• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.5
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• pp.421-428
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• 2011

Introduction: The purpose of this study was to evaluate the clinical result of vertical alveolar distraction, especially the distracted alveolar bone and installed implants. Materials and Methods: Twenty-one patients who have been received the vertical alveolar distraction and implant installation on 22 areas (3 maxilla and 19 mandible) using intraoral alveolar distraction device were examined. After consolidation period of 3-4 months, distraction devices were removed and 91 implants were installed in the distracted alveolar bone. The distracted bone and implants were evaluated clinically and radiographically. Results: Mean height of distracted alveolar bone was $7.5{\pm}3.2$ mm (range: 2.5-15.0 mm). Mean follow-up period after completion of the distraction was 3.1 years (range: 1.4-11.5 years). Mean resorption of distracted alveolar bone was $1.6{\pm}1.8$ mm. The success and survival rates of implants was 95.3% and 100%, respectively. Conclusion: Results of this study indicate that vertical alveolar distraction procedure is a useful and stable method for alveolar ridge augmentation and implantation.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.4
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• pp.325-329
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• 2009

Objective : This is to report the effectiveness of intraoral distraction osteogenesis, iliac bone graft for alveolar augmentation in the extremely atrophied alveolar defects after infected allobone grafted area. Subjects and Methods : Anterior segmental osteotomy was performed and the trans-oral alveolar distractors (Martin, Germany) were applied in patient with the severe acquired anterior mandibular and mandibular defect after ameloblastoma enucleation. Iliac bone grafts were performed in defect sites and distraction osteogenesis were treated. After latent period for 1 week, the osteomized alveolar segments were distracted by 0.75 mm a day (0.25 mm/1 turn) for 10 days The consolidation period was about 12 weeks. Thereafter, 2 titanium threaded implants were simultaneously installed with removal of distractor. For oral rehabilitiation, The implants were installed in maxilla, mandible. It was tested with clinically and radiographically. Results : Amounts of acquired alveolar bone were 10 mm with the increased width of the ridge crests and soft tissue expansion. Dental implants installated on the augmented alveolar ridges in 12 weeks after distraction were confirmed as in good osseointegration and in good function without any complications. Conclusion : Intraoral distraction osteogenesis can be a good option for alveolar ridge augmentation of the severely atrophied ridges and soft-tissue defects.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.28 no.4
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• pp.326-329
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• 2002

Adequate alveolar bone height and width are required for the successful placement of dental implants. Conventional therapeutic regimens for alveolar atrophy are bone grafts or augmentation using allografts and membrane (GBR). Conventional graft techniques have some limitations and complications such as infection, soft tissue problem and high resorption rate. Recently, distraction osteogenesis of alveolar bone is considered as a new alternative for ridge augmentation. Distraction osteogenesis was originally defined and popularized by Ilizarov for lengthening of long bone. Some clinicians have tried to apply distraction osteogenesis in treatment of maxillofacial discrepancies. It was also used to augment alveolar bone. Cologne study group successfully applied the technique for augmentation of alveolar bone and designed several miniplate-distractor systems fabricated by Martin Medizintechnik GmbH in Germany. Vertical distraction of alveolar bone was successfully completed in 104 patients with miniplate-distractor systems. The mean distance of distraction was 10.2mm (range: 6-15 mm) and the mean length of segment was 45 mm (range: 6-127 mm). 162 dental implants in 54 patients were placed immediately or 4 weeks later after removal of the distractor. The results of our study show that vertical distraction of alveolar bone is an effective and reliable technique to restore alveolar atrophy and alveolar vertical defect caused by trauma or tumor.

