Molar Extraction and Bone Grafting to Optimize Bone Stock for Future Mandibular Distraction

Area of Science:

• Oral and Maxillofacial Surgery
• Regenerative Medicine
• Orthodontics

Background:

• Mandibular distraction osteogenesis (MDO) is crucial for treating micrognathia and severe class II malocclusion.
• Insufficient bone stock at the osteotomy site is a common complication limiting MDO effectiveness.
• Previous surgeries or inadequate original bone can compromise MDO outcomes.

Purpose of the Study:

• To present a stepwise protocol for augmenting mandibular bone stock prior to MDO.
• To address the challenge of limited bone availability in patients with severe micrognathia and insufficient bone.
• To evaluate the efficacy of bone grafting techniques in preparing the mandible for MDO.

Main Methods:

• A protocol involving extraction of mandibular third molars and subsequent grafting of the defect was implemented.
• Graft materials included autologous bone or a combination of demineralized bone matrix, bone morphogenic protein, and freeze-dried bone chips.
• Computed tomography was used to assess bone stock 9 months post-grafting.

Main Results:

• The described technique achieved 100% graft take in all 9 grafted sites across 6 patients.
• Both autologous bone grafts and the combination graft material demonstrated equal efficacy.
• The protocol successfully prepared the mandible for subsequent MDO in patients with insufficient bone stock.

Conclusions:

• This stepwise bone grafting protocol effectively enhances mandibular bone stock for MDO.
• The technique offers a viable solution for patients with severe micrognathia and limited bone availability.
• Both tested graft materials are equally efficacious for this pre-MDO augmentation procedure.