[Implant insertion in distracted bone for reconstruction after gunshot injury]. / Pose d'implants en os distracté chez les patients reconstruits après traumatisme balistique.

Distraction osteogenesis is a tissue engineering technique with two clinical applications in maxillofacial surgery: alveolar distraction and basal bone distraction. Even if it appears to be a binding and major surgery, distraction osteogenesis applied to facial bone, and especially to the mandible, has the great advantage of producing a pluritissular reconstruction of ideal quality and quantity, suitable for the ultimate goal of dental implant rehabilitation management. This technique had some drawbacks due to technical constraints related to the material. Distraction osteogenesis is well placed in the armamentarium of reconstructive surgery techniques for bone defects caused by trauma or tumor. It allows rapid restoration of adequate physiological conditions for mandibular dental implant placement. We reviewed the various modifications of this technique.

[Distraction osteogenesis for the premaxillary reconstruction. Report of 3 cases]. / Reconstruction du prémaxillaire par distraction ostéogénique. A propos de trois cas cliniques.

Reconstructing the premaxillary is well-known for being difficult and usually requires a bone implant, in grafts or flaps. This technique has a high morbidity rate and its middle or long term results remain uncertain. Thanks to their experience and to the results they achieved in mandible and maxillary osteogenic distraction, the authors suggest applying the principle of distraction osteogenesis to the premaxillary reconstruction. Three patients have been treated: first, two hypoplasias of the premaxillary, sequelae of a cleft palate and of a former traumatic loss of teeth; secondly one premaxillary defect following a gunshot wound. The first two were women, the other one was man, all adults. For premaxillary distraction, an intraoral extramucosa device is made-up for each individual case before the surgical operation itself and after an orthognathic analysis. The surgical operation consists in a classical segmental maxillary osteotomy which respects the palatal periosteum, and also in fitting a distractor device with transmucosa screws into the palatal bone. In each of the three cases, with a follow-up from 24 to four months, the reconstruction of the premaxillary by distraction osteogenesis is considered satisfactory and stable as regards both bone and soft tissues. This achieves particularly a very good expansion of the fibrous mucosa of the palate which makes it possible to re-insert false teeth, with or without implants into the bone. The principle of distraction osteogenesis applied to premaxillary reconstruction has shown, in our cases, very good functional and aesthetic results. Yet the techniques we used are simple and have a low morbidity rate; secondly the distraction device is easy to design and little expansive.