Acta Biomaterialia ( IF 9.4 ) Pub Date : 2023-10-20 , DOI: 10.1016/j.actbio.2023.10.021 Vignesh Selvaprithiviraj 1 , Cedryck Vaquette 2 , Saso Ivanovski 1
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Tension-free flap closure to prevent soft tissue dehiscence is a prerequisite for successful bone augmentation in orodental reconstructive surgery. Since soft tissue contour follows the underlying jaw bony architecture, resorption of alveolar (jaw) bone limits the availability of soft tissue for wound closure following major bone reconstruction, required to facilitate oral rehabilitation with endosseous dental implants following tooth loss. Although there are several clinical procedures to increase soft tissue volume, these techniques are complicated and technically demanding. Soft tissue expansion, an established technique in reconstructive surgery, is an ideal alternative to generate surplus soft tissue prior to bone augmentation and dental implant placement. Increase in tissue volume can be achieved by using soft tissue expanders (STEs). Contemporary STEs have evolved from silicone balloons to osmotically inflating hydrogel-based systems. Here, we provide an overview of STEs in clinical oral surgery, outline the current research in STEs, and an update on recent clinical trials as well as the associated complications. Also, the mechanism governing soft tissue expansion and the critical factors that control the expansion process are covered. Design considerations for STEs for intraoral applications are given particular attention. Finally, we present our perspectives on utilization of minimally invasive methods to administer STEs for orodental applications.
Statement of Significance
Soft tissue expansion is required for a range of reconstructive applications and more notably in regenerative dentistry for vertical bone augmentation. This review describes the commercially available soft tissue expanders along with the latest systems being currently developed. This review insightfully discusses the biological and physical mechanisms leading to soft tissue expansion and critically assesses the design criteria of soft tissue expanders. A particular focus is given on the development of a new generation of hydrogel-based soft tissue expanders; their chemistry and required physical properties for tissue expansion is described and the obstacles towards clinical translations are identified. Finally, the review elaborates on promising minimally invasive injectable hydrogel-based tissue expanders and highlights the beneficial features of these systems.
中文翻译：
用于口腔重建的水凝胶软组织扩张器
无张力瓣闭合以防止软组织裂开是口腔修复手术中成功骨增量的先决条件。由于软组织轮廓遵循下面的颌骨结构，牙槽（颌）骨的吸收限制了主要骨重建后软组织用于伤口闭合的可用性，这是牙齿缺失后促进骨内牙种植体口腔康复所需的。尽管有多种增加软组织体积的临床手术，但这些技术都很复杂且技术要求很高。软组织扩张是重建手术中的一项成熟技术，是在骨增量和牙种植体植入之前产生剩余软组织的理想替代方法。使用软组织扩张器 (STE) 可以增加组织体积。当代 STE 已从硅胶气球发展到基于渗透膨胀水凝胶的系统。在这里，我们概述了临床口腔外科中的 STE，概述了 STE 的当前研究，并更新了最近的临床试验以及相关并发症。此外，还涵盖了控制软组织扩张的机制和控制扩张过程的关键因素。用于口腔内应用的 STE 的设计考虑因素受到特别关注。最后，我们提出了我们对利用微创方法在口腔牙科应用中进行 STE 的看法。
重要性声明
一系列重建应用都需要软组织扩张，尤其是在垂直骨增量的再生牙科中。这篇评论描述了市售的软组织扩张器以及当前正在开发的最新系统。这篇综述深入讨论了导致软组织扩张的生物和物理机制，并严格评估了软组织扩张器的设计标准。特别关注新一代水凝胶软组织扩张器的开发；描述了它们的化学性质和组织扩张所需的物理特性，并确定了临床转化的障碍。最后，该综述详细阐述了有前景的微创可注射水凝胶组织扩张器，并强调了这些系统的有益特征。
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