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.for more details please visit
www.indiandentalacademy.com
Distraction osteogenesis of craniofacial regionKunaal Agrawal
The document provides an overview of distraction osteogenesis (DO). It discusses the historical origins and development of DO, from Hippocrates applying traction on broken bones to Ilizarov's modern principles of bone regeneration through gradual traction. The biological basis and phases of DO are explained, including fracture/osteotomy, latency period, distraction period, and consolidation period. Each phase is accompanied by the histological and cellular processes involved in regenerating new bone through gradual traction rather than acute advancement. The document serves as an introduction to DO and its application in craniofacial reconstruction.
The document discusses distraction osteogenesis, which is a technique for regenerating bone and soft tissue by gradually separating bone segments that have been surgically cut. It describes the history, biological process, phases involving surgery, latency period and distraction period, factors to consider like rate and rhythm of distraction, applications for maxillofacial deficiencies and reconstruction, and techniques involved. Distraction osteogenesis is an alternative to orthognathic surgery that allows for gradual adjustment of bony and soft tissues.
This document discusses recent advances in orthognathic surgery, including mock surgery software and 3D planning tools. It describes how mock surgery on dental casts allows simulation of surgical movements. Nemoceph and Dolphin software integrate bite registration data, laser scans, and CT scans to create 3D reconstructions for virtual planning and mock surgery. The Orthognathic Positioning System uses reference landmarks and a digitally-fabricated splint to transfer the virtual surgical plan to the operating field, aiding in precise repositioning of osteotomized segments. Stereolithography is used to create skulls and splints for planning. These advances enhance accuracy, reliability and precision in orthognathic surgery.
This document provides an overview of distraction osteogenesis. It discusses the history of distraction techniques dating back to the early 1900s. It then covers the indications, contraindications, advantages, and disadvantages of distraction osteogenesis. The document explains the biology and phases of distraction osteogenesis including osteotomy, latency, distraction, consolidation, and remodeling. It discusses variables in the distraction phase such as rate and rhythm. Overall, the document provides a high-level summary of distraction osteogenesis techniques and processes.
Distraction Osteogenesis of Craniofacial RegionSuresh Menon
This document provides an overview of distraction osteogenesis including:
1. The definition, history, and biology of distraction osteogenesis.
2. The types of devices used, factors influencing success, and indications.
3. Details on the diagnosis, treatment planning, vector planning, and role of orthodontics.
4. Specific applications for mandibular and midface distraction are discussed.
This document discusses distraction osteogenesis, a technique used to lengthen bones by gradual separation of surgically cut bone segments. It originated for treating leg length discrepancies and was later used for craniofacial bones. The key steps are cutting the bone, applying distraction forces slowly over 1-2mm per day in two sessions, allowing new bone formation in the gap. This immature bone then remodels into mature bone over 4-6 weeks of consolidation. Distraction osteogenesis is now commonly used as an alternative to orthognathic surgery for treating craniofacial abnormalities.
Distraction Osteogenesis in OrthodonticsWaqar Jeelani
Distraction osteogenesis is a surgical technique that involves gradually separating bone segments that have been cut. This causes new bone to form in between the segments. There are several phases to this process including latency, distraction, consolidation, and remodeling. Historically, Codivilla first reported limb lengthening in 1905 but it was Ilizarov who developed the technique in the 1950s using gradual distraction. Since then it has been used for many purposes like lengthening the mandible to treat deficiencies. Planning involves factors like the distraction device used, bone quality, and distractor orientation. It can have advantages over other techniques like allowing for more correction and growing tissues with the patient.
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.for more details please visit
www.indiandentalacademy.com
Distraction osteogenesis of craniofacial regionKunaal Agrawal
The document provides an overview of distraction osteogenesis (DO). It discusses the historical origins and development of DO, from Hippocrates applying traction on broken bones to Ilizarov's modern principles of bone regeneration through gradual traction. The biological basis and phases of DO are explained, including fracture/osteotomy, latency period, distraction period, and consolidation period. Each phase is accompanied by the histological and cellular processes involved in regenerating new bone through gradual traction rather than acute advancement. The document serves as an introduction to DO and its application in craniofacial reconstruction.
The document discusses distraction osteogenesis, which is a technique for regenerating bone and soft tissue by gradually separating bone segments that have been surgically cut. It describes the history, biological process, phases involving surgery, latency period and distraction period, factors to consider like rate and rhythm of distraction, applications for maxillofacial deficiencies and reconstruction, and techniques involved. Distraction osteogenesis is an alternative to orthognathic surgery that allows for gradual adjustment of bony and soft tissues.
This document discusses recent advances in orthognathic surgery, including mock surgery software and 3D planning tools. It describes how mock surgery on dental casts allows simulation of surgical movements. Nemoceph and Dolphin software integrate bite registration data, laser scans, and CT scans to create 3D reconstructions for virtual planning and mock surgery. The Orthognathic Positioning System uses reference landmarks and a digitally-fabricated splint to transfer the virtual surgical plan to the operating field, aiding in precise repositioning of osteotomized segments. Stereolithography is used to create skulls and splints for planning. These advances enhance accuracy, reliability and precision in orthognathic surgery.
This document provides an overview of distraction osteogenesis. It discusses the history of distraction techniques dating back to the early 1900s. It then covers the indications, contraindications, advantages, and disadvantages of distraction osteogenesis. The document explains the biology and phases of distraction osteogenesis including osteotomy, latency, distraction, consolidation, and remodeling. It discusses variables in the distraction phase such as rate and rhythm. Overall, the document provides a high-level summary of distraction osteogenesis techniques and processes.
Distraction Osteogenesis of Craniofacial RegionSuresh Menon
This document provides an overview of distraction osteogenesis including:
1. The definition, history, and biology of distraction osteogenesis.
2. The types of devices used, factors influencing success, and indications.
3. Details on the diagnosis, treatment planning, vector planning, and role of orthodontics.
4. Specific applications for mandibular and midface distraction are discussed.
This document discusses distraction osteogenesis, a technique used to lengthen bones by gradual separation of surgically cut bone segments. It originated for treating leg length discrepancies and was later used for craniofacial bones. The key steps are cutting the bone, applying distraction forces slowly over 1-2mm per day in two sessions, allowing new bone formation in the gap. This immature bone then remodels into mature bone over 4-6 weeks of consolidation. Distraction osteogenesis is now commonly used as an alternative to orthognathic surgery for treating craniofacial abnormalities.
Distraction Osteogenesis in OrthodonticsWaqar Jeelani
Distraction osteogenesis is a surgical technique that involves gradually separating bone segments that have been cut. This causes new bone to form in between the segments. There are several phases to this process including latency, distraction, consolidation, and remodeling. Historically, Codivilla first reported limb lengthening in 1905 but it was Ilizarov who developed the technique in the 1950s using gradual distraction. Since then it has been used for many purposes like lengthening the mandible to treat deficiencies. Planning involves factors like the distraction device used, bone quality, and distractor orientation. It can have advantages over other techniques like allowing for more correction and growing tissues with the patient.
