dible was subsequently harvested. Following sacrificeand tissue harvesting, microCT scans were performedon each of the specimens in order to provide objectivemeasurements in evaluating the quality of the newlyregenerated bone. Following imaging, specimenswere fixed for 48 hours in a 10% neutral-bufferedsolution, sequentially dehydrated in 70%, 95%, and100% ethanol, and then infiltrated and embedded inmethylmethacrylate. Embedded specimens were sec-tioned to 25-um thickness and examined under ultra-violet light to evaluate new bone formation as markedby tetracycline labeling.

Three Dimensional Analysis of ABM/ P-15 With Sodium Hyaluronate Carrier inSinus AugmentationH. Emam: Georgia Health Sciences University, M.Stevens, H.A. Ferguson, G. Behiri, M. Sharawy

PepGen P-15 Putty is anorganic bovine matrix coupledwith a synthetic cell binding peptide (ABM/P-15) sus-pended in a sodium hyaluronate carrier. The P-15 por-tion has a similar structure to, and subsequently exhibitssimilar properties of, the cell-binding region of type Icollagen.

Purpose: To evaluate ABM/P-15 Putty (DENTSPLYFriadent CeraMed, Lakewood, CO) as the sole graft ma-terial in sinus augmentation for future reconstructionwith root form dental implants.

Patients & Methods: Ten patients were enrolled in aclinical trial in which sinus augmentations were per-formed on each patient using ABM/P-15 Putty. Bone corebiopsies were harvested using a 2.0 mm diameter tre-phine bur at 8 and 16 weeks, followed by immediateimplant placement. Twenty collected bone cores wereevaluated histologically and using Micro-CT to examinethe bone at the grafted sites.

Results: The student t-test showed significant in-crease (P�0.05) in the bone mineral density (BMD) at 8weeks (0.7 � 0.13 gm/cm3) and 16 weeks (0.97 � 0.08gm/cm3) in the ABM/P-15 graft compared to the nativeresidual (control) bone (0.04 � 0.02 gm/cm3). Therewas no significant difference (P�0.05) in the percentbone volume (PBV) at the 2 time intervals (PBV 21.14 �4.56 at 8 weeks, and 26.33 � 5.6 at 16 weeks). Theaverage increase in bone height at 16 weeks was10.55 � 0.53 mm. Micro-CT images and histologic sec-tions demonstrated dense graft particles surrounded byvital bone in an interconnected trabecular pattern.Three-year clinical and radiographic follow-up revealedall implants successfully integrated.Conclusion: PepGen P-15 Putty is an osteoconductivegraft material capable of conducting new bone forma-tion and successfully supports osseointegration of dentalimplants when used for sinus augmentation.

References:

Bhatnagar RS, Qian JJ, Wedrychowska A, Sadeghi M, Wu YM, SmithN. Design of biomimetic habitats for tissue engineering with P-15, asynthetic peptide analogue of collagen. Tissue Eng 1999;5(1):53-65.

Schwartz Z, Goldstein M, Raviv E, Hirsch A, Ranly DM, Boyan BD.Clinical evaluation of demineralized bone allograft in a hyaluronicacid carrier for sinus lift augmentation in humans: a computedtomography and histomorphometric study. Clin Oral Implants Res2007;18(2):204-11.

Automated Continuous DistractionOsteogenesis Allows for Faster Rates ofDistractionZ. S. Peacock: Massachusetts General Hospital,B. Tricomi, B. Murphy, J. Magill, M. Troulis, L. Kaban

Distraction osteogenesis (DO) is a method of skeletalexpansion that exploits the body’s natural healing capac-ity to form new bone. Distraction of the mandible at arate of 1 mm/day and rhythm of 1-4 times per day hasbeen shown to produce adequate bone formation andclinical union; faster rates have resulted in inadequatebone formation and non-union.1,2 We hypothesize thatcontinuous distraction will allow for osseous union ofthe distraction gap at rates faster than 1 mm/day. Thepurpose of this study was to assess whether continuousDO at rates greater than 1 mm per day would result inadequate bone formation in the distraction gap and clin-ical union in a standardized mini-pig model.

An automated, continuous distraction device has beendeveloped and evaluated by the Massachusetts GeneralHospital Department of Oral and Maxillofacial Surgeryand Physical Sciences Incorporated® (Andover, MA).The device uses hydraulic pressure to open and sensesposition using an induction sensor with closed-loop con-trol. The automated distraction device was placed acrossa mandibular osteotomy 1 cm in front of the mandibularangle in 10 Yucatan immature mini-pigs. No latencyperiod was used and the devices were continuouslyopened to 12 mm followed by a consolidation period of24 days. The predictor variables were rates of distrac-tion: Group 1: 1.5 mm/day and Group 2: 3 mm/day. Theoutcome variables were clinical stability of the distrac-tion gap (a 4 point semi-quantitative scale; 3�no mobil-ity, 2, 1�mobility in 1 or 2 anatomical planes respec-tively, 0�mobility in 3 dimensions); clinical appearanceof the mandible (3 � osteotomy not visible, 2� 50%visible, 0� clearly visible); and radiographic density ofdistraction gap (3� entire gap opaque, 2� �50% opac-ity, 1� �50% opacity, or 0� completely radiolucent. Aprevious study using the same mini-pig model usingdiscontinuous distraction at rates of 1, 2, and 4 mm daywas used as control groups. The curvilinear vector (5 cmradius of curvature) of distraction allowed for assess-ment of differential distraction rate with the superioraspect distracting slower than the inferior aspect. With a

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1.5 mm/day distraction rate at the center the mandible,the superior portion opened 1 mm/day while the infe-rior border opened at 2 mm/day. The 3 mm distractionrate opened the superior portion 2 mm/day and theinferior portion 4 mm/day.

