种植体周角化组织增宽的临床意义和研究进展

摘要/Abstract

摘要： 种植体周角化组织宽度不足是种植修复过程中常见的问题。已有研究表明，充足的角化组织宽度不仅利于菌斑控制，还可提高种植体的长期稳定性。目前，临床中用于角化组织增宽的术式主要有：根向复位瓣术、自体组织移植和异体组织移植等。本文就种植体周角化组织宽度的意义及各类角化组织增宽术的研究进展作一综述，以期为临床诊疗提供借鉴。

关键词: 种植体, 角化组织宽度, 根向复位瓣术, 自体组织移植, 异体组织移植

Abstract: Insufficient width of peri-implant keratinized tissue is a common problem of implant restoration. Previous studies have shown that sufficient keratinized tissue width is not only conducive to the control of plaque, but also can improve the long-term stability of implants. At present, the main approaches for increasing the width of keratinized tissue in clinical practice are: apically repositioned flap, autologous tissue transplantation, allogeneic tissue transplantation, etc. This review summarized the significance of peri-implant keratinized tissue width and the research progress on various methods of keratinized tissue, providing reference for clinical diagnosis and treatment.

Key words: implant, the width of keratinized tissue, apically repositioned flap, autologous tissue transplantation, allogeneic tissue transplantation

中图分类号:

R782.1

孙坚炜雷利红陈莉丽. 种植体周角化组织增宽的临床意义和研究进展[J]. 口腔医学, 2021, 41(3): 252-258.

