Download Interdisciplinary Treatment - American Association of Orthodontists

How to treat open bite or
upper anterior protrusion
cases with ankylosed teeth
Introduction
Interdisciplinary treatment
Review of Literatures
Open bite
Tae-Woo Kim DDS MSD PhD
Professor, Department of Orthodontics
School of Dentistry
Seoul National University
Seoul, Korea
Upper anterior protrusion
Summary
Interdisciplinary Treatment
Introduction
• Impaction (ankyloses) of lower molars
Interdisciplinary
treatment
Review of Literatures
Open bite
Upper anterior protrusion
Summary
Case 1
Case 2
1) If there is an erupting lower third molar, it may be recommended to
extract the impacted first or second molar as one of options.
Case 1
Case 2
1) If there is an erupting lower third molar, it may be recommended to
extract the impacted first or second molar as one of options.
2) If there is an erupting upper third molar, the extruded or malpositioned
upper second molar may be extracted.
3) Regarding the interdisciplinary approach, oral surgeons should be
realized the possibility of second molar extraction.
Review of Literatures
Introduction
Interdisciplinary treatment
Review of Literatures
Open bite
Upper anterior protrusion
Summary
E-handout(open bite series lectures) are
available at
1) 2013
2) 2014
3) 2015
https://www.aaoinfo.org/node/625
https://www.aaoinfo.org/node/2382
https://www.aaoinfo.org/node/4792
Etiology of Open bite
More questions are welcome
[email protected]
There are several causes of open bite.
Mouth
Mouth
breathing
breathing
Ankylosed
Tongue
incisors
thrusting
Open
Ankylosed
Tongue
incisors
thrusting
Open
bite
Thumb
bite
TMD
sucking
Thumb
TMD
sucking
Macroglossia
Open-bite cases look very similar. All of open bites have different causes.
Macroglossia
Open bite caused by an
ankylosed central incisor
• Ankylosis or anchylosis (from Greek
ἀγκύλος, bent, crooked) is a stiffness of a
joint due to abnormal adhesion and
rigidity of the bones of the joint, which
may be the result of injury or disease.
(From Wikipedia, the free encyclopedia)
Traumatic injuries of the incisors
cause several problems;
①
②
③
④
⑤
⑥
⑦
⑧
avulsion,1
pulp necrosis,1
crown fracture,2
tooth discoloration,2
external root resorption,1
intrusion,3
impaction,4 or
ankylosis.1
1. Hecova H, Tzigkounakis V, Merglova V, Netolicky J. A retrospective study of 889 injured permanent teeth. Dent Traumatol 2010;26:466-75.
2. Chang HY, Chang YL, Chen HL. Treatment of a severely ankylosed central incisor and a missing lateral incisor by distraction osteogenesis and
orthodontic treatment. Am J Orthod Dentofacial Orthop 2010;138:829-38.
3. Campbell KM, Casas MJ, Kenny DJ. Development of ankylosis in permanent incisors following delayed replantation and severe intrusion. Dent
Traumatol 2007;23:162-6.
4. Macías E. Posttraumatic impaction of both maxillary central incisors. American Journal of Orthodontics and Dentofacial Orthopedics 2003;124:331-8.
• Ankylosis is a common complication
associated with the reimplantation of an
avulsed maxillary incisor.3
• Ankylosis/replacement resorptions were
observed in 21(42.9%) of 49 replanted
teeth in Hecova’s retrospective study of
889 injured permanent teeth.1
1. Hecova H, Tzigkounakis V, Merglova V, Netolicky J. A retrospective study of 889 injured permanent teeth. Dent Traumatol 2010;26:466-75.
3. Campbell KM, Casas MJ, Kenny DJ. Development of ankylosis in permanent incisors following delayed replantation and severe intrusion. Dent
Traumatol 2007;23:162-6.
Diagnosis of Ankylosis
• The anterior openbite may be limited
only to the ankylosed incisor6-8,13-17 or
involve the whole anterior teeth.2,5,8,10,12
1. Ankylosis often can be identified by the
metallic sound when percussing the
teeth,
2. the lack of mobility,
3. the lack of periodontal space on the
radiographic examination.
Shafer WG, Hine MK, Levy BM. Textbook of oral pathology. 4th ed. Philadelphia: Saunders; 1983. p. 540-1.
•
•
Diagnosis of Ankylosis
Diagnosis of Ankylosis
1. Ankylosis often can be identified by the
metallic sound when percussing the
teeth,
2. Ankylosis often can be identified by the
lack of mobility,
By using digital sound wave analysis, the ankylosed incisors will
exhibit a higher proportion of their signal energy in high frequency
bands, and this can be used for detection of the sound. But most of
the time, the change in the percussion sound is hardly
distinguishable.
However, if the area of ankylosis is small or located on the buccal
or lingual surface of the tooth, it is difficult to identify on a 2dimensional radiograph.
Shafer WG, Hine MK, Levy BM. Textbook of oral pathology. 4th ed. Philadelphia: Saunders; 1983. p. 540-1.
Campbell KM, Casas MJ, Kenny DJ, Chau T. Diagnosis of ankylosis in permanent incisors by expert ratings, Periotest and digital sound wave analysis. Dent
Traumatol 2005;21:206-12.
Diagnosis of Ankylosis
3. Ankylosis often can be identified by the
lack of periodontal space on the
radiographic examination.
In addition, Periotest (Siemens/Medizintechnik-Gulden, Bensheim,
Germany) can be used to assess tooth mobility. Ankylosed
incisors have lower Periotest values. Unfortunately, clinical
diagnosis of ankylosis, by mobility and percussion tests, is only
reliable when at least 20% of the root surface is affected.
•
•
•
Shafer WG, Hine MK, Levy BM. Textbook of oral pathology. 4th ed. Philadelphia: Saunders; 1983. p. 540-1.
Campbell KM, Casas MJ, Kenny DJ, Chau T. Diagnosis of ankylosis in permanent incisors by expert ratings, Periotest and digital sound wave analysis. Dent
Traumatol 2005;21:206-12.
Delmar DA. Ankylosis of teeth in the developing dentition. Quintessence Int 1986;17:303-8.
Shafer WG, Hine MK, Levy BM. Textbook of oral pathology. 4th ed. Philadelphia: Saunders; 1983. p. 540-1.
Diagnosis of Ankylosis
Accurate diagnosis is possible only
through orthodontic force application as
reported in several cases.5,7,11,16-18,25,30
5. Hwang DH, Park KH, Kwon YD, Kim SJ. Treatment of Class II open bite complicated by an ankylosed maxillary central incisor. Angle Orthod
2011;81:726-35.
7. Dolanmaz D, Karaman AI, Pampu AA, Topkara A. Orthodontic treatment of an ankylosed maxillary central incisor through osteogenic distraction. Angle
Orthod 2010;80:391-5.
11. Kofod T, Wurtz V, Melsen B. Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device. Am
J Orthod Dentofacial Orthop 2005;127:72-80.
16. Medeiros PJ, Bezerra AR. Treatment of an ankylosed central incisor by single-tooth dento-osseous osteotomy. Am J Orthod Dentofacial Orthop
1997;112:496-501.
17. Ohkubo K, Susami T, Mori Y, Nagahama K, Takahashi N, Saijo H, et al. Treatment of ankylosed maxillary central incisors by single-tooth dentoosseous osteotomy and alveolar bone distraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:561-7.
18. McNamara TG, O'Shea D, McNamara CM, Foley TF. The management of traumatic ankylosis during orthodontics: a case report. J Clin Pediatr Dent
2000;24:265-7.
25. Takahashi T, Takagi T, Moriyama K. Orthodontic treatment of a traumatically intruded tooth with ankylosis by traction after surgical luxation. Am J
Orthod Dentofacial Orthop 2005;127:233-41.
30. Moffat MA, Smart CM, Fung DE, Welbury RR. Intentional surgical repositioning of an ankylosed permanent maxillary incisor. Dent Traumatol
2002;18:222-6.
An ankylosed central incisor in a
growing child
• fails to erupt and the alveolar process
adjacent to the ankylosed tooth also fails
to grow vertically, causing anterior open
bite.
• This phenomenon was presented in
many case reports.2,5-12
Ankylosed
central incisor
(growing child)
Anterior open
bite
2. Chang HY, Chang YL, Chen HL. Treatment of a severely ankylosed central incisor and a missing lateral incisor by distraction osteogenesis and
orthodontic treatment. Am J Orthod Dentofacial Orthop 2010;138:829-38.
5. Hwang DH, Park KH, Kwon YD, Kim SJ. Treatment of Class II open bite complicated by an ankylosed maxillary central incisor. Angle Orthod
2011;81:726-35.
6. Alcan T. A miniature tooth-borne distractor for the alignment of ankylosed teeth. Angle Orthod 2006;76:77-83.
7. Dolanmaz D, Karaman AI, Pampu AA, Topkara A. Orthodontic treatment of an ankylosed maxillary central incisor through osteogenic distraction. Angle
Orthod 2010;80:391-5.
8. Epker BN, Paulus PJ. Surgical-orthodontic correction of adult malocclusions- Single tooth dento-osseous osteotomies. Am J Orthod Dentofacial Orthop
1978;74:551-63.
9. Menini I, Zornitta C, Menini G. Distraction osteogenesis for implant site development using a novel orthodontic device: a case report. Int J Periodontics
Restorative Dent 2008;28:189-96.
