Defect in alveolar ridge presents an obstacle to ideal prosthetic appliance placement by compromising biological, mechanical and esthetic considerations.
Multiple reconstructive and regenerative methods have been followed in order to increase the alveolar ridge defect. These include soft tissue and bone grafting, visor osteotomy, guided bone regeneration [GBR] with or without bone graft and alloplastic materials. Each of these modalities have its own advantages and disadvantages.
Donor site morbidity in case of soft and hard tissue graft, unpredictable resorption of bone grafts and alloplast, limitation of GBR to small size alveolar defect and poor support provided by alloplastic material; make alveolar distraction osteogenesis a good alternative for increasing the vertical height of deficient alveolar ridge.
Vertical Alveolar distraction osteogenesis is a method that allows increase in vertical height of deficient alveolar ridge with new bone formation as well as obtaining a significant increase in surrounding soft tissue in a more physiologic way; offering a predictable result with low morbidity, less infection rate and a significant shorter waiting period for prosthetic rehabilitation in comparison with traditional methods.
This procedure is being used extensively by many clinicians with a high success rate. Despite the clinical success and extensive experimental studies; information on effectiveness of alveolar distraction osteogenesis in human jaw is still limited.
The purpose of this study is to evaluate the effectiveness of vertical alveolar distraction osteogenesis to increase vertical height of vertically deficient edentulous ridge for complete denture prosthetic rehabilitation.
REVIEW OF LITERATURE:
Matteo Chiapasco et al in his study on 37 patients who presented with vertically deficient edentulous ridges were treated by means of distraction osteogenesis with an intraalveolar distracter and at the end of treatment mean bone gain obtained by distraction was 9.9 mm (range 4 to 15 mm)1
R.Mazzonato et al in his retrospective study to analyze the potential complications during alveolar distraction osteogenesis in a large series of 55 cases came to conclusion that the mean alveolar height achieved was 6 mm with overall success rate of this technique was 89.1%2 T Kanno et al in his study on 35 patients (17 males and 18 females with mean age 43.9 years) on decrease in bone height following alveolar distraction osteogenesis found that it was 2.1 mm during the consolidation period and 3.6 mm at implant placement and hence came to conclusion that any alveolar distraction osteogenesis protocol should include a waiting period after the surgical intervention ,as well as over correction of more than 25% within the limits of applied surgical protocol3 Sinna Uckan et al in their study on 10 patients with alveolar ridge deficiencies who were treated with alveolar distraction osteogenesis by means of intra osseous distracter found that the mean alveolar distraction achieved was 8.7 mm with few intraoperative and postoperative complications4 A.Rachmiel et al in their study on 14 patients who underwent vertical alveolar distraction came to the conclusion that average bone gain was 10.3 mm with the main advantage is that there is an increase in alveolar bone height with new bone formation beneath the distracted bone5
OBJECTIVE OF THE STUDY:
The objective of the study is to evaluate the effectiveness of vertical alveolar distraction osteogenesis to increase the vertical height of vertically deficient edentulous ridge for complete denture prosthetic rehabilitation.
7. MATERIALS AND METHODS:
SOURCE OF DATA:
Completely deficient alveolar ridge in edentulous patients for complete denture prosthetic rehabilitation referred to Department Of Oral and Maxillofacial Surgery, P.M.N.M Dental College and Hospital . 10 cases will be taken for the study as per following criteria.
1. Clinical evaluation of distraction achieved by comparing pre-operative and post-operative;
2.Radiographic evaluation of vertical alveolar distraction achieved by comparing OPG taken before, after distraction phase and 3 months after distraction phase of alveolar distraction, taking magnification factor of radiograph into consideration.
3. Patients included in the study will be managed as follows;
Written informed consent.
Analysis as per clinical, radiological and models.
Surgical procedure [Involves the osteotomy and fixation of distracter device under local or general anesthesia.]
2. Vertically deficient edentulous ridge with at least 5 mm of bone height.
1. History of radiotherapy in head and neck region.
2. Medically compromised patients.
Sample size: 10 patients.
DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO PLEASE DESCRIBE BRIEFLY.
1. Routine blood investigation.
2. Radiographs (Orthopantomograph).
HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?
LIST OF REFERENCES:
1. Matteo Chiapasco et al “Alveolar Distraction Osteogenesis for the Correction of Vertically Deficient Edentulous Ridges ;a multicenter prospective study on Humans” International Journal Oral Maxillofac Implants 2004; 19:399- 407.
2. .R.Mazzonetto et al “ A Retrospective Study of The Potential Complication During Alveolar Distraction Osteogenesis in 55 Patients” International Journal of Oral and Maxillofacial Surgery jan 2007 vol. 36 issue 1 page 6-10.
3. .T Kanno et al “Over correction in vertical alveolar distraction osteogenesis for dental implants” International J Oral Maxillofacial surgery, 2007; 36:398 -402.
4 Sina Uckan et al “Alveolar distraction: Analysis of 10 cases ”Oral Surgery Oral Med Oral Pathol Oral Radiol Endod 2002; 94:561-565.
5.A.Rachmiel et al “ Alveolar ridge augmentation by distraction osteogenesis “ Int. J. Oral Maxillofacial Surgery 2001:30:510-517.