参考文献

[1]Derks J, Hakansson J, Wennstrom JL, et al.Effectiveness of implant therapy analyzed in a Swedish population: early and late implant loss[J].J Dent Res, 2015, 94(3 Suppl):44-S
[2] Frisch E, Ziebolz D, Vach K, et al.The effect of keratinized mucosa width on peri-implant outcome under supportive postimplant therapy[J]. Clin Implant Dent Relat Res, 2015, 17 Suppl 1:e236-44.[J].Clin Implant Dent Relat Res, 2015, 17 Suppl 1(Suppl 1):e236-44
[3]Lim HC, Wiedemeier DB, Hammerle CHF, et al.The amount of keratinized mucosa may not influence peri-implant health in compliant patients: A retrospective 5-year analysis[J].J Clin Periodontol, 2019, 46(3):354-362
[4] Berglundh T, Armitage G, Araujo MG, et al.Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions[J]. J Clin Periodontol, 2018, 45 Suppl 20:S286-S291.[J].J Clin Periodontol, 2018, 45(Suppl 20):S286-S291
[5]Ivanovski S, Lee R.Comparison of peri-implant and periodontal marginal soft tissues in health and disease[J].Periodontol, 2018, 76(1):116-130
[6]Ueno D, Nagano T, Watanabe T, et al.Effect of the Keratinized Mucosa Width on the Health Status of Periimplant and Contralateral Periodontal Tissues: A Cross-sectional Study[J].Implant Dent, 2016, 25(6):796-801
[7]Lindhe J, Berglundh T, Ericsson.Experimental Breakdown of Peri-Implant and Periodontal TissuesA Study in the Beagle Dog[J].Clin Oral Implants Res, 1992, 3(1):9-16
[8]赵萌, 高益鸣.种植体周围软组织的临床意义和研究进展[J].口腔颌面外科杂志, 2019, 29(02):105-109
[9]Chackartchi T, Romanos GE, Sculean A.Soft tissue-related complications and management around dental implants[J].Periodontol, 2019, 81(1):124-138
[10]Renvert S, Polyzois I.Treatment of pathologic peri-implant pockets[J].Periodontol, 2018, 76(1):180-190
[11]Chiu YW, Lee SY, Lin YC, et al.Significance of the width of keratinized mucosa on peri-implant health[J].J Chin Med Assoc, 2015, 78(7):389-94
[12]Souza AB, Tormena M, Matarazzo F, et al.The influence of peri-implant keratinized mucosa on brushing discomfort and peri-implant tissue health[J].Clin Oral Implants Res, 2016, 27(6):650-5
[13]Perussolo J, Souza AB, Matarazzo F, et al.Influence of the keratinized mucosa on the stability of peri-implant tissues and brushing discomfort: A 4-year follow-up study[J].Clin Oral Implants Res, 2018, 29(12):1177-1185
[14]Gobbato L, Avila-Ortiz G, Sohrabi K, et al.The effect of keratinized mucosa width on peri-implant health: a systematic review[J].Int J Oral Maxillofac Implants, 2013, 28(6):1536-45
[15]Canullo L, Penarrocha-Oltra D, Covani U, et al.Clinical and microbiological findings in patients with peri-implantitis: a cross-sectional study[J].Clin Oral Implants Res, 2016, 27(3):376-82
[16]Askin SB, Berker E, Akincibay H, et al.Necessity of keratinized tissues for dental implants: a clinical,immunological,and radiographic study[J].Clin Implant Dent Relat Res, 2015, 17(1):1-12
[17]Monje A, Blasi G.Significance of keratinized mucosagingiva on peri-implant and adjacent periodontal conditions in erratic maintenance compliers[J].J Periodontol, 2019, 90(5):445-453
[18]Lin GH, Chan HL, Wang HL.The significance of keratinized mucosa on implant health: a systematic review[J].J Periodontol, 2013, 84(12):1755-67
[19] Wennstrom JL, Derks J.Is there a need for keratinized mucosa around implants to maintain health and tissue stability?[J]. Clin Oral Implants Res, 2012, 23 Suppl 6:136-46.[J].Clin Oral Implants Res, 2012, 23(Suppl 6):136-46
[20] Heitz-Mayfield LJA, Salvi GE.Peri-implant mucositis[J]. J Periodontol, 2018, 89 Suppl 1:S257-S266.[J].J Periodontol, 2018, 89(Suppl 1):S257-S266
[21]Grischke J, Karch A, Wenzlaff A, et al.Keratinized mucosa width is associated with severity of peri-implant mucositisA cross-sectional study[J].Clin Oral Implants Res, 2019, 30(5):457-465
[22]Warrer K, Buser D, Lang NP, et al.Plaque-induced peri-implantitis in the presence or absence of keratinized mucosaAn experimental study in monkeys[J].Clin Oral Implants Res, 1995, 6(3):131-8
