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Erazo C. C, Ríos V. M, Troncoso O. E, Quezada R. G. DISTRACCIÓN ÓSEA DEL TERCIO MEDIO FACIAL EN MALFORMACIONES CRÁNEO-MAXILOFACIALES. REVISTA MÉDICA CLÍNICA LAS CONDES 2016. [DOI: 10.1016/j.rmclc.2016.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Guo P, Zeng JJ, Zhou N. Nonvascular transport distraction osteogenesis in bone formation and regeneration. Is it an accidental phenomenon? J Craniomaxillofac Surg 2014; 43:21-7. [PMID: 25457741 DOI: 10.1016/j.jcms.2014.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 10/03/2014] [Accepted: 10/10/2014] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To explore the osteogenic mechanism of nonvascular transport distraction osteogenesis (NTDO) by constructing mandibular defects in dogs. METHODS Sixty adult dogs were randomly divided into three groups with 20 dogs in each group. Canine mandibular defect models of NTDO were constructed. Animals were euthanized 1, 4 and 12 weeks after distraction, and the transport disc and surrounding tissue were collected and fixed. Histochemical staining using hematoxylin and eosin (H&E) and electron microscopic observations were used to examine bone regeneration. RESULTS Distraction bone regeneration was observed in the distraction gap and around the transport disc, and osseous connections had formed between new bone and the transport disc after one week. Osteoclasts gathered around the transport disc, and bone absorption pit formation could be seen. After 4 weeks of distraction, the new bone around the transport disc was close to maturity with thick sclerostin on the middle of the transport disc. After 12 weeks the new bone and the transport disc were fully integrated, and were difficult to distinguish by H&E staining and electron microscopy. CONCLUSIONS Canine mandibular defects were successfully repaired by NTDO resulting in ideal new bone formation and fully recovered mandibular physiological function. The surrounding tissues, including musculoskeletal tissues, the periosteum and other soft tissues and the nonvascular transport disc, together contribute to bone regeneration and neovascularization in NTDO.
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Affiliation(s)
- Peng Guo
- College of Stomatology, GuangXi Medical University, Nanning Guangxi, China
| | - Jing-Jing Zeng
- College of Stomatology, GuangXi Medical University, Nanning Guangxi, China
| | - Nuo Zhou
- College of Stomatology, GuangXi Medical University, Nanning Guangxi, China.
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Alzahrani MM, Anam EA, Makhdom AM, Villemure I, Hamdy RC. The effect of altering the mechanical loading environment on the expression of bone regenerating molecules in cases of distraction osteogenesis. Front Endocrinol (Lausanne) 2014; 5:214. [PMID: 25540639 PMCID: PMC4261813 DOI: 10.3389/fendo.2014.00214] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/26/2014] [Indexed: 12/11/2022] Open
Abstract
Distraction osteogenesis (DO) is a surgical technique where gradual and controlled separation of two bony fragments following an osteotomy leads to the induction of new bone formation in the distracted gap. DO is used for limb lengthening, correction of bony deformities, and the replacement of bone loss secondary to infection, trauma, and tumors. Although DO gives satisfactory results in most cases, one major drawback of this technique is the prolonged period of time the external fixator has to be kept on until the newly formed bone consolidates thus leading to numerous complications. Numerous attempts at accelerating bone formation during DO have been reported. One specific approach is manipulation of the mechanical environment during DO by applying changes in the standard protocol of distraction. Attempts at changing this mechanical environment led to mixed results. Increasing the rate or applying acute distraction, led to poor bone formation in the distracted zone. On the other hand, the addition of compressive forces (such as weight bearing, alternating distraction with compression or by over-lengthening, and then shortening) has been reported to increase bone formation. It still remains unclear why these alterations may lead to changes in bone formation. While the cellular and molecular changes occurring during the standard DO protocol, specifically increased expression of transforming growth factor-β1, platelet-derived growth factor, insulin-like growth factor, basic fibroblast growth factor, vascular endothelial growth factor, and bone morphogenic proteins have been extensively investigated, the literature is sparse on the changes occurring when this protocol is altered. It is the purpose of this article to review the pertinent literature on the changes in the expression of various proteins and molecules as a result of changes in the mechanical loading technique in DO and try to define potential future research directions.
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Affiliation(s)
- Mohammad M. Alzahrani
- Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, Montreal, QC, Canada
- Department of Orthopaedic Surgery, University of Dammam, Dammam, Saudi Arabia
| | - Emad A. Anam
- Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, Montreal, QC, Canada
- Department of Orthopaedic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Asim M. Makhdom
- Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, Montreal, QC, Canada
- Department of Orthopaedic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Isabelle Villemure
- Department of Mechanical Engineering, École Polytechnique de Montreal, Montreal, QC, Canada
- Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Reggie Charles Hamdy
- Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, Montreal, QC, Canada
- *Correspondence: Reggie Charles Hamdy, Division of Orthopaedic Surgery, Shriners Hospital for Children, McGill University, 1529 Cedar Avenue, Montreal, QC H3G 1A6, Canada e-mail:
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Responses of distraction regenerate to high-frequency traction at a rapid rate. J Trauma Acute Care Surg 2012; 72:1035-9. [PMID: 22491623 DOI: 10.1097/ta.0b013e31823cc867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Continuous traction is capable of creating an optimal biological environment for bone healing which may finally compensate for the rapid distraction rate in distraction osteogenesis. This study was designed to investigate the response of distraction callus to continuous distraction at a rapid rate using a rabbit model of mandibular lengthening. METHODS Thirty adult New Zealand white rabbits were randomly assigned to the intermittent (1 step/d) or continuous distraction (8 steps/s) group, with 15 in each. After osteotomy, manual-driven or autodriven distractor was adapted accordingly. The distraction was activated at a rate of 3.0 mm/d for 4 days. Five rabbits in each group were killed at week 2, week 4, and week 12 of consolidation, respectively. Plain radiography, microcomputed tomography, and histology examinations were used to evaluate the bone regeneration status. RESULTS Plain radiographs and histologic studies demonstrated more advanced bone healing in continuous distraction group than that in intermittent distraction group at all the examined time points. Quantitative microcomputed tomography analysis showed significantly higher bone volume in continuous distraction group at week 2 (p < 0.01) and week 4 (p < 0.05) of consolidation. CONCLUSIONS Continuous traction by autodriven distractor could be a promising clinical alternative to shorten the treatment course of distraction osteogenesis. Further studies to test its clinical potential using large animals that have similar metabolic rate and muscular resistance with human being are necessary.
