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Introduction
Overview

  1. Introduction

  2. Historical Perspective

  3. Maxillofacial Application

  4. The Process

  5. The Device

Chapter One
Principles of Alveolar Distraction Osteogenesis
    

     1.  Section I

     2.  Section II

     3.  Section III

     4.  Section IV

     5.  Section V

     6.  Section VI

     7.  Section VII

     8.  Section VIII

     9.  Section IX

   10.  Section X

   11.  Section XI

Chapter Two
Alveolar Distraction Osteogenesis

  1. Section I

  2. Section II

  3. Section III

  4. Section IV

  5. Section V

  6. Section VI

  7. Section VII

  8. Section VIII

  9. Section IX

Chapter Three
Maxillary Alveolar Distraction
Osteogenesis

  1. Section I

  2. Section II

  3. Section III

  4. Section IV

  5. Section V

  6. Section VI

  7. Section VII

Alveolar Distraction Device

Development of miniature, internal distraction devices has made transport of alveolar segments possible. The alveolar distraction device has been developed for reconstruction of alveolar process deformities using the distraction osteogenesis process. The implantable components of the alveolar distraction device consists three components. (fig).

When placed into a properly formed segmental osteotomy, the distraction device allows for controlled elevation of the segment resulting in coronal displacement of the alveolar crest. The transport slowly displaces the overlying soft tissue producing expansion. A regeneration chamber is established in the portion of the osteotomy that is perpendicular to the transport axis. The portion of the osteotomy that is parallel to the transport acts to maintain alignment of the segment. After the desired amount of transport has been achieved, the lead screw is left in place until bone healing occurs across the sliding component of the osteotomy. The regeneration chamber fills with bone of several weeks. As a result of the distraction process the volume of both bone and soft tissue has been increased. The reconstructed site is them suitable for further rehabilitation with osseointegrated implants, prosthetic pontic placement, or movement of a tooth with orthodontics.

Model simulated surgery using the Alveolar Distraction Device.

Indications:

Primary indications. Combined deficiencies in bone and soft tissue.

Compromised wound healing environment.

Secondary indications.

Alternative treatments. (Use Lower slide as example)
Expansion of the alveolar housing for:

          Create site for dental implant placement
          Improve ridge esthetics for pontic
          Improve periodontal enviornenvironmentacent teeth
          Expand alveolus for orthodontic tooth movement

 

Limitations

          Must have a minimum quantity of bone

          transport and anchorage segment must have adequate strength to withstand forces             of mobilization and transport.

Expansion occurs only in the direction of transport.

Patient must cooperate with activation process

Complications

          fracture of transport segment

          fracture of anchorage segment

          premature consolidation

          undesirable transport vector

Objectives of Distraction Process

          expansion of bone and soft tissue volume

          displacement of bone into deficient site

Combining Distraction with other techniques

The distraction process may not produce the anatomical objective in a single step. Maxillofacial skeletal deformities are most often complex and three dimensional in nature. Alveolar deformities are not an exception. It is rare that the distraction process alone would result in an alveolar ridge of ideal shape and size. Usually additional osteoplasty is indicated. The distraction process results in the substrate, increased bone volume and expanded soft tissue, which makes creation of an appropriate alveolar morphology possible. Knife edge bony alveolar ridges are usually removed and discarded. If the ridge crest is slightly palatal to the ideal position, the labial cortex may require labial displacement. The distraction process has raised the medullary component of the alveolus allowing the labial plate to be displaced. The resultant increase in alveolar volume is accommodated by the expanded gingiva so that a nontension soft tissue closure is possible.

Objectives of Alveolar reconstruction

Indications for Alveolar Reconstruction with Distraction