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.for more details please visit
www.indiandentalacademy.com
The document discusses different types of bone grafts. Autografts, which are bone grafts taken from one site of a patient's own body and transplanted to another site, are still considered the best option. Autografts can incorporate, revascularize, and withstand mechanical stresses well over time. Allografts, which are bone grafts transplanted between two genetically unrelated individuals of the same species, are becoming more widely accepted but do not completely vascularize. A variety of graft forms and sources are discussed including cortical, cancellous, corticocancellous grafts as well as some newer options like vascularized grafts.
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.for more details please visit
www.indiandentalacademy.com
This document provides information on onlay bone grafts, including definitions, classifications, sources, types, structure, indications, and surgical protocols. An onlay bone graft is a graft where transplanted tissue is laid directly onto the surface of recipient bone. Sources include intraoral sites like the mandibular ramus and symphysis, as well as extraoral sites like the calvarium and iliac crest. Surgical protocols are described for harvesting bone grafts from various donor sites and performing onlay grafting procedures. Complications and bone healing are also briefly discussed.
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.for more details please visit
www.indiandentalacademy.com
Distraction osteogenesis in orthodontics -Dr.G V SHETTYDr.G.V SHETTY
DISTRACTION IN ORTHODONTICS IMPLICATIONS
ROLE OF ORTHODONTIST IN MANAGEMENT OF SEVERE MAXILLOMANDIBULAR OR OROFACIAL DISCREPANCY
SCOPE OF DISTRACTION OSTEOGENESIS
What is fixation?
Fixation in orthopedics is the process by which an injury is rendered immobile. This may be accomplished by internal fixation, or by external fixation.
What is internal fixation?
Internal fixation is an operation in orthopedics that involves the surgical implementation of implants for the purpose of repairing a bone
Rigid internal fixation refers to the direct method of fracture fixation where the hardware or implant used for fixation provides sufficient rigidity for the jawbone to withstand masticatory stresses.
Avoids immobilization by MMF
Does not allow micromotion of fracture segments
Goals of AO/ASIF technique for rigid fixation
Anatomic reduction of bone fragments
Functionally stable fixation of the fragments
Preserving the blood supply to the fragments by atraumatic surgical procedures
Early, active and pain free mobilisation
Compression osteosynthesis
Based on AO/ASIF principles
These plates included pear-shaped holes at the extreme ends
Dynamic compression plate
Produce compression between bone fragments on activation
300kPa/cm2
Indication
Nonoblique fracture with good bony apposition after reduction
Contraindications
Severely oblique fracture
Comminuted fracture
Fracture with bone loss
Properties of plate
Plate has inclined plane in the hole proximal to the fracture
The highest portion of the inclined plane lies on the outer aspect
2 types of screws- compression screw and static screw
Min two screws on each side
Unfavourable fracture requires longer plates with more screws
Order of fixation
Plate bending
Bicortical screws are used
Fixation protocol
Disadvantages
Require precise adaptation
If used on oblique fractures, the fragments slide over one another
Maladapted plate in anterior mandiblecreates widening of mandible
Technique sensitive
Ideally should be placed on tension zone, but due to anatomic reasons the plate is placed on the inferior border
In fracture with good reduction and no bone loss, causes stripping of screws and bone splintering adjacent to fracture
Eccentric dynamic compression plate
Used in situations where tension band application is not possible
Presence of impacted 8 with angle fracture
Edentulous mandibular fracture
Avulsion of bone from fracture site
Plate design
Advantage
Even distribution of forces along length of fracture
Disadvantage
Technique sensitive
Results not superior to other fixation methods
Lag screw
Oblique fracture in long bones
Principle- a screw that glides through the cortex of one fragment and engages the cortex of the opposite fragment with its thread, draws the fragments together and compresses them when tightened. Gliding holes and thread holes must be coaxial
- (Pics)
Fixation osteosynthesis
This includes
Reconstruction plate
THORP
Locking plate
Indications
Oblique fracture
Comminuted fracture
Loss of bone fragments in fracture
Questionable post op compliance
Non atrophic edentulous fracture
Reconstr
The document discusses bone grafts and bone substitutes. It provides background on the history and development of bone grafting, including the early use of autografts. It defines different types of bone grafts such as autografts, allografts, and synthetic bone grafts. It describes various forms bone grafts can take, including cortical, cancellous, and corticocancellous grafts. Autografts are described as the most preferred option as they integrate well with the recipient site. Indications for bone grafting and factors affecting graft incorporation are also summarized.
This document provides a history of distraction osteogenesis. It began in 1905 with lengthening of long bones, was pioneered for the maxillofacial region by Ilizarov in the 1950s using gradual traction to regenerate bone, and was first applied to the human mandible by McCarthy in 1989. Since then, distraction techniques have been used increasingly as alternatives to orthognathic surgery, with applications to the maxilla beginning in the 1990s and advances in device design improving three-dimensional control and outcomes. The biology of distraction osteogenesis involves regeneration of new bone between segments separated by gradual traction applied during the distraction phase.
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.for more details please visit
www.indiandentalacademy.com
Distraction osteogenesis is a biological process used to treat craniofacial deformities. It involves separating bone segments gradually through incremental traction to stimulate new bone formation. Historically, it has been used since the early 1900s to lengthen limbs, and was first applied to the craniofacial skeleton in the 1980s. The process involves osteotomy, latency, distraction, consolidation, and remodeling phases. Both internal and external devices can be used uni-directionally or multi-directionally. Factors like age, site of surgery, rate and rhythm of distraction influence outcomes. The orthodontist plays a key role in planning distraction vectors and post-treatment orthodontics.
This document summarizes a seminar on bone grafts in hard tissue reconstruction. It discusses the properties, indications, advantages, and disadvantages of various types of bone grafts including autogenous, allogenous, xenografts, and alloplasts. It also describes the principles of bone grafting, factors affecting graft incorporation, classification of grafts, and their mode of action. Specifically, it provides details on autogenous bone grafts including their sources, advantages, and types based on histologic features and vascularity.
This document describes surgical techniques for treating TMJ ankylosis in children, including:
1. Excising the ankylotic mass through a preauricular incision and reconstructing the ramus condyle unit with either a costochondral graft or distraction osteogenesis.
2. Lining the glenoid fossa with a vascularized temporalis fascia flap to prevent reankylosis.
3. An intensive post-operative physical therapy regimen to regain jaw mobility.
Bone replacement grafts are widely used to promote
bone formation and periodontal regeneration.
Xenografts are grafts shared between different species.
