Mandibular distraction osteogenesis: A historic perspective and future directions

Although orthognathic surgery has gained a generalized acceptance for maxillomandibular deformity correction, several limitations are associated with acute advancement of osteotomized bone segments. Furthermore, large skeletal discrepancies, such as those seen in syndromic patients, require such extensive bone movements that the surrounding soft tissues will not adapt to their new position, resulting in relapse or compromised function and esthetics. Recently, a number of experimental and clinical investigations have demonstrated that gradual mechanical traction of bone segments at an osteotomy site created in the craniofacial region can generate new bone parallel to the direction of traction. This phenomenon, known as distraction osteogenesis, opens up new possibilities in the correction of craniofacial deformities by orthodontists and maxillofacial surgeons. Hence, the purpose of this article is to review the historic development and biologic foundation of mandibular distraction osteogenesis, critically evaluate the current mandibular distraction devices with their clinical applications, and predict the future evolution of mandibular osteodistraction techniques.