龈乳头保存术在牙周组织再生中的应用及进展

doi:10.13591/j.cnki.kqyx.2023.08.012

摘要/Abstract

摘要：

获得缺失牙周组织的再生是牙周疾病治疗的终极目标,对病变的临床改善、牙齿的长期存活和美学要求的满足有着重要意义。近年来,随着临床技术及医疗器械设备的发展和进步,为了达到更理想的邻间牙周组织再生效果及美学要求,学者们通过各种技术手段对牙周再生术的术式进行了创新和改良,以尽量保存牙间组织来提高早期创口愈合质量、减少牙龈退缩。本文详述了牙周组织再生术中各种龈乳头保存方法的发展历程及特点,包括传统龈乳头保存瓣、微创龈乳头保存技术、完整龈乳头保存术以及联合软组织增量的龈乳头保存术。重点关注这些方法的适应证、切口设计和临床效益,以期为临床医生制定个性化治疗方案提供更多选择。

关键词: 牙周组织再生, 龈乳头保存, 微创手术, 翻瓣设计

Abstract:

Regeneration of lost periodontal tissue is the ultimate goal of periodontal treatment, which is of great significance for the clinical improvement of lesions, the long-term survival of teeth and the satisfaction of aesthetic requirements. In recent years, with the development of clinical technology and medical instruments, in order to achieve better interdental tissue regeneration and aesthetic effect, researchers have innovated and improved the periodontal regeneration procedures through various techniques, preserving interdental tissues, improving the primary wound healing quality and reducing gingival recession. This review describes the development and characteristics of various papilla preservation procedures in periodontal tissue regeneration, including traditional papilla preservation flap, minimally invasive papilla preservation technique, entire papilla preservation technique and papilla preservation combined with soft tissue augmentation and focuses on the indications, incision design, and clinical benefits of these approaches in order to provide clinicians with more options for developing personalized treatments.

Key words: periodontal tissue regeneration, gingival papilla preservation, minimally invasive surgery, flap design

中图分类号:

R781.4

赵丹唯, 段丁瑜, 吴亚菲. 龈乳头保存术在牙周组织再生中的应用及进展[J]. 口腔医学, 2023, 43(8): 730-735.

ZHAO Danwei, DUAN Dingyu, WU Yafei. Application and progress of gingival papilla preservation in periodontal tissue regeneration[J]. Stomatology, 2023, 43(8): 730-735.

