下颌后牙区“香肠技术”植骨后颊侧角化龈宽度的临床观察

目的　探讨下颌后牙区“香肠技术”植骨后颊侧角化龈宽度的变化及其与植骨量的相关性,并评价颊侧角化龈宽度不足患者进行游离龈移植术后的临床效果。方法    选择2019年4月至2020年9月在大连市口腔医院种植科因牙列缺损行下颌后牙区“香肠技术”植骨后种植修复患者24例。测量所有患者植骨前后的颊侧角化龈宽度以及植骨后当天植骨量,对植骨前后的角化龈宽度进行比较,并分析植骨后角化龈宽度变化与植骨量的相关性。对植骨后6个月颊侧角化龈宽度不足2 mm的患者进行腭部游离龈移植术,移植术后3个月复查,对获得的种植体颊侧角化龈宽度、龈瓣收缩率进行观察和评价。结果     24例患者平均植骨量为（629.30 ± 226.42）mm3,植骨后角化龈宽度平均减少量为（1.15 ± 0.82）mm,植骨量与角化龈宽度减少量呈正相关。12例进行游离龈移植术患者的术后角化龈宽度增加,移植术后3个月龈瓣收缩率为（22.89 ± 2.85）%。结论    “香肠技术”植骨术后角化龈宽度有所减小,与植骨量呈正相关;游离龈移植后龈瓣收缩较少,可显著增加种植体周围角化龈宽度。     

应用游离龈移植术增宽磨牙缺失区域角化组织利于种植治疗的临床观察（附1例3年随访报告）

种植体周围良好的软组织条件是保证种植体长期健康与稳定的前提,也是种植治疗取得良好生物学与美学效果的基础。而由于牙周炎症造成的破坏、拔牙后组织改建或个体差异等原因,种植位点常出现角化组织宽度的不足甚至缺如,不利于菌斑控制,给种植治疗带来一定风险。游离龈移植术（free gingival graft,FGG）是牙周临床常用的软组织增量方法,可显著增加种植体周围角化组织宽度。文章展示了1例左下磨牙连续缺失病例应用FGG增宽角化组织后行种植修复并获得良好修复效果的诊疗过程,为此类病例的临床处置积累了一定经验。     

双侧上下后牙种植修复后应用游离龈移植术改善软组织条件利于健康维护（附1例2年随访报告）

随着种植技术的日益成熟,种植修复已经成为缺失牙修复首要考虑的方案。种植修复后常因软组织轮廓欠佳、角化组织不足而导致患者出现食物嵌塞、清洁难度大等问题,长期的菌斑堆积成为最终导致植体周病的关键因素之一。反之,充足的角化组织有利于患者口腔卫生的维护,消除清洁时的不适感。游离龈移植（free gingival graft,FGG）可增加角化组织宽度和改善植体周软组织轮廓且临床效果稳定,但在种植修复后进行此手术面临诸多难题。文章展示了1例种植修复治疗后实施游离龈移植术来改善种植修复效果的诊疗过程,为临床医生处置此类病例提供指导。     

腭侧游离龈瓣修复上颌前牙区牙龈瘤切除术后缺损的临床效果评价

目的：评价腭侧游离龈瓣修复上颌前牙区牙龈瘤切除术后缺损的临床效果。方法制取腭侧游离龈瓣修复上颌前牙区牙龈瘤切除术后牙龈缺损22例。采用龈缘形态评价标准、龈乳头指数、改良出血指数等评价腭侧游离龈瓣修复前牙区牙龈瘤切除术后缺损的临床效果。结果22例患者缺损区牙龈质地、厚度与高度、牙龈乳头丰满度均取得良好的效果。结论腭侧游离龈瓣修复前牙区牙龈瘤切除术后缺损的临床效果满意。     

改良种植体周游离龈移植术增宽角化黏膜1例

角化黏膜宽度不足常见于长期缺牙的下颌后牙区种植位点,本病例通过改良的游离龈移植术式重建了充足的种植体周角化黏膜宽度,维持了种植体周软硬组织的长期健康。     

位点保存术及种植联合游离龈移植术修复牙周炎患者后牙缺失1例报告

固定桥修复是临床常见的修复方式之一,外形美观、咀嚼效率高。然而固定桥修复不利于患者自我清洁,菌斑控制不佳时可加速基牙牙周炎进展,联冠修复往往掩盖病情,不利于基牙疾病的早期发现。缺牙区常伴有牙槽骨高度、宽度减少,角化龈消失等软硬组织缺陷。随着种植技术的发展,种植修复已成为牙列缺损的首选修复方法。本文展示1例牙周炎患者拆除不良固定桥修复体后位点保存术及种植联合膜龈手术修复后牙缺失的治疗过程,种植后游离龈移植增加种植体周围角化龈宽度,改善功能及美观,术后1年效果稳定。现报道如下。     

