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Liu K, Wang S, Yalikun A, Ren P, Yusufu A. The accordion technique enhances bone regeneration via angiogenesis factor in a rat distraction osteogenesis model. Front Physiol 2023; 14:1259567. [PMID: 37745241 PMCID: PMC10514895 DOI: 10.3389/fphys.2023.1259567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/30/2023] [Indexed: 09/26/2023] Open
Abstract
Objective: The purpose of this study was to observe the effect of the accordion technique (AT) during the distraction phase on chondrogenesis and bone regeneration in a rat femoral distraction osteogenesis (DO) model, and investigate its potential mechanism for reducing the total treatment time of DO. Methods: Fifty-four male Sprague-Dawley (SD) rats that were specific-pathogen-free (SPF) were subjected to DO surgery on the right femur. The distraction rate was 0.5 mm/day for 10 days, following a latency period of 5 days. Rats were randomly divided into Control (no AT, n = 18), Group LA (low amplitude with AT, n = 18), and Group HA (high amplitude with AT, n = 18) according to different AT protocols in the distraction phase. Rats were respectively euthanized by anesthesia overdose at 2, 4 and 6 weeks of the consolidation phase, and the femurs were harvested. Digital radiography, micro-computed tomography (micro-CT), biomechanical tests, and histomorphological analysis were used to assess the quality of regenerated bone in the distraction area. Results: Digital radiographic, micro-CT, biomechanical tests, and histological analysis revealed an increase in early-stage callus formation (p < 0.05) and improved blood supply to the callus tissue in Group LA, as compared to both the Control and Group HA. The enhanced differentiation of fibrous and cartilaginous tissue into bone tissue was also observed in Group LA, leading to improved strength and stiffness (p < 0.05) of the regenerated bone at 6 weeks of the consolidation phase. The angiogenic (hypoxia-inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF), p < 0.05) and osteogenic (runt-related transcription factor 2 (RUNX2), osteocalcin (OCN) and osteopontin (OPN), p < 0.05) biomarkers were higher expressed in Group LA at 2 and 4 weeks of consolidation phase, whereas decreased at 6 weeks of consolidation phase. Conclusion: The application of AT with low amplitude during the distraction phase can enhance chondrogenesis and bone regeneration by activating the angiogenesis factor pathway and upregulating the expression of osteogenic-related biomarkers such as HIF-1α, VEGF, RUNX2, OCN, and OPN.
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Affiliation(s)
| | | | | | - Peng Ren
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Aihemaitijiang Yusufu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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Fu R, Feng Y, Liu Y, Gao X, Bertrand DT, Du T, Liu Y, Willie BM, Yang H. Effect of the accordion technique on bone regeneration during distraction osteogenesis: A computational study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 227:107232. [PMID: 36371976 DOI: 10.1016/j.cmpb.2022.107232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/18/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Distraction osteogenesis (DO), a bone lengthening technique, is widely employed to treat congenital and acquired limb length discrepancies and large segmental bone defects. However, a major issue of DO is the prolonged consolidation phase (10-36 months) during which patients must wear a cumbersome external fixator. Attempts have been made to accelerate the healing process of DO by an alternating distraction and compression mode (so-called "accordion" technique or AT). However, it remains unclear how varied AT parameters affect DO outcomes and what the most effective AT mode is. METHODS Based on an experimentally-verified mechanobiological model, we performed a parametric analysis via in silico simulation of the bone regeneration process of DO under different AT modes, including combinations of varied application times (AT began at week 1-8 of the consolidation phase), durations (AT was used continuously for 1 week, 2 weeks or 4 weeks) and rates (distraction or compression at 0.25, 0.5, 0.75, and 1 mm/12 h). The control group had no AT applied during the consolidation phase. RESULTS Compared with the control group (no AT), AT applied at an early consolidation stage (e.g. week 1 of the consolidation phase) significantly enhanced bone formation and reduced the overall healing time. However, the effect of AT on bone healing was dependent on its duration and rate. Specifically, a moderate rate of AT (e.g. 0.5 mm/12 h) lasting for two weeks promoted blood perfusion recovery and bone regeneration, ultimately shortening the healing time. Conversely, over-high rates (e.g. 1 mm/12 h) and longer durations (e.g. 4 weeks) of AT adversely affected bone regeneration and blood perfusion recovery, thereby delaying bone bridging. CONCLUSIONS These results suggest that the therapeutic effects of AT on DO are highly dependent of the AT parameters of choice. Under appropriate durations and rates, the AT applied at an early consolidation phase is beneficial for blood recovery and bone regeneration. These results may provide a basis for selecting effective AT modes to accelerate consolidation and reduce the overall treatment period of DO.
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Affiliation(s)
- Ruisen Fu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Yili Feng
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Yang Liu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Xing Gao
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - David T Bertrand
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada; Research Centre, Shriners Hospital for Children-Canada, Montreal, Canada
| | - Tianming Du
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Youjun Liu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Bettina M Willie
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada; Research Centre, Shriners Hospital for Children-Canada, Montreal, Canada
| | - Haisheng Yang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China.
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Pumping the Periosteum: A Feasibility Study: Periosteal Distraction Osteogenesis in a Rat Model. Ann Plast Surg 2022; 89:218-224. [PMID: 35276708 DOI: 10.1097/sap.0000000000003108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Gradual elevation of periosteum from the bone surface is known to promote the adaptation of soft tissues and the formation of hard tissues. The aim of our study was to estimate the benefit of periosteal distraction osteogenesis (PDO) on de novo bone formation in a rat model. MATERIALS AND METHODS After device placement, animals were allowed for a latency period of 7 days. Animals in the PDO group were subjected to distraction at a rate of 0.1 mm/d for 10 days. In the periosteal pumping (PP) group, the animals were subjected to distraction at a rate of 0.1 mm/d. The direction of distraction was alternated every 2 days. The animals were euthanized at 17, 31, and 45 days after surgery, and the samples were analyzed histologically and by microcomputed tomography. RESULTS In both groups, the new bone was characterized as primary woven bone that was located at the leading edge of bone apposition. Bone volumes significantly increased throughout the observation period both in the PP group (P = 0.018) and in the PDO group (P < 0.001). The new bone was denser and more mature in the PP group than in the PDO group, and the difference was significant at the 31-day time point (P = 0.024). However, the volume of the new bone was higher in the PDO at the 45-day time point (P < 0.001). CONCLUSIONS We propose that the PP may be applied to enhance the osteogenic capacity of periosteum without plate elevation. Because this is only a proof-of-principle study, the alternated protocol of periosteal distraction warrants evaluation in the future studies.
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Saulacic N, García-González M, Muñoz Guzon FM, Garcia Garcia A, Sadath-Marashi Z, Rohrer U, Ferrari SL. Regeneration of Craniofacial Bone Induced by Periosteal Pumping. Tissue Eng Part C Methods 2022; 28:61-72. [PMID: 35107342 DOI: 10.1089/ten.tec.2022.0001] [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: 11/13/2022] Open
Abstract
A variety of surgical techniques and tissue engineering strategies utilizing osteogenic potential of the periosteum have been developed for the repair of extended bone deficiencies. The aim of the present study was to assess the impact of an alternating protocol of periosteal distraction osteogenesis (PDO) on bone regeneration in an intraoral model. Eight adult, male Beagle dogs were used for the study. Two distraction devices were placed on each side of the mandible. After a 7-day latency period, distraction devices in all animals were manipulated at the rate of 0.5 mm for a total of 8 days. The pumping protocol in two test groups proceeded twice daily by alternating activation with relaxation. In the periosteal pumping/distraction (PPDO) group, the distraction screws were activated two times (at 12 and 24 h) and then turned back (at 36 h), and in the periosteal pumping (PP) group repeatedly activated and turned back (at 12 h). In the PDO group, only activation was performed once daily (positive control). Devices were left inactivated in the negative control (NC) group. The samples were harvested after 8 weeks of consolidation period and investigated by micro-CT and histological analysis. New mature, lamellar bone was formed over the pristine bone in all groups. PPDO and PDO groups showed more new bone area (NBA) compared to the PP (p < 0.001 and p < 0.001, respectively) and to the NC group (p = 0.032 and p = 0.031, respectively). Furthermore, greater NBA was found in the PP group than the NC group (p = 0.006). PDO demonstrated higher relative connective tissue area than the PPDO group (p = 0.005) and lower relative new bone volume than the NC group (p = 0.025). Pumping protocol of periosteal distraction may successfully induce the endogenous regeneration of the mandibular bone in dogs. Impact Statement Repair of extended bone defects impose a significant challenge to oral and maxillofacial surgeons. In this article, a principle of distraction osteogenesis was applied to stimulate bone regeneration in the mandible. A periosteum-based regeneration approach may represent a valuable step toward creating a significant volume of hard and soft tissues, without need for autogenous bone harvesting or application of biomaterials.
