Complications in transpalatal distraction osteogenesis: a retrospective clinical study

Transpalatal distraction osteogenesis is a bone-borne technique to expand the maxilla and has become a routine method in treating patients with transverse maxillary hypoplasia. Limited reports concerning treatment difficulties have been published. The purpose of this study was to investigate and categorize the short- and middle-term incidence of peri- and postoperative difficulties (categorized by the classification of Paley in problems, obstacles, and complications). The signs of adverse dental and periodontal effects were established at least 1 year after removal of the distractor.

A total of 73 patients (27 male, 46 female; mean age: 28 years; range: 9-59) that underwent bone-borne SARPE in 3 centers were retrospectively investigated. Clinical follow-up was performed in 63 patients after an average period of 23.9 months (range: 6-63 months).

Twenty-seven problems (mainly appliance related), 10 obstacles (appliance-related and asymmetric maxillary expansion), and 1 complication (premature loss of the TPD-module, due to lack of space, in a cleft patient) occurred. Clinical examination showed minimal periodontal damage (gingival recession on 15 sites and pocket depths 4-5 mm in 11 sites). In 28.6% of the incisors radiographic signs of external apical root resorption were seen.

Bone-borne SARPE is a reliable technique with predictable outcomes. These results suggest that bone-borne SARPE is associated with a low incidence of dental and periodontal damage. Nevertheless, further research, preferably in randomized controlled design, is needed to evaluate the long-term effects and stability.