Three Dimensional Reconstruction of Post Traumatic Deficient Anterior Maxilla

Publication date: Available online 15 May 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Adi Rachmiel, Dekel Shilo, Dror Aizenbud, Mark Pen, Dana Rachmiel, Omri Emodi
PurposeMaxillary retrognathism appears in 14.3% of the patients exhibiting malocclusion following trauma treatment. In this manuscript we describe the application of alveolar distraction osteogenesis(ADO) for treating the severely deficient anterior maxilla following trauma injuries, both in the vertical and anteroposterior planes.Material and MethodsThis is a retrospective study of patients exhibiting severe vertical and anteroposterior maxillary bone deficiency following trauma injuries and treated by ADO as a first stage with additional Le Fort I advancement when required. Predictor variables included ADO for alveolar augmentation and Le Fort I advancement for anteroposterior discrepancy following ADO. Outcome variables included dental implant failure and anteroposterior maxillary relations.ResultsTwelve patients with severe atrophic anterior maxilla secondary to trauma injuries were included and treated using ADO. In accordance to the size of the horizontal deficiency, one or two distractors were used. Vertical alveolar distraction was performed and the transported segments were elongated at a rate of 0.5 mm/day to a mean total of 13.9 mm (between 12-15 mm). In four cases out of twelve there was a severe anterior-posterior discrepancy of over 8 mm which could not be fully corrected using an anterior inclination during the vertical elongation. Therefore, a second stage of conventional Le-Fort I advancement was performed. 38 dental implants were inserted showing a survival rate of 97.37% with a median of 6.2 years follow-up.ConclusionsIn this manuscript we described the treatment of the deficient anterior maxilla following trauma injuries, both in the vertical and anteroposterior planes, including implant-based dental rehabilitation. The main advantages include simultaneous bone and mucosa augmentation, no donor site morbidity, significantly higher vertical augmentation compared to other methods and minimal relapse. Using an additional Le-Fort I advancement in severe cases permits a useful method for proper repositioning of the maxilla, thus resulting in superior inter-maxillary relations.



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