Abstract Aims: This study deals with the results of multidimensional tooth-supported osteodistraction of the dento-osseous segment. The description of the orthodontic, surgical and prosthodontic treatment procedures is one of the aims of this work. Providing a checklist and compulsory treatment procedure for a systematic approach to a standard operating procedure, to assure quality of treatment, shall deliver the base for the use of this method in the future. The study analyses the determination of an indication group of patients. The demand for a standard procedure and quality in a complex treatment procedure, which involves interdisciplinary work of several specialized experts, can be met, as this work shows.
Overview: The usual therapy plans for correction of infrapositioned or ankylosed teeth, which inhibit the growth of the alveolar bone are connected with esthetic and functional compromise.
Osteodistraction, a method of gradual lengthening of artficially separated bone is a good new way of therapy for ankylosed teeth.
Osteodistraction ( syn. callus distraction or distraction osteogenesis) was first described by Langenbeck in 1869, later rediscovered by Codivilla in 1905, but was forgotten due to treatment failure with severe complications. The important breakthrough was brought by the Russian surgeon Ilizarov in the 50ies of the last century. In his basic research he brought a standard to the gradual lenghtening of artficially separated bones, and he could introduce a low- risk standard method of osteodistraction to modern medicine. Many years of Ilizarovs first publications, orthopedists in Western Europe started dealing with the new techniques of callus-distraction. In 1989 McCarthy first performed a distraction of the mandible of a human.
In many study groups clinical and experimental progress was made (DalMonte & Donzelli1987; Martini & Castaman 1987; Ilizarov1988; Ilizarov1990; Yasui et al. 1991; Karp et al. 1992;; Block 1996; Celar 2002; Chin 1996; Watzek 2000; Zechner 2001; Zauza 2003).
Another great development was the multidimensional distraction device, first used by Watzek, This method provides the base for his work (Watzek 2000; Zechner 2001; Zauza 2003).
Method: In three patients with ankylosed permanent teeth and three patients with partly multiple aplasia and ankylosed deciduous teeth, a multidimensional osteodistraction with 1 3 strictly tooth-supported individually designed distractors was performed. The treatment was planned and performed by the departments for orthodontics, oral surgery and prosthodontics of the University Dental Clinic of Vienna. The departments of periodontology and restorative dentistry were involved in case of specific problems. The average age of patients at the time of osteotomy was 18,2 years. The treatment consisted of a presurgical part with orthodontic preparations and interdisciplinary planning and crafting of individual distractors by the department of prosthodontics. The surgical period was performed at the department of oral surgery. The post-surgical callus-distraction was performed after a 7 day latency period, lasted 7 days on the average and was followed by a 9-12 week consolidation period.
Following the consolidation period the future proceeding was determined after new clinical and radiographic diagnostics.
To evaluate these cases, distraction protocols, patient charts, casts, photographs, cephalometric orthodontic analysis, panoramic x-ray, dental CT and post treatment check-ups were used.
Results: In five of six cases an osteodistraction of the dento-osseous segment could be performed succesfully. One patient developed a wound infection, that occured at the end of the distraction process. In this patient the distractor had to be removed prematurely.
In the cases of ankylosed teeth a functionally and esthetically satisfying new position of the distracted teeth and bone were achieved. In the distracted deciduous teeth in two sites of alltogether six sites autogenous bone had to be additionally transplanted, to create a suitable implant bed. A compulsory treatment protocol could be determined. The evaluation of the interdisciplinary cooperation lead to a checklist and to the clear separation of two indication groups.
Conclusion: The method of distraction of the dentoalveolar unit could be used as a new procedure, especially in ankylosed permanent teeth, although a strict selection of patients and their compliance is always required for this long and complex therapy.
It could be successfully shown, that in ankylosed teeth a further therapy option can be used beneficially for the patient in the future. Only a perfect planning and an intense cooperation of the departments involved and an accurate indication can provide the base for a successful treatment.