This document summarizes distraction osteogenesis (DO), which is a process where new bone is formed between bone segments that are gradually separated. DO involves three phases: a latency phase, distraction phase where the bone is gradually separated, and consolidation phase where the new bone mineralizes. It discusses the history and applications of DO, including for lengthening of long bones and the mandible. Key advantages are that it allows for larger movements than traditional bone grafts and avoids prolonged fixation. Potential complications include non-compliance, pain, premature consolidation, and neurological damage.
Lateral pedicle graft is a surgical technique used to increase attached gingiva around teeth affected by recession. It involves raising a partial-thickness flap of tissue from an adjacent donor site and rotating it to cover the exposed root surface. The pedicle flap provides good vascularization and ability to cover denuded roots. However, it is limited to one or two teeth and carries risks of recession at the donor site. Key steps include preparing the recipient and donor sites, outlining incisions, raising and positioning the pedicle flap, and suturing to cover the exposed root.
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.
This document provides an overview of genioplasty procedures. It begins with an introduction to genioplasty and anatomy. It then discusses preoperative evaluation including facial analysis, cephalometric evaluation, and chin classifications. Next, it covers various techniques for correcting chin deformities including osseous genioplasty procedures like horizontal osteotomy with advancement or reduction, and alloplastic genioplasty. It concludes with a brief discussion of complications. The document provides detailed information on evaluating patients, planning procedures, and technical aspects of different genioplasty techniques.
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 document discusses various approaches to accelerate orthodontic tooth movement including biomechanical, physiological/mechanical, pharmacological, surgical-assisted, and surgery-simulated approaches. The biomechanical approach examines self-ligating bracket systems. The physiological/mechanical approach explores direct electric current stimulation, enzymatic micro batteries, piezoelectric stimulation, low-level laser therapy, and photobiomodulation. The pharmacological approach investigates prostaglandins, corticosteroids, growth hormone, parathyroid hormone, vitamin D, and relaxin. The surgical-assisted approach examines rapid canine retraction through distraction of the periodontal ligament and dentoalveolar distraction. The surgery-simulated
The document discusses the classification, etiology, diagnosis and management of open bite malocclusions. Open bite can be classified based on the region involved, etiological factors, molar relationship and degree of clinical involvement. Common etiologies include thumb/digit sucking habits, tongue thrusting and mouth breathing. Management involves correcting habits, guiding growth in mixed dentition, and fixed appliances with or without surgery in permanent dentition depending on the skeletal versus dental components. Treatment aims to close the bite through mechanics like elastics, activators or myofunctional appliances combined with orthodontics or orthognathic surgery if needed.
Lateral pedicle graft is a surgical technique used to increase attached gingiva around teeth affected by recession. It involves raising a partial-thickness flap of tissue from an adjacent donor site and rotating it to cover the exposed root surface. The pedicle flap provides good vascularization and ability to cover denuded roots. However, it is limited to one or two teeth and carries risks of recession at the donor site. Key steps include preparing the recipient and donor sites, outlining incisions, raising and positioning the pedicle flap, and suturing to cover the exposed root.
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.
This document provides an overview of genioplasty procedures. It begins with an introduction to genioplasty and anatomy. It then discusses preoperative evaluation including facial analysis, cephalometric evaluation, and chin classifications. Next, it covers various techniques for correcting chin deformities including osseous genioplasty procedures like horizontal osteotomy with advancement or reduction, and alloplastic genioplasty. It concludes with a brief discussion of complications. The document provides detailed information on evaluating patients, planning procedures, and technical aspects of different genioplasty techniques.
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 document discusses various approaches to accelerate orthodontic tooth movement including biomechanical, physiological/mechanical, pharmacological, surgical-assisted, and surgery-simulated approaches. The biomechanical approach examines self-ligating bracket systems. The physiological/mechanical approach explores direct electric current stimulation, enzymatic micro batteries, piezoelectric stimulation, low-level laser therapy, and photobiomodulation. The pharmacological approach investigates prostaglandins, corticosteroids, growth hormone, parathyroid hormone, vitamin D, and relaxin. The surgical-assisted approach examines rapid canine retraction through distraction of the periodontal ligament and dentoalveolar distraction. The surgery-simulated
The document discusses the classification, etiology, diagnosis and management of open bite malocclusions. Open bite can be classified based on the region involved, etiological factors, molar relationship and degree of clinical involvement. Common etiologies include thumb/digit sucking habits, tongue thrusting and mouth breathing. Management involves correcting habits, guiding growth in mixed dentition, and fixed appliances with or without surgery in permanent dentition depending on the skeletal versus dental components. Treatment aims to close the bite through mechanics like elastics, activators or myofunctional appliances combined with orthodontics or orthognathic surgery if needed.
This document provides an overview of Periodontally Accelerated Osteogenic Orthodontics (PAOO). It discusses the history and development of PAOO, the biological mechanisms underlying rapid tooth movement using this technique, the surgical procedures involved, indications and contraindications for its use, advantages and disadvantages compared to traditional orthodontics, and case reports. PAOO combines selective alveolar corticotomy, particulate bone grafting, and orthodontic forces to accelerate tooth movement based on the regional acceleratory phenomenon response to the corticotomy injury.
Tmd in orthodontics /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
The document discusses temporomandibular disorders (TMD) in orthodontics. It covers definitions of TMD, the historical background and classifications. The relationship between TMD and orthodontic treatment is examined. Etiology is multifactorial and can include anatomical, psychological and neuromuscular factors. Symptoms commonly seen in TMD include pain in the jaw joints or muscles, joint sounds like clicking or crepitus, and limited jaw movement. Epidemiological studies find a high prevalence of TMD signs and symptoms.
Indirect Sinus Lift
A sinus lift procedure is essentially done to increase bone height and density in the posterior maxilla.
Extremely effective in increasing bone height. for more details visit our website https://www.implantdentistindia.com/i...
Direct Sinus Lift
The direct sinus lift or the lateral window sinus elevation is a widely used technique when resorption of the alveolar bone which leads to insufficient bone height (No bone to place implant). for more details please visit https://www.implantdentistindia.com/d...
We will assure you of the best treatment in this area.
Experienced Implantologist -Dr. Sudhakar Reddy, a Maxillofacial surgeon by specialization has vast experience with such a surgical procedures and can make this surgery very simple.
