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ORTHODONTIC PERSPECTIVE OF
DISTRACTION OSTEOGENESIS
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.com
The symbiotic relationship between the
Orthodontist and the Oro-Maxillofacial
surgeon is a fairly recent phenomenon
www.indiandentalacademy.com
While the surgeon can bring about gross
changes (which make dramatic improvement
in facial appearance), the orthodontic
expertise is needed in fine-tuning the results.
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www.indiandentalacademy.com
Application of Distraction Osteogenesis to the
craniofacial areas is even more recent.
Hence, the role of Orthodontics is now getting
properly defined.
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DISTRACTION OSTEOGENESIS
Our experiences with distraction
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DISTRACTION OSTEOGENESIS
Our experiences with distraction
www.indiandentalacademy.com
DISTRACTION OSTEOGENESIS
Our experiences with distraction
www.indiandentalacademy.com
DISTRACTION OSTEOGENESIS
Our experiences with distraction
www.indiandentalacademy.com
DISTRACTION OSTEOGENESIS
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DISTRACTION OSTEOGENESIS
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DISTRACTION OSTEOGENESIS
Pre-surgical Orthodontic phase
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DISTRACTION OSTEOGENESIS
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DISTRACTION OSTEOGENESIS
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DISTRACTION OSTEOGENESIS
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DISTRACTION OSTEOGENESIS
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SCOPE OF THE TALK
1) How the Orthodontic practice will get
benefited from this surgical procedure
2) How the surgeon can utilise the
Orthodontist’s expertise to improve the
quality of treatment.
www.indiandentalacademy.com
Why is Distraction of interest to an
Orthodontist?
1. It enlarges the envelope in which he/she
operates. It is one step ahead of
Orthognathic surgery.
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Why is Distraction of interest to an
Orthodontist?
Envelope of discrepancy
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Why is Distraction of interest to an
Orthodontist?
2. It more or less eliminates the restrictions
imposed by the soft tissues.
Hence, chances of relapse reduce
drastically
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Why is Distraction of interest to an
Orthodontist?
3. Early intervention in life helps to restore the
normal growth process.
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Why is Distraction of interest to an
Orthodontist?
4. Reduced morbidiy, reduced need for bone
grafts,improved airway.
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Application from an Orthodontist’s point of view
1. Treating craniofacial deformities.
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Application from an Orthodontist’s point of view
2. As an alternative to surgery in less gross
deficiencies.
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Application from an Orthodontist’s point of
view
3. Widening the transverse dimension of the
mandible
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Application from an Orthodontist’s point of view
4. Surgically assisted RME
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DISTRACTION OSTEOGENESIS
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DISTRACTION OSTEOGENESIS
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DISTRACTION OSTEOGENESIS
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DISTRACTION OSTEOGENESIS
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DISTRACTION OSTEOGENESIS
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Application from an Orthodontist’s point of view
5. Distraction for Orthodontic tooth movements
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DISTRACTION OSTEOGENESIS
DENTAL DISTRACTION
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DISTRACTION OSTEOGENESIS
DENTAL DISTRACTION
www.indiandentalacademy.com
How will the surgeon benefit by associating
with the Orthodontist?
1. Treatment Planning Amount
Vector
2. Pre and Post-surgical Orthodontics for
facilitating surgery and for optimum post-
surgical occlusal function
www.indiandentalacademy.com
How will the surgeon benefit by associating
with the Orthodontist?
3. During Surgery – for fixing intra-oral
devices, for adjusting the vector of extra-
oral devices.
4. For maintaining or improving the results of
surgery – use of functional appliances or
headgears, elastics - ‘Bone moulding’
5. Post-op followups, records, measurements
etc.
www.indiandentalacademy.com
Thank you
THANK YOU
www.indiandentalacademy.com
ROLE OF CEPHALOMETRICS IN PLANNING
DISTRACTION PROCEDURES
Prof. Vijay P. Jayade
Chairman and Head,
Department of Orthodontics
SDM Dental College
www.indiandentalacademy.com
Treatment Planning- Consideration of
size, placement, orientation.
Cephalometry – not a perfect science but a
great tool if used properly (also could
totally mislead if used without proper
understanding)
www.indiandentalacademy.com
www.indiandentalacademy.com
How to judge the amount of distraction
needed?
1. Use of normative values ?
Not very appropriate, since they cannot be
accurately applied to different ethnic
groups,males and females, persons with
varying builds etc.
www.indiandentalacademy.com
2. Norms based on hard tissues alone?
Not appropriate because variable thickness of
soft tissues can compensate for/or
aggravate the hard tissue relations.
www.indiandentalacademy.com
3. Instead of absolute linear
measurements, their projected values are
more meaningful to judge their true
contribution to the skeletal dysplasia in a
horizontal or vertical direction
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The best known analysis employing the
co-ordinate reference is the COGS of
Burstone and Legan.
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COGS of Burstone and Legan.
The drawbacks, however, are
1. Small sample
2. Unreliable ‘surrogate’ horizontal plane.
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4.The best option would be probably the True
horizontal or the True vertical references
as applied to the ‘ Natural Head Position’.
The values for Indian population are currently
being established.
www.indiandentalacademy.com
5.Ratios are more reliable than individual
linear measurements, because they
overcome the differences in the individual
size.
www.indiandentalacademy.com
Certain useful ratios are
a) For sagittal measurements
i. Antr. Cranial base/ Max./Mand
= 20/ 14 /21
ii.. Mandibular components
Corpus/ Ramus
= 7 / 5
www.indiandentalacademy.com
www.indiandentalacademy.com
b. For vertical dimension
Post. Face height/Ant.Face height(Jarabak ratio)
= 62-64%
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6. These help to customize the ‘normal’ values
for maxillary and mandibular sizes in
proportion to the cranial base.
Thus, individual specific norms (as against
population specific) can be derived.
www.indiandentalacademy.com
7. Placement of the maxilla and mandible with
respect to the cranial base (sella) can
compensate or aggravate the size
abnormality
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www.indiandentalacademy.com
8. Orientation of the maxillary base or the
mandibular corpus would affect the final
position of the anterior limits of maxilla and
mandible.
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www.indiandentalacademy.com
9. These are assessed in relation to the
thickness of the soft tissue drape to arrive
at the final estimate of maxillary and
mandibular alterations needed.
www.indiandentalacademy.com
10. As of now, there is some uncertainty about
the exact quantum of soft tissue
displacement which follows hard tissue
changes.
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
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THANK YOU
www.indiandentalacademy.com
For more details please visit
www.indiandentalacademy.com

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