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

Abstract

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.

Minimizing risk of customized titanium mesh exposures – a retrospective analysis

“…Although flap design did not affect the outcome of the treatment, according to authors´opinion, a proper flap management will remain a key point in working with individualized titanium meshes. This includes planning of the incision in advance according to Kleinheinz et al [51] and adopted to the kind of defect, a careful flap elevation and a tension-free primary wound closure [11]. This will avoid necrosis of the flap and a premature exposure.…”

“…Therefore, rebuilding such a complex defect also implicates a detailed focus on soft tissue management. Membrane and graft exposures are frequent complications associated with non-resorbable membranes [9][10][11][12].…”

“…Treatment opportunities like self-inflating soft tissue expanders [19] or free fat grafts (FFG) from the buccal fat pad [20] aiming to stabilize the soft tissue healing process increase comorbidity of the patient and need additional surgical skills. A promising solution may be the enhancement of soft tissue wound healing by Platelet-Rich Fibrin (PRF) as shown in literature [21][22][23].…”

Mucosal Perfusion Preservation by a Novel Shapeable Tissue Expander for Oral Reconstruction

“…Based on the findings presented by Kaner et al, 23 we believe that reduced blood perfusion in the oral mucosa covering bone grafts is associated with decreased bone oxygenation, reduction of the volume and quality of the bone graft, and overall decline of the healing process. 24 …”

“…Osmotic devices, carefully formulated to achieve the proper rate and final volume of expansion, are designed for full implantation without the presence of exposed tubes or ports. HTE for use in oral mucosa before a bone graft has shown significantly improved outcomes in dogs 24 and humans, 21 when compared with the traditional split-thickness advancement of the oral mucosa over bone grafts.…”