Biomedical subjects

M L Samchukov

Publications and source records attributed to M L Samchukov.

At least 19 recordsLinked to original sources

PubMed1999

Biomechanics of mandibular distractor orientation: an animal model analysis.

PURPOSE: Previous reports suggest that device orientation may be one of the most important parameters affecting the successful application of osteodistraction. However, only computer models or cadaver mandibles have been used to investigate the biomechanical effects of device orientation during mandibular distraction osteogenesis. Therefore, the purpose of this study was to compare two different device orientations during bilateral mandibular osteodistraction in an animal model. MATERIALS AND METHODS: Fifteen skeletally mature beagle dogs underwent 10 mm of bilateral mandibular lengthening by intraoral distraction osteogenesis. The dogs were divided into two groups based on the orientation of the distraction device relative to the mandible when viewed occlusally: either parallel to the body of the mandible (group I) or parallel to the axis of distraction (group II). The effects of device orientation during osteodistraction were then analyzed clinically, radiographically, and by dental cast measurements. RESULTS: Distractors oriented parallel to the body of the mandible caused an increase in the anterior width of the proximal mandibular segments. This lateral displacement of the proximal segments led to several clinical complications, including screw fixation failure and bone resorption under the fixation plates. These effects were minimized when the device was oriented parallel to the axis of distraction. CONCLUSIONS: Device orientation plays an important role when applying distraction osteogenesis in a clinical setting. Although other intrinsic and extrinsic factors affect the success of osteodistraction, the devices should be oriented parallel to the axis of distraction to minimize adverse biomechanical effects during bilateral mandibular lengthening.

Animals↗

PubMed1999

Intraoral widening and lengthening of the mandible in baboons by distraction osteogenesis.

PURPOSE: The purpose of this study was to analyze the skeletal and dental positional changes and histomorphology of the distraction regenerates and mucogingival periosteal tissues that occurred after simultaneous widening and bilateral lengthening of the mandible in baboons by a miniaturized intraoral bone-borne distraction appliance. MATERIALS AND METHODS: Distraction appliances were activated 5 days after vertical ramus and symphyseal osteotomies at a rate of 0.9 mm/d for 10 days. The appliances were then stabilized for 8 weeks, after which the animals were killed. The distraction gaps and gingival tissues were analyzed clinically, histologically, and by standardized radiographic studies. RESULTS: Positional changes of the canines and incisor apices were proportional to the skeletal movements. Tipping of both incisors toward the center of the distraction gap was observed. Proportionate movement of the superior and inferior portion of the distracted segments was noted. Newly formed longitudinal trabecular columns parallel to the vector of distraction originated from the intact margins of alveolar bone contiguous with the adjacent teeth. Active histogenesis occurred in the stretched mucogingival periosteal tissues located in the distraction gaps. CONCLUSIONS: The results of this investigation support the clinical use of the miniaturized intraoral bone-borne distraction appliance to selectively widen and lengthen the mandible. The orientation of the mandibular distractors must be parallel to the common vector of distraction, which should be parallel to the maxillary occlusal plane. The formation of a bone regenerate in the alveolar region depends on the presence of an adequate bone interface on either side of the distraction gap.

Alveolar Process↗

PubMed1999

The effect of sagittal orientation of the distractor on the biomechanics of mandibular lengthening.

PURPOSE: It has been previously demonstrated that distractors placed parallel to the mandible in the transverse plane, without regard to the vector of distraction create lateral displacement tendencies at the appliance-bone interface, leading to potential clinical problems and complications. The purpose of this study was to evaluate the biomechanical effects of linear distractor orientation in the sagittal plane relative to the anatomic axis of the mandible (mandibular plane) and the maxillary occlusal plane. MATERIALS AND METHODS: A 2-dimensional model of the human mandible was generated for computer simulation of osteodistraction. Positional changes of the distal mandibular segment were then analyzed during 10 mm of incremental lengthening based on distractor orientation relative to the maxillary occlusal plane. RESULTS: Distractors placed parallel to the inferior border of the mandible without regard to the maxillary occlusal plane created a vertical translation of the distal bone segment resulting in an anterior open bite. The magnitude of the anterior open bite was proportional to the angle between the vector of distraction and the maxillary occlusal plane, and to the amount of distraction. Placement of the distractors parallel to the maxillary occlusal plane eliminated the tendency for an anterior open bite. CONCLUSIONS: The orientation of the distractors relative to the maxillary occlusal plane is one of the important biomechanical parameters that must be included in preoperative planning for mandibular osteodistraction.

