IBIMA Publishing Journal of Research and Practice in Dentistry http://www.ibimapublishing.com/journals/DENT/dent.html Vol. 2014 (2014), Article ID 798969, 20 pages DOI: 10.5171/2014.798969 Research Article Distraction Osteogenesis: Evolution and Contemporary Applications in Orthodontics George Jose Cherackal and Navin Oommen Thomas Department of Orthodontics, Pushpagiri College of Dental Sciences, Medicity, Tiruvalla, Kerala, India Correspondence should be addressed to: George Jose Cherackal; [email protected] Received Date: 30 June 2013; Accepted Date: 31 July 2013; Published Date: 31 January 2014 Academic Editor: Doǧan Dolanmaz Copyright © 2014 George Jose Cherackal and Navin Oommen Thomas. Distributed under Creative Commons CC-BY 3.0 Abstract Orthodontic tooth movement is brought about by the biomechanical utilization of the physiological mechanisms for bone remodeling in order to achieve optimal occlusion and thereby maximize the esthetic outcome. Distraction osteogenesis is a biomechanical process of bone tissue formation, where the distraction forces which act between the bone segments effect the biological potential of the bone. Though initially used in long bones, through the past years the technique has undergone significant advancements and innovations, that it has had increasing applications in the facial skeleton. The gradual evolution of compact internal appliances has lately led to the use of this concept in the field of orthodontics for moving tooth segments rapidly for an accelerated treatment outcome, and for novel modalities in the treatment of ankylosed teeth. This article is presented under the light of current literature to review the history, evolution and role of distraction in contemporary orthodontics. Keywords: Distraction Osteogenesis; Dentoalveolar Distraction; Canine Retraction; Ankylosed Tooth. Introduction deformities. Initially external devices were used for distraction. Lately devices for Distraction Osteogenesis (DO) involves intraoral usage are being engineered gradual, controlled displacement of thereby increasing its potential surgically created fractures (subperiosteal applications in dentistry. The essence of osteotomy) by incremental traction orthodontic treatment is the movement of (Ilizarov, 1988), resulting in simultaneous teeth through alveolar bone to obtain an expansion of soft tissue and bone volume esthetically ideal occlusion. Many advances due to mechanical stretching through the have occurred in orthodontics over the osteotomy site (Ilizarov, 1989). This ability past century, but relatively little has been to reconstruct combined deficiencies in done to enhance the rate at which tooth bone and soft tissue makes the process movement occurs and for successful unique and invaluable to all types of management of complications such as reconstructive surgeons. The procedure is ankylosed teeth. The current applications now widely used by maxillofacial surgeons of DO in orthodontics focuses on for the correction of craniofacial addressing these concerns. _____________ Cite this Article as : George Jose Cherackal and Navin Oommen Thomas (2014), "Distraction Osteogenesis: Evolution and Contemporary Applications in Orthodontics," Journal of Research and Practice in Dentistry, Vol. 2014 (2014), Article ID 798969, DOI: 10.5171/2014.798969 Journal of Research and Practice in Dentistry 2 History of the Procedure of the mandible. Subsequently Polley and Figueroa (1997) made use of the procedure The history of DO begins with the old in the treatment of severe maxillary techniques of repositioning and deficiency in children and adolescents with stabilization of bone fractures used by cleft problems. Presently craniofacial DO is Hippocrates, as noted in the book by implemented in the lower face (mandible), Samchukov, Cherkashin, and Cope (1999). mid face (maxilla, orbits), upper face In early 20 th century Alessandro Codivilla (fronto-orbital, cranial vault), and in (1905) introduced a crude method of DO congenital and acquired anomalies. for lengthening of the lower limbs. Later, Craniofacial anomalies account for most Abbott (1927) improved the Codivilla applications of distraction. method by incorporating pins instead of casts; and Rosenthal (1930) first Evolution in Orthodontics performed this technique in the maxillofacial region; who was followed by Modern research and development in the Kazanjian (1941) and Crawford (1948). field of DO has led to the implementation of Subsequently, Allan (1948) incorporated a numerous innovative and revolutionary screw device to control the rate of distraction systems. A wide variety of distraction. However, DO did not gain intraoral internal distractors now available immediate acceptance until the are engineered to be small and compact