Alveolar distraction osteogenesis: an alternative in the reconstruction of atrophic alveolar ridges
Distracción osteogénica alveolar: una alternativa en la reconstrucción de rebordes alveolares atróficos

The appearance of osteogenic distraction as a therapeutic arm in the treatment of the atrophic alveolar condition has meant, on the one hand, the approach of reconstructive techniques to the clinician given its lower technical complexity and complications index in relationship to other commonly used techniques and, on the other, the opening of new research lines in the field of implantology and facial skeleton reconstruction after traumatisms, tumors, or malformations such as in the case of patients with a cleft lip.

The use of different types of distractors and distractor implants is conditioned not only by surgical indication but also by the habit of the team performing the treatment, especially in the case of intraosseous distractors and distractor implants, whose results are fully contrasted in the literature, although they have easier application limitation to solve in the case of using juxtaosseous distractors. However, as an advantage, we should mention that they are adequate to carry out prosthetic rehabilitation on the device in some cases.¹

The experience presented in this article shows the excellent results obtained in several indications as is shown by the versatility of the technique, however, we must add the possibility of increasing the thickness with transversal or multidirectional distractors^2-4 or using a vertical distraction at the expense of the baseline and eliminating the most coronal portion, that can be used as a particulated graft if complementary techniques are required.

In regards to the commonly accepted protocol, the main variations described by the different work groups are found in the technique and instrumental used in the osteotomy (surgical phase in which we have recently introduced the piezoelectric surgery, which contributes better safety, especially in the area of the important tissues)^5,6 and in the time of initiating the implantological phase, the withdrawal of the distractor and simultaneous placement of the implants being as is described by the authors. This means a gain in time in regards to the traditional techniques since the implant is integrated during the callus maturity phase, permitting early loading.⁷

Based on this and other articles on the subject, we can conclude that the distraction applied to the reconstruction of the alveolar process opens a wide range of possibilities including individual as well as combined technique with the reconstructions that are considered «traditional».

A. Bilbao Alonso
Doctor en Medicina y Cirugía.
Facultativo Especialista de Área. Cirugía Oral y Maxilofacial. España. 
Complejo Hospitalario Universitario. Santiago de Compostela. 
Práctica privada La Rosaleda Hospital Policlínico.
Santiago de Compostela. España

References

1. Gaggl A, Schultes G, Karcher H. Vertical alveolar ridge distraction with prosthetic treatable distractors: a clinical investigation. Int J Oral Maxillofac Implants 2000;15:701-10.

2. Watzek G, Zechner W, Crismani A, Zauza K: A distraction abutment system for 3-dimensional distraction osteogenesis of the alveolar process: technical note. Int J Oral Maxillofac Implants 2000;15:731-7.

3. Aparicio C, Jensen OT. Alveolar ridge widening by distraction osteogenesisa case report. Pract Proced Aesthet Dent 2001;13:663-8.

4. Kitano S, Wada K, Komori T. Endosseus implants in horizontal alveolar ridge distraction osteogenesis. Nosaka Y. Int J Oral Maxillofac Implants 2002;17:846-53.

5. Vercellotti T, De Paoli S, Nevins M. The piezoelectric bony window osteotomy and sinus membrane elevation: introduction of a new technique for simplification of the sinus augmentation procedure. Int J Periodontics Restorative Dent 2001;21:561-7.

6. Vertellotti T. Piezoelectric Surgery in implantology: a case report-a new piezoelectric ridge expansion technique. Int J Periodontics Restorative Dent 2000;20:358-65.

7. Consolo U, Bertoldi C, Urbani G, Zaffe D. Clinical evaluation, radiologic and histologic análisis in mandibular alveolar distraction procedures. Preliminary study. Minerva Stomatol 2000;49:475-84.