DOCSLIB.ORG

The Role of Orthodontist in Distraction Osteogenesis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Role of Orthodontist in Distraction Osteogenesis Original Research Article DOI: 10.18231/2455-6785.2017.0028 The role of orthodontist in distraction osteogenesis Vedavathi H.K.1, Chirag Arora2,*, Bharath Reddy3, Sowmya K.S.4, Goutham N5 1,3,4,5Reader, 2PG Student, Dept. of Orthodontics, V.S. Dental College & Hospital, Bengaluru, Karnataka *Corresponding Author: Email: [email protected] Abstract Although orthognathic surgery has gained recognition over the last few decades it still has not overcome several limitations like acute advancement of bone segments and adaptation of soft tissue relative to the new position. With the advent of distraction osteogenesis these limitations have been omitted. Recently, several experimental and clinical investigations have established that controlled progressive mechanical traction of bone segments at an osteotomy site created in the craniofacial region can form new bone parallel to the direction of traction. Thorough planning, careful evaluation and communication between the orthodontist and maxillofacial surgeon is the key to a successful outcome of the treatment and resolution of malocclusion. In addition, management of dentition prior to distraction need careful assessment for better finish of occlusion after distraction osteogenesis has been performed. Hence, the purpose of this article is to review the historic development and biologic foundation of mandibular distraction osteogenesis, and role of orthodontist in distraction osteogenesis. Keyword: Distraction osteogenesis, Soft tissue capsule, Neuromuscular Introduction distraction. By applying distraction forces sequence of Facial asymmetry, mandibular hypoplasia, and adaptive changes surrounding periosteal matrix is congenital malformation of jaws are common propagated, termed as distraction histogenesis. Due to abnormalities of the craniofacial complex. the influence of tensional stresses generated by gradual Traditionally, skeletal deformities have been corrected distraction, active histogenesis occurs in surrounding via functional orthopedics in growing patients or tissues. These adaptive changes may permit larger orthognathic surgery with skeleton fixation in non- skeletal movements while diminishing the potential growing patients.(1-4) Adaptation and stability of the relapse seen in acute orthopedic corrections. adjacent muscles and soft tissues are one of the Distraction process includes following fundamental limitations and controversies related to orthognathic sequential phases in which different biologic surgery and functional orthopedics.(2,4,5) Many phenomenon are induced. congenial deformities require large amount of skeletal 1. Osteotomy cut movements which is perhaps not possible with 2. Latency period orthognathic surgery may lead to compromise in 3. Distraction phase function and esthetics.(6-7) One of the major demerits of 4. Consolidation phase orthognathic surgery is that it permits only acute The distraction technique presents wide changes in the spatial arrangement of skeleton rather possibilities of use in some areas of dentistry, i.e. than provide de novo bone formation and which surgical orthodontics, facial orthopedics and in oral requires the needs of bone graft. It does not permit the rehabilitation where one of the major problems is the change in shape and size of the bones to maximize the alveolar bone loss for the support for prosthesis, structural integrity, functional balance and esthetic of implantation and adjacent soft tissues. Recent clinical the patient. reports have acknowledged the successful application Taking into account of these limitations, recent of osteodistraction in treating skeletal deformities of the approaches have been directing at new bone growth craniofacial region.(16-33) The use of gradual incremental which is called as “distraction osteogenesis”. traction of the mandible has allowed up to 20 mm of Distraction Osteogenesis is defined as the creation of de lengthening with no associated pain. Because these novo bone and adjacent soft tissue after the gradual and conditions are typically treated by a team approach, a controlled displacement of a bone fragment obtained by thorough understanding of the evolution and future surgical osteotomy. Periosteal matrix adjacent to development of osteodistraction is of paramount skeletal tissue have been noted to form under stress, importance to the orthodontist. which includes mucosa, skin, tendon, muscle, blood vessel, cartilage and peripheral nerves.