Treatment planning and biomechanics of distraction osteogenesis from an orthodontic perspective

As in traditional combined surgical and orthodontic procedures, the orthodontisthas a role in the planning and orthodontic support of patients undergoing distraction osteogenesis. This role includes predistraction assessment of the craniofacial skeleton and occlusal function in addition to planning...

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Bibliographic Details
Published in:Seminars in orthodontics 1999-03, Vol.5 (1), p.9-24
Main Authors: Grayson, Barry H., Santiago, Pedro E.
Format: Article
Language:English
Subjects:
Biomechanical Phenomena
Child
Dentistry
External Fixators
Facial Asymmetry - surgery
Humans
Jaw Fixation Techniques
Male
Malocclusion - etiology
Malocclusion - therapy
Mandible - abnormalities
Mandible - surgery
Mandibular Advancement - instrumentation
Mandibular Advancement - methods
Mandibulofacial Dysostosis - surgery
Maxilla - abnormalities
Maxilla - surgery
Micrognathism - complications
Micrognathism - surgery
Orthodontics, Corrective - methods
Osteogenesis, Distraction - instrumentation
Osteogenesis, Distraction - methods
Patient Care Planning
Patient Care Team
Recurrence
Syndrome
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Summary:As in traditional combined surgical and orthodontic procedures, the orthodontisthas a role in the planning and orthodontic support of patients undergoing distraction osteogenesis. This role includes predistraction assessment of the craniofacial skeleton and occlusal function in addition to planning both the predistraction and postdistraction orthodontic care. Based on careful clinical evaluation, dental study models, photographic analysis, cephalometric evaluation, and evaluation of three-dimensional computed tomographic scans, the orthodontist, in collaboration with the surgeon, plans distraction device placement and the predicted vectors of distraction. Both surgeon and orthodontist closely monitor the patient during the active distraction phase, using intermaxillary elastic traction, sometimes combined with guide planes, bite plates, and stabilization arches, to mold the newly formed bone (regenerate) while optimizing the developing occlusion. Postdistraction change caused by relapse is minimal. Growth after mandibular distraction is variable and appears to be dependent on the genetic program of the native bone and the surrounding soft tissue matrix. A significant advantage of distraction osteogenesis is the gradual lengthening of the soft tissues and surrounding functional spaces. Distraction osteogenesis can be applied at an earlier age than traditional orthognathic surgery because the technique is relatively simple and bone grafts are not required for augmentation of the hypoplastic craniofacial skeleton. In this new technique, the surgeon and the orthodontist have become collaborators in a process that gradually alters the magnitude and direction of craniofacial growth.
ISSN:1073-8746
1558-4631
DOI:10.1016/S1073-8746(99)80038-3