Distraction osteogenesis /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.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
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Distraction osteogenesis /certified fixed orthodontic courses by Indian dental academy

  1. 1. DISTRACTION OSTEOGENESIS – A FAREWELL TO MAJOR OSTEOTOMIES ? --- Dr. Chetan Jayade Asst. Professor Department of Orthodontics S.D.M. College of Dental Sciences www.indiandentalacademy.com
  2. 2. DISTRACTION OSTEOGENESIS – A FAREWELL TO MAJOR OSTEOTOMIES ? INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. The treatment of craniofacial deformities poses a great challenge to the Orthodontist and the Oral Surgeon alike. www.indiandentalacademy.com
  4. 4. Treatment modalities •Functional appliances in the growing years. •Orthognathic Surgery. www.indiandentalacademy.com
  5. 5. The latest technique for combating the same is a procedure termed “DISTRACTION OSTEOGENESIS” www.indiandentalacademy.com
  6. 6. SCOPE OF THE TALK • A look at the origins of DO • DO in the long bones • DO in the craniofacial region www.indiandentalacademy.com
  7. 7. SCOPE OF THE TALK • Biologic effects of DO • Factors affecting DO • The role of an Orthodontist in DO www.indiandentalacademy.com
  8. 8. DISTRACTION OSTEOGENESIS (Transosseous synthesis) (Osteodistraction) DEFINITION: A process of new bone formation between the surfaces of bone segments gradually incremental traction seperated by - COPE (1999) www.indiandentalacademy.com
  9. 9. DISTRACTION OSTEOGENESIS Steps involved : a) Corticotomy/Osteotomy b) Latency period Rate c) Distraction phase Rhythm d) Consolidation phase www.indiandentalacademy.com
  10. 10. DISTRACTION OSTEOGENESIS Steps involved : www.indiandentalacademy.com
  11. 11. DISTRACTION OSTEOGENESIS Steps involved : a) Corticotomy/Osteotomy : A low energy osteotomy of the cortex preserving the local blood supply to both the cortex and the medullary canal. www.indiandentalacademy.com
  12. 12. DISTRACTION OSTEOGENESIS Steps involved : b) Latency period : The time following the osteotomy when initial fracture healing bridges the cut bone prior to initiating the distraction. www.indiandentalacademy.com
  13. 13. DISTRACTION OSTEOGENESIS Steps involved : c) Distraction phase : i) Rate – the number of millimeters/day at which the bone surfaces are stretched. ii) Rhythm – The number of incremental distractions per day. www.indiandentalacademy.com
  14. 14. DISTRACTION OSTEOGENESIS Steps involved : d) Consolidation phase : The time following distraction, for which the device is stabilized. www.indiandentalacademy.com
  15. 15. DISTRACTION HISTOGENESIS The sequence of adaptive changes in the soft tissues, adjacent to the distracted segments. Healing Index: The number of days or months from the surgery to full, unprotected load bearing for each centimeter of bone length. www.indiandentalacademy.com
  16. 16. DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE • ALESSANDRO CODIVILLA – 1905 • LEROY ABBOT – 1927 www.indiandentalacademy.com
  17. 17. DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE ALESSANDRO CODIVILLA – 1905 www.indiandentalacademy.com
  18. 18. DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE LEROY ABBOT – 1927 www.indiandentalacademy.com
  19. 19. DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE KAZANJIAN -- 1937 www.indiandentalacademy.com
  20. 20. DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE Problems with the earlier attempts: a) Lack of control of the bone segments b) Inadequacy of the appliances c) Instability of fixation and complications www.indiandentalacademy.com
  21. 21. DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE GAVRIIL ILIZAROV (1951) rejuvenated the procedure when he accidentally found that new bone growth was possible. www.indiandentalacademy.com
  22. 22. DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE Theories favouring Compression in Bone healing: i. Roux’s hypothesis ii. Wolff’ doctrine iii. Huter-Volkmann theory www.indiandentalacademy.com
