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。     

口腔扫描数字化测量法在评估膜龈手术疗效中的可靠性及有效性研究

目的:评估基于口腔扫描技术的数字化测量法在评价牙周膜龈手术疗效中的可靠性及有效性.方法:本实验共纳入12名患者33颗因牙龈退缩接受过结缔组织移植相关膜龈手术的患牙.术前和术后6月通过口腔扫描获取数字化模型.2名检测者分别用探针法和数字化法测量术前牙龈退缩高度(GRH)、牙龈退缩宽度(GRW)及术后牙龈高度增加(GHG)...     

传统隧道技术与改良隧道技术治疗上前牙牙龈退缩临床疗效

目的比较传统隧道技术(tunnel technique,TUN)与经前庭沟切口的骨膜下改良隧道技术(vestibu?lar incisionsubperiostealtunnelaccess,VISTA)联合上皮下结缔组织瓣(connective tissuegraft,CTG)移植进行根面覆盖治疗上前牙牙龈退缩的临床效果,为临床上治疗牙龈退缩提供参考。方法对1例13?14,22?23 Mill?er I类牙龈退缩患者采用自身左右对照的方法,22、23行TUN联合CTG移植,13、14行VISTA联合CTG移植治疗牙龈退缩。术后进行测量牙龈退缩高度(gingival recessionheight,GRH)、牙龈退缩宽度(gingival recession width,GRW)、角化龈宽度(keratinized gingivalwidth,KW),且进行根面覆盖美学评分(root coverageesthetic score,RES)与视觉模拟评分(visual analoguescale,VAS)。结果术后13、14、22、23取得完全的根面覆盖效果,两种术式的术后效果均稳定,GRH、GRW降低,KW增加;根面RES评分均为10分;术后VISTA+CTG患者VAS为6,较TUN+CTG的VAS高。结论TUN+CTG和VISTA+CTG术式均可以有效地治疗牙龈退缩,美学效果较好,患者满意,VISTA增加附加切口使临床操作更为简便,但舒适感较差。     

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。     

改良盾构术与传统即刻种植术的临床效果对比研究

目的 对比研究美学区改良盾构术与传统即刻种植术的临床效果。方法 选取24例行上颌前牙区单颗牙即刻种植的患者,12例行改良盾构术（试验组）,12例行传统即刻种植术（对照组）,随访1年,比较两组患者的种植成功率、红色美学指数（PES）、唇侧骨板吸收量以及患者满意度。采用SPSS 21.0软件进行统计学分析。结果 术后1年,两组患者的种植成功率均为100%;试验组PES评分以及患者满意度均高于对照组,唇侧骨板吸收量低于对照组,差异均有统计学意义（P<0.05）。结论 改良盾构术有利于维持唇侧骨量,从而获得更好的软组织美学效果。     

改良盾构术与传统即刻种植术的临床效果对比研究

目的 对比研究美学区改良盾构术与传统即刻种植术的临床效果。方法 选取24例行上颌前牙区单颗牙即刻种植的患者,12例行改良盾构术（试验组）,12例行传统即刻种植术（对照组）,随访1年,比较两组患者的种植成功率、红色美学指数（PES）、唇侧骨板吸收量以及患者满意度。采用SPSS 21.0软件进行统计学分析。结果 术后1年,两组患者的种植成功率均为100%;试验组PES评分以及患者满意度均高于对照组,唇侧骨板吸收量低于对照组,差异均有统计学意义（P<0.05）。结论 改良盾构术有利于维持唇侧骨量,从而获得更好的软组织美学效果。     

半导体激光辅助重度慢性牙周炎牙周非手术治疗的临床研究

目的: 评估半导体激光在辅助重度慢性牙周炎的牙周非手术治疗中发挥的作用。方法: 20例重度慢性牙周炎患者基线时进行牙周各项检查,包括探诊深度(probing depth, PD)、临床附着水平(Clinical attachment level, CAL)、出血指数(bleeding index, BI)、松动度(tooth mobility, MOB)。将患者的牙列分为左右两侧,右侧患牙为对照组,仅采用牙周非手术治疗;左侧患牙为实验组,先行牙周非手术治疗,再选取检查时重度慢性牙周炎的患牙,进行半导体激光的牙周袋消毒。治疗后8周对患者进行同样的牙周检查,比较牙周指标恢复情况。结果: 8周复查时两组的PD、CAL及BI均较基线时明显降低(P＜0.05);实验组PD和CAL的改善程度比对照组更明显(P＜0.05),治疗后的MOB无明显改善(P＞0.05)。结论: 半导体激光在辅助重度慢性牙周炎牙周非手术治疗时可以增加其疗效,能有效增加附着水平,它可能是对当前牙周非手术治疗方案的有效补充。     