Book an appointment now
This document discusses anchorage in orthodontics. It defines anchorage as the resistance to unwanted tooth movement. It classifies anchorage according to site (intraoral vs extraoral), number of units (simple vs compound), and arch form (Moyers and Burstone classifications). Biological factors like tooth morphology and muscles affect anchorage. Mechanically, friction influences anchorage. The document reviews anchorage considerations for removable and fixed appliances historically used like edgewise and Begg appliances. It also discusses anchorage preparation and loss.
This document provides an overview of orthognathic surgery. It begins by discussing facial deformities and how orthognathic surgery can alter facial form and function to improve aesthetics and function. It defines orthognathic surgery as surgically manipulating the facial skeleton to restore proper jaw relationships. The document then covers etiology of dentofacial deformities, classifications of deformities, assessment of patients, treatment planning including various phases, and details of different surgical procedures including single tooth osteotomies, anterior segmental osteotomies, and blood supply to the maxilla. The goal of orthognathic surgery is to restore an aesthetically pleasing face through surgical correction of underlying skeletal deformities.
This document discusses various pre-prosthetic hard tissue procedures including: recontouring alveolar ridges through alveoloplasty and Dean's alveoloplasty; reducing maxillary tuberosities, palatal exostoses, mylohyoid ridges, and genial tubercles; removing tori and bone augmentation of atrophic maxillary and mandibular ridges through onlay grafts, sinus lifts, and hydroxyapatite grafts. The goal is to modify oral anatomy and eliminate undercuts/protuberances to facilitate dental prosthesis placement through reshaping bony areas.
The document discusses Wolff's law which states that bone remodels in response to stresses placed upon it. It then discusses different types of functional appliances used in orthodontics including myotonic appliances which rely on muscle mass/resting pressure and myodynamic appliances which make use of muscle activity/movement. The controversy around the degree of bite opening with appliances like activators is also summarized. The document argues that light bite opening may stimulate muscles and growth, while more opening relies on soft tissue stretching.
Description :
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
1. There are several methods to assess skeletal maturity including hand-wrist radiographs, cervical vertebrae shape assessment, and tooth development stages.
2. Hand-wrist radiographs can be assessed using the Greulich-Pyle atlas method or the Bjork, Grave, and Brown method which divides skeletal development into 9 stages.
3. Cervical vertebrae shape changes through 6 stages of maturation and can indicate how much growth remains.
4. Tooth development through 8 stages of calcification as shown in the Demirjian Index also corresponds to skeletal maturity.
1. The document discusses the history, principles, types, and mechanisms of bone grafts. It provides definitions of key terms like graft, flap, osteogenesis, osteoinduction, and osteoconduction.
2. The main types of bone grafts discussed are autogenous grafts, allografts, xenografts, alloplasts, and composite grafts. Autogenous grafts are considered the gold standard due to their osteogenic, osteoinductive and osteoconductive properties but require a second surgical site.
3. Allografts avoid a second surgical site but have reduced osteoinductive potential and risks of disease transmission or immune rejection. Growth factor based grafts and
The document discusses principles of managing impacted teeth. It describes Archer's classification system for impacted maxillary canines, which categorizes them based on their position. Palatally impacted canines are the most common. Clinical and radiographic examinations are used to determine the position and angulation of impacted teeth. Treatment options include retention, surgical exposure and orthodontic traction, transplantation, or removal. Surgical removal requires raising mucoperiosteal flaps and sometimes bone removal to extract the impacted tooth. Mandibular and lower premolar impactions are also discussed and may require surgical removal.
This document discusses the classification, causes, and treatment options for Class II and Class III malocclusions. It begins with an overview of Class II malocclusions, including the dental and skeletal classifications. Common causes are discussed, such as heredity and environmental factors. Treatment options for Class II malocclusions include camouflage with orthodontics alone, extraction of premolars with orthodontics, and distalization of maxillary molars with appliances or temporary skeletal anchorage. Class III malocclusions are also briefly covered, discussing etiology, classification, and treatment including camouflage or surgical options.
1. Orthodontic tooth movement occurs through remodeling of the alveolar bone in response to prolonged mechanical forces on teeth. Bone resorbs on the pressure side and forms on the tension side of the periodontal ligament.
2. Physiologic tooth movements include eruption, drift, and minor movements during mastication. Eruption occurs through growth of the root and forces from the periodontal ligament.
3. When forces are within physiologic limits, tooth movement occurs through frontal resorption on the pressure side and bone formation on the tension side. Excessive forces cause hyalinization and undermining resorption.
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.
A study of 2 bone plating methods for fractures of mandibular symphysis and bodyDr. SHEETAL KAPSE
This study compared outcomes of using two miniplates versus one larger plate for internal fixation of mandibular symphysis and body fractures. Two hundred sixty-five patients were treated with either two miniplates or one larger plate. The use of two miniplates resulted in higher rates of wound dehiscence, plate exposure, and need for plate removal compared to the use of a single larger plate. However, both techniques provided sufficient stability for fracture healing.
This document provides an overview of dental implant sinus lift procedures. It begins with brief anatomy of the maxillary sinus and defines a dental implant. It then discusses patient evaluation, including radiographic assessment and anatomical limitations for implantation. Classification systems for the posterior maxilla are presented. The document reviews indications, contraindications, and surgical techniques for sinus lift procedures, including direct and indirect methods. It also discusses graft materials, post-operative instructions, and potential complications.
The document discusses implant failure, its classification, diagnosis and management. It defines different types of implant failures such as ailing, failing and failed implants. The most common implant failures discussed are malpositioning, improper occlusal scheme, cantilevers that are too long, and implant abutment misfit. Management strategies focus on identifying the cause, nonsurgical debridement, and antiseptic treatment to resolve inflammation and prevent further bone loss.
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 methods used to accelerate orthodontic tooth movement. It begins with an introduction to the topic and discusses the main concerns with traditional orthodontic treatment duration. It then outlines several methods to speed up tooth movement, including pharmacological methods using agents like prostaglandins, surgical methods like corticotomy and piezocision, and physical methods employing vibratory stimulation or low-level laser therapy. For each method, the document discusses the procedure, indications, advantages, disadvantages and relevant studies. It primarily serves to educate on the various techniques available to reduce the length of orthodontic treatment.
