锥形束CT法在上颌前牙区牙龈厚度评估中的应用

目的 探究锥形束CT(CBCT)法在不同牙位、不同牙龈生物型及不同牙龈退缩类型上颌前牙区牙龈厚度评估中的应用。方法 选择2018年3月至2019年7月在我院口腔科接受CBCT检查的40例患者（225颗患牙）为研究对象，测量上颌前牙区龈缘下2 mm各患牙的牙龈厚度，比较其在不同牙位、牙龈生物型、牙龈退缩类型的差异。结果 中切牙的牙龈厚度（1.56±0.32） mm>侧切牙的牙龈厚度（1.34±0.28） mm>尖牙的牙龈厚度（1.13±0.24） mm；无退缩牙龈厚度（1.42±0.38） mm>退缩牙龈厚度（1.19±0.37） mm，退缩程度越深，牙龈厚度越小，差异具有统计学意义（P<0.05）；中切牙多为厚龈型，侧切牙和尖牙多为薄龈型；大部分患者为薄龈生物型，薄龈型相比厚龈型更容易发生牙龈退缩。CBCT法测量牙龈厚度具有准确性和可重复性。结论 CBCT法在上颌前牙区不同牙位、牙龈生物型及牙龈退缩类型上评估牙龈厚度具有良好的准确性。有助于牙科医生选择牙周治疗方案、评估美学修复预后提供参考依据。     

改良隧道技术治疗牙龈退缩合并非龋性牙颈部缺损的临床研究

目的 探讨改良隧道技术（MTUN）治疗牙龈退缩合并非龋性牙颈部缺损（NCCL）的临床疗效。方法 纳入42颗Miller Ⅰ度牙龈退缩患牙,根据是否伴有NCCL分为NCCL组和对照组,均采用MTUN联合上皮下结缔组织移植进行治疗。记录患牙术前及术后3、6月的牙周探诊深度（PD）、牙龈退缩高度（GRH）、牙龈退缩宽度（GRW）、附着龈宽度（AGW）以及临床附着丧失（CAL）,并计算术后6月的平均根面覆盖率（MRC）。使用美学评分系统记录美学评分。结果 2组患牙术后GRH、GRW、CAL较术前相比均明显减小,PD、AGW未发现明显改变。NCCL组MRC为63.40%±28.02%,对照组MRC为67.00%±21.72%,二者间差异无统计学意义（P=0.815）。2组间术后美学评分无统计学意义。结论 MTUN能够有效改善牙龈退缩问题,较浅NCCL（≤1 mm）的存在不会影响MTUN的手术疗效。     

改良隧道技术治疗牙龈退缩合并非龋性牙颈部缺损的临床研究

目的 探讨改良隧道技术（MTUN）治疗牙龈退缩合并非龋性牙颈部缺损（NCCL）的临床疗效。方法 纳入42颗Miller Ⅰ度牙龈退缩患牙,根据是否伴有NCCL分为NCCL组和对照组,均采用MTUN联合上皮下结缔组织移植进行治疗。记录患牙术前及术后3、6月的牙周探诊深度（PD）、牙龈退缩高度（GRH）、牙龈退缩宽度（GRW）、附着龈宽度（AGW）以及临床附着丧失（CAL）,并计算术后6月的平均根面覆盖率（MRC）。使用美学评分系统记录美学评分。结果 2组患牙术后GRH、GRW、CAL较术前相比均明显减小,PD、AGW未发现明显改变。NCCL组MRC为63.40%±28.02%,对照组MRC为67.00%±21.72%,二者间差异无统计学意义（P=0.815）。2组间术后美学评分无统计学意义。结论 MTUN能够有效改善牙龈退缩问题,较浅NCCL（≤1 mm）的存在不会影响MTUN的手术疗效。     