(8-15) Steady bone History remodeling, in varied directions without surgical The progression of craniofacial distraction interventions is now possible by utilization of osteogenesis was based on the development and distraction osteogenesis. The traction by the distractor refinement of dentofacial traction, craniofacial appliance institutes tension within the callus which osteotomies, and skeletal fixation methods. Later, stimulates new bone formation parallel to the vector of modifications of these techniques were merged into Indian Journal of Orthodontics and Dentofacial Research, July-September 2017;3(3):141-147 141 Vedavathi H.K. et al. The role of orthodontist in distraction osteogenesis osteodistraction procedures that were finally application of Illizarov’s principle to the mandible standardized based on experiences with distraction appeared in 1973 by Snyder et al. osteogenesis on long bones. External fixation device for mandibular The application of tensile and compressive forces lengthening was first applied given by McCarthy in to bones of the craniofacial skeleton in the field of 1989. Illizarov (1990) showed that the fibrous matrix in orthodontics and dentofacial orthopedics is not a new the tensioned area was capable of differentiating by concept. Since eighteenth century principles of dental itself into lamellar bone tissue. He entitled the so called traction for the correction of skeletal deficiencies have “Illizarov effect”. A comprehensive analysis of been popular in dentistry. In 1728, Pierre Fauchard distraction regeneration at different stages of formation illustrated the use of the expansion arch. When the was given by Karp and co-workers based on metal plate was ligated to the crowded dentition, the experimental studies in 1990. teeth were widened to a normal form. However, the McCarthy et al (1992)(40) was the first author to limitation of this form of traction was that only tooth relate distraction osteogenesis application in human. movement arose with little effect on the skeletal tissue. Querido and Fan were among the first authors to use an In 1859, Wescott was the first who reported the intra-buccal distraction in human for orthopedic implementation of mechanical forces on the bones of corrections. the maxilla. He used two double clasps separated by a telescopic bar to correct a crossbite in a 15-year-old Indications of Mandibular Distraction girl. However, the demerits of this procedure were that Osteogensis(41-43) it was slow and tedious andprolonged treatment 1. Severe mandibular retrognathia/micrognathia duration. Later on, Angell performed a similar 2. Craniofacial syndromes: hemifacial microsomia, procedure with a differentially threaded jackscrew Treacher Collins syndrome, Nager syndrome, connected to the premolars. Palatal expansion was Pierre Robin sequence achieved through the separation of the maxillary bones 3. Severe mandibular asymmetry at the midpalatal suture in 2 weeks. A new protocol for 4. Post-traumatic deficient mandibular growth and palatal expansion was further standardized by Goddard temporomandibular joint ankylosis in 1893. He activated the device twice a day for 3 5. Revision mandibular orthognathic surgery weeks followed by a stabilization period to allow the 6. Mandibular retrognathia with temporomandibular deposition of “osseous material” in the created gap. joint disease or juvenile rheumatoid arthritis In 1905, Alessandro Codivilla(34) introduced 7. Mandibular retrognathia with obstructive sleep surgical techniques for lengthening of the lower apnea extremities. In 1934, the New York hospital for joint 8. Mandibular defects from tumor resection disease worked on an early method developed by Illizarov. The US team of surgeons came up with the Advantages of Distraction Osteogensis(40,44-49) concept of metal frame to hold the limb in placed until 1. Allows greater mandibular lengthening of 10–30 the healing was complete. Major amelioration came mm with a technique introduced by Russian orthopedic 2. Can be applied to unusual bony and soft tissue surgeon Gavril Illizarov. He developed procedure anatomy which induced new bone formation and regeneration of 3. Allows slow gradual soft tissue adaptation to surrounding soft tissues under the tension.(35-36) extreme mandibular lengthening According to Wassmund in 1927,(37) intraoral tooth 4. Minimal to no skeletal relapse after extreme borne appliances for first mandibular distraction mandibular lengthening osteogenesis which was gradually activated over a 5. Can be applied to neonates, infants, and pediatric period of 1 month which was carried out by Rosenthal. patients with obstructive sleep apnea In 1937, Kazanjian(38) implemented a new protocol for 6. Less invasive surgery compared with bone-grafting mandibular osteodistraction by using gradual procedures incremental fraction. After L-Shaped osteotomies in 7. Avoids intermaxillary fixation corpus he attached a wire hook to the symphysis, 8. Avoids bone grafting and potential donor-site thereby providing direct skeletal fixation. morbidity In 1948, even though Crawford(39) followed