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Affiliation(s)
- Nikola Saulacic
- Department of Cranio-Maxillofacial Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Mario García-González
- Department of Veterinary Clinical Sciences, Faculty of Veterinary, University of Santiago de Compostela, Lugo, Spain
| | - Fernando M Muñoz Guzon
- Department of Veterinary Clinical Sciences, Faculty of Veterinary, University of Santiago de Compostela, Lugo, Spain
| | - Abel Garcia Garcia
- Department of Maxillofacial Surgery, Complejo Hospitalario Universitario de Santiago de Compostela and Oral Surgery Unit, School of Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Zahra Sadath-Marashi
- Department of Cranio-Maxillofacial Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Urs Rohrer
- ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | - Serge L Ferrari
- Division of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospital and Faculty of Medicine, Genève, Switzerland
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Liu Y, Cai F, Liu K, Liu J, Zhang X, Yusufu A. Cyclic Distraction–Compression Dynamization Technique Enhances the Bone Formation During Distraction Osteogenesis. Front Bioeng Biotechnol 2022; 9:810723. [PMID: 35118057 PMCID: PMC8806138 DOI: 10.3389/fbioe.2021.810723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 12/13/2021] [Indexed: 01/17/2023] Open
Abstract
Background: Interfragmentary movements have benefits in the improvement of bone formation during distraction osteogenesis (DO). Although several clinical studies reported positive outcomes regarding the application of the cyclic distraction–compression (CDC) dynamization technique in cases with poor bone formation during DO, they are mostly anecdotal without a detailed description. The purpose of this study was to investigate the effectiveness and potential mechanism of different amplitudes and rates of the CDC technique on bone regeneration in a rat femur DO model.Methods: A total of 60 adult male Sprague-Dawley rats underwent right femoral mid-diaphysis transverse osteotomy and were randomly and evenly divided into Control (no manipulation), Group1 (CDC therapy), Group2 (CDC therapy with larger amplitude), and Group3 (CDC therapy with a slower rate) after distraction. The CDC technique was performed during the middle phase of the consolidation period according to different protocols. Animals were sacrificed after 4 and 6 weeks of consolidation. The process of bone formation was monitored by digital radiographs, and the regenerate bone was evaluated by micro-computed tomography (micro-CT), biomechanical test, and histological analysis. The serum contents of hypoxia-inducible factor (HIF)-1α and vascular endothelial growth factor (VEGF) were measured by enzyme-linked immunosorbent assay (ELISA).Results: Bone regeneration after the CDC technique was improved significantly during DO. The digital radiograph, micro-CT, histomorphological analysis, and biomechanical evaluation showed better effects regarding volume, continuity, and mechanical properties of the regenerate bone in Group2 and Group3 when compared to Group1. The angiogenic and osteogenic markers were more highly expressed in Group2 and Group3 than in Group1 according to the immunohistochemical analysis. As for ELISA, the serum contents of HIF-1α and VEGF were also increased after the CDC technique, especially in Group2 and Group3.Conclusion: The CDC dynamization technique has benefits on the improvement of bone formation during DO, and the mechanism may be due to tissue hypoxia activating the HIF pathway followed by the augmentation of osteogenic–angiogenic coupling. Better outcomes may be achieved by moderately increasing the amplitude and slowing down the rate of the CDC technique.
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Affiliation(s)
- Yanshi Liu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Feiyu Cai
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Kai Liu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jialin Liu
- Department of Prosthodontics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiaoxu Zhang
- School of Public Health, Xinjiang Medical University, Urumqi, China
| | - Aihemaitijiang Yusufu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- *Correspondence: Aihemaitijiang Yusufu,
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The Distraction Osteogenesis Callus: a Review of the Literature. Clin Rev Bone Miner Metab 2022. [DOI: 10.1007/s12018-021-09282-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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7
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Fu R, Feng Y, Liu Y, Yang H. Mechanical regulation of bone regeneration during distraction osteogenesis. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Effect of Cyclic Compressive Forces on New Bone Formation during the Distraction Period in Mandibular Distraction Osteogenesis Using a Microactuator-Generated Distractor. Plast Reconstr Surg 2020; 146:783-791. [DOI: 10.1097/prs.0000000000007152] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Red-blue light irradiation in the prevention of surgical wound infection after mandibular distraction using internal distractors in hemifacial microsomia: A randomized trial. J Craniomaxillofac Surg 2019; 47:1343-1350. [PMID: 31358401 DOI: 10.1016/j.jcms.2019.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/28/2019] [Accepted: 07/02/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Postoperative infection is a complication of mandibular distraction osteogenesis (DO) in patients with hemifacial microsomia (HFM). The risk of surgical wound infection in DO is reported to be high due to the long duration of the distraction process. Treatment during the perioperative period is critical in combating infection. AIM This study aimed to evaluate the effectiveness of red-blue irradiation in the prevention of surgical wound infection after mandibular distraction. METHODS In our single-centered, randomized clinical study, 118 patients diagnosed with HFM who had undergone DO between April 2016 and April 2018 were included. The patients were randomly divided into two groups: the experimental group received red-blue irradiation treatment and the control group received white-light irradiation. RESULTS None of the infections occurring in this study resulted in serious complications. The postoperative infection rate during the 4 weeks after DO in the experimental group was 1.7%, whereas that in the control group was 13.6% (p = 0.016) (based on a modified NHSN wound infection criterion). The total social cost during the active period for the experimental group was 3386840 RMB, 5.12% higher than for the control group (3221882 RMB). CONCLUSIONS Red-blue irradiation is recommended as adjunctive therapy after mandibular distraction osteogeneis in HFM.
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10
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Xu J, Sun Y, Wu T, Liu Y, Shi L, Zhang J, Kang Q, Chai Y, Li G. Enhancement of bone regeneration with the accordion technique via HIF-1α/VEGF activation in a rat distraction osteogenesis model. J Tissue Eng Regen Med 2017; 12:e1268-e1276. [PMID: 28763580 DOI: 10.1002/term.2534] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 07/05/2017] [Accepted: 07/27/2017] [Indexed: 11/05/2022]
Abstract
Axial micromotion of bone fragments promotes callus formation and bone healing during the process of distraction osteogenesis (DO). This study investigated the effects of the combined axial compression and distraction (accordion) technique on bone regeneration in rat DO model. Male Sprague-Dawley rats (n = 62) underwent right tibial transverse osteotomy and were randomly divided into four groups after lengthening: control (no manipulation) and three experimental groups assigned on the basis of the period of accordion manoeuvres in the consolidation phase (Groups 1, 2, and 3 with accordion technique applied at Weeks 1, 3, and 5, respectively). Animals were terminated at 1 week after each accordion phase (i.e., Weeks 2, 4, and 6). Callus formation was monitored by X-ray radiography; new bone quality was evaluated by microcomputed tomography, histological analysis, and mechanical testing. Serum levels of hypoxia-inducible factor (HIF)-1α and vascular endothelial growth factor (VEGF) were measured. Callus formation after accordion manoeuvre at Week 3 (Group 2) increased significantly over time of consolidation. The microcomputed tomography and mechanical analysis revealed Group 2 had more newly formed bone and superior mechanical properties in contrast to the other groups at termination. Histomorphological and immunohistochemical analyses confirmed a greater degree of osteogenesis and angiogenesis corresponding to increased serum levels of HIF-1α and VEGF in Group 2. The accordion technique was effective in promoting bone consolidation via activation of HIF-1α/VEGF during DO. The accordion technique may be used in the middle phase of bone consolidation to promote bone formation in patients undergoing DO treatment.
