Journal of Maxillofacial and Oral Surgery

, Volume 16, Issue 3, pp 347–355 | Cite as

Study of Distracted Bone in Maxilla: A Comparative Analysis

  • Rohan Thomas Mathew
  • Mustafa Khader
  • Shehzana Fathima
  • B. H. Sripathi Rao
Research Paper



Anterior maxillary distraction is one of the accepted modalities to treat hypoplastic maxilla. The study was undertaken to assess the maturation of the bone formed, which is measured by analyzing the amount of mineralization of the bone.

Materials and Methods

For the study 29 patients were chosen, who were divided into three groups. First group consist of patients who had undergone distraction osteogenesis. Second group has cleft patients and third group is the control group. A bone biopsy using trephine drill is obtained from the subjects. This sample is subjected to Fourier transform infrared spectroscopy (FTIR).


From  the results a mineral to matrix ratio is obtained which is then compared between the three groups. There is a statistically significant difference between the mineralization of the three groups. The distracted bone shows the lowest mineralization while mineralization of the cleft bone is also less than the normal bone.


The study conclusively establishes that the distracted bone is not as mineralized as the normal bone. Although functionally the distracted bone is as good as the native bone and grafted bone as proved by the success rate of the implants placed. The study also highlights the use of FTIR for assessing the bone quality.


Distraction osteogenesis Anterior maxillary distraction Bone quality FTIR 



The authors would like to acknowledge the assistance of Mr.Ganesh, University Science Instrumentation Centre, Mangalore University for the FTIR analysis. This is a self-funded study done in the Yenepoya University, Mangalore, Karnataka, India. There are no conflicts of interest reported. Institutional ethical committee approval has been obtained for the study numbered YUEC 49/14/2/2014. Written patient consents were taken for publishing clinical photographs. All the authors have viewed the manuscript and agreed for submission.


