Soft tissue expander for vertically atrophied alveolar ridges: Prospective, multicenter, randomized controlled trial

Abstract

ObjectivesConventional guided bone regeneration (GBR) limits the amount of bone graft due to limited soft tissue expansion. We hypothesize that the use of tissue expander will successfully augment soft tissue prior to bone graft, allowing for sufficient amount of grafting which will lead to a more stable and effective vertical bone graft. The authors aimed to evaluate effectiveness of the novel self‐inflating tissue expander for vertical augmentation in terms of soft tissue expansion, clinical outcomes, and related complications.Material and methodsA prospective, multicenter, randomized controlled trial was performed on patients requiring vertical augmentation. For experimental group patients, the tissue expander was subperiosteally implanted and followed by a tunneling bone graft without full flap reflection. Control patients underwent conventional vertical GBR. Primary objectives were to evaluate the dimensional changes of soft tissue and radiographic vertical bone gain and retention. As a secondary outcome, clinical complications and thickness changes of expanded overlying tissue were assessed and analyzed.ResultsTwenty‐three patients in each group were included. During a 4‐week expansion, two of the experimental group showed over‐expansion and one showed mucosal perforation associated with previous severe scars. The other patients showed uneventful expansion and mean tissue augmentation was 6.88 ± 1.64 mm vertically. Ultrasonographic measurements of overlying gingiva revealed no thinning after tissue expansion (p > .05). Significantly higher vertical bone gain was shown in the experimental group (5.12 ± 1.25 mm) compared with that in the control patients (4.22 ± 1.15 mm; p < .05). After a 6‐month retention period, the mean vertical bone measurement of the controls had decreased to 1.90 mm (55.0% reduction), which was a significantly greater decrease than that in the experimental group (mean 3.55 mm, 30.7% reduction; p < .05).ConclusionOur results demonstrated the effectiveness of tissue expanders followed by tunneling bone graft for vertical augmentation; however, studies comparing the two techniques without tissue expanders are needed to elucidate the net effect of tissue expansion.

Surgical reconstructive treatment for infraosseous peri‐implantitis defects with a submerged healing approach: A prospective controlled study

“…Replacement of cover screws at least 1 month before the regenerative therapy also led to the expansion of adjacent soft tissues before the procedure, which is an advantage on its own for such bone augmentation procedures . 27 Last, in the prospect of obtaining long-term success and avoiding treatment relapse, carefully re-fabricated restorations were provided to all patients as part of the study.…”

“…In addition, removal of implant suprastructures before the surgical procedure, allowed for a greater access to the osseous defects, and implant surfaces at the time of detoxification. Replacement of cover screws at least 1 month before the regenerative therapy also led to the expansion of adjacent soft tissues before the procedure, which is an advantage on its own for such bone augmentation procedures 27 . Last, in the prospect of obtaining long‐term success and avoiding treatment relapse, carefully re‐fabricated restorations were provided to all patients as part of the study.…”

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

“…The study was conducted in accordance with the Declarations of Helsinki, internationally accepted guidelines for RCTs, and the CONSORT (consolidated standards of reporting trials) statement. This research was conducted by the same team of researchers as an extension of the pilot study on the clinical feasibility of the novel tissue expander [19]. After confirming its feasibility, the authors additionally included a group using the tissue expander and the guided bone regeneration (GBR) method (TEG) apart from the original TET and control (conventional GBR) groups to allow comparison between the study groups and its true control.…”

“…The use of a hydrogel-type, self-inflating soft tissue expander prior to bone graft can improve soft tissue management and facilitate successful settlement of the graft. In our previous pilot study, we were able to find that enough soft tissue volume was gained with the use of a self-inflating tissue expander [19]. This combined treatment modality-alveolar soft tissue expansion and subsequent bone graft-showed favorable augmented tissue integrity with minimal side effects.…”

Mechanical Stretch Induced Skin Regeneration: Molecular and Cellular Mechanism in Skin Soft Tissue Expansion

“…Mechanical stretch stimulation is the dominant factor to induce expanded skin biological growth during tissue expansion. At present, skin soft tissue expansion is widely used for both adults and children [ 2 , 3 ] and applied in various conditions, such as breast reconstruction [ 4 ], ear reconstruction [ 4 ], burn deformities [ 4 ], bone graft [ 5 ], removal of giant congenital melanocytic nevi [ 6 ], and other medical applications.…”