树脂充填结合多牙位冠向复位瓣技术治疗伴非龋性牙颈部病变合并牙龈退缩的临床疗效

目的 观察树脂充填结合多牙位冠向复位瓣技术（multiple coronally advanced flap, MCAF）治疗伴非龋性牙颈部病变（noncarious cervical lesion，NCCL）合并牙龈退缩的临床疗效。方法 选取伴NCCL的多牙位牙龈退缩患者3例，使用树脂充填+MCAF，并结合上皮下结缔组织移植术（subepthelial connective tissue graft，SCTG）进行缺损区域软硬组织的修复。术后随访3年，比较手术前后的探诊深度(probing depth，PD)、出血指数(bleeding index，BI)、菌斑指数（plaque index, PLI）、退缩高度(recession height，RH)、角化龈宽度(keratinized tissue width，KTW)、牙龈厚度(gingiva thickness，GT)，并计算根面覆盖美学评分（root coverage esthetic score, RES）评价术后长期随访的美学效果。结果 本研究共纳入3例患者，共10个位点。PD由(1.10±0.32)mm至(1.65±0.34)mm，P=0.001；BI由0.10±0.32至0.50±0.53，P=0.037；PLI由0.30±0.48至0.40±0.52，P=0.660；10个位点均获得了100%的根面覆盖率和角化龈宽度、牙龈厚度的增加，P值分别为＜0.000、0.003、＜0.000。术后3年随访的RES为（9.40±0.95）分。结论 树脂充填结合MCAF+SCTG技术可以修复NCCL造成的牙颈部硬组织缺损和牙龈软组织缺损，美学效果良好。     

铸瓷高嵌体修复牙体严重缺损的 年轻恒磨牙的效果分析

目的 评价铸瓷高嵌体修复严重缺损的年轻恒磨牙的临床效果。方法 选取牙体严重缺损的第一恒磨牙60颗,随机分为2组,分别进行树脂直接充填（树脂组）和铸瓷高嵌体修复（高嵌体组）。在修复后3、6、12、24个月检查两组患牙的修复体状态及咬合情况。按照改良USPHS/Ryge标准对修复体进行评价,使用T-Scan Ⅲ咬合分析系统进行咬合分析,记录牙龈状况和邻接关系恢复情况。结果 治疗后12个月,两组边缘适合性评分的差异有统计学意义,高嵌体组的A级多于树脂组（P<0.05）。治疗后12和24个月,两组表面光滑度评分的差异有统计学意义,高嵌体组的A级多于树脂组（P<0.05）。树脂组的患牙与对侧同名牙力百分比的差异均有统计学意义,患牙平均力百分比低于对侧同名牙（P<0.05）;而高嵌体组的患牙与对侧同名牙力百分比的差异均无统计学意义（P>0.05）。两组的牙龈状况和食物嵌塞情况均无明显差异（P>0.05）。结论 在本研究条件下,高嵌体组在修复体边缘适合性和表面光滑度方面,成功率较树脂组高,咬合力恢复也较树脂组更佳。在修复牙体严重缺损的年轻恒牙时,铸瓷高嵌体修复可作为推荐方案之一,有较好的修复效果。     