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating
bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
11. Kofod T, Wurtz V, Melsen B. Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device. Am
J Orthod Dentofacial Orthop 2005;127:72-80.
12. Kim Y, Park S, Son W, Kim S, Mah J. Treatment of an ankylosed maxillary incisor by intraoral alveolar bone distraction osteogenesis. Am J Orthod
Dentofacial Orthop 2010;138:215-20.
CASE 1
CASE 2
Ankylosed
central incisor
(growing child)
Ankylosed
central incisor
Anterior open
bite
(growing child)
Anterior open
bite
A 21-year-old woman with a chief complaint of an anterior open bite.
She had a history of facial trauma when she was 8 years old.
The patient’s chief complaint was a progressive anterior open bite.
His maxillary right central incisor had been extrusively subluxated by trauma 1 year
earlier.
2. Chang HY, Chang YL, Chen HL. Treatment of a severely ankylosed central incisor and a missing lateral incisor by distraction osteogenesis and
orthodontic treatment. Am J Orthod Dentofacial Orthop 2010;138:829-38.
5. Hwang DH, Park KH, Kwon YD, Kim SJ. Treatment of Class II open bite complicated by an ankylosed maxillary central incisor. Angle Orthod
2011;81:726-35.
CASE 3
CASE 4
Ankylosed
central incisor
(growing child)
Ankylosed
central incisor
Anterior open
bite
The patient’s chief complaint was a progressive anterior open bite.
This case was a 16-year-old girl with an ankylosed maxillary left central incisor.
When she was nine years old, this tooth was broken and treated endodontically.
6. Alcan T. A miniature tooth-borne distractor for the alignment of ankylosed teeth. Angle Orthod 2006;76:77-83.
CASE 5
(growing child)
Anterior open
bite
A 9-year-old boy presented about 10 hours after losing his maxillary right central
incisor as a result of facial trauma. The patient had brought his lost tooth, which was
apparently undamaged. No sign of injury was detected on the soft tissues
surrounding the empty socket. The tooth was replanted and splinted. The replanted
tooth remained firmly in place and the surrounding soft tissues appeared healthy at
the follow-up visits for 7 years, but a progressive infraocclusion.
9. Menini I, Zornitta C, Menini G. Distraction osteogenesis for implant site development using a novel orthodontic device: a case report. Int J Periodontics
Restorative Dent 2008;28:189-96.
CASE 6
Ankylosed
central incisor
(growing child)
Anterior open
bite
Ankylosed
central incisor
(growing child)
Anterior open
bite
The patient was first referred to our oral surgery clinic when she was 8 years 2
months old, after an accident in the swimming pool. Her traumatic injury included
subluxation of a maxillary central incisor. The tooth was repositioned and stabilized
with intramaxillary wire fixation.
She returned to our clinic at age of 12 for orthodontic treatment. The injured incisor
was ankylosed, and the radiograph showed apical root resorption of teeth, 11,
21and 22.
The patient was 10 years old when orthodontic treatment began. She had a Class II
Division 1 malocclusion with an overjet of 8 mm. The upper left central incisor had
not completed eruption, and there was a history of trauma at age 5 to its
predecessors.
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating
bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
11. Kofod T, Wurtz V, Melsen B. Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device. Am
J Orthod Dentofacial Orthop 2005;127:72-80.
An central incisor ankylosed
after growing finished.
CASE 7
Ankylosed
central incisor
(growing child)
Anterior open
bite
• There was no anterior open bite. Usually,
only the labially displaced incisor was
traumatized and ankylosed.
• This phenomenon was presented in a
case report.7
The patient was a girl, aged 11 years 11 months, who had bumped against the
corner of a desk and damaged her maxillary incisors when she was 7 years old. The
incisors were reimplanted, but the left central incisor eventually became ankylosed,
preventing further growth of the alveolar bone, creating an open bite in the
maxillary incisors.
12. Kim Y, Park S, Son W, Kim S, Mah J. Treatment of an ankylosed maxillary incisor by intraoral alveolar bone distraction osteogenesis. Am J Orthod
Dentofacial Orthop 2010;138:215-20.
CASE 1
7. Dolanmaz D, Karaman AI, Pampu AA, Topkara A. Orthodontic treatment of an ankylosed maxillary central incisor through osteogenic distraction.
Angle Orthod 2010;80:391-5.
CASE 2
Ankylosed
central incisor
(after growing
finished)
No anterior
open bite
Ankylosed
central incisor
No anterior
open bite
(after growing
finished)
51 years old man
The patient was a 35-year-old woman.
7. Dolanmaz D, Karaman AI, Pampu AA, Topkara A. Orthodontic treatment of an ankylosed maxillary central incisor through osteogenic distraction.
Angle Orthod 2010;80:391-5.
Treatment modalities in growing
children
•
•
•
•
Resection18
Spontaneous re-eruption15
Decoronation20,21
Extraction and substitution with the
adjacent tooth22
15. Schott TC, Engel E, Goz G. Spontaneous re-eruption of a permanent maxillary central incisor after 15 years of ankylosis - a case report. Dent
Traumatol 2011.
18. McNamara TG, O'Shea D, McNamara CM, Foley TF. The management of traumatic ankylosis during orthodontics: a case report. J Clin
Pediatr Dent 2000;24:265-7.
20. Malmgren B. Decoronation: how, why, and when? J Calif Dent Assoc 2000;28:846-54.
21. Sapir S, Kalter A, Sapir MR. Decoronation of an ankylosed permanent incisor: alveolar ridge preservation and rehabilitation by an implant
supported porcelain crown. Dent Traumatol 2009;25:346-9.
22. Janson G, Valarelli DP, Valarelli FP, de Freitas MR, Pinzan A. Atypical extraction of maxillary central incisors. Am J Orthod Dentofacial Orthop
2010;138:510-7.
Case 749418 권영민
Resection
• In the past, an ankylosed permanent
incisor was often surgically resected and
replaced with a fixed or removable
prosthetic tooth.18
A Caucasian female, aged 11 years
and 5 months, was referred for
orthodontic treatment of a marked
Class II Div 1 malocclusion.
18. McNamara TG, O'Shea D, McNamara CM, Foley TF. The management of traumatic ankylosis during orthodontics: a case report.
J Clin Pediatr Dent 2000;24:265-7.
Resection
Resection
During Frankel appliance therapy, the patient experienced an acute
traumatic episode to the maxillary incisor region following a fall from a
bicycle.
The maxillary right central incisor was avulsed and it was replanted.
After extraction of four first premolars, orthodontic treatment was done.
But the central incisor failed to move. The ankylosed incisor was
immediately excuded from any further archwire mechanics.
18. McNamara TG, O'Shea D, McNamara CM, Foley TF. The management of traumatic ankylosis during orthodontics: a case report. J Clin Pediatr
Dent 2000;24:265-7.
After orthodontic treatment, the clinical crown was reduced.
18. McNamara TG, O'Shea D, McNamara CM, Foley TF. The management of traumatic ankylosis during orthodontics: a case report. J Clin Pediatr
Dent 2000;24:265-7.
Spontaneous re-eruption
Resection
2006
22Y
2002
18Y
The crown was restored with a light cured composite resin material, using
an incremental build-up technique.
A long-term definitive restorative treatment using a single endosseous
implant, is planned.
But a vertical alveolar defect makes an esthetic prosthetic replacement
difficult and often results in a compromised esthetic outcome. In growing
children the remaining vertical alveolar growth of adjacent teeth makes the
treatment more difficult.
18. McNamara TG, O'Shea D, McNamara CM, Foley TF. The management of traumatic ankylosis during orthodontics: a case report.
J Clin Pediatr Dent 2000;24:265-7.
Spontaneous re-eruption
In 1991, a 7-year-old boy suffered a traumatic intrusion leading to an
infraposition of tooth 21 along with its immobility. Based on the clinical
findings, including bright-sounding percussion testing, disappearance of the
periodontal space and a failed attempt at orthodontic movement, a
diagnosis of ankylosis was made.
Resin
restoration
15.
Metal ceramic crown restoration
(2003), when she was 19.
2mm extrusion, for 3
years (2006)
Schott TC, Engel E, Goz G. Spontaneous re-eruption of a permanent maxillary central incisor after 15 years of ankylosis - a case report.
Dent Traumatol 2011.
Spontaneous re-eruption
Condition 6 days after trauma in a 10year-old girl with complete intrusion of
the right central incisor. The right lateral
and left central incisor are partially
intruded (>2 mm).
Within a few months using a partial multibracket appliance in the maxilla
(Fig. 3), the previously ankylosed tooth could be extruded by several
millimeters.
A wait-and-see strategy in anticipation of such spontaneous
elongation cannot be considered a valid treatment option, as the
likelihood of this eventuality is very low.
But spontaneous re-eruption after several years is an extremely rare
finding.
15.
Schott TC, Engel E, Goz G. Spontaneous re-eruption of a permanent maxillary central incisor after 15 years of ankylosis - a case report.
Dent Traumatol 2011.
Material and Methods: Fifty-one intruded permanent incisors were studied
in 20 boys and 19 girls aged 6 to 17 years. Only three patients were over
12 years of age. Complete intrusion had occurred in 21 teeth, and 31 teeth
were classified as immature. Re-eruption was awaited for 37 teeth. The
remaining teeth were repositioned orthodontically (7 teeth) or surgically (7
teeth).