浓缩生长因子对游离龈移植术后供区创面愈合的效果评价

目的:比较血小板衍生物浓缩生长因子(concentrated growth factor,CGF)与常规处理对于游离龈移植术后硬腭供区伤口愈合的临床效果.方法:选取就诊于重庆医科大学附属口腔医院行游离龈移植术的患者共计30例(对照组14例;CGF组16例),其中对照组在获取游离龈瓣后仅在供区位置缝合碘仿纱条,而CGF组则在硬腭供区创面覆盖CGF膜,随后缝合碘仿纱条.术后定期复诊,以患者术后创面愈合程度作为主要结局,患者创口的痛感、肿胀等主观感受以及牙龈的颜色质地等为次要结局,观察并统计相应临床结果.结果:CGF组在愈合面积上除术后3 d相较于对照组无显著性差异外(P=0.138),其余时间点均优于对照组(P<0.05);就术后供区愈合后的牙龈黏膜质地而言,CGF组在术后即刻、术后3 d和7 d均优于对照组(P<0.05);就术后供区疼痛、肿胀而言,CGF组在术后各个时间点上给患者带来的主观感受均优于对照组(P<0.05).结论:与常规术后对供区的处理相比,CGF的覆盖促进了术后供区的伤口愈合与黏膜状态,且缓解了患者术后的疼痛、肿胀及不适,值得临床推广使用.     

下颌后牙区Straumann短种植体的临床效果观察

目的 评价Straumann短种植体应用于下颌后牙区单牙种植的临床效果.方法 收集下颌后牙缺失单冠修复的患者共6例,剩余骨量最适合植入长度6 mm、直径4.1 mm的标准种植体,共植入8颗种植体.结果 临床追踪12～38个月种植体没有明显的边缘骨丧失,没有种植体失败.结论 非早期负重种植时,在能够获得足够初期稳定性的情况下,长种植体不一定是必须的选择.下颌后牙缺失剩余牙槽骨高度较低时,采用Straumann短种植体的单牙种植修复是一种可供选择的治疗方案.     

前牙美学区早期种植技术的临床应用

牙列缺损会影响患者的咀嚼功能和美观,种植修复是临床上治疗牙列缺损的有效方案之一。正确地选择种植时机对种植修复功能及美观十分重要。随着种植技术的发展,如何选择缺牙后的种植时机在学界引起广泛讨论。近年来随着种植治疗的规范,使得早期种植的成功率不断提高,早期种植这一技术得到医生青睐。文章就早期种植在临床中的应用和临床研究进展做一介绍。     

改良根向复位瓣技术在上颌后牙区种植二期手术中的应用效果评价

目的 探讨上颌后牙区种植体颊侧角化龈重建方法,评估其临床疗效及对种植体牙周状况的影响。方法 筛选种植二期手术且伴有角化龈不足的患者11例,共11个上颌后牙区种植位点,应用改良根向复位瓣技术在种植二期手术同期为患者进行角化龈重建。于二期手术后6周进行冠修复,并于冠修复3个月后复诊。分别记录术前、冠修复时和冠修复完成3个月后的角化龈宽度。拍摄根尖片,测量牙周探诊深度（PD）和探诊出血位点百分比（BOP）。采用SPSS 19.0软件包对数据进行配对样本t检验。结果 冠修复完成时,角化龈宽度为（3.30±0.36） mm,术前为（1.44± 0.34）mm,平均增加1.86 mm（P<0.01）。重建的角化龈宽度在冠修复3个月后仍然保持稳定,平均（3.34±0.33） mm（P=0.58）,无明显炎症与骨吸收。PD为（2.83±1.20） mm,BOP比为18.2%。结论 在种植二期手术同期,采用改良根向复位瓣技术能有效重建上颌后牙区种植体颊侧附着龈,短期内可以保证良好、稳定的效果。     

Influence of free gingival grafts on the health of the marginal gingiva

Abstract In order to evaluate the effect of increasing the width of inadequate attached gingiva on the health of the marginal gingiva, 12 free gingival grafts were performed on 12 patients with less than 1.0 mm of attached gingiva on homologous contralateral pairs of mandibular teeth. A baseline examination, which included measurements of plaque, gingival exudate, sulcus bleeding, sulcus probing depth and width of attached gingiva, was done before surgery. One week after surgery, plaque was eliminated mechanically on the test and control sides. All measurements were repeated 7 and 14 weeks after surgery. During the week following the first postsurgical examination, individual oral hygiene instruction was given until the patient could show plaque-free test and control sites. The width of the attached gingiva increased significantly on the side where the grafting was performed (test side). The only other significant changes observed during the experiment were a decrease of the mid-buccal plaque index on the test side during the first 7 weeks following surgery and a decrease of the buccoproximal plaque index on the test and control sides during the total experimental period (14 weeks). None of the other clinical parameters measured showed significant differences when test and control sites were compared or when the same sites were compared longitudinally.     

