Abrahamsson Peter, Wälivaara Dan-Åke, Isaksson Sten, Andersson Gunilla
Department of Maxillofacial Surgery, Maxillofacial Unit, Länssjukhuset, Halmstad, Sweden,
J Oral Maxillofac Surg. 2012 Oct;70(10):e521-30. doi: 10.1016/j.joms.2012.06.003. Epub 2012 Aug 5.
To evaluate the outcome of intraoral soft tissue expansion by measuring the profile change using objective 3D metering equipment and to evaluate localized bone grafting after soft tissue expansion with regard to gain of bone and complications.
Using a prospective study design, we asked patients with an osseous and soft tissue defect on the buccal aspect of the alveolar process to participate in this study. In 10 patients (experimental group) a self-inflatable soft tissue expander was placed under the periosteum. After 2 weeks, the expander was removed and a particulated onlay bone graft was placed in the expanded area, protected by a titanium mesh covered with a collagen membrane. Ten patients (reference group) were treated with a mandibular ramus bone block graft. The soft tissue profile was registered before each surgical procedure. The vertical and lateral dimensions of the bone grafts were noted at the grafting procedure and at the implant installation. P < .05 was considered significant.
The mean soft tissue profile change was 2.9 ± 1.1 mm after soft tissue expansion and 2.3 ± 2.1 mm at implant placement in the experimental group compared with 1.5 ± 1.4 mm at implant placement in the reference group (P = .065). Two patients had minor perforations of the soft tissue expander. In the experimental group, the mean lateral bone augmentation after soft tissue expansion was 4.5 ± 1.3 mm, and after healing, it decreased to 3.9 ± 1.4 mm (P = .063). The mean vertical augmentation was 4.1 ± 1.7 mm and had decreased at implant placement to 3.0 ± 1.4 mm (P = .041). In the reference group, the mean lateral augmentation was 3.8 ± 0.8 mm, and after healing, it reduced to 2.7 ± 0.8 mm (P = .024). The mean vertical augmentation was 2.9 ± 0.9 mm, and after healing of the bone graft at implant placement, it was reduced to 1.6 ± 0.8 mm (P = .01). When smokers were excluded, there was significantly less resorption of the bone grafts in both lateral (P = .049) and vertical (P = .012) dimensions in the experimental group compared with the reference group.
Hydrogel expansion of the periosteum is an applicable method to achieve a surplus of soft tissue to cover bone grafts. More refinements to the technique may be required to minimize complications, especially in smoking patients.
通过使用客观的三维测量设备测量轮廓变化来评估口腔内软组织扩张的效果，并评估软组织扩张后局部植骨的骨增量和并发症情况。
采用前瞻性研究设计，我们邀请了牙槽突颊侧存在骨与软组织缺损的患者参与本研究。在10例患者（实验组）中，将一个自充气式软组织扩张器置于骨膜下。2周后，取出扩张器，并在扩张区域植入颗粒状贴附骨移植块，用覆盖有胶原膜的钛网进行保护。10例患者（参照组）接受下颌支骨块移植治疗。在每次手术前记录软组织轮廓。在植骨手术和种植体植入时记录骨移植块的垂直和横向尺寸。P <.05被认为具有统计学意义。
实验组软组织扩张后平均软组织轮廓变化为2.9±1.1mm，种植体植入时为2.3±2.1mm，而参照组种植体植入时为1.5±1.4mm（P = 0.065）。2例患者的软组织扩张器出现轻微穿孔。在实验组中，软组织扩张后平均横向骨增量为4.5±１．３ｍｍ，愈合后降至3.9±1.4ｍｍ（P = 0.063）。平均垂直增量为4.1±1.7ｍｍ，种植体植入时降至3.0±1.4ｍｍ（P = 0.041）。在参照组中，平均横向增量为3.8±0.8ｍｍ，愈合后降至2.7±0.8ｍｍ（P = 0.024）。平均垂直增量为2.9±0.9ｍｍ，骨移植块在种植体植入时愈合后降至1.6±0.8ｍｍ（P = 0.01）。排除吸烟者后，实验组骨移植块在横向（P = 0.049）和垂直（P = 0.012）维度上的吸收明显少于参照组。
骨膜水凝胶扩张是一种可实现软组织过剩以覆盖骨移植块的适用方法。可能需要对该技术进行更多改进以尽量减少并发症，尤其是在吸烟患者中。
