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

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.

Tissue Expander Followed by Autogenous Bone Graft Versus Autogenous Bone Graft Alone for Mandibular Reconstruction: Quantitative Assessment

“…that can overcome problems such as the loss of bone graft and dehiscence of graft area. 4,6,8 Recent advances in tissue expander technology have made it easier for successful implantation of bone or synthetic grafts and development of tissue with matching color and texture to the area of defect. 2 .…”

“…Although the procedure of tissue expansion necessitates patient cooperation and some tolerance for the unaesthetic expansion period, the results are always great and result in tissue with the same characteristics as the neighboring tissue 6,11…”

“…It has started to gain attention in various maxillofacial surgical procedures due to its numerous advantages for the development of additional tissue without involving tissue flap transfer while providing adequate amount of soft tissue for alveolar bone augmentation. that can overcome problems such as the loss of bone graft and dehiscence of graft area 4,6,8…”

“…Tissue expanders are now available in a wide range of shapes and sizes, and the outcomes of tissue gain are highly encouraging, with lower incidence of problems such as infection and tissue herniation 7,8,11,12. Bone grafts in expanded tissue have also been successful in implant osseointegration, possibly due to the greater vascularity and flexibility of the expanded capsule and tissue bed 6,13…”

Comparação da expansão óssea promovida pela técnica de osseodensificação com dois tipos de conjunto de fresas

“…Pensando em novas possibilidades para viabilizar a instalação de implantes com boa estabilidade primária em áreas com disponibilidade óssea limitada, foram desenvolvidas técnicas de expansão que consistem em aplicar expansores durante o preparo das perfurações para instalação dos implantes por compressão do osso trabeculado e cortical 9 . Essas técnicas possibilitam a instalação de implantes em locais que, caso contrário, precisariam passar por um procedimento de reconstrução óssea 10 .…”