  23. 23. DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE ILIZAROV’S TECHNIQUE Foundations laid via rigorous experimentation a) Dog experiments (Long bones)– 7 groups • Group I,II and III differed in the type of fixation • Group IV and V in the amount of marrow • Group VI and VII distraction underwent transverse www.indiandentalacademy.com
  24. 24. DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE ILIZAROV’S TECHNIQUE Foundations laid via rigorous experimentation b) Dog experiments (Membrane bones) Distraction results were similar to that seen in the long bones. www.indiandentalacademy.com
  25. 25. DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE ILIZAROV’S TECHNIQUE Membrane bone experiment www.indiandentalacademy.com
  26. 26. DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE ILIZAROV’S TECHNIQUE • Limb lengthening procedures • Correction of angular deformities • Repair of fracture, mal-union • Miscellaneous www.indiandentalacademy.com
  27. 27. DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE ILIZAROV’S EXTERNAL RING FIXATOR www.indiandentalacademy.com
  28. 28. DISTRACTION OSTEOGENESIS ILIZAROV’S CRITERIA a) Surgical procedure must involve minimum marrow; hence, corticotomy preferred. b) Fixity of the device: Rigid fixation is a must. c) Rate: Optimal to be 1 mm per day d) Rhythm: Optimum of 2-4 activations/day www.indiandentalacademy.com
  29. 29. DISTRACTION OSTEOGENESIS THE TENSION-STRESS EFFECT The histologic evidences of Ilizarov’s work form the basis of distraction procedures in any part of the body. These histologic findings were coined by Ilizarov as the ‘Tension-Stress’ effect. www.indiandentalacademy.com
  30. 30. DISTRACTION OSTEOGENESIS THE TENSION-STRESS EFFECT FZ- Fibrous Inter-zone MZ- Mineralising Zone www.indiandentalacademy.com
  31. 31. DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE SNYDER (1972,73) resected a dog mandible and performed distraction successfully. 10 week healing period followed by distraction of 1mm/day for 14 days. MICHELLI and MIOTI (1977) and PANIKAROVSKI (1982)carried out modified experiments in the canine mandibles www.indiandentalacademy.com
  32. 32. DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE Mc’Carthy– (1989) conducted the first reported human trial of craniofacial distraction using external fixators. www.indiandentalacademy.com
  33. 33. DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE 4 children with craniofacial anomalies subjected to a distraction protocol of three weeks followed by a 8-10 consolidation. were upto week Long-term studies of the same patients indicate a successful result. www.indiandentalacademy.com
  34. 34. DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE MOLINA and ORTIZ MONASTERIO(1995) used bidirectional appliances Mc’CARTHY demonstrated the efficacy of a mulitdirectional appliance. GUERRERO (1990) used an intra-oral appliance to widen mandibular arches. www.indiandentalacademy.com
  35. 35. DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE Evolution of distraction appliances www.indiandentalacademy.com
  36. 36. DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE GUERRERO –Intra-oral devices www.indiandentalacademy.com
  37. 37. DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE www.indiandentalacademy.com
  38. 38. DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE Midface distraction – RACHMIEL (1993) carried out midface distraction on sheep www.indiandentalacademy.com
  39. 39. DISTRACTION OSTEOGENESIS A BIRD’S EYE-VIEW THE ORIGINS AND EVOLUTION OF DO IN THE CRANIOFACIAL REGION a) Phase of traction without surgery b) Upsurge in limb-lengthening procedures c) Progression from Extra-oral Unidirectional to Extra-oral Multidirectional distraction. www.indiandentalacademy.com
  40. 40. DISTRACTION OSTEOGENESIS A BIRD EYE-VIEW THE ORIGINS AND EVOLUTION OF DO IN THE CRANIOFACIAL REGION d) Progression from extra-oral to intraoral devices e) Progression from manual devices to motorized devices f) Progression from the removable fixators to biodegradable fixators www.indiandentalacademy.com
