1例根面覆盖术改善多牙位牙龈退缩5年纵向观察

doi:10.13591/j.cnki.kqyx.2023.06.011

摘要/Abstract

摘要：

牙龈退缩是指牙龈边缘向牙齿釉牙骨质界根方退缩导致的根面暴露,可造成牙本质敏感、美观缺陷等问题。临床上常采用根面覆盖术治疗牙龈退缩,以期获得完全根面覆盖。本文报道了一例采用冠向复位瓣术联合或不联合上皮下结缔组织移植治疗全口多牙位牙龈退缩,纵向观察5年,探讨了影响术后根面覆盖效果的因素,以期为治疗牙龈退缩提供参考。

关键词: 牙龈退缩, 根面覆盖术, 上皮下结缔组织移植

Abstract:

Gingival recession refers to the root surface exposure caused by the retraction of the gingival margin from enamelo-cemental junction to the root, which can cause dentin sensitivity, aesthetic defects and other problems. Root coverage procedures are often applied in clinical practice to treat gingival recessions to obtain complete root coverage. This article reports a case of multiple gingival recessions treated by coronal advanced flap with or without subepithelial connective tissue graft with longitude observation of 5 years. We discussed the factors that may affect root coverage result in order to provide reference for the treatment of gingival recession.

Key words: gingival recession, root coverage procedure, subepithelial connective tissue graft

中图分类号:

R781.4

戴安娜, 丁佩惠. 1例根面覆盖术改善多牙位牙龈退缩5年纵向观察[J]. 口腔医学, 2023, 43(6): 540-545.

DAI Anna, DING Peihui. Root coverage procedure for treatment of multiple gingival recessions:A 5-year case report[J]. Stomatology, 2023, 43(6): 540-545.

