Korean J Orthod.  2025 Mar;55(2):142-153. 10.4041/kjod24.184.

Finite element analysis of anterior maxillary segmental distraction osteogenesis using asymmetric distractors in patients with unilateral cleft lip and palate

• Jin Z
• Li R
• Shi J
• Zhang Y
• Chen Z

• KMID: 2565922
• DOI: http://doi.org/10.4041/kjod24.184

Abstract

Objective
The treatment of asymmetric maxillary hypoplasia and dental crowding secondary to unilateral cleft lip and palate (UCLP) is often challenging. This study introduced an asymmetric tooth-borne distractor in anterior maxillary segmental distraction osteogenesis and used three-dimensional finite element analysis to evaluate its potential for clinical application in cases of asymmetrical maxillary hypoplasia.
Methods
A cone-beam computed tomography scan of a late adolescent with UCLP was used to construct a three-dimensional finite element model of the teeth and maxillary structures. An asymmetric distractor model was used to simulate conventional distraction osteogenesis and asymmetric distraction osteogenesis (ADO) to evaluate the resultant stress distribution and displacement.
Results
Postoperatively, both distraction methods resulted in anterior maxillary segment advancement with a slight upward movement. ADO yielded a greater increase in the dental arch length on the cleft side and induced rotation of the anterior maxillary segment, potentially improving midline deviation. Both methods showed similar stress distributions, with higher stress concentrations on the cleft side.
Conclusions
ADO may offer clinical advantages in correcting asymmetrical maxillary hypoplasia in patients with UCLP by facilitating asymmetrical expansion and rotation of the maxilla. Further research is needed to generalize these findings to other clinical presentations.

Keyword

Finite element method; Appliances; Cleft lip and palate; Distraction osteogenesis

Figure

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  Figure 1 A, Design and installation of the asymmetric distractor for patients with unilateral cleft lip and palate. B, Anterior and rotational movement of the segment was achieved by turning the middle and left screws.

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  Figure 2 A, Anterior maxillary segmental distraction osteogenesis horizontal and vertical osteotomy lines for anterior maxillary segment separation in the frontal view. B, Geometrical models and finite element meshes of the maxillary segments, teeth, and asymmetric distractor of the patient with unilateral cleft lip and palate in the occlusal view.

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  Figure 3 Displacement patterns of the bone segment and teeth in the frontal views. (A, B) Total displacement, (C, D) transversal movement on the X-axis, (E, F) sagittal movement on the Y-axis, (G, H) vertical movement on the Z-axis. (A, C, E, G) The displacement patterns of conventional distraction osteogenesis, and (B, D, F, H) the displacement patterns of asymmetric distraction osteogenesis.

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  Figure 4 Displacement patterns of teeth in frontal views. (A, B) The total displacement, (C, D) transversal movement on the X-axis, (E, F) sagittal movement on the Y-axis, (G, H) vertical movement on the Z-axis. (A, C, E, G) The displacement patterns of conventional distraction osteogenesis, and (B, D, F, H) the displacement patterns of asymmetric distraction osteogenesis.

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  Figure 5 Stress distributions of the bone segment and teeth. (A, C) The stress distributions of conventional distraction osteogenesis, and (B, D) the stress distributions of asymmetric distraction osteogenesis.

Reference

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