•Distraction Osteogenesis is an innovative treatment option in

cranio- maxillo -facial surgery. It is a means of stimulating

production of new bone. In this procedure, the jaw bone is cut
and the two arms of the distractor device are attached to the
cut bone segments.
 Distraction osteogenesis (DO), also called callus
distraction, callotasis and osteodistraction, is a process
used in orthopedic surgery, pediatric surgery, and oral and
maxillofacial surgery to repair skeletal deformities and in
reconstructive surgery.
 The procedure involves cutting and slowly separating bone,
allowing the bone healing process to fill in the gap.

USES:
 (1) Deficient maxilla or midface,
 (2) Deficient hypoplastic mandible,
 (3) Deficient alveolar bone prior to implants placement.
.
 The first Ilizarov principle postulates that gradual traction
creates stress that can Stimulate and maintain regeneration
and active growth of living tissue.
 The second Ilizarov principle stated that the shape and mass
of bones and joints are dependent on an interaction between
mechanical loading and blood supply.
 If blood supply is inadequate to support normal or increased
mechanical loading, then the bone cannot respond favorably,
leading to atrophic or degenerative changes.
 OSTEOTOMY
 LATENCY
 DISTRACTION
 CONSOLIDATION
 REMODELLING
OSTEOTOMY PHASE
 Divides the bone into two segments.
 Triggers process of bone repair.
 Angiogenesis
 Fibrogenesis
 Osteogenesis
PHASES(CONTD.)
LATENCY PHASE
 Period from bone
division to onset of
distraction.
 Inflammation and soft
callus formation of the
fractured bone.
 Soft callus formation
begins in 3-7 days and
lasts 2-3 weeks.
 Latency period=5-7
days
DISTRACTION PHASE
 Characterized by the
application of traction
forces to osteomized
segments.
 Rate:1mm/day
 Rhytm:0.25mm every 6
hours;0.5mm twice a day
 Duration:1-3 weeks
CONSOLIDATION PHASE
 Cessation of traction
forces to removal of
distractor
 Newly formed bone
mineralises and increases
in bone density and
strength.
 Duration:3-4 months
REMODELLING PHASE

 Removal of distractor
to application of
functional loading.
 Formation of lamellar
bone.
EXTERNAL INTERNAL
DEVICE DEVICE
 Lengthen the lower jaw.
 Correcting anterior-posterior deformity
of the jaws.
 Trauma reconstruction.
 Cancer reconstruction.
 Craniofacial syndromes.
 Increasing bone width and height of
teeth bearing region of upper or lower
jaw for dental implants.
 In children with craniofacial/ hemifacial
microsomia.
 Simultaneous maxillary- mandibular distraction.
 In children with significant bilateral mandibular
hypoplasia.
 Neonatal distraction.
 Children with severe midfacial deformities in the
context of facial clefts and craniofacial
conditions may also benefit from distraction.
 Generalised bone disorders
 Poor patient compliance.
 History of poor fracture healing.
 Aggressive jaw tumor.
 Pre existing TMJ disorders.
 Unwilling patients
 Long duration treatment strategy.
 Minimal likelihood of relapse.
 Increased stability with large movements.
 Simultaneous expansion of soft tissue.
 Decreased operative time.
 Decreased blood loss and morbidity
associated with bone grafts.
 Device failure.
 Cutaneous scars with external pin-based
devices.
 Limited control of the distracting vector
with internal devices.
 Patient compliance and acceptance of the
device.
 Injury to the developing tooth follicles (e.g.,
maxillary and mandibular osteotomies).
 Injury to various branches of the facial or
trigeminal nerves (e.g., the inferior alveolar
nerve with mandibular distraction)..
 Pin site infection with external devices or
semi buried devices.
 Nonunion and premature fusion.
 Psychosocial issues related to the recovery.
 Distraction Osteogenesis is a fairly new
procedure in orthognathic surgery,
providing a way to treat deformities of the
oral and facial skeleton. It can be
performed on patients of all ages.