Results: Re-eruption occurred in 35 out of 37 teeth over a period of 3–12
months.
19. Wigen TI, Agnalt R, Jacobsen I. Intrusive luxation of permanent incisors in Norwegians aged 6-17 years: a retrospective study of treatment and
outcome. Dent Traumatol 2008;24:612-8.
Spontaneous re-eruption
Spontaneous re-eruption
Results: After a mean observation period of 4 years ranging
from 1–12 years, retained pulp vitality was recorded in 22 teeth (43%). Pulp
necrosis had developed in 57%, inflammatory resorption in 26% and
replacement resorption in 12%.
In the analysis all orthodontic and surgical repositioned teeth were
combined into an active treatment group. The non-active treatment group
consisted of teeth allowed to re-erupt. The distribution of replacement
resorption was significantly lower in teeth allowed to re-erupt than in
teeth repositioned actively.
Fig. 3. Complete intrusion of left
central incisor. Re-eruption was
awaited.
(a, b) Condition 5 days after
injury, before start of endodontic
treatment. A gingivectomy was
performed to gain access to the
root canal.
(c, d) Partial re-eruption 1 month
later. Pulp canal is filled
temporarily with calcium hydroxide.
(e, f) Complete re-eruption and
permanent root filling 10 months
after trauma. (Delayed eruption of
right incisor is due to
supernumerary tooth).
Conclusions: The best treatment of intruded incisors in 6–12 year-old
children is to await re-eruption. The time interval between trauma and
complete re-eruption varied from 3 to 12 months with a mean of 5.6
months. Should endodontic treatment be required before re-eruption has
occurred, a gingivectomy can be performed to gain access to the root
canal.
19. Wigen TI, Agnalt R, Jacobsen I. Intrusive luxation of permanent incisors in Norwegians aged 6-17 years: a retrospective study of treatment and
outcome. Dent Traumatol 2008;24:612-8.
19. Wigen TI, Agnalt R, Jacobsen I. Intrusive luxation of permanent incisors in Norwegians aged 6-17 years: a retrospective study of treatment and
outcome. Dent Traumatol 2008;24:612-8.
Decoronation
Decoronation
5 years
Fig. 1. Intraoral occlusal view of the
ankylosed right maxillary
central incisor at the initial
examination.(12-year old)
Fig. 2. Intraoral view of the wound
edge approximation (over
the decoronated ankylosed root) and
suturing without tension.
Decoronation is a surgical method for treating ankylosed incisors in
children and adolescents. Decoronation preserves not only the width of
the ridge but also the vertical height.20,21
20. Malmgren B. Decoronation: how, why, and when? J Calif Dent Assoc 2000;28:846-54.
21. Sapir S, Kalter A, Sapir MR. Decoronation of an ankylosed permanent incisor: alveolar ridge preservation and rehabilitation by an implant supported
porcelain crown. Dent Traumatol 2009;25:346-9.
Decoronation
(18 year old)
Fig. 4. Periapical radiograph of the
Fig. 3. Postoperative alveolar bone ridge 5 years after
periapical radiograph decoronation. Notice the complete
of the decoronated remodeling of the root to bone.
Moderate apical root resorption of
ankylosed central
adjacent roots because of the
incisor.
orthodontic treatment is also
noticeable.
Decoronation
(12 year old)
Fig. 6. Intraoral view of the
alveolar bone ridge at the
time of implant insertion.
Notice the preservation
of the alveolar bone
ridge.
20. Malmgren B. Decoronation: how, why, and when? J Calif Dent Assoc 2000;28:846-54.
21. Sapir S, Kalter A, Sapir MR. Decoronation of an ankylosed permanent incisor: alveolar ridge preservation and rehabilitation by an implant supported
porcelain crown. Dent Traumatol 2009;25:346-9.
Extraction and substitution with
the adjacent tooth
Root
resorption
Fig. 7. Intraoral view of the
prosthetic porcelain crown on the
day of cementation.
Fig. 8. Periapical radiograph of the
implant and prosthetic
restoration.
We conclude that treatment of an ankylosed young permanent incisor by
decoronation may maintain the alveolar bone ridge width, height and continuity,
and assist future rehabilitation with minimal, if any, ridge augmentation procedures.
The disadvantages are its surgical nature, which may be challenging in young
children, and the necessity for a long-term esthetic space maintainer.21
20. Malmgren B. Decoronation: how, why, and when? J Calif Dent Assoc 2000;28:846-54.
21. Sapir S, Kalter A, Sapir MR. Decoronation of an ankylosed permanent incisor: alveolar ridge preservation and rehabilitation by an implant supported
porcelain crown. Dent Traumatol 2009;25:346-9.
A boy, aged 13 years 11
months.
He had a traumatic episode at age 11
years, and the maxillary left central incisor
was avulsed. The tooth received
endodontic treatment and was
reimplanted.
The option of extracting the maxillary central incisors followed by space closure,
with lateral incisors substituting for the central incisors, may be considered in some
growing patients and also in adults.22
22. Janson G, Valarelli DP, Valarelli FP, de Freitas MR, Pinzan A. Atypical extraction of maxillary central incisors. Am J Orthod Dentofacial Orthop
2010;138:510-7.
Extraction and substitution with
the adjacent tooth
Lateral
incisors
Treatment modalities in nongrowing adolescents and adults.
Several surgical treatment protocols
1. Single tooth osteotomy8,16,23
2. Surgical luxation24-27
Extraction of maxillary central
incisors and mandibular first
premolars because of crowding and
protrusion.
Gingivectomy and direct composite
buildup of the maxillary lateral incisors
and canines transformed them into central
and lateral incisors, respectively.
Extraction of the maxillary central incisors is not a usual treatment protocol in
orthodontics. However, in some patients with ankylosis of the maxillary central
incisors and wide maxillary anterior teeth, this might be a good alternative to
preserve tooth structure and avoid permanent prostheses as long as the patient’s
diagnostic characteristics will permit this plan.22
22. Janson G, Valarelli DP, Valarelli FP, de Freitas MR, Pinzan A. Atypical extraction of maxillary central incisors. Am J Orthod Dentofacial Orthop
2010;138:510-7.
Single tooth osteotomy8,16,23
3. Corticotomy5
4. Distraction osteogenesis (DO)2,6,9-14,23,26,28
2. Chang HY, Chang YL, Chen HL. Treatment of a severely ankylosed central incisor and a missing lateral incisor by distraction osteogenesis and orthodontic treatment. Am J Orthod Dentofacial Orthop 2010;138:829-38.
5. Hwang DH, Park KH, Kwon YD, Kim SJ. Treatment of Class II open bite complicated by an ankylosed maxillary central incisor. Angle Orthod 2011;81:726-35.
6. Alcan T. A miniature tooth-borne distractor for the alignment of ankylosed teeth. Angle Orthod 2006;76:77-83.
8. Epker BN, Paulus PJ. Surgical-orthodontic correction of adult malocclusions- Single-tooth dento-osseous osteotomies. Am J Orthod Dentofacial Orthop 1978;74:551-63.
9. Menini I, Zornitta C, Menini G. Distraction osteogenesis for implant site development using a novel orthodontic device: a case report. Int J Periodontics Restorative Dent 2008;28:189-96.
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
11. Kofod T, Wurtz V, Melsen B. Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device. Am J Orthod Dentofacial Orthop 2005;127:72-80.
12. Kim Y, Park S, Son W, Kim S, Mah J. Treatment of an ankylosed maxillary incisor by intraoral alveolar bone distraction osteogenesis. Am J Orthod Dentofacial Orthop 2010;138:215-20.
13. Im JJ, Kye MK, Hwang KG, Park CJ. Miniscrew-anchored alveolar distraction for the treatment of the ankylosed maxillary central incisor. Dent Traumatol 2010;26:285-8.
14. Razdolsky Y, El-Bialy TH, Dessner S, Buhler JE, Jr. Movement of ankylosed permanent teeth with a distraction device. J Clin Orthod 2004;38:612-20.
16. Medeiros PJ, Bezerra AR. Treatment of an ankylosed central incisor by single-tooth dento-osseous osteotomy. Am J Orthod Dentofacial Orthop 1997;112:496-501.
23. Kim Y, Kim S, Son W, Park S. Orthodontic treatment of an ankylosed tooth; application of single tooth osteotomy and alveolar bone distraction osteogenesis. Korean J Orthod 2009;39:185-98.
24. Salas Cordova J, Yokozeki M, Moriyama K. An unusual ankylosis in an orthodontic case. J Clin Orthod 2001;35:763-6.
25. Takahashi T, Takagi T, Moriyama K. Orthodontic treatment of a traumatically intruded tooth with ankylosis by traction after surgical luxation. Am J Orthod Dentofacial Orthop 2005;127:233-41.
26. Son W, Chung IK, Shin SH. Surgically assisted orthodontic treatment of ankylosed maxillary incisor. Korean J Orthod 2002;32:257-64.
27. Im DH, Nahm DS, Chang YI. The treatment of an ankylosed canine: luxation and forced eruption. Korean J Orthod 2002;32:395-400.
28. Isaacson RJ, Strauss RA, Bridges-Poquis A, Peluso AR, Lindauer SJ. Moving an ankylosed central incisor using orthodontics, surgery and distraction osteogenesis. Angle Orthod 2001;71:411-8.
