20 years of alveolar distraction: A systematic review of the literature

BACKGROUND: The Vertical Alveolar Distraction Osteogenesis (VADO) technique is an excellent solution for bone and soft tissue neoformation in areas in which there has been significant bone atrophy that hinders normal rehabilitation using dental implants. The goal of this systematic review is to analyze the most relevant articles published on VADO in the literature over the past 20 years. MATERIAL AND METHODS: The review was performed by using the keywords: "alveolar ridge", "distraction ostegenesis" and "dental implant". This search produced a total result of 240 articles. The clinical studies and cases reported in humans amounted to 113 articles, 18 articles referred to studies developed on animals and 33 review articles. The presentation of this systematic analysis follows the criteria described in the PRISMA declaration. RESULTS: 22 articles complied with the inclusion criteria and 7 articles more were added manually, reaching a total sample of 29 studies. Following the analysis of the studies, they were classified into 18 high-quality, 10 mediumquality and 1 low-quality study. Only 4 studies achieved a maximum score of 9 (according to NewCastle Ottawa Scale, NOS). CONCLUSIONS: VADO is a technique with greater potential in vertical gain. The performance of dental implants has a success and survival rate similar to dental implants placed on bones that are not subject to increase techniques

Vertical Osseodistraction with a New Intraosseous Alveolar Distractor Prototype for Dental Implant Rehabilitation: A Pilot Study in Dogs.

PURPOSE: To evaluate in dogs a newly developed intraosseous alveolar distractor (Mozo-Grau Alveolar Distractor) for vertical bone augmentation to allow placement of dental implants. MATERIALS AND METHODS: Four dogs had their posterior teeth removed, and sockets were left to heal for 20 weeks. The right and left sides of the posterior mandibles were randomly allocated, according to a split-mouth design, to receive either two distractors, distracting a 32-mm-long bone segment, or two distractors supporting one bony segment 20 mm long and one 8 mm long. Each side of the jaw was treated by a different operator. Eight days after placement, distractors were activated with one complete turn (corresponding to 0.75 mm of vertical distraction) per day for 8 days, followed by a latency period of 10 weeks. Distractors were removed, and seven dental implants of two randomly allocated designs were placed in each dog. Implants were submerged for 2 months, and the dogs were sacrificed. Outcome measures were: success of the augmentation procedure (defined as a vertical gain of at least 5 mm of bone), any complications, implant failure, bone-to-implant contact (BIC), and peri-implant marginal bone level changes. RESULTS: One dog was withdrawn because of a mandible fracture. Eight complications occurred, and six osseodistractors were lost, but no implant failed. Only two segments in one dog achieved a vertical bone gain of at least 5 mm. The mean radiographic vertical bone gain was 2.28 mm, whereas the mean histologic vertical bone gain was 3.16 mm. Histologically, all the implants were osseointegrated. The mean BIC for implants placed in new distracted bone was 34.78% ± 11.60% and 35.66% ± 8.84% for those placed in native bone. The mean peri-implant marginal bone level loss was 0.56 ± 0.54 mm. CONCLUSION: It is possible to achieve vertical augmentation using intraosseous alveolar distractors to allow successful implantation of dental implants; however, the technique still requires surgical refinements and a dedicated training of the surgeons before being applied to humans.