Comparison of intraosseous and extraosseous alveolar distraction osteogenesis.

PURPOSE: To evaluate and compare intraosseous and extraosseous alveolar distraction osteogenesis. PATIENTS AND METHODS: Twenty-three distractors (13 intraosseous; 10 extraosseous) were placed in 21 patients (9 males, 12 females; age range, 12 to 55 years; mean age, 37.9 years) with alveolar ridge deficiencies. Periodontal disease and alveolar resorption following tooth removal was the most common reason for alveolar distraction osteogenesis (n = 14). The length of the segments were less than 2 cm in 15 defects, 2 to 4 cm in 2 defects and more than 4 cm in 6 defects. At the end of consolidation period 25 implants were inserted to the intraosseous group and 17 implants to the extraosseous group.
RESULTS: In 21 patients with 23 distracted sites, the mean alveolar distraction was 11.6 mm (range, 5 to 20 mm). The overall complication rates in the intraosseous and extraosseous groups were 61.5% and 50%, respectively. Complications of both groups were mostly minor (95.8%; tilting of the segment, rod interference), only 1 segment fracture in the intraosseous group (4.2%) was considered as a major complication. The most common minor complication in the intraosseous group was tilting of the distracted segment (38.3%). Rod interference with the opposing arch (30%) was the most common minor complication in the extraosseous group. The survival rates of the implants for intraosseous and extraosseous groups were 88% and 94%, respectively. Although complication rate was higher and implant success rate was lower in the intraosseous group, there was no statistical significance between the groups (P > .05).
CONCLUSION: Intraosseous and extraosseous alveolar distractors presented no statistically significant complication rates and implant success rates. The clinician must choose an ideal size and type of the distractor according to the defect size, shape, patient tolerance, and distance to the opposing arch.