The document discusses temporomandibular disorders (TMD) and temporomandibular joint (TMJ) ankylosis. It provides details on the anatomy and physiology of the TMJ, as well as common disorders including TMD, disc displacement, and ankylosis. The document examines evidence for and against relationships between TMD, malocclusion, occlusal interferences, and orthodontic treatment. While some studies found weak correlations, others found no significant relationships or that orthodontics does not cause TMD or alter the condyle position.
The document describes two tests used by orthodontists to measure progress in treatment - the K test and condylar test. The K test measures vertical overlap of incisors to detect improvements in deep bites. The condylar test measures sagittal movement of the mandible using incisors as reference points, allowing orthodontists to track corrections of Class II malocclusions and prevent mistaken assumptions of full correction. Both tests are important for monitoring progress at each appointment and ensuring treatments are progressing as planned.
This document provides an overview of Periodontally Accelerated Osteogenic Orthodontics (PAOO). It discusses the history and development of PAOO, the biological mechanisms underlying rapid tooth movement using this technique, the surgical procedures involved, indications and contraindications for its use, advantages and disadvantages compared to traditional orthodontics, and case reports. PAOO combines selective alveolar corticotomy, particulate bone grafting, and orthodontic forces to accelerate tooth movement based on the regional acceleratory phenomenon response to the corticotomy injury.
Tmd in orthodontics /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
The document discusses temporomandibular disorders (TMD) in orthodontics. It covers definitions of TMD, the historical background and classifications. The relationship between TMD and orthodontic treatment is examined. Etiology is multifactorial and can include anatomical, psychological and neuromuscular factors. Symptoms commonly seen in TMD include pain in the jaw joints or muscles, joint sounds like clicking or crepitus, and limited jaw movement. Epidemiological studies find a high prevalence of TMD signs and symptoms.
Indirect Sinus Lift
A sinus lift procedure is essentially done to increase bone height and density in the posterior maxilla.
Extremely effective in increasing bone height. for more details visit our website https://www.implantdentistindia.com/i...
Direct Sinus Lift
The direct sinus lift or the lateral window sinus elevation is a widely used technique when resorption of the alveolar bone which leads to insufficient bone height (No bone to place implant). for more details please visit https://www.implantdentistindia.com/d...
We will assure you of the best treatment in this area.
Experienced Implantologist -Dr. Sudhakar Reddy, a Maxillofacial surgeon by specialization has vast experience with such a surgical procedures and can make this surgery very simple.
Book an appointment now
This document discusses anchorage in orthodontics. It defines anchorage as the resistance to unwanted tooth movement. It classifies anchorage according to site (intraoral vs extraoral), number of units (simple vs compound), and arch form (Moyers and Burstone classifications). Biological factors like tooth morphology and muscles affect anchorage. Mechanically, friction influences anchorage. The document reviews anchorage considerations for removable and fixed appliances historically used like edgewise and Begg appliances. It also discusses anchorage preparation and loss.
This document provides an overview of orthognathic surgery. It begins by discussing facial deformities and how orthognathic surgery can alter facial form and function to improve aesthetics and function. It defines orthognathic surgery as surgically manipulating the facial skeleton to restore proper jaw relationships. The document then covers etiology of dentofacial deformities, classifications of deformities, assessment of patients, treatment planning including various phases, and details of different surgical procedures including single tooth osteotomies, anterior segmental osteotomies, and blood supply to the maxilla. The goal of orthognathic surgery is to restore an aesthetically pleasing face through surgical correction of underlying skeletal deformities.
This document discusses various pre-prosthetic hard tissue procedures including: recontouring alveolar ridges through alveoloplasty and Dean's alveoloplasty; reducing maxillary tuberosities, palatal exostoses, mylohyoid ridges, and genial tubercles; removing tori and bone augmentation of atrophic maxillary and mandibular ridges through onlay grafts, sinus lifts, and hydroxyapatite grafts. The goal is to modify oral anatomy and eliminate undercuts/protuberances to facilitate dental prosthesis placement through reshaping bony areas.
The document discusses Wolff's law which states that bone remodels in response to stresses placed upon it. It then discusses different types of functional appliances used in orthodontics including myotonic appliances which rely on muscle mass/resting pressure and myodynamic appliances which make use of muscle activity/movement. The controversy around the degree of bite opening with appliances like activators is also summarized. The document argues that light bite opening may stimulate muscles and growth, while more opening relies on soft tissue stretching.
Description :
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
1. There are several methods to assess skeletal maturity including hand-wrist radiographs, cervical vertebrae shape assessment, and tooth development stages.
2. Hand-wrist radiographs can be assessed using the Greulich-Pyle atlas method or the Bjork, Grave, and Brown method which divides skeletal development into 9 stages.
3. Cervical vertebrae shape changes through 6 stages of maturation and can indicate how much growth remains.
4. Tooth development through 8 stages of calcification as shown in the Demirjian Index also corresponds to skeletal maturity.
1. The document discusses the history, principles, types, and mechanisms of bone grafts. It provides definitions of key terms like graft, flap, osteogenesis, osteoinduction, and osteoconduction.
2. The main types of bone grafts discussed are autogenous grafts, allografts, xenografts, alloplasts, and composite grafts. Autogenous grafts are considered the gold standard due to their osteogenic, osteoinductive and osteoconductive properties but require a second surgical site.
3. Allografts avoid a second surgical site but have reduced osteoinductive potential and risks of disease transmission or immune rejection. Growth factor based grafts and
The document discusses principles of managing impacted teeth. It describes Archer's classification system for impacted maxillary canines, which categorizes them based on their position. Palatally impacted canines are the most common. Clinical and radiographic examinations are used to determine the position and angulation of impacted teeth. Treatment options include retention, surgical exposure and orthodontic traction, transplantation, or removal. Surgical removal requires raising mucoperiosteal flaps and sometimes bone removal to extract the impacted tooth. Mandibular and lower premolar impactions are also discussed and may require surgical removal.
This document discusses the classification, causes, and treatment options for Class II and Class III malocclusions. It begins with an overview of Class II malocclusions, including the dental and skeletal classifications. Common causes are discussed, such as heredity and environmental factors. Treatment options for Class II malocclusions include camouflage with orthodontics alone, extraction of premolars with orthodontics, and distalization of maxillary molars with appliances or temporary skeletal anchorage. Class III malocclusions are also briefly covered, discussing etiology, classification, and treatment including camouflage or surgical options.
