������ϸ����Ƥ���������������е�Ӧ��

异体脱细胞真皮基质(acellular allogeneic dermal matrix,ADM)来源于正常的异体皮肤组织,经过特殊的理化处理去除真皮中的细胞成分,保留原有的胶原三维结构和完整的基底膜,成为一种多孔的三维膜性支架,其空间网状结构有利于细胞的增殖、毛细血管增生,加速组织的愈合过程,移植后可以迅速被血管化和自体细胞重建。作为一种新兴的皮肤黏膜移植材料,ADM拥有良好的组织相容性和极低的免疫性,现已被应用于牙周领域。     

异种脱细胞真皮基质修复骨引导再生术后软组织缺损的临床观察

目的：观察异种脱细胞真皮基质在骨引导再生术中充当屏障膜并直接修复术后软组织不足的临床效果及对引导骨再生的影响。方法：选择在中山大学附属口腔医院种植科要求种植修复治疗,但因种植区牙槽嵴萎缩,宽度不足而需先行骨引导再生术的患者7例（其中女性5例,男性2例,平均34岁）,术中用脱细胞真皮基质覆盖骨引导再生区域,并直接修补创面软组织不足,临床观察脱细胞真皮基质愈合情况。通过影像学和临床检查评价新生的引导再生骨。结果：术后2周可见创面生物膜有部分降解,骨移植材料表面有薄层胶原基质覆盖;术后3周,创面开始有少量牙龈上皮覆盖;术后4周,牙龈上皮覆盖全部创面,与周围牙龈融合。术后1年,牙种植手术中见再生骨质量好,缺牙区牙槽嵴宽度明显增宽。影像学检查显示,随愈合时间延长,骨粉颗粒高密度影像逐渐消失,与周围正常骨质间界限不清。结论：脱细胞真皮基质充当骨引导生物膜并同时修复骨增量术后软组织不足的临床效果满意。     

A two-year prospective study of coronally positioned flap with or without acellular dermal matrix graft

AIM: Evaluation of the treatment of gingival recessions with coronally positioned flap with or without acellular dermal matrix allograft (ADM) after a period of 24 months. METHODS: Thirteen patients with bilateral gingival recessions were included. The defects were randomly assigned to one of the treatments: coronally positioned flap plus ADM or coronally positioned flap alone. The clinical measurements were taken before the surgeries and after 6, 12 and 24 months. RESULTS: At baseline, the mean values for recession height were 3.46 and 3.58 mm for the defects treated with and without the graft, respectively (p>0.05). No significant differences between the groups were observed after 6 and 12 months in this parameter. However, after 24 months, the group treated with coronally positioned flap alone showed a greater recession height when compared with the group treated with ADM (1.62 and 1.15 mm, respectively--p<0.05). A significant increase in the thickness of keratinized tissue was observed in the group treated with ADM as compared with coronally positioned flap alone (p<0.05). CONCLUSIONS: ADM may reduce the residual gingival recession observed after 24 months in defects treated with coronally positioned flap. In addition, a greater gingival thickness may be achieved when the graft is used.     

Early implant placement and peri-implant augmentation with a porcine-derived acellular dermal matrix and synthetic bone in the aesthetic area: a 2-year follow-up prospective cohort study

The aim of this study was to evaluate the 2-year follow-up results of early implant placement with simultaneous peri-implant augmentation using an acellular dermal matrix (ADM) and a synthetic bone substitute in the aesthetic zone. Twenty subjects were enrolled in this study, they were either males (eight) or females (12), with a mean age of 47.8 ± 4.45 years and each patient was treated with one implant. Simultaneous contour augmentation with guided bone regeneration was performed using synthetic bone particles (maxresorb®) and an ADM (mucoderm®). Keratinized mucosa width (KMW) and gingival thickness (GT) were assessed at baseline, 1, 3, 6, 12 and 24 months. Marginal bone loss, probing pocket depth, bleeding on probing and plaque index were also recorded. GT and KMW increased between baseline and 1 month, slightly decreased between 1 month and 12 months (P < 0.001) and remained stable between 12 and 24 months (P < 0.001). After 2 years, mean marginal bone loss level was 0.51 ± 0.63 mm, with no probing pocket depth values >5 mm and no concomitant signs of inflammation registered. Pink aesthetic score was 8.3. Combining an ADM and guided bone regeneration with early implant placement revealed a significant increase of 1.9 mm for GT and 1.6 mm for KMW after 2 years, showing good patient satisfaction regarding the aesthetic outcomes of soft tissues and prosthetic crown.     

