Mandibulotomy Technique and Permanent Molar Injury After Mandibular Distraction Osteogenesis in Infants

Area of Science:

• Craniofacial surgery
• Pediatric dentistry
• Orthodontics

Background:

• Mandibular distraction osteogenesis (MDO) is a surgical procedure to correct micrognathia.
• MDO carries a known risk of injury to developing mandibular dentition, particularly permanent molars.
• The impact of specific osteotomy instrumentation on molar development post-MDO is not well-understood.

Purpose of the Study:

• To investigate the effect of different mandibular osteotomy cutting techniques on the development of permanent mandibular molars following MDO.
• To compare the incidence of molar anomalies associated with side-cutting burr versus piezoelectric saw osteotomies in infants undergoing MDO.

Main Methods:

• Retrospective chart review of infants with micrognathia treated with MDO using external devices (2010-2018).
• Radiographic assessment of first and second permanent mandibular molars years after MDO to evaluate for injury.
• Comparison of molar anomaly rates between osteotomies performed with a side-cutting burr (n=16) and a piezoelectric saw (n=6).

Main Results:

• A total of 11 patients (22 osteotomies) met inclusion criteria after exclusions.
• The rate of abnormal permanent molar findings was significantly higher in the side-cutting burr group (88%) compared to the piezoelectric saw group (17%) (P = 0.004).
• The median age at distraction surgery was 3 weeks.

Conclusions:

• Mandibular distraction osteogenesis poses a risk to developing mandibular molars.
• Utilizing a piezoelectric device for mandibular osteotomy during MDO is associated with a significant reduction in molar injury risk.
• This finding suggests piezoelectric instrumentation as a potentially safer option for preserving permanent molar development during MDO.