1. Orthodontic tooth movement occurs through remodeling of the alveolar bone in response to prolonged mechanical forces on teeth. Bone resorbs on the pressure side and forms on the tension side of the periodontal ligament.
2. Physiologic tooth movements include eruption, drift, and minor movements during mastication. Eruption occurs through growth of the root and forces from the periodontal ligament.
3. When forces are within physiologic limits, tooth movement occurs through frontal resorption on the pressure side and bone formation on the tension side. Excessive forces cause hyalinization and undermining resorption.
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.
A study of 2 bone plating methods for fractures of mandibular symphysis and bodyDr. SHEETAL KAPSE
This study compared outcomes of using two miniplates versus one larger plate for internal fixation of mandibular symphysis and body fractures. Two hundred sixty-five patients were treated with either two miniplates or one larger plate. The use of two miniplates resulted in higher rates of wound dehiscence, plate exposure, and need for plate removal compared to the use of a single larger plate. However, both techniques provided sufficient stability for fracture healing.
This document provides an overview of dental implant sinus lift procedures. It begins with brief anatomy of the maxillary sinus and defines a dental implant. It then discusses patient evaluation, including radiographic assessment and anatomical limitations for implantation. Classification systems for the posterior maxilla are presented. The document reviews indications, contraindications, and surgical techniques for sinus lift procedures, including direct and indirect methods. It also discusses graft materials, post-operative instructions, and potential complications.
The document discusses implant failure, its classification, diagnosis and management. It defines different types of implant failures such as ailing, failing and failed implants. The most common implant failures discussed are malpositioning, improper occlusal scheme, cantilevers that are too long, and implant abutment misfit. Management strategies focus on identifying the cause, nonsurgical debridement, and antiseptic treatment to resolve inflammation and prevent further bone loss.
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 methods used to accelerate orthodontic tooth movement. It begins with an introduction to the topic and discusses the main concerns with traditional orthodontic treatment duration. It then outlines several methods to speed up tooth movement, including pharmacological methods using agents like prostaglandins, surgical methods like corticotomy and piezocision, and physical methods employing vibratory stimulation or low-level laser therapy. For each method, the document discusses the procedure, indications, advantages, disadvantages and relevant studies. It primarily serves to educate on the various techniques available to reduce the length of orthodontic treatment.
The document discusses temporomandibular disorders (TMD) and temporomandibular joint (TMJ) ankylosis. It provides details on the anatomy and physiology of the TMJ, as well as common disorders including TMD, disc displacement, and ankylosis. The document examines evidence for and against relationships between TMD, malocclusion, occlusal interferences, and orthodontic treatment. While some studies found weak correlations, others found no significant relationships or that orthodontics does not cause TMD or alter the condyle position.
The document describes two tests used by orthodontists to measure progress in treatment - the K test and condylar test. The K test measures vertical overlap of incisors to detect improvements in deep bites. The condylar test measures sagittal movement of the mandible using incisors as reference points, allowing orthodontists to track corrections of Class II malocclusions and prevent mistaken assumptions of full correction. Both tests are important for monitoring progress at each appointment and ensuring treatments are progressing as planned.
Surgically assisted rapid maxillary expansion (SARME) is a surgical technique used to widen the maxilla. It involves performing corticotomies through the zygomatic buttress and releasing other resistant structures like the midpalatal suture and pterygoid plates. An expander is placed preoperatively and activated starting 5 days post-op at 0.5mm/day. SARME allows for greater expansion than orthodontics alone and has better stability than segmental osteotomies. It is used to treat transverse deficiencies over 5mm and failed orthodontic expansion in adults. Risks include periodontal damage, root damage, and nasal complications.
Nager syndrome is similar to HFM but also includes preaxial limb anomalies such as hypoplastic or aplastic thumbs and radial hypoplasia. It also involves agenesis of the soft palate, known as the "sign post" sign, as well as ear defects and TMJ ankyloses.
Marfan syndrome is a genetic disorder of connective tissue that affects the heart, eyes, bones and other tissues. It is caused by mutations in the FBN1 gene and is inherited in an autosomal dominant pattern. Diagnosis is based on the Ghent criteria, which looks for major and minor clinical features in different organ systems. Common signs and symptoms include elongated limbs, scoliosis, eye problems like retinal detachment, heart issues like mitral valve prolapse and aortic aneurysm, and skeletal issues like joint hypermobility and pain. While there is no cure, treatment focuses on managing heart and eye complications through medication and surgery.
This document discusses joint restorative orthodontic treatment and summarizes several situations where combined orthodontic and restorative treatment may be required, including uprighting tilted molars, managing peg laterals or other diminutive teeth, managing traumatized teeth before or during orthodontic treatment, treating periodontal patients, managing cleft lip and palate patients, and treating orthognathic patients. It also discusses the impact of endodontically treated teeth, the role of orthodontics in prosthodontic treatment, tooth surface loss, and modification of tooth color.
This document provides an overview of oral health assessment as it relates to orthodontic treatment planning and management. Key points discussed include:
1. Oral health encompasses the health of teeth, supporting structures, and soft tissues, and is an important consideration in orthodontic treatment.
2. A thorough oral health assessment includes examining factors like caries risk, periodontal health, plaque, gingivitis, diet, and oral hygiene habits.
3. Standard examination methods and indices are described to evaluate various oral health parameters like caries detection, periodontal screening, plaque levels, and gingival inflammation. Maintaining good oral health is important during orthodontic treatment.
This document summarizes the normal development of primary and permanent dentition. It discusses the chronology of tooth development, including calcification and eruption times. It also describes the typical stages of postnatal dental development, from the edentulous stage to the functional permanent dentition stage. Abnormalities during development like natal or neonatal teeth are also addressed.
This document discusses four dental anomalies:
1. Dens in dent is a developmental anomaly where the enamel organ invaginates into the dental papilla. It can increase risks of caries, pulpal pathosis, and difficult endodontic treatment.
2. Macrodontia is when teeth are abnormally large. It can cause aesthetic and orthodontic problems. Treatment may include stripping, reshaping, or extraction.
