Can Custom Jaw Angle Implants Create Significant Vertical Length?

Q: Dr. Eppley, I am looking for extreme jaw angle augmentation. I recently came across a paper that described a technique for mandibular angle augmentation, where segmental distraction osteogenesis and rib cartilage transplants were used to achieve the desired effect. What I found notable was that the degree of vertical augmentation and the extent to which the jaw became “square” was extreme, beyond what I have traditionally seen achieved with implants. For reference, I have included the before/after pictures from the paper below. 

My questions are:

1. Do you (or would you) ever perform distraction osteogenesis to vertically lengthen the jaw, without affecting the bite?

2. Assuming you do not perform this type of surgery, would custom implants be able to achieve the same effect to the same degree?

A: That is an extreme approach to jaw angle implant augmentation for which there is a much simpler technique to get to the same place, custom jaw angle implants. I have done numerous jaw angle implants that drop the angles down as much a 25 to 30mms. I see no reason to ever do a distraction technique to achieve that kind of jaw angle result. What that paper is not showing you is the long-term result of that technique of which I will wager that much of the jaw angle lengthening either relapses or resorbs….not to mention the notching that undoubtable develops between the anterior edge of the distracted bone segment to the normal mandible in front of it. The x-ray shown does not show bony consolidation across the distraction site…probably because it does not occur in an adult. Such a result demonstrates that it can be technically done but that does not always mean it is a good thing to do.

Dr. Barry Eppley

Indianapolis, Indiana