铸瓷高嵌体修复牙体严重缺损的年轻恒磨牙的效果分析

目的 评价铸瓷高嵌体修复严重缺损的年轻恒磨牙的临床效果。方法 选取牙体严重缺损的第一恒磨牙60颗,随机分为2组,分别进行树脂直接充填（树脂组）和铸瓷高嵌体修复（高嵌体组）。在修复后3、6、12、24个月检查两组患牙的修复体状态及咬合情况。按照改良USPHS/Ryge标准对修复体进行评价,使用T-Scan Ⅲ咬合分析系统进行咬合分析,记录牙龈状况和邻接关系恢复情况。结果 治疗后12个月,两组边缘适合性评分的差异有统计学意义,高嵌体组的A级多于树脂组（P<0.05）。治疗后12和24个月,两组表面光滑度评分的差异有统计学意义,高嵌体组的A级多于树脂组（P<0.05）。树脂组的患牙与对侧同名牙力百分比的差异均有统计学意义,患牙平均力百分比低于对侧同名牙（P<0.05）;而高嵌体组的患牙与对侧同名牙力百分比的差异均无统计学意义（P>0.05）。两组的牙龈状况和食物嵌塞情况均无明显差异（P>0.05）。结论 在本研究条件下,高嵌体组在修复体边缘适合性和表面光滑度方面,成功率较树脂组高,咬合力恢复也较树脂组更佳。在修复牙体严重缺损的年轻恒牙时,铸瓷高嵌体修复可作为推荐方案之一,有较好的修复效果。     

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.     

Root coverage using the coronally positioned flap with or without a subepithelial connective tissue graft

BACKGROUND: Various surgical techniques have been proposed for treating gingival recession. This randomized clinical trial compared the coronally positioned flap (CPF) alone or in conjunction with a subepithelial connective tissue graft (SCTG) in the treatment of gingival recession. METHODS: Eleven non-smoking subjects with bilateral and comparable Miller Class I recession defects were selected. The defects, at least 3.0 mm deep, were randomly assigned to the test (CPF + SCTG) or control group (CPF alone). Recession depth (RD), probing depth (PD), clinical attachment level (CAL), width of keratinized tissue (KT), and gingival/mucosal thickness (GT) were assessed at baseline and 6 months postoperatively. RESULTS: Recession depth was significantly reduced 6 months postoperatively (P<0.05) for both groups. Mean root coverage was 75% and 69% in the test and control groups, respectively. There were no significant differences between the two groups in RD, PD, or CAL, either at baseline or at 6 months postoperatively. However, at 6 months postoperatively, the test group showed a statistically significant increase in KT and GT compared to the control group (P<0.05). CONCLUSIONS: The results indicate that both surgical approaches are effective in addressing root coverage. However, when an increase in gingival dimensions (keratinized tissue width, gingival/mucosal thickness) is a desired outcome, then the combined technique (CPF + SCTG) should be used.     

Coronally advanced flap with or without enamel matrix derivative for root coverage: a 2-year study

AIM: The purpose of this study was to assess the ability of enamel matrix derivative (EMD) to improve root coverage with a coronally advanced flap (CAF) during a 2-year follow-up. METHODS: Fifteen patients each with two single and similar bilateral Miller Class I or II gingival recessions (30 recessions) were selected. Each recession was randomly assigned to the test group (CAF+EMD) or the control group (CAF only). Clinical parameters recorded at baseline and at 6, 12 and 24 months were recession depth (R), recession width (WR), probing depth (PD), clinical attachment level (CAL) and keratinized tissue (KT). RESULTS: Reduction of R resulted in a significant CAL gain in both groups, whereas PD was not altered. In the test group, R decreased from 4.07 mm (SD+/-0.59) at baseline to 0.47 mm (SD+/-0.74) at 24 months, corresponding to a mean root coverage (MRC) of 90.67%, whereas in the control group R shrank from 4.13 mm (SD+/-0.74) at baseline to 0.60 mm (SD+/-0.83) at 24 months (MRC=86.67%). Complete root coverage was achieved at 24 months in 73.33% and 60% of the two groups. A significant KT increase was observed in both groups. CONCLUSIONS: Root coverage outcomes were similar in both groups and no statistically significant differences were found at all between them. Hence, the additional use of EMD to CAF is not justified for clinical benefits of root coverage, but as an attempt of achieving periodontal regeneration rather than repair.     

