Fabrication of a custom made Maxillary Internal Distractor
The maxillary internal distractor is a tooth-borne device. It receives its anchorage from the tooth and exhibits it force on the bone to get the desired result.
Indications for Internal maxillary distraction
- Cleft of lip and palate
- Maxillary hypoplasia
- Certain orthognathic surgeries
- Craniofacial corrective surgeries
Fabrication of Internal maxillary distractor
The internal maxillary distractor is custom made. The impression of the upper jaw is made using Alginate, an irreversible hydrocolloid impression material.
Separators are placed interdentally between molars and premolars to create adequate space for the cementation of the fabricated appliance.
Design of distractor
Specially designed screws are used in a distractor. The distractor is fabricated on the cast made from the impression. Stainless steel bands are molded to fit the premolars and molars of both right and left sides. Specially designed screws are placed in the midline posteriorly. The crew is then soldered to bands on premolars and molars.
Intraoral cementation of the distractor
Separators placed earlier are removed. The intraoral fit of the distractor is checked. Oral prophylaxis is performed. The distractor is fixed intraorally using luting Glass Ionomer cement. The distractor is left passive until the distraction surgery.
Maxillary Distraction Surgery
Surgery is performed under general anesthesia. Osteotomy of the maxillary segment is done. Movement of the segment is checked by activating the screw. Once checked, a screw is deactivated. Sutures are placed.
Activation of Distractor
Screw activation begins from the 5th-day postoperatively. It is activated two times a day. Each activation includes 4 turns of the screw. Activation is continued until the desired maxillary movement is achieved.
Intraorally, dentoalveolar space is gained between the second premolar and first molar.
Success Story of Distractor
After required activation screw is allowed to remain intraorally as a retainer. Permitting new bone formation to take place in the space created. Probably after a month a Cone Beam Computed Tomography imaging of craniofacial structure is advised.
CBCT imaging helps to evaluate the amount of bone formed, to determine the progress of treatment with the change in profile, to decide the need for removal of the appliance.
Post – Distractor phase
The appliance is removed and oral prophylaxis is done for the benefit of the patient. Alginate impression of the upper jaw is made. Acrylic plate is fabricated and delivered to maintain the space created. Later on, a bridge can be designed for this space gained.
Advantages of Internal distractor:
- Postoperative activation
- Easy removal
- Aesthetically pleasing
Disadvantages of Internal distractor:
- Poor oral hygiene
- Pain is experienced with each activation
In Richardsons Dental and Craniofacial Hospital we encounter a number of similar patients exhibiting high success rate with treatment. Surgery is performed by Dr. Sunil Richardson, Oral and Maxillofacial surgeon, a specialist in craniofacial surgeries
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