• 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.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.

• 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.

• 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.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.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.6
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• pp.526-531
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• 2005

Distraction osteogenesis is a technique of bone lengthening by gradual movement and subsequent remodeling. Distraction forces applied to bone also create tension in the surrounding soft tissues, distraction histiogenesis. Distraction osteogenesis is used to correct facial asymmetry, such as patients with hemifacial microsomia, maxillary or mandibular retrusion, cleft lip & palate, alveolar defect and craniofacial deficiency. Hemifacial microsomia is characterized by unilateral facial hypoplasia, often with unilateral shortening of the mandible and subsequent malocclusion. This report describes two cases of hemifacial microsomia(type IIB). In these two cases, distraction osteogenesis was used to correct a facial asymmetry. Two patients underwent unilateral mandibular distraction osteogenesis of ascending ramus of the mandible with extraoral devices. Successful distraction osteogenesis was achieved in the patients with hemifacial microsomia.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.3
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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.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.4
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• pp.312-321
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• 2007

Purpose: Distraction osteogenesis has been applied to the maxillofacial implantology and good experimental and clinical results have been reported. However, histologic studies of implants placement on distraction osteogenesis of atrophic alveolar ridges are scarce. In this study, we compare the bone formation between in the transport part and in the distraction part by histomorphometric analysis. Materials & methods: Three adult beagle dogs were served as experimental subjects. The 2 premolars and 1st molar were extracted on the Lt. side of mandible in each beagle dog. After one month later, osteotomy was performed and distraction device was adapted. Distraction was performed with gradual incremental separation of two bone pieces at a rate of 1.0mm per day for 5 days. During consolidation phase, new bone was formed in the distraction zone between the separated bone pieces. 5 weeks after distraction phase, 3 implants were placed in each beagle dog. The implants were inserted through transport part and distraction part and inferior basal bone. The animals were sacrificed at 2 weeks, 4 weeks, and 12 weeks after implant placement. BIC and BA of implants on distraction part and transport part were measured histomorphometrically. Results: BIC, BA increased after implant placement as time goes by passes and new bone formation was slightly higher in transport part than in distraction part at 2 weeks, 4 weeks after implant placement. At 12 weeks after implant placement, BIC, BA of were 74%, 61% in transport part and 77%, 59% in distraction part, therefore there were no difference in BIC and BA between transport part and distraction part at 12 weeks after implant placement.