Distraction osteogenesis in maxillofacial surgery a review of

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					Ilizarov technique in Maxillary Alveolar Distraction: A report of three patients.

O’Connell J, Kearns G.

Department of Oral and Maxillofacial Surgery, Mid Western Regional Hospital,

Distraction Osteogenesis (DO) was first described by Von Langenbeck 1in 1869 and later
by Codivilla2 in 1905, and is defined as the process of generating new bone in a gap,
created by osteotomy, between two bone segments in response to the application of
graduated tensile stress across the gap3. The technique remained under-developed until a
series of experimental and clinical studies4, 5 performed in the 1950’s in Western Siberia
by the Russian surgeon Ilizarov, advanced the technique. He successfully applied DO to
the endochondral bone of the upper and lower limbs. Uniquely, bone regeneration by DO
is accompanied by simultaneous expansion of the functional soft tissue matrix, including
blood vessels, nerves, skin, muscle, mucosa, fascia, ligaments, cartilage and periosteum6.
The application of DO in the maxillofacial complex, as an alternative to orthognathic
surgery, began in 1973 with Snyder et al7 and in1977 with Micheili et al8 who reported
on mandibular elongation in dogs. In 1992, McCarthy et al9 reported the use of
distraction to treat patients with hemifacial microsomia and Nagar syndrome.
DO is now used for vertical augmentation of the alveolar ridge10, surgical palatal
expansion11, anterior advancement in maxillary hypoplasia12, correction of congenital
facial abnormalities13, treating cleft patients14, mandibular symphysis elongation15, and
mandibular reconstruction after tumour reconstruction16. Chin and Toth17 described
alveolar distraction osteogenesis(ADO) in 1996. This technique is used for increasing
alveolar bone where rehabilitation with dental implants is required. Some of the
advantages of ADO, compared with the conventional techniques of bone grafting and
guided tissue regeneration, are decreased bone resorption, no donor site morbidity, and
associated soft- tissue regeneration18.
The purpose of this retrospective study was to analyse the outcome of ADO used to treat
Anterior Maxillary Atrophy including vertical and horizontal defects, prior to placement
of endosseous implants.

Patients and Methods
This is a review of 3 patients who underwent Alveolar Distraction Osteogenesis at the
Oral and Maxillofacial Department, Mid Western Regional Hospital, Limerick. All
patients were male, with a mean age of 34 years (range, 21 to 50 years). All had a
diagnosis of anterior maxillary deficiency and loss of associated teeth, secondary to
trauma. The absence of alveolar bone, in a horizontal and vertical direction, prevented the
placement of endosseous implants used to enhance function and aesthetics.
All patients were treated using the following protocol:
    1) Creation of a three sided osteotomy in the maxillary alveolus and placement of
        the distractor under general anaesthesia.
    2) Latency period of 5 days.
    3) Distractor activation at a rate of 1mm per day.
    4) Consolodation phase of 12 weeks.

Following consolidation, the distractor was removed. Adequate vertical alveolar height
was achieved in all cases. Horizontal bone deficiency was corrected using autogenous
bone grafts (1 mandibular symphyseal and 2 iliac crest).
Following bone graft healing of approximately four months, all patients underwent
placement of dental implants with subsequent restoration of the dentition by their dentist.
The mean follow up was 30 months (range, 3 to 36 months).

In patients with severe horizontal or vertical maxillary alveolar atrophy, the combination
of Alveolar Distraction to increase vertical bone height and the associated soft tissue
envelope followed by horizontal autogenous bone grafting, provides a predictable
increase in alveolar bone volume to permit implant placement and restoration of the
maxillary dentition.

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