Maxillary bone and dento-alveolar changes in cleft lip and palate patients: Total maxillary distraction osteogenesis versus anterior maxillary segmental distraction osteogenesis

Abstract

This study aimed to evaluate maxillary bone and dento-alveolar changes in cleft lip and palate patients after total maxillary distraction osteogenesis (TMDO) and anterior maxillary segmental distraction osteogenesis (AMSDO).

The retrospective study included 18 cleft lip and palate patients who underwent either with TMDO or AMSDO. CBCT scans of individuals were obtained and measured at predistraction (T1), post distraction (T2). Linear and angular measurements of maxillary bone and dento-alveolar bone were performed using three-dimensional reconstruction images. For intragroup comparisons, a paired t-test or Wilcoxon signed-rank test was used. For intergroup comparisons, an independent t-test or Mann-Whitney U test was used, with the Bonferroni correction applied.

In sagittal plane, sella-nasion-point A angles (SNA) and overjet increased significantly after distraction osteogenesis in both groups, but greater value was found in TMDO group. Palatal length (ANS-PNS) was significantly increased more in AMSDO group compared to TMDO group. In the vertical plane, Nasion-ptm-point A angles (N-ptm-A) and overbite increased significantly in TMDO, but not in AMSDO. In the axial plane, there was a greater increase of posterior arch width and a decrease in anterior arch width in AMSDO but difference was not statistically significant.

TMDO is optimal for comprehensive profile correction, while AMSDO is ideal for increasing arch length. The distractor's angulation directly controls the magnitude of arch lengthening and vertical elongation.