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What do your gingiva and a packed suitcase have in common?
There are a few situations, when a tooth that has been lost long ago is to be replaced. To prepare such an intervention, the dentist should install implants in a seriously atrophied jawbone. In this case, the installation of the implant is preceded by the bone substitution, by which we reconstruct the jawbone arch ensuring this way the necessary bone height or the needed bone thickness to reach the sufficient setting of the implant. However, this is not enough, because the gingiva (gum) must be extended and enlarged to cover the bone substitute and „to ensure the comfortable closure of the suitcase”. This procedure is called soft-tissue management and there are different methods for its execution. The gentlest of these is the hydrogel expander mucosa and periosteum pre-treatment.
With the rising of implants, the removable denture has become outdated, the clients are much rather searching for implants consisting of fixed crowns and bridges. In most of the cases, an experienced oral surgery specialist can reconstruct a seriously atrophied jaw-bone arch, in which an implant can be installed. Generally, bone substitution is necessary just as well in case of an implant replacing one single tooth, as in case of a completely toothless jawbone for the insertion of more implants.
On the place of missing teeth – if the state of vacuity has been lasting – the jawbone is gradually withering away. If there is not enough bone available for installing the implant, then first the bone is to be substituted. This so-called augmentation can be accomplished by different methods and by different materials, for example by inborn bone transplantation, or by using bone-substituting materials.
Imagine a packed suitcase, in which you put something more… What happens than? Either you will not be able to close it at all, or you risk the sudden reopening of your suitcase during the journey.
The same can happen to your soft tissues (your gingiva), if a larger volume of bone reconstruction or bone substitution is needed for the implants. In some of the cases, the existing gingiva is not enough to cover the additional cubic content. Eventually, the soft tissue is pulled, by stretching over the new bone. However, in this case there is a real danger, that during the recovery period, the bone perforates the soft tissues. In such a case, the most reasonable solution is the preceding soft tissue expansion method.
Before the jawbone augmentation (bone substitution), by crossing through a slight cut, we installed a minuscule tissue expander under the gingiva, where it starts to slowly swell. In the meantime, the soft tissue situated above it is also starting to continuously rise. The expansion doesn’t cause any pain or inconvenience to the client. Normally, the installation is executed under local anaesthesia, the intervention doesn’t take more than 15 min.
Following a recovery period of 3-12 weeks, by removing the expander, the augmentation can be executed without any problem, since we have enough soft tissues to cover the bone substitution zone.
How can the dental tissue expander swell up? The dental tissue expander is composed of a special kind of hydrogel, that absorbs humidity from the body, thus, by a predetermined pace, gradually it swells up. This way, the expander surely reaches its final size and form. During the bone substitution treatment, we remove the hydrogel expander and put the bone substitute on its place.