Possible problems of moulding the regenerate in mandibular distraction osteogenesis -- experimental aspects in a...

Moulding of the regenerate created by distraction osteogenesis has been shown clinically to be efficient and good enough so that for complex three-dimensional deformities, final adjustments by moulding the regenerate may be part of the treatment plan. This study assessed possible drawbacks of moulding a regenerate, taking into consideration compressive and tensile forces acting simultaneously on the fresh callus.

Distraction osteogenesis in 15 Beagle mandibles was performed using custom made devices which allowed for lengthening as well as for angulation. After linear distraction of 10 mm, a defined 20 degrees angulation was performed in one step. The position of the fulcrum of the device allowed simultaneously compression and stretching of the regenerated bone. Effects on bone healing were assessed after 6 and 13 weeks of consolidation respectively and compared with a control group where only linear distraction was performed.

Radiological and histological investigations demonstrated that no significant differences between the biological behaviour of the compressed and the stretched zones of the regenerate could be found. However, there were signs showing the more critical character of the stretched area. After 6 weeks of consolidation some specimens revealed delayed ossification of the stretched zone. Under stable conditions, this delay was compensated for after 13 weeks of consolidation and complete osseous healing occurred.

Under stable conditions, a fresh regenerate can be moulded to a considerable extent without permanently endangering osseous healing. Nevertheless tensile forces acting on the regenerate should be minimized to prevent damage to the new bone. This can be achieved by overdistraction prior to callus moulding or by gradually changing the vector of distraction during the lengthening process.