• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.2
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• pp.123-131
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• 2007

Introduction: Distraction osteogenesis is widely used as for bone lengthening in patients with maxillofacial deformity and alveolar bone atrophy. One of the major problems in distraction osteogenesis is long consolidation period for 2-3 months, in which the devices have to be fixed on the bone to prevent relapse. It results in scar formation on the face, disturbance of mastication and speech. This study was performed to evaluate the stimulating effect of pulsed electromagnetic field on the early bone consolidation in distraction osteogenesis. Materials and methods: Total 10 rabbit were used (5 for control group, 5 for experimental group). A vertical osteotomy in the mandibular body was performed and the distraction device was fixed. After 5 days distraction was done 1mm per a day for 7 days. A pulsed electromagnetic field (38 Gauss, 60 Hz) was applied for 8 hours per day and it continued for 5 days immediately after distraction in the experimental group. Both groups were sacrificed after 2 weeks. Histological specimens with H&E and Masson Trichrome staining were made and histomorphometrically analysed with image analyser. Results: The device for distraction osteogenesis was displaced in one animal for each group, therefore, only four animals in both groups were evaluated. In both groups, a new bone formation was observed in the distracted area after 2 weeks. The bone formation was enhanced in the experimental groups ($31.76{\pm}8.68%$) compared with control group ($9.94{\pm}3.23%$), its difference was statistically significant (p<0.001). Conclusion: This study suggests that electrical stimulation with electromagnectic field may be effective in the early bone formation after distraction osteogenesis. Further studies with large number of animals are needed before clinical application.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.6
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• pp.591-601
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• 2000

The objective of this study was to find out whether the unilateral distraction of mandible has an influence on temporomandibular joint and if it does, how significant the influence is. Four beagle dogs were used in this study. Each dog had two implants placed into the left mandible. The mandible was distracted for 14days with an distraction device as an amount of 0.75mm, twice per day after osteotomy between two implants. Each animals were sacrificed at the second, fourth, sixth and eighth week after the total distraction amount of 10.5mm were gotten. Upon embedding and staining, the specimens were evaluated with a light microscope. The results were as follows. 1. For the second week group, the articular cartilage and osteoid seam of temporal bone and condyle were relatively well maintained. There were not any significant differences between distraction side and non distraction side. 2. For the fourth week group, the periosteal reaction was activated and the articular cartilage and osteoid seam of temporal bone and condyle were severely thickened - especially at posterior portion of distraction side. This findings revealed that the unilateral distraction forces has more influence on distraction side than on non distraction side, and on posterior portion than on anterior portion. 3. For the sixth and eighth week group, the thickness of meniscus in distraction side gradually recovered to the initial level. The thickened articular cartilage and osteoid seam of temporal bone and condyle were decreased in distraction side and showed relatively stable in non distraction side. From this results, we suggest that several considerations are required such as using an occlusal splint, maintaining the stability of bone distraction device and evaluating bone distraction rate to minimize the damages of temporomandibular joint tissues in early stage of distraction side.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.6
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• pp.526-531
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• 2005

Distraction osteogenesis is a technique of bone lengthening by gradual movement and subsequent remodeling. Distraction forces applied to bone also create tension in the surrounding soft tissues, distraction histiogenesis. Distraction osteogenesis is used to correct facial asymmetry, such as patients with hemifacial microsomia, maxillary or mandibular retrusion, cleft lip & palate, alveolar defect and craniofacial deficiency. Hemifacial microsomia is characterized by unilateral facial hypoplasia, often with unilateral shortening of the mandible and subsequent malocclusion. This report describes two cases of hemifacial microsomia(type IIB). In these two cases, distraction osteogenesis was used to correct a facial asymmetry. Two patients underwent unilateral mandibular distraction osteogenesis of ascending ramus of the mandible with extraoral devices. Successful distraction osteogenesis was achieved in the patients with hemifacial microsomia.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.1
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• pp.1-9
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• 2007

Purpose: To evaluate the effect of compression on the distracted area in new bone formation during mandibular distraction osteogenesis in rabbits. Materials and method: Sixteen rabbits, weighing approximately 2 Kg, and the prefabricated distraction device were used. With the rabbits under general anesthesia, we performed vertical osteotomies between the anterior and posterior mandibular teeth and then placed the distraction device. After a 5 -day latency period, the mandible was distracted to a length of 10.0 mm at a rate of 1 mm/day and then immediately compressed 4 mm in the experimental group (n=8). In the control group (n=8), the mandible was distracted to a length of 6.0 mm at a rate of 1 mm/day. Rabbits in the control group were killed at 2 and 8 weeks during the consolidation period. The specimens were evaluated with light microscope after H & E stain. Histomorphometric analysis was done at 8 week specimens. Results: All experimental animals showed mandibular elongation on the macroscopical and radiographic evaluations. At 2 week, immature bone formation was observed from the surface of the host bone margins with collagen fibers arranged parallel to the direction of distraction in the control group; in the experimental group, immature bone formation was observed adjacent to the host bone, and the collagen fibers were not arranged uniformly. At 8 week, spindle-shaped new bone formation was seen in the direction of distraction in distracted area of the control group, while in the experimental group, the newly formed bone was arranged in a multidirectional manner, like the pattern of trabeculae. In the histomorphometric analysis of 8 weeks, the area of bone deposition was $2.12{\pm}\;0.75\;inch^2$ in the experimental group and $0.87{\pm}0.51\;inch^2$ in the control group (p<0.01). The bone deposition ratio was $29.60{\pm}10.50%$ in the experimental group and $12.10{\pm}7.17%$ in the control group (p<0.01). Conclusion: These results suggest that compression after over-distraction during the mandibular distraction osteogenesis is an effective method of increasing the amount of newly formed bone in distracted area.

