种植体周角化组织增宽的临床意义和研究进展

种植体周角化组织宽度不足是种植修复过程中常见的问题.已有研究表明,充足的角化组织宽度不仅利于菌斑控制,还可提高种植体的长期稳定性.目前,临床中用于角化组织增宽的术式主要有:根向复位瓣术、自体组织移植和异体组织移植等.本文就种植体周角化组织宽度的意义及各类角化组织增宽术的研究进展作一综述,以期为临床诊疗提供借鉴.     

Clinical evaluation of a new collagen matrix (Mucograft® prototype) to enhance the width of keratinized tissue in patients with fixed prosthetic restorations: a randomized prospective clinical trial

Aim: The aim of this study was to test a new collagen matrix (CM) aimed to increase keratinized gingiva/mucosa when compared with the free connective tissue graft (CTG).
Material and Methods: This randomized longitudinal parallel controlled clinical trial studied 20 patients with at least one location with minimal keratinized tissue (1 mm).
Main Outcome Measure: The 6-month width of keratinized tissue. As secondary outcomes, the aesthetic outlook, the maintenance of periodontal health and the patient morbidity were assessed pre-operatively at 1, 3 and 6 months.
Results: At 6 months, the CTG attained a mean width of keratinized tissue of 2.6 (0.9) mm, while the CM was 2.5 (0.9) mm, these differences being insignificant. In both groups, there was a marked contraction (60% and 67%, respectively) although the periodontal parameters were not affected. The CM group had a significantly lower patient morbidity (pain and medication intake) as well as reduced surgery time.
Conclusions: These results prove that this new CM was as effective and predictable as the CTG for attaining a band of keratinized tissue, but its use was associated with a significantly lower patient morbidity.     

Effect of the use of a ready-made plastic stent on the peri-implant soft tissue

Abstract

Objective. This study compared the effect of the use of a ready-made plastic stent on the width of peri-implant keratinized mucosa with that of conventional methods and examined the effects of a plastic stent on peri-implant soft tissue. Materials and methods. Five young-adult beagle dogs were used. Forty titanium implants were placed in the mandibular alveolar ridge. Stage 2 surgery was performed 8 weeks after implant installation. Each dog received a full-thickness, apically positioned flap (fAPF) with a lingual crestal incision using a suture material in the control group (n = 20) and a ready-made plastic stent in the test group (n = 20). The keratinized mucosa width after stage 2 surgery was measured in each group. The pocket depth, length of connective-tissue contact and biological width were measured in the tissue samples. A student's t-test was used to test the differences between the groups (95% confidence level). Results. The width of the keratinized mucosa was significantly higher and the distance from the top of the implant platform to the mucogingival junction was significantly longer in the test group than the control group. Histometric observations revealed the pocket depth and biological width to be significantly lower in the test group than the control group. Conclusion. The use of a fAPF with a lingual crestal incision using a ready-made plastic stent can effectively preserve or enhance the width of the keratinized mucosa and might restore a more optimal biological environment at the early soft-tissue healing stage.     

Enhancing the zone of keratinized tissue around implants

Presence or absence of a minimal zone of keratinized tissue around dental implants has been a matter of controversy. However, a consensus exists that a thick zone of keratinized zone around implants provides a prosthetic friendly environment, facilitates precise prosthetic procedures, allows oral hygiene maintenance, resists recession, and enhances esthetic blending. The aim of the present case series was to increase the zone of keratinized soft tissue around dental implants supporting overdentures. Three different surgical techniques modified palatal roll technique with and without apical positioning and connective tissue graft (CTG) were used to achieve this goal. There was a significant gain of keratinized soft tissue with all the three techniques, which remained stable over a period of 6 months. Modified palatal roll technique with and without apical positioning and CTG are simpler surgical techniques, which can be successfully and predictably used for increasing the zone of keratinized tissue around implants.