into 3 groups (12 rats in each group); neurorrhaphy and distraction (group I), neurorrhaphy and osteotomy without distraction (group II), and only distraction without neurorrhaphy (group III), respectively. After osteotomy on the right tibia, distraction started after 1 week and was continued for 40 days with 0.25 mm per day. Histological evaluation was carried out to identify nerve regeneration at 4, 8, and 12 weeks after surgery. Walking tract analysis was performed to assess the functional recovery preoperatively and 1, 4, 8, and 12 weeks postoperatively. Histologically, axon number ratio was significantly impaired in group I (0.48 ± 0.14) and group II (0.53 ± 0.13) compared with group III (0.88 ± 0.04) at 4 weeks (P = 0.020). There was no significant difference at both 8 and 12 weeks. Walking tract analysis showed significant differences between groups I and III (-40.5 ± 4.3), and groups II and III (-35.5 ± 5.0) at 1 week (P = 0.001), but no difference was observed at 8 and 12 weeks. Distraction osteogenesis in early stage after nerve repair is safe and effective, when performed at a rate of 0.25 mm per day in rats.

  2. Effects of osteoformin in the rapid distraction osteogenesis of rabbit mandibles.

    PubMed

    Dayisoylu, Ezher Hamza; Pampu, Alper; Senel, Figen Cizmeci; Onder, Ercument; Dolanmaz, Dogan; Altintas, Nuray Yilmaz; Avunduk, Mustafa Cihat

    2016-02-01

    To evaluate the effects of osteoformin on mineralisation and quality of the new bone formation during rapid distraction osteogenesis. This multi-centre study was conducted at the Karadeniz Technical University, Middle East Technical University and Selcuk University. The experimental study was conducted from January 2010 to September 2012 and comprised New-Zealand rabbits that were randomly divided into three groups. In group I distraction rate was 1 mm/day while in groups II and III distraction rates were 2mm/day and 1 mm/day. In groups I and II 100µg/kg osteoformin was injected after the latency period. Distraction region was evaluated by radiological, histomorphometrical and dual energy X-ray absorptiometry analyses. SPSS 17 was used for statistical analysis. There were 18 rabbits with each of three groups having 6(33.3%). Accelerated bone healing was noted in groups I and II compared with group III (p<0.05). No significant differences were indicated between groups I and II (p>0.05). Local injection of osteoformin was effective in the craniomaxillofacial distraction osteogenesis in rabbits. Further experimental studies are recommended before using osteoformin on humans.

  3. Surgical guide assistant mandibular distraction osteogenesis and sagittal split osteotomy in the treatment of hemifacial microsomia.

    PubMed

    Shi, Lei; Liu, Wei; Yin, Lin; Feng, Shi; Xu, Shuo; Zhang, Zhi-Yong

    2015-03-01

    Hemifacial microsomia is the second most common congenital craniofacial malformation after cleft lip/palate with a wide variety of pathologic expression in jaws, skeletal components, ears, and soft tissues. Among the deformities, mandibular hypoplasia is the most common and is the main component that affects facial asymmetry. Mandibular distraction osteogenesis is the mainstay treatment; however, the vector of device and osteotomy lines need to be well designed. We utilized the sagittal split osteotomy for mandibular distraction with rapid prototyping surgical guide plate, making a successful outcome. Hemifacial microsomia with unilateral Pruzansky II mandibular hypoplasia were selected in this study. Three-dimensional CT reconstructive data was put into Proplan CFM for preoperative designing and then manufacturing the surgical guide plate. The mandibular osteotomy and implantation of the internal distractor were performed through an intraoral approach aided with the prefabricated guide plate. Distraction began 7 days postoperation with a frequency of 1 mm/d and the distractor was kept in place 6 to 10 months after the first operation, then the distractor was removed. From July 2012 to March 2014, 6 cases of Pruzansky II hemifacial microsomia aged from 7 to 11 years were treated with the technique mentioned above. The range of distraction extends from 20 to 30 mm. The facial asymmetry deformities were improved obviously and without any complication. Mandibular distraction osteogenesis by sagittal split osteotomy through rapid prototyping surgical guide plate provides certain advantages in the treatment of hemifacial microsomia.

  4. Angiogenesis is enhanced by continuous traction in rabbit mandibular distraction osteogenesis.

    PubMed

    Zheng, Li Wu; Ma, Li; Cheung, Lim Kwong

    2009-10-01

    Distraction osteogenesis is a controlled surgical procedure that initiates a regenerative process and uses mechanical strain to enhance the biological responses of the injured tissues to create new bone. To test the hypothesis that high frequency mechanical traction can enhance the angiogenesis in distraction regenerate, we compared the neo-vessel formation and gene expression of the angiogenic mediators between intermittent and continuous distraction osteogenesis. Eighty adult New Zealand white rabbits were randomly assigned to the continuous and intermittent distraction groups. Unilateral mandibular osteotomy was performed and custom-designed manual-driven or autodriven distractor was bridged over the osteotomy segments. Animals were sacrificed at day-6, day-10, day-14 and day-21 after osteotomy and examined with histology, immunohistochemistry and real-time polymerase chain reaction (PCR). Histological examination showed a more advanced bone formation in the continuous distraction group associated with significantly increased micro-vascular density and up-regulated mRNA expression of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF). We concluded that the high frequency traction provides a proper mechanical environment for angiogenesis contributing to the enhanced bone formation likely to be through up-regulation of the angiogenic mediators.

  5. Successful management of a childhood osteosarcoma with epiphysiolysis and distraction osteogenesis

    PubMed Central

    Xu, S.F.; Yu, X.C.; Xu, M.; Chen, X.

    2014-01-01

    In an 11-year-old boy with osteosarcoma in the proximal tibia (type iii), 2 cycles of dia chemotherapy (cisplatin, ifosfamide, doxorubicin) were administered preoperatively while epiphysiolysis was performed. Clinical response was determined to be complete by radiography and histopathology. Marginal excision was then performed with preservation of the proximal tibial epiphysis. Metaphyseal reconstruction was performed using distraction osteogenesis. Six cycles of dia chemotherapy were administered postoperatively. Twenty months later, the patient had developed no complications and experienced full bone healing, with no limb discrepancy. In selected adolescent patients with osteosarcoma, in whom the tumour is in full contact with the epiphysis, epiphyseal preservation by epiphysiolysis and reconstruction by distraction osteogenesis can provide an excellent outcome, resulting in a stable reconstruction that functionally restores the native limb. PMID:25089114

  6. Molecular mechanisms controlling bone formation during fracture healing and distraction osteogenesis.

    PubMed

    Ai-Aql, Z S; Alagl, A S; Graves, D T; Gerstenfeld, L C; Einhorn, T A

    2008-02-01

    Fracture healing and distraction osteogenesis have important applications in orthopedic, maxillofacial, and periodontal treatment. In this review, the cellular and molecular mechanisms that regulate fracture repair are contrasted with bone regeneration that occurs during distraction osteogenesis. While both processes have many common features, unique differences are observed in the temporal appearance and expression of specific molecular factors that regulate each. The relative importance of inflammatory cytokines in normal and diabetic healing, the transforming growth factor beta superfamily of bone morphogenetic mediators, and the process of angiogenesis are discussed as they relate to bone repair. A complete summary of biological activities and functions of various bioactive factors may be found at COPE (Cytokines & Cells Online Pathfinder Encyclopedia), http://www.copewithcytokines.de/cope.cgi.

  7. Molecular Mechanisms Controlling Bone Formation during Fracture Healing and Distraction Osteogenesis

    PubMed Central

    AI-Aql, Z.S.; Alagl, A.S.; Graves, D.T.; Gerstenfeld, L.C.; Einhorn, T.A.

    2011-01-01

    Fracture healing and distraction osteogenesis have important applications in orthopedic, maxillofacial, and periodontal treatment. In this review, the cellular and molecular mechanisms that regulate fracture repair are contrasted with bone regeneration that occurs during distraction osteogenesis. While both processes have many common features, unique differences are observed in the temporal appearance and expression of specific molecular factors that regulate each. The relative importance of inflammatory cytokines in normal and diabetic healing, the transforming growth factor beta superfamily of bone morphogenetic mediators, and the process of angiogenesis are discussed as they relate to bone repair. A complete summary of biological activities and functions of various bioactive factors may be found at COPE (Cytokines & Cells Online Pathfinder Encyclopedia), http://www.copewithcytokines.de/cope.cgi. PMID:18218835

  8. Perceptual Speech Assessment After Anterior Maxillary Distraction in Patients With Cleft Maxillary Hypoplasia.

    PubMed

    Richardson, Sunil; Seelan, Nikkie S; Selvaraj, Dhivakar; Khandeparker, Rakshit V; Gnanamony, Sangeetha

    2016-06-01

    To assess speech outcomes after anterior maxillary distraction (AMD) in patients with cleft-related maxillary hypoplasia. Fifty-eight patients at least 10 years old with cleft-related maxillary hypoplasia were included in this study irrespective of gender, type of cleft lip and palate, and amount of required advancement. AMD was carried out in all patients using a tooth-borne palatal distractor by a single oral and maxillofacial surgeon. Perceptual speech assessment was performed by 2 speech language pathologists preoperatively, before placement of the distractor device, and 6 months postoperatively using the scoring system of Perkins et al (Plast Reconstr Surg 116:72, 2005); the system evaluates velopharyngeal insufficiency (VPI), resonance, nasal air emission, articulation errors, and intelligibility. The data obtained were tabulated and subjected to statistical analysis using Wilcoxon signed rank test. A P value less than .05 was considered significant. Eight patients were lost to follow-up. At 6-month follow-up, improvements of 62% (n = 31), 64% (n = 32), 50% (n = 25), 68% (n = 34), and 70% (n = 35) in VPI, resonance, nasal air emission, articulation, and intelligibility, respectively, were observed, with worsening of all parameters in 1 patient (2%). The results for all tested parameters were highly significant (P ≤ .001). AMD offers a substantial improvement in speech for all 5 parameters of perceptual speech assessment. Copyright © 2016 The American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Transcription factor osterix modified bone marrow mesenchymal stem cells enhance callus formation during distraction osteogenesis.

    PubMed

    Lai, Qing-Guo; Yuan, Kui-Feng; Xu, Xin; Li, De-ren; Li, Guo-Ju; Wei, Fu-Lan; Yang, Zhong-Jun; Luo, Sheng-Lei; Tang, Xiao-Peng; Li, Shu

    2011-04-01

    This study was designed to investigate the effects of local delivery of bone marrow mesenchymal stem cells (BMMSCs) with or without osterix (OSX) gene transfected on bone regeneration in the distracted zone using a rabbit model of mandibular lengthening. Fifty-four New Zealand white rabbits underwent osteodistraction of the left mandible and were then randomly divided into group A, group B, and group C (n = 18 for each group). At the end of distraction BMMSCs transfected with OSX, autologous BMMSCs and physiological saline were injected into the distraction gaps in groups A, B, and C, respectively. Nine animals from each group were humanely killed at 2 and 6 weeks after completion of distraction. The distracted mandibles were harvested and processed for radiographic, histological, and immunohistochemical examination. Excellent bone formation in the distracted callus was observed in group A and group B; the former showed better bone formation and highest bone mineral density (BMD), thickness of new trabeculae (TNT, mm) and volumes of the newly formed bone area (NBV) in the distraction zones. Group C animals showed poor bone formation in the distracted callus when compared with groups A and B. Positive immunostaining of bone sialoprotein (BSP) was observed in the distracted callus in all groups; however, BSP expression was much stronger in group A than in groups B and C. The results of this study suggest transplantation of BMMSCs can promote bone formation in DO; OSX-mediated ex vivo gene therapy was more effective during bone deposition and callus formation in distraction osteogenesis. Copyright © 2011 Mosby, Inc. All rights reserved.

  10. An Update on Midface Advancement Using Le Fort II and III Distraction Osteogenesis

    PubMed Central

    Tahiri, Youssef; Taylor, Jesse

    2014-01-01

    Le Fort II and III distraction osteogenesis (DO) is a powerful tool in the craniofacial armamentarium that is most often employed to treat patients with craniofacial syndromes such as Crouzon, Apert, or Pfeiffer syndrome who present with midfacial retrusion, shallow orbits, exorbitism, malocclusion, obstructive sleep apnea and facial imbalance. In this article, the authors will provide the reader with an update on techniques for the treatment of various forms of midfacial retrusion. PMID:25383053

  11. [Complications of distraction-compression osteogenesis and their prophylaxis--a clinical report].

    PubMed

    Orzechowski, W; Morasiewicz, L; Krawczyk, A; Uher, T

    2001-01-01

    The authors present a historical overview of various classifications of distraction osteogenesis complications. Paley's classification as well as the authors' own classification also presented. Basing on the authors' own 10 year experiences with the Ilizarov method, selected complications at different stages of diagnostics, treatment and rehabilitation are presented. The most effective forms of prophylaxis are presented, with special attention given to the surgeon's own experience with the Ilizarov method.

  12. Reconstruction of large mandibular bone and soft-tissue defect using bone transport distraction osteogenesis.

    PubMed

    Elsalanty, Mohammed E; Taher, Taher N; Zakhary, Ibrahim E; Al-Shahaat, Osama A; Refai, Mohammed; El-Mekkawi, Hatem A

    2007-11-01

    Reconstruction of large anterior mandibular defects is a challenging task. The condition can become even more complex if primary reconstruction fails, leading to loss of the entire midline portion of the lower face with massive scarring of the remaining tissues. Bone transport distraction osteogenesis can provide a viable treatment option for these patients. One of such cases will be presented, followed by a discussion of the advantages, disadvantages, and limitations of the technique.

  13. The role of distraction osteogenesis in the management of craniofacial syndromes

    PubMed Central

    Heggie, Andrew A.; Kumar, Ricky; Shand, Jocelyn M.

    2013-01-01

    Distraction osteogenesis (DO) has been established as a useful technique in the correction of skeletal anomalies of the long bones for several decades. However, the use of DO in the management of craniofacial deformities has been evolving over the past 20 years, with initial experience in the mandible, followed by the mid-face and subsequently, the cranium. This review aims to provide an overview of the current role of DO in the treatment of patients with craniofacial anomalies. PMID:23662252

  14. Stimulation of Fos- and Jun-related genes during distraction osteogenesis.

    PubMed

    Lewinson, Dina; Rachmiel, Adi; Rihani-Bisharat, Souhir; Kraiem, Zaki; Schenzer, Pesia; Korem, Sigal; Rabinovich, Yaron

    2003-09-01

    Bone cells respond to mechanical stimulation by gene expression. The molecular events involved in the translation of mechanical stimulation into cell proliferation and bone formation are not yet well understood. We looked for the expression of early-response genes of the AP-1 transcription factor complex in an in vivo bone regeneration system subjected to mechanical forces because these genes were found to be related to mechanotransduction and important for bone development. Sheep maxillary bone was distracted daily for 15 days. c-Jun and c-Fos were evaluated by Northern blotting analysis and immunohistochemistry in biopsy specimens removed at 8 and 15 days and were compared with post-osteotomy but not distracted repair tissue. Elevated levels of c-Jun and c-Fos mRNA were found after 8 days of distraction. Likewise, mesenchyme-like and fibroblast-like cells composing the 8-day distracted regeneration tissue showed increases in the intensity of immunostaining compared to cells in the corresponding non-distracted fracture repair tissue. After 15 days of distraction, when bone trabeculae start to form distally and proximally in the distracted regeneration tissue, mostly preosteoblasts and osteoblasts retained c-Fos and c-Jun immunoreactivity, similar to bone-associated cells in control non-distracted fracture repair tissue. We propose that the elevated expression of c-Jun and c-Fos is related to mechanical stimulation in this in vivo bone regeneration system.

  15. Three-dimensional virtual-surgery simulation-assisted asymmetric bilateral mandibular distraction osteogenesis for a patient with bilateral condylar fractures.

    PubMed

    Kim, Myung-Jin; Seo, Jihee; Kim, Do-Keun; Baek, Seung-Hak

    2017-01-01

    Our objective was to report a patient treated with 3-dimensional virtual-surgery simulation-assisted asymmetric bilateral mandibular distraction osteogenesis. A boy (age, 9.5 years) had mandibular hypoplasia and facial asymmetry, induced by bilateral condylar fractures at 4 years of age. The asymmetric bilateral mandibular distraction osteogenesis was planned to correct facial asymmetry and mandibular hypoplasia. The 3-dimensional virtual-surgery simulation results were 11 mm of horizontal distraction on the right side and 4.5 mm of horizontal and 18 mm of vertical distraction on the left side of the mandible. Bilateral ramus osteotomies were performed, and intraoral unidirectional distraction devices were inserted. After a 6-day latency period, distraction was performed at 1 mm per day, followed by a 5-month consolidation period. Transarch and interarch elastics and an acrylic plate were used during distraction and consolidation. Total treatment time was 30 months. Satisfactory outcomes were obtained (achievement ratios between postconsolidation results and simulated results: gonial angle, 106% and 103.9%; mandibular body length, 94.2% and 89.9%; ramus height, 104.1% and 94.5% [values of the right and left sides, respectively]). The chin-point deviation and the transverse cant of the maxillary occlusal plane were significantly improved (10.1 mm to 3.3 mm; -6.8° to -4.4°). At 53 months of follow-up, the Class I molar relationship was well maintained. The transverse cant of the maxillary occlusal plane was slightly improved to -3.7° during pubertal growth. Three-dimensional virtual-surgery simulation can help clinicians to determine the optimal vector and amount of distraction with high accuracy in complex cases requiring simultaneous correction of a hypoplastic mandible and facial asymmetry. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  16. The study of distraction osteogenesis with nitinol shape memory alloy spring controlled by infrared light.

    PubMed

    Wang, Cheng; Zeng, Rong-sheng; Wang, Jian-ning; Huang, Hong-zhang; Sun, Jun; Luo, Zhi-bin

    2010-08-01

    The objective of this study was to investigate the feasibility of distraction osteogenesis with a nitinol shape memory alloy spring controlled by infrared light. In each of 20 New Zealand white rabbits, a critical-size defect (15 x 10 mm) was made in the body of the mandible, and a 10 x 8-mm segmental osteotomy was performed just anterior to the defect to create a transporting disk. A heat-controlled distractor and a temperature detector were then inserted (experimental group). Nothing was attached to the other side of the mandible (control group). After a 2-day latency period, the distractor was activated by the infrared at a rate of once per day for 9 days. The contralateral side was treated with the same infrared light. Gross, radiographic, and histologic analyses and dual energy x-ray absorptiometry were performed at regular intervals. In the experimental group, the mandibular defect was reconstructed, whereas in the control group it was not. The histologic appearance of regenerated bone was similar to that observed with traditional distraction osteogenesis. Distraction osteogenesis using a nitinol spring controlled by infrared light is possible. Copyright 2010 Mosby, Inc. All rights reserved.

  17. The biology of distraction osteogenesis for correction of mandibular and craniomaxillofacial defects: A review

    PubMed Central

    Natu, Subodh Shankar; Ali, Iqbal; Alam, Sarwar; Giri, Kolli Yada; Agarwal, Anshita; Kulkarni, Vrishali Ajit

    2014-01-01

    Limb lengthening by distraction osteogenesis was first described in 1905. The technique did not gain wide acceptance until Gavril Ilizarov identified the physiologic and mechanical factors governing successful regeneration of bone formation. Distraction osteogenesis is a new variation of more traditional orthognathic surgical procedure for the correction of dentofacial deformities. It is most commonly used for the correction of more severe deformities and syndromes of both the maxilla and the mandible and can also be used in children at ages previously untreatable. The basic technique includes surgical fracture of deformed bone, insertion of device, 5-7 days rest, and gradual separation of bony segments by subsequent activation at the rate of 1 mm per day, followed by an 8-12 weeks consolidation phase. This allows surgeons, the lengthening and reshaping of deformed bone. The aim of this paper is to review the principle, technical considerations, applications and limitations of distraction osteogenesis. The application of osteodistraction offers novel solutions for surgical-orthodontic management of developmental anomalies of the craniofacial skeleton as bone may be molded into different shapes along with the soft tissue component gradually thereby resulting in less relapse. PMID:24688555

  18. The biology of distraction osteogenesis for correction of mandibular and craniomaxillofacial defects: A review.

    PubMed

    Natu, Subodh Shankar; Ali, Iqbal; Alam, Sarwar; Giri, Kolli Yada; Agarwal, Anshita; Kulkarni, Vrishali Ajit

    2014-01-01

    Limb lengthening by distraction osteogenesis was first described in 1905. The technique did not gain wide acceptance until Gavril Ilizarov identified the physiologic and mechanical factors governing successful regeneration of bone formation. Distraction osteogenesis is a new variation of more traditional orthognathic surgical procedure for the correction of dentofacial deformities. It is most commonly used for the correction of more severe deformities and syndromes of both the maxilla and the mandible and can also be used in children at ages previously untreatable. The basic technique includes surgical fracture of deformed bone, insertion of device, 5-7 days rest, and gradual separation of bony segments by subsequent activation at the rate of 1 mm per day, followed by an 8-12 weeks consolidation phase. This allows surgeons, the lengthening and reshaping of deformed bone. The aim of this paper is to review the principle, technical considerations, applications and limitations of distraction osteogenesis. The application of osteodistraction offers novel solutions for surgical-orthodontic management of developmental anomalies of the craniofacial skeleton as bone may be molded into different shapes along with the soft tissue component gradually thereby resulting in less relapse.

  19. Complications of mandibular distraction osteogenesis for acquired deformities: a systematic review of the literature.

    PubMed

    Verlinden, C R A; van de Vijfeijken, S E C M; Tuinzing, D B; Becking, A G; Swennen, G R J

    2015-08-01

    A systematic review on complications in all forms of mandibular distraction osteogenesis (MDO) for acquired deformities was performed. Search terms expressing distraction osteogenesis were used in 'AND' combination with search terms comprising 'mandible' and terms for complication, failure, and morbidity. A search using PubMed (National Library of Medicine, NCBI), EMBASE, and the Cochrane Controlled Trials Register yielded 644 articles published between 1966 and mid October 2013. Three hundred and twenty-one eligible articles were screened in detail. Complications related to MDO in acquired deformities were reported in 105 clinical articles, involving 1332 patients. Treatments included alveolar distraction osteogenesis (ADO), mandibular lengthening, DO in bone grafts, and bi-/trifocal transport disc DO (TDDO) for segmental mandibular defects. A high incidence of complications was seen in MDO for acquired deformities (ADO 44.4%; residual group 43.9%). An index for classifying complications in MDO, based on the impact and further treatment or final results, was used. In the ADO group, soft tissue complications (8.0%), insufficient vector control (7.6%), temporary inferior alveolar nerve (IAN) neurosensory disturbances (6.5%), device-related problems (3.5%), mandible fractures (2.8%), insufficient bone formation (2.5%), and fracture of the transport disc (1.3%) were seen. In the residual group, temporary IAN neurosensory disturbances (13.4%), minor infection (5.3%), DO failure (4.0%), and device-related problems (3.8%) were reported. Copyright © 2015. Published by Elsevier Ltd.

  20. [Biomechanical studies of forces occurring in the Ilizarov and Orthofix apparatuses during limb lengthening by distractive osteogenesis].

    PubMed

    Snela, S; Kisiel, J; Gregosiewicz, A; Dziubiński, F

    2000-01-01

    The magnitude of the distractive forces occurring in the Ilizarov and Orthofix apparatuses during limb lengthening by distractive osteogenesis has been investigated. Eighteen patients treated between 1995 and 1998 were included in the study. The data obtained were computerized and related to clinical, radiographic and sonographic findings. Typical and repeatable graphs of forces were found during the process of lengthening as well as typical relationships between the callus and the values of distractive forces.

  1. Automating skeletal expansion: An implant for distraction osteogenesis of the mandible

    PubMed Central

    Magill, John C.; Byl, Marten F.; Goldwaser, Batya; Papadaki, Maria; Kromann, Roger; Yates, Brent; Morency, Joseph R.; Kaban, Leonard B.; Troulis, Maria J.

    2010-01-01

    Background Distraction osteogenesis (DO) is a technique of bone lengthening that makes use of the body’s natural healing capacity. An osteotomy is created and a rigid distraction device is attached to the bone. After a latency period, the device is activated 2–4 times per day for a total of 1 mm/day of bone lengthening. This technique is used to correct a variety of congenital and acquired deformities of the mandible, midface and long bones. To shorten the treatment period and to eliminate the complications of patient activation of the device, an automated continuous distraction device would be desirable. It has been reported that continuous distraction generates adequate bone with lengthening at a rate of 2 mm/day, thereby reducing the treatment time. Method of Approach The device we describe here uses miniature high-pressure hydraulics, position feedback, and a digital controller to achieve closed-loop control of the distraction process. The implanted actuator can produce up to 40N of distraction force on linear trajectories as well as curved distraction paths. In the paper we detail the spring-powered hydraulic reservoir, controller, and user interface. Results Experiments to test the new device design were performed in a porcine cadaver head and in live pigs. In the cadaver head, the device performed an 11-day/11 mm distraction with a root-mean-squared position error of 0.09 mm. The device functioned for periods of several days in each of five live animals, though some component failures occurred, leading to design revisions. Conclusions The test series showed that the novel design of this system provides the capabilities necessary to automate distraction of the mandible. Further developments will focus on making the implanted position sensor more robust and then carrying out clinical trials. PMID:20740071

  2. Correction of rabbit model with mandibular ramus shortening by distraction osteogenesis at condylar neck.

    PubMed

    Meng, Qinggong; Yang, Xuewen; Long, Xing; Li, Jian; Cai, Hengxing

    2012-04-01

    The rabbit model has been established to mimic the effect of temporomandibular joint (TMJ) arthroplasty of ankylosis, and distraction at the level of the condylar neck is used to elongate the ascending ramus. The histomorphologic changes of TMJ and distraction gap were investigated. The unilateral condyles and articular discs were extirpated, and the experimental mandibular rami were shortened by 5 mm. An embedded distracter was used to restore the height of the mandibular ramus by unilateral condylar neck distraction (0.8 mm daily for 7 days). A total of 12 adult white rabbits were used, 8 in the experimental group and 4 in the control group. Of the 8 rabbits in the experimental group, 4 each were killed at 4 and 8 weeks after completion of distraction. The TMJ and distracted calluses were harvested and processed for radiographic and histologic examination. An open bite was seen in all rabbits postoperatively that had diminished at the end of distraction. The newly formed condyles radiologically showed remodeling, flattening, and sclerosis. The bony transport disc had gradually remodeled to a new condyle that was similar to the original condyle in appearance and structure. The surface of the transport disc was covered with a fibrous tissue. Moreover, the bony regeneration was perfect in the distraction gap. These results suggest that distraction osteogenesis at the condylar neck using the traditional preauricular approach of TMJ surgery, without the additional incision, can be performed concurrently with arthroplasty of TMJ ankylosis at the same region. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Architecture and microstructure of cortical bone in reconstructed canine mandibles after bone transport distraction osteogenesis.

    PubMed

    Zapata, Uriel; Halvachs, Emily K; Dechow, Paul C; Elsalanty, Mohammed E; Opperman, Lynne A

    2011-11-01

    Reconstruction of the canine mandible using bone transport distraction osteogenesis has been shown to be a suitable method for correcting segmental bone defects produced by cancer, gunshots, and trauma. Although the mechanical quality of the new regenerate cortical bone seems to be related to the mineralization process, several questions regarding the microstructural patterns of the new bony tissue remain unanswered. The purpose of this study was to quantify any microstructural differences that may exist between the regenerate and control cortical bone. Five adult American foxhound dogs underwent unilateral bone transport distraction of the mandible to repair bone defects of 30-35 mm. Animals were killed 12 weeks after the beginning of the consolidation period. Fourteen cylindrical cortical samples were extracted from the superior, medial, and inferior aspects of the lingual and buccal plates of the reconstructed aspect of the mandible, and 21 specimens were collected similarly from the contralateral aspect of the mandible. Specimens were evaluated using histomorphometric and micro-computed tomographic techniques to compare their microstructure. Except for differences in haversian canal area, histomorphometric analyses suggested no statistical differences in microstructure between regenerate and control cortical bone. Morphological evaluation suggested a consistent level of anisotropy, possibly related to the distraction vector. After 12 weeks' consolidation, bone created during bone transport distraction osteogenesis was comparable to native bone in microstructure, architecture, and mechanical properties. It is proposed that, after enough time, the properties of the regenerate bone will be identical to that of native bone.

  4. Distraction osteogenesis: a method to improve facial balance in asymmetric patients.

    PubMed

    Robiony, Massimo

    2010-03-01

    Distraction osteogenesis is a well-established surgical procedure to elongate the maxillofacial skeleton. The authors propose a new method to balance facial asymmetry by means of distraction of the inferior borders of the mandible, without change of the occlusion, using an alveolar device. Nine patients with asymmetry were treated. Records included panoramic radiographs and computed tomographic scans. Preoperatively, stereolithographic models and virtual-reality surgery were performed to have a precise surgical planning. The surgical procedure was based on segmental inferior osteotomy and simultaneous positioning of the alveolar device upside-down. Postoperative clinical evaluation demonstrated that a very impressive elongation of the inferior bony border with simultaneous expansion of the soft tissues had been achieved, resulting in a satisfying facial balance. The postdistraction radiographs showed the ossification of the gap, and the new bone formation was observed and confirmed by biopsy. Distraction osteogenesis of the inferior border of the mandible and the chin represents a new method to correct facial asymmetry and is a valid alternative to the traditional techniques. In addition, surgical virtual reality and stereolithographic models are, without a doubt, an advantage in defining the vector of distraction and in simulating the final result.

  5. Effects of local simvastatin on periosteal distraction osteogenesis in rabbits.

    PubMed

    Kahraman, O E; Erdogan, Ö; Namli, H; Sencar, L

    2015-04-01

    Our aim was to evaluate the effect of local simvastatin on the formation of new bone using a new design of periosteal distractor. The distractors were placed between the periosteum and bone at the inferior border of the mandible of 20 New Zealand rabbits. In the first group (n=10) simvastatin was applied locally to the distraction zone. The other 10 rabbits served as controls. The formation of new bone was evaluated with digital direct radiography, computed tomography (CT), and histomorphometric analyses. New bone formed in all rabbits, but more formed in the experimental group according to histomorphometric variables. However, other measurements did not differ significantly between the groups. The new design of the periosteal distraction device was successful in causing new bone to form. Local simvastatin made no significant contribution to the procedure.

  6. LeFort III advancement with and without osteogenesis distraction.

    PubMed

    Iannetti, Giorgio; Fadda, Teresa; Agrillo, Alessandro; Poladas, Giulio; Iannetti, G; Filiaci, Fabio

    2006-05-01

    The LeFort III osteotomy is the surgical treatment performed in patients with mid-facial retrusions in craniofacial dysostoses such as Crouzon, Apert, Pfeiffer syndromes, etc. The first authors to report the accomplishment of this osteotomy were Gillies and Harrison in 1951, this technique was then resumed and improved by Tessier in 1967, who made five different variants mainly regarding the typology of the osteotomy concerning the lateral wall of the orbit. Recently, distraction techniques have been applied to the upper mid-face which foresees a gradual advancement of the mid-face through the osteogenetic distraction procedure. The purpose of this retrospective clinical outcome study is to evaluate and compare the two different surgical techniques through the experience acquired during the treatment of 15 cases of craniofacial dysostoses from 1990-2005, and through international literature. The standard surgery technique was performed in 5 of these patients, whereas the osteogenetic distraction technique was performed in the remaining 10. All patients were studied preoperatively through the acquisition of photographic images, cephalometric analysis of the skull, and the study on plaster models of the occlusion of the dental arches. The instrumental exams required before surgery are the following: telecranium X-rays in two projections, orthopanoramic X-rays, CT. The results of this study indicate that the osteodistraction technique represents the choice treatment in severe retrusions of the mid-face while the traditional surgical technique remains indicated in adult patients that are in need of moderate advancements.

  7. Computer-assisted planning of distraction osteogenesis for lower face reconstruction in gunshot traumas.

    PubMed

    Benateau, Hervé; Chatellier, Anne; Caillot, Aude; Labbe, Daniel; Veyssiere, Alexis

    2016-10-01

    Reconstruction of gunshot wounds of the lower face remains a challenge for the maxillofacial surgeon. We present our experience with the use of virtual surgery using Computer-Assisted Design (CAD)/Computer-Assisted Manufacturing (CAM) techniques to create a custom-made distraction device and prefabricated cutting guides (for both fibula and jaw osteotomies) and for device positioning. We describe two cases of lower face reconstruction after gunshot wounds by osteogenic distraction osteogenesis (DO) and computer-assisted surgery (SurgiCase CMF 5.0(®) software, Materialise). Surgical osteotomies and placement of the custom-made distraction device were performed intraoperatively based on prefabricated guides. This fully digital preoperative planning improves the precision of osteotomies sites and distraction vectors. It largely reduces the operative time, with a greater operative safety. Reconstruction by DO allows the bone and soft tissues to be simultaneously regenerated. However, the control of three-dimensional reconstruction of the lower face with distraction is difficult in facial gunshot patients because of the difficulties in locating anatomical landmarks. Surgical osteotomies are pre-planned and rapidly performed using a cutting guide. Precise placement of the distraction device is achieved without the need for subjective assessment of the sole surgeon. In our experience, the surgery has resulted in outcomes similar to those predicted by the computer-assisted planning. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  8. Evaluation of inferior alveolar nerve regeneration by bifocal distraction osteogenesis with retrograde transportation of horseradish peroxidase in dogs.

    PubMed

    Shogen, Yosuke; Isomura, Emiko Tanaka; Kogo, Mikihiko

    2014-01-01

    Bifocal distraction osteogenesis has been shown to be a reliable method for reconstructing segmental mandibular defects. However, there are few reports regarding the occurrence of inferior alveolar nerve regeneration during the process of distraction. Previously, we reported inferior alveolar nerve regeneration after distraction, and evaluated the regenerated nerve using histological and electrophysiological methods. In the present study, we investigated axons regenerated by bifocal distraction osteogenesis using retrograde transportation of horseradish peroxidase in the mandibles of dogs to determine their type and function. Using a bifocal distraction osteogenesis method, we produced a 10-mm mandibular defect, including a nerve defect, in 11 dogs and distracted using a transport disk at a rate of 1 mm/day. The regenerated inferior alveolar nerve was evaluated by retrograde transportation of HRP in all dogs at 3 and 6 months after the first operation. At 3 and 6 months, HRP-labeled neurons were observed in the trigeminal ganglion. The number of HRP-labeled neurons in each section increased, while the cell body diameter of HRP-labeled neurons was reduced over time. We found that the inferior alveolar nerve after bifocal distraction osteogenesis successfully recovered until peripheral tissue began to function. Although our research is still at the stage of animal experiments, it is considered that it will be possible to apply this method in the future to humans who have the mandibular defects.

  9. Hybrid surgery for scaphocephaly with distraction osteogenesis using skull expanders: technical note.

    PubMed

    Morota, Nobuhito; Ogiwara, Hideki; Kaneko, Tsuyoshi

    2012-09-01

    The authors described their surgical technique for scaphocephaly in relatively older infants who are 5 months old or over. The technique is a kind of hybrid of distraction osteogenesis utilizing skull expanders and a traditional cranial reconstruction procedure. The surgery usually consists of four procedures. The first is to make strip craniotomy over the superior sagittal sinus (SSS) from the major fontanelle to the minor one. The second is the occipital craniotomy for the occipital bossing. The occipital bone flap undergoes barrel stave osteotomy and is repositioned later. The third is placement of skull expander for distraction osteogenesis. Bidirectional small strip craniotomy is made along the coronal and lambdoid sutures, then transverse cutting is added to make a hinge point near the base of the parietal bone. Two to three skull expanders are placed crossing the SSS. The last procedure is radial-oriented osteotomy on the dorsal end of frontal bone to meet the elevated, expanded parietal bone. Skull expansion starts within a week with 5 mm/week base up to 20 to 30 mm. Exposed shafts of the expander are cut at the end of skull expansion. Process of osteogenesis is followed at an outpatient clinic, and the expanders are removed 4 to 6 months later after confirming the sufficient ossification. An advantage of our procedure is that maximum skull expansion is possible with minimum regression after distraction osteogenesis in the long term. Limited craniotomy enables limited blood loss. The skin trouble caused by stretching can be avoided. No postoperative helmet is required. A disadvantage is that the procedure leaves a foreign body on the skull for several months and requires additional surgery for removal.

  10. Ankylosis of temporomandibular joints after mandibular distraction osteogenesis in patients with Nager syndrome: Report of two cases and literature review.

    PubMed

    Wu, Cheng Chun; Sakahara, Daisuke; Imai, Keisuke

    2017-10-01

    Nager syndrome, also known as Nager acrofacial dysostosis, was first described by Nager and de Reynier in 1948. The patients commonly present with micrognathia, and a preventive tracheostomy is necessary when there are symptoms of upper airway obstruction. Mandibular distraction osteogenesis is considered as an effective procedure, which not only improves micrognathia but also minimizes the chances of tracheostomy. However, mandibular distraction osteogenesis has some complications such as relapse, teeth injury, infection, and injury of the temporomandibular joints (TMJs). In this study, the author reported two patients with Nager syndrome who suffered from ankylosis of TMJs after mandibular distraction osteogenesis. In addition, a comprehensive literature review of post-distraction ankylosis of TMJs in patients with Nager syndrome was performed. Few studies demonstrated the condition of TMJs after mandibular distraction osteogenesis, and three studies were identified from the review. One study reported ankylosis of bilateral coronoid processes, in which coronoidectomies were necessary. Another study reported the use of prostheses to replace the ankylosed joints in a patient who had undergone many surgeries of the joints, such as gap arthroplasties, reconstructions with costochondral grafts, etc. One other study raised the concept of unloading the condyles during the mandibular distraction to prevent subsequent ankylosis. It seems that multiple factors are related to the ankylosis of TMJs after mandibular distraction osteogenesis in patients with Nager syndrome. Prevention of post-distraction ankylosis of the joints is important because the treatment is difficult and not always effective. We should conduct more studies about protection of the joints during mandibular distraction in the future. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Distraction Osteogenesis Normalizes Mandibular Body-Symphysis Morphology in Infants With Robin Sequence.

    PubMed

    Susarla, Srinivas M; Evans, Kelly N; Kapadia, Hitesh; Vasilakou, Nefeli; Egbert, Mark A; Hopper, Richard A

    2017-06-30

    To evaluate changes in mandibular morphology in infants with Robin sequence (RS) after mandibular distraction osteogenesis (MDO) and compare the post-distraction morphology with that in infants without RS and infants with RS who had not undergone MDO. Infants with RS treated with MDO were retrospectively evaluated over a 12-year period. All patients had pre-distraction and end-consolidation maxillofacial computed tomograms. Morphologic features of the mandible were divided into ramus and condyle, body and symphysis, and composite measurements. Post-distraction RS mandibular morphology was compared with pre-distraction morphology, as well as to age-matched infants without RS and age-matched infants with RS who had not undergone MDO. Comparisons were done using nonparametric paired-samples analyses. During the study period, 17 patients with RS treated with MDO met the inclusion criteria for the study. The mean ages at distraction and end-consolidation were 1.95 ± 3.24 and 8.46 ± 5.99 months, respectively. The post-MDO mandible was significantly different from the pre-MDO mandible with regard to the ramps-condyle unit and body-symphysis measurements, including development of a more parabolic mandibular arch form (P ≤ .001). Compared with age-matched non-RS infant mandibles, the post-distraction RS mandibles had similar morphologies. Compared with age-matched non-MDO RS mandibles, the post-distraction mandibles had significantly different morphologies anterior to the gonial angle, including a more parabolic arch form (P ≤ .006). MDO normalized mandibular morphology in infants with RS, with the greatest effect on measurements anterior to the gonial angle. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Improvement in the airway after mandibular distraction osteogenesis surgery in children with temporomandibular joint ankylosis and mandibular hypoplasia.

    PubMed

    Zanaty, Ola; El Metainy, Shahira; Abo Alia, Doaa; Medra, Ahmed

    2016-04-01

    Temporomandibular joint (TMJ) ankylosis accompanied by mandibular micrognathia can severely obstruct a patient's upper airway. The obstructive sleep apnea and hypopnea syndrome (OSAHS) resulting from TMJ ankylosis and accompanied by mandibular micrognathia, can severely influence the patient's life. The aim of this study was to determine if there is a difference in Cormack and Lehane score before and after distraction osteogenesis in such patients, and to evaluate the airway changes and the respiratory outcome using polysomnography after mandibular distraction osteogenesis. This observational prospective study was carried out on 30 ASA II patients with micrognathia and TMJ ankylosis undergoing internal distraction osteogenesis. All patients were assessed with polysomnography before surgery and 6 month after surgery. Nasal intubation was done using a fiberoptic bronchoscope, then patients were subjected to the same anesthetic protocol. Direct laryngoscopy was attempted for the Cormack and Lehane grading after induction. The Cormack and Lehane grade was reassessed after facial symmetry was obtained on removal of the distractor. Mouth opening and Cormack and Lehane score improved significantly between the initial presentation for placement of mandibular distraction osteogenesis devices and on removal of the destructor under general anesthesia. Polysomnographic studies conducted after distraction confirmed the correction of airway obstruction in all patients: Improvement in Apnea-Hypopnea Index, mean difference (95% CI), 39.8 (38.8-40.9); the number of apneas per hour, mean difference, (95% CI) 41.1 (42.1-40.1); and oxygen-desaturation-index mean difference (95% CI) 27.6 (28.3-26.8). Mandibular distraction osteogenesis improved laryngeal view. Distraction osteogenesis can be successfully used for the treatment of obstructive sleep apnea in mandibular hypoplasia patients. © 2016 John Wiley & Sons Ltd.

  13. Formation of new bone during vertical distraction osteogenesis of the human mandible is related to the presence of blood vessels.

    PubMed

    Amir, Lisa R; Becking, Alfred G; Jovanovic, Andreas; Perdijk, Frits B T; Everts, Vincent; Bronckers, Antonius L J J

    2006-08-01

    We examined the effect of distraction rate on blood vessel growth in intramembraneous ossification after vertical distraction osteogenesis in the human mandible. Six edentulous patients (aged 60+/-9 years) with a severely atrophic mandible underwent bone augmentation with distraction osteogenesis. Two distraction rates (0.5 and 1 mm/day) were compared and for each group three patients were analyzed. Vascular histomorphometry was carried out in two different areas in the distraction gap: (1) in the first and (2) in the second 1 mm area from the osteotomy line, representing the oldest and younger new-bone area, respectively. Correlation analysis was performed between blood vessel parameters and the amount of new bone formed during distraction. Histological analysis demonstrated the presence of blood vessels throughout the soft connective tissue in the distraction gap. The volume density of blood vessels between the two investigated areas was significantly lower in the 1 mm/day groups, suggesting a delay in angiogenesis in this group of patients. A positive correlation between blood vessel volume and bone volume density was found in the younger new-bone area but not in the oldest new-bone area. This correlation was due to a higher number of blood vessels rather than to a larger size of the blood vessels. Our data suggest that the lower blood vessel density found in the patients with 1 mm/day distraction rate may be related to disruption of angiogenesis in the soft connective tissue of the gap or to a less optimal mechanical stimulation of cells involved in angiogenesis. This probably results in the slower rate of osteogenesis seen at the 1 mm/day distraction rate compared with the 0.5 mm/day distraction rate. The data support the concept that a positive relationship exists between the density of blood vessels and the formation of bone. For distraction of the human mandible in elderly patients, a distraction rate of 0.5 mm/day seems beneficial.

  14. Histological evaluation of condylar hyperplasia model of rabbit following distraction osteogenesis of the condylar neck.