两种排龈方法排龈效果的数字化分析

目的 数字化分析比较半导体激光排龈及单线排龈法的临床排龈效果,即排龈疼痛度分析以及对游离龈龈沟宽度（sulcus width,SW）和牙龈退缩量（gingival recession,GR）的影响。方法 选择需行固定修复的患者42例,共计52颗患牙,随机分为半导体激光排龈组及单线排龈组,选择26颗正常牙作为空白对照组。采用VRS疼痛数字分级法,评估两种排龈法疼痛度;采用3Shape扫描仪制取排龈前及排龈后即刻、1周、6周的数字化模型,在geomagic qualify 2014软件中,分析比较两种排龈法排龈后SW、GR0、GR1、GR6。结果 半导体激光排龈组疼痛度低于单线排龈组（P<0.05）;半导体激光组SW颊=（0.394 2±0.087 3）mm、SW腭=（0.397 4±0.086 8）mm,大于单线排龈组SW颊=（0.322 8±0.057 3）mm、SW腭=（0.306 0±0.050 6）mm（P<0.05）;半导体激光组GR0＝（0.342 5±0.027 9）mm、GR1＝（0.162 5±0.056 9）mm、GR6＝（0.239 3±0.020 6）mm大于单线排龈组GR0＝（0.273 0±0.018 7）mm、GR1＝（0.145 9±0.030 8）mm、GR6＝（0.162 5±0.015 9）mm（P<0.05）。结论 半导体激光排龈疼痛度较低,单线排龈法及半导体激光排龈法均能达到良好的龈沟宽度,但二者均会导致永久性龈退缩,且半导体激光排龈后牙龈退缩量较单线排龈法大,故针对厚龈型牙龈建议使用单线排龈。但对于疼痛较为敏感的患者,也可考虑使用激光排龈。     

PRF治疗牙龈退缩的对照研究

目的：通过对比观察采用Choukroun's富血小板纤维蛋白膜(PRF膜)和采用结缔组织瓣治疗牙龈退缩的临床效果。方法：临床上选取有牙龈退缩且有意愿进行手术治疗的患者13例,分为PRF膜组和对照组,分别实施手术治疗,在术前、术后3个月测量牙周袋深度（PD）、角化龈宽度（KTW）以及牙龈退缩量,并对结果进行对照分析。结果：两组数据中牙周袋深度术前术后比较均无显著性差异（P≤0.05）;角化龈宽度和牙龈退缩量术前术后比较均有显著性差异（P≥0.05）。角化龈宽度术后比较两组之间无显著性差异（P≥0.05）;牙龈退缩量对照组小于PRF组（P≤0.05）。结论：PRF膜（富血小板纤维蛋白）治疗牙龈退缩的根面覆盖量虽不及结缔组织瓣＋冠向复位组,但对于MillerⅠ°、Ⅱ°同样可以达到很好的根面覆盖效果;且术后角化龈宽度明显增加,和膜龈组之间无显著性差异(P＞0.05)。     

牙龈退缩根面覆盖治疗1例

目的 牙龈退缩常常导致根面敏感、菌斑控制不良和牙龈美学等问题,影响患者的口腔健康和颜面美观。本病例采用根面覆盖术治疗牙龈退缩,以改善患者牙齿敏感问题。诊治经过：手术采用冠向复位瓣联合结缔组织移植瓣双层技术治疗退缩类型（recession type,RT）为1类的牙龈退缩。结果 术后2周,受区龈缘略水肿;术后12个月复诊,龈缘位置趋于稳定,根面覆盖率达100%,角化龈宽度及临床附着水平增加。患者无牙齿敏感、系带牵拉和瘢痕形成等不适症状,牙龈美学效果良好。结论 冠向复位瓣联合结缔组织移植瓣双层技术治疗RT 1类牙龈退缩效果良好,不仅能够获得完全根面覆盖、牙龈美学效果良好,而且增加了术区角化牙龈的宽度和临床附着水平。     