Gingival recession treatment: guided tissue regeneration with bioabsorbable membrane versus connective tissue graft

BACKGROUND: Gingival recession represents a significant concern for patients and a therapeutic problem for clinicians. Several techniques have been proposed to achieve root coverage. The purpose of this randomized clinical trial was to evaluate the effect of a guided tissue regeneration (GTR) procedure in comparison to connective tissue graft (CTG) in the treatment of gingival recession defects. METHODS: Twelve patients, each contributing a pair of Miller Class I or II buccal gingival recessions, were treated. In each patient one randomly chosen defect received a poly(lactic acid)-based bioabsorbable membrane, while the paired defect received a CTG. Clinical recordings included oral hygiene standards and gingival health, recession depth (RD), recession width (RW), probing depth (PD), clinical attachment level (CAL), and keratinized tissue width (KT). RESULTS: Mean RD statistically significantly decreased from 2.5 mm presurgery to 0.5 mm with GTR (81% root coverage), and from 2.5 mm to 0.1 mm with CTG (96% root coverage), at 6 months postsurgery. Prevalence of complete root coverage was 58% for the GTR group and 83% for the CTG group. Mean CAL gain was 2.0 mm for the GTR group and 2.2 mm for the CTG group. No statistically significant differences between treatment groups were observed for changes in RD, RW, PD, CAL, and KT. CONCLUSIONS: Treatment of human gingival recession defects by means of either GTR or CTG results in clinically and statistically significant improvement of the soft tissue conditions of the defect when pre- and post-treatment measurements were compared. Although differences between CTG and GTR in mean root coverage and prevalence of complete coverage consistently favored the CTG procedure, the differences in measurements were not statistically significant.     

Coronally positioned flap with or without acellular dermal matrix graft in the treatment of Class I gingival recessions: a randomized controlled clinical study

BACKGROUND: The aim of this study was to clinically evaluate the treatment of Class I gingival recessions by coronally positioned flap with or without acellular dermal matrix allograft (ADM). METHODS: Thirteen patients with comparable bilateral Miller Class I gingival recessions (> or = 3.0 mm) were selected. The defects were randomly assigned to one of the treatments: coronally positioned flap and acellular dermal matrix (ADM group) or coronally positioned flap alone (CPF group). The clinical parameters included: probing depth (PD), clinical attachment level (CAL), recession height (RH), recession width (RW), height of keratinized tissue (HKT), thickness of keratinized tissue (TKT), plaque index (PI), and gingival index (GI). The measurements were taken before the surgeries and after 6 months. RESULTS: The mean baseline recession was 3.4 mm and 3.5 mm for ADM group and CPF group, respectively. After 6 months, both treatments resulted in significant root coverage (P < 0.01), reaching an average of 2.6 mm (76%) in the ADM group and 2.5 mm (71%) in the CPF group. The difference in recession reduction between treatments was not statistically significant. There were no statistically significant differences between the treatments in PD, CAL, RH, RW, and HKT. However, the mean TKT gain was 0.7 mm for the ADM group and 0.2 mm for the CPF group (P < 0.01). CONCLUSION: It can be concluded that both techniques could provide significant root coverage in Class I gingival recessions; however, a greater keratinized tissue thickness can be expected with ADM.     

Coronally positioned flap with or without acellular dermal matrix graft in the treatment of class II gingival recession defects: A randomized controlled clinical study

The aim of the randomized controlled single blind study is to evaluate the treatment of Miller's class II gingival recessions by coronally positioned flap (CPF) with or without acellular dermal matrix allograft (ADMA). Ten patients with 20 sites with maxillary bilateral Miller's class II facial recession defects were selected randomly into two groups of test (ADMA+CPF) and control (CPF alone) group with each group having 10 recession defects to be treated. The clinical parameters included plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), recession height (RH), recession width (RW), height of the keratinized tissue (HKT), and thickness of the keratinized tissue (TKT). These measurements were recorded at baseline and after 6 months post-surgery. Statistical analysis was made by the paired "t" test for intragroup and intergroup comparison was done by the unpaired "t" test. The percentage of root coverage for both the experimental and control groups were 82.2% and 50%, respectively. The changes from baseline to 6 months were significant in both the groups for PD, CAL, and RH; however, for parameters such as RW, HKT, and TKT significance was seen only in the experimental group. On comparison between two groups, only TKT showed statistically significance. It can be concluded that the amount of root coverage obtained with ADMA + CPF was superior compared to CPF alone.