distraction osteogenesis ppt

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Histomorphometric and Micro-CT analysis of the contralateral mandible during unilateral Mandibular Distraction Osteogenesis Daniel A Schwarz MD; Krikor Arman BS, Ayman Elmeligy MD, Ameen Jamali, Jordan Stewart and Steven R Buchman MD:

Histomorphometric and Micro-CT analysis of the contralateral mandible during unilateral Mandibular Distraction Osteogenesis Daniel A Schwarz MD; Krikor Arman BS, Ayman Elmeligy MD, Ameen Jamali, Jordan Stewart and Steven R Buchman MD

Introduction:

Introduction Craniofacial Surgeons DO mandible 15yrs Increased use craniofacial skeleton Currently study: Mechanism action; Metrics healing; New methods to enhance osteogenesis

Purpose:

Purpose Unilateral use in mandible Affect on contralateral mandible? No healing regenerate or fracture Micro-architecture of existing bone

Hypothesis:

Hypothesis The forces involved with unilateral MDO will show a significant affect on the ultra-structure of contralateral hemi-mandibles, when compared to un-operated controls.

Study Design - Methods:

Study Design - Methods B ilateral f rame distractor Male SD rats (400g) Unilateral vertica l osteotomy Posterior to m olar s

Distraction Osteogenesis:

Ext ernal fixat or Gradual Distraction Biomechanical stress and strain Induced/transmitted affect Distraction Osteogenesis

Micro-CT:

Micro-CT Non-Destructive Quantitation of bone Microarchitecture at 45 µ resolution Bone Quality via Quantitative means

Quantitative Histomorphometry:

Quantitative Histomorphometry De-Calcified 7 µm Paraffin Gomori Trichrome Bioquant ® Thresholding

Slide 9:

ROI Template Calibrated between µ CT and Histology Reviewers BMD, BVF, vBMD ~ µ CT BV/TV ~ histology

Statistics:

Statistics cC n = 26 µ CT; n = 6 Histology uC n = 18 µ CT; n = 6 Histology ANOVA w/ post hoc comparison Significance @ p < 0.05

µCT Analysis:

µCT Analysis BVF = % bone in ROI

BMD and vBMD:

BMD and vBMD BMD general for entire ROI vBMD specific for actual bone in ROI vBMD = BMD/ BVF ; More of Same cC uC

Slide 14:

Bioquant ® cC Total Volume uC Total Volume

Slide 15:

Bioquant ® Bone Volume cC uC

Results:

Results Two separate modalities bone quantity: Significant ultrastructural changes contralateral mandible during unilateral MDO Increase both BMD and BVF supported by similar increase in BV/TV Increase quantity bone same density

CONCLUSIONS:

CONCLUSIONS Increased bone in cC of MDO occurs due to a probable force induced upregulation in osteogenesis, or a potential decrease in bone resorption.

CONCLUSIONS:

CONCLUSIONS In line with the functional matrix theory, there are unexpected and unintended consequences which we must take into consideration when planning unilateral distraction osteogenesis.

Acknowledgements:

Acknowledgements Steve Goldstein, PhD Paul Makidon, DVD University of Michigan Orthopaedic Research Laboratories Carl’s Foundation