Tissue expansion improves the outcome and predictability for alveolar bone augmentation: Prospective, multicenter, randomized controlled trial

Soo Hwan Byun, Sun Hyun Kim, Sura Cho, Ho Lee, Ho Kyung Lim, Ju Won Kim, Ui Lyong Lee, Wan Song, Sun Jong Kim, Min Kyoung Kim, Jin Woo Kim

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


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.

Original languageEnglish
Article number1143
JournalJournal of Clinical Medicine
Issue number4
StatePublished - Apr 2020

Bibliographical note

Funding Information:
We thank the bioinformatics support from Dr. Yun Liu from Fudan University, Dr. Zizhang Sheng from Columbia University and Dr. Yuanhua Liu from Institut Pasteur of Shanghai.

Funding Information:
This work was supported by the Strategic Priority Research Program [grant number XDB29030302]; the Frontier Science Key Research Project, Chinese Academy of Sciences [grant number QYZDB-SSW-SMC036]; the National Natural Science Foundation of China [grant numbers 31770960, 81602488, 81861138010]; the National Key R&D Program of China [grant number 2017YFC1311004]; and the PIFI project [grant number 2016PB076].

Publisher Copyright:
© 2020 by the authors. Licensee MDPI, Basel, Switzerland.


  • Bone regeneration
  • Clinical trial
  • Dental implant
  • Graft
  • Tissue expansion


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