两种瓷贴面粘结方法对龈上皮损伤的比较研究

［摘要］ 目的 比较瓷贴面粘结中用排龈线排龈和直接抛光机械损伤龈上皮对牙龈健康的影响,为临床应用提供参考。方法 将牙周健康对称性贴面修复的36颗前牙纳入研究,采用自身左右同源配对的办法,随机分配某侧修复牙为排龈线退龈后粘结,另一侧为直接抛光粘结,健康天然邻牙为对照组。在粘结后1周和2周,对修复体进行回访,使用探诊深度(probing depth,PD)、Mazza出血指数（Mazza index,MI）、菌斑指数(plaque index, PLI)对贴面修复牙和对照牙的牙龈进行检查记录。采用多配对样本的Friedman双向评秩方差检验和两配对样本的非参检验（Wilcomxon）观察2种粘结方法处理后的牙龈和对照组牙龈各项指标的差异（α=0.05）。结果 在粘结后1周,排龈组MI1.00(0.75~1.00)和直接抛光组MI1.00(1.00~2.00)与对照牙MI1.00(0.00~1.00)均有显著性差异 (P=0.004)。2组间无统计差异（P=0.16）。PLI与PD在两个观测时间点均无显著性差异。术后1年复查,所有病例均未出现明显牙龈退缩及粘结边缘着色。结论 瓷贴面粘结中用排龈线排龈和直接抛光均会引起牙龈两周内短期损伤性炎症。2种处理之间并无显著性差异。     

一种新的牙龈退缩分度方法的检查者自身和检查者间的一致性研究

目的：文献中已经提出了许多关于牙龈退缩分度的方法．但是这些分度方法都未见有经过有效的统计学的分析和验证。因此,这些分度方法在不同临床医师中应用时．是否都同样有效还不详。本研究旨在研究一种新的牙龈退缩分度方法在检查者自身和检查者问的一致性．并评估其在不同临床医师中的一致性。材料和方法：通过以下3个方面评估提出的这一新的分度方法：牙龈角化组织量（〈2mm或≥2mm）．是否存在牙颈部的非龋性病变以及是否存在邻面附着丧失。采用盲法分析3位检查者的KaPPa统计值（一致性检验）。结果：使用该新分度方法对120例牙龈退缩患者进行评估,牙龈角化组织变量的检查者自身一致性值为074～096．非龋性牙颈部缺损变量的检查者自身一致性值为067～094,邻面附着丧失变量的检查者自身一致性值为0．70～092。牙龈角化组织变量的检查者问一致性值为070～085．非龋性牙颈部缺损变量的检查者自身一致性值为054～059,邻面附着丧失变量的检查者自身一致性值为054～077。结论：基于本研究结果和人群,新提出的分度方法在调查者中的一致性为中度到高度。因此．该方法可以判定牙龈退缩的严重程度。     

上颌非龋性牙颈部缺损合并多发龈退缩的牙体一牙周美学修复：追踪12个月的个案报道

非龋性牙颈部缺损（norl—cariouscervicallesions．NCCLs）的充填治疗．向树脂材料发出了挑战．原因在于牙齿结构中存在不同的粘结特性．牙颈部生物力学的特点，以及治疗部位的难以入路和隔湿困难。治疗NCCLs时应顾及邻近的牙周组织。当牙颈部缺损伴有龈退缩时，牙体充填与牙周治疗都关系到美学效果和长期成功率。本文报道1例历时12个月的牙体一牙周联合治疗NCCLs伴多发性龈退缩的病例。     

口内扫描数字化印模技术在磨牙区牙体达龈下缺损全冠修复中的应用

目的:探索口内扫描数字化印模(IDI)技术在磨牙区牙体缺损达龈下全冠修复的效果。方法:选择2020年9月～2021年10月因磨牙区牙体缺损达牙龈下患者16例(16颗患牙)。完成牙体预备后，采用IDI获取龈上基牙数据，再用改良法双相二次印模技术获得包括龈下缺损牙体组织的基牙石膏模型；通过扫描石膏模型将龈下牙体组织数据与IDI获得的数字模型数据拟合，获取完整的基牙数据。CAD/CAM完成全解剖氧化锆冠的设计与制作。评价修复效果，并于治疗1个月、6个月后复查基牙牙菌斑指数(PLI)和牙龈指数(GI)。结果:16颗全冠边缘完整性、就位支点、边缘台阶评级、咬合评级均为临床接受等级。冠边缘适合性检查颊侧(92.36±10.32)μm、舌/腭侧(106±12.35)μm、近中(85±8.35)μm、远中(88±9.45)μm。修复后1个月患牙PLI和GI分别为(0.78±0.43)分和(0.82±0.53)分；修复后6个月PLI和GI分别为(0.58±0.40)分和(0.72±0.46)分。结论:通过改良IDI技术，实现磨牙区舌/腭侧牙体缺损达龈下冠修复，短期修复效果临床接受。     