    PubMed

    Meng, Q; Chen, G; Long, X; Deng, M; Cai, H; Li, J

    2011-01-01

    Condylar hyperplasia is the excessive unilateral growth of mandibular leading to facial asymmetry, occlusal disturbance, joint pain and dysfunction. The aim of this study is to evaluate the histological presence of temporomandibular joint in model of condylar hyperplasia by lengthening unilateral condylar neck of distraction osteogenesis. An extra oral distractor was employed to achieve unilateral condylar neck distraction (1·0 mm daily for 7 days). The experimental condylar necks were elongated by 7 mm compared to the contralateral. Eleven adult white rabbits were used. Eight rabbits were, respectively, sacrificed after the post-distraction period (4 or 8 weeks). All animals were evaluated clinically and histomorphometrically. The condyles radiologically showed remodelling, flattening and sclerosis. In 4-week group, thinning of the cartilage was evident, and the trabeculae were long, not multiply connected. A thin, dense fibrous layer covered all over the surface of cartilage. In 8-week group, the cartilaginous layer was similar to thickness of the normal cartilage, but still thinner than control. However, the fibrous layers covering condyle manifested slight degenerative changes, and even depressions and erosions were seen in the cartilage and subchondral bone. The trabeculae showed denser and multiply connected. In 8-week group, the cartilaginous thickness of surgical condyles was significantly thinner than the contralateral. This study indicates that unilateral distraction of condylar neck loads the condyles asymmetrically. Asymmetrical loads affect more on the surgical condyles than the contralateral, and after 8 weeks of the post-distraction, condyle could recover from asymmetrical loads in some degree.

  15. Trans-sutural distraction osteogenesis for alveolar cleft repair: an experimental canine study.

    PubMed

    Liang, Limin; Liu, Chunming

    2012-11-01

    To explore a new method of repair of alveolar cleft by trans-sutural distraction osteogenesis. Nine 8-week-old mongrel dogs were assigned randomly to two groups with three in the control group and six in the experimental group. First, an alveolar cleft model was created surgically in all animals. After 2 weeks, a U-shaped distractor, made of nickel-titanium (NiTi) shape memory alloy wire with 200 g tensile force, was inserted into the premaxilla of the experimental dogs to distract the mid-premaxillary suture for 3 weeks. Periosteoplasty of the alveolar cleft was performed when the premaxilla at the side of cleft approached the maxilla at the same side. The distractor was removed 2 weeks post periosteoplasty. The results were evaluated clinically, radiographically, and morphologically. The cleft model was stable and similar to the human alveolar cleft. No spontaneous bone union occurred in the control. In experimental dogs, the premaxilla was moved slowly toward the maxilla, and the cleft became gradually narrower and closed in the third week. Radiographically, the distracted mid-premaxillary suture showed a gradually widened triangle, with the tip of the triangle pointed posteriorly. The density of the distracted triangle suture was increased gradually. The alveolar cleft was completely bony 3 months post periosteoplasty. The morphology of the mid-premaxillary suture was also restored. The alveolar cleft could be repaired by the technique of mid-premaxillary suture distraction using the elastic device of NiTi shape memory alloy.

  16. Sclerostin antibody enhances bone formation in a rat model of distraction osteogenesis.

    PubMed

    McDonald, Michelle M; Morse, Alyson; Birke, Oliver; Yu, Nicole Yc; Mikulec, Kathy; Peacock, Lauren; Schindeler, Aaron; Liu, Min; Ke, Hua Zhu; Little, David G

    2017-09-08

    Neutralizing monoclonal sclerostin antibodies are effective in promoting bone formation at a systemic level and in orthopedic scenarios including closed fracture repair. In this study we examined the effects of sclerostin antibody (Scl-Ab) treatment on regenerate volume, density and strength in a rat model of distraction osteogenesis. Surgical osteotomy was performed on 179 Sprague Dawley rats. After 1 week, rats underwent distraction for 2 weeks, followed by 6 weeks for consolidation. Two treatment groups received biweekly subcutaneous Scl-AbIII (a rodent form of Scl-Ab; 25 mg/kg), either from the start of distraction onwards or restricted to the consolidation phase. These groups were compared to controls receiving saline. Measurement modalities included longitudinal DXA, ex vivo QCT and microCT, tissue histology, and biomechanical 4-point bending tests. Bone volume was increased in both Scl-Ab treatments regimens by the end of consolidation (+26-38%, p < 0.05), as assessed by microCT. This was associated with increased mineral apposition. Importantly, Scl-Ab led to increased strength in united bones, and this reached statistical significance in animals receiving Scl-Ab during consolidation only (+177%, p < 0.01, maximum load to failure). These data demonstrate that Scl-Ab treatment increases bone formation, leading to regenerates with higher bone volume and improved strength. Our data also suggest that the optimal effects of Scl-Ab treatment are achieved in the latter stages of distraction osteogenesis. These findings support further investigation into the potential clinical application of sclerostin antibody to augment bone distraction, such as limb lengthening, particularly in the prevention of refracture. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  17. Correction of shortening and/or angular deformities by distraction osteogenesis using AO-tubular fixator.

    PubMed

    Sangkaew, Chanchit

    2003-01-01

    Eighteen patients (20 bony segments) who had shortening and/or angular deformities were treated by distraction osteogenesis using AO-tubular external fixator. The mean angular correction was 18.9 degrees (range, 8-40 degrees). Of the group in whom shortening and angulation was corrected, the mean length gained was 4.2 cm (3-6 cm). The mean treatment time was 4.9 months (range, 2-13 months) and the mean follow-up was 12 months after removal of the fixator (range, 3-30 months). Delayed union with loosening of the fixator occurred in one patient which resulted in residual shortening of 1.5 cm. The author's technique of distraction osteogenesis using AO-tubular fixator with the new distraction rate of 1 mm/48 h (1 mm/step) could adequately correct shortening and/or angular deformities. No extra equipment was needed other than the readily-available AO-tubular fixation systems. No serious complications such as neurovascular injury were encountered.

  18. Comparison of two protocols of periosteal distraction osteogenesis in a rabbit calvaria model.

    PubMed

    Saulacic, Nikola; Nakahara, Ken; Iizuka, Tateyuki; Haga-Tsujimura, Maiko; Hofstetter, Willy; Scolozzi, Paolo

    2016-08-01

    The regenerative pathways during periosteal distraction osteogenesis may be influenced by the local environment composed by cells, growth factors, nutrition and mechanical load. The aim of the present study was to evaluate the influence of two protocols of periosteal distraction on bone formation. Custom made distraction devices were surgically fixed onto the calvariae of 60 rabbits. After an initial healing period of 7 days, two groups of animals were submitted to distraction rates of 0.25 and 0.5 mm/24 h for 10 days, respectively. Six animals per group were sacrificed 10 (mid-distraction), 17 (end-distraction), 24 (1-week consolidation), 31 (2-week consolidation) and 77 days (2-month consolidation) after surgery. Newly formed bone was assessed by means of micro-CT and histologically. Expression of transcripts encoding tissue-specific genes (BMP-2, RUNX2, ACP5, SPARC, collagen I α1, collagen II α1 and SOX9) was analyzed by quantitative PCR. Two patterns of bone formation were observed, originating from the old bone surface in Group I and from the periosteum in Group II. Bone volume (BV) and bone mineral density (BMD) significantly increased up to the 2-month consolidation period within the groups (p < 0.05). Significantly more bone was observed in Group II compared to Group I at the 2-month consolidation period (p < 0.001). Expression of transcripts encoding osteogenic genes in bone depended on the time-point of observation (p < 0.05). Low level of transcripts reveals an indirect role of periosteum in the osteogenic process. Two protocols of periosteal distraction in the present model resulted in moderate differences in terms of bone formation. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1121-1131, 2016.

  19. Management of obstructive sleep apnea in a Treacher Collins syndrome patient using distraction osteogenesis of the mandible.

    PubMed

    Damlar, İbrahim; Altan, Ahmet; Turgay, Berk; Kiliç, Soydan

    2016-12-01

    In this study, we present the surgical treatment of obstructive sleep apnea in a child with Treacher Collins syndrome. A 10-year-old girl with a past history of Treacher Collins syndrome presented to our clinic with her parents for respiratory distress and insomnia. The patient was referred to a sleep laboratory where she was diagnosed with obstructive sleep apnea, which was a consequence of her Treacher Collins syndrome. The patient underwent mandibular distraction osteogenesis under general anesthesia. The mandible was expanded by 15 mm using internal bilateral distractors. After distraction osteogenesis, the patient's respiratory problems resolved, and she was able to sleep comfortably. Distraction osteogenesis was an effective method of advancing the mandible, increasing the upper airway space and ultimately preventing obstructive sleep apnea syndrome in patients with Treacher Collins syndrome.

  20. Management of obstructive sleep apnea in a Treacher Collins syndrome patient using distraction osteogenesis of the mandible

    PubMed Central

    2016-01-01

    In this study, we present the surgical treatment of obstructive sleep apnea in a child with Treacher Collins syndrome. A 10-year-old girl with a past history of Treacher Collins syndrome presented to our clinic with her parents for respiratory distress and insomnia. The patient was referred to a sleep laboratory where she was diagnosed with obstructive sleep apnea, which was a consequence of her Treacher Collins syndrome. The patient underwent mandibular distraction osteogenesis under general anesthesia. The mandible was expanded by 15 mm using internal bilateral distractors. After distraction osteogenesis, the patient’s respiratory problems resolved, and she was able to sleep comfortably. Distraction osteogenesis was an effective method of advancing the mandible, increasing the upper airway space and ultimately preventing obstructive sleep apnea syndrome in patients with Treacher Collins syndrome. PMID:28053912

  1. Distraction Osteogenesis Correction of Mandibular Ramis Fracture Malunion in a Juvenile Mute Swan ( Cygnus olor ).

    PubMed

    Calvo Carrasco, Daniel; Dutton, Thomas A G; Shimizu, Naomi; Sabater, Mikel; Forbes, Neil A

    2016-03-01

    A juvenile mute swan (Cygnus olor) was presented with right lateral deviation of the mandible. Radiographs demonstrated a healed fracture of the right mandibular ramis, which had compromised osteogenesis. A corrective osteotomy was performed and an osteogenic distractor was inserted over the lateral aspect of the right mandible. Dental acrylic implants were fixed to the rhinotheca to correct rotational alignment. A pharyngostomy tube was placed to facilitate administration of nutrition and medication. Postoperative images confirmed correct alignment of the mandible in relation to the maxilla. Implants were removed and postoperative complications were not reported. This is the first report of an osteogenic distractor used to correct mandibular deviation in an avian species. Distraction osteogenesis should be considered as a valid surgical option in juvenile or adult avian patients with pathologic bone shortening.

  2. A systematic review of distraction osteogenesis in hand surgery: what are the benefits, complication rates, and duration of treatment?

    PubMed

    Kempton, Steve J; McCarthy, James E; Afifi, Ahmed M

    2014-05-01

    This work analyzes the utility of distraction osteogenesis as a surgical option for the management of acquired and traumatic hand deformities through a systematic review of the published literature. A PubMed search for articles reporting results of distraction osteogenesis in the hand was performed. Data collected included age, sex, cause, bone distracted, latency period, distraction rate, consolidation period, treatment time, length gained, and complications. Proportion data variables were compared using the chi-square test. A meta-analysis was also performed to assess the size effect of variables on complication development. Thirty articles (424 distractions) met inclusion criteria. The average length gained from distraction was 2.2 cm; the average total treatment time was 116 days; the average complication rate was 26.4 percent. Proportion analysis, including all articles, showed that congenital cause had significantly fewer complications compared with traumatic cause (p = 0.0129). A lower complication rate in pediatric patients compared with adults approached but did not reach significance (p = 0.0507). Studies that underwent meta-analysis, including only articles comparing both variables of interest, were homogeneous (I < 25) and without publication bias (Kendall's tau p > 0.05 and symmetric funnel plot). None of the variables analyzed by meta-analysis had a significant odds ratio for complication development (p > 0.05). Despite distinct advantages, distraction osteogenesis is associated with a long duration of treatment and high complication rates, particularly in adults and in posttraumatic reconstruction. Therapeutic, IV.

  3. Mandibular distraction osteogenesis in very young patients to correct airway obstruction.

    PubMed

    Denny, A D; Talisman, R; Hanson, P R; Recinos, R F

    2001-08-01

    a consistent change in tongue base position that improves obstructive airway symptoms by increasing measured effective airway space. The potential for mandibular distraction exceeds the simple correction of malocclusion also by eliminating soft-tissue obstruction of the micrognathic airway. Airway improvement is independent of the syndrome diagnosed. Mandibular distraction osteogenesis may be useful to avoid or decannulate existing tracheostomy in infants with micrognathia.

  4. Mouse Models in Orthopaedic Research: An Overview of Fracture, Marrow Ablation, and Distraction Osteogenesis

    PubMed Central

    Lybrand, Kyle; Bragdon, Beth; Gerstenfeld, Louis

    2015-01-01

    Three commonly used murine surgical models of bone healing (closed fracture with intramedullary fixation, distraction osteogenesis (DO), and marrow ablation by reaming) are presented. Detailed surgical protocols for each model are outlined. The nature of the regenerative processes and the types of research questions that may be addressed with these models are briefly outlined. The relative strengths and weaknesses of these models are compared to a number of other surgical models that are used to address similar research questions. Refer to our companion article for more detailed overview of the underlying biology of each model. PMID:25727199

  5. Vertical distraction osteogenesis of fibular free flap in mandibular prosthetic rehabilitation: a case report.

    PubMed

    Marchetti, Claudio; Degidi, Marco; Scarano, Antonio; Piattelli, Adriano

    2002-06-01

    A 17-year-old boy underwent three cycles of chemotherapy and a subsequent mandibular resection for a Ewing's sarcoma of the left body and ramus. The mandible was immediately reconstructed with a microvascular osteomuscular fibular flap. One year after the mandibular reconstruction, distraction osteogenesis of the anterior portion of the fibula was performed using a Martin distractor according to the Hoffmeister technique. Bone lengthening was achieved at a rate of 1 mm/day by turning the device twice each day for 12 days. Subsequently, we waited for 70 days for bone consolidation to occur. After 6 additional weeks, five Maestro implants were placed into the distracted fibula. Bone specimens were retrieved with a trephine bur during implant placement. Mature bone was present after 70 days and after 6 months. The bone height increase was 12 mm.

  6. Advances in the Treatment of Syndromic Midface Hypoplasia Using Monobloc and Facial Bipartition Distraction Osteogenesis

    PubMed Central

    Kumar, Anand R.; Steinbacher, Derek

    2014-01-01

    Midface hypoplasia or retrusion remains a persistent feature of syndromic craniosynostosis years after successful treatment of the cranium. Although expansion of the cranial vault in infancy by traditional fronto-orbital advancement, posterior expansion, or both, can treat the immediate intracranial constriction, midface hypoplasia and its stigmata of exorbitism, sleep apnea, central face concavity, and malocclusion remain suboptimally treated. Initial enthusiasm for the procedures was tempered due to a high rate of infectious complications; timing and indications for surgery continue to stir controversy. During the last decade renewed interest with the monobloc and facial bipartition procedure using distraction osteogenesis with either an internal or external distraction system has decreased morbidity significantly. These procedures have re-emerged as powerful and comprehensive tools in the treatment of syndromic midface hypoplasia. PMID:26417208

  7. Simulation-guided navigation for vector control in pediatric mandibular distraction osteogenesis.

    PubMed

    Badiali, Giovanni; Cutolo, Fabrizio; Roncari, Andrea; Marchetti, Claudio; Bianchi, Alberto

    2017-06-01

    Navigation technology has given surgeons the capacity to know precisely where their instruments are during surgery, and simulation-guided navigation is a surgical method which is based on the use of navigation technology linked to 3D virtual surgery simulation. The aim of the present study was to evaluate the absolute accuracy of simulation-guided navigation as an aid to reproduce the planned position of the distraction device vector in pediatric mandibular distraction osteogenesis. We retrospectively evaluated seven patients affected by unilateral (3 pts.) or bilateral (4 pts.) mandibular hypoplasia and treated with this method between 2012 and 2014 at the Maxillofacial Surgery Unit of the University of Bologna, Italy. All patients were enrolled for mandibular distraction using internal unidirectional devices (11 distraction devices implanted overall). Patients were studied through a complete three-dimensional workflow, which led to obtaining a virtual reconstruction of the facial bones and the simulation of the distraction device positioning using a specific experimental software. The surgical planning was loaded on the navigation system and the distraction device was placed following the virtual plan, which is displayed on the navigation system as a guide and tracked with the navigation instruments. We analyzed the outcome comparing the recorded three-dimensional coordinates of the achieved distractor position and the three-dimensional coordinates of the planned distractor position. Among the eleven placed distractors, we found a mean angular error of 3.74° ± 3.30° on the axial axis (yaw) and of 6.27° ± 5.32° on the sagittal axis (pitch), while median angular errors are 3.72° on the axial axis (yaw) and 4.08° on the sagittal axis (pitch). Our preliminary experience seems to support that simulation-guided navigation for vector control in mandibular distraction osteogenesis could be a useful procedure for reproducing the virtually planned outcome

  8. [Ultrastructural and element spectrometric analysis of distraction osteogenesis for reconstruction of cleft palate in rhesus macaque model].

    PubMed

    Chen, Gang; Liu, Yi; Liu, Yan-Shan; Shen, Dai; Wang, Zhi-Qi; Wang, Jian

    2010-07-01

    To study the ultrastructure and Ca/P element spectrometry of distraction osteogenesis (DO) for reconstruction of cleft palate (CP), so as to explore the osteogenesis and remodeling of new bone in situ. 23 rhesus macaques were operated to establish animal models of CP. 2 monkeys didn't received DO as controls. The other 21 monkeys in experimental group underwent DO to correct both bony and soft tissue defects in palate. The distraction was performed at a rate of 0.8 mm/d, twice a day until the cleft was closed. After fixation for 1, 2, 4, 6, 8, 12, 24 weeks, every 3 animals were sacrificed to get the specimens at the distraction gap. The scanning electron microscopic study and Ca, P elements spectrometric analysis were adopted. There were also two unoperated animals as sham group. After fixation for 1-2 weeks, the distraction gap was full of collagen fibers oriented along vector of distraction. Few trabeculae was seen at the margin area. After fixation for 4-6 weeks, active osteogenesis was presented with new formed bone trabeculae and abundant cellular component. After fixation for 8-12 weeks, the new formed bone became mature and couldn't distinguish from the normal bone. 24 weeks later, the bone between the distraction gap had a similar structure to the normal bone. Elements spectrometric analysis results indicated that in early stage of osteogenesis, the P and S peaks were relatively high while the Ca peak was much lower. During the late stage, the S peak was obviously decreased, and Ca/P ratio increased to normal level as in the empty control group. The CP can be corrected by DO. The new bone between the distraction gap is formed and remodeled through intramembraneous osteogenesis.

  9. Tracheostomy-dependent child with temporomandibular ankylosis and severe micrognathia treated by piezosurgery and distraction osteogenesis: case report.

    PubMed

    de Castro e Silva, Lucas Martins; Pereira Filho, Valfrido Antonio; Vieira, Eduardo Hochuli; Gabrielli, Mário Francisco Real

    2011-10-01

    Ankylosis of the temporomandibular joint in children is one the most difficult and complex conditions managed by oral and maxillofacial surgeons, and often leads to some facial deformity. Distraction osteogenesis of the mandible provides an excellent treatment for mandibular airway obstruction in children who do not respond to conservative measures, and allows for early removal of the tracheostomy. We report the case of a 1-year-old boy with severe micrognathia and temporomandibular ankylosis who was dependent on a tracheostomy; he was treated with piezosurgery and mandibular advancement by distraction osteogenesis. Copyright © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  10. Distraction osteogenesis for bone repair in the 21st century: lessons learned.

    PubMed

    Catagni, Maurizio A; Guerreschi, Francesco; Lovisetti, Luigi

    2011-06-01

    Bone regeneration obtained by distraction osteogenesis is influenced by a series of factors. These include factors that are related to the mechanical stability of the system of distraction (internal or external devices), and to factors directly depending on the biology of the bone tissue, such as the method of bone interruption (osteotomy), the delay and rhythm of distraction, the anatomical site of the osteotomy, and the histological characteristics of the bone requiring reconstruction. The stability of the system of bone fixation depends on the rigidity of the frame, the connexion of the apparatus to the bone (wires, pins) and the intrinsic stability of the segment (length and level of maturation of bone regenerate). The radiological characteristics of bone regeneration (hypo- or hypertrophy) lead to the adaptation of the rhythm of distraction. Following more than 28 years of experience of application of the Ilizarov method for bone reconstruction, the authors describe the technique of frame assembly and the methods of evaluation and treatment of the complications of new bone formation.

  11. Current practice of distraction osteogenesis for craniofacial anomalies in Europe: a web based survey.

    PubMed

    Nada, Rania M; Sugar, Adrian W; Wijdeveld, Maarten G M M; Borstlap, Wilfred A; Clauser, Luigi; Hoffmeister, Bodo; Kuijpers-Jagtman, Anne Marie

    2010-03-01

    Aim of the study was to get more insight into the opinion of European surgeons and orthodontists on the use of distraction osteogenesis (DO) for patients with different diagnoses and treatment protocols. A web based survey was set up, showing records of four patients with different conditions: hemifacial microsomia (case 1), bilateral mandibular deficiency (case 2), cleft lip and palate (case 3) and Crouzon syndrome (case 4). Respondents from 181 Eurocleft centres were asked to fill out a questionnaire for each patient. Most of the respondents considered case 1 (80%), case 3 (81%) and case 4 (86%) suitable for DO, while only 31% were considering case 2 for DO. There was lack of consensus among the respondents about many aspects of DO. Out of six different treatment parameters, an acceptable degree of agreement was only seen in two: a latency period of 3-7 days and a distraction rate of 1mm per day. Furthermore, there was noticeable disagreement on the ideal age for treatment, surgical technique, distraction device, and retention period. Our results showed that there is a wide variety in treatment approaches for craniofacial anomalies in Europe. There is disagreement on essential steps in the distraction procedures.

  12. Potential complications and precautions in vertical alveolar distraction osteogenesis: a retrospective study of 40 patients.

    PubMed

    Ugurlu, Faysal; Sener, B Cem; Dergin, Guhan; Garip, Hasan

    2013-10-01

    The aim of this retrospective study was to analyse the outcome of 44 cases of vertical alveolar distraction osteogenesis (ADO) and to investigate the complications, precautions, and treatment associated with ADO. The 44 alveolar distractions were performed on 40 patients. Extraosseous distraction was used in all cases. Complications associated with the intraoperative, postoperative, distraction, and consolidation periods were recorded and evaluated. Intraoperative complications were noted in two patients (4.5%) where fracture of the basal bone was evident. Three (6.8%) complications were recorded postoperatively, and 12 (27.3%) complications were recorded during the activation period. During the consolidation period, 4.5% of the patients (n = 2) were affected. The total prevalence of complications was 43.2% (n = 19), and the success rate of the ADO was 95.5%. Most complications occurred in the anterior mandibular region. Although complications associated with vertical ADO were not rare, the use of this procedure for maxillofacial defects results in satisfactory outcomes. Early diagnosis and management of related complications are crucial for increasing the success rate of ADO procedures. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

  13. Immunolocalization of sibling and RUNX2 proteins during vertical distraction osteogenesis in the human mandible.

    PubMed

    Amir, Lisa R; Jovanovic, Andreas; Perdijk, Frits B T; Toyosawa, Satoru; Everts, Vincent; Bronckers, Antonius L J J

    2007-11-01

    We tested the hypothesis that mechanical loading of human bone increases expression of the transcription factor RUNX2 and bone matrix proteins osteopontin (OPN), bone sialoprotein (BSP), dentin matrix protein-1 (DMP1), and matrix extracellular phosphoglycoprotein (MEPE). We examined this in tissue sections of atrophic mandibular bone taken from edentulous patients who had undergone distraction osteogenesis. In undistracted bone, weak to moderate staining for OPN and BSP was found in osteoblasts and bone matrix of immature woven bone. RUNX2 was also detectable in osteoblasts and in cells of the periosteum. In woven bone, but not in lamellar bone, a small number of osteocytes stained for all proteins tested. After distraction, staining intensity had increased in the existing old bone and staining was seen in more bone cells than before distraction. We also found a high expression of DMP1 and MEPE in many osteocytes embedded in woven bone and in some osteocytes of lamellar bone not seen before distraction. New bone trabeculae were forming in the fibrous tissue of the distraction gap containing all stages of intramembranous bone formation. Moderate to strong staining was seen for all five proteins tested in osteocytes located in woven bone of these trabeculae and for RUNX2, OPN, and BSP in osteoblasts lining the trabecular surfaces. We conclude that loading of atrophic human jawbone by distraction activates matrix synthesis of bone cells in and around existing bone. Increased staining of DMP1 and MEPE in osteocytes after loading is in line with the concept that these proteins may be involved in signaling the effector cells to adapt the bone structure to its mechanical demands.

  14. [Dental assisted distraction osteogenesis of the mandible. Results of an animal experimental study and initial clinical application].

    PubMed

    Braumann, B; Niederhagen, B; Schmolke, C; von Lindern, J J

    1999-01-01

    In recent years lengthening of the human mandible by distraction osteogenesis has become an accepted treatment for correction of severe mandibular disto-basal discrepancies. Using extra-oral and intra-oral distraction devices the technique of osseous anchorage is usually preferred. To avoid the disadvantages of this method it is the aim of many research groups to develop a tooth-borne distraction. In the present animal study, six minipigs were treated with a new solely dentally fixed orthodontic device for mandibular distraction osteogenesis. Following bilateral osteotomy in the dentigerous area of the mandibular body and a latent period of 2-7 days, a mandibular lengthening of 9 mm was reached within a period of 9 days. This situation was retained using the distraction device for 6 weeks. After the removal of the apparatus, there followed a period of another 6 weeks of consolidation. The callus and bone formation and potential dental, periodontal and nerval reactions were radiologically examined and histological examination was performed at the end of the experiment. At 12 weeks after the mandibular lengthening, the osteogenesis in the distraction areas was complete. No destructive processes were recognizable, either at the roots or at the periodontium of the teeth near the osteotomy gap. The mandibular nerve at the osteotomy site remained intact. The results justified transferring this procedure to humans. The clinical application of the device is presented.

  15. Statistical analysis of axial deformity during distraction osteogenesis of the tibia.

    PubMed

    Leyes, M; Noonan, K J; Forriol, F; Cañadell, J

    1998-01-01

    In this study, we documented the prevalence of coronal axis malalignment in a series of 93 tibias (from 54 patients) lengthened with monolateral fixation. The average length obtained by distraction osteogenesis was 8.9 cm (range, 3.5-15.6) or 38% of the original bone length (range, 11-78%). Fifty (54%) of 93 tibias had documented valgus angulation of > or = 10 degrees or had fixator manipulation during the lengthening process for undesirable or progressive angulation; no cases of varus angulation were noted. Thirteen (14%) segments had later corrective osteotomy for unsatisfactory valgus malalignment. Statistical analysis revealed two factors to have a significant effect on the rate of malalignment. Those cases that had tibial osteotomy below the proximal one third of the original tibial length and those cases in which the fixator was placed > 5 degrees out of parallel had higher rates of angulation or manipulation (p < 0.001 and p = 0.002). Although the percentage of original bone lengthened was not statistically significant (p = 0.083), it did have an important effect on rates of axial malalignment. From this study we conclude that relatively high rates of malalignment in the tibia during distraction osteogenesis with monolateral external fixation are predominately the result of more distal osteotomies and nonparallel fixator placement. Attention to these details in general, and particularly where long lengthenings are planned, may significantly reduce this common complication.

  16. Effect of SDF-1/Cxcr4 Signaling Antagonist AMD3100 on Bone Mineralization in Distraction Osteogenesis.

    PubMed

    Xu, Jia; Chen, Yuanfeng; Liu, Yang; Zhang, Jinfang; Kang, Qinglin; Ho, Kiwai; Chai, Yimin; Li, Gang

    2017-03-16

    Distraction osteogenesis (DO) is a widely applied technique in orthopedics surgery, which involves rapid stem cell migration, homing, and differentiation. Interactions between the chemokine receptor Cxcr4 and its ligand, stromal derived factor-1 (SDF-1), regulate hematopoietic stem cell trafficking to the ischemic area and induce their subsequent differentiation. Here, we examined SDF-1 expression and further investigated the role of SDF-1/Cxcr4 signaling antagonist AMD3100 during bone regeneration in rat DO model. The results showed that expression levels of SDF-1 and osteogenic genes were higher in DO zones than in the fracture zones, and SDF-1 expression level was the highest at the termination of the distraction phase. Radiological, mechanical, and histological analyses demonstrated that the local administration of AMD3100 (400 μM) to DO rats significantly inhibited new bone formation. In the rat bone marrow mesenchymal stem cells culture, comparing to the group treated with osteogenic induction medium, AMD3100 supplement led to a considerable decrease in the expression of alkaline phosphatase and early osteogenic marker genes. However, the amount of calcium deposits in rat MSCs did not differ between the groups. Therefore, our study demonstrated that the DO process induced higher expression of SDF-1, which collated to rapid induction of callus formation. Local application of SDF-1/Cxcr4 signaling antagonist AMD3100 significantly inhibited bone mineralization and osteogenesis in DO, which may represent a potential therapeutic approach to the enhancement of bone consolidation in patients undergoing DO.

  17. Distraction osteogenesis: a new surgical technique for use with the multiplanar mandibular distractor.

    PubMed

    Gateño, J; Teichgraeber, J F; Aguilar, E

    2000-03-01

    If distraction osteogenesis is to reach its full potential and achieve the level of accuracy that is possible with orthognathic surgery, its outcomes need to be as predictable. To this end, the authors developed a planning process for distraction osteogenesis similar to that used in orthognathic surgery. However, the success of the planning process depends on the authors' ability to execute the plan at the time of surgery. As a result, the authors needed to develop a surgical technique that would enable them to precisely install the distractor as indicated in the presurgical plan. The surgical technique presented in this article was developed for this purpose. The authors used this technique in seven patients (four boys and three girls; age range, 4 to 10 years). Four patients presented with unilateral deformities, and three patients presented with bilateral deformities. The follow-up period in this group of patients ranged from 12 to 33 months. The purpose of the technique is to replicate the position of the distractor on the mandible as determined by the presurgical plan. To this purpose, a custom drill guide and a surgical template have been developed. Both of these are used following the principles of triangulation to establish the pin position and orientation of the distractor. In the authors' hands, the use of this surgical technique has resulted in outcomes close to those predicted by the planning process.

  18. Mandibular distraction osteogenesis assisted by cell-based tissue engineering: a systematic review.

    PubMed

    Tee, B C; Sun, Z

    2015-04-01

    To review the advances and limitations of recent investigations on mandibular distraction osteogenesis (MDO) assisted by mesenchymal stem cell (MSC) transplantation. Following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines, the PubMed, Scopus, and Cochrane electronic databases were systematically searched and screened from their inception through August 2014. Searching terms included the following: 'distraction osteogenesis', 'mandible OR mandibular OR jaw', and 'cells', without any other limitations. Nineteen studies meeting the eligibility criteria were selected from 227 published articles and used for qualitative synthesis. Fifteen of the studies used small animal models (rats or rabbits), while the other four used large animal models (dogs, pigs or sheep). Among these studies, large variations exist in MDO protocol, cell transplantation time, route and quantity, as well as methodology of outcome assessment. Additionally, all studies had certain biases. Nevertheless, the majority of studies found that MSC transplantation enhanced MDO bone regeneration. Evidence from animal studies indicates that MDO may be enhanced by mesenchymal stem cell transplantation, but many questions related to animal models, MDO protocols, and cell transplantation remain to be investigated. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  19. Monobloc Frontofacial or Le Fort III Distraction Osteogenesis in Syndromic Craniosynostosis: Three-Dimensional Evaluation of Treatment Outcome and the Need for Central Distraction.

    PubMed

    Hu, Ching-Hsuan; Wu, Chieh-Tsai; Ko, Ellen Wen-Ching; Chen, Philip Kuo-Ting

    2017-07-01

    The objectives of this study were to investigate the treatment effect, morphology, and volumetric outcomes of monobloc frontofacial or Le Fort III distraction osteogenesis in syndromic craniosynostosis by 3-dimensional evaluation. Nine consecutive patients underwent monobloc frontofacial or Le Fort III distraction during 2003 to 2012 were included and evaluated. The patient's evaluation is a minimum of a 4-year follow-up. Pretreatment, post-treatment advancement, and relapse were quantified. The changes in intracranial volume, upper airway volume, globe protrusion, advancement at bilateral malar eminence, and central face were calculated from computerized tomography before and after treatment. After distraction, the intracranial volume was increased by 16.4% in average, and the upper airway volume increased by 64.1%. Orbital protrusion improved by 9.9 mm in the left eye and 10.5 mm in the right eye in comparison to the preoperative status. Bilateral malar eminences advancement was greater than the dorsum advancement by 7.1 mm. The external distraction osteogenesis device caused significant technical difficulties with advancement of the midface in growing bones. The central midface did not advance as hoped for. This finding may suggest a need for modification in the distraction device in order to improve the central facial distraction vector.

  20. [Mesenchymal stem cells modified with Runt-related transcription factor 2 promote bone regeneration in rabbit mandibular distraction osteogenesis].

    PubMed

    Feng, Guijuan; Zheng, Ke; Song, Donghui; Wu, Senbin; Zhu, Songsong; Hu, Jing

    2016-04-01

    This work investigated mesenchymal stem cells (MSCs) modified with Runt-related transcription factor 2 (Runx2) therapy for bone regeneration in rabbit mandibular distraction osteogenesis. Forty-eight New Zealand mature white rabbits were randomly divided into three groups after the rabbit model of mandibular distraction osteogenesis was established: reconstruction plasmid modified with Runx2 (group A), plasmid without Runx2 (group B), and the same dose of saline as control (group C). At the fifth day of distraction phase, MSCs with reconstruction plasmid modified with adv-hRunx2-gfp were injected into the distraction gap of group A. MSCs with reconstruction plasmid modified with adv-gfp was injected into the distraction gap of group B, whereas group C was injected with the same dose of saline. At 8 weeks after injection, all animals were sacrificed, and the distracted mandibles were harvested. The general imaging histological observation and three-point bending test were used for evaluation. CT plain scan and histological analysis confirmed that the amount of new bone forming in the distraction gap of group A was significantly higher than those in groups B and C. Dual-energy X ray and three-point bending test results also showed that the bone mineral density, bone mineral content, and maximum load of the distraction gap of group A were significantly higher than those of groups B and C (P<0.01). Runx2-ex vivo gene therapy based on MSCs can effectively promote the bone regeneration in rabbit mandibular distraction osteogenesis and shorten the stationary phase. Therefore, reconstruction of craniofacial fracture would be a valuable strategy

  1. 3D computed tomographic evaluation of the upper airway space of patients undergoing mandibular distraction osteogenesis for micrognathia.

    PubMed

    Bianchi, A; Betti, E; Badiali, G; Ricotta, F; Marchetti, C; Tarsitano, A

    2015-10-01

    Mandibular distraction osteogenesis (MDO) is currently an accepted method of treatment for patients requiring reconstruction of hypoplastic mandibles. To date one of the unsolved problems is how to assess the quantitative increase of mandible length needed to achieve a significant change in the volume of the posterior airway space (PAS) in children with mandibular micrognathia following distraction osteogenesis. The purpose of this study is to present quantitative volumetric evaluation of PAS in young patients having distraction osteogenesis for micrognathia using 3D-CT data sets and compare it with pre-operative situation. In this observational retrospective study, we report our experience in five consecutive patients who underwent MDO in an attempt to relieve severe upper airway obstruction. Each patient was evaluated before treatment (T0) and at the end of distraction procedure (T1) with computer tomography (CT) in axial, coronal, and sagittal planes and three-dimensional CT of the facial bones and upper airway. Using parameters to extract only data within anatomic constraints, a digital set of the edited upper airway volume was obtained. The volume determination was used for volumetric qualification of upper airway. The computed tomographic digital data were used to evaluate the upper airway volumes both pre-distraction and post-distraction. The mean length of distraction was 23 mm. Quantitative assessment of upper airway volume before and after distraction demonstrated increased volumes ranging from 84% to 3,087% with a mean of 536%. In conclusion, our study seems to show that DO can significantly increase the volume of the PAS in patients with upper airway obstruction following micrognathia, by an average of 5 times. Furthermore, the worse is the starting volume, the greater the increase in PAS to equal distraction.

  2. Clinical Application of Curvilinear Distraction Osteogenesis for Correction of Mandibular Deformities

    PubMed Central

    Kaban, Leonard B.; Seldin, Edward B.; Kikinis, Ron; Yeshwant, Krishna; Padwa, Bonnie L.; Troulis, Maria J.

    2009-01-01

    Purpose To report the use of a semiburied curvilinear distraction device, with a 3-D CT treatment planning system, for correction of mandibular deformities. Methods This is a retrospective evaluation of 13 consecutive patients, with syndromic and non-syndromic micrognathia, who underwent correction by curvilinear distraction osteogenesis. A 3-D CT scan was obtained for each patient and imported into a 3-D treatment planning system (Slicer/Osteoplan™). Surgical guides were constructed to localize the osteotomy and to drill holes for securing the distractor’s proximal and distal footplates to the mandible. Postoperatively, patients were followed by clinical examination and plain radiographs to ensure the desired vector of movement. At end distraction, when possible, a 3-D CT scan was obtained to document the final mandibular position. Results Eight females and 5 males with a mean age of 11.9 years (range=15months–39 years) underwent bilateral mandibular curvilinear distraction. Eight of the 13 patients were 16 years or younger and 5 were less than 6 years of age. The diagnoses included Treacher Collins (n=3) and Nager (n=3) syndromes, craniofacial microsomia (n=2), post-traumatic ankylosis (n=1), and micrognathia (syndromic, n=3; non-syndromic, n=1). Correct distractor placement, vector of movement and final mandibular position were achieved in 10/13 patients. In the other 3 patients, desired jaw position was achieved by “molding” the regenerate. Conclusion The use of a semiburied curvilinear distraction device, with 3-dimensional treatment planning, is a potentially powerful tool to correct complex mandibular deformities. PMID:19375009

  3. Bilateral Automated Continuous Distraction Osteogenesis in a Design Model: Proof of Principle

    PubMed Central

    Peacock, Zachary S.; Tricomi, Brad J.; Faquin, William C.; Magill, John C.; Murphy, Brian A.; Kaban, Leonard B.; Troulis, Maria J.

    2015-01-01

    The purpose of this study was to demonstrate that automated, continuous, curvilinear distraction osteogenesis (DO) in a minipig model is effective when performed bilaterally, at rates up to 3mm/day, to achieve clinically relevant lengthening. A Yucatan minipig in the mixed dentition phase, underwent bilateral, continuous DO at a rate of 2 mm/day at the center of rotation; 1.0 and 3.0 mm/day at the superior and inferior regions, respectively. The distraction period was 13 days with no latency period. Vector and rate of distraction were remotely monitored without radiographs, using the device sensor. After fixation and euthanasia, the mandible and digastric muscles were harvested. The ex-vivo appearance, stability, and radiodensity of the regenerate were evaluated using a semi-quantitative scale. Percent surface area (PSA) occupied by bone, fibrous tissue, cartilage, and hematoma were calculated using histomorphometrics. The effects of DO on the digastric muscles and mandibular condyles were assessed via microscopy and degenerative changes were quantified. The animal was distracted to 21 mm and 24 mm on the right and left sides, respectively. Clinical appearance, stability, and radiodensity were scored as ‘3’ bilaterally indicating osseous union. The total PSA occupied by bone (right = 75.53±2.19%; left PSA = 73.11±2.18%) approached that of an unoperated mandible (84.67±0.86%). Digastric muscles and condyles showed negligible degenerative or abnormal histologic changes. This proof of principle study is the first report of osseous healing with no ill-effect on associated soft tissue and the mandibular condyle using bilateral, automated, continuous, curvilinear DO at rates up to 3 mm/day. The model approximates potential human application of continuous automated distraction with a semiburied device. PMID:26594967

  4. Effect of thrombin peptide 508 (TP508) on bone healing during distraction osteogenesis in rabbit tibia.

    PubMed

    Amir, Lisa R; Li, Gang; Schoenmaker, Ton; Everts, Vincent; Bronckers, Antonius L J J

    2007-10-01

    Thrombin-related peptide 508 (TP508) accelerates bone regeneration during distraction osteogenesis (DO). We have examined the effect of TP508 on bone regeneration during DO by immunolocalization of Runx2 protein, a marker of osteoblast differentiation, and of osteopontin (OPN) and bone sialoprotein (BSP), two late markers of the osteoblast lineage. Distraction was performed in tibiae of rabbits over a period of 6 days. TP508 (30 or 300 microg) or vehicle was injected into the distraction gap at the beginning and end of the distraction period. Two weeks after active distraction, tissue samples were harvested and processed for immunohistochemical analysis. We also tested the in vitro effect of TP508 on Runx2 mRNA expression in osteoblast-like (MC3T3-E1) cells by polymerase chain reaction analysis. Runx2 and OPN protein were observed in preosteoblasts, osteoblasts, osteocytes of newly formed bone, blood vessel cells and many fibroblast-like cells of the soft connective tissue. Immunostaining for BSP was more restricted to osteoblasts and osteocytes. Significantly more Runx2- and OPN-expressing cells were seen in the group treated with 300 microg TP508 than in the control group injected with saline or with 30 microg TP508. However, TP508 failed to increase Runx2 mRNA levels significantly in MC3T3-E1 cells after 2-3 days of exposure. Our data suggest that TP508 enhances bone regeneration during DO by increasing the proportion of cells of the osteoblastic lineage. Clinically, TP508 may shorten the healing time during DO; this might be of benefit when bone regeneration is slow.

  5. Local injection of substance P increases bony formation during mandibular distraction osteogenesis in rats.

    PubMed

    Zhang, Ya-bo; Wang, Lei; Jia, Sen; Du, Zhao-jie; Zhao, Ying-hua; Liu, Yan-pu; Lei, De-lin

    2014-10-01

    Substance P is a neuropeptide that is distributed in those sensory nerve fibres that innervate the medullary tissues of bone. It is a potent accelerator of proliferation and differentiation of osteoblasts in vitro. However, its capacity for promoting repair of mandibular defects is not known. We have investigated the osteogenic effects of local injections of substance P during mandibular distraction osteogenesis in rats. Twenty Sprague-Dawley rats were randomly assigned to 2 groups (n = 10 in each): substance P 10(-7) mmol/l in normal saline 0.2ml was injected into the experimental group, and saline alone into the controls. The mandibular distraction rate was 0.2mm every 12hours for 10 days. Daily injections of substance P or saline were given during the distraction period. Regeneration of bone was assessed quantitatively on days 15 and 29 using microcomputed tomography (microCT), and histological analysis. The rate of bony union in the group treated with substance P was significantly higher than that in the saline alone group on day 29 (p=0.001) The microCT images and quantitation showed more callus and more mature cortical bone when substance P was given than with control. Histological examination showed that cartilaginous tissues had formed in the middle of the distraction gaps in both groups. Bony bridges were seen only in the substance P group at the final time point (day 29). Injection of substance P into the gap of a rat mandible during mandibular distraction improved formation of good-quality bone and accelerated bony union. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  6. Distraction osteogenesis for management of obstructive sleep apnoea in temporomandibular joint ankylosis patients before the release of joint.

    PubMed

    Yadav, Rahul; Bhutia, Ongkila; Shukla, Garima; Roychoudhury, Ajoy

    2014-07-01

    To evaluate the effects of distraction osteogenesis in management of obstructive sleep apnoea patients secondary to temporomandibular joints ankylosis. Fifteen patients were included in study. Preoperatively the patients were worked up for polysomnography and CT scans. Only those patients with Apnoea-hypopnoea index >15 events/h denoting moderate to severe obstructive sleep apnoea were included in the study. Distraction osteogenesis was followed with 5 days latency period in adult patients and 0 days for children. Rate of distraction was 1 mm/day for adults and 2 mm/day for children till the mandibular incisors were in reverse overjet. After 3 months post distraction assessment was done using polysomnography and CT scan. TMJ ankylosis was released by doing gap arthroplasty after distraction osteogenesis. Post distraction improvement was seen in clinical features of OSA like daytime sleepiness and snoring. Epworth sleepiness scale improved from a mean of 10.25 to 2.25. Polysomnographic analysis also showed improvement in all cases with apnoea-hypopnoea index from 57.03 to 6.67 per hour. Lowest oxygen saturation improved from 64.47% to 81.20% and average minimum oxygen saturation improved from 92.17% to 98.19%. Body mass index improved from a mean of 18.26 to 21.39 kg/m2. Distraction osteogenesis is a stable and beneficial treatment option for temporomandibular joint ankylosis patients with obstructive sleep apnoea. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  7. Three-dimensional computed tomographic evaluation of Le Fort III distraction osteogenesis with an external device in syndromic craniosynostosis.

