Alveolar distraction for closure of cleft for implant placement, docking with rhBMP-2 - Dr SM Balaji скачать в хорошем качестве

Alveolar distraction for closure of cleft for implant placement, docking with rhBMP-2 - Dr SM Balaji

Alveolar cleft is an opening in the bone of the upper jaw that sometimes contains teeth and is covered with gums before the eruption of the teeth. The cleft in the bone and gum means that teeth cannot grow properly and the floor of the nose does not develop normally. Missing teeth have a huge adverse effect on facial growth. The aim of alveolar cleft repair is therefore to repair the hole in the bone, provide better support for the base of the nose and produce new bone for the growth of the developing teeth. An 18 year old female patient presented with the chief complaint of a maxillary alveolar cleft between the right maxillary central incisor and canine region, with the missing lateral incisor. Instead of bone grafting for correcting the cleft, she was planned for the maxillary alveolar distraction using the principle of distraction osteogenesis, where the bone can be mobilized to the opposite side closing the alveolar cleft at the same time correcting her midline shift. By this principle, the small device (distractor) is fixed to the either side of the pre-planned split (surgical cut) of the alveolar bone and activated to move the transport fragment thus creating a new bone formation in the surgical cut area. The vestibular incision is made and the vertical surgical cut is given between the left central and lateral incisor followed by the superior cut which is 6mm above the root apex to avoid the damage to the root. The distractor is fixed to the both sides of the cut using 1.5mm width and 6mm length titanium screws. The free mobility of the bone segment is checked by activating the distractor by rotating in the anti-clock wise direction of the activating arm. The mucosa is sutured in layers and the distraction is started 7 days after the procedure at a distraction rate of 0.5 mm/day. By this the new bone is formed in the distracted region and the moving segment is docked to the opposite side thus correcting her midline shift. rhBMP-2 is used in the docking region for the perfect fusion of the transport segment followed by implant placement in the future. In the mobilized area, there will be the formation of the fresh new bone, thus the need for second surgery for bone grafting can be avoided.