Currently, there are two available sources of xenografts
used as bone replacement grafts in periodontics: bovine
bone and natural coral.
application of bone graft in dentistryOmar Mabrouk
Bone grafting involves transplanting bone material from one site to another to aid bone regeneration. There are several types of grafts including autografts, allografts, xenografts, and alloplasts. Autografts are considered the gold standard as they are osteoinductive, osteoconductive, and osteogenic, but require a second surgical site. Allografts risk disease transmission. Bone graft healing relies on revascularization, with cancellous grafts replacing with new host bone within a year, while cortical grafts take longer. Grafting has various applications including alveolar ridge preservation and augmentation, maxillary sinus lifts, and distraction osteogenesis. Complications can include membrane perforation
This document discusses implant biomechanics and treatment planning. It notes that implant overload can lead to bone loss and failure if excessive loads are placed on implants during treatment planning. Linear implant arrangements are less predictable than curvilinear arrangements, especially in posterior areas with heavy biting forces. The number of implants, their arrangement, angulation, length, diameter and the quality of surrounding bone all influence the load bearing capacity of implant restorations. Treatment plans must be designed to minimize non-axial forces and prevent implant overload.
This document provides an overview of bone graft materials and procedures, as well as first stage surgery. It discusses the history of bone grafting, defines common types of grafts like autografts, allografts, xenografts, and alloplasts. Characteristics of ideal graft materials are outlined. The document also examines graft choice considerations, various graft forms, and the biological properties and mechanisms of different materials. First stage surgery is briefly mentioned at the end.
Distraction osteogenesis is a technique that involves cutting bone and gradually separating the bone segments to stimulate new bone growth. It relies on prolonged, controlled distraction to expand soft tissue and bone volume simultaneously without disrupting blood supply. The process was discovered accidentally by Russian orthopedic surgeon Ilizarov in 1988. It has various applications including lengthening of bones like the mandible and advancing structures like the midface. The treatment involves phases like latency, distraction, consolidation and retention to achieve the desired correction.
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.for more details please visit
www.indiandentalacademy.com
The document discusses different types of bone grafts. Autografts, which are bone grafts taken from one site of a patient's own body and transplanted to another site, are still considered the best option. Autografts can incorporate, revascularize, and withstand mechanical stresses well over time. Allografts, which are bone grafts transplanted between two genetically unrelated individuals of the same species, are becoming more widely accepted but do not completely vascularize. A variety of graft forms and sources are discussed including cortical, cancellous, corticocancellous grafts as well as some newer options like vascularized grafts.
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.for more details please visit
www.indiandentalacademy.com
This document provides information on onlay bone grafts, including definitions, classifications, sources, types, structure, indications, and surgical protocols. An onlay bone graft is a graft where transplanted tissue is laid directly onto the surface of recipient bone. Sources include intraoral sites like the mandibular ramus and symphysis, as well as extraoral sites like the calvarium and iliac crest. Surgical protocols are described for harvesting bone grafts from various donor sites and performing onlay grafting procedures. Complications and bone healing are also briefly discussed.
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.for more details please visit
www.indiandentalacademy.com
Distraction osteogenesis in orthodontics -Dr.G V SHETTYDr.G.V SHETTY
DISTRACTION IN ORTHODONTICS IMPLICATIONS
ROLE OF ORTHODONTIST IN MANAGEMENT OF SEVERE MAXILLOMANDIBULAR OR OROFACIAL DISCREPANCY
SCOPE OF DISTRACTION OSTEOGENESIS
What is fixation?
Fixation in orthopedics is the process by which an injury is rendered immobile. This may be accomplished by internal fixation, or by external fixation.
What is internal fixation?
Internal fixation is an operation in orthopedics that involves the surgical implementation of implants for the purpose of repairing a bone
Rigid internal fixation refers to the direct method of fracture fixation where the hardware or implant used for fixation provides sufficient rigidity for the jawbone to withstand masticatory stresses.
Avoids immobilization by MMF
Does not allow micromotion of fracture segments
Goals of AO/ASIF technique for rigid fixation
Anatomic reduction of bone fragments
Functionally stable fixation of the fragments
Preserving the blood supply to the fragments by atraumatic surgical procedures
Early, active and pain free mobilisation
Compression osteosynthesis
Based on AO/ASIF principles
These plates included pear-shaped holes at the extreme ends
Dynamic compression plate
Produce compression between bone fragments on activation
300kPa/cm2
Indication
Nonoblique fracture with good bony apposition after reduction
Contraindications
Severely oblique fracture
Comminuted fracture
Fracture with bone loss
Properties of plate
Plate has inclined plane in the hole proximal to the fracture
The highest portion of the inclined plane lies on the outer aspect
2 types of screws- compression screw and static screw
Min two screws on each side
Unfavourable fracture requires longer plates with more screws
Order of fixation
Plate bending
Bicortical screws are used
Fixation protocol
Disadvantages
Require precise adaptation
If used on oblique fractures, the fragments slide over one another
Maladapted plate in anterior mandiblecreates widening of mandible
Technique sensitive
Ideally should be placed on tension zone, but due to anatomic reasons the plate is placed on the inferior border
In fracture with good reduction and no bone loss, causes stripping of screws and bone splintering adjacent to fracture
Eccentric dynamic compression plate
Used in situations where tension band application is not possible
Presence of impacted 8 with angle fracture
Edentulous mandibular fracture
Avulsion of bone from fracture site
Plate design
Advantage
Even distribution of forces along length of fracture
Disadvantage
Technique sensitive
Results not superior to other fixation methods
Lag screw
Oblique fracture in long bones
Principle- a screw that glides through the cortex of one fragment and engages the cortex of the opposite fragment with its thread, draws the fragments together and compresses them when tightened. Gliding holes and thread holes must be coaxial
- (Pics)
Fixation osteosynthesis
This includes
Reconstruction plate
THORP
Locking plate
Indications
Oblique fracture
Comminuted fracture
Loss of bone fragments in fracture
Questionable post op compliance
Non atrophic edentulous fracture
Reconstr
The document discusses bone grafts and bone substitutes. It provides background on the history and development of bone grafting, including the early use of autografts. It defines different types of bone grafts such as autografts, allografts, and synthetic bone grafts. It describes various forms bone grafts can take, including cortical, cancellous, and corticocancellous grafts. Autografts are described as the most preferred option as they integrate well with the recipient site. Indications for bone grafting and factors affecting graft incorporation are also summarized.
This document provides a history of distraction osteogenesis. It began in 1905 with lengthening of long bones, was pioneered for the maxillofacial region by Ilizarov in the 1950s using gradual traction to regenerate bone, and was first applied to the human mandible by McCarthy in 1989. Since then, distraction techniques have been used increasingly as alternatives to orthognathic surgery, with applications to the maxilla beginning in the 1990s and advances in device design improving three-dimensional control and outcomes. The biology of distraction osteogenesis involves regeneration of new bone between segments separated by gradual traction applied during the distraction phase.