breakthrough in 1951 when Gavril Ilizarov with increased patient comfort and (1969), developed a technique for acceptance. This paved way to further repairing complex fractures or nonunion of investigating the technique for applications the long bones. Ilizarov’s procedure was in influencing the rate and vector of tooth based on the biology of bone and the ability movement. of the surrounding soft-tissues to regenerate under tension. He was able to Liou and Huang (1998) first applied this reduce the frequency and severity of the concept to orthodontic tooth movement complications and made the surgery safer. and performed rapid canine retraction Over the ensuing years, the technique was through distraction, which they aptly perfected, stimulating interest in DO. termed as ‘Dental Distraction’. Later investigations validated that this rapid The first reports of craniofacial DO maybe movement is a form of DO of the attributed to the rapid expansion of the periodontal ligament which acts a ‘suture’ palate that was carried out in growing between alveolar bone and tooth with patients in the 1960s (Haas, 1961). This similar osteogenic potential (Liou, Figueroa practice, however, involved the distraction & Polley, 2000). In a more recent study, of a naturally occurring physis since it Sayin et al. (2004) investigated the clinical incorporates controlled soft-tissue and validation of this technique and hard tissue expansion through a suture. substantiated that this procedure reduced Finally, Snyder et al. (1973) first described the net orthodontic treatment time. Soon the Ilizarov technique to lengthen a after this concept was introduced, İşeri et surgical osteotomy of the canine mandible al. (2001) and Kişnişci et al. (2002) used a by 15mm. By the early 1990s, experimental different technique called ‘Dentoalveolar investigation intensified following reports Distraction’ (DAD) for rapid canine from New York University (Karp, Thorne, distalization by performing osteotomies McCarthy & Sissons, 1990) and from around the canines and achieved Constantino et al. (1993), where DO was accelerated movement. This surgical successfully used to augment and to close technique does not rely on the stretching canine segmental lower jaw defects. and widening of the periodontal ligament, thus prevents overloading and stress The first clinical results of craniofacial DO accumulation in the periodontal tissues were reported by McCarthy et al. (1992) in (Gürgan, İşeri, & Kişnişçi, 2005). The patients with congenital deformities who technique was later substantiated with successfully underwent gradual distraction follow-up (Kurt, İşeri, & Kişnişci, 2010) and _______________ George Jose Cherackal and Navin Oommen Thomas (2014), Journal of Research and Practice in Dentistry, DOI: 10.5171/2014.798969 3 Journal of Research and Practice in Dentistry a large number of cases have since been Distraction Device Classification treated successfully (Kişnişçi & Iseri, 2011). Distraction devices used for craniofacial osteodistraction are classified into two In the same year Isaacson et al. (2001) basic types: external and internal devices successfully attempted to move an (Figure 1). Depending on the direction of ankylosed central incisor using action, they are further categorized as orthodontics, surgery and DO. Later, Kodof unidirectional, bidirectional, or et al. (2005) demonstrated the multidirectional devices (Andrade, effectiveness of treating ankylosed tooth Gandhewar & Kalra, 2011). External and the surrounding alveolar ridge defect devices are attached to the bone with by a simple DO apparatus. More recent case percutaneous pins and fixation clamps, reports have emphasized the evolutionary connected by a distraction rod. The internal role of DO in attaining orthodontic devices can be placed subcutaneously, or correction of ankylosed anterior teeth placed intraorally as extramucosal or (Dolanmaz, Karaman, Pampu & Topkara, submucosal. Devices can be attached to the 2010; Kim, Park, Son, Kim, Kim & Mah, bone (bone-borne); to the teeth (tooth 2010). borne) or attached to both (hybrid type). Figure 1: Classification of Craniofacial Distraction Devices Influencing Rate of Tooth Movement accelerate orthodontic tooth movement. Kharkhar et al. (2010) in their quasi- To date, several innovative modalities have randomized controlled trial to evaluate the been reported to accelerate orthodontic best approach to reduce the overall tooth movement, including low-level laser orthodontic treatment time by means of therapy, pulsed electromagnetic fields, distraction osteogenesis inferred that electrical currents, corticotomy, distraction dentoalveolar distraction was superior to osteogenesis, and mechanical vibration. periodontal distraction in all areas of Recently