• 제목/요약/키워드: Distraction osteogenesis

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상악 전치부의 전하방 이동을 위한 치조골신장술 (Alveolar Bone Distraction Osteogenesis at Maxillary Anterior Region for Forward-Downward Movement)

  • 양훈주;이수연;황순정
    • Maxillofacial Plastic and Reconstructive Surgery
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    • 제32권5호
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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.

성견에서 하악골 신장술 후 하악과두 연골의 조직학적 변화와 Matrix Metalloproteinase-2 (MMP-2)와 Tissue Inhibitor of Matrix Metalloproteinase-2 (TIMP-2)의 발현 (HISTOLOGICAL CHANGES AND EXPRESSION OF MATRIX METALLOPROTEINASE-2 AND TISSUE INHIBITOR OF MATRIX METALLOPROTEINASE-2 IN THE CANINE MANDIBULAR CONDYLE AFTER DISTRACTION OSTEOGENESIS)

  • 변준호;박봉욱;조영철;성일용;손재희;김종렬
    • Maxillofacial Plastic and Reconstructive Surgery
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    • 제28권5호
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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.

가토에서 하악골 신장술이 악관절에 미치는 영향 (THE CHANGE OF THE TEMPOROMANDIBULAR JOINT AFTER EXPERIMENTAL DISTRACTION OF MANDIBULAR RAMUS IN RABBIT)

  • 임승규;김철환;김경욱
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • 제34권5호
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    • pp.543-549
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    • 2008
  • Distraction osteogenesis is a commonly used technique for mandibular lengthening, but changes in the temporomandibular joint(TMJ) have not been well documented. The TMJ is one of the most complex joint in the body and is composed of a fibrous surface layer, a proliferative zone, hypertrophic cartilage, and bone. The shape and role of the TMJ change and modify during a person's life-time. Possible complications that can arise after mandibular distraction include failure of the formation, failure of callus, infection, disturbance of TMJ and of occlusion. However, there are only a few reports on changes in the TMJ as a result of distraction osteogenesis. Hence, the goal of this study was to evaluate the change of the TMJ after experimental distraction of mandibular ramus in rabbit. We studied histological changes of mandibular condyle, articular disk and retrodiscal tissue, and also examined the collagen I gene expression and MMP-1 gene expression. The results were as follows. 1. In the histological staining, experimental condylar surface showed more thick fibrous articular layer and proliferative layer, compared with the control condyle and experimental articular disc showed thick and dense collagen fibers compared with the control disc. 2. In the collagen I and MMP-1 gene RT-PCR analysis, experimental discs showed increased collagen I expression compared with the control disc, while MMP-1 gene expression was decreased compared with the control disc. The retrodiscal tissue was almost equal expressions of the collagen I and MMP-1 genes compared with the control retrodiscal tissue. These findings suggest that histological and biomolecular changes occur in condyles and discs after unilateral mandibular distraction osteogenesis.

가토 하악골에서 신연 골형성술시 제 I형 및 II형 교원질의 발현 (EXPRESSION OF TYPE I, TYPE II COLLAGEN ON DISTRACTION OSTEOGENESIS IN THE RABBIT MANDIBLE)

  • 강대실;지유진;송현철
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • 제30권4호
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    • pp.261-270
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    • 2004
  • The purpose of this experiment was to examine the histological changes and the pattern of expression of type I, II collagen in the elongated area by distraction osteogenesis in the rabbit mandible. Sixteen rabbits weighing 2.5kg-3kg were used for this experiment. Experimental group was distracted at the rate of 0.7mm, twice/day for 7days, and control group was only osteotomized. After 5 days latency, osteotomic site is distracted for 7days. Consolidation period is 28days. The animal was sacrificed at the 3rd, 7th, 14th, 28th day after the operation. The distracted bone was examined by histological analysis and RT-PCR analysis. The results were summarized as follows: 1. Experimental group was observed that the gaps between the distracted bone edges were occupied by new bone. 2. Expression of Type I collagen were detected throughout the experiment in both groups and Expression of Type I collagen were markedly increased during distraction and consolidation period in experimental group than control group. 3. Expression of Type II collagen were detected throughout the experiment in both groups and expression of Type II collagen were maintained at high level during distraction and consolidation period in experimental group than control group. From these results, in contrast to type II collagen, type I collagen seemed to be more expressed by mechanical stimuli during distraction and consolidation period. The predominent mechanism of new bone formation in the distraction gap was intramembranous bone formation, but some of the regenerated bone was formed by endochondral ossification.