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Affiliation(s)
- Jia Xu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Department of Orthopaedics & Traumatology, Stem Cells and Regeneration Laboratory, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yuxin Sun
- Department of Orthopaedics & Traumatology, Stem Cells and Regeneration Laboratory, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tianyi Wu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Department of Orthopaedics & Traumatology, Stem Cells and Regeneration Laboratory, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yang Liu
- Department of Orthopaedics & Traumatology, Stem Cells and Regeneration Laboratory, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Liu Shi
- Department of Orthopaedics & Traumatology, Stem Cells and Regeneration Laboratory, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jinfang Zhang
- Department of Orthopaedics & Traumatology, Stem Cells and Regeneration Laboratory, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Qinglin Kang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yimin Chai
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Gang Li
- Department of Orthopaedics & Traumatology, Stem Cells and Regeneration Laboratory, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Shah SR, Tatara AM, Lam J, Lu S, Scott DW, Bennett GN, van den Beucken JJJP, Jansen JA, Wong ME, Mikos AG. Polymer-Based Local Antibiotic Delivery for Prevention of Polymicrobial Infection in Contaminated Mandibular Implants. ACS Biomater Sci Eng 2016; 2:558-566. [DOI: 10.1021/acsbiomaterials.5b00545] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Sarita R. Shah
- Department
of Bioengineering, Rice University, Houston, Texas 77030, United States
| | - Alexander M. Tatara
- Department
of Bioengineering, Rice University, Houston, Texas 77030, United States
| | - Johnny Lam
- Department
of Bioengineering, Rice University, Houston, Texas 77030, United States
| | - Steven Lu
- Department
of Bioengineering, Rice University, Houston, Texas 77030, United States
| | - David W. Scott
- Department
of Statistics, Rice University, Houston, Texas 77251, United States
| | - George N. Bennett
- Department
of BioSciences, Rice University, Houston, Texas 77005, United States
| | | | - John A. Jansen
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark E. Wong
- University of Texas Health Science Center at Houston, Houston, Texas 77030, United States
| | - Antonios G. Mikos
- Department
of Bioengineering, Rice University, Houston, Texas 77030, United States
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12
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The Accordion Maneuver: A Noninvasive Strategy for Absent or Delayed Callus Formation in Cases of Limb Lengthening. Adv Orthop 2015; 2015:912790. [PMID: 26557996 PMCID: PMC4628974 DOI: 10.1155/2015/912790] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/27/2015] [Indexed: 12/17/2022] Open
Abstract
The distraction osteogenesis (DO) technique has been used worldwide to treat many orthopaedic conditions. Although successful, absent or delayed callus formation in the distraction gap can lead to significant morbidities. An alternate cycle of distraction-compression (accordion maneuver) is one approach to accelerate bone regeneration. The primary aim of our study is to report our experience with the accordion maneuver during DO and to provide a detailed description of this technique, as performed in our center. The secondary aim is to present a review of the literature regarding the use of accordion maneuver. We reviewed the database of all patients undergoing limb lengthening from the year of 1997 to 2012. Four patients (6.15%) out of 65 showed poor bone regenerate in their tibiae and therefore accordion maneuver was applied for a mean of 6.75 weeks. Of these, three patients have had successful outcome with this technique. The literature showed that this technique is successful approach to trigger bone healing. However, details of how and when to apply this combination of distraction-compression forces were lacking. In conclusion, the accordion technique is safe noninvasive approach to promote bone formation, thus avoiding more invasive surgical procedures in cases of poor callus formation in limb lengthening.
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Dehghan MM, Baghaban Eslaminejad M, Motallebizadeh N, Ashrafi Halan J, Tagiyar L, Soroori S, Nikmahzar A, Pedram M, Shahverdi A, Kazemi Mehrjerdi H, Izadi S. Transplantation of Autologous Bone Marrow Mesenchymal Stem Cells with Platelet-Rich Plasma Accelerate Distraction Osteogenesis in A Canine Model. CELL JOURNAL 2015. [PMID: 26199903 PMCID: PMC4503838 DOI: 10.22074/cellj.2016.3724] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective Distraction osteogenesis (DO) is a surgical procedure used to generate large
volumes of new bone for limb lengthening.
Materials and Methods In this animal experimental study, a 30% lengthening of the left
tibia (mean distraction distance: 60.8 mm) was performed in ten adult male dogs by callus
distraction after osteotomy and application of an Ilizarov fixator. Distraction was started on
postoperative day seven with a distraction rate of 0.5 mm twice per day and carried out at
a rate of 1.5 mm per day until the end of the study. Autologous bone marrow mesenchymal stem cells (BM-MSCs) and platelet-rich plasma (PRP) as the treatment group (n=5)
or PRP alone (control group, n=5) were injected into the distracted callus at the middle
and end of the distraction period. At the end of the consolidation period, the dogs were
sacrificed after which computerized tomography (CT) and histomorphometric evaluations
were performed.
Results Radiographic evaluationsrevealed that the amount and quality of callus formations were significantly higher in the treatment group (P<0.05). As measured by
CT scan, the healing parametersin dogs of the treatment group were significantly
greater (P<0.05). New bone formation in the treatment group was significantly higher
(P<0.05).
Conclusion The present study showed that the transplantation of BM-MSCs positively
affects early bony consolidation in DO. The use of MSCs might allow a shortened period
of consolidation and therefore permit earlier device removal.
