Vertical distraction osteogenesis of edentulous ridges for improvement of oral implant positioning: a clinical report of preliminary results.

This study examined the opportunities offered by intraoral distraction osteogenesis to vertically elongate insufficient alveolar ridges and thereby improve local anatomy for ideal implant placement. Eight patients presenting with vertically deficient edentulous ridges were treated by means of the distraction osteogenesis principle with an intraoral alveolar distractor. Two to 3 months after consolidation of the distracted segments, 26 implants were placed in the distracted areas. Four to 6 months later, abutments were connected and prosthetic loading of the implants was started. The mean follow-up after initial prosthetic loading was 14 months. In all patients, the desired bone gain was reached at the end of distraction (mean vertical bone gain of 8.5 mm). Probing depth, Bleeding Index, and Plaque Index around implants were evaluated, and Periotest values were also calculated. The cumulative success rate of implants was 100%. Radiographic examinations 12 months after functional loading of implants showed a significant increase in the density of the newly generated bone in the distracted areas. This technique seems to be reliable, and the regenerated bone has withstood the functional demands of implant loading. Success rates of implants, periodontal indices of peri-implant soft tissues, and Periotest values were consistent with those reported in the literature regarding implants placed in native bone.

[1]  F. Isidor,et al.  Mobility assessment with the Periotest system in relation to histologic findings of oral implants. , 1998, The International journal of oral & maxillofacial implants.

[2]  M. Chiapasco,et al.  Behavior of implants in bone grafts or free flaps after tumor resection. , 2000, Clinical oral implants research.

[3]  A Schmitt,et al.  The longitudinal effectiveness of osseointegrated dental implants. The Toronto Study: bone level changes. , 1992, The International journal of periodontics & restorative dentistry.

[4]  M. Chiapasco,et al.  Distraction osteogenesis of a fibular revascularized flap for improvement of oral implant positioning in a tumor patient: a case report. , 2000, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[5]  M. Yokota,et al.  Periodontal parameters of osseointegrated dental implants. A 4-year controlled follow-up study. , 1997, Clinical oral implants research.

[6]  H. Sailer,et al.  Seven years clinical experience with mandibular distraction in children. , 1998, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[7]  D Buser,et al.  Lateral ridge augmentation using autografts and barrier membranes: a clinical study with 40 partially edentulous patients. , 1996, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[8]  G A Ilizarov,et al.  The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. , 1989, Clinical orthopaedics and related research.

[9]  R. Mericske-Stern,et al.  Periotest measurements and osseointegration of mandibular ITI implants supporting overdentures. A one-year longitudinal study. , 1995, Clinical oral implants research.

[10]  M. Ueda,et al.  Experimental alveolar ridge augmentation by distraction osteogenesis using a simple device that permits secondary implant placement. , 2000, The International journal of oral & maxillofacial implants.

[11]  D van Steenberghe,et al.  A study of 589 consecutive implants supporting complete fixed prostheses. Part I: Periodontal aspects. , 1992, The Journal of prosthetic dentistry.

[12]  I. Taylor Discussion: Lengthening the Human Mandible by Gradual Distraction by Joseph G. McCarthy, M.D., Jonathan Schreiber, M.D., Nolan Karp, M.D., Charles H. Thorne, M.D., and Barry H. Grayson, D.M.D. , 1992 .

[13]  W. Kalk,et al.  A Multicenter Clinical-Trial of Implant-Retained Mandibular Overdentures in Patients with Severely Resorbed Mandibles - Clinical Aspects , 1995 .

[14]  I Herrmann,et al.  Osseointegrated implants for treatment of partially edentulous jaws: A 5 year prospective multicentre study , 1994 .

[15]  J. Lévignac,et al.  Mandibular Elongation and Remodeling by Distraction: A Farewell to Major Osteotomies , 1995, Plastic and reconstructive surgery.

[16]  G. Widmark,et al.  Mandibular bone graft in the anterior maxilla for single-tooth implants. Presentation of surgical method. , 1997, International journal of oral and maxillofacial surgery.

[17]  M. Block,et al.  Bone response to functioning implants in dog mandibular alveolar ridges augmented with distraction osteogenesis. , 1998, The International journal of oral & maxillofacial implants.

[18]  E. Genden,et al.  Vascularized bone flaps in oromandibular reconstruction. A comparative anatomic study of bone stock from various donor sites to assess suitability for enosseous dental implants. , 1994, Archives of otolaryngology--head & neck surgery.

[19]  K. Kahnberg,et al.  Combined use of bone grafts and Brånemark fixtures in the treatment of severely resorbed maxillae. , 1989, The International journal of oral & maxillofacial implants.

[20]  C. Dahlin,et al.  Bone augmentation at fenestrated implants by an osteopromotive membrane technique. A controlled clinical study. , 1991, Clinical oral implants research.

[21]  D. van Steenberghe,et al.  Treatment of fenestration and dehiscence bone defects around oral implants using the guided tissue regeneration technique: a prospective multicenter study. , 1995, The International journal of oral & maxillofacial implants.

[22]  L Sennerby,et al.  Effects of barrier membranes on bone resorption and implant stability in onlay bone grafts. An experimental study. , 1999, Clinical oral implants research.

[23]  E. Keller Reconstruction of the severely atrophic edentulous mandible with endosseous implants: a 10-year longitudinal study. , 1995, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[24]  J. Mellonig,et al.  Enhancement of the damaged edentulous ridge to receive dental implants: a combination of allograft and the GORE-TEX membrane. , 1992, The International journal of periodontics & restorative dentistry.

