DISTRACTION OSTEOGENESIS VS BSSO

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
...
INTRODUCTION
BSSO and DO are the most common technique

currently applied to correct mandibular retrognathia
But it is t...
AIM OF THE STUDY
Was to review the literature on BSSO and DO for

correction of non-syndromic deficent mandible with
emph...
MATERIALS AND METHODS
Literature from january1995 to august 2006 was
searched on
Mandibular advancement and mandibular sur...
Unfortunately randomized clinical trials are lacking

and thus could not be used as an inclusion criterion
for the litera...
AGE:
DO is more advantageous than BSSO in actively

growing children
Facial growth completion of approximately 98%
occur...
Difficulties of performing BSSO in
younger patients due to:
1)greater bone elasticity
2)thick cortical bone
3)unerupted...
Difficulties of performing DO
1)patient and parent compliance
2)high risk of damaging tooth bud

But DO is easily accomp...
NERVE DAMAGE
Permanent neurosensory disturbance is a common

complication which may be correlated with
age

magnitude of
...
The strech injury from DO beyond the adaptive

capacity of the nerve may result in serious
damage(>7mm)
Therefore distra...
STABILITY AND RELAPSE
Different types of rigid fixation methods are used to

decrease soft tissue tension
Causes of relap...
2)high mandibular plane angle
3)amount of advancement
4)non compliance of patient
5)persistant growth
6)progressive c...
PATIENT CENTERED OUTCOME
Discomfort experienced by patients are1)General anesthesia
2)Post operative diet and weight loss
...
Discomforts in patients during DO:
Routine activities are disturbed during DO.
Duration of hospitalization is less in DO t...
DISCUSSION
DO

BSSO

AGE

early intervention possible
POST SURGICAL
GROWTH
growth seen
NERVE INJURY
with distraction ra...
DO



BSSO

 MANDIBULAR PLANE

ANGLE (MPA)
Normal/low MPA-less relapse(due
to osteotomy cut distal to
pterygomasseteric...
CONCLUSION
Considering the literature available,there is support for

the assumption that DO might have advantages over
B...
www.indiandentalacademy.com
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Distraction osteogenesis versus bsso for advancement of the retrognathic mandible /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

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Distraction osteogenesis versus bsso for advancement of the retrognathic mandible /certified fixed orthodontic courses by Indian dental academy

  1. 1. DISTRACTION OSTEOGENESIS VS BSSO INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. INTRODUCTION BSSO and DO are the most common technique currently applied to correct mandibular retrognathia But it is the responsibility of the maxillofacial surgeon to determine the optimal treatment option in each individual case. www.indiandentalacademy.com
  3. 3. AIM OF THE STUDY Was to review the literature on BSSO and DO for correction of non-syndromic deficent mandible with emphasis on influence of Age Post surgical growth Damage to inf.alv.N Post surgical stability Relapse www.indiandentalacademy.com
  4. 4. MATERIALS AND METHODS Literature from january1995 to august 2006 was searched on Mandibular advancement and mandibular surgery distraction osteogenesis Angle class II child,inferior alveolar nerve,mandibular condyle,retrognathism,stability,TMJ,patient satisfaction. www.indiandentalacademy.com
  5. 5. Unfortunately randomized clinical trials are lacking and thus could not be used as an inclusion criterion for the literature search. The result were classified according to age and post surgical growth,nerve damage,stability and relapse,and patient-centred out come. www.indiandentalacademy.com
  6. 6. AGE: DO is more advantageous than BSSO in actively growing children Facial growth completion of approximately 98% occurs in girls boys 15 yrs 17-18 yrs Above the age of 5 yrs,the basic dentoskeletal morphology is established(almost >97%) www.indiandentalacademy.com
  7. 7. Difficulties of performing BSSO in younger patients due to: 1)greater bone elasticity 2)thick cortical bone 3)unerupted molar 4)lingula-more posterior and superior placement As per studies BSSO may be used as safe technique in growing children with no restrictions on post surgical vertical mandibular growth,but should be applied with caution in youngsters. www.indiandentalacademy.com
  8. 8. Difficulties of performing DO 1)patient and parent compliance 2)high risk of damaging tooth bud But DO is easily accomplished in growing children due to high bone regeneration potential. www.indiandentalacademy.com
  9. 9. NERVE DAMAGE Permanent neurosensory disturbance is a common complication which may be correlated with age magnitude of mandibular advancement Older patientmechanical tearing poor regeneration of axon ischemia by compression of vasa nervosum www.indiandentalacademy.com
  10. 10. The strech injury from DO beyond the adaptive capacity of the nerve may result in serious damage(>7mm) Therefore distraction rate should not exceed 1mm/24hr which may result in either no change in sensation or there may be a short period of decreased function following gradual recovery. After large mandibular advancements in older patients the risk of permanent sensory nerve damage is high in BSSO than in DO www.indiandentalacademy.com
  11. 11. STABILITY AND RELAPSE Different types of rigid fixation methods are used to decrease soft tissue tension Causes of relapse: 1)Anatomic locationa)osteotomy site-slippage of fragment -perimandibular soft tissue tension. b)TMJ-due to condylar malpositioning or resorption www.indiandentalacademy.com
  12. 12. 2)high mandibular plane angle 3)amount of advancement 4)non compliance of patient 5)persistant growth 6)progressive condylar resorption(more in BSSO,but in DO the force of 1mm/day is gradual and resorption is less). BSSO is considered a stable procedure with minimal relapse in patients with normal or decreased facial height,whereas it shows a tendency for relapse in high mandibular plane angle and when advancements>7mm was used. DO showed less relapse after advancement of 10mm or more www.indiandentalacademy.com
  13. 13. PATIENT CENTERED OUTCOME Discomfort experienced by patients are1)General anesthesia 2)Post operative diet and weight loss 3)Absence from work/school 4)Regular check ups 5)Numbness 6)Damage to dentition 7)Swelling,pain,hemorrhage 8)Post surgical infections www.indiandentalacademy.com
  14. 14. Discomforts in patients during DO: Routine activities are disturbed during DO. Duration of hospitalization is less in DO than in BSSO,but DO requires a 2nd surgical intervention for removal of the distraction device. www.indiandentalacademy.com
  15. 15. DISCUSSION DO BSSO AGE early intervention possible POST SURGICAL GROWTH growth seen NERVE INJURY with distraction rate of 0.51mm/day,no long term damage seen with large advancement. www.indiandentalacademy.com only after 12yrs no much growth seen High with age>30yrs &>7mm advancement
  16. 16. DO  BSSO  MANDIBULAR PLANE ANGLE (MPA) Normal/low MPA-less relapse(due to osteotomy cut distal to pterygomasseteric sling & less periosteal stripping.) High MPA-more relapse  AMOUNT OF ADVANCEMENT 10mm or more  PCR Advancement with in the physiological limit-reversible Injury  PATIENT FACTOR More discomfort www.indiandentalacademy.com Normal/low MPA-less relapse High MPA-more relapse 7mm in low to normal MPA High progressive condylar resorption Less discomfort.
  17. 17. CONCLUSION Considering the literature available,there is support for the assumption that DO might have advantages over BSSO in mandibular retrognathism ,in low and normal mandibular plane angle where large advancemnts are needed, since BSSO is associated with nerve injury and relapse. There is need of more randomized clinical trials comparing DO with BSSO in all types of retrognathia inorder to select the type of sugery….. www.indiandentalacademy.com
  18. 18. www.indiandentalacademy.com

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