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Affiliation(s)
- Mohammad Mehdi Dehghan
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Mohamadreza Baghaban Eslaminejad
- Department of Stem Cells and Developmental Biology at Cell Sciences Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | | | - Javad Ashrafi Halan
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Tabriz University, Tabriz, Iran
| | - Leila Tagiyar
- Department of Stem Cells and Developmental Biology at Cell Sciences Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Sarang Soroori
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Agbibi Nikmahzar
- Department of Stem Cells and Developmental Biology at Cell Sciences Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Mirsepehr Pedram
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Abdolhossein Shahverdi
- Department of Stem Cells and Developmental Biology at Cell Sciences Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Hossein Kazemi Mehrjerdi
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Sadra Izadi
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
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14
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Lee DH, Ryu KJ, Kim JW, Kang KC, Choi YR. Bone marrow aspirate concentrate and platelet-rich plasma enhanced bone healing in distraction osteogenesis of the tibia. Clin Orthop Relat Res 2014; 472:3789-97. [PMID: 24599650 PMCID: PMC4397746 DOI: 10.1007/s11999-014-3548-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND During lower limb lengthening, poor bone regeneration is a devastating complication. Several local or systemic applications have been used to promote osteogenesis, and biologic stimulations are gaining attention, but their utility has not been proven in this setting. QUESTIONS/PURPOSES In patients undergoing bilateral tibial lengthening, we compared those receiving an osteotomy site injection of autologous bone marrow aspirate concentrate (BMAC) plus platelet-rich plasma (PRP) with those not receiving such an injection in terms of external fixator index (time in external fixation divided by amount of lengthening), full weightbearing index (time until a patient was permitted to do full weightbearing divided by amount of lengthening), four cortical healing indexes (time until each cortical union divided by amount of lengthening), and callus shape and type. METHODS Twenty-two patients (44 tibias) undergoing bilateral tibial lengthening enrolled in this randomized trial. Two patients were excluded, one due to insufficient radiographic evaluation and one who was lost to followup, leaving 20 patients (40 segments) for inclusion. Ten patients (20 segments) received BMAC combined with PRP injection (treatment group) and 10 patients (20 segments) received no injection (control group). All patients underwent stature lengthening for familial short stature with the lengthening over nail technique. Autologous BMAC combined with PRP was injected at the tibial osteotomy site at the end of the index surgery. Mean distraction rates were similar between groups (0.75 mm/day in the treatment group versus 0.72 mm/day in the control group; p = 0.24). Full weightbearing was permitted when we observed radiographic evidence of healing at two cortices; this assessment was made by the surgeon who was blinded to the treatment each patient received. Minimum followup was 24 months (mean, 28 months; range, 24-34 months). RESULTS There was no difference in mean external fixator index between groups. However, mean cortical healing indexes (anterior/posterior/medial/lateral) were 1.14/0.81/0.96/0.88 months/cm in the treatment group and 1.47/1.26/1.42/1.22 months/cm in the control group (all p < 0.001), showing faster healing in the treatment group at each cortex. Full weightbearing was permitted earlier in the treatment group than in the control group (index: 0.99 months/cm and 1.38 months/cm, respectively, p < 0.001). Callus shape and type were not different between groups. CONCLUSIONS Autologous BMAC combined with PRP injection at the osteotomy site helped improve bone healing in distraction osteogenesis of the tibia, although the effect size was small. LEVEL OF EVIDENCE Level I, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Dong Hoon Lee
- Department of Orthopaedic Surgery, Severance Hospital, College of Medicine, Yonsei University, 134 Sinchondong, CPO Box 8044, Seoul, Republic of Korea
| | - Keun Jung Ryu
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, 351 Yatap-dong, Bundang-gu, Sung-nam, Kyungki-do Republic of Korea
| | - Jin Woo Kim
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, 351 Yatap-dong, Bundang-gu, Sung-nam, Kyungki-do Republic of Korea
| | - Kyung Chung Kang
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, 351 Yatap-dong, Bundang-gu, Sung-nam, Kyungki-do Republic of Korea
| | - Young Rak Choi
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, 351 Yatap-dong, Bundang-gu, Sung-nam, Kyungki-do Republic of Korea
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Alkaisi A, Ismail AR, Mutum SS, Ahmad ZAR, Masudi S, Abd Razak NH. Transplantation of human dental pulp stem cells: enhance bone consolidation in mandibular distraction osteogenesis. J Oral Maxillofac Surg 2013; 71:1758.e1-13. [PMID: 24040948 DOI: 10.1016/j.joms.2013.05.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 05/14/2013] [Accepted: 05/16/2013] [Indexed: 01/08/2023]
Abstract
PURPOSE The main aim of the present study was to evaluate the capacity of stem cells from human exfoliated deciduous teeth (SHED) to enhance mandibular distraction osteogenesis (DO) in rabbits. MATERIALS AND METHODS A randomized controlled trial was conducted. Eighteen skeletally immature New Zealand white rabbits were divided into 2 groups, with 9 in the control group and 9 in the SHED group. The SHED were isolated, expanded, and characterized. Six million cells were transplanted into the distracted area during the osteotomy period. After a 4-day latency period, a total of 6 mm was distracted for 6 days. The newly formed bone was analyzed radiologically, histologically, and histomorphometrically at 2, 4, and 6 weeks postoperatively. Nonparametric analysis of variance (Kruskal-Wallis test) was used for data analysis, and P < .05 was considered statistically significant. RESULTS The cell lineage was positive for the 2 mesenchymal stem cell markers tested (CD105 and CD166). More mature bone in the SHED transplanted group was observed radiographically and histologically. Histomorphologically, the percentage of newly formed bone after 2, 4, and 6 weeks was 18.41% and 41.53%, 31.68% and 59.78%, and 52.34% and 65.24% in the control and SHED groups, respectively. The difference between the groups was statistically significant (P = .012). The bone union and stage of bone maturity scores were significantly different between the control and SHED groups (P = .006 and P = .011, respectively). CONCLUSIONS Our findings suggest that SHED can serve as an additional cell resource for DO enhancement in rabbits and might be a promising model for the reconstruction of large mandibular defects in human oral maxillofacial surgery.
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Affiliation(s)
- Amera Alkaisi
- Lectural, PhD Student, Universiti Sains Malaysia; Lectural in University of Anbar, College of Dentistry; Oral and Maxillofacial Department, Alramady, Iraq.
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Hong P, Boyd D, Beyea SD, Bezuhly M. Enhancement of bone consolidation in mandibular distraction osteogenesis: A contemporary review of experimental studies involving adjuvant therapies. J Plast Reconstr Aesthet Surg 2013; 66:883-95. [DOI: 10.1016/j.bjps.2013.03.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 02/14/2013] [Accepted: 03/16/2013] [Indexed: 11/28/2022]
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The Ilizarov paradigm: thirty years with the Ilizarov method, current concerns and future research. INTERNATIONAL ORTHOPAEDICS 2013; 37:1533-9. [PMID: 23712212 DOI: 10.1007/s00264-013-1935-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 05/07/2013] [Indexed: 02/06/2023]
Abstract
The Ilizarov method of bone lengthening, reconstruction and osteosynthesis has developed immensely since its introduction by G.A. Ilizarov in the Soviet Union in the 1960s and in the Western countries in the early 1980s. It has become an integral part of the arsenal used by the orthopaedic community worldwide. The evolutionary development of the method and its current role has considerably improved the quality of life for millions of people around the whole world. Despite the great versatility of its possible applications for bone injuries and diseases, the Ilizarov method could not and cannot be the alternative to a range of other methods that are applied for some specific bone conditions, but rather is a method of choice. Its combination with the current methods of internal fixation or the means of internal fixation that use the biological principles that were laid down by G.A. Ilizarov have demonstrated the importance of tension stress, blood supply, functional loading, and fragment control during bone treatment. The objective of this study was to present an overview of the current state and concerns in the application of the Ilizarov method and define the prospective research trends aimed at regeneration stimulation, better control of treatment, infection barriers and patient comfort.
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18
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Ozgül S, Akdeniz ZD, Celebiler O, Alcan T, Sav A. The effect of 2 different distraction-compression models on new bone generation. J Oral Maxillofac Surg 2012; 70:e490-9. [PMID: 22907114 DOI: 10.1016/j.joms.2012.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 05/12/2012] [Accepted: 05/14/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the stimulating effect of distraction and 2 different distraction-compression models on maturation of new bone during healing. MATERIALS AND METHODS Thirty adult Sprague-Dawley rats underwent unilateral mandibular osteotomy. The animals were divided into 3 groups. A unidirectional external distraction device was fixed to the mandible. A total of 4 mm of distraction was planned in all groups. After a latency period of 3 days, 0.2 mm of distraction was performed twice a day for 10 days in the distraction group. In the intermittent distraction-compression group, 0.2 mm of distraction was performed twice a day for 3 days, followed by 0.2 mm of compression twice a day for 1 day. In the overdistraction-compression group, 0.2 mm of distraction was performed twice a day for 14 days, followed by 0.2 mm of compression twice a day for 4 days. After a consolidation period of 6 weeks in all groups, animals were killed for macroscopic, microscopic, and radiologic evaluation. RESULTS Radiologic evaluation proved that more mature bone generation occurred in the groups in which compression was added to distraction. The number of osteoblasts in the intermittent distraction-compression group was significantly higher than that in the distraction group and overdistraction-compression group (P < .001). The highest number of vessels was found in the intermittent distraction-compression group (17.7 ± 6.4) (P < .001). CONCLUSIONS The intermittent distraction-compression model was found to generate greater new bone compared with distraction alone. In clinical applications, to increase the quality of the bone and to shorten the consolidation period, compression can be applied during distraction.
