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Gül A, van der Tas JT, Ramdat Misier KRR, de Gijt JP, Strabbing EM, Tjoa STH, Wolvius EB, Koudstaal MJ. Three-dimensional dento-skeletal effects of mandibular midline distraction and surgically assisted rapid maxillary expansion: A retrospective study. J Craniomaxillofac Surg 2023:S1010-5182(23)00069-0. [PMID: 37355373 DOI: 10.1016/j.jcms.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 03/03/2023] [Accepted: 04/30/2023] [Indexed: 06/26/2023] Open
Abstract
It was the aim of the study to provide a three-dimensional evaluation of dento-skeletal effects following bone-borne vs tooth-borne mandibular midline distraction (MMD) and tooth-borne surgically assisted rapid maxillary expansion (SARME). A retrospective observational study was conducted. Cone beam computed tomography (CBCT) records were taken pre-operatively (T1), immediately post-distraction (T2) and 1 year post-operatively (T3). All included 30 patients had undergone MMD (20 bone-borne MMD; 10 tooth-borne MMD). A total of 20 bone-borne MMD and 8 tooth-borne MMD patients had simultaneously undergone tooth-borne SARME. At T1 vs T3, canine (p = 0.007; 26.0 ± 2.09 vs 29.2 ± 2.02) and first premolar (p = 0.005; 33.8 ± 2.70 vs 37.0 ± 2.43) showed significant expansion on the tip level for tooth-borne MMD. This was no significant on the apex level, indicating tipping. Bone-borne MMD showed a parallel distraction gap, whereas tooth-borne MMD showed a V-shape. There was a significant (p = 0.017; 138 ± 17.8 vs 141 ± 18.2) inter-condylar axes increase for bone-borne MMD. In conclusion, bone-borne vs tooth-borne MMD and tooth-borne SARME showed stable dento-skeletal effects at 1 year post-operatively. Bone-borne and tooth-borne MMD seemed not to be superior to each other. The choice of distractor type therefore depends more on anatomical and comfort factors.
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Affiliation(s)
- Atilla Gül
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
| | - Justin T van der Tas
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Karan R R Ramdat Misier
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Jan P de Gijt
- Department of Oral and Maxillofacial Surgery, Ikazia Hospital, Rotterdam, the Netherlands
| | - Elske M Strabbing
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Stephen T H Tjoa
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Eppo B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Maarten J Koudstaal
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
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Gül A, Tjoa STH, de Gijt JP, van der Tas JT, Sutedja H, Wolvius EB, van der Wal KGH, Koudstaal MJ. Current Practice for Transverse Mandibular and Maxillary Discrepancies in the Netherlands: A Web-Based Survey Among Orthodontists and Oral and Maxillofacial Surgeons. Craniomaxillofac Trauma Reconstr 2022; 15:219-228. [PMID: 36081680 PMCID: PMC9446273 DOI: 10.1177/19433875211027694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023] Open
Abstract
The main objective of this study was to provide an overview of the current practice for transverse mandibular and maxillary discrepancies in the Netherlands using a web-based survey. Orthodontists (ORTHO) and Oral and Maxillofacial Surgeons (OMFS) in the Netherlands were invited to the web-based survey via their professional association. Three cases were presented which could be treated non-surgically and surgically. Participants were asked what treatment they preferred: no treatment, orthodontic treatment with optional extractions or surgically assisted orthodontic treatment. The web-based survey ended with questions on various technical aspects and any experienced complication. Invitation was sent to all 303 members of professional association for ORTHO and to all 379 members of professional association for OMFS. Overall response number was 276 (response rate of 40.5%), including 127 incomplete responses. Generally, ORTHO prefer orthodontic treatment with optional extractions and OMFS lean towards surgically assisted orthodontic treatment. Mandibular Midline Distraction appears to be less preferred, possibly due to lack of clinical experience or knowledge by both professions despite being proven clinical stable surgical technique with stable long-term outcomes. There seems to be consensus on technical aspects by both professions, however, there are various thoughts on duration of consolidation period. Complications are mostly minor and manageable.
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Affiliation(s)
- Atilla Gül
- Department of Oral and
Maxillofacial Surgery, Erasmus MC, University Medical Center
Rotterdam, the Netherlands
| | - Stephen T. H. Tjoa
- Department of Oral and
Maxillofacial Surgery, Erasmus MC, University Medical Center
Rotterdam, the Netherlands
| | - Jan P. de Gijt
- Department of Oral and
Maxillofacial Surgery, Ikazia Hospital, Rotterdam, the Netherlands
| | - Justin T. van der Tas
- Department of Oral and
Maxillofacial Surgery, Erasmus MC, University Medical Center
Rotterdam, the Netherlands
| | | | - Eppo B. Wolvius
- Department of Oral and
Maxillofacial Surgery, Erasmus MC, University Medical Center
Rotterdam, the Netherlands
| | - Karel G. H. van der Wal
- Department of Oral and
Maxillofacial Surgery, Erasmus MC, University Medical Center
Rotterdam, the Netherlands
| | - Maarten J. Koudstaal
- Department of Oral and
Maxillofacial Surgery, Erasmus MC, University Medical Center
Rotterdam, the Netherlands
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Southard TE, Marshall SD, Allareddy V, Shin K. Adult transverse diagnosis and treatment: A case-based review. Semin Orthod 2019. [DOI: 10.1053/j.sodo.2019.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gül A, de Jong MA, de Gijt JP, Wolvius EB, Kayser M, Böhringer S, Koudstaal MJ. Three-dimensional soft tissue effects of mandibular midline distraction and surgically assisted rapid maxillary expansion: an automatic stereophotogrammetry landmarking analysis. Int J Oral Maxillofac Surg 2018; 48:629-634. [PMID: 30459065 DOI: 10.1016/j.ijom.2018.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 07/14/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
Abstract
Studies on mandibular midline distraction (MMD) are mostly performed using conventional research methods. Concerning surgically assisted rapid maxillary expansion (SARME), more research is conducted using three-dimensional (3D) techniques. Research on bimaxillary expansion, the combination of MMD and SARME, is reported sparsely. The main objective of this study was to provide a 3D evaluation of soft tissue effects following SARME and/or MMD. Patients who underwent SARME and/or MMD between 2008 and 2013 were included. Stereophotogrammetry was undertaken at the following time points: preoperative (T1), immediately post-distraction (T2), 1year postoperative (T3). An automatic 3D facial landmarking algorithm using two-dimensional Gabor wavelets was applied for the analysis. Twenty patients who had undergone SARME were included, 12 of whom had undergone bimaxillary expansion. Age at the time of surgery ranged from 16 to 47 years. There was a significant downward displacement of soft tissue pogonion. Furthermore, there was a significant mean increase of 2.20mm in inter-alar width and a non-significant mean increase of 1.77mm in inter-alar curvature point width. In conclusion, automatic stereophotogrammetry landmarking analysis of soft tissue effects showed downward displacement of soft tissue pogonion following bimaxillary expansion and transverse widening of the inter-alar width and a tendency towards an increase in inter-alar curvature point width after SARME.
