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Mishra S, Singh H, Srivastava D, Sharma P. Interim use of Hyrax Screw Assembly for Single-Step Closure of Small Alveolar Cleft before Anterior Maxillary Distraction Osteogenesis. Sultan Qaboos Univ Med J 2023; 23:534-538. [PMID: 38090242 PMCID: PMC10712396 DOI: 10.18295/squmj.5.2023.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/06/2023] [Accepted: 04/11/2023] [Indexed: 12/18/2023] Open
Abstract
Anterior maxillary distraction osteogenesis (AMDO) is often used for the correction of maxillary retrognathia in select cleft lip and palate cases. The restoration of alveolar arch continuity is desirable before the initiation of AMDO in these cleft maxillary deformities; however, AMDO is technically difficult in a patient with coexisting alveolar cleft where there is a discontinuity of the defect that presents a challenge in terms of adequate vector control of the movement of the anterior segment and the potential risk of tipping of teeth, which already have compromised anchorage/bone support on the cleft side. The treatment becomes more challenging when ongoing management is compounded by failed previous alveolar cleft grafting procedures, along with the patient's reluctance to undergo further grafting of alveolar clefts. This technical note demonstrates a novel application of the modification of the Hyrax screw where an initially fully opened Hyrax screw was utilised as an interim assembly for accomplishing the single-step closure of a small alveolar cleft before the commencement of anterior maxillary distraction osteogenesis. This technique may prove to be feasible for patients presenting with alveolar cleft defects of smaller widths of up to 5 mm and relatively well-aligned upper arches.
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Affiliation(s)
- Sonal Mishra
- Department of Oral & Maxillofacial Surgery, ESIC Dental College and Hospital, New Delhi, India
| | - Harpreet Singh
- Department of Orthodontics & Dentofacial Orthopedics, ESIC Dental College and Hospital, New Delhi, India
| | - Dhirendra Srivastava
- Department of Oral & Maxillofacial Surgery, ESIC Dental College and Hospital, New Delhi, India
| | - Poonam Sharma
- Department of Orthodontics & Dentofacial Orthopedics, ESIC Dental College and Hospital, New Delhi, India
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How Is the Created Alveolar Space Finally Restored After Maxillary Anterior Segmental Distraction Osteogenesis? J Craniofac Surg 2020; 31:e343-e347. [PMID: 32149967 DOI: 10.1097/scs.0000000000006282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Maxillary anterior segmental distraction osteogenesis (MASDO) for cleft and palate patients is the alternative treatment option to correct malocclusion with maxillary arch deficiency and severe crowding. After MASDO, prosthetic considerations are crucial for patients with cleft lip and palate because it is related to facial esthetics and occlusal function. The objectives of this study were to investigate the final restoration type for created alveolar space by MASDO. METHODS Thirteen patients with cleft lip and palate who underwent MASDO and orthodontic treatment from the years 2000 to 2010 in Yonsei University were examined. Final restorations are classified as dental implants, conventional prosthesis, and orthodontic space closure. The relationship between the distracted areas and final restoration type was investigated. The authors evaluated lateral cephalograms obtained at predistraction osteogenesis (pre-DO; T1), postdistraction osteogenesis (post-DO; T2), and debond (T3), and measured changes from T1 to T2 and from T2 to T3. RESULTS There was no significant difference of final restoration percentage of dental implants, conventional prosthesis, and space closure with orthodontic treatment. However, dental implants and conventional prostheses were applied more frequently in the posterior area and in the anterior area, respectively. The relapse rate was observed as 36.7% and 22.4% in the values of N-A distance and ANB angulation in T2-T3 stage. CONCLUSION The MASDO site should be decided, based on final restoration goal. Among the created alveolar spaces, implants were applied mainly to the posterior site and the conventional prostheses were mostly restored to the anterior site. For space closure by orthodontic approach, the area could be both anterior or posterior.