3. Natal teeth are present at birth due to premature development, while neonatal teeth erupt within 30 days of birth. They are usually extracted to prevent complications.
4. Neonatal and natal teeth have several potential complications but are usually managed conservatively or through extraction with prec
This document discusses various methods for analyzing space in orthodontic treatment planning. It describes the Royal London Space Analysis method in detail, including its two stages: 1) assessing space requirements and 2) creating or utilizing space through treatment mechanics. The method is considered easy to use, reliable, and valid, but it may overestimate crowding and have limited impact on treatment decisions. Alternative space analysis methods and their advantages/disadvantages are also reviewed.
This document discusses Molar-Incisor Hypomineralization (MIH), a condition characterized by hypomineralized enamel in first molars and often incisors. It defines MIH and describes its clinical features, diagnosis, classification, and differential diagnosis. The document notes that MIH molars experience rapid decay and difficulty with anesthesia and restorations. It causes tooth sensitivity and issues during brushing for children. The prevalence of MIH ranges from 3.6-25% depending on location. Potential causes include respiratory infections, perinatal complications, dioxins, and childhood illnesses. Treatments include preventing decay, applying desensitizing agents, sealants, restorations, and sometimes extra
This document discusses Molar-Incisor Hypomineralization (MIH), a condition characterized by hypomineralized enamel in first molars and often incisors. It defines MIH and describes its clinical features, diagnosis, classification, and differential diagnosis. The document notes that MIH molars experience rapid decay and difficulty with anesthesia and restorations. It causes tooth sensitivity and pain in children. While the cause of MIH is unclear, potential factors discussed include respiratory infections, perinatal complications, dioxins, and childhood illnesses. The document recommends preventive treatments like fluoride and restorations, and considers extraction if prognosis is poor.
This document discusses several potential iatrogenic effects of orthodontic treatment, including:
- Tissue damage such as enamel demineralization, which can lead to white spot lesions on teeth, as well as enamel fractures. Preventive measures like fluoride application and oral hygiene maintenance are important.
- Periodontal problems such as gingival recession and alveolar bone loss. Incidence of these issues can be reduced through proper oral hygiene and non-traumatic orthodontic techniques.
- Root resorption caused by excessive orthodontic forces. It is important to identify risk factors and use lighter forces to help prevent this problem.
- Pulp damage from trauma to teeth.
This document provides guidelines for clinical facial analysis (CFA) for orthodontists and maxillofacial surgeons. It details the steps and assessments involved in CFA from both frontal and profile views. Key areas examined include facial type, vertical heights, symmetry, skeletal bases, lip assessments, smile analysis, and dental factors. CFA is used to diagnose and classify dentofacial deformities, plan appropriate treatment, and predict outcomes. It should be performed at initial examination and precedes intraoral examination while the patient is in natural head position.
Oro-facial-digital syndromes are a rare group of genetic disorders that affect around 1 in 50,000 people and have similar features. They are caused by mutations in different genes and are classified into eight types. Common signs include digital anomalies of the hands and feet, facial abnormalities such as frontal bossing and wide-set eyes, and oral features like cleft lip and high arched palate.
The document discusses third molar impaction, including prevalence, causes, types of impaction, problems that can be caused by impacted third molars, and debates around their relationship to crowding. It also outlines recommendations and guidelines for management and treatment of impacted third molars, indicating when removal may or may not be advisable based on factors like symptoms, risk of complications, and orthodontic considerations. Complications of removal are also discussed.
1. There are several methods for predicting outcomes of orthognathic surgery, including manual tracings, computer programs, and 3D modeling.
2. Accuracy of prediction varies depending on the method and software used, with 3D modeling generally providing the most accurate predictions but manual methods still common.
3. Studies have found most software to be reasonably accurate for hard tissue predictions but with more variability for soft tissues like lips and less ability to account for individual patient differences.
The document outlines health and safety regulations that a dentist must follow, including providing instruction and training to employees, maintaining a safe work environment, and safely handling and storing hazardous substances. It also describes the main purposes of guidance documents as helping people understand and comply with the law by interpreting it and providing technical advice. Finally, it lists the seven steps required for compliance with COSHH, which controls exposure to substances hazardous to health, such as assessing risks, implementing control measures, and monitoring exposure.
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1. There are several methods for predicting surgical outcomes of orthognathic surgery, including manual tracings, computer software programs, and video imaging.
2. Studies have found that current prediction methods tend to be inaccurate, especially in predicting soft tissue changes like lip and chin positions. Predictions often differ from actual outcomes by 2mm or more.
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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 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
Distraction osteogenesis is a technique where bone is lengthened by slowly pulling apart the fragments of a surgically cut bone. New bone forms in the gap created. It has advantages over orthognathic surgery like being safer, decreasing hospitalization time, and allowing treatment at a younger age as it regenerates both bone and soft tissues. There are different types including monofocal, bifocal, and trifocal distraction used for various bone defects. Distraction is done in phases including latency, distraction, consolidation, and retention using both internal and external distraction devices. It is used to treat conditions like jaw hypoplasia, asymmetry, and defects from tumors or trauma.
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.
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.
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This document provides an overview of distraction osteogenesis. It begins with definitions and the need for distraction to gradually advance bone segments. Key topics covered include the history, biology, types of devices, factors influencing distraction, diagnosis/planning, and indications. Simultaneous distraction is described as a technique used for hemifacial microsomia. Presurgical orthodontics and vector planning are important preparation steps. Complications and current concepts are also briefly mentioned.
Disraction Osteogenesi
Distraction osteogenesis (DO) is a tissue engineering method and can be integrated with various craniomaxillofacial surgical techniques to generate new bone via stretching the surgically osteotomized bone with the aid of a mechanical device that is designed to control both the traction rate and the movement vector.
This technique utilizes the fundamental healing properties of the human body by inducing regeneration and remodeling of callus between osteotomized site, also known as distraction gap.
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.
The document discusses the development and philosophy behind twin block therapy. It was developed in 1977 by Dr. William Clark to treat a patient with a class II malocclusion. The twin block uses occlusal inclined planes and proprioceptive stimulus to encourage mandibular growth. Details are provided on case selection, diagnosis, treatment planning, and bite registration techniques for twin block.
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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.
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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.