Single tooth osteotomy8,16,23
• move the dento-osseous segment into
the desired position with adequately
attached mucoperiosteal pedicles in
order to maintain the blood supply to
the tooth-bone segment
• Sufficient interdental space must exist so
that a fine cut (osteotomy) can be made
between adjacent teeth without injury to
them
8. Epker BN, Paulus PJ. Surgical-orthodontic correction of adult malocclusions- Single-tooth dento-osseous osteotomies. Am J Orthod Dentofacial Orthop 1978;74:551-63.
16. Medeiros PJ, Bezerra AR. Treatment of an ankylosed central incisor by single-tooth dento-osseous osteotomy. Am J Orthod Dentofacial Orthop 1997;112:496-501.
23. Kim Y, Kim S, Son W, Park S. Orthodontic treatment of an ankylosed tooth; application of single tooth osteotomy and alveolar bone distraction osteogenesis. Korean J Orthod 2009;39:185-98.
Single tooth osteotomy8,16,23
The patient was 10 years old when orthodontic treatment
began. She had a Class II, Division 1 malocclusion
with an overjet of 8 mm. The upper left central incisor had
not completed eruption, and there was a history of trauma
at age 5 to its predecessor
16. Medeiros PJ, Bezerra AR. Treatment of an ankylosed central incisor by single-tooth dento-osseous osteotomy. Am J Orthod Dentofacial Orthop 1997;112:496-501.
8. Epker BN, Paulus PJ. Surgical-orthodontic correction of adult malocclusions- Single-tooth dento-osseous osteotomies. Am J Orthod Dentofacial Orthop 1978;74:551-63.
Single tooth osteotomy8,16,23
The surgical luxation was performed
with an elevator (301 type), and good
mobilization was obtained. One day
after this procedure, the coil spring was
reactivated for 8 months with 50 gm of
orthodontic force. However, instead of
leveling the central incisor, the other
teeth began intrusion and the bite
opened.
Clinical aspect before surgical
procedure.
16. Medeiros PJ, Bezerra AR. Treatment of an ankylosed central incisor by single-tooth dento-osseous osteotomy. Am J Orthod Dentofacial Orthop 1997;112:496-501.
Single tooth osteotomy8,16,23
Schematic drawing showing soft tissue
incisions slightly divergent and
osteotomies parallel to each other
(dashed lines).
With a thin osteotome, the cuts involving
the medullary and the palatal bone were
completed.
Immediate postoperative view after
stabilization of segment.
After adequate mobilization, the
segment was displaced inferiorly and
attached to the arch wire.
16. Medeiros PJ, Bezerra AR. Treatment of an ankylosed central incisor by single-tooth dento-osseous osteotomy. Am J Orthod Dentofacial Orthop 1997;112:496-501.
Surgical
luxation24-27
Single tooth osteotomy8,16,23
Clinical aspect 18 months after procedure.
Periapical radiograph 8 months
after procedure.
The dento-osseous segment
was kept wired to the arch for 4
weeks.
The best time to perform this type of
osteotomy would be after the facial growth
has been completed. We had to consider
that the tooth may not stay at the same level
of the central incisor and this situation might
require a crown restoration for elongation.
16. Medeiros PJ, Bezerra AR. Treatment of an ankylosed central incisor by single-tooth dento-osseous osteotomy. Am J Orthod Dentofacial Orthop 1997;112:496-501.
Surgical luxation24-27
He had a dental history of trauma at age 10 years 2 months on the bilateral
maxillary central incisors (teeth 11 and 21), the right maxillary and mandibular
lateral incisors (teeth 12 and 42), and the right mandibular central incisor
(tooth 41). Teeth 11 and 41 had suffered from crown fracture, and tooth 41
had been restored by composite resin bonding. Both teeth had been treated
endodontically. Ankylosis was suspected on teeth 12 and 42, because of severe
intrusive luxation (tooth 12) and replantation after traumatic avulsion (tooth
42). The intruded tooth 12 had been observed for a year after injury, and no
spontaneous eruption had occurred.
24. Salas Cordova J, Yokozeki M, Moriyama K. An unusual ankylosis in an orthodontic case. J Clin Orthod 2001;35:763-6.
25. Takahashi T, Takagi T, Moriyama K. Orthodontic treatment of a traumatically intruded tooth with ankylosis by traction after surgical luxation. Am J Orthod Dentofacial Orthop 2005;127:233-41.
26. Son W, Chung IK, Shin SH. Surgically assisted orthodontic treatment of ankylosed maxillary incisor. Korean J Orthod 2002;32:257-64.
27. Im DH, Nahm DS, Chang YI. The treatment of an ankylosed canine: luxation and forced eruption. Korean J Orthod 2002;32:395-400.
Surgical luxation24-27
25. Takahashi T, Takagi T, Moriyama K. Orthodontic treatment of a traumatically intruded tooth with ankylosis by traction after surgical luxation. Am J Orthod Dentofacial Orthop 2005;127:233-41.
Surgical luxation24-27
At age 12 years 8 months
Orthodontic forces were applied to teeth 12 and 42. A traction spring from
the maxillary lingual arch was used to attempt eruption of tooth 12; after 3
months with no extrusive movement, a definitive diagnosis of ankylosis was made,
and the surgical luxation was performed.
A periapical radiograph of tooth 42, taken after leveling, showed that the root
filling material (calcium hydroxide) had disappeared, and replacement root
resorption had occurred. Consequently, the application of orthodontic force was
stopped immediately.
Surgical luxation was performed again.
25. Takahashi T, Takagi T, Moriyama K. Orthodontic treatment of a traumatically intruded tooth with ankylosis by traction after surgical luxation. Am J Orthod Dentofacial Orthop 2005;127:233-41.
25. Takahashi T, Takagi T, Moriyama K. Orthodontic treatment of a traumatically intruded tooth with ankylosis by traction after surgical luxation. Am J Orthod Dentofacial Orthop 2005;127:233-41.
Surgical luxation24-27
Corticotomy5
A periapical radiograph of tooth 42, taken after leveling, showed that the root
filling material (calcium hydroxide) had disappeared, and replacement root
resorption had occurred. Consequently, the application of orthodontic force was
stopped immediately.
25. Takahashi T, Takagi T, Moriyama K. Orthodontic treatment of a traumatically intruded tooth with ankylosis by traction after surgical luxation. Am J Orthod Dentofacial Orthop 2005;127:233-41.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
5. Hwang DH, Park KH, Kwon YD, Kim SJ. Treatment of Class II open bite complicated by an ankylosed maxillary central incisor. Angle Orthod 2011;81:726-35.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• History2
• History2
 The distraction osteogenesis technique was first
successfully applied to long bones by Ilizarov in
1988,31 subsequently employed in the alveolar
bone by Chin and Toth.32
 and reported for a single-incisor dentoalveolar
distraction by Isaacson et al and others.2,6,9-14,23,26,28
 This technique involves a segmental osteotomy,
followed by distraction osteogenesis to reposition
the ankylosed tooth, the adjacent alveolar bone
and the gingival tissue.
31. Ilizarov GA. The tension-stress effect on the genesis and growth of tissues: Part II. The influence of the rate and frequency of distraction. Clin Orthop Relat Res
1989:263-85.
32. Chin M, Toth BA. Distraction osteogenesis in maxillofacial surgery using internal devices: review of five cases. J Oral Maxillofac Surg 1996;54:45-53
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Indication2
 With a severely displaceded (ankylosed) tooth,
the tooth cannot be moved the entire distance
necessary to reach the occlusal plane,
 because of the stretching limitations of the
attached soft tissue during the surgery, additional
undermining of the soft tissue was not an option
because of the risk of interfering with the blood
supply to the tooth and the alveolar segment.
2. Chang HY, Chang YL, Chen HL. Treatment of a severely ankylosed central incisor and a missing lateral incisor by distraction osteogenesis and orthodontic treatment. Am J Orthod Dentofacial Orthop 2010;138:829-38.
6. Alcan T. A miniature tooth-borne distractor for the alignment of ankylosed teeth. Angle Orthod 2006;76:77-83.
9. Menini I, Zornitta C, Menini G. Distraction osteogenesis for implant site development using a novel orthodontic device: a case report. Int J Periodontics Restorative Dent 2008;28:189-96.
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
11. Kofod T, Wurtz V, Melsen B. Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device. Am J Orthod Dentofacial Orthop 2005;127:72-80.
12. Kim Y, Park S, Son W, Kim S, Mah J. Treatment of an ankylosed maxillary incisor by intraoral alveolar bone distraction osteogenesis. Am J Orthod Dentofacial Orthop 2010;138:215-20.
13. Im JJ, Kye MK, Hwang KG, Park CJ. Miniscrew-anchored alveolar distraction for the treatment of the ankylosed maxillary central incisor. Dent Traumatol 2010;26:285-8.
14. Razdolsky Y, El-Bialy TH, Dessner S, Buhler JE, Jr. Movement of ankylosed permanent teeth with a distraction device. J Clin Orthod 2004;38:612-20.
16. Medeiros PJ, Bezerra AR. Treatment of an ankylosed central incisor by single-tooth dento-osseous osteotomy. Am J Orthod Dentofacial Orthop 1997;112:496-501.
