open access
메뉴
open access
메뉴
ISSN : 0376-4672
We evaluated a self-inflatable osmotic tissue expander for its utility in creating sufficient soft tissue elongation for primary closure after bone grafting. Six patients with alveolar defects who required vertical augmentation of >6 mm before implant placement were enrolled. All had more than three prior surgeries, and flap advancement for primary coverage was restricted by severely fibrosed scars. Expanders were inserted beneath the flap and fixed with a screw. After 4 weeks, expander removal and bone grafting were performed simultaneously. A vertical block autograft and guided bone regeneration and distraction osteogenesis were performed. Expansion was sufficient to cover the grafted area without additional periosteal incision. Complications included mucosal perforation and displacement of the expander. All augmentation procedures healed uneventfully and the osseous implants were successfully placed. The tissue expander may facilitate primary closure by increasing soft tissue volume. In our experience, this device is effective, rapid, and minimally invasive, especially in fibrous scar tissue.
1. Misch CM. Comparison of intraoral donor sites for onlay grafting prior to implant placement. Int J Oral Maxillofac Implants 1997;12:767-776.
2. Simion M, Baldoni M, Zaffe D. Jawbone enlargement using immediate implant placement associated with a split-crest technique and guided tissue regeneration. Int J Periodontics Restorative Dent 1992;12:462-473.
3. Hammerle CH, Karring T. Guided bone regeneration at oral implant sites. Periodontol 2000 1998;17:151-175.
4. Oda T, Sawaki Y, Ueda M. Experimental alveolar ridge augmentation by distraction osteogenesis using a simple device that permits secondary implant placement. Int J Oral Maxillofac Implants 2000;15:95-102.
5. Wang HL, Boyapati L. "PASS" principles for predictable bone regeneration. Implant Dent 2006;15:8-17.
6. Neumann CG. The expansion of an area of skin by progressive distention of a subcutaneous balloon;use of the method for securing skin for subtotal reconstruction of the ear. Plast Reconstr Surg (1946) 1957;19:124-130.
7. Lew D, Clark R, Shahbazian T. Use of a soft tissue expander in alveolar ridge augmentation: a preliminary report. J Oral Maxillofac Surg 1986;44:516-519.
8. Radovan C. Breast reconstruction after mastectomy using the temporary expander. Plast Reconstr Surg 1982;69:195-208.
9. Berge SJ, Wiese KG, von Lindern JJ, Niederhagen B, Appel T, Reich RH. Tissue expansion using osmotically active hydrogel systems for direct closure of the donor defect of the radial forearm flap. Plast Reconstr Surg 2001;108:1-5, discussion 6-7.
10. Uijlenbroek HJ, Liu Y, He JF, Visscher C, van Waas MA, Wismeyer D. Expanding soft tissue with Osmed tissue expanders in the goat maxilla. Clin Oral Implants Res 2011;22:121-128.
11. Ronert MA, Hofheinz H, Manassa E, Asgarouladi H, Olbrisch RR. The beginning of a new era in tissue expansion: self-filling osmotic tissue expander--four-year clinical experience. Plast Reconstr Surg 2004;114:1025-1031.
12. Seibert JS. Reconstruction of deformed, partially edentulous ridges, using full thickness onlay grafts. Part II. Prosthetic/periodontal interrelationships. Compend Contin Educ Dent 1983;4:549-562.
13. Proussaefs P, Lozada J. The use of intraorally harvested autogenous block grafts for vertical alveolar ridge augmentation: a human study. Int J Periodontics Restorative Dent 2005;25:351-363.
14. Roccuzzo M, Ramieri G, Bunino M, Berrone S. Autogenous bone graft alone or associated with titanium mesh for vertical alveolar ridge augmentation: a controlled clinical trial. Clin Oral Implants Res 2007;18:286-294.
15. Greenstein G, Greenstein B, Cavallaro J, Elian N, Tarnow D. Flap advancement: practical techniques to attain tension-free primary closure. J Periodontol 2009;80:4-15.
16. Kaner D, Friedmann A. Soft tissue expansion with self-filling osmotic tissue expanders before vertical ridge augmentation: a proof of principle study. J Clin Periodontol 2011;38:95-101.
17. Mertens C, Thiele O, Engel M, Seeberger R, Hoffmann J, Freier K. The Use of Self-Inflating Soft Tissue Expanders Prior to Bone Augmentation of Atrophied Alveolar Ridges. Clin Implant Dent Relat Res 2013.
18. Anwander T, Schneider M, Gloger W, Reich RH, Appel T, Martini M, et al. Investigation of the expansion properties of osmotic expanders with and without silicone shell in animals. Plast Reconstr Surg 2007;120:590-595.
19. von See C, Rucker M, Bormann KH, Gellrich NC. Using a novel self-inflating hydrogel expander for intraoral gingival tissue expansion prior to bone augmentation. Br J Oral Maxillofac Surg 2010;48:e5-6.
20. Abrahamsson P, Isaksson S, Gordh M, Andersson G. Periosteal expansion of rabbit mandible with an osmotic self-inflatable expander. Scand J Plast Reconstr Surg Hand Surg 2009;43:121-125.
21. Schwartz HC, Relle RJ. Extraoral placement of a subperiosteal tissue expander for reconstruction with hydroxylapatite of the severely atrophic mandibular alveolar ridge. J Oral Maxillofac Surg 1990;48:157-161.
22. van Damme PA, Freihofer HP, van't Hof MA, Kuijpers-Jagtman AM, Maltha JC, Spijkers JM. Radiologic analysis of the effects of subperiosteal palatal soft-tissue expansion in growing cats. Int J Oral Maxillofac Surg 1994;23:393-394.
23. Stuehmer C, Rucker M, Schumann P, Bormann KH, Harder Y, Sinikovic B, et al. Osseous alterations at the interface of hydrogel expanders and underlying bone. J Craniomaxillofac Surg 2009;37:258-262.
24. Wiese KG. Osmotically induced tissue expansion with hydrogels: a new dimension in tissue expansion? A preliminary report. J Craniomaxillofac Surg 1993;21:309-313.
25. Tominaga K, Matsuo T, Kuga Y, Mizuno A. An animal model for subperiosteal tissue expansion. J Oral Maxillofac Surg 1993;51:1244-1249.