A lower border augmentation technique to allow implant placement after a bilateral mandibular fracture as a complication of vertical distraction osteogenesis: a case report.

As with other techniques, vertical distraction osteogenesis (VDO) can also induce complications. The case of a patient with a residual alveolar ridge in the symphyseal area of 8 mm is presented. After performing VDO, the patient returned at 1-day postoperatively complaining of pain and dislocation of the distractor device, due to a fracture of the lower mandibular segment on the right side. After removal of the distractor device and application of osteosynthesis plates, the patient returned 2 weeks later due to a second fracture of the lower segment, yet on the left side. After removing the osteosynthesis material, stabilization of the mandible was achieved with an acrylic splint, which was fixated with peri-mandibular wiring. Finally, reconstruction was accomplished by lower border onlay grafting, limited to the symphyseal area, in preparation for implant insertion. Ultimately, after a healing period of 5 months, two endosseous implants were installed. The patient's function has remained satisfactory for 3 years. Reinforcement of the extreme resorbed edentulous mandible after fracture healing by lower border bone augmentation can be a reliable method to allow implant installation in a second stage.

The use of intra-osseous versus extra-osseous distraction devices in atrophic mandibles.

To allow for implant placement in severe atrophic edentulous mandibles, distraction osteogenesis can be used to gain sufficient bone height. The efficacy of extra-osseous and intra-osseous devices is evaluated. In this retrospective study, 45 patients treated with an extra-osseous device (EOD) were compared with 43 patients treated with an intra-osseous device (IOD). From a statistical point of view, both patient groups were comparable for age and sex ratio. The IOD group gained more bone height (9.8 mm) than the EOD group (6.0mm). A significantly higher degree of backward tilting of the device was observed in the EOD group (12.1°), compared with the IOD group (3.0°). There were also significantly more fractures of the basal bone segment and sensory disturbances of the chin area in the EOD group than in the IOD group. The IOD group scored significantly better on bone height gained, backward tilting of the device, occurrence of fractures, and postoperative sensory disturbances. Despite the fact that the mean preoperative bone height for the IOD group was substantially higher (18.6mm) than for the EOD group (11.9 mm), it may be concluded that for augmentation procedures of the edentulous mandible, the IOD is more favourable.

[Orthodontics and vertical distraction osteogenesis of the maxilla]. / Orthodontie en verticale distractieosteogenese van de maxilla.

A female patient (age 26) visited the orthodontist for correction of the reduced exposure of the upper incisors during laughing. She also reported crowding of the lower incisors and an association between lisping and her open bite. The diagnosis in this case: a Class III malocclusion case with incisor crowding and an open bite. Because her main complaint was reduced upper incisor exposure while talking and laughing, which would not be corrected with orthodontic appliances only, the position of the maxilla was corrected during orthodontic treatment by means of vertical intra-oral maxillary distraction. An acceptable and relatively stable result was achieved.

Complications in alveolar distraction osteogenesis of the atrophic mandible.

To improve the starting point for placement of dental implants, 45 patients suffering from atrophied edentulous mandibles, with a vertical height varying between 7.3 and 15.8mm, were treated by alveolar vertical distraction osteogenesis (VDO). The mean follow-up period was 3 years, ranging from 1 to 7 years. Associated complications, as occurred during instalment of the distractor device, VDO period and consolidation phase, and also after dental implant placement, were evaluated. Observed complications were: early fractures (2%), late fractures (17%), bleeding or haematoma (4%), infections (6%), skin perforation (2%), mucosal dehiscence (8%), sensory disturbances (28%), sagging chin (13%) and failure of dental implants (13%). In 10 patients 2 complications and in 1 patient 3 complications were monitored. All complications occurred in the first year. It is concluded that VDO to restore vertical bone height in patients with mandibular atrophy is a surgically delicate technique with a high risk of various complications. The likelihood of the most striking complication, namely fracture occurrence, increases with decreasing residual bone height.

Complications in bilateral mandibular distraction osteogenesis using internal devices.

OBJECTIVE: We sought to evaluate the possibility of distraction osteogenesis as an alternative to conventional bilateral sagittal split osteotomy. Complications (intraoperative, intradistraction, and postdistraction) were evaluated retrospectively. STUDY DESIGN: Seventy consecutive patients (40 males and 30 females, 11.2-37.3 years old; mean, 14.2 years) underwent distraction osteogenesis to lengthen the mandible. The surgical procedure was carried out with the patient under general anesthesia. After the osteotomy was performed, 2 intraoral monodirectional distraction devices were placed on the mandibular cortex in the third molar region. The rate of distraction was 1 mm/day. The different complications encountered during all phases of the distraction procedure were recorded. RESULTS: A total of 28 complications (40%) were recorded. In 10 patients (14.3%), the complications were technique- or device-related, or both, and occurred early in the learning period. Five patients (7.1%) had infection occur, and 3 patients (4.3%) had prolonged sensory loss in the distribution of the alveolar nerve. Severe complications occurred in 6 patients (8.6%). Rehospitalization was necessary in 5 patients (7.1%), 4 of whom (5.7% of the series) required further surgery under general anesthesia. CONCLUSION: Distraction osteogenesis can be considered a safe and predictable procedure for lengthening the mandible, with a low incidence of major complications. The infection rate and the incidence of damage to the inferior alveolar nerve (2.1%) are low. Compliance of both patients and parents during the whole treatment period is of the utmost importance.

[A mistake in the picture processing procedure?]. / Een fout in de afdrukprocedure?

A 12-year old boy was referred to an orthodontist. During examination of his dental status a swelling was seen at the right side of his palate. Further examination demonstrated a central giant cell granuloma. This is a rare benign tumor that often causes local destruction of the bone and displacement of teeth. Surgical curettage of these large central giant cell granulomas gives mulilations of the jaws and loss of teeth and tooth germs. Furthermore, it has a high recurrence rate. Therefore, calcitonin was chosen as an alternative therapy.

Cost, operation and hospitalization times in distraction osteogenesis versus sagittal split osteotomy.

INTRODUCTION: Distraction osteogenesis in 'common' surgical orthodontics is mentioned as an alternative for conventional sagittal split osteotomy. After a 'learning curve' in the surgical skills of distraction, the two techniques can be compared concerning time and cost aspects. PATIENTS: Forty-seven patients (male n=28, female n=19, age 11.7-17.9 yr (mean 14.2) with an Angle's class II division 1malocclusion of skeletal mandibular origin were operated on using distraction osteogenesis and were compared with a second group of 21 patients (male n=4, female n=17, age 16-36yr (mean 22.8) who underwent bilateral sagittal split osteotomies in the same period in order to correct the same type of dysgnathia. METHOD: The first group of 47 patients was treated with intraorally placed bone-born distraction devices to correct mandibular deficiency following a standard protocol, with removal of the third molar tooth germs if present. The second group of 21 patients underwent standard sagittal split osteotomies to correct the mandibular deficiency. The costs of hospitalization, distraction devices and operation time were compared. RESULTS: In this study, distraction osteogenesis took on average more operative time (mean 37%), but 1 day less hospitalization than the bilateral sagittal split osteotomies. The surgical cost of distraction osteogenesis was 36% higher than the conventional sagittal split osteotomy. CONCLUSION: In this study, correcting Angle's class II deficiencies by means of distraction osteogenesis was shown not to be a time-saving procedure when compared with sagittal split osteotomy. Surgical costs were significantly higher using distraction, mainly due to the price of the distractors. Changes in hospital policies concerning hospital admission of adults and children and European legislation concerning re-usability of surgical instruments may balance the cost of both procedures.