[25]  M. Ueda,et al.  Alveolar ridge augmentation by distraction osteogenesis using titanium implants: an experimental study. , 1999, International journal of oral and maxillofacial surgery.

[26]  J. Zöller,et al.  KNOCHERNE REGENERATION DES UNTERKIEFERALVEOLARFORTSATZES MIT HILFE DER VERTIKALEN KALLUSDISTRAKTION , 1999 .

[27]  A Codivilla,et al.  On the means of lengthening, in the lower limbs, the muscles and tissues which are shortened through deformity. 1904. , 1905, Clinical orthopaedics and related research.

[28]  R. Triplett,et al.  Guided tissue regeneration and endosseous dental implants. , 1994, The International journal of periodontics & restorative dentistry.

[29]  U. Lekholm,et al.  Patient selection and preparation , 1985 .

[30]  R. Williamson Rehabilitation of the resorbed maxilla and mandible using autogenous bone grafts and osseointegrated implants. , 1996, The International journal of oral & maxillofacial implants.

[31]  W. Ra Rehabilitation of the resorbed maxilla and mandible using autogenous bone grafts and osseointegrated implants. , 1996 .

[32]  J. Hayter,et al.  Oral rehabilitation with endosteal implants and free flaps. , 1996, International journal of oral and maxillofacial surgery.

[33]  J. McCarthy,et al.  Lengthening the human mandible by gradual distraction. , 1992, Plastic and reconstructive surgery.

[34]  M Simion,et al.  Vertical ridge augmentation around dental implants using a membrane technique and autogenous bone or allografts in humans. , 1998, The International journal of periodontics & restorative dentistry.

[35]  G. Polizzi,et al.  Vertical ridge augmentation: what is the limit? , 1996, The International journal of periodontics & restorative dentistry.

[36]  N. Lang,et al.  Guided tissue regeneration in jawbone defects prior to implant placement. , 1994, Clinical oral implants research.

[37]  N. Lang,et al.  Regeneration and enlargement of jaw bone using guided tissue regeneration. , 1990, Clinical oral implants research.

[38]  J. McCarthy Distraction osteogenesis in maxillofacial surgery using internal devices: Review of five cases , 1996 .

[39]  G Zarb,et al.  The long-term efficacy of currently used dental implants: a review and proposed criteria of success. , 1986, The International journal of oral & maxillofacial implants.

[40]  G A Ilizarov,et al.  The tension-stress effect on the genesis and growth of tissues: Part II. The influence of the rate and frequency of distraction. , 1989, Clinical orthopaedics and related research.

[41]  C. Misch Comparison of intraoral donor sites for onlay grafting prior to implant placement. , 1997, The International journal of oral & maxillofacial implants.

[42]  P. Cortellini,et al.  Localized ridge augmentation using guided tissue regeneration in humans. A report of nine cases. , 1993 .

[43]  K. Kahnberg,et al.  Bone grafts and Brånemark implants in the treatment of the severely resorbed maxilla: a 2-year longitudinal study. , 1993, The International journal of oral & maxillofacial implants.

[44]  D. Wismeijer,et al.  One-step reconstruction of the severely resorbed mandible with onlay bone grafts and endosteal implants. A 5-year follow-up. , 1996, International journal of oral and maxillofacial surgery.

[45]  P. Stoll,et al.  Use of the "double barrel" free vascularized fibula in mandibular reconstruction. , 1998, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[46]  Ilizarov Ga,et al.  Basic principles of transosseous compression and distraction osteosynthesis , 1971 .

[47]  R. Schenk,et al.  Supracrestal bone formation around dental implants: an experimental dog study. , 1995, The International journal of oral & maxillofacial implants.

[48]  N. Lang,et al.  The microbiota associated with successful or failing osseointegrated titanium implants. , 1987, Oral microbiology and immunology.

[49]  M. Chiapasco,et al.  Tridimensional reconstruction of knife-edge edentulous maxillae by sinus elevation, onlay grafts, and sagittal osteotomy of the anterior maxilla: preliminary surgical and prosthetic results. , 1998, The International journal of oral & maxillofacial implants.

[50]  G A Ilizarov,et al.  [Basic principles of transosseous compression and distraction osteosynthesis]. , 1971, Ortopediia travmatologiia i protezirovanie.

[51]  J. Fiorellini,et al.  A 5-year prospective clinical and radiographic study of non-submerged dental implants. , 2000, Clinical oral implants research.

[52]  A H Geering,et al.  Peri-implant mucosal aspects of ITI implants supporting overdentures. A five-year longitudinal study. , 1994, Clinical oral implants research.

[53]  N. Lang,et al.  Correlations between radiographic, clinical and mobility parameters after loading of oral implants with fixed partial dentures. A 2-year longitudinal study. , 1996, Clinical oral implants research.

[54]  C Crawford,et al.  Mandibular alveolar ridge augmentation in the dog using distraction osteogenesis. , 1996, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[55]  M. Chiapasco,et al.  Clinical outcome of autogenous bone blocks or guided bone regeneration with e-PTFE membranes for the reconstruction of narrow edentulous ridges. , 1999, Clinical oral implants research.

[56]  P. Branemark,et al.  Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws. , 1990, The International journal of oral & maxillofacial implants.