Orthodontic management of the patient undergoing mandibular distraction osteogenesis

Distraction osteogenesis is a gradual incremental bone-lengthening technique that requires very precise treatment planning and surgical execution. Subtle variation in the position of the corticotomy/osteotomy or in the position of the distraction device will affect the ultimate position of the tooth-bearing (distal) segment. Other functional and/or anatomic factors (that at this time are not well understood) also have an influence on the direction in which the tooth-bearing segment moves during distraction. These factors combine to create a discrepancy between the planned direction and the actual or observed direction of distraction. The charge for the orthodontist is to plan, as carefully as possible and in concert with the surgeon, the direction (vector) in which the tooth-bearing segment will travel during distraction. Further, the orthodontist must be able to modify the position that the tooth-bearing segment takes by exerting orthopedic and orthodontic forces and by making adjustments to the distraction device. In addition, the orthodontist must prepare the dentition before distraction, manage the dentition during distraction, and finish the occlusion after distraction in a manner that is different from more traditional jaw-respositioning techniques.