Maxillary anterior segmental distraction osteogenesis with 2 different types of distractors

Abstract

OBJECTIVE: Maxillary anterior segmental distraction osteogenesis (DO) has been the alternative treatment option for patients with midfacial retrusion. To investigate a potentially more effective maxillary anterior segmental DO, a newly designed intraoral alveolar distractor was applied. The objectives of this study were to investigate the skeletal and dental effects of maxillary anterior segmental DO and the relapse pattern.

METHODS: The study was carried out for 8 patients with unilateral cleft lip and palate (mean age, 16 years 7 months). Four patients were treated with an intraoral appliance (IA), and the remaining with a rigid external distractor (RED). Dental and skeletal measurements were obtained for both groups. These measurements were compared for different time points including pre-DO (T1), post-DO (T2), postconsolidation (T3), and 1-year follow-up (T4).

RESULTS: Horizontal change of A point was significantly larger after distraction period (T2) in the RED group (mean, 11.0 mm; median, 10.1 mm) than in the IA group (mean, 6.6 mm; median, 7.4 mm) (P < 0.05). Relapse of A point was observed in both RED (mean, -2.3 mm; median, -2.3 mm) and IA groups (mean, -2.6 mm; median, -1.5 mm) at T4. The vertical position of the anterior nasal spine was found to have moved downward in the RED group (mean, 5.5 mm; median, 4.9 mm) but upward in the IA group (mean, -2.5 mm; median, -2.7 mm) after distraction, showing a significant difference between groups (P < 0.05). Axis of upper incisor increased at T2 in the IA group (mean, 10.4 degrees; median, 11.3 degrees), but decreased in the RED group (mean, -10.2 degrees; median, -9.0 degrees) (P < 0.05). It recovered in the RED group at T4.

CONCLUSIONS: Maxillary anterior segmental DO is effective for the treatment of patients with cleft lip and palate. The alveolar space is regained, and the facial profile is improved without velopharyngeal problems. Superior results are obtained using the RED appliance for maxillary anterior segmental DO relative to the use of the intraoral distractor appliance.