How Is A Custom-Made Maxillary Internal Distractor Fabricated
A maxillary internal distractor is a tooth-borne device that 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
We custom-make the internal maxillary distractor by taking an impression of the upper jaw using Alginate, an irreversible hydrocolloid impression material.
We then place the Separators inter-dentally between molars and premolars to create adequate space to cement the fabricated appliance.
Design of distractor
We use specially designed screws in a distractor to fabricate on the cast made from the impression. The physician then molds stainless steel bands to fit the premolars and molars of both right and left sides. We place specially designed screws in the midline posteriorly. The next step is to solder the crew to bands on premolars and molars.
Intraoral cementation of the distractor
We then remove the Separators placed earlier and check the intraoral fit of the distractor. The next step is to perform the oral prophylaxis and fix the distractor intraorally using luting glass ionomer cement. We leave the distractor undisturbed until the surgery.
Maxillary Distraction Surgery
Physicians perform the surgery under general anesthesia and then perform Osteotomy of the maxillary segment. The next step is to check the movement of the segment by activating the screw. Once checked, we deactivate the screw and place the sutures.
Activation of Distractor
The screw is activated from the 5th-day after operation. It is activated two times a day; with each activation, includes 4 turns of the screw. The next step is to continue this activation until we achieve the desired maxillary movement.
Intra-orally, dento-alveolar space is gained between the second premolar and first molar.
Success Story of Distractor
After required activation, physicians allow the screw to remain intra-orally as a retainer, allowing a new bone to form in in the created space . Sometimes, we advise a Cone Beam Computed Tomography imaging of craniofacial structure after a month.
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 next step involves removing the appliance and perform oral prophylaxis for the benefit of the patient.We make an alginate impression of the upper jaw and fabricate the Acrylic plate to maintain the created space , and finally design a bridge for this space gained.
Advantages of Internal distractor:
- Postoperative activation
- Easy removal
- Aesthetically pleasing
Disadvantages of Internal distractor:
- Poor oral hygiene
- The patient may experience pain 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