CLINICAL ASPECTS AMT, v. II, no. 2, 2014, p. 290 DISTRACTION OSTEOGENESIS IN IMPLANT DENTISTRY VIOREL IBRIC CIORANU 1 , VLADIMIR SORIN IBRIC CIORANU 2 , DANA DUMITRA 3 , SILVIU NICOLAE 4 , VASILE NICOLAE 5 1,2,3,4,5 “Lucian Blaga” University of Sibiu Keywords: distraction osteogenesis, bone atrophy, implant supported prosthesis Abstract: When dealing with severe bone atrophy, implantologists and oral surgeons have many options to restore the lost bone including: sinus lifting, IAN lateralization, bone splitting, bone condensing and distraction osteogenesis. Case report: The paper presents the case of a 54-year-old male diagnosed 3 years ago with carcinoma of the floor of the mouth. He was subjected to a marginal anterior resection and modified neck dissection. Histological exam for the lymph node proved to be negative. After a non eventful follow-up period, the surgical team placed an internal distraction device, followed by insertion of 4 implants and prosthesis. Results and discussions: distraction osteogenesis represents a viable option in treating bone deficiencies. The good results obtained by us confirm the importance of this surgical technique that has many advantages. One of the many advantages of the technique is that is does not require a donor site for graft, it enhances both hard and soft tissue together and the resorption is kept to minimum due to good blood supply, the transplantation also having periostal vessels and the minimal complications. Cuvinte cheie: osteodistracție, atrofie osoasă, reconstrucție implanto-protetică Rezumat: În defectele osoase importante ale proceselor alveolare alături de reconstrucția acestora cu ajutorul grefelor osoase sau a altor tehnici chirurgicale alternative precum: sinus lifting, lateralizarea nervului, bone splitting, bone condensing s-a impus și osteodistracția procesului alveolar pentru a permite inserarea implantelor. Prezentare de caz – Este vorba despre un pacient de 54 ani operat în urmă cu 3 ani pentru carcinom spinocelular (scuamos) de planșeu bucal anterior (T2N1aMo) la care s- a făcut ablația tumorii cu rezecția segmentară a procesului alveolar anterior și evidare ganglionară supraomohioidiană bilaterală, ganglionii fiind negativi la examenul anatomopatologic. Datorită evoluției favorabile a afecțiunii de bază se efectuează osteodistracția procesului alveolar restant în zona anterioară a mandibulei (interforaminal), urmată de inserarea a 4 implanturi și reconstrucție protetică conjunctă. Rezultate și discuții – Elongarea dirijată a procesului alveolar constituie o alternativă viabilă în refacerea defectelor osoase pentru a permite reabilitarea implanto-protetică. Rezultatul bun obținut de noi confirmă importanța acestei tehnici chirurgicale ce are multiple avantaje: elimină o nouă intervenție de recoltare a unor grefe osoase, obținerea concomitentă a unor țesuturi moi, resorbție minimă, transplantul având și vase periostale, complicații minime. 1 Corresponding author: Sorin Ibric Cioranu, Bd. Tineretului, Nr. 51, Ap. 47, București, Sector 4, România, E-mail: isorin83@yahoo.com, Tel: +40748 365320 Article received on 10.11.2013 and accepted for publication on 02.04.2014 ACTA MEDICA TRANSILVANICA June 2014;2(2):290-292 INTRODUCTION Implant supported prosthesis is often hard to manage in sites where there is a severe bone atrophy caused by early edentulism, age, systemic disease, tumour resection. The standard techniques used to treat such cases require the knowledge of experienced surgeons and are often associated to many complications.(1) The introduction of distraction osteogenesis led to more accurate bone management with good efficacy allowing implants to be placed in more favourable prosthetic positions. This technique is derived from orthopedic treatment and it was first described in the past century, when a report mentioned that an orthopedist tried to fix a femur fracture with an external device. The result was not bone fixation but rather progressive bone elongation. The final result was the achievement of good quality new bone tissue. The Russian orthopedist Ilizarov is the one who applied the technique in large bone defects.(2) This method was introduced to current maxillo-facial practice after the ’90. After 1996, the treatment was applied to alveolar bone deficiency and led to new bone formation with a good blood supply.(3) A bone fracture when it heals, it passes through several stages and it relies on a bone callus. The blood clot between the 2 bone fragments will turn into a mesenchyme tissue. The macrophages cells will resorb it and the fibroblasts will form a fibrous tissue which will mature in an osteoid tissue. This tissue will receive minerals thus forming a bone tissue that will reshape itself.(4) When a distraction device is applied in an osteotomy site, it will impact on the newly formed non mineralized bone tissue and it will lead in a new bone formation with a good supply. Also, soft tissue will follow the regenerated bone.(5) CASE REPORT We followed up on a period of 6 years, a 54-year-old male patient diagnosed with squamous carcinoma of the floor of