Distraction osteogenesis (DO) is a surgical technique that takes advantage of
natural wound healing mechanisms to augment bone and soft tissues. DO is
extremely versatile and can be applied to nearly any bone. In the craniofacial
skeleton, the cranial vault, midface, maxilla andmandible are themost common
sites for DO. This technique allows larger skeletal movements than could be
achieved with conventional techniques, decreases operative time and blood
loss, eliminates the need for bone grafts and associated donor site morbidity,
and may improve postoperative stability. DO can be used in preparation for, in
lieu of, or in combination with orthognathic surgery to correct dentofacial deformities.
Distraction osteogenesis, also called callus distraction, callotasis and osteodistraction, is a process used in orthopedic surgery, podiatric surgery, and oral and maxillofacial surgery to repair skeletal deformities and in reconstructive surgery
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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This document summarizes a surgical technique called L-shaped corticotomy with vascularized bone flap sliding for treating chronic osteomyelitis of the tibia. Some key points:
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Distraction osteogenesis / for orthodontists by Almuzian
1. Distraction osteogenesis (DO)
MATTICK 2000
Distraction osteogenesis (DO) is a biologic process of new bone formation between bone
segments that are gradually separated by incremental traction.
This controlled distraction, generates new bone within the distracted gap. So in a way, it is an
in-vivo bone tissue engineering
History
Alessandro Codivilla in 1905, was the first to perform DO surgery. He published a case report
of femoral extension by applying axial forces of distraction.
Distraction osteogenesis for bone lengthening was an accidental discovery off Ilizarov when
he observed callus formation in a patient who had mistakenly distracted his frame instead of
compressing it.
The Russian surgeon, Gavriil Ilizarov, who pioneered the biological principles of bone and soft
tissue regeneration and popularized the technique of distraction osteogenesis, (Ilizarov,
1989).
McCarthy from United States, reported the first craniofacial DO in humans and Guerrero was
the first to use inta-oral device to widen mandibular arches.
Sequence of DO
I. Osteotomy
• Trigger fracture healing will initiate: Angiogenesis, fibrogenisis, Osteoinduction &
Osteoconduction
a. Latency phase (3 to 7 days)
• Phase immediately following the osteotomy,
• Reparative callous formation
b. Distraction phase
• Gradual distraction at a rate of ~1.0 mm day
c. Consolidation phase (6-10 weeks)
• Distraction is ceased
• Mineralization and Corticalisation. The bone produced is less denseand of lower volume than
the ‘original’ bone, but is believed to have equivalent growth potential.
2. d. Remodeling Phase
• Continues approxiamtely for a year after completion
Histologically distinct stages of DO
Normally, four histologically distinct stages of bone repair are observed:
1. an inflammatory phase, immediately following an osteotomy, blood fills the space between
the separated bone segments, and an inflammatory cell infiltrate is observed. This
inflammatory stage represents an acute response to the injury and lasts several days. If DO
started at this stage, then the result is decreased bone formation, often with cartilaginous
elements present, and decreased mechanical strength of the newly created bone. An
important consideration in treatment planning for mandibular lengthening is how the bone
cuts will be coordinated with placement of the distractor. Some recommend:
Making the cortectomy, placing the distractor, and then completing the osteotomy with the
distractor in place. With that approach, the distractor may hinder completion of the
osteotomy.
First cortectomies followed by completion of the osteotomy through activation of the device
Completion of the osteotomy and placing the distractor after completing the initial incision
and dissection, doing the buccal cortectomy, removing the distractor and completing the
osteotomy, and then finallyplacing a distractor with the originalrelationships of the segments
intact.
2. The initialhematoma is then replaced by granulation tis sue. Largenumbers of fibroblasts and
mesenchymal stem cells arc recruited to the region, and synthesis of type 1 collagen is seen
within the fracture zone. In addition, there is a vascularresponse marked by formation of new
capillaries. These fibrous structures create a soft callus that bridges across the fractured bone
segments. DO should start at this stage. The blood supply duitng DO increased *7 times.
The cellular basis for induction of regeneration under stretching is that:
• Any cells under pressure will demonstrates catabolic state where it starts degeneration by
releasing of tissueresorbing factors. This in the pressure side of orthodontic tooth movement.
• Any cells under stretch will demonstrates anabolic state where it starts regeneration by
releasing of tissue forming factors. This is the stretch phase in DO.
3. There are two important variables in the activation:
I. Rate, or the amount of distraction per day, and rhythm, or how frequently the device is
activated. If the rate of distraction is too small, there is a risk of premature consolidation. On
the other hand, too great a rate of distraction may place undue stress on the soft callus,
resulting in thinning of alldimensions in the mid-portion of the regenerate and an "hourglass"
at the distraction site. This can be likened to the effect of pulling taffy apart
II. With regard to rhythm, constant activation probably would be ideal, although this is not
possible with current devices.
a. Ilizarov felt that rhythm was critical to osteogenic activity. His recommendation was for 0.25
mm four times a day.
b. In the majority of maxillofacial cases described in the literature, the most common protocol
is 0.5 mm increments twice daily. Clinical experience suggests that activation of more than
0.5 mm at a time results in a marked increase in pain, from more aggressive stretching of the
periosteum and musculature.
c. In some instance activation of 0.5 mm may result in complaints of pain by the patient, and in
such cases distraction at a rate of 0.25 mill four times daily is an acceptable alternative.
d. Due to the fast healing response of infants, distraction can be initiated immediately, at the
rate of 1.5 mm per day in three 0.5 mm activations.
e. During the stabilization phase the use of orthodontic elastics guides the dentition, and is also
thought to aid vectorization and ‘mould’ the developing regenerate.
f. One of the primary considerations in treating hypo plastic mandibles is the extent to which
lengthening of the ramus versus the body is desired. Proportional analysis is one way to
establishthis. The average relationship of ramus height (Co-Go) to body length (Go-Gn) is 5:7;
the relationship of the maxillary jaw length (ANS-PNS) to mandibular body length is 2:3.