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Liu XL, Cheung LK, Zhang HX, Li JY, Ma L, Zheng LW. Comparison of gene expression of tissue inhibitor of matrix metalloproteinase-1 between continuous and intermittent distraction osteogenesis: a quantitative study on rabbits. J Craniomaxillofac Surg 2011; 40:e185-8. [PMID: 22093241 DOI: 10.1016/j.jcms.2011.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 09/27/2011] [Accepted: 10/06/2011] [Indexed: 10/15/2022] Open
Abstract
BACKGROUND Distraction osteogenesis is a controlled surgical procedure that initiates a regenerative process and uses mechanical strain to enhance the biological responses of the injured tissues to create new bone. To explore the effect of high-frequency mechanical traction on the expression of tissue inhibitor of matrix metalloproteinase-1 (TIMP-1), we compared the gene expression of TIMP-1 between continuous and intermittent distraction osteogenesis using a rabbit model of mandibular lengthening. MATERIALS AND METHODS Forty adult New Zealand white rabbits were randomly assigned to the intermittent and continuous distraction groups. A unilateral mandibular osteotomy was performed and a custom-designed manual-driven or auto-driven distractor was bridged over the osteotomy segments. Animals were sacrificed at day-6, day-10, day-14 and day-21 after osteotomy. Samples were examined with real-time polymerase chain reaction (PCR). RESULTS Real-time PCR examination showed significantly higher mRNA levels of TIMP-1 under continuous distraction than that under intermittent distraction at day-6 and day-10. No significant differences were found at day-14 and day-21. CONCLUSION High-frequency traction provides a good mechanical environment for accelerating bone formation by up-regulating TIMP-1.
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Affiliation(s)
- Xi Ling Liu
- Discipline of Oral Diagnosis and Polyclinics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
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Li Wu Zheng, Wong MCM, Lim Kwong Cheung. Quasi-Continuous Autodriven System With Multiple Rates for Distraction Osteogenesis. Surg Innov 2011; 18:156-9. [DOI: 10.1177/1553350610397216] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. For a given rate of distraction a greater frequency of distraction improves bone formation. However, the current distractors used in clinic are activated manually and produces intermittent advancement. Method. The authors developed an automatic driver that is capable of producing quasi-continuous distraction at a set of rates of 0.5, 1.0, 1.5, 2.0, 2.5, and 3.0 mm/d. Using a customized in vitro experimental system, the function and stability of the autodriven system were tested during loading. Results. The angular displacement of the automatic driver was quite regular while driving a constant torque of 4.268 × 10−3 kg m. The driving achieved the target speed with the constant torque. Conclusions. The automatic driven system provides a useful tool to assess the tissue healing at variable distraction rates with quasi-continuous traction. It demonstrates a potential for clinical application to shorten the treatment course of distraction osteogenesis.
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Affiliation(s)
- Li Wu Zheng
- The University of Hong Kong, Hong Kong SAR, China
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Ji B, Jiang G, Fu J, Long J, Wang H. Why high frequency of distraction improved the bone formation in distraction osteogenesis? Med Hypotheses 2009; 74:871-3. [PMID: 20018456 DOI: 10.1016/j.mehy.2009.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 11/22/2009] [Indexed: 11/29/2022]
Abstract
Distraction osteogenesis, currently a standard method of bone lengthening, is based upon the "tension-stress principle", as proposed by G.A. Ilizarov. Mechanical stimulation by distraction induces biological responses of skeletal regeneration that is accomplished by a cascade of biologic processes including differentiation of pluripotential tissue, angiogenesis, mineralization, and remodeling. The exact mechanism by which strain stimulates bone formation remains unclear. Distraction rate and rhythm must have great influence on the quality of the newly formed bone generated by mechanical traction. The preliminary results demonstrated that for a given rate higher frequency of distraction improved the bone formation, but the mechanism remains unclear. In this article we present a hypothesis that the reason why higher frequency of distraction improved the bone formation for a given rate is that higher frequency of distraction provides smaller microtrauma to tissues within the gap and longer existence time of the microenvironment stimulating tissues within the gap than low frequency distraction. This hypothesis, if proven to be valid, will not only represent a breakthrough in research of mechanism of distraction osteogenesis, but also will open a new door to the bone regeneration.
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Affiliation(s)
- Baohui Ji
- State Key Laboratory of Oral Disease, Sichuan University, Chengdu, PR China
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