PMC4073465_01
(a and b) Clinical assessment on patient presentation. Note the wide complex size of the alveolar cleft which was suggestive of higher risk of failure of a secondary alveolar bone graft procedure. The maxillary right canine has not erupted completely and the distance measured from the mesial surface of the right first premolar to the left central incisor is 21 mm
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F1
The maxilla was composed of a lesser (right) and a larger (left) segment with a wide maxillary cleft [Figure 1a and b].
(a and b) Clinical and radiographic assessment following 1 year of pre-distraction orthodontic treatment and alignment of maxillary teeth. The aim was to create atleast 3 mm distance between the mesial root of the right first molar and the second premolar to facilitate the osteotomy. The distance between right canine and left central is now reduced to 11 mm
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F2
One year of orthodontic treatment did achieve alignment of the maxillary teeth [Figure 2a and b] and most importantly a 3 mm initial space between the 1st molar and the 2nd premolar in order to minimize risk of dental root injury during the surgery.
(a and b) Intraoral images on follow-up visits on the 3rd and 7th day of distraction. Overall distance of the alveolar segment between 1st molar and 2nd premolar was increased to 10 mm (7 mm of regenerate bone and 3 mm from pre-distraction orthodontics). The distance between left central-right canine is now reduced to 4 mm
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F3
Oral photographs taken at the 3rd and 7th day of the distraction stage clearly demonstrate the expansion of the alveolar segment between the 1st molar and 2nd premolar [Figure 3].
(a and b) Image of the distracted maxillary segment following device removal after a 12 week consolidation phase
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F4
Clinical assessment revealed new bone and soft-tissue formation 8 weeks after completion of the distraction phase [Figure 4].
Ultrasonographic image of the gap before distractor removal performed at 8 weeks following completion of the distraction phase. Mineralization of the osseous regenerate is clearly seen (within +)
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F5
This was confirmed by ultrasonography [Figure 5].