Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
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BIOMECHANICAL EVALUATION ON BONE REGENERATION IN MANDIBULAR DISTRACTION OSTEOGENESIS COMBINED WITH COMPRESSION STIMULATION

하악골 신장술에서 압축자극을 통한 골 재생방식에 대한 생체 역학적 평가

  • Heo, June (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Pusan National University) ;
  • Kim, Uk-Kyu (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Pusan National University) ;
  • Hwang, Dae-Seok (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Pusan National University) ;
  • Kim, Yong-Deok (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Pusan National University) ;
  • Shin, Sang-Hun (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Pusan National University) ;
  • Chung, In-Kyo (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Pusan National University) ;
  • Kim, Cheol-Hun (Dept. of Oral and Maxillofacial Surgery, Dong-A Medical Center) ;
  • Yun, Seok-Young (College of Engineering, Pusan National University)
  • 허준 (부산대학교 치과대학 구강악안면외과학교실) ;
  • 김욱규 (부산대학교 치과대학 구강악안면외과학교실) ;
  • 황대석 (부산대학교 치과대학 구강악안면외과학교실) ;
  • 김용덕 (부산대학교 치과대학 구강악안면외과학교실) ;
  • 신상훈 (부산대학교 치과대학 구강악안면외과학교실) ;
  • 정인교 (부산대학교 치과대학 구강악안면외과학교실) ;
  • 김철훈 (동아대학교병원 구강악안면외과) ;
  • 윤석영 (부산대학교 공과대학)
  • Published : 2007.10.31
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Abstract

The purpose of this study was to investigate the clinical, biomechanical, and histologic changes in new distraction osteogenesis(DO) technique combined with a compression stimulation in accordance to different compression-distraction force ratio. 23 adult male rabbits underwent open-osteotomy at the mandibular body area and a external distraction device was applied. In the control group of 8 rabbits, only a 8 mm of distraction was performed by conventional DO technique. In an experimental group of 15 rabbits, a distraction followed by a compression force was performed according to the ratio of compression-distraction suggested by authors. The rate of experimental group I was set up as a 2 mm compression versus 10 mm distraction and the rate of experimental group II was set up as a 3 mm compression versus 11 mm distraction. All the rabbits were sacrificed for a gross finding, biomechanical, histomorphometric and histologic findings at the time of 55 days from the operation day. The results were as follows: 1. On the gross findings, because all rabbits had a sufficient healing time, every distracted new bone had good bone quality and we could not find any difference among all three groups. 2. In the histologic findings, rapid bone maturation(wide lamellar bone formation in the cancellous and cortical bone areas) was observed in two experimental groups compared to the control group. 3. On the bone density tests, the experimental group II showed higher bone density than the other experimental group and control group(control group-$0,2906g/cm^2$, experimental group I-$0.2961g/cm^2$, experimental group II-$0.3328g/cm^2$). 4. On the biomechanical tests, the experimental group II had significantly higher bone microhardness than the other experimental group and control group(control group-252.7 MPa, experimental group I-263.5 MPa, experimental group II-426.0 MPa). 5. On the microhardness tests, when we compared the hardness ratio of distracted bone versus normal bone, we could find experimental group II had significantly higher hardness ratio than the other experimental group and control group(control group-0.47, experimental group I-0.575, experimental group II-0.80). From this study, we could deduce that the modified distraction osteogenesis method with a compression stimulation might improve the quality of bone regeneration and shorten the consolidation period in comparison with conventional distraction osteogenesis techniques.

