D. Shilo

Reconstruction of complex mandibular defects using integrated dental custom-made titanium implants

i g t G i t econstruction of the craniofacial complex is challengng because of the unique anatomy, the presence of vital tructures, and the diversity of defects. In craniofacial recontruction, restoration of appearance and function is the rimary goal. Autografts are the gold standard treatment,1 but hey have several disadvantages, which has led to research nto alloplastic materials. The development of CADCAM ystems allows for precise preoperative planning and design f patient-specific implants.2,3 The workflow of customade implants is shown in Fig. 1. Two-dimensional DICOM les were converted into 3-dimensional stereolithography STL) files and the custom-made implant was designed sing AB Guided 3-dimensional software (A.B. Dental, Ashod, Israel). The skull and the implant were printed as n STL model in resin for compatibility tests using a 3imensional Objet260 Dental Selection printer (Stratasys©, ehovot, Israel). The titanium implant was then printed sing a laser sintering 3-dimensional printer (EOS, Novi, MI,

Controlling the vector of distraction osteogenesis in the management of obstructive sleep apnea

Background: Obstructive sleep apnea (OSA) in individuals with craniofacial anomalies can compromise airway and is a serious life-threatening condition. In many cases, tracheostomy is carried out as the treatment of choice. Distraction osteogenesis of the mandible as a treatment modality for OSA is very useful and may spare the need for tracheostomy or allow decannulation, yet controlling the vector of distraction is still a major challenge. We present a method for controlling the vector of distraction. Materials and Methods: Eight patients with severe respiratory distress secondary to a micrognathic mandible were treated by mandibular distraction osteogenesis using either external or internal devices. Temporary anchorage devices (TADs) and orthodontic elastics were used to control the vector of distraction. Cephalometric X-rays, computed tomography, and polysomnographic sleep studies were used to analyze the results. Results: A mean distraction of 22 mm using the internal devices and a mean of 30 mm using the external devices were achieved. Increase in the pharyngeal airway and hyoid bone advancement was also observed. Anterior-posterior advancement of the mandible was noted with no clockwise rotation. Most importantly, clinical improvement in symptoms of OSA, respiratory distress, and feeding was noted. Conclusions: We describe a method for controlling the vector of distraction used as a treatment for OSA. In these cases, TADs were used as an anchorage unit to control the vector of distraction. Our results show excellent clinical and radiographical results. TADs are a simple and nonexpensive method to control the vector of distraction.

Three-dimensional planning and printing of guides and templates for reconstruction of the mandibular ramus and condyle using autogenous costochondral grafts

Fig. 1. Lateral view of a 3-dimensional reconstruction (with no right ramus o h ostochondral grafts are conventionally used for the recontruction of the ascending ramus and condyle of the andible.1–3 Their main advantages are their biocompatiility and potential for growth, and disadvantages are the npredictability of the pattern of this growth, and the large mounts of cartilage that are needed. 4,5 When we harvest the graft we estimate the amount of bone equired intraoperatively and must be cautious not to remove xcessive cartilage. Later we trim the graft and attempt to dapt it to the missing bony segment. We use 3-dimensional planning and manufacture guides nd templates for the optimal reconstruction of the mandible. he software used for planning applies mirroring technology nd creates 3-dimensional printed stereolithographic temlates of the planned graft, which results in precise harvesting nd accurate reconstruction. We used this technique on an 8-year-old boy with no right ygomatic arch, condyle, or ascending ramus, and on a 6ear-old boy, who had hemifacial microsomia, Pruzansky ype III (Fig. 1). First, the patients were scanned with spiral com-

Sandwich osteotomy for the reconstruction of deficient alveolar bone

Alveolar bone deficiency is a very common problem encountered by the practitioner when planning dental implants. The severity of the deficiency is variable. Many practitioners perform augmentation using the method they feel comfortable with and do not necessarily use the most appropriate method. This is a retrospective study on 21 patients between the ages of 25 and 63 years exhibiting moderate vertical alveolar bone deficiency and treated by the sandwich technique. Mean vertical bone gain was 7.5mm. Sixty-one dental implants were inserted showing a survival rate of 96.7% with a median of 3.1 years follow-up. Main advantages of the method include minimal relapse, single operation and preservation of the native cortical bone in the occlusal surface. We believe the surgeon should maintain the capability of using different augmentation techniques and utilize them appropriately for different severities of deficiency. We wish to establish a paradigm for using different augmentation methods We recommend using the sandwich technique in the moderate deficient cases as described in this work, using alveolar distraction osteogenesis for the severe cases as described in our previous work, where lack of soft tissue for proper closure is a major limitation, and using guided bone regeneration for minor deficiencies.

The use of distraction osteogenesis in oral and maxillofacial surgery.

Distraction osteogenesis (DO) is a method of generating new bone following a corticotomy or an osteotomy and gradual distraction. The method is based on the tension‐stress principle proposed by Ilizarov.[1,2] The gradual bone distraction creates mechanical stimulation which induces biological responses and consequently bone regeneration. This is accomplished by a cascade of biological processes which may include differentiation of pluripotential cells, angiogenesis, osteogenesis, and bone mineralization.[3‐5] In facial bones, the method was proved to be predictable in animal studies with the generation of new bone[4,5] and was later used in clinical practice.