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.for more details please visit
www.indiandentalacademy.com
Distraction osteogenesis is a biological process used to treat craniofacial deformities. It involves separating bone segments gradually through incremental traction to stimulate new bone formation. Historically, it has been used since the early 1900s to lengthen limbs, and was first applied to the craniofacial skeleton in the 1980s. The process involves osteotomy, latency, distraction, consolidation, and remodeling phases. Both internal and external devices can be used uni-directionally or multi-directionally. Factors like age, site of surgery, rate and rhythm of distraction influence outcomes. The orthodontist plays a key role in planning distraction vectors and post-treatment orthodontics.
This document summarizes a seminar on bone grafts in hard tissue reconstruction. It discusses the properties, indications, advantages, and disadvantages of various types of bone grafts including autogenous, allogenous, xenografts, and alloplasts. It also describes the principles of bone grafting, factors affecting graft incorporation, classification of grafts, and their mode of action. Specifically, it provides details on autogenous bone grafts including their sources, advantages, and types based on histologic features and vascularity.
This document describes surgical techniques for treating TMJ ankylosis in children, including:
1. Excising the ankylotic mass through a preauricular incision and reconstructing the ramus condyle unit with either a costochondral graft or distraction osteogenesis.
2. Lining the glenoid fossa with a vascularized temporalis fascia flap to prevent reankylosis.
3. An intensive post-operative physical therapy regimen to regain jaw mobility.
Bone replacement grafts are widely used to promote
bone formation and periodontal regeneration.
Xenografts are grafts shared between different species.
Currently, there are two available sources of xenografts
used as bone replacement grafts in periodontics: bovine
bone and natural coral.
application of bone graft in dentistryOmar Mabrouk
Bone grafting involves transplanting bone material from one site to another to aid bone regeneration. There are several types of grafts including autografts, allografts, xenografts, and alloplasts. Autografts are considered the gold standard as they are osteoinductive, osteoconductive, and osteogenic, but require a second surgical site. Allografts risk disease transmission. Bone graft healing relies on revascularization, with cancellous grafts replacing with new host bone within a year, while cortical grafts take longer. Grafting has various applications including alveolar ridge preservation and augmentation, maxillary sinus lifts, and distraction osteogenesis. Complications can include membrane perforation
This document discusses implant biomechanics and treatment planning. It notes that implant overload can lead to bone loss and failure if excessive loads are placed on implants during treatment planning. Linear implant arrangements are less predictable than curvilinear arrangements, especially in posterior areas with heavy biting forces. The number of implants, their arrangement, angulation, length, diameter and the quality of surrounding bone all influence the load bearing capacity of implant restorations. Treatment plans must be designed to minimize non-axial forces and prevent implant overload.
This document provides an overview of bone graft materials and procedures, as well as first stage surgery. It discusses the history of bone grafting, defines common types of grafts like autografts, allografts, xenografts, and alloplasts. Characteristics of ideal graft materials are outlined. The document also examines graft choice considerations, various graft forms, and the biological properties and mechanisms of different materials. First stage surgery is briefly mentioned at the end.
Distraction osteogenesis is a technique that involves cutting bone and gradually separating the bone segments to stimulate new bone growth. It relies on prolonged, controlled distraction to expand soft tissue and bone volume simultaneously without disrupting blood supply. The process was discovered accidentally by Russian orthopedic surgeon Ilizarov in 1988. It has various applications including lengthening of bones like the mandible and advancing structures like the midface. The treatment involves phases like latency, distraction, consolidation and retention to achieve the desired correction.
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.for more details please visit
www.indiandentalacademy.com
This document discusses distraction osteogenesis, a technique used to regenerate bone by gradually separating bone segments. It was introduced in 1951 by Ilizarov who used external fixation devices. The key steps involve cutting and separating the bone followed by slow distraction of 1mm per day which stimulates new bone formation. Both extraoral and intraoral devices are described. Applications include lengthening of the mandible for conditions like micrognathia. The process relies on stability of fixation, controlled distraction rate, and preservation of soft tissues. It allows reconstruction of craniofacial bones without growth factors.
Distraction osteogenesis 1 /certified fixed orthodontic courses by Indian den...Indian dental academy
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.
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.for more details please visit
www.indiandentalacademy.com
This document discusses distraction osteogenesis, a technique where new bone is formed between vascular bone surfaces that are gradually pulled apart. It involves three phases: a latency period, distraction period where the bone surfaces are distracted 1mm per day, and consolidation period. Histologically, a fibrous interzone forms between the bone surfaces that takes on the role of a growth plate, with intramembranous ossification forming new bone columns across the gap. Key factors for successful new bone formation include stability of fixation, atraumatic corticotomy, and appropriate distraction rate and rhythm.
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.for more details please visit
www.indiandentalacademy.com
Distraction osteogenesis /certified fixed orthodontic courses by Indian denta...Indian dental academy
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
Distraction osteogenesis 2 /certified fixed orthodontic courses by Indian den...Indian dental academy
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.
The document summarizes a lecture on the Ilizarov external fixator. It discusses the history of its invention by Professor Gavril Ilizarov in Russia in the 1950s. It outlines the principles of distraction osteogenesis and details the components, application procedure, post-operative care, rehabilitation and removal of the Ilizarov fixator. Key indications for its use include limb lengthening, deformity correction, infected non-unions, and congenital pseudarthrosis. The document concludes with experiences using the Ilizarov technique at EMCH, including cases of infected non-unions and complex fractures.
This document summarizes the process of distraction osteogenesis, which involves surgically separating bone segments and using an external fixator to slowly pull the segments apart, inducing new bone growth in the gap. It describes the three phases of distraction osteogenesis - the latent phase involving inflammation and recruitment of stem cells; the distraction phase where mechanical strain promotes new bone formation; and the consolidation phase where the new bone matures. Key cellular processes involving osteoblasts and osteoclasts during bone formation and remodeling are also summarized. Potential future approaches to improve distraction osteogenesis outcomes through modulating these cells are outlined.
This case report describes the treatment of a 22-year-old female patient with a unilateral cleft lip and palate using distraction osteogenesis (DO) followed by orthognathic surgery. The patient had midface deficiency, a class III malocclusion, and a retrognathic maxilla. Treatment involved using a RED device to perform DO for 7mm of maxillary advancement. This was followed by Lefort I osteotomy, mandibular setback, and genioplasty. Post-treatment, the patient's profile and occlusion were improved with good stability after 2 years. The report concludes that DO is an effective treatment for severe cleft-related maxillary deficiency.
La cirugía ortognática se puede acompañar de arreglos de desarmonías faciales como "cara de viejo", "cara larga" y otras muchas, esto ayuda a conseguir un mejora sustancial en los resultados finales.
Más información en: http://www.clinicabenarroch.com/cirugia-ortognatica-estetica.html
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Distraction osteogenesis versus bsso for advancement of the retrognathic mand...Indian dental academy
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.
