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Indicates sessions with recordings available for purchase.Vertical Alveolar Distraction Osteogenesis (VADO) has been used successfully to increase the height of the alveolus for 2 decades. In large defects VADO planning is sometimes impossible as the amount of native bone over the anatomic structures may not be enough. Onlay bone grafting to these large defects is mostly unsuccessful due to limited amount of thin mucosa covering the graft. Alveolar transport distraction osteogenesis (ATDO) is a relatively new method and indications, technique, complications is not well known.
ATDO was performed to ten patients (4male, 6 female) with 12 defects (3 cleft lip-palate, 3 benign tumour resection, 1 posttraumatic, 2 gun shot injury, 3 post extraction severe atrophy). The location of the defects was the anterior mandible (1), posterior mandible (4), anterior maxilla (5), and posterior maxilla (2). 12 distractor were inserted (2 of them were bilateral, 10 of them were unilateral). The mean age of the patients was 39.1 years. All of the surgical procedures were performed by the same surgeon, and . average bone length gained was 18.2 mm (10-26). One or two teeth were distracted with the alveolar bone depending to the position of the teeth. Implants inserted following 3 months of consolidation period. Three patients needed additional horizontal bone grafting from symphyseal area and to these patients implants were inserted 5 months after onlay bone grafting. The length and diameter of the implants were 11.5-13 mm long and 3.5-4 mm wide. Final prosthetic rehabilitation was performed 3 months after implant insertion.
Radiographic examination (panoramic, cephalometric radiographs, CBCT) was performed before and after implant insertion. Photographs were taken from these patients for visual examination. After a mean follow-up of 45 months (range 6-96 months) the survival rate of the 25 implant was 91.4% ( 2 implant failure). All failures occurred during the early healing period (within 3 months after distraction).
ATDO is an alternative treatment to other techniques used to obtain sufficient alveolar bone and mucosa. No donor site is needed, the amount of augmentation can be controlled and implant insertion time will be reduced. It can be concluded that ATDO can be an effective and reliable method for reconstructing wide alveolar defects with dental implants.
Reference
1. Uckan S, Haydar SG, Dolanmaz D. Alveolar distraction: analysis of 10 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Nov;94(5):561-5.
2. Pektas, Z.O., Kircelli, B.H., Bayram, B., Uckan S. Alveolar cleft closure by distraction osteogenesis with skeletal anchorage during consolidation. Int J Oral Maxillofac Implants. 2008;23:147.