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A Journal on Dentistry and Maxillofacial Surgery

Official Journal of the Italian Society of Odontostomatology and Maxillofacial Surgery
Indexed/Abstracted in: CAB, EMBASE, Index to Dental Literature, PubMed/MEDLINE, Scopus, Emerging Sources Citation Index



Minerva Stomatologica 2018 Feb 09

DOI: 10.23736/S0026-4970.18.04113-4


language: English

New technique for large mandibular and surrounding soft tissue reconstruction that uses an intraoral three-dimensional distractor for one step transport disc distraction osteogenesis

Antonio CORTESE 1 , Mario CAGGIANO 2, Giuseppe PANTALEO 3, Massimo AMATO 2, Pier P. CLAUDIO 4

1 Department of Medicine and Surgery, Unit of Maxillofacial Surgery, University of Salerno, Salerno, Italy; 2 Department of Medicine and Surgery, University of Salerno, Salerno, Italy; 3 Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy; 4 Department of Maxillofacial Surgery, Department of BioMolecular Sciences, and Department Radiation Oncology, University of Mississippi, Jackson Cancer Center, Jackson, Mississippi, USA


BACKGROUND: Mandibular reconstruction after ablative surgery is challenging not only for the amount of bone tissue needed following bone loss after benign or malignant tumor surgical removal, but mainly to reconstruct bone shape and structure necessary for subsequent implant insertion to preserve the function (speech, swallowing and chewing) and aesthetic of the lower face. Several different techniques for maxillary bone defects reconstruction have been described. The aim of our work is to describe a new technique for mandibular reconstruction that uses an intramural distractor, which is placed in one surgical step and without the need for a skin incision.
METHODS: A 30-year-old Caucasian man with a relapsed ameloblastoma was operated in an emergency setting because he exhibited incoercible pain, and difficulty to chew and swallow. To reconstruct the mandibular defect, we have used a modified intraoral distractor originally designed by Triaca. The modified device we used is totally intraoral and it is inserted without the need of any skin incision. The distractor is made of a three-dimensional conformed metal guide reproducing the morphology of the mandible section that needs to be reconstructed.
RESULTS: Bone regeneration of the resected segment was achieved using a modified intraoral distractor. Regenerated bone was similar to that of the normal resected bone for shape and quality of bone. Additionally, fixed and mobile mucosae were also regenerated by concomitant histo-distraction. Additionally, acceptable aesthetic was preserved and achieved during and after distraction. Patient was able to eat a normal solid diet during active distraction and consolidation time.
CONCLUSIONS: When compared with extra oral techniques, internal distraction has several advantages including improved stability, aesthetics, and patient motivation. The morphology, size and quality of the regenerated bone are comparable to those of normal bone, allowing both physiological mandibular aesthetic and function, especially following implant insertion and prosthetic dental rehabilitation.

KEY WORDS: Mandible - Reconstruction - TDDO - Distractor

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Publication History

Article first published online: February 9, 2018
Manuscript accepted: February 1, 2018
Manuscript revised: January 29, 2018
Manuscript received: October 30, 2017

Cite this article as

Cortese A, Caggiano M, Pantaleo G, Amato M, Claudio PP. New technique for large mandibular and surrounding soft tissue reconstruction that uses an intraoral three-dimensional distractor for one step transport disc distraction osteogenesis. Minerva Stomatol 2018 Feb 09. DOI: 10.23736/S0026-4970.18.04113-4

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