MANDIBULAR WIDENING BY INTRAORAL DISTRACTION OSTEOGENESIS

Transverse mandibular deficiency with crowding of the mandibular anter ior teeth is frequently present in patients with Class I and II malocc lusions. The hallmarks of treatment by compensating orthodontics, func tional appliances or orthopaedic devices are instability, compromised periodontium and compromised facial aesthetics, A new surgical techniq ue has been developed to widen the mandible, The method is based upon gradual osteodistraction following vertical interdental symphyseal ost eotomy Ten patients with transverse mandibular deficiency and signific ant dental crowding were treated by symphyseal distraction and subsequ ent non-extraction decompensating orthodontic treatment, Either an int raoral tooth-borne Hyrax appliance or a new custom-made bone-borne ost eodistractor was used to gradually widen the mandible, The surgical pr ocedures were accomplished under local anaesthesia and intravenous sed ation in an ambulatory surgical setting using an individualized distra ction protocol, The appliances were activated 7 days after symphyseal osteotomies, once each day at a rate of 1 mm per day and stabilized fo r 30-60 days after distraction, After the segments were distracted, no n-extraction orthodontic alignment of the mandibular anterior teeth wa s accomplished, The symphyseal distraction gaps were bridged by new bo ny regenerate, Distraction osteogenesis provided an efficient surgical alternative to orthognathic surgery for widening the mandible and tre atment of transverse mandibular deficiency without extraction of teeth .