Load more

Recommended publications
  • Multidirectional Cranial Distraction Osteogenesis Technique for Treating Bicoronal Synostosis
    Journal of Cranio-Maxillo-Facial Surgery 47 (2019) 1436e1440 Contents lists available at ScienceDirect Journal of Cranio-Maxillo-Facial Surgery journal homepage: www.jcmfs.com Multidirectional cranial distraction osteogenesis technique for treating bicoronal synostosis * Ataru Sunaga a, b, , Yasushi Sugawara c, Akira Gomi d, Daekwan Chi b, Hideaki Kamochi e, Hirokazu Uda b, Kotaro Yoshimura b a Department of Pediatric Plastic Surgery, Jichi Children's Medical Center Tochigi, 3311-1, Yakushiji, Shimotsuke, 329-0498 Tochigi, Japan b Department of Plastic Surgery, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, 329-0498, Tochigi, Japan c Lilla Craniofacial Clinic Tokyo, 1-7-17, Ginza, Chuo-ku, 104-0061, Tokyo, Japan d Department of Pediatric Neurosurgery, Jichi Children's Medical Center Tochigi, 3311-1, Yakushiji, Shimotsuke, 329-0498, Tochigi, Japan e Department of Plastic Surgery, Shizuoka Children's Hospital, 860, Urushiyama, Aoi, Shizuoka, 420-8660, Shizuoka, Japan article info abstract Article history: Fronto-orbital advancement by distraction osteogenesis is a useful means of surgically correcting Paper received 6 March 2019 bicoronal synostosis. However, the scope for morphological revision is limited. To address this issue, we Accepted 19 June 2019 developed a multidirectional cranial distraction osteogenesis (MCDO) technique that we quantitatively Available online 25 June 2019 assessed in patients with bicoronal synostosis. In this case series, five patients with bicoronal synostosis were treated with MCDO at a mean age of Keywords: 13.4 months (range 9e22 months). Distraction started 5 days after surgery and the activation period was Bicoronal synostosis 11.2 days (range 10e14 days). The distraction devices were removed 47.2 days (range 33e67 days) after Distraction osteogenesis fi Apert syndrome completing distraction.
    [Show full text]
  • The Role of Bone Morphogenetic Protein 2 in SMA-Directed Angiogenesis During Distraction Osteogenesis
    Boston University OpenBU http://open.bu.edu Theses & Dissertations Boston University Theses & Dissertations 2015 The role of bone morphogenetic protein 2 in SMA-directed angiogenesis during distraction osteogenesis https://hdl.handle.net/2144/16261 Boston University BOSTON UNIVERSITY SCHOOL OF MEDICINE Thesis THE ROLE OF BONE MORPHOGENETIC PROTEIN 2 IN SMA-DIRECTED ANGIOGENESIS DURING DISTRACTION OSTEOGENESIS by THOMAS W. CHENG B.S., Johns Hopkins University, 2013 Submitted in partial fulfillment of the requirements for the degree of Master of Science 2015 © 2015 by THOMAS W. CHENG All rights reserved Approved by First Reader Dr. Louis C. Gerstenfeld, Ph.D. Professor, Department of Orthopaedic Surgery Second Reader Dr. Beth Bragdon, Ph.D. Postdoctoral Research Fellow, Department of Orthopaedic Surgery ACKNOWLEDGMENTS I will like to thank my family for their support. I will like to express special appreciation to Dr. Gerstenfeld and Dr. Bragdon for giving me the opportunity to conduct research in the laboratory and being close mentors throughout this project. iv THE ROLE OF BONE MORPHOGENETIC PROTEIN 2 IN SMA-DIRECTED ANGIOGENESIS DURING DISTRACTION OSTEOGENESIS THOMAS W. CHENG ABSTRACT Bone is one of the few organs capable of regeneration after a substantial injury. As the bone heals itself after trauma, the coupling of angiogenesis to osteogenesis is crucial for the restoration of the skeletal tissue. In prior studies we have shown that Bone Morphogenetic Protein 2 (BMP2), a potent agonist for skeletal formation is expressed by vessels making it a prime candidate that links the morphogenesis of the two tissues. To investigate the role of BMP2 in the coordination of vessel and bone formation, we used a tamoxifen inducible Smooth Muscle Actin (SMA) promoter that conditionally expresses Cre recombinases crossed with a BMP2 floxed mouse in order to conditionally delete the BMP2 gene in smooth muscle actin (SMA) expressing cells.
