Objective: To design a dentoalveolar attachment system for Le Fort III distraction osteogenesis in children who lack permanent teeth for anchorage.A system that offers precise control of the pitch, yaw and roll of the skeletal component during active distraction is also desirable for patients of all ages.
Methods: This is a retrospective study involving children (n=14, mean age 6 years) with severe midfacial deficiency secondary to synostoses (Apert,Crouzon) and other craniofacial malformations. Traditional rigid halo fixation was employed, but with a new type of a skeletal transport device. This consisted of (1)a palatal/acrylic dentoalveolar component; (2)activated circumferential suspension wires, passing orally through the acrylic, then percutaneously through the soft palate and exiting at the nasofrontal junction and (3)circumaxillary wiring to anchor the acrylic component to the maxilla.
Results: Mean linear distances were 15 mm at A point and 19 mm at the nasofrontal junction. One patient was distracted 18 mm at A point and 24 mm at the nasofrontal junction. Additionally, this technique was able to effect posterior maxillary “lift”and superior repositioning at the level of the maxillary occlusal plane, when needed, to resolve skeletal apertognathia.
Conclusions: This new technique solves the dentoalveolar anchorage problem for young children and offers excellent 3-D control for precise “docking” of the maxillary occlusion with its mandibular counterpart while attaining pleasing midfacial soft tissue esthetics.Most importantly, it enables clockwise rotational control of the midfacial skeleton in the sagittal plane, which greatly benefits children with ventilatory obstruction. It reliably closes even severe open bites.