Keywords

References

  1. Codivilla A: On the means of lengthening in the lower limbs, the muscles, and tissues which are shortened through deformity. Am J Orthop Surg 1905;2:353(cited from a reprint of the original article under the title 'The Classic' in Clin Orthop 1994;4:301)
  2. Ilizarov GA: The tension-stress effect on the genesis and growth of tissue : Part I The influence of stability of fixation and soft-tissue preservation. Clin Orthop 1989;238:249
  3. Ilizarov GA: The tension-stress effect on the genesis and growth of tissue : Part II The influence of the rate and frequency of distraction. Clin Orthop 1989;239:263
  4. Snyder CC, Levine GA, Swanson HM, Browne EZ jr: Mandibular lengthening by gradual distraction. Plast Reconstr Surg 1973;51:506 https://doi.org/10.1097/00006534-197305000-00003
  5. McCarthy JG, Schreiber J, Karp N, Thorne CH, Grayson BH: Lengthening of the human mandible by gradual distraction. Plast Reconstr Surg 1992;89:1-10 https://doi.org/10.1097/00006534-199289010-00001
  6. Guerrero CA, Bell WH, Contasti GI, Rodriguez AM: Mandibular widening by intraoral distraction osteogenesis. Br J Oral Maxillofac Surg 1997;35:383-392 https://doi.org/10.1016/S0266-4356(97)90712-9
  7. Diner PA, Kollar EM, Martinez H, Vazquez MP: Submerged intraoral device for mandibular lengthening. J Craniomaxillofac Surg 1997;25:116-123 https://doi.org/10.1016/S1010-5182(97)80002-9
  8. Davies J, Tuner S, Sandy JR: Distraction osteogenesis-a review. Br Dent J 1998;185:462-467 https://doi.org/10.1038/sj.bdj.4809838
  9. McCarthy JG, Stelnicki EJ, Mehrara BJ, Longaker MT: Distraction osteogenesis of the craniofacial skeleton. Plast Reconstr Surg 2001;107:1812-1827 https://doi.org/10.1097/00006534-200106000-00029
  10. 김욱규, 이광호, 신상훈, 정인교, 박봉수: 백서 하악골에서 신연골형성술시 신장력과 수축력 복합적용후의 조직반응. 대한구강악안면외과학회지 2002;28:103
  11. Leung KS, Cheung WH, Yeung HY, Lee KM, Fung KP: Effect of weightbearing on bone formation during distraction osteogenesis. Clin Orthop Relat Res 2004;419:251-257 https://doi.org/10.1097/00003086-200402000-00041
  12. Takeda T, Narita T, Ito H: Experimental study on the effects of mechanical stimulation on the early stage of fracture healing. J Nippon Med Sch 2004;71:252-62 https://doi.org/10.1272/jnms.71.252
  13. 김욱규, 신상훈, 정인교, 김철훈, 허준, 윤일: 수축력과 신장력을 병용한 골신장술에서의 다양한 힘의 비와 부여시기에 따른 신연골 반응. 대한악안면성형외과학회지 2005;27:403
  14. Ilizarov GA: A new principles of osteosynthesis with the use of crossing pins and rings. In Collection of Scientific Works of the Kurgan Regional Scientific Medical Society. Kurgan, USSR 1954;145-160
  15. Klotch DW, Ganey TM, Slater-Hasse A, Sasse J: Assessment of bone formation during osteogenesis. A canine model. Otolaryngol. Head Neck Surg 1995;112:291
  16. Kojimoto H, Yasui N, Goto T, Matsuda S, Shimomura Y: Bone lengthening in rabbits by callus distraction : the role of periosteum and endosteum. J Bone Joint Surg 1989;70:543-549
  17. Block MS, Cervini D, Chang A, Gottsegen GB: Anterior maxillary advancement using tooth-supported distraction osteogenesis. J Oral Maxillofac Surg 1995;53:561-565 https://doi.org/10.1016/0278-2391(95)90069-1
  18. Block MS, Brister GD: Use of distraction osteogenesis for maxillary advancement : preliminary results. J Oral Maxillofac Surg 1994;52:282-286 https://doi.org/10.1016/0278-2391(94)90301-8
  19. Aronson J, Shen XC, Skinner RA, Hogue WR, Badger TM, Lumpkin CK Jr: Rat model of distraction osteogenesis. J Orthop Res 1997;15:221 https://doi.org/10.1002/jor.1100150210
  20. Rowe NM, Mehrara BJ, Dudziak ME, Steinbreck DS, Mackool RJ, Gittes GK, McCarthy JG, Longaker MT: Rat mandibular Distraction osteogenesis: Part I. Histologic and radiographic analysis. : Plast Reconstr Surg 1998;102:2022 https://doi.org/10.1097/00006534-199811000-00033
  21. Babak JM, Norman MR: Rat Mandibular Distraction Osteogenesis: II. Molecular Analysis of Transforming Growth Factor Beta-1 and Osteocalcin Gene Expression. Plast Reconstr Surg 1999;103:536
  22. Warren SM, Mehrara BJ, Steinbrech DS, Paccione MF, Greenwald JA, Spector JA, Longaker MT: Rat mandibular distraction osteogenesis: part III. Gradual distraction versus acute lengthening. Plast Reconstr Surg 2001;107:441 https://doi.org/10.1097/00006534-200102000-00021
  23. Kim BK, Shin SH, Kim JR: A comparison study on distraction osteogenesis in the rat's tibia according to distraction rates. J Kor Oral Maxillofac Surg 2000;26:620
  24. Paccione MF, Mehrara BJ, Warren SM, Greenwald JA, Spector JA, Luchs Js, Longaker MT: Rat mandibular distraction osteogenesis: latency, rate, and rhythm determine the adaptive response. J Craniofac Surg 2001;12:175 https://doi.org/10.1097/00001665-200103000-00015
