Application of Interdental Distraction Osteogenesis to Unilateral Cleft Lip and Palate Patients

Abstract

Distraction osteogenesis is widely used for the treatment of craniofacial deformities. In patients with cleft lip and palate, distraction osteogenesis can be employed to repair the alveolar cleft. In this report, we describe the management of three cases of unilateral cleft lip and palate by interdental distraction osteogenesis. Interdental distraction osteogenesis of the maxillary bone was performed to reduce the width of the alveolar cleft in these patients in conjunction with orthodontic treatment. Tooth-tooth type distraction devices were fabricated and delivered at the same time as osteotomy. Distraction was continued until the midline of the dentition coincided with the facial midline, and until the width of the alveolar cleft was reduced to the width of lateral incisor or had closed. One month after distraction was complete, orthodontic treatment with an edgewise appliance was initiated, and neighboring teeth were moved into the newly created bone. A favorable treatment outcome was achieved in all three cases.

A Novel Minimally Invasive Technique of Using Tooth-Borne Hyrax Expansion Screw for Distraction Osteogenesis of Large Alveolar Cleft Defects (HYDIS-TB)

“…The rate of activation in the present technique was 1 mm/ day, similar to that used by Sakamoto et al (2011). This was found to be optimal in bringing about the movement of the osteotomized bone only, with a fair amount of soft tissue regeneration at the area of distraction.…”

Interdental Distraction Osteogenesis in Unilateral Cleft Lip and Palate Patient with Wide Alveolar Cleft

“…This allows new bone to be produced and gingiva attached in regions away from the cleft in order to reduce its width. The benefits of performing IDO in patients with cleft lip and palate include the following: 1) closure or reduction of the alveolar cleft; 2) relief of dental crowding; 3) improvement of postoperative results after secondary alveolar bone grafting; 4) correction of deviation of the maxillary dental midline; and 5) avoidance or simplification of prosthodontic procedures for missing teeth 14) . Removable partial dentures (RPDs) were used to restore defects before the development of IDO.…”

Manejo no quirúrgico de fisura alveolar severa en paciente adulta mediante tratamiento ortodóncico fijo. Reporte de caso

“…Aunque el injerto oseo es el tratamiento ideal para corregir las fisuras alveolares, este debe realizarse, según la evidencia, entre los nueve y once años, antes de la erupción de caninos permanentes 4 . En la adultez, este tipo de procedimiento ha demostrado tener menor tasa de éxito, independiente del tipo de tejido utilizado.…”

“…En la adultez, este tipo de procedimiento ha demostrado tener menor tasa de éxito, independiente del tipo de tejido utilizado. Con el tiempo, es posible apreciar una pérdida gradual de hueso alveolar a nivel vestibular, lateral y palatino en los dientes adyacentes a la fisura, exponiéndose el cemento radicular, lo que dificulta que el injerto pueda adherirse 4 . Si bien la paciente no deseaba someterse a ningún procedimiento quirúrgico, la baja tasa de éxito de los injertos en la adultez sugiere considerar otras alternativas terapéuticas.…”

“…Clínicamente son muy variables, desde un pequeño surco en la cara vestibular del proceso alveolar hasta una franca brecha en el hueso maxilar que puede o no comunicar con la cavidad nasal. Los dientes adyacentes a la fisura suelen presentar pobre soporte periodontal, malposiciones y alteraciones en su desarrollo, lo que empeora su pronóstico 4 .…”