自体软组织替代材料在天然牙牙龈增量中的应用和研究进展

传统的膜龈手术中常使用上皮下结缔组织或游离龈移植治疗牙龈退缩和角化龈不足, 但由于自体软组织移植瓣存在需要开辟第二术区、供区组织量有限和患者术后不适明显等缺点, 自体软组织替代材料的研究受到广泛关注。目前多种不同来源的供体替代材料应用于膜龈手术中, 包括富血小板纤维蛋白、脱细胞真皮基质及异种胶原基质等。本文就目前应用的几种类型的自体软组织替代材料在天然牙软组织增量中的应用及研究进展作一综述, 以期为临床牙龈增量手术中自体软组织替代物的应用提供参考。     

角化龈增宽术的角化龈宽度测量分析

目的:对角化龈增宽术使用3种测量方法比较角化龈宽度增量的差别,为临床角化龈增宽效果的测量标准提供参考。方法:纳入2020年12月至2022年5月于南京大学医学院附属口腔医院牙周病科参加角化龈增宽术的患者46例,随机分成试验组(移植物为可吸收梯度层修复膜)和对照组(移植物为自体游离龈组织)。在术前及术后6个月利用3种方法测量角化龈宽度(the width of keratinized gingival, KW),分别为颊侧中点法、颊侧近中/中央/远中位点法及自定义定点法,并按整体、不同分区及不同牙位数分类计算3种方法组间KW增量的差别。结果:从整体上,3种测量方法在试验组和对照组的KW增量的3组间差异均无统计学意义(P>0.05)。从手术区域上,前牙区3种测量方法的KW增量组间差异无统计学意义(P>0.05),但在后牙区,试验组中方法三与方法一的组间差异有统计学意义(P=0.04),对照组的3组间差异无统计学意义(P>0.05)。从手术牙位数上,当牙位数少于3颗牙时,试验组和对照组的3组间KW增量均无统计学差异(P>0.05);当牙位数达3颗及以上时,试验组方法三...     

正畸-膜龈手术联合治疗正畸后的牙龈退缩

本文介绍一例年轻患者正畸后下前牙出现严重龈退缩的跨学科治疗病例。MillerⅢ度龈退缩患牙常伴有严重的牙根异位,这类牙的根面覆盖术的预期效果往往是不确定的。治疗方案应包括：①牙齿邻面去釉获得牙弓间隙;②受累牙在颌骨内移动;③膜龈手术根面覆盖。该患者固定矫治后7个月复查时,可见异位牙已得到矫正,根面暴露处的根方角化龈组织已开始形成,变成了Miller度龈退缩,这时可认为根面覆盖术的可预测性将得到改善。根面覆盖术中采用上皮下结缔组织移植技术。术后1年的临床检查见根面已完全覆盖,牙龈颜色与邻近的组织协调,唇侧龈厚度增加。正畸-牙周联合技术,用在严重的膜龈异常牙的治疗上,可以达到理想的牙周美学效果。     

植体周角化龈研究进展

种植牙周围角化龈对抵抗菌斑刺激及机械创伤起到屏障作用,无论从功能还是美观角度,对最终种植修复成功有着重要意义.早期研究表明,至少2 mm的角化龈(其中附着龈至少1mm)才能维护牙周健康.角化龈的存在有利于植体周围菌斑控制及后期维护,但关于角化龈确切的量与种植体周围感染的关系尚有争议.文章就近年来植体周角化龈的研究做一综...     

改良膜龈手术在牙龈退缩治疗中的应用

随着人们对美观需求的日益提升，治疗牙龈退缩已经成为牙周科临床常见的患者诉求。临床上主要通过手术的方式治疗牙龈退缩，常见的手术包括游离龈移植术、带蒂瓣技术和双层瓣技术，适应证选择恰当时，通常可以获得满意的效果，但上述术式仍存在一定的不足，如根面覆盖效果不理想等。近年来，学者们针对这些不足陆续提出了一些改良方案来治疗不同程度的牙龈退缩，如改良游离龈移植术，即包含龈乳头及游离龈的牙龈单元移植，可改善受体区血供，提高根面覆盖效果，其针对轻度退缩的部位可获得良好的根面覆盖，同时可增宽角化龈和加深前庭沟，但应用于上颌美学区时可能存在术后牙龈颜色、形态不协调，美学效果欠佳的问题。牙龈瓣采用半厚-全厚-半厚的技术进行制备的改良冠向复位瓣，用于多颗牙牙龈退缩时，以退缩最严重牙为中心的改良切口设计的冠向复位信封瓣技术，可提高根面覆盖效果。不离断龈乳头，使龈瓣形成隧道，以容纳移植物的隧道技术及各种改良的隧道技术，可以有效减少术区的组织损伤，并促进创面愈合。本文通过对各类术式的阐述和文献回顾，总结改良膜龈手术治疗牙龈退缩的临床应用及注意事项，并提出牙龈退缩的治疗方案建议，同时强调牙龈退缩的对因治疗，以达到稳定...     