$Synthes^{(R)}$상악골 신장기를 이용한 성인 구개구순열 환자의 치험례 (An Adult Cleft Lip and Plate Patient Using a Maxillary Distractor by $Synthes^{(R)}$ : Report of a case)

  • 김준영;이부규
    • 대한구순구개열학회지
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    • 제12권1호
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    • pp.21-32
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    • 2009
  • Generally, an adult cleft lip or/and palate patient shows some amount of maxillary deficiency due to limitation of bony growth caused by heavy scars resulted from previous operations such as a cheiloplasty and/or a palatoplasty at an early child age. To solve the problem, advancement of the maxilla is usually required during orthognathic surgery. However, severe tensional force resulted from heavy scars on the palate and/or the lip, as well as the bony defect at the cleft area limited sufficient advancement of the maxillary segment and finally caused relapse of the reposed maxilla. Therefore, distraction osteogenesis of the maxilla was introduced for the successful maxillary advancement inthose kinds of patients. As both hard and soft tissues can be simultaneously and gradually extended with this technique, tensional force caused by heavy scars opposed to forward movement of the maxilla can be reduced to an extent not to develop severe relapse of the advanced maxilla. Since distraction osteogenesis of the maxilla was applied as one of standard protocols for the treatment of the patients with severe maxillary hypoplasia dueto cleft lip and/or palate, the devices for the distraction was improved to control the vectors of distraction with better and more stable. We have treated a 23-year-old male cleft patient with a severe maxillary hypoplasia using a newly developed a maxillary distraction device and a RP model for a pre-operative simulation surgery. As a result, we could successfully move the maxilla as we designed pre-operatively and also reduce much of operation time. Therefore, we report of the case to share our experience with colleagues.

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성인 구순구개열 환자에서 Multidisciplinary 치료로 기능성 교합을 형성한 증례 (Multidisciplinary Treatment Approach in a Secondary Cleft Lip and Palate Patient for Functional Occlusal Rehabilitation)

  • 이지나
    • 대한구순구개열학회지
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    • 제15권1호
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    • pp.29-38
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    • 2012
  • A 20 year-old cleft lip and palate patient came for occlusal rehabilitation, but the constricted maxilla and early loss of posterior teeth called for an unusual treatment modalities. Distraction osteogenesis in the edentulous areas followed by artificial bone graft, dental implant along with orthodontic tooth movement were planed. Multidisciplinary treatment enabled both esthetic and functional oral rehabilitation of this patient.

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구순구개열환자에서 골신장술을 통한 상악골 열성장의 치험례 (Distraction Osteogenesis for Maxillary Hypoplasia in a Cleft Patient)

  • 김종렬;변준호;장원선;정태영;손우성
    • 대한구순구개열학회지
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    • 제6권1호
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    • pp.27-34
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    • 2003
  • 본 교실에서는 상악골의 열성장을 보이는 구순구개열환자에서 RED 장치를 이용한 골신장술을 통하여 상악골의 점진적인 전방이동을 실시하고 약 3년정도의 추시기간을 포함하는 현재까지 특별한 기능 장애없이 양호한상, 하악관계 및 안모를 보이는 증례를 문헌고찰과 함께 보고하는 바이다.

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골신장술을 이용한 상악 전치부 수복의 치험보고 (AUGMENTATION OF MAXILLARY ANTERIOR AREA USING DISTRACTION OSTEOGENESIS : CASE REPORT)

  • 김현경;이현진;여덕성;임소연;안미라;손동석
    • Maxillofacial Plastic and Reconstructive Surgery
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    • 제28권3호
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    • pp.242-246
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    • 2006
  • Objective : This is to report the criteria of success of intraoral distraction osteogenesis for alveolar augmentation in the severely atrophied alveolar defects through clinical result of 2 cases. Subjects and Methods : Anterior segmental osteotomy was performed and alveolar distractors (Martin and Leibinger, Germany) were applied each in 2 patients with severely defected anterior maxillary area. The osteomized alveolar segments were distracted by 1mm a day after latency period. After the consolidation period implants were installed with removal of distractor. The implants were evaluated clinically and radiographically. Results : In Case I, the distracted bone was directed to the palatal side, and another augmentation treatment - block bone graft, guided bone regeneration - was needed. In Case II, the successful alveolar bone augmentation was achieved. Dental implant was placed on distracted alveolar bone, and showed good osseointegration and good function without any complication. Conclusion : Distraction osteogenesis can be a good choice for alveolar ridge augmentation of severely atrophied ridges. However, the anterior esthetic prosthetics relies on the control of the vector, the kind of distractor, the healing capacity of patient and the etiology of atrophy. Therefore another study of each category would be needed.