Efficacy of Human Chorion Membrane Allograft for Recession Coverage: A Case Series

Background : Membranes of human placentas have been used in the field of medicine for skin grafts, treatment of burns, and ulcerated skin conditions with great success. The use of placenta allografts in dentistry is a more recent development, with the first commercial product being made available in 2008. The unique inherent biologic properties in placenta allografts enhance wound healing and may propagate regeneration. Methods: Ten healthy adult patients presenting with 21 Miller Class I gingival recession (GR) defects (isolated or adjacent multiple) were surgically treated with a modified coronally advanced flap and chorion membrane for root coverage. Clinical parameters measured at baseline, 3 months, and 6 months were probing depth, clinical attachment level, GR height, width of keratinized gingiva, and assessment of gingival biotype. Statistical analysis was performed to compare the treatment outcomes at the follow‐up intervals. Results: The results showed statistically significant (P <0.001) improvements in all clinical parameters at the 3‐ and 6‐month follow‐ups. The mean percentage of root coverage at the end of 6 months was 89.92% ± 15.59%, and 14 of 21 treated GR defects showed 100% root coverage. The gingival biotype also showed a thick biotype in nine sites that had an initial thin biotype. Conclusions: Fetal membranes possess distinctive properties that can be harnessed to promote periodontal healing. The chorion membrane covered by a modified coronally advanced flap is a new approach that has shown promising results in terms of root coverage, increased width of keratinized tissue, and thickness of the gingival biotype.     

上前牙区即刻种植修复的软组织效果评估

目的：评估上前牙区即刻种植联合即刻修复的软组织效果。方法上前牙区单牙即刻种植患者26例,微创拔牙后植入ZIMMER TSV种植体,获得良好初期稳定性并实施即刻修复,经过6～12个月骨结合和牙龈塑形后完成上部修复,观察负重6个月后牙龈组织情况。结果26例患者完成骨整合及最终修复,负重正常,无探诊出血、牙龈红肿,近中龈乳头、远中龈乳头及龈缘高度降低分别为（0．52±0．22） mm、（0．56±0．31） mm 和（0．71±0．34） mm,差异无统计学意义（F＝1．297,P＝0．29）。结论上前牙区单牙即刻种植联合即刻修复存在不同程度的软组织退缩。     

Comparative evaluation of surgical modalities for coverage of gingival recession: An Armed Forces Medical College perspective

Background

Esthetics represents an inseparable part of today''s oral therapy, and several procedures have been proposed to preserve or enhance it. Gingival recessions may cause hypersensitivity, impaired esthetics and root caries. Keeping in mind patient''s desire for improved esthetics and other related problems, every effort should be made to achieve complete root coverage.

Methods

Different types of modalities have been introduced to treat gingival recession including displaced flaps, free gingival graft, connective tissue graft, different type of barrier membranes and combination of different techniques. The aim of this study was to compare the commonly used techniques for gingival recession coverage and evaluate the results obtained. 73 subjects were selected for the present study who were randomly divided into four groups and were followed at baseline and 180 days where following parameters were recorded: (a) Assessment of gingival recession depth (RD); (b) Assessment of pocket depth (PD); (c) Assessment of clinical attachment level (CAL) and (d) Assessment of width of attached gingiva (WAG).

Results

Results of this study showed statistically significant reduction of gingival recession, with concomitant attachment gain, following treatment with all tested surgical techniques. However, SCTG with CAF technique showed the highest percentage gain in coverage of recession depth as well as gain in keratinized gingiva. Similar results were obtained with CAF alone. The use of GTR and other techniques showed less predictable coverage and gain in keratinized gingiva.

Conclusion

Connective tissue grafts were statistically significantly superior to guided tissue regeneration for improvement in gingival recession reduction.     

外直肌超常量后徙固定在知觉性外斜视手术中的应用

目的 观察外直肌超常量后徙固定在知觉性外斜视手术中的远期疗效,分析其应用价值.方法 回顾性分析我科2012年5月至2013年9月行外直肌超常量后徙固定的知觉性外斜视病例12例.外斜视度数均＞50△,患眼固视功能差.在斜视眼行外直肌超常量后徙固定(缝合于原肌止点后12.0 mm)联合内直肌缩短术(4.0～7.0 mm),观察术后眼位、眼球运动、眼面外观及视功能远期疗效.结果 随访13 ～ 27个月后,12例患者术后眼位正位,眼球外转稍有受限;眼面外观良好;均获得较稳定的患眼固视能力,但未建立明确的双眼视功能.结论 外直肌超常量后徙固定稳定了后徙外直肌的位置,减少了手术肌肉条数,具有安全可行、远期疗效稳定等优点.     

牙周致病菌免疫逃逸机制的研究进展

牙周致病菌可引起牙周组织慢性炎症,由其引发的宿主过度的免疫炎症反应会进一步加重牙周组织的损伤。本文就龈沟的天然免疫防御机制,微生物对龈沟防御机制的敏感性,中性粒细胞和牙龈上皮细胞对牙周致病菌的免疫反应进行系统阐述,旨在表明真正的牙周致病菌因不能很好地激发或者抑制宿主的免疫反应,从而逃避宿主的免疫防御,导致牙周炎的发生,为牙周病的治疗和早期预防提供参考依据。     

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目的评价单纯牙周基础治疗对苯妥英钠(PHT)所致药物性牙龈增生的治疗效果。方法选择佛山市禅城区向阳医院·禅城区口腔医院2011年1月至2013年6月因服用PHT导致牙龈增生的患者16例,在不停药亦不换药的情况下行牙周基础治疗,并于治疗前及治疗后1、3、6个月进行牙龈增生指数(GHI)、菌斑指数(PLI)、龈沟出血指数(SBI)、探诊深度(PD)等临床指标检查。结果单纯牙周基础治疗后1、3、6个月的GHI、PLI、SBI、PD各项临床指标逐步改善,牙龈炎症逐步减轻,牙龈增生状况持续好转;与治疗前基线相比,差异均有统计学意义(均P<0.05)。结论单纯牙周基础治疗对PHT所致药物性牙龈增生有效。