    PubMed

    Wery, M F; Nada, R M; van der Meulen, J J; Wolvius, E B; Ongkosuwito, E M

    2015-03-01

    There is little anteroposterior growth of the midface in patients with syndromic craniosynostosis who are followed up over time without intervention. A Le Fort III with distraction osteogenesis can be done to correct this. This is a controlled way in which to achieve appreciable stable advancement of the midface without the need for bone grafting, but the vector of the movement is not always predictable. The purpose of this study was to evaluate the 3-dimensional effect of Le Fort III distraction osteogenesis with an external frame. Ten patients (aged 7-19 years) who had the procedure were included in the study. The le Fort III procedure and the placement of the external frame were followed by an activation period and then a 3-month retention period. Computed tomographic (CT) images taken before and after operation were converted and loaded into 3-dimensional image rendering software and compared with the aid of a paired sample t test and a colour-coded qualitative analysis. Comparison of the CT data before and after distraction indicated that the amount of midface advancement was significant. Le Fort III distraction osteogenesis is an effective way to advance the midface. However, the movement during osteogenesis is not always exactly in the intended direction, and a secondary operation is often necessary. Three-dimensional evaluation over a longer period of time is necessary.

  8. Curvilinear Segmental Mandibular Reconstruction Utilizing Distraction Osteogenesis and Early Open Callus Manipulation.

    PubMed

    Pereira, Alberto Rocha; Neves, Paulo; Rosa, José; Bartlett, Scott

    2017-01-01

    The authors present a new technique for reconstruction of large curvilinear mandibular defects with distraction osteogenesis and early open callus manipulation. In phase 1, transport disks are created from mandibular bone and distracted across the entire length of the defect, without the restriction from a mandible plate fixation. This allows for full-length distraction until enough regenerate is obtained to reconstruct the defect without the need for additional bone grafts. Taking advantage of the soft moldable regenerate, the second and final operative procedure allows for the manipulation, repositioning, and fixation of the transported segments in the ideal position creating perfect tridimensional form and symmetry of the mandible arch. In addition, the consolidation phase is shortened by the early removal of distractors, substantially reducing the total length of treatment. This article describes 2 clinical cases treated according to this technique, one with a 6-cm mandibular defect where a sagittal plane manipulation was performed, and the other with a 7-cm defect and axial plane manipulation. Five years postsurgery, both patients had achieved full stable reconstruction without the need for bone grafting, and had obtained good facial symmetry, with no recorded complications. This technique serves to establish bone transport as a valuable alternative to bone free flaps in the reconstruction of large curvilinear segmental mandibular defects.

  9. Strain-related bone remodeling in distraction osteogenesis of the mandible.

    PubMed

    Meyer, U; Wiesmann, H P; Kruse-Lösler, B; Handschel, J; Stratmann, U; Joos, U

    1999-03-01

    Distraction osteogenesis has become a mainstay in craniofacial surgery. However, there are several unresolved problems concerning the biology of bone regeneration. We investigated the biomechanical effects of mandibular lengthening in 32 rabbits on a cellular and histologic level. The mandible was subjected to a corticotomy, held in a neutral position for 4 days, and then lengthened at various strain rates and frequencies for 10 days. Radiographic, histologic, and electron microscopic examinations showed a strain-related bone regeneration. Application of physiologic strain rates (2000 microstrains or 0.2 percent) led to a bridging of the artificial fracture exhibiting woven ossification, whereas at 20,000 microstrains trabecular bone formation was demonstrated. In contrast, hyperphysiologic strain magnitudes (200,000 microstrains and 300,000 microstrains) showed a fibrous tissue formation. Multiple strain applications (10 cycles/day versus 1 cycle/day) increased the width of the distraction gap without changing the stage of bone regeneration. The gradual distraction of bone in physiologic magnitudes at higher frequencies seems to be desirable for a bony differentiation and may help to improve clinical applications.

  10. Curvilinear Segmental Mandibular Reconstruction Utilizing Distraction Osteogenesis and Early Open Callus Manipulation

    PubMed Central

    Neves, Paulo; Rosa, José; Bartlett, Scott

    2017-01-01

    Summary: The authors present a new technique for reconstruction of large curvilinear mandibular defects with distraction osteogenesis and early open callus manipulation. In phase 1, transport disks are created from mandibular bone and distracted across the entire length of the defect, without the restriction from a mandible plate fixation. This allows for full-length distraction until enough regenerate is obtained to reconstruct the defect without the need for additional bone grafts. Taking advantage of the soft moldable regenerate, the second and final operative procedure allows for the manipulation, repositioning, and fixation of the transported segments in the ideal position creating perfect tridimensional form and symmetry of the mandible arch. In addition, the consolidation phase is shortened by the early removal of distractors, substantially reducing the total length of treatment. This article describes 2 clinical cases treated according to this technique, one with a 6-cm mandibular defect where a sagittal plane manipulation was performed, and the other with a 7-cm defect and axial plane manipulation. Five years postsurgery, both patients had achieved full stable reconstruction without the need for bone grafting, and had obtained good facial symmetry, with no recorded complications. This technique serves to establish bone transport as a valuable alternative to bone free flaps in the reconstruction of large curvilinear segmental mandibular defects. PMID:28203515

  11. Acceleration of consolidation period by thrombin peptide 508 in tibial distraction osteogenesis in rats.

    PubMed

    Cakarer, S; Olgac, V; Aksakalli, N; Tang, A; Keskin, C

    2010-12-01

    We aimed to find out whether a single local injection of two different doses of thrombin peptide 508 (TP508) could accelerate consolidation of bone in sites of tibial distraction osteogenesis in rats. Forty-eight adult male Sprague-Dawley rats were divided equally (n=16 in each group) into controls (given saline alone), and two experimental groups, given injections of TP508 10μg or 100 μg. The animals were killed on days 14 and 28 after distraction. Histomorphometric evaluation showed that the TP508 resulted in significantly larger areas of newly formed bone (p<0.003 and p<0.0001) than saline alone. At 2 weeks, more new bone had formed in the group given TP508 100 μg than in the group given 10 μg, but the difference was not significant (p=0.8). However, the difference was significant at 4 weeks (p=0.03). These findings suggest that a single injection of TP508 given at the end of the distraction period increased the degree of consolidation. The higher dose was more effective at the later time point.

  12. Dynamic Analysis of New Bone Obtained by Nonvascular Transport Distraction Osteogenesis in Canines.

    PubMed

    Guo, Peng; Zhou, Nuo; Lu, Xia; Huang, Xuan-Ping; Jiang, Xian-Fang; Wang, Yan

    2016-01-01

    The aim of the present study was to construct a nonvascular transport disc to repair the canine mandibular defects model and to perform a dynamic analysis of the new bone obtained by nonvascular transport distraction osteogenesis (NTDO) in canines. Thirty adult dogs were randomly divided into 3 groups, with 10 dogs in each group. Canine mandibular defect models of NTDO were constructed. All the dogs were marked by tetracycline hydrochloride at a different distraction stage. The dogs were euthanized at 2, 4, and 12 weeks after distraction, and the quality ratio of calcium and phosphate for the new bone was measured using electron dispersive spectroscopy. The canine mandibular defects were successfully repaired. Using tetracycline hydrochloride, we successfully observed the quality and speed of new bone formation. The quality ratio of calcium and phosphate was similar between the new bone formation and the original bone. The time spent using a nonvascular transport disc to repair mandibular defects was consistent with using a vascularized transport disc, and the quality of the new bone and the original bone was exactly the same. When the bone mass is insufficient or the conditions are not suitable for a vascularized transport disc, the nonvascular transport disc can be used as an alternative. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Stem cell-conditioned medium accelerates distraction osteogenesis through multiple regenerative mechanisms.

    PubMed

    Ando, Yuji; Matsubara, Kohki; Ishikawa, Jun; Fujio, Masahito; Shohara, Ryutaro; Hibi, Hideharu; Ueda, Minoru; Yamamoto, Akihito

    2014-04-01

    Distraction osteogenesis (DO) successfully induces large-scale skeletal tissue regeneration, but it involves an undesirably long treatment period. A high-speed DO mouse model (H-DO) with a distraction speed twice that of a control DO model failed to generate new bone callus in the distraction gap. Here we demonstrate that the local administration of serum-free conditioned medium from human mesenchymal stem cells (MSC-CM) accelerated callus formation in the mouse H-DO model. Secretomic analysis identified factors contained in MSC-CM that recruit murine bone marrow stromal cells (mBMSCs) and endothelial cells/endothelial progenitor cells (EC/EPCs), inhibit inflammation and apoptosis, and promote osteoblast differentiation, angiogenesis, and cell proliferation. Functional assays identified MCP-1/-3 and IL-3/-6 as essential factors in recruiting mBMSCs and EC/EPCs. IL-3/-6 also enhanced the osteogenic differentiation of mBMSCs. MSC-CM that had been depleted of MCP-1/-3 failed to recruit mBMSCs, and consequently failed to promote callus formation. Taken together, our data suggest that MSCs produce a broad repertoire of trophic factors with tissue-regenerative activities that accelerate healing in the DO process. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Targeting P38 Pathway Regulates Bony Formation via MSC Recruitment during Mandibular Distraction Osteogenesis in Rats

    PubMed Central

    Yang, Zi-hui; Wu, Bao-lei; Ye, Chen; Jia, Sen; Yang, Xin-jie; Hou, Rui; Lei, De-lin; Wang, Lei

    2016-01-01

    Distraction osteogenesis (DO) is a widely used self-tissue engineering. However, complications and discomfort due to the long treatment period are still the bottleneck of DO. Novel strategies to accelerate bone formation in DO are still needed. P38 is capable of regulating the osteogenic differentiation of both mesenchymal stem cells (MSCs) and osteoblasts, which are crucial to bone regeneration. However, it is not clear whether targeting p38 could regulate bony formation in DO. The purpose of the current work was to investigate the effects of local application of either p38 agonist anisomycin or p38 inhibitor SB203580 in a rat model of DO. 30 adult rats were randomly divided into 3 groups: (A) rats injected with DMSO served as the control group; (B) rats injected with p38 agonist anisomycin; (C) rats injected with p38 inhibitor SB203580. All the rats were subjected to mandibular distraction and the injection was performed daily during this period. The distracted mandibles were harvested on days 15 and 30 after surgery and subjected to the following analysis. Micro-computed tomography and histological evaluation results showed that local application of p38 agonist anisomycin increased new bone formation in DO, whereas p38 inhibitor SB203580 decreased it. Immunohistochemical analysis suggested that anisomycin promoted MSC recruitment in the distraction gap. In conclusion, this study demonstrated that local application of p38 agonist anisomycin can increase new bone formation during DO. This study may lead to a novel cell-based strategy for the improvement of bone regeneration. PMID:27766028

  15. Alveolar distraction osteogenesis for dental implant rehabilitation following fibular reconstruction: a case series.

    PubMed

    Cheung, Lim Kwong; Chua, Hannah Daile P; Hariri, Firdaus; Pow, Edmond H N; Zheng, Liwu

    2013-02-01

    Alveolar distraction osteogenesis (ADO), a novel bone augmentation technique, is gaining acceptance in restoring the vertical bone discrepancy between the transplanted graft and the residual alveolar bone after mandibular reconstruction. This case series presents the outcomes of ADO in fibula-reconstructed mandibles rehabilitated with dental implants, with an emphasis on clinical indications, surgical protocol, clinical outcomes, histologic evidence, and complications. Five patients underwent fibula distraction procedures after undergoing mandibular reconstruction with a vascularized fibula bone graft. The indication for the application of ADO was for the correction of the vertical discrepancy between the top of the reconstructed fibula and the adjacent alveolar crest to achieve adequate vertical bone height before implant placement. The mean vertical bone height achieved was 13.58 mm. Twenty-two dental implants were placed in 5 patients. All patients were rehabilitated with implant-supported prostheses. Bone biopsies showed the distracted area was filled with newly formed, bony trabeculae between the transported fibula and the basal segments. The most common complication was transient infection around the distractor rod. ADO can be performed on fibula-reconstructed mandibles to achieve the restoration of alveolar height, which then can be rehabilitated with dental implant-supported prostheses. The procedure has a minor risk of infection associated with the distractor rod, which does not compromise the bone regeneration from distraction. Patients with mandibles reconstructed with fibulas can attain dental implant rehabilitation with ADO, achieving good esthetic and occlusal outcomes. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Targeting P38 Pathway Regulates Bony Formation via MSC Recruitment during Mandibular Distraction Osteogenesis in Rats.

    PubMed

    Yang, Zi-Hui; Wu, Bao-Lei; Ye, Chen; Jia, Sen; Yang, Xin-Jie; Hou, Rui; Lei, De-Lin; Wang, Lei

    2016-01-01

    Distraction osteogenesis (DO) is a widely used self-tissue engineering. However, complications and discomfort due to the long treatment period are still the bottleneck of DO. Novel strategies to accelerate bone formation in DO are still needed. P38 is capable of regulating the osteogenic differentiation of both mesenchymal stem cells (MSCs) and osteoblasts, which are crucial to bone regeneration. However, it is not clear whether targeting p38 could regulate bony formation in DO. The purpose of the current work was to investigate the effects of local application of either p38 agonist anisomycin or p38 inhibitor SB203580 in a rat model of DO. 30 adult rats were randomly divided into 3 groups: (A) rats injected with DMSO served as the control group; (B) rats injected with p38 agonist anisomycin; (C) rats injected with p38 inhibitor SB203580. All the rats were subjected to mandibular distraction and the injection was performed daily during this period. The distracted mandibles were harvested on days 15 and 30 after surgery and subjected to the following analysis. Micro-computed tomography and histological evaluation results showed that local application of p38 agonist anisomycin increased new bone formation in DO, whereas p38 inhibitor SB203580 decreased it. Immunohistochemical analysis suggested that anisomycin promoted MSC recruitment in the distraction gap. In conclusion, this study demonstrated that local application of p38 agonist anisomycin can increase new bone formation during DO. This study may lead to a novel cell-based strategy for the improvement of bone regeneration.

  17. Mandibular distraction osteogenesis as first step in the early treatment of severe dysgnathia in childhood.

    PubMed

    Klein, C; Howaldt, H P

    1996-02-01

    The sole orthodontic treatment of severe dysgnathias in childhood often leads to unsatisfactory results. On the other hand, standard surgical procedures are very difficult and due to their high risks not practicable in early childhood. The distraction osteogenesis enables us to correct hypoplastic mandibles, so that secondary malformations of the midfacial complex can be avoided. During the operation the hypoplastic site of the mandible is osteotomized behind the last visible tooth bud and a bidirectional distractor is inserted. Following the principles of Ilizarov the new callus is lengthened gradually until the required length of the mandible has been achieved. Out of a total sample of 27 patients 3 case reports of young children are presented. The new surgical concept describes new treatment perspectives.

  18. Rat mandibular distraction osteogenesis: II. Molecular analysis of transforming growth factor beta-1 and osteocalcin gene expression.

    PubMed

    Mehrara, B J; Rowe, N M; Steinbrech, D S; Dudziak, M E; Saadeh, P B; McCarthy, J G; Gittes, G K; Longaker, M T

    1999-02-01

    Distraction osteogenesis is a powerful technique capable of generating viable osseous tissue by the gradual separation of osteotomized bone edges. Although the histologic and ultrastructural changes associated with this process have been extensively delineated, the molecular events governing these changes remain essentially unknown. We have devised a rat model of mandibular distraction osteogenesis that facilitates molecular analysis of this process. Such information has significant clinical implications because it may enable targeted therapeutic manipulations designed to accelerate osseous regeneration. In this study, we have evaluated the expression of transforming growth factor beta-1, a major regulator of osteogenesis during endochondral bone formation and development, and osteocalcin, an abundant noncollagenous extracellular matrix protein implicated in the regulation of mineralization and bone turnover. The right hemimandible of 36 adult male rats was osteotomized, and a customized distraction device was applied. Animals were allowed to recover and, after a 3-day latency period, were distracted at a rate of 0.25 mm twice daily for 6 days followed by a 2- or 4-week consolidation period. Distraction regenerate was harvested after the latency period, days 2, 4, or 6 of distraction, and after 2 or 4 weeks of consolidation and processed for Northern analysis (n = 4 at each time point) and immunohistochemical localization of TGF-beta1 (n = 2 at each time point). Six sham-operated animals (i.e., skin incision without osteotomy) were also killed (immediately postoperatively), and the mandibles were harvested and prepared in a similar fashion. Equal loading and transfer of RNA for Northern analysis was ensured by stripping and probing membranes with a probe against GAPDH (a housekeeping gene). Our results demonstrate that the spatial and temporal patterns of TGF-beta1 mRNA expression and protein production coincide with osteoblast migration, differentiation, and

  19. Hydroxyapatite-coated Schanz pins in external fixators used for distraction osteogenesis : a randomized, controlled trial.

    PubMed

    Pommer, Axel; Muhr, Gert; Dávid, Andreas

    2002-07-01

    Complications of external fixation include loosening of the fixation pins and pin-track infection. Laboratory studies and clinical trials have suggested that hydroxyapatite coating improves the osteointegration of various orthopaedic implants. The purpose of this study was to determine whether the prevalence of pin-related complications can be reduced by the use of hydroxyapatite-coated pins in fixators applied for distraction osteogenesis. Forty-six consecutive patients undergoing segmental transport or lengthening of the tibia were randomized to the use of either standard titanium Schanz pins or hydroxyapatite-coated stainless-steel Schanz pins. The fixators were used for an average of thirty-eight weeks (range, fourteen to seventy-two weeks). All patients were closely monitored for pin loosening and infection, and digitized radiographs were assessed for bone resorption around all pins. When the external fixator was removed, the torque required to extract the pins was determined with use of an electronic torque wrench. In the control group (titanium pins), twenty-two pins (13%) loosened and an infection occurred at the site of twenty pins. An extensive infection of the canal developed in one patient. Twenty-two pins were removed or replaced because of these complications. In the hydroxyapatite group, no clinical or radiographic signs of pin loosening or infection were observed and no pins required early removal or exchange. The mean torque (and standard deviation) required to remove the hydroxyapatite-coated pins was 0.43 0.18 N-m compared with 0.10 0.09 N-m for the uncoated pins (p < 0.001). Coating pins with hydroxyapatite increases their fixation to bone and reduces the rate of infection and loosening during external fixation for distraction osteogenesis. Use of hydroxyapatite-coated pins should be considered in clinical situations requiring prolonged external fixation.

  20. Morphometric analysis of the Korean mandibular ramus for distraction osteogenesis using micro-computed tomography.

    PubMed

    Lee, Jae-Gi; Kim, Il-Soo; Kim, Young-Woo; Park, Jong-Tae; Hu, Kyung-Seok; Kim, Hyung-Gon; Kim, Hee-Jin

    2011-01-01

    When performing distraction osteogenesis, the osteotomy is normally applied to the cortical bone posterior to the mandibular second molar. We measured the topographic thickness of the cortical and trabecular bone of the mandibular ramus and at the mandibular canal (MC) to provide crucial anatomic data aimed at minimizing complications and elucidating the most appropriate site for placing the distractor. Forty sides of the mandibles were prepared from 20 Korean cadavers (10 men and 10 women with a mean age of 68 years). The specimens were scanned and reconstructed into three-dimensional images using a micro-computed tomography system. Coronal and horizontal sectional images of the mandibular ramus were taken at thickness intervals of 2 mm from the reconstructed three-dimensional images. Image analysis software was used to measure the thicknesses of the cortical and trabecular bone and to identify the locations of the MC within the body and the mandibular ramus on each section. The mean thicknesses of the buccal cortical plate, trabecular bone, and lingual cortical plate were 2.9 mm (men, 3.0 mm; women, 2.8 mm), 9.1 mm (men, 9.8 mm; women, 8.5 mm), and 2.2 mm (men, 2.3 mm; women, 2.1 mm), respectively. The distance from the buccal surface of the mandible to the MC increased from 5.3 to 10.0 mm (men, 5.3-10.0 mm; women, 5.3-9.1 mm) when moving progressively anterosuperior from the mandibular angle region. Morphometric analyses of the mandibular ramus can provide crucial data when performing mandibular osteotomy and locating an appropriate placement site for a distractor device during the distraction-osteogenesis procedure.

  1. Evaluation of Vertical Bone Gain Following Alveolar Distraction Osteogenesis in the Anterior Edentulous Mandible: A Clinical Study.

    PubMed

    Kumar, K A Jeevan; Masrom, Aruna Kishore; Patil, Kapil; Kunusoth, Ramesh; Begum, Farzana; Venkatesh, Veerareddy

    2014-12-01

    To calculate the gain in bony height and volume of the distracted upper segment using an extraosseous unidirectional device to improve the retention of the future prosthesis. Ten cases with completely or partially edentulous but severely or considerably resorbed anterior mandibles were managed by vertical alveolar distraction osteogenesis. All the patients were evaluated preoperatively, intraoperatively and post-operatively for various parameters clinically and radiographically i.e. on OPG, lateral cephalogram and on CT scan, at different time intervals. In all cases there was increase in vertical bone height. The study showed mean vertical bone gain (VBG) on OPG as 8.2 mm. The mean VBG on lateral cephalogram was 8.1 mm. The mean VBG on CT scan at right canine was 8.35 mm, at left canine was 8.2 mm and at midline was 8.27 mm. Alveolar distraction osteogenesis is a predictable method for restoring alveolar ridges prior to implant placement or prosthesis. Distraction osteogenesis is ideally suited for recreating missing tissue in the anterior esthetic zone by increasing vertical bone height as well as good width and soft tissue growth.

  2. Quantitative expression of bone-related cytokines induced by mechanical tension-stress during distraction osteogenesis in a rabbit mandible.

    PubMed

    Nuntanaranont, Thongchai; Suttapreyasri, Srisurang; Vongvatcharanon, Surapong

    2014-11-01

    The aim of the present study was to investigate the temporal and spatial gene expression of bone morphogenetic proteins (BMP)-2, -4, and -7, and transforming growth factor-β (TGF-β), during the distraction process of the rabbit mandible. Twenty rabbits each had an osteotomy on the left mandibular body, and distraction devices were fixed. After a delay of 3 days, distraction was started at a rate of 0.5 mm/12 h for 10 days, followed by a 3-week consolidation phase. Four rabbits were killed 5 and 10 days of distraction, and 1, 2, and 3 weeks after the completion of distraction. The clinical, histological, and radiographic appearances were evaluated and analyzed with the concomitant BMP expression pattern at each interval. After the distraction was started, the fibrous interzone developed between the osteotomy fragments, where intramembranous ossification was noted. The quantitative expression of BMP-2, -4, and -7, and TGF-β, were increased immediately after active distraction before a gradual decline to normal levels after the third week of consolidation. These results suggest that BMP and TGF-β play an important role in the induction of bone formation during distraction osteogenesis. The selective expression of each bone-related cytokine could provide useful insight into accelerated bone maturation and the treatment of poorly-healing fractures in clinical cases. © 2014 Wiley Publishing Asia Pty Ltd.

  3. Rehabilitation of edentulous atrophic anterior mandible - the role of vertical alveolar distraction osteogenesis.

    PubMed

    Mampilly, Mathew O; Rao, Latha P; Sequiera, Joyce; Rao, B H Sripathi; Chandra, Jagadish; Rai, Gunachandra

    2014-11-01

    The rehabilitation of patients with edentulous alveolar ridge is always a challenge, more so in case of a long standing atrophic mandible. Mandible, the largest movable bone in the maxillofacial skeleton is associated with many soft tissue attachments which imparts dislodging forces to prosthesis. In addition to this, the rate of resorption of the mandibular ridge is four times that of the maxilla. These factors make the environment of the mandibular arch less favorable to complete denture stability and retention. An ideal solution would be to augment the atrophic alveolar ridge with native bone of the individual which shall eliminate the possible complications, associated with conventional ridge augmentation procedures. With advent of modern technology, and increased biological understanding, the principles of distraction osteogenesis are increasingly being applied to the craniofacial skeleton and have been found to be a viable option in augmenting the native alveolar bone in the mandible. Here the application of an indigenous stainless steel vertical alveolar distraction device to augment atrophic anterior mandibular ridge is assessed in six patients.

  4. Rehabilitation of Edentulous Atrophic Anterior Mandible – The Role of Vertical Alveolar Distraction Osteogenesis

    PubMed Central

    Rao, Latha P; Sequiera, Joyce; Rao, B H Sripathi; Chandra, Jagadish; Rai, Gunachandra

    2014-01-01

    The rehabilitation of patients with edentulous alveolar ridge is always a challenge, more so in case of a long standing atrophic mandible. Mandible, the largest movable bone in the maxillofacial skeleton is associated with many soft tissue attachments which imparts dislodging forces to prosthesis. In addition to this, the rate of resorption of the mandibular ridge is four times that of the maxilla. These factors make the environment of the mandibular arch less favorable to complete denture stability and retention. An ideal solution would be to augment the atrophic alveolar ridge with native bone of the individual which shall eliminate the possible complications, associated with conventional ridge augmentation procedures. With advent of modern technology, and increased biological understanding, the principles of distraction osteogenesis are increasingly being applied to the craniofacial skeleton and have been found to be a viable option in augmenting the native alveolar bone in the mandible. Here the application of an indigenous stainless steel vertical alveolar distraction device to augment atrophic anterior mandibular ridge is assessed in six patients. PMID:25584344

  5. Skeletal and soft tissue response to automated, continuous, curvilinear distraction osteogenesis.

    PubMed

    Peacock, Zachary S; Tricomi, Brad J; Lawler, Matthew E; Faquin, William C; Magill, John C; Murphy, Brian A; Kaban, Leonard B; Troulis, Maria J

    2014-09-01

    To document the bone formation and soft tissue changes in response to automated, continuous, curvilinear distraction osteogenesis (DO) at rates greater than 1 mm/day in a minipig model. Two groups of Yucatan minipigs underwent automated, continuous, curvilinear DO of the right mandible: group A, 1.5 mm/day (n = 5); and group B, 3.0 mm/day (n = 5). Each minipig underwent 12 mm of distraction followed by 24 days of fixation. The distracted and contralateral mandibles were harvested at the end of fixation. The percentage of surface area (PSA) of the regenerate occupied by bone, fibrous tissue, cartilage, and hematoma was determined using computerized histomorphometric analysis. The control groups consisted of DO wounds distracted discontinuously at 1 mm/day and the nonoperated contralateral mandible. The ipsilateral and contralateral digastric muscles were harvested and stained for proliferating cell nuclear antigen (PCNA), myogenic differentiation-1 (MyoD), and paired Box 7 protein (PAX7). All 10 minipigs completed the distraction and fixation period. The PSA occupied by bone was similar for groups A (PSA 64.36% ± 5.87%) and B (PSA 63.83% ± 3.37%) and the control group (1 mm/day; PSA 64.89% ± 0.56%) but was less than that on the nonoperated side (PSA 84.67% ± 0.86%). The PSA occupied by cartilage and hematoma in all groups was minimal (<1.1%). The digastric muscles had no abnormal tissue or inflammation, and PAX7, MyoD, and PCNA expression had returned to the baseline levels. The results of the present study indicate that bone formation in response to automated, continuous, and curvilinear DO at a rate of 1.5 and 3.0 mm/day is nearly identical to that with discontinuous DO at 1 mm/day. In addition, no deleterious effects were found on the digastric muscles. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Transplantation of human dental pulp stem cells: enhance bone consolidation in mandibular distraction osteogenesis.

    PubMed

    Alkaisi, Amera; Ismail, Abd Rashid; Mutum, Samarendra S; Ahmad, Zainal A Rifin; Masudi, Sam'an; Abd Razak, Noor Hayati

    2013-10-01

    The main aim of the present study was to evaluate the capacity of stem cells from human exfoliated deciduous teeth (SHED) to enhance mandibular distraction osteogenesis (DO) in rabbits. A randomized controlled trial was conducted. Eighteen skeletally immature New Zealand white rabbits were divided into 2 groups, with 9 in the control group and 9 in the SHED group. The SHED were isolated, expanded, and characterized. Six million cells were transplanted into the distracted area during the osteotomy period. After a 4-day latency period, a total of 6 mm was distracted for 6 days. The newly formed bone was analyzed radiologically, histologically, and histomorphometrically at 2, 4, and 6 weeks postoperatively. Nonparametric analysis of variance (Kruskal-Wallis test) was used for data analysis, and P < .05 was considered statistically significant. The cell lineage was positive for the 2 mesenchymal stem cell markers tested (CD105 and CD166). More mature bone in the SHED transplanted group was observed radiographically and histologically. Histomorphologically, the percentage of newly formed bone after 2, 4, and 6 weeks was 18.41% and 41.53%, 31.68% and 59.78%, and 52.34% and 65.24% in the control and SHED groups, respectively. The difference between the groups was statistically significant (P = .012). The bone union and stage of bone maturity scores were significantly different between the control and SHED groups (P = .006 and P = .011, respectively). Our findings suggest that SHED can serve as an additional cell resource for DO enhancement in rabbits and might be a promising model for the reconstruction of large mandibular defects in human oral maxillofacial surgery. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Comparison of the Effects of Local and Systemic Zoledronic Acid Application on Mandibular Distraction Osteogenesis.

    PubMed

    Dundar, Serkan; Artas, Gokhan; Acikan, Izzet; Yaman, Ferhan; Kirtay, Mustafa; Ozupek, Muhammed Fatih; Asutay, Fatih; Kom, Mustafa

    2017-10-01

    Bisphosphonates are antibone resorptive drugs that are used to prevent bone tissue resorption in several skeletal diseases. The aim of this study was to examine the effects of systemic and local applications of zoledronic acid (ZA) on newly regenerated bone in a model of experimental distraction osteogenesis (DO). To do this mandibular DO was applied to 30 adult female Sprague Dawley rats, which were randomly divided into 3 groups: control, DO only, systemic zoledronic acid (SZA), and local zoledronic acid (LZA). In the LZA group, the gap between the bone fragments was filled with a gelatin sponge soaked in 2 mg of ZA and 0.1 mL of sterile saline. In the SZA group, a single dose of 0.1 mg/kg ZA was administered systemically. After the surgery, there was a 5-day latent waiting period and 10-day distraction phase. Following a 28-day consolidation period, the rats were euthanized and their mandibles were collected. The distracted bone area was seen to be filled with newly regenerated bone tissue in all 3 groups, both histologically and histomorphometrically. In addition, amounts of new bone formation, osteoblast cella, osteoclast (OC) cells, osteopontin, and vascular endothelial growth factor in the SZA and LZA groups were found to be higher when compared with the controls. Furthermore, in the SZA group, new bone formation, osteoblast, OC, osteopontin, and vascular endothelial growth factor were detected in significant amounts compared with the LZA group. Osteoclast numbers did not differ in a statistically significant manner in the SZA group with respect to the LZA group. Based on the results of this study, systemic and local applications of ZA could increase the formation of new bone in patients of DO, and systemic application is a more effective method compared with local application.

  8. Temporo-spatial analysis of Osterix, HNK1 and Sox10 during odontogenesis and maxillaries osteogenesis.

    PubMed

    Tomazelli, Karin Berria; Modolo, Filipe; Trentin, Andrea Gonçalves; Garcez, Ricardo Castilho; Biz, Michelle Tillmann

    2015-10-01

    Cell differentiation is essential for maxillaries and tooth development. Facial mesenchymal tissue is formed by neural crest cells (NC). These cells are highly migratory, giving rise to various cell types, considered with a high level of plasticity, indicating that they contain progenitor cells with a great power of differentiation. In this study, it was analyzed the presence of NC cell progenitors and mesenchymal stem cells (MSC) during maxillaries osteogenesis and odontogenesis in rats. Histological slides were collected in two phases: embryonic age of 15 and 17 days; 2, 4 and 7 days after birth. Immunohistochemistry for MSC markers (Osterix) and NC cells (Sox10, HNK1) was performed. The results showed positive expression for Osterix and HNK1 in undifferentiated ectomesenchymal cells in early and late stages; Sox10 was present only in early stages in undifferentiated cells. All markers were present in differentiated cells. Although the experiments performed do not allow us to explain a possible role for Osx, HNK1 and Sox10 in both differentiated and undifferentiated cells during osteogenesis and odontogenesis, it had shown important results not yet described: the presence of HNK1 and Sox10 in osteoblasts and odontoblasts in late development stages and in the tooth germ epithelial cells and ameloblasts. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. An Examination of Differences in the New Bone Formation Promoted by Different Doses of Recombinant Human Parathyroid Hormone during Mandibular Distraction Osteogenesis.

    PubMed

    Tang, Zheng-Long; Bai, Shuo; Zhu, Peng-Na; Li, Yong-Di; Wang, Dong-Xiang; Cai, Yang

    2016-02-01

    The administration of different doses of parathyroid hormone to promote mandibular distraction osteogenesis remains unclear. The objective of the present study was to examine the effects of recombinant human parathyroid hormone on new bone formation during mandibular distraction osteogenesis and to investigate the dose-effect relationship associated with this phenomenon. A total of 45 rabbits were used to establish the mandibular distraction osteogenesis model. The rabbits were divided into a control group (that received a subcutaneous injection of 1 ml of saline every other day) and experimental groups A, B, C, and D (that received subcutaneous injections of 10, 20, 30, and 40 μg/kg of recombinant human parathyroid hormone, respectively, every other day). On days 1, 7, and 14 of the consolidation period after the distraction had been completed, new bone in the distraction region was examined through histomorphometric investigation and bone mineral density testing. On days 1, 7, and 14 of the fixation period, the number of osteoblasts, trabecular bone area, and bone mineral density were greater in each experimental group than in the control group. On day 1 of the consolidation period, group C featured the highest average number of osteoblasts. On day 14 of the consolidation period, group C exhibited the highest bone mineral densities and largest trabecular bone areas. Intermittent subcutaneous injections of recombinant human parathyroid hormone can promote new bone formation during mandibular distraction osteogenesis. Different doses of recombinant human parathyroid hormone promoted mandibular distraction osteogenesis to differing extents.

  10. Sympathetic denervation-induced MSC mobilization in distraction osteogenesis associates with inhibition of MSC migration and osteogenesis by norepinephrine/adrb3.

    PubMed

    Du, Zhaojie; Wang, Lei; Zhao, Yinghua; Cao, Jian; Wang, Tao; Liu, Peng; Zhang, Yabo; Yang, Xinjie; Cheng, Xiaobing; Liu, Baolin; Lei, Delin

    2014-01-01

    The sympathetic nervous system regulates bone formation and resorption under physiological conditions. However, it is still unclear how the sympathetic nerves affect stem cell migration and differentiation in bone regeneration. Distraction osteogenesis is an ideal model of bone regeneration due to its special nature as a self-engineering tissue. In this study, a rat model of mandibular distraction osteogenesis with transection of cervical sympathetic trunk was used to demonstrate that sympathetic denervation can deplete norepinephrine (NE) in distraction-induced bone callus, down-regulate β3-adrenergic receptor (adrb3) in bone marrow mesenchymal stem cells (MSCs), and promote MSC migration from perivascular regions to bone-forming units. An in vitro Transwell assay was here used to demonstrate that NE can inhibit stroma-derived factor-1 (SDF-1)-induced MSC migration and expression of the migration-related gene matrix metalloproteinase-2 (MMP-2) and downregulate that of the anti-migration gene tissue inhibitor of metalloproteinase-3 (TIMP-3). Knockdown of adrb3 using siRNA abolishes inhibition of MSC migration. An in vitro osteogenic assay was used to show that NE can inhibit the formation of MSC bone nodules and expression of the osteogenic marker genes alkaline phosphatase (ALP), osteocalcin (OCN), and runt-related transcription factor-2 (RUNX2), but knockdown of adrb3 by siRNA can abolish such inhibition of the osteogenic differentiation of MSCs. It is here concluded that sympathetic denervation-induced MSC mobilization in rat mandibular distraction osteogenesis is associated with inhibition of MSC migration and osteogenic differentiation by NE/adrb3 in vitro. These findings may facilitate understanding of the relationship of MSC mobilization and sympathetic nervous system across a wide spectrum of tissue regeneration processes.

  11. Sympathetic Denervation-Induced MSC Mobilization in Distraction Osteogenesis Associates with Inhibition of MSC Migration and Osteogenesis by Norepinephrine/adrb3

    PubMed Central

    Zhao, Yinghua; Cao, Jian; Wang, Tao; Liu, Peng; Zhang, Yabo; Yang, Xinjie; Cheng, Xiaobing; Liu, Baolin; Lei, Delin

    2014-01-01

    The sympathetic nervous system regulates bone formation and resorption under physiological conditions. However, it is still unclear how the sympathetic nerves affect stem cell migration and differentiation in bone regeneration. Distraction osteogenesis is an ideal model of bone regeneration due to its special nature as a self-engineering tissue. In this study, a rat model of mandibular distraction osteogenesis with transection of cervical sympathetic trunk was used to demonstrate that sympathetic denervation can deplete norepinephrine (NE) in distraction-induced bone callus, down-regulate β3-adrenergic receptor (adrb3) in bone marrow mesenchymal stem cells (MSCs), and promote MSC migration from perivascular regions to bone-forming units. An in vitro Transwell assay was here used to demonstrate that NE can inhibit stroma-derived factor-1 (SDF-1)-induced MSC migration and expression of the migration-related gene matrix metalloproteinase-2 (MMP-2) and downregulate that of the anti-migration gene tissue inhibitor of metalloproteinase-3 (TIMP-3). Knockdown of adrb3 using siRNA abolishes inhibition of MSC migration. An in vitro osteogenic assay was used to show that NE can inhibit the formation of MSC bone nodules and expression of the osteogenic marker genes alkaline phosphatase (ALP), osteocalcin (OCN), and runt-related transcription factor-2 (RUNX2), but knockdown of adrb3 by siRNA can abolish such inhibition of the osteogenic differentiation of MSCs. It is here concluded that sympathetic denervation-induced MSC mobilization in rat mandibular distraction osteogenesis is associated with inhibition of MSC migration and osteogenic differentiation by NE/adrb3 in vitro. These findings may facilitate understanding of the relationship of MSC mobilization and sympathetic nervous system across a wide spectrum of tissue regeneration processes. PMID:25144690

  12. Transplantation of Autologous Bone Marrow Mesenchymal Stem Cells with Platelet-Rich Plasma Accelerate Distraction Osteogenesis in A Canine Model

    PubMed Central

    Dehghan, Mohammad Mehdi; Baghaban Eslaminejad, Mohamadreza; Motallebizadeh, Nader; Ashrafi Halan, Javad; Tagiyar, Leila; Soroori, Sarang; Nikmahzar, Agbibi; Pedram, Mirsepehr; Shahverdi, Abdolhossein; Kazemi Mehrjerdi, Hossein; Izadi, Sadra

    2015-01-01

    Objective Distraction osteogenesis (DO) is a surgical procedure used to generate large volumes of new bone for limb lengthening. Materials and Methods In this animal experimental study, a 30% lengthening of the left tibia (mean distraction distance: 60.8 mm) was performed in ten adult male dogs by callus distraction after osteotomy and application of an Ilizarov fixator. Distraction was started on postoperative day seven with a distraction rate of 0.5 mm twice per day and carried out at a rate of 1.5 mm per day until the end of the study. Autologous bone marrow mesenchymal stem cells (BM-MSCs) and platelet-rich plasma (PRP) as the treatment group (n=5) or PRP alone (control group, n=5) were injected into the distracted callus at the middle and end of the distraction period. At the end of the consolidation period, the dogs were sacrificed after which computerized tomography (CT) and histomorphometric evaluations were performed. Results Radiographic evaluationsrevealed that the amount and quality of callus formations were significantly higher in the treatment group (P<0.05). As measured by CT scan, the healing parametersin dogs of the treatment group were significantly greater (P<0.05). New bone formation in the treatment group was significantly higher (P<0.05). Conclusion The present study showed that the transplantation of BM-MSCs positively affects early bony consolidation in DO. The use of MSCs might allow a shortened period of consolidation and therefore permit earlier device removal. PMID:26199903

  13. Adipose-derived stem cells transfected with pEGFP-OSX enhance bone formation during distraction osteogenesis*

    PubMed Central

    Lai, Qing-guo; Sun, Shao-long; Zhou, Xiao-hong; Zhang, Chen-ping; Yuan, Kui-feng; Yang, Zhong-jun; Luo, Sheng-lei; Tang, Xiao-peng; Ci, Jiang-bo

    2014-01-01

    This study was designed to investigate the effects of local delivery of adipose-derived stem cells (ADSCs) transfected with transcription factor osterix (OSX) on bone formation during distraction osteogenesis. New Zealand white rabbits (n=54) were randomly divided into three groups (18 rabbits per group). A directed cloning technique was used for the construction of recombinant plasmid pEGFP-OSX, where EGFP is the enhanced green fluorescence protein. After osteodistraction of the right mandible of all experimental rabbits, rabbits in group A were treated with ADSCs transfected with pEGFP-OSX, group B with ADSCs transfected with pEGFP-N1, and group C with physiological saline. Radiographic and histological examinations were processed after half of the animals within each group were humanely killed by injection of sodium pentothal at Week 2 or 6 after surgery. The distraction bone density was measured as its projectional bone mineral density (BMD). Three parameters were measured, namely, the thickness of new trabeculae (TNT), and the volumes of the newly generated cortical bone (NBV1) and the cancellous bone (NBV2) of the distracted regions. Good bone generation in the distraction areas was found in group A, which had the highest BMD, TNT, and NBV in the distraction zones among the groups. There was no significant difference in bone generation in the distraction areas between groups B and C. The results indicate that the transplantation of ADSCs transfected with pEGFP-OSX can effectively promote bone generation during distraction in vivo. PMID:24793766

  14. Adipose-derived stem cells transfected with pEGFP-OSX enhance bone formation during distraction osteogenesis.

    PubMed

    Lai, Qing-guo; Sun, Shao-long; Zhou, Xiao-hong; Zhang, Chen-ping; Yuan, Kui-feng; Yang, Zhong-jun; Luo, Sheng-lei; Tang, Xiao-peng; Ci, Jiang-bo

    2014-05-01

    This study was designed to investigate the effects of local delivery of adipose-derived stem cells (ADSCs) transfected with transcription factor osterix (OSX) on bone formation during distraction osteogenesis. New Zealand white rabbits (n=54) were randomly divided into three groups (18 rabbits per group). A directed cloning technique was used for the construction of recombinant plasmid pEGFP-OSX, where EGFP is the enhanced green fluorescence protein. After osteodistraction of the right mandible of all experimental rabbits, rabbits in group A were treated with ADSCs transfected with pEGFP-OSX, group B with ADSCs transfected with pEGFP-N1, and group C with physiological saline. Radiographic and histological examinations were processed after half of the animals within each group were humanely killed by injection of sodium pentothal at Week 2 or 6 after surgery. The distraction bone density was measured as its projectional bone mineral density (BMD). Three parameters were measured, namely, the thickness of new trabeculae (TNT), and the volumes of the newly generated cortical bone (NBV1) and the cancellous bone (NBV2) of the distracted regions. Good bone generation in the distraction areas was found in group A, which had the highest BMD, TNT, and NBV in the distraction zones among the groups. There was no significant difference in bone generation in the distraction areas between groups B and C. The results indicate that the transplantation of ADSCs transfected with pEGFP-OSX can effectively promote bone generation during distraction in vivo.