All mini-pigs survived the operation, distraction, andconsolidation periods. Group 1 (n�5) averaged 1.4 mm/day of distraction and 25 days of fixation. Mean scoresfor stability, clinical bone fill and radiographic densitieswere 2.4, 2.6 and 2.6, respectively. Group 2 (n�5)averaged 2.4 mm/day of distraction and 28 days of fixa-tion. Mean scores for stability, clinical bone fill andradiographic densities were respectively 3, 2.6, and 2.6.The historical control groups using discontinuous dis-traction rates of 1, 2 and 4mm/day had mean stabilityscores of: 3, 1.5 and 1.5, respectively, clinical bone fill: 3,2, and 2 and for radiographic bone fill 3, 2, and 1.5.

Results of this study validate a novel automated devicefor DO and demonstrate that continuous distraction al-lows bone fill at faster rates than discontinuous DO.Continuous distraction rates up to 4 mm/day allowed forstability, clinical and radiographic bone fill. This deviceand technique has the potential to shorten treatmenttime in the management of craniofacial deformities.

References:

Glowacki J, Shusterman EM, Troulis M et al. Distraction osteogenesisof the porcine mandible: histomorphometric evaluation of bone. PlastReconstr Surg:566-73, 2004.

Troulis MJ, Glowacki J, Perrott DH et al. Effects of latency and rateon bone formation in a porcine mandibular distraction model. J OralMaxillofac Surg58:507-13, 2000.

3D Evaluation and Analysis of theGrowth Pattern of the Upper AirwaySpace in Normal Pediatric to Early AdultPatientsJ. A. Broujerdi: Private Practice, R. Jacobson, S. A.Schendel

Background & Purpose: To evaluate, quantify andanalyze growth of the upper airway space of normalpediatric to early adult group of patients.

Methods: 180 DICOM files from cone-beam CAT Scanstudy of individuals in orthodontic treatment were eval-uated for the upper airway space (UAS) using 3dMDvaul-tus software (Atlanta, GA). Patients’ age ranged from 6 to25 years and consisted of 90 male, 90 female patients.Patients were categorized into six age groups rangingfrom, 6-8, 9-11, 12-14, 15-17, 18-20 and 21-25. Patientswere other wise healthy individuals and did not havesymptoms or history of sleep apnea. The UAS was iden-tified between the PNS to the hyoid. The UAS dividedinto retropalatal (PNS-soft palate) and retroglossal (softpalate-hyoid) space. The total volume of the UAS, retro-palatal and retroglossal measured. The surface area,

transverse and AP dimensions at the PNS, hyoid, occlusalplane, retropalatal and retroglossal choke points mea-sured. The vertical length of the UAS, soft palatal lengthand the distance from the hyoid to the mandibular planemeasured.

Results: The UAS volume at age 6-8 is 5.67cm3 and atage 21-25 is 14.23cm3, this is a 250% increase. The UASheight is 44 mm at age 6-8 and at age 21-25 is 59.77 mm,this is a 135% increase. The retropalatal volume, chokepoint surface area and length is larger than retroglossalbut the retroglossal volume, choke point surface areaand length increased more in percentage growth. Thesoft palate measured 29.23 mm at ages 6-8 and 37.50 mmat age 21-25, this is a 128% increase. The distance hyoidto the mandibular plane measured 8.34 mm at age 6-8and 14.6 mm at age 21-25, this a 175% increase. There isa growth spur between the ages 9-17 in all 3 dimensionsof the airway, this also affects the length and width ofthe soft palate and the descent of the hyoid.

Conclusions: The UAS can be evaluated and quanti-fied. There is growth in 3 planes, the growth spur ac-counts for vertical growth of the face. This data can beused as a norm and base line to evaluate, classify andtreat pedatric to early adult group of patients withcraniofacial anomalies (Pierre Roban Sequence) affectingthe upper airway causing obstructive sleep apnea.

Main Objectives of Presentation: Evaluate, quantifyand analyze growth of the upper airway in normal heall-thy pedatric patients.

Refference:

Schendel SA et al. Airway analysis: with bilateral distraction of infantmandible. J Craniofac Surg. 2009 Sep:20(5):1341-6.

Schendel SA et al. Airway growth and development: A computerized3-dimensional analysis. J Oral Maxillofac Surg. 2012 Feb 9.

Idiopathic Condylar Resorption:Analysis of Outcomes Following TotalJoint ReplacementP. Mehra, J. He, O. Norris: Boston University

Statement of Problem: Idiopathic condylar resorp-tion (ICR) continues to present a major diagnostic andtherapeutic challenge to practitioners for many reasonsincluding rarity of the condition, progressive nature ofthe deformity, and its simultaneous involvement of skel-etal, occlusal and articular disorders. Recommendedtreatment alternatives range from no surgery, only or-thognathic surgery (maxillary impaction and chin cam-ouflage surgery), staged TMJ and orthognathic surgery,to concomitant TMJ and orthognathic surgery. Tradition-ally, costochondral grafts have been used for TMJ re-placement in this sub-group of patients, but advances intechnology and availability of modern, patient-fitted TMJalloplastic replacement systems may offer many benefitsover such autogenous replacement options.

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