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HOPON (Hyperbaric Oxygen for the Prevention of Osteoradionecrosis): A Randomized Controlled Trial of Hyperbaric Oxygen to Prevent Osteoradionecrosis of the Irradiated Mandible After Dentoalveolar Surgery. Int J Radiat Oncol Biol Phys 2019; 104:530-539. [DOI: 10.1016/j.ijrobp.2019.02.044] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/28/2019] [Accepted: 02/21/2019] [Indexed: 11/23/2022]
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Midfacial Changes Through Anterior Maxillary Distraction Osteogenesis in Patients With Cleft Lip and Palate. J Craniofac Surg 2018; 28:1057-1062. [PMID: 28141644 DOI: 10.1097/scs.0000000000003506] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Maxillary hypoplasia is a major issue in cleft lip and palate patients, and predictable surgical maxillary advancement is required. In the present study, the changes and stability of the maxilla and soft tissue profile achieved after the application of anterior maxillary distraction osteogenesis (AMDO) using intraoral expander in unilateral cleft lip and palate and isolated cleft palate patients were investigated by comparing to the Le Fort I osteotomy (LFI) and maxillary distraction osteogenesis (DO) with rigid external distraction (RED) system.Ten patients who underwent orthognathic treatment with AMDO were examined (AMDO group). Changes in the positions of soft and hard tissue landmarks were calculated from the lateral cephalograms taken before the distraction, at the end of the distraction, and 1 year after the surgery. They were compared with the changes in 7 other unilateral cleft lip and palate patients who underwent LFI (LFI group) and 6 others who underwent DO with RED (RED group).The mean maxillary advancement of the AMDO group was similar to that of the RED group, judged by the change of point A. During DO, the AMDO group showed less clockwise rotation of mandible compared to the RED group. The soft tissue advancement of the upper lip and nose in the AMDO group was similar to that in the RED group, which was significantly larger than that in the LFI group.Our results indicate that AMDO can be surgical option to cleft lip and palate patients with less invasive but excellent improvement in both midfacial skeletal and soft tissue similar to DO-RED.
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Nasopharyngoscopic Analyses through Anterior Maxillary Distraction Osteogenesis for Adolescent Patients With Cleft Palate. J Craniofac Surg 2017; 29:270-274. [PMID: 29077684 DOI: 10.1097/scs.0000000000004095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Anterior maxillary distraction osteogenesis (AMDO) is a novel technique for correcting hypoplastic maxilla by sagittal expansion of the maxilla. Recent reports suggest that AMDO does not have an effect on fragile velopharyngeal function in patients with cleft palate. Furthermore, no studies have evaluated the impact of AMDO on velopharyngeal function.We adopted AMDO to correct severe hypoplastic maxilla in adolescent patients with cleft palate and evaluated its impact on velopharyngeal space and function in 8 patients aged 12 to 21 years who underwent AMDO from 2006 to 2014. All the patients had received treatment for cleft palate; however, they still exhibited marginal velopharyngeal insufficiency. The mean activation of the distractor was 10.9 ± 0.9 mm.We determined changes in velopharyngeal closure ratio and closure pattern via nasopharyngoscopy. Additionally, skeletal changes were evaluated using lateral cephalograms.The mean horizontal advancement in the cephalogram obtained 1 year after the distraction was +6.4 mm. Nasopharyngoscopic examination revealed that no deterioration of velopharyngeal gap had occurred after AMDO in all 8 patients. The velopharyngeal closure pattern changed from coronal to circular in 1 patient.Our results indicate that AMDO achieved correction of hypoplastic maxilla without deterioration in velopharyngeal gap and function. Therefore, AMDO is an effective and optimal approach for correcting hypoplastic maxilla especially in patients with fragile velopharyngeal function, such as those with cleft palate.
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Orthodontic Treatment and Maxillary Anterior Segmental Distraction Osteogenesis of a Subject with Williams-Beuren Syndrome and Isolated Cleft Palate: A Long-Term Follow-Up from the Age of 5 to 24 Years. Case Rep Dent 2017; 2017:7019045. [PMID: 28744380 PMCID: PMC5514341 DOI: 10.1155/2017/7019045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/15/2017] [Indexed: 11/17/2022] Open
Abstract
Williams–Beuren syndrome (WBS) is a rare multisystem disorder caused by a hemizygous deletion of the elastin gene on chromosome 7q11.23. WBS patients have characteristic skeletal features and dental anomalies accompanied by mental retardation, a friendly outgoing personality, and mild to moderate intellectual disability or learning problems. In this case report, we present the combined orthodontic and surgical treatment of a WBS patient with an isolated cleft palate through a long-term follow-up from the age of 5 to 24 years. During the period of active treatment, comprehensive orthodontic treatment combined with maxillary anterior segmental distraction osteogenesis and prosthetic treatment using dental implants were effective in dramatically improving the patient's malocclusion. The patient's mental abilities and the cooperation shown by the patient and her family were crucial for the success of this complex and long-term treatment course.
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Kageyama-Iwata A, Haraguchi S, Iida S, Aikawa T, Yamashiro T. Maxillary Anterior Segmental Distraction Osteogenesis to Correct Maxillary Deficiencies in a Patient With Cleft Lip and Palate. Cleft Palate Craniofac J 2016; 54:465-473. [PMID: 27115561 DOI: 10.1597/14-326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This report describes a case of successful orthodontic treatment using maxillary anterior segmental distraction osteogenesis with an internal maxillary distractor and bilateral sagittal split ramus osteotomy in a girl with cleft lip and palate. A 16-year-old girl with unilateral cleft lip and palate exhibited midface retrusion because of growth inhibition of the maxillary complex and mandibular excess. After the presurgical orthodontic treatment, 6.0-mm advancement of the maxillary anterior segment and 4.0-mm set back of the mandible were performed. After a retention period, the patient's midface convexity was greatly improved and the velopharyngeal competence was preserved without relapse.