  41. 41. DISTRACTION OSTEOGENESIS CURRENT SCOPE OF DO  Correction of Maxillo-Mandibular deformities a) Maxillary lengthening b) Mandibular lengthening c) Maxillary and Mandibular widening d) Lengthening of the Hard palate e) Distraction in other cranio-facial areas. www.indiandentalacademy.com
  42. 42. DISTRACTION OSTEOGENESIS CURRENT SCOPE OF DO  Alveolar ridge augmentation  Transport disc osteogenesis. and  Dental Distraction. www.indiandentalacademy.com Transformation
  43. 43. DISTRACTION OSTEOGENESIS CURRENT SCOPE OF DO  Alveolar ridge augmentation www.indiandentalacademy.com
  44. 44. DISTRACTION OSTEOGENESIS TRANSFORMATION OSTEOGENESIS The conversion of non-osseous interpositions into normal bone by combined compression and traction forces, sometimes augmented by a nearby corticotomy. www.indiandentalacademy.com
  45. 45. DISTRACTION OSTEOGENESIS BONE TRANSPORTATION The regeneration of intercalary bone defects by combined distraction and transformation osteogenesis. i. Bifocal transportation ii. Trifocal transportation www.indiandentalacademy.com
  46. 46. DISTRACTION OSTEOGENESIS BONE TRANSPORTATION www.indiandentalacademy.com
  47. 47. DISTRACTION OSTEOGENESIS BONE TRANSPORTATION www.indiandentalacademy.com
  48. 48. DISTRACTION OSTEOGENESIS TISSUE CHANGES FOLLOWING DO a. Skeletal changes – Formation of Regenerate b. Soft tissue adaptations Histogenesis www.indiandentalacademy.com – Distraction
  49. 49. DISTRACTION OSTEOGENESIS TISSUE CHANGES FOLLOWING DO HISTOLOGIC CHANGES • During latency phase – formation of a fibrous bridge. • During distraction phase – distinct zones seen www.indiandentalacademy.com
  50. 50. DISTRACTION OSTEOGENESIS TISSUE CHANGES FOLLOWING DO BIOCHEMICAL FEATURES OF REGENERATE • Increased levels of alkaline phosphate, pyruvic acid. • TGF- Beta 1 levels increase upto the consolidation phase; Osteocalcin after the consolidation phase. www.indiandentalacademy.com
  51. 51. DISTRACTION OSTEOGENESIS TISSUE CHANGES FOLLOWING DO DISTRACTION HISTOGENESIS Sinusoidal • Neovascularization • Neomyogenesis Transport Atrophy seen is transient www.indiandentalacademy.com
  52. 52. DISTRACTION OSTEOGENESIS TISSUE CHANGES FOLLOWING DO DISTRACTION HISTOGENESIS • Nerve growth as during embryogenesis was reported by Ilizarov. • However, studies by Block and Ippolito have shown mild nerve injury due to stretching www.indiandentalacademy.com
  53. 53. DISTRACTION OSTEOGENESIS TISSUE CHANGES FOLLOWING DO DISTRACTION HISTOGENESIS • Mild pathoogic changes have been reported on the TMJ by a few authors like Mc’Carthy. These are again reversible with time www.indiandentalacademy.com
  54. 54. DISTRACTION OSTEOGENESIS FACTORS AFFECTING DO Biologic Biomechanical www.indiandentalacademy.com
  55. 55. DISTRACTION OSTEOGENESIS FACTORS AFFECTING DO BIOLOGIC FACTORS • AGE • SITE OF SURGERY • LATENCY PERIOD • RATE AND RYTHM www.indiandentalacademy.com
  56. 56. DISTRACTION OSTEOGENESIS FACTORS AFFECTING DO BIOLOGIC FACTORS • Increased micromotion by increasing rhythm causes increased vasculogenesis and enzymes and decreases the tissue damage and the degenerative changes www.indiandentalacademy.com
  57. 57. DISTRACTION OSTEOGENESIS FACTORS AFFECTING DO CONSOLIDATION PHASE Assessment of new bone is by: I. Plain radiography ii. Quantitaive Computed Tomography (QCT) iii. Ultrasonography iv. Dual energy X-ray absorptimetry www.indiandentalacademy.com
  58. 58. DISTRACTION OSTEOGENESIS CONSOLIDATION PHASE Assessment of new bone by Plain radiography www.indiandentalacademy.com
  59. 59. DISTRACTION OSTEOGENESIS FACTORS AFFECTING DO CONSOLIDATION PHASE Clinical assessment of consolidation • Distraction Consolidation index This however, is applicable to the long bones. • 6-8 weeks optimal in the craniofacial region – SACHDEVA, COPE (1999,2000) www.indiandentalacademy.com
  60. 60. DISTRACTION OSTEOGENESIS FACTORS AFFECTING DO BIOMECHANICAL FACTORS • Planning the distraction vector • Device fixity • Need for ‘ Bone moulding’ www.indiandentalacademy.com
  61. 61. DISTRACTION OSTEOGENESIS PLANNING THE DISTRACTION VECTOR VERTICAL HORIZONTAL www.indiandentalacademy.com OBLIQUE