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Affiliation(s)
- A Gül
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - M A de Jong
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Department of Genetic Identification, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands
| | - J P de Gijt
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - M Kayser
- Department of Genetic Identification, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - S Böhringer
- Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands
| | - M J Koudstaal
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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Three-dimensional evaluation of mandibular midline distraction: A systematic review. J Craniomaxillofac Surg 2018; 46:1883-1892. [PMID: 30249482 DOI: 10.1016/j.jcms.2018.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 07/24/2018] [Accepted: 08/22/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To provide a literature overview on mandibular midline distraction (MMD) using three-dimensional (3D) imaging analysis techniques. Regarding different distractor types, the focus was on changes in position and/or morphology of the mandibular condyle and temporomandibular joint (TMJ), skeletal effects, dental effects, soft tissue effects, and biomechanical and masticatory effects, specifically on the mandible and TMJ. METHODS Studies up to March 27 2017 were included, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines, using Embase, Medline OvidSP, Web-of-science, Scopus, Cochrane, and Google Scholar. RESULTS Thirty-one full-text papers were assessed for eligibility and 15 met the inclusion criteria: prospective (2), retrospective (2), case-report (1) and computational analysis (10). All included studies were graded low (level 4-5) for quality of evidence, using the Oxford Centre for Evidence-Based Medicine criteria. CONCLUSION There is a limited number of studies available, with low levels of evidence and small sample sizes. Bone-borne distraction seems preferable when taking skeletal effects into account. Tooth-borne distraction leads to significant dental tipping. Hybrid distractors combined with parasymphyseal step osteotomy seem to be the most stable under functional masticatory loads. The effects of chewing appeared to be marginal during the latency period. No permanent TMJ symptoms were reported, and little is known about soft tissue effects. SYSTEMATIC REVIEW REGISTRATION International Prospective Register of Systematic Reviews, PROSPERO CRD42014010010.
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Kita H, Kochi S, Yamada A, Imai Y, Konno N, Saitou C, Mitani H. Mandibular Widening by Distraction Osteogenesis in the Treatment of a Constricted Mandible and Telescopic Bite. Cleft Palate Craniofac J 2017; 41:664-73. [PMID: 15516173 DOI: 10.1597/03-003.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objective Documentation of the application of mandibular widening by distraction osteogenesis and orthodontics. Patients Three patients with telescopic bite resulting from an extremely constricted mandible related to hypoglossia-hypodactyly syndrome. Intervention Mandibular widening by distraction osteogenesis using an extraoral device and subsequent orthodontic treatment. Results The extremely constricted mandible and telescopic bite were dramatically improved by mandibular widening using distraction osteogenesis and subsequent orthodontics. Two of the three patients had transient complications; one reported temporomandibular joint pain and the other showed evidence of periodontal damage. Conclusion Mandibular widening by distraction osteogenesis is an effective technique for the treatment of telescopic bite resulting from an extremely constricted mandible.
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Affiliation(s)
- Hiroki Kita
- Health Administration Center, Tohoku University, Aoba-ku, Sendai, Japan.
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Facial improvement after mandibular midline distraction and surgically assisted rapid maxillary expansion. Am J Orthod Dentofacial Orthop 2017; 152:523-542. [PMID: 28962738 DOI: 10.1016/j.ajodo.2016.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 09/01/2016] [Accepted: 09/01/2016] [Indexed: 11/22/2022]
Abstract
This case report describes the retreatment of a 49-year-old woman with severe crowding in the mandibular incisor region and tapered maxillary and mandibular arches. Treatment consisted of mandibular midline distraction and surgically assisted rapid maxillary expansion to increase arch length. The need for proper presurgical orthodontics is described, and the complications during treatment are discussed. The results of treatment, including the superimposition of 3-dimensional facial scans, are presented. The treatment approach we used is typically indicated for patients with previous extractions of all first premolars who develop significant crowding after treatment. Surgical planning in 3 dimensions and the use of a 3-dimensional designed surgical osteotomy guiding wafer should improve the predictability of this treatment approach.