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Terbish M, Yoo SH, Kim HJ, Yu HS, Hwang CJ, Baik HS, Cha JY. Accelerated Bone Formation in Distracted Alveolar Bone After Injection of Recombinant Human Bone Morphogenetic Protein-2. J Periodontol 2015; 86:1078-86. [PMID: 25957054 DOI: 10.1902/jop.2015.140697] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND This study evaluates the effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) on the quality and quantity of regenerated bone when injected into distracted alveolar bone. METHODS Sixteen adult beagle dogs were assigned to either the control or rhBMP-2 group. After distraction was completed, an rhBMP-2 dose of 330 μg in 0.33 mL was injected slowly into the distracted alveolar crest of the mesial, middle, and distal parts of the alveolar bone in the experimental group. Histologic and microcomputed tomography analyses of regenerated bone were done after 2 and 6 weeks of consolidation. RESULTS After 6 weeks of consolidation, the vertical defect height in the middle of the regenerated bone was significantly lower in the rhBMP-2 group (2.2 mm) than in the control group (3.4 mm) (P <0.05). Additionally, the width of the regenerated bone was significantly greater in the rhBMP-2 group (4.3 mm) than in the control group (2.8 mm) (P <0.05). The bone density and volume of regenerated bone in the rhBMP-2 group were greater than in the control group after 6 weeks of consolidation (P <0.001). CONCLUSION Injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dentoalveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density.
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Affiliation(s)
- Munkhdulam Terbish
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Seong-Hun Yoo
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Hee-Jin Kim
- Division of Anatomy and Developmental Biology, Department of Oral Biology, Yonsei University
| | - Hyung-Seog Yu
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Chung-Ju Hwang
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Hyung-Seon Baik
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Jung-Yul Cha
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, South Korea
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Terbish M, Choi HY, Park YC, Yi CK, Cha JY. Premaxillary Distraction Osteogenesis Using an Intraoral Appliance for Unilateral Cleft Lip and Palate: Case Report. Cleft Palate Craniofac J 2014; 52:e95-e102. [PMID: 25275540 DOI: 10.1597/14-105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Premaxillary distraction osteogenesis was introduced using intraoral devices to correct maxillary hypoplasia and lengthen the alveolar bone horizontally in a patient with unilateral cleft lip and palate. METHODS For premaxillary distraction osteogenesis, Le Fort I osteotomy was performed. Vertical osteotomy lines were located distally of the upper right canine and left first premolar to separate the anterior segment of the maxilla. After a 7-day latency period, distraction was allowed to continue for 20 days at a rate of 0.5 mm/d, followed by a 3-month consolidation period. After consolidation, orthodontic treatment and bilateral intraoral vertical ramus osteotomy were performed for the mandibular setback. The implant and prosthodontic treatments were applied to the alveolar ridge area created by the distraction osteogenesis. RESULTS The A-point moved 8.0 mm forward during the distraction osteogenesis period, and the recurrence rate was 25% after the retention period. The transverse dimension of the upper arch was expanded during orthodontic treatment. The quality of the alveolar bone created by distraction osteogenesis was acceptable for the prosthodontic implant. CONCLUSIONS Premaxillary distraction osteogenesis and arch expansion is an effective treatment strategy, improving function, aesthetics, and stability for cleft patients with multiple missing teeth.
