Dentoalveolar changes following maxillary distraction osteogenesis

Lili Yang, Eduardo Yugo Suzuki, Boonsiva Suzuki

Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, Chiang Mai University, Thailand.
Faculty of Dentistry, Chiang Mai University, Thailand.

DOI: 10.4236/ojst.2013.38071                

Abstract

The purpose of this study was to compare the dentoalveolar changes produced when using two different intraoperative surgical procedures for maxillary distraction osteogenesis. Eight patients were assigned into two groups according to the surgical procedure: down-fracture (DF, n = 6) vs non-down-fracture (NDF, n = 2). Lateral cephalograms and 3-D models before and after maxillary distraction were analyzed. The Mann-Whitney U test was used to compare the differences in the amounts of advancement and dento-alveolar changes between the DF and NDF groups. The significance level was established at 0.05. Although a significantly greater amount of maxillary movement was observed in the DF group (10.0 mm ± 2.2) than in the NDF group (5.9 mm ± 2.3), significantly greater arch length (8.7 mm ± 5.2) and arch width changes (6.0 mm ± 1.0) were observed in the NDF group than in the DF group, (arch lengths 3.0 mm ± 1.1 and arch width changes 3.2 mm ± 2.0). A significantly greater amount of dental anchorage loss was observed in the NDF group. The use of the NDF procedure resulted in greater amounts of dental anchorage loss than resulted from the DF procedures when tooth-borne devices were used during maxillary distraction osteogenesis. The type of surgical procedure might play an important role in the amount and direction of the dental changes.

