Basic and patient-oriented research
Complications in Transpalatal Distraction Osteogenesis: A Retrospective Clinical Study

https://doi.org/10.1016/j.joms.2010.11.026Get rights and content

Purpose

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.

Patients and Methods

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).

Results

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.

Conclusion

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.

Section snippets

Patients and Methods

A group of 73 consecutive patients (27 male and 46 female) underwent bone-borne SARPE for maxillary expansion in 3 centers between April 2000 and August 2007. Surgery was performed in a residency training program under supervision of the attending surgeon. The mean age was 28 years (range: 9 to 59 years). Sixty-seven patients had bilateral maxillary widening. Six patients underwent unilateral bone-borne SARPE, mainly to correct unilateral crossbite. Four patients underwent simultaneous

Medical File Analysis

A problem occurred in 27 cases during the distraction phase in the initial group (n = 73). Most of the problems were hardware-related. In 12 cases, the TPD-module showed signs of loosening, dislocation, or other dysfunction and could be mended without surgical intervention. In 6 patients, a fixation screw was lost or replaced without any consequences. In 1 patient, the module could not be activated by the patient and initial distraction was performed under local anesthesia due to pain that was

Discussion

The objective of this study was to investigate any difficulties during bone-borne SARPE. Problems were considered minor and did not interfere with the final result nor necessitated additional intervention. Obstacles (asymmetrical distraction and instable occlusion postdistraction) that required surgical intervention (Le Fort I osteotomy) were of the most concern. The incidence of problems was comparable to that of the group of Neyt.1 The treatment had to be postponed. The obstacles group also

Acknowledgments

We kindly express our gratitude to Dr M.Y. Mommaerts (St Jan Hospital, Bruges, Belgium) for his valuable contribution to the bone-borne SARPE technique and his clinical assistance for the implementation in our hospital.

References (26)

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