Pre‐augmentation soft tissue expansion: an overview

Asa’ad, Farah; Rasperini, Giulio; Pagni, Giorgio; Ríos, Héctor F.; Giannì, Aldo Bruno

doi:10.1111/clr.12617

Cited by 19 publications

(23 citation statements)

References 148 publications

(381 reference statements)

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“…It is estimated that up to 45% of attempted ridge augmentations are lost or significantly compromised when using "split-thickness" technique for bone grafts compared to a 4% bone graft exposure when using a tissue expander [15][16][17]. This warrants the use of tissue expanders in the dental field [18].…”

Section: Introductionmentioning

confidence: 99%

Tissue Expansion Improves the Outcome and Predictability for Alveolar Bone Augmentation: Prospective, Multicenter, Randomized Controlled Trial

Byun

Kim

Cho

et al. 2020

JCM

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Objectives: The purpose of this study was to evaluate the effectiveness of the intraoral use of subperiosteally placed self-inflating tissue expanders for subsequent bone augmentation and implant integrity. Material and methods: A prospective, multicenter, randomized controlled trial was performed on patients requiring alveolar bone graft for dental implant insertion. Patients were assigned to three groups: tissue expansion and tunneling graft (TET group), tissue expansion and conventional bone graft (TEG), and control group without tissue expansion. Dimensional changes of soft tissue and radiographic vertical bone gain, retention, and peri-implant marginal bone changes were evaluated and secondary outcomes; clinical complications and thickness changes of expanded overlying tissue were assessed. Results: Among 75 patients screened, a total of 57 patients were included in the final analysis. Most patients showed uneventful soft tissue expansion without any inflammatory sign or symptoms. Ultrasonographic measurements of overlying gingiva revealed no thinning after tissue expansion (p > 0.05). Mean soft vertical and horizontal tissue measurements at the end of its expansion were 5.62 and 6.03 mm, respectively. Significantly higher vertical bone gain was shown in the TEG (5.71 ± 1.99 mm) compared with that in the control patients (4.32 ± 0.97 mm; p < 0.05). Hard tissue retention— measured by bone resorption after 6 months—showed that control group showed higher amount of vertical (2.06 ± 1.00 mm) and horizontal bone resorption (1.69 ± 0.81 mm) compared to that of the TEG group (p < 0.05). Conclusion: The self-inflating tissue expander effectively augmented soft tissue volume and both conventional bone graft and tunneling techniques confirmed their effectiveness in bone augmentation. With greater amount of bone gain and better 6 month hard tissue integrity, the TEG group compared to the control group—without tissue expansion—showed that the combined modality of tissue expander use and guided bone regeneration (GBR) technique may improve the outcome and predictability of hard tissue augmentation.

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Section: Introductionmentioning

confidence: 99%

Tissue Expansion Improves the Outcome and Predictability for Alveolar Bone Augmentation: Prospective, Multicenter, Randomized Controlled Trial

Byun

Kim

Cho

et al. 2020

JCM

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“…Tissue expanders have a long history of successful use in clinical applications, dating back to 1957, to expand skin and support tissues by applying pressure underneath the dermis [1–4]. When a part of the human body is lost or damaged, tissue expanders are used to increase the amount of soft tissue in preparation for replacement of tissues lost [5]. For example, a tissue expander can be used to increase the oral mucosa for a significantly more predictable bone graft, developing for a subsequent dental implant.…”

Section: Introductionmentioning

confidence: 99%

Reshapable polymeric hydrogel for controlled soft-tissue expansion: In vitro and in vivo evaluation

Garner

Davidson

Eckert

et al. 2017

Journal of Controlled Release

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Tissue expansion is the process by which extra skin is generated using a device that applies pressure from underneath the skin. Over the course of weeks to months, stretching by this pressure creates a flap of extra tissue that can be used to cover a defect area or enclose a permanent implant. Conventional tissue expanders require a silicone shell inflated either by external injections of saline solution or air, or by internal osmotic pressure generated by a hydrophilic polymer. In this study, a shell-free tissue expander comprised only of a chemically cross-linked biocompatible polymeric hydrogel is developed. The cross-linked network of hydrophilic polymer provides for intrinsically controlled swelling in the absence of an external membrane. The new type of hydrogel expanders were characterized in vitro as well as in vivo using a rat-skin animal model. It was found that increasing the hydrophobic polyester content in the hydrogel reduced the swelling velocity to a rate and volume that eliminate the danger of premature swelling rupturing the sutured area. Additionally, increasing the crosslinking density resulted in enough mechanical strength of the hydrogel to allow for complete post-swelling removal, without the hydrogel cracking or crumbling. No systemic toxicity was noted with the expanders and histology showed the material to be highly biocompatible. These expanders have an advantage of tissue expansion without requiring an external silicone membrane, and thus, they can be cut or reshaped at the time of implantation for applications in small or physically constrained regions of the body.

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confidence: 99%

“…; for review, see Asa'ad et al. ). As yet, the effects of STE on the outcome of vertical augmentation have only been investigated using autogenous grafts.…”

mentioning

confidence: 99%

“…Soft tissue expansion (STE) improves tissue quantity and quality in order to facilitate the subsequent reconstructive surgery; that is, STE provides a tissue surplus for easier primary closure and improves flap vascularity and viability (Asa'ad et al 2015;Bascom & Wax 2002;Cherry et al 1983). Pre-treatment by STE prior to vertical augmentation with autogenous bone leads to high gain of new bone, minimizes graft resorption, and results in a very low incidence of wound dehiscences (Abrahamsson et al 2012;Kaner & Friedmann 2011;Mertens et al 2013;for review, see Asa'ad et al 2015).…”

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confidence: 99%

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Pre‐augmentation soft tissue expansion improves scaffold‐based vertical bone regeneration – a randomized study in dogs

Kaner

Zhao

Arnold

et al. 2016

Clinical Oral Implants Res

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ObjectiveSoft tissue (ST) dehiscence with graft exposure is a frequent complication of vertical augmentation. Flap dehiscence is caused by failure to achieve tension‐free primary wound closure and by the impairment of flap microcirculation due to surgical trauma.Soft tissue expansion (STE) increases ST quality and quantity prior to reconstructive surgery. We hypothesized that flap preconditioning using STE would reduce the incidence of ST complications after bone augmentation and that optimized ST healing would improve the outcome of bone regeneration.Materials and methodsSelf‐filling tissue expanders were implanted in mandibular bone defects in ten beagle dogs. After expansion, alloplastic scaffolds were placed for vertical bone augmentation in STE sites and in control sites without STE pre‐treatment. ST flap microcirculation was analysed using laser Doppler flowmetry. The incidence of graft exposures was evaluated after 2 weeks. Bone formation was assessed after 2 months, using histomorphometry and immunohistochemistry.ResultsTest sites showed significantly less impairment of perfusion and faster recovery of microcirculation after bone augmentation. Furthermore, no flap dehiscences occurred in STE sites. Bone regeneration was found in both groups; however, significantly greater formation of new bone was detected in test sites with preceding STE.ConclusionsPreconditioning using STE improved ST healing and bone formation after vertical augmentation. The combination of STE and the subsequent placement of alloplastic scaffolds may facilitate the reconstruction of severe bone defects.

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Pre‐augmentation soft tissue expansion: an overview

Abstract: Further clinical trials with larger sample sizes and long-term follow-up are needed before soft tissue expanders can be confidently applied in everyday clinical practice.

Cited by 19 publications

References 148 publications

Tissue Expansion Improves the Outcome and Predictability for Alveolar Bone Augmentation: Prospective, Multicenter, Randomized Controlled Trial

Tissue Expansion Improves the Outcome and Predictability for Alveolar Bone Augmentation: Prospective, Multicenter, Randomized Controlled Trial

Reshapable polymeric hydrogel for controlled soft-tissue expansion: In vitro and in vivo evaluation

Pre‐augmentation soft tissue expansion improves scaffold‐based vertical bone regeneration – a randomized study in dogs

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