• The Journal of the Korean dental association
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• v.50 no.11
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• pp.670-676
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• 2012

Distraction osteogenesis and orthognathic surgery are the widely used surgical methods for treating hemifacial microsomia and cleft lip and palate, the representative forms of congenital deformity. Distraction osteogenesis is an outstanding treatment of choice when more traction is needed than what can be achieved by general orthognathic surgery. However, the stability of distraction osteogenesis has not yet been established, and in most of the cases, additional orthognathic surgery is mandatory. Moreover, the difficulty in precise control of the traction directions is another disadvantage of distraction osteogenesis. Therefore, it would be desirable not to conduct distraction osteogenesis when the patient is suitable for an orthognathic surgery. Also, distraction osteogenesis should be recognized as an accessorial method of treatment, and be used restrictively.

• Korean Journal of Cleft Lip And Palate
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• v.7 no.2
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• pp.107-121
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• 2004

Midface and maxillary distraction osteogenesis (DO) can be an alternative treatement modality for the craniofacial syndrome patients and cleft lip and palate patients. Rigid External Distraction (RED) II system has more advantages in the force vector control than the other types of distraction systems. Despite of increasing popularity of RED system there is few report on the failure factors. Some considerations should be pointed out in using RED II system for successful treatment; the rigidity of intraoral splint, complete separation of bony segment, and the cooperation of patients. Orthodontists, surgeons, and patients have the same amount of responsibility for the successful midface and maxillary DO using RED II system from the beginning to the end of the treatment.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.27 no.5
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• pp.403-414
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• 2005

The purpose of this study was to identify the effectiveness of the modified distraction osteogenesis (DO) method with the concept of overdistraction and compression stimulation which have been previously suggested by the authors in 2002 and to explore the optimal distraction-compression ratio and appropriate latency period for the compression force application during consolidation. The experimental specimens were assessed with radiography, histologic findings, and dual energy x-ray absorptiometry (DEXA) after the conventional DO method and the modified DO technique had been applied on rat mandibles. Total 60 rats were used for the study. In experimental group of 54 adult rats, mandibular osteotomies between the first and second molar areas were performed and customized external distractors were applied. The surgeries on 6 rats of control group also were done with same osteotomy technique and DO device application. Final amount of distraction was set-up as 2 mm on both groups. But, in a experimental group of 54 rats, distraction osteogenesis with a compression force were performed with the different distraction-compression ratio and variant latency periods for compression. The three ratio-subgroups were made as distraction 4 mm group with compression 2 mm, distraction 3 mm group with compression 1 mm, and distraction 2.5 mm group with compression 0.5 mm. In addition, The three subgroups with 3, 7, 11 days latency period prior compression were allocated on each ratio-subgroups. Total 9 subgroups consisted of 6 rats on each subgroup. In control group of 6 rats, conventional distraction technique were routinely performed. The rats of control groups were sacrificed on postoperative 3, 6 weeks after 2 mm distraction. The rats in the experimental groups also were sacrificed on the same euthanasia days of control groups to compare the wound healing. Final available specimens were 55 rats except 5 due to osteomyelitis, device dislodgement. Distraction-compression combined group on 6 weeks generally had showed increased bone mineral density than the same period group of conventional distraction technique on the DEXA study. More matured lamellar bone state and extended trabecular pattern in the combined group than those of control group were also observed in the histologic findings on 6 weeks. In the distraction-compression combined groups, the bone density of 2.5 mm distraction subgroups with 0.5 mm compression showed the highest value on the DEXA study among various force ratio groups. In the distraction-compression combined groups, the bone density of 3 day latency period subgroups showed the highest value on the DEXA study among various latency period groups for the compression application. From this study, we could deduce that 1/5 force ratio for the compression versus distraction, 3 day latency period prior compression application would be the most effective condition if modified distraction osteogenesis technique might be applicable. The modified DO method with a compression force may improve the quality of bone regenerate and shorten total treatment period in comparison with conventional DO technique clinically.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.2
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• pp.116-129
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• 2005

