scholarly journals Automating Skeletal Expansion: An Implant for Distraction Osteogenesis of the Mandible

2009 ◽  
Vol 3 (1) ◽  
Author(s):  
John C. Magill ◽  
Marten F. Byl ◽  
Batya Goldwaser ◽  
Maria Papadaki ◽  
Roger Kromann ◽  
...  
Keyword(s):  
Distraction Osteogenesis ◽  
Treatment Time ◽  
Patient Activation ◽  
Latency Period ◽  
Bone Lengthening ◽  
Loop Control ◽  
New Device ◽  
Distraction Device ◽  
Component Failures ◽  
Natural Healing

Distraction osteogenesis is a technique of bone lengthening that makes use of the body’s natural healing capacity. An osteotomy is created, and a rigid distraction device is attached to the bone. After a latency period, the device is activated two to four times per day for a total of 1 mm/day of bone lengthening. This technique is used to correct a variety of congenital and acquired deformities of the mandible, midface, and long bones. To shorten the treatment period and to eliminate the complications of patient activation of the device, an automated continuous distraction device would be desirable. It has been reported that continuous distraction generates adequate bone with lengthening at a rate of 2 mm/day, thereby reducing the treatment time. The device we describe here uses miniature high-pressure hydraulics, position feedback, and a digital controller to achieve closed-loop control of the distraction process. The implanted actuator can produce up to 40 N of distraction force on linear trajectories as well as curved distraction paths. In this paper we detail the spring-powered hydraulic reservoir, controller, and user interface. Experiments to test the new device design were performed in a porcine cadaver head and in live pigs. In the cadaver head, the device performed an 11 day/11 mm distraction with a root-mean-squared position error of 0.09 mm. The device functioned for periods of several days in each of five live animals, though some component failures occurred, leading to design revisions. The test series showed that the novel design of this system provides the capabilities necessary to automate distraction of the mandible. Further developments will focus on making the implanted position sensor more robust and then on carrying out clinical trials.

scholarly journals Experience with Mandibular Reconstruction Using Transport-Disc-Distraction Osteogenesis

2015 ◽  
Vol 8 (2) ◽  
pp. 117-122 ◽  
Author(s):  
Lorena Pingarrón-Martín ◽  
T. González Otero ◽  
L.J.Arias Gallo
Keyword(s):  
Distraction Osteogenesis ◽  
Soft Tissues ◽  
Donor Site ◽  
Latency Period ◽  
Donor Site Morbidity ◽  
Mandibular Reconstruction ◽  
Distraction Device ◽  
Duration Of Hospitalization ◽  
Education And Awareness ◽  
Comminuted Fractures

The goal of transport-disc-distraction osteogenesis (TDDO) is to restore bone continuity by using in-situ bone. It may be useful following trauma, gunshot injuries, or tumor ablation, especially when there may be contraindications at the donor site or for prolonged surgery. To the best of the authors’ knowledge, this is the first time TDDO has been used for mandibular reconstruction reporting additional procedures, which include osseointegrated dental implants rehabilitation and orthognathic surgery. A retrospective study is performed analyzing all mandibular reconstruction cases that may be suitable for distraction from January 2006 to December 2011. A thorough description of the documented cases includes details about sex, gender, complications, duration of hospitalization, etiology, size, and location of the defect. Eight cases of mandibular reconstruction were included. Six cases correspond to mandibular ameloblastoma. The remaining two cases were mandibular gunshot comminuted fractures. Range of the defects was from 45 to 60 mm. Length of the transport disc was 15 to 20 mm. Protocolized technique consisted of 5 days of latency period, 19 to 45 days of activation term (average 30 days), and 8 to 12 weeks for consolidation. Mean distraction length achieved was 40.45 mm. We can conclude that TDDO is an alternative to conventional and more invasive procedures, when we face severe segmental mandibular defects reconstruction. It shows the potential to restore a better anatomical bone regeneration, also providing soft tissues and reducing donor-site morbidity. Patients’ education and awareness about the proper use of the transport-disc-distraction device is important to optimize functional outcomes.

scholarly journals Systemic Administration of G-CSF Accelerates Bone Regeneration and Modulates Mobilization of Progenitor Cells in a Rat Model of Distraction Osteogenesis

2021 ◽  
Vol 22 (7) ◽  
pp. 3505
Author(s):  
Flavy Roseren ◽  
Martine Pithioux ◽  
Stéphane Robert ◽  
Laure Balasse ◽  
Benjamin Guillet ◽  
...  
Keyword(s):  
Bone Regeneration ◽  
Progenitor Cells ◽  
Distraction Osteogenesis ◽  
Rat Model ◽  
Late Phase ◽  
Control Group ◽  
Bone Lengthening ◽  
Hematopoietic Stem ◽  
Osteoblast Activity ◽  
Positron Emission

