Methods to Enhance Bone Formation in Distraction Osteogenesis

Though distraction osteogenesis is one of the most anabolic processes known, it too has its limitations leading to the failure of the regenerate. Many mechanical, biological, and pharmacological methods have been developed to improve the quantity and quality of the new bone formation. In this chapter, we describe various methods to monitor the regenerate, including the easy-to-use and objective pixel value ratio method. Physical stimulation techniques, including mechanical, ultrasound, and electromagnetic stimulation, have been in practice for quite some time. We have given special emphasis on the biological methods, including platelet-rich plasma, bone morphogenetic protein, stem cells, and growth factors, which are the current fields of research. A wide range of pharmacological agents from bisphosphonates to experimental drugs are being researched. But until now there has been no ideal foolproof option, and most of these methods are still in an experimental stage. The best treatment option is to identify the basic problem in every patient—poor anabolism or excessive catabolism—and treat accordingly with the available arsenal of mechanical, biological, and pharmacological methods.