  62. 62. DISTRACTION OSTEOGENESIS PLANNING THE DISTRACTION VECTOR www.indiandentalacademy.com
  63. 63. DISTRACTION OSTEOGENESIS BIOMECHANICAL EFFECTS OF THE DISTRACTION VECTOR www.indiandentalacademy.com
  64. 64. DISTRACTION OSTEOGENESIS Mandibular Distraction INDICATIONS: Hemifacial Microsomia Treacher Collin Syndrome etc. TMJ ankylosis and condylar fractures Transverse deficiency of the mandible www.indiandentalacademy.com
  65. 65. DISTRACTION OSTEOGENESIS MANDIBULAR DISTRACTION www.indiandentalacademy.com
  66. 66. DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
  67. 67. DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
  68. 68. DISTRACTION OSTEOGENESIS MANDIBULAR DISTRACTION Intra-oral Devices www.indiandentalacademy.com
  69. 69. DISTRACTION OSTEOGENESIS MANDIBULAR DISTRACTION Intra-oral Devices www.indiandentalacademy.com
  70. 70. DISTRACTION OSTEOGENESIS MANDIBULAR DISTRACTION www.indiandentalacademy.com
  71. 71. DISTRACTION OSTEOGENESIS MAXILLARY DISTRACTION TOTH – Le-Fort III osteotomy www.indiandentalacademy.com
  72. 72. DISTRACTION OSTEOGENESIS MAXILLARY DISTRACTION www.indiandentalacademy.com
  73. 73. DISTRACTION OSTEOGENESIS MAXILLARY DISTRACTION www.indiandentalacademy.com
  74. 74. DISTRACTION OSTEOGENESIS MAXILLARY DISTRACTION www.indiandentalacademy.com
  75. 75. DISTRACTION OSTEOGENESIS MAXILLARY DISTRACTION www.indiandentalacademy.com
  76. 76. DISTRACTION OSTEOGENESIS MAXILLARY DISTRACTION www.indiandentalacademy.com
  77. 77. DISTRACTION OSTEOGENESIS DENTAL DISTRACTION www.indiandentalacademy.com
  78. 78. DISTRACTION OSTEOGENESIS DENTAL DISTRACTION www.indiandentalacademy.com
  79. 79. DISTRACTION OSTEOGENESIS TOOTH MOVEMENT THROUGH REGENERATE The earlier views suggested that tooth movement should not be initiated into the regenerate. Present views as supported by Liou and Cope point out to the possibility of initiating tooth movement immediately after or even during the distraction period. www.indiandentalacademy.com
  80. 80. DISTRACTION OSTEOGENESIS Our experiences with distraction www.indiandentalacademy.com
  81. 81. DISTRACTION OSTEOGENESIS Our experiences with distraction www.indiandentalacademy.com
  82. 82. DISTRACTION OSTEOGENESIS Our experiences with distraction www.indiandentalacademy.com
  83. 83. DISTRACTION OSTEOGENESIS Our experiences with distraction www.indiandentalacademy.com
  84. 84. DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
  85. 85. DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
  86. 86. DISTRACTION OSTEOGENESIS Our experiences with distraction www.indiandentalacademy.com
  87. 87. DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
  88. 88. DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
  89. 89. DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
  90. 90. DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
  91. 91. DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
  92. 92. DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
  93. 93. DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
  94. 94. DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
  95. 95. DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
  96. 96. DISTRACTION OSTEOGENESIS The Orthodontist’s role a. Decompensation of the dentition b. Planning the distraction vector c. Bone Moulding using intermaxillary elastics Functional d. Post-distraction Orthodontics www.indiandentalacademy.com Fixed
  97. 97. DISTRACTION OSTEOGENESIS Currently Unresolved issues a. Effects of distraction on growth b. Limits of distraction osteogenesis c. Effects of distraction on eruption and movement of teeth. d. Long term stability of regenerate bone. www.indiandentalacademy.com
  98. 98. DISTRACTION OSTEOGENESIS Directions for the future a. Refinements in the distraction protocol b. Improvement in distraction devices c. Enhancement of regenerate maturation www.indiandentalacademy.com
  99. 99. www.indiandentalacademy.com
  100. 100. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com
  101. 101. www.indiandentalacademy.com
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