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Analysis of dentoalveolar structures with novel corticotomy-facilitated mandibular expansion: A 3-dimensional finite element study. Am J Orthod Dentofacial Orthop 2017; 151:767-778. [DOI: 10.1016/j.ajodo.2016.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 09/01/2016] [Accepted: 09/01/2016] [Indexed: 11/18/2022]
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Winsauer H, Ploder O, Juengling K, Walter A, Kolk A. Comparison of two preoperative protocols for mandibular symphyseal distraction osteogenesis to reduce the risk of tooth damage. J Craniomaxillofac Surg 2017; 45:540-546. [PMID: 28189490 DOI: 10.1016/j.jcms.2016.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 12/14/2016] [Accepted: 12/22/2016] [Indexed: 11/17/2022] Open
Abstract
Two techniques to separate the lower incisors prior to mandibular symphyseal distraction osteogenesis (MSDO) were evaluated with respect to avoiding tooth damage. METHODS Fifty patients (20.2 ± 7.0 years) requiring MSDO were treated with a tooth-borne appliance by utilizing two preoperative protocols to separate the central incisors: i) brackets and a V-bent wire with an open coil spring (two-step; TS; n = 24) and ii) a wire attached from the appliance to the central incisors with subsequent dento-alveolar expansion prior to surgery (one-step; OS; n = 26). The distance between the lower incisors was measured preoperatively on radiographs and measurements at the cast models were performed. Complications and radiographs were analyzed. RESULTS The mean distance (±SD) between the lower central incisors for OS and TS prior to surgery was 3.44 ± 1.05 and 3.18 ± 1.13 mm, respectively. The mean expansion for OS and TS was 4.3 ± 2.9 and 4.3 ± 2.7 mm at the dental level and 3.8 ± 3.2 and 4.0 ± 2.1 mm at the bone level, respectively. Four patients undergoing the TS and one patient undergoing the OS showed transient dental complications. CONCLUSION Pre-surgical dento-alveolar expansion by utilizing a one-step technique to separate the lower central incisors reduces the risk of permanent tooth damage and weakens the mandibular bone in the midline.
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Affiliation(s)
| | - Oliver Ploder
- Department of Oral and Maxillofacial Surgery, Academic Teaching Hospital, Feldkirch, Austria.
| | - Katharina Juengling
- Department of Oral- and Cranio-Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Andre Walter
- Department of Orthodontics and Dentofacial Orthopaedics, School of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Andreas Kolk
- Department of Oral- and Cranio-Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Bianchi FA, Gerbino G, Corsico M, Schellino E, Barla N, Verzè L, Ramieri G. Soft, hard-tissues and pharyngeal airway volume changes following maxillomandibular transverse osteodistraction: Computed tomography and three-dimensional laser scanner evaluation. J Craniomaxillofac Surg 2017; 45:47-55. [DOI: 10.1016/j.jcms.2016.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 08/26/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022] Open
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de Gijt J, Gül A, Sutedja H, Wolvius E, van der Wal K, Koudstaal M. Long-term (6.5 years) follow-up of mandibular midline distraction. J Craniomaxillofac Surg 2016; 44:1576-1582. [DOI: 10.1016/j.jcms.2016.06.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 05/15/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022] Open
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Singh P, Wang C, Ajmera DH, Xiao SS, Song J, Lin Z. Biomechanical Effects of Novel Osteotomy Approaches on Mandibular Expansion: A Three-Dimensional Finite Element Analysis. J Oral Maxillofac Surg 2016; 74:1658.e1-1658.e15. [PMID: 27182974 DOI: 10.1016/j.joms.2016.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/01/2016] [Accepted: 04/04/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Surgically assisted mandibular arch expansion has proved to be an effective treatment modality in alleviating constriction and crowding issues. However, only mandibular symphyseal distraction osteogenesis has been in favor for the purpose of mandibular arch expansion. In addition, no relevant study has compared the biomechanical response of different osteotomy designs on mandibular expansion. The present study evaluated the effect of different osteotomy approaches and modes of loading on the expansion of the adult mandible using biomechanics. MATERIALS AND METHODS To address the research purpose, 9 finite element (FE) models, including 2 novel osteotomy designs, were simulated. Stress, strain, and displacement of crown, root, and bone were calculated and compared under different osteotomy approaches and loading conditions. RESULTS The biomechanical response envisaged by the FE models in terms of displacement on the X axis was consistent from the anterior to posterior teeth with parasymphyseal step osteotomy and a hybrid mode of force application. In addition, the amount of displacement predicted by parasymphyseal step osteotomy with the hybrid mode was greater compared with that of the other models. CONCLUSIONS The results of our study suggest parasymphyseal step osteotomy with the hybrid mode is a viable treatment option for true bony expansion in the adult mandible.
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Affiliation(s)
- Pradeep Singh
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education; and Department of Oral and Maxillofacial Surgery, College of Stomatology, Chongqing Medical University, Chongqing, China
| | - Chao Wang
- Department Head, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Deepal Haresh Ajmera
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education; and Department of Orthodontics and Dentofacial Orthopedics, College of Stomatology, Chongqing Medical University, Chongqing, China
| | - Shui Sheng Xiao
- Professor, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education; and Department of Oral and Maxillofacial Surgery, College of Stomatology, Chongqing Medical University, Chongqing, China.
| | - Jinlin Song
- Vice Dean, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education; and Department of Orthodontics and Dentofacial Orthopedics, College of Stomatology, Chongqing Medical University, Chongqing, China
| | - Zeng Lin
- Attending Doctor, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences; and Department of Oral and Maxillofacial Surgery, College of Stomatology, Chongqing Medical University, Chongqing, China
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Krishnaswamy NR, Varghese BT, Ahmed KS, Bharadwaj R, Devi VRS. Treatment of a unilateral complete lingual crossbite in an adult with skeletal anchorage assisted orthodontics. J Orthod 2016; 43:228-36. [PMID: 26777996 DOI: 10.1179/1465313315y.0000000020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
An asymmetry caused by a complete lingual crossbite can compromise aesthetics and impair occlusal function. The following case report describes the correction of a complete lingual crossbite using orthodontic mini implants and mini-plates to achieve absolute anchorage. A comprehensive correction of the crossbite and re-establishment of the buccal occlusion was achieved.