Distraction osteogenesis /certified fixed orthodontic courses by Indian denta...Indian dental academy
Distraction osteogenesis is a surgical technique that involves gradually stretching bone and soft tissue by applying tension over time in order to reconstruct skeletal defects. It utilizes the body's natural healing process to generate new bone where it is needed. Some key advantages are that it causes little relapse, allows for larger movements than traditional bone grafts, can mold the new bone shape, and has lower morbidity. The technique was first developed in the early 1900s but was refined by Russian orthopedic surgeon Gavriel Ilizarov in the 1950s. It was later adapted for use in dental applications involving the mandible and maxilla.
Ilizarove technique Instruments and implantsOm Patil
This document provides a list of instruments and implants used with the Ilizarov technique for limb lengthening and bone reconstruction, including various rings, plates, rods, wires, bolts, nuts, washers, and other connecting hardware. It also mentions tools used such as a corticotome for bone cuts and devices for lengthening and supporting limbs.
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
The document discusses the history and development of distraction osteogenesis for correcting skeletal dysplasias. It describes how distraction osteogenesis involves mechanically separating bone segments at a constant rate to generate new bone in the gap. Early experiments in the 1970s-1980s established the technique for limb lengthening and mandibular lengthening in animals. This led to the first clinical use of distraction osteogenesis on the craniofacial skeleton in 1989. The document outlines the various devices used, including both intraoral and extraoral unidirectional and bidirectional devices.
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.for more details please visit
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Distraction osteogenesis /certified fixed orthodontic courses by Indian denta...Indian dental academy
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
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.
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.for more details please visit
www.indiandentalacademy.com
This document discusses surgical procedures for osteonecrosis of the femoral head, including both joint preserving and replacing options. Key joint preserving procedures described are core decompression, various bone grafting techniques using vascularized and nonvascularized grafts, and proximal femoral osteotomies. Total hip arthroplasty and hip resurfacing are mentioned as joint replacing options.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
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.for more details please visit
www.indiandentalacademy.com
This document provides an overview of orthodontic wires, including their history, properties, classifications, uses, advantages, and disadvantages. It discusses key figures in the development of removable appliances and how their designs influenced modern orthodontics. The document also covers the properties of orthodontic wires, including esthetics, stiffness, strength, range, springback, formability, resiliency, friction, biohostability, and biocompatibility. It notes that the use of removable appliances varies but can provide adequate results for simple tipping cases.
This document discusses non-vascularized bone grafts. It notes that autogenous bone grafts are the gold standard for bony reconstruction of the jaws. Costochondral rib harvesting is described as a technique for obtaining bone grafts. The document outlines the advantages of autogenous bone grafts and principles of non-vital grafts, such as needing a blood supply from the recipient site. It provides details on harvesting and using costochondral rib grafts, including preoperative preparation, incision and procedure steps.
Evolution of orthognathic surgery /certified fixed orthodontic courses by Ind...Indian dental academy
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.
1) Zygomatic fractures are the second most common fractures of the facial bones. The zygomatic bone forms a prominent part of the cheek and is susceptible to fractures.
2) Diagnosis involves clinical examination to identify deformities, step defects, and numbness as well as radiological imaging like CT scans.
3) Treatment aims to restore facial contour and nerve function through either closed or open reduction and fixation methods depending on the fracture pattern and degree of displacement.
The Ilizarov apparatus is a type of external fixation used in orthopedic surgery to lengthen or reshape limb bones; as a limb-sparing technique to treat complex and/or open bone fractures; and in cases of infected nonunions of bones that are not amenable with other techniques. It is named after the orthopedic surgeon Gavriil Abramovich Ilizarov from the Soviet Union, who pioneered the technique.
1. Bone is composed of cortical and cancellous bone, with cells including osteoblasts, osteoclasts, and osteoprogenitors. Bone remodeling occurs through the actions of osteoblasts and osteoclasts.
2. There are two types of bone formation: endochondral ossification and intramembranous ossification. Fractures can be classified based on location, displacement, and whether the skin is broken (open vs closed fracture).
3. Fracture healing consists of hematoma, proliferation, callus formation, and remodeling phases. Treatment depends on fracture type and may include splinting, casting, traction, closed or open reduction, and internal or external fixation. Management of
This document provides an overview of Lefort I osteotomy, including:
- A brief history describing the development of maxillary osteotomy techniques.
- Anatomical considerations and the biologic basis for maxillary osteotomies, which have shown adequate blood supply can be maintained.
- Indications for Lefort I osteotomy include altering vertical dimension, anteroposterior movements, and surgical expansion of the maxilla.
- Types of Lefort I osteotomies are described, including classic, quadrangular, and segmental variations. Postoperative management and potential complications are also outlined.
This document provides an overview of minimally invasive surgery techniques in orthopedics. It discusses the history and basic principles of minimally invasive surgery. Key areas where minimally invasive techniques are used include minimally invasive spine surgery using tubular retractors, arthroscopy of joints like the shoulder, knee, hip and ankle, minimally invasive surgeries for fracture management using techniques like IM nailing and MIPO, and minimally invasive joint replacements like knee and hip arthroplasty. Benefits of minimally invasive surgeries include minimal tissue trauma, reduced pain and morbidity, shorter hospital stays and faster recovery.
This document provides an overview of distraction osteogenesis (DO), including:
- A brief history of DO and its development by Ilizarov involving gradual bone separation.
- The biological basis of DO which involves latency, distraction, and consolidation periods to form new regenerate bone between divided segments.
- Applications of DO in the craniofacial region to lengthen the mandible, maxilla, and midface for conditions like hemifacial microsomia.
- Considerations for DO including patient selection, indications, contraindications, principles of rate and rhythm of distraction, and potential complications.
This document outlines details from a seminar on osteotomies around the hip presented by Dr. Vaibhav Gandhi at Gandhi Medical College, Bhopal. It includes definitions of osteotomy procedures, classifications based on anatomic location and indications, as well as overviews and details of specific osteotomies such as the Salter, Pemberton, triple innominate, Ganz, and shelf (Staheli) procedures. Force diagrams and biomechanical principles relating to the hip are also discussed.
Opportunity for Dentists (BDS/MDS )to relocate to United kingdom -Register as a DENTAL HYGIENIST/ DENTAL THERAPIST without Board exams and after approval you can register in GDC as a DH/DT and start working as a DH/DT Immediately and get paid.
You can complete the whole process in 3-4 months.Salary range for DH/DT is around 2500-3500 Pounds per month.
Eligibility / requirements-
1. An International English Language Testing System (IELTS) certificate
at the appropriate level.(Within 2 yrs of application date )
2: A recent primary dental qualification that has been taught and examined in English..(Within 2 yrs of application date )
3: A recent pass in a language test for registration with a regulatory authority in a country where the first language is English.
If you are interested Please contact us for more details.
1ST, 2ND AND 3RD ORDER BENDS IN STANDARD EDGEWISE APPLIANCE SYSTEM /Fixed ort...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals
who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry,
Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
I –Aligners are made with FDA approved transparent thermoplastic materials using 3D scanning, 3D Printing and finally Trays with Pressure vacuum formers.
