Trifocal distraction-compression osteosynthesis in conjunction with passive self-ligating brackets for the reconstruction of a large bony defect and multiple missing teeth

Reconstruction of a maxillary dentoalveolar defect and closure of a wide oronasal fistula in a patient with a traumatic injury are challenging for both orthodontists and surgeons. A conventional bone graft is used to fill the alveolar bone defect, to restore continuity between bony segments, and to provide bony support for tooth eruption adjacent to the defect or for orthodontic tooth movement into the bony defect. However, if the defect is too large to allow for a conventional bone graft, transport distraction osteogenesis can be used for reconstruction of the alveolar bone and implant placement. However, there is usually a discrepancy in the movement rates between the bony segment and the teeth. Passive self-ligating brackets can minimize friction between the bracket and the archwire; therefore, the rate of tooth movement can be balanced with that of the bony segment. By using orthodontic miniscrew and elastomeric traction, the regenerated bony segments can be bent to form a curved arch in the alveolar bone. In the treatment reported here, trifocal distraction-compression osteosynthesis with orthodontic miniscrews and passive self-ligating brackets helped establish bone continuity in a bony defect area, created anterior curvature of the alveolar bone, and provided good-quality regenerated bone for implant placement.