• Archives of Plastic Surgery
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• v.36 no.4
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• pp.445-449
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• 2009

Purpose: A successful surgical treatment for a wide alveolar cleft with bone graft is difficult to achieve due to several factors such as the limitation of gingivoperiosteal flap, the presence of large scar tissues, and the poor blood circulation. To overcome these problems, alveolar distraction osteogenesis using Liou alveolar distraction device was applied. We analyzed the consequences of this surgical treatment. Method: Between 2006 January and 2007 August, we have conducted analysis on the methods and consequences of Liou alveolar distraction osteogenesis for 6 patients. The age of patients was 12 years and 6 months in average. The follow up period was 19 months in average. The Reverse L osteotomy followed by the placement of the Liou alveolar distraction device was performed. After serial distraction, the distractor was removed after 5 months of the process of osteogenesis, and the result was analyzed using the computed tomography and the x-ray films of the alveolar bone and the teeth. Results: The alveolar cleft with 12.5 mm in average width was filled with 8.5 mm of newly formed bone tissue in average width after 5 months of osteogenesis. Among the 6 cases, 5 required the additional bone graft and 1 case only required the gingivoperioplasty. The newly formed bone tissues did not show any signs of bone resorption. However, a considerable degree of teeth displacement was shown. Conclusion: For the alveolar cleft too wide to be reconstructed by a general bone graft, it is strongly recommended to perform the reverse L osteotomy of the cleft side with Liou alveolar distraction device to initiate the alveolar osteogenesis. However, the migrated teeth showed some degree of relapse, thus, the orthodontic treatment is essential following the distraction osteogenesis treatment.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.4
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• pp.329-338
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• 2006

Objectives: Distraction osteogenesis has recently evolved a challenging technique to overcome the limitations of conventional augmentation procedures. The aim of this report was to evaluate the clinical result of alveolar distraction osteogenesis for implant installation. Methods: Twenty five patients with alveolar ridge deficiencies were treated with vertical alveolar distraction osteogenesis by intraoral device (total 27 devices: 25 extraosseous and 2 intraosseous devices). After the latency periods of 5-7 days, activation of the device was started. The distraction rhythm and rate was 0.75-1.0 mm a day with 2 or 3 times a day. After 3-4 months, dental implants were placed with removing the distractor simultaneously. Results: On average, a vertical gain of $9.8{\pm}3.4\;mm$ was obtained by distraction osteogenesis. Total 84 implants were installed. Average follow up period was $13.5{\pm}7.5$ months. No implant was removed during the follow up period. Three patients showed infection during the distraction osteogenesis. Three devices were broken and 2 devices among them were replaced with new one. Conclusion: Relatively larger amount of alveolar bone augmentation could be obtained with distraction osteogenesis. For the ideal anatomically and functionally ideal regeneration of alveolar bone to install dental implant, the complication of distraction should be controlled.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.4
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• pp.324-331
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• 2001

The present study was aimed to investigate the effects of latency period on alveolar ridge distraction using the intraoral distraction device. Nine adult mongrel dogs of either sex, weighing about 15kg, were used. They were divided into 3-day, 5-day, and 7-day groups according to the latency period. The left upper and lower premolars and first molars were extracted. Twelve weeks after the extraction, an osteotomy was performed and the distraction device was applied. After the latency period, the distraction was applied at a rate of 1.2mm for 8 days. The distraction device was left in place for 2 weeks to allow consolidation and was then removed. The animals were sacrified at 8 weeks after completion of distraction and were examined macroscopically, radiographically, and histologically. After completion of the distraction, the alveolar crest protruded prominently, showing the vertical augmentation of the alveolar bone. Soft tissues were broken down after the 6th day of distraction in 3-day latency group, and premature union occurred on the 7th day of distraction in the 7-day latency group. The average distance was $9.40{\pm}0.3mm$ in 3-day latency group, $9.35{\pm}0.1mm$ in 5-day latency group, and $8.85{\pm}0.1mm$ in 7-day latency group. In the radiograph taken at 8 weeks after distraction, there was slight bone resorption around the medial and distal edges of the alveolar bone segment, and a new bone deposition was observed in the neighboring alveolar crest area in all groups. Fibrous tissues were present in a part of the buccal cortical bone area of the distraction gap, and the woven and lamellar bones were observed in the distracted gap. There were bony bridges in the distraction gap in all animals examined. These results suggest that optimal time of latency period on alveolar ridge distraction using the intraoral distraction device is about 5 days in dogs, and about 7days in human beings.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.20 no.3
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• pp.250-255
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• 1998