• The korean journal of orthodontics
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• v.32 no.6 s.95
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• pp.455-466
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• 2002

The objective of this study was to evaluate the changes that occurred over time in the distracted periodontal ligament space following the rapid retraction of a tooth by periodontal distraction after bone undermining surgery had been conducted in the dogs. The upper second premolars were extracted on the left and right side in 4 male beagle dogs. Immediately after extraction, the interseptal bone distal to the upper first premolar was thinned and undermined by grooving to decrease the bone resistance. Activating an individualized distraction appliance at the rate of 0.225mm twice a day, the upper first premolar was retracted rapidly toward the extraction socket. Periodontal distractions were performed for 5, 10, and 20 days, and 20-day-distraction cases were followed by maintenance periods of 0, 14, 28, and 56 days. After 20 days of rapid retraction, the average distal movement of the upper first premolar was 5.02mm, and the average mesial movement of the upper third premolars serving as an anchorage unit was 0.18 mm. On histological examination, the regeneration of bone occurred in a highly organized pattern. Distracted periodontal ligament space was filled with newly formed bone oriented in the direction of the distraction, and this was followed by extensive bone remodeling. This result was similar to those observed in other bones after distraction osteogenesis. In the periodontal ligament, the relationship between collagen fibers and cementum began to be restored 2 weeks after the distraction was completed, and showed almost normal features 8weeks after the completion of the periodontal distraction. However, on the alveolar side, the new bone formation was still in process and collagen fiber bundles and Sharpey's fibers were not present 8 weeks after the completion of the periodontal distraction. Reactions in the periodontal ligament of the anchorage tooth represented bone resorption on the compressed side and new bone deposition on the tension side as occurred in conventional orthodontic tooth movement. In conclusion, the results of this study showed that periodontal structures on the distracted side of the periodontal ligament were regenerated well histologically following rapid tooth movement.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.4
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• pp.261-270
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• 2004

The purpose of this experiment was to examine the histological changes and the pattern of expression of type I, II collagen in the elongated area by distraction osteogenesis in the rabbit mandible. Sixteen rabbits weighing 2.5kg-3kg were used for this experiment. Experimental group was distracted at the rate of 0.7mm, twice/day for 7days, and control group was only osteotomized. After 5 days latency, osteotomic site is distracted for 7days. Consolidation period is 28days. The animal was sacrificed at the 3rd, 7th, 14th, 28th day after the operation. The distracted bone was examined by histological analysis and RT-PCR analysis. The results were summarized as follows: 1. Experimental group was observed that the gaps between the distracted bone edges were occupied by new bone. 2. Expression of Type I collagen were detected throughout the experiment in both groups and Expression of Type I collagen were markedly increased during distraction and consolidation period in experimental group than control group. 3. Expression of Type II collagen were detected throughout the experiment in both groups and expression of Type II collagen were maintained at high level during distraction and consolidation period in experimental group than control group. From these results, in contrast to type II collagen, type I collagen seemed to be more expressed by mechanical stimuli during distraction and consolidation period. The predominent mechanism of new bone formation in the distraction gap was intramembranous bone formation, but some of the regenerated bone was formed by endochondral ossification.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.3
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• pp.258-262
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• 2001

Distraction osteogenesis(DO) can be performed in the bony defect associated with trauma, anomaly, and various kinds of disease. The gap generated by DO is filled with growing callus : during the period of distraction, the osteogenesis is continued. However, there have been few reports about expression pattern of growth factors in newly formed bone during the consolidation periods. We performed DO in the mandibular defect case and studied the expressed pattern of growth factors. Its pattern was compared to that of the same patient. BMP-2 and -4 were strongly expressed in the DO site. Particularly, BMP-4 was not expressed in the normal mature bone, but expressed in new bone in DO. However, there was no difference in the FGF-7 expression between the sites. Therefore, strong expression of BMP-4 are related to new bone formation in DO and they may not be related to the normal homeostasis in human bone. Though FGF-7 is related to the growth of keratinocyte, it may have minimal role in the DO and normal mature bone.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.4
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• pp.331-339
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• 2007

