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Review

Soft tissue expansion using self-inflating osmotic hydrogel expanders prior to bone augmentation: healing and complications. Evidence-based review

Publicated to:Bdj Open. 9 (1): 48- - 2023-11-11 9(1), DOI: 10.1038/s41405-023-00175-3

Authors: Ellesoe, AG; Shado, R; Pereira, IN; Madruga, D; Hassan, H

Affiliations

Queen Mary Univ, Blizard Inst Cell & Mol Sci, Ctr Cutaneous Res, Barts & London Sch Med & Dent, 4 Newark St, London E1 2AT, England - Author
Queen Mary Univ, Royal London Dent Hosp, Inst Dent, Barts & London Sch Med & Dent, Turner St, London E1 2AD, England - Author
Rey Juan Carlos Univ, Av Atenas S-N, Alcorcon 28922, Madrid, Spain - Author
Univ Porto, Fac Dent Med, R Dr Manuel Pereira Silva, P-4200393 Porto, Portugal - Author

Abstract

AIM: This review aims to assess complication rates, soft tissue gain, and bone gain associated with the use of self-inflating osmotic hydrogel tissue expanders (SOHTEs) for soft tissue expansion (STE).METHODS: A comprehensive search on Pubmed and Google Scholar databases was conducted to identify human studies using SOHTEs for STE; last searched in March 2023. Expansion phase details and expander variables were documented. Complication rates, soft tissue gain, and bone gain reported in each study were also recorded. The inclusion criteria encompassed human studies ranging from evidence levels II-IV (Oxford Centre for Evidence-Based Medicine Levels of Evidence), without specific date limits. For assessing bias in randomized controlled trials (RCTs), a Risk of Bias tool was employed. The synthesised results were presented through tables, sunburst plots, and bar charts.RESULTS: A total of 13 studies were identified, comprising 4 RCTs, 1 cohort study, and 8 case-series. Employment of SOHTEs yielded an overall complication rate of 17% (24/140 sites), with expander perforation accounting for 9.3% (13/140) of the sites. Specific complication rates included dehiscence (1.4%, 2/140 sites), paraesthesia (1.4%, 2/140 sites), and infection (1.4%, 2/140 sites). All randomized controlled trials (RCTs) were categorised at Level II. The remaining investigations primarily consisted of Level IV case-series lacking controls. All studies demonstrated some concerns towards bias.CONCLUSION: STE studies using SOHTEs exhibit a reduction in complications associated with bone augmentation in scenarios of inadequate soft tissue coverage. Preliminary evidence suggests potential benefits even in cases with sufficient soft tissue. Adherence to procedural precautions may reduce the risk of expander perforations, further diminishing complications. Subsequent studies should incorporate individual patient and expander variables in their reports to explore the impact of expansion phases on complication rates, as well as bone and soft tissue augmentation.

Keywords

ClosureCoverageFlapGraftsImplantsMaxillaRidge augmentationStabilityTension

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Bdj Open due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2023, it was in position 43/158, thus managing to position itself as a Q2 (Segundo Cuartil), in the category Dentistry, Oral Surgery & Medicine. Notably, the journal is positioned en el Cuartil Q2 para la agencia Scopus (SJR) en la categoría Dentistry (Miscellaneous).

Independientemente del impacto esperado determinado por el canal de difusión, es importante destacar el impacto real observado de la propia aportación.

Según las diferentes agencias de indexación, el número de citas acumuladas por esta publicación hasta la fecha 2025-06-19:

  • Scopus: 1

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-06-19:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 17.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 17 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 0.75.
  • The number of mentions on the social network Facebook: 1 (Altmetric).
  • The number of mentions on the social network X (formerly Twitter): 1 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Portugal; United Kingdom.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author () and Last Author ().

the author responsible for correspondence tasks has been .