  15. Direct bone formation during distraction osteogenesis does not require TNF alpha receptors and elevated serum TNF alpha fails to inhibit bone formation in TNFR1 deficient mice

    USDA-ARS?s Scientific Manuscript database

    Distraction osteogenesis (DO) is a process which induces direct new bone formation as a result of mechanical distraction. Tumor necrosis factor-alpha (TNF) is a cytokine that can modulate osteoblastogenesis. The direct effects of TNF on direct bone formation in rodents are hypothetically mediated th...

  16. Internal Distraction Osteogenesis With Piezosurgery Oblique Osteotomy of Supraorbital Margin of Frontal Bone for the Treatment of Unilateral Coronal Synostosis.

    PubMed

    Shen, Weimin; Cui, Jie; Chen, Jianbing; Ji, Yi; Kong, Liangliang

    2017-05-01

    To assess the utility of internal distraction osteogenesis with Piezosurgery oblique osteotomy of supraorbital margin of frontal bone for the treatment of unilateral coronal synostosis and to study the outcome and complications of this procedure. Oblique osteotomy allows for entry into the cranial cavity, and along with parallel cut to the roof of the orbit, avoids the need to cut into the orbit which forms the frontal flap. Oblique osteotomy was performed along the supraorbital rim to do a frontal suture of the glabella (ages of patients were less than 1 year) or on the opposite side of the supraorbital rim (ages of patients were older than 1 year) after performing a suturectomy of the effected coronal suture. Two internal distraction devices were subsequently placed across the osteotomized, fused coronal suture. Finally, the cranium pieces were divided in the middle and placed in the middle of the frontal bone using biological glue. Five days after the operation, a 0.6-mm distraction was done twice daily. The distraction was removed 6 months after reaching 2 to 3 cm. Internal distraction osteogenesis with supraorbital oblique osteotomy was performed in 9 patients suffering from unilateral coronal synostosis. Eight patients had no postoperative infections around the shaft puncture wounds. One patient had infection in the rods around the distraction during the period of fixed, but was cured with antibiotic treatment. During a mean follow-up period of 12 months (5-26 months), all patients were satisfied with the cosmetic and functional results. No complications, including fixed screw displacement, penetration of the cranium and dura mater or retraction of distraction devices, occurred. The devices were exposed in 1 patient, resulting in a postoperative scar. Despite these complications, the cranium was successfully expanded in all patients. Use of this procedure avoids the need for frontal osteotomy to move the orbit forward. Adding 2 cranium strips can be used to

  17. Activated FGFR3 promotes bone formation via accelerating endochondral ossification in mouse model of distraction osteogenesis.

    PubMed

    Osawa, Yusuke; Matsushita, Masaki; Hasegawa, Sachi; Esaki, Ryusaku; Fujio, Masahito; Ohkawara, Bisei; Ishiguro, Naoki; Ohno, Kinji; Kitoh, Hiroshi

    2017-08-10

    Achondroplasia (ACH) is one of the most common short-limbed skeletal dysplasias caused by gain-of-function mutations in the fibroblast growth factor receptors 3 (FGFR3) gene. Distraction osteogenesis (DO) is a treatment option for short stature in ACH in some countries. Although the patients with ACH usually show faster healing in DO, details of the newly formed bone have not been examined. We have developed a mouse model of DO and analyzed new bone regenerates of the transgenic mice with ACH (Fgfr3(ach) mice) histologically and morphologically. We established two kinds of DO protocols, the short-DO consisted of 5days of latency period followed by 5days of distraction with a rate of 0.4mm per 24h, and the long-DO consisted of the same latency period followed by 7days of distraction with a rate of 0.3mm per 12h. The callus formation was evaluated radiologically by bone fill score and quantified by micro-CT scan in both protocols. The histomorphometric analysis was performed in the short-DO protocol by various stainings, including Villanueva Goldner, Safranin-O/Fast green, tartrate-resistant acid phosphatase, and type X collagen. Bone fill scores were significantly higher in Fgfr3(ach) mice than in wild-type mice in both protocols. The individual bone parameters, including bone volume and bone volume/tissue volume, were also significantly higher in Fgfr3(ach) mice than in wild-type mice in both protocols. The numbers of osteoblasts, as well as osteoclasts, around the trabecular bone were increased in Fgfr3(ach) mice. Cartilaginous tissues of the distraction region rapidly disappeared in Fgfr3(ach) mice compared to wild-type mice during the consolidation phase. Similarly, type X collagen-positive cells were markedly decreased in Fgfr3(ach) mice during the same period. Fgfr3(ach) mice exhibited accelerated bone regeneration after DO. Accelerated endochondral ossification could contribute to faster healing in Fgfr3(ach) mice. Copyright © 2017 Elsevier Inc. All rights

  18. Influence of a Magnetic Field and Laser Therapy on the Quality of Mandibular Bone During Distraction Osteogenesis in Rabbits.

    PubMed

    Freddo, Angelo Luiz; Giongo, Caroline Comis; Ponzoni, Deise; Corsetti, Adriana; Puricelli, Edela

    2016-11-01

    This study evaluated the use of low-level laser therapy (LLLT) and exposure to a magnetic field (MF) during distraction osteogenesis. The sample consisted of 18 rabbits divided into 3 groups of 6 animals each: control, MF exposure (briefly, magnetized gold-coated washers were placed next to the distractor device), and LLLT exposure (830 nm applied every 48 hours over 4 points [dose, 5 J/cm(2)] during the consolidation period). The same distraction osteogenesis protocol was used in all 3 groups (0.5 mm every 12 hours for 1 week). Quantitative microscopic analysis of sections stained with hematoxylin and eosin showed a statistically significant difference in the amount of newly formed bone in the MF group compared with the LLLT group (P = .006). The number of cells with more than 3 argyrophilic nucleolar organizer regions also was significantly different between the LLLT and control groups (P = .038). Distraction osteogenesis effectively promoted bone lengthening. The LLLT group exhibited a larger amount of newly formed bone and a larger number of osteoblasts in the cell division phase, but the difference was not statistically relevant compared with the control group. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  19. Segmental distraction osteogenesis of the anterior alveolar process using tooth-borne devices: is it skeletal movement or mainly dental tipping?

    PubMed

    Zemann, Wolfgang; Metzler, Philipp; Jacobsen, Christine; Obwegeser, Joachim Anton

    2012-06-01

    Segmental distraction osteogenesis of the anterior alveolar process has been introduced as a technique designed to avoid extractions in patients with severe dental crowding. The aim of this study was to quantify the degree of dental tipping within the alveolar segment after distraction osteogenesis. Patients treated for dental crowding, retruded anterior alveolar process, or flat curves of Spee using segmental distraction osteogenesis of the anterior alveolar process were included in the study. Dental-borne distraction devices were used while measuring points, and angles were defined to analyze the amount of dental tipping of the lower incisors after distraction. The measurements were performed using cone-beam computed tomographic scans. Periodontal health (eg, gingival recession, tooth mobility, and dental socket depths) was evaluated after distraction. A descriptive statistical analysis was performed. Fifteen patients were included in the study. The amount of dental tipping within the total movement of the alveolar process showed a mean of 24% after distraction osteogenesis, whereas the skeletal movement was 76%. Dental socket depths and tooth mobility remained at the same levels as those before distraction osteogenesis. In one third of patients, gingival recession was observed around the canines. Segmental distraction osteogenesis of the anterior process is a powerful technique that can prevent extractions in patients with dental crowding. The technique can also compensate for retruded anterior alveolar process and accelerate or decelerate the curve of Spee. Patients with constricted periodontal health and those with a thin mandibular symphysis, however, cannot be treated with this technique because of the increased risk of dental tipping. Severe gingival recession must also be considered a possible side effect associated with this technique. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Cellular effect of low-level laser therapy on the rate and quality of bone formation in mandibular distraction osteogenesis.

    PubMed

    Fazilat, Farzad; Ghoreishian, Mahdi; Fekrazad, Reza; Kalhori, Katayoun A M; Khalili, Sara Dehghan; Pinheiro, Antonio Luiz Barbosa

    2014-06-01

    Therapeutic lasers have been shown to influence bone physiology and repair. The aim of the present investigation was to evaluate the use of a GaAlAs (λ:810 nm) laser in distraction osteogenesis. To reduce problems associated with distraction osteogenesis and shorten the time required for treatment, it is desirable to accelerate the process of bone formation. Eighteen male rabbits underwent corticotomy of mandibular body, and customized distraction devices were inserted. After a 5-day latency period, the mandibles were lengthened by 0.5 mm/day for 10 days. The rabbits were divided into two groups. A GaAlAs (λ: 810 nm) laser beam with the parameters power (P), 200 mW; energy density (ED), 3 J/cm(2); time (T), 7.5 sec; power density (PD) 400 mW/cm(2); energy (E) 1.5 J and spot diameter, 0.8 mm was directed medially and laterally in the study group; the control group received no laser treatment. The exposure continued with six more doses every other day. Three rabbits from each of the two groups were euthanized on the 10th, 20th, and 40th days post-distraction (consolidation) period. Both light microscopy and scanning electron microscopic (SEM) analysis showed significant improvement in new bone formation in the study group at the 10th and 20th days compared with the control group, but the difference was more prominent on the 10th day. By the 40th day, there were no significant differences between the two groups. This study shows that a low-level GaAlAs (λ:810 nm; P, 200 mW) laser hastens new bone formation only in the early stages of the consolidation period in distraction osteogenesis, and has no significant effect in later stages.

  1. Influence of periosteal coverage on distraction osteogenesis with dental implant distractors.

    PubMed

    Yin, Xuelai; Zhang, Chenping; Hze-Khoong, Eugene Poh; Wang, Yang; Xu, Liqun

    2014-10-01

    The continuity and integrity of the enveloping nutritive periosteum can be compromised during installation of a dental implant distractor (DID) device. This novel animal experiment investigated the influence of the periosteum on the bony regenerate in 3 scenarios of periosteal coverage: whole periosteum (WP), half periosteum (HP), and no periosteum (NP). Twelve goat tibias were vertically osteotomized into 2 segments each and divided into 3 groups (WP, HP, and NP). A DID device was surgically installed onto each segment, followed by 10 days of distraction at a rate of 0.35 mm twice daily. Fluorescence labeling and trabecula count per high-power field (TBC/HPF) measurements were performed and statistically compared across groups. Implant stability quotients (ISQs) of all fixtures were performed. New bone formation occurred sooner in the WP and HP groups than in the NP group under fluoroscopy. The TBC/HPF values showed an obvious but not statistically significant decrease between the WP and HP groups (P = .500), WP and NP groups (P = .157), and HP and NP (P = .077). And the WP group showed no significantly higher ISQ values compared with the HP (P = .712) and NP (P = .958) groups, also between the HP and NP (P = .751) groups. Vertical distraction osteogenesis can be performed successfully with the DID to obtain bone of adequate stock and density. However, the enveloping periosteum should be preserved as much as possible during installation of the DID device. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Long-term maxillomandibular skeletal and dental changes in children with cleft lip and palate after maxillary distraction.

    PubMed

    Harada, Kiyoshi; Sato, Masaru; Omura, Ken

    2006-09-01

    Long-term skeletal and dental changes were examined in 8 children with cleft lip and palate who underwent maxillary distraction to allow the maxilla to catch up to their mandibular growth at the treatment point. Changes in the overjet (OJ), overbite (OB), and positions of the anterior nasal spine (ANS), upper incisors (U1), pogonion (Pog), and lower incisors (L1) were measured on preoperative to 36 months postoperative lateral-cephalograms. In most of the children, the long-term changes after the maxillary distraction resulted in an inferior growth of the maxilla and anteroinferior growth of the mandible. This seems to suggest that maxillary distraction performed during childhood needs considerable overcorrection. However, if the maxilla is distracted to an adult position during childhood, the masticatory functions of the children will markedly deteriorate until their jaws grow. Therefore, we believe that one goal of maxillary distraction during childhood can be to allow the maxilla to catch up to the mandibular growth of the children at the treatment point.

  3. Chronic ethanol exposure inhibits distraction osteogenesis in a mouse model: Role of the TNF signaling axis

    SciTech Connect

    Wahl, Elizabeth C.; Aronson, James; Liu, Lichu; Liu, Zhendong; Perrien, Daniel S.; Skinner, Robert A.; Badger, Thomas M.; Ronis, Martin J.J.; Lumpkin, Charles K. . E-mail: lumpkincharlesk@uams.edu

    2007-05-01

    Tumor necrosis factor-alpha (TNF-{alpha}) is an inflammatory cytokine that modulates osteoblastogenesis. In addition, the demonstrated inhibitory effects of chronic ethanol exposure on direct bone formation in rats are hypothetically mediated by TNF-{alpha} signaling. The effects in mice are unreported. Therefore, we hypothesized that in mice (1) administration of a soluble TNF receptor 1 derivative (sTNF-R1) would protect direct bone formation during chronic ethanol exposure, and (2) administration of recombinant mouse TNF-{alpha} (rmTNF-{alpha}) to ethanol naive mice would inhibit direct bone formation. We utilized a unique model of limb lengthening (distraction osteogenesis, DO) combined with liquid diets to measure chronic ethanol's effects on direct bone formation. Chronic ethanol exposure resulted in increased marrow TNF, IL-1, and CYP 2E1 RNA levels in ethanol-treated vs. control mice, while no significant weight differences were noted. Systemic administration of sTNF-R1 during DO (8.0 mg/kg/2 days) to chronic ethanol-exposed mice resulted in enhanced direct bone formation as measured radiologically and histologically. Systemic rmTNF-{alpha} (10 {mu}g/kg/day) administration decreased direct bone formation measures, while no significant weight differences were noted. We conclude that chronic ethanol-associated inhibition of direct bone formation is mediated to a significant extent by the TNF signaling axis in a mouse model.

  4. Neurosensory and functional evaluation in distraction osteogenesis of the anterior mandibular alveolar process.

    PubMed

    Joss, C U; Triaca, A; Antonini, M; Kuijpers-Jagtman, A M; Kiliaridis, S

    2013-01-01

    Neurosensory status and craniomandibular function of 19 patients (mean age 35.2 years, range 17.8-58.8 years) treated by combined surgical orthodontic treatment with distraction osteogenesis of the mandibular anterior alveolar process (DO group) was compared with that in 41 orthodontically treated patients (mean age 22.9 years, range 15.1-49.0 years; control group). Clinical examination took place on average 5.9 years (DO group) and 5.4 years (control group) after treatment ended. Neurosensory status was determined by two-point discrimination (2-pd) and the pointed and blunt test. Lateral cephalograms evaluated advancement of the mandibular alveolar process and possible relapse. There was no significant difference in craniomandibular function and neurosensory status between the groups. Age was significantly correlated with 2-pd at the lips (DO: p=0.01, R=0.575; control group: p=0.039, R=0.324) and chin (DO: p=0.029, R=0.501; control group: p=0.008, R=0.410). Younger patients had smaller 2-pd values. Gender, age, the amount of advancement, and relapse at point B or incision inferior show no correlation with craniomandibular function and neurosensory impairment. DO of the mandibular anterior alveolar process is a valuable and safe method with minor side effects regarding neurosensory impairment.

  5. Surgically assisted-rapid orthopedic lengthening of the maxilla in primates--relapse following distraction osteogenesis.

    PubMed

    Altuna, G; Walker, D A; Freeman, E

    1995-01-01

    A recent study has shown that the maxilla in primates can be successfully lengthened (0.5 mm every other day up to 6.0 mm) by means of surgically assisted-rapid orthopedic movement, using the principles of distraction osteogenesis. The present study was designed to determine if the maxilla can be advanced at a faster rate and if relapse would occur after removal of the orthodontic appliance. Metallic markers were placed in the cranial base and maxilla of two Cynomolgus primates, and cephalometric radiographs were taken. Bilateral horizontal and interdental osteotomies were created between in the first premolars and the canines, and the anterior segment was completely mobilized. An orthodontic appliance was bonded to the teeth and the screw was closed, compressing the osteotomy site. One week postoperatively the appliance was opened four quarter turns every day until the anterior segment was advanced by 10 mm. Cephalometric radiographs were taken at 6, 8, and 12 weeks postadvancement. At 12 weeks, the orthodontic appliance was removed, and at that time and 2, 4, and 6 weeks later, cephalometric radiographs were taken and study models fabricated. At the end of the postretention period, the animals were sacrificed, and the maxillae were evaluated by light microscopy. Results showed that the maxilla can be successfully advanced at a faster rate and for longer distances, and that the advanced maxilla does not relapse during the 6-week postretention period.

  6. Three-dimensional histomorphometric analysis of distraction osteogenesis using an implanted device for mandibular lengthening in sheep.

    PubMed

    Ploder, Oliver; Kanz, Fabian; Randl, Ulrike; Mayr, Winfried; Voracek, Martin; Plenk, Hanns

    2002-07-01

    The aim of this study was to lengthen the sheep mandible with a fully buried device and to quantitatively analyze the tissue regenerate in the distraction gap by means of two-dimensional and three-dimensional histomorphometry. A custom-made device for continuous distraction was used in five adult sheep and fixed with three bicortical screws on either side of an osteotomy, anterior to the premolar region of the mandible. A cable-connected power and control unit was implanted in the neck region. After a 5-day latency period, distraction was activated every 2 hours and advanced at a rate of 1.01 mm per day. The distraction period was planned for 14 days, but because of stability problems and cable breakage, the actual distraction period ranged from 2 to 17 days, resulting in gap distances from 1.7 to 17.1 mm (mean, 0.95 mm/day). Osteogenesis was followed by radiographic imaging, and after a 6-week consolidation period, the harvested mandibles were serially sectioned for histologic and two-dimensional histomorphometric analysis, with three-dimensional reconstruction. Histologic examination of the specimens demonstrated predominantly membranous bone formation with remodeling bridging the distraction gap mainly in the periosteal region of the lingual side. In addition, cartilaginous areas and chondral bone formation were observed where the bridging appeared incomplete. Because of device fixation on the buccal side of the mandible, the preservation of the lingual periosteum seemed to play the major role for sufficient bone repair in the distraction gap. Cartilage within the distraction gap suggests fixation instability in this animal model.

  7. The effects of clinical factors on airway outcomes of mandibular distraction osteogenesis in children with Pierre Robin sequence.

    PubMed

    Ren, X C; Gao, Z W; Li, Y F; Liu, Y; Ye, B; Zhu, S S

    2017-07-01

    Mandibular distraction osteogenesis (MDO) is an effective treatment for tongue-based airway obstruction in children with severe Pierre Robin sequence. An investigation was performed to determine whether certain clinical factors influence the airway outcomes of MDO. A literature search of several databases was performed to identify studies providing individual patient data. Data extracted from the studies included patient sex, age at distraction, disease type, experience of any previous surgery on the airway, length of distraction, pre- and postoperative blood oxygen saturation nadir, and osteotomy design. Non-parametric tests and multivariate logistic regression analysis were conducted to investigate the potential interaction between these clinical factors and the efficacy of surgery. Five studies met the inclusion criteria, with data available for 73 individual patients. The results of the statistical analysis revealed that few of the factors investigated influenced the surgical efficacy in children with Pierre Robin sequence; the effect of the length of distraction was regarded as uncertain because of the limited amount of individual data available. In conclusion, no influencing factors were found, and according to this analysis, mandibular distraction may be a widely effective procedure. However, more well-designed studies and more individual data are needed to strengthen the results of this meta-analysis. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  8. Periosteal distraction osteogenesis versus immediate periosteal elevation in a rat model: Histological and micro-CT analysis.

    PubMed

    Nakahara, Ken; Haga-Tsujimura, Maiko; Sawada, Kosaku; Mottini, Matthias; Schaller, Benoit; Saulacic, Nikola

    2017-05-01

    The aim of the present study was to compare periosteal distraction osteogenesis (PDO) to immediate periosteal elevation (IPE) in terms of de novo bone formation. Animals of PDO Group were subjected to a 7-day latency period and a 10-day distraction period. Distraction device in IPE Group were activated for 1 mm at placement. Both groups of animals were euthanized at 17, 31 and 45-day following surgery and the samples analyzed histologically and by micro-CT. Total gap region (TG) was divided in two subregions, less than 0.5 mm (LG) and over 0.5 mm of the gap height (HG). Bone formation in PDO Group was observed in the distal region of the distraction gap, whereas in IPE Group proximally and distally from the distraction gap. Bone volume increased in both groups in LG, HG and TG (p < 0.001), while bone mineral density only in HG (p = 0.001). More new bone was observed in PDO than in IPE Group in HG (p = 0.017) and in TG (p < 0.001), without differences found in bone mineral density. The function of immediately elevated periosteum is limited to the distance to the underlying bone. PDO may be successfully applied to maintain the osteogenic capacity of elevated periosteum. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  9. The natural limb is best: joint preservation and reconstruction by distraction osteogenesis for high-grade juxta-articular osteosarcomas.

    PubMed

    Tsuchiya, Hiroyuki; Abdel-Wanis, Mohamed E; Kitano, Shinji; Sakurakichi, Keisuke; Yamashiro, Teruhisa; Tomita, Katsuro

    2002-01-01

    This paper introduces an innovative technique of highly conservative limb-saving surgery for juxta-articular osteosarcoma. This technique consists of marginal tumour excision, joint preservation and reconstruction by distraction osteogenesis. Ten patients, with a mean age of 19.5 years and high-grade osteosarcoma, underwent this procedure. The distal femur and proximal tibia were affected in five patients each. After effective pre-operative chemotherapy, the tumour was excised with preservation of the epiphysis, the articular surface and the maximun amount of healthy soft tissue. This was followed by application of an external fixator. Bone transport was performed for seven patients and shortening-distraction for three. The limb function was rated excellent in seven patients, good in one and fair in two. At the final follow-up, three patients were dead after a mean of 25.3 months while seven patients remained free of disease with a mean follow-up of 55.4 months. Joint preservation and biological reconstruction through distraction osteogenesis can produce excellent and long-lasting functional results.

  10. The Radiological and Stereological Analysis of the Effect of Low-Level Laser Therapy on the Mandibular Midline Distraction Osteogenesis.

    PubMed

    Çakir-Özkan, Nilüfer; Bereket, Cihan; Arici, Nursel; Elmali, Muzaffer; Şener, Ismail; Bekar, Esengül

    2015-10-01

    The aim of this study was to evaluate the effect of low level laser therapy (LLLT) on bone mineral density by using high-resolution computerized tomography (HR-CT) and stereology in patients subjected to mandibular midline distraction. Nine patients between the ages of 13 and 16 years with mandibular transverse deficiency (>5 mm) were evaluated. Mandibular midline distraction osteogenesis was performed for all the patients. The patients were divided into 2 groups: the control group (n = 4) and the laser group (n = 5). GaAlAs, 830 nm wavelength, power of 40 mW, energy of 8.4 J/cm2 dose per spot, was directly applied from 2 points on the mandibular midline. The laser was applied in 8 treatment sessions at 48-hour intervals. Bone mineral density and volume of the newly formed bone were analyzed using HR-CT and stereological methods. A higher bone mineral density rate was found in the laser group (P < 0.05). A higher newly formed immature bone rate was found in the control group (P < 0.001). These findings suggest that more mature bone may also have a greater mineral organization than that of immature newly formed bone, which is shown by HR-CT and stereological results. The retention period can be shortened and mineralization may be increased by using LLLT in mandibular distraction osteogenesis.

  11. Forearm lengthening by distraction osteogenesis in children: a report of 22 cases.

    PubMed

    Hill, R A; Ibrahim, T; Mann, H A; Siapkara, A

    2011-11-01

    We present our experience of forearm lengthening in children with various conditions performed by a single surgeon between 1995 and 2009. A total of 19 children with a mean age of 9.8 years (2.1 to 15.9) at the time of surgery had 22 forearm lengthenings using either an Ilizarov/spatial and Ilizarov circular frame or a monolateral external fixator. The patients were divided into two groups: group A, in whom the purpose of treatment was to restore the relationship between the radius and the ulna, and group B, in whom the objective was to gain forearm length. The mean follow-up after removal of the frame was 26 months (13 to 53). There were ten patients (11 forearms) in group A with a mean radioulnar discrepancy of 2.4 cm (1.5 to 3.3) and nine patients (11 forearms) in group B. In group A, the mean lengthening achieved was 2.7 cm (1.0 to 5.5), with a lengthening index of 11.1 weeks/cm. Equalisation or overcorrection of the discrepancy was achieved in seven of 11 forearms, but lengthening was only partially successful at preventing subluxation or dislocation of the radial head. In group B, the mean lengthening achieved was 3.8 cm (1.9 to 6.8), with a lengthening index of 7.25 weeks/cm. Common complications in both groups were pin-site infection and poor regenerate formation. Forearm lengthening by distraction osteogenesis is a worthwhile procedure in children that can improve cosmesis and function, particularly in patients with shortening of both radius and ulna.

  12. Combined Bimaxillary Distraction Osteogenesis Associated with Orthognathic Surgery for Hemifacial Microsomia in Adults.

    PubMed

    Liu, Hanghang; Zhang, Xiaohui; Liu, Li; Chen, Qianming; Shao, Jun; Luo, En

    2017-06-01

    Hemifacial microsomia (HFM) is one of the most common congenital craniofacial asymmetries. Distraction osteogenesis (DO) is always recommended as an effective option for the treatment of HFM, but some studies showed that the asymmetry remained after DO. In comparison with DO, stable clinical outcomes could be achieved by orthognathic surgery approach as well. However, soft tissue expansion cannot be performed. In this study, we aim to assess the radiographic and clinical results of bimaxillary DO associated with staged orthognathic surgery in the treatment of craniofacial asymmetry for adult HFM patients. Twelve HFM patients who had been treated with bimaxillary DO and secondary orthognathic surgery between 2006 and 2013 were included in this study. Bimaxillary DO and staged orthognathic surgery were performed according to the particular condition. Clinical and cephalometric photographs were carried out pre- and postoperatively to evaluate the outcomes. No significant complications occurred postoperatively. Excellent cosmetic outcomes such as notable improvement in facial pattern and occlusion were achieved. Cephalometrically, the height ratios of the affected/unaffected ramus were improved by 23.81% on average, and the photographic analysis demonstrated a rotation of the chin point toward the mid-line. Moreover, the occlusal cant was corrected from the slant to level by 8.95° on average. The application of bimaxillary DO associated with staged orthognathic surgery in correcting the asymmetry of adult patients with HFM could have satisfactory aesthetic results, and it should be considered an alternative option for these patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

  13. A Histomorphometric Analysis of Radiation Damage in an Isogenic Murine Model of Distraction Osteogenesis

    PubMed Central

    Zheutlin, Alexander R.; Deshpande, Sagar S.; Nelson, Noah S.; Polyatskaya, Yekaterina; Rodriguez, Jose J.; Donneys, Alexis; Buchman, Steven R.

    2015-01-01

    Purpose The devastation radiation therapy (XRT) causes to endogenous tissue in head and neck cancer (HNC) patients can be a prohibitive obstacle in reconstruction of the mandible, demanding a better understanding of XRT-induced damage and options for reconstruction. Our study investigates the cellular damage caused by radiation in an isogenic murine model of mandibular distraction osteogenesis (DO). We posit that radiation will result in reduced osteocytes, with elevated empty lacunae and immature osteoid. Methods Twenty Lewis rats were randomly assigned to two groups: DO (n=10) and XRT/DO (n=10). Both groups underwent an osteotomy and mandibular DO across a 5.1 mm gap. XRT was administered to the XRT/DO group at a fractionated, human equivalent dose of 35 Gy prior to surgery. Animals were sacrificed on postoperative day 40 and mandibles were harvested and sectioned for histological analysis. Results Bone that underwent radiation revealed a significantly decreased osteocyte count and complementary increase in empty lacunae when compared to non-XRT bone (p=0.019, p=0.000). Additionally, XRT bone demonstrated increased immature osteoid and decreased mature woven bone when compared to non-radiated bone (p=0.001 and p=0.003, respectively). Furthermore, analysis of the ratio of immature osteoid to woven bone volume exhibited a significant increase in the XRT bone, further revealing the devastating damage brought by XRT (p=0.001). Conclusion These results clearly demonstrate the cellular diminution that occurs as a result of radiation. This foundational study provides the groundwork upon which to investigate cellular therapies in an immunoprivileged model of mandibular DO. PMID:26341682

  14. Review of the cellular and biological principles of distraction osteogenesis: An in vivo bioreactor tissue engineering model.

    PubMed

    Dhaliwal, K; Kunchur, R; Farhadieh, R

    2016-02-01

    Distraction osteogenesis (DO) is a widely used technique in plastic and orthopaedic surgery. During the process, mechanical force is applied to fractured bone to enhance the regenerative processes and induce new bone formation. Although there is an abundance of literature on the clinical process of DO, there is a distinct lack of focus on the underlying biological principles governing this process. DO follows the basic premises of tissue engineering. The mechanical stress stimulates mesenchymal stem cell differentiation down an osteoblastic lineage on a matrix background. The aim of this review is to give an overview of the current knowledge of the molecular mechanism governing this process.

  15. Monobloc Le Fort III Distraction Osteogenesis for Correction of Severe Fronto-orbital and Midface Hypoplasia in Pediatric Crouzon Syndrome.

    PubMed

    Hariri, Firdaus; Cheung, Lim Kwong; Rahman, Zainal Ariff Abdul; Mathaneswaran, Vickneswaran; Ganesan, Dharmendra

    2016-01-01

    In severe syndromic craniosynostosis, distraction osteogenesis (DO) provides superior segmental advancement and allows progressive clinical monitoring to ensure that adequate skeletal expansion is achieved. We report two cases of Crouzon syndrome involving a 3-year-old boy and a 4-year-old girl, who were both treated with monobloc Le Fort III DO using a combination of external and internal distraction devices (Synthes, Oberdorf, Switzerland) to treat severe orbital proptosis and obstructed nasopharyngeal airway secondary to severe hypoplastic craniofacial skeletal components. Their skeletal segments were advanced in daily increments by 27 mm and 23 mm, respectively. Results at 18 months postoperatively showed successful outcomes, as evidenced by adequate eye protection, tracheostomy tube decannulation following objective evidence of patent nasopharyngeal airway, and acceptable facial appearance. Monobloc Le Fort III DO using a combination of external and internal devices produces favorable functional and clinical outcomes for the treatment of severe orbital and airway discrepancy in Crouzon syndrome.

  16. Treatment of large bone defects with a novel biological transport disc in non-vascular transport distraction osteogenesis.

    PubMed

    Zeng, J J; Guo, P; Zhou, N; Xie, Q T; Liao, F C

    2016-05-01

    The aim of this study was to investigate a potential novel biological transport disc that avoids secondary injury to the body and facilitates bone healing. Twenty-seven dogs were divided randomly into three groups: group A were treated with human bone morphogenetic protein 2 (BMP-2) modified bone mesenchymal stem cell (BMSC) sheets combined with freeze-dried bone allograft as biological transport disc; group B were treated with BMSC sheets combined with freeze-dried bone allograft as transport disc (control); and group C were treated with direct extension only (blank). There were nine dogs in each group. Non-vascular transport distraction osteogenesis was performed in groups A and B to repair the mandibular bone defects, and in group C only mandibular truncation surgery was performed. The regeneration of bone was evaluated through X-ray, haematoxylin and eosin assay, and immunohistochemistry. After 2, 4, and 8 weeks of distraction, new bone density values in group A were 49.00±1.16, 66.63±2.62, and 72.78±2.67, respectively, and these were significantly different to values in groups B (P=0.0005, P=0.0004, P=0.0012) and C (P<0.0005, P=0.0001, P=0.0003). The average grey value for BMP-2 expression in group A after 4 weeks of distraction was 195.63±4.45, which was significantly different when compared to groups B (P=0.0022) and C (P=0.0006). This novel biological transport disc represents an effective non-secondary injury method to enhance new bone formation in non-vascular transport distraction osteogenesis.

  17. Expression of bone morphogenetic protein, vascular endothelial growth factor, and basic fibroblast growth factor in irradiated mandibles during distraction osteogenesis.

    PubMed

    Zhang, Wen Biao; Zheng, Li Wu; Chua, Daniel Tsin Tien; Cheung, Lim Kwong

    2011-11-01

    The present study evaluated the expression of bone morphogenetic proteins (BMPs)-2, -4, -7, vascular endothelial growth factor (VEGF), and basic fibroblast growth factor (bFGF) in irradiated mandibles during distraction osteogenesis. A total of 24 rabbits were randomly assigned to the control and experimental groups. Each rabbit in the experimental group underwent preoperative radiation to 9 Gy in 5 fractions. After 1 month, all rabbits underwent osteotomy and distraction osteogenesis with 7 days of latency. Three rabbits in the control and experimental groups were killed at day 7 (end of the latency period), day 12 (middle of active distraction), day 18 (end of active distraction), and day 25 (1 week after consolidation). The specimens were used for immunohistochemical staining and real-time polymerase chain reaction analysis. Histologically, at day 25, cortical bone formation was much better in the control group than in the radiotherapy group. In the radiotherapy group, the bone spicules were aligned in the direction of tension stress. At day 12, the expression of BMP-2, -4, and -7 was elevated in the radiotherapy group compared with the control group. At day 25, the expression of BMP-2 was significantly greater in the radiotherapy group. At day 7, the expression of bFGF was significantly suppressed in the radiotherapy group. At day 12, the expression of bFGF and VEGF was significantly elevated in the radiotherapy group compared with the control group. At day 25, the expression of VEGF was significantly greater in the radiotherapy group. The results of our study have shown that radiotherapy changes the expression pattern of BMPs, VEGF, and bFGF. Copyright © 2011. Published by Elsevier Inc.

  18. Nerve growth factor injected systemically improves the recovery of the inferior alveolar nerve in a rabbit model of mandibular distraction osteogenesis.

    PubMed

    Du, Zhao-jie; Wang, Lei; Lei, De-lin; Liu, Bao-lin; Cao, Jian; Zhang, Pu; Ma, Qin

    2011-10-01

    Our aim was to find out if nerve growth factor (NGF) injected systemically could improve the recovery of the inferior alveolar nerve in a rabbit model of mandibular distraction osteogenesis. We used 48 New Zealand white rabbits that were treated with bilateral distraction osteogenesis at a rate of 0.5mm/12h for 10 days. Immediately postoperatively, NGF or sodium chloride 0.6 μg/day was injected intramuscularly for 20 days. At the end of distraction and after consolidation times of 1, 2, and 4 weeks, the inferior alveolar nerves were evaluated histologically and histomorphometrically. Histologically, at 2 and 4 weeks there was less myelin debris, and more regenerating axons were present, in the NGF than the control groups. The density of myelinated axons was significantly greater in groups with NGF than controls at 2 and 4 weeks (p<0.05). NGF given systemically can accelerate the recovery of the inferior alveolar nerve in rabbits after mandibular distraction osteogenesis, and is a promising treatment option for neurological complications of mandibular distraction osteogenesis.

  19. Recruitment of exogenous mesenchymal stem cells in mandibular distraction osteogenesis by the stromal cell-derived factor-1/chemokine receptor-4 pathway in rats.

    PubMed

    Cao, Jian; Wang, Lei; Du, Zhao-jie; Liu, Peng; Zhang, Ya-bo; Sui, Jian-fu; Liu, Yan-pu; Lei, De-lin

    2013-12-01

    Distraction osteogenesis is widely used in orthopaedic and craniofacial surgery. However, its exact mechanism is still poorly understood. The purpose of this study was to find out whether there is systemic recruitment of mesenchymal stem cells (MSC) to the neocallus in the distraction gap by the stromal cell-derived factor-1 (SDF-1)/CXC chemokine receptor 4 (CXCR4) axis during osteogenesis. We examined the migration of MSC towards a gradient of SDF-1 in vitro. We also transplanted MSC labelled with green fluorescent protein (GFP) intravenously, with or without treatment with CXCR4-blocking antibody, into rats that had had unilateral mandibular distraction osteogenesis, and investigated the distribution of cells labelled with GFP in the soft callus after 24 h. We found that SDF-1 facilitated the migration potency of MSC both in vitro and in vivo, and this migration could be inhibited by AMD3100, an antagonist of CXCR4, and promoted by local infusion of exogenous SDF-1 into the distraction gap. This study provides a new insight into the molecular basis of how new bone is regenerated during distraction osteogenesis. Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  20. The Effect of Altering the Mechanical Loading Environment on the Expression of Bone Regenerating Molecules in Cases of Distraction Osteogenesis

    PubMed Central

    Alzahrani, Mohammad M.; Anam, Emad A.; Makhdom, Asim M.; Villemure, Isabelle; Hamdy, Reggie Charles

    2014-01-01

    Distraction osteogenesis (DO) is a surgical technique where gradual and controlled separation of two bony fragments following an osteotomy leads to the induction of new bone formation in the distracted gap. DO is used for limb lengthening, correction of bony deformities, and the replacement of bone loss secondary to infection, trauma, and tumors. Although DO gives satisfactory results in most cases, one major drawback of this technique is the prolonged period of time the external fixator has to be kept on until the newly formed bone consolidates thus leading to numerous complications. Numerous attempts at accelerating bone formation during DO have been reported. One specific approach is manipulation of the mechanical environment during DO by applying changes in the standard protocol of distraction. Attempts at changing this mechanical environment led to mixed results. Increasing the rate or applying acute distraction, led to poor bone formation in the distracted zone. On the other hand, the addition of compressive forces (such as weight bearing, alternating distraction with compression or by over-lengthening, and then shortening) has been reported to increase bone formation. It still remains unclear why these alterations may lead to changes in bone formation. While the cellular and molecular changes occurring during the standard DO protocol, specifically increased expression of transforming growth factor-β1, platelet-derived growth factor, insulin-like growth factor, basic fibroblast growth factor, vascular endothelial growth factor, and bone morphogenic proteins have been extensively investigated, the literature is sparse on the changes occurring when this protocol is altered. It is the purpose of this article to review the pertinent literature on the changes in the expression of various proteins and molecules as a result of changes in the mechanical loading technique in DO and try to define potential future research directions. PMID:25540639

  1. Dual midfacial distraction osteogenesis for Crouzon syndrome: long-term follow-up study for relapse and growth.

    PubMed

    Lee, Dong Won; Ham, Ki Weon; Kwon, Soon Man; Lew, Dae Hyun; Cho, Eul Je

    2012-03-01

    Rigid external distraction osteogenesis is regarded as a standard treatment for congenital midfacial hypoplasia. However, external distraction for the upper portion of the midface is not as effective and tends to rotate the midfacial segment in a counterclockwise direction. Moreover, patients poorly tolerate it because of the device's bulkiness. To prevent such drawbacks of an external distractor, both external and internal distractors were synchronously applied to patients with Crouzon syndrome. In 6 patients with Crouzon syndrome in whom a dual-distraction technique was applied, distraction of the midfacial region was performed for up to a mean length of 15.3 mm. The external distractor was removed after a 1-month consolidation period, but the internal distractor was maintained for more than 6 months. The degree of advancement of the midface and ossification was measured with lateral cephalometry and 3-dimensional computed tomography imaging, respectively. At long-term follow-up (mean, 4.6 years), the facial contours retained the initial distraction geometry with almost no relapse, showing that the ideal facial contour and occlusion could be obtained. Bone deposition was found to be continually progressing even 6 months postoperatively, and more than 6 months of consolidation was required for complete ossification that mainly occurred in the pterygomaxillary junction and lateral orbital wall. The dual-distraction technique can induce balanced growth without the recurrence of hypoplasia, and it may eventually yield satisfactory outcomes in Crouzon syndrome. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  2. An injectable composite material containing bone morphogenetic protein-2 shortens the period of distraction osteogenesis in vivo.

    PubMed

    Eguchi, Yoshitaka; Wakitani, Shigeyuki; Naka, Yoshifumi; Nakamura, Hiroaki; Takaoka, Kunio

    2011-03-01

    To investigate new methods that can decrease the duration of bone transport (BT) distraction osteogenesis, we injected composite materials containing recombinant human bone morphogenetic protein-2 (BMP-2) and induced the generation of a callus bridge by rapid segmental transport (4 mm/day) in a rabbit bone defect model. The composite materials consisted of BMP-2 (0, 30, or 100 µg), β-tricalcium phosphate powder (βTCP, 100 mg/animal; particle size, <100 µm), and polyethylene glycol (PEG; 40 mg/animal). A paste of equivalent composition was percutaneously injected at the lengthening and the docking sites after surgery and after BT, respectively. The radiographic, mechanical, and histological examinations 12 weeks post-operative revealed that the generation of bridging callus in the presence and in the absence of BMP-2 was significantly different. The callus mass in the bone defect region was adequately and consistently developed in the presence of 100 µg of BMP (administered for 6 weeks), and the bones were consolidated in 12 weeks. Such an adequate callus formation was not observed in the control animals without BMP-2 treatment. The result of this experimental study suggests the potential application of BMP-2 in accelerating callus formation and in enabling rapid bone transporting, thereby shortening the treatment period for the repair of diaphyseal bone defects by distraction osteogenesis.

  3. Runx2 modified dental pulp stem cells (DPSCs) enhance new bone formation during rapid distraction osteogenesis (DO).

    PubMed

    Feng, Guijuan; Zhang, Jinlong; Feng, Xingmei; Wu, Senbin; Huang, Dan; Hu, Jing; Zhu, Songsong; Song, Donghui

    Distraction osteogenesis (DO) remains a major challenge in orthopedic and craniofacial surgery. The transplantion of mesenchymal stem cells (MSCs) could reduce the treatment period and the associated complications by increasing new bone formation during long-bone DO. Runt-related transcription factor 2 (Runx2) encodes a nuclear protein that is a pivotal regulator of osteoblast differentiation. It significantly stimulates calcium accumulation and alkaline phosphatase (ALP) activity in dental pulp stem cells (DPSCs). In this study, we investigated the effects of gene therapy using Runx2 on new bone formation during tibia DO of rabbits. The distraction gap of the rabbits was injected with adenovirus (Adv)-Runx2-green fluorescent protein (GFP)-transfected DPSCs (overexpression group, Group OE) or Adv-GFP-transfected DPSCs (negative control group, Group NC). Rabbits in the control group (Groups CON) were injected with physiologic saline. The generation of new bone tissue in the distraction gap was studied by radiographic examination, micro-computed tomography (CT) evaluation, histological analyze, and Mechanical testing at weeks 8 in the consolidation period. Excellent bone formation in the distracted callus was observed in Group OE and Group NC. Moreover, the OE group showed better bone formation and the highest bone mineral density (BMD) and bone mineral content (BMC). Group CON animals showed inadequate bone formation in the distracted callus compared to the other groups. The results suggest that gene therapy using Runx2-modified DPSCs was more effective during bone deposition and new bone formation in tibia DO. Copyright © 2016 International Society of Differentiation. Published by Elsevier B.V. All rights reserved.

  4. Evaluation of bone regenerative capacity following distraction osteogenesis of goat mandibles using two different bone cutting techniques.

    PubMed

    Nooh, Nasser; Abdullah, Walid A; El-Awady Grawish, Mohammed; Ramalingam, Sundar; Hassan, Ghada; Javed, Fawad; Al-Hezaimi, Khalid

    2014-04-01

    To compare the regenerative capacity of goat mandibles following sagittal split osteotomy and distraction osteogenesis with a vertical body osteotomy. Bilateral vertical and sagittal body osteotomy was performed on the left and right sides of the mandibles in 18 goats. The distraction period lasted for 10 days at 1 mm/day. Animals were sacrificed at 0, 10, and 35 days post-distraction. Bone mineral density (BMD) and bone volume (BV) were analysed by microcomputed tomography (MCT). Types of bone and cells present in the regenerated defect sites were analysed histologically. At 0, 10, and 35 days, BMD was 0.358 ± 0.012, 0.410 ± 0.012, and 1.070 ± 0.019, respectively, for vertical osteotomy and 0.420 ± 0.013, 0.421 ± 0.009 and 1.182 ± 0.030, respectively, for sagittal osteotomy. BV was 973.310 ± 5.048, 1234.589 ± 4.159, and 2121.867 ± 6.519, respectively, for vertical osteotomy and 995.967 ± 2.781, 1755.938 ± 4.379, and 2618.441 ± 21.429, respectively, for sagittal osteotomy at these three time points. BMD and BV differed significantly at all three times. Histological analysis shows that sagittal splitting was characterized by more robust lamellar bone formation bridging the distraction gap than vertical body osteotomy. Both MCT and histological analyses showed that distraction using the sagittal osteotomy technique resulted in significantly higher BV and BMD than using vertical body osteotomy. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  5. Role of guided bone regeneration principle in preventing fibrous healing in distraction osteogenesis at high speed: experimental study in rabbit mandibles.

