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International Poster Journal of Dentistry and Oral Medicine
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Int Poster J Dent Oral Med 6 (2004), No. 3     15. Sep. 2004

Int Poster J Dent Oral Med 2004, Vol 6 No 03, Poster 239

Simultaneous vertical and horizontal bone augmentation with a new bi-directional distraction device

Case report

Language: English

Authors:
Dr. Dr. Andres Stricker,
Dr. Dr. Alexander Schramm,
Kai-Hendrik Bormann,
Prof. Dr. Dr. Rainer Schmelzeisen,
Department of Oral and Maxillofacial Surgery,
Universityhospital of Freiburg

Date/Event/Venue:
July, 2nd - 5th, 2003
Distraction 2003
Paris

Introduction

The concept of distraction osteogenesis enables the creation of new bone formation between vascularized bone surfaces being expanded and moved via a stable distraction device after an osteotomy. Many authors demonstrated that distraction osteogenesis is a reliable method for vertical augmentation.

Objectives

But orientation of the distraction direction has to be defiened prior to the first movement. Mistakes in the way of angulation are very difficult to correct.

Material und Methods

Case report

This 45 year old woman suffering of severe atrophy of the alveolar crest due to periodontal bone resorption wanted to have an aesthetic rehabili-tation. Avoiding mismanagement of the crown to root relation of the proposed implant structure, augmentation procedures were necessary. Avoiding angulation problems of the transferable bone segment this bi- directional distraction device offers segmental bone transport in 2 di-mension- vectors, i.e. vertival and/or horizontal direction. Following vestibulary incision and osteotomy, the distraction device (MEDARTIS"¦) was installed. One week later, after removing sutures the segment was moved 0,5 mm once a day. Initially the movement was only in vertical direction, after 8 days movement was performed to the vertical and to the horizontal direction. After 14 days the distraction process was finished. Following a healing period of 3 months implant insertion (Replace Select"¦) was performed in the same session of the removal of the dis-traction device. Implant uncovering will be performed after 3 months of osseointegra-tion. During the whole treatment period patient had a fixed provisional bridge construction in the maxilla and in the mandible.

Fig. 1-2: Lack of alveolar bone due to severe periodontitis.

Fig. 3-4: Clinical and radiological situation after fixation of the distraction device.

Fig. 5-6: Initial distraction in vertical direction.

Fig. 7-8: Secondary combined distraction in horizontal and vertical direction.

Fig. 9-10: Clinical aspect 3 months after the start of the distraction.

Fig. 11-12: Clinical and radiological situation 3 months after fixation of the distraction device.

Fig. 13-14: Removal of the overcorrected bone and implant insertion due to the occlusal cast.

Fig. 15: Aspect of the bi-directional distraction device (MEDARTIS).

Fig. Clinical and radiological situation after implant insertion.

Results

The bi-directionnal distraction device (MEDARTIS) was stable enough compensating the vertical and horizontal bone deficit. Distrac-tion process was performed easily and was partielly performed by the patient itself. To this date no implant has been lost.

Discussion and Conclusions

Presenting the new bi-directional distraction device (MEDARTIS) it can be demonstrated the way and the opportunity to correct misangulation during the distraction process. Clinical short- term results demon-strate that simultaneous vertical and horizontal bone augmentation is possible by this new bi-directional distraction device.

Bibliography

  • Ilizarov GA. The principles of the Ilizarov method. Bull Hosp Joint Disord Orthop Inst 1988;48:1-11
  • Chin M, Toth BA. Distraction osteogenesis in maxillofacial surgery using internal devices: review of five cases. J Oral Maxillofac Surg 1996;54:45-53
  • Block MS, Chang A, Crawford C. Mandibular alveolar ridge augmentation in the dog using distraction osteogenesis. J Oral Maxillofac surg 1996; 54:309-314
  • Block MS, Almerico B, Crawford C, Gardiner D, Chang A. Bone response to functioning implants in dog mandibular alveolar ridges augmented with distraction osteogenesis. Int J Oral Maxillofac implants 1998;13:342-351
  • Gaggl A, Schultes G, Kärcher H. Die Korrektur von Alveolarkammdefekten mit Distraktionsimplantaten: Fallbericht einer 19-jährigen Patientin mit traumatischem Zahnverlust. Stomatologie 1999;96:149-154
  • Hidding J, Lazar F, Zöller JE. The vertical distraction of the alveolar bone. J Craniomaxillofac Surg 1998;26:72-73
  • Stricker A, Schramm A,Marukawa E, Lauer G,Schmelzeisen R. Distraction osteogenesis and tissue engineering ¡V new options for enhancing the implant site. IntJPerioRest Dent 2003;3

This poster was submitted by Dr. Dr. Andres Stricker.

Correspondence address:
Dr. Dr. Andres Stricker
Department of Oral and Maxillofacial Surgery,
Universityhospital of Freiburg,
Hugstetter Straße 55,
79106 Freiburg
Germany