The Treatment of Wide Alveolar Cleft: Bilateral Interdental Distraction Osteogenesis

ABSTRACT

Alveolar bone graft has several benefits such as bony support to teeth adjacent to the cleft, bony matrix for eruption of teeth in the line of the cleft, stability of maxillary segments, and elimination of oronasal fistula. But wide gap alveolar cleft is difficult to treat using bone graft, because a large amount of bone harvesting is required and complete closure by using local attached gingiva is difficult to achieve. Therefore we introduced bilateral interdental distraction osteogenesis method to treat patients who had wide alveolar gap. From August, 1999 to April, 2000, we treated 4 patients of unilateral complete alveolar cleft(aged 10 - 4 years) by using this method. Distraction device was fitted to the supporting teeth. And then horizontal osteotomy was performed bilaterally at the level of 3 - 5 mm away from the dental roots, vertical osteotomy was performed between the second premolar and the first molar. Simultaneously, oronasal fistula was repaired. After the latency period of 3 to 5 days, we distracted bilateral distal segments as distraction protocol. After completing distraction, device was left for about 4 weeks before initiating the post-operative orthodontic treatment. The alveolar bone graft and buccal mucosa local flap were not required in these patients. By using interdental distraction osteogenesis, wide gap alveolar cleft was treated effectively.