Another guideline is that the anterior cranial base length (S-N) is slightly less than (2 to 3 mm)
the mandibular body length.
g. Weekly panoramic radiographs arc taken until the distractor is fully activated
3. Approximately 2 week; following the initial injury, there is a progressive mineralization of the
soft callus, resulting in formation of a hard callus. The hard callus is composed of immature
bone. In the finalphase of fracture repair, there is extensiveremodeling of this "woven" bone,
and the normal lamellar architecture is regained. If DO started at this stage the distraction
4. device may be unable to further separate the bony segments. In the Case of large
advancements. additional stabilization can be obtained from a brief period of
maxillomandibular fixation during the consolidation phase. With internal distraction devices
in children, a consolidation period of 4- months is recommended before the distractor is
removed, bur in older patients or patients with a compromised physical condition, 6 months
may be a minimal, and in some cases (e.g., multiple previous operations, patient who
smokes), consolidation may be considered for up to a year.
Differences between DO in facial region and long bone
Distraction of the jaws differs from distraction of the limbs in at least four ways:
1. The requirements for movement of the bony segments are more complex and requires
complex three-dimensional movements
2. There are complex soft tissue and muscle attachments.
3. Mobilization of the maxilla involves separation at several Sutures as well as osteotomy across
skeletal buttresses, and new bone formation must occur along the thin cortical plates.
4. Facial aesthetic issues
5. Smaller devices often with multidirectional vectors of force
6. Beyond early childhood, the dental occlusion requires precise control of the magnitude and
direction of movement of the jaws.
Advantages
• Less mobilisation
• Reduced operative time
• Reduced hospital stay
• Expands soft tissue (CFM / Cleft palate)
• Avoid bone grafts (Donor site morbidity)
• ? Increased stability
• Reduced blood transfusion
• Avoid prolonged fixation
• Can clinically judge end point of treatment
5. • The ability to lengthen previously grafted bone.
• The ability to repeat distraction osteogenesis at a later date if need be.
• Allows larger movements
Disadvantages
• Second surgery required to remove distractor
• Pain during distraction phase
• Bony movements dependent on distractor position
• Distractor integrity crucial
• Scarring with external devices.
• Significant cooperation is required from both the patient and their family in most cases.
• Technical considerations include the very small size of the jaw, patient management after
surgery during the distraction phase, and avoiding tooth buds and the inferior alveolar nerve
during osteotomy and placement of the appliance. Stereolithographic models facilitate
treatment planning. Current models can identify the presence of tooth buds and the nerve,
as well as provide an opportunity to contour the device prior to surgery.
Complications
Non compliance and premature removal of distractor
Pain may be significant and prevent completion of treatment- usually from the TMJ's and
traction elastics can help to "un-load" the joints
6. Premature consolidation
Neurological damage
Failure to form a callus
Incorrect vectors and therefore incorrect occlusion
Relapse
VPI because of large movements
TMJ ankylosis
Failure to "grow" normal and need for more surgery
Applications
1. Mandibular distraction can be used to
A short mandihular ramus that must be lengthened, but with conventional surgery, the
musculature of the pterygomandibular sling does not adapt to lengthening of the ramus.
Distraction histogenesis, at least theoretically, could be a way to overcome this limitation
Mandibular hypoplasia with airway risk(e.g.Pierre robin neonate/child or nager’s syndromes)
Mandibular retrognathia severe class ii skeletal pattern more than 10 to 15 m
Mandibular asymmetry hemifacial microsomia, ankylosed child temporomandibular joint
Post-mandibulectomy previous ablative surgery
Sleep apnoea diagnosed by sleep physician due to short ramus and body
2. Mid symphyseal distraction osteogenesis (MSDO)
3. Maxillary distraction
Bring the midface forward, and holds potential for people with cleft lip and palate and
patients with craniofacial syndromes. However, a Cochrane review by Kloukos in 2016
showed that there is only one small randomised controlled trial concerning the effectiveness
of distraction osteogenesis compared to conventional orthognathic surgery. Based on
measured outcomes, distraction osteogenesis may produce more satisfactory results;
however, further prospective research comprising assessment of a larger sample size with
participants with different facial characteristics is required to confirm possible true
differences between interventions.
Widening the Maxilla: SARPE as a Form of Distraction
4. augmentation of alveolar ridges
7. 5. Regeneration of mandibular tissue following tumour resection show considerable promise.
Mid symphyseal distraction osteogenesis (MSDO)
A narrow mandible or a severely constricted mandible which could be associated with any
one of these syndromes (Russell Silver Syndrome, Treacher Collins Syndrome, Craniofacial
Microsomia, Pierre Robin sequence, Apert Syndrome)
In situations where you have a severe crowding in the lower arch but the upper arch has no
crowding and is normal. The patient has a very obtuse nasolabial angle and you cannot afford
to retract the upper
Reduced Intercanine width.
Narrow chin. If it is not desirable to widen the chin, a Genioplasty be performed to maintain
the genial width.
Types of distractors for MSDO
I. Tooth borne
Simpler with less surgical time
But….
Disproportional widening at the basal and dentoalveolar level. Del Santo et al. (2000) used
tooth borne devices and found insignificantincreases inbicondylar, bigonial,and biantegonial
widths after mandibular widening. He demonstrated that dentoalveolar expansion was
greater than basal bone expansion with tooth-borne distraction devices.
Alveolar bone widening not supported by apical base, is usually unstable1
Periodontal problems, fenestration defects2
Buccal root resorption
Anchorage loss
8. II. Bone-borne
Others state that a greater skeletal effect can be achieved using the bone-borne appliance
owing to the fact that bone-borne distractors transfer the distraction forces directly to the
mandible (Conley and Legan, 2003; Bayram et al., 2007).
Malkoc ̧ et al. (2006) stated that parallel widening of the mandible could be achieved with
tooth- and bone- borne distraction devices.
More skeletal changes (Mommaerts et al, 2008)
But….
Complications (infection, gingival recession, breakage)
Morbidity seemed to be higher
Higher cost
9. TMJ symptoms secondary to MSDO
Every 1 mm of mandibular midline widening = 0.34” of Lateral rotational movement of each
mandibular condyle (Computer simulation data by Samchukov et al)
However, identifying the cause of postoperative TMJ symptoms in patients treated with
distraction osteogenesisof the mandibular symphysis will be difficult.