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Affiliation(s)
| | - Biju Tom Varghese
- a Ragas Dental College and Hospital , Uthandi, Chennai , Tamil Nadu , India
| | | | - Rekha Bharadwaj
- a Ragas Dental College and Hospital , Uthandi, Chennai , Tamil Nadu , India
| | - V R Shobbana Devi
- a Ragas Dental College and Hospital , Uthandi, Chennai , Tamil Nadu , India
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14
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The Radiological and Stereological Analysis of the Effect of Low-Level Laser Therapy on the Mandibular Midline Distraction Osteogenesis. J Craniofac Surg 2015; 26:e595-9. [DOI: 10.1097/scs.0000000000002046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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15
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San Miguel Moragas J, Oth O, Büttner M, Mommaerts MY. A systematic review on soft-to-hard tissue ratios in orthognathic surgery part II: Chin procedures. J Craniomaxillofac Surg 2015; 43:1530-40. [PMID: 26321067 DOI: 10.1016/j.jcms.2015.07.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 07/02/2015] [Accepted: 07/28/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Precise soft-to-hard tissue ratios in orthofacial chin procedures are not well established. The aim of this study was to determine useful soft-to-hard tissue ratios for planning the magnitude of sliding genioplasty (chin osteotomy), osseous chin recontouring and alloplastic chin augmentation. MATERIAL AND METHODS A systematic review of English and non-English articles using PubMed central, ProQuest Dissertations and Theses, Science Citation Index, Elsevier Science Direct Complete, Highwire Press, Springer Standard Collection, SAGE premier 2011, DOAJ Directory of Open Access Journals, Sweetswise, Free E-Journals, Ovid Lippincott Williams & Wilkins total Access Collection, Wiley Online Library Journals, and Cochrane Plus databases from their onset until July 2014. Additional studies were identified by searching the references. Search terms included soft tissue, ratios, genioplasty, mentoplasty, chin, genial AND advancement, augmentation, setback, retrusion, impaction, reduction, vertical deficit, widening, narrowing, and expansion. Study selection criteria were as follows: only academic publications; human patients; no reviews; systematic reviews or meta-analyses; no cadavers; no syndromic patients; no pathology at the chin or mandible region; only articles of level of evidence from I to IV; number of patients must be cited in the articles; hard-to-soft tissue ratios must be cited in the articles or at least are able to be calculated with the quantitative data available in the article; if all patients of one article have had bilateral sagittal split osteotomy (BSSO) performed along with chin osteotomy, there should be an independent group evaluation of the data concerning to the chin; and no restriction regarding the size of the group. Independent extraction of articles by two authors using predefined data fields, including study quality indicators (level of evidence). RESULTS The search identified 22 articles. Eleven additional articles were found in their reference sections. Of these, two were evidence level IIIb, three were evidence level IIb, and the rest were evidence level IV. Three studies were prospective in nature. A high variability of soft-to-hard tissue ratios regarding genioplasty seemed to disappear if data were stratified according to confounding factors. With the available data, a soft-to-hard pogonion ratio of 0.9:1 and 0.55:1 could be used for chin advancement and chin setback surgery, respectively. CONCLUSION Advancement and extrusion movements of the chin segment show respectively a 0.9:1 of sPg:Pg horizontally and 0.95:1 of sMe:Me vertically. Setback and impaction movements show respectively a -0.52:1 of sPg:Pg horizontally and -0.43:1 of sMe:Me vertically. Prospective studies are needed that stratify by confounding factors such as type of osteotomy technique, magnitude of the movement, age, sex, race/ethnicity, and quantity and quality of the soft tissues. More specifically, studies are needed regarding soft-to-hard tissue changes after chin extrusion ("downgrafting"), intrusion ("impaction"), and widening and narrowing surgery.
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Affiliation(s)
- Joan San Miguel Moragas
- European Face Centre (Head: Prof. Maurice Y. Mommaerts, MD, DMD, PhD, FEBOMFS, FICS, FAACS), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Olivier Oth
- European Face Centre (Head: Prof. Maurice Y. Mommaerts, MD, DMD, PhD, FEBOMFS, FICS, FAACS), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Michael Büttner
- European Face Centre (Head: Prof. Maurice Y. Mommaerts, MD, DMD, PhD, FEBOMFS, FICS, FAACS), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Maurice Y Mommaerts
- European Face Centre (Head: Prof. Maurice Y. Mommaerts, MD, DMD, PhD, FEBOMFS, FICS, FAACS), Universitair Ziekenhuis Brussel, Brussels, Belgium.
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Nadjmi N, Stevens S, Van Erum R. Mandibular midline distraction using a tooth-borne device and a minimally invasive surgical procedure. Int J Oral Maxillofac Surg 2015; 44:452-4. [DOI: 10.1016/j.ijom.2014.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 08/31/2014] [Accepted: 11/05/2014] [Indexed: 11/25/2022]
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Recours à la distraction symphysaire dans le cadre d’un traitement d’orthodontie : à propos d’une série de 35 cas. Int Orthod 2015. [DOI: 10.1016/j.ortho.2014.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Garreau É, Wojcik T, Rakotomalala H, Raoul G, Ferri J. Symphyseal distraction in the context of orthodontic treatment: a series of 35 cases. Int Orthod 2015; 13:81-95. [PMID: 25703076 DOI: 10.1016/j.ortho.2014.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Use of symphyseal distraction osteogenesis to treat a mandibular bone deficit with tooth-jaw discrepancy due to lack of space makes it possible to avoid the risks associated with the techniques usually envisaged (stripping, labioversion of incisors, extractions). PATIENTS AND METHOD This retrospective study presents the symphyseal distraction technique used in the maxillofacial surgery department of Lille University Hospital between January 1998 and March 2013. Treatment efficacy, complications and the stability of results were all evaluated. RESULTS Thirty-five patients were included in the study. The gain of inter-mental-foramen space was on average 7 mm (3-12, standard deviation 1.8 mm). A good occlusal result with dental Class I and no labioversion of the lower incisors was obtained in 27 of the 35 patients (77%). CONCLUSION Mandibular distraction by symphyseal osteotomy seems to be a quick, safe treatment for an anterior transversal mandibular deficit giving results that are stable over time. Its success depends on good collaboration between the orthodontist and the surgeon, and on strict patient selection.