    [Show full text]
  • Distraction Osteogenesis: Evolution and Contemporary Applications in Orthodontics
    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.
    [Show full text]
  • Metacarpal Lengthening in Adults with Brachymetacarpia
    HANXXX10.1177/1558944717736859HANDLam et al 736859research-article2017 Surgery Article HAND 1 –7 Metacarpal Lengthening in © The Author(s) 2017 Reprints and permissions: sagepub.com/journalsPermissions.nav Adults With Brachymetacarpia DOI:https://doi.org/10.1177/1558944717736859 10.1177/1558944717736859 hand.sagepub.com Aaron Lam1, Austin T. Fragomen2, and S. Robert Rozbruch2 Abstract Background: Metacarpal lengthening by distraction osteogenesis has been well documented in pediatric patients but limited in older patients. Fewer studies have assessed the success of the procedure through outcome measure scores. The purpose of this study is to assess the outcomes of distraction osteogenesis in skeletally mature adults with brachymetacarpia and patients’ perspectives on their satisfaction through outcome measure scores. Methods: Retrospective chart review of a consecutive series of metacarpal lengthenings for the treatment of brachymetacarpia was performed. Key parameters collected include starting metacarpal length, amount lengthened, range of motion of metacarpophalangeal joint, type of fixator used, distraction time, and total time in fixator. Relevant comorbidities and complications encountered were recorded as well. The Body Image Quality of Life Inventory (BIQLI) and Limb Deformity Modified Scoliosis Research Society (LD-SRS) score were given to evaluate patients’ perspectives on their satisfaction of surgery. Results: Seven metacarpal lengthenings were performed in 4 adult females (average age: 22.8 years) between 2005 and 2016. The average amount lengthened was 1.5 cm (range, 1.2-2.1 cm), corresponding to a mean percent lengthening of 44.4% (range, 33.3%- 57.1%). The mean distraction rate was 0.432 mm/day (range, 0.286-0.724 mm/day). The mean distraction time was 38 days (range, 28-55 days).
    [Show full text]
  • The Potential Roles of Nanobiomaterials in Distraction Osteogenesis Asim M
    CLINICAL SIGNIFICANCE Nanomedicine: Nanotechnology, Biology, and Medicine 11 (2015) 1–18 Regenerative Nanomedicine (Ed. A. Seifalian) nanomedjournal.com The potential roles of nanobiomaterials in distraction osteogenesis Asim M. Makhdom, MD, MSca,b, Lamees Nayef, PhDc,1, ⁎ Maryam Tabrizian, PhDc, , Reggie C. Hamdy, MB, ChB, MSc, FRCSCd aDivision of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada bDepartment of Orthopedic Surgery, King AbdulAziz University, Jeddah, Saudi Arabia cDepartment of Biomedical Engineering, McGill University, Montreal, Quebec, Canada dDivision of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, Montreal, Quebec, Canada Received 19 January 2014; accepted 16 May 2014 Abstract Distraction osteogenesis (DO) technique is used worldwide to treat many orthopedic conditions. Although successful, one limitation of this technique is the extended period of fixators until the bone is consolidated. The application of growth factors (GFs) is one promising approach to accelerate bone regeneration during DO. Despite promising in vivo results, its use is still limited in the clinic. This is secondary to inherent limitations of these GFs. Therefore, a development of delivery systems that allow sustained sequential release is necessary. Nanoparticles and nanocomposites have prevailing properties that can overcome the limitations of the current delivery systems. In addition, their use can overcome the current challenges associated with the insufficient mechanical
    [Show full text]
  • Lengthening by Distraction Osteogenesis in Congenital Shortening of Metacarpals
    ORIGINAL ARTICLE Acta Orthop Traumatol Turc 2013;47(2):79-85 doi:10.3944/AOTT.2013.3080 Lengthening by distraction osteogenesis in congenital shortening of metacarpals Mehmet BULUT1, Bekir Yavuz UÇAR1, ‹brahim AZBOY1, Oktay BELHAN2, Erhan YILMAZ2, Lokman KARAKURT2 1Department of Orthopedics and Traumatology, Faculty of Medicine, Dicle University, Diyarbak›r, Turkey; 2Department of Orthopedics and Traumatology, Faculty of Medicine, F›rat University, Elaz›¤, Turkey Objective: The aim of this study was to present the results of seven cases of metacarpal lengthening by distraction osteogenesis and to discuss the ideal daily rate of distraction. Methods: Metacarpal lengthening was performed by distraction osteogenesis in the seven metacarpals of four patients (3 females, 1 male; mean age: 14.9 years). A unilateral external fixator was used for length- ening. Lengthening was initiated with a distraction rate of 2×0.5 mm/day in the patient with bilateral involvement of the middle and ring metacarpals. On the tenth day of lengthening, distraction was discon- tinued due to pain and contracture. Then, distraction was continued with a rate of 2×0.25 mm/day. In all other cases, the distraction rate was 0.5 mm/day. Pre- and postoperative range of motion was measured with a goniometer. Patient satisfaction was evaluated with visual analog scale. Results: The mean pre- and postoperative metacarpal lengths were 34.6 mm (range: 33 to 37) and 49.7 mm (range: 47 to 52), respectively. The mean lengthening achieved was 15.1 mm (range: 14 to 17), while the mean distraction rate was 0.55 mm/day (range: 0.48 to 0.63).