23. Kim Y, Kim S, Son W, Park S. Orthodontic treatment of an ankylosed tooth; application of single tooth osteotomy and alveolar bone distraction osteogenesis. Korean J Orthod 2009;39:185-98.
26. Son W, Chung IK, Shin SH. Surgically assisted orthodontic treatment of ankylosed maxillary incisor. Korean J Orthod 2002;32:257-64.
28. Isaacson RJ, Strauss RA, Bridges-Poquis A, Peluso AR, Lindauer SJ. Moving an ankylosed central incisor using orthodontics, surgery and distraction osteogenesis. Angle Orthod 2001;71:411-8.
2. Chang HY, Chang YL, Chen HL. Treatment of a severely ankylosed central incisor and a missing lateral incisor by distraction osteogenesis and orthodontic treatment. Am J Orthod Dentofacial Orthop 2010;138:829-38.
6. Alcan T. A miniature tooth-borne distractor for the alignment of ankylosed teeth. Angle Orthod 2006;76:77-83.
9. Menini I, Zornitta C, Menini G. Distraction osteogenesis for implant site development using a novel orthodontic device: a case report. Int J Periodontics Restorative Dent 2008;28:189-96.
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
11. Kofod T, Wurtz V, Melsen B. Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device. Am J Orthod Dentofacial Orthop 2005;127:72-80.
12. Kim Y, Park S, Son W, Kim S, Mah J. Treatment of an ankylosed maxillary incisor by intraoral alveolar bone distraction osteogenesis. Am J Orthod Dentofacial Orthop 2010;138:215-20.
13. Im JJ, Kye MK, Hwang KG, Park CJ. Miniscrew-anchored alveolar distraction for the treatment of the ankylosed maxillary central incisor. Dent Traumatol 2010;26:285-8.
14. Razdolsky Y, El-Bialy TH, Dessner S, Buhler JE, Jr. Movement of ankylosed permanent teeth with a distraction device. J Clin Orthod 2004;38:612-20.
16. Medeiros PJ, Bezerra AR. Treatment of an ankylosed central incisor by single-tooth dento-osseous osteotomy. Am J Orthod Dentofacial Orthop 1997;112:496-501.
23. Kim Y, Kim S, Son W, Park S. Orthodontic treatment of an ankylosed tooth; application of single tooth osteotomy and alveolar bone distraction osteogenesis. Korean J Orthod 2009;39:185-98.
26. Son W, Chung IK, Shin SH. Surgically assisted orthodontic treatment of ankylosed maxillary incisor. Korean J Orthod 2002;32:257-64.
28. Isaacson RJ, Strauss RA, Bridges-Poquis A, Peluso AR, Lindauer SJ. Moving an ankylosed central incisor using orthodontics, surgery and distraction osteogenesis. Angle Orthod 2001;71:411-8.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Three stages
 Distraction osteogenesis consists of 3 sequential
periods: latency, distraction, and consolidation.
 Latency is the period from bone division to the onset
of traction and is the time allowed for callus
formation.
 During the distraction period, gradual traction is
applied, and new bone, or distraction regenerate, is
formed.
 The consolidation period allows maturation of the
regenerate bone after the traction forces are
discontinued.11
11.. Kofod T, Wurtz V, Melsen B. Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device. Am J Orthod Dentofacial Orthop 2005;127:72-80.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
The latency periods
for the distraction of the dento-osseous block
varied considerably for different case reports from
4 days,11 5 days,12,14 one week,2,10,13 and two
weeks.14,28
In most cases, after a latency period of one week ,
distraction of the dentoalveolar segment began.2,13
2. Chang HY, Chang YL, Chen HL. Treatment of a severely ankylosed central incisor and a missing lateral incisor by distraction osteogenesis and
orthodontic treatment. Am J Orthod Dentofacial Orthop 2010;138:829-38.
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating
bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
11. Kofod T, Wurtz V, Melsen B. Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device. Am
J Orthod Dentofacial Orthop 2005;127:72-80.
12. Kim Y, Park S, Son W, Kim S, Mah J. Treatment of an ankylosed maxillary incisor by intraoral alveolar bone distraction osteogenesis. Am J Orthod
Dentofacial Orthop 2010;138:215-20.
13. Im JJ, Kye MK, Hwang KG, Park CJ. Miniscrew-anchored alveolar distraction for the treatment of the ankylosed maxillary central incisor. Dent
Traumatol 2010;26:285-8.
14. Razdolsky Y, El-Bialy TH, Dessner S, Buhler JE, Jr. Movement of ankylosed permanent teeth with a distraction device. J Clin Orthod 2004;38:612-20.
18. McNamara TG, O'Shea D, McNamara CM, Foley TF. The management of traumatic ankylosis during orthodontics: a case report. J Clin Pediatr Dent
2000;24:265-7.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
Rates of distraction
For dento-alveolar distraction of a single tooth,
various rates of distraction have been used
previously
from 0.5 mm to 1.0 mm per day.2,6,914,17,28
2. Chang HY, Chang YL, Chen HL. Treatment of a severely ankylosed central incisor and a missing lateral incisor by distraction osteogenesis and
orthodontic treatment. Am J Orthod Dentofacial Orthop 2010;138:829-38.
6. Alcan T. A miniature tooth-borne distractor for the alignment of ankylosed teeth. Angle Orthod 2006;76:77-83.
9. Menini I, Zornitta C, Menini G. Distraction osteogenesis for implant site development using a novel orthodontic device: a case report. Int J Periodontics
Restorative Dent 2008;28:189-96.
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating
bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
11. Kofod T, Wurtz V, Melsen B. Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device. Am
J Orthod Dentofacial Orthop 2005;127:72-80.
12. Kim Y, Park S, Son W, Kim S, Mah J. Treatment of an ankylosed maxillary incisor by intraoral alveolar bone distraction osteogenesis. Am J Orthod
Dentofacial Orthop 2010;138:215-20.
13. Im JJ, Kye MK, Hwang KG, Park CJ. Miniscrew-anchored alveolar distraction for the treatment of the ankylosed maxillary central incisor. Dent
Traumatol 2010;26:285-8.
14. Razdolsky Y, El-Bialy TH, Dessner S, Buhler JE, Jr. Movement of ankylosed permanent teeth with a distraction device. J Clin Orthod 2004;38:612-20.
17. Ohkubo K, Susami T, Mori Y, Nagahama K, Takahashi N, Saijo H, et al. Treatment of ankylosed maxillary central incisors by single-tooth dentoosseous osteotomy and alveolar bone distraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:561-7.
28. Isaacson RJ, Strauss RA, Bridges-Poquis A, Peluso AR, Lindauer SJ. Moving an ankylosed central incisor using orthodontics, surgery and distraction
osteogenesis. Angle Orthod 2001;71:411-8.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Methods2
The traction of the single-tooth osteotomy block
can be repositioned to the desired position by
 vertical extrusion bends,
 vertical elastics,
 a coil spring,
 a nickel-titanium wire,
 or a simple distraction device.
2. Chang HY, Chang YL, Chen HL. Treatment of a severely ankylosed central incisor and a missing lateral incisor by distraction osteogenesis and orthodontic treatment. Am J Orthod Dentofacial Orthop 2010;138:829-38.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
The latency periods
In my cases, following a seven-day latency
period, distraction was begun on the day of
stich-out. The authors noted that it would be
safe and convenient to start distraction on the
day of stich-out after primary healing of soft
tissue.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
Rates of distraction
In an animal study, bone regenerate produced
by dentoalveolar distraction rates of 1 and 2 mm
per day were similar in quality and quantity.34
34. Spencer AC, Campbell PM, Dechow P, Ellis ML, Buschang PH. How does the rate of dentoalveolar distraction affect the bone regenerate produced?
Am J Orthod Dentofacial Orthop 2011;140:e211-21.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
 Advantages of using a distraction
device
• Recently, many distractors have been invented
and reported. The advantages of using a
distraction device is that the displacement of
the dento-alveolar block gradually increases in
accurate amounts and the patient can extend
the distractor at home.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
 Disadvantages of using a distraction
device
• Placing a distractor during surgery was a difficult
task for the maxillofacial surgeon, because the
distractor was unidirectional.
• Furthermore, lengthening occurs only in a linear
direction, with no possibility of 3-dimensional
alignment of the osteotomized segment.
• The secondary surgery to remove the distractor is
the main disadvantage of the bone-borne distractor.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
 Consolidation of the bone segment
• The stability of the dento-osseous block after the
distraction may be considered a key determinant in
bone formation within the gap.35
• For consolidation of the bone segment, a passive
heavy archwire has been left in place for 6 weeks,2,28
12 weeks,11 or up to 5 months.9
2. Chang HY, Chang YL, Chen HL. Treatment of a severely ankylosed central incisor and a missing lateral incisor by distraction osteogenesis and orthodontic treatment. Am J Orthod
Dentofacial Orthop 2010;138:829-38.
9. Menini I, Zornitta C, Menini G. Distraction osteogenesis for implant site development using a novel orthodontic device: a case report. Int J Periodontics Restorative Dent 2008;28:189-96.
11. Kofod T, Wurtz V, Melsen B. Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device. Am J Orthod Dentofacial Orthop
2005;127:72-80.
28. Isaacson RJ, Strauss RA, Bridges-Poquis A, Peluso AR, Lindauer SJ. Moving an ankylosed central incisor using orthodontics, surgery and distraction osteogenesis. Angle Orthod
2001;71:411-8.
