Morphofunctional and clinical study on mandibular alveolar distraction osteogenesis

Alveolar Distraction Osteogenesis (ADO) is a process which forms new alveolar bone to correct alveolar deformities in ridge height and width. This work aims (a). to verify the predictability of the augmentation of height of atrophic alveolar ridges using an extra-alveolar distraction device and (b). to study the bone processes in order to optimize implanto-prosthetic rehabilitation. ADO was performed on 10 patients with ridge deformities to obtain the required ridge augmentation. Clinical and radiological (OPT and CT with densitometric assay) evaluations were carried out during the following 12 weeks, before implant insertion. Biopsies at 40, 60 and 88 days were studied after general, specific and histochemical staining of slides; microradiographs were analyzed to evaluate the Trabecular Bone Volume. Forty days after the end of distraction, soft callus indicated the start of ossification. Sixty days after the end of distraction, the soft callus was largely converted into a network of trabecular woven bone; osteogenic activity was high and TBV was about 50%. Eighty-eight days after the end of distraction, the amount of bone appeared reduced, with a more ordered structure; bone formation activity and TBV also diminished, whereas osteoclast erosion was active. The densitometric assay shows values increasing from the end of distraction, particularly after implant insertion. Histological results show a regression in bone deposition processes 88 days after the end of distraction culminating in a virtual steady-state after a certain time. The results suggest that early implant insertion may be desirable to avoid bone loss due to mechanical unloading.