    [Show full text]
  • Distraction Osteogenesis – Evolution & Technique- an Overview
    IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 15, Issue 12 Ver. I (December. 2016), PP 115-120 www.iosrjournals.org Distraction Osteogenesis – Evolution & Technique- An Overview Dr. Siddharth Sharma1, Dr. Abhishekrathi2, Dr. Gaurav Mittal3, Dr. Rakesh Ranjan4 1Senior Lecturer – OMFS Institute Of Dental Studies & Technologies, UP 2Senior Lecturer – OMFS Institute Of Dental Studies & Technologies, UP 3Professor & Head- OMFS Institute Of Dental Studies & Technologies, UP 4Post Graduate – Iind Year Institute Of Dental Studies & Technologies, UP Abstract: Distraction osteogenesis is a novel method for neo-tissue generation which involves development of both hard and soft tissue under applied force in certain direction. The major advantage of this procedure is diminishing reliability on grafting for reconstruction hence lack of donor site morbidity. Myriad of applications of distraction osteogenesis are present in maxillofacial surgery field which include mandibular distraction, midfacial distraction, alveolar ridge augmentation for functional, aesthetic and rehabilitative purpose. Keywords: distraction, craniofacial distraction, alveolar distraction I. Introduction Distraction Osteogenesis (DO), also called callus distraction, callotasis, osteodistraction, and distraction histogenesis is a biological process of regenerating neo formed bone and adjacent soft tissue by gradual and controlled traction of the surgically separated bone segments1. Specifically, 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. Importantly, distraction forces applied to the bone also create tension in the surrounding soft tissues, initiating a sequence of adaptive changes termed distraction histogenesis.
    [Show full text]
  • Anatomical Concepts of Distraction Osteogenesis: an Orthopaedic Case in Western Kenya
    J Orthop Sports Med 2021; 3 (2): 075- 081 DOI: 10.26502/josm.511500043 Case Report Anatomical Concepts of Distraction Osteogenesis: An Orthopaedic Case in Western Kenya Adero Walter1, Marera Domnic1⃰ 1Department of Human Anatomy, School of Medicine, Maseno University, Private bag-40105 Maseno- Kenya *Corresponding Author: Domnic Marera, Department of Human Anatomy, School of Medicine, Maseno University, Private bag-40105 Maseno- Kenya Received: 18 May 2021; Accepted: 24 May 2021; Published: 28 May 2021 Citation: Adero Walter, Marera Domnic. Anatomical Concepts of Distraction Osteogenesis: An Orthopaedic Case in Western Kenya. Journal of Orthopaedics and Sports Medicine 3 (2021): 075-081. Abstract 1. Introduction Various pathologies that lead to bone gaps of are Distruction osteogenesis is a novel technique utilizing difficult to manage and each presentation may require intramembranous ossification of bone to equalize an individualized protocol of management. In the discrepant limb lengths. It involves a low energy present case, the compound wedge fracture was corticotomy and slow deliberate distraction of callus initially sub-optimally managed leading to more to fill large bone defects. In addition to equalizing complications, non-union, large collection of limb lengths, destraction osteogenesis has sequestrum and sepsis. This unique case required a successfully been used in maxillofacial cosmesis and complex management and salvage of the limb without orthopedic limb salvage [1]. The concept of damaging vital relations such as the nerves, muscles intentional destruction followed by controlled healing and blood vessels. After thorough assessment, a process of bones can be traced back as early as 1905 distraction osteogenesis procedure was recommended [2]. Its main intention was to ensure healing while to restore the limb functions.
