RETRACTION THROUGH

DISTRACTION

RATIONALE:
Resistance of the alveolar bone limits the rate of tooth
movement. Therefore reduction of bony resistance on the
compression side of the tooth will diminish physical alveolar bone
contact, thereby minimizing undermining resorption and
accelerating the rate of orthodontic tooth movement.

2 TYPES

via Periodontal Ligament via Dentoalveolar Segment

Hypothesis: the PDL is a
suture-like tissue located
between the tooth and
alveolar bone, and therefore
can be rapidly stretched in a
manner similar to midpalatal
suture during RPE.
Liou and Huang 1998 AJO
Hypothesis: the principles of
DO by means of
transportation of a bone
disc are used to move a
dentoalveolar segment.
Kisnisci and Iseri 2002 JOMFS
DISTRACTION

INDICATIONS:

moderate to severe dentoalveolar bimaxillary protrusion

anterior crowding with maximum anchorage requirement
severe Class II Div I malocclusions with maxillary
dentoalveolar protrusion
mild to moderate skeletal Class III malocclusion
orthognathic surgery patients who need dental
decompensation
pts with small root-shape malformations, short roots, or
ankylosed teeth
both adolescents and adults
DISTRACTION SURGICAL TECHNIQUE FOR PDL DISTRACTION

EXTRACTION = SOCKET DEPTH ISB THICKNESS ISB UNDERMINING

DISTRACTION SURGICAL TECHNIQUE FOR D-A-D
DISTRACTION

PRE Rx MID DISTRACTION POST DISTRACTION

APPLIANCE REMOVAL
DISTRACTION COMPARISON OF PDL AND DAD

PDL DAD
Procedure involves Dentoalveolus is designed
undermining of the as a transport bone
Interseptal Bone segment for posterior
movement
Pre surgical ortho Rx Pre surgical ortho Rx is not
usually lasts one month implemented

Appliance is a custom made

Appliance is a custom made
semi-rigid tooth borne
rigid tooth borne device
distractor
Activation is begun the day Activation is begun the day
of insertion @ of insertion @ 0.4mm/turn,
0.35mm/turn, twice a day twice a day
Type of tooth movement is
a combination of tipping Tipping and translation
and translation

Duration = 3 weeks Duration = 8 to 14 days

DISTRACTION

RAPID OSTEOGENESIS IN PDL

Occurs in 5 stages:

Stage I: Stretching and widening of the PDL (1st week after

initiation)
Stage II: Active growing of striated bone in the distracted PDL
(2nd week after initiation)
Stage III: Recovery of the distracted PDL (1st-4th week after
completing distraction)
Stage IV: Remodeling of the striated bone(4th week 3rd month
after completing distraction)
Stage V: Maturation of the striated bone (3 months after
completing the distraction)
DISTRACTION
RAPID OSTEOGENESIS IN DAD

Occurs in 4 Stages:

Stage of fibrous tissue consisting of highly organized, longitudinally

oriented parallel strands of collagen with spindle shaped fibroblasts and
undifferentiated mesenchymal precursor cells throughout the matrix.

Stage of extending bone formation in which fibroblasts and

undifferentiated precursor cells of the matrix were in continuity with
osteoblasts.The osteoblasts had a longitudinal orientation. The
osteoblasts arouse from transformed spindle shaped fibroblastic cells
located between the collagen bundles.

Stage of bone remodeling consisting of advancing fields of bone

resorption and apposition. There were increased numbers of osteoclasts.

Stage of mature bone in which compact cortical bone was located

adjacent to the mature bone in the nondistracted areas. The bone
spicules were thicker and less longitudinal than in the remodeling stage.
DISTRACTION

UNFAVOURABLE SEQUALAE

Loss of Posterior and Vertical Anchorage. (but less than 0.5mm)

One should consider the vertical anchorage loss in pts with open
bite tendency.
Tipping of the canines were commonly observed.
Extrusion of canines in the mandible.
Lack of 3D control of vectors of movement.
Minimal Root resorption was reported in PDL distraction and
none in DAD.
Reaction to pulp vitality testing was questionable when using
Electronic Pulp Tester.
Procedure is technique sensitive.
No reports on Root Ankylosis following distraction.