The Endo-Distractor for preimplant mandibular regeneration.
OBJECTIVE
A simple practical device for a new technique of vertical distraction osteogenesis was developed. The Endo-Distractor Krenkel was originally intended for the anterior regeneration of highly atrophic mandibles. The Endo-Distractor features several novelties. Placement is made intraosseously in the basal cortical bone. The distraction screw length may be adapted to the depth of chin soft tissues. The quality of anchorage in the basal cortical bone guarantees the stability of the distraction vector. The endobuccal emergence is that of an artificial crown, and does not cause any patient discomfort. The device can easily be removed without secondary surgery. All kinds of implants may be placed after the retention time. This study's objective was to evaluate the use of the Endo-Distractor Krenkel in edentulous patients with highly atrophic mandibles.


METHODS
This new device was used on 18 patients, between January 2000 and September 2004, who were then followed-up for at least 36 months. Mandibular atrophy was measured with a lateral cephalogram, then classified according to Atwood's modified classification. The studied criteria included the amplitude of distraction, its duration, the distractor's lingual tilt, the number and outcome of implants, and complications.


RESULTS
The sex ratio was 17 female for one male patient. The mean patient age was 56 years (43 to 66 years). The mean distraction amplitude was 11.3mm (8 to 14 mm). The mean retention time was 186.8 days (37 to 309 days). The distractor's mean lingual tilt was 4.3 degrees (0 to 23 degrees ). Two mandibular fractures occurred 6 weeks after placing the Endo-Distractor. The first one was treated medically, and the second one required removing the Endo-Distractor and osteosynthesis. An average of four interforaminal implants were placed for a total of 24 Brånemark and 51 Straumann implants. Four implants were lost in a patient due to infection. All other implants were osseointegrated. No bone loss was detected at follow-up after functional loading.


CONCLUSIONS
These results show that alveolar distraction is possible on severely atrophic mandibles. The quality of bone and gum reconstruction is satisfactory both for functional and esthetic results. Surgical difficulty and rate of complications were lower than with conventional distraction techniques.
Krenkel
C
C
Clinic of Oral and Maxillofacial Surgery, Paracelsus Medical School, Federal Medical Center Salzburg, Landeskrankenhaus Salzburg, Muellner Hauptstrasse 48, Salzburg, Austria. c.krenkel@salk.at
Grunert
I
I
D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000601:surgery; D001861:Bone Regeneration; D003758:Dental Implantation, Endosseous; D019094:Dental Prosthesis, Implant-Supported; D005260:Female; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008334:Mandible / Q000601:surgery*; D008875:Middle Aged; D013516:Oral Surgical Procedures, Preprosthetic / Q000295:instrumentation*; D019857:Osteogenesis, Distraction / Q000295:instrumentation*; D014716:Vertical Dimension