{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:31:20Z","timestamp":1760236280793,"version":"build-2065373602"},"reference-count":40,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,11,8]],"date-time":"2021-11-08T00:00:00Z","timestamp":1636329600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>(1) Background: Mandibular deficiency is one of the most common growth disorders of the facial skeleton. Recently, distraction osteogenesis has been suggested as the treatment of choice for overcoming the limitations of conventional orthognathic surgery; (2) Methods: A new custom-manufactured dental-anchored distractor was built and anchored in the first molar and lower canine. It consists of a stainless-steel disjunction screw, adapted and welded to the orthodontic bands through two 1.2 mm diameter connector bars with a universal silver-based and cadmium-free solder; (3) Results: The distractor described can be a useful tool to correct mandibular retrognathia and is better tolerated by patients, especially in severe cases; (4) Conclusions: The dental-anchored distractor increases the anterior mandibular bone segment without affecting the gonial angle or transverse angulation of the segments and avoids posterior mandibular rotation, overcoming the limitations of conventional surgical treatment.<\/jats:p>","DOI":"10.3390\/bioengineering8110180","type":"journal-article","created":{"date-parts":[[2021,11,8]],"date-time":"2021-11-08T22:08:41Z","timestamp":1636409321000},"page":"180","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["A New Orthodontic-Surgical Approach to Mandibular Retrognathia"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2615-2929","authenticated-orcid":false,"given":"Francisco","family":"Vale","sequence":"first","affiliation":[{"name":"Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"}]},{"given":"Joana","family":"Queiroga","sequence":"additional","affiliation":[{"name":"Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"}]},{"given":"Fl\u00e1via","family":"Pereira","sequence":"additional","affiliation":[{"name":"Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"}]},{"given":"Madalena","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"}]},{"given":"Filipa","family":"Marques","sequence":"additional","affiliation":[{"name":"Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8937-361X","authenticated-orcid":false,"given":"Raquel","family":"Travassos","sequence":"additional","affiliation":[{"name":"Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"}]},{"given":"Catarina","family":"Nunes","sequence":"additional","affiliation":[{"name":"Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6154-4173","authenticated-orcid":false,"given":"Anabela Baptista","family":"Paula","sequence":"additional","affiliation":[{"name":"Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Clinical Academic Center of Coimbra (CACC), 3000-075 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3283-5104","authenticated-orcid":false,"given":"In\u00eas","family":"Francisco","sequence":"additional","affiliation":[{"name":"Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1564","DOI":"10.1016\/j.joms.2015.01.003","article-title":"Bilateral Sagittal Split Ramus Osteotomy Versus Distraction Osteogenesis for Advancement of the Retrognathic Mandible","volume":"73","author":"Ellis","year":"2015","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/j.ajodo.2013.01.014","article-title":"Changes in the Pattern of Patients Receiving Surgical-Orthodontic Treatment","volume":"143","author":"Proffit","year":"2013","journal-title":"Am. J. Orthod. Dentofacial Orthop."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1111\/j.1365-263X.2006.00768.x","article-title":"The Impact of Malocclusion and Its Treatment on Quality of Life: A Literature Review","volume":"16","author":"Zhang","year":"2006","journal-title":"Int. J. Paediatr. Dent."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"977","DOI":"10.2319\/091707-444.1","article-title":"Condition-Specific Impacts on Quality of Life Attributed to Malocclusion by Adolescents with Normal Occlusion and Class I, II and III Malocclusion","volume":"78","author":"Sheiham","year":"2008","journal-title":"Angle Orthod."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/00003086-199404000-00005","article-title":"Experimental Healing of Distraction Osteogenesis Comparing Metaphyseal with Diaphyseal Sites","volume":"301","author":"Aronson","year":"1994","journal-title":"Clin. Orthop."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/S0736-0266(00)90025-1","article-title":"The Effect of Aging on Distraction Osteogenesis in the Rat","volume":"19","author":"Aronson","year":"2001","journal-title":"J. Orthop. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/0278-2391(89)90276-0","article-title":"Factors Contributing to Relapse in Rigidly Fixed Mandibular Setbacks","volume":"47","author":"Franco","year":"1989","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/j.ijom.2005.02.013","article-title":"Changes in Condylar Long Axis and Skeletal Stability after Bilateral Sagittal Split Ramus Osteotomy with Poly-l-Lactic Acid or Titanium Plate Fixation","volume":"34","author":"Ueki","year":"2005","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1053\/joms.2002.35734","article-title":"Management of Severe Mandibular Retrognathia in the Adult Patient Using Traditional Orthognathic Surgery","volume":"60","author":"Tucker","year":"2002","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1054\/ijom.2000.0033","article-title":"Craniofacial Distraction Osteogenesis: A Review of the Literature. Part 1: Clinical Studies","volume":"30","author":"Swennen","year":"2001","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/S1010-5182(96)80019-9","article-title":"Intraoral Distraction for Mandibular Lengthening: A Technical Innovation","volume":"24","author":"Diner","year":"1996","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1597\/1545-1569_1999_036_0269_mlbdoi_2.3.co_2","article-title":"Mandibular Lengthening by Distraction Osteogenesis in Children-A One-Year Follow-Up Study","volume":"36","author":"Huang","year":"1999","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1097\/00001665-199509000-00007","article-title":"Distraction Osteogenesis of the Human Craniofacial Skeleton: Initial Experience with a New Distraction System","volume":"6","author":"Cohen","year":"1995","journal-title":"J. Craniofac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/j.joms.2010.09.007","article-title":"Use of the Mandibular Distraction Technique to Treat Obstructive Sleep Apnea Syndrome","volume":"69","author":"Brevi","year":"2011","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2903","DOI":"10.1007\/s11999-008-0518-7","article-title":"The Classic: On the Means of Lengthening, in the Lower Limbs, the Muscles and Tissues Which Are Shortened through Deformity","volume":"466","author":"Codivilla","year":"2008","journal-title":"Clin. Orthop."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1097\/00001665-199411000-00007","article-title":"Mandibular Distraction Lengthening in the Severely Hypoplastic Mandible: A Problematic Case with Tongue Aplasia","volume":"5","author":"Havlik","year":"1994","journal-title":"J. Craniofac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"603","DOI":"10.5177\/ntvt.2015.11.15158","article-title":"Verlenging van de Onderkaak: Bilaterale Sagittale Splijtingsosteotomie versus Distractieosteogenese","volume":"122","author":"Akkerman","year":"2015","journal-title":"Ned. Tijdschr. Tandheelkd."},{"key":"ref_18","first-page":"CD010403","article-title":"Maxillary Distraction Osteogenesis versus Orthognathic Surgery for Cleft Lip and Palate Patients","volume":"8","author":"Kloukos","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1007\/BF02682670","article-title":"Mandibular Distraction Osteogenesis-Preliminary Results of an Animal Study with a Dentally Fixed Distraction Device","volume":"58","author":"Braumann","year":"1997","journal-title":"J. Orofac. Orthop. Fortschr. Kieferorthop\u00e4die"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/S0266-4356(97)90712-9","article-title":"Mandibular Widening by Intraoral Distraction Osteogenesis","volume":"35","author":"Guerrero","year":"1997","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/S1010-5182(98)80015-2","article-title":"Seven Years Clinical Experience with Mandibular Distraction in Children","volume":"26","author":"Carls","year":"1998","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_22","first-page":"1","article-title":"An Implantable Battery System for a Continuous Automatic Distraction Device for Mandibular Distraction Osteogenesis","volume":"4","author":"Chung","year":"2010","journal-title":"J. Med. Devices Trans. ASME"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"58","DOI":"10.4103\/2231-0746.83159","article-title":"Development and Evolution of Distraction Devices: Use of Indigenous Appliances for Distraction Osteogenesis-An Overview","volume":"1","author":"Andrade","year":"2011","journal-title":"Ann. Maxillofac. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1097\/00006534-199010000-00004","article-title":"The Le Fort III Advancement OSteotomy in the Child under 7 Years of Age","volume":"86","author":"McCarthy","year":"1990","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_25","first-page":"117","article-title":"Skeletal Distraction for Mandibular Lengthening with a Completely Intraoral Toothborn Distractor","volume":"Volume 34","author":"McNamara","year":"1998","journal-title":"Advances in Craniofacial Orthopedics"},{"key":"ref_26","unstructured":"Francisco, V. (2014). Distra\u00e7\u00e3o Osteog\u00e9nica Mandibular Dento-Ancorada. [Ph.D. Thesis, University of Coimbra]."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1097\/00003086-198901000-00038","article-title":"The Tension-Stress Effect on the Genesis and Growth of Tissues. Part I. The Influence of Stability of Fixation and Soft-Tissue Preservation","volume":"238","author":"Ilizarov","year":"1989","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Molina, F., and Monasterio, F.O. (1995). Mandibular Elongation and Remodeling by Distraction: A Farewell to Major Osteotomies. Plast. Reconstr. Surg., 841\u2013842.","DOI":"10.1097\/00006534-199509001-00011"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1596","DOI":"10.1097\/01.prs.0000187170.48370.76","article-title":"Gunshot Wounds: Reconstruction of the Lower Face by Osteogenic Distraction","volume":"116","author":"Nicolas","year":"2005","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.coms.2007.06.004","article-title":"Distraction Osteogenesis: Advancements in the Last 10 Years","volume":"19","year":"2007","journal-title":"Oral Maxillofac. Surg. Clin. N. Am."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1016\/S0889-5406(99)70266-0","article-title":"Mandibular Distraction Osteogenesis: A Historic Perspective and Future Directions","volume":"115","author":"Cope","year":"1999","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2234","DOI":"10.1016\/j.ijporl.2014.10.019","article-title":"Difference in maxillary sinus volumes of patients with cleft lip and palate","volume":"78","author":"Barbosa","year":"2014","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.otohns.2007.03.035","article-title":"Distraction osteogenesis in the pediatric population","volume":"137","author":"Lin","year":"2007","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1016\/S0278-2391(99)90869-8","article-title":"Mandibular Lengthening Using Preprogrammed Intraoral Tooth-Borne Distraction Devices","volume":"57","author":"Dessner","year":"1999","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_35","first-page":"3","article-title":"Mandibular Symphyseal Distraction Osteogenesis: Diagnosis and Treatment Planning Considerations","volume":"73","author":"Conley","year":"2003","journal-title":"Angle Orthod."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e866","DOI":"10.4317\/jced.58095","article-title":"Radiographic healing patterns after tooth-borne distraction in canine model","volume":"13","author":"Vale","year":"2021","journal-title":"J. Clin. Exp. Dent."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1097\/00001665-199807000-00006","article-title":"Controlled multiplanar distraction of the mandible: Device development and clinical application","volume":"9","author":"McCarthy","year":"1998","journal-title":"J. Craniofac. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"214","DOI":"10.4103\/2231-0746.200319","article-title":"Controlling the vector of distraction osteogenesis in the management of obstructive sleep apnea","volume":"6","author":"Shilo","year":"2016","journal-title":"Ann. Maxillofac. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"100098","DOI":"10.1016\/j.adoms.2021.100098","article-title":"Contemporary 3D planning for distraction osteogenesis creating predictable outcomes","volume":"3","author":"Suffern","year":"2021","journal-title":"Adv. Oral Maxillofac. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1055\/s-0034-1390174","article-title":"Orthodontic Considerations for Maxillary Distraction Osteogenesis in Growing Patients with Cleft Lip and Palate Using Internal Distractors","volume":"28","author":"Silveira","year":"2014","journal-title":"Semin. Plast. Surg."}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/8\/11\/180\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:27:43Z","timestamp":1760167663000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/8\/11\/180"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,8]]},"references-count":40,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["bioengineering8110180"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering8110180","relation":{},"ISSN":["2306-5354"],"issn-type":[{"type":"electronic","value":"2306-5354"}],"subject":[],"published":{"date-parts":[[2021,11,8]]}}}