[23] Thoma DS, Naenni N, Figuero E, et al.Effects of soft tissue augmentation procedures on peri-implant health or disease: A systematic review and meta-analysis[J]. Clin Oral Implants Res, 2018, 29 Suppl 15:32-49.[J].Clin Oral Implants Res, 2018, 29(Suppl 15):32-49
[24]Ladwein C, Schmelzeisen R, Nelson K, et al.Is the presence of keratinized mucosa associated with periimplant tissue health? A clinical cross-sectional analysis[J].Int J Implant Dent, 2015, 1(1):11-
[25] Giannobile WV, Jung RE, Schwarz F, et al.Evidence-based knowledge on the aesthetics and maintenance of peri-implant soft tissues: Osteology Foundation Consensus Report Part 1-Effects of soft tissue augmentation procedures on the maintenance of peri-implant soft tissue health[J]. Clin Oral Implants Res, 2018, 29 Suppl 15:7-10.[J].Clin Oral Implants Res, 2018, 29(Suppl 15):7-10
[26]Al-Sabbagh, M.P. Xenoudi,FAl-Shaikhli,et al. Does Peri-Implant Mucosa Have a Prognostic Value?[J].Dent Clin North Am, 2019, 63(3):567-580
[27]Bassetti RG, Stahli A, Bassetti MA, et al.Soft tissue augmentation around osseointegrated and uncovered dental implants: a systematic review[J].Clin Oral Investig, 2017, 21(1):53-70
[28] 宿玉成.口腔种植学[M]. 北京:人民卫生出版社, 2014:370-371.
[29]Carnio J, Miller Jr PD.Increasing the Amount of Attached Gingiva Using a Modified Apically Repositioned Flap[J].J Periodontol, 1999, 70(9):1110-7
[30]Carnio J, Camargo PM.The Modified Apically Repositioned Flap to Increase the Dimensions of Attached Gingiva The Single Incision Technique for Multiple Adjacent Teeth[J].Int J Periodontics Restorative Dent, 2006, 26(3):265-9
[31]Carnio J, Camargo PM, Pirih PQ.Surgical Techniques to Increase the Apicocoronal Dimension of the Attached Gingiva: A 1-Year Comparison Between the Free Gingival Graft and the Modified Apically Repositioned Flap[J].Int J Periodontics Restorative Dent, 2015, 35(4):571-8
[32]Carnio J, Camargo PM, Klokkevold PR, et al.The Modified Apically Repositioned Flap Technique: A Long-Term (4 to 16 Years) Retrospective Study[J].Int J Periodontics Restorative Dent, 2018, 38(4):519-524
[33]Carnio J, Carnio AT, Pirih FQ, et al.The Modified Apically Repositioned Flap Technique and Its Potential to Create Attached Gingiva in Areas with No Keratinized Tissue: A Long-Term (1 to 11 Years) Retrospective Case Series Study[J].Int J Periodontics Restorative Dent, 2020, 40(1):103-109
[34]Raoofi S, Asadinejad SM, Khorshidi H.Evaluation of Color and Width of Attached Gingiva Gain in Two Surgical Techniques: Free Gingival Graft and Connective Tissue Graft Covered By Thin Mucosal Flap,a Clinical Trial[J].J Dent (Shiraz), 2019, 20(4):224-231
[35]Bassetti RG, Stahli A, Bassetti MA, et al.Soft tissue augmentation procedures at second-stage surgery: a systematic review[J].Clin Oral Investig, 2016, 20(7):1369-87
[36]Cortellini P, Tonetti M, Prato GP.The partly epithelialized free gingival graft (Pe-Fgg) at lower incisorsA pilot study with implications for alignment of the mucogingival junction[J].J Clin Periodontol, 2012, 39(7):674-80
[37]Gumus P, Buduneli E.Graft stabilization with cyanoacrylate decreases shrinkage of free gingival grafts[J].Aust Dent J, 2014, 59(1):57-64
[38]Yildiz MS, Gunpinar S.Free gingival graft adjunct with low-level laser therapy: a randomized placebo-controlled parallel group study[J].Clin Oral Investig, 2019, 23(4):1845-1854
[39]Resende DRBD, Greghi SLA, Siqueira AF, et al.Acellular dermal matrix allograft versus free gingival graft: a histological evaluation and split-mouth randomized clinical trial[J].Clin Oral Investig, 2019, 23(2):539-550
[40]Baltac?o?lu E, Bagis B, Korkmaz FM, et al.Peri-Implant Plastic Surgical Approaches to Increasing Keratinized Mucosa Width[J].J Oral Implantol, 2015, 41(3):e73-81
[41]Tunkel J, Stavola LD, Khoury F.Changes in soft tissue dimensions following three different techniques of stage-two surgery: a case series report[J].Int J Periodontics Restorative Dent, 2013, 33(4):411-8