Background: Distraction osteogenesis(DO) is a useful method for treating cases demanding the generation of new bone. During DO, the angiogenic activity is crucial factor in the new bone formation. The aim of this study was to detect the autocrine growth activity in the cellular components of the distracted bone with observation of the co-expression of vascular endothelial growth factor(VEGF) and its receptors following the mandibular DO. Materials and methods: Unilateral mandibular distraction(0.5 mm twice per day for 10 days) was performed in six mongrel dogs. Two animals were killed at 7, 14, and 28 days after completion of distraction, respectively. Immediately after the animals were killed, the right mandibles were harvested en block. Immunohistochemical staining was processed for observation of the VEGF expression, and double immunofluorescent staining was also processed for detection of the co-expression of osteocalcin and VEGF's two distinct receptors(VEGFR-1 and VEGFR-2). Results: At 7 and 14 days after distraction, the expressions of VEGF were significantly increased in the osteogenic cells of the distracted bone. Up to 28 days after distraction, VEGF was still expressed moderate in the osteoblastic cells of distracted bone. The co-expressions of osteocalcin/VEGFR-1 and osteocalcin/VEGFR-2 were observed in the distracted bone at 7 and 14 days after distraction. In the double immunofluorescent staining, the co-expression' s level of osteocalcin/VEGFR-1 was more than that of osteocalcin/VEGFR-2. Conclusion: Taken together, this study suggested that VEGF plays an important role in the osteogenesis, and these osteoblastic cell-derived VEGF might act as autocrine growth factor during distraction osteogenesis. In the other word, the cellular components, such as osteoblasts and immature fibroblast-like cellsor mesenchymal cells in the distracted bone, might have autocrine growth activity during distraction osteogenesis.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.3
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• pp.193-202
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• 2004

Distraction osteogenesis(DO) is defined as a gradual mechanical process of mechanical stretching two vascularized bone surface apart with a critical rate and rhythm such that new bone forms within the expanding gap, reliably bridges the gap, and ultimately remodels to normal structure. DO has become a mainstay in bone tissue engineering and has significantly improved our armamentarium for reconstructive craniomaxillofacial procedures. But the molecular and biological mechanisms that regulate the formation of new bone during distraction osteogenesis are not completely understood. BMPs are potent osteoinductive agents. Our hypothesis was that BMPs, especially BMP-2 and BMP-4, might play an importent role in the signaling pathways that link the mechanical forces created by distraction to biological responses and in promting new bone formation. Using a rabbit's mandible, we investigated the expression of BMP-2, -4 at different time points during distraction osteogenesis. The purpose of this study is to research the pattern of expression of BMP-2, -4 in new bone formation during distraction osteogenesis of the rabbit mandible. The experimental group was applied gradual distraction (0.7mm a day by twice a day, 4.9mm in total, for 7 days) and the control group was carried out osteotomy alone. They were examined clinically, histologically, and by RT-PCR analysis. On 3 days after osteotomy, the high level of expression of BMP-2, -4 was detected. But, the expression of BMP-4 was decreased during latency period. As distraction was started, its expression was increased and maintained till postoperative 28days. In control group, the expression of BMP-4was remarkably decreased till postoperative 14 days. On the other hand, the expression of BMP-2 was no difference between experimental group and control group. The expression of BMP-4 was maintanined at high level during the entire experimental period in both group. These findings suggested that excellent bone formation during distraction osteogenesis is associated with enhanced expression of BMP-4 genes by mechanical tension stress.

• Journal of Veterinary Clinics
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• v.19 no.2
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• pp.165-173
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• 2002

The purpose of this study was to evaluate the effect of chitosan-calcium sulfate mixture on early bony consolidation in osteodistracted dogs. The experimental group was divided into 3 groups: saline group(Control), chitosan group(Group CH) and chitosan-calcium sulfate mixture group(Group CH+CS). Four dogs were allocated to each group and classified into B week observation subgroups and 5 week observation subgroups, respectively. Two dogs were allocated to each subgroup. The lateral surface of the left mandibular body was exposed in the subperiosteal plane and vertical osteotomy was carried out on the mandibular body. An external distraction device was applied to the mandibular body. Mandibular distraction was started 5 days after the osteotomy at a rate of 1 m per day for a total of 10 w distraction for 10 days. After completion of distraction, chitosan, chitosan-calcium sulfate and saline were injected into the distracted zone of the group CH, group CH+CS and control. The external device was left in place for 3 or 5 weeks to allow for bony consolidation. Serial radiographs were carried out every week. Two dogs of each group, six dogs in total, were sacrificed at 3 weeks, and the other six dogs at 5 week after distraction. Bone specimens of the distracted mandibles were taken for histologic examination. New bone was not noted in the distracted zone of 3 week observation subgroups in the control and group CH. However, new bone was developed in the group CH+CS with a narrow fibrous interzone in the area of the distracted zone. While osteogenesis was mild in the margin of the distracted Bone of 5 week observation subgroup in the control, new bone was noted much in the group CH and group CH+CS. However, osteogenesis was noted more significantly in the group CH+CS than that of group CH. In conclusion, chitosan-calcium sulfate mixture was more effective on early bony consolidation in distraction osteogenesis