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Dentoalveolar distraction cochi ida
- 1. Dr Arun George MDS Oral & Maxillofacial Surgeon India drarun1g@gmail.com Rapid Canine Distalisation
- 2. Definition • A PROCESS OF NEW BONE FORMATION BETWEEN THE SURFACES OF BONE SEGMENTS GRADUALLY SEPARATED BY INCREMENTAL TRACTION. …basics, what is it ???
- 3. 1992, McCarthy 1951- Ilizarov Chin & Toth (1996): Kisnisci et al and Iseri et al (2002)
- 4. Literature Review and need of DAD
- 5. • Orthodontic tooth movement rate= 1mm a month • Dentoalveolar Distraction movement rate= 1mm a day Orthodontics movement Vs Distraction
- 6. Bimax protrusion Anterior Crowding FOT with first premolar Extraction and Canine Retraction Minimum anchorage loss When we do canine distraction ?
- 7. Ilizarov’s – “Siberian surgical technique” Latency phase Initial migration of connective tissue into the osteotomy site in which occurs to re-establish the continuity of soft tissue covering. Distraction phase Gradual incremental separation of two bone pieces at a rate of 0.8-1mm/day Consolidation phase New bone is formed in the regenerate zone …osteoid tissue is laid down between the bone ends . distraction regenerates, mineralizes and achieves functional activity…. Maturation of regenerated bone.
- 8. Keyed in for success…… •stability of the distractor •observing adequate latency period •proper rate and rhythm of the distraction process •allowing for a consolidation periods
- 9. Horizontal Alveolar Distraction Osteogenesis The objectives of this portion of the study was to achieve rapid canine distalization by segmental horizontal alveolar distraction. Materials and methods - 10 teeth in three patients … whose orthodontic treatment required extraction of the upper and lower first pre molar. Results- Duration – 8 to 12 days Distal displacement – 6 to 8 mm
- 10. Custom made semi-rigid distraction device Canine Distractor screw with molar and canine bands
- 11. Protocol• Latency – 3-7 days •Rate of distraction was 0.4 mm – twice daily Distraction Phase averaged at 10-12 days. Orthodontic treatment started following the Consolidation Phase ? Orthodontic movement can be as fast as 1.2 mm a week
- 12. Dento alveolar distraction …surgery to scale
- 13. Surgical procedure Crevicular incision and mucoperiosteal flap was elevated Vertical Osteotomy cut made surrounding the canine Pre molar extracted after the Osteotomy cut Depth of the pre molar socket increased Bony interferences eliminated Intra oral distraction device fixation and the dento alveolar segment was mobilized.
- 15. Pat Patient - 1n -2,Nargis 28/ F
- 16. Patient - 1
- 17. Patient -2, 18/f
- 18. …18/f
- 19. Patient -3, 22/f
- 20. Advantages Overall treatment time is reduced to 50 % 0.8 mm movement a day Anterior segment can be retracted simultaniously using Zygoma Implants Over all treatment time could be reduced to 5 months.
- 21. Results Patient Teeth Movement achieved 1 13, 23 13- 7mm , 23- 8mm Latency period – 6 days , DO @ 0.4mm– twice daily, 12 days. Patient Teeth Movement achieved 2 13, 23, 33, 43 13- 8mm , 23- 7mm , 33- 8mm, 43- 9mm Latency period - 6 days , DO @ 0.4mm- twice daily,13 days. Patient Teeth Movement achieved 1 13, 23 13- 7mm , 23- 8mm Latency period – 6 days , DO @ 0.4mm– twice daily. 2 13, 23, 33, 43 13- 8mm , 23- 7mm , 33- 8mm, 43- 9mm Latency period - 6 days , DO @ 0.4mm- twice daily. 3 13, 23, 33, 43 13- 7 mm, 23- 8mm, 33- 9mm, 43- 7mm Latency period – 6 days , DO @ 0.4mm twice daily.