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Affiliation(s)
- Sevin Ozgül
- Department of Plastic, Reconstructive and Aesthetic Surgery, School of Medicine, Marmara University, Istanbul, Turkey
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19
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Taub PJ, Lampert JA. Pediatric Craniofacial Surgery: A Review for the Multidisciplinary Team. Cleft Palate Craniofac J 2011; 48:670-83. [DOI: 10.1597/08-051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Pediatric craniofacial surgery is a specialty that grew dramatically in the 20th century and continues to evolve today. Out of the efforts to correct facial deformities encountered during World War II, the techniques of modern craniofacial surgery developed. An analysis of the relevant literature allowed the authors to explore this historical progression. Current advances in technology, tissue engineering, and molecular biology have further refined pediatric craniofacial surgery. The development of distraction osteogenesis and the progressive study of craniosynostosis provide remarkable examples of this momentum. The growing study of genetics, biotechnology, the influence of growth factors, and stem cell research provide additional avenues of innovation for the future. The following article is intended to reveal a greater understanding of pediatric craniofacial surgery by examining the past, present, and possible future direction. It is intended both for the surgeon, as well as for the nonsurgical individual specialists vital to the multidisciplinary craniofacial team.
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Affiliation(s)
- Peter J. Taub
- Division of Plastic Surgery, Mount Sinai Medical Center, New York, New York
| | - Joshua A. Lampert
- Division of Plastic Surgery, Mount Sinai Medical Center, New York, New York
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20
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A Piezoelectric Motor-Based Microactuator-Generated Distractor for Continuous Jaw Bone Distraction. J Craniofac Surg 2011; 22:1486-8. [DOI: 10.1097/scs.0b013e31821d196b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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21
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Nagashima LK, Rondon-Newby M, Zakhary IE, Nagy WW, Zapata U, Dechow PC, Opperman LA, Elsalanty ME. Bone regeneration and docking site healing after bone transport distraction osteogenesis in the canine mandible. J Oral Maxillofac Surg 2011; 70:429-39. [PMID: 21601342 DOI: 10.1016/j.joms.2011.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 12/22/2010] [Accepted: 02/01/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE Bone transport distraction osteogenesis provides a promising alternative to traditional grafting techniques. However, existing bone transport distraction osteogenesis devices have many limitations. The purpose of this research was to test a new device, the mandibular bone transport reconstruction plate, in an animal model with comparable mandible size to humans and to histologically and mechanically examine the regenerate bone. MATERIALS AND METHODS Eleven adult foxhounds were divided into an unreconstructed control group of 5 animals and an experimental group of 6 animals. In each animal, a 34-mm segmental defect was created in the mandible. The defect was reconstructed with a bone transport reconstruction plate. Histologic and biomechanical characteristics of the regenerate and unrepaired defect were analyzed and compared with bone on the contralateral side of the mandible after 4 weeks of consolidation. RESULTS The reconstructed defect was bridged with new bone, with little bone in the control defect. Regenerate density and microhardness were 22.3% and 42.6%, respectively, lower than the contralateral normal bone. Likewise, the anisotropy of the experimental group was statistically lower than in the contralateral bone. Half the experimental animals showed nonunion at the docking site. CONCLUSION The device was very stable and easy to install and activate. After 1 month of consolidation, the defect was bridged with new bone, with evidence of active bone formation. Regenerate bone was less mature than the control bone. Studies are underway to identify when the regenerate properties compare with normal bone and to identify methods to augment bone union at the docking site.
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Affiliation(s)
- Lucy K Nagashima
- Department of Prosthodontics, Baylor College of Dentistry, Texas A&M University System, Dallas, TX, USA
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22
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Effects of zoledronic acid on healing of mandibular fractures: an experimental study in rabbits. J Oral Maxillofac Surg 2011; 69:1726-35. [PMID: 21256644 DOI: 10.1016/j.joms.2010.07.063] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 07/16/2010] [Indexed: 01/06/2023]
Abstract
PURPOSE The purpose of the present study was to evaluate the effects of systemically administered zoledronic acid (ZA) on mandibular fracture healing in a rabbit model using radiodensitometric, biomechanical, histologic, and histomorphometric methods. MATERIALS AND METHODS A total of 36 skeletally mature male New Zealand white rabbits were used. The rabbits were randomly divided into 2 groups. A mandibular corpus fracture was created experimentally in all 36 rabbits. The experimental group was administered an intravenous, single dose of 0.1 mg/kg ZA, and the control group was administered only saline infusion during the procedure. All rabbits were sacrificed on the 21st postoperative day. Digital radiodensitometric analysis, a 3-point bending test, and histologic and histomorphometric examinations were performed on the harvested hemimandibles. The data were analyzed statistically. RESULTS Biomechanical testing data showed that ZA treatment resulted in a significant increase in the healed bone strength. This result was supported by the radiologic, histologic, and histomorphometric findings. CONCLUSIONS The results of the present study have revealed that systemic administration of ZA accelerates and improves the bone healing of mandibular fractures.
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Kretlow JD, Mikos AG. 2007 AIChE Alpha Chi Sigma Award: From Material to Tissue: Biomaterial Development, Scaffold Fabrication, and Tissue Engineering. AIChE J 2008; 54:3048-3067. [PMID: 19756176 DOI: 10.1002/aic.11610] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The need for techniques to facilitate the regeneration of failing or destroyed tissues remains great with the aging of the worldwide population and the continued incidence of trauma and diseases such as cancer. A 16-year history in biomaterial scaffold development and tissue engineering is examined, beginning with the synthesis of novel materials and fabrication of 3D porous scaffolds. Exploring cell-scaffold interactions and subsequently cellular delivery using biomaterial carriers, we have developed a variety of techniques for bone and cartilage engineering. In addition to delivering cells, we have utilized growth factors, DNA, and peptides to improve the in vitro and in vivo regeneration of tissues. This review covers important developments and discoveries within our laboratory, and the increasing breadth in the scope of our work within the expanding field of tissue engineering is presented.
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Affiliation(s)
- James D Kretlow
- Department of Bioengineering, Rice University, P.O. Box 1892, MS 142, Houston, TX 77251-1892
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Saulacic N, Iizuka T, Martin MS, Garcia AG. Alveolar distraction osteogenesis: a systematic review. Int J Oral Maxillofac Surg 2008; 37:1-7. [PMID: 17822881 DOI: 10.1016/j.ijom.2007.07.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 06/06/2007] [Accepted: 07/16/2007] [Indexed: 11/26/2022]
Abstract
This literature review was performed to analyse the outcomes of clinical studies of alveolar distraction osteogenesis (DO) listed by PUBMED between January 1996 and December 2006. A PUBMED search identified 128 articles on alveolar DO. Twenty articles covering 209 cases were analysed, considering location, device and procedural parameters, rate of augmentation, aspect of final implant placement and follow up. The mean latency period was 7.26+/-2.31 days, distraction rate 0.71+/-0.27 mm/day, rate of augmentation 6.88+/-2.52 mm and consolidation period 12.22+/-5.58 weeks. A total of 469 implants were placed and followed post loading for an average of 14.19+/-11.03 months, with a survival rate of 97%. Of the different procedural parameters, only the difference between mean consolidation period for failed (8.10+/-2.51 weeks) and successful (12.43+/-5.62 weeks) implants was statistically significant (P=0.01). Use of DO may be advantageous in terms of the success rate of implants placed in augmented sites, but there is still a lack of sufficient data based on long-term follow up. Future experimental studies should evaluate the application of different methods with a view to shortening the overall treatment period and improving the performance of implants placed in distracted alveolar ridges.