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Maxillary anterior segmental distraction osteogenesis with 2 different types of distractors. J Craniofac Surg 2012; 23:706-11. [PMID: 22565878 DOI: 10.1097/scs.0b013e31824dba4d] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Maxillary anterior segmental distraction osteogenesis (DO) has been the alternative treatment option for patients with midfacial retrusion. To investigate a potentially more effective maxillary anterior segmental DO, a newly designed intraoral alveolar distractor was applied. The objectives of this study were to investigate the skeletal and dental effects of maxillary anterior segmental DO and the relapse pattern. METHODS The study was carried out for 8 patients with unilateral cleft lip and palate (mean age, 16 years 7 months). Four patients were treated with an intraoral appliance (IA), and the remaining with a rigid external distractor (RED). Dental and skeletal measurements were obtained for both groups. These measurements were compared for different time points including pre-DO (T1), post-DO (T2), postconsolidation (T3), and 1-year follow-up (T4). RESULTS Horizontal change of A point was significantly larger after distraction period (T2) in the RED group (mean, 11.0 mm; median, 10.1 mm) than in the IA group (mean, 6.6 mm; median, 7.4 mm) (P < 0.05). Relapse of A point was observed in both RED (mean, -2.3 mm; median, -2.3 mm) and IA groups (mean, -2.6 mm; median, -1.5 mm) at T4. The vertical position of the anterior nasal spine was found to have moved downward in the RED group (mean, 5.5 mm; median, 4.9 mm) but upward in the IA group (mean, -2.5 mm; median, -2.7 mm) after distraction, showing a significant difference between groups (P < 0.05). Axis of upper incisor increased at T2 in the IA group (mean, 10.4 degrees; median, 11.3 degrees), but decreased in the RED group (mean, -10.2 degrees; median, -9.0 degrees) (P < 0.05). It recovered in the RED group at T4. CONCLUSIONS Maxillary anterior segmental DO is effective for the treatment of patients with cleft lip and palate. The alveolar space is regained, and the facial profile is improved without velopharyngeal problems. Superior results are obtained using the RED appliance for maxillary anterior segmental DO relative to the use of the intraoral distractor appliance.
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Takahashi I, Terao F, Suzuki M, Kawamura H, Takano-Yamamoto T. Mandibular body lengthening by distraction osteogenesis for correction of skeletal class II problems with an impacted premolar. J Oral Maxillofac Surg 2010; 68:2893-902. [PMID: 20828909 DOI: 10.1016/j.joms.2010.05.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2008] [Revised: 03/22/2010] [Accepted: 05/20/2010] [Indexed: 11/25/2022]
Affiliation(s)
- Ichiro Takahashi
- Division of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Tohoku University, Sendai, Japan
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Aikawa T, Haraguchi S, Tanaka S, Uematsu S, Ishibashi M, Kogo M, Iida S. Rotational movement of the anterior maxillary segment by hybrid distractor in patients with cleft lip and palate. ACTA ACUST UNITED AC 2010; 110:292-300. [DOI: 10.1016/j.tripleo.2010.01.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 01/04/2010] [Accepted: 01/26/2010] [Indexed: 10/19/2022]
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Midmaxillary Internal Distraction Osteogenesis: Ideal Surgery for the Mature Cleft Patient. Plast Reconstr Surg 2008; 121:1768-1778. [DOI: 10.1097/prs.0b013e31816a9f2d] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Iida S, Yagi T, Yamashiro T, Okura M, Takada K, Kogo M. Maxillary anterior segmental distraction osteogenesis with the dynaform system for severe maxillary retrusion in cleft lip and palate. Plast Reconstr Surg 2007; 120:508-516. [PMID: 17632357 DOI: 10.1097/01.prs.0000267435.17767.0a] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Seiji Iida
- Osaka and Gifu, Japan From the First Department of Oral and Maxillofacial Surgery and Department of Orthodontology, Osaka University Graduate School of Dentistry, and Department of Orthodontology, Asahi University, Graduate School of Dentistry
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Ho CT, Heller F, Lo LJ, Liou EJW, Huang CS, Chen YR. Distraction Osteogenesis in Adolescents with Maxillary Arch Deficiency and Dental Crowding: A 3-Year Follow-Up. Plast Reconstr Surg 2006; 117:2337-46. [PMID: 16772940 DOI: 10.1097/01.prs.0000218785.34959.4c] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In this study, the authors evaluated the long-term results after using anterior segmental osteotomy and distraction osteogenesis for the correction of sagittal maxillary deficiency associated with dental crowding. METHODS Six young adolescents (four boys and two girls) underwent surgery and distraction at a mean age of 11.2 years (range, 10 to 12 years) and were followed up for 3 years. A tooth-borne distraction device was used for interdental distraction. The evaluation consisted of hard- and soft-tissue profile analysis and dental arch measurements before, immediately after, and 3 years after distraction. RESULTS The results showed that the facial profile, the occlusion, and the dental crowding could be successfully corrected and that the results were stable after 3 years' follow-up. The mean facial convexity angle was changed from 1 to 8 degrees. The average advancement at point A was 4 mm and the SNA increased by an average of 4 degrees. Lengthening of the dental arch by an average of 4 mm created approximately 8 mm of new space, sufficient to resolve the dental crowding in all patients, thus avoiding an extraction of healthy teeth. CONCLUSION The results of this study demonstrated that anterior segmental maxillary osteotomy combined with distraction osteogenesis offers an alternative for the treatment of adolescents suffering from sagittal maxillary deficiency with dental crowding.
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Affiliation(s)
- Cheng Ting Ho
- Department of Orthodontics, Chang Gung Memorial Hospital, Kwei Shan, Taoyuan, Taiwan
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