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Distraction osteogenesis /certified fixed orthodontic courses by Indian dental academy
 

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
0091-9248678078

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    Distraction osteogenesis /certified fixed orthodontic courses by Indian dental academy Distraction osteogenesis /certified fixed orthodontic courses by Indian dental academy Presentation Transcript

    • 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
    • DISTRACTION OSTEOGENESIS – A FAREWELL TO MAJOR OSTEOTOMIES ? INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    • The treatment of craniofacial deformities poses a great challenge to the Orthodontist and the Oral Surgeon alike. www.indiandentalacademy.com
    • Treatment modalities •Functional appliances in the growing years. •Orthognathic Surgery. www.indiandentalacademy.com
    • The latest technique for combating the same is a procedure termed “DISTRACTION OSTEOGENESIS” www.indiandentalacademy.com
    • SCOPE OF THE TALK • A look at the origins of DO • DO in the long bones • DO in the craniofacial region www.indiandentalacademy.com
    • SCOPE OF THE TALK • Biologic effects of DO • Factors affecting DO • The role of an Orthodontist in DO www.indiandentalacademy.com
    • 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
    • DISTRACTION OSTEOGENESIS Steps involved : a) Corticotomy/Osteotomy b) Latency period Rate c) Distraction phase Rhythm d) Consolidation phase www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS Steps involved : www.indiandentalacademy.com
    • 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
    • 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
    • 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
    • DISTRACTION OSTEOGENESIS Steps involved : d) Consolidation phase : The time following distraction, for which the device is stabilized. www.indiandentalacademy.com
    • 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
    • DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE • ALESSANDRO CODIVILLA – 1905 • LEROY ABBOT – 1927 www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE ALESSANDRO CODIVILLA – 1905 www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE LEROY ABBOT – 1927 www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE KAZANJIAN -- 1937 www.indiandentalacademy.com
    • 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
    • DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE GAVRIIL ILIZAROV (1951) rejuvenated the procedure when he accidentally found that new bone growth was possible. www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE Theories favouring Compression in Bone healing: i. Roux’s hypothesis ii. Wolff’ doctrine iii. Huter-Volkmann theory www.indiandentalacademy.com
    • 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
    • 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
    • DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE ILIZAROV’S TECHNIQUE Membrane bone experiment www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE ILIZAROV’S TECHNIQUE • Limb lengthening procedures • Correction of angular deformities • Repair of fracture, mal-union • Miscellaneous www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE ILIZAROV’S EXTERNAL RING FIXATOR www.indiandentalacademy.com
    • 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
    • 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
    • DISTRACTION OSTEOGENESIS THE TENSION-STRESS EFFECT FZ- Fibrous Inter-zone MZ- Mineralising Zone www.indiandentalacademy.com
    • 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
    • DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE Mc’Carthy– (1989) conducted the first reported human trial of craniofacial distraction using external fixators. www.indiandentalacademy.com
    • 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
    • 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
    • DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE Evolution of distraction appliances www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE GUERRERO –Intra-oral devices www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS HISTORICAL PERSPECTIVE Midface distraction – RACHMIEL (1993) carried out midface distraction on sheep www.indiandentalacademy.com
    • 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
    • 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
    • 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
    • DISTRACTION OSTEOGENESIS CURRENT SCOPE OF DO  Alveolar ridge augmentation  Transport disc osteogenesis. and  Dental Distraction. www.indiandentalacademy.com Transformation
    • DISTRACTION OSTEOGENESIS CURRENT SCOPE OF DO  Alveolar ridge augmentation www.indiandentalacademy.com
    • 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
    • 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
    • DISTRACTION OSTEOGENESIS BONE TRANSPORTATION www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS BONE TRANSPORTATION www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS TISSUE CHANGES FOLLOWING DO a. Skeletal changes – Formation of Regenerate b. Soft tissue adaptations Histogenesis www.indiandentalacademy.com – Distraction
    • 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
    • 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
    • DISTRACTION OSTEOGENESIS TISSUE CHANGES FOLLOWING DO DISTRACTION HISTOGENESIS Sinusoidal • Neovascularization • Neomyogenesis Transport Atrophy seen is transient www.indiandentalacademy.com
    • 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
    • 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
    • DISTRACTION OSTEOGENESIS FACTORS AFFECTING DO Biologic Biomechanical www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS FACTORS AFFECTING DO BIOLOGIC FACTORS • AGE • SITE OF SURGERY • LATENCY PERIOD • RATE AND RYTHM www.indiandentalacademy.com
    • 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
    • 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
    • DISTRACTION OSTEOGENESIS CONSOLIDATION PHASE Assessment of new bone by Plain radiography www.indiandentalacademy.com
    • 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
    • DISTRACTION OSTEOGENESIS FACTORS AFFECTING DO BIOMECHANICAL FACTORS • Planning the distraction vector • Device fixity • Need for ‘ Bone moulding’ www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS PLANNING THE DISTRACTION VECTOR VERTICAL HORIZONTAL www.indiandentalacademy.com OBLIQUE
    • DISTRACTION OSTEOGENESIS PLANNING THE DISTRACTION VECTOR www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS BIOMECHANICAL EFFECTS OF THE DISTRACTION VECTOR www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS Mandibular Distraction INDICATIONS: Hemifacial Microsomia Treacher Collin Syndrome etc. TMJ ankylosis and condylar fractures Transverse deficiency of the mandible www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS MANDIBULAR DISTRACTION www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS MANDIBULAR DISTRACTION Intra-oral Devices www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS MANDIBULAR DISTRACTION Intra-oral Devices www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS MANDIBULAR DISTRACTION www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS MAXILLARY DISTRACTION TOTH – Le-Fort III osteotomy www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS MAXILLARY DISTRACTION www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS MAXILLARY DISTRACTION www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS MAXILLARY DISTRACTION www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS MAXILLARY DISTRACTION www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS MAXILLARY DISTRACTION www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS DENTAL DISTRACTION www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS DENTAL DISTRACTION www.indiandentalacademy.com
    • 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
    • DISTRACTION OSTEOGENESIS Our experiences with distraction www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS Our experiences with distraction www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS Our experiences with distraction www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS Our experiences with distraction www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS Our experiences with distraction www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
    • DISTRACTION OSTEOGENESIS www.indiandentalacademy.com
    • 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
    • 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
    • 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
    • www.indiandentalacademy.com
    • Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com
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