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Affiliation(s)
- N Saulacic
- Department of Cranio-Maxillofacial Surgery, Inselspital, University of Bern, CH-3010 Bern, Switzerland.
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25
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Erdoğan O, Shafer DM, Taxel P, Freilich MA. A review of the association between osteoporosis and alveolar ridge augmentation. ACTA ACUST UNITED AC 2007; 104:738.e1-13. [PMID: 17656117 DOI: 10.1016/j.tripleo.2007.04.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Revised: 02/11/2007] [Accepted: 04/09/2007] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Because of increasing life expectancy and popularity of dental implants, surgeons face a larger number of osteoporotic patients who require bone augmentation. Relationship between low bone density/osteoporosis and bone graft success is still not clear. The purpose of this article is to review and summarize the literature regarding the success of alveolar bone augmentation in osteoporosis. STUDY DESIGN The study design includes a literature review of relevant preclinical and clinical articles that address the association between osteoporosis and alveolar bone augmentation. RESULTS Increased rate of complications such as resorption of bone graft, non-integration of bone graft, delayed healing time, and implant failure in augmented bone especially in the maxilla may be associated with compromised bone health. CONCLUSIONS Despite the decreased success rate, osteoporosis is not an absolute contraindication for bone augmentation and dental implant placement. The modifiable risk factors for osteoporosis should be eliminated before surgery.
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Affiliation(s)
- Ozgür Erdoğan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cukurova University, Adana, Turkey
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26
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Kim U. M615: New Mandibular DO Technique Versus Bone Graft. J Oral Maxillofac Surg 2007. [DOI: 10.1016/j.joms.2007.06.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Amir LR, Li G, Schoenmaker T, Everts V, Bronckers ALJJ. Effect of thrombin peptide 508 (TP508) on bone healing during distraction osteogenesis in rabbit tibia. Cell Tissue Res 2007; 330:35-44. [PMID: 17636332 PMCID: PMC2039796 DOI: 10.1007/s00441-007-0448-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 05/22/2007] [Indexed: 11/25/2022]
Abstract
Thrombin-related peptide 508 (TP508) accelerates bone regeneration during distraction osteogenesis (DO). We have examined the effect of TP508 on bone regeneration during DO by immunolocalization of Runx2 protein, a marker of osteoblast differentiation, and of osteopontin (OPN) and bone sialoprotein (BSP), two late markers of the osteoblast lineage. Distraction was performed in tibiae of rabbits over a period of 6 days. TP508 (30 or 300 μg) or vehicle was injected into the distraction gap at the beginning and end of the distraction period. Two weeks after active distraction, tissue samples were harvested and processed for immunohistochemical analysis. We also tested the in vitro effect of TP508 on Runx2 mRNA expression in osteoblast-like (MC3T3-E1) cells by polymerase chain reaction analysis. Runx2 and OPN protein were observed in preosteoblasts, osteoblasts, osteocytes of newly formed bone, blood vessel cells and many fibroblast-like cells of the soft connective tissue. Immunostaining for BSP was more restricted to osteoblasts and osteocytes. Significantly more Runx2- and OPN-expressing cells were seen in the group treated with 300 μg TP508 than in the control group injected with saline or with 30 μg TP508. However, TP508 failed to increase Runx2 mRNA levels significantly in MC3T3-E1 cells after 2–3 days of exposure. Our data suggest that TP508 enhances bone regeneration during DO by increasing the proportion of cells of the osteoblastic lineage. Clinically, TP508 may shorten the healing time during DO; this might be of benefit when bone regeneration is slow.
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Affiliation(s)
- Lisa R. Amir
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit Amsterdam, Van der Boechorststr 7, 1081BT Amsterdam, The Netherlands
| | - Gang Li
- Musculoskeletal Education and Research Unit, School of Biomedical Sciences, Musgrave Park Hospital, Queen’s University Belfast, Belfast, UK
| | - Ton Schoenmaker
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit Amsterdam, Van der Boechorststr 7, 1081BT Amsterdam, The Netherlands
| | - Vincent Everts
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit Amsterdam, Van der Boechorststr 7, 1081BT Amsterdam, The Netherlands
| | - Antonius L. J. J. Bronckers
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit Amsterdam, Van der Boechorststr 7, 1081BT Amsterdam, The Netherlands
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Shao Z, Liu B, Peng Q, Liu W, Liu Y, Liu R, Xu Y, Liu L. Transplantation of osteoblast-like cells to the distracted callus in the rabbit mandible. Plast Reconstr Surg 2007; 119:500-7. [PMID: 17230082 DOI: 10.1097/01.prs.0000246374.53516.78] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to investigate whether injections of marrow-derived mesenchymal progenitor cells could be used to facilitate new bone formation during distraction osteogenesis. METHODS Fifteen New Zealand rabbits underwent bilateral osteotomy. After a 1-week latency period, bone distraction was activated at a rate of 2.0 mm/day for 5 days. The marrow-derived mesenchymal progenitor cells derived from the ilium marrow were cultured to a population of 10 in 0.5 ml and then unilaterally transplanted to the gap of distracted callus immediately after distraction had been terminated. Rabbits were killed at 2, 4, and 6 weeks after completion of bone lengthening. The distracted areas were harvested and evaluated by histologic, histomorphometric, radiographic, and scanning electron microscopic analysis. Bone mineral density in the lengthened callus was evaluated using dual-energy x-ray absorptiometry. RESULTS Radiographic evaluation indicated a significant increase in bony union of the distraction regenerate in the experimental side compared with the control side. Corresponding to the radiographic findings, the histologic examination showed an earlier and more intensive bone formation in the experimental side after 2, 4, and 6 weeks compared with the control side. Larger chondroid islands were found evident in distracted bone of the control side than in the experimental side. CONCLUSIONS The results show that transplantation of osteoblast-like cells promotes maturity of the distracted callus, as observed on the second and fourth weeks after lengthening. The method appears promising as a means of shortening the consolidation period of osteodistraction and decreasing complications during bone lengthening.
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Affiliation(s)
- Zhen Shao
- Department of Traumatic and Aesthetic Surgery, Huangsi Aesthetic Surgery Hospital, 9 Huangsi Street, Beijing 100011, People's Republic of China.
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Saulacić N, Somosa Martín M, de Los Angeles Leon Camacho M, García García A. Complications in Alveolar Distraction Osteogenesis: A Clinical Investigation. J Oral Maxillofac Surg 2007; 65:267-74. [PMID: 17236932 DOI: 10.1016/j.joms.2006.03.049] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Revised: 12/30/2005] [Accepted: 03/21/2006] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study was to evaluate distraction osteogenesis for reconstruction of vertically deficient alveolar ridges and to investigate the occurrence of complications during treatment and the effect of these complications on the final outcome. PATIENTS AND METHODS The study included 23 patients who underwent a total of 29 distraction procedures. Two types of distractors were used: intraosseous and juxtaosseous. All of the patients were submitted to the same distraction protocol. The complications occurring during treatment were classified as 1) intraoperative, 2) postoperative, 3) during distraction and consolidation, and 4) postdistraction. RESULTS The prevalence of cases with complications was 41.37% intraoperative, 24.13% postoperative, 65.51% during distraction and consolidation, and 58.62% postdistraction. Because many complications coincided in some patients, the overall prevalence throughout the treatment was 79.31% of cases; 3.44% of the complications jeopardized subsequent implant placement. CONCLUSIONS Although a high frequency of complications was encountered, severe complications were rare. Most of the complications had simple solutions, and most did not jeopardize the final outcome. Distraction osteogenesis is a viable option for treating vertical alveolar bone defects.
