Research Article| Volume 50, ISSUE 6, P519-522, September 2012

Introduction of the “Rotterdam mandibular distractor” and a biomechanical skull analysis of mandibular midline distraction

Published:September 19, 2011DOI:


      The Rotterdam mandibular distractor (RMD) is a slim, rigid, boneborne distractor for use in midline distraction of the mandible. We did a biomechanical study to compare the RMD with the Trans Mandibular Distractor-flex (TMD-flex). This included an anatomical biomechanical study that was conducted on 9 dentate human cadaveric heads using both the RMD and the TMD-flex. In the vertical plane less tipping was measured in the RMD group than in the TMD-flex group. Significantly less skeletal tipping was found in the horizontal plane in the RMD group (P = 0.021). There was minimal difference in the intercondylar distance between the groups. As the amount of lateral displacement of the condyle was similar in both groups and there was less rotational movement in the RMD group, the TMD-flex would be expected to increase stress on the temporomandibular joint. As a result of the increased parallel widening in the vertical plane, more basal bone is being created and less relapse is expected using the RMD. The study design involves an in vitro anatomical model and conclusions must be drawn with care. At present clinical studies are under way and results will follow.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to British Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kessler P.
        • Wiltfang J.
        • Merten H.A.
        • Neukam F.W.
        Distraction osteogenesis of the mandible in craniofacial abnormalities.
        Mund Kiefer Gesichtschir. 2000; 4 ([in German]): 178-182
        • Kita H.
        • Kochi S.
        • Yamada A.
        • et al.
        Mandibular widening by distraction osteogenesis in the treatment of a constricted mandible and telescopic bite.
        Cleft Palate Craniofac J. 2004; 41: 664-673
        • King J.W.
        • Wallace J.C.
        Unilateral Brodie bite treated with distraction osteogenesis.
        Am J Orthod Dentofacial Orthop. 2004; 125: 500-509
        • Proffit W.R.
        • White R.P.
        • Sarver D.M.
        Contemporary treatment of dentofacial deformity.
        Mosby, St. Louis2003
        • Guerrero C.A.
        • Bell W.H.
        • Contasti G.I.
        • Rodriguez A.M.
        Mandibular widening by intraoral distraction osteogenesis.
        Br J Oral Maxillofac Surg. 1997; 35: 383-392
        • Conley R.
        • Legan H.
        Mandibular symphyseal distraction osteogenesis: diagnosis and treatment planning considerations.
        Angle Orthod. 2003; 73: 3-11
        • Little R.M.
        Stability and relapse of dental arch alignment.
        Br J Orthod. 1990; 17: 235-241
        • Ilizarov G.A.
        Clinical application of the tension-stress effect for limb lengthening.
        Clin Orthop Relat Res. 1990; : 8-26
        • Koudstaal M.J.
        • Wolvius E.B.
        • Schulten A.J.
        • Hop W.C.
        • van der Wal K.G.
        Stability, tipping and relapse of bone-borne versus tooth-borne surgically assisted rapid maxillary expansion; a prospective randomized patient trial.
        Int J Oral Maxillofac Surg. 2009; 38: 308-315
        • Alkan A.
        • Ozer M.
        • Bas B.
        • et al.
        Mandibular symphyseal distraction osteogenesis: review of three techniques.
        Int J Oral Maxillofac Surg. 2007; 36: 111-117
        • Mommaerts M.Y.
        • Spaey Y.J.
        • Soares Correia P.E.
        • Swennen G.R.
        Morbidity related to transmandibular distraction osteogenesis for patients with developmental deformities.
        J Craniomaxillofac Surg. 2008; 36: 192-197
        • Uckan S.
        • Guler N.
        • Arman A.
        • Mutlu N.
        Mandibular midline distraction using a simple device.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 101: 711-717
        • Gunbay T.
        • Akay M.C.
        • Aras A.
        • Gomel M.
        Effects of transmandibular symphyseal distraction on teeth, bone, and temporomandibular joint.
        J Oral Maxillofac Surg. 2009; 67: 2254-2265
        • Chung Y.W.
        • Tae K.C.
        Dental stability and radiographic healing patterns after mandibular symphysis widening with distraction osteogenesis.
        Eur J Orthod. 2007; 29: 256-262
        • Seeberger R.
        • Kater W.
        • Davids R.
        • et al.
        Changes in the mandibular and dento-alveolar structures by the use of tooth borne mandibular symphyseal distraction devices.
        J Craniomaxillofac Surg. 2011; 39: 177-181
        • Mommaerts M.Y.
        • Polsbroek R.
        • Santler G.
        • Correia P.E.
        • Abeloos J.V.
        • Ali N.
        Anterior transmandibular osteodistraction: clinical and model observations.
        J Craniomaxillofac Surg. 2005; 33: 318-325
        • Boccaccio A.
        • Lamberti L.
        • Pappalettere C.
        • Cozzani M.
        • Siciliani G.
        Comparison of different orthodontic devices for mandibular symphyseal distraction osteogenesis: a finite element study.
        Am J Orthod Dentofacial Orthop. 2008; 134: 260-269
        • Koudstaal M.J.
        • Smeets J.B.
        • Kleinrensink G.J.
        • Schulten A.J.
        • van der Wal K.G.
        Relapse and stability of surgically assisted rapid maxillary expansion: an anatomic biomechanical study.
        J Oral Maxillofac Surg. 2009; 67: 10-14
        • Samchukov M.L.
        • Cope J.B.
        • Harper R.P.
        • Ross J.D.
        Biomechanical considerations of mandibular lengthening and widening by gradual distraction using a computer model.
        J Oral Maxillofac Surg. 1998; 56: 51-59
        • Bell W.H.
        • Gonzalez M.
        • Samchukov M.L.
        • Guerrero C.A.
        Intraoral widening and lengthening of the mandible in baboons by distraction osteogenesis.
        J Oral Maxillofac Surg. 1999; 57: 548-563
        • Djasim U.M.
        • Wolvius E.B.
        • Bos J.A.
        • van Neck H.W.
        • van der Wal K.G.
        Continuous versus discontinuous distraction: evaluation of bone regenerate following various rhythms of distraction.
        J Oral Maxillofac Surg. 2009; 67: 818-826
        • Mommaerts M.Y.
        Bone anchored intraoral device for transmandibular distraction.
        Br J Oral Maxillofac Surg. 2001; 39: 8-12
        • Raoul G.
        • Wojcik T.
        • Ferri J.
        Outcome of mandibular symphyseal distraction osteogenesis with bone-borne devices.
        J Craniofac Surg. 2009; 20: 488-493
        • Weltman B.
        • Vig K.W.
        • Fields H.W.
        • Shanker S.
        • Kaizar E.E.
        Root resorption associated with orthodontic tooth movement: a systematic review.
        Am J Orthod Dentofacial Orthop. 2010; 137 (discussion 12A): 462-476
        • Harper R.P.
        • Bell W.H.
        • Hinton R.J.
        • Browne R.
        • Cherkashin A.M.
        • Samchukov M.L.
        Reactive changes in the temporomandibular joint after mandibular midline osteodistraction.
        Br J Oral Maxillofac Surg. 1997; 35: 20-25