牙周膜龈手术的临床应用Ⅱ：异体材料的应用

牙周膜龈手术主要用于治疗牙龈退缩,增加临床附着水平和牙龈角化组织（附着龈）,以及牙周美容。近年来牙周膜龈手术技术和材料发展迅速,自体上皮下游离软组织移植术一直被公认为是效果最好和最稳定的术式,但由于存在多手术区的缺点,研究人员也一直在探索代替自体组织的材料。本文主要介绍目前临床常用的几种膜龈手术异体材料：1）同种无细胞上皮基质;2）异种胶原基质;3）重组人血小板衍生生长因子;4）釉质基质衍生物蛋白;5）引导组织再生膜;6）组织工程来源结构。应用异体材料的牙周膜龈手术,不仅避免了自体组织的缺点,有些手术效果可以等同甚至超过自体组织,因此异体材料的应用有着广泛的前景。本文介绍了牙周膜龈手术中常用异体材料的优缺点和适应证,并简要介绍了各种膜龈手术的临床选择思路。     

膜龈增宽术在口腔种植临床上的应用

目的：寻找牙种植龈缘不足的解决方法。方法：24例50颗种植牙附着龈严重不足患者在种植Ⅱ期术中行膜龈增宽术伴前庭沟加深术．术后两周测量附着龈宽度增加量。结果：附着龈宽度增加量最少5mm，最多10mm。平均8.1mm，失败两例。结论：膜龈增宽术可增加牙种植后附着龈宽度。     

牙周（外科）手术中结缔组织移植的应用

结缔组织移植在牙周美学外科手术中已被广泛的接受和应用。自从30年前第一例游离结缔组织移植报道以来．获取结缔组织的技术和结缔组织的应用领域也不断改变和发展。本文综述了获取结缔组织移植的技术和其在治疗领域中的应用以及未来的发展方向。     

牙周膜龈手术的临床应用Ⅰ:自体组织的应用

近年来,随着口腔科学的迅速发展,牙周病学方面的新技术和新材料也层出不穷.膜龈手术已在包括牙周再生、牙周美容、种植、正畸等方面得到了越来越广泛的应用.膜龈手术主要包括:1)带蒂软组织瓣术,可以覆盖暴露的牙根表面,也可以结合游离结缔组织移植术达到覆盖根面的治疗效果;2)游离牙龈移植术,不但可以重建附着龈,还可以保护牙齿健康,防止牙龈退缩;3)结缔组织移植术,是治疗牙龈退缩最常用的术式.本文主要以笔者多年的临床经验为基础,采用手术临床照片结合简要文字的方式,介绍常见的各种膜龈手术的适应证、优缺点和临床应用,以使口腔医师能更好地了解并掌握该技术.     

牙周膜龈手术的临床应用Ⅰ：自体组织的应用

近年来,随着口腔科学的迅速发展,牙周病学方面的新技术和新材料也层出不穷。膜龈手术已在包括牙周再生、牙周美容、种植、正畸等方面得到了越来越广泛的应用。膜龈手术主要包括：1）带蒂软组织瓣术,可以覆盖暴露的牙根表面,也可以结合游离结缔组织移植术达到覆盖根面的治疗效果;2）游离牙龈移植术,不但可以重建附着龈,还可以保护牙齿健康,防止牙龈退缩;3）结缔组织移植术,是治疗牙龈退缩最常用的术式。本文主要以笔者多年的临床经验为基础,采用手术临床照片结合简要文字的方式,介绍常见的各种膜龈手术的适应证、优缺点和临床应用,以使口腔医师能更好地了解并掌握该技术。     

Minimal invasiveness in gingival augmentation and root coverage procedures

Minimally invasive surgical procedures aim at optimal wound healing, a reduction of postoperative morbidity and, thus, at increased patient satisfaction. The present article reviews the concept of minimal invasiveness in gingival augmentation and root coverage procedures, and critically discusses the influencing factors, technical and nontechnical ones, and relates them to the underlying biological mechanisms. Furthermore, the corresponding outcomes of the respective procedures are assessed and evaluated in relation to a possible impact of a minimized surgical invasiveness on the clinical, aesthetic, and patient-related results.     

辅助正畸扩弓治疗的上颌后牙区牙周软硬组织增量1例

目的 本病例报道1例牙周软硬组织增量在正畸治疗过程中出现骨开裂及根面暴露的临床应用。诊治经过：一位26岁男性患者在正畸扩弓治疗过程中出现右上后牙牙龈退缩,遂停止正畸加力,要求牙周治疗。临床检查显示7-5牙Miller Ⅲ类牙龈退缩,CBCT检查显示$\underline{7-5}\rvert$牙颊侧根中1/3-根颈1/3牙槽骨吸收。一期通过膜龈手术完成根面覆盖及角化龈增量后,二期采用骨皮质切开+骨增量手术治疗$\underline{7-5}\rvert$牙颊侧骨开裂。结果 术后1年随访,正畸治疗顺利结束,$\underline{7-5}\rvert$牙根面覆盖效果稳定,颊侧骨充盈良好。结论 治疗正畸过程中出现骨开裂及根面暴露时,基于上皮下结缔组织移植的根面覆盖术联合骨皮质切开+骨增量技术能够取得满意效果,然而其长期稳定性仍有待进一步探究。     

种植体周围的牙龈退缩及自体软组织移植治疗的研究进展

牙龈退缩是临床上较为常见的一种症状.牙龈退缩引起的牙周组织缺损会导致一定的美学风险,在前牙美学区种植修复中往往造成较严重的美学并发症.细菌感染、牙周生物型、修复体设计等均会对牙龈退缩造成影响.牙龈退缩的手术治疗有很长的历史,其中自体软组织移植,包括游离龈移植和上皮下结缔组织移植,是较为可靠的方法.本文针对这两种自体软组...     