    PubMed

    Elshahat, Ahmed; Inoue, Nozomu; Marti, Guy; Safe, Ikram; Manson, Paul; Vanderkolk, Craig

    2004-11-01

    The formation of fibrous tissues at the distraction gap may result from the accumulation of rapidly migrating fibroblasts at the site of an osteotomy, especially when distraction is rapid. Addition of osteopromotive membranes could theoretically prevent fibroblasts from entering the distraction gap, allowing the osteotomy site to be filled with only osteogenic cells. This study is an attempt to achieve a rapid successful distraction without fibrosis through the use of collagen membranes. Sixteen skeletally mature New Zealand white rabbits were used in this study. They were divided into two groups. One rabbit from each group was excluded from the study because of dislodgement of the distractors. In one group (n = 7), distraction was done as usual. In the other group (n = 7), a collagen membrane surrounded the osteotomy site to be distracted. After a 7-day latency period, distraction started at a rate 2 mm once per day for 5 days. The distractor was left in place for 4 weeks to allow consolidation. Results showed osteogenesis in both groups. Whereas addition of the membrane to distraction increased the quantity of bone formed, absence of the membrane allowed early mineralization (better quality of bone regarding the density). Neither of the two groups showed significant fibrosis or cartilage formation. The endosteum served as a source of blood supply when the periosteum was excluded. The periosteum served as a membrane for guided bone regeneration. Membranes for guided bone regeneration can be used with distraction when the periosteum is lost from trauma or is broken from fast distraction.

  6. Large Reactional Osteogenesis in Maxillary Sinus Associated with Secondary Root Canal Infection Detected Using Cone-beam Computed Tomography.

    PubMed

    Estrela, Carlos; Porto, Olavo César Lyra; Costa, Nádia Lago; Garrote, Marcel da Silva; Decurcio, Daniel Almeida; Bueno, Mike R; Silva, Brunno Santos de Freitas

    2015-12-01

    Inflammatory injuries in the maxillary sinus may originate from root canal infections and lead to bone resorption or regeneration. This report describes the radiographic findings of 4 asymptomatic clinical cases of large reactional osteogenesis in the maxillary sinus (MS) associated with secondary root canal infection detected using cone-beam computed tomographic (CBCT) imaging. Apical periodontitis, a consequence of root canal infection, may lead to a periosteal reaction in the MS and osteogenesis seen as a radiopaque structure on imaging scans. The use of a map-reading strategy for the longitudinal and sequential slices of CBCT images may contribute to the definition of diagnoses and treatment plans. Root canal infections may lead to reactional osteogenesis in the MS. High-resolution CBCT images may reveal changes that go unnoticed when using conventional imaging. Findings may help define initial diagnoses and therapeutic plans, but only histopathology provides a definitive diagnosis. Surgical enucleation of the periapical lesion is recommended if nonsurgical root canal treatment fails to control apical periodontitis.

  7. Effect of Recombinant Human Bone Morphogenetic Protein-2 and Adipose Tissue-Derived Stem Cell on New Bone Formation in High-Speed Distraction Osteogenesis.

    PubMed

    Lee, Sung Joo; Kim, Byung Jun; Kim, Young Il; Sohn, Chul-Ho; Jeon, Yoon Kyung; Xu, Lianji; Kim, Sang Hyon; Kwon, Sun Young; Choi, Tae Hyun; Kim, Suk Wha

    2016-01-01

    The effects of recombinant human bone morphogenetic protein-2 (rhBMP-2) and osteogenically differentiated adipose tissue-derived stem cells (ADSC) on new bone formation in high-speed distraction osteogenesis of adult rabbit cranium were investigated. A total of 41 adult rabbits were used in the study. Distraction began after a 5-day latency period at a rate of 1.5 mm twice a day until 10-mm length gain was obtained both in the control group, where a bone defect was induced, and in the experimental group, in which ADSC (group A), rhBMP-2 (group B), or both (group C) were injected in the distraction gap after distraction. At 4, 8, and 12 weeks after distraction, computed tomography analysis was done to determine the bone defect dimension and bone mineral density (BMD), while histologic examination was also done to calculate bone formation ratio. Bone defect dimension significantly decreased in groups B and C, compared with the control group, at 4 and 12 weeks after distraction. BMD was significantly increased in groups B and C at 4 weeks. On histologic examination, bone formation ratio was significantly increased in group C only at 12 weeks. This study suggests that the use of rhBMP-2 in combination with or without ADSC is helpful to promote bone regeneration in high-speed distraction osteogenesi s of adult rabbit cranium.

  8. Alveolar distraction osteogenesis for bone augmentation of severely atrophic ridges in 10 consecutive cases: a histologic and histomorphometric study.

    PubMed

    Marchetti, Claudio; Corinaldesi, Giuseppe; Pieri, Francesco; Degidi, Marco; Piattelli, Adriano

    2007-02-01

    This study analyzed bone healing in surgically osteodistracted maxillary and mandibular ridges histologically and histomorphometrically at two different times to determine the best time to insert dental implants. Ten consecutive patients with severe maxillary (two patients) or mandibular (eight patients) atrophy underwent surgical osteodistraction with an extraosseous distractor. Seven days after the surgery, the distractor was activated at a rate of 1 mm/day until achieving the planned bone lengthening. The distractor was removed after a consolidation period of 70 days. Bone biopsies were obtained at implant insertion: 70 days after the end of distraction on the day of distractor removal in six patients (group A) or 180 days afterwards in four patients (group B). The biopsies were evaluated histologically and histomorphometrically to measure the osteocyte lacunar area (OLA). The histologic and histomorphometrical analysis of the distracted bone 70 days after the end of distraction showed well-organized lamellar bone. At 180 days, the bone was more compact and mature; the mineralization of the matrix was greater; and an increased, but small, amount of marrow space was evident (35% versus 45%). The mean OLA was 80.11 +/- 27.59 microm2 in group A and 70.4 +/- 33.58 microm2 in group B. The difference between the two biopsy groups was not significant (P = 0.315). The results of this study showed that there was definitely similar bone formation in the distracted area for both healing periods, and placing implants clinically worked in both of these time periods in the limited number of cases observed.

  9. Locally injection of cell sheet fragments enhances new bone formation in mandibular distraction osteogenesis: a rabbit model.

    PubMed

    Ma, Dongyang; Ren, Liling; Yao, Hong; Tian, Wenyan; Chen, Fulin; Zhang, Junrui; Liu, Yanpu; Mao, Tianqiu

    2013-07-01

    Effective methods to shorten the treatment period of distraction osteogenesis (DO) are needed. To investigate whether injections of osteogenic bone marrow stromal cell (BMSC) sheet fragments could be used to facilitate new bone formation during DO, 30 rabbits underwent bilateral mandibular osteotomy and their mandibles were lengthened at a rate of 0.75 mm/12 h for 6 days after a 5-day latency period. There were three treatment groups (n = 10 for each group): Serum-free medium, dissociated BMSCs, and BMSC sheet fragments. A local injection was conducted with a needle directly into the distracted areas immediately after distraction. Rabbits were sacrificed for examination at 3 and 6 weeks after injection. Gross examination, radiographic evaluation, and micro-CT scanning indicated a significant increase in bony union in the BMSC sheet fragment group, compared with the medium group and the dissociated cell group. The histomorphometric analysis showed more intensive bone formation in the sheet fragment group than the other two groups at each time point. Additionally, the peak load was significantly higher in the fragment group than those in the others. The results show that injection of BMSC sheet fragments promotes bone formation in DO and indicate a promising approach to shorten the treatment period of osteodistraction. Copyright © 2013 Orthopaedic Research Society.

  10. Initial Experience With a New Intraoral Midface Distraction Device

    PubMed Central

    Burstein, Fernando; Soldanska, Magdalena; Granger, Michael; Berhane, ChiChi; Schoemann, Mark

    2015-01-01

    Abstract Maxillary hypoplasia that necessitates surgical advancement affects approximately 25% of patients born with cleft lip and palate. Syndromic conditions such as Crouzon may also be accompanied by significant maxillary hypoplasia. Severe maxillary hypoplasia can result in airway obstruction, malocclusion, proptosis, and facial disfigurement. For optimal stability, severe hypoplasia is best addressed with maxillary distraction osteogenesis. Twenty-two patients (15 boys, 7 girls, ages 6–16 years, mean age 10 years) with severe midface hypoplasia underwent midface distraction with new internal maxillary distraction (IMD) device at our institution. Total distraction distances ranged from 15 to 30 mm. There were no major complications, and all of them had improvement in functional and aesthetic parameters. There were 2 minor complications and 2 patients failed to distract the full distance because of converging vectors. Early maxillary distraction in patients with severe midface hypoplasia is a useful technique to provide interval correction of severe maxillary hypoplasia before skeletal maturity and definitive orthognathic surgery is contemplated, and it is a good tool to improve occlusion, aesthetics, and self-perception in younger patients. PMID:26080162

  11. Long-Term Results of Mandibular Distraction Osteogenesis with a Resorbable Device in Infants with Robin Sequence: Effects on Developing Molars and Mandibular Growth.

    PubMed

    Paes, Emma C; Bittermann, Gerhard K P; Bittermann, Dirk; Muradin, Marvick M; van Hogezand, Rose; Etty, Erika; Mink van der Molen, Aebele B; Kon, Moshe; Breugem, Corstiaan C

    2016-02-01

    Mandibular distraction osteogenesis with a unidirectional resorbable device is an effective treatment option for severe upper airway obstruction in infants with Robin sequence. Long-term effects, especially with regard to tooth development and mandibular outgrowth, are not known. Robin sequence infants with a follow-up of greater than or equal to 5 years were included. Baseline characteristics were extracted from medical records. Panoramic and lateral cephalometric radiographs were analyzed and patients were recalled for physical examination. Ten infants underwent mandibular distraction osteogenesis at a mean age of 3.7 months (median, 19 months; range, 11 days to 27 months). Mean length of follow-up was 6.8 years (range, 5.0 to 7.9 years). Ten Robin sequence infants without mandibular distraction osteogenesis (mean length of follow-up, 7.4 years; range, 6.7 to 8.9 years) were the controls. Shape anomalies, positional changes, and root malformations of molars were seen significantly more often than in the control group (p = 0.007, p = 0.009, and p = 0.043, respectively). Mandibular length was shorter (p = 0.030), but mandibular ramus height was comparable (p = 0.838) with that of the non-mandibular distraction osteogenesis group. Compared with healthy controls, all Robin sequence infants had a significantly shorter mandible. Mandibular distraction osteogenesis with a resorbable system reveals overall good short- and long-term results, but the effects on developing molars and mandibular outgrowth likely necessitate secondary procedures. This factor should be considered when deciding on treatment options and counseling of parents. Therapeutic, III.

  12. A preliminary study of the effect of low intensity pulsed ultrasound on new bone formation during mandibular distraction osteogenesis in rabbits.

    PubMed

    Xie, L K; Wangrangsimakul, K; Suttapreyasri, S; Cheung, L K; Nuntanaranont, T

    2011-07-01

    This study assesses the effect of low intensity pulsed ultrasound (LIPUS) on new bone formation during mandibular distraction osteogenesis (DO) in rabbits. 24 rabbits underwent DO on the right side of the mandible. 12 rabbits received a daily 20-min LIPUS (1.5 MHz, 30 mW/cm2) treatment on the first day of the distraction until they were killed at week 0 (immediately after the distraction), week 2 and week 4 after the distraction. Four rabbits were killed at each time point. The other 12 rabbits followed the same protocol without the ultrasound treatment. A plain radiography, a micro-CT scan, a microhardness test and a histological examination were used to evaluate new bone formation in the distraction gap. At week 0 and week 2 after the distraction, the treatment groups showed higher radiopacity and microhardness (p<0.05), and more bone formation was detected by the histological examination. At week 4 after the distraction, there was no statistical difference between the two groups. In this study, LIPUS accelerated new bone formation during the distraction period and 2 weeks after the distraction, which implies that the effective time for using LIPUS is in the early stage of DO. Copyright © 2011 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  13. A comparison of the low-level laser versus low intensity pulsed ultrasound on new bone formed through distraction osteogenesis.

    PubMed

    Kocyigit, Ismail Doruk; Coskunses, Fatih Mehmet; Pala, Elvan; Tugcu, Funda; Onder, Ercument; Mocan, Asriye

    2012-08-01

    To assess and compare the effects of low-intensity pulsed ultrasound stimulation (LIPUS) and low-level laser therapy (LLLT) on the bone mineral density (BMD) of bone formed through distraction osteogenesis (DO) using dual energy x-ray absorptiometry (DEXA). LIPUS and LLLT are noninvasive supporting treatment concepts used for wound healing. LIPUS has been used to accelerate bone healing through the therapeutic effect arising from piezoelectric and angiogenetic effects on cell membranes. LLLT known as "photobiomodulation" is used in the treatment of soft and hard tissue injuries. The study was conducted with 15 New Zealand rabbits randomly divided into three groups of 5 according to treatment, as follows: Group A: DO was performed with no further treatment; Group B: DO was performed followed by 30 mW/cm(2) LIPUS at 1 Mhz for 20 min/day during the distraction period; Group C: DO was performed followed by 25 mW/cm(2) LLLT at 650 nm for 10 min/day during the distraction period. DEXA was used to examine the treated areas prior to surgery and at 30 and 60 days postoperatively. In the control group, the mean BMD values at both 30 and 60 days postoperatively were below the baseline level, whereas they were above at the same time intervals in the LIPUS group. In the LLLT group, the mean BMD value at 30 days postoperatively was below the baseline level, whereas it was above the baseline level at 60 days postoperatively. LIPUS and LLLT applied during the distraction period accelerated the DO treatment.

  14. Relative contributions of osteogenic tissues to new bone formation in periosteal distraction osteogenesis: histological and histomorphometrical evaluation in a rat calvaria.

    PubMed

    Saulacic, Nikola; Hug, Cladius; Bosshardt, Dieter D; Schaller, Benoit; Buser, Daniel; Haeniwa, Hideya; Iizuka, Tateyuki

    2013-10-01

    The relative contributions of different, potential factors to new bone formation in periosteal distraction osteogenesis are unknown. The aim of the present study was to assess the influence of original bone and periosteum on bone formation during periosteal distraction osteogenesis in a rat calvarial model by means of histology and histomorphometry. A total of 48 rats were used for the experiment. The contribution of the periosteum was assessed by either intact or incised periosteum or an occlusive versus a perforated distraction plate. The cortical bone was either left intact or perforated. Animals were divided in eight experimental groups considering the three possible treatment modalities. All animals were subjected to a 7-day latency period, a 10-day distraction period and a 7-day consolidation period. The newly formed bone was analyzed histologically and histomorphometrically. New, mainly woven bone was found in all groups. Differences in the maximum height of new bone were observed and depended on location. Under the distraction plate, statistically significant differences in maximum bone height were found between the group with perforations in both cortical bone and distraction plate and the group without such perforations. If the marrow cavities were not opened, the contribution to new bone formation was dominant from the periosteum. If the bone perforations opened the marrow cavities, a significant contribution to new bone formation originated from the native bone. © 2011 Wiley Periodicals, Inc.

  15. Demineralized Bone Matrix Injection in Consolidation Phase Enhances Bone Regeneration in Distraction Osteogenesis via Endochondral Bone Formation.

    PubMed

    Kim, Ji-Beom; Lee, Dong Yeon; Seo, Sang Gyo; Kim, Eo Jin; Kim, Ji Hye; Yoo, Won Joon; Cho, Tae-Joon; Choi, In Ho

    2015-09-01

    Distraction osteogenesis (DO) is a promising tool for bone and tissue regeneration. However, prolonged healing time remains a major problem. Various materials including cells, cytokines, and growth factors have been used in an attempt to enhance bone formation. We examined the effect of percutaneous injection of demineralized bone matrix (DBM) during the consolidation phase on bone regeneration after distraction. The immature rabbit tibial DO model (20 mm length-gain) was used. Twenty-eight animals received DBM 100 mg percutaneously at the end of distraction. Another 22 animals were left without further procedure (control). Plain radiographs were taken every week. Postmortem bone dual-energy X-ray absorptiometry and micro-computed tomography (micro-CT) studies were performed at the third and sixth weeks of the consolidation period and histological analysis was performed. The regenerate bone mineral density was higher in the DBM group when compared with that in the saline injection control group at the third week postdistraction. Quantitative analysis using micro-CT revealed larger trabecular bone volume, higher trabecular number, and less trabecular separation in the DBM group than in the saline injection control group. Cross-sectional area and cortical thickness at the sixth week postdistraction, assessed using micro-CT, were greater in the regenerates of the DBM group compared with the control group. Histological evaluation revealed higher trabecular bone volume and trabecular number in the regenerate of the DBM group. New bone formation was apparently enhanced, via endochondral ossification, at the site and in the vicinity of the injected DBM. DBM was absorbed slowly, but it remained until the sixth postoperative week after injection. DBM administration into the distraction gap at the end of the distraction period resulted in a significantly greater regenerate bone area, trabecular number, and cortical thickness in the rabbit tibial DO model. These data suggest

  16. Demineralized Bone Matrix Injection in Consolidation Phase Enhances Bone Regeneration in Distraction Osteogenesis via Endochondral Bone Formation

    PubMed Central

    Kim, Ji-Beom; Seo, Sang Gyo; Kim, Eo Jin; Kim, Ji Hye; Yoo, Won Joon; Cho, Tae-Joon; Choi, In Ho

    2015-01-01

    Background Distraction osteogenesis (DO) is a promising tool for bone and tissue regeneration. However, prolonged healing time remains a major problem. Various materials including cells, cytokines, and growth factors have been used in an attempt to enhance bone formation. We examined the effect of percutaneous injection of demineralized bone matrix (DBM) during the consolidation phase on bone regeneration after distraction. Methods The immature rabbit tibial DO model (20 mm length-gain) was used. Twenty-eight animals received DBM 100 mg percutaneously at the end of distraction. Another 22 animals were left without further procedure (control). Plain radiographs were taken every week. Postmortem bone dual-energy X-ray absorptiometry and micro-computed tomography (micro-CT) studies were performed at the third and sixth weeks of the consolidation period and histological analysis was performed. Results The regenerate bone mineral density was higher in the DBM group when compared with that in the saline injection control group at the third week postdistraction. Quantitative analysis using micro-CT revealed larger trabecular bone volume, higher trabecular number, and less trabecular separation in the DBM group than in the saline injection control group. Cross-sectional area and cortical thickness at the sixth week postdistraction, assessed using micro-CT, were greater in the regenerates of the DBM group compared with the control group. Histological evaluation revealed higher trabecular bone volume and trabecular number in the regenerate of the DBM group. New bone formation was apparently enhanced, via endochondral ossification, at the site and in the vicinity of the injected DBM. DBM was absorbed slowly, but it remained until the sixth postoperative week after injection. Conclusions DBM administration into the distraction gap at the end of the distraction period resulted in a significantly greater regenerate bone area, trabecular number, and cortical thickness in the

  17. Periosteal distraction osteogenesis and barrier membrane application: an experimental study in the rat calvaria.

    PubMed

    Saulacic, Nikola; Schaller, Benoit; Bosshardt, Dieter D; Buser, Daniel; Jaun, Pascal; Haeniwa, Hideya; Iizuka, Tateyuki

    2012-06-01

    Distraction of the periosteum results in the formation of new bone in the gap between the periosteum and the original bone. We postulate that the use of a barrier membrane would be beneficial for new bone formation in periosteal distraction. To selectively influence the contribution of the periosteum, a distraction plate with perforations was used alone or covered by a collagen barrier membrane. All animals were subjected to a 7-day latency period and a 10-day distraction period with a rate of 0.1 mm/day. Four animals per group with or without a barrier membrane were sacrificed at 2, 4, and 6 weeks after the end of the distraction. The height of new bone generated relative to the areas bound by the parent bone and the periosteum was determined by histomorphometric methods. New bone was found in all groups. At the periphery of the distraction plate, significant differences in bone height were found between the hinge and the distraction screw for the group without barrier membrane at 2 weeks (0.39 ± 0.19 mm) compared to 4 weeks (0.84 ± 0.44 mm; P = 0.002) and 6 weeks (1.06 ± 0.39 mm; P = 0.004). Differences in maximum bone height with and without a barrier membrane were observed laterally to the distraction plate at 2 weeks (1.22 ± 0.64 versus 0.55 ± 0.14 mm; P = 0.019) and 6 weeks (1.61 ± 0.56 versus 0.73 ± 0.33 mm; P = 0.003) of the consolidation period. Within the limitations of the present study, the application of a barrier membrane may be considered beneficial for new bone formation induced by periosteal distraction.

  18. One-piece bone flap osteotomy using thread wire saw for fronto-orbital advancement with distraction osteogenesis in craniosynostosis.

    PubMed

    Yamashita, Masanobu; Akai, Takuya; Kishibe, Miyuki; Shimada, Kenichi

    2015-02-01

    The objectives of this study are to describe our new technique of one-piece bone flap osteotomy for fronto-orbital advancement with distraction osteogenesis in craniosynostosis using a thin, flexible, and safe thread wire saw (the T-saw) and to compare the results with those of classic osteotomy using an osteotome. Initial osteotomy is performed between two pterion burr holes using a craniotome with a guarded footplate. The outer sphenoid wing and lateral orbital rim are separated using a reciprocating saw. Limited dura dissection from inner cortex between burr holes in the pterion and nasion is performed. The T-saw is inserted through the epidural space behind the superior orbital wall between the lateral orbital rim and nasion burr hole; the osteotomy is performed with gentle reciprocating strokes. Dura protection with a malleable retractor is not absolutely necessary. Five patients underwent one-piece fronto-orbital bone flap osteotomies using a T-saw in 2009-2014. The median age was 26 months (7-132 months), median operation time was 275 min (183-303 min), and median estimated blood loss was 65 mL (20-250 mL). These values did not differ from those of control cases. No complications, including incomplete osteotomy, occurred. The T-saw creates an osteotomy as a "one-stroke sketch," so incomplete osteotomy never occurs. The osteotomy can be performed safely without protecting the dura. Osteotomy with T-saw does not negate the advantages of fronto-orbital advancement with distraction osteogenesis, including shorter operative time, less intraoperative bleeding, and fewer complications.

  19. [New bone distraction device for induced osteogenesis of the mandible. Experience with 126 clinical cases].

    PubMed

    Fuente del Campo, A

    2000-01-01

    In this paper, the author describes the distraction devise designed and developed by the author to perform the procedure of inducted bone generation or "bone distraction". The characteristics, principles, and advantages of this device are also described in comparison with other more expensive devices. The author's clinic experience using this device: 126 patients with a maximum follow-up of 54/12 years and an average bone distraction of 31 mm. The procedure was done on patients from 8/12 to 38 years of age. Bone distraction is a good option for early reconstruction of craniofacial skeletal defects, eliminating the need for bone grafts, maxillo-mandibular fixation, and other more aggressive and complex procedures. The results obtained with this distractor show that it is a stable, precise, and useful device. Its low cost and the simplicity of the technique make it very accessible to every surgeon with some experience in bone surgery and craniofacial or othognatic surgery.

  20. Mesenchymal stem cells modified with nerve growth factor improve recovery of the inferior alveolar nerve after mandibular distraction osteogenesis in rabbits.

    PubMed

    Wang, L; Zhao, Y; Cao, J; Yang, X; Lei, D

    2015-03-01

    Distraction osteogenesis is widely used in the treatment of bony deformities and defects. However, injury to the inferior alveolar nerve is a concern. Our aim was to investigate the feasibility of using lentiviral-mediated human nerve growth factor beta (hNGFβ) of the inferior alveolar nerve in mandibular distraction osteogenesis in rabbits. To achieve this, mesenchymal stem cells (MSC) from the bone marrow of rabbit mandibles were isolated and genetically engineered using recombinant lentiviral vector containing hNGFβ. Twenty New Zealand white rabbits underwent mandibular distraction osteogenesis, and 5 million MSC transduced with hNGFβ-vector or control vector were transplanted around the nerve in the gap where the bone had been fractured during the operation (n=10 in each group). After gradual distraction, samples of the nerve were harvested for histological and histomorphometric analysis. We found that the genetically engineered MSC transduced by the lentiviral vector were able to secrete hNGFβ at physiologically relevant concentrations as measured by ELISA. Histological examination of the nerve showed more regenerating nerve fibres and less myelin debris in the group in which hNGFβ-modified MSC had been implanted than in the control group. Histomorphometric analysis of the nerve showed increased density of myelinated fibres in the group in which hNGFβ-modified MSC had been implanted than in the control group. The data suggest that implantation of hNGFβ-modified MSC can accelerate the morphological recovery of the inferior alveolar nerve during mandibular distraction osteogenesis in rabbits. The use of lentiviral-mediated gene treatment to deliver hNGFβ through MSC may be a promising way of minimising injury to the nerve. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  1. Serum Concentration of Growth Factors in Dogs under Different Conditions of Distraction Osteogenesis.

    PubMed

    Stogov, M V; Tushina, N V; Emanov, A A

    2015-12-01

    Concentrations of insulin-like growth factors 1 and 2 (IGF-1 and IGF-2), stem cell factor (SCF), vascular endothelial growth factor (VEGF), and transforming growth factor β1 (TGF-β1) were measured in the blood serum of dogs subjected to experimental lengthening of shin bones. In animals subjected to shin bone lengthening at a rate of 1 mm/day in 4 steps, the concentrations of SCF and TGF-β1 significantly increased in the middle of distraction and IGF-1 concentration increased by the end of distraction. In animals subjected to lengthening at a rate of 1.5 mm/day in 6 steps, the levels of IGF-1 and TGF-β1 significantly increased in the middle of distraction and the concentration of IGF-2 at the end of distraction. In animals subjected to lengthening at a rate of 3 mm/day in 120 steps, the concentrations of IGF-1 and TGF-β1 significantly decreased in the middle of distraction and concentrations of IGF-1, VEGF, and TGF-β1 increased by the end of distraction.

  2. Experimental comparison of the effects of locally administered zoledronic acid and alendronate on the rate of mandibular distraction osteogenesis in dogs.

    PubMed

    Baiomy, Abdel Aziz; Nassan, Mohamed A; Abdellatif, Elsaeed M; Abdel Fattah, Ashraf; El-Fekey, Ahmed A H; Abdel Aal, Abdel Bassit M

    2014-07-01

    The objective of this study was the evaluation of effects of locally administered zoledronic acid and alendronate on rate of osteogenesis in distracted mandible of dogs. Following mandibular corticotomy, bone segments were maintained in a neutral position by distractor for 7 days then distraction was initiated at a rate of 0.5 mm twice a day for 10 days to achieve a total distraction of 10 mm, followed by a consolidation period. Animals were divided into 3 equal groups according to the injected drug (saline solution [control], zoledronic acid, alendronate). The dogs were killed 2, 6, and 10 weeks following distraction and samples were collected for radiographic examination, assessment of bone mineral density, and histopathological evaluation. Radiographs and histopathological results pointed out that bone formation and maturation of experimental groups were faster than those of the control group. Local administration of zoledronic acid and alendronate proved to be effective in shortening the consolidation period. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Fast and Early Mandibular Osteodistraction: The Long-Term Follow-Up of Mandibular Distraction Osteogenesis on Teeth Position.

    PubMed

    Cascone, Piero; Basile, Emanuela; Saccucci, Matteo; Di Carlo, Gabriele; Angeletti, Diletta; Ramieri, Valerio; Polimeni, Antonella

    2015-11-01

    Pierre Robin Sequence is a congenital pathology defined by the triad micrognathia, glossoptosis and often a U-shaped cleft of soft palate. Newborns affected by airways obstruction may necessitate more invasive options: tongue-lip adhesion, tracheostomy and mandibular distraction osteogenesis. The authors analyzed the effect of fast and early mandibular osteodistraction on deciduous dental development in patients affected by Pierre Robin Sequence. Analysis of the patients treated for severe form was performed by a team composed by maxillofacial surgeons and dentists. Five patients were included for the analysis: before and long term clinical and radiological assessments were considered. All patients underwent fast and early mandibular osteodistraction; two years follow up computed tomography and panorex reconstructions showed bone consolidation, 33 of 35 teeth analyzed before ostedistraction are present after distraction protocol; no positional changes were detected at the follow up analysis either deciduous teeth and molar permanent buds. No deformities regarding molar buds were detected. In conclusion external mandibular distractor devices have been associated with dental injuries and facial scaring. Even though, the dental complications identified can not be unambiguously connected to the external distractor devices.

  4. Complications of the Intramedullary Skeletal Kinetic Distractor (ISKD) in distraction osteogenesis.

    PubMed

    Lee, Dong Hoon; Ryu, Keun Jung; Song, Hae Ryong; Han, Soo-Hong

    2014-12-01

    The Intramedullary Skeletal Kinetic Distractor (ISKD) (Orthofix Inc, Lewisville, TX, USA) is an intramedullary device designed for more comfortable limb lengthening than that with external fixators; lengthening is achieved with this nail using rotational oscillation between two telescoping sections. However, the degree to which this device achieves this goal and its complication rate have not been fully documented. We determined (1) the frequency with which distraction was not achieved at the desired rate, (2) whether pain differed between patients with normally and abnormally distracting nails, (3) risk factors for abnormal nails, and (4) other complications. We analyzed 35 lengthening segments (26 femurs, nine tibias) in 19 patients. Mean length achieved was 47 mm. Femoral nails were categorized into four groups according to distraction rate: normal, runaway (unintentionally faster rate [> 1.5 mm/day]), difficult-to-distract (slower rate [< 0.8 mm/day] requiring manual manipulation but not requiring general anesthesia), and nondistracting (slower rate [< 0.8 mm/day] requiring manual manipulation under general anesthesia or reosteotomy). Possible risk factors, including age, BMI, preoperative thigh circumferences, degree of intramedullary overreaming, and length of the thicker portion of the nail within the distal fragment, were compared among groups. VAS pain scores were compared among groups under three conditions: rest, physiotherapy, and distraction motion. Complications were also analyzed. Minimum followup was 15 months (mean, 26 months; range, 15-38 months) after first-stage surgery. Abnormal distraction rate was observed in 21 of 35 segments (60%; 17 femurs, four tibias). VAS pain scores showed no differences among groups during rest or physiotherapy but were higher (p = 0.02) in the problematic nails (7-8 points) versus normal nails (3 points) during distraction. Only mean length of the thicker portion of the nail within the distal fragment

  5. Recombinant human bone morphogenetic protein-2 suspended in fibrin glue enhances bone formation during distraction osteogenesis in rabbits

    PubMed Central

    Li, Yunfeng; Li, Rui; Hu, Jing; Song, Donghui; Jiang, Xiaowen

    2016-01-01

    Introduction Bone morphogenetic protein-2 (BMP-2) has high potential for bone formation, but its in vivo effects are unpredictable due to the short life time. This study was designed to evaluate the effects of recombinant human (rh) BMP-2 suspended in fibrin on bone formation during distraction osteogenesis (DO) in rabbits. Material and methods The in vitro release kinetics of rhBMP-2 suspended in fibrin was tested using an enzyme-linked immunosorbent assay. Unilateral tibial lengthening for 10 mm was achieved in 48 rabbits. At the completion of osteodistraction, vehicle, fibrin, rhBMP-2 or rhBMP-2 suspended in fibrin (rhBMP-2 + fibrin) was injected into the center of the lengthened gap, with 12 animals in each group. Eight weeks later, the distracted callus was examined by histology, micro-CT and biomechanical testing. Radiographs of the distracted tibiae were taken at both 4 and 8 weeks after drug treatment. Results It was found that fibrin prolonged the life span of rhBMP-2 in vitro with sustained release during 17 days. The rhBMP-2 + fibrin treated animals showed the best results in bone mineral density, bone volume fraction, cortical bone thickness by micro-CT evaluation and mechanical properties by the three-point bending test when compared to the other groups (p < 0.05). In histological images, rhBMP-2 + fibrin treatment showed increased callus formation and better gap bridging compared to the other groups. Conclusions The results of this study suggest that fibrin holds promise to be a good carrier of rhBMP-2, and rhBMP-2 suspended in fibrin showed a stronger promoting effect on bone formation during DO in rabbits. PMID:27279839

  6. Effects of nerve growth factor delivery via a gel to inferior alveolar nerve in mandibular distraction osteogenesis.

    PubMed

    Wang, Lei; Cao, Jian; Lei, De-lin; Cheng, Xiao-bing; Yang, Yao-wu; Hou, Rui; Zhao, Ying-hua; Cui, Fu-zhai

    2009-11-01

    Inferior alveolar nerve (IAN) injury is a concern in mandible distraction osteogenesis (DO). We have previously demonstrated that repeated local injections of human nerve growth factor beta (NGF-beta) have significantly enhanced the histologic recovery of the IAN in a rabbit model of DO. This study was to further test the effect of a single injection of human NGF-beta delivered via a collagen/nanohydroxyapatite/kappa-carrageenan gel to the recovery of the IAN in DO. Rabbits underwent mandibular DO at a rate of 0.75 mm/12 h for 6 days. At the end of the distraction period, injections were performed near the IAN percutaneously as follows: group 1, human NGF-beta in the gel; group 2, human NGF-beta in saline; group 3, the gel alone; and group 4, saline alone. At 14 days after the end of distraction, IAN histologic findings and histomorphometric parameters were evaluated. Histologically, there were less myelin debris and more abundant regenerating nerve fibers in group 1 than the other groups. Both the myelinated fiber density and the myelinated axon area in group 1 were significantly higher than groups 3 and 4 (P < 0.01); the myelinated axon area in the group 1 was significantly higher than group 2 (P < 0.01). In conclusion, the delivery of human NGF-beta in the gel leads to a better acceleration of the IAN injury recovery over the saline delivery. It provides a possible way to enhance the recovery of nerve injuries in craniofacial DO clinically.

  7. Treatment outcomes of archwise distraction osteogenesis in mandibular dentoalveolar retrognathia cases.

    PubMed

    Yöndem, C; Acar, Y B; Şener, B C; Erverdi, A N

    2017-08-01

    The aim of this study was to describe the treatment of class II malocclusion by sagittal advancement of the alveolar bone in the symphyseal area using an intraoral archwise distractor device and to determine the effects of this method on the dentoalveolar complex. Fifteen patients (10 female, five male) aged 16-20 years with a class II division 2 malocclusion, characterized by mandibular dentoalveolar retrusion and a prominent chin, underwent archwise alveolar distraction in the anterior mandible. Lateral cephalometric radiographs were obtained before distraction (T0), after 6 weeks of consolidation (T1), and after debonding (T2). Linear and angular skeletal, dental, and soft tissue measurements were performed. Forty-seven parameters were measured for each of the 15 subjects on pre- and postoperative lateral cephalometric radiographs (T0, T1, and T2). The distraction protocol was successful in all patients. Skeletally, the mandible showed a clockwise rotation. B-point moved forward significantly (P<0.05). Overjet decreased significantly (P<0.001). The total profile angle was unaffected, and the improvement in the submental fold was highly significant (P<0.001). The intraoral archwise distraction force that is applied through brackets and archwires is sufficiently effective for alveolar advancement. This procedure is simple and effective in the treatment of specific adult patients with a class II division 2 malocclusion, characterized by a prominent chin and severe mandibular dentoalveolar retrusion. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  8. Scaffold-Based Delivery of Autologous Mesenchymal Stem Cells for Mandibular Distraction Osteogenesis: Preliminary Studies in a Porcine Model

    PubMed Central

    Sun, Zongyang; Tee, Boon Ching; Kennedy, Kelly S.; Kennedy, Patrick M.; Kim, Do-Gyoon; Mallery, Susan R.; Fields, Henry W.

    2013-01-01

    Purpose Bone regeneration through distraction osteogenesis (DO) is promising but remarkably slow. To accelerate it, autologous mesenchymal stem cells have been directly injected to the distraction site in a few recent studies. Compared to direct injection, a scaffold-based method can provide earlier cell delivery with potentially better controlled cell distribution and retention. This pilot project investigated a scaffold-based cell-delivery approach in a porcine mandibular DO model. Materials and Methods Eleven adolescent domestic pigs were used for two major sets of studies. The in-vitro set established methodologies to: aspirate bone marrow from the tibia; isolate, characterize and expand bone marrow-derived mesenchymal stem cells (BM-MSCs); enhance BM-MSC osteogenic differentiation using FGF-2; and confirm cell integration with a gelatin-based Gelfoam scaffold. The in-vivo set transplanted autologous stem cells into the mandibular distraction sites using Gelfoam scaffolds; completed a standard DO-course and assessed bone regeneration by macroscopic, radiographic and histological methods. Repeated-measure ANOVAs and t-tests were used for statistical analyses. Results From aspirated bone marrow, multi-potent, heterogeneous BM-MSCs purified from hematopoietic stem cell contamination were obtained. FGF-2 significantly enhanced pig BM-MSC osteogenic differentiation and proliferation, with 5 ng/ml determined as the optimal dosage. Pig BM-MSCs integrated readily with Gelfoam and maintained viability and proliferative ability. After integration with Gelfoam scaffolds, 2.4–5.8×107 autologous BM-MSCs (undifferentiated or differentiated) were transplanted to each experimental DO site. Among 8 evaluable DO sites included in the final analyses, the experimental DO sites demonstrated less interfragmentary mobility, more advanced gap obliteration, higher mineral content and faster mineral apposition than the control sites, and all transplanted scaffolds were completely

  9. Effects of bone morphogenetic protein 2 gene therapy on new bone formation during mandibular distraction osteogenesis at rapid rate in rabbits.

    PubMed

    Long, Jie; Li, Peng; Du, Hong-ming; Liu, Lei; Zheng, Xiao-hui; Lin, Yun-feng; Wang, Hang; Jing, Wei; Tang, Wei; Chen, Wei-hui; Tian, Wei-dong

    2011-07-01

    We investigated the effect of recombinant human bone morphogenetic protein 2 (rhBMP-2) on new bone formation during rapid-rate mandibular distraction osteogenesis. We also explored the feasibility of using local BMP-2 gene therapy to compensate for bad callus formation caused by a rapid distraction rate. Bone marrow mesenchymal stem cells (MSCs) from Japanese rabbits were transfected with adenovirus (adv)-BMP-2. The right mandibles of the rabbits were distracted after corticotomy. The distraction rate in group A was 0.8 mm/d. The distraction rate in group B was 2.4 mm/d, and the distraction gap was injected with adv-lacZ-transfected bone marrow MSCs. The distraction rate in group C was 2.4 mm/d, and the distraction gap was injected with adv-BMP-2-transfected bone marrow MSCs. New generation bone tissue in the distraction gap was analyzed by plain radiograph examinations, microfocus computerized tomography (micro-CT) examinations, and biomechanical tests at weeks 2, 4, and 8 of the consolidation period. Radiographic and micro-CT examinations showed a better bone quality in group C compared with group A at weeks 2 and 4 of the consolidation period. There was no obvious new bone formation in group B. The trabecular parameters (trabecular thickness, trabecular number, volumetric bone mineral density at tissue, and bone volume fraction) were significantly higher in group C than in group A at weeks 2 and 4. At week 8, no significant difference were detected for all parameters except trabecular number between groups A and C. All biomechanical stress parameters were significantly higher in group C than in group A at week 4, and only peak stress was significantly different at week 8. Gene therapy using rhBMP-2-modified MSCs promoted new bone formation during mandibular distraction osteogenesis, and effectively compensated for the detrimental effect of rapid distraction rate on new bone formation. Copyright © 2011 Mosby, Inc. All rights reserved.

  10. [Significance of roentgenologic indications of osteogenesis in the choice of tactics in distraction osteosynthesis using G. A. Ilizarov's method in rigid pseudarthrosis].

    PubMed

    Giul'nazarova, S V; Kazak, L A; Mashinskaia, T M

    1991-09-01

    On the basis of 274 observations the authors stated the conception of staged roentgenologic course of the osseous tissue regeneration in case of close distraction of rigid false joints according to G. A. Ilizarov. In line with visual appraisal of roentgenograms there were used roentgenometry and densitometry. There are described in details the stages of reparative regeneration and in accordance with them are given the tactical recommendation as to the selection of the distraction rate and its duration, the terms of loading and immobilization of fractures by means of perosseous apparatus. The tactics of the patient control with regard to the peculiarities of osteogenesis in the process of distraction allowed to decrease the number of failures in treatment of false joints by 2 times.

  11. Piezosurgery: A new and safe technique for distraction osteogenesis in Pierre Robin sequence review of the literature and case report

    PubMed Central

    Galié, Manlio; Candotto, Valentina; Elia, Giovanni; Clauser, Luigi C.

    2014-01-01

    Introduction Pierre Robin sequence (PRS) is characterized by microgenia and retrognathia. Cleft palate and glossoptosis are frequently associated with airway obstruction and difficulty in swallowing. Distraction osteogenesis with micro-distractors has recently been considered as a surgical option during the neonatal age. Case presentation A 6-week-old female with PRS underwent mandibular lengthening in neonatal age. Mandibular osteotomies were performed with the piezoelectric scalpel. Discussion Piezosurgery represents an innovative technique as it offers the maxillofacial surgeon the opportunity to make precise bone cuts without damaging the soft tissue, minimizing the invasiveness of the surgical procedure, and the opportunity of working in a field which is almost totally blood free. Conclusion The use of a piezoelectric device to perform this kind of surgery provides clinical and surgical results which would be difficult with traditional instruments, not only for the patient’s benefit but also for the surgeon’s. Preservation of the original bony structure, especially of the cancellous bone, will benefit the bone healing process due to its high estrogenic potential. PMID:25555147

  12. Distraction osteogenesis using combined locking plate and Ilizarov fixator in the treatment of bone defect: A report of 2 cases

    PubMed Central

    Mukhopadhaya, John; Raj, Manish

    2017-01-01

    Distraction osteogenesis and bone transport has been used to reconstruct bone loss defect by allowing new bone to form in the gap. Plate-guided bone transport has been successfully described in literature to treat bone loss defect in the femur, tibia, and mandible. This study reports two cases of fracture of femur with segmental bone loss treated with locking plate fixation and bone transport with Ilizarov ring fixator. At the time of docking, when the transport segment is compressed with bone fragment, the bone fragment is fixed with additional locking or nonlocking screws through the plate. The bone defect size was 7 cm in case 1 and 8 cm in case 2 and the external fixation indexes were 12.7 days/cm and 14 days/cm. No shortening was present in either of our cases. The average radiographic consolidation index was 37 days/cm. Both cases achieved infection-free bone segment regeneration and satisfactorily functional outcome. This technique reduces the duration of external fixation during the consolidation phase, allows correction of length and alignment and provides earlier rehabilitation.

  13. Piezosurgery: A new and safe technique for distraction osteogenesis in Pierre Robin sequence review of the literature and case report.

    PubMed

    Galié, Manlio; Candotto, Valentina; Elia, Giovanni; Clauser, Luigi C

    2015-01-01

    Pierre Robin sequence (PRS) is characterized by microgenia and retrognathia. Cleft palate and glossoptosis are frequently associated with airway obstruction and difficulty in swallowing. Distraction osteogenesis with micro-distractors has recently been considered as a surgical option during the neonatal age. A 6-week-old female with PRS underwent mandibular lengthening in neonatal age. Mandibular osteotomies were performed with the piezoelectric scalpel. Piezosurgery represents an innovative technique as it offers the maxillofacial surgeon the opportunity to make precise bone cuts without damaging the soft tissue, minimizing the invasiveness of the surgical procedure, and the opportunity of working in a field which is almost totally blood free. The use of a piezoelectric device to perform this kind of surgery provides clinical and surgical results which would be difficult with traditional instruments, not only for the patient's benefit but also for the surgeon's. Preservation of the original bony structure, especially of the cancellous bone, will benefit the bone healing process due to its high estrogenic potential. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  14. Distraction osteogenesis and nonunion of the docking site: is there an ideal treatment option?