Biomechanical Phenomena↗

PubMed1999

Experimental tooth movement through regenerate alveolar bone: A pilot study.

The purpose of this pilot study was to experimentally evaluate tooth movement through regenerate bone at an early time point during the consolidation phase after bilateral mandibular osteodistraction. Two beagle dogs underwent 10 mm of bilateral mandibular lengthening via intraoral distraction osteogenesis between the fourth premolars and first molars. After 1 week of consolidation, retraction of the fourth premolars was initiated. Immediately after completing premolar retraction, the dogs were sacrificed and the mandibles were analyzed radiographically, histologically, and by dental cast measurements. Initially, all 4 fourth premolars moved distally, with 2 of the 4 touching the first molars at the time of sacrifice. Based on the current data, it is possible to move teeth through regenerate bone, and it appears that tooth movement can begin within weeks of starting the consolidation period.

Animals↗

PubMed1999

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.

Craniofacial Abnormalities↗

PubMed1998

Evaluation of inferior alveolar nerve function during distraction osteogenesis in the dog.

PURPOSE: A series of electrophysiologic studies were performed in a canine model to evaluate inferior alveolar nerve (IAN) function during distraction osteogenesis of the mandible. MATERIALS AND METHODS: Fourteen dogs, including two controls, were used in the study. Twelve dogs underwent a 10-mm bilateral mandibular lengthening with an intraoral bone-borne appliance and midbody osteotomy. By using sensory nerve action potentials, IAN function was assessed before and immediately after surgery, before and at the completion of distraction, and before necropsy after 4, 6, or 8 weeks of fixation. RESULTS: Twelve of the 24 nerves showed a complete loss of evoked potential after surgery without recovery at any point throughout the study. Acute nerve injury caused by either the osteotomy or screw encroachment was identified at necropsy. The other 12 nerves showed reproducible responses after surgery. Eight of these nerves had significant amplitude attenuation of the evoked potentials, which was identified at necropsy as a result of acute injury. The remaining four nerves did not show significant evoked potential abnormalities and appeared to be grossly normal at necropsy. During distraction, the amplitude of evoked potentials in all 12 nerves remained at the postoperative level, whereas latency showed a significant delay. In 7 of these 12 nerves, various degrees of evoked potential recovery were identified at the completion of the study. CONCLUSIONS: The high incidence of acute IAN injury in the current study was primarily related to device construction and osteotomy technique. If acute nerve injury is avoided at surgery, distraction osteogenesis with 10 mm mandibular lengthening appears to produce minimal deleterious effect on IAN function.

Action Potentials↗

PubMed1998

Biomechanical considerations of mandibular lengthening and widening by gradual distraction using a computer model.

PURPOSE: Experience using distraction osteogenesis for limb lengthening has shown the importance of appliance orientation. Although successful results of mandibular lengthening using osteodistraction have been reported, optimal orientation of the distractors relative to the mandible has not been determined. The purpose of this study was to evaluate the biomechanical effects of linear distractors placed parallel to the body of the mandible or parallel to the axis of distraction. MATERIALS AND METHODS: A two-dimensional model of the human mandible was generated for computer simulation of mandibular osteodistraction. Linear distractors were then analyzed based on their orientation, either parallel to the body of the mandible or parallel to the axis of distraction. In addition, two types of distraction osteogenesis procedures for mandibular reconstruction were analyzed: 1) bilateral mandibular lengthening, and 2) bilateral mandibular lengthening in combination with midline mandibular widening. RESULTS: Distractors oriented parallel to the body of the mandible caused a lateral displacement of the posterior components of the distraction devices and a reduction of the midline distraction gap during mandibular lengthening. These effects were eliminated when the device was oriented parallel to the axis of distraction. Midline symphyseal widening created axial rotation of the mandibular condyles regardless of the orientation of the distractors. CONCLUSIONS: Distraction appliances must be oriented parallel to the axis of distraction to prevent adverse biomechanical effects during bilateral mandibular lengthening. Additional ramus osteotomies, using hinged devices for angular correction, may be necessary to compensate for rotational movements of the mandibular condyles secondary to midline osteodistraction.

