改良根向复位瓣技术在上颌后牙区种植二期手术中的应用效果评价

目的 探讨上颌后牙区种植体颊侧角化龈重建方法,评估其临床疗效及对种植体牙周状况的影响。方法 筛选种植二期手术且伴有角化龈不足的患者11例,共11个上颌后牙区种植位点,应用改良根向复位瓣技术在种植二期手术同期为患者进行角化龈重建。于二期手术后6周进行冠修复,并于冠修复3个月后复诊。分别记录术前、冠修复时和冠修复完成3个月后的角化龈宽度。拍摄根尖片,测量牙周探诊深度（PD）和探诊出血位点百分比（BOP）。采用SPSS 19.0软件包对数据进行配对样本t检验。结果 冠修复完成时,角化龈宽度为（3.30±0.36） mm,术前为（1.44± 0.34）mm,平均增加1.86 mm（P<0.01）。重建的角化龈宽度在冠修复3个月后仍然保持稳定,平均（3.34±0.33） mm（P=0.58）,无明显炎症与骨吸收。PD为（2.83±1.20） mm,BOP比为18.2%。结论 在种植二期手术同期,采用改良根向复位瓣技术能有效重建上颌后牙区种植体颊侧附着龈,短期内可以保证良好、稳定的效果。

Effect of modified root directional flap applied for implant surgery in the secondary implantation of maxillary posterior teeth

PURPOSE: To explore the reconstruction method of buccal keratinized gingiva around implant in posterior maxillary area, and to evaluate its clinical effects and periodontal condition around the implants. METHODS: A total of 11 implants were selected by screening from 11 patients who had inadequate keratinized gingiva and needed to undergo secondary operation. An optimized root directional flap technique was applied to reconstruct keratinized gingiva in the stage of secondary operation. Crown restoration was finished 6 weeks after surgery and the patients were recalled 3 months after dental restoration. Effective keratinized mucosal width was recorded separately before the operation, crown restoration and 3 months after restoration. Clinical periodontal examination was conducted 3 months after restoration including probing depth (PD), bleeding on probing (BOP) and periapical film. SPSS19.0 software package was used for paired t test. RESULTS: The average keratinized mucosal width was (1.44±0.34) mm and (3.30±0.36) mm before operation and after crown restoration, respectively.There was an average increase of 1.86 mm in effective keratinized mucosal width compared with preoperative value (P<0.05). Three months after restoration, the newly health keratinized gingiva remained stable without obvious inflammation. The mean width was (3.34±0.33) mm (P=0.58). Clinical periodontal examinations showed a mean PD of 2.83±1.20 and the mean BOP of 18.2%. CONCLUSIONS: By using modified root directional flap technique in the secondary implant operation, the buccal keratinized gingiva around the implants can be effectively reconstructed. The short-term outcomes are satisfactory.