Comparison of two preoperative protocols for mandibular symphyseal distraction osteogenesis to reduce the risk of tooth damage

• Published in: Journal of cranio-maxillo-facial surgery Vol. 45; no. 4; pp. 540 - 546
• Main Authors: Winsauer, Heinz, Ploder, Oliver, Juengling, Katharina, Walter, Andre, Kolk, Andreas
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01.04.2017
• Subjects: Adolescent; Adult; Child; Clinical Protocols; Complication; Dentistry; Female; Humans; Incisor - surgery; Intraoperative Complications - prevention & control; Male; Mandible - surgery; Mandibular symphyseal distraction osteogenesis; Osteogenesis, Distraction - methods; Preoperative Care - methods; Relapse; Risk Factors; Surgery; Tooth damage; Tooth Injuries - prevention & control; Tooth-borne appliance; Young Adult; Complication; Tooth damage; Relapse; Mandibular symphyseal distraction osteogenesis; Tooth-borne appliance
• ISSN: 1010-5182; 1878-4119
• DOI: 10.1016/j.jcms.2016.12.022

Abstract Two techniques to separate the lower incisors prior to mandibular symphyseal distraction osteogenesis (MSDO) were evaluated with respect to avoiding tooth damage. Methods Fifty patients (20.2 ± 7.0 years) requiring MSDO were treated with a tooth-borne appliance by utilizing two preoperative protocols to separate the central incisors: i) brackets and a V-bent wire with an open coil spring (two-step; TS; n = 24) and ii) a wire attached from the appliance to the central incisors with subsequent dento-alveolar expansion prior to surgery (one-step; OS; n = 26). The distance between the lower incisors was measured preoperatively on radiographs and measurements at the cast models were performed. Complications and radiographs were analyzed. Results The mean distance (±SD) between the lower central incisors for OS and TS prior to surgery was 3.44 ± 1.05 and 3.18 ± 1.13 mm, respectively. The mean expansion for OS and TS was 4.3 ± 2.9 and 4.3 ± 2.7 mm at the dental level and 3.8 ± 3.2 and 4.0 ± 2.1 mm at the bone level, respectively. Four patients undergoing the TS and one patient undergoing the OS showed transient dental complications. Conclusion Pre-surgical dento-alveolar expansion by utilizing a one-step technique to separate the lower central incisors reduces the risk of permanent tooth damage and weakens the mandibular bone in the midline.