改良侧向转位冠向复位瓣联合结缔组织移植治疗单牙重度牙龈退缩的临床效果  

Clinical outcomes of a modified laterally moved and coronally advanced flap combined with a connective tissue graft for the treatment of severe recession defects

作　　者：林智恺[1] 束蓉[1] 钱洁蕾[1] 谢玉峰[1] LIN Zhi-kai;SHU Rong;QIAN Jie-lei;XIE Yu-feng(Shanghai Key Laboratory of Stomatology, Department of Periodontology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China)

机构地区：[1]上海交通大学医学院附属第九人民医院牙周病科,上海市口腔医学重点实验室,上海200011

出　　处：《上海交通大学学报（医学版）》2017年第5期656-660,共5页Journal of Shanghai Jiao tong University:Medical Science

基　　金：国家自然科学基金(81570977);上海市教育委员会高原高峰学科建设计划~~

摘　　要：目的·观察侧向转位冠向复位瓣联合结缔组织移植治疗重度Miller Ⅱ或Miller Ⅲ类单牙牙龈退缩缺损的临床效果。方法·选取存在5 mm及以上的牙龈退缩缺损且部分伴有牙唇(颊)向移位突出于牙弓之外的患者3例,采用改良的侧向转位冠向复位瓣联合结缔组织移植进行手术治疗。在基线和治疗1年后随访时,记录退缩深度(RD)、角化龈宽度(KTH)、探诊深度(PD)和临床附着丧失(CAL),并计算根面覆盖率(RC),采用视觉模拟评分(VAS)法评估患者对手术结果的满意度。结果·3例患者基线RD平均为(5.3±0.5)mm,随访时RD平均为(0.3±0.5)mm;RC平均达(93.3±9.4)%,其中2例达到完全根面覆盖。退缩位点(受区)和邻近位点(供区)的KTH,基线为(0.3±0.5)mm和(6.0±0.8)mm,随访时为(4.3±0.5)mm和(5.7±1.3)mm;PD和CAL从基线的(1.7±0.5)mm和(7.0±0.8)mm分别降低到随访时的(1.3±0.5)mm和(1.3±1.2)mm。治疗1年后随访时患者满意度为(9.0±0.8)分,根面敏感和美学等患者主观评价有极大提高。结论·对于重度单牙龈退缩患者,尤其是当患牙根面缺乏角化龈且伴有牙突出移位时,采用改良的侧向转位冠向复位瓣联合结缔组织移植治疗仍可取得临床良好且患者满意的结果。Objective·To observe the clinical outcomes of a modified laterally moved and coronally advanced flap combined with a connective tissue graft(CTG)for the treatment of severe Miller class II or classⅢisolated recession defects.Methods·Three patients with initial defect depths of more than5mm and malposition in some teeth were enrolled and underwent a modified laterally moved and coronally advanced flap combined with CTG.Recession depth(RD),keratinized tissue height(KTH)of both donor and adopted site,pocket depth(PD),and clinical attachment loss(CAL)at baseline and follow-up one-year after treatment were documented.Root coverage rate(RC)was calculated and visual analogue scale(VAS)was used to evaluate patient’s satisfaction degree.Results·The mean RDs at baseline and followup were(5.3±0.5)mm and(0.3±0.5)mm.The mean RC at follow-up was(93.3±9.4)%and two cases had complete root coverage.The KTHs at adopted and donor sites were(0.3±0.5)mm and(6.0±0.8)mm at baseline and(4.3±0.5)mm and(5.7±1.3)mm at follow-up,respectively.PD and CAL were decreased from(1.7±0.5)mm and(7.0±0.8)mm at baseline to(1.3±0.5)mm and(1.3±1.2)mm at follow-up,respectively.The VAS value was9.0±0.8and subjective evaluation of patients was improved significantly at one-year follow-up,including root sensitivity and aesthetics.Conclusion·The modified laterally moved and coronally advanced flap with CTG has ideal clinical outcomes and satisfaction degree for the treatment of patients with severe recession defects that lack keratinized tissue and combine with buccal malposition.

关 键 词：牙龈退缩 根面覆盖 侧向转位冠向复位瓣 结缔组织移植 临床疗效 

分 类 号：R781.4[医药卫生—口腔医学]