Granulocyte colony-stimulating factor (G-CSF) was shown to promote bone regeneration and mobilization of vascular and osteogenic progenitor cells. In this study, we investigated the effects of a systemic low dose of G-CSF on both bone consolidation and mobilization of hematopoietic stem/progenitor cells (HSPCs), endothelial progenitor cells (EPCs) and mesenchymal stromal cells (MSCs) in a rat model of distraction osteogenesis (DO). Neovascularization and mineralization were longitudinally monitored using positron emission tomography and planar scintigraphy. Histological analysis was performed and the number of circulating HSPCs, EPCs and MSCs was studied by flow cytometry. Contrary to control group, in the early phase of consolidation, a bony bridge with lower osteoclast activity and a trend of an increase in osteoblast activity were observed in the distracted callus in the G-CSF group, whereas, at the late phase of consolidation, a significantly lower neovascularization was observed. While no difference was observed in the number of circulating EPCs between control and G-CSF groups, the number of MSCs was significantly lower at the end of the latency phase and that of HSPCs was significantly higher 4 days after the bone lengthening. Our results indicate that G-CSF accelerates bone regeneration and modulates mobilization of progenitor cells during DO.

scholarly journals Unprecedented tibial bone lengthening of 33.5 cm by distraction osteogenesis for the reconstruction of a subtotal tibial bone defect. A case report and literature review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Abdulnassir Ali ◽  
Ying Ren ◽  
Chun-Hao Zhou ◽  
Jia Fang ◽  
Cheng-He Qin
Keyword(s):  
Bone Defect ◽  
Distraction Osteogenesis ◽  
Chronic Osteomyelitis ◽  
Weight Bearing ◽  
Lower Leg ◽  
Bone Lengthening ◽  
Case Presentation ◽  
Tibial Length ◽  
Tibial Bone ◽  
The Right

Abstract Background We present a case of an immense unprecedented tibial bone lengthening of 33.5 cm. The management of chronic osteomyelitis of the right tibia with subtotal tibial bone defect, talus defect and equinus ankle deformity. We demonstrate limb reconstruction by distraction osteogenesis and correction of ankle deformity with the Ilizarov technique. Limb salvage was preferred as an alternative to amputation to restore basic limb function. Case presentation A 16-year-old male patient fell and injured his right lower leg. He attempted to treat the symptoms with traditional home remedies. During 15 months of self-treating, he developed osteomyelitis of the right tibia and had lost function in his foot. Radiology revealed immense bone defect of the right tibia, including talus bone defect and equinus deformity of the calcaneus. The patient’s right tibia was non weight-bearing, had drainage sinus just below his knee and a large scar anteriorly along the entire length of the tibia. Conclusion Upon completion of treatment, the patient was able to avoid amputation of his leg with partially restored function for weight-bearing. He carried himself without assistance after 3 years of lost function in his right leg. Tibial bone distraction osteogenesis of 33.5 cm was done after 90% of the tibial length was defected. To the best of our best knowledge, this case is one of a kind to achieve distraction of tibial bone to such length.

scholarly journals Intermolar Mandibular Distraction Osteogenesis—A Preliminary Report

2021 ◽  
Vol 11 (9) ◽  
pp. 4118
Author(s):  
Suen A. N. Lie ◽  
Britt H. B. T. Engelen ◽  
Veronique C. M. L. Timmer ◽  
Nico M. P. Vrijens ◽  
Paolo Asperio ◽  
...  
Keyword(s):  
Distraction Osteogenesis ◽  
Treatment Time ◽  
Average Length ◽  
Case Series ◽  
Growth Spurt ◽  
Overall Treatment Time ◽  
Mandibular Distraction ◽  
Mandibular Distraction Osteogenesis ◽  
Root Fractures

Background: Dental Class II is the most common indication for combined orthodontic-orthognathic treatment. Intermolar mandibular distraction osteogenesis (IMDO) treatment was performed during the growth spurt, to avoid surgery at a later age. The aim of this study is to present our first experience with IMDO. Methods: This is a retrospective case series of patients who underwent an IMDO. All patients showed mandibular retrognathism, and orthodontic treatment with functional appliances was not successful. Results: In total, 20 patients (mean age of 14.8 years (SD = 0.9 ys) were included. All patients achieved a Class I occlusion. An average length gain of 9.6 mm (SD = 3.7 mm) was reached. In one patient an abscess occurred. Nine patients presented with root fractures of the second molar; three were lost, one treated endodontically. The average time between insertion and removal of the distractors was 4.6 months (SD = 1.5 mths). In one case a premature consolidation was seen. Conclusion: We achieved satisfactory results with IMDO, although undesirable effects occurred. An advantage is the manageable overall treatment time. Open questions concern the occurrence of root fractures. Furthermore, the question of long-term stability is open. The question of dynamic distraction treatment in relation to temporomandibular joint changes can only be answered in the long term.

