Up to the present time, bone transplants are commonly used to reconstruct bone defects. Recently, several bone substitutes have been suggested to overcome the disadvantages of the procedure of bone harvesting. However, research reveals that an autogenous bone graft is still the gold standard. To replicate the structure and function of natural bone, growth factors or even living, bone-forming cells can be added to enhance the formation of new bone. In that case, one speaks of cell-based tissue-substition. As an alternative distraction osteogenesis, a mechanical-based way of tissue engineering is suggested. In this procedure, tissue-generation takes place without the addition of external material. A combination of both tissue-substitution techniques, consisting of the addition of bone-replacement materials or growth factors during distraction osteogenesis, has also been evaluated in research on animals, although not with unequivocal results.

For several decades, distraction osteogenesis has been applied in orthopedics for lengthening limbs. Other indications for distraction osteogenesis in orthopedics are non-unions, open fractures, oncologic defects, and ankle osteoarthritis. The main principle of distraction osteogenesis is that, with a certain degree of distraction of 2 bone segments, linear bone generation will take place between the 2 segments. The most frequent complications are infection, loosening and breaking of the introduced pins, osteomyelitis, and fracture of the newly generated bone. Disadvantages of distraction appliances are expensiveness, degree of technical difficulty, and a long training period. Distraction osteogenesis in orthopedics is a very intensive treatment. Therefore, only patients who are motivated and well instructed and who are physically and mentally capable of coping with the fixtures are suitable.

Primary stability for an implant that is placed in a prostheticaly and aesthetically desirable position is of essential importance for a successful result. A limiting factor for achieving sufficient stability for an implant is insufficient volume of bone at the implant site. With the help of distraction osteogenesis, sufficient volume of bone can be generated at the desired implant site. Distraction osteogenesis can be adapted for reconstructing both extremely resorbed mandibles and local bone defects. The various distraction techniques for intra-oral bone defects are enossal, extra-cortical, and a combination of vertical and horizontal distraction.

Orofacial anomalies are generally treated by a combination of orthodontics and oral and maxillofacial surgery. The application of distraction osteogenesis offers new possibilities for treatment such as mandibular widening in the transverse direction and lengthening of the vertical mandibular ramus. It has also become apparent that distraction osteogenesis is a very useful alternative treatment for conventional osteotomy for the lengthening of the horizontal mandibular ramus in case of retrognathia and for surgical midfacial advancement at Le Fort I, II or III level. Widening of the maxilla by means of distraction osteogenesis is probably the most common application. Distraction osteogenesis should not be seen as a replacement for conventional osteotomies, but as a valuable supplement. Advantages of distraction osteogenesis over conventional osteotomies which are often mentioned are application at a younger age, lower risk of nerve damage, the displacement of the jaw or parts of the jaw over a greater distance, better stability of the treatment result, no need for bridging bonegrafts, lower surgical risk and shorter surgery time. For many advantages of distraction osteogenesis, however, scientific evidence is still lacking.

A cleft lip and palate is the most common congenital anomaly in the craniofacial region. There are many other congenital craniofacial anomalies. These anomalies may be part of a syndrome with a wide variety of expression. Some of these syndromes are characterized by hypoplasia of the mandible or by hypoplasia of the maxilla and the orbits, often in combination with premature closure of the skull sutures. In addition, posttraumatic and tumour resection defects are also classified as craniofacial anomalies. The care for patients with craniofacial anomalies is highly complex and, therefore, organised in multidisciplinary craniofacial teams. Some craniofacial anomalies treated by distraction osteogenesis are mandibular hypoplasia due to hemifacial microsomia or temporomandibular joint ankylosis, and mid facial hypoplasia due to craniosynostosis.

Behçet’s disease is a multisystem inflammatory disorder, characterized by recurrent oral and genital ulceration and uveitis. Additionally, skin lesions, vasculitis, and arthritis may occur. The disease is chronic, with exacerbations and remissions. Treatment of Behçet’s disease is symptomatic depending on the symptoms and their severity. Oral ulcers are seen in 98% of patients with Behçet’s disease. Some aspects of oral health, such as the amount of plaque and the presence of periodontal disease, and possibly also caries, are more prevalent in patients with the disease when compared to healthy persons. All oral health aspects will probably benefit from good oral health care. Medications which can be employed for treatment of the various symptoms of the disease are colchicine, corticosteroids, immunosuppressives, cyclosporine, pentoxyfylline, anticoagulants, and thalidomide.