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参考文献 22

[1]	Romandini M, Soldini MC, Montero E, et al. Epidemiology of mid-buccal gingival recessions in NHANES according to the 2018 world workshop classification system[J]. J Clin Periodontol, 2020, 47(10):1180-1190. doi: 10.1111/jcpe.v47.10
[2]	Rios FS, Costa RSA, Wagner TP, et al. Incidence and progression of gingival recession over 4 years:A population-based longitudinal study[J]. J Clin Periodontol, 2021, 48(1):114-125.
[3]	Antezack A, Ohanessian R, Sadowski C, et al. Effectiveness of surgical root coverage on dentin hypersensitivity:A systematic review and meta-analysis[J]. J Clin Periodontol, 2022, 49(8):840-851. doi: 10.1111/jcpe.v49.8
[4]	Chambrone L, Chambrone LA. The concepts of evidence-based periodontal plastic surgery:Application of the principles of evidence-based dentistry for the treatment of recession-type defects[J]. Periodontol 2000, 2019, 79(1):81-106. doi: 10.1111/prd.2019.79.issue-1
[5]	Chambrone L, Botelho J, Machado V, et al. Does the subepithelial connective tissue graft in conjunction with a coronally advanced flap remain as the gold standard therapy for the treatment of single gingival recession defects? A systematic review and network meta-analysis[J]. J Periodontol, 2022, 93(9):1336-1352. doi: 10.1002/JPER.22-0167 pmid: 35451068
[6]	Dai AN, Huang JP, Ding PH, et al. Long-term stability of root coverage procedures for single gingival recessions:A systematic review and meta-analysis[J]. J Clin Periodontol, 2019, 46(5):572-585. doi: 10.1111/jcpe.2019.46.issue-5
[7]	de Queiroz CA, Sallum AW, Casati MZ, et al. A two-year prospective study of coronally positioned flap with or without acellular dermal matrix graft[J]. J Clin Periodontol, 2006, 33(9):683-689. doi: 10.1111/j.1600-051X.2006.00969.x pmid: 16856894
[8]	Cairo F, Nieri M, Cincinelli S, et al. The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes:An explorative and reliability study[J]. J Clin Periodontol, 2011, 38(7):661-666. doi: 10.1111/jcpe.2011.38.issue-7
[9]	Pini Prato G, di Gianfilippo R. On the value of the 2017 classification of phenotype and gingival recessions[J]. J Periodontol, 2021, 92(5):613-618. doi: 10.1002/JPER.20-0487 pmid: 33098573
[10]	Cairo F, Rotundo R, Miller PD, et al. Root coverage esthetic score:A system to evaluate the esthetic outcome of the treatment of gingival recession through evaluation of clinical cases[J]. J Periodontol, 2009, 80(4):705-710. doi: 10.1902/jop.2009.080565
[11]	Novaes AB Jr, Palioto DB. Experimental and clinical studies on plastic periodontal procedures[J]. Periodontol 2000, 2019, 79(1):56-80. doi: 10.1111/prd.2019.79.issue-1
[12]	Blasi G, Monje A, Muñoz-Peñalver J, et al. Influence of vestibular depth on the outcomes of root coverage therapy:A prospective case series study[J]. J Periodontol, 2022, 93(12):1857-1866. doi: 10.1002/jper.v93.12
[13]	Cairo F, Cortellini P, Pilloni A, et al. Clinical efficacy of coronally advanced flap with or without connective tissue graft for the treatment of multiple adjacent gingival recessions in the aesthetic area:A randomized controlled clinical trial[J]. J Clin Periodontol, 2016, 43(10):849-856. doi: 10.1111/jcpe.2016.43.issue-10
[14]	Ahmedbeyli C, DirikanIpçi S, Cakar G, et al. Coronally advanced flap and envelope type of flap plus acellular dermal matrix graft for the treatment of thin phenotype multiple recession defects. A randomized clinical trial[J]. J Clin Periodontol, 2019, 46(10):1024-1029. doi: 10.1111/jcpe.13174 pmid: 31350924
[15]	Zuhr O, Rebele SF, Vach K, et al. Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivate for root coverage:2-year results of an RCT using 3D digital measuring for volumetric comparison of gingival dimensions[J]. J Clin Periodontol, 2020, 47(9):1144-1158. doi: 10.1111/jcpe.v47.9
[16]	Zuhr O, Akakpo D, Eickholz P, et al. Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivate for root coverage:5-year results of an RCT using 3D digital measurement technology for volumetric comparison of soft tissue changes[J]. J Clin Periodontol, 2021, 48(7):949-961. doi: 10.1111/jcpe.v48.7
[17]	Barootchi S, Tavelli L, diGianfilippo R, et al. Soft tissue phenotype modification predicts gingival margin long-term (10-year) stability:Longitudinal analysis of six randomized clinical trials[J]. J Clin Periodontol, 2022, 49(7):672-683. doi: 10.1111/jcpe.13641 pmid: 35561034
[18]	Rasperini G, Acunzo R, Pellegrini G, et al. Predictor factors for long-term outcomes stability of coronally advanced flap with or without connective tissue graft in the treatment of single maxillary gingival recessions:9 years results of a randomized controlled clinical trial[J]. J Clin Periodontol, 2018, 45(9):1107-1117. doi: 10.1111/jcpe.12932 pmid: 29777632
[19]	Cairo F, Cortellini P, Tonetti M, et al. Stability of root coverage outcomes at single maxillary gingival recession with loss of interdental attachment:3-year extension results from a randomized, controlled, clinical trial[J]. J Clin Periodontol, 2015, 42(6):575-581. doi: 10.1111/jcpe.12412
[20]	丁成, 傅淑蕾, 马语卓, 等. 改良隧道技术在治疗多牙位Miller Ⅲ度牙龈退缩中的应用[J]. 口腔医学, 2021, 41(6):541-544.
[21]	Cairo F, Barootchi S, Tavelli L, et al. Aesthetic-And patient-related outcomes following root coverage procedures:A systematic review and network meta-analysis[J]. J Clin Periodontol, 2020, 47(11):1403-1415. doi: 10.1111/jcpe.v47.11
[22]	Petsos H, Eickholz P, Raetzke P, et al. Clinical and patient-centred long-term results of root coverage using the envelope technique in a private practice setting:10-year results-A case series[J]. J Clin Periodontol, 2020, 47(3):372-381. doi: 10.1111/jcpe.13242 pmid: 31868936

牙位	牙龈退缩高度	角化龈宽度	牙龈厚度
14	3.0	6.0	0.5
15	4.0	5.0	0.5
16	2.0	7.0	1.0
24	2.0	5.0	0.8
25	3.5	6.0	0.8
26	1.0	8.0	1.0
33	3.0	2.5	0.5
34	3.0	3.0	0.5
35	2.0	4.0	0.5
44	3.0	3.0	0.5
45	2.0	4.0	0.5
46	2.0	4.0	0.5

牙位	牙龈退缩高度/mm	角化龈宽度/mm	牙龈厚度/mm	根面覆盖率/%	红色美学评分
14	0	9.0	1.0	100.0	10
15	0	9.0	1.0	100.0	10
16	0	9.0	1.0	100.0	10
24	0.5	7.0	0.8	75.0	6
25	1.0	8.0	0.8	71.4	7
26	0.5	8.0	1.0	50.0	7
33	0	6.0	1.0	100.0	10
34	0.5	6.0	1.0	83.3	7
35	0.5	6.0	1.0	75.0	7