Available Online at http://www.recentscientific.com International Journal of CODEN: IJRSFP (USA) Recent Scientific International Journal of Recent Scientific Research Research Vol. 11, Issue, 08 (B), pp. 39498-39503, August, 2020 ISSN: 0976-3031 DOI: 10.24327/IJRSR Research Article TISSUE EXPANDER IN PERIODONTICS *Lakshana S., Esther Nalini H., Arun Kumar Prasad P., and Renuka Devi R Department of Periodontology, K.S.R. Institute of Dental Science and Research, Tiruchengode, Tamilnadu, India DOI: http://dx.doi.org/10.24327/ijrsr.2020.1108.5515 ARTICLE INFO ABSTRACT Article History: Periodontitis is a multifactorial inflammatory disease which leads to the destruction of soft and hard tissues surrounding the teeth. Tissue expansion in periodontics was introduced to correct the tissue Received 12th May, 2020 rd (soft and hard) defects, preserve and augment the dimensions of alveolar ridge. It overcomes the Received in revised form 23 complications like soft tissue dehiscence, poor tension free primary closure associated with the June, 2020 conventional augmentation procedures. Materials which are widely used as tissue expanders in Accepted 7th July, 2020 th dentistry are silicon expander, Hydrogel expander, Hydroxyapatite and Chitosan. Hydroxyapatite Published online 28 August, 2020 and chitosan are hard tissue expander, while Silicon and Hydrogel are soft tissue expanders. Hydrogel expander provides a greater advantage compared to silicon expander because of its hydrophilic Key Words: property which cause gradual expansion of the expander. In medicine it is mainly used for breast periodontitis, ridge, augmentation, augmentation after mastectomy, for renewing scar formation after burns, alopecia and to correct any expander, expansion facial deformities. In periodontics soft tissue expander is used in procedures like expansion of alveolar ridge, before bone augmentation procedure and implants dentistry so that it can provide a tension free flap closure and avoid dehiscence. Thus tissue expander is boon in regenerative periodontics since it provides adequate tissue coverage, good esthetics in defect area, with minimal hospital visit and discomfort. Copyright © Lakshana S et al, 2020, this is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited. INTRODUCTION defect area. This new technique which is used for the construction of edentulous alveolar ridges also over comes the Periodontitis is a multifactorial disease infectious disease complications of all previously used techniques.4 resulting in inflammation within the supporting tissue of the teeth with progressive attachment loss and bone loss.1To History correct this defect, bone augmentation procedure is mandatory, The first tissue expander was introduced by NEWMANN in to achieve adequate dimension of alveolar ridge. To preserve the year 1957 for an ear defect which was made up of silicon the ridge many different types of techniques have been rubber. It was a conventional expander where an external port described, such as horizontal or vertical ridge augmentation, was visible and this external port was used for manual guided bone regeneration, onlay grafting, distraction 4 osteogenesis etc. The most common complication of all the inflations The self-inflating tissue expander was then above mentioned procedures is soft tissue dehiscence and poor introduced by AUSTAD and ROSE in 1982. It was semi tension free primary closure over the grafted area.2 To permeable silicon balloon filled with sodium chloride, without overcome this difficulty and unaesthetic failure procedure, soft an external port. The alveolar ridge tissue expander was then tissue expansion procedure was introduced. introduced by LEW ET AL (1989) with hydroxyapatite which was a hard tissue expander4. The novel self-inflating Tissue expansion is defined as, “The ability of at least some osmotically active soft tissue expander was introduced by living tissue such as skin, mucous membrane to accommodate a 3 WEISE in 1993, which was made up of co- polymers of slowly enlarging mass beneath it by increase in surface area”. hydrogel, where the inflation takes by the osmotic gradient.4 As a result tissue expansion procedure aids to achieve, tension and complete free soft tissue closure and thereby it decrease Characteristics of Ideal Expander5 soft tissue dehiscence, for a successful surgical procedure. An ideal expander should be more comfortable and does not provide any damage to tissues and adjacent Soft tissue expander is mainly used for alveolar ridge 5 reconstruction, it aids in formation of new cell and its growth, area of expander placement . provide a good function and texture of skin or mucosa in the *Corresponding