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Minor complications arising in alveolar distraction osteogenesis
Abel Garcia Garcia1, Manuel Somoza Martin, Pilar Gandara Vila
1Department of Maxillofacial Surgery, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain. ciabelgg@usc.es
Purpose:
This study evaluates complications that arise during mandibular alveolar distraction osteogenesis and suggests treatments.
Methods:
We monitored complications that arose during alveolar distraction osteogenesis in 5 patients who underwent a total of 7 distractions, in all cases using an intraosseous distractor (Lead System, Leibinger, Germany). We report our responses to each type of complication.
Results:
All 7 distractions were followed by the placement of 2 implants. The restoration was ideal in 4 of the 7 cases and functional but not ideal in the remaining 3. In all 7 distractions, we observed complications, although many were minor complications readily avoided by the use of appropriate technique. The complications were, first, intraoperative complications, namely 1) fracture of the transport segment (1 of 7 cases;
Response:
appropriate preventative measures), 2) difficulties in finishing the osteotomy on the lingual side (7 of 7 cases;
Response:
use of fine chisels made from cement spatulas), and 3) excessive length of the threaded rod (1 of 7 cases;
Response:
cut the rod). Second, complications arose during distraction: 1) incorrect direction of distraction (2 of 7 cases; no corrective measures necessary in the present cases), 2) perforation of the mucosa by the transport segment (2 of 7 cases; response: smooth the crest of the segment with a bone rongeur), and 3) suture dehiscence (1 of 7 cases; no significant implications). Third, there were postdistraction complications, namely bone formation defects (4 of 7 cases; response: guided bone regeneration).
Conclusions:
A number of complications may arise during alveolar distraction osteogenesis. Most of these complications can be considered minor and are readily avoided or resolved by the use of appropriate procedures.