[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.

Outcome of treatment of Class II malocclusion by intraoral mandibular distraction.

Our aim was to find out long-term results of treatment in patients treated orthodontically and by mandibular distraction osteogenesis. Data on duration of treatment, costs, and results of 26 patients (13 girls and 13 boys) with a mean age of 15 years were analysed. The preoperative cephalograms were compared with those taken at the last follow-up visit. There was a significant reduction in duration of treatment when patients were treated without a first phase that included functional appliances. The differences in costs of orthodontic treatment were not significant. The costs of the operation for distraction were significantly higher compared to BSSO, mainly because of the costs of the distraction devices. Comparison of the cephalograms showed a significant increase in SNB angle, Wits value, ANB angle, overjet, and overbite. The Y-axis, MP/S, and SpP/MP angle increased. Orthodontic treatment and distraction of the mandible was a successful, but more expensive, treatment.

[Class II malocclusion. Time and cost of a combined orthodontic and surgical treatment]. / Klasse II-malocclusie. Duur en kosten van een gecombineerde orthodontische en chirurgische behandeling.

During orthodontic treatment of 29 patients with a Class II malocclusion, the remaining overjet was corrected surgically by intraoral mandibular distraction osteogenesis. The patients were divided in two groups. Group A was treated orthodontically in a two-phase approach, using functional and fixed appliances. Group B was treated in a one-phase approach with only fixed appliances. Before treatment the differences in age, gender and severity of the malocclusion between the groups, were not statistically significant. After distraction-osteogenesis, all orthodontic treatments could be finished successfully. The mean treatment time was for group A 44.2 and for group B 28.6 months. The difference was statistically significant (p < 0.001). The mean orthodontic treatment time after distraction osteogenesis was 9.1 months. The mean cost for the orthodontic treatment was not statistically significant different between the groups.

Stability after distraction osteogenesis to lengthen the mandible: results in 50 patients.

PURPOSE: The purpose of this study was to investigate mandibular stability after lengthening the mandible by means of distraction. MATERIALS AND METHODS: Fifty patients (mean age, 14.7 years; range, 11.2 to 37.3 years) with Angle Class II mandibular hypoplasia were treated by bilateral distraction osteogenesis to lengthen the mandible. Patients were divided into a high-angle group, with a high mandibular angle (sella/nasion-mandibular plane [SN-MP] >38 degrees), and a normal-to-low mandibular angle group (SN-MP

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.

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.

[Mandibular distraction during orthodontic treatment]. / Distractie tijdens een orthodontische behandeling.

In this article a young, still growing female patient with a Class II division 1 malocclusion and a short mandible is presented. She was treated with functional and fixed orthodontic appliances. During orthodontic treatment with fixed appliances, mandibular lengthening by means of the intra oral distraction technique was used to correct the jaw relation. The orthodontic treatment could be finished successfully after lengthening of the mandible. The results are presented. In the discussion some alternatives for mandibular distraction are mentioned. It was concluded, that intra oral mandibular distraction is useful and successful, in selected cases.

Distraction osteogenesis for mandibular advancement.

The purpose of this study was to investigate the possibilities of distraction osteogenesis to correct mandibular hypoplasia. Fourteen young patients (mean age 14.1 years) with a proven resistance to initial, functional orthodontic therapy, were treated by means of bilateral intraoral distractors. The corticotomy was performed in the region of the third molar. The latency time was six days and the stabilization period six weeks. In all cases the planned lengthening of the mandible and class 1 occlusion were achieved. Seven patients required additional elastic band traction to close a mild open-bite directly after active distraction. In the first seven patients, insufficient mobilization at the site of the corticotomy had resulted in a broken distraction rod in two patients and incomplete distraction of the lingual cortex in one patient. Adequate mobilization at the site of the corticotomy prevented these problems in later cases. No permanent sensory disturbances were seen. Twelve patients finished their orthodontic treatment within six months after distraction.

[Distraction osteogenesis. A new development in craniofacial surgery]. / Distractie-osteogenese. Een nieuwe ontwikkeling in de aangezichtschirurgie.

By means of distraction osteogenesis (callus distraction) it is possible to reshape bone by creating stress across an iatrogenic fracture line. Subsequent to the successful use of this method in orthopaedic surgery, the development of small intra-oral distractors has opened up the possibilities for its application in maxillo-facial surgery, and the correction of orthodontic and dental problems. Following corticotomy and the fixing of the distractor, it is usually possible to begin adjustment on the fifth post-operative day. Adjustment of the distractor twice a day results in a daily distraction of 1 mm. Both congenital and acquired deformities can be corrected in this way. Class II-1 malocclusion can be corrected by simultaneous bilateral distraction. It is concluded that distraction would seem to have a place in maxillo-facial surgery.