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Affiliation(s)
- Nikola Saulacić
- Oral Surgery Unit, School of Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
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Kim UK, Chung IK, Lee KH, Swift JQ, Seong WJ, Ko CC. Bone regeneration in mandibular distraction osteogenesis combined with compression stimulation. J Oral Maxillofac Surg 2006; 64:1498-505. [PMID: 16982308 DOI: 10.1016/j.joms.2006.03.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE This study compared modified distraction osteogenesis (DO) protocol with conventional DO protocol on healing bone formation. Computer simulation was performed to understand the mechanical environment of modified DO protocol, which applies compression during the consolidation period. MATERIALS AND METHODS Fifty rats were used in this study. Twenty-five rats in the conventional DO (control) group were sacrificed at postoperative days 11, 21, 28, 35, and 49 after osteotomy. In the modified DO (experimental) group, compression was applied on day 7 after distraction (day 18 postoperatively) for 4 days during the early consolidation period and 25 rats were sacrificed on postoperative day 19, 28, 39, 46, and 53. The histologic and radiographic findings were used to compare the 2 groups. Further, computer simulation was used to predict the mechanical environment of healing bone under conventional and modified DO protocol. RESULTS Radiographic findings showed that the experimental group resulted in denser and wider healing bone. Histologically, the experimental group yielded more mature lamellar bone than the control group. Computer simulation showed that absolute values of tissue strains were nearly double in the control group because of the softer healing tissues. Both the experimental and control groups showed high strains at the ridge crest. Concentrated tensile strain along the distraction direction at the ridge crest might hinder bone formation at the interface, while compressive strain could facilitate the process. CONCLUSION This study proposed a modified DO protocol of adding compression during the early consolidation period of conventional DO protocol. This new technique appears to provide faster and denser bone regeneration.
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Affiliation(s)
- Uk-Kyu Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Busan, South Korea.
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31
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Abstract
Repair and reconstruction of the craniofacial skeleton represents a significant biomedical burden, with thousands of procedures per-formed annually secondary to injuries and congenital malformations. Given the multitude of current approaches, the need for more effective strategies to repair these bone deficits is apparent. This article explores two major modalities for craniofacial bone tissue engineering: distraction osteogenesis and cellular based therapies. Current understanding of the guiding principles for each of these modalities is elaborated on along with the knowledge gained from clinical and investigative studies. By laying this foundation, future directions for craniofacial distraction and cell-based bone engineering have emerged with great promise for the advancement of clinical practice.
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Affiliation(s)
- Derrick C Wan
- Stanford University School of Medicine, 257 Campus Drive West, Stanford, CA 94305-5148, USA
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32
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Erdogan O, Esen E, Ustün Y, Kürkçü M, Akova T, Gönlüşen G, Uysal H, Cevlik F. Effects of Low-Intensity Pulsed Ultrasound on Healing of Mandibular Fractures: An Experimental Study in Rabbits. J Oral Maxillofac Surg 2006; 64:180-8. [PMID: 16413888 DOI: 10.1016/j.joms.2005.10.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2005] [Indexed: 11/29/2022]
Abstract
PURPOSE Pulsed ultrasonic waves have been shown to accelerate fracture healing of the long bones. The aim of this study was to evaluate the effects of low-intensity pulsed ultrasound (LIPU) on healing of mandibular fractures. MATERIALS AND METHODS Thirty skeletally mature male New Zealand rabbits were used. Animals underwent unilateral mandibular osteotomy. The bone segments were repositioned and fixed with miniplates and miniscrews. Half of the animals received daily ultrasound treatment, 20 min/day, for 20 days. Ultrasound signals consisted of a 1.5-MHz pressure wave administered in pulses of 200 microsec with an average temporal and spatial intensity of 30 mW/cm2. Animals in the control group received sham application. All of the animals were killed on postoperative day 22. Three-point bending test, digital radiodensitometric analysis, and histologic and histomorphometric examinations were performed on the harvested hemimandibles. The data were statistically analyzed. RESULTS Biomechanical tests revealed significant improvement in the mechanical properties of the healing bone in the LIPU-treated group. This was supported by histologic and radiologic findings. CONCLUSIONS Results of this study suggest that LIPU improves the bone healing of mandibular fractures in rabbits.
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Affiliation(s)
- Ozgür Erdogan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cukurova University, Adana, Turkey.
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33
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Discussion. J Craniofac Surg 2006. [DOI: 10.1097/01.scs.0000188746.52464.b3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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34
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Cano J, Campo J, Moreno LA, Bascones A. Osteogenic alveolar distraction: A review of the literature. ACTA ACUST UNITED AC 2006; 101:11-28. [PMID: 16360604 DOI: 10.1016/j.tripleo.2005.04.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2005] [Revised: 04/20/2005] [Accepted: 04/21/2005] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Alveolar distraction is a relatively novel procedure by which alveolar bone and underlying mucosa are regenerated. The low predictability of other vertical or horizontal bone regeneration methods has increased interest in this promising technique. This article was designed to review published clinical and experimental results on alveolar distraction, including basic research in other disciplines (maxillofacial and orthopedic distraction) related to or with influence on alveolar distraction. STUDY DESIGN A review of the international literature was performed to summarize results of clinical and experimental studies on alveolar distraction and on distraction at other anatomical sites that contribute important findings on tissue biology, molecular mechanisms, and other factors that influence and participate in the alveolar distraction process. RESULTS Research into alveolar distraction has addressed the latency phase, distraction phase, and consolidation phase, yielding highly variable results. Little experimental research has been carried out on this procedure, and most publications are clinical studies with a short follow-up period. Published studies have reported a high rate of complications, attributable to our current lack of understanding of the process. CONCLUSIONS Definitive conclusions on alveolar distraction are hampered by the lack of clinical and experimental studies to date. Greater knowledge of the factors that influence the distraction process will lead to a more predictable and efficacious distraction technique and a better distractor design.
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35
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Nacamuli RP, Wan DC, Lenton KA, Longaker MT. New developments in pediatric plastic surgery research. Clin Plast Surg 2005; 32:123-36, ix-x. [PMID: 15636770 DOI: 10.1016/j.cps.2004.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pediatric plastic surgery research is a rapidly expanding field. Unique in many ways, researchers in this field stand at the union of multiple scientific specialties, including biomedical engineering, tissue engineering, polymer science, molecular biology, developmental biology, and genetics. The goal of this scientific effort is to translate research advances into improved treatments for children with congenital and acquired defects. Although the last decade has seen a dramatic acceleration in research related to pediatric plastic surgery, the next 10 years will no doubt lead to novel treatment strategies with improved clinical outcomes.
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Affiliation(s)
- Randall P Nacamuli
- Children's Surgical Research Program, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford University Medical Center, 257 Campus Drive, Stanford, CA 94305-5148, USA
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36
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Abstract
This article reviews the form and function of cranial sutures across the temporal and spatial scales. The temporal scale spans 530 million years, from ostracoderms to contemporary humans. The spatial scale spans eight orders of magnitude, from the macroarchitectural level (the entire cranium), through the mesoarchitectural (the local/regional bone-suture-bone complex) and microarchitectural levels (tissues and cells), to the nanoarchitectural level (molecules within and outside the cells). A mechanomorphologic loop, or cycle, exists. The mechanical strain experienced by the sutures eventually alters the morphology of the sutures. In turn, these morphological changes affect the strain distribution within and around the sutures. At the microarchitectural level, the responses of bone and sutural cells to environmental perturbations depend on the content (what that perturbation is), the context (the other coexisting extrinsic and intrinsic factors), and the history of the perturbation (how often and for how long).