参考文献 51

[1]	Cortellini P, Tonetti MS. Clinical concepts for regenerative therapy in intrabonydefects[J]. Periodontol 2000, 2015, 68(1):282-307. doi: 10.1111/prd.12048
[2]	Cirelli JA, Fiorini T, Moreira CHC, et al. Periodontal regeneration: Is it still a goal in clinical periodontology?[J]. Braz Oral Res, 2021, 35(Supp 2):e09. doi: 10.1590/1807-3107bor-2021.vol35.0097 pmid: 34586211
[3]	Cortellini P, Stalpers G, Mollo A, et al. Periodontal regeneration versus extraction and dental implant or prosthetic replacement of teeth severely compromised by attachment loss to the apex: A randomized controlled clinical trial reporting 10-year outcomes, survival analysis and mean cumulative cost of recurrence[J]. J Clin Periodontol, 2020, 47(6):768-776. doi: 10.1111/jcpe.13289 pmid: 32249446
[4]	Polimeni G, Xiropaidis AV, Wikesjö UME. Biology and principles of periodontal wound healing/regeneration[J]. Periodontol 2000, 2006, 41: 30-47.
[5]	Cortellini P, Tonetti MS. Focus on intrabony defects: Guided tissue regeneration[J]. Periodontol 2000, 2000, 22: 104-132.
[6]	Lim G, Lin GH, Monje A, et al. Wound healing complications following guided bone regeneration for ridge augmentation: A systematic review and meta-analysis[J]. Int J Oral Maxillofac Implants, 2018, 33(1):41-50.
[7]	Majzoub J, Barootchi S, Tavelli L, et al. Guided tissue regeneration combined with bone allograft in infrabony defects: Clinical outcomes and assessment of prognostic factors[J]. J Periodontol, 2020, 91(6):746-755. doi: 10.1002/JPER.19-0336 pmid: 31680235
[8]	Machtei EE. The effect of membrane exposure on the outcome of regenerative procedures in humans: A meta-analysis[J]. J Periodontol, 2001, 72(4):512-516. doi: 10.1902/jop.2001.72.4.512 pmid: 11338304
[9]	Alhabashneh R, Alomari S, Khaleel B, et al. Interdental papilla reconstruction using injectable hyaluronic acid: A 6 month prospective longitudinal clinical study[J]. J Esthet Restor Dent, 2021, 33(3):531-537. doi: 10.1111/jerd.12680 pmid: 33174355
[10]	Akcalı A, Lang NP. Dental Calculus: The calcified biofilm and its role in disease development[J]. Periodontol 2000, 2018, 76(1):109-115. doi: 10.1111/prd.12151
[11]	Zucchelli G, Tavelli L, McGuire MK, et al. Autogenous soft tissue grafting for periodontal and peri-implant plastic surgical reconstruction[J]. J Periodontol, 2020, 91(1):9-16. doi: 10.1002/JPER.19-0350 pmid: 31461778
[12]	张创为, 胡文杰, 杨刚, 等. 龈乳头缺陷的相关因素与治疗策略[J]. 中华口腔医学杂志, 2021, 56(7):704-708.
[13]	Takei HH, Han TJ, Carranza FA Jr, et al. Flap technique for periodontal bone implants. Papilla preservation technique[J]. J Periodontol, 1985, 56(4):204-210. pmid: 3889270
[14]	Kadkhodazadeh M, Amid R, Kermani ME, et al. A modified frenectomy technique: A new surgical approach[J]. Gen Dent, 2018, 66(1):34-38. pmid: 29303760
[15]	Cortellini P, Prato GP, Tonetti MS. The modified papilla preservation technique. A new surgical approach for interproximal regenerative procedures[J]. J Periodontol, 1995, 66(4):261-266. doi: 10.1902/jop.1995.66.4.261 pmid: 7782979
[16]	Cortellini P, Pini Prato G, Tonetti MS. The modified papilla preservation technique with bioresorbable barrier membranes in the treatment of intrabony defects. Case reports[J]. Int J Periodontics Restorative Dent, 1996, 16(6):546-559.
[17]	Nakayama Y, Matsuda H, Itoh S, et al. Impact of adjunctive procedures on recombinant human fibroblast growth factor-2-mediated periodontal regeneration therapy: A retrospective study[J]. J Periodontol, 2021, 92(7):983-994. doi: 10.1002/JPER.20-0481 pmid: 33128399
[18]	Cortellini P, Prato GP, Tonetti MS. The simplified papilla preservation flap. A novel surgical approach for the management of soft tissues in regenerative procedures[J]. Int J Periodontics Restorative Dent, 1999, 19(6):589-599.