  25. Kessler P, Wiltfang J, Neukam FW: A new distraction device to compare continuous and discontinuous bone distraction in mini-pigs : a preliminary report. J Craniomaxillofac Surg 2000;28:5-11 https://doi.org/10.1054/jcms.2000.0101
  26. Wiltfang J, KeBler P. Merten H, Neukam FW: Continuous and intermittant bone distraction using a microhydraulic cylinder : an experimental study in minipigs. Br J Oral Maxillofac Surg 2001;39:2-7 https://doi.org/10.1054/bjom.2000.0564
  27. Ilizarov GA: Clinical application of tension-stress effect for limb lengthening. Clin Orthop 1990;250:8
  28. Kojimoto H, Yasui N, Gato T, Matsuda S, Shimomura Y: Bone lengthening in rabbits by callus distraction. J Bone Joint Surg(Br) 1988;70B:543
  29. Yasui N, Sato M, Ochi T, Kimura T, Kawahata H, Kitamura Y, Nomura S: Three modes of ossification during distraction osteogenesis in the rat. J Bone Joint Surg Br 1997;79:824 https://doi.org/10.1302/0301-620X.79B5.7423
  30. Ueda M: Mechanisms of new bone formation during distraction osteogenesis a preliminary report. Craniofacial Distraction Osteogenesis. 1st edi. Mosby 2001:37-45
  31. Sato M, Yasui N, Nakase T, Kawahata H, Sugimoto M, Hirota S, Kitamura Y, Nomura S, Ochi T: Expression of bone matrix proteins mRNA during distraction osteogenesis. J Bone Miner Res 1998;13:1221 https://doi.org/10.1359/jbmr.1998.13.8.1221
  32. Karp N: Bone lengthening on the craniofacial skeleton. Ann Plast Surg 1990;24:231 https://doi.org/10.1097/00000637-199003000-00007
  33. Kershaw CJ, Cunningham JL, Kenwright J: Tibial external fixation, weight bearing and fracture movement. Clin Orthop 1993;293:28-36
  34. Noordeen MH, Lavy CB, Shergill NS, Tuite JD, Jackson AM: Cyclical micromovement and fracture healing. J. Bone Joint Surg.(Br.)1995;77:645
  35. Yamaji T, Ando K, Wolf S, Augat P, Claes L: The effect of micromovement on callus formation. J Orthop Sci 2001; 6:571-575 https://doi.org/10.1007/s007760100014
  36. Schortinghuis J, Stegenga B, Raghoebar GM, de Bont LG: Ultrasound stimulation of maxillofacial bone healing. Crit Rev Oral Biol Med 2003;14:63-74 https://doi.org/10.1177/154411130301400106
  37. Sakurakichi K, Tsuchiya H, Uehara K, Yamashiro T, Tomita K, Azuma Y: Effects of timing of low-intensity pulsed ultrasound on distraction osteogenesis. J Orthop Res 2004;22:395-403 https://doi.org/10.1016/S0736-0266(03)00181-5
  38. Claes L, Ruter A, Mayr E: Low-intensity ultrasound enhances maturation of callus after segmental transport. Clin Orthop Relat Res 2005;430:189-194
  39. Wolff J: The Law of Bone Remodeling. Orthopade 1995;24:378
  40. De Bastiani G, Aldegheri R, and Renzi Brivio L: The treatment of fractures with a dynamic axial fixator. J Bone Joint Surg Br. 1984;66:538
  41. Lazo-Zbikowski J, Aguilar F, Mozo F, Gonzalez-Buendia R, Lazo JM: Biocompression external fixation. sliding external osteosynthesis. Clin. Orthop. 1986;206:169
  42. Dehne E, Metz CW, Deffer PA, Hall RM: Nonoperative treatment of the fractured tibia by immediate weight bearing. J Trauma 1961;1: 514
  43. Burger EH, Klein-Nulend J, Veldhuijzen JP: Mechanical stress and osteogenesis in vitro. J Bone Miner Res. Suppl 2, 1992;S397
  44. Castello JR, Olaso AS, Chao JJ, McCarthy JG, Molina F: Craniofacial shortening by contraction osteogenesis: An experimental Model. Plast Reconstr Surg 2000;105:617 https://doi.org/10.1097/00006534-200002000-00021
  45. Mofid MM, Inoue N, Atabey A, Marti G, Chao EY, Manson PN, Vander Kolk CA: Callus stimulation in distraction osteogenesis. Plast Reconstr Surg Apr 2002;109:1621-1629 https://doi.org/10.1097/00006534-200204150-00020
  46. Lazar FC, Klesper B, Carls P, Siessegger M, Hidding J, Zoeller J: Callusmassage. A new treatment modality for non-unions of the irradiated mandible. Int J Oral Maxillofac Surg 2005;34:202-207
  47. Schneider PE, Miller HI, Nakamoto T: Effects of caffeine intake during gestation and lactation on bones of young growing rats. Res Exp Med 1990;190:131-136 https://doi.org/10.1007/PL00020015
  48. Riches PE, Everitt NM, Heggie AR, McNally DS: Microhardness anisotropy of lamellar bone. J Biomech 1997;30:1059-1061 https://doi.org/10.1016/S0021-9290(97)00075-4
  49. Du C, Cui FZ, Feng QL, Zhu XD, de Groot K: Tissue response to nano-hydroxyapatite/collagen composite implants in marrow cavity. J Biomed Mater Res 1998;42:540-548 https://doi.org/10.1002/(SICI)1097-4636(19981215)42:4<540::AID-JBM9>3.0.CO;2-2