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Affiliation(s)
- Jack C Yu
- Craniofacial Center, Department of Oral Biology and Maxillofacial Pathology, Medical College of Georgia, 1467 Harper Street, HB 5040, Augusta, GA 30912-4080, USA
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37
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Fang TD, Nacamuli RP, Song HM, Fong KD, Warren SM, Salim A, Carano RAD, Filvaroff EH, Longaker MT. Creation and characterization of a mouse model of mandibular distraction osteogenesis. Bone 2004; 34:1004-12. [PMID: 15193546 DOI: 10.1016/j.bone.2004.02.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2003] [Revised: 01/29/2004] [Accepted: 02/02/2004] [Indexed: 10/26/2022]
Abstract
While the histological and ultrastructural changes associated with distraction osteogenesis have been extensively characterized using various animal models, the molecular mechanisms governing this technique remain poorly understood. In the current study, for the first time, we describe a mouse mandibular distraction osteogenesis model. Development of this model will allow assessment of factors involved in normal vs. abnormal healing (especially in non-unions) of craniofacial skeletal elements. Complete osteotomies were created on the right hemimandibles of 51 adult male CD-1 mice and customized distraction devices attached. Thirty-three animals underwent gradual distraction (5 days latency, distraction at 0.2 mm BID x 8 days, 28 days consolidation), while the remaining 18 mice underwent acute lengthening (immediate distraction to 3.2 mm) at the time of surgery. Mandibles were harvested at time points corresponding to the latent (POD 5), distraction (POD 9, 13), and consolidation (POD 28, 41) periods and processed for histological or quantitative real-time RT-PCR analysis. Specimens from each group were processed for microCT analysis. Histological and radiological data demonstrated that all mandibles undergoing gradual distraction achieved complete bony union by the end of consolidation, while those undergoing acute lengthening formed a fibrous non-union. Quantitative real-time RT-PCR demonstrated upregulation of mRNA for VEGF, FGF-2, collagen I, and osteopontin during gradual distraction but not during acute lengthening. These data validate our novel mouse mandibular distraction model and demonstrate its utility in elucidating the molecular mechanisms regulating bone formation during distraction osteogenesis as compared to those that are expressed during the formation of fibrous non-unions.
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Affiliation(s)
- Tony D Fang
- Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305-5148, USA
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38
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García García A, Somoza Martin M, Gandara Vila P, Gandara Rey JM. A preliminary morphologic classification of the alveolar ridge after distraction osteogenesis. J Oral Maxillofac Surg 2004; 62:563-6. [PMID: 15122560 DOI: 10.1016/j.joms.2003.08.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE We sought to develop and evaluate a preliminary morphologic classification of the alveolar ridge after distraction osteogenesis. MATERIALS AND METHODS Twelve patients (7 women and 5 men; mean age, 42.6 years; age range, 30 to 57 years) underwent a total of 17 alveolar ridge distractions before the placement of a total of 44 dental implants. Ridge bone morphology was evaluated and categorized at implant placement, with subsequent evaluation of the frequency and type of complications in each category. RESULTS Four morphologic categories were identified, as follows. Category I consisted of wide alveolar rim and no bone defects; 7 (41.2%) of the 17 ridges were assigned to this category, and a total of 22 implants were placed with no complications. Category II consisted of wide alveolar rim, lateral bone surface concavity; 4 (24%) of the 17 ridges were assigned to this category, and a total of 8 implants were placed, with fenestration defects being the most frequent complication (2 of 8 implants [25%]). Category III consisted of narrow alveolar rim, lateral bone surface concavity; 5 (29.4%) of the 17 ridges were assigned to this category, and a total of 13 implants were placed, with dehiscence defects being the most frequent complication (4 of 13 implants [31%]). Category IV consisted of distraction transport segment forming a bridge, without bone formed beneath, necessitating guided bone regeneration; 1 (6%) of the 17 ridges was assigned to this category, and following bone regeneration 1 implant was placed, without complications. Subcategory D consisted of lingual deviation of the distraction axis, occurring in any of categories I to IV, and when severe requiring corrective osteotomy to free and reposition the transport segment and neoformed bone; 4 (24%) of the 17 ridges were assigned to this subcategory (ie, to subcategory ID, IID, IIID, or IVD); in 1 case, the deviation was severe, requiring corrective osteotomy; in this case 3 implants were placed, without complications. CONCLUSION This preliminary morphologic classification of the postdistraction alveolar ridge effectively categorizes the variation observed in our patients and in our experience provides a useful basis for decision-making regarding implant placement. However, further studies are required to confirm the generality of this classification and incidences of complications in each category.
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Affiliation(s)
- Abel García García
- Department of Maxillofacial Surgery, Complejo Hospitalario Universitario de Santiago, Spain.
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39
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Abstract
Over the course of the past year, many interesting aspects of the multidisciplinary approach to the treatment of craniofacial disorders have been furthered. Several authors have shared their experiences, and new innovations have been described. Traditional ideas with regard to bone healing and growth have been expanded upon, and the role of alloplasts also is better understood now. Diagnosis and treatment planning have come a long way with the advent of new imaging techniques and applications. The ongoing discussion regarding absorbable fixation devices has continued, and the development of new technology has been presented. Some new techniques have also been brought to the forefront. Of note, distraction osteogenesis has been embraced as a viable alternative to traditional maxillomandibular surgery with bone grafting as well as other morbid procedures.
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Affiliation(s)
- Raam S Lakhani
- Division of Facial Plastic Surgery, Department of Otolaryngology, Upstate Medical University-University Hospital, 750 East Adams Street, Syracuse, NY 13210, USA.
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40
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Mofid MM, Inoue N, Tufaro AP, Vander Kolk CA, Manson PN. Spring-Mediated Mandibular Distraction Osteogenesis. J Craniofac Surg 2003; 14:756-62. [PMID: 14501343 DOI: 10.1097/00001665-200309000-00029] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Successful performance of distraction osteogenesis requires rigorous patient compliance with a daily activation regimen of a percutaneous screw. Previous clinical studies have found that failure of patient compliance with this regimen is the most common complication leading to technical failure of the distraction process. The authors have developed an internalized spring-mediated device for mandibular distraction osteogenesis that can potentially abrogate the risks associated with patient compliance by allowing for automated distraction across an osteotomy. Twenty adult New Zealand White rabbits underwent unilateral mandibular osteotomy. A segment of nickel-titanium shape memory alloy reinforced at both ends with a pinball was fashioned into an inferiorly based arc and secured to the mandible with stainless steel wire. On postoperative day 12, spring activation commenced by cutting a wire binding the two pinballs to one another. Animals were observed for 6 weeks before they were killed. Radiographic studies and decalcified histologic analysis were performed on extracted mandibles. Temperature- and displacement-dependent properties of the shape memory alloy were also examined. Five animals were excluded from the study due to infection, nonunion, or device failure. A mean distraction of 1.2 mm in the distracted hemimandible relative to the nonoperated hemimandible was found (P <.001, two-tailed paired t test). The maximum distraction achieved in an experimental specimen using the spring distractor was 3.7 mm. There were no other histologic or radiographic differences found between study specimens and specimens subjected to traditional distraction methods. Biomechanical testing of the shape memory alloy revealed a temperature-dependent increase in force at body temperature compared with room temperature and a reduction in force with increased displacement of the spring. This study demonstrates the feasibility of spring-mediated distraction osteogenesis across an osteotomy. As the field of distraction osteogenesis matures, the next level of sophistication in the clinical development of devices will incorporate technology that permits fully internalized and automated distraction to occur.
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Affiliation(s)
- Mehrdad M Mofid
- Department of Surgery, Division of Plastic, Reconstructive, The Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA.
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