Closure of the Alveolar Cleft by Bone Segment Transport Using an Intraoral Tooth-Borne Custom-Made Distraction Device

PurposeThe fact that bone transportation generates not only bone but also surrounding soft tissues makes it an ideal technique for tissue regeneration. This study evaluates bone segment transport using an intraoral tooth-borne distraction device for alveolar cleft closure.Materials and MethodsPatients with an alveolar cleft were enrolled in the study. They were treated at the Al-Azhar University Hospital, Cairo, Egypt, between 2004 and 2007. Anterior transportation of the posterior dentoalveolar segment was performed by use of an intraoral tooth-borne custom-made distractor. Clinical evaluations included the following: preoperative and postoperative intraoral photographs, vitality testing of the teeth in the transport segment, cast analysis, and measurement of tooth mobility. Radiographic evaluations included occlusal films, orthopantomography, and computed tomography and 3D computed tomography for volumetric and densitometric evaluations of the distracted bone.ResultsAfter distraction was completed, the transported segments were positioned 1 to 4 mm superior to the occlusal plane. The radiographic evaluation showed residual triangular bone deficits that were closed through gingivoperiosteoplasty or bone grafting. Once the transported segments came in contact with the alveolar bone of the normal side, the intervening fibrous tissue at the docking site was removed, and docking-site surgery was then performed. The results obtained from both clinical examinations and radiographic imaging showed complete closure of the alveolar clefts.ConclusionsMaxillary alveolar bone transport offers an alternative technique in the latest treatment of the alveolar cleft.