Distraction osteogenesis is a new bone formation technique. There is a advantage of the environmental adaptation when distraction force is applied to the gap between osteotomy lines. But it has a disadvantage of long-term wearing of the appliance and long consolidation period. Therefore we make an effort to reduce it and repair normal function. Extracellular matrix proteins have a function to control the cellular growth, migration, shape and metabolism. In these, hyaluronic acid is a member of polysaccharide glycosaminoglycans (GAGs) and has a important function as bone formation and osteoinduction property. Purpose : In this experimental study in rabbit mandibular distraction osteogenesis, we investigated the bone enhancing property of hyaluronic acid and the expression of extracellular proteins such as osteocalcin and osteonectin. Materials and Methods : The experimental study was carried out on 24 Korean male white rabbits (both mandibular body, n=48). Distraction group was divided to distraction experimental (A, n=16) and distraction control (B, n=16) by the application of hyaluronic acid (Hyruan, LGCI, Seoul, Korea). Normal control group (C, n=16) was only osteotomized. After 5 days latency, distraction devices were activated at a rate of 1.4 mm per day (0.7 mm every 12hours) for 3.5 days. Animals were sacrificed at postoperative 3, 7, 14, and 28 days. H&E stain and immunohistochemical stain was done on decalcified section. Additionally RT-PCR analysis was done for the identification of the expression of osteocalcin and osteonectin. Results : The bone formation in distraction experimental group was much more than that in distraction and normal control group at postoperative 28 days. In immunohistochemical stain, osteocalcin was enhanced at only postoperative 14 days, but osteonectin was not different at each post-operation days. In RT-PCR analysis, osteocalcin was not different at each post-operation days, but osteonectin was strongly expressed in distraction experimental group at postoperative 7 days. The expression of osteocalcin and osteonectin was elevated during the healing period. Conclusion : We found the good bone formation ability of hyaluronic acid in distraction osteogenesis through the immunohistochemistry and RTPCR analysis to osteocalcin and osteonectin, known as a bone formation marker. The application of hyaluronic acid in distraction osteogenesis is a method to reduce the consolidation period.

• Journal of Korean Neurosurgical Society
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• v.59 no.3
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• pp.233-241
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• 2016

In this review, we discuss in detail our current procedure for treating craniosynostosis using multidirectional cranial distraction osteogenesis (MCDO). The MCDO method allows all phenotypes of skull deformity to be reshaped by distraction osteogenesis, except in patients who are 5 months of age or younger and patients with posterior cranial vault problems. We report the results of clinical data of 36 children with craniosynostosis who underwent MCDO between 2005 and 2014 in our institute. This method has the following benefits, such as a high flexibility of reshaping, shorter treatment period and less invasive secondary intervention. We also discuss the other distraction osteogenesis techniques that are used to treat craniosynostosis and compare them with MCDO. The preferred procedure for correction of craniosynostosis may depend on the patient's age, the extent of deformity, and the extent of correction achievable by surgery. We can arrange the combinations of various methods according to the advantage and disadvantage of each technique.

• 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.30 no.5
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• pp.480-488
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• 2008

Orthodontists often treat cases which are difficult to treat with conventional orthodontics. In such cases, it could be treated with surgical procedures with the help of an oral surgeon. Especially, transverse deficiency of the mandible can be corrected by widening the transverse width of mandibular symphysis, using distraction osteogenesis. Transverse widening of mandibular sympysis is known as a safe treatment but still complications could occur during the treatment. We are reporting some complications of cases that mandibular symphysis transverse widening were applied. Some cases showed complications because of the inappropriate osteotomy line. Since straight vertical osteotomy line was inclined to the left, only the left bony segment was likely to expand. According to bio-mechanical considerations, it will be better to perform a step osteotomy, cutting the eccentric area of the alveolar crest and the centric area of the basal symphyseal area. Complications could also occur by the failure of the distraction device. The tooth borne distraction device was attached on the lingual side of the tooth with composite resin. During the distraction period, it was impossible to obtain appropriate distraction speed and rhythm because of frequent fall off of the distraction device. Therefore, distraction device should be attached firmly with orthodontic band or bone screw, etc. Tooth mobility increasement could also occur as a complication. 'Walking teeth phenomenon' was observed during the distraction period, showing severe teeth mobility and pain during mastication. These symptoms fade out during the consolidation period. Since the patient could feel insecure and uncomfortable, it should be notified to the patient before the procedure. Finally, alveolar crestal bone loss could occur. Alveolar crestal bone loss occurred because of lack of distraction device firmness and teeth trauma caused by lower lip biting habit. Therefore, adequate firmness of the distraction device and habit control will be needed.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.28 no.6
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• pp.456-463
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• 2002