Good occlusion and adaptation to gradual distraction ensures normal joints
MSDO is kinder to the TMJ due to slower rate of movement compared with traditional
orthognathic procedures with acute skeletal movements
Technique of MSDO
I. Pre-surgical Orthodontics
Align and level the maxillary arch
Obtain ideal maxillary arch
Placement of rectangular surgical maxillary arch
Fabrication of the intraoral distractor appliance
Placement of the distractor appliance on the mandibular arch
II. Post-Surgical Orthodontics
Placement of lower anterior brackets
Maintenance of the dental gap for 2 months with a plastic tooth
Orthodontic mechanics are undertaken 2 months after surgery
Periodically stripping of plastic tooth
Mobilization of teeth into the distraction site
Align and level, arch interdigitation and finishing followed by retention
10. TOOTH Movement after MSDO: When should we start?
I. Early tooth movement leads to
Root resorption (established in canine models)
Periodontal and bony defects in addition to potential loss of at least 1 tooth
II. Consolidation periods of at least 6-10 weeks before moving tooth into the new bone
Radiographs for evaluating the bone density in the gap
Mandibular Distraction Devices
These were placed ulilizing intraoral incision to visualize the osteotomy cuts and small stab
incision to place the pins on which the device was mounted.
Advantages
multiplane distraction can be more easily incorporated into the design,
the device can be removed easily.
Activation may be easier than with an internal device as well.
Disadvantages
excessive scarring
increased urgency to remove the device because it is so apparent.
the psychosocial problems associated with an external device may be such that the
11. consolidation period is shortened more than is reasonable.
an external distractor must be placed at distance from the mandible, which decreases the
rigidity of fixation.
Intraoral device
Types
Bone borne,
Hybrid (bone-borne and tooth-borne)
Tooth-borne
Advantages: Because an intraoral device is much less apparent, it can be left indefinitely
without great pressure from the patient
Disadvantages
Second surgical procedure is required for removal. In addition, when the ramus is being
lengthened, it may be difficult to activate the appliance entirely within the mouth.
Additionally, because the natural shape of the mandible is transversely wider in its posterior
aspect and narrower in its anterior aspect, the distractor appliances need to be adjusted by
creating a 5- to 8-mm step in the anterior fixation plates so that the distractor’s screw can be
placed parallel to the axis of distraction. If this is underestimated, the reciprocal forces
exerted on the mandible by the appliance will advance the mandible by moving the proximal
segment not only posteriorly but also laterally and exert very detrimental forces on the TMJ,
which will cause pain, dysfunction, and damage to the joints. In addition, there will be lateral
torque force against the condyle, loosening of the screws, and bending of the appliance as
the muscle forces bend the device. This situation is overcome with the use of heavy class II
elastics, 6 oz per side, during the activation and consolidation period
12. Maxillary Distraction Osteogenesis
Even though there is still an ongoing debate if rapid maxillary expansion is a version
of maxillary distraction osteogenesis, the first study on true midfacial distraction was
initiated on an ovine model by Rachmiel et al. in 1993 (Rachmiel et al. 1995), in which
they were able to achieve 36 mm of midfacial advancement on the nasofrontal area
with 7 % relapse in 1 year follow-up time.
This study sets a starting point for the correction of midfacial deformities by
distraction osteogenesis. Currently, the most frequent indications of maxillary
distraction osteogenesis can be counted as cleft lip and palate, and craniofacial
dysostosis associated with maxillary hypoplasia (Imola and Tatum 2002).
About 25 % of these cleft cases with class III malocclusion require secondary surgical
intervention to correct the maxillomandibular relationship (Ross 1987).
Types of distractors
1. Extraoral
Distraction osteogenesis ofmaxilla with external tension devices, which takes anchorage from
the temporal region of the head using pin retained hemi halo and screw generated pull by
elastics, provided a solution to the sagittal discrepancies of cleft cases.
13. This device provided high advancement amounts on
the higher regions of the facial skeleton with low
relapse rate (Figueroa and Polley 1999; Figueroa et al.
2004)
It provide Greater movements in Multiplanar
Easy to adjust in DO phase
Psychosocial implications
Pin site infection and scars
Nerve damage
2. Intraoral
Lin et al 1999, Rachmiel et al 2000
Avoid cutaneous scars
Socially more convenient
Need space for device
3d control not good
Archwise Distraction on Fixed Orthodontic Appliances
14.
15. DOCKING SITE SURGERY, Once the two segments dock with each other, a second procedure
is required for uniting the two segments. The epithelial tissue between the two segments is
removed, as well as the hypotrophic bone edges from each disk, as described for the
mandible.
Class II Correction by Anterior Alveolar Distraction
16.
17.
18.
19. This method has several advantages upon the conventional methods:
Shortening the treatment time: Conventional treatment protocol in such cases, in which
either orthognathic surgery or fixed functional orthodontic treatment is an option, takes 16–
24 months time. However, in this approach, alveolar distraction followed by dental implants
shortens the treatment time significantly
It can be performed under local anesthesia, and it is less invasive.
Room available for the tongue can increase significantly without any changes to the muscular
structure compared to the mandibular advancement.
Risk of hemorrhage and developing lip paresthesia is reduced.
As the tooth movement is less in this method, the root resorption risk and the periodontal
20. problem risk are reduced as well.
Alveolar DISTRACTION OSTEOGENESIS
• Patients medically compromised in whom major bone grafts are not indicated
• As an alternative for reintervention after an unsuccessful bone graft reconstruction
• A need to minimize costs related to the expense of prolonged surgery and hospitalizations
• After removal of benign tumors
• Reconstruction of gunshot wound defects
• Management of osteomyelitis
• Treatment for malunions or nonunions
VELOPHARYNGEAL INCOMPETENCE
The use of pharyngoplasties, pharyngeal flaps, and secondary push-backs to correct
velopharyngeal incompetence has been overcome by distraction osteogenesis of the palatine
bones to project the palate posteriorly. This technique permits titration of the movement
until the velopharyngeal competence is achieved, with predictable results and a low
morbidity, avoiding hyponasality, snoring, and nasal obstruction
Nerve Lengthening
21. Histologically, there are three possibilities after distraction. First, the nerve may exhibit
perineural thickening and decreased surface area of axons, various axonal abnormalities,
myelin thickening, and disruption of the lamellar pattern, and there is a direct relationship
between the number of millimeters advanced and alterations in the nerve. Second, the nerve
can be damaged during surgery and have no axonal connection, with the subsequent
development of fibrosis. Third, a distractor screw can be placed within the nerve canal and
cause damage to or displace neural structures.