Biomechanical Phenomena↗

PubMed1998

Histomorphometry of distraction osteogenesis in a caprine tibial lengthening model.

Standardized histomorphometry of bone formation and remodeling during distraction osteogenesis (DO) has not been well characterized. Increasing the rhythm or number of incremental lengthenings performed per day is reported to enhance bone formation during limb lengthening. In 17 skeletally immature goats, unilateral tibial lengthenings to 20 or 30% of original length were performed at a rate of 0.75 mm/day and rhythms of 1, 4, or 720 times per day using standard Ilizarov external fixation and an autodistractor system. Two additional animals underwent frame application and osteotomy without lengthening and served as osteotomy healing controls. Histomorphometric indices were measured at predetermined regions from undecalcified tibial specimens. Within the distraction region, bone formation and remodeling activity were location dependent. Intramembranous bone formed linearly oriented columns of interconnecting trabecular plates of woven and lamellar type bone. Total new bone volume and bone formation indices were significantly increased within the distraction and osteotomy callus regions (Tb.BV/TV, 226% [p < 0.05]; BFR/BS, 235-650% [p < 0.01]) respectively, compared with control metaphyseal bone. Bone formation indices were greatest adjacent to the mineralization zones at the center of the distraction gap; mineral apposition rate 96% (p < 0.01); mineralized bone surfaces 277% [p < 0.001]); osteoblast surfaces 359% [p < 0.001]); and bone formation rate (650% [p < 0.01]). There was no significant difference (p < 0.14; R = 0.4) in the bone formation rate of the distracted callus compared with the osteotomy control callus. Within the original cortices of the lengthened tibiae, bone remodeling indices were significantly increased compared with osteotomy controls; activation frequency (200% [p < 0.05]); osteoclast surfaces (295% [p < 0.01]); erosion period (75%); porosity (240% [p < 0.001]). Neither the rhythm of distraction nor the percent lengthening appeared to significantly influence any morphometric parameter evaluated. Distraction osteogenesis shares many features of normal fracture gap healing. The enhanced bone formation and remodeling appeared to result more from increased recruitment and activation of bone forming and resorbing cells rather than from an increased level of individual cellular activity.

Animals↗

PubMed1997

Distraction osteogenesis to widen the mandible.

The purpose of this investigation was to elucidate the biology of distraction osteogenesis during mandibular widening. Midsymphyseal vertical interdental osteotomies were performed in nine Macaca mulatta monkeys. After a latency period a tooth-borne appliance was activated at a rate of 0.5 mm twice a day for 7-10 days. The appliance was then stabilized for a period of 4 or 8 weeks. The distraction gap at the inferior portion of the symphysis was bridged completely by new bony trabeculae. Bone formation in the interdental area was apparently related to the surgical technique. Newly formed bony trabeculae were oriented parallel to the direction of distraction. The location of the osteotomy site with an adequate margin of alveolar bone contiguous with the adjacent teeth was necessary for the induction of the distraction osteogenesis. Disproportional movement between superior and inferior portions of the distracted segments was noted.

Alveolar Process↗

PubMed1997

Reactive changes in the temporomandibular joint after mandibular midline osteodistraction.

The purpose of this study was to evaluate the histologic changes within the condyle in response to mandibular widening using osteodistraction. Mandibular midline osteotomies were made in nine Macaca mulatta monkeys and tooth-borne distraction devices were bonded to the mandibular dentition. Distraction was continued until a 3-5 mm widening was achieved. The appliances were then stabilized for a period of 4 weeks. Non-decalcified sagittal sections of the lateral, middle and medial thirds of the condyles were analyzed. Although three of the seven animals showed no unusual morphology, four others exhibited morphologic differences within the fibrous layer, cartilage layer or bone/cartilage interface. Histologic changes were seen to occur in the fibrous layer, cartilaginous layer and cartilage/bone interface. The severity of these changes were correlated with the likely rotational forces directed at the condyle on the postero-lateral and antero-medial surfaces.

Analysis of Variance↗

PubMed1996

Effects of external fixation and limb lengthening on peripheral nerve function.

