Interdental distraction osteogenesis and rapid orthodontic tooth movement:A novel approach to approximate a wide alveolar cleft or bony defect

The closure of a wide alveolar cleft and fistula in cleft patients and the reconstruction of a maxillary dentoalveolar defect in traumatic patients ar e challenging for both orthodontists and surgeons. This is due to the diffi culty in achieving complete closure by using local attached gingiva and the great volume of bone required for the graft. In this article, the authors propose using interdental distraction osteogenesis to create a segment of n ew alveolar bone and attached gingiva for the complete approximation of a w ide alveolar cleft/fistula and the reconstruction of a maxillary dentoalveo lar defect. They performed this procedure on one patient with a traumatic m axillary dentoalveolar defect and 10 patients with unilateral or bilateral cleft lips and palates who had varied dentoalveolar clefts/fistulas. Interd ental and maxillary osteotomies were performed on one side of the dental ar ch by the cleft or defect. After a latency period of 3 days, the osteotomiz ed distal segment of the dental arch was then distracted and transported to ward the cleft or defect by using a tooth-borne intraoral distraction devic e. The alveoli and gingivae on bath ends of the cleft or defect were approx imated after distraction osteogenesis. The need for extensive alveolar bone grafting was eliminated. A segment of new edentulous alveolus and attached gingiva was created interdentally at a site distant to the cleft or defect In the cleft patients, teeth were moved orthodontically into the regenerat e (newly formed alveolar bone) dental crowding 1 week after distraction. Th e orthodontic tooth movement was rapidly completed in 3 months, and the ede ntulous space was eliminated. Interdental distraction osteogenesis minimize s an alveolar cleft/fistula and helps reconstruct a maxillary dentoalveolar defect by approximating the native alveoli and gingivae; it also creates n ew alveolar bone and gingiva for rapid orthodontic tooth movement.