35. Saulacic N, Zix J, Iizuka T. Complication rates and associated factors in alveolar distraction osteogenesis: a comprehensive review. Int J Oral Maxillofac Surg 2009;38:210-7.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
 Complication
• In the review article by Saulacic et al regarding
alveolar distraction osteogensis, the most common
complication was insufficient bone formation
following the consolidation period (22 cases of 256
patients, 8%), followed by regression of distraction
distance (18 cases, 7%).35 Incorrect design of the
vertical osteotomy lines may also impede the
movement of the transport segment.35
35. Saulacic N, Zix J, Iizuka T. Complication rates and associated factors in alveolar distraction osteogenesis: a comprehensive review. Int J Oral Maxillofac Surg 2009;38:210-7.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
 Disadvantages of using a distraction
device
• if the bulky device is placed in the vestibule, it
is irritable to the vestibular gingival, and if
placed incisally, it is unesthetic.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
 Consolidation of the bone segment
• Kinzinger et al reduced the consolidation period
(only seventeen days of consolidation) to move the
incisor into the final position by applying orthodontic
forces early (“floating bone concept”), because the
tooth was not moved to the desired position using
the bone-borne distractor.10
35. Saulacic N, Zix J, Iizuka T. Complication rates and associated factors in alveolar distraction osteogenesis: a comprehensive review. Int J Oral Maxillofac Surg 2009;38:210-7.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
 Complication
• The overcorrection concept was emphasized by
Saulacic et al,36 for relapse of the distractiongenerated bone typically occured during the later
period of healing, leading to a loss of
approximately 1.6~1.8 mm or 20% of the
distracted bone height (6.1~6.2mm).
36. Saulacic N, Somoza-Martin M, Gandara-Vila P, Garcia-Garcia A. Relapse in alveolar distraction osteogenesis: an indication for overcorrection. J Oral Maxillofac Surg 2005;63:978-81.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
 Complication
• Because ankylosis-related external replacement
resorption always led to complete root resorption,9,19 it
was notified to the patient and her parents that external
resorption would be a complication leading eventually to
tooth loss.
• Although the ankylosed incisor will eventually be lost, the
tooth can be used for several years with conservation of
alveolar bone. Even if the root of the ankylosed tooth is
progressively resorbed, our treatment could be an
excellent way to prepare the site for future implant
treatment.9
9. Menini I, Zornitta C, Menini G. Distraction osteogenesis for implant site development using a novel orthodontic device: a case report. Int J Periodontics Restorative Dent 2008;28:189-96.
19. Wigen TI, Agnalt R, Jacobsen I. Intrusive luxation of permanent incisors in Norwegians aged 6-17 years: a retrospective study of treatment and outcome. Dent Traumatol 2008;24:612-8.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Bone-borne distraction devices10
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Bone-borne distraction devices10
The patient was first referred to our oral surgery clinic when she was 8 years 2
months old, after an accident in the swimming pool. Her traumatic injury
included subluxation of a maxillary central incisor (#11) and fracture of the buccal
processus alveolaris. The tooth was repositioned and stabilized with intramaxillary
wire fixation. She returned to our clinic at age 12 for orthodontic treatment
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Bone-borne distraction devices10
TREATMENT PROGRESS
Several treatment alternatives were explored.
1. Perform a conventional osteotomy and augment the alveolar ridge
vertically by removing autogenous bone or by using xenogenous
materials. Secondary soft tissue surgery might be required later.
2. Extract the ankylosed tooth and replace it with an implant or a
bridge.
3. Perform a segmental osteotomy with vertical callus distraction of the
ankylosed tooth, using the floating bone concept; surgery would be
preceded and followed by orthodontic treatment.
Option 3 was selected.
1. Preliminary orthodontic treatment with fixed appliances was initiated
to create sufficient interradicular distance in the projected region of
the osteotomy
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Bone-borne distraction devices10
TREATMENT PROGRESS
1. Preliminary orthodontic treatment with fixed appliances was initiated
to create sufficient interradicular distance in the projected region of
the osteotomy
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
• Bone-borne distraction devices10
TREATMENT PROGRESS
After the segmental osteotomy, a single-tooth distractor
(Gebrüder Martin GmbH & Co KG, Track 1.0, Tuttlingen, Germany)
was placed surgically.
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Bone-borne distraction devices10
TREATMENT PROGRESS
After a 7-day latency period, a distractor was applied to change the
vertical incisor position, with activation during the 8-day distraction
phase at a rate of 0.6 mm/day and a frequency of 2 activations/day
(15 activations). The total distraction distance achieved was 4.5 mm.
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
Although sufficiently deep vertical adjustment of tooth 11 was obtained,
there was clinically a marked palatal deviation.
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Bone-borne distraction devices10
TREATMENT PROGRESS
The decision was then made to reduce the consolidation phase and, by
using the floating bone effect, to move the tooth-supporting segment
into the therapeutically desired position.
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
At start of floating bone effect
Seventeen days later, before final consolidation of the newly formed
bone, the distractor was removed. During surgery, the tooth-supporting
bone segment and the callus could be visualized from the vestibular
aspect after removing the distractor.
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
At start of floating bone effect
Floating bone
effect.
Floating bone
effect.
After 8 days
After 18
Four days postoperatively, movement of the osteotomy segment into
its final position was started by applying orthodontic forces and
moments to the tooth in the segment. A bracket was bonded onto tooth
11 and, in addition to the passive bypass archwire, a superelastic 0.016x
0.022-in copper-nickel-titanium segmented archwire was placed.
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
After 8 days
After 18
After only 18 days, 3-dimensional positioning of the tooth-supporting
segment had been achieved with the floating bone effect, and the dental
arch in the anterior region had been leveled sufficiently to allow a
continuous 0.016x0.022-in stainless steel archwire to be placed for
stabilization.
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Bone-borne distraction devices10
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Bone-borne distraction devices10
Skeletal and somatic maturity was
determined by hand-wrist analysis according
to Hägg and Taranger. The patient was
found to be at the radius stadium R-IJ
development stage, suggesting that the
potential for future growth was limited.
In general, the vertical callus distraction of
an ankylosed tooth should not be
attempted until the patient has finished
growing.
Posttreatment (retention period; 1.5 years later) intraoral photographs.
Posttreatment (retention period; 1.5 years later).
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Bone-borne distraction devices10
Adavantages
1. Hard and soft tissues are
gradually expanded simultaneously
over a period of several days, and
this normally results in a clear-cut
gain in alveolar mucosa.
the callus could be visualized
from the vestibular aspect
after removing the distractor
• Bone-borne distraction devices10
Disadavantages
1. a clinical study by Krafft showed
that in alveolar crest distraction,
especially in the maxilla, the palatal
mucosa followed the distraction to
only a minor extent, thus producing
a deviation of the distraction axis
to the palatal.
2. Dental distractor during surgery
thus becomes a difficult task for the
maxillofacial surgeon because the
intraorally applied distractor has a
unidirectional impact.
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Bone-borne distraction devices10
Disadavantages
3. Furthermore, lengthening occurs
only in a linear direction, with no
possibility of 3-dimensional
alignment of the osteotomized
segment.
4. Ready-made alveolar distractors
are expensive and require a second
surgery to remove the device.
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
• Bone-borne distraction devices10
Floating bone effect
Krafft described a means of exerting a limited influence on the
direction of the newly formed alveolar bone after removing the
distractor: he found that the still soft, newly formed bone matrix
could be slowly moved by applying firm, constant pressure with
the finger. However, because the alveolar segment sprang back to
the palatal after this manipulation, it had to be held buccally in the
desired position with small metal plates. This procedure entails a
longer retention phase and another surgery to remove the metal
plates.
In addition, the mobilization period was brief. At the same time,
3-dimensional alignment of the tooth-supporting segment was
completed quickly, with a multiband apparatus and appropriate
biomechanics.
10. Kinzinger GS, Janicke S, Riediger D, Diedrich PR. Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating bone concept. Am J Orthod Dentofacial Orthop 2003;124:582-90.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Wire2
21-year-old woman with a chief complaint of an anterior open bite.
she had a history of facial trauma when she was 8 years old.
Her maxillary left lateral incisor was missing at that time. Avulsion of the
maxillary right and left central incisors occurred from this trauma. These teeth
were replanted and fixed with wire and resin.
2. Chang HY, Chang YL, Chen HL. Treatment of a severely ankylosed central incisor and a missing lateral incisor by distraction osteogenesis and orthodontic treatment. Am J Orthod Dentofacial Orthop 2010;138:829-38.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Wire2
Another issue in distraction is the 3-dimensional problem of moving a dentalosseous segment. In this patient, the bony cuts were slightly divergent occlusally
and facially, so the segment could be rotated to obtain adequate anterior labial
root torque.
2. Chang HY, Chang YL, Chen HL. Treatment of a severely ankylosed central incisor and a missing lateral incisor by distraction osteogenesis and orthodontic treatment. Am J Orthod Dentofacial Orthop 2010;138:829-38.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Wire2
A,B. Single-tooth dental-osseous osteotomy was performed under local anesthesia.