Sub‐epithelial connective tissue graft for the management of Miller's class I and class II isolated gingival recession defect: A systematic review of the factors influencing the outcome

The aim of the present systematic review was to analyze the factors that affect the outcome of subepithelial connective tissue graft (SCTG) for managing Miller's class I and class II isolated gingival recession defect. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) guidelines for systematic reviews were used. Quality assessments of selected articles were performed. Data on root surface condition, recession type defect, flap thickness, different flap designs, different harvesting techniques, presence/absence of the epithelial collar, graft thickness, flap tension, suturing techniques, and smoking‐related outcomes on root coverage were assessed. The SCTG procedure provides the best root coverage outcomes for Miller's class I and class II recession. The critical threshold of flap thickness was found to be 1 mm. Maximum root coverage was achieved by envelope and modified tunnel technique. SCTG with the epithelial collar does not provide additional gains than SCTG without the epithelial collar. The thickness of SCTG for root coverage was found to be 1.5‐2 mm. Greater flap tension and smoking adversely affect root coverage outcomes. Analysis of the factors discussed would be of key importance for technique selection, and a combined approach involving factors favoring outcomes of SCTG could be of clinical relevance in recession coverage.     

Extracellular matrix-based scaffolding technologies for periodontal and peri-implant soft tissue regeneration

The present article focuses on the properties and indications of scaffold-based extracellular matrix (ECM) technologies as alternatives to autogenous soft tissue grafts for periodontal and peri-implant plastic surgical reconstruction. The different processing methods for the creation of cell-free constructs resulting in preservation of the extracellular matrices influence the characteristics and behavior of scaffolding biomaterials. The aim of this review is to discuss the properties, clinical application, and limitations of ECM-based scaffold technologies in periodontal and peri-implant soft tissue augmentation when used as alternatives to autogenous soft tissue grafts.     

Gingival dimensions after root coverage with free connective tissue grafts

Abstract. Traumatic injury in the presence of a thin and narrow zone of gingival tissue may lead to gingival recession. Especially in class I and II recessions, root coverage may be accomplished with connective tissue grafts. In order to prevent recurrent recession, altering gingival dimensions width and thickness might be of advantage. In the present study, dimensions of gingiva were followed for 1 year after root coverage with connective tissue grafts. The study population consisted of 18 patients with a total of 28 class I or II recessions. Gingival width and depth of the recession were measured with a caliper, and thickness of the marginal tissue with an ultrasonic device. Periodontal probing depth was determined with a pressure-controlled electronic probe. Mean (±sd) recession depth at baseline was 3.l±l.4 mm. After 12 months, coverage amouted to 74±30%. Width of gingiva rose from 2.1±1.0 mm to 3.2±1.4 mm. whereas thickness was increased from 0.8±0.3 mm to 1.5±0.7 mm, on average. No significant alteration of periodontal probing depth was observed but a mean gain of clinical attachment of 1.7± 1.1 mm was ascertained. In a multiple regression analysis, recession depth and presence of the recession in the maxilla, but not tooth type significantly influenced relative root coverage (R²-=0.34, p <0.01). Attachment gain after surgery depended on baseline attachment loss and was negatively influenced by smoking. The present results point to the possibility of doubling gingival thickness after root coverage with connective tissue crafts.     

Use of platelet gel with connective tissue grafts for root coverage: a randomized-controlled trial

Background: Platelet‐rich plasma (PRP) was speculated to be a promoter of periodontal regeneration. There are only a few clinical comparative studies using PRP in the treatment of gingival recession. Aim: The aim of the present study was to compare connective tissue graft (CTG)+PRP with CTG alone in the treatment of gingival recession. Material and Methods: Forty patients with Miller I/II recessions were included. Each recession was randomly treated with either CTG+PRP or CTG. Clinical variables were recorded at baseline and at 6 weeks, 6 and 12 months. Root coverage (RC) and attachment gain (AG) were also calculated. Results: Probing depth, recession depth, clinical attachment level, keratinized tissue width and recession width (RW) were improved in both study groups. However, no difference was observed between groups, except RW. RW in the control group was statistically lower than the test group at all follow‐up periods. Conclusion: Treatment of recession with CTG or a CTG–PRP combination resulted in favourable clinical outcomes. However, no difference could be found between CTG and CTG+PRP. Whether much longer follow‐up studies with higher statistical power may change these results remains questionable.