- 22. Radiographs
- 23. Frequent appointments Gingival recession Extrusion of teeth Delayed thermal response Tooth Out of the arch Pain Distractor Loosening Bulky Appliance Pit Falls
- 24. Future Distractors Bioresorable distraction appliances (inside –resorable part & out side tissue – detachable metal part ) Flexible Distracters (rigid part – inside & flexible spring like outside ) Micro incremental motor driven devices Hydraulic devices and magnetic devices
- 26. Thank You
Editor's Notes
- Minimizing the orthodontic treatment time and controlling the anchorage loss are always aims of research.
- Formation of new bone is achieved by the Callus stretching. After osteotomy is performed, a hematoma begins to organize in the latency period. Pluripotential mesenchymal cells are activated into fibroblasts and osteoblasts, and type I collagen is laid down parallel to the vector of distraction. Bony trabeculae grow into the fibrous area from the periphery, parallel to the line of tension that occurs during the distraction phase. A bridge of immature bone forms across the distraction gap. During the consolidation phase, bony remodeling begins. The regenerate eventually matures into osseous tissue similar to the native bone. Soft tissue also has the ability to grow linearly along lines of tension. This is referred to as distraction histogenesis. Skin, muscle, nerves, and vascular tissue are generated, not stretched. The advantage is obvious, especially for severe retrognathia, in which the stretched soft tissue envelope can contribute to relapse when a traditional mandibular osteotomy is performed for a large (>10 mm) advancement.
- Circa 1951- Ilizarov developed a technique for repairing complex fractures or non unions of the long bones. While treating a patient with a short amputation stump, Ilizarov performed an osteotomy and applied an external fixator to lengthen the stump with the intention of placing a bone graft. However, by chance, he discovered that the bone grew in the distraction gap, eliminating the need for a bone graft . Distraction osteogenesis decreases the need for bone grafting for large (>10 mm) mandibular advancements; one can achieve 20 mm or more of advancement without a bone graft and the associated donor site morbidity, scarring, and potential for infection
- Rapid Canine distalisation gained significance importance for the last decade because it reduces time needed for canine distalisation and reduces the anchorage loss.Lieu and Huang reported the first canine distalisation using periodontal traction. Osman (2006) reported a case with bimaxillary protrusion which requires all 4 extraction and retraction by combining with Zygoma implants anchorage and canine distraction were the treatment time is reduced to 6 months. Following the distraction consolidation period is 2 months.
- Distraction osteogenesis appears to have a decreased potential for relapse, especially with large advancements.
- DAD is primarily indicated in adults presenting bimaxillary protrusion with maxillary dentoalveolar excess or anterior crowding.
- The traditional latency period is 5-7 days. Young children have an increased bone metabolism and may have a latency period as short as 24-48 hours, without affecting ultimate consolidation. Waiting too long increases the risk of bony union; waiting 7 days is advised if the periosteum is excessively traumatized. In addition, if both hard tissue and soft tissue are less than ideal in quality or quantity, increasing the latency period may be considered. According to most study results, the recommended rate of distraction is 1 mm/d. A slower rate could result in premature bony union, whereas a faster rate could result in a fibrous union. The inferior alveolar nerve seems to tolerate a distraction rate of 1 mm/d. Ilizarov recommended a continuous rhythm for distraction; however, this is not feasible in the clinical setting, so a rhythm of 1-2 times per day is recommended. The surgeon or a responsible adult should activate the appliance. During a bilateral mandibular advancement, an anterior open bite tends to develop; this can be corrected at the end of advancement with orthodontic elastics. The consolidation phase is typically 8 weeks, although some adults may require up to 12 weeks of consolidation. During this phase, the fixation must be rigid enough to prevent the formation of fibrous tissue but not too rigid to prevent physiologic loading of the new bone. The formation of the regenerate can be monitored with serial radiographs or CT scans.
- Gingival recession and mobilyty of the teeth Extrusion of teeth Delayed thermal response Appliance Failure Tooth Moving Out of the arch Pain, Distractor Loosening Flap Dehiscence Bulky Appliance Swelling