Formation of new bone during vertical distraction osteogenesis of the human mandible is related to the presence of blood vessels

Abstract

We examined the effect of distraction rate on blood vessel growth in intramembraneous ossification after vertical distraction osteogenesis in the human mandible. Six edentulous patients (aged 60+/-9 years) with a severely atrophic mandible underwent bone augmentation with distraction osteogenesis. Two distraction rates (0.5 and 1 mm/day) were compared and for each group three patients were analyzed. Vascular histomorphometry was carried out in two different areas in the distraction gap: (1) in the first and (2) in the second 1 mm area from the osteotomy line, representing the oldest and younger new-bone area, respectively. Correlation analysis was performed between blood vessel parameters and the amount of new bone formed during distraction. Histological analysis demonstrated the presence of blood vessels throughout the soft connective tissue in the distraction gap. The volume density of blood vessels between the two investigated areas was significantly lower in the 1 mm/day groups, suggesting a delay in angiogenesis in this group of patients. A positive correlation between blood vessel volume and bone volume density was found in the younger new-bone area but not in the oldest new-bone area. This correlation was due to a higher number of blood vessels rather than to a larger size of the blood vessels. Our data suggest that the lower blood vessel density found in the patients with 1 mm/day distraction rate may be related to disruption of angiogenesis in the soft connective tissue of the gap or to a less optimal mechanical stimulation of cells involved in angiogenesis. This probably results in the slower rate of osteogenesis seen at the 1 mm/day distraction rate compared with the 0.5 mm/day distraction rate. The data support the concept that a positive relationship exists between the density of blood vessels and the formation of bone. For distraction of the human mandible in elderly patients, a distraction rate of 0.5 mm/day seems beneficial.

Beneficial Role of Periosteum in Distraction Osteogenesis of Mandible: Its Preservation Prevents the External Bone Resorption

“…Three-dimensional observation is possible without destruction of the specimen using micro CT (Odgaard 1997). Some studies have adopted two-dimensional morphometrical parameters for DO (Zimmermann et al 2005;Amir et al 2006), but it has not been confirmed three-dimensionally. Our morphometrical observations that remodeling is delayed without periosteum are in line with the CLSM findings that bone remodeling was sparse during the latter half period.…”

“…Firstly, excessive elongation (overcorrection) is an actual solution as many reports point out (Saulacic et al 2005;Kanno et al 2006;Ettl et al 2009). Secondly, the distraction rate is an important condition, and it has been indicated that frequent distraction was more effective for good bone formation (Zimmerman et al 2005;Amir et al 2006). Thirdly, combination of growth factors may be useful.…”

“…Blood supply to the vector is sometimes insufficient because blood is supplied only from the attached mucosa, and the vector size tends to be small (Rachmiel et al 2001). Therefore, reduction of alveolar bone height and total necrosis of the vector have been reported in vertical DO (Amir et al 2006).…”

Bone regeneration during distraction osteogenesis

“…[17][18][19][20][21][22][23] More recent studies have also demonstrated bone regeneration in human jaws in conjunction with optimal distraction protocols. 24,25 The aim of this review is to present current knowledge of bone formation during distraction osteogenesis.…”

Endothelial cell cultured on HA/TCP/chitosan scaffold for bone tissue engineering

“…[7][8][9][10] Angiogenesis include migration, proliferation and differentiation of endothelial cells for new capillary from the existing vessels. Firstly, vascularization delivers oxygen for osteoblasts metabolic activity.…”