Systematic Review of Soft Tissue Alterations and Esthetic Outcomes Following Immediate Implant Placement and Restoration of Single Implants in the Anterior Maxilla

Background: The aim of this review is to assess the outcome of single‐tooth immediate implant placement and restoration (IPR) in the maxillary anterior region, with a particular emphasis on soft tissue and esthetic outcomes. Methods: An electronic search in Medline, EBSCOhost, and Ovid (PubMed) was performed to identify studies that reported on soft tissue outcomes following immediate placement and restoration of implants in the maxillary esthetic region with a mean follow‐up of ≥1 year. Results: Nineteen studies on single implants inserted immediately into fresh extraction sockets and provisionally restored in the maxillary esthetic region were included. Soft tissue changes were found to be acceptable, with most studies reporting mean gingival recession of 0.27 ± 0.38 mm and mean papillary height loss of 0.23 ± 0.27 mm after follow‐up of ≥1 year. Advanced buccal recession (>1 mm) occurred in 11% of cases. Long‐term follow‐up studies (>2 years) reported that the interdental papillae, in particular, showed a tendency to rebound over time. The few studies that reported on patient‐centered outcomes showed a high level of patient satisfaction with the outcomes of IPR treatment. Conclusions: The IPR protocol resulted in generally acceptable soft tissue and esthetic outcomes, with suboptimal results reported in ≈11% of low‐risk cases. Factors such as preoperative tissue biotype or use of a flap or connective tissue graft did not significantly influence soft tissue and esthetic outcomes. Long‐term prospective controlled clinical trials are necessary to identify factors that may influence the esthetic outcomes associated with IPR.     

Coronally positioned flap for treatment of restored root surfaces: a 6-month clinical evaluation

BACKGROUND: The aim of this study was to evaluate clinically the treatment of gingival recession associated with non-carious cervical lesions (NCCLs) by resin modified glass ionomer cement (RMGI) or microfilled resin composite (MRC) and coronally positioned flap (CPF) at 6 months following surgery. METHODS: Fifty-nine patients were assigned to one of three treatments: root exposure without NCCL treated with CPF (group 1); root exposure with NCCL treated with RMGI restoration plus CPF (group 2); or root exposure with NCCL treated with MRC restoration plus CPF (group 3). Clinical measurements that were assessed at baseline and at 3 and 6 months after surgery included plaque index (PI), bleeding on probing (BOP); probing depth (PD), recession reduction (RR), clinical attachment level gain (CALG), keratinized tissue height (KTH), keratinized tissue thickness (KTT), percentage of root coverage (RC), and percentage of restored root coverage (RRC). RESULTS: Intra- and intergroup analyses demonstrated no significant differences in PI, BOP, PD, RR, CALG, KTH, or KTT (P >0.05) among the groups at any time. At 6 months, the mean RC was 80.83% +/- 21.08% for group 1; the mean RRCs were 71.99% +/- 18.69% and 74.18% +/- 15.02% for groups 2 and 3, respectively. There were no statistically significant differences in RRC between groups 2 and 3. CONCLUSION: All treatments showed root coverage improvement without damage to periodontal tissues, supporting the use of CPF for treatment of root surfaces restored with RMGI or MRC as being effective over the 6-month period.     

