Osteodistractionclinical applications in maxillofacial reconstructive surgery

Abstract

Current standards in implant dentistry aim to provide natural prosthetic restorations with the finest esthetic and functional outcomes. Several parameters have been suggested in order to achieve gold-standard results: adequate bone height, width, antero-posterior projection, adequate soft tissue quantity and quality, preservation of buccal sulcus, adequate papillae, and gingival contour. Thus the preservation and reconstruction of the alveolar bone and surrounding soft tissues for the placement of dental implants has become one of the bases of the contemporary practice of oral and maxillofacial surgery. Since its introduction in 1996, alveolar distraction osteogenesis has been considered a viable technique for reconstruction of alveolar bone prior to implant placement Alveolar distraction is a technique in constant evolution. A review of literature within the past 14 years reveal that clear indications for its use exist with outcomes similar and sometimes even more predictable than traditional bone grafting techniques in preparation for implant placement. Although, complications also exist with alveolar distraction, it seems that the majority of them are minor and easy to manage. Appropriate patient selection and a better understanding of the technique are paramount in successful bone regeneration with alveolar distraction osteogenesis. In this way we present three studies with three majors objectives 1º-To determine the implant stability in osseodistraction-generated bone after a 2-month consolidation period, assessed by resonance frequency analysis Conclusion: under the limitations of this study, osseodistraction offers ¿after a 2 month consolidation period- a high primary and secondary stabilities after implant placement. 2º To determine the feasibility of the transport distraction osteogenesis on the reconstruction of the maxillary defects of oncologic patients Conclusion: Transport distraction osteogeneis can be considered a recommendable reconstructive option after oral cancer treatment ¿including radiotherapy- particularly for high-surgical-risk, collaborative patients. In the early ages of the technique, many case series reported high percentages of complications, mostly minor in nature. Many of these complications could have been minimized by a comprehensive treatment planning. 3º To determine if three-dimensional image studies and stererolithografic models ease surgical planning and improve the final results of the treatment. Conclusion: Using of computadorized-aided planning does not avoid the necessity of other techniques of planning and vector control during the distraction treatment.