ABSTRACT
BACKGROUND: Temporomandibular joint (TMJ) ankylosis can be accompanied by various degrees of functional and esthetic problems. Adequate mouth opening, occlusal stability, and harmonious facial form are the main goals of treatment for ankylosis. Distraction osteogenesis has proven to be an excellent treatment for lengthening the ramus-condyle unit. However, various timings for distraction have been suggested, and there is no consensus on selection criteria for performing the procedure in stages or simultaneously with other treatments. CASE PRESENTATION: In this case report, concomitant intraoral distraction and gap arthroplasty was planned to treat TMJ ankylosis and associated facial asymmetry. After gap arthroplasty and 23 mm of distraction, the ramus-condyle segment was successfully lengthened and mouth opening range was significantly increased. The resultant interocclusal space was stably maintained with an occlusal splint for 4 months after distraction. Finally, good occlusion was achieved after prosthetic treatment. The remaining mandibular asymmetry was corrected with osseous contouring and augmentation surgery. The mouth-opening range was maintained at 35 mm 24 months after treatment. CONCLUSION: Gap arthroplasty with intraoral distraction as a one-stage treatment and subsequent contouring surgery can be applied to correct ankylosis with moderate malocclusion and facial asymmetry.
Subject(s)
Ankylosis , Arthroplasty , Consensus , Facial Asymmetry , Malocclusion , Mouth , Occlusal Splints , Osteogenesis, Distraction , Patient Selection , Temporomandibular JointABSTRACT
Subject(s)
Alveolar Process , Alveolar Ridge Augmentation , Follow-Up Studies , Mandible , Osseointegration , Osteogenesis, DistractionABSTRACT
Subject(s)
Adult , Animals , Dogs , Humans , Alveolar Process , Bicuspid , Bone Resorption , Latency Period, Psychological , Molar , OsteotomyABSTRACT
The aim of this study was to show the feasibility and potential advantages of using the new intraoral distraction device for alveolar ridge augmentation. Four adult mongrel dogs were used. We designed intraoral distraction device for augmentation of vertical height of the edentulous ridge. The left upper and lower premolars and first molars were extracted and an alveoloplasty was performed to simulate an atrophic ridge. After 12 weeks of healing, an osteotomy was made and the intraoral distraction device was applied in order to distract alveolar segment upward. A permucosal pin was exposed intraorally. Latency period was allowed for 7 days before distraction began. The distraction device was activated with a rate of 1.0 mm/day for 9 days. At 2 weeks after completion of the distraction, the device was removed. At 8 weeks after distraction, the animals were sacrificed. Clinical, radiographic, and histologic examinations were performed. Macroscopically, no significant abnormalities such as infection were occurred in the distracted area. The average distracted distance was 7.6+/-1.4 mm and new bone was formed in the distracted gap in all animals. Bone remodeling without crestal bone resorption was observed in the distracted area. In several animals, fibrous tissue was present in the buccal cortical bone area. These results suggest that the intraoral diatraction device may have the potential for use in augmentation of the atrophic edentulous ridge.