    PubMed

    Giotakis, Nikolaos; Narayan, Badri; Nayagam, Selvadurai

    2007-03-01

    Docking sites are the result of a classic bone transport technique for dealing with bone loss. Union may prove to be the rate-limiting step in the duration of treatment. Strategies to improve union have focused on surgical manipulation such as immediate coaptation of the margins of the segmental defect in the process of acute shortening to prevent fibrocartilaginous capping of the ends of bone during transport. This procedure has the highest success rate for union but is limited by its effect on the limb's vascularity. Other techniques for improving union involve compression, alternate compression-distraction, and bone grafts, all of which induce union to a variable degree. The application of external stimulators and bone morphogenetic proteins, the use of which is supported in fracture healing and even regenerate formation, is as yet unproven at docking sites.

  15. Evaluation of the effect of low-level diode laser therapy applied during the bone consolidation period following mandibular distraction osteogenesis in the human.

    PubMed

    Abd-Elaal, A Z; El-Mekawii, H A; Saafan, A M; El Gawad, L A; El-Hawary, Y M; Abdelrazik, M A

    2015-08-01

    The aim of this study was to evaluate the effect of low-level laser therapy (LLLT) on new bone formation obtained by distraction osteogenesis in the early consolidation period. Ten selected patients with bilateral mandibular retrusion seen at the Nasser Institute Hospital, Egypt between June 2009 and June 2012 underwent this clinical trial; seven were female and three were male, and their mean age was 31±5.1 years. The left mandible of each patient was assigned to group A (n=10) and the right mandible to group B (n=10); mandibular distraction osteogenesis was performed on both sides and then LLLT was used in group B only. The amounts of bone acquired were compared according to their radiographic density on digital panoramic radiographs after 6, 12, 24, and 54 days of consolidation. Statistically significant differences in bone density were found between the two groups. Group B showed bone consolidation and growth differences on day 6 (P=0.402), day 12 (P=0.006), day 24 (P=0.021), and day 54 (P=0.028). The use of LLLT on distracted bone was found to increase the quality and quantity of bone and to shorten the consolidation period, allowing early removal of the distractor and resulting in decreased morbidity and relapse.

  16. Finite element analysis of masticatory stress on neoformed bone tissue after distraction osteogenesis and low-level laser therapy: a pilot study.

    PubMed

    Freddo, Angelo Luiz; Hauser, Eliete Biasotto; de Castro, Victor Velho; Noritomi, Pedro Yoshito; de Almeida, Alexandre Simões; de Oliveira, Marília Gerhardt

    2014-08-01

    This study aimed to understand the action of masticatory forces on an implant virtually introduced into the sheep mandible after distraction osteogenesis and low-level laser therapy (LLLT) by using finite element analysis. Distraction osteogenesis as an alternative for bone reconstruction that may be used in the treatment of deformities. Four ewes underwent distraction osteogenis to elongate the left mandibular body by 15 m, and three of them underwent LLLT with the purpose of improving bone properties. After death, animals were scanned by computed tomography and their mandibles were tridimensionally reconstructed by computer programs. The physical properties related to hardness and modulus of elasticity of each animal were obtained from the dissected mandibles, and data were transferred to Femap software for finite element analysis. Animals exposed and not exposed to LLLT irradiation showed remarkably similar values for superficial hardness and modulus of elasticity, without statistically significant difference (p>0.05), between the values observed for the cortical bone and the cancellous bone among the groups. The neoformed mandible, after a brief period for bone healing, was able to promote stability for implant placement and proper distribution of masticatory forces. An implant introduced virtually into the site of bone neoformation did not suffer any micromotions relevant to osteointegration. Furthermore, finite element analysis showed that the neoformed portion of the mandible was able to absorb and distribute masticatory forces throughout its structure, even after a brief period for bone maturation.

  17. The role of transforming growth factor-beta, insulin-like growth factor I, and basic fibroblast growth factor in distraction osteogenesis of the mandible.

    PubMed

    Farhadieh, R D; Dickinson, R; Yu, Y; Gianoutsos, M P; Walsh, W R

    1999-01-01

    Distraction osteogenesis is a viable method for regenerating large amounts of bone. In contrast to fracture healing, the mode of bone formation in distraction osteogenesis is primarily intramembranous ossification. The basic biology of the process is still not well understood. The growth factor cascade is likely to play an important role in distraction. This study examines the growth factor cascade in a lengthened ovine mandible model. Twenty-four animals were divided into four groups with varying rates of distraction (1, 2, 3, and 4 mm/day). A unilateral distractor at the angle of the mandible was used. The mandibles were lengthened to 24 mm and fixed for a period of 5 weeks, after which the animals were killed. The sections were probed for transforming growth factor-beta, basic fibroblast growth factor, and insulin-like growth factor I. The growth factors studied were present in all four groups. Transforming growth factor-beta, basic fibroblast growth factor, and insulin-like growth factor I were present in both the bony matrix of the sections and the cytoplasm of the cells, osteoblasts, and a small number of mesenchymal cells. The sections obtained from groups distracted at faster rates showed stronger presence of the growth factors examined by more intense staining. In fracture healing, the localization of transforming growth factor-beta in stage I of healing corresponded with the precise region of intramembranous ossification in stage II. Diffuse presence of transforming growth factor-beta throughout the lengthened region corresponded with the process of intramembranous ossification observed in distraction. In fracture healing, insulin-like growth factor I and basic fibroblast growth factor have been shown to promote proliferation and differentiation of osteoblasts from precursor cells. The intense presence of insulin-like growth factor I and basic fibroblast growth factor in the distracted region may account for osteoblast proliferation and formation from

  18. Distraction osteogenesis of free flap reconstructed mandible following ameloblastoma resection for optimal functional rehabilitation

    PubMed Central

    Bousdras, V. A.; Kalavrezos, N.

    2014-01-01

    This case highlights the use of a custom-made distractor (Synthes GmbH, Oberdorf, Switzerland), used to increase bone height prior to rehabilitation with implant placement, in a patient following excision of an ameloblastoma and reconstruction of her mandible with a fibular flap. A 27-year-old patient had her mandible reconstructed following wide resection of an ameloblastoma. Although a 2.0 LOCK reconstruction plate (Synthes GmbH, Oberdorf, Switzerland) was used for fixation of the fibular bone, the vertical deficiency between the reconstructed segment and the occlusal plane made oral rehabilitation impossible. To overcome this, the fibular bone segment was vertically distracted following a latency period of 4 days. Distractor was left in place for 20 weeks for bone consolidation. Following device removal implants were placed. The novelty of this approach included fixation of the lower arm of the distractor on the LOCK plate. The distractor was unidirectional with two arms of different length. The lower arm composed of a 2.0 mini-plate to fit exactly on the 2.0 LOCK plate whereas the upper arm used a standard 1.5 mini-plate. Advantages of this custom-made distractor included: (i) No need for removal of the reconstruction plate, (ii) no need for an extraoral surgical approach, and (iii) no need for additional drilling to fit the lower arm of the distractor. Technical details and limitations are presented. PMID:25593885

  19. Complications of mandibular distraction osteogenesis for congenital deformities: a systematic review of the literature and proposal of a new classification for complications.

    PubMed

    Verlinden, C R A; van de Vijfeijken, S E C M; Jansma, E P; Becking, A G; Swennen, G R J

    2015-01-01

    A systematic review of English and non-English language articles on the complications of mandibular distraction osteogenesis (MDO) for patients with congenital deformities was performed, in accordance with the PRISMA statement. Search terms expressing distraction osteogenesis were used in 'AND' combination with search terms comprising 'mandible' and terms for complication, failure, and morbidity. A search using PubMed (National Library of Medicine, NCBI), EMBASE, and the Cochrane Central Register of Controlled Trials yielded 644 articles published between 1966 and mid October 2013. Clinical articles that reported complications related to MDO were included. Finally 81 articles on MDO in congenital deformities were eligible and were screened in detail. Complications including minor infection (6.0%), device-related problems (7.3%), skeletal open bite (2.4%), hypertrophic scar formation (2.1%), facial nerve palsy (1.8%), neurosensory disturbances of the inferior alveolar nerve (1.9%), and (fibrous) non-union (0.7%) were seen. A new index for more detailed classification of complications in MDO is proposed based on six categories that indicate the impact of the complication and its further treatment or final results. The proposed complication index may be a useful tool to classify complications related to MDO. Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  20. Serial bone mineral density ratio measurement for fixator removal in tibia distraction osteogenesis and need of a supportive method using the pixel value ratio.

    PubMed

    Song, Sang-Heon; Agashe, Mandar; Kim, Tae-Young; Sinha, Shivam; Park, Young-Eun; Kim, Seung-Ju; Hong, Jin-Ho; Song, Sang-Youn; Song, Hae-Ryong

    2012-03-01

    Distraction osteogenesis is one of the common procedures for limb lengthening. However, attempts are being made constantly to establish objective guidelines for early and safe removal of a fixator using a sensitive and quantitative measurement technique. Dual-energy X-ray absorptiometry (DEXA) has been evaluated in the past for understanding callus stiffness, and the present study is a step further in this direction. The purpose of this study was to evaluate the correlation between bone mineral density ratio (BMDR) obtained by a DEXA scan and the pixel value ratio (PVR) on plain digital radiographs at each cortex and various callus pathways and callus shapes as described by Ru-Li's classification. A retrospective analysis of 40 tibial segments in 23 patients operated upon for various indications for limb lengthening was carried out. There were 11 male and 12 female patients with a mean age of 18 years. The Ilizarov method was applied after monofocal osteotomy, and distraction and consolidation were monitored using digital radiographs and DEXA scanning. BMDR was positively correlated with PVR, and the optimal BMDR for removal of the fixator was found to be 0.511. PVR of all cortices, except the anterior cortex, showed significant positive correlation with BMDR of the regenerate. There was good correlation between BMDR and PVR in the homogenous or heterogenous pathway according to callus shape and pathway. Thus, this study shows that BMD measurement can provide an objective and noninvasive method for assessing the rate of new bone formation during tibial distraction osteogenesis. It can thus function as an effective adjunct to measure callus stiffness, along with PVR, using digital radiographs, especially in cases in which callus maturation and stiffness is doubtful. Further studies especially dealing with callus progression through the lucent pathway as well as those dealing with regenerate fractures may be needed to conclusively prove the efficacy of this method

  1. Transport distraction osteogenesis as a method of reconstruction of the temporomandibular joint following gap arthroplasty for post-traumatic ankylosis in children: a clinical and radiological prospective assessment of outcome.

    PubMed

    Bansal, V; Singh, S; Garg, N; Dubey, P

    2014-02-01

    This clinical and radiographic study investigated the use of transport distraction osteogenesis in unilateral temporomandibular joint (TMJ) ankylosis patients. Six patients aged between 4 and 8 years were selected for the study; the mean preoperative maximal inter-incisal opening (MIO) was 3.5mm without lateral and protrusive mandibular movements. The ankylotic mass along with the posterior border of the ascending ramus was exposed via 'lazy-S' incision. A gap arthroplasty was performed, followed by a 'reverse L' osteotomy on the posterior border of the ramus. In-house manufactured extraoral distraction devices were used for this prospective study. Follow-up clinical and radiographic evaluation was carried out for 13-27 months after completion of the activation period. After a mean follow-up of 19 months, the mean MIO was 29.1mm and the lateral and protrusive movements changed from none to slight. Cone beam computed tomography images of all patients showed remodelled neocondyle created by transport distraction osteogenesis with no statistically significant differences observed for average cancellous bone density, trabecular number, and trabecular spacing between the neocondyle of the operated side (test) and the condyle of the non-operated side (control). Neocondyle formation by transport distraction osteogenesis using the in-house distraction device is a promising treatment option for TMJ reconstruction in ankylosis patients. Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  2. Appropriate indication of fronto-orbital advancement by distraction osteogenesis in syndromic craniosynostosis: Beyond the conventional technique.

    PubMed

    Satoh, Kaneshige; Mitsukawa, Nobuyuki; Kubota, Yoshitaka; Akita, Shinsuku

    2015-12-01

    Currently the distraction technique could be very useful for posterior expansion in syndromic craniosynostosis. Even for fronto-orbital advancement (FOA), it is thought that distraction has the definitive advantage over the conventional technique. The authors describe the appropriate indication of distraction for FOA in our series of craniosynostosis patients. Since 1998, FOA by distraction has been used for 61 cases of simple and syndromic craniosynostosis. Among these, seven severe cases were extracted with a conspicuous craniofacial deformity with a multiple honeycomb appearance in 3DCT views. Early surgery for FOA by distraction to the extent possible was performed and a retrospective study was conducted. Seven children were identified. All of them exhibited a severe craniofacial deformity. Pfeiffer syndrome in 5 children and clover-leaf skull in two unidentified children were diagnosed. Mean age at surgery for FOA by distraction ranged 10-18 months. Mean operative time: 3-3.5 h. Blood loss: 230-320 mL. The mean advancement by distraction: 20-27 mm. We conclude FOA by distraction when a large amount of advancement is required for early severe cases as our series can be definitely one of the most appropriate candidates beyond the conventional technique, despite disadvantages. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  3. Is it possible to change of the duration of consolidation period in the distraction osteogenesis with the repetition of extracorporeal shock waves?

    PubMed Central

    Bereket, Cihan; Sener, Ismail; Ozkan, Nilufer; Senel, Erman; Polat, Ahmet-Veysel

    2017-01-01

    Background In this study we examined the effects of two different repeated Extracorporeal Shock Waves (ESW) on the consolidation period of the distraction osteogenesis (DO) of the rabbit mandible using stereological, radiological and immunohistochemical methods. Material and Methods DO was performed unilaterally in the mandible of 18 New Zealand rabbits (six months old, weighing between 2.5-3 kg). In the consolidation period, rabbits were divided into three groups randomly after the distraction period. The distraction zone of the mandible was received no treatment as controls (E0*2). Group 2 (E 500*2) received ESWT (twice 500 impulses at 14 kV and 0.19 mJ/mm2 energy) in the first and fourth days of the consolidation. Group 3 (E1000*2) treated with ESWT (twice 1000 impulses at 14 kV and 0.19 mJ/mm2 energy) in the first and fourth days of the consolidation period. After the sacrification, radiologically bone mineral density, new bone formation, new fibrous tissue and new vessel formation were analyzed by stereological. Results It was found a statistically significant difference between the study groups and control group in the bone mineral density measurements and the highest value was in the E1000*2 group. In the stereological analysis, new bone formation was highest in the E1000*2 group and there was a significant difference compared to the other groups (E0*2 and E500*2) (p=0.000). The lowest connective tissue volume was found in the E500*2 and there was a significant difference compared to the other groups (E0*2 and E1000*2) (p=0.000). The volume of the new vessel was highest in the E500*2 and lowest in the E0*2 group. It was found statistically significant difference between the values of the study and control groups. Conclusions Interestingly, we found that repetition of the 1000 impulses ESWT accelerated the consolidation, 500 impulses ESWT extended consolidation period of the DO. Key words:Distraction osteogenesis, extracorporeal shock waves, stereology

  4. Distraction osteogenesis technique using an intramedullary nail and a monolateral external fixator in the reconstruction of massive postosteomyelitis skeletal defects of the femur

    PubMed Central

    Li, Zhihong; Zhang, Xiangsheng; Duan, Liqun; Chen, Xiaoming

    2009-01-01

    Background Large skeletal defects due to postosteomyelitis are uncommon, and they present a challenging reconstructive problem. The aim of our study was to summarize our experience performing a distraction osteogenesis technique using an intramedullary nail and a monolateral external fixator in the reconstruction of massive postosteomyelitis skeletal defects of the femur. Methods Between January 1998 and October 2004, 17 patients with massive postosteomyelitis skeletal defects of the femur (11 men and 6 women), underwent the reconstruction procedure. After osteotomy of diaphysis of the femur, we inserted an intramedullary nail into the femur, and we placed a monolateral external fixator with half-pins lateral to the nail. Lengthening was started on the seventh postoperative day at a rate of 1 mm/d. Once we achieved solid bone union, we removed the monolateral external fixator; the intramedullary nail remained for bone consolidation until reconsruction was complete. We assessed the outcomes clinically and radiographically at a mean of 70.3 months postoperatively. Results At follow-up (mean 70.3, range 14.0–96.0 mo), all the skeletal defects were filled, bone union at docking sites was achieved without bone graft and leg length discrepancies were less than 2.5 cm in all patients. The mean gain in length was 12.9 (range 10.2–18.4) cm. According to Paley and Maar's evaluation criteria, we graded the bone results as excellent for 10 patients, good for 5, fair for 1 and poor for 1. We graded the functional results as excellent for 12 patients, good for 4 and fair for 1. The mean external fixator index was 18.1 d/cm; the consolidation index was 35.7 d/cm. Ten patients experienced pin infection, and 1 patient experienced a recurrence of deep infection. There were no neurologic or vascular injuries. Conclusion Our study demonstrates that a distraction osteogenesis technique using an intramedullary nail and a monolateral external fixator is a reliable method for the

  5. Synergistic enhancement of new bone formation by recombinant human bone morphogenetic protein-2 and osteoprotegerin in trans-sutural distraction osteogenesis: a pilot study in dogs.

    PubMed

    Yao, Yusheng; Wang, Guijun; Wang, Zhiying; Wang, Chengyue; Zhang, Haizhong; Liu, Chunming

    2011-11-01

    The previous decade has witnessed increasing emphasis on the technique of trans-sutural distraction osteogenesis (TSDO), a new and challenging procedure to reconstruct deficiencies in craniomaxillofacial bone. The purpose of this study was to determine if locally administered recombinant human bone morphogenetic protein-2 (BMP-2)/Poly(lactic-co-glycolic acid)/Fibrin sealant and recombinant human osteoprotegerin recombinant OPG fusion protein improves osteoblastogenesis and new bone formation by TSDO. Thirty-two dogs were divided into 4 groups: control, BMP-2, OPG, or BMP-2 plus OPG. Two dogs from each group were sacrificed at 1, 2, 4, and 6 weeks after initiating the DO protocol. Immunohistochemical, histomorphometric, and electron microscopic assessments were performed to investigate the effects of BMP-2 or OPG induced by TSDO. The animals demonstrated significant overgrowth of the maxilla (control, 19.5 ± 2.61 mm; BMP-2, 19.9 ± 1.47 mm; OPG, 18.3 ± 1.2 mm; BMP-2 + OPG, 20.5 ± 2.65 mm). Histologically, the palatine suture widened dramatically within 2 weeks after distraction. Osteoblast number, trabecular thickness, content of alkaline phosphatase, and integrated optical density of BMP-2 increased obviously in the BMP-2 + OPG group (P < .05). TSDO in growing dogs is a safe, well-tolerated technology. The study found that OPG alone did not improve bone regeneration, but that it acted synergistically with BMP-2 to increase recruitment of mesenchymal stem cells and led to a significant enhancement of bone formation and healing. The temporal pattern of BMP-2 expression is consistent with a role in the regulation of mechanical and biological interventions designed to promote bone regeneration. Crown Copyright © 2011. Published by Elsevier Inc. All rights reserved.

  6. Modified internal mandibular distraction osteogenesis in the treatment of micrognathia secondary to temporomandibular joint ankylosis: 4-year follow-up of a case.

    PubMed

    Shang, Hongtao; Xue, Yang; Liu, Yanpu; Zhao, Jinlong; He, Lisheng

    2012-06-01

    Micrognathia and obstructive sleep apnoea syndrome (OSAS) are problems subsequent to temporomandibular joint ankylosis (TMJa) in growing patients. For patients with micrognathia and OSAS secondary to TMJa, it is important to restore proper mandibular form and dimension, achieve occlusal stability and recover satisfactory joint movement. We report a 4-year follow-up of a patient with micrognathia and OSAS secondary to bilateral TMJa. The treatment of this patient involved (1) a modified internal mandibular distraction osteogenesis without altering the pre-existing occlusion; (2) TMJ arthroplasty in which the dislocated disc was found and repositioned and the shape of the glenoid fossa and articular head was formed without removing bone in vertical dimension; (3) passive mouth-opening exercise with an individualized occlusal pad postoperatively for one month; and (4) orthodontic treatment for the occlusal disturbance and active mouth-opening exercise for one year. After the treatment the micrognathia was corrected; the oropharyngeal airway was increased significantly; mouth-opening increased to 40mm intraoperatively was maintained at 36.66mm 4 years after surgery. Satisfactory occlusion was achieved after orthodontic treatment. Through the 4-year follow-up, no signs of reankylosis were found. In conclusion, this new clinical protocol is a safe, effective and quick way to treat micrognathia and OSAS secondary to TMJa.

  7. Prediction of the articular eminence shape in a patient with unilateral hypoplasia of the right mandibular ramus before and after distraction osteogenesis-A simulation study.

    PubMed

    de Zee, Mark; Cattaneo, Paolo M; Svensson, Peter; Pedersen, Thomas K; Melsen, Birte; Rasmussen, John; Dalstra, Michel

    2009-05-29

    The aim of this work was to predict the shape of the articular eminence in a patient with unilateral hypoplasia of the right mandibular ramus before and after distraction osteogenesis (DO). Using a patient-specific musculoskeletal model of the mandible the hypothesis that the observed differences in this patient in the left and right articular eminence inclinations were consistent with minimisation of joint loads was tested. Moreover, a prediction was made of the final shape of the articular eminence after DO when the expected remodelling has reached a steady state. The individual muscle forces and the average TMJ loading were computed for each combination of articular eminence angles both before and after DO. This exhaustive parameter study provides a full overview of average TMJ loading depending on the angles of the articular eminences. Before DO the parameter study resulted in different articular eminence inclinations between left and right sides consistent with patient data obtained from CT scans, indicating that in this patient the articular eminence shapes result from minimisation of joint loads. The simulation model predicts development of almost equal articular eminence shapes after DO. The same tendency was observed in cone beam CT scans (NewTom) of the patient taken 6.5 years after surgery.

  8. Effects of locally applied nerve growth factor to the inferior alveolar nerve histology in a rabbit model of mandibular distraction osteogenesis.

    PubMed

    Wang, L; Zhao, Y; Cheng, X; Yang, Y; Liu, G; Ma, Q; Shang, H; Tian, L; Lei, D

    2009-01-01

    Distraction osteogenesis (DO) is widely used in deformities and defects of the craniofacial bone. Accelerating inferior alveolar nerve (IAN) recovery would aid the process. Nerve growth factor (NGF) plays a vital role in peripheral nerve regeneration. In this study, the ability of locally applied human NGF beta (hNGFbeta) to enhance the morphological recovery of the IAN in a rabbit model of mandibular DO was studied. Rabbits underwent bilateral DO with a rate of 0.5mm per 12h. Two doses of 40 microg hNGFbeta in buffer were injected into callus at the beginning the of consolidation time. The contralateral side received injections of placebo. Rabbits were killed at 14 and 28 days. IAN specimens were subjected to histological and histomorphometric analysis. In both 14 and 28 days consolidation experiments, nerve histological analysis showed less degeneration and more regeneration in nerve fibers on the hNGFbeta treated side than the control side. Histomorphometric analysis showed that the myelinated fiber density on the hNGFbeta treated side was significantly higher than on the control side (p<0.01). The data indicate that locally applied hNGFbeta can accelerate the morphological recovery of the IAN and may play a role in reducing nerve injury in mandibular DO clinically.

  9. The Use of a Bioadhesive (BioGlue®) Secured Conchal Graft and Mandibular Distraction Osteogenesis to Correct Pediatric Facial Asymmetry as Result of Unilateral Temporomandibular Joint Ankylosis

    PubMed Central

    Muhammad, Joseph Kamal; Al Hashimi, Bader Abdulla; Al Mansoor, Abu Bakr; Ali, Iqbal

    2013-01-01

    The rehabilitation of children affected by early traumatic facial deformity is a challenge for both the craniofacial team and the child's family. Although the immediate goals of surgery are to restore both form and function, the psychological needs of the growing child must also be addressed. Early surgery may be required to assist integration of the child into the community and thereby avert both social isolation and stigmatization of the child. Timed correctly, such surgery has the potential to harness the patient's own growth to assist in correction of the deformity and to maintain some of the surgical gains. The use of autogenous tissue rather than nondegradable implants to facilitate craniofacial reconstruction in the growing child avoids some of the concerns associated with permanent implants. These include both their potential to adversely affect growth and to migrate. The purpose of this article is to illustrate how advances in tissue adhesion using protein polymers (BioGlue®; CryoLife, Inc., Kennesaw, GA) and bone regeneration techniques (distraction osteogenesis) have been used to correct the disfiguring and functional problems associated with unilateral temporomandibular joint ankylosis acquired in early childhood. PMID:24436736

  10. [Treatment of defects of the long bones using distraction osteogenesis (Ilizarov) and intramedullary nailing. Theoretic principles, animal experiments, clinical relevance].

    PubMed

    Brunner, U; Kessler, S; Cordey, J; Rahn, B; Schweiberer, L; Perren, S M

    1990-06-01

    For large shaft defects of tibia and femur, distraction-compression osteosynthesis (Ilizarov) provides an ideal autologous bone graft. Combination of this with an intramedullary interlocking nail instead of an external fixator could improve patient comfort, because transport with a small external device takes only one-third of the total fixation period. Using 21 adult female sheep we created standardized tibia shaft defects 20 mm (medium size) and 45 mm (large size) in length. The tibiae were stabilized with non-reamed intramedullary interlocking nails. Following corticotomy by chisel, segments were transported using subcutaneous traction wires with a screw as a fulcrum to maintain stationary skin exit points without soft tissue problems. The external traction devices were removed after 12 or 16 weeks. Animals were sacrificed after 12 or 24 weeks with medium-size defects, and after 16 or 32 weeks with large defects. We evaluated the results clinically, by standardized weekly X-rays and, after sacrifice, by quantitative computed tomography (QCT). No animals had to be excluded from the study. Despite primary destruction of the intramedullary circulation all distraction gaps were spanned with bone. X-Rays showed typical signs of good quality of distraction bone regeneration (narrow radiolucent zone in the middle of the regenerate, longitudinal structure), continuous calcification, and cortex formation. QCT cross sections showed completely circular bone regeneration with small and large defects. Bone regeneration was faster on the dorsal side, where more bone was formed than ventrally. Small defects can remain ventrally in the regenerate; these close secondarily.(ABSTRACT TRUNCATED AT 250 WORDS)

  11. Distraction osteogenesis of the lower extremity with use of monolateral external fixation. A study of two hundred and sixty-one femora and tibiae.

    PubMed

    Noonan, K J; Leyes, M; Forriol, F; Cañadell, J

    1998-06-01

    We reviewed the results of distraction osteogenesis of 114 femora and 147 tibiae that had been lengthened to treat a variety of diagnoses. The femora had been lengthened an average of eleven centimeters (range, 3.5 to 17.0 centimeters), or 48 per cent (range, 8 to 86 per cent) of the original femoral length. The average total time for the treatment of the femora (use of the fixator and any subsequent immobilization) was 257 days (range, 105 to 420 days). There were 114 complications related to the femoral lengthenings, which led to eighty-seven additional operations. The tibiae were lengthened an average of nine centimeters (range, 3.0 to 15.6 centimeters), or 41 per cent (range, 9 to 100 per cent) of the original tibial length. The average total time for the treatment of the tibiae was 268 days (range, 110 to 497 days). There were 196 complications related to the tibial lengthenings, which led to 219 additional operations. The Achilles tendon was lengthened during or after seventy-three (50 per cent) of the tibial lengthenings. The femoral lengthenings that were performed to treat a limb-length discrepancy were associated with significantly higher rates of complications overall (p = 0.010) and additional operations (p = 0.023) for each percentage of length gained than those that were performed to treat achondroplasia or another skeletal dysplasia. The femoral lengthenings that were performed to treat short stature (of an endocrine or idiopathic etiology) were also associated with higher rates of complications overall and additional operations than those performed to treat skeletal dysplasias, but the rates were lower than those for lengthenings performed to treat limb-length discrepancy. The rate of complications overall associated with femoral lengthening in patients who were fourteen years old or more was significantly higher than that associated with lengthening in patients who were less than fourteen years old (p = 0.047). Femoral lengthening through the

  12. A surgical protocol of ankle arthrodesis with combined Ilizarov's distraction-compression osteogenesis and locked nailing for osteomyelitis around the ankle joint.

    PubMed

    Chen, Chuan-Mu; Su, Alvin W; Chiu, Fang-Yao; Chen, Tain-Hsiung

    2010-09-01

    Managing refractory osteomyelitis around the ankle joint has been challenging. Destruction of both the ankle and the subtalar joints was common in cases of open fracture. For those who already had multiple surgeries, it would be tough to salvage the limb. Our goal was to set up a staged surgical protocol aiming in treating the aforementioned clinical issue. Twelve male patients underwent our protocol since year 2000. All patients presented refractory osteomyelitis, ankle and subtalar joint destruction, and poor soft tissue condition. All cases had internal fixation for open fractures followed by multiple debridement surgery before. The mean age was 50.8 years (range, 37-71 years), and the median follow-up time was 61 months (range, 48-96 months). The surgical protocol consisted of radical debridement, distraction osteogenesis for segmental bone transport, and tibia lengthening to avoid leg length discrepancy followed by intramedullary nailing for tibio-talo-calcaneal arthrodesis. The external fixation period averaged 24.7 weeks (range, 12-36 weeks). The mean duration to solid union of the arthrodesis and the bridging callus was 18.3 weeks (range, 16-20 weeks). Mild surgical site infection occurred in four cases but all subsided after removal of the nail and oral antibiotics use. At latest follow-up, all patients were infection free and could walk with plantigrade feet. The mean American Orthopaedic Foot and Ankle Society hindfoot score rising from 21.5 points (range 20-24 points) preoperatively to 65.5 points (range, 60-72). This study has shown our staged surgical protocol may be effective in solving complicated osteomyelitis around the ankle, although salvaging the limb with successful ankle arthrodesis and minimized limb length inequality, yet improving the patients' ambulation level.

  13. Virtual reality surgical planning for maxillofacial distraction osteogenesis: the role of reverse engineering rapid prototyping and cooperative work.

    PubMed

    Robiony, Massimo; Salvo, Iolanda; Costa, Fabio; Zerman, Nicoletta; Bazzocchi, Massimo; Toso, Francesco; Bandera, Camillo; Filippi, Stefano; Felice, Martina; Politi, Massimo

    2007-06-01

    The purpose of this article is the demonstration of virtual reality (VR) and rapid prototyping (RP) in surgical planning in maxillofacial surgery. The authors emphasize the role of reverse engineering (RE) and RP, suggesting a model of cooperative work, with the interaction of maxillofacial surgeons, radiologists, and engineers. Data acquisition is performed using computed tomography. The 3D model is the result of RE practices based on image segmentation, and the real model is produced via stereolithography. Virtual simulations are performed on the 3D model obtained from image segmentation. All these stages require the interaction and collaboration of various experts: maxillofacial surgeons, radiologists, and RE and RP experts. VR and stereolithography models represent a new technology to help the surgeon who has to work in cooperation with engineers and radiologists to improve the results in surgical planning of maxillofacial distraction. When performing the VR simulation, surgeons and engineers operate together in order to optimize the exploitation of the instruments available. Both VR and RP, with different and complementary advantages and limitations, can improve surgical planning activities and this is particularly effective when dealing with complex anatomical structures in maxillofacial surgery.

  14. Distraction or orthognathic surgery for cleft lip and palate patients: which is better?

    PubMed

    Cheung, L K; Chua, Hannah Daile P

    2008-06-01

    Maxillary deformities of cleft lip and palate (CLP) can be treated by either conventional osteotomies (CO) or distraction osteogenesis (DO). Which one is better for CLP patients suffering from a moderate extent of maxillary hypoplasia? The aim of the study was to evaluate the treatment outcomes of CO and compared with DO in correction of moderate maxillary hypoplasia. The results showed that CLP patients receiving DO were more anxious and depressed during the first three months but became happier in the long-term. The nasalance of DO and CO was found to be similar. However, on the skeletal stability, DO was shown to be significantly more stable when compared with CO in the horizontal plane within the first six months and in vertical plane during the first three months and between 1-2 year.

  15. Alar Pinning in Rigid External Distraction for Midfacial Hypoplasia.

    PubMed

    Yu, Jenny L; Woo, Albert S

    2017-09-01

    Distraction osteogenesis with a rigid external distractor is a widely accepted treatment for midfacial hypoplasia. In this study, the authors introduce the utilization of alar pinning with the external halo distractor for maxillary advancement, in place of an oral splint. A retrospective chart review was conducted of 7 patients who successfully underwent distraction osteogenesis using the alar pinning technique. Midfacial hypoplasia was secondary to Crouzon syndrome (n = 4), Apert syndrome (n = 1), Pfeiffer syndrome (n = 1), or bacterial meningitis (n = 1). Three patients were managed with monobloc osteotomies, 2 with Le Fort III osteotomies, 1 with Le Fort III osteotomy and frontoorbital advancement, and 1 with Le Fort I osteotomy alone. Patient charts were analyzed for postoperative course and complications relating to the alar pins. Two patients had minor complications specifically related to the alar pins. One patient had concern for a mild skin infection at a pin site that resolved with oral antibiotics. The other patient had loosening of an alar pin, which did not require operative management. Retrospective chart review indicated that all patients were pleased with their results from the distraction, and no patients opted for further advancement. Utilization of alar pin sites for external distraction is a feasible and reasonable option for treatment of midfacial hypoplasia involving a Le Fort osteotomy or monobloc procedure. Fixation sites within the alar crease minimize the visibility of pin site scars and eliminate the need for a custom-made oral splint, which prevents usage of the upper dentition and frequently requires consulting a dentist or orthodontist for fabrication. Alar pinning with an external halo distraction system for management of midfacial hypoplasia has minimal complications and is an alternative to using a custom-made oral splint.

  16. Role of parathyroid hormone therapy in reversing radiation-induced nonunion and normalization of radiomorphometrics in a murine mandibular model of distraction osteogenesis

    PubMed Central

    Gallagher, K. Kelly; Deshpande, Sagar; Tchanque-Fossuo, Catherine N.; Donneys, Alexis; Sarhaddi, Deniz; Nelson, Noah S.; Chepeha, Douglas B.; Buchman, Steven R.

    2014-01-01

    Background The use of mandibular distraction osteogenesis (MDO) for tissue replacement after oncologic resection or for defects caused by osteoradionecrosis has been described but, in fact, has seen limited clinical utility. Previous laboratory work has shown that radiation (XRT) causes decreased union formation, decreased cellularity, and decreased mineral density in an animal model of MDO. Our global hypothesis is that radiation-induced bone damage is partly driven by the pathologic depletion of both the number and function of osteogenic cells. Parathyroid hormone (PTH) is a U.S. Food and Drug Administration-approved anabolic hormonal therapy that has demonstrated efficacy for increasing bone mineral density for the treatment of osteoporosis. We postulate that intermittent systemic administration of PTH will serve as an anabolic stimulant to cellular function that will act to reverse radiation-induced damage and enhance bone regeneration in a murine mandibular model of DO. Methods A total of 20 isogenic male Lewis rats were randomly assigned into 3 groups. Group 1 (XRT-DO, n = 7) and group 2 (XRT-DO-PTH, n = 5) received a human bioequivalent dose of 70 Gy fractionated over 5 days. All groups including group 3 (DO, n = 8) underwent a left unilateral mandibular osteotomy with bilateral external fixator placement. Four days later, mandibular DO was performed at a rate of 0.3 mm every 12 hours to reach a maximum gap of 5.1 mm. Group 2 was injected PTH (60 μg/kg) subcutaneously daily for 3 weeks following the start of MDO. On postoperative day 41, all left hemimandibles were harvested. Micro-CT at 45-μm voxel size was performed and radiomorphometrics parameters of bone mineralization were generated. Union quality was evaluated on a 4-point qualitative grading scale. Radiomorphometric data were analyzed using 1-way ANOVA, and union quality assessment was analyzed via the Mann–Whitney test. Statistical significance was considered at p ≤ .05. Results Groups 1 and 2

  17. Lower Face Asymmetry: Can We Distract the Mandibular Lower Border?

    PubMed

    Rao, Santhosh; Rao, Sruthi

    2015-12-01

    Orthognathic surgery and alloplastic grafting are the main stay in management in hemifacial microsomia. Distraction osteogenesis is used to increase the ramus and corpus length in the management, but here we have described a technique to increase the height of the body of the mandible using the principles of basal osteotomy and distraction osteogenesis.

  18. Early, computer-Aided Design/Computer-Aided Modeling Planned, Le Fort I Advancement With Internal Distractors to Treat Severe Maxillary Hypoplasia in Cleft Lip and Palate.

    PubMed

    Chang, Catherine S; Swanson, Jordan; Yu, Jason; Taylor, Jesse A

    2017-04-11

    Traditionally, maxillary hypoplasia in the setting of cleft lip and palate is treated via orthognathic surgery at skeletal maturity, which condemns these patients to abnormal facial proportions during adolescence. The authors sought to determine the safety profile of computer-aided design/computer-aided modeling (CAD/CAM) planned, Le Fort I distraction osteogenesis with internal distractors in select patients presenting at a young age with severe maxillary retrusion. The authors retrospectively reviewed our "early" Le Fort I distraction osteogenesis experience-patients performed for severe maxillary retrusion (≥12 mm underjet), after canine eruption but prior to skeletal maturity-at a single institution. Patient demographics, cleft characteristics, CAD/CAM operative plans, surgical complications, postoperative imaging, and outcomes were analyzed. Four patients were reviewed, with a median age of 12.8 years at surgery (range 8.6-16.1 years). Overall mean advancement was 17.95 + 2.9 mm (range 13.7-19.9 mm) with mean SNA improved 18.4° to 87.4 ± 5.7°. Similarly, ANB improved 17.7° to a postoperative mean of 2.4 ± 3.1°. Mean follow-up was 100.7 weeks, with 3 of 4 patients in a Class I occlusion with moderate-term follow-up; 1 of 4 will need an additional maxillary advancement due to pseudo-relapse. In conclusion, Le Fort I distraction osteogenesis with internal distractors is a safe procedure to treat severe maxillary hypoplasia after canine eruption but before skeletal maturity. Short-term follow-up demonstrates safety of the procedure and relative stability of the advancement. Pseudo-relapse is a risk of the procedure that must be discussed at length with patients and families.

  19. Evaluating Loading Deflection of Distraction Osteogenic Rib in a Rabbit Model.

    PubMed

    Shen, Weimin; Tang, Chenlu; Yang, Junyi; Kong, Liangliang; Zhang, Xiaoying

    2016-10-01

    The treatment of patients with partially atrophic rib and rib defects requires an ideal arc of the rib that has adequate bone length and width. To design and assemble a distraction device with a strain gauge, we need to establish an animal model for testing it during rib distraction osteogenesis. Osteotomies were performed at the same position in the fifth rib in 8 rabbits. Customized distraction devices attached to strain gauges were used to distract the ribs. After a month of distraction and consolidation, loading deflection gauges were used, and specimens were examined histologically to record bone formation. Distraction osteogenesis was carried out successfully in all rabbits when the device used to distract the rib up to 4 cm. The device can be used for strain testing during rib distraction osteogenesis performed in a rabbit model. There was no significant difference in the loading deflection gauges of the bone between osteogenic and contralateral ribs. This animal model of costal distraction osteogenesis is successful.

  20. Unfavourable results with distraction in craniofacial skeleton

    PubMed Central

    Agarwal, Rajiv

    2013-01-01

    Distraction osteogenesis has revolutionised the management of craniofacial abnormalities. The technique however requires precise planning, patient selection, execution and follow-up to achieve consistent and positive results and to avoid unfavourable results. The unfavourable results with craniofacial distraction stem from many factors ranging from improper patient selection, planning and use of inappropriate distraction device and vector. The present study analyses the current standards and techniques of distraction and details in depth the various errors and complications that may occur due to this technique. The commonly observed complications of distraction have been detailed along with measures and suggestions to avoid them in clinical practice. PMID:24501455

  1. Osteogenesis imperfecta

    MedlinePlus

    ... this page: //medlineplus.gov/ency/article/001573.htm Osteogenesis imperfecta To use the sharing features on this page, please enable JavaScript. Osteogenesis imperfecta is a condition causing extremely fragile bones. Causes ...

  2. [The effect of mandibular distraction on the maxilla growth in children with hemifacial microsomia].

    PubMed

    Yang, Renkai; Tang, Xiaojun; Shi, Lei; Yin, Lin; Yang, Bin; Yin, Hongyu; Liu, Wei; Zhang, Zhiyong

    2014-11-01

    To analyze the effect of mandibular distraction on the maxilla growth in children with hemifacial microsomia through measurement with the posterior-anterior cephalometric X-ray films and Three-dimensional CT reconstruction images. The deviation angular of maxilla occlusion plane and nasal base plane from the infra-orbital plane were measured on the posterior-anterior cephalometric X-ray films in 22 patients before and half a year after operation. The vertical distance from the midpoint of 5th teeth alveolar and the lowest point of maxillary sinus to reference plane were measured on 3D reconstruction images in 15 patients. The data were statistically analyzed. On posterior-anterior cephalometric X-ray films, the cant of occlusion plane were significantly reduced (P < 0.05), While the angular of nasal base plane and the infra-orbital plane had no significant change. On 3D reconstruction images, all the detection points had significantly declined except the lowest point of maxillary sinus on normal side. Distraction osteogenesis of mandible can promote the growth of the maxilla in children with HFM, the accelerated growth parts include alveolar bone and maxillary sinus.

  3. Functional changes following distraction osteogenesis treatment of asymmetric mandibular growth deviation in unilateral juvenile idiopathic arthritis: a prospective study with long-term follow-up.

    PubMed

    Nørholt, S E; Pedersen, T K; Herlin, T

    2013-03-01

    In juvenile idiopathic arthritis (JIA), temporomandibular joint involvement is a frequent complication leading to deficient mandibular growth. Occurring unilaterally this will give rise to mandibular and maxillary asymmetry that will affect the soft tissue and the muscles and result in complex dentofacial anomaly. In the case of severe dentofacial malformation, orthognathic surgery is the only treatment option. Vertical osseodistraction of the mandibular ramus has been suggested as a means of rectifying the mandibular growth deviation and soft-tissue problems. Whether such treatment introduces dysfunctional side effects of the temporomandibular joint and muscles has been debated and concern has been raised that treatment impairs the patient's mouth opening capacity and mandibular movement. The present study prospectively evaluated 23 patients with JIA and mandibular asymmetry caused by unilateral temporomandibular joint arthritis. The authors found a clinical effect on the asymmetry with only minor subjective complaints and limited objective changes in functional parameters.

  4. New Technique for Mandibular Symphyseal Distraction by a Double-Level Anchorage and Fixation System: Advantages and Results.

    PubMed

    Carlino, Franco; Pantaleo, Giuseppe; Ciuffolo, Fabio; Claudio, Pier Paolo; Cortese, Antonio

    2016-09-01

    A surgical technique to widen the mandible is the mandibular midline distraction: the most common indications for mandibular midline distraction are severe mandibular anterior crowding, severe mandibular transverse deficiency, uni- or bilateral crossbite, impacted anterior teeth with inadequate space, and tipped teeth. Commonly used distraction devices can be divided into 2 systems: bone-borne distraction system appliance, dental-borne distraction systems. Each system has peculiar advantages, disadvantages, and different indications. To combine advantages of both systems we developed a new technique adopting an immediate basal bone widening with fixation after osteotomy and a dental borne rigid lingual system for distraction. The aim of this work is to show a new technique for symphysis mandibular distraction based on a double-level anchorage and fixation system on clinical patients showing final results and advantages. Two patients affected by dento-alveolar and basal bone maxillary and mandibular transversal collapse even in association with other skeletal malocclusion were selected. Patients were clinically and radiographically studied and analyzed at different times before and after surgery. Dental and basal bone measurements were performed clinically and radiographically. The results were optimal with perfect dental arches alignment followed by closing of the open bites with multiple-segmented surgery in a second surgical time. No misalignment of the 2 mandibular halves was noticed during the distraction procedure. Dental-bone discrepancies correction is mandatory before orthodontic treatment alignment. Transversal jaw expansion can be achieved safely and stably by distraction of both maxillae for the combination of osteogenesis and histogenesis with augmentation of both bone and soft tissue. Bone-borne distraction will result in more stable results; dental-borne devices will result in more simple and aesthetically rewarding procedures. Hybrid techniques

  5. Learning about Osteogenesis Imperfecta

    MedlinePlus

    ... genetic terms used on this page. Learning About Osteogenesis Imperfecta What is Osteogenesis imperfecta? What are the symptoms ... imperfecta Additional Resources on Osteogenesis imperfecta What is Osteogenesis imperfecta? Osteogenesis imperfecta (OI) is a genetic disorder that ...