脱细胞真皮基质在口腔医学中的应用进展

脱细胞真皮基质(acellular dermalm atrix,ADM)是取自异体皮肤,经过脱细胞处理的一种真皮替代物。因其具有良好的组织相容性和生物安全性,被越来越广泛地用于各临床学科。本文就脱细胞真皮基质的组织学特点、生物学特点及其在口腔中的应用现状作一综述。     

脱细胞真皮基质复合小牛脱细胞骨修复口腔上颌窦瘘

目的 评价脱细胞真皮基质复合小牛脱细胞骨修复口腔上颌窦瘘的效果。方法 选择上颌骨囊肿摘除术或上颌磨牙拔除术后口腔与上颌窦相通的9例口腔上颌窦瘘患者（缺损大于5 mm×5 mm）,采用脱细胞真皮基质复合小牛脱细胞骨进行同期植入修复缺损。结果 9例患者术后切口均一期愈合,随访6个月,口腔上颌窦相通处黏膜均未见瘘道及分泌物,无鼻塞、流脓涕等上颌窦炎症相关症状,临床检查鼓气试验及CT检查均证实创口愈合。结论 应用脱细胞真皮基质及小牛脱细胞骨修复口腔上颌窦瘘,是一种有效的治疗方法。     

Clinical and histological evaluation of an acellular dermal matrix allograft in combination with the coronally advanced flap in the treatment of miller class I recession defects: an experimental study in the mini-pig

Objectives: To study the wound healing of acellular dermal matrix (ADM) allografts when used together with coronally advanced flaps (CAF) in the treatment of localized gingival recessions in the mini-pig experimental model.
Material and Methods: Dehiscence defects 4 × 5 mm were surgically created in one buccal root surface in each quadrant of PI, II, or III in three mini-pigs. They were then treated with CAF and the interposition of either a connective tissue graft (CTG) or ADM. As the primary outcome, the histological interface between the ADM and the root surface was studied and was compared with CTG. As secondary outcomes, we assessed the amount and quality of the keratinized tissue and clinical outcomes in terms of root coverage and recession reduction.
Results: At 3 months, the CTG group attained a mean 76% root coverage, versus 62% in the ADM group. The histological interface with the root surface was similar in both groups. The apical migration of the epithelium was 1.79±0.46 mm for the CTG and 1.21±0.35 mm for ADM. Newly formed cementum was observed with both treatments. New bone and a newly formed periodontal ligament were shown in five specimens in the ADM group and in three in the CTG group.
Conclusion: Both materials showed similar clinical and histological outcomes.     

���ֺ�������ϸ����Ƥ�����޸��ղ�����֯ȱ����Ч�۲�

目的观察脱细胞真皮基质（ADM）修复颊部软组织缺损的疗效。方法选择2010年11月至2012年11月在安徽医科大学附属口腔医院就诊的颊部软组织缺损患者38例,其中20例应用异种ADM治疗,18例应用异体ADM治疗。随访6个月,观察患者缺损修复治疗效果,并对2种ADM在组织相容性、引导组织再生及补片成活情况等方面进行临床效果评价。结果应用异种ADM修复的患者,修复膜完全成活18例,大部成活2例,修复区表面颜色多为粉红色,质地柔软,瘢痕轻微;应用异体ADM修复的患者,修复膜完全成活17例,1例患者术后补片与创缘边缘有约0.8cm脱离区,补片与基底组织面贴合,补片色泽呈红色,愈合尚可。38例患者均未出现明显局部或全身反应,进食基本不受影响,无明显异物感,张口度未见明显改变。结论异种及异体ADM对颊部软组织缺损的修复效果均较为满意。     

异种脱细胞真皮基质在牙种植术中的临床应用

目的：评价异种脱细胞真皮基质（H-ADM）在种植义齿修复中的临床效果。方法：收集行牙种植术同时使用异种脱细胞真皮基质病例52例。术后使用抗生素一周,随访观察术后1周、1月、3月、6月、12月H-ADM的愈合情况及种植体的骨结合情况。结果：52例患者在术后随访中,未出现排异及明显的炎症反应。种植体均形成良好的骨结合并成功地恢复咀嚼功能;异种脱细胞真皮基质成活率达100%。结论：异种脱细胞真皮基质可有效关闭即刻种植术的软组织创面,重建种植体周围软组织附着,改善种植区美学效果。     

