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

OBJECTIVE: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

The comparison of psychological adjustment of patients with cleft lip and palate after maxillary distraction osteogenesis and conventional orthognathic surgery.

OBJECTIVE: The objective of this study was to compare the psychological changes of patients with cleft lip and palate (CLP) undergoing maxillary Le Fort I advancement by distraction osteogenesis (DO) and conventional orthognathic surgery (CO). STUDY DESIGN: Prospective randomized controlled study. Participants completed a set of questionnaires to measure their psychological states preoperatively and postoperatively. RESULT: When compared with CO, CLP patients treated with DO had lower social self-esteem and higher social avoidance and distress levels during the first 3 postoperative months. Their self-esteem, social avoidance, and distress levels improved after the distractors were removed. Both CO and DO patients had similar levels of self-esteem, social avoidance, and distress levels 2 years postoperatively. The CLP patients treated with DO were more satisfied with their lives after 2 years. CONCLUSIONS: DO may induce short-term distress to patients up to 3 months but CLP patients who received DO were more satisfied with their lives in the long term.

Soft tissue changes from maxillary distraction osteogenesis versus orthognathic surgery in patients with cleft lip and palate--a randomized controlled clinical trial.

PURPOSE: The objective of this randomized controlled clinical trial was to compare the soft tissue changes after maxillary advancement using conventional orthognathic surgery (CO) and distraction osteogenesis (DO) in patients with cleft lip and palate (CLP). MATERIALS AND METHODS: The study group of 39 CLP patients with maxillary hypoplasia underwent either CO or DO with 4 to 10 mm of maxillary advancement. Lateral cephalographs were taken preoperatively and postoperatively at regular intervals. A series of skeletal, dental, and soft tissue landmarks was used to evaluate the changes in the soft tissue and the correlation of hard and soft tissue changes and ratios. RESULTS: Significant differences were found between the CO and DO patients at A point in both maxillary advancement and downgrafting in the early follow-up period. On soft tissue landmarks of pronasale, subnasale, and labial superius, significant differences were found between the 2 groups at 6 months postoperatively only with maxillary advancement. There was better correlation of hard and soft tissue changes with maxillary advancement. The nasal projection was significantly different between the 2 groups at the early and intermediate period. There was much more consistent hard to soft tissue ratios in maxillary advancement with DO than with CO. CONCLUSIONS: Both CO and DO can induce significant soft tissue changes of the upper lip and nose, particularly with maxillary advancement. DO generates more consistent hard to soft tissue ratios.

Cleft maxillary distraction versus orthognathic surgery--which one is more stable in 5 years?

OBJECTIVE: The objective of this study was to compare the long-term stability of distraction osteogenesis (DO) and conventional orthognathic surgery (CO) in patients with cleft lip and palate (CLP). STUDY DESIGN: CLP patients requiring maxillary advancement of 4 to 10 mm were randomized and assigned to either CO or DO. In the CO group, the maxilla was fully mobilized to the preplanned position and fixed using titanium miniplates. In the DO group, the maxilla was mobilized to a limited extent and distractors were fixed on each side of the maxilla. Serial lateral cephalographs were taken for the assessment of stability at different postoperative periods up to 5 years. RESULTS: In the CO group, the maxilla relapsed backward and upward, whereas in the DO group, it advanced more forward and downward over 5 years. CONCLUSIONS: Distraction of the cleft maxilla can achieve better long-term skeletal stability in maintaining its advanced position than CO.

Distraction or orthognathic surgery for cleft lip and palate patients: which is better?

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.

Cleft maxillary distraction versus orthognathic surgery: clinical morbidities and surgical relapse.

BACKGROUND: This is the first randomized controlled study aiming to compare the postoperative clinical morbidities in cleft lip and palate patients treated with distraction osteogenesis versus conventional orthognathic surgery. METHODS: Twenty-nine cleft lip and palate patients with moderate maxillary hypoplasia requiring a maxillary Le Fort I advancement of 4 to 10 mm were randomized into two groups for either internal maxillary distractors or immediate fragment transposition using miniplates and screw fixation. Clinical morbidities were recorded using standardized questionnaires. Skeletal and dental relapses were assessed using lateral cephalometric landmarks. RESULTS: In the distraction group, two of 15 patients developed infection around the distractors and one patient had an occlusal relapse. Among the 14 patients who received conventional orthognathic surgery, the complications included intraoperative hemorrhage (n = 1), plate exposure leading to sinusitis (n = 1), and occlusal relapse (n = 1). In the skeletal relapses of the osteotomy group, a statistically significant vertical relapse of the A point was noted during the second to twelfth weeks when compared with the distraction group. A statistically significant horizontal relapse of the A and P points during the eighth to twelfth weeks was noted when the osteotomy group was compared with the distraction group. CONCLUSIONS: There were no major differences in the clinical morbidities between the osteotomy and distraction groups. Distraction provided better skeletal stability, whereas there was a significant amount of skeletal relapse in the first 12 weeks after conventional cleft maxillary osteotomy.