Patients suffering sleep apnea, severe mandibular AP and transverse deficiency, TMJ arthrosis and syndromic mandibles have been treated with limited success with traditional surgery. Distraction osteogenesis offers new possibilities, unlimited amount of controlled progressive movements and excellent bone and soft tissues healing.

The original surgical techniques were based on extraoral appliances, cutaneous incisions to approach the bone and very uncomfortable devices. Scientific research, continuous evolution, psychological evaluations and engineers input have created a myriad of new surgical techniques, better instrumentation, sophisticated evaluation imaging and Orthodontics combination have opened a complete surgical sub-specialty to treat the above mentioned problems with a higher level of care, improving children and young adults living standards with minimal morbidity and predictable outcomes.

Minimal incisions, osteotomies under controlled temperature, different surgical designs, miniaturized distractors and special extensions for easy activation, permit the surgeons to correct deformities that were impossible in the past.

Trans-mucosal devices with closed distraction chambers, lengthening the ramus protecting the temporo-mandibular joints, distraction anterior to the mental nerves to avoid paresthesias, longer consolidation periods to ensure bone healing and stability, use of blood morphogenetic proteins into the chamber to improve healing and decrease remodelling; are some of the new improvements in treating patients.

Newer technologies, instrumentation and long term follow up based on 24 years experience and 1210 patients treated with Intraoral distraction osteogenesis will be discussed.