牙周膜龈手术的临床应用Ⅱ：异体材料的应用

牙周膜龈手术主要用于治疗牙龈退缩,增加临床附着水平和牙龈角化组织（附着龈）,以及牙周美容。近年来牙周膜龈手术技术和材料发展迅速,自体上皮下游离软组织移植术一直被公认为是效果最好和最稳定的术式,但由于存在多手术区的缺点,研究人员也一直在探索代替自体组织的材料。本文主要介绍目前临床常用的几种膜龈手术异体材料：1）同种无细胞上皮基质;2）异种胶原基质;3）重组人血小板衍生生长因子;4）釉质基质衍生物蛋白;5）引导组织再生膜;6）组织工程来源结构。应用异体材料的牙周膜龈手术,不仅避免了自体组织的缺点,有些手术效果可以等同甚至超过自体组织,因此异体材料的应用有着广泛的前景。本文介绍了牙周膜龈手术中常用异体材料的优缺点和适应证,并简要介绍了各种膜龈手术的临床选择思路。

The applications of periodontal gingival surgery. Ⅱ: alternative materials

The main purposes of periodontal graft surgery include achieving root coverage, improving the clinical attach-ment level and keratinized tissue, and advancing the procedure of periodontal plastic surgery. Autogenous graft, such as sube-pithelial connective tissue graft-based procedure, provide the best outcomes for mean and complete root coverage, as well as increase in keratinized tissue. However, a disadvantage of the procedure is in the location of the operation itself: the additional surgical site (palate). Therefore, clinicians are always looking for graft substitutes. This article will discuss the evidence sup-porting the use of 1) acellular dermal matrix (ADM); 2) xenogeneic collagen matrix (XCM); 3) recombinant human platelet-derived growth factor (rhPDGF); 4) enamel matrix derivative (EMD); 5) guided tissue regeneration (GTR); 6) living cellularconstruct (LCC), all of which are used in conjunction with coronally advanced flaps as alternatives to autogenous donor tissue. The decision tree for treatments of Miller recession-type defects are also discussed.