[19]	Corbella S, Alberti A, Calciolari E, et al. Enamel matrix derivative for the treatment of partially contained intrabony defects: 12-month results[J]. Aust Dent J, 2019, 64(1):27-34. doi: 10.1111/adj.12654 pmid: 30257036
[20]	Retzepi M, Tonetti M, Donos N. Comparison of gingival blood flow during healing of simplified papilla preservation and modified Widman flap surgery: A clinical trial using laser Doppler flowmetry[J]. J Clin Periodontol, 2007, 34(10):903-911. pmid: 17850609
[21]	Harrel SK, Rees TD. Granulation tissue removal in routine and minimally invasive procedures[J]. Compend Contin Educ Dent, 1995, 16(9):960, 962, 964passim.
[22]	Harrel SK. A minimally invasive surgical approach for periodontal regeneration: Surgical technique and observations[J]. J Periodontol, 1999, 70(12):1547-1557. pmid: 10632530
[23]	Harrel SK, Wilson TG, Nunn ME. Prospective assessment of the use of enamel matrix proteins with minimally invasive surgery[J]. J Periodontol, 2005, 76(3):380-384. pmid: 15857071
[24]	Cortellini P, Tonetti MS. A minimally invasive surgical technique with an enamel matrix derivative in the regenerative treatment of intra-bony defects: A novel approach to limit morbidity[J]. J Clin Periodontol, 2007, 34(1):87-93. pmid: 17243998
[25]	陈雨, 笪海芹, 陈莹, 等. 浓缩生长因子联合微创外科技术治疗牙周炎垂直骨缺损的效果评价[J]. 中国实用口腔科杂志, 2022, 15(3):325-329.
[26]	Liu B, Ouyang XY, Kang J, et al. Efficacy of periodontal minimally invasive surgery with and without regenerative materials for treatment of intrabony defect: A randomized clinical trial[J]. Clin Oral Investig, 2022, 26(2):1613-1623. doi: 10.1007/s00784-021-04134-w
[27]	Cortellini P, Tonetti MS. Improved wound stability with a modified minimally invasive surgical technique in the regenerative treatment of isolated interdental intrabonydefects[J]. J Clin Periodontol, 2009, 36(2):157-163. doi: 10.1111/j.1600-051X.2008.01352.x pmid: 19207892
[28]	Imamura K, Suzuki E, Takeuchi T, et al. Clinical outcomes of periodontal regenerative therapy using rhFGF-2 with a modified minimally invasive surgical technique for intrabonydefects: Case series with a 12-month follow-up[J]. Int J Periodontics Restorative Dent, 2022, 42(4):507-513. doi: 10.11607/prd.5572
[29]	Cortellini P, Cortellini S, Tonetti MS. Papilla preservation flaps for periodontal regeneration of molars severely compromised by combined furcation and intrabony defects: Retrospective analysis of a registry-based cohort[J]. J Periodontol, 2020, 91(2):165-173. doi: 10.1002/JPER.19-0010 pmid: 31376157
[30]	Cortellini P, Cortellini S, Bonaccini D, et al. Modified minimally invasive surgical technique in human intrabony defects with or without regenerative materials-10-year follow-up of a randomized clinical trial: Tooth retention, periodontitis recurrence, and costs[J]. J Clin Periodontol, 2022, 49(6):528-536. doi: 10.1111/jcpe.v49.6
[31]	Windisch P, Iorio-Siciliano V, Palkovics D, et al. The role of surgical flap design (minimally invasive flap vs. extended flap with papilla preservation) on the healing of intrabony defects treated with an enamel matrix derivative: A 12-month two-center randomized controlled clinical trial[J]. Clin Oral Investig, 2022, 26(2):1811-1821. doi: 10.1007/s00784-021-04155-5
[32]	Cortellini P. Minimally invasive surgical techniques in periodontal regeneration[J]. J Evid Based Dent Pract, 2012, 12(3 Suppl):89-100. doi: 10.1016/S1532-3382(12)70021-0 pmid: 23040341
[33]	Trombelli L, Farina R, Franceschetti G, et al. Single-flap approach with buccal access in periodontal reconstructive procedures[J]. J Periodontol, 2009, 80(2):353-360. doi: 10.1902/jop.2009.080420 pmid: 19186978
[34]	Schincaglia GP, Hebert E, Farina R, et al. Single versus double flap approach in periodontal regenerative treatment[J]. J Clin Periodontol, 2015, 42(6):557-566. doi: 10.1111/jcpe.12409 pmid: 25924545