Distraction osteogenesis is a well-established clinical treatment for limb length discrepancy and skeletal deformities. Appropriate mechanical tension-stress is believed not to break the callus but rather to stimulate osteogenesis. In contrast to fracture healing, the mode of bone formation in distraction osteogenesis is primarily intramembranous ossification. Although the biomechanical, histological, and ultrastructural changes associated with distraction osteogenesis have been widely described, the basic biology of the process is still not well known. Moreover, the molecular mechanisms in distraction osteogenesis remain largely unclear. Recent studies have implicated the growth factor cascade is likely to play an important role in distraction. And current reserch suggested that mechanical tension-stress modulates cell shape and phenotype, and stimulates the expression of the mRNA for bone matrix proteins. This article presents the hypotheses and current research that have furthered knowledge of the molecular biology that govern distraction osteogenesis. The gene regulation of growth factors and extracellular matrix proteins during distraction osteogenesis are discussed in this article. It is believed that understanding the biomolecular mechanisms that mediate distraction osteogenesis may guide the development of targeted strategies designed to improve distraction osteogenesis and accelerate bone healing.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.5
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• pp.404-416
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• 2006

Purpose : This study was to clarify the changes in mandibular condyle after unilateral mandibular distraction osteogenesis throughout histological changes and expression of matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of matrix metalloproteinase-2 (TIMP-2). Materials & Methods : Intraoral distractors were placed via submandibular incision in 8 dogs. Two unoperated animals served as controls. Distraction was performed five days after osteotomy as a rate of 0.5 mm twice per day for 10 days. Two animals were sacrificed on 7, 14, 28, and 56 days after completion of distraction, respectively. Ipsilateral condyles were harvested and processed for histological and immunohistochemical examinations. Results : The condyle cartilage is separated into four layers: fibrous layer, proliferative layer, hypertrophic layer, and calcified layer. At 7 days and 14 days after distraction, the condylar cartilage showed the decreased thickness of the articular cartilage and reduced cellularity. At 28 days after distraction, there was an increase in cellularity of fibrous, proliferative, and hypertrophic layer. However, it demonstrated reduced cellularity compared to the control. At 56 days of after distraction, the articular cartilage was an almost normal histologic structure. Positive Safranin-O staining, indicative of sulfated proteoglycans, was examined in the condylar cartilge of nonloaded control. At 7 days and 14 days after distraction, the sulfated proteoglycans is almost completely depleted from the noncalcified part of the condylar cartilage. At 28 days after distraction, there was an increase in Safranin-O staining intensity. However, the staining intensity of the experimental condyle was weaker than that of the control. At 56 days of after distraction, the condylar cartilage showed almost normal Safranin-O staining pattern. In control condyle, MMP-2 immunostaining was seen in fibrous, proliferative, and hypertrophic layer of condylar cartilage, however, it demonstrated lack of staining in fibrous and proliferative layer. At 7 days and 14 days after distraction, strong MMP-2 immunoreactivity was seen in the fibrous, proliferative and hypertrophic layer of the condylar cartilage. At 28 days after distraction, MMP-2 immunostaining was seen in the fibrous and hypertrophic layer of condylar cartilage, however, their immunoactivity was reduced. At 56 days after distraction, MMP-2 immunoreactivity showed almost normal immunostaining pattern. In control condyle, TIMP-2 immunostaining was primarily seen in fibrous and hypertrophic layer of condylar cartilage, however, it demonstrated lack of staining in proliferative layer. At 7 days after distraction, very weak TIMP-2 immunoreactivity appeared in fibrous, proliferative and hypertrophic layer of the condylar cartilage. At 14 days after distraction, weak TIMP-2 immunoreactivity was seen in the fibrous, proliferative and hypertrophic layer of the condylar cartilage. At 28 days after distraction, TIMP-2 immunoreactivity was increased in the fibrous and hypertrophic layer of condylar cartilage. At 56 days after completion of distraction, TIMP-2 immunoreactivity showed almost normal immunostaining pattern. Conclusions : The results show that short-term outcome of physiologic distraction osteogenesis may lead to degenerative changes in the condylar cartilage. These alterations in the condylar cartilage may be considered as a pressure-related degeneration of the cartilage tissue. However, the long-term results suggest that the condylar cartilage display repair activity after mandibular distraction osteogenesis.

• The Journal of Korea CHUNA Manual Medicine
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• v.5 no.1
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• pp.243-249
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• 2004

Objectives : This study is to evaluate the effect of flexion-distraction technique by measuring surface EMG in low back pain groups. Methods : 5 low back pain patients' constact time, power, fatigue, recovery of muscle were measured before and after flexion-distraction technique. Results : The asymmetry ratio of surface EMG in low back pain groups were Increased, but decreased after flexion-distraction technique. Conclusions : Surface EMG might be used for evaluating the effect of flexion-distraction technique.