异种脱细胞真皮基质在预防腮腺术后Frey综合征中的效果评价

目的：评价异种脱细胞真皮基质预防腮腺术后味觉出汗综合征的临床疗效。方法：256例腮腺良性肿瘤患者分为2组,第1组（组织补片组）148例,在腮腺浅叶或部分切除术后,植入异种脱细胞真皮基质组织补片,第2组（对照组）108例,采用常规术式。术后随访所有患者,通过调查问卷形式,对味觉出汗综合征进行主观评价,并对患者进行碘-淀粉试验作为客观评价。应用SPSS13.0软件包对2组计数资料进行χ2检验。结果：术后12～18个月复查时,组织补片组和对照组出现味觉出汗综合征主观症状的例数分别为5例（3.38%）和30例（27.78%）,经检验,χ^2=31.49,P〈0.01。碘-淀粉试验阳性例数分别为8例（5.41%）和42例（38.89%）,经检验,χ^2=44.54,P〈0.01,其差异均有统计学意义。结论：异种脱细胞真皮基质能有效预防腮腺切除术后味觉出汗综合征的发生。     

A novel surgical procedure for coronally repositioning of the buccal implant mucosa using acellular dermal matrix: a case report

Background: This case report describes a surgical procedure for coronally advancing the peri‐implant mucosa to treat a soft tissue dehiscence in a single‐tooth implant‐supported restoration in combination with an acellular dermal matrix graft. Methods: The patient was a 41‐year‐old systemically healthy, non‐smoking female. Her chief complaint pertained to the unesthetic appearance of her right lateral upper incisor, caused by recession of the mucosal margin. On examination, a 3‐mm recession could be observed. The periodontium was classified as thin. A 2‐mm band of keratinized peri‐implant mucosa was present. Keratinized gingiva was approximately 6 mm at adjacent areas. The surgical technique included a novel incision design to coronally position the flap over an acellular dermal matrix graft. Results: Partial coverage of the recession was achieved. After a 6‐month period, tissues appeared thicker than preoperatively, with no bleeding on probing and no probing depth >2 mm. The patient was satisfied with the overall treatment result. Conclusions: This case report shows the possibility of achieving partial soft tissue coverage over an implant‐supported restoration with the combined use of an acellular dermal matrix and a coronally positioned flap. A novel technique is presented that allowed advancing the flap over the graft in a single‐tooth restoration where enough keratinized tissue was present preoperatively.     

运用脱细胞真皮基质或结缔组织移植物治疗多发性相邻牙龈退缩的Meta分析

目的 应用Meta分析方法评估运用脱细胞真皮基质或自体结缔组织移植物治疗多发性相邻牙龈退缩的差异性。 方法 根据纳入和排除标准在4个英文电子数据库中筛选随机对照试验,检索日期截止至2022年4月20日,主要结局指标为角化牙龈组织宽度、退缩深度、探诊深度、临床附着水平、完全根面覆盖和根面覆盖美学评分。 结果 共纳入7项随机对照试验,术后12个月后,对照组结缔组织移植物较试验组脱细胞真皮基质能增加角化牙龈组织宽度［MD=-0.28（-0.47,-0.08）,P=0.006］、降低牙龈退缩深度［MD=0.23（0.12,0.35）,P<0.000 1］和提高完全根面覆盖［RR=0.80,95%CI（0.69,0.93）,P=0.003］;探诊深度、临床附着水平和根面覆盖美学评分差异无统计学意义。 结论 多发性相邻牙龈退缩治疗后,结缔组织移植物在增加角化牙龈组织宽度、降低牙龈退缩深度和提高完全根面覆盖方面具有优势,但脱细胞真皮基质由于手术简便并有相似的效果亦有临床应用价值。     

脱细胞真皮基质胶原网架转归的研究进展

脱细胞真皮基质是最近几年兴起来的一种天然生物材料,已有在神经外科、耳鼻咽喉、烧伤整形、牙周病学等学科领域的研究报道。笔者着重就其结构与特性、异体移植后的生物学转归及其机制的研究进展作一综述,为临床应用提供理论依据。