自体游离硬腭黏膜移植在牙种植体周附着龈增量中的应用评价

目的：应用自体游离硬腭黏膜移植,进行种植体周附着龈增量,评价其临床效果。方法：选择21例种植术后种植体周附着龈严重不足患者．在种植术后1个月行自体游离硬腭黏膜移植,术后6个月测量附着龈宽度增加量。采用SPSS11．5软件包中的配对t检验分析手术前、后的附着龈宽度值变化。结果：种植体周附着龈宽度术后6个月平均增加量为（3．77±0．43）mm,手术前、后比较,差异显著（P〈0．05）。结论：自体游离硬腭黏膜移植是种植体周附着龈增量的有效方法。     

Vertical and horizontal dimensional evaluation of free gingival grafts in the anterior mandible: a case report series

The shrinkage of free gingival grafts (FGGs) is a well-known clinical phenomenon but there are limited studies demonstrating the dimensional changes during healing in FGGs. The aim of the study is to examine the shrinkage of FGG in both horizontal and vertical dimensions and calculate the changes in the surface area of the graft at early and delayed periods of healing. The FGG procedure was applied to 15 consecutive patients in their mandibular anterior area. The graft sizes and areas were measured and the shrinkage of the graft was calculated at baseline and days 10, 21 and 180. Hemorrhage, sense alteration and pain symptoms were also examined. Change in the horizontal direction was not statistically significant during the whole study period (p > 0.05). However, there was a statistically significant reduction in the vertical direction in all visits, except day 10 (p < 0.05). Calculated graft area was also significantly reduced during the study period at all time-points compared to the baseline (p < 0.001). At day 10, 4 (26.7%) recipient sites and 5 (33%) donor sites demonstrated paresthesia. Only one (0.07%) recipient site demonstrated paresthesia at day 21 where the donor site resulted with an uneventful healing. At day 10, 5 (33%) patients demonstrated bleeding at their donor regions and resulted with a complete cessation of bleeding at day 21. Pain symptom was found in 8 (53.3%) recipient sites where 3 (20%) donor regions presented pain symptom at day 10. Graft shrinkage in the vertical dimension seems to affect the clinical outcomes of the FGG procedure. However, the influence of horizontal graft shrinkage was minimal.     

3-year observations on gingival recession in mandibular incisors in children

28 children aged 6-13 years, with gingival recession localized to mandibular incisors, were monitored longitudinally to evaluate any changes of the labial periodontal tissues. Measurements included dental plaque, gingival inflammation, gingival recession, probing depth, probing attachment level, keratinized and attached gingiva. Following baseline examination, the incisors were observed at yearly intervals over 3 years. The results showed that a high level of oral hygiene was maintained and that gingival inflammation occurred only to a minor degree throughout the observation period. Gradual reductions in the amount of gingival recession and probing attachment levels took place in all children except for 1 of the subjects with 1 severely malpositioned tooth. Probing depths and widths of keratinized and attached gingiva remained relatively unchanged. The finding that gingival recession in mandibular incisors in young children often improves over time suggests that preventive or reparative treatment in this part of the developing dentition may not be necessary. Decisions about such treatment should be postponed until any spontaneous improvement has taken place.     

改良游离牙龈移植技术临床效果评价

目的:评价种植体周围改良游离牙龈移植技术的临床效果。方法:选择36例患者42个下颌后牙区种植位点,种植后颊侧龈缘中点处角化龈宽度均小于2 mm。修复前2个月采用改良游离牙龈移植技术,即供区使用个性化腭护板,受区使用个性化移植物压板。术后观察移植物的成活情况。术后即刻,术后2、6、12个月对种植体颊侧角化龈宽度进行测量。术后1、3、6 d用目测类比法（VAS）记录患者术创疼痛。采用SPSS 25.0软件包对数据进行配对t检验和单因素方差分析。结果:42个种植位点移植瓣均成活。术前种植体颊侧角化龈宽度平均（0.39±0.41）mm,术后12个月平均（4.17±0.43）mm,与术前相比,平均增加（3.78±0.21）mm,平均收缩量为（1.12±0.12）mm。结论:改良游离牙龈移植技术可有效增加种植体颊侧角化龈宽度,术后1年移植物收缩量较小,患者术后疼痛不明显。     

Changes of facial gingival dimensions in children

Abstract Facial gingival surfaces of maxillary and mandibular anterior teeth were monitored to evaluate changes of the width of the keratinized and attached gingiva. 96 children 6 to 12 years of age were examined 2 × with an interval of 2 years. Measurements included dental plaque, gingival inflammation, probing depth, and width of keratinized and attached gingiva. In addition, study models were used to determine the facial/lingual position of the teeth. The results of this report, evaluating well-aligned teeth only, showed that during the 2-year observation period, increases in widths of the facial keratinized and attached gingiva took place. Increases occurred for the various teeth regions examined, and for deciduous as well as permanent teeth. During transition from the deciduous to the permanent dentition, patterns of change were variable. The increase of gingival widths was greatest for sites with the smallest baseline width of attached gingiva, and smallest for sites with the greatest baseline width. It was concluded that in well-aligned teeth, a conservative, monitoring approach prior to a corrective, surgical intervention seems prudent in children of this age with a minimal zone or absence of attached gingiva.