重度牙周炎磨牙拔除运用微翻瓣位点保存术后种植修复效果短期观察

目的:评价重度牙周炎磨牙进行微创拔牙和微翻瓣位点保存术后植体负重1年的效果。方法:纳入2015年1月~2017年1月于牙周科就诊的18名患者共20颗磨牙,种植修复后负重1个月(基线)和12个月对种植牙进行临床检查,记录菌斑指数(silness&leo plaque index,PLI)、植体周软组织探诊深度(peri-implant probing depth,PPD)、出血指数(mazza bleeding index,BI)、颊侧角化组织宽度(width of keratinized tissue,KTW);基线和负重1年拍摄平行投照根尖片测量边缘骨丧失(marginal bone loss,MBL)。结果:20颗种植修复体负重1年后存留率和成功率为100%。负重即刻和负重1年PLI、PPD、BI、KTW变化均无统计学差异(P>0.05),MBL为(0.12±0.24)mm。结论:微翻瓣位点保存术后种植修复负重1年获得了良好的临床效果。     

Peri-implant soft tissue level secondary to a connective tissue graft in conjunction with immediate implant placement: a 2-year follow-up report of 11 consecutive cases

The purpose of this case series was to evaluate secondary soft tissue level changes of a single-stage surgical protocol combining immediate implant placement and connective tissue grafting in maxillary incisors associated with gingival recession defects. Ten patients underwent the proposed combined treatment consisting of 11 single-tooth implant restorations. Peri-implant soft tissue level and the width of keratinized gingiva were evaluated at baseline, the time of implant restoration connection, and 2 years postrestoration. All parameters used to assess esthetic outcomes showed improvements. The proposed clinical procedure can be considered an alternative approach to achieving an ideal esthetic anterior restoration.     

上颌前牙单牙即刻种植术后即刻修复和延期修复的临床效果比较

目的 比较上颌前牙单牙缺失即刻种植术后即刻修复与延期修复的临床效果。 方法 收集2015年1月至2017年9月在安徽省口腔医院种植中心完成修复的58例上颌前牙单牙种植病例,其中即刻种植即刻修复组29例（II组）,即刻种植延期修复29例（ID组）。分别于患者永久修复时,修复后3个月、6个月、12个月,检测种植存留率,比较两组的红色美学评分（PES）、白色美学评分（WES）、种植体边缘骨吸收以及患者满意度。 结果 种植体存留率：两组种植体存留率皆为100%;边缘骨吸收：垂直骨吸收：3个月时远中位点骨吸收量即刻种植即刻修复组为（0.34±0.18）mm,即刻种植延期修复组为（0.45±0.13）mm,差异有统计学意义(P<0.05),而永久修复3个月近中位点、6个月12个月近远中位点两组均无统计学差异(P>0.05),水平骨吸收：永久修复12个月,MP1位点骨吸收量即刻种植即刻修复组（0.67±0.16）mm,即刻种植延期修复组（0.65±0.15）mm;MP2位点骨吸收量即刻种植即刻修复组（0.54±0.14）mm,即刻种植延期修复组（0.56±0.12）mm,MP1、MP2两个位点两组水平骨吸收量均无统计学差异; PES得分：即刻种植即刻修复组的PES总分在戴牙时,永久修复3个月、6个月、12个月得分分别为（9.69±1.04）、（10.00±1.03）、（10.59±1.20）、（10.79±0.98）,均显著高于即刻种植延期修复组（P<0.05）;WES评分：即刻种植即刻修复组为（7.41±0.83）,即刻种植延期修复组为（6.66±1.04）,两组得分有统计学差异（P<0.05）;患者满意度：即刻种植即刻修复组患者满意度（9.12±0.28）,即刻种植延期修复组为（8.89±0.35）,两组得分有统计学差异（P<0.05）。 结论 即刻种植术后即刻修复与延期修复永久修复1年后在种植体存留率、边缘骨吸收方面无显著差异,但在美学效果方面优于即刻种植延期修复,患者满意度高。     

Factors affecting the outcomes of coronally advanced flap root coverage procedure