    [Show full text]
  • Oral and Maxillofacial Surgery
    Oral and Maxillofacial Surgery Ibrahim Zakhary, Brian M Laing, Moniba Mirkhani and Hatem El-Mekkawi Oral and Maxillofacial Surgery Chapter 1 Distraction Osteogenesis for Correction of Oral and Craniofacial Deformities Ibrahim Zakhary1*, Brian M Laing1, Moniba Mirkhani1 and Hatem El-Mekkawi2 1Department of Oral and maxillofacial surgery, School of Dentistry. University of Detroit-Mercy, USA 2Formerly Dean & Professor OMFS Misr University of Science and Technology, Egypt *Corresponding Author: Ibrahim Zakhary, Department of Oral and maxillofacial surgery, School of Dentistry, University of Detroit-Mercy, USA, Tel: 313-494-6678; Fax: 313-494-6666; Email: [email protected] First Published December 10, 2017 Copyright: © 2017 Ibrahim Zakhary, Brian M Laing and Moniba Mirkhani. This article is distributed under the terms of the Creative Com- mons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source. 2 www.avidscience.com Oral and Maxillofacial Surgery Definition Distraction osteogenesis (DO) is a biological process of new bone regeneration between surgically separated bony segments as a result of gradual traction at a specific rate and rhythm [1]. Synonyms for this process include osteodistraction, callus distraction, callotasis and, most accurately, distraction histogenesis. This latter term en- compasses the active histogenes is not only in bone but in adjacent tissues including gingiva, skin, fascia, muscle, cartilage, blood vessels, and nerves [2,3]. Distraction os- teogenesis is an alternative treatment to conventional or- thognathic surgery for correction of craniofacial deformi- ties [4]. It offers movements of greater magnitude and better post-operative stability compared to conventional orthognathic surgery [5].
    [Show full text]
  • Transplantation of Autologous Bone Marrow Mesenchymal Stem Cells with Platelet-Rich Plasma Accelerate Distraction Osteogenesis in a Canine Model
    Original Article Transplantation of Autologous Bone Marrow Mesenchymal Stem Cells with Platelet-Rich Plasma Accelerate Distraction Osteogenesis in A Canine Model 0RKDPPDG0HKGL'HKJKDQ'903K'10RKDPDGUH]D%DJKDEDQ(VODPLQHMDG3K'2 1DGHU0RWDOOHEL]DGHK0'3-DYDG$VKUD¿+DODQ'903K'4/HLOD7DJL\DU06F2 6DUDQJ6RURRUL'903K'1$JELEL1LNPDK]DU06F20LUVHSHKU3HGUDP '903K'1$EGROKRVVHLQ6KDKYHUGL3K'2+RVVHLQ.D]HPL 0HKUMHUGL'903K'56DGUD,]DGL'901 'HSDUWPHQWRI&OLQLFDO6FLHQFHV)DFXOW\RI9HWHULQDU\0HGLFLQH8QLYHUVLW\ of Tehran7HKUDQ,UDQ 'HSDUWPHQWRI6WHP&HOOVDQG'HYHORSPHQWDO%LRORJ\DW&HOO6FLHQFHV5HVHDUFK&HQWHU5R\DQ,QVWLWXWHIRU 6WHP&HOO%LRORJ\DQG7HFKQRORJ\$&(&57HKUDQ,UDQ /LPE/HQJWKHQLQJRI,UDQ7HKUDQ,UDQ 'HSDUWPHQWRI&OLQLFDO6FLHQFHV)DFXOW\RI9HWHULQDU\0HGLFLQH7DEUL]8QLYHUVLW\ 7DEUL],UDQ 'HSDUWPHQWRI&OLQLFDO6FLHQFHV)DFXOW\RI9HWHULQDU\0HGLFLQH)HUGRZVL8QLYHUVLW\RI0DVKKDG 0DVKKDG,UDQ *Corresponding Address: P.O.Box: 16635-148, Department of Stem Cells and Developmental Biology at Cell Sciences Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran Email: [email protected] 5HFHLYHG'HF$FFHSWHG$SU Abstract 2EMHFWLYHDistraction osteogenesis (DO) is a surgical procedure used to generate large volumes of new bone for limb lengthening. 0DWHULDOVDQG0HWKRGV 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 GLVWUDFWLRQDIWHURVWHRWRP\DQGDSSOLFDWLRQRIDQ,OL]DURY¿[DWRU'LVWUDFWLRQZDVVWDUWHGRQ 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 mesenchy- mal 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.