C,D. Downward repositioning was attempted (an archwire was modified and placed
in the bracket on the partially repositioned tooth, and the soft tissue was closed
2. Chang HY, Chang YL, Chen HL. Treatment of a severely ankylosed central incisor and a missing lateral incisor by distraction osteogenesis and orthodontic treatment. Am J Orthod Dentofacial Orthop 2010;138:829-38.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Wire2
The maxillary left central incisor during the distraction osteogenesis:
A, 1 week after surgery
B, 2 weeks after surgery
C, 3 weeks after surgery
D, 5 weeks after surgery
2. Chang HY, Chang YL, Chen HL. Treatment of a severely ankylosed central incisor and a missing lateral incisor by distraction osteogenesis and orthodontic treatment. Am J Orthod Dentofacial Orthop 2010;138:829-38.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Tooth-borne distraction devices6,11-14,23
Kofod T, Wurtz V, Melsen B.11
The Posttreatment intraoral photographs
Alcan T. A miniature
tooth-borne distractor6
6. Alcan T. A miniature tooth-borne distractor for the alignment of ankylosed teeth. Angle Orthod 2006;76:77-83.
11. Kofod T, Wurtz V, Melsen B. Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device. Am J Orthod
Dentofacial Orthop 2005;127:72-80.
2. Chang HY, Chang YL, Chen HL. Treatment of a severely ankylosed central incisor and a missing lateral incisor by distraction osteogenesis and orthodontic treatment. Am J Orthod Dentofacial Orthop 2010;138:829-38.
12. Kim Y, Park S, Son W, Kim S, Mah J. Treatment of an ankylosed maxillary incisor by intraoral alveolar bone distraction osteogenesis. Am J Orthod Dentofacial Orthop 2010;138:215-20.
13. Im JJ, Kye MK, Hwang KG, Park CJ. Miniscrew-anchored alveolar distraction for the treatment of the ankylosed maxillary central incisor. Dent Traumatol 2010;26:285-8.
14. Razdolsky Y, El-Bialy TH, Dessner S, Buhler JE, Jr. Movement of ankylosed permanent teeth with a distraction device. J Clin Orthod 2004;38:612-20.
23. Kim Y, Kim S, Son W, Park S. Orthodontic treatment of an ankylosed tooth; application of single tooth osteotomy and alveolar bone distraction osteogenesis. Korean J Orthod 2009;39:185-98.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Tooth-borne distraction devices6,11-14,23
Kim Y, Park S, Son W, Kim S, Mah J.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• SAS distraction devices13
12
Im JJ, Kye MK, Hwang KG, Park CJ.
6. Alcan T. A miniature tooth-borne distractor for the alignment of ankylosed teeth. Angle Orthod 2006;76:77-83.
11. Kofod T, Wurtz V, Melsen B. Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device. Am J Orthod Dentofacial Orthop
2005;127:72-80.
12. Kim Y, Park S, Son W, Kim S, Mah J. Treatment of an ankylosed maxillary incisor by intraoral alveolar bone distraction osteogenesis. Am J Orthod Dentofacial Orthop
2010;138:215-20.
13. Im JJ, Kye MK, Hwang KG, Park CJ. Miniscrew-anchored alveolar distraction for the treatment of the ankylosed maxillary central incisor. Dent Traumatol 2010;26:285-8.
14. Razdolsky Y, El-Bialy TH, Dessner S, Buhler JE, Jr. Movement of ankylosed permanent teeth with a distraction device. J Clin Orthod 2004;38:612-20.
23. Kim Y, Kim S, Son W, Park S. Orthodontic treatment of an ankylosed tooth; application of single tooth osteotomy and alveolar bone distraction osteogenesis. Korean J Orthod 2009;39:185-98.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• SAS distraction devices13
Im JJ, Kye MK, Hwang KG, Park CJ.
13
6. Alcan T. A miniature tooth-borne distractor for the alignment of ankylosed teeth. Angle Orthod 2006;76:77-83.
11. Kofod T, Wurtz V, Melsen B. Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device. Am J Orthod Dentofacial Orthop 2005;127:72-80.
12. Kim Y, Park S, Son W, Kim S, Mah J. Treatment of an ankylosed maxillary incisor by intraoral alveolar bone distraction osteogenesis. Am J Orthod Dentofacial Orthop 2010;138:215-20.
13. Im JJ, Kye MK, Hwang KG, Park CJ. Miniscrew-anchored alveolar distraction for the treatment of the ankylosed maxillary central incisor. Dent Traumatol 2010;26:285-8.
14. Razdolsky Y, El-Bialy TH, Dessner S, Buhler JE, Jr. Movement of ankylosed permanent teeth with a distraction device. J Clin Orthod 2004;38:612-20.
23. Kim Y, Kim S, Son W, Park S. Orthodontic treatment of an ankylosed tooth; application of single tooth osteotomy and alveolar bone distraction osteogenesis. Korean J Orthod 2009;39:185-98.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• SAS distraction devices13
13
Im JJ, Kye MK, Hwang KG, Park CJ.
13
6. Alcan T. A miniature tooth-borne distractor for the alignment of ankylosed teeth. Angle Orthod 2006;76:77-83.
11. Kofod T, Wurtz V, Melsen B. Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device. Am J Orthod Dentofacial Orthop 2005;127:72-80.
12. Kim Y, Park S, Son W, Kim S, Mah J. Treatment of an ankylosed maxillary incisor by intraoral alveolar bone distraction osteogenesis. Am J Orthod Dentofacial Orthop 2010;138:215-20.
6. Alcan T. A miniature tooth-borne distractor for the alignment of ankylosed teeth. Angle Orthod 2006;76:77-83.
11. Kofod T, Wurtz V, Melsen B. Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device. Am J Orthod Dentofacial Orthop 2005;127:72-80.
12. Kim Y, Park S, Son W, Kim S, Mah J. Treatment of an ankylosed maxillary incisor by intraoral alveolar bone distraction osteogenesis. Am J Orthod Dentofacial Orthop 2010;138:215-20.
14. Razdolsky Y, El-Bialy TH, Dessner S, Buhler JE, Jr. Movement of ankylosed permanent teeth with a distraction device. J Clin Orthod 2004;38:612-20.
23. Kim Y, Kim S, Son W, Park S. Orthodontic treatment of an ankylosed tooth; application of single tooth osteotomy and alveolar bone distraction osteogenesis. Korean J Orthod 2009;39:185-98.
14. Razdolsky Y, El-Bialy TH, Dessner S, Buhler JE, Jr. Movement of ankylosed permanent teeth with a distraction device. J Clin Orthod 2004;38:612-20.
23. Kim Y, Kim S, Son W, Park S. Orthodontic treatment of an ankylosed tooth; application of single tooth osteotomy and alveolar bone distraction osteogenesis. Korean J Orthod 2009;39:185-98.
13. Im JJ, Kye MK, Hwang KG, Park CJ. Miniscrew-anchored alveolar distraction for the treatment of the ankylosed maxillary central incisor. Dent Traumatol 2010;26:285-8.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
13. Im JJ, Kye MK, Hwang KG, Park CJ. Miniscrew-anchored alveolar distraction for the treatment of the ankylosed maxillary central incisor. Dent Traumatol 2010;26:285-8.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Tooth-borne distraction devices6,11-14,23
• Tooth-borne distraction devices6,11-14,23
Razdolsky Y, El-Bialy TH, Dessner S, Buhler JE, Jr.
Razdolsky Y, El-Bialy TH, Dessner S, Buhler JE, Jr.
14
6. Alcan T. A miniature tooth-borne distractor for the alignment of ankylosed teeth. Angle Orthod 2006;76:77-83.
11. Kofod T, Wurtz V, Melsen B. Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device. Am J Orthod Dentofacial Orthop
2005;127:72-80.
12. Kim Y, Park S, Son W, Kim S, Mah J. Treatment of an ankylosed maxillary incisor by intraoral alveolar bone distraction osteogenesis. Am J Orthod Dentofacial Orthop 2010;138:215-20.
13. Im JJ, Kye MK, Hwang KG, Park CJ. Miniscrew-anchored alveolar distraction for the treatment of the ankylosed maxillary central incisor. Dent Traumatol 2010;26:285-8.
14. Razdolsky Y, El-Bialy TH, Dessner S, Buhler JE, Jr. Movement of ankylosed permanent teeth with a distraction device. J Clin Orthod 2004;38:612-20.
23. Kim Y, Kim S, Son W, Park S. Orthodontic treatment of an ankylosed tooth; application of single tooth osteotomy and alveolar bone distraction osteogenesis. Korean J Orthod 2009;39:185-98.
14
6. Alcan T. A miniature tooth-borne distractor for the alignment of ankylosed teeth. Angle Orthod 2006;76:77-83.
11. Kofod T, Wurtz V, Melsen B. Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device. Am J Orthod Dentofacial Orthop
2005;127:72-80.
12. Kim Y, Park S, Son W, Kim S, Mah J. Treatment of an ankylosed maxillary incisor by intraoral alveolar bone distraction osteogenesis. Am J Orthod Dentofacial Orthop 2010;138:215-20.
13. Im JJ, Kye MK, Hwang KG, Park CJ. Miniscrew-anchored alveolar distraction for the treatment of the ankylosed maxillary central incisor. Dent Traumatol 2010;26:285-8.
14. Razdolsky Y, El-Bialy TH, Dessner S, Buhler JE, Jr. Movement of ankylosed permanent teeth with a distraction device. J Clin Orthod 2004;38:612-20.
