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Distraction Osteogenesis May Promote Periodontal Bone Regeneration

¹ Private practice, SCN Q.5 bl.A sala 408 BsB Shopping, Brasília, DF, Brazil CEP 70715-900;
² Departamento de Genética e Morfologia, Instituto de Ciências Biológicas, Universidade de Brasília, Brazil; and
³ Departamento de Biologia Celular, Instituto de Ciências Biológicas, Universidade de Brasília, Brazil;

View larger version (68K): [in a new window]   Figure 1. Diagram of clinical procedures. (A,B) Periodontium before and after the defect production; the arrow in A indicates the area in which the defect would be created; the arrow in B points to the defect. (C) Monocortical autogenous bone grafts (detail) were placed in the maxilla 8 mm above the bone crest. (D) Periodontal splitting was done; the upper portion of the corticotomy passed through the point indicated by the white arrow. Black arrows point to the 2 marks that outlined the bone crest and gingival margin. A chisel was introduced into the gingival sulcus and hammered to split the tooth root from the sectioned periodontium. (E) Periodontal distraction system attached to tooth crown and anchor loops. (F) End of periodontal distraction; arrow in the detail shows area of osteogenesis.

View larger version (127K): [in a new window]   Figure 2. Surgical periodontal splitting technique and periodontal distraction. (A) Stainless steel wires were tied to anchor loops in the grafted region; the curved chisel (arrow) was hammered to create a split between the tooth root and the periodontium after corticotomies were performed in the maxilla. (B) Needle is passing under the split periodontium. (C) Distractor when activation began. (D) Distractor at the end of activation.

View larger version (153K): [in a new window]   Figure 3. Photomicrographs of treatment site. (A) Bone crest (lower rectangle) and its original position (middle rectangle) in animal 3, demonstrating the displacement of bone crest by periodontal distraction. The graft (g) is undergoing bone remodeling. The arrow shows the initial position of the gingival margin. (B) Enlarged image of the middle rectangle. Arrows show the original bone crest position. (C) Area of osteogenesis with bone columns (bc) extending toward the central fibrous interzone (f) in animal 1. (D) Enlarged view of the lower box in A. Bone crest is indicated by the arrows. (E) Detailed view of the area of osteogenesis in the dashed upper box in A. The distraction gap is completely bridged by bone, and remodeling is taking place. (F) Details of cementum regeneration (arrows) over the root surface in animal 4. (G) Detail of an area of regenerated cementum in animal 5; Sharpey’s fibers (arrow) penetrating the cementum. H&E. b = bone; bc = bone columns; d = dentin; ce = cementum; f = central fibrous interzone; g = graft; and pl = periodontal ligament.

View larger version (66K): [in a new window]   Figure 4. Photomicrographs of control site. (A) Bone crest (small arrows) and the mark indicating initial bone crest position (large arrow). White arrow points to gingival mark. (B) Ankylosis in animal 5. H&E. ak = ankylosis; b = bone; ce = cementum; d = dentin; and pl = periodontal ligament.