BONE REGENERATION UNDER TENSION: ADVANCES IN DISTRACTION OSTEOGENESIS

Distraction osteogenesis (DO) is a biologically driven reconstructive technique that promotes new bone formation through the application of controlled tensile forces between osteotomized segments. In dental and craniofacial surgery, DO has evolved into a versatile modality for managing mandibular deficiencies, midface hypoplasia, syndromic craniosynostosis, alveolar ridge atrophy, and complex post-traumatic or oncologic defects. Unlike conventional graft-based approaches, DO enables simultaneous skeletal expansion and adaptive soft tissue histogenesis, reducing donor-site morbidity and enhancing volumetric stability.Recent advances in digital surgical planning,three-dimensional (3D) printing, and internal distraction devices have significantly improved vector control, precision, and patient comfort. Concurrently, biologic augmentation strategies; including growth factors, stem cell therapy, and mechanotransduction modulation; have demonstrated potential in accelerating consolidation and improving regenerate quality. Despite its advantages, DO remains technique-sensitive and may be associated with complications such as regenerate insufficiency, relapse, neurosensory disturbance, and temporomandibular joint dysfunction. Emerging technologies integrating artificial intelligence, fully implantable automated distractors, and regenerative medicine approaches are expected to further refine treatment outcomes. This review synthesizes contemporary evidence (2018-2025) on dental and craniofacial distraction osteogenesis, highlighting clinical applications, limitations, innovations, and future directions in maxillofacial reconstruction.