BACKGROUND: The coronally advanced flap (CAF) has been used to treat gingival recession. However, the final outcomes (percentage of root coverage) vary from case to case. Hence, the purpose of this study was to analyze the factors that may affect the results of CAF root coverage procedures. METHODS: Twenty-three systemically healthy patients (mean age, 43.8 +/- 11.9 years) each with one Miller's Class I buccal recession defect were included. Baseline clinical parameters included recession depth (RD), recession width (RW), gingival thickness (GT), width of keratinized tissue (WKT), clinical attachment level (CAL), probing depth (PD), plaque index (PI), and gingival index (GI). CAF root coverage procedures were performed to correct the recession defects. Patients were followed at 2, 4, 12, and 24 weeks post-surgery, at which time wound healing index (WHI) and other measurements were recorded. RESULTS: The mean baseline RD was 2.9 +/- 0.4 mm; RW, 3.4 +/- 0.6 mm; WKT, 2.7 +/- 1.3 mm; and GT, 1.1 +/- 0.3 mm. At mid-buccal, the mean CAL was 4.5 +/- 0.8 mm. Six months after surgery, the average RC was 82.3% +/- 24.7%; RD, 0.5 +/- 0.7 mm; RW, 0.4 +/- 0.9 mm; WKT, 3.2 +/- 0.9 mm; and GT, 1.5 +/- 0.5 mm. At mid-buccal, the mean CAL was 1.8 +/- 1.1 mm. From baseline to the 6-month follow-up, the changes of RC, RD, RW, WKT, GT, and CAL showed statistical significance (P < 0.05). Fourteen patients achieved 100% RC. The mean RC in partial coverage cases was 54.8% +/- 16.8%. Analysis revealed that an initial GT thicker than 1.2 +/- 0.3 mm was associated with complete root coverage at the 6-month follow-up (P < 0.05). CONCLUSIONS: CAF is a predictable procedure to treat Miller's Class I mucogingival defects. Initial GT was the most significant factor associated with complete root coverage.     

Coronally positioned flap plus resin-modified glass ionomer restoration for the treatment of gingival recession associated with non-carious cervical lesions: a randomized controlled clinical trial

BACKGROUND: The aim of this randomized clinical trial was to evaluate the treatment of gingival recession associated with non-carious cervical lesions by a coronally advanced flap alone (CAF) or in combination with a resin-modified glass ionomer restoration (CAF+R). METHODS: Nineteen subjects with bilateral Miller Class I buccal gingival recessions associated with non-carious cervical lesions were selected. The recessions were assigned randomly to receive CAF or CAF+R. Bleeding on probing (BOP), probing depth (PD), relative gingival recession (RGR), clinical attachment level (CAL), non-carious cervical lesion height (CLH), and dentin sensitivity (DS) were measured at baseline; 45 days; and 2, 3, and 6 months postoperatively. Keratinized tissue width (KTW) and keratinized tissue thickness (KTT) were measured at baseline and 6 months. The height of the non-carious cervical lesion located on the root and crown were estimated, allowing calculation of root coverage. RESULTS: Both groups showed statistically significant gains in CAL and soft tissue coverage. The differences between groups were not statistically significant for BOP, PD, RGR, CAL, KTW, and KTT after 6 months. The percentages of CLH covered were 56.14% +/- 11.74% for CAF+R and 59.78% +/- 11.11% for CAF (P >0.05). The root and crown surfaces affected by the non-carious cervical lesion were 1.67 +/- 0.31 mm and 0.96 +/- 0.29 mm, respectively, for CAF+R and 1.59 +/- 0.37 mm and 1.01 +/- 0.33 mm, respectively, for CAF. The estimated root coverage was 88.02% +/- 19.45% for CAF+R and 97.48% +/- 15.36% for CAF (P >0.05). CAF+R reduced DS significantly compared to CAF (P <0.05). CONCLUSIONS: Both procedures provided similar soft tissue coverage after 6 months. Despite the fact that a greater reduction in DS was observed after CAF+R, longitudinal observations are necessary to confirm these results.