author: Lakshana S Department of Periodontology, K.S.R. Institute of Dental Science and Research, Tiruchengode, Tamilnadu, India Lakshana S et al., Tissue Expander in Periodontics Sudden rapid expansion should be avoided since it “xerogel”11The hydrogel has 2 component, the polymer and leads to perforation of the tissues. aqueous component. The polymer component remains constant Henceslow and gradual expansion is advisable5. and the aqueous component varies and the expanders self- The expander should be soft and easy to insert, the inflate through osmotic process.8 size of the soft tissue expander must be comparatively 4 smaller than that of the defect area.5 Phases in Hydrogen Expander T he expander should be able to withstand the external There are 3 phase in hydrogel expander, stimuli, it should not dislocate from its position.5 PHASE 1(“Time switch”): In this phase there is usually a 5 C osteffective,easy to handle for surgeons. delay in the expansion of the expander, immediately after the Itshould be easy to adaptand easy to rem ove before and after placement. This phase last up to 2 weeks of implantation4. 5 surgicalprocedure. PHASE 2: It is the expansion phase, the expander gradually Materials used in tissue Expander starts to expand, which is carefully controlled by the polymer reaction and also helps to prevent the inhibition of unwanted Materials which are widely used as tissue expanders in swelling4. dentistry are silicon expander, Hydrogel expander, 6 Hydroxyapatite and Chitosan. Hydroxyapatite and chitosan PHASE 3: In this phase, completion of swelling is significant, are hard tissue the hydrogel turns inert &removed4. expander, while Silicon and Hydrogel are soft tissue 6 Comparison of silicone balloon expander and hydrogel expanders . 7 Expander Hydroxyapatite Silicone Balloon 9 9 Hydrogel Expander It is a hard tissue expander used for alveolar ridge Expander augmentation. Its characteristics include, It is soft and easy to Hard in consistency, not adaptable to the . Easily carved and molded7. adapt to the 9 9 . Adequate mechanical properties to support a denture7. underlying tissues underlying tissues Soft, sometimes hard to 9 7 9 Hard, easy to push into its pocket . Biocompatible and stable . place in tissue pocket . Bond firmly with bone and soft tissue7. Delayed expansion can 7 sometimes take place Immediate expansion, starts as soon as body . Soft tissue healing after implant exposure . after placement of the 9 fluids touch the hydrogel 9 . Resistance to infection7. expander 9 9 . No adverse effect on the adjacent bone7 Presence of Filling port No filling port Periodic filling moments . Hydroxyapatite is extremely biocompatible in bone and in 9 9 No periodic filling moment soft tissue, and it does not initiate any foreign body needed for expansion 7 Expansion speed can be reaction in the host . handled at the filling Expansion speed cannot be influenced by the moments by the surgeon 9 surgeon 4 9 Hydrogel Expander as its manual inflation More gradual expansion provided it is 9 Before hydrogel expander, conventional expander were used Expansion peaks 9 which was introduced by NEUMAN in 1957, the expander body Enveloped End volume can be 9 is covered with a silicone elastomer and an injection port was 9 End volume pre-defined attached to the body for serial injection, though the convention handled by the filling Leakageof the expander exhibited some positive results, it was always expander can 9 accompanied with some discomfort to the patients like increase Leakage of the expander impossible damage in frequency of hospital visit, expander perforation and cost of 4 the treatment4. Classification of Expanders The above mentioned disadvantage of conventional expander Standard Expanders4 lead to the rise of novel self-inflating expander by WEISE in The expanding volume ranges from, 50cc to 1000cc these the year 1993, which was made up of copolymer of expanders are manufactured in predetermined shapes which methylmetacrylate and n-vinyl-pyrrol this polymeric 4 4 include the shapes like , component, made the expander insoluble in aqueous solution . It is named as “hydrogel” as it has good affinity towards water 1. Cylindrical4. and gels with it and the name is not related to any chemical 4 formulation. It is made up of cross linked hydrogel co polymers 2. Rectangular . of methylmethacrylate and n-vinyl pyrroli, which makes it 3. Crescent4. hydrophilic, before implantation and the expander is referred as 39499 | P a g e International Journal of Recent Scientific Research Vol. 11, Issue, 08 (B), pp. 39498-39503, August, 2020 4. Cupola4. Cupola and cylindrical shape tissue expander are used for soft tissue expansion in