The purpose of this study was to evaluate the histologic change of the inferior alveolar nerve according to distraction amount following mandibular lengthening. Seven rabbits weighing about 2 kg were used. Corticotomy was performed on the mandibular body anterior to the right first premolar region and unilateral external fixation device was placed. Every effort was made to preserve the inferior alveolar nerve during the corticotomy. The rabbits were then allowed to heal for 7 days without distraction of the device. The mandible was lengthened 0.36 mm/day, 0.76 mm/day, or 1.0 mm/day. Corticotomy and lengthening of mandible were not performed in control group. After the completion of the lengthening process, a 14-day-consolidation period was allowed. After consolidation, rabbits were sacrificed, and histologic examination of the inferior alveolar nerve was performed. The results obtained were as follows : 1. In the control group, normal trifascicular pattern of inferior alveolar nerve was observed. Epineurium, perineurium, endoneurium, and axon with myelin sheath were observed in normal appearance. 2. In 0.36 mm/day distraction group, the trifascicular pattern was normally shown, and there was no destruction in epineurium, perineurium, and endoneurium. The mild changes including myelin attenuation, axoplasmic swelling and darkening were observed. 3. In 0.72 mm/day distraction group, it was possible to differentiate the epineurium from the perineurium. Two normal fascicles and one injuried fascicle were observed with a partially destructed perineurium. Most of the axons had axoplasmic swelling and darkening. 4. In 1 mm/day distraction group, it was difficult to differentiate the nerve structures such as fascicles, epineurium, perineurium, and endoneurium. The axons were severely destroyed, except few which showed decreases in size and changes in shape. Some collagen matrices were observed around the axons. These results suggest that the higher the distraction amount, the more severe the injury to the inferior alveolar nerve, fascicles, axons. Although distraction osteogenesis may be useful, the amount of distraction should be carefully selected.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.30 no.5
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• pp.495-499
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• 2008

For the successful placement of dental implants, adequate alveolar bone height and width are required. Alveolar distraction osteogenesis is an effective method that resolves insufficient alveolar bone height for dental implant placement, and thus has been clinically applied with satisfactory results. But, minor and major problems may occur during the treatment. In the following report, we studied for such problematic cases. The problems are as follows: 1) sharp edges of the transport segment, 2) infection, 3) soft tissue dehiscence, 4) limitation of distraction, 5) numbness, 6) insufficient bone formation. But, most of them were answered by simple solutions and did not jeopardize the final outcomes. Distraction osteogenesis can be considered a safe and predictable procedure for lengthening the alveolar bone.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.5
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• pp.459-466
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• 2010

Alveolar distraction osteogenesis (ADO) has been regarded as an acceptable treatment for the alveolar bone deficiency. For ADO at anterior maxillary area, the vector should be oriented to forward and down-ward direction to get an adequate occlusion with mandibular teeth and to increase bone length and width for implant placement. However, the conventional commercial distraction devices for ADO are designed to allow mainly downward movement of alveolar segment, even though a forward movement can be obtained a little by controlling of inclination of device. To make ADO with controllable bidirectional vector possible, we used customized devices using self-manufactured ABDUL (Alveolar Bone Distractor Using Lag screw principle) and commercial orthodontic palatal expansion device ($Hyrex^{(R)}$). In all cases (n = 4), ADO could be performed successfully and dental implants were able to placed with adequate occlusion. We report the procedures, advantages and disadvantages of these methods.

• Korean Journal of Cleft Lip And Palate
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• v.7 no.1
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• pp.47-61
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• 2004

The closure of a wide alveolar cleft and fistula in cleft patients and the reconstruction of a maxillary dentoalveolar defect in bilateral cleft lip and palate (BCLP) patients are challenging for both orthodontists and oromaxillofacial surgeons. It is due to the difficulty in achieving complete closure by using local attached gingiva (palatal flap) and the great volume of bone required for the graft. In this article, the authors used bifocal distraction-compression osteosynthesis(BDCO) to create a segment of new alveolar bone and attached gingiva for the complete approximation of a wide alveolar cleft/fistula and the reconstruction of a maxillary dentoalveolar defect. Since the alveoli and gingivae on both ends of the cleft were approximated after BDCO, the need for extensive alveolar bone grafting was eliminated. It also could create new alveolar bone and gingiva for orthodontic tooth movement and implant.