title: Long-term skeletal and dental stability of mandibular symphyseal distraction osteogenesis with a hybrid distractor.
abstract: BACKGROUND
  The purpose of this study was to examine the long-term skeletal and dental stability of mandibular symphyseal distraction osteogenesis (MSDO) with a tooth-borne and bone-borne hybrid distractor. To differentiate the effects of MSDO from the orthodontic movement and relapse, each phase of treatment was analyzed.
  
  
  METHODS
  Twenty-five patients were included in the study, ranging in age from 12.0 to 30.9 years at the initiation of treatment (mean, 15.8 ± 4.8 years). Of this group, 16 patients were recalled at a mean of 7.5 ± 0.9 years (range, 6.3-9.6 years) after distraction for long-term analysis of skeletal and dental changes. Orthodontic records were taken at 5 times: T1, pretreatment; T2, predistraction; T3, postdistraction; T4, posttreatment, and T5, postretention. The data were statistically analyzed by using repeated-measures analysis of variance (ANOVA).
  
  
  RESULTS
  There were significant increases in all interdental transverse measurements except the mandibular intersecond molar distance from T1 to T4. The largest overall expansion was achieved between the mandibular second premolars (4.32 ± 0.60 mm), followed by the interfirst premolar (3.44 ± 0.44 mm), the interfirst molar (2.60 ± 0.65 mm), and the intercanine (1.87 ± 0.44 mm) widths. The overall amount of transverse dental expansion was substantially less when analyzed from the time of the mandibular symphyseal osteotomy to posttreatment (T2-T4). From T3 to T4, there were significant decreases between the mandibular intersecond premolars (-3.10 ± 0.52 mm), interfirst premolars (-3.90 ± 0.35 m), intercanines (-4.47 ± 0.38 mm), and intercentral incisors (-5.60 ± 0.32 mm). There were no significant changes in bicondylar, bigonial, and biantigonial widths. At the long-term follow-up, there were no significant changes in the interdental or skeletal measurements between T4 and T5, except for interincisor apices. The irregularity index significantly decreased during the orthodontic treatment but significantly increased in the long-term follow-up period (T4-T5). After the MSDO, T3 to T5, the results indicated symphyseal basal bone skeletal stability.
  
  
  CONCLUSIONS
  The results indicate that the expansion of the mandibular arch with MSDO and conventional orthodontic mechanics produces no statistically significant transverse changes from posttreatment to long-term follow-up. The risks of using a surgical procedure and MSDO to achieve additional expansion should be evaluated by the clinician and compared with more traditional orthodontic methods.
authors.affiliation: West Virginia University, Morgantown, West Virginia, USA. drjohnking@comcast.net
authors.forename: John W
authors.initials: JW
authors.lastname: King
authors.forename: James C
authors.initials: JC
authors.lastname: Wallace
authors.forename: Daniel Luke
authors.initials: DL
authors.lastname: Winter
authors.forename: Julia A
authors.initials: JA
authors.lastname: Niculescu
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D002508:Cephalometry; D002648:Child; D002680:Chin / Q000601:surgery; D003724:Dental Arch / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008310:Malocclusion / Q000601:surgery* / Q000628:therapy; D008334:Mandible / Q000601:surgery*; D019647:Oral Surgical Procedures / Q000295:instrumentation* / Q000379:methods*; D009971:Orthodontics, Corrective; D019857:Osteogenesis, Distraction / Q000295:instrumentation*; D055502:Secondary Prevention; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D055815:Young Adult