    [Show full text]
  • Intermolar Mandibular Distraction Osteogenesis—A Preliminary Report
    applied sciences Article Intermolar Mandibular Distraction Osteogenesis—A Preliminary Report Suen A. N. Lie 1,2,* , Britt H. B. T. Engelen 1, Veronique C. M. L. Timmer 1, Nico M. P. Vrijens 1, Paolo Asperio 3 and Peter A. W. H. Kessler 1,2 1 Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center—MUMC+, 6202 AZ Maastricht, The Netherlands; [email protected] (B.H.B.T.E.); [email protected] (V.C.M.L.T.); [email protected] (N.M.P.V.); [email protected] (P.A.W.H.K.) 2 GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands 3 Division of Maxillo Facial Surgery, Cardinal Massaia Hospital, 14100 Asti, Italy; [email protected] * Correspondence: [email protected]; Tel.: +31-4-3387-2010 Abstract: Background: Dental Class II is the most common indication for combined orthodontic- orthognathic treatment. Intermolar mandibular distraction osteogenesis (IMDO) treatment was performed during the growth spurt, to avoid surgery at a later age. The aim of this study is to present our first experience with IMDO. Methods: This is a retrospective case series of patients who underwent an IMDO. All patients showed mandibular retrognathism, and orthodontic treatment with functional appliances was not successful. Results: In total, 20 patients (mean age of 14.8 years (SD = 0.9 ys) were included. All patients achieved a Class I occlusion. An average length gain of 9.6 mm (SD = 3.7 mm) was reached. In one patient an abscess occurred. Nine patients presented Citation: Lie, S.A.N.; Engelen, with root fractures of the second molar; three were lost, one treated endodontically.
    [Show full text]
  • Pamela R, Hanson, DDS, MS to Distract Or Not Distract in the Surgical/Orthodontic
    Pamela R, Hanson, DDS, MS To Distract or not Distract in the Surgical/Orthodontic I. Definition of Distraction Osteogenesis a. Distraction osteogenesis is a process that results in new bone formation between the surfaces of bone segments gradually separated by incremental traction. b. The volume of soft tissue adjacent to the generating bone is also increased c. Histiogenesis i. occurs in different tissues: ii. bone, skin, fascia, blood vessels, nerves, muscle, ligament, cartilage & periosteum. Melugin MB, Hanson PR, Bergstrom CA, Schuckit WI, Gerald Bradley T. Soft tissue to hard tissue advancement ratios for mandibular elongation using distraction osteogenesis in children. Angle Orthod. 2006 Jan:76(1):72-6 II. Understanding Distraction Osteogenesis a. What it can and can’t do i. Can do: 1. Lengthen bones 2. Increase volume of bones 3- dimensionally 3. Increase the soft tissue envelope 4. Decrease relapse Linear distraction device (above) (below)3 dimensional volume increase of right side of dog mandible following distraction utilizing the above linear distraction device images from : Karp NS,et al. Membranous bone lengthening: a serial histological study. Annals Plast Surg 1992:29:2-7. ii. Cannot do: 1. Make bones shorter 2. Make bones smaller 3. Move bones backwards III. To Distract or not distract is the question a. To Distract-When to consider distraction as a treatment modality i. If magnitude is too great for any other procedure ii. If function demands early and/or large magnitude correction iii. If stability is better with DO iv. If it sets up the patient for a more stable and precise definitive procedure at skeletal maturity v.
    [Show full text]