[42]Cairo F, Barbato L, Tonelli P, et al.Xenogeneic collagen matrix versus connective tissue graft for buccal soft tissue augmentation at implant siteA randomized,controlled clinical trial[J].J Clin Periodontol, 2017, 44(7):769-776
[43]Zucchelli G, Mazzotti C, Mounssif I, et al.A novel surgical-prosthetic approach for soft tissue dehiscence coverage around single implant[J].Clin Oral Implants Res, 2013, 24(9):957-62
[44] Thoma DS, Buranawat B, Hammerle CH, et al.Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review[J]. J Clin Periodontol, 2014, 41 Suppl 15:S77-91.[J].J Clin Periodontol, 2014, 41(Suppl 15):S77-91
[45]Bari DC, Dell' Accio F, Vanlauwe J, et al.Mesenchymal multipotency of adult human periosteal cells demonstrated by single-cell lineage analysis[J].Arthritis Rheum, 2006, 54(4):1209-21
[46] Li R, Liu YQ, Xu T, et al.The Additional Effect of Autologous Platelet Concentrates to Coronally Advanced Flap in the Treatment of Gingival Recessions: A Systematic Review and Meta-Analysis[J]. Biomed Res Int, 2019:2587245.[J]., 2019, :2587246-
[47]Schar MO, Diaz-Romero J, Kohl S, et al.Platelet-rich concentrates differentially release growth factors and induce cell migration in vitro[J].Clin Orthop Relat Res, 2015, 473(5):1635-43
[48]Temmerman A, Cleeren GJ, Castro AB, et al.L-PRF for increasing the width of keratinized mucosa around implants: A split-mouth,randomized,controlled pilot clinical trial[J].J Periodontal Res, 2018, 53(5):793-800
[49]Luo HY, Li RM, Wang CL, et al.The adjunctive use of platelet concentrates in the therapy of gingival recessions: a systematic review and meta-analysis[J].J Oral Rehabil, 2015, 42(7):552-61
[50]Fabbro MD, Bortolin M, Taschieri S, et al.Is platelet concentrate advantageous for the surgical treatment of periodontal diseases? A systematic review and meta-analysis[J].J Periodontol, 2011, 82(8):1100-11
[51]Park JB.Increasing the width of keratinized mucosa around endosseous implant using acellular dermal matrix allograft[J].Implant Dent, 2006, 15(3):275-81
[52] Lu W, Qi G, Ding Z, et al.Clinical efficacy of acellular dermal matrix for plastic periodontal and implant surgery: a systematic review[J]. Int J Oral Maxillofac Surg, 2019. Doi: 10.1016/j.ijom.2019.12.005.[J]., 2019, :-
[53]Basegmez C, Karabuda ZC, Demirel K, et al.The comparison of acellular dermal matrix allografts with free gingival grafts in the augmentation of peri-implant attached mucosa: a randomised controlled trial[J].Eur J Oral Implantol, 2013, 6(2):145-52
[54] Papi P, Pompa G.The Use of a Novel Porcine Derived Acellular Dermal Matrix (Mucoderm) in Peri-Implant Soft Tissue Augmentation: Preliminary Results of a Prospective Pilot Cohort Study[J]. Biomed Res Int, 2018:6406051.[J]., 2018, :6406051-
[55]Atieh MA, Alsabeeha N, Tawse-Smith A, et al.Xenogeneic collagen matrix for periodontal plastic surgery procedures: a systematic review and meta-analysis[J].J Periodontal Res, 2016, 51(4):438-52
[56]Thoma DS, Alshihri A, Fontolliet A, et al.Clinical and histologic evaluation of different approaches to gain keratinized tissue prior to implant placement in fully edentulous patients[J].Clin Oral Investig, 2018, 22(5):2111-2119
[57]Sanz M, Lorenzo R, Aranda JJ, et al.Clinical evaluation of a new collagen matrix (Mucograft prototype) to enhance the width of keratinized tissue in patients with fixed prosthetic restorations: a randomized prospective clinical trial[J].J Clin Periodontol, 2009, 36(10):868-76
[58]Schmitt CM, Moest T, Lutz R, et al.Long-term outcomes after vestibuloplasty with a porcine collagen matrix (Mucograft?) versus the free gingival graft: a comparative prospective clinical trial[J].Clin Oral Implants Res, 2016, 27(11):e125-e133
[59]Izumi K, Feinberg SE, Iida A, et al.Intraoral grafting of an ex vivo produced oral mucosa equivalent: a preliminary report[J].Int J Oral Maxillofac Surg, 2003, 32(2):188-97
[60]Bayar GR, Aydintug YS, Gunhan O, et al.Ex vivo produced oral mucosa equivalent by using the direct explant cell culture technique[J].Balkan Med J, 2012, 29(3):295-300