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Indication
Indication
Wide variation in these days
Hypoplastic Mandible
Missing bone as a consequency of
pathology
Craniofacial microsomia
Micrognathia
Midface deficiency
Indication
Calvarial expansion in craniosynostosis
Severe resorbed alveolar bone
Dental implant placement
Alveolar cleft
Periodontal ligament distraction
Pediatric sleep apnea
Hypoplastic mandible,
Hemifacial Microsomia,
Congenital
anormaly
Micrognathia.
Pierr Robin syndrome,
Bliateral microsomia,
Treacher Collin syndrome,
Nagars syndrome, etc.
Midface deficiency
midface deficiency,
craniofacial dysplasias,
facial clefts.
Rigid external distraction (RED) system
Three-Dimensional Midface distraction
device
Internal distraction device
Calvarial expansion in
craniosynostosis
Conventional bone graft method reveals the
insufficiency of quantity of bone and dead
space occuring leading to postoperative
infection, bone resorption, and relapse.
patients with complex or reccurent
abnormalitie resulting in limited craniofacial
growth
Alveolar cleft
Patients with insufficien secondary
bone alveolar graft
Vertical osteotomy is applied on pregrafted bone and miniplate must be
fastened under the nasal mucosa.
Periodontal ligament
distraction.
The movement of canine after extraction
of premolar tooth.
Rapid canine movements is for the
adult patients required short treatment
times and maximum anchorage
construction
Treatment planning
of distraction
device.
Patient selection
Patient age.
Sex.
Metabolic disturbance of bone.
Problem of breathing and food intaking,
Susceptibility to infection.
Psychosocial stability.
Skin texture (kelloid),
Considering Factor
Surgical correction,
Potential for the future skeletal
growth and developement
Need for overcorrection
Possible future operation.
Lengthening Capabilities
The actual bone distraction, which is usually
less than anticipated and difficult to predict
prior to distraction.
Soft tissue interference. Vector of
ostetomy line and device.
Direction of Distraction
Unidirectional or multidirectional?
Influence of Masticatory
Muscles
Induced recurrent episodic forces
Soft tissue traction due to physiologic muscle activity
exerted contribute to distal segment directional
instability.
Such movement can be altered by making
adjustment in sequence and amount of activation of
the multidirectionla device
Occlusal Interferences
Posterior occlusal interferences
Stepping posterior teeth off of the occlusal plane
Utilization or biteplane or biteblock appliances,
orthodontic adjustment, occlusal equibrium..
Anterior occlusal interference
Advancing, proclining, intruding the maxillary
anterior teeth.
Using biteplane of biteblock
Orthodontic/Orthopedic forces
During the active distraction phase and
consolidation phase
~ Intermaxillary elastics, headgear,
functional appliances
Presurgical Orthodontic
Preparation
Evaluation of the dentition and its relation to the
projected skeletal changes.
Elemination of dental malrelationships
Tooth position and maxillary width should enhance
distraction, not inhibit it.
Fabrication and utilization of distraction stabilization
appliance
Postconsolidation orthodontic
therapy
To support new bone at the distraction gap.
Bilateral Distraction
~ In anticipation of a future mandibular
growth deficiency.
~ Guidance of eruption and alignment of the dentition
~ Growing children planned future orthognathic surgery
or distraction
Postconsolidation orthodontic
therapy
Unilateral distraction:
Occlusal plane management
Correction of dental midline
Correction of the maxillomandibular transverse
disharmony
If closing of the posterio openbite is failed, correction of
the occlusal canting cannot be possible. In this case,
surgical correction of the compensated occlusal plane
(bimaxillary osteotomy) can be considered.