Bone augmentation after soft-tissue expansion using hydrogel expanders: effects on microcirculation and osseointegration

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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Repair Exposure of the Postauricular Tissue Expander Using the Modified Brent Method: A 7-Year Experience

Ear Nose & Throat Journal ◽

10.1177/01455613211007967 ◽

2021 ◽

pp. 014556132110079

Author(s):

Tongyu Cao ◽

Qingguo Zhang

Keyword(s):

Soft Tissue ◽

Skin Flap ◽

Tissue Expander ◽

Tissue Expansion ◽

Ear Reconstruction ◽

Lower Pole ◽

Tension Free ◽

Subsequent Exposure ◽

Free Closure ◽

Complicated Conditions

Objectives: Ear reconstruction is a challenging surgery for the complicated conditions in patients with microtia. The tissue expansion techniques were necessary and relatively safe for patients with insufficient soft tissue. However, complications such as necrosis of expanded flap and exposure of tissue expander limited the popularization of this method. This study described the use of modified Brent method to handle the exposure of the postauricular tissue expander. Methods: From January 2013 to December 2019, 27 ear reconstruction patients with trauma or necrosis on an expanded skin flap and subsequent exposure of tissue expander were treated with modified Brent method, which consisted of 3 stages: removal of the expander, tension-free closure of wound, and framework fabrication; elevation of reconstructed ear; lobule rotation; and minor modification. Results: Fifty-six percent of exposures occurred in the lower pole of the tissue expander. Exposure usually occurred 54.5 days after implantation. The majority of reconstructed ears had a satisfactory appearance and showed relatively stable outcomes. Only one case of cartilage exposure required revision surgery and was repaired by the temporoparietal fascia. Conclusion: With reasonable distribution of expanded flap, prolonged interval, and sutures under tension-free conditions, complications like the occurrence of trauma or necrosis-induced exposure of tissue expander can be repaired efficiently by a staging modified Brent method.

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A case series of profilometric changes in two implant placement protocols at periodontally compromised non-molar sites

Scientific Reports ◽

10.1038/s41598-021-81402-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kwantae Noh ◽

Daniel S. Thoma ◽

Jung-Chul Park ◽

Dong-Woon Lee ◽

Seung-Yun Shin ◽

...

Keyword(s):

Soft Tissue ◽

Tooth Extraction ◽

Case Series ◽

Tissue Level ◽

Ridge Preservation ◽

Bone Augmentation ◽

Implant Placement ◽

Alveolar Ridge Preservation ◽

Tissue Changes ◽

Facial Area

AbstractInformation regarding profilometric changes at a soft tissue level following implant placement with different protocols is insufficient. Therefore, this study aimed to comparatively investigate the profilometric tissue changes with respect to late implant placement following alveolar ridge preservation (LP/ARP) and early implantation (EP) in periodontally compromised non-molar extraction sites. Sixteen patients were randomly assigned to the following groups: implant placement 4 months post-ARP (group LP/ARP) and tooth extraction and implant placement 4–8 weeks post-extraction (group EP). Dental impressions were obtained immediately after final prosthesis insertion and at 3, 6, and 12 months. At the time of implant placement, bone augmentation was performed in the majority of the patients. Profilometric changes of the tissue contour were minimal between the final prosthesis insertion and 12 months in the mid-facial area (0.04–0.35 mm in group LP/ARP, 0.04–0.19 mm in group EP). The overall tissue volume increased in both groups (1.70 mm3 in group LP/ARP, 0.96 mm3 in group EP). In conclusion, LP/ARP and EP led to similar stability of the peri-implant tissue contour between the final prosthesis insertion and at 12 months. Moreover, the change of peri-implant tissue on the soft tissue level was minimal in both modalities.

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Dermal and Epidermal Response to Soft-Tissue Expansion in the Pig

Plastic & Reconstructive Surgery ◽

10.1097/00006534-198803000-00013 ◽

1988 ◽

Vol 81 (3) ◽

pp. 390-395 ◽

Cited By ~ 47

Author(s):

Peter E. Johnson ◽

Desmond A. Kernahan ◽

Bruce S. Bauer

Keyword(s):

Soft Tissue ◽

Tissue Expansion

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Use of Tissue Expansion in Clubfoot Surgery

Foot & Ankle ◽

10.1177/107110079301400301 ◽

1993 ◽

Vol 14 (3) ◽

pp. 117-122 ◽

Cited By ~ 16

Author(s):

Lester Silver ◽

Alfred D. Grant ◽

Dan Atar ◽

Wallace B. Lehman

Keyword(s):

Soft Tissue ◽

Tissue Expansion ◽

Outpatient Clinics ◽

Gradual Expansion

Tissue expansion was used successfully to prepare ade-quate soft tissue for closure following a difficult clubfoot correction. The gradual expansion was done weekly at the outpatient clinics (average 3–4 months). The procedure proved to be useful in severe cases of clubfoot.

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Tissue expansion reconstruction of soft tissue avulsions of the face: Report of two cases

Journal of Oral and Maxillofacial Surgery ◽

10.1016/0278-2391(87)90362-4 ◽

1987 ◽

Vol 45 (4) ◽

pp. 362-370 ◽

Cited By ~ 2

Author(s):

Harold E. Cook ◽

Michael K. Lewis ◽

Noel G. Stoker

Keyword(s):

Soft Tissue ◽

Tissue Expansion ◽

The Face

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Reconstruction of the stump after below-the knee amputation. Soft-tissue expansion and local muscle rotation flaps

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-198769080-00021 ◽

1987 ◽

Vol 69 (8) ◽

pp. 1240-1245 ◽

Cited By ~ 5

Author(s):

J W May ◽

J Sheppard

Keyword(s):

Soft Tissue ◽

Tissue Expansion ◽

Knee Amputation ◽

Below The Knee

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Ten technical considerations revisited in tissue expansion

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa273 ◽

2020 ◽

Vol 2020 (8) ◽

Author(s):

Luke Geoghegan ◽

Dariush Nikkhah

Keyword(s):

Soft Tissue ◽

Skin Flap ◽

Tissue Expansion ◽

Soft Tissue Defect ◽

Illustrative Case ◽

Soft Tissue Defects ◽

Case Presentation ◽

Versatile Tool ◽

Technical Factors ◽

Tissue Defects

Abstract Tissue expansion is a versatile tool in resurfacing soft tissue defects of the breast, extremity, head and neck that involves the placement of a temporary implant adjacent to a soft tissue defect. Incremental expansion exploits the viscoelastic properties of skin to generate a skin flap that can be used to resurface defects and provide cover over permanent protheses. Infection, implant extrusion and skin necrosis are recognized complications of tissue expansion. This article presents a revised framework of 10 technical factors to reduce the risk of complications and optimize outcomes with tissue expansion using an illustrative case presentation.

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