Dear Doctor,
Indian Dental Academy Now offers comprehensive online Orthodontics course.
Course includes:
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For Demo please visit :www.idalectures.com/preview/
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Indian Dental Academy
Leader in continuing dental education
www.indiandentalacademy.com
skype:indiandentalacademy
+919248678078
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...Indian dental academy
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.for more details please visit
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Diagnosis and treatment planning in completely endntulous arches/dental coursesIndian dental academy
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.for more details please visit
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Properties of Denture base materials /rotary endodontic coursesIndian dental academy
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.for more details please visit
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Use of modified tooth forms in complete denture occlusion / dental implant...Indian dental academy
This document discusses dental occlusion concepts and philosophies for complete dentures. It introduces key terms like physiologic occlusion and defines different occlusion schemes like balanced articulation and monoplane articulation. The document discusses advantages and disadvantages of using anatomic versus non-anatomic teeth for complete dentures. It also outlines requirements for maintaining denture stability, such as balanced occlusal contacts and control of horizontal forces. The goal of occlusion for complete dentures is to re-establish the homeostasis of the masticatory system disrupted by edentulism.
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
This document discusses dental casting investment materials. It describes the three main types of investments - gypsum bonded, phosphate bonded, and ethyl silicate bonded investments. For gypsum bonded investments specifically, it details their classification, composition including the roles of gypsum, silica, and modifiers, setting time, normal and hygroscopic setting expansion, and thermal expansion. It provides information on how the properties of gypsum bonded investments are affected by their composition. The document serves as a comprehensive overview of dental casting investment materials.
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
Beyond Degrees - Empowering the Workforce in the Context of Skills-First.pptxEduSkills OECD
Iván Bornacelly, Policy Analyst at the OECD Centre for Skills, OECD, presents at the webinar 'Tackling job market gaps with a skills-first approach' on 12 June 2024
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
Gender and Mental Health - Counselling and Family Therapy Applications and In...PsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
The temple and the sanctuary around were dedicated to Asklepios Zmidrenus. This name has been known since 1875 when an inscription dedicated to him was discovered in Rome. The inscription is dated in 227 AD and was left by soldiers originating from the city of Philippopolis (modern Plovdiv).
Film vocab for eal 3 students: Australia the movie
Distraction osteogenesis (9)
1. DISTRACTION OSTEOGENESIS – ADISTRACTION OSTEOGENESIS – A
FAREWELL TO MAJOR OSTEOTOMIES ?FAREWELL TO MAJOR OSTEOTOMIES ?
--- Dr. Chetan Jayade--- Dr. Chetan Jayade
Asst. ProfessorAsst. Professor
Department of OrthodonticsDepartment of Orthodontics
S.D.M. College of Dental SciencesS.D.M. College of Dental Sciences
2. DISTRACTION OSTEOGENESIS – ADISTRACTION OSTEOGENESIS – A
FAREWELL TO MAJOR OSTEOTOMIES ?FAREWELL TO MAJOR OSTEOTOMIES ?
3. The treatment of craniofacial deformitiesThe treatment of craniofacial deformities
poses a great challenge to theposes a great challenge to the
Orthodontist and the Oral Surgeon alike.Orthodontist and the Oral Surgeon alike.
5. The latest technique for combating theThe latest technique for combating the
same is a procedure termedsame is a procedure termed
“DISTRACTION OSTEOGENESIS”“DISTRACTION OSTEOGENESIS”
6. SCOPE OF THE TALKSCOPE OF THE TALK
• A look at the origins of DOA look at the origins of DO
• DO in the long bonesDO in the long bones
• DO in the craniofacial regionDO in the craniofacial region
7. SCOPE OF THE TALKSCOPE OF THE TALK
• Biologic effects of DOBiologic effects of DO
• Factors affecting DOFactors affecting DO
• The role of an Orthodontist in DOThe role of an Orthodontist in DO
8. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
(Transosseous synthesis)(Transosseous synthesis)
(Osteodistraction)(Osteodistraction)
DEFINITION: A process of new boneDEFINITION: A process of new bone
formation between the surfaces of boneformation between the surfaces of bone
segments gradually seperated bysegments gradually seperated by
incremental traction -incremental traction - COPECOPE (1999)(1999)
10. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
Steps involved :Steps involved :
a)a) Corticotomy/OsteotomyCorticotomy/Osteotomy : A low energy: A low energy
osteotomy of the cortex preserving theosteotomy of the cortex preserving the
local blood supply to both the cortex andlocal blood supply to both the cortex and
the medullary canal.the medullary canal.
11. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
Steps involved :Steps involved :
b)b) Latency periodLatency period : The time following the: The time following the
osteotomy when initial fracture healingosteotomy when initial fracture healing
bridges the cut bone prior to initiating thebridges the cut bone prior to initiating the
distraction.distraction.
12. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
Steps involved :Steps involved :
c)c) Distraction phaseDistraction phase ::
i) Rate – the number of millimeters/day ati) Rate – the number of millimeters/day at
which the bone surfaces are stretched.which the bone surfaces are stretched.
ii) Rhythm – The number of incrementalii) Rhythm – The number of incremental
distractions per day.distractions per day.
13. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
Steps involved :Steps involved :
d)d) Consolidation phaseConsolidation phase : The time following: The time following
distraction, for which the device is stabiliseddistraction, for which the device is stabilised
14. DISTRACTION HISTOGENESISDISTRACTION HISTOGENESIS
The sequence of adaptive changes in the softThe sequence of adaptive changes in the soft
tissues, adjacent to the distracted segments.tissues, adjacent to the distracted segments.
Healing IndexHealing Index: The number of days or months: The number of days or months
from the surgery to full, unprotected loadfrom the surgery to full, unprotected load
bearing for each centimeter of bone length.bearing for each centimeter of bone length.
19. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
HISTORICAL PERSPECTIVEHISTORICAL PERSPECTIVE
Problems with the earlier attempts:Problems with the earlier attempts:
a)a) Lack of control of the bone segmentsLack of control of the bone segments
b)b) Inadequacy of the appliancesInadequacy of the appliances
c)c) Instability of fixation and complicationsInstability of fixation and complications
20. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
HISTORICAL PERSPECTIVEHISTORICAL PERSPECTIVE
GAVRIIL ILIZAROV (1951) rejuvenated theGAVRIIL ILIZAROV (1951) rejuvenated the
procedure when he accidentally found thatprocedure when he accidentally found that
new bone growth was possible.new bone growth was possible.
21. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
HISTORICAL PERSPECTIVEHISTORICAL PERSPECTIVE
Theories favouring Compression in Bone healing:Theories favouring Compression in Bone healing:
i.i. Roux’s hypothesisRoux’s hypothesis
ii.ii. Wolff’ doctrineWolff’ doctrine
iii.iii. Huter-Volkmann theoryHuter-Volkmann theory
22. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
HISTORICAL PERSPECTIVEHISTORICAL PERSPECTIVE
ILIZAROV’S TECHNIQUEILIZAROV’S TECHNIQUE
Foundations laid via rigorous experimentationFoundations laid via rigorous experimentation
a)a) Dog experimentsDog experiments (Long bones)– 7 groups(Long bones)– 7 groups
• Group I,II and III differed in the type of fixationGroup I,II and III differed in the type of fixation
• Group IV and V in the amount of marrowGroup IV and V in the amount of marrow
• Group VI and VII underwent transverseGroup VI and VII underwent transverse
distractiondistraction
23. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
HISTORICAL PERSPECTIVEHISTORICAL PERSPECTIVE
ILIZAROV’S TECHNIQUEILIZAROV’S TECHNIQUE
Foundations laid via rigorous experimentationFoundations laid via rigorous experimentation
b)b) Dog experimentsDog experiments (Membrane bones)(Membrane bones)
Distraction results were similar to that seen in theDistraction results were similar to that seen in the
long bones.long bones.
27. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
ILIZAROV’S CRITERIAILIZAROV’S CRITERIA
a)a) Surgical procedure must involve minimumSurgical procedure must involve minimum
marrow; hence, corticotomy preferred.marrow; hence, corticotomy preferred.
b)b) Fixity of the device: Rigid fixation is a must.Fixity of the device: Rigid fixation is a must.
c)c) Rate: Optimal to be 1 mm per dayRate: Optimal to be 1 mm per day
d)d) Rhythm: Optimum of 2-4 activations/dayRhythm: Optimum of 2-4 activations/day
28. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
THE TENSION-STRESS EFFECTTHE TENSION-STRESS EFFECT
The histologic evidences of Ilizarov’s work formThe histologic evidences of Ilizarov’s work form
the basis of distraction procedures in any partthe basis of distraction procedures in any part
of the body.of the body.
These histologic findings were coined by IlizarovThese histologic findings were coined by Ilizarov
as the ‘Tension-Stress’ effect.as the ‘Tension-Stress’ effect.
30. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
HISTORICAL PERSPECTIVEHISTORICAL PERSPECTIVE
SNYDER (1972,73) resected a dog mandible andSNYDER (1972,73) resected a dog mandible and
performed distraction successfully.performed distraction successfully.
10 week healing period followed by distraction10 week healing period followed by distraction
of 1mm/day for 14 days.of 1mm/day for 14 days.
MICHELLI and MIOTI (1977) and PANIKAROVSKIMICHELLI and MIOTI (1977) and PANIKAROVSKI
(1982)carried out modified experiments in the(1982)carried out modified experiments in the
canine mandiblescanine mandibles
31. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
HISTORICAL PERSPECTIVEHISTORICAL PERSPECTIVE
Mc’Carthy– (1989) conducted the first reportedMc’Carthy– (1989) conducted the first reported
human trial of craniofacial distraction usinghuman trial of craniofacial distraction using
external fixators.external fixators.
4 children with craniofacial anomalies were4 children with craniofacial anomalies were
subjected to a distraction protocol of uptosubjected to a distraction protocol of upto
three weeks followed by a 8-10 weekthree weeks followed by a 8-10 week
consolidation.consolidation.
Long-term studies of the same patients indicate aLong-term studies of the same patients indicate a
successful result.successful result.
32. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
HISTORICAL PERSPECTIVEHISTORICAL PERSPECTIVE
MOLINA and ORTIZ MONASTERIO(1995) used bi-MOLINA and ORTIZ MONASTERIO(1995) used bi-
directional appliancesdirectional appliances
Mc’CARTHY demonstrated the efficacy of aMc’CARTHY demonstrated the efficacy of a
mulitdirectional appliance.mulitdirectional appliance.
GUERRERO (1990) used an intra-oral appliance toGUERRERO (1990) used an intra-oral appliance to
widen mandibular arches.widen mandibular arches.
35. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
HISTORICAL PERSPECTIVEHISTORICAL PERSPECTIVE
Midface distraction –Midface distraction – RACHMIEL (1993) carriedRACHMIEL (1993) carried
out midface distraction on sheepout midface distraction on sheep
36. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
A BIRD EYE-VIEW THE ORIGINS ANDA BIRD EYE-VIEW THE ORIGINS AND
EVOLUTION OF DO IN THE CRANIOFACIALEVOLUTION OF DO IN THE CRANIOFACIAL
REGIONREGION
a)a) Phase of traction without surgeryPhase of traction without surgery
b)b) Upsurge in limb-lengthening proceduresUpsurge in limb-lengthening procedures
c) Progression from Extra-oral Unidirectional toc) Progression from Extra-oral Unidirectional to
Extra-oral Multidirectional distraction.Extra-oral Multidirectional distraction.
37. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
A BIRD EYE-VIEW THE ORIGINS ANDA BIRD EYE-VIEW THE ORIGINS AND
EVOLUTION OF DO IN THE CRANIOFACIALEVOLUTION OF DO IN THE CRANIOFACIAL
REGIONREGION
d) Progression from extra-oral to intraoral devicesd) Progression from extra-oral to intraoral devices
e) Progression from manual devices to motorizede) Progression from manual devices to motorized
devicesdevices
f) Progression from the removable fixators tof) Progression from the removable fixators to
biodegradable fixatorsbiodegradable fixators
38. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
CURRENT SCOPE OF DOCURRENT SCOPE OF DO
Correction of Maxillo-Mandibular deformitiesCorrection of Maxillo-Mandibular deformities
a) Maxillary lengtheninga) Maxillary lengthening
b) Mandibular lengtheningb) Mandibular lengthening
c) Maxillary and Mandibular wideningc) Maxillary and Mandibular widening
d) Lengthening of the Hard palated) Lengthening of the Hard palate
e) Distraction in other cranio-facial areas.e) Distraction in other cranio-facial areas.
39. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
CURRENT SCOPE OF DOCURRENT SCOPE OF DO
Alveolar ridge augmentationAlveolar ridge augmentation
Transport disc and TransformationTransport disc and Transformation
osteogenesis.osteogenesis.
Dental Distraction.Dental Distraction.
40. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
TRANSFORMATION OSTEOGENESISTRANSFORMATION OSTEOGENESIS
The conversion of non-osseous interpositionsThe conversion of non-osseous interpositions
into normal bone by combined compressioninto normal bone by combined compression
and traction forces, sometimes augmented byand traction forces, sometimes augmented by
a nearby corticotomy.a nearby corticotomy.
41. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
BONE TRANSPORTATIONBONE TRANSPORTATION
The regeneration of intercalary bone defects byThe regeneration of intercalary bone defects by
combined distraction and transformationcombined distraction and transformation
osteogenesis.osteogenesis.
i.i. Bifocal transportationBifocal transportation
ii.ii. Trifocal transportationTrifocal transportation
43. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
TISSUE CHANGES FOLLOWING DOTISSUE CHANGES FOLLOWING DO
a.a. Skeletal changes – Formation of RegenerateSkeletal changes – Formation of Regenerate
b. Soft tissue adaptations – Distractionb. Soft tissue adaptations – Distraction
HistogenesisHistogenesis
44. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
TISSUE CHANGES FOLLOWING DOTISSUE CHANGES FOLLOWING DO
HISTOLOGIC CHANGESHISTOLOGIC CHANGES
• During latency phase – formation of a fibrousDuring latency phase – formation of a fibrous
bridge.bridge.
• During distraction phase – distinct zones seenDuring distraction phase – distinct zones seen
45. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
TISSUE CHANGES FOLLOWING DOTISSUE CHANGES FOLLOWING DO
BIOCHEMICAL FEATURES OF REGENERATEBIOCHEMICAL FEATURES OF REGENERATE
• Increased levels of alkaline phosphate, pyruvicIncreased levels of alkaline phosphate, pyruvic
acid.acid.
• TGF- Beta 1 levels increase upto theTGF- Beta 1 levels increase upto the
consolidation phase; Osteocalcin after theconsolidation phase; Osteocalcin after the
consolidation phase.consolidation phase.
46. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
TISSUE CHANGES FOLLOWING DOTISSUE CHANGES FOLLOWING DO
DISTRACTION HISTOGENESISDISTRACTION HISTOGENESIS
• NeovascularizationNeovascularization
• NeomyogenesisNeomyogenesis
Atrophy seen is transientAtrophy seen is transient
SinusoidalSinusoidal
TransportTransport
47. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
TISSUE CHANGES FOLLOWING DOTISSUE CHANGES FOLLOWING DO
DISTRACTION HISTOGENESISDISTRACTION HISTOGENESIS
• NeovascularizationNeovascularization
• NeomyogenesisNeomyogenesis
Atrophy seen is transientAtrophy seen is transient
SinusoidalSinusoidal
TransportTransport
48. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
TISSUE CHANGES FOLLOWING DOTISSUE CHANGES FOLLOWING DO
DISTRACTION HISTOGENESISDISTRACTION HISTOGENESIS
• Nerve growth as during embryogenesis wasNerve growth as during embryogenesis was
reported by Ilizarov.reported by Ilizarov.
• However, studies by Block and Ippolito haveHowever, studies by Block and Ippolito have
shown mild nerve injury due to stretchingshown mild nerve injury due to stretching
49. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
TISSUE CHANGES FOLLOWING DOTISSUE CHANGES FOLLOWING DO
DISTRACTION HISTOGENESISDISTRACTION HISTOGENESIS
• Mild pathoogic changes have been reported onMild pathoogic changes have been reported on
the TMJ by a few authors like Mc’Carthy.the TMJ by a few authors like Mc’Carthy.
These are again reversible with timeThese are again reversible with time
51. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
FACTORS AFFECTING DOFACTORS AFFECTING DO
BIOLOGIC FACTORSBIOLOGIC FACTORS
• AGEAGE
• SITE OF SURGERYSITE OF SURGERY
• LATENCY PERIODLATENCY PERIOD
• RATE AND RYTHMRATE AND RYTHM
52. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
FACTORS AFFECTING DOFACTORS AFFECTING DO
BIOLOGIC FACTORSBIOLOGIC FACTORS
• Increased micromotion by increasing rhythmIncreased micromotion by increasing rhythm
causes increased vasculogenesis andcauses increased vasculogenesis and
enzymes and decreases the tissue damage andenzymes and decreases the tissue damage and
the degenerative changesthe degenerative changes
53. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
FACTORS AFFECTING DOFACTORS AFFECTING DO
CONSOLIDATION PHASECONSOLIDATION PHASE
Assessment of new bone is by:Assessment of new bone is by:
I. Plain radiographyI. Plain radiography
ii. Quantitaive Computed Tomography (QCT)ii. Quantitaive Computed Tomography (QCT)
iii. Ultrasonographyiii. Ultrasonography
iv. Dual energy X-ray absorptimetryiv. Dual energy X-ray absorptimetry
54. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
FACTORS AFFECTING DOFACTORS AFFECTING DO
CONSOLIDATION PHASECONSOLIDATION PHASE
Clinical assessment of consolidationClinical assessment of consolidation
• Distraction Consolidation indexDistraction Consolidation index
This however, is applicable to the long bones.This however, is applicable to the long bones.
• 6-8 weeks optimal in the craniofacial region6-8 weeks optimal in the craniofacial region
– SACHDEVA, COPE (1999,2000)– SACHDEVA, COPE (1999,2000)
55. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
FACTORS AFFECTING DOFACTORS AFFECTING DO
BIOMECHANICAL FACTORSBIOMECHANICAL FACTORS
• Planning the distraction vectorPlanning the distraction vector
• Device fixityDevice fixity
• Need for ‘ Bone moulding’Need for ‘ Bone moulding’
60. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
MANDIBULAR DISTRACTIONMANDIBULAR DISTRACTION
Classification of devicesClassification of devices
Intra-oral devices can be eitherIntra-oral devices can be either
a) Tooth bornea) Tooth borne
b) Bone borneb) Bone borne
c) Hybridc) Hybrid
71. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
TOOTH MOVEMENT THROUGH REGENERATETOOTH MOVEMENT THROUGH REGENERATE
The earlier views suggested that toothThe earlier views suggested that tooth
movement should not be initiated into themovement should not be initiated into the
regenerate.regenerate.
Present views as supported by Liou and CopePresent views as supported by Liou and Cope
point out to the possibility of initiatingpoint out to the possibility of initiating
tooth movement immediately after or eventooth movement immediately after or even
during the distraction period.during the distraction period.
88. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
The Orthodontist’s roleThe Orthodontist’s role
a.a. Decompensation of the dentitionDecompensation of the dentition
b.b. Planning the distraction vectorPlanning the distraction vector
c.c. Bone Moulding using intermaxillaryBone Moulding using intermaxillary
elasticselastics
d.d. Post-distraction OrthodonticsPost-distraction Orthodontics
FunctionalFunctional
FixedFixed
89. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
Currently Unresolved issuesCurrently Unresolved issues
a.a. Effects of distraction on growthEffects of distraction on growth
b.b. Limits of distraction osteogenesisLimits of distraction osteogenesis
c.c. Effects of distraction on eruption andEffects of distraction on eruption and
movement of teeth.movement of teeth.
d.d. Long term stability of regenerate bone.Long term stability of regenerate bone.
90. DISTRACTION OSTEOGENESISDISTRACTION OSTEOGENESIS
Directions for the futureDirections for the future
a.a. Refinements in the distraction protocolRefinements in the distraction protocol
b.b. Improvement in distraction devicesImprovement in distraction devices
c.c. Enhancement of regenerate maturationEnhancement of regenerate maturation