23. Kim Y, Kim S, Son W, Park S. Orthodontic treatment of an ankylosed tooth; application of single tooth osteotomy and alveolar bone distraction osteogenesis. Korean J Orthod 2009;39:185-98.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Tooth-borne distraction devices6,11-14,23
Segmental osteotomies
Five days after surgery
Distractor activated 180° by
patient three times per day
with hex wrench.
Razdolsky Y, El-Bialy TH, Dessner S, Buhler JE, Jr.
14
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Tooth-borne distraction devices6,11-14,23
After two weeks of
distraction
Fixed appliances placed
to stabilize incisor after
removal of distractor
After removal
of fixed appliances.
Razdolsky Y, El-Bialy TH, Dessner S, Buhler JE, Jr.
14
6. Alcan T. A miniature tooth-borne distractor for the alignment of ankylosed teeth. Angle Orthod 2006;76:77-83.
11. Kofod T, Wurtz V, Melsen B. Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device. Am J Orthod Dentofacial Orthop
2005;127:72-80.
6. Alcan T. A miniature tooth-borne distractor for the alignment of ankylosed teeth. Angle Orthod 2006;76:77-83.
11. Kofod T, Wurtz V, Melsen B. Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device. Am J Orthod Dentofacial Orthop
2005;127:72-80.
14. Razdolsky Y, El-Bialy TH, Dessner S, Buhler JE, Jr. Movement of ankylosed permanent teeth with a distraction device. J Clin Orthod 2004;38:612-20.
14. Razdolsky Y, El-Bialy TH, Dessner S, Buhler JE, Jr. Movement of ankylosed permanent teeth with a distraction device. J Clin Orthod 2004;38:612-20.
12. Kim Y, Park S, Son W, Kim S, Mah J. Treatment of an ankylosed maxillary incisor by intraoral alveolar bone distraction osteogenesis. Am J Orthod Dentofacial Orthop 2010;138:215-20.
13. Im JJ, Kye MK, Hwang KG, Park CJ. Miniscrew-anchored alveolar distraction for the treatment of the ankylosed maxillary central incisor. Dent Traumatol 2010;26:285-8.
23. Kim Y, Kim S, Son W, Park S. Orthodontic treatment of an ankylosed tooth; application of single tooth osteotomy and alveolar bone distraction osteogenesis. Korean J Orthod 2009;39:185-98.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Tooth-borne distraction devices6
12. Kim Y, Park S, Son W, Kim S, Mah J. Treatment of an ankylosed maxillary incisor by intraoral alveolar bone distraction osteogenesis. Am J Orthod Dentofacial Orthop 2010;138:215-20.
13. Im JJ, Kye MK, Hwang KG, Park CJ. Miniscrew-anchored alveolar distraction for the treatment of the ankylosed maxillary central incisor. Dent Traumatol 2010;26:285-8.
23. Kim Y, Kim S, Son W, Park S. Orthodontic treatment of an ankylosed tooth; application of single tooth osteotomy and alveolar bone distraction osteogenesis. Korean J Orthod 2009;39:185-98.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Tooth-borne distraction devices6
Alcan T. A miniature toothborne distractor6
6. Alcan T. A miniature tooth-borne distractor for the alignment of ankylosed teeth. Angle Orthod 2006;76:77-83.
11. Kofod T, Wurtz V, Melsen B. Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device. Am J Orthod Dentofacial Orthop
2005;127:72-80.
12. Kim Y, Park S, Son W, Kim S, Mah J. Treatment of an ankylosed maxillary incisor by intraoral alveolar bone distraction osteogenesis. Am J Orthod Dentofacial Orthop 2010;138:215-20.
13. Im JJ, Kye MK, Hwang KG, Park CJ. Miniscrew-anchored alveolar distraction for the treatment of the ankylosed maxillary central incisor. Dent Traumatol 2010;26:285-8.
14. Razdolsky Y, El-Bialy TH, Dessner S, Buhler JE, Jr. Movement of ankylosed permanent teeth with a distraction device. J Clin Orthod 2004;38:612-20.
23. Kim Y, Kim S, Son W, Park S. Orthodontic treatment of an ankylosed tooth; application of single tooth osteotomy and alveolar bone distraction osteogenesis. Korean J Orthod 2009;39:185-98.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
Alcan T. A miniature tooth-borne distractor6
6. Alcan T. A miniature tooth-borne distractor for the alignment of ankylosed teeth. Angle Orthod 2006;76:77-83.
Distraction osteogenesis
(DO)2,6,9-14,23,26,28
• Tooth-borne distraction devices6
• Tooth-borne distraction devices6
Alcan T. A miniature tooth-borne distractor6
Alcan T. A miniature tooth-borne distractor6
Advantages
No second surgery is required to remove
the device.
Disadvantages
Anchorage teeth were intruded.
6. Alcan T. A miniature tooth-borne distractor for the alignment of ankylosed teeth. Angle Orthod 2006;76:77-83.
6. Alcan T. A miniature tooth-borne distractor for the alignment of ankylosed teeth. Angle Orthod 2006;76:77-83.
Open bite
Introduction
Interdisciplinary treatment
Review of Literatures
Open bite
Upper anterior protrusion
• Case 1
; When ankylosis happens to an central
incisor at a growing stage, alveolar bone
around the tooth doesn’t grow vertically.
After growing up, the patient presented
anterior open bite.
Summary
Pretreatment intraoral photos (18 years
and 8 months old)
Black arrow indicates the gingival margin. A pink resin was added to look like a
gingiva and a tooth-colored resin was added incisal edge for camouflage by her
dentist.
Progress intraoral photographs, 5 months
after start of treatment (2008-11-28).
In the maxillary arch, MEAW (Multi-loop edgewise archwire, .018 x .022 stainless
steel) was ligated. In the mandibular arch a .019 x .025 stainless steel archwire
with shoe hooks was engaged. Class II elastics (5/16” 6oz) and up-and-down
elastics (3/16” 6oz) were applied.
Pretreatment radiographs and cephalometric tracing
Figure D shows the ankylosed maxillary left central incisor. The white arrow
indicates the external resorption.
Progress intraoral photographs, 12
months after start of treatment (2009-626)
After open bite was resolved well except of the ankylosed incisor, two miniimplants were placed (1.6 x 6.0 mm mini-implant between #12 & #11 and # 22 &
23). On the maxillary upper left incisor, a new temporary crown was cemented over
the ankylosed incisor for esthetics. Stainless steel wires (0.9 mm in diameter) were
bonded for indirect anchorage.
Seven days after osteotomy
(2009-7-7)
Schematic drawing to explain the procedure
To keep the palatal mucosa intact for blood supply, only the labial bone
was opened and osteotomy was done.
The temporary crown was removed before surgery.
Distraction 3 days
(2009-7-10)
a soft 0.020-in stainless steel surgical wire
(Stainless Steel Soft Wire. HL-03309-3, Hanil Dental Ind. Co.,
Seoul, Korea)
Two small holes were made on the incisal resin of the crown to insert a surgical wire.
By twisting and tightening the wire everyday, distraction was done.
Distraction 13 days
(2009-7-21)
Distraction was stopped. The incisor was fixed to the archwire by bonding resin on
the incisal edge for consolidation.
Distraction 6 days
An average of 0.8 mm
was distracted everyday.
(2009-7-15)
(0.5~1 mm)
Resin was removed from the incisal edge as the incisor was extruded.
Distraction 13 days
(2009-7-21)
Distraction was stopped. The incisor was fixed to the archwire by bonding resin on
the incisal edge for consolidation.
Progress intraoral photographs, 1 year
and 10 months after start of treatment
(2010-4-14)
Mini-implants were removed and a bracket was bonded on the maxillary left
central incisor. In the mandibular arch .019 x 025 TMA with a root lingual torque
on a mandibular right central incisor.
Posttreatment intraoral photographs (2010-7-21). 21 years old. 2 years and 1
month after start of Treatment.
2013.8.30
Post-retention
3 years 1 month .
Introduction
Interdisciplinary treatment
Review of Literatures
Open bite
Upper anterior protrusion
Summary
24 years and 1 month old. 3 years 1 month after debonding (2013.8.30).
2013.6.18 First visit
Upper anterior protrusion
• Case 2
; When trauma happens to the protruded
central incisors in a nongrowing persons,
there will be no open bite.
Cervical abrasion was treated before starting orthodontic treatment.
2013.6.18 First visit
2014.5.2
Lower third molars were extracted.
2014.7.2 19 days after segmental osteotomy
At the initial leveling stage, #11 was diagnosed as ’ankylosis’, because it was not
moved at all. Spaces were gained for the osteotome.
016”NT
2014.7.2
2014.7.5
Slight retraction of upper right central incisor.
6.13: Segmental osteotomy
2014.12.17
Introduction
Interdisciplinary treatment
Review of Literatures
Open bite
Upper anterior protrusion
Summary
Summary
• When the ankylosis happened during growth stage, it
brought open bite. This open bite was treated with
distraction osteogenesis.
• When the ankyloses was brought after growth finished
and the distance of displacement is not great,
segmental osteotomy, movement and fixation was
used.
• Even after the consolidation, the position of tooth
could be adjusted shortly by an arch wire, ‘Floating
bone concept’.
• Interdisciplinary work with good oral surgeons
understanding the direction & treatment plan of
orthodontic treatment is recommended.