Future Directions: Osteotomy Techniques
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Due to the anatomy of the mandible, the osteotomy will remain one of the most critical components of distraction osteogenesis. Improvements in osteotomy techniques should proceed toward a division of bone without disruption of the periosteum, endosteum, or neurovascular bundle within the medullary canal (Miao et al., 1997). This is particularly important at sites with insufficient host bone at the ends of the osteotomized segments, as is the case with bone cuts between teeth. Recently, Bell and colleagues demonstrated that marginal alveolar bone at interdental osteotomy sites had to be maintained in order to maximize bone formation within the regenerate tissue (Bell et al., 1997)

FIG. 7.1-7.4. Schematic drawings and histologic assessment of alveolar distraction regenerate 4 weeks after mandibular midline widening in macaca mulatta monkeys with intact residual bone present on both sides of the osteotomy (left) and with intact residual bone present on only one side of the osteotomy (right). Note that bony trabeculae within the regenerate connected both bony surfaces (left) and formed only from the side with preserved residual bone (right). Reproduced with permission from Bell WH, Harper RH, Gonzalez M, Cherkashin AM, Samchukov ML. Distraction osteogenesis to widen the mandible. Br J Oral Maxillofac Surg 1997;35:11-19.

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