CASE REPORT

Distraction osteogenesis is one of the latest treatment modalities in correcting skeletal discrepancies in the craniofacial region. Maxillary retrusion is a common problem when deformity of the face is concerned, especially in cleft lip and palate patients. Distraction osteogenesis utilizing internal or external has an enormous role in future as an alternative method of skeletal correction in patients with severe maxillary hypoplasia. In addition, periodontal rehabilitation in these patients is of utmost importance especially at the end of treatment. This case report presents one such case of severe maxillary retrusion treated successfully by distraction osteogenesis. JMS 2012;15(1):78-81.

cases it is difficult to mobilize the maxilla due to scar tissue.Distraction osteogenesis is an alternative procedure for maxillary advancement in these cases, which leads to marked 4 forward movement of maxilla.Distraction osteogenesis can [5][6][7] utilize devices that can be internal or external.

Case Report
A 20 year male with bilateral repaired group III cleft reported to Oral Health Sciences Centre, Post Graduate Institute of Medical Education a n d R e s e a r c h (PGIMER), Chandigarh with a complaint of Smid face deficiency (Figure 1).He had skeletal class III malocclusion mainly d u e t o m a x i l l a r y retrusion, The angle ANB was -40.The maxillary length was 3 8 m m , w h i c h w a s Distraction osteogenesis with periodontal rehabilitation: A Case Report Tutor, Government Dental College and Hospital, Srinagar; Professor and Head, Oral Health Sciences Centre, PGIMER, Chandigarh; 3 Roobal Behal, Lecturer, Government Dental College and Hospital, Srinagar.
Distraction osteogenesis is one of the latest treatment modalities in correcting skeletal discrepancies in the craniofacial region.Maxillary retrusion is a common problem when deformity of the face is concerned, especially in cleft lip and palate patients.Distraction osteogenesis utilizing internal or external has an enormous role in future as an alternative method of skeletal correction in patients with severe maxillary hypoplasia.In addition, periodontal rehabilitation in these patients is of utmost importance especially at the end of treatment.This case report presents one such case of severe maxillary retrusion treated successfully by distraction osteogenesis.JMS 2012;15(1):78-81.

A B S T R A C T
(Figure 5) .Phase II was the surgical phase It was carried on the maxilla to mobilize the segment.A rigid extra oral distractor was attached to intra oral splint followed by a lag phase of 5 days.During this lag phase, the patient recovered from facial edema Distraction was commenced with a rate of 1mm per day till a positive over jet was achieved (Figures 8,9,10).This was followed by consolidation period for 8 weeks and after that the distractor was removed (Figure 12).
approximately 10-12 mm less than the normal value, and the mandibular length was near normal.The treatment was divided into three phases: Phase 1 was the presurgical phase .It consisted of alignment and leveling of both upper and lower arches by orthodontic treatment (Figures 2,3,4).Surgical splint consisting of custom designed face bow and acrylic occlusal bite plane was prepared Face bow alongwith the surgical splint was cemented to the maxillary teeth The pre and post distraction Cephalometric radiographs showed a tremendous change (Figure 13, Table 1).Phase III consisted of post distraction phase in which settling and good intercuspation of teeth was achieved (Figure 14).In this patient, the periodontal rehabilitation was of utmost importance as the splint in place had done iatrogenic damage to the gingiva (Figure 11), So periodontal therapy in the form of scaling and root planing was carried out and the patient was prescribed 0.2% cholorhexidene mouthwash The patient was asked to continue it for four weeks The patient showed obvious signs of improvement in the gingival condition after 4 weeks (Figure 14).

Discussion
Maxillary advancement with Distraction Osteogenesis improves facial profile by reducing the facial concavity, increasing nasal projection and moving upper lip forward in a range greater than conventional orthognathic surgery as 3,4 described by Molina.The amount of maxillary advancement by the procedure was about 10-11 mm which corrected the anterioposterior discrepancy (Table 1).In addition, periodontal therapy after the distraction device is removed provides good improvement in overall rehabilitation of these cleft patients.Advantages of Distraction Osteogenesis include brief operating time, distraction histogenesis, maintenance of vascularity and neurosensory integrity of bone, no need for bone grafts, greater stability, single jaw surgery instead of two-step jaw surgery, Pre-surgical orthodontics is optional in many cases.
In conclusion, the amount of maxillary advancement in the above mentioned case was significantly greater in

TABLE 1 . Comparison of pre and post-distraction Cephalometric values
FIGURE 14. Post treatment Intraoral Photographs distraction as compared to conventional orthognathic surgery alone.Distraction osteogenesis can induce significant soft tissue changes thus, improving the facial esthetics Periodontal rehabilitation improved the gingival health as well as micro aesthetics.