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Affiliation(s)
- Émilie Garreau
- Département Universitaire de Chirurgie Maxillofaciale et Stomatologie, Hôpital Roger-Salengro, CHU de Lille, rue Émile-Laine, 59037 Lille, France; Association Internationale de Médecine Orale et Maxillofaciale, 7bis, rue de la Créativité, 59650 Villeneuve-d'Ascq, France.
| | - Thomas Wojcik
- Département Universitaire de Chirurgie Maxillofaciale et Stomatologie, Hôpital Roger-Salengro, CHU de Lille, rue Émile-Laine, 59037 Lille, France; Unité INSERM U1008, Médicaments et Biomatériaux à Libération Contrôlée, Faculté des Sciences pharmaceutiques et Biologiques, 3, rue du Professeur-Laguesse, 59000 Lille, France; Association Internationale de Médecine Orale et Maxillofaciale, 7bis, rue de la Créativité, 59650 Villeneuve-d'Ascq, France
| | - Hervey Rakotomalala
- Département Universitaire de Chirurgie Maxillofaciale et Stomatologie, Hôpital Roger-Salengro, CHU de Lille, rue Émile-Laine, 59037 Lille, France
| | - Gwenaël Raoul
- Département Universitaire de Chirurgie Maxillofaciale et Stomatologie, Hôpital Roger-Salengro, CHU de Lille, rue Émile-Laine, 59037 Lille, France; Unité INSERM U1008, Médicaments et Biomatériaux à Libération Contrôlée, Faculté des Sciences pharmaceutiques et Biologiques, 3, rue du Professeur-Laguesse, 59000 Lille, France; Association Internationale de Médecine Orale et Maxillofaciale, 7bis, rue de la Créativité, 59650 Villeneuve-d'Ascq, France; Université Lille Nord de France, UDSL, 1, rue Lefèvre, 59000 Lille, France
| | - Joël Ferri
- Département Universitaire de Chirurgie Maxillofaciale et Stomatologie, Hôpital Roger-Salengro, CHU de Lille, rue Émile-Laine, 59037 Lille, France; Unité INSERM U1008, Médicaments et Biomatériaux à Libération Contrôlée, Faculté des Sciences pharmaceutiques et Biologiques, 3, rue du Professeur-Laguesse, 59000 Lille, France; Association Internationale de Médecine Orale et Maxillofaciale, 7bis, rue de la Créativité, 59650 Villeneuve-d'Ascq, France; Université Lille Nord de France, UDSL, 1, rue Lefèvre, 59000 Lille, France
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Mandibular midline distraction: A systematic review. J Craniomaxillofac Surg 2012; 40:248-60. [DOI: 10.1016/j.jcms.2011.04.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 02/06/2011] [Accepted: 04/27/2011] [Indexed: 11/20/2022] Open
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King JW, Wallace JC, Winter DL, Niculescu JA. Long-term skeletal and dental stability of mandibular symphyseal distraction osteogenesis with a hybrid distractor. Am J Orthod Dentofacial Orthop 2012; 141:60-70. [DOI: 10.1016/j.ajodo.2011.06.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 06/01/2011] [Accepted: 06/01/2011] [Indexed: 10/14/2022]
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Introduction of the "Rotterdam mandibular distractor" and a biomechanical skull analysis of mandibular midline distraction. Br J Oral Maxillofac Surg 2011; 50:519-22. [PMID: 21924532 DOI: 10.1016/j.bjoms.2011.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 08/19/2011] [Indexed: 11/24/2022]
Abstract
The Rotterdam mandibular distractor (RMD) is a slim, rigid, boneborne distractor for use in midline distraction of the mandible. We did a biomechanical study to compare the RMD with the Trans Mandibular Distractor-flex (TMD-flex). This included an anatomical biomechanical study that was conducted on 9 dentate human cadaveric heads using both the RMD and the TMD-flex. In the vertical plane less tipping was measured in the RMD group than in the TMD-flex group. Significantly less skeletal tipping was found in the horizontal plane in the RMD group (P=0.021). There was minimal difference in the intercondylar distance between the groups. As the amount of lateral displacement of the condyle was similar in both groups and there was less rotational movement in the RMD group, the TMD-flex would be expected to increase stress on the temporomandibular joint. As a result of the increased parallel widening in the vertical plane, more basal bone is being created and less relapse is expected using the RMD. The study design involves an in vitro anatomical model and conclusions must be drawn with care. At present clinical studies are under way and results will follow.
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22
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La distraction symphysaire : protocole simplifié. ACTA ACUST UNITED AC 2010; 111:259-69. [DOI: 10.1016/j.stomax.2010.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Accepted: 10/19/2010] [Indexed: 11/24/2022]
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23
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Transport dentoalveolar distraction osteogenesis–assisted rapid orthodontic canine retraction. ACTA ACUST UNITED AC 2010; 109:687-93. [DOI: 10.1016/j.tripleo.2009.10.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 10/05/2009] [Accepted: 10/09/2009] [Indexed: 01/11/2023]
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Six year follow-up of a patient treated with mandibular symphyseal distraction osteogenesis. J Craniomaxillofac Surg 2010; 38:26-31. [DOI: 10.1016/j.jcms.2009.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 06/02/2009] [Accepted: 06/11/2009] [Indexed: 11/19/2022] Open
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Gunbay T, Akay MC, Aras A, Gomel M. Effects of Transmandibular Symphyseal Distraction on Teeth, Bone, and Temporomandibular Joint. J Oral Maxillofac Surg 2009; 67:2254-65. [DOI: 10.1016/j.joms.2009.04.055] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 03/25/2009] [Accepted: 04/21/2009] [Indexed: 11/28/2022]
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Soares Correia PE, Wehrbein H, Mommaerts MY. Periodontal impact of surgically induced dental lesions in mandibular osteodistraction: An animal study. J Craniomaxillofac Surg 2009; 37:174-81. [DOI: 10.1016/j.jcms.2008.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Accepted: 07/16/2008] [Indexed: 10/21/2022] Open
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Abstract
Facing a dental crowding, the orthodontist has several therapeutic options. If maxillary expansion is often used, mandibular orthodontic expansion is proscribed because of its tendency of inefficiency and relapse. Mandibular symphyseal distraction osteogenesis allows to remove this proscription. This therapeutic protocol consists in a pre-surgery orthodontic preparation phase followed by surgery (symphyseal osteotomy and placement of the distraction device), a latency period (five to seven days), then an activation period (most of the time 1 mm/day in two steps) followed by a consolidation period (three months) during which the orthodontic treatment can be resumed. Skeletal and alveolar expansion corrects dental crowding. This surgical technique is versatile, minimally invasive, and stable with time. Major indications are hypoplastic symphysis, anterior crowding, relapse of orthodontic treatments and some syndromes. This method can also be an answer to aesthetic concerns or an alternative for treatment of dental crowding. Face à un encombrement dentaire, l'orthodontiste dispose de plusieurs options thérapeutiques. Si au maxillaire, l'expansion est fréquemment utilisée, l'expansion mandibulaire orthodontique est proscrite, car inefficace et récidivante. La distraction symphysaire permet de lever cet interdit. Ce protocole thérapeutique comprend : une préparation orthodontique pré-chirurgicale, une chirurgie (ostéotomie symphysaire et pose du distracteur), une période de latence (cinq à sept jours), puis une période d'activation (le plus souvent 1 mm/j en deux fois) suivie d'une période de consolidation (trois mois) pendant laquelle le traitement orthodontique peut être repris. L'expansion basale et alvéolaire corrige l'encombrement dentaire. Cette technique est polyvalente, peu invasive et stable dans le temps. Ses indications majeures sont l'hyposymphysie, l'encombrement incisif, la récidive de traitements orthodontiques et certains grands syndromes. Cette méthode peut aussi être proposée pour répondre à des préoccupations esthétiques ou comme alternative aux traitements classiques de l'encombrement dentaire.
