الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Along the journey of treatment of cleft patients, secondary autogenous alveolar bone grafting is the technique basically used for cleft alveolus and palate repair during mixed dentition stage, in order to create bone support for teeth adjacent to the cleft, making a bone matrix through which teeth in the line of the cleft can erupt, re-stabilize alveolar process contour and maxillary segments. In cases with wide alveolar clefts, more than the width of a maxillary canine, failure of this procedure is usually encountered. So, a further step prior to grafting procedure can be done in an attempt to reduce cleft width to enhance success of future grafting. Distraction osteogenesis (DO) which is a procedure of growing new bone by mechanical stretching of the ordinary pre-existing vascularized bone tissue by a distraction device, where both segments of new alveolar bone as well as attached gingiva are formed can be used here to aid in minimizing cleft width.
The aim of this study was to introduce a new custom-made tooth-borne distractor that could provide 3D control upon using interdental distraction osteogenesis (IDO) with a posterior segment transport anteriorly along curvature of the arch through creating a controlled fracture, then applying this distractor device carrying a bone transport segment forward, decreasing the cleft width anteriorly with another benefit of leaving behind regenerated bone and attached gingiva posteriorly. The population of the study was 7 patients with age range between 12 and 25 years, with wide alveolar clefts, 4 of them had previous failed alveolar cleft grafting procedures while the other 3 had no previous intervention for the alveolar cleft closure.
Patients eligible to the study were prepared to receive interdental distraction osteogenesis, starting with arch expansion in 5 participants where constricted arches were present. Following expansion, preparation of the osteotomy site was done, through inducing root divergence at site of interdental osteotomy. CBCT was taken in order to plan accurately the sites of osteotomies. Then the appliance was custom made for each patient. It is made up of orthodontic bands, labial, palatal arches and micro expander screw. Osteotomies were performed under general anesthesia using piezo-surgery, there were 2 osteotomies in a L-shape; interdental vertical osteotomy mesial to 1st molar and a horizontal one above apices of teeth in the transport segment.
The distraction protocol advocated in this study was a latency period of 7 days, after which appliance activation started with a distraction rate of 0.4 mm/day with a rhythm of twice daily. Activation proceeded till teeth at the edge of the cleft came into contact. Then the appliance was fixed in place for a 3 months consolidation period.
Post-consolidation CBCT was taken to assess the amount of dental movements that had occurred, effect of distraction on anchor teeth and to assess the newly regenerated bone quality. Linear and angular measurements were made for each tooth in the transport segment as well as the anchor molar to assess the amount of teeth movement anteriorly, with differential cusp tip and root apex movement, to assess whether there existed cranial shift of teeth in transport segment, to know the effect on 1st molar anchor tooth and to know the change in tip of these teeth long axis. Radiodensity was also compared between the patients’ ordinary bone and the newly regenerated alveolar ridge.
The results of the study showed a statistically significant change in the long axis angular measurement of teeth in the transport segment, no significant cranial shift of teeth upon moving forward along arch curvature, no significant movement of the anchor 1st molar and no significant difference in radiodensity of the newly regenerated bone and the same area before distraction.