Craniofacial distraction osteogenesis: the orthodontic perspective

Purpose: In this study the literature dealing with clinical and experimental craniofacial distraction osteogenesis (DO) was reviewed from an orthodontic perspective. The purpose of this review was two-fold: (1) to evaluate clinical indications and DO parameters; (2) to evaluate the different DO experimental animal models. Methods: A Pubmed search (NCBI, New Pubmed System) from 1966 through December 2000 was conducted. Key words applied in the search were distraction, orthodontics, lengthening, mandible, maxilla, midface, monobloc, cranial, craniofacial and maxillofacial. The clinical (revised 3 April 2000) and experimental (revised 1 April 2001) search revealed 109 and 120 articles, respectively. Flow sheets were made of each article with the specific parameters relative to DO and orthodontics.Results: A total of 828 patients underwent craniofacial DO: 579 (70.0%) mandibular, 129 (15.6%) maxillary, 24 (2.9%) simultaneous mandibular-maxillary, and 96 (11.6%) midfacial and/or cranial DO. Only 479 patients (57.9%) had data on follow-up and in only 248 patients (30,0%) information on relaps was given. A total of 1207 animals were used in seven different animal models: 54 (45.0%) dog, 25 (20.8%) rabbit, 18 (15.0%) sheep, 11 (9.2%) minipig, 7 (5.8%) monkey, 4 (3.3%) rat and 1 (0.8%) cat model. Only 3 (2.5%) articles investigated on orthodontic tooth movement in the regenerate and only 2 (1.7%) on relaps. Conclusion: On the basis of these results an attempt was done to provide treatment protocols and success criteria for clinical craniofacial DO and guidelines for future experimental DO research. There is still a lack of sufficient data, especially on orthodontic management, dental-skeletal relaps and follow-up, so that treatment strategies have to be validated. Keywords: craniofacial distraction, orthodontics