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Affiliation(s)
- Bastien Lesne
- 1 Bd du Guillon, Résidence Le Mille Pas, 38500 Voiron, France
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28
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Prospective changes to condylar position in symphyseal distraction osteogenesis. ACTA ACUST UNITED AC 2008; 106:163-72. [DOI: 10.1016/j.tripleo.2007.12.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Revised: 12/08/2007] [Accepted: 12/24/2007] [Indexed: 11/21/2022]
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Morbidity related to transmandibular distraction osteogenesis for patients with developmental deformities. J Craniomaxillofac Surg 2008; 36:192-7. [DOI: 10.1016/j.jcms.2007.10.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Accepted: 10/04/2007] [Indexed: 11/23/2022] Open
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Mommaerts MY, Collado J, Mareque Bueno J. Morbidity related to "endo-corticotomies" for transpalatal osteodistraction. J Craniomaxillofac Surg 2008; 36:198-202. [PMID: 18358736 DOI: 10.1016/j.jcms.2007.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 11/02/2007] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The objective of this study was to evaluate morbidity arising from transnasal, endoscopically assisted corticotomies for transpalatal osteodistraction. This minimally invasive technique utilizes three 1-cm incisions in the nasal vestibule instead of the classical, two lateral and one medial oral vestibule incisions of 2-3 cm and 1cm long, respectively. MATERIAL AND METHODS Fifty-nine patients (33 females and 26 males; age range: 9-50 years, mean 20 years) who underwent surgery in the hub hospital by the senior surgeon were included in a prospective registry. Patients with congenital maxillary hypoplasia were excluded. Difficulties were systematically recorded. RESULTS Mean operative time was 68 min (SD: 15 min) when no other procedures were combined with the transpalatal osteodistraction. Ten difficulties unrelated to either the device or oral hygiene were encountered: rhinorrhoea and minor nasal obstruction (1), nasal bleeding with hospital admission (1), periostitis at the piriform aperture that necessitated revision using local anaesthesia (1), periostitis with spontaneous healing (1), postoperative pain (2), dermatitis (1), infraorbital ecchymosis (1), excessive postoperative oedema (1), and prolonged cheek hyperaesthesia (1). DISCUSSION AND CONCLUSION Operative time as well as both percentage and nature of complications was similar to those experienced with "open-sky TPD" (transpalatal distraction), with less pronounced oedema and patient surgical threshold decreased.
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Affiliation(s)
- Maurice Y Mommaerts
- Division of Maxillo-Facial Surgery, General Hospital St. Jan, Bruges, Belgium.
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31
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Bayram M, Ozer M, Alkan A. Mandibular Symphyseal Distraction Osteogenesis Using a Bone-Supported Distractor. Angle Orthod 2007; 77:745-52. [PMID: 17605491 DOI: 10.2319/070506-274] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2006] [Accepted: 09/01/2006] [Indexed: 11/23/2022] Open
Abstract
Abstract
Increases in mandibular width by symphyseal distraction osteogenesis have recently been shown to be an acceptable and stable treatment option for transverse deficiencies. This case report presents the application of symphyseal distraction osteogenesis for increasing mandibular width using a bone-supported distractor as part of the orthodontic treatment of a 14-year-old male with a tapered shaped mandible and severe mandibular anterior crowding.
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Affiliation(s)
- Mehmet Bayram
- Karadeniz Teknik Universitesi, Diş Hekimliği Fakültesi, Ortodonti AD, Trabzon,Turkey.