[35]	Trombelli L, Simonelli A, Minenna L, et al. Simplified procedures to treat periodontal intraosseous defects in esthetic areas[J]. Periodontol 2000, 2018, 77(1):93-110. doi: 10.1111/prd.2018.77.issue-1
[36]	Trombelli L, Simonelli A, Quaranta A, et al. Effect of flap design for enamel matrix derivative application in intraosseous defects[J]. JDR Clin Trans Res, 2021, 6(2):184-194.
[37]	Aslan S, Buduneli N, Cortellini P. Entire papilla preservation technique: A novel surgical approach for regenerative treatment of deep and wide intrabonydefects[J]. Int J Periodontics Restorative Dent, 2017, 37(2):227-233. doi: 10.11607/prd.2584
[38]	Aslan S, Buduneli N, Cortellini P. Reconstructive surgical treatment of isolated deep intrabony defects with guided tissue regeneration using entire papilla preservation technique: A prospective case series[J]. J Periodontol, 2021, 92(4):488-495. doi: 10.1002/jper.v92.4
[39]	Aslan S, Buduneli N, Cortellini P. Clinical outcomes of the entire papilla preservation technique with and without biomaterials in the treatment of isolated intrabonydefects: A randomized controlled clinical trial[J]. J Clin Periodontol, 2020, 47(4):470-478. doi: 10.1111/jcpe.v47.4
[40]	Najafi B, Kheirieh P, Torabi A, et al. Periodontal regenerative treatment of intrabonydefects in the esthetic zone using modified vestibular incision subperiostealtunnel access (M-VISTA)[J]. Int J Periodontics Restorative Dent, 2018, 38(Suppl):e9-e16. doi: 10.11607/prd.3138
[41]	Zadeh HH. Minimally invasive treatment of maxillary anterior gingival recession defects by vestibular incision subperiosteal tunnel access and platelet-derived growth factor BB[J]. Int J Periodontics Restorative Dent, 2011, 31(6):653-660. pmid: 22140667
[42]	Moreno Rodriguez JA, Caffesse RG. Nonincisedpapillae surgical approach (NIPSA) in periodontal regeneration: Preliminary results of a case series[J]. Int J Periodontics Restorative Dent, 2018, 38(Suppl):s105-s111. doi: 10.11607/prd.3195
[43]	Moreno Rodríguez JA, Ortiz Ruiz AJ, Caffesse RG. Supra-alveolar attachment gain in the treatment of combined intra-suprabony periodontal defects by non-incised papillae surgical approach[J]. J Clin Periodontol, 2019, 46(9):927-936. doi: 10.1111/jcpe.13158 pmid: 31190409
[44]	Pei XY. New surgery approaches preserving entire papilla to treat isolated interdental intrabony defects: A narrative review[J]. Clin Exp Dent Res, 2021, 7(5):719-725. doi: 10.1002/cre2.410 pmid: 33594801
[45]	Moreno Rodríguez JA, Ortiz Ruiz AJ, Caffesse RG. Periodontal reconstructive surgery of deep intraosseous defects using an apical approach. Non-incised papillae surgical approach (NIPSA):A retrospective cohort study[J]. J Periodontol, 2019, 90(5):454-464. doi: 10.1002/JPER.18-0405 pmid: 30421495
[46]	Pardo-Zamora G, Moreno-Rodríguez JA, Ortiz-Ruíz AJ. Non-incised papilla surgical approach and leukocyte platelet-rich fibrin in periodontal reconstruction of deep intrabonydefects: A case series[J]. Int J Environ Res Public Health, 2021, 18(5):2465. doi: 10.3390/ijerph18052465
[47]	Moreno Rodríguez JA, Ortiz Ruiz AJ. Apical approach in periodontal reconstructive surgery with enamel matrix derivate and enamel matrix derivate plus bone substitutes: A randomized, controlled clinical trial[J]. Clin Oral Investig, 2022, 26(3):2793-2805. doi: 10.1007/s00784-021-04256-1
[48]	李熠, 王琪, 邱立新. 半月-隧道瓣技术在引导组织再生术中的临床应用[J]. 中华口腔医学杂志, 2021, 56(12):1237-1243.
[49]	Graziani F, Gennai S, Cei S, et al. Clinical performance of access flap surgery in the treatment of the intrabony defect. A systematic review and meta-analysis of randomized clinical trials[J]. J ClinPeriodontol, 2012, 39(2):145-156.
[50]	Zucchelli G, Mazzotti C, Tirone F, et al. The connective tissue graft wall technique and enamel matrix derivative to improve root coverage and clinical attachment levