Abstract
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.
Highlights
Soft tissue deficiency may occur due to various causes including tumor resection, trauma, congenital problems, etc
TET and tissue expansion and conventional bone graft (TEG) groups received an insertion of self-inflating osmotic expanders before bone augmentation
Ultrasonographic measurements of gingival thickness overlying the expanders revealed that mucosa was not thinned post tissue expansion, indicating minimal clinical risk of dehiscence during the expansion
Summary
Soft tissue deficiency may occur due to various causes including tumor resection, trauma, congenital problems, etc. Restoration of soft tissue deficiency in such circumstances is a challenge to clinicians, but they may be resolved with local flaps, pedicled flaps, free flaps, and other substitutes such as allograft and alloplastic graft [1]. An alternative method to flap exposure or graft is a tissue expansion. The concept of tissue expansion was first postulated by Neumann as a method of expanding local skin for ear reconstruction in 1957 [2]. After about 20 years, the concept of tissue expansion was brought into attention by the study of Radovan et al [3], who later with Austad and Rose, developed a self-inflating tissue expander [4]. A tissue expander reduces the need for free tissue graft, minimizing the morbidity of donor site in addition to preserving the texture, color, and sensation of local soft tissue [5]
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