Alveolar vertical distraction osteogenesis: historical and biologic review and case presentation

Dental rehabilitation of partially or totally edentulous patients with dental implants has become common practice in the last few decades, with reliable long-term results. However, local conditions of edentulous alveolar ridges may be unfavorable for implant placement. Vertically deficient alveolar ridges, in particular, may have insufficient bone volume to hold implants of adequate dimensions, making implant placement difficult or impossible. To correct this situation, a variety of surgical procedures have been proposed, including onlay bone grafts, vertical guided bone regeneration, and alveolar distraction osteogenesis. Distraction osteogenesis is a biologic process of new bone formation between the surfaces of bone segments that are gradually separated by incremental traction. This process is initiated when a traction force is applied to the bone segments and continues as long as the callus tissues are stretched. This traction force, in turn, generates tension within the tissues that connect the bone segments, which stimulates new bone formation parallel to the vector of distraction. The aim of this article is to provide clinicians with the historical background of and biologic basis for the concept of distraction osteogenesis, which can be traced back to the 1800s. Finally, a clinical case is presented to demonstrate a step-by-step application of alveolar distraction osteogenesis as a treatment protocol in a partially edentulous ridge for improvement of esthetics.