title: Periosteal expansion before local bone reconstruction using a new technique for measuring soft tissue profile stability: a clinical study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Maxillofacial Surgery, Maxillofacial Unit, Länssjukhuset, Halmstad, Sweden, peter.abrahamsson@regionhalland.se
authors.forename: Peter
authors.initials: P
authors.lastname: Abrahamsson
authors.forename: Dan-Åke
authors.initials: DÅ
authors.lastname: Wälivaara
authors.forename: Sten
authors.initials: S
authors.lastname: Isaksson
authors.forename: Gunilla
authors.initials: G
authors.lastname: Andersson
mesh_terms: D000293:Adolescent; D000328:Adult; D016301:Alveolar Bone Loss / Q000473:pathology / Q000601:surgery*; D001672:Biocompatible Materials; D001862:Bone Resorption / Q000473:pathology; D016025:Bone Transplantation / Q000379:methods* / Q000473:pathology; D003094:Collagen; D005260:Female; D005500:Follow-Up Studies; D005881:Gingiva / Q000473:pathology / Q000601:surgery; D006801:Humans; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008336:Mandibular Diseases / Q000473:pathology / Q000601:surgery*; D008567:Membranes, Artificial; D008875:Middle Aged; D061848:Optical Imaging / Q000379:methods; D010521:Periosteum / Q000601:surgery*; D011446:Prospective Studies; D013526:Surgical Mesh; D013529:Surgical Wound Dehiscence / Q000209:etiology; D015626:Tissue Expansion / Q000379:methods*; D015625:Tissue Expansion Devices; D014025:Titanium; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult
chemical_list: D001672:Biocompatible Materials; D008567:Membranes, Artificial; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate; D003094:Collagen; D014025:Titanium