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Bayram M, Ozer M, Arici S, Alkan A. Nonextraction Treatment with Rapid Maxillary Expansion and Mandibular Symphyseal Distraction Osteogenesis and Vertical Skeletal Dimensions. Angle Orthod 2007; 77:266-72. [PMID: 17319761 DOI: 10.2319/0003-3219(2007)077[0266:ntwrme]2.0.co;2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Accepted: 04/01/2006] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate the effects of rapid maxillary expansion (RME) and mandibular symphyseal distraction osteogenesis (MSDO) on vertical dimensions of the face. MATERIALS AND METHODS Fourteen patients, nine girls and five boys, underwent RME and MSDO procedures. Distraction was carried out at a rate of 1 mm per 24 hours with a tooth-borne appliance. The amount of distraction was 7 mm for each patient. Standardized lateral cephalograms were taken at the following time periods: before treatment (T0), after RME (T1), at the completion of MSDO (T2), and at the end of fixed orthodontic treatment (T3). The data were evaluated by using a general linear model of repeated-measures analysis of variance and paired t-tests at the 95% confidence level. RESULTS RME significantly increased the vertical dimensions of the face and decreased the overbite (P < .001). Although the vertical parameters of the face on the lateral cephalogram decreased after MSDO, these decreasing effects were statistically insignificant just for the distances measured from the horizontal reference line to the chin points. In other words, MSDO decreased the vertical skeletal dimensions that were increased by RME, but this neutralizing effect of MSDO was not as much as the increase caused by RME. CONCLUSION Treatment modalities (RME, MSDO, and fixed orthodontic treatment) described in this study, in total, had little effect on the vertical skeletal measurements of the face.
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Affiliation(s)
- Mehmet Bayram
- Ondokuz Mayis University, Department of Orthodontics, Turkey
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Alkan A, Ozer M, Baş B, Bayram M, Celebi N, Inal S, Ozden B. Mandibular symphyseal distraction osteogenesis: review of three techniques. Int J Oral Maxillofac Surg 2007; 36:111-7. [PMID: 17223309 DOI: 10.1016/j.ijom.2006.11.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2006] [Revised: 10/24/2006] [Accepted: 11/20/2006] [Indexed: 11/18/2022]
Abstract
Mandibular symphyseal distraction osteogenesis (MSDO) is an alternative strategy to correct mandibular transverse deficiencies and dental crowding. Only a limited number of practitioners have reported their clinical experience and potential complications of this procedure to widen the mandible in a large case series. This study involved retrospective analysis of 40 patients who underwent mandibular symphyseal distraction osteogenesis. Three different types of distractor were used to widen the mandible: tooth-borne in 21 patients, bone-borne in 5 patients and hybrid (both bone and tooth-borne) in 14 patients. The distraction amount ranged from 7 to 11 mm (mean 7.31 mm). While 39 patients underwent successful mandibular symphyseal distraction, there was one failure. Most of the complications were experienced in bone-borne distractors, such as breakage of the distractor rod, gingival recession, secondary infection and ptosis of the chin. In the light of these findings, it is suggested that a lingually placed tooth-borne hyrax appliance is more suitable and reliable than the other distraction devices. Further larger studies are needed in order to better evaluate the effectiveness of bone-borne or hybrid devices.
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Affiliation(s)
- A Alkan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, Kayseri, Turkey.
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Malkoç S, Işeri H, Karaman AI, Mutlu N, Küçükkolbaşi H. Effects of mandibular symphyseal distraction osteogenesis on mandibular structures. Am J Orthod Dentofacial Orthop 2006; 130:603-11. [PMID: 17110257 DOI: 10.1016/j.ajodo.2005.02.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2004] [Revised: 01/18/2005] [Accepted: 02/02/2005] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the effects of mandibular symphyseal distraction osteogenesis on dental and mandibular skeletal structures with a tooth- and bone-borne distraction device. METHODS The sample comprised 20 patients, ranging in age from 15.8 to 23.3 years (mean, 20.1 +/- 2.3 years) at the start of treatment. The distraction device was activated 1 mm per day. The device was usually maintained in position about 90 days after surgery. Records were obtained at the start of treatment, at the end of distraction (11.4 +/- 2.2 days after surgery), and at follow-up periods (24.1 +/- 4.2 months after surgery). The records included posteroanterior cephalograms and study casts. The data were analyzed statistically by using the repeated measure analysis of variance and paired t test. RESULTS Posteroanterior cephalometric analysis demonstrated no significant changes in bigonial widths and ramal angles at the end of distraction period. On the other hand, bimolar widths were significantly increased, whereas bicondylar widths were markedly decreased. The dental cast analysis indicated that the maximum amount of increase was found between the mandibular canines, and the widening effect gradually decreased from the mandibular canines to the second molars. The follow-up data confirmed that the treatment results were stable. CONCLUSIONS The long-term findings indicate that mandibular symphyseal distraction osteogenesis is an efficient nonextraction treatment alternative for mandibular dental crowding to increase mandibular skeletal and dental arch widths.
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Affiliation(s)
- Siddik Malkoç
- Department of Orthodontics, School of Dentistry, University of Selçuk, Konya, Turkey.
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Mommaerts MY, Polsbroek R, Santler G, Correia PEGS, Abeloos JVS, Ali N. Anterior transmandibular osteodistraction: clinical and model observations. J Craniomaxillofac Surg 2005; 33:318-25. [PMID: 16139505 DOI: 10.1016/j.jcms.2005.02.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2004] [Accepted: 02/24/2005] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The aim of this paper was to study the effect of transmandibular distraction on the periodontal and dental structures, and the initial movements of the mandibular halves, when using an axial plane non-rigid bone-borne distractor (TMD). MATERIAL AND METHODS Fourteen patients undergoing bimaxillary transverse osteodistraction had their six lower anterior teeth assessed for mobility, sensitivity, and pocket depth. Recordings were made pre-operatively, post-distraction, post-consolidation and at 1-year follow-up. Selected landmarks on pre-operative and post-consolidation models were also digitised in three dimensions to study individual tooth movements, and positional changes of the mandibular halves. RESULTS Pockets depths around the incisor teeth increased during the consolidation period (probably due to reduced oral hygiene), but returned to normal by the 1-year post-operative consultation. Tooth mobility increased temporarily in the active phase (central incisors, lateral incisors) and in the consolidation phase (lateral incisors, canine teeth). Sensitivity to cold was temporarily lost in the incisor teeth, probably as a result of 'apical contusion'. One central incisor was inadvertently apically osteotomized and needed root canal treatment. The angle between the mandibular halves closed by 9.4 degrees. CONCLUSION Periodontal and dental morbidity is transient and limited to the distraction and consolidation period, as long as the tooth apices are avoided when the osteotomy is performed. A step-design osteotomy may be preferable when the central incisor apices are close to each other. The transmandibular distractor (TMD) allows for rotation at the temporomandibular joints.