Controlled Freezing of Nonideal Solutions With Application to Cryosurgical Processes

1991 ◽  
Vol 113 (4) ◽  
pp. 430-437 ◽  
Author(s):  
H. M. Budman ◽  
J. Dayan ◽  
A. Shitzer
Keyword(s):  
Cooling Rate ◽  
Freezing Process ◽  
Data Sets ◽  
Tracking Accuracy ◽  
Loop Control ◽  
Set Point ◽  
New Device ◽  
Loop Control System ◽  
The Stability ◽  
Controlled Freezing

Success of a cryosurgical procedure, i.e., maximal cell destruction, requires that the cooling rate be controlled during the freezing process. Standard cryosurgical devices are not usually designed to perform the required controlled process. In this study, a new cryosurgical device was developed which facilitates the achievement of a specified cooling rate during freezing by accurately controlling the probe temperature variation with time. The new device has been experimentally tested by applying it to an aqueous solution of mashed potatoes. The temperature field in the freezing medium, whose thermal properties are similar to those of biological tissue, was measured. The cryoprobe temperature was controlled according to a desired time varying profile which was assumed to maximize necrosis. The tracking accuracy and the stability of the closed loop control system were investigated. It was found that for most of the time the tracking accuracy was excellent and the error between the measured probe temperature and the desired set point is within ±0.4°C. However, noticeable deviations from the set point occurred due to the supercooling phenomenon or due to the instability of the liquid nitrogen boiling regime in the cryoprobe. The experimental results were compared to those obtained by a finite elements program and very good agreement was obtained. The deviation between the two data sets seems to be mainly due to errors in positioning of the thermocouple junctions in the medium.

scholarly journals 11. The effects of latency period in mandibular distraction osteogenesis

2000 ◽  
Vol 54 (4) ◽  
pp. 368
Author(s):  
Takayuki Aida ◽  
Izumi Yoshioka ◽  
Kazuhiro Tominaga ◽  
Jinichi Fukuda
Keyword(s):  
Distraction Osteogenesis ◽  
Latency Period ◽  
Mandibular Distraction ◽  
Mandibular Distraction Osteogenesis

A Custom-Made Distraction Device for Experimental Mandibular Distraction Osteogenesis

2005 ◽  
Vol 16 (4) ◽  
pp. 675-683 ◽  
Author(s):  
Muhitdin Eski ◽  
Mustafa Nisanci ◽  
Yakup Cil ◽  
Mustafa ??engezer ◽  
Ayhan ??zcan
Keyword(s):  
Distraction Osteogenesis ◽  
Mandibular Distraction ◽  
Mandibular Distraction Osteogenesis ◽  
Distraction Device ◽  
Custom Made

scholarly journals Fully-customized distraction assembly for maxillofacial distraction osteogenesis: a novel device and its experimental accuracy verification

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Sang-Hoon Kang ◽  
Hye-Jin Tak ◽  
Ha-Won Park ◽  
Jin-Ung Kim ◽  
Sang-Hwy Lee
Keyword(s):  
Distraction Osteogenesis ◽  
Reference Points ◽  
Assembly System ◽  
Control Group ◽  
Novel Device ◽  
Mandibular Distraction Osteogenesis ◽  
Distraction Device ◽  
Cad Cam ◽  
3D Printed ◽  
Group 1

Abstract Background A new distraction osteogenesis assembly system comprising a fully customized CAD/CAM-based fixation unit and ready-made distraction unit was developed. The aim of this study was to introduce our new distraction system and to evaluate its accuracy level in a sampled mandibular distraction osteogenesis. Methods Our system consists of a fully customized CAD/CAM-based fixation plate unit with two plates for each moving and anchoring part, and a ready-made distraction unit with attachment slots for fixation plates. The experimental distractions were performed on 3D-printed mandibles for one control and two experimental groups (N = 10 for each group). All groups had reference bars on the chin region and teeth to measure distraction accuracy. The control group had the classical ready-made distraction system, and experimental groups 1 and 2 were fitted with our new distraction assembly using a different distractor-positioning guide design. All distracted experimental mandibles were scanned by CT imaging, then superimposed on a 3D simulation to get their discrepancy levels. Results The measured 3D distances between the reference landmarks of the surgical simulations and the experimental surgeries for the three groups were significantly different (p < 0.0001) by statistical analysis. The errors were greater in the control group (with a total average of 19.18 ± 3.73 mm in 3D distance between the simulated and actual reference points) than those in the two experimental groups (with an average of 3.68 ± 1.41 mm for group 1 and 3.07 ± 1.39 mm for group 2). The customized distraction assembly with 3D-printed bone plate units in group 1 and 2, however, did not show any significant differences between simulated and actual distances (p > 0.999). Conclusion Our newly-developed distraction assembly system with CAD/CAM plate for the distraction osteogenesis of the mandible produced a greater level of accuracy than that of a conventional distraction device. The system appears to address existing shortcomings of conventional distraction devices, including inaccuracy in vector-controlled movement of the system. However, it also needs to be further developed to address the requirements and anatomical characteristics of specific regions.

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