Long-Term Effects of Distraction Osteogenesis of the Mandible

Publication date: Available online 31 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Zachary S. Peacock, Alfonso Salcines, Maria J. Troulis, Leonard B. Kaban
PurposeTo assess the fate of the permanent teeth in and adjacent to the regenerate in pediatric patients who underwent mandibular distraction osteogenesis (DO). Second, to compare the post-operative growth of the distracted mandible to age and gender matched controls.MethodsThis was a retrospective cohort study of children who underwent mandibular DO, during the primary or mixed dentition period and prior to completion of somatic growth (males ≤ 14 years old; females ≤12 years old), at Massachusetts General Hospital from 1996-2014. From the DO Registry, subjects were selected who had complete clinical and radiographic records and ≥1 year follow-up. Patients with disorders of dental development (e.g. ectodermal dysplasia) were excluded. Panoramic radiographs were used to assess changes in morphology, eruption and orientation of the the dentition. Standardized digital lateral cephalograms were used to assess the mandible (SNB, mandibular unit length, ramus height, body length) preoperatively(T0), at end-distraction(T1), 1 year post-device removal(T2) and longest follow-up(T3).ResultsA total of 118 patients in the registry had DO during the study period. For assessment of the effects on the dentition, 26 patients, who had 36 osteotomies and distraction wounds, met inclusion criteria. In this sample, 22/26 subjects (85%) experienced 52 adverse effects in 38/90 permanent teeth (42.2%) assessed. Cephalometric measurements at T3 indicated that there was net mandibular growth at longest follow-up, after a period of skeletal relapse during T1-T2; however, only 2/25 (8%) subjects regained a growth rate in the vector of DO that matched or exceeded normal age and gender matched controls.ConclusionDO commonly results in adverse effects on the dentition within and adjacent to the DO gap with only a minority resolving over time. Net growth of the mandible occurs after DO but at a slower rate and lesser magnitude than that of age and sex matched controls.



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