To identify factors affecting peripheral nerve function during limb lengthening, serial somatosensory evoked potentials studies were performed in 18 goats and correlated with gross appearance of the soft tissues at necropsy. In 15 goats, a 20% or 30% tibial lengthening was done using the Ilizarov apparatus at a rate of 0.75 mm per day and rhythm of 1, 4, or 720 times per day. Three animals served as frame/corticotomy controls. Seven lengthened and 2 control animals maintained normal somatosensory evoked potentials throughout the study. At necropsy, the peroneal and tibial nerves appeared grossly normal. In one control animal with irreversible loss of evoked potentials documented intraoperatively, peroneal nerve impalement by a transfixion wire was identified at necropsy. Eight lengthened animals experienced significant changes of peroneal nerve conduction. In 6 of these 8 animals, transfixion wires were found to be disrupting the nerve in some way. In the remaining 2 animals, no offending wires were identified, but there was extensive diffuse soft tissue fibrosis within the extremity. The rhythm of distraction did not have an important influence on evoked potential changes during the course of distraction. Although there was a correlation between the amount of lengthening performed and the degree of evoked potentials deterioration, the anatomic relationship between the wires and nerves was a more important factor in the development of these abnormalities.

Animals↗

PubMed1995

Computer-assisted surgery planning for lower extremity deformity correction by the Ilizarov method.

Starting in 1952, Prof. Gavril Ilizarov, a Russian orthopedic surgeon, devised a complex method of long bone deformity correction using an external bone fixation system consisting of rings and wires. We have developed a computer-assisted surgery planning system to aid in correction using the Ilizarov method. The hardware for the system is composed of an ultrasonic digitizer as input device, an HI plotter as output device, a 386/486 personal computer with super VGA monitor, and a mouse interfacing between user and computer. The software includes two separate programs. The main program is a menu-driven two-dimensional graphics program, which divides the planning procedure into several major stages, including preoperative planning and postoperative verification. The second program uses the information generated from the first program to create an image of the ideal three-dimensional frame construction to give a general impression of the appearance of the constructed frame.

Computer Simulation↗

PubMed1994

Somatosensory evoked potential evaluation of acute nerve injury associated with external fixation procedures.

The effects of different mechanisms of acute nerve injury on peripheral nerve function during K wire application and 1 stage limb lengthening were evaluated prospectively in 24 goats using somatosensory evoked potentials. Stable somatosensory evoked potential recordings throughout 3-day experiments were obtained in animals with wires placed at a distance from or directly adjacent to a nerve but without producing any tension or pressure. Complete loss of the peroneal nerve somatosensory evoked potentials occurred if this nerve was perforated by wire, underwent excessive pressure by wire, or had been over-stretched due to acute 10% limb lengthening. Acute distraction resulted only in peroneal nerve dysfunction, while the tibial nerve was relatively unaffected. Although somatosensory evoked potential changes were not specific for the type of injury produced and the time of waveform disappearance varied, significant somatosensory evoked potential changes (> 50% amplitude reduction, > 10% latency delay or both) were seen within the first 15 minutes after injury in 90% of the cases. The somatosensory evoked potential changes did not reverse if the offending wire or distraction was left in place for the full duration of the experiment. Variable nerve conduction recovery was observed in all animals who had the insult removed immediately after the somatosensory evoked potentials disappearance. The greatest improvement occurred after discontinuation of nerve distraction. The worst somatosensory evoked potential waveform recovery was noted in animals with nerve perforation. Intraoperative somatosensory evoked potential monitoring proved to be a reliable and useful technique for earlier detection of acute nerve injury during external fixation procedures.

Animals↗

PubMed1992

Pelvic support femoral reconstruction using the method of Ilizarov: a case report.

A 15-year-old boy presented with a fixed, irreducible congenital dislocation of the hip associated with other multiple lower extremity growth disturbances secondary to neonatal multifocal osteomyelitis. The affected hip had very limited abduction, and the patient had a very severe Trendelenburg gait secondary to the dislocation. The hip was reconstructed according to the Ilizarov method, by a combination of maximum proximal femoral adduction osteotomy in the subtrochanteric region and distal femoral corticotomy, to permit the gradual realignment of the knee into the new weight-bearing axis produced by the proximal osteotomy. Total fixation time for the femoral reconstruction was two months. Five months after removal of the apparatus, the patient was returned to full function with a remarkably improved gait.

Adolescent↗

PubMed1988