  6. Weight-bearing alters the expression of collagen types I and II, BMP 2/4 and osteocalcin in the early stages of distraction osteogenesis.

    PubMed

    Radomisli, T E; Moore, D C; Barrach, H J; Keeping, H S; Ehrlich, M G

    2001-11-01

    This study was performed to investigate the effect of loading on the biology of newly forming bone during limb lengthening. Unilateral 2.0 mm femoral lengthenings were performed in 20 male Sprague Dawley rats. Half (n = 10) of the animals were allowed to bear weight freely, while the other half were prevented from weight-bearing via an ipsilateral through-knee amputation. The animals in each group were sacrificed after one (n = 5) or four (n = 5) days of consolidation (post-operative days seven and 10, respectively). In situ hybridization for osteocalcin and collagen I, and antibody staining for collagen II and BMP 2/4 were used to evaluate the molecular influence of loading. There was more new bone in the distraction gap of the weight-bearing animals than there was in the non-weight-bearing animals. BMP 2/4 expression, and the messages for collagen I and osteocalcin, were more abundant in tissue from the weight-bearing animals; collagen II was higher in the non-weight-bearing animals. This suggests that early regenerate tissue is capable of responding to loading, and that weight-bearing appears to stimulate intramembranous ossification. These findings support the concept of early weight-bearing after limb lengthening.

  7. Coronal suturectomy through minimal incisions and distraction osteogenesis are enough without other craniotomies for the treatment of plagiocephaly due to coronal synostosis.

    PubMed

    Tellado, Manuel Gómez; Lema, Ana

    2009-11-01

    In the last few years, many surgeons have tried to reduce the damage produced during surgical approaches by trying to apply the principles of minimal invasive surgical techniques in every type of surgery. Some endoscopic techniques, added to orthopedic mechanisms, allow us to reduce the size of the incisions needed for the craniosynostosis surgery. We present a conservative surgical option in the treatment of one frequent craniofacial malformation due to synostosis: plagiocephaly due to coronal synostosis. We have operated on 10 patients with unilateral coronal synostosis. In all cases, a unique craniotomy, just in the coronal suture, was made without other accessory craniotomies. Mobilization of the frontal bone was not done at time of surgery, but it was done slowly with a distractor device later. All the patients were younger than 14 months, and the minimum follow-up has been 1 year after the operative course, and in all the patients, the anthropometric results were satisfactory both for the families and the medical team.The treatment of coronal synostosis can be made with both a simple coronal suturectomy, using small incisions under endoscopic control, and the application of a unidirectional bone distraction system. An orthopedic helmet can help to gain better results for reshaping a patient's cranial vault, during the last part of the postoperative period.

  8. Application of a newly designed mandibular distraction device for navigation surgery in goats.

    PubMed

    Cai, Ming; Chen, Yang; Lu, Xiaofeng; Xu, Lei; Wang, Xudong; Shen, Guofang

    2017-10-01

    This animal study is to investigate the accuracy of navigation-guided mandibular distraction osteogenesis with a special designed distraction device by TBNavis-CMFS navigation system. Four goats were included in this study. The 3D simulation unilateral mandibular distraction osteogenesis was simulated for 14 mm lengthening in TBNavis-CMFS navigation system. A new designed mandibular distraction device with the detachable adapter for navigation surgery in combination with the specific mandibular dynamic reference frame was applied. Navigation guided distraction osteogenesis was performed on goats and mandible was gradually distracted according to the simulation. Postsurgical 3-D skeletal measurements of presurgical simulations and postsurgical outcomes were compared statistically. Navigation assisted distraction osteogenesis was successfully performed and the new designed distraction devices worked uneventful. The accuracy of intra-operative registration was within 1 mm. The mandible was lengthened for 14.25 mm in average (13.87-14.36 mm). There were no significant differences between simulation distraction and post-operative 3-D measurements (p > 0.05). A new designed distraction device could be used in navigation guided mandibular distraction osteogenesis on goats with high accuracy by using the TBNavis-CMFS navigation system. Copyright © 2017. Published by Elsevier Ltd.

  9. A Comparative Study of Canine Retraction by Distraction of the Periodontal Ligament and Dentoalveolar Distraction Methods.

    PubMed

    Kateel, Shashidhara Kamath; Agarwal, Amit; Kharae, Gagan; Nautiyal, Vijay Prakash; Jyoti, Anant; Prasad, P Narayana

    2016-06-01

    Canine distraction was introduced as an alternative treatment to retract the canines in minimum possible period of 3 weeks. It involved rapid canine retraction through distraction of the periodontal ligament. Another technique for rapid canine distalization involved osteotomies surrounding the canines to achieve rapid movement of the canines in the dentoalveolar segment known as dentoalveolar distraction. The present study is intended to assess and evaluate canine retraction by the above two mentioned methods of distraction osteogenesis. Eight orthodontic patients who required first premolar extractions were selected and 16 canines were distracted into the extraction space, using a distraction screw. The distraction procedure was completed in 15.38 ± 1.51 days on the side of periodontal ligament distraction while it took 14.50 ± 2.45 days on the side of dentoalveolar distraction. No significant anchorage loss was seen in both the sides. The distal displacement of the canines was 6.63 ± 0.90 mm on the periodontal distraction side at the rate of 0.43 ± 0.05 mm/day and 6.91 ± 1.16 mm on the side of dentoalveolar distraction at the rate of 0.48 ± 0.08 mm/day. An angulation change of 14.94° ± 7.58° was observed in canine inclination in periodontal distraction side while change of 14.88° ± 3.15° was seen in the dentoalveolar distraction side. No significant differences in the various parameters were found between both the techniques of canine retraction by distraction osteogenesis, while reducing orthodontic treatment duration by 6-9 months without any unfavorable short-term effects on the periodontium.

  10. The Marine Sponge-Derived Inorganic Polymers, Biosilica and Polyphosphate, as Morphogenetically Active Matrices/Scaffolds for the Differentiation of Human Multipotent Stromal Cells: Potential Application in 3D Printing and Distraction Osteogenesis

    PubMed Central

    Wang, Xiaohong; Schröder, Heinz C.; Grebenjuk, Vladislav; Diehl-Seifert, Bärbel; Mailänder, Volker; Steffen, Renate; Schloßmacher, Ute; Müller, Werner E. G.

    2014-01-01

    , supplemented with polyP and/or biosilica, is a suitable biomaterial that promotes the growth and differentiation of hMSCs and might be beneficial for application in 3D tissue printing of hMSCs and for the delivery of hMSCs in fractures, surgically created during distraction osteogenesis. PMID:24566262

  11. The marine sponge-derived inorganic polymers, biosilica and polyphosphate, as morphogenetically active matrices/scaffolds for the differentiation of human multipotent stromal cells: potential application in 3D printing and distraction osteogenesis.

    PubMed

    Wang, Xiaohong; Schröder, Heinz C; Grebenjuk, Vladislav; Diehl-Seifert, Bärbel; Mailänder, Volker; Steffen, Renate; Schloßmacher, Ute; Müller, Werner E G

    2014-02-21

    , supplemented with polyP and/or biosilica, is a suitable biomaterial that promotes the growth and differentiation of hMSCs and might be beneficial for application in 3D tissue printing of hMSCs and for the delivery of hMSCs in fractures, surgically created during distraction osteogenesis.

  12. Osteogenesis imperfecta.

    PubMed

    Marini, Joan C; Forlino, Antonella; Bächinger, Hans Peter; Bishop, Nick J; Byers, Peter H; Paepe, Anne De; Fassier, Francois; Fratzl-Zelman, Nadja; Kozloff, Kenneth M; Krakow, Deborah; Montpetit, Kathleen; Semler, Oliver

    2017-08-18

    Skeletal deformity and bone fragility are the hallmarks of the brittle bone dysplasia osteogenesis imperfecta. The diagnosis of osteogenesis imperfecta usually depends on family history and clinical presentation characterized by a fracture (or fractures) during the prenatal period, at birth or in early childhood; genetic tests can confirm diagnosis. Osteogenesis imperfecta is caused by dominant autosomal mutations in the type I collagen coding genes (COL1A1 and COL1A2) in about 85% of individuals, affecting collagen quantity or structure. In the past decade, (mostly) recessive, dominant and X-linked defects in a wide variety of genes encoding proteins involved in type I collagen synthesis, processing, secretion and post-translational modification, as well as in proteins that regulate the differentiation and activity of bone-forming cells have been shown to cause osteogenesis imperfecta. The large number of causative genes has complicated the classic classification of the disease, and although a new genetic classification system is widely used, it is still debated. Phenotypic manifestations in many organs, in addition to bone, are reported, such as abnormalities in the cardiovascular and pulmonary systems, skin fragility, muscle weakness, hearing loss and dentinogenesis imperfecta. Management involves surgical and medical treatment of skeletal abnormalities, and treatment of other complications. More innovative approaches based on gene and cell therapy, and signalling pathway alterations, are under investigation.

  13. Osteogenesis Imperfecta Foundation

    MedlinePlus

    ... Better Bones Upcoming Events Online Store What is Osteogenesis Imperfecta? Osteogenesis Imperfecta (OI) is a genetic bone disorder ... known as "brittle bone disease." Learn More The Osteogenesis Imperfecta Foundation The OI Foundation provides medically verified information ...

  14. Systemic administration of lithium improves distracted bone regeneration in rats.

    PubMed

    Wang, Xuemei; Zhu, Songsong; Jiang, Xiaowen; Li, Yunfeng; Song, Donghui; Hu, Jing

    2015-06-01

    Lithium, popular in psychology field, has been recognized as an activator component of the canonical Wnt signaling pathway. The effect of lithium on osteogenesis or on the human fracture risk has been widely reported. However, little is known on its role in distraction osteogenesis to date. In this study, the effect of systematic administrated lithium on distraction osteogenesis in a rat model was investigated. The osteotomy was performed on the right tibia in 40 adult male Sprague-Dawley rats. Then they were randomly assigned into two equal groups (n = 20/group), which underwent Lithium or saline treatment through gastric gavage until the day they were killed. One week after the osteotomy, the tibias were distracted for 14 days (rate 0.6 mm/day). Following 8 weeks consolidation period, the distracted tibias in both groups were harvested and examined by X-ray plain radiography, histology, dual-energy X-ray absorptiometry, Micro-CT, and biomechanical tests. The results showed that lithium group possessed higher bone mineral density, more mature new bone tissue, and better regenerated bone mass continuity in the distraction gaps without any local or systemic adverse effects was encountered. This study suggested lithium could increase bony callus ossification volume and accelerate distracted tissue mineralization to facilitate bone regeneration in distraction gap.

  15. Distracted Driving

    MedlinePlus

    ... other distractions. 3 At 55 mph, the average text takes your eyes off the road long enough ... risk behaviors among high school students, including sending texts while driving. 6,7 In 2013, more than ...

  16. Evaluating Loading Deflection of Distraction Osteogenic Rib in a Rabbit Model

    PubMed Central

    Shen, Weimin; Tang, Chenlu; Yang, Junyi; Kong, Liangliang

    2016-01-01

    Background: The treatment of patients with partially atrophic rib and rib defects requires an ideal arc of the rib that has adequate bone length and width. To design and assemble a distraction device with a strain gauge, we need to establish an animal model for testing it during rib distraction osteogenesis. Methods: Osteotomies were performed at the same position in the fifth rib in 8 rabbits. Customized distraction devices attached to strain gauges were used to distract the ribs. After a month of distraction and consolidation, loading deflection gauges were used, and specimens were examined histologically to record bone formation. Results: Distraction osteogenesis was carried out successfully in all rabbits when the device used to distract the rib up to 4 cm. Conclusions: The device can be used for strain testing during rib distraction osteogenesis performed in a rabbit model. There was no significant difference in the loading deflection gauges of the bone between osteogenic and contralateral ribs. This animal model of costal distraction osteogenesis is successful. PMID:27826456

  17. Orthodontic spring guidance of bilateral mandibular distraction in rabbits.

    PubMed

    Yen, S L; Shang, W; Shuler, C; Yamashita, D D

    2001-10-01

    Although distraction osteogenesis can lengthen congenitally small mandibles, the distraction procedure can be difficult to control. To study the efficacy and safety of orthodontic spring guidance on bilateral mandibular distraction, an 8-mm anterior open bite was experimentally produced and corrected during bilateral mandibular distraction in rabbits. Orthodontic springs were attached to the anterior maxilla and mandible to redirect an ongoing distraction procedure. Sixteen rabbits underwent mandibular distraction: 6 rabbits received heavy springs (8 oz), 6 rabbits received light force springs (2 oz), and 4 rabbits served as control animals with anterior open bites without spring guidance. Nickel-titanium springs were applied during the last week of osseous distraction and the first week of consolidation. Distractors were left in place throughout a 2-month consolidation period. None of the animals developed fibrous union as a result of spring guidance. The 8-mm open bite did not close in the control group or in the light spring group after 2 weeks of spring wear or during the consolidation period. Heavy springs completely closed the experimental open bites within 2 weeks (P <.01, analysis of variance). Bite corrections did not change during the consolidation period. This study indicated that the addition of an orthodontic spring to a mandibular distraction procedure did not impair bone healing. With the distraction device in place, heavy spring forces redirected an ongoing mandibular distraction procedure and corrected an open bite, distraction side effect. Direct measurements, radiographic measurements, and tissue histologic factors described changes in segment position and shape of the distraction site.

  18. [Osteogenesis imperfecta].

    PubMed

    Hamuy, J; Nissen Abente, J C; Rolón Arámbulo, P R; Campuzano de Rolón, A E

    1976-01-01

    Our clinical files on osteogenesis imperfecta are brought up-to-date reviewing a total of 33,555 cases admitted between 4/XII/48 and 31/VIII/76. From these, 5 clinical cases were found. The extreme rareness of this regional pathology in our Cátedra y Sericio de Pediatría, which is the largest concentration center in Paraguay had led us to make this publication. From our casuistics, we may single out a three-month-old infant which would be a case of congenital osteogenesis imperfecta. The remaining 4 would correspond to cases of late osteogenesis imperfecta. Generalized osteoporosis was present in 3 patients and all of them showed blue sclera the same as fractures of femur. Fractures of radius, tibia and fibula were seen in 2 cases. The humerus was fractured in one patient and the ulna in another one. Three patients were under one year old, another one was on his second year and the last one was a school ager. An audiologic examination was normal in the nine-year-old patient. In the other 4 cases, it was not possible to carry out such test.

  19. Osteogenesis imperfecta.

    PubMed

    Forlino, Antonella; Marini, Joan C

    2016-04-16

    Osteogenesis imperfecta is a phenotypically and molecularly heterogeneous group of inherited connective tissue disorders that share similar skeletal abnormalities causing bone fragility and deformity. Previously, the disorder was thought to be an autosomal dominant bone dysplasia caused by defects in type I collagen, but in the past 10 years discoveries of novel (mainly recessive) causative genes have lent support to a predominantly collagen-related pathophysiology and have contributed to an improved understanding of normal bone development. Defects in proteins with very different functions, ranging from structural to enzymatic and from intracellular transport to chaperones, have been described in patients with osteogenesis imperfecta. Knowledge of the specific molecular basis of each form of the disorder will advance clinical diagnosis and potentially stimulate targeted therapeutic approaches. In this Seminar, together with diagnosis, management, and treatment, we describe the defects causing osteogenesis imperfecta and their mechanism and interrelations, and classify them into five groups on the basis of the metabolic pathway compromised, specifically those related to collagen synthesis, structure, and processing; post-translational modification; folding and cross-linking; mineralisation; and osteoblast differentiation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Mandibular distraction force: laboratory data and clinical correlation.

    PubMed

    Robinson, R C; O'Neal, P J; Robinson, G H

    2001-05-01

    In vitro data were collected to measure torque-force values of an internal distraction device. The measurements were correlated with in vivo torque readings in an attempt to better understand the force required to distract the osteogenic bone callus of the human mandible during distraction osteogenesis. Five internal craniofacial distraction devices were mounted on an apparatus to test load limits and torque measurements. The apparatus aligned the devices so that weight provided a force opposite and parallel to the vector of distraction. Weights were added in 5-lb increments, and the devices were activated 0.5 mm for each torque reading. Torque readings were obtained from a calibrated torque wrench. Measurements were plotted on a graph and correlated with clinical torque readings obtained from 8 patients undergoing mandibular lengthening. The average torque for distracting the human mandible 0.5 mm twice a day was 4.2 +/- 1.6 Newton-centimeters (N-cm). The average slope of the in vitro data shows that 4.2 N-cm of torque is equivalent to a force of 35.6 N. The average force of device failure was 235.8 N. Torque-force diagrams offer an effective means for calibrating safety margins and load capabilities for internal distraction devices. Quantification of axial forces encountered in mandibular lengthening will help contribute to the overall understanding and biomechanics of mandibular distraction osteogenesis. Copyright 2001 American Association of Oral and Maxillofacial Surgeons

  1. Multivectorial, external halo-assisted midface distraction in patients with severe hypoplasia.

    PubMed

    Malagon, Hector Hidalgo; Romo, Gabriela Wong; Quintero Mosqueda, Francisco Rafael; Magaña, Fernando Gonzalez

    2008-11-01

    Osteogenesis distraction is an increasingly used technique for the correction of facial deformities because it offers a faster and more controlled growth of the hypoplasic bone along with the elongation of the soft tissues. In this article, we describe the technique and our experience in midface distraction using an external multivectoral distraction device (BLUE Device; W. Lorenz, Jacksonville, FL) and custom-made midface osteotomies for the correction of severe hypoplasia.

  2. Deadly distractions.

    PubMed

    Zuzek, Crystal

    2013-04-01

    In 2011, the National Transportation Safety Board urged all states to ban the use of portable electronic devices while driving, including hand-held and hands-free devices. Texting while driving concerns several Texas legislators, who have filed bills, backed by the Texas Medical Association, to ban the practice. TMA physicians recognize that the use of hand-held and hands-free devices and other factors associated with distracted driving affect their patients' safety.

  3. Osteogenesis Imperfecta Issues: Constipation

    MedlinePlus

    ... Constipation is a problem for some people with osteogenesis imperfecta. Constipation is defined as a decrease in frequency ... to a more serious problem called rectal prolapse. Osteogenesis Imperfecta Foundation • 804 W. Diamond Ave, Suite 210 • Gaithersburg, ...

  4. Sternoplasty and rib distraction in neonatal Jeune syndrome.

    PubMed

    Conroy, Eimear; Eustace, Nicholas; McCormack, Damian

    2010-09-01

    A 12-week-old boy with Jeune syndrome (asphyxiating thoracic dystrophy) was referred to the orthopaedic unit with progressive respiratory failure, recurrent respiratory tract infections, and recurrent admissions to the intensive care unit for ventilatory support. His chest x-ray revealed a small and narrow thoracic cage with short broad ribs and abnormal costal cartilages. His chest expansion was impaired by the short, horizontally positioned ribs resulting in alveolar hypoventilation. Without surgical intervention to expand his thoracic cage, he would die of respiratory failure. Using the technique of distraction osteogenesis, we split his sternum and slowly expanded this split to a total of 3 cm using a Leibinger mid-face distractor allowing adequate wound healing and bone formation between the 2 sternal edges. He returned to the theater 4 weeks after his initial surgery to have the distractor removed and 2 Leibinger plates inserted to hold the sternum out to length. Sternal distraction was repeated and the sternum was then supplemented with a Leibinger mesh. At 8 months, he had successful expansion of his ribs bilaterally using this technique of distraction osteogenesis. Presently, the patient is 30 months old and is living at home, is not oxygen dependent, and continues to thrive. Jeune syndrome presenting with respiratory failure in the neonate is fatal without surgical intervention to expand the thoracic cage. No successful surgical techniques have been described in the literature for neonates. This is the first case in which distraction osteogenesis has been used to distract both sternum and ribs in an infant with Jeune syndrome. Hence, distraction osteogenesis in thoracic dystrophy is a novel approach in the neonate. Case report.

  5. Uncoupled angiogenesis and osteogenesis in nicotine-compromised bone healing.

    PubMed

    Ma, Li; Zheng, Li Wu; Sham, Mai Har; Cheung, Lim Kwong

    2010-06-01

    Nicotine is the main chemical component responsible for tobacco addiction. This study aimed to evaluate the influence of nicotine on angiogenesis and osteogenesis and the associated expression of angiogenic and osteogenic mediators during bone healing. Forty-eight adult New Zealand White rabbits were randomly assigned to a nicotine group and a control group. Nicotine pellets (1.5 g, 60-day time release) or placebo pellets were implanted in the neck subcutaneous tissue. The nicotine or placebo exposure time for all the animals was 7 weeks. Unilateral mandibular distraction osteogenesis was performed. Eight animals in each group were euthanized on day 5, day 11 of active distraction, and week 1 of consolidation, respectively. The mandibular samples were subjected to radiographic, histologic, immunohistochemical, and real-time reverse-transcriptase polymerase chain reaction examinations. Nicotine exposure upregulated the expression of hypoxia inducible factor 1alpha and vascular endothelial growth factor and enhanced angiogenesis but inhibited the expression of bone morphogenetic protein 2 and impaired bone healing. The results indicate that nicotine decouples angiogenesis and osteogenesis in this rabbit model of distraction osteogenesis, and the enhanced angiogenesis cannot compensate for the adverse effects of nicotine on bone healing.

  6. Orthopedic intrusion of premaxilla with distraction devices before alveolar bone grafting in patients with bilateral cleft lip and palate.

    PubMed

    Liou, Eric Jein-Wein; Chen, Philip K T; Huang, C Shing; Chen, Y Ray

    2004-03-01

    Surgical repositioning of the downward displaced premaxilla in bilateral cleft lip and palate patients remains a controversial and perplexing issue because of its detrimental effects on the growth of the premaxilla. The purpose of this prospective clinical study was to introduce and evaluate the treatment results of an innovative technique for nonsurgically intruding the downward displaced premaxilla. Eight consecutive cases of bilateral cleft lip and palate at the age of mixed dentition were included for the correction of their premaxillary deformities. A pair of intraoral tooth-borne distraction devices was used for the orthopedic intrusion. Serial lateral and posteroanterior cephalometric radiographs were taken periodically for evaluating the growth of the premaxilla 1 year before the intrusion, changes during the intrusion, and growth/relapse up to 1 year after the intrusion. There was no overgrowth of the premaxilla or overeruption of the maxillary incisors during the 1-year observing period before the orthopedic intrusion. The treatment results revealed that the downward displaced premaxillae were all corrected within 1 month. Cephalometrically, 46 percent of the correction resulted from a true orthopedic intrusion and another 54 percent from a dentoalveolar effect in which the maxillary incisors were intruded and the premaxillary dentoalveolus was shortened. The cephalometric evaluations also implied that what occurred during the orthopedic intrusion was mostly the sutural contraction osteogenesis/osteolysis in the vomeropremaxillary suture combined with slightly mechanical upward displacement of the vomeronasal septum complex and nasal bones. The orthopedic intrusion of the premaxilla with distraction devices is an effective nonsurgical method for correcting the downward displaced premaxilla before alveolar bone grafting in patients with bilateral cleft lip and palate, and the results remained stable after 1 year.

  7. The effectiveness of mandibular distraction in improving airway obstruction in the pediatric population.

    PubMed

    Tahiri, Youssef; Viezel-Mathieu, Alex; Aldekhayel, Salah; Lee, James; Gilardino, Mirko

    2014-03-01

    Distraction osteogenesis is an effective technique for elongating the deficient mandible. The authors specifically evaluated its effectiveness in the treatment of airway obstruction in pediatric patients with mandibular hypoplasia. A comprehensive literature review of the National Library of Medicine (PubMed) database was performed. English-language studies involving isolated distraction of the pediatric mandible (younger than 18 years) with descriptive reporting of airway changes were included. Extracted data included demographics, initial diagnosis, distractor type, distraction protocol, predistraction and postdistraction airway status, and complications. Seventy-four articles met the inclusion criteria, resulting in 711 patients with craniofacial abnormalities who underwent mandibular distraction osteogenesis. Mean age at the time of distraction was 18.1 months. The most common diagnoses were isolated Pierre Robin sequence (52.9 percent), syndromic Pierre Robin sequence (7 percent), and Treacher Collins syndrome (6.8 percent). Mandibular distraction osteogenesis successfully treated airway obstruction in 89.3 percent of cases. Success was defined as either decannulation of tracheostomy, avoidance of tracheostomy or continuous positive airway pressure, or alleviation or significant improvement of obstructive sleep apnea symptoms. One hundred seventy-one (84.2 percent) of the 203 tracheostomy-dependent patients were successfully decannulated. Among the 181 patients with obstructive sleep apnea, mandibular distraction osteogenesis successfully allowed for either complete resolution or significant improvement of symptoms in 95.6 percent. A 23.8 percent overall complication rate was noted. The mean follow-up time was 28.7 months. In addition to its positive effect on facial appearance, mandibular distraction osteogenesis is an effective procedure for the treatment of airway obstruction associated with congenital craniofacial defects involving mandibular hypoplasia in

  8. Mandibular distraction lengthening in the severely hypoplastic mandible: a problematic case with tongue aplasia.

    PubMed

    Havlik, R J; Bartlett, S P

    1994-11-01

    Distraction lengthening is a technique that was initially developed for correction of lower limb length discrepancies. It has recently been adapted to maxillofacial problems and has gained increasing popularity in this application. This report illustrates the principles involved in mandibular distraction lengthening and offers possible solutions to potentially limiting clinical problems. First, conventional technique dictates that a distinct periosteal sleeve is necessary for distraction osteogenesis to occur. However, in this case, distraction was performed through an area of scar tissue in which the native periosteum was destroyed. The ability to extend the use of the technique of distraction successfully to suboptimal clinical situations may broaden the indications for its use. Second, fixator instability is a potentially common problem in these cases because of the forces involved in distraction osteogenesis and the duration of the process. However, mechanical rigidity is essential consolidation (typically requiring twice as long as the distraction phase). Fixator instability can be successfully salvaged during the mineralization phase of bony healing through the use of an onlay corticocancellous bone "plate," which resorbs as the distraction gap gains strength. This report highlights one of the main advantages of the distraction process: the expansion of the soft-tissue matrix of the face.

  9. Genetics Home Reference: osteogenesis imperfecta

    MedlinePlus

    ... Email Facebook Twitter Home Health Conditions osteogenesis imperfecta osteogenesis imperfecta Printable PDF Open All Close All Enable Javascript to view the expand/collapse boxes. Description Osteogenesis imperfecta (OI) is a group of genetic disorders that ...

  10. [A new surgical method: lengthening of jaw bone by means of distraction technique].

    PubMed

    Nord, P G

    2001-05-30

    Callus distraction, or distraction osteogenesis as the method also is called, is a new surgical technique which makes it possible to create new bone by bone elongation. The method was originally used in orthopedic surgery to extend long bones but has subsequently proved useful for extending the mandible as well as other bones in the facial skeleton. By callus distraction, it is now possible to treat severe jaw anomalies and also to treat bone defects in the jaws without bone transplantation. This article describes the biological background to the method and the basic principles that must be observed for successful results. The treatment of four patients illustrates the method.

  11. The evaluation of bony union after frontofacial distraction.

    PubMed

    Eley, Karen A; Witherow, Helen; Hayward, Richard; Evans, Robert; Young, Karen; Clark, Allan; Dunaway, David

    2009-03-01

    Frontofacial advancement by distraction osteogenesis using the rigid external distraction device has become an accepted treatment for the deformity associated with craniofacial dysostoses (e.g., Crouzon, Apert, and Pfeiffer syndromes). The technical and physiological principles of osteogenesis distraction are well understood. This study documents the pattern of calcification at the osteotomy sites after distraction by analysis of serial three-dimensional computed tomography (CT) scans. The CT scans of 25 patients (11 with Crouzon, 6 with Apert, and 8 with Pfeiffer syndrome) were analyzed. Eleven individual areas along the osteotomy lines were assessed for evidence of bone formation. Scores were assigned within 4 categories ranging from no bone, calcification without bridge formation, a bony bridge, to complete bony infill (>95%). The scans were reviewed on 2 separate occasions by 2 independent assessors. There was high concordance both for intraobserver and interobserver scores. Rigid external distraction frame removal was undertaken after a 6-week consolidation period. All CT scan timings were calculated from this date. Of the 25 patients studied, 16 patients had CT scans available at 3 to 6 months, 12 at 9 to 12 months, and 7 at or more than 18 months. The scans were available in standard coronal slices with three-dimensional reconstructions. Bone formation is most consistently seen in the pterygoid region with calcification consistently occurring earlier and more completely in this area. Bone formation was often delayed in the orbital region and severely delayed or absent in the frontal region and zygomatic arches. There was no significant difference in the order or quality of bony union for the 3 underlying craniofacial dysostoses. This preliminary study confirms the clinical impression that bone formation after distraction is greatest in the pterygoid regions. The clinical implications of these findings are discussed.

  12. Myths about OI (Osteogenesis Imperfecta)

    MedlinePlus

    ... Based on the OI Foundation publication Introduction to Osteogenesis Imperfecta: A Guide for Medical Professionals, Individuals and Families ... for Children, editor, 2013. Page updated August, 2015. © Osteogenesis Imperfecta Foundation, 2015 Privacy Policy

  13. Humeral lengthening by distraction osteogenesis: a safe procedure?

    PubMed

    Ruette, Peter; Lammens, Johan

    2013-12-01

    This study was conducted to assess the safety of humeral lengthening using an Ilizarov frame. We retrospectively reviewed 26 humeral segments in 17 patients that were lengthened at our department between 1993 and 2011. There were varying aetiologies including achondroplasia, epiphyseal dysplasia, Oilier disease, trauma or infection of the proximal humeral growth-plate, unicameral bone cyst and brachial plexus injury. Mean age at start of surgery was 17.05 years (range : 5-40). The mean lengthening achieved was 8.85 (3-13) cm. Mean lengthening percentage was 353% (range : 10-48). Average healing index was 30.56 days/cm (range : 17.46-4232). There was a significant difference in healing index between achondroplasia patients (28.79 days/cm) compared to others (33.41 days/cm). Minor problems included pin tract infection (14 segments). More important obstacles were temporary elbow flexion contracture (7 segments), premature consolidation (6 segments), radial nerve dysaesthesia (6 segments) and loosening of a Schanz screw (1 segment). Complications included one fracture and one progressive bowing after frame removal. One planned lengthening was not completely achieved. Despite a lot of obstacles, humeral lengthening using an Ilizarov frame provided a reliable method to treat the functional or cosmetic problems of upper limb shortening.

  14. DEXA as a Predictor of Fixator Removal in Distraction Osteogenesis

    PubMed Central

    Saran, Neil

    2008-01-01

    Premature removal of the fixator after a lengthening procedure can result in gradual bending or acute fracture of the regenerate. We reviewed the records of 26 patients who underwent 28 limb lengthenings between 1997 and 2005 to assess the post lengthening regenerate fracture rate and bone healing index when using dual energy xray absorptiometry (DEXA) to aid in deciding on when to remove the fixator. Sixteen male and 10 female patients with an average age at lengthening of 12.3 years underwent an average lengthening of 5.2 cm (range, 3–9.1 cm). Nineteen femurs and nine tibiae were lengthened. Serial monthly DEXA scans were analyzed for bone mineral density. Bone healing indices and post fixator removal complications were assessed. The fixators were removed once the bone mineral density had plateaued to a less than 10% increase and plain radiographs showed no obvious defects precluding fixator removal. There were no regenerate fractures and only one fracture in the proximal segment of the lengthened bone after apparatus removal and the healing index for the series averaged 47 d/cm (range, 20–73 d/cm). Using serial DEXA scans during the consolidation phase of lengthening has a low rate (3.6%) of fractures while maintaining an acceptable bone healing index without excessively increasing fixation time. Level of Evidence: Level IV, therapeutic retrospective study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18820988

  15. Adamantinoma of the tibia: local resection and distraction osteogenesis.

    PubMed

    Kitsoulis, P; Mantellos, G; Xenakis, Th

    2009-01-01

    We describe a case of adamantinoma of the distal tibia in a 31-year-old woman. Segmental resection of the part of the tibia containing the tumour in normal bone was done and the bone defect was bridged with bone transport and external fixation. The tibia healed uneventfully and one year after the operation the patient resumed full activity. Three years postoperatively no local recurrence or metastasis has occurred.

  16. Complex Compound Fracture of Tibia Managed with Distraction Osteogenesis

    PubMed Central

    Parekh, Hemant Prakash; Dwidmuthe, Samir Chandrakant; Patil, Sampat Dumbre; Sonar, Satish

    2014-01-01

    Introduction: The treatment of tibia bone loss can be challenging. The surgical options for the treatment of bone loss include bone transport, vascularized fibula graft, and induced membrane. Case Report: We present a case of complex compound fracture of tibia with bone loss. Interestingly patient sustained this injury in spite of having intramedullary nail in tibia which was inserted to stabilize previous fracture 9 months prior to trauma. The proximal half of the nail was protruding out of the wound at the time of presentation in emergency department. The nail was removed and stabilized with external fixator after wound closure. The bone gap and nonunion at fracture site was managed with Ilizarov fixator. At the end of treatment patient got satisfactory functional outcome. Conclusion: Ilizarov method is a biologic and comprehensive method for management of bone loss, non union and limb length discrepancy. PMID:27298985

  17. [Distraction of the maxilla].

    PubMed

    Marchac, D; Arnaud, E

    1997-10-01

    The distraction of the maxilla provides very useful possibilities in young children with unstable articulation and in infants in order to avoid excessively radical operations. The principles of the distraction are reviewed. The authors report 13 clinical cases and complications. The material needs to be perfected, as numerous incidents are still observed.

  18. Does Guided Bone Regeneration Prevent Unfavorable Bone Shapes in Distraction Gap?

    PubMed

    Demetoglu, Umut; Alkan, Alper; Kiliç, Erdem; Ozturk, Mustafa; Bilge, Suheyb

    2017-08-05

    Complications related to distraction osteogenesis can cause degradation of newly regenerated bone. Additionally, an unfavorable shape of the regenerated bone at the distraction gap can reduce the quantity of regenerated bone. The aim of the present study was to report on the prevention of unfavorable shapes of regenerated bone using guided bone regeneration during distraction. Bilateral alveolar distraction was performed in 10 beagle dog mandibles. One side of the mandible formed the experimental group and the other side served as the control group. In the experimental group, guided bone regeneration was performed simultaneously with distraction osteogenesis. In the control group, only alveolar distraction was applied. At the end of a 1-week latent period, all mandibles were distracted 10 mm (1 mm/day). After the distraction period, 3 months were allowed for consolidation. After consolidation, all the dogs were euthanized, and the shape of the regenerated bone was determined to be either favorable or unfavorable. Densitometric evaluation and area measurements were performed using computed tomography scans. Statistical evaluation was performed using the independent t test, with a significance level of P < .05. In the experimental group, no unfavorable bone shape developed in the distraction gap, and the new bone had a surface and volume similar to those of the segments. In contrast, in the control group, 4 mandibles had an unfavorable bone shape in the distraction gap and 4 showed favorable bone healing with no defect. The surface area of the regenerating bone in the experimental group was significantly greater than that in the control group. Also, the surface area differed significantly between the experimental and control groups (P < .05). However, the densitometric values did not differ between the 2 groups (P < .05). Concomitant use of guided bone regeneration with distraction osteogenesis could be an optimal method for generating a favorable bone shape

  19. Model of the distraction callus tissue behavior during bone transport based in experiments in vivo.

    PubMed

    Mora-Macías, Juan; Reina-Romo, Esther; Domínguez, Jaime

    2016-08-01

    Bone transport studies have measured the forces related to bone segment distraction (Brunner et al., 1994; Hyodo et al., 1996). However, no distraction force distribution between callus and docking-site was reported. Besides, most of these works have not provided continuous and long-term force relaxation measurements. The fit of the relaxation curves allows for modeling the mechanical behavior of the callus tissue during distraction osteogenesis, particularly in bone transport, where the resistance of the soft tissue and muscle is reduced compared with the bone lengthening. Bone transport experiments were carried out in sheep in which the distraction force was monitored continuously in vivo. The daily force relaxation curves were fitted, and two experimental models of the mechanical behavior of the callus tissue were obtained, assuming the total daily force relaxation or the accumulation of the residual forces. According to these models, the residual force 24h after each distraction step was a maximum of 71.6N, and the peak distraction force increased with the number of steps from 7-34N to 41-246N. The maximum residual force values that were predicted are much lower than those measured during bone lengthening in the literature. These results indirectly differentiate the influence of the surrounding soft tissues during bone transport compared with bone lengthening. Moreover, experimental measurements showed that distraction force through the docking-site was negligible with respect to distraction force through the callus. Experimental models of the callus tissue allow for an understanding of the mechanobiology of distraction osteogenesis and for predicting outcomes in its application processes. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Effects of distraction on muscle length: mechanisms involved in sarcomerogenesis.

    PubMed

    Caiozzo, Vincent J; Utkan, Ali; Chou, Richard; Khalafi, Afshin; Chandra, Heena; Baker, Michael; Rourke, Bryan; Adams, Greg; Baldwin, Ken; Green, Stuart

    2002-10-01

    Although a great deal of interest has been given to understanding the mechanisms involved in regulating the radial growth that occurs because of resistance training, much less has been given to studying the longitudinal growth of skeletal muscle that occurs because of passive stretch. The current authors provide a brief overview of key issues relevant to the longitudinal growth of skeletal muscle that occurs during distraction osteogenesis. Specifically, five key issues are addressed: (1) the pattern of sarcomerogenesis during distraction; (2) sarcomerogenesis and altered expression of sarcomeric and nonsarcomeric genes; (3) the satellite cell hypothesis; (4) mitogenic factors; and (5) new approaches for studying the longitudinal growth of skeletal muscle. A discussion is provided that revolves around the concept of a negative feedback loop. One of the most interesting issues to be resolved in muscle biology is the role of satellite cells in regulating the growth of skeletal muscle. Currently, it is not known whether satellite cell activation is a prerequisite for the longitudinal growth of skeletal muscle. Gene chip analyses provide a paradoxical view, showing that distraction osteogenesis results in the upregulation of a gene, GADD45, involved with growth arrest and deoxyribonucleic acid destruction.

  1. A New Technique for Posterior Distraction in Craniosynostosis: The Double-Door Technique.

    PubMed

    Sakamoto, Yoshiaki; Miwa, Tomoru; Nakajima, Hideo; Yoshida, Kazunari; Kishi, Kazuo

    2016-06-01

    Posterior cranial vault distraction osteogenesis is a common treatment for syndromal patients of brachycephaly and oxycephaly. Although posterior distraction can increase intracranial volume, the flattened head phenotype is difficult to correct. The authors examined a new posterior distraction technique termed double-door distraction for improvement of the flattened head phenotype. From 2010 to 2013, 6 patients with flattened posterior craniums were operated on using the double-door distraction technique. The calvarial segment was cut at the midline and divided into 2 pieces. Distractors were then fixed in parallel to join the calvarial pieces. The distraction was initiated at a rate of 1.0 mm/day and continued until proper cranial form was confirmed by radiography and appearance. The average surgery time was 2 hours 47 minutes and the amount of distraction ranged from 15 to 22 mm. An improved head shape and expanded cranial vault was achieved in all patients without any complications. The double-door distraction technique is a useful technique not only for calvarial expansion, but also for correction of the flattened posterior cranium phenotype.

  2. The effect of distraction rate on bone histological and histomorphometrical properties in an ovine mandible model.

    PubMed

    Dinu, C; Kretschmer, W; Băciuţ, Mihaela; Rotaru, H; Bolboacă, Sorana Daniela; Gheban, D; Muste, A; Cătoi, C; Peştean, C; Băciuţ, G

    2011-01-01

    Lengthening the mandible by distraction osteogenesis (DO) is nowadays a well-recognized technique in maxillofacial surgery. This study compared two different distraction rates and evaluated histological and histomorphometrical properties of the distracted bone in an experimental ovine mandible model with the goal of elaborating a universally accepted distraction protocol. Tissue blocks of regenerated bone were harvested from twelve young adult sheep. DO was performed on the mandibular midline after five days of latency period. The sheep were divided into two groups. The first group underwent activation of 0.8 mm÷day during 12 days resulting in 9.6 mm of new bone while the second group followed a geometric rate pattern of 0.2 mm - three days, 0.4 mm - three days, 0.8 mm - three days and 1.6 mm - three days resulting in 9 mm of new bone. The regenerated bone was histologically and histomorphometrically analyzed after 30, 45 and 60 days of consolidation. The relative osteoid volume (OV÷TTV) was significantly increased in the geometric rate distraction group (p=0.015) comparing with linear distraction group while the relative bone volume (BV÷TTV) was significantly increased in the linear distraction group (p=0.019) compared to the geometric distraction group.

  3. Distractions in Everyday Driving

    MedlinePlus

    ... activity in the mix -- even talking to your passengers or changing a radio station -- can be enough ... same things that distracted drivers 100 years ago -- passengers, things that catch one’s attention outside the vehicle, ...

  4. Primary study of the use of an internal, self-activated shape memory alloy distraction device in the dog mandible: alveolar ridge distraction and implant placement.

    PubMed

    Xie, Min; Hu, Min; Liu, Hongchen; Xiao, Hongxi

    2011-07-01

    To investigate the use of an internal self-activated distraction device made of titanium-nickel memory alloy to augment the mandibular alveolar ridge. Twelve adult mongrel canines were randomly divided into 4 groups. Groups I and II were sacrificed 1 month and 3 months after distraction, respectively. In group III (distraction-planting group), 2 implants were placed on both sides of the mandible 3 months after distraction. In group IV (control group), no implants were placed. X-rays were taken and histologic research was performed. When the distraction device was in place, the transport segments were lifted up 3.0 to 4.5 mm immediately, and a range of 7.5 to 11.5 mm of augmentation was reached after 3 to 5 days of device activation. X-rays showed that bone mineral density increased, and new bone formed in the distraction area 1 month after distraction. Three months later, the bone mineral density of the distraction area was close to that of the surrounding alveolar bone. Histologic observation showed that collagen bundles initially formed in the distraction region and were followed by calcification and osteogenesis. X-rays showed that the implants were well integrated 3 months after implant placement. The implant-bone interface showed bony integration, and there was no significant difference in the implant-bone contact rate between the distraction and control sides. The titanium-nickel memory alloy distractor can be used successfully to augment the posterior mandibular alveolar ridge of canines. New bone formed between the buccal and lingual periosteal layers. A conventional implant surgical procedure could be performed 3 months later and the desirable implant-bone integration was produced. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  5. To distract or not to distract: an algorithm for airway management in isolated Pierre Robin sequence.