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Affiliation(s)
- Maurice Y Mommaerts
- Division of Maxillo-Facial Surgery, Department of Surgery, General Hospital St. Jan, Bruges, Belgium.
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Iseri H, Malkoç S. Long-term skeletal effects of mandibular symphyseal distraction osteogenesis. An implant study. Eur J Orthod 2005; 27:512-7. [PMID: 16043467 DOI: 10.1093/ejo/cji026] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The purpose of this study was to investigate the long-term skeletal effects of mandibular symphyseal distraction osteogenesis (MSDO) with a tooth- and bone-borne distraction device, analysed using the metallic implant method. The study sample comprised 20 patients between 15.8 and 25 years of age, with a mean age of 20.01 +/- 2.25 years at the start of treatment. In 12 subjects, titanium implants were inserted in the mandible to analyse mandibular skeletal changes in the short and long term. A custom-made intraoral, tooth- and bone-borne distractor was designed and used. After a latency period of 7 days, the distractor was activated twice daily, by a total amount of 1 mm. Postero-anterior (PA) cephalograms were obtained at the start of distraction and at the end of consolidation (94.95 +/- 5.79 days after surgery) and follow-up periods (21.5 +/- 4.6 months after consolidation). The data were analysed statistically using paired t-tests. The mean amount of screw activation was 8.10 +/- 1.68 mm. The inter-symphyseal and inter-molar implant distances and the bimolar width significantly increased during the consolidation period (P < 0.001) and were maintained at the end of the follow-up. On the other hand, the bicondylar width was markedly decreased (P < 0.05), while no significant skeletal changes were observed in bigonion and biantigonion widths, inter-ramal implant distance, or inter-ramal and implant angles at the end of the consolidation period. The long-term findings of this study indicate that MSDO provides an efficient and stable non-extraction treatment alternative, mainly by increasing the anterior mandibular skeletal and dental arches.
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Affiliation(s)
- Haluk Iseri
- Department of Orthodontics, University of Ankara, Turkey.
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King JW, Wallace JC. Unilateral Brodie bite treated with distraction osteogenesis. Am J Orthod Dentofacial Orthop 2004; 125:500-9. [PMID: 15067268 DOI: 10.1016/j.ajodo.2003.07.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Mandibular widening by distraction osteogenesis has recently been shown to be a very predictable, successful, and stable procedure with limited morbidity. One indication for mandibular widening by distraction osteogenesis is a Brodie bite (scissors or buccal crossbite). This case report demonstrates a technique used to treat a 12-year-old girl with a true unilateral buccal crossbite (no functional shift). It details how distraction osteogenesis can successfully treat unilateral problems with a distractor, a splint, and elastics. Details on this treatment technique have not been previously published.
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Mommaerts M, Steyaert L, Polsbroek R, Correia P. Corrélation entre les données échographiques et radiographiques dans l’évaluation de la maturation du cal osseux symphysaire après distraction. ACTA ACUST UNITED AC 2004; 105:19-22. [PMID: 15041866 DOI: 10.1016/s0035-1768(04)72908-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To search for means of reducing ionizing radiation during treatment planning for transmandibular osteodistraction. MATERIAL AND METHODS Eleven patients (6 female, 5 male) underwent combined bimaxillary osteodistraction at a mean age of 18 Years. The following investigations were performed to determine symphyseal callus maturation: occlusal radiographs (O-RX) preoperatively, after the active phase of distraction (mean 27 days); ultrasound investigations (US) after the active and consolidation phase. RESULTS US showed calcification foci at the end of the active phase, when O-RX failed to do so. Both US and O-RX detected callus immaturity after 2 Months of consolidation in 1 patient. Both detected bridging ossification one Month later. DISCUSSION US can replace radiography in the diagnosis of callus maturation related to distractor removal.
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Affiliation(s)
- M Mommaerts
- Service de chirurgie maxillo-faciale, département de chirurgie, GH St. Jan, Bruges (B).
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Neyt NMF, Mommaerts MY, Abeloos JVS, De Clercq CAS, Neyt LF. Problems, obstacles and complications with transpalatal distraction in non-congenital deformities. J Craniomaxillofac Surg 2002; 30:139-43. [PMID: 12220991 DOI: 10.1054/jcms.2002.0304] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The transpalatal distractor is a bone-borne device that eliminates negative orthodontic effects during and after maxillary expansion. It produces virtually parallel expansion in the coronal plane. Orthodontic appliances can be installed at an earlier date than when tooth-borne expanders are used. Our aim was to improve the technique by reviewing the difficulties encountered during applications in the past. PATIENTS AND METHODS The files of 57 patients were analyzed for problems (difficulties requiring surgical intervention), obstacles (difficulties requiring surgical intervention but not interfering with the result), and complications (difficulties not resolved at the end of the treatment). RESULTS Twenty-nine difficulties occurred. In 25 cases they were considered to be a 'problem'. Nine problems were surgery related and 16 problems were related to the distraction device itself (14 episodes of loosening of the module, two instances of loss of one osteosynthesis screw). 'Obstacles' occurred in three cases, i.e. loosening of an abutment plate. There was only one 'complication': unilateral infraorbital hyposensibility in a case of a high level corticotomy. CONCLUSION The expansion goal was achieved in all patients. Loosening of the module proved to be the major cause of discomfort. The incidence of difficulties has lead to a change in the design of the hardware and in the surgical protocol.
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Affiliation(s)
- Nathalie M F Neyt
- Division of Maxillo-Facial Surgery, General Hospital St. Jan, Bruges, Belgium
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"DISTRACTION OSTEOGENESIS" AN EMERGING CONCEPT IN THE CORRECTION OF CRANIOFACIAL DEFORMITIES. Med J Armed Forces India 2001; 57:273-4. [PMID: 27365619 DOI: 10.1016/s0377-1237(01)80001-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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