经前庭沟切口的骨膜下隧道技术在治疗MillerⅠ、Ⅱ度单牙牙龈退缩中的应用

doi:10.19723/j.issn.1671-167X.2019.01.015

摘要/Abstract

摘要：

目的:拟评价经前庭沟切口的骨膜下隧道技术(vestibular incision subperiosteal tunnel access,VISTA)联合上皮下结缔组织移植术(connective tissue graft,CTG)治疗MillerⅠ、Ⅱ度单牙牙龈退缩的效果。方法:采用VISTA联合CTG技术治疗10颗单牙、退缩深度≥2 mm的MillerⅠ、Ⅱ度牙龈退缩,比较术前及术后6个月时的牙龈退缩深度、宽度、角化龈宽度、牙龈生物型、探诊深度和临床附着丧失水平,计算根面覆盖率,用视觉模拟评分法评价患者术中和术后2周内疼痛情况以及对术后6个月美观效果满意度。结果:牙龈退缩深度术前达(2.65±0.82) mm,术后6个月时减少了(2.30±0.98) mm(P<0.001),平均根面覆盖率为86.67%±21.94%,完全根面覆盖率为70%;角化龈宽度增加了(0.90±1.22) mm(P<0.05);患者对美观效果满意,评分为8.30分,患者术中及术后2周内疼痛感较轻,评分在2.40~4.30分。进一步分析发现牙龈退缩改善效果与患牙的牙龈生物型及上、下颌牙位分布无关。结论:VISTA技术联合CTG可以有效地治疗单颗牙Miller Ⅰ、 Ⅱ 度牙龈退缩,增加角化龈宽度;患者的疼痛感较轻,患者对术后6个月时的美学效果较满意。该技术可作为临床上治疗单牙Miller Ⅰ、 Ⅱ 度牙龈退缩的方法之一。

关键词: 牙龈退缩, 经前庭沟切口的骨膜下隧道技术, 结缔组织移植

Abstract:

Objective: To evaluate the clinical outcomes of vestibular incision subperiosteal tunnel access (VISTA) with connective tissue graft (CTG) in the treatment of Miller classes Ⅰ and Ⅱ localized gingival recession. Methods: Ten patients with 10 Miller classes Ⅰ and Ⅱ localized gingival recessions were enrolled in the study. All defects were equal to or above 2 mm in recession depth. All the patients received treatment with VISTA+CTG. Their clinical parameters, including recession depth (Rec), recession width (RW), keratinized tissue width (KT), clinical attachment loss (CAL), probing depth (PD) were recorded and compared before surgery and 6 months later. The mean root coverage (MRC) and complete root coverage (CRC) were calculated at the end of 6 months. A visual analogue scale (VAS) was used to estimate the patients’ discomfort during the operation and during the 2 weeks post-operation. Patient-based aesthetic satisfaction 6 months after surgery was evaluated by a VAS. Results: The mean Rec was (2.65±0.82) mm at baseline, and (0.35±0.58) mm after 6 months. The VISTA+CTG treatment resulted in an improvement of (2.30±0.98) mm in recession depth (P<0.001). MRC was 86.67%±21.94% and CRC reached 70% at the end of 6 months. KT increased (0.90±1.22) mm (P<0.05) . Aesthetic satisfaction on the patients’ level was 8.30 based on VAS (0=unsatisfied, 10=extremely satisfied). The patients’ discomfort during the operation and 2 weeks post operation were 2.40 and 4.30 (0=no pain, 10=extreme pain). Furthermore, clinical outcomes showed no statistically significant difference between the gingival biotypes, and between the teeth positioned in maxillary and in mandibular. Conclusion: VISTA+CTG could be an effective treatment for Miller classes Ⅰ and Ⅱ localized gingival recession. Clinical outcomes indicated decrease in recession depth and width, and increase in width of keratinized tissue. Patients suffered little pain during the operation and 2 weeks post-operation of healing and accessed good aesthetic satisfaction. VISTA+CTG could be an option for the treatment of Miller classes Ⅰ and Ⅱ localized gingival recession.

Key words: Gingival recession, Vestibular incision subperiosteal tunnel access, Connective tissue graft

中图分类号:

R781.4

范可昂,钟金晟,欧阳翔英,谢颖,陈子圆,周爽英,章嫄. 经前庭沟切口的骨膜下隧道技术在治疗MillerⅠ、Ⅱ度单牙牙龈退缩中的应用[J]. 北京大学学报（医学版）, 2019, 51(1): 80-85.

Ke-ang FAN,Jin-sheng ZHONG,Xiang-ying OUYANG,Ying XIE,Zi-yuan CHEN,Shuang-ying ZHOU,Yuan ZHANG. Vestibular incision subperiosteal tunnel access with connective tissue graft for the treatment of Miller classⅠ and Ⅱ gingival recession[J]. Journal of Peking University(Health Sciences), 2019, 51(1): 80-85.

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Items	Baseline	6 months	Change	P value
Rec	2.65±0.82	0.35±0.58	2.30±0.98	<0.001
RW	3.55±0.64	1.00±1.55	2.55±1.61	0.001
KT	2.20±1.30	3.10±1.29	0.90±1.22	0.045
PD	2.40±0.34	2.63±0.53	0.23±0.52	0.191
CAL	2.90±0.32	2.35±0.94	1.90±1.27	0.060

Biotype	Thick (n=4)	Thin (n=6)	P value
ΔRec/mm	2.67±1.00	1.75±0.50	0.156
ΔRW/mm	2.92±1.88	2.00±1.08	0.409
ΔKT/mm	0.67±1.03	1.25±1.55	0.492
MRC/%	91.67±20.41	79.17±25.00	0.409
CRC/%	83	50	0.312

Site	Maxillary (n=5)	Mandibular (n=5)	P value
ΔRec/mm	2.20±1.15	2.40±0.89	0.767
ΔRW/mm	2.80±2.08	2.30±1.15	0.651
ΔKT/mm	1.20±1.10	0.60±1.39	0.470
MRC/%	80.00±27.39	93.33±14.91	0.367
CRC/%	60	80	0.545