    PubMed

    Schaefer, Richard B; Stadler, James A; Gosain, Arun K

    2004-04-01

    Approaches advocated for treatment of airway obstruction among neonates with Pierre Robin sequence include positioning, tongue-lip adhesion, mandibular distraction, and tracheostomy, with no established guidelines regarding which modality is appropriate for a specific patient. This report proposes an algorithm for the management of neonatal upper airway obstruction among patients with isolated Pierre Robin sequence. Data for 21 patients with isolated Pierre Robin sequence who were treated by one surgeon during a 9-year period were reviewed. Eighteen patients presented during the first 1 week of life and three patients presented late, between 12 and 33 months of age. Follow-up periods ranged from 9 to 70 months (median, 33 months). Successful airway management was achieved with positioning alone for 10 patients, with tongue-lip adhesion for seven of nine patients, with tracheostomy for two patients, and with mandibular distraction for three patients. Changes in the maxillary-mandibular discrepancy were significant with natural mandibular growth during the first 1 year of life (p < 0.0001). Oromotor studies performed 3 months or more after tongue-lip adhesion reversal (n = 9) demonstrated no appreciable deficits in tongue function, relative to other children with cleft lips/palates. A multidisciplinary team should evaluate all patients with isolated Pierre Robin sequence, to fully assess the maxillary-mandibular relationship, anatomically define the site of airway obstruction, and identify feeding difficulties. Patients should be evaluated for episodes of desaturation occurring spontaneously, during feeding, or during sleeping. Patients with desaturation should be further evaluated with double endoscopy (nasoendoscopy and bronchoscopy). If the airway obstruction is localized to the tongue base alone and cannot be controlled with positioning, then tongue-lip adhesion is the initial treatment of choice, because such patients demonstrate significant mandibular growth

  6. [Principles of callus distraction].

    PubMed

    Hankemeier, S; Bastian, L; Gosling, T; Krettek, C

    2004-10-01

    Callus distraction is based on the principle of regenerating bone by continuous distraction of proliferating callus tissue. It has become the standard treatment of significant leg shortening and large bone defects. Due to many problems and complications, exact preoperative planning, operative technique and careful postoperative follow-up are essential. External fixators can be used for all indications of callus distraction. However, due to pin tract infections, pain and loss of mobility caused by soft tissue transfixation, fixators are applied in patients with open growth plates, simultaneous lengthening with continuous deformity corrections, and increased risk of infection. Distraction over an intramedullary nail allows removal of the external fixator at the end of distraction before callus consolidation (monorail method). The intramedullary nail protects newly formed callus tissue and reduces the risk of axial deviation and refractures. Recently developed, fully intramedullary lengthening devices eliminate fixator-associated complications and accelerate return to normal daily activities. This review describes principles of callus distraction, potential complications and their management.

  7. Electronic gaming as pain distraction

    PubMed Central

    Jameson, Eleanor; Trevena, Judy; Swain, Nic

    2011-01-01

    The current study investigated whether active distraction reduces participants’ experience of pain more than passive distraction during a cold pressor task. In the first experiment, 60 participants were asked to submerge their hand in cold (2°C) water for as long as they could tolerate. They did this with no distraction, and then with active (electronic gaming system) and passive (television) distraction, in randomly assigned order. Tolerance time, pain intensity ratings and task absorption ratings were measured for each condition. A second experiment attempted to control for participants’ expectations about the effects of distraction on pain. Forty participants underwent the same experimental procedure, but were given verbal suggestions about the effects of distraction by the experimenter before each distraction condition. Participants in both experiments had a significantly higher pain tolerance and reported less pain with the active distraction compared with passive or no distraction. Participants reported being more absorbed, and were significantly more willing to do the task again when they had the active distraction compared with both passive distraction and no distraction. They also had more enjoyment, less anxiety and greater reduction in pain with active distraction than with passive distraction. There was no effect of suggestion. These experiments offer further support for the use of electronic games as a method of pain control. PMID:21369538

  8. Electronic gaming as pain distraction.

    PubMed

    Jameson, Eleanor; Trevena, Judy; Swain, Nic

    2011-01-01

    The current study investigated whether active distraction reduces participants' experience of pain more than passive distraction during a cold pressor task. In the first experiment, 60 participants were asked to submerge their hand in cold (2°C) water for as long as they could tolerate. They did this with no distraction, and then with active (electronic gaming system) and passive (television) distraction, in randomly assigned order. Tolerance time, pain intensity ratings and task absorption ratings were measured for each condition. A second experiment attempted to control for participants' expectations about the effects of distraction on pain. Forty participants underwent the same experimental procedure, but were given verbal suggestions about the effects of distraction by the experimenter before each distraction condition. Participants in both experiments had a significantly higher pain tolerance and reported less pain with the active distraction compared with passive or no distraction. Participants reported being more absorbed, and were significantly more willing to do the task again when they had the active distraction compared with both passive distraction and no distraction. They also had more enjoyment, less anxiety and greater reduction in pain with active distraction than with passive distraction. There was no effect of suggestion. These experiments offer further support for the use of electronic games as a method of pain control.

  9. Effect of gene transfection timing on TGF-β1 expression in rabbit mandibular distraction gap.

    PubMed

    Xie, M-K; Hu, C-B; Zhou, B; Wu, G-P

    2017-04-13

    Transforming growth factor-β1 (TGF-β1) is a member of the TGF-β superfamily, and plays an important role in promoting various stages of intramembranous and endochondral bone formation. It is one of the major growth factors that influence new bone formation in the distraction gap during distraction osteogenesis (DO). The major problem of DO is the time required for the treatment. Reports show that gene therapy accelerates osteogenesis, which can significantly benefit patients with DO. However, the optimal timing of gene transfection has not yet been reported. In this study, we used the New Zealand rabbit mandibular DO model for transfecting recombinant plasmid pIRES-hVEGF165-hBMP2 during the latency, distraction, and consolidation periods of DO. The TGF-β1 levels in the distraction gap were detected at different time-points by immunohistochemistry and analyzed semi-quantitatively with the CMIAS-2001A computerized image analyzer. The TGF-β1 levels peaked after 7 days and decreased after 14 days of consolidation in each group. In contrast, the TGF-β1 levels in the transfected distraction period group were significantly higher than those in the other groups. After 28 days of consolidation, TGF-β1 levels decreased and there was no significant difference among the groups. These results indicated that the genes transfected in the distraction period up-regulated the expression of TGF-β1 more than in the latency and consolidation periods, which promoted bone formation in the distraction gap through a series of biological effects. Thus, we obtained a remarkable effect on new bone formation, and showed that the distraction period is optimal for gene therapy.

  10. Molding of the regenerate in mandibular distraction: clinical experience.

    PubMed

    McCarthy, Joseph G; Hopper, Richard A; Hollier, Larry H; Peltomaki, Timo; Katzen, Timothy; Grayson, Barry H

    2003-10-01

    Initial clinical experience with distraction osteogenesis has demonstrated the risk of developing postdistraction malocclusion that requires secondary orthodontic correction. In addition, optimal mandibular form is not always achieved. Both animal studies and preliminary clinical investigations have suggested that the regenerate can be successfully "molded" during active mandibular distraction. The authors have applied this concept clinically to obtain a more desirable occlusal relationship in a group of mandibular distraction patients. Eleven patients are described in whom angulation of the distraction device or intermaxillary/interdental elastics were employed to mold the regenerate. Two representative case studies are provided to illustrate the principles. When using elastic traction to close an anterior open bite, care must be taken that extrusion of individual teeth is minimized by distributing the force over the entire dental arch, especially the basilar portions of the jaws. The authors demonstrate that molding of the regenerate can be successfully accomplished not only during device activation but also early in the consolidation period. The outer limit of the time window in which molding is effective remains to be defined.

  11. [Effect of TGF-β1 expression on periodontal tissue reconstruction for rapid teeth movement through reducing resistance and distraction].

    PubMed

    Li, Ning; Yang, Le-le; Peng, Zao-xia; Li, Pei; Li, Mei-jing; Chen, Xi; Xu, Ran

    2014-10-01

    To investigate the role of transforming growth factor-β1 (TGF-β1) in periodontal tissue reconstruction during rapid teeth movement through reducing resistance and distraction. Twenty Beagle dogs were randomly divided into five groups according to time points: distraction for 5 days, 10 days, 15 days, retaining 10 days after distraction for 15 days, and retaining 90 days after distraction for 15 days. The mandibular first premolar was moved by using reducing resistance and distraction (experimental group) or conventional distraction (control group) randomly. For each group, tooth movement distance was measured and first premolar periodontal tissue pieces were obtained in scheduled time. Hematoxylin-eosin stain, Picric acid-Sirius red, and immunohistochemistry were performed. The data was analyzed by using SPSS 18.0 software package. The speed of tooth movement and periodontal reconstruction of the experimental group were significantly faster than the control group. TGF-β1 positive expression in two groups had similar distribution area, and reached peak at most active stage of osteogenesis in both groups. But in different stages of distraction, the positive expression in the experimental group was significantly higher than the control group(P<0.05). Compared with conventional orthodontic method, reducing resistance and distraction can obviously increase the expression of TGF-β1 of tension side of the distracted tooth, and accelerate periodontal tissue reconstruction.

  12. [Progressive bone elongation of the maxillo-facial area: mandibular distraction].

    PubMed

    Sancho, M A; Parri, F J; Rivera, A; Grande, C; Sarget, R; Casal, C; Morales, L

    2000-10-01

    Thanks to the distraction osteogenesis technique, it is nowadays possible to create new bone in the facial area. Between january 1997 and march 1999 we have performed 20 such procedures, from which 15 were mandibular. We present our experience in 10 patients with this new technique, 5 unilateral and 5 bilateral. Those were 7 boys and 3 girls, aged 2 to 14 years, affected with hemifacial microsomia, Goldenhar syndrome: 3; retrognatism with severe malocclusion: 4; facial assimetry due temporomandibular joint abnormalities: 2; and facial assimetry: 1. The proposed elongation was achieved in all cases. There was not only a skeletal improvement, but also growth and remodeling of the facial soft tissues. Distraction osteogenesis is the early treatment of the mandibulofacial deformities and offers a great deal of advantages to the growing patient.

  13. Lateral transport osteogenesis in maxillofacial oncology patients for rehabilitation with dental implants: a retrospective case series

    PubMed Central

    Bilbao-Alonso, Arturo; García-Rielo, José M.; Varela-Centelles, Pablo

    2013-01-01

    Objectives: To report on the use of lateral transport osteogenesis in cancer patients after maxillo/mandibular resections and on the implant survival rate in the generated bone Material and Methods: Four patients treated using lateral transport osteogenesis entered this descriptive study and were retrospectively studied (mean age 55; range 41-62). Results: Reconstruction of segmentary defects after surgical and radiological cancer treatment on maxilla and mandible was achieved. No relevant intra- or post-operative complications occurred. No differences on implant survival were observed between patients who had received radiotherapy and those who had not. Conclusions: This approach can be considered a recommendable reconstructive option after oral cancer treatment –including radiotherapy- particularly for high-surgical-risk, collaborative patients. Key words:Distraction osteogenesis, oral cancer, radiotherapy, reconstruction, dental implants. PMID:22926475

  14. [Maxillary sinus hypoplasia].

    PubMed

    Plaza, G; Ferrando, J; Martel, J; Toledano, A; de los Santos, G

    2001-03-01

    Maxillary sinus hypoplasia is rare, with an estimated prevalence of 1-5%. Out of the CT scans performed in sinusal patients between March 1998 and June 1999, we report on 4 isolated maxillary sinus hypoplasia, 4 maxillary sinus hypoplasia associated to concha bullosa, and 10 isolated conchae bullosas. All cases were evaluated by nasosinusal endoscopy and CT scan. Size, location and uni/bilateral presentation of concha bullosa is correlated to maxillary sinus hypoplasia presence, specially with regards to uncinate process presence, medial or lateral retraction. The pathogenesis of maxillary sinus hypoplasia is reviewed, and its relation to concha bullosa, evaluating how this could explain some cases of the so called chronic maxillary sinus atelectasia, as an acquired and progressive variant of maxillary sinus hypoplasia in adults.

  15. Supervising children during parental distractions.

    PubMed

    Boles, Richard E; Roberts, Michael C

    2008-09-01

    To examine the effects of parenting distractions on supervising behaviors in relation to child risky behaviors. Forty preschool-aged children and their parents were randomly assigned to occupy a simulated home living room for 45 min with the parent involved in either (a) no planned distraction, (b) a telephone call distraction, (c) a TV show distraction, or (d) a computer assignment distraction. Parent and child behaviors were recorded and coded. Parent supervising behaviors were significantly intercorrelated but revealed no relation to risky child behavior. Children showed higher risky behavior during parental distractions and steadily over time when parent distractions occurred. Additionally, younger children were more likely to engage in risky behavior when compared to older children. Parents showed significant reductions in their ability to supervise children during distractions, limiting the ability to provide education or to take immediate action necessary to prevent or minimize possible injuries.

  16. Supervising Children During Parental Distractions

    PubMed Central

    Roberts, Michael C.

    2008-01-01

    Objective To examine the effects of parenting distractions on supervising behaviors in relation to child risky behaviors. Methods Forty preschool-aged children and their parents were randomly assigned to occupy a simulated home living room for 45 min with the parent involved in either (a) no planned distraction, (b) a telephone call distraction, (c) a TV show distraction, or (d) a computer assignment distraction. Parent and child behaviors were recorded and coded. Results Parent supervising behaviors were significantly intercorrelated but revealed no relation to risky child behavior. Children showed higher risky behavior during parental distractions and steadily over time when parent distractions occurred. Additionally, younger children were more likely to engage in risky behavior when compared to older children. Conclusions Parents showed significant reductions in their ability to supervise children during distractions, limiting the ability to provide education or to take immediate action necessary to prevent or minimize possible injuries. PMID:18334495

  17. Controversies in the management of neonatal micrognathia: to distract or not to distract, that is the question.

    PubMed

    Jarrahy, Reza

    2012-01-01

    Symptomatic micrognathia, as seen in syndromic and isolated presentations of the Robin sequence (RS), can pose immediate an ongoing threats to the well-being of neonates. Upper airway obstruction can manifest as acute respiratory insufficiency requiring postpartum intubation and mechanical ventilation or as a mild irregularity in the oropharyngeal airflow that can be managed by positioning the newborn in a prone or decubitus position. Clinically significant micrognathia is often accompanied by some degree of feeding difficulty, obstructive sleep apnea, and gastroesophageal reflux disease, all of which should be evaluated by a multidisciplinary team of specialists before a definitive treatment plan is formulated. Numerous surgical and nonsurgical options have been described for airway management in RS; there is no single agreed-upon therapy. Most recently, our expanding experience with craniofacial distraction has resulted in greater application of distraction osteogenesis to the congenitally hypoplastic mandible. Rather than serve as a panacea, however, the practice of neonatal mandibular distraction for infants with upper airway obstruction has probably given rise to more questions than it has answered. The debate over its most appropriate indication in the micrognathia patient is quite current. In this article, we consider some of the controversies surrounding the use of distraction compared with other techniques in the management of the neonatal airway.

  18. Virtual Surgical Planning for Mandibular Distraction in Infants with Robin Sequence.

    PubMed

    Resnick, Cory M

    2017-06-01

    Mandibular distraction osteogenesis (MDO) successfully relieves obstructive sleep apnea in many infants with Robin sequence. Preoperative virtual surgical planning and fabrication of three-dimensionally printed cutting guides may lead to further improvements in the MDO technique and decrease the risk for damage to adjacent structures such as developing teeth and the inferior alveolar nerve. This report presents an algorithm for virtual surgical planning and three-dimensionally printing of cutting guides for MDO in infants with RS.

  19. Virtual Surgical Planning for Mandibular Distraction in Infants with Robin Sequence

    PubMed Central

    2017-01-01

    Summary: Mandibular distraction osteogenesis (MDO) successfully relieves obstructive sleep apnea in many infants with Robin sequence. Preoperative virtual surgical planning and fabrication of three-dimensionally printed cutting guides may lead to further improvements in the MDO technique and decrease the risk for damage to adjacent structures such as developing teeth and the inferior alveolar nerve. This report presents an algorithm for virtual surgical planning and three-dimensionally printing of cutting guides for MDO in infants with RS. PMID:28740786

  20. Child Abuse or Osteogenesis Imperfecta?

    MedlinePlus

    Child Abuse or Osteogenesis Imperfecta? A child is brought into the emergency room with a fractured leg. The parents are unable to explain how ... the fractures is not child abuse. It is osteogenesis imperfecta , or OI. OI is a genetic disorder characterized ...

  1. Passenger distractions among adolescent drivers.

    PubMed

    Heck, Katherine E; Carlos, Ramona M

    2008-01-01

    Adolescents who drive with peers are known to have a higher risk of crashes. While passengers may distract drivers, little is known about the circumstances of these distractions among teen drivers. This study used survey data on driving among 2,144 California high school seniors to examine distractions caused by passengers. Overall, 38.4% of youths who drove reported having been distracted by a passenger. Distractions were more commonly reported among girls and students attending moderate- to high-income schools. Talking or yelling was the most commonly reported type of distraction. About 7.5% of distractions reported were deliberate, such as hitting or tickling the driver or attempting to use the vehicle's controls. Driving after alcohol use and having had a crash as a driver were both significant predictors of reporting passenger-related distraction. Adolescents often experience distractions related to passengers, and in some cases these distractions are intentional. These results provide information about teenage drivers who are distracted by passenger behaviors. In some cases, passengers attempted to use vehicle controls; however, it seems unlikely that this behavior is common enough to warrant redesign of controls to make them less accessible to passengers.

  2. Maxillary air cyst.

    PubMed

    Doucette-Preville, Stephane; Tamm, Alexander; Khetani, Justin; Wright, Erin; Emery, Derek

    2013-12-01

    Pathologic dilatation of the maxillary sinus by air is a rare condition with unclear etiology. We present a case of a 17 year old male with a maxillary air cyst diagnosed by computed tomography. The CT demonstrated air-filled expansion of the maxillary sinus beyond the normal anatomical limits with associated cortical bone thinning. The case report highlights the pathognomonic computed tomography findings of this rare entity and discusses the perplexing nomenclature, proposed etiologies and various treatment options.

  3. Osteogenesis imperfecta type I with unusual dental abnormalities.

    PubMed

    Levin, L S; Young, R J; Pyeritz, R E

    1988-12-01

    A large kindred with dominantly inherited osteogenesis imperfecta was evaluated. Affected individuals had bone fractures, blue sclerae, and hearing loss. In addition, all had dental abnormalities distinct from those previously described in other families with this syndrome. Deciduous teeth were normal in color or blue-grey. On radiographs of an early developing deciduous dentition, pulps were larger than normal. In patients with mixed dentitions, pulp chambers of deciduous teeth were partially obliterated. Increased constriction at the junctions of the crowns and roots was found in some deciduous teeth. One patient had large pulp stones in the pulp chambers of all maxillary deciduous molars. Permanent teeth were normal in color but had oval pulp chambers with apical extensions into the coronal portions of the roots, large coronal pulp stones, narrow root canals, and thin roots. Individuals in this family who did not have osteogenesis imperfecta had normal teeth. In addition, a well circumscribed radiolucency without a sclerotic periphery, involving the apices of all permanent mandibular incisors, was found in the anterior mandible in one patient. These findings support the hypothesis that this family has yet another type I osteogenesis imperfecta "syndrome".

  4. Mandible distraction using internal device: mathematical analysis of the results.

    PubMed

    Freitas, Renato da Silva; Alonso, Nivaldo; Busato, Luciano; D'oro, Ubiratã; Ferreira, Marcus Castro

    2007-01-01

    For many years, surgeons have sought a method to treat severe facial deformities without using bone grafts and extensive surgery. Distraction osteogenesis offers this promise. The technique used in mandibular hypoplasia follows the basic principles proposed by Ilizarov which states that the device must be elongated 1 mm per day to create optimal bone production. Despite the widespread implementation of this recommendation to include the 1-mm/day separation, doubt still exists as to whether this is the optimal treatment regimen. Intraoral devices with percutaneous activator pins were used in 16 patients with hypoplastic mandibles. The results of distraction were documented by panorex and cephalogram of the mandible. The length of the ramus as well as multiple mandible dimensions and facial angles were measured. The panorex and cephalogram of the mandible were effective in demonstrating the significant increase in length of the mandible and ramus, as well as the entire mandible, but there was no correlation between the stretching obtained by the distraction device and that measured by the radiographic studies. The S-N-B angle was the only facial angle in which there is a statistically significant increase measured and this appeared to be related to a mandible rotation. It is concluded that the mandible distraction (using an intraoral device and an external activator pin) was effective in increasing the ramus length and both the panorex and the cephalogram were effective in demonstrating this morphologic change. There was no correlation between the clinical result and the radiographic studies demonstrating that the clinical judgment still has a significant role in controlling mandible distraction.

  5. Evolving surgical prosthetic rehabilitation protocol for success of dental implant placed in distracted alveolar ridge.

    PubMed

    Rath, S K; Sinha, Ramen; D'Souza, Derek

    2014-10-01

    Remodelling of bone in the form of resorption generally follows the extraction of a tooth. During all stages of atrophy of the alveolar ridge, characteristic shapes result from the resorptive process, as influenced by anatomic alterations in the alveolar bone. Various ridge augmentation procedures have been documented as predictable means of establishing new vital bone for implant placement, out of which distraction osteogenesis is one such modality. Hence the following study has been conducted to evolve a surgico- prosthetic rehabilitation protocol in grossly atrophic alveolar ridge by distraction osteogenesis and subsequent implant placement and to provide an effective alternative to lost dental tissue to serving soldiers, their families and ex-servicemen of the Indian Army in a cost effective manner. A total of 30 patients with ridge defects in age group between 18 to 70 years were selected for the study. The net success rate of distraction procedure was 93.33% (100% in maxilla and 80% in mandible) with 2 cases deemed as failures out of a total of 30 cases. The average amount of defect compensated was 76.1% (85.1% and 59.5% in maxilla and mandible respectively). For the implant surgical procedure the success rate was 100% and subsequently prosthetic rehabilitation on implants was proved to be successful. Distraction ostoeogenesis of an atrophied ridge for further implant placement certainly proves to be successful procedure by this study. Further studies in the same procedure using a larger sample size will definitely be more beneficial.

  6. A piezoelectric motor-based microactuator-generated distractor for continuous jaw bone distraction.

    PubMed

    Park, Jong-Tae; Lee, Jae-Gi; Kim, Soo-Yeon; Kim, Gyu-Hag; Hu, Kyung-Seok; Cha, Jung-Yul; Kim, Hyung Jun; Kim, Hee-Jin

    2011-07-01

    Distraction osteogenesis is widely applied to correct oral and maxillofacial deformities, and intermittent distraction protocols have been used in various clinical applications. There are many challenges for continuous distraction of the jaw bone such as when using hydraulic motors and motor-driven plates. The size of the motor is critical to the ability to miniaturize the complete distractor system, and the importance of size makes it difficult to extrapolate the results of animal models to the clinical situation. This study developed a microactuator-generated distractor (MAGD) for continuous jaw bone distraction. The MAGD system consists of control software based on Microsoft Windows and a Squiggle piezoelectric motor. The system allows various intermittent and continuous distraction protocols to be simply selected using the control software. The maximum force of the laboratory-scale MAGD is 3 N, and the device is ready for adoption in small-animal distraction models such as the rat and mouse. The MAGD needs further refinement before it can be applied to humans, but a fully implanted MAGD system will reduce soft-tissue complications resulting from exposure of the extraoral component. Moreover, the MAGD will support the patient's social activities and require only minimal cooperation from the patient.

  7. Expression of nerve growth factor and its receptor in distracted tibial nerve after limb lengthening.

    PubMed

    Shao, Heng; Shu, Hengsheng; Wang, Chunmei; Yuan, Wu; Li, Yunsheng

    2013-02-01

    Despite many experimental and clinical studies conducted on distraction osteogenesis (DO) in the past decade, changes in the surrounding tissues that occur after the procedure remains poorly understood. To study the biochemical changes of recovery in nerve tissues upon DO-induced nerve injury, we prepared a rabbit model of tibia lengthening to observe the expression pattern of nerve growth factor (NGF) and low-affinity NGF receptor (p75NGFR) in the distracted tibial nerve. The distracted tibial nerve was harvested at various time points during the consolidation period of new bone formation and immunohistochemical staining was performed to detect the expression of NGF and p75NGFR. The expression levels of NGF and p75NGFR were found to be different at various times after DO. The changes in expression of these two cellular factors show similar tendencies with significantly elevated expression in Schwann cells at 7 and 14 days after distraction, but low or undetectable levels of expression at 0, 28, and 56 days. These results suggest that NGF and p75NGFR may play important roles in the adaptive process of the distracted nerve. NGF and p75NGFR are autocrine growth factors present in the distracted nerve during the early consolidation period. NGF interacts with p75NGFR to promote damage repair and reconstruction of nerves. Together, this study furthers the understanding of the relative mechanisms of nerve repair, as well as provides a further basis for the clinical application of neurotrophins.

  8. Maxillary canine-to-maxillary incisor transposition.

    PubMed

    Lin, Yng-Tzer J

    2013-01-01

    Dental transposition is the positional interchange of two adjacent teeth. Canine transpositions are usually accompanied by other dental anomalies, such as: impaction of the incisors; missing teeth; peg-shaped lateral incisors; severe rotation or malposition of adjacent teeth; dilacerations; and malformations. Local pathologic processes, such as tumors, cysts, retained primary canines, and supernumerary teeth, might be responsible for canine transposition. The purpose of this paper was to present a rare case of maxillary canine-to-maxillary incisor transposition in an 8-year-old girl. The patient presented with noneruption of the permanent maxillary left central incisor, and a radiographic examination revealed an impacted dilacerated incisor. The central incisor was extracted because the root was severely dilacerated. At the 3-year follow-up, an oral examination revealed that the canine had transposed to the extraction site. Through orthodontic traction, combined with reshaping of the tooth, the transposed canine was successfully positioned into the incisor position.

  9. Maxillary protraction after surgically assisted maxillary expansion

    PubMed Central

    FURQUIM, Laurindo Zanco; JANSON, Guilherme; FURQUIM, Bruno D’Aurea; IWAKI FILHO, Liogi; HENRIQUES, José Fernando Castanha; FERREIRA, Geovane Miranda

    2010-01-01

    This case report describes the orthodontic treatment of a 32-year-old woman with a Class III malocclusion, whose chief compliant was her dentofacial esthetics. The pretreatment lateral cephalometric tracings showed the presence of a Class III dentoskeletal malocclusion with components of maxillary deficiency. After discussion with the patient, the treatment option included surgically assisted rapid maxillary expansion (SARME) followed by orthopedic protraction (Sky Hook) and Class III elastics. Patient compliance was excellent and satisfactory dentofacial esthetics was achieved after treatment completion. PMID:20857013

  10. A novel technique to secure the Rigid External Distraction (RED) frame in a thin skull allowing sutural mid-face distraction.

    PubMed

    Dobbs, Thomas D; Wall, Steven A; Richards, Peter G; Johnson, David

    2014-10-01

    Distraction osteogenesis (DO) has revolutionised the treatment of mid-face hypoplasia in children, allowing advancement of the mid-face in excess of that achievable by traditional Le Fort III osteotomy. One method of performing DO is to use an externally applied frame, such as the Rigid External Distraction (RED) frame. However, at young ages the cranial bone is often too weak to support the frame, preventing its safe use. We present the case of a patient with Crouzon syndrome who required mid-face distraction at 4-months of age due to severe exorbitism, raised intracranial pressure and airway compromise. In order to allow safe application of an external distraction frame laminated bone grafts were secured to the cranium at the areas of frame pin insertion. We believe this to be the first reported case of the use of the patients own cranial bone to create laminated bone grafts and thicken the site of pin insertion. The method described adds to the armamentarium of the surgeon treating these patients who require placement of an external distraction frame for DO at a young age where the thickness of the cranial bone may otherwise prevent safe application. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  11. Distracted Biking: An Observational Study

    PubMed Central

    Wolfe, Elizabeth Suzanne; Arabian, Sandra Strack; Breeze, Janis L; Salzler, Matthew J.

    2016-01-01

    Commuting via bicycle is a very popular mode of transportation in the Northeastern United States (US). Boston, MA has seen a rapid increase in bicycle ridership over the past decade which has raised concerns and awareness about bicycle safety. An emerging topic in this field is distracted bicycle riding. This study was conducted to provide descriptive data on the prevalence and type of distracted bicycling in Boston at different times of day. This was a cross-sectional study in which observers tallied bicyclists at four high traffic intersections in Boston during various peak commuting hours for two types of distractions: auditory (ear buds/phones in or on ears), and visual/tactile (electronic device or other object in hand). Nineteen hundred seventy-four bicyclists were observed and 615 (31.2%, 95% CI: 29%-33%) were distracted. Of those observed, auditory distractions were the most common (N= 349 [17.7%, 95% CI: 16%-19%], p=0.0003) followed by visual/tactile distractions (N= 266 [13.5%, 95% CI: 12%-15%]). The highest proportion (40.7%, 95% CI: 35%-46%) of distracted bicyclists was observed during the midday commute (between 13:30-15:00). Distracted bicycling is a prevalent safety concern in the city of Boston, as almost one-third of all bicyclists exhibited distracted behavior. Education and public awareness campaigns should be designed to decrease distracted bicycling behaviors and promote bicycle safety in Boston. An awareness of the prevalence of distracted biking can be utilized to promote bicycle safety campaigns dedicated to decreasing distracted bicycling and to provide a baseline against which improvements can be measured. PMID:26953533

  12. Pharmacological management of osteogenesis

    PubMed Central

    Nardone, Valeria; D'Asta, Federica; Brandi, Maria Luisa

    2014-01-01

    Osteogenesis and bone remodeling are complex biological processes that are essential for the formation of new bone tissue and its correct functioning. When the balance between bone resorption and formation is disrupted, bone diseases and disorders such as Paget's disease, fibrous dysplasia, osteoporosis and fragility fractures may result. Recent advances in bone cell biology have revealed new specific targets for the treatment of bone loss that are based on the inhibition of bone resorption by osteoclasts or the stimulation of bone formation by osteoblasts. Bisphosphonates, antiresorptive agents that reduce bone resorption, are usually recommended as first-line therapy in women with postmenopausal osteoporosis. Numerous studies have shown that bisphosphonates are able to significantly reduce the risk of femoral and vertebral fractures. Other antiresorptive agents indicated for the treatment of osteoporosis include selective estrogen receptor modulators, such as raloxifene. Denosumab, a human monoclonal antibody, is another antiresorptive agent that has been approved in Europe and the USA. This agent blocks the RANK/RANKL/OPG system, which is responsible for osteoclastic activation, thus reducing bone resorption. Other approved agents include bone anabolic agents, such as teriparatide, a recombinant parathyroid hormone that improves bone microarchitecture and strength, and strontium ranelate, considered to be a dual-action drug that acts by both osteoclastic inhibition and osteoblastic stimulation. Currently, anti-catabolic drugs that act through the Wnt-β catenin signaling pathway, serving as Dickkopf-related protein 1 inhibitors and sclerostin antagonists, are also in development. This concise review provides an overview of the drugs most commonly used for the control of osteogenesis in bone diseases. PMID:24964310

  13. [The value of methods of bone regeneration evaluation in limb lengthening by the Wagner, Ilizarov methods and by physeal distraction].

    PubMed

    Tesiorowski, Maciej; Kacki, Wojciech; Jasiewicz, Barbara; Rymarczyk, Adrian; Sebastianowicz, Piotr

    2005-01-01

    Limb lengthening is a long-lasting process, and during new bone formation different complications may occur. Due to this, early diagnosis of disturbances of new bone formation leading to such complications is of importance. The goal of this study is to analyze already used methods of regenerate evaluation. Material consists of retrospective data of 237 patients, who underwent limb lengthening between 1983 and 2002 by one of three methods: Wagner method, Ilizarow method and physeal distraction. During femoral lengthening by Wagner method appropriate shape of regenerate according to Hamanishi was observed in 9 cases (29.0%), and during tibia lengthening--only in 1 case (6.7%). During femoral lengthening by physeal distraction appropriate shape of regenerate (A or B according to Hamanishi) was observed in 24 cases (77.4%), and during tibia lengthening--in 11 cases (78.6%). During femoral lengthening by Ilizarow method appropriate shape of regenerate was observed in 51 cases (72.9%), and during tibia lengthening--in 46 cases (66.7%). Only in Wagner method a correlation between abnormal regenerate shape and bone consolidation complications was noted. Methods of evaluation of bone regeneration during distraction osteogenesis give only descriptive assessment. So far parameters applied for evaluation of distraction osteogenesis in Ilizarow method and physeal distraction do not allow for detailed assessment of bone regeneration process.

  14. Maxillary orthognathic surgery.

    PubMed

    Bauer, Richard E; Ochs, Mark W

    2014-11-01

    Maxillary surgery to correct dentofacial deformity has been practiced for almost 100 years. Significant advances have made maxillary surgery a safe and efficient means of correcting midface deformities. Anesthetic techniques, specifically hypotensive anesthesia, have allowed for safer working conditions. Landmark studies have proven manipulation and segmentalization of the maxilla is safe and allowed this surgery to become a mainstay in corrective jaw surgery. This article provides an overview of surgical techniques and considerations as they pertain to maxillary surgery for orthognathic surgery. Segmental surgery, openbite closure, vertical excess, grafting, and a technology update are discussed.

  15. Bilateral Maxillary Sinus Hypoplasia

    PubMed Central

    Khanduri, Sachin; Agrawal, Sumit; Goyal, Swati

    2014-01-01

    Maxillary sinus hypoplasia (MSH) is an uncommon abnormality of paranasal sinuses noted in clinical practice. Computed tomography (CT) scan helps in diagnosing the anomaly along with any anatomical variation that may be associated with it. MSH is usually associated with other anomalies like uncinate process hypoplasia. Three types of MSH have been described. Type 1 MSH shows mild maxillary sinus hypoplasia, type 2 shows significant sinus hypoplasia with narrowed infundibular passage and hypoplastic or absent uncinate process, and type 3 is cleft like maxillary sinus hypoplasia with absent uncinate process. CT and endoscopic examination usually complement each other in diagnosing MSH. PMID:25548709

  16. Recommendations for optimal distraction protocols for various animal models on the basis of a systematic review of the literature.

    PubMed

    Djasim, U M; Wolvius, E B; van Neck, J W; Weinans, H; van der Wal, K G H

    2007-10-01

    The principles of orthopaedic distraction osteogenesis (DO) have been successfully applied to the craniofacial skeleton, but the latency time, rate and rhythm of distraction, and length of the consolidation period that are optimal for long-bone distraction may be suboptimal for craniofacial DO. The aim of this study was to provide recommendations for optimal distraction parameters in animal experimental research on craniofacial DO. The data used were from studies, added to the PubMed database between 1 January 1973 and 1 January 2007, on the outcome of DO resulting from variations in a single distraction parameter while standardizing the other distraction parameters. Although experimental animal group sizes were rather small, especially in those studies that used large animals, and both skeletally mature and immature animals were used, the (in most cases quantitative) data provided useful information on the optimal parameters in craniofacial DO. A latency period may not be necessary at all. Distraction should be performed at a rate of 1mm/day (this may be halved when small animals such as rats are used) preferably with a continuous rhythm, followed by a consolidation period of 6-8 weeks. These recommendations can be used as basic guidelines for further animal experimental studies on craniofacial DO.

  17. Distraction subtalar arthrodesis.

    PubMed

    Jackson, J Benjamin; Jacobson, Lance; Banerjee, Rahul; Nickisch, Florian

    2015-06-01

    There is a high potential for disability following calcaneal fracture. This potential exists whether a patient is treated with conservative or operative management. Subfibular impingement and irritation of the peroneal tendon and sural nerve may also be present. Posttraumatic arthritis of the subtalar joint can occur. In patients with symptomatic calcaneal malunion, systematic evaluation is required to determine the source of pain. Nonsurgical treatment may be effective. One surgical treatment option is subtalar distraction arthrodesis. High rates of successful arthrodesis and patient satisfaction have been reported with this surgical option in correctly selected patients. Published by Elsevier Inc.

  18. Neural Basis of Visual Distraction

    ERIC Educational Resources Information Center

    Kim, So-Yeon; Hopfinger, Joseph B.

    2010-01-01

    The ability to maintain focus and avoid distraction by goal-irrelevant stimuli is critical for performing many tasks and may be a key deficit in attention-related problems. Recent studies have demonstrated that irrelevant stimuli that are consciously perceived may be filtered out on a neural level and not cause the distraction triggered by…

  19. Neural Basis of Visual Distraction

    ERIC Educational Resources Information Center

    Kim, So-Yeon; Hopfinger, Joseph B.

    2010-01-01

    The ability to maintain focus and avoid distraction by goal-irrelevant stimuli is critical for performing many tasks and may be a key deficit in attention-related problems. Recent studies have demonstrated that irrelevant stimuli that are consciously perceived may be filtered out on a neural level and not cause the distraction triggered by…

  20. Osteogenesis imperfecta: diagnosis and treatment.

    PubMed

    Palomo, Telma; Vilaça, Tatiane; Lazaretti-Castro, Marise

    2017-08-31

    Here we summarize the diagnosis of osteogenesis imperfecta, discuss newly discovered genes involved in osteogenesis imperfecta, and review the management of this disease in children and adults. Mutations in the two genes coding for collagen type I, COL1A1 and COL1A2, are the most common cause of osteogenesis imperfecta. In the past 10 years, defects in at least 17 other genes have been identified as responsible for osteogenesis imperfecta phenotypes, with either dominant or recessive transmission. Intravenous bisphosphonate infusions are the most widely used medical treatment. This has a marked effect on vertebra in growing children and can lead to vertebral reshaping after compression fractures. However, bisphosphonates are less effective for preventing long-bone fractures. At the moment, new therapies are under investigation. Despite advances in the diagnosis and treatment of osteogenesis imperfecta, more research is needed. Bisphosphonate treatment decreases long-bone fracture rates, but such fractures are still frequent. New antiresorptive and anabolic agents are being investigated but efficacy and safety of these drugs, especially in children, need to be better established before they can be used in clinical practice.

  1. [Front Block distraction].

    PubMed

    Esnault, Olivier

    2015-03-01

    The contribution of the segmental osteotomies in the ortho-surgical protocols is no longer to demonstrate and found a new lease of life thanks to the combination with the bone distraction techniques. The osteotomy of Köle, initially described to close infraclusies, and then used to level very marked curves of Spee has more recently been used to correct anterior crowding. This support is therefore aimed at patients with an incisor and canine Class 2 but molar Class 1 with an isolated mandibular footprint. With minimal orthodontic preparation we can create in two weeks bilateral diastemas that will then be used to align the incisivocanin crowding without stripping or bicuspid extractions. Dental orthodontic movements can be resumed one month after the end of the distraction. This technique is therefore likely to avoid bicuspid extraction and replace some sagittal osteotomy advancement by correction of the overjet. It also helps to correct a incisors labial or lingual tipping playing on differential activation of the cylinders and the distractor. This segmental surgery can be combined with Le Fort 1 surgeries with correction of the transverse and associated meanings, but in a second time, to a mandibular advancement and/or a genioplasty.

  2. [Segmental monobloc osteotomy and bi-directional distraction for the treatment of Crouzon syndrome in an infant].

    PubMed

    Shen, Wei-Min; Cui, Jie; Chen, Jian-Bin; Chen, Hai-Ni; Zou, Ji-Jun; Ji, Yi

    2011-09-01

    To discuss the segmental monobloc osteotomy and bi-directional distraction for the treatment of Crouzon syndrome in an infant. A 9-month-old female infant underwent monobloc osteotomy through combined intra- and extra-cranial way. The facial skull was divided into frontal, orbital and maxillary segments. The external distractor was used to move the frontal segment, orbital segment and midface forward. The internal distractor was used to move the maxilla downward. The consolidation lasted for 3 months after distraction. The osteotomy and distraction were successfully completed. The distraction distance reached 18 mm, showing by distractor. The real distraction distance of facial bone was 12 mm, documented by 3-D image. The skull deformity and severe depression of midface improved a lot. The exophthalmos and underbite were corrected. The obstructive sleep apnea also improved markedly. However, the downward movement of maxilla was limited. Monobloc osteotomy with external distractor, as well as maxillary distraction, could be used for Crouzon syndrome in infant. It is safe and effective method which can be performed in an early age for Crouzon syndrome with obstructive sleep apnea.

  3. Laser effects on osteogenesis

    NASA Astrophysics Data System (ADS)

    Freitas, I. G. F.; Baranauskas, V.; Cruz-Höfling, M. A.

    2000-02-01

    The traumatic or surgical cutting of a long bone is immediately followed by a sequence of repair processes in which the osteogenic cells of the periosteum start to proliferate and differentiate in osteoblast cells. In this work, we explored the influence of a He-Ne laser on osteogenesis after a controlled surgical fracture. We used young male adult Wistar rats (of mass between 250 and 300 g). The fracture was provoked by piercing a 2-mm-diameter hole in just one cortical tibia surface. Laser treatment was started 24 h after the surgery. The animals were separated into three groups, for different radiation doses, and after daily applications, they were sacrificed at 8 or 15 days. Light and electron microscopies revealed that the laser treatment of the lesion with doses of 31.5 and 94.7 J cm -2 resulted in the formation of thicker bony trabeculae, which indicates a greater synthesis of collagen fibers and therefore that the osteoblastic activity was increased by the low-energy laser radiation.

  4. Assessment of Mandibular Distraction Regenerate Using Ultrasonography and Cone Beam Computed Tomography: A Clinical Study

    PubMed Central

    Dabas, Jitender; Mohanty, Sujata; Chaudhary, Zainab; Rani, Amita

    2015-01-01

    Distraction osteogenesis (DO) is becoming a popular method of reconstruction for maxillofacial bony deformities or defects secondary to trauma or surgical tumor ablation. However, the technique is very sensitive in terms of the rate and rhythm of distraction. Because of this, there is a need for monitoring of the distraction regenerate during the distraction as well as the consolidation period. The present study was conducted to assess the regenerate using two imaging modalities, namely, ultrasonography (USG) and cone beam computed tomography (CBCT) to determine their relative efficacies and to weigh their clinical usefulness in assessment of DO regenerate. The study was conducted on 12 patients (18 sites) who underwent mandibular distraction for correction of facial deformities. The results showed that overall USG correlated better with the condition of regenerate (r = 0.606) as compared with CBCT (r = 0.476). However, USG was less effective as compared with CBCT in assessing the regenerate once corticomedullary differentiation occurred in the bone. PMID:26889351

  5. Young and Older Adults' Reading of Distracters

    ERIC Educational Resources Information Center

    Kemper, Susan; Mcdowd, Joan; Metcalf, Kim; Liu, Chiung-Ju

    2008-01-01

    Eye-tracking technology was employed to examine young and older adults' performance in the reading with distraction paradigm. Distracters of 1, 2, and 4 words that formed meaningful phrases were used. There were marked age differences in fixation patterns. Young adults' fixations to the distracters and targets increased with distracter length.…

  6. Get the message: distracted driving and teens.

    PubMed

    Adeola, Ruth; Gibbons, Mallory

    2013-01-01

    Distracted driving is a growing problem in the United States. With the integration of wireless devices into everyday life, cell phone use behind the wheel is a distraction requiring increasing concern. Teen drivers are most susceptible to the dangers of distracted driving as made evident in the overrepresentation of teens in distraction-related motor vehicle crashes. This article describes the causes, consequences, and statistics related to distracted driving in teenagers and an injury prevention program for teenagers.

  7. Orthodontic treatment in combination with Le Fort II bone distraction in patient with Apert syndrome.

    PubMed

    Miyazaki, Haruyo; Katada, Hidenori; Ichinokawa, Yoshimi; Hirabayashi, Shinichi; Sueishi, Kenji

    2013-01-01

    We report a case of an 11-year-old girl presenting with Apert syndrome characterized by midface concavity, protrusion of the eyeballs, and ocular hypertelorism. She had class III anterior crossbite, narrow upper and lower arches, and marked crowding. Based on cephalometric analysis, anterior crossbite associated with marked midfacial hypoplasia was diagnosed. Orthodontic treatment in combination with Le Fort II maxillary distraction was scheduled. The dentition was laterally extended using a Rapid palatal expander in the upper jaw and a Bihelix in the lower jaw. Multi-bracket appliances were simultaneously applied for leveling. N