Keywords

Maxillary Distraction; Non-Down-Fracture; Down-Fracture; 3-D Model Analysis

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Ilizarov, G.A. (1989) The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. Clinical Orthopaedics and Related Research, 238, 249-281.
[2]	Ilizarov, G.A. (1989) The tension-stress effect on the genesis and growth of tissues: Part II. The influence of the rate and frequency of distraction. Clinical Orthopaedics and Related Research, 239, 263-285.
[3]	Molina, F., et al. (1998) Maxillary distraction: Aesthetic and functional benefits in cleft lip-palate and prognathic patients during mixed dentition. Plastic and Reconstructive Surgery, 101, 951-963. http://dx.doi.org/10.1097/00006534-199804040-00010
[4]	Samchukov, M.L., Cherkashin, A.M. and Cope, J.B., (1998) Distraction osteogenesis: History and biologic basis of new bone formation. In: Lynch, S. E. Genco, R.J. and Marx, R.E., Eds., Tissue Engineering: Applications in Maxillofacial Surgery and Periodontics, Quintessence, Carlo Stream.
[5]	Figueroa, A.A., Polley, J.W. and Ko, E.W. (1999) Maxillary distraction for the management of cleft maxillary hypoplasia with a rigid external distraction system. Seminars in Orthodontics, 5, 46-51. http://dx.doi.org/10.1016/S1073-8746(99)80042-5
[6]	Polley, J.W. and Figueroa, A.A. (1997) Management of severe maxillary deficiency in childhood and adolescence through distraction osteogenesis with an external, adjustable, rigid distraction device. Journal of Craniofacial Surgery, 8, 186. http://dx.doi.org/10.1097/00001665-199705000-00008
[7]	Polley, J.W. and Figueroa, A.A. (1998) Rigid external distraction: its application in cleft maxillary deformities. Plastic and Reconstructive Surgery, 102, 1373-1374. http://dx.doi.org/10.1097/00006534-199810000-00007
[8]	Figueroa, A.A., et al. (2004) Long-term skeletal stability after maxillary advancement with distraction osteogenesis using a rigid external distraction device in cleft maxillary deformities. Plastic and Reconstructive Surgery, 114, 1393-1394. http://dx.doi.org/10.1097/01.PRS.0000138593.89303.1B
[9]	Rachmiel, A., Aizenbud, D. and Peled, M. (2006) Distraction osteogenesis in maxillary deficiency using a rigid external distraction device. Plastic and Reconstructive Surgery, 117, 2399-2406. http://dx.doi.org/10.1097/01.prs.0000204798.50710.a7
[10]	Suzuki, E.Y., Motohashi, N. and Ohyama, K. (2004) Longitudinal dento-skeletal changes in UCLP patients following maxillary distraction osteogenesis using RED system. Journal of Medical and Dental Sciences, 51, 27-33.
[11]	Lo, L.J., Hung, K.F. and Chen, Y.R. (2002) Blindness as a complication of Le Fort I osteotomy for maxillary distraction. Plastic and Reconstructive Surgery, 109, 699-700.
[12]	Yamauchi, K., Mitsugi, M. and Takahashi, T. (2006) Maxillary distraction osteogenesis using Le Fort I osteotomy without intraoperative down-fracture. International Journal of Oral and Maxillofacial Surgery, 35, 493-498. http://dx.doi.org/10.1016/j.ijom.2006.01.008
[13]	Kanno, T., et al. (2008) Long-term skeletal stability after maxillary advancement with distraction osteogenesis in non-growing patients. Journal of Oral and Maxillofacial Surgery, 66, 1833-1846. http://dx.doi.org/10.1016/j.joms.2007.10.013
[14]	Nadjmi, N., Schutyser, F. and Van Erum, R. (2006) Trans-sinusal maxillary distraction for correction of midfacial hypoplasia: Long-term clinical results. International Journal of Oral and Maxillofacial Surgery, 35, 885-896. http://dx.doi.org/10.1016/j.ijom.2006.06.023
[15]	Chen, G., et al. (2011) Stable region for maxillary dental cast superimposition in adults, studied with the aid of stable miniscrews. Orthodontics & Craniofacial Research, 14, 70-79. http://dx.doi.org/10.1111/j.1601-6343.2011.01510.x
[16]	Bassarelli, T., Dalstra, M. and Melsen, B. (2005) Changes in clinical crown height as a result of transverse expansion of the maxilla in adults. European Journal of Orthodontics, 27, 121-128.
[17]	Chua, H.D., Hagg, M.B. and Cheung, L.K. (2010) Cleft maxillary distraction versus orthognathic surgery--which one is more stable in 5 years? Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 109, 803-814.
[18]	Houston, W.J. (1983) The analysis of errors in orthodontic measurements. American Journal of Orthodontics, 83, 382-390. http://dx.doi.org/10.1016/0002-9416(83)90322-6
[19]	Cha, B.K., et al. (2007) Analysis of tooth movement in extraction cases using three-dimensional reverse engineering technology. European Journal of Orthodontics, 29, 325-331.
[20]	Ghafari, J., Baumrind, S. and Efstratiadis, S.S. (1998) Misinterpreting growth and treatment outcome from serial cephalographs. Clinical Orthodontics and Research, 1, 102-106.
[21]	Alkan, A., et al. (2007) Incomplete mobilization of the maxilla resulting in failed maxillary distraction: A case report. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 104, e5-11. http://dx.doi.org/10.1016/j.tripleo.2007.07.002
[22]	Wenghoefer, M., et al. (2006) Trans-sinusoidal maxillary distraction in three cleft patients. International Journal of Oral and Maxillofacial Surgery, 35, 954-960. http://dx.doi.org/10.1016/j.ijom.2006.07.015.
[23]	Dolanmaz, D., et al. (2008) Comparison of two different approaches to the pterygomaxillary junction in Le Fort I osteotomy. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 106, e1-5. http://dx.doi.org/10.1016/j.tripleo.2008.05.036
[24]	Block, M.S., et al. (1995) Anterior maxillary advancement using tooth-supported distraction osteogenesis. Journal of Oral and Maxillofacial Surgery, 53, 561-565. http://dx.doi.org/10.1016/0278-2391(95)90069-1
[25]	Aksu, M., et al. (2010) Skeletal and dental stability after maxillary distraction with a rigid external device in adult cleft lip and palate patients. Journal of Oral and Maxillofacial Surgery, 68, 254-259. http://dx.doi.org/10.1016/j.joms.2009.03.030
[26]	Figueroa, A.A., Polley J.W. and Figueroa, A.L. (2009) Introduction of a new removable adjustable intraoral maxillary distraction system for correction of maxillary hypoplasia. Journal of Craniofacial Surgery, 20, 1776-1786. http://dx.doi.org/10.1097/SCS.0b013e3181b5d66a
[27]	Feng, Y., et al. (2010) Reconstruction of partial maxillary defect with intraoral distraction osteogenesis assisted by miniscrew implant anchorages. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 110, e1-7. http://dx.doi.org/10.1016/j.tripleo.2010.03.039