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Dentistry and Craniofacial Research
ISSN: 2576-392X
October 08-09, 2018
Moscow, Russia
Advanced Dental Care 2018
Page 9
26th International Conference on
Advanced Dental Care
Distraction osteogenesis (DO) initially developed by Ilizarov for
limb lengthening has recently been applied to the correction
of severe congenital or acquired craniofacial deformities
as an early alternative to orthognathic surgery. Distraction
osteogenesis involves the lengthening and reshaping of
deformed bone by surgical fracture and gradual separation of
bony segments. The surgeon lengthens and reshapes deformed
bone by surgically fracturing the bone and slowly separating
(distracting) the resultant segments with specially fabricated
hardware. The bony fragments are held in place during the first
week following surgical fracture to allow callus to form between
the fragments. During the next several weeks, the fragments are
gradually separated at a rate of 1 to 2 millimetres per day, up to
a pre-determined length (e.g., 20 days for 20 millimetres or 5/8
inches). The bone segments are moved gradually to allow callus
formation and adaptation of fibromuscular attachments. Once
the desired length and shape is achieved, the hardware is left
in place for an additional 6 weeks until the newly formed bone
calcifies. The primary advantage claimed in connection with
distraction osteogenesis is that it allows major reshaping of the
facial bones without bone grafts or jaw wiring. Proponents claim
that distraction osteogenesis may be safer than other methods
of facial reconstruction, since it can involve less blood loss and
a lower risk of infection. Orthognathic surgery is the surgical
correction of skeletal anomalies or malformations involving
the midface, mandible and maxilla. These malformations
may be present at birth or may become evident as the patient
grows and develops. Jaw malformations can cause chewing
and eating difficulties, abnormal speech patterns, early loss
of teeth, and disfigurement and dysfunction of the maxilla
and mandible. Malocclusion may be caused by a deficiency or
excess of bony tissue in one or both jaws, or by trauma to the
facial bones. In orthognathic surgery, an osteotomy is made
in the affected jaw, and the bones are repositioned in a more
physiologic alignment. Generally, the bones are held in their new
positions with plates, screws and wires. The patient may also
need arch bars placed on both jaws to add stability. Patients
with deficient bone tissue may require grafts from their ribs,
hips or skull. Alloplastic replacement of missing bone may also
be required. Several studies have evaluated DO as a definitive
mandibular advancement technique and it has been proved that
advancements of between 6 and 10mmresulted in no significant
differences in stability be it distraction or orthognathic surgery.
With the enthusiasm of successful results using midfacial and
mandibular distraction, it has been asserted that the introduction
of DO techniques would result in the elimination of traditional
orthognathic surgery. However, this has not proved to be the
case. In patients with syndromic craniosynostoses, DO can be
applied at strategic times as part of a staged surgical treatment
plan for the management of severe skeletal discrepancies.
Distraction may be regarded as a useful additional technique to
minimize skeletal deformities but definitive orthognathic surgery
remains the treatment of choice to enable accurate occlusal
correction and good facial balance.
Biography
Simon Chummar completed his BDS, MDS, from Royal College of Sur-
geons of Edinburgh, AO Fellow from United Kingdom. He is Scholar from
International Bone Research Association, Germany. He is a specialist Im-
plantologist and Oral and maxillofacial surgeon, at present he is working in
a Dental department, NMC Specialty Hospital, UAE.
Distraction osteogenesis versus
orthognathic surgery
Simon Chummar
NMC Hospital, UAE
Simon Chummar, Dent Craniofac Res 2018, Volume 3
DOI: 10.21767/2576-392X-C4-010