  1. 1.
    Ilizarov GA (1989) The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res 238:249–281Google Scholar
  2. 2.
    McCarthy JG, Schreiber J, Karp N, Thorne CH, Grayson BH (1992) Lengthening the human mandible by gradual distraction. Plast Reconstr Surg 89:1CrossRefPubMedGoogle Scholar
  3. 3.
    McCarthy JG, Stelnicki EJ, Grayson BH (1999) Distraction osteogenesis of the mandible: a ten-year experience. Semin Orthod 5:3CrossRefPubMedGoogle Scholar
  4. 4.
    Cohen SR (1999) Craniofacial distraction with a modular internal distraction system: evolution of design and surgical techniques. Plast Reconstr Surg 103:1592CrossRefPubMedGoogle Scholar
  5. 5.
    Alonso N, Munhoz AM, Fogaca W, Ferreira MC (1998) Midfacial advancement by bone distraction for treatment of craniofacial deformities. J Craniofac Surg 9:114CrossRefPubMedGoogle Scholar
  6. 6.
    Toth BA, Kim JW, Chin M, Cedars M (1998) Distraction osteogenesis and its application to the midface and bony orbit in craniosynostosis syndromes. J Craniofac Surg 9:100CrossRefPubMedGoogle Scholar
  7. 7.
    Cohen SR, Simms C, Burstein FD (1998) Mandibular distraction osteogenesis in the treatment of upper airway obstruction in children with craniofacial deformities. Plast Reconstr Surg 101:312CrossRefPubMedGoogle Scholar
  8. 8.
    Karaharju EO, Aalto K, Kahri A et al (1993) Distraction bone healing. Clin Orthop 297:38Google Scholar
  9. 9.
    Boskey A, Camacho NP (2007) FTIR imaging of the native ad tissue engineered bone and cartilage. Biomaterials 28(15):2465–2478CrossRefPubMedGoogle Scholar
  10. 10.
    Figueiredo MM, Gamelas JAF, Martins AG (2012) Characterization of bone and bone-based graft materials using FTIR spectroscopy, infrared spectroscopy—Life and biomedical sciences, Prof. Theophanides Theophile (ed), ISBN: 978-953-51-0538-1Google Scholar
  11. 11.
    Mazzonetto R, Allais de Maurette M (2005) Radiographic evaluation of alveolar distraction osteogenesis: analysis of 60 cases. J Oral Maxillofac Surg 63(12):1708–1711CrossRefPubMedGoogle Scholar
  12. 12.
    Delloye C, Delefortrie G, Coutelier L, Vincent A (1990) Bone regenerate formation in cortical bone during distraction lengthening: an experimental study. Clin Orthop Relat Res 250:34–42Google Scholar
  13. 13.
    Midgett RJ, Shaye R, Fruge JF (1981) The effect of altered bone metabolism on orthodontic tooth movement. Am J Orthod 80:256–262CrossRefPubMedGoogle Scholar
  14. 14.
    Chiapasco M, Lang NP, Bosshardt DD (2006) Quality and quantity of bone following alveolar distraction osteogenesis in the human mandible. Clin Oral Impl Res 17:394–402CrossRefGoogle Scholar
  15. 15.
    Liou EJW, Figueroa AA, Polley JW (2000) Rapid orthodontic tooth movement into newly distracted bone after mandibular distraction osteogenesis in a canine model. Am J Orthod Dentofacial Orthop 117(4):391–398CrossRefPubMedGoogle Scholar
  16. 16.
    Consolo U, Bertoldi C, Zaffe D (2000) Clinical evaluation, radiologic and histologic analysis in mandibular alveolar distraction procedures. Preliminary study. Minerva Stomatol 49:475–484PubMedGoogle Scholar
  17. 17.
    McAllister BS (2001) Histologic and radiographic evidence of vertical ridge augmentation utilizing distraction osteogenesis: 10 consecutively placed distractors. J Periodontol 72:1767–1779CrossRefPubMedGoogle Scholar
  18. 18.
    Polley JW, Figueroa AA (2001) Distraction Osteogenesis for treatment of severe cleft maxillary deficiency with the RED technique. In: Cherkashin AM (ed) Craniofacial distraction osteogenesis. Mosby, St Louis, pp 485–493Google Scholar
  19. 19.
    Rao S, Kotrashetti SM, Lingaraj JB, Pinto PX, Keluskar KM, Jain S, Rao S (2013) Anterior segmental distraction osteogenesis in the hypoplastic cleft maxilla: report of five cases. Sultan Qaboos Univ Med J 13(3):454CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Saulacic N, Somoza-Martin M, Gándara-Vila P, Garcia-Garcia A (2005) Relapse in alveolar distraction osteogenesis: an indication for overcorrection. J Oral Maxillofac Surg 63(7):978–981CrossRefPubMedGoogle Scholar
  21. 21.
    Gamsjaeger S, Masic A, Roschger P, Kazanci M, Dunlop JWC, Klaushofer K et al (2010) Cortical bone composition and orientation as a function of animal and tissue age in mice by Raman spectroscopy. Bone 47(2):392–399CrossRefPubMedGoogle Scholar
  22. 22.
    Seeman E (2003) Reduced bone formation and increased bone resorption: rational targets for the treatment of osteoporosis. Osteoporos Int 14(3):2–8CrossRefGoogle Scholar
  23. 23.
    Roschger P, Paschalis EP, Fratzl P, Klaushofer K (2008) Bone mineralization density distribution in health and disease. Bone 42(3):456–466CrossRefPubMedGoogle Scholar
  24. 24.
    Van Strijen PJ, Breuning KH, Becking AG et al (2004) Stability after distraction osteogenesis to lengthen the mandible: results in 50 patients. J Oral Maxillofac Surg 62:304CrossRefPubMedGoogle Scholar
  25. 25.
    Costantino PD, Friedman CD, Shindo ML, Houston CG, Sisson GA (1993) Experimental mandibular regrowth by distraction osteogenesis: long term results. Arch Otolaryngol Head Neck Surg 119:511–516CrossRefPubMedGoogle Scholar
  26. 26.
    Elo JA, Herford AS, Boyne PJ (2009) Implant success in distracted bone versus autogenous bone-grafted sites. J Oral Implantol 35(4):181–184CrossRefPubMedGoogle Scholar
  27. 27.
    Fratzl P, Gupta HS, Paschalis EP, Roschger P (2004) Structure and mechanical quality of the collagen/mineral nano-composite in bone. J Mater Chem 14(14):2115CrossRefGoogle Scholar
  28. 28.
    Robling AG, Castillo AB, Turner CH (2006) Biomechanical and molecular regulation of bone remodelling. Annu Rev Biomed Eng 8:455–498CrossRefPubMedGoogle Scholar
  29. 29.
    Nyquist RA, Putzig CL, Leugers MA (1997) The handbook of infrared and raman spectra of inorganic compounds and organic salts, vol 1 and 4. Academic Press, San DiegoGoogle Scholar
  30. 30.
    Boskey A (2006) Assessment of bone mineral and matrix using backscatter electron imaging and FTIR imaging. Curr Osteoporos Rep 4:71–75CrossRefPubMedGoogle Scholar
  31. 31.
    Boskey A (2011) Using bone quality to assess fracture risk. Am Assoc Orthop Surg Now 5(9)Google Scholar
  32. 32.
    Paschalis EP, Betts F, DiCarlo E, Mendelsohn R, Boskey AL (1997) FTIR microspectroscopic analysis of normal human cortical and trabecular bone. Calcif Tissue Int 61:480–486CrossRefPubMedGoogle Scholar
  33. 33.
    Donnelly E (2010) Methods for assessing bone quality: a review. Clin Orthop Relat Res 469(8):2128–2138CrossRefPubMedCentralGoogle Scholar
  34. 34.
    Petibois C, Wehbe K, Belbachir K, Noreen R, Déléris G (2009) Current trends in the development of ftir imaging for the quantitative analysis of biological samples. Acta Physica Polonica A 115(2):507–512CrossRefGoogle Scholar
  35. 35.
    Kourkoumelis N, Tzaphlidou M (2010) Spectroscopic assessment of normal cortical bone: differences in relation to bone site and sex. The Scientific World Journal 10:402–412CrossRefPubMedGoogle Scholar
  36. 36.
    Álvarez-lloret P, Rodríguez-navarro AB, Romanek CS, Gaines KF, Congdon YJ (2006) Quantitative analysis of bone mineral using ftir XXVI REUNi ÓN (SEM)/XX REUNiÓN (SEA) – 2006Google Scholar
  37. 37.
    Boskey A, Camacho NP (2007) FT-IR imaging of native and tissue-engineered bone and cartilage. Biomaterials 28(15):2465–2478CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Oral and Maxillofacial Surgeons of India 2017

Authors and Affiliations

  • Rohan Thomas Mathew
    • 1
    • 2
  • Mustafa Khader
    • 3
  • Shehzana Fathima
    • 3
  • B. H. Sripathi Rao
    • 1
    • 2
  1. 1.Department of Oral and Maxillofacial SurgeryYenepoya Dental CollegeMangaloreIndia
  2. 2.Yenepoya University MangaloreIndia
  3. 3.Centre for Craniofacial AnomaliesYenpoya UniversityMangaloreIndia

Personalised recommendations