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This clinical study provided a modified simple and small appliance for reduction of wide alveolar clefts in cleft lip and palate patients, making the grafting procedure of better prognosis and increase its success rate.
Along the journey of treatment of cleft patients, secondary autogenous alveolar bone grafting is the technique basically used for cleft alveolus and palate repair during mixed dentition stage, in order to create bone support for teeth adjacent to the cleft, making a bone matrix through which teeth in the line of the cleft can erupt, re-stabilize alveolar process contour and maxillary segments. In cases with wide alveolar clefts, more than the width of a maxillary canine, failure of this procedure is usually encountered. So, a further step prior to grafting procedure can be done in an attempt to reduce cleft width to enhance success of future grafting.
Distraction osteogenesis (DO) which is a procedure of growing new bone by mechanical stretching of the ordinary pre-existing vascularized bone tissue by a distraction device, where both segments of new alveolar bone as well as attached gingiva are formed can be used here to aid in minimizing cleft width.
The aim of this study was to introduce a new custom-made tooth-borne distractor that could provide 3D control upon using interdental distraction osteogenesis (IDO) with a posterior segment transport anteriorly along curvature of the arch through creating a controlled fracture, then applying this distractor device carrying a bone transport segment forward, decreasing the cleft width anteriorly with another benefit of leaving behind regenerated bone and attached gingiva posteriorly.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Tooth borne interdental distraction along arch curvature appliance | Experimental | Patients eligible to the study were prepared to receive interdental distraction osteogenesis. The appliance was custom made for each patient. It is made up of orthodontic bands, labial, palatal stainless steel 0.9mm arches and micro expander screw soldered to the first permanent molar and to the first premolar in the transport segment . |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Tooth borne Interdental distraction appliance with mini hyrax screw | Device | This study aimed to provide a new design of a tooth-borne, custom-made distractor that could be easily constructed and rigid enough for controlled segment transport. After cases' selection, arch expansion was done first. Following expansion, preparation of the osteotomy site was done, through inducing root divergence at site of interdental osteotomy. Osteotomies were performed under general anesthesia using piezo-surgery, there were 2 osteotomies in a L-shape; interdental vertical osteotomy mesial to 1st molar and a horizontal one above apices of teeth in the transport segment. The distraction protocol was a latency period of 7 days, after which appliance activation started with a distraction rate of 0.4 mm/day with a rhythm of twice daily. Activation proceeded till teeth at the edge of the cleft came into contact. Then the appliance was fixed in place for a 3 months consolidation period. |
| Measure | Description | Time Frame |
|---|---|---|
| Reduction of width of alveolar cleft and oronasal fistula | Reduction or even closure of the wide interdental alveolar defect and the oronasal fistula measured on CBCT radiograph | 2-3 months |
| Measure | Description | Time Frame |
|---|---|---|
| Dental changes with distraction | Amount of dental tipping that occurred with distraction forces measured on CBCT radiograph | 2-3 months |
| Quality of distracted bone | Measurement of bone radio density in Hounsfield Unit from CBCT |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Orthodontics, Faculty of Dentistry, Ain Shams University Cairo, Abbaseya, Egypt | Cairo | 11566 | Egypt |
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| ID | Term |
|---|---|
| D000070631 | Diastasis, Bone |
| ID | Term |
|---|---|
| D004204 | Joint Dislocations |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
| D014947 | Wounds and Injuries |
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| 3-6 months |
| Loss of anchorage with distraction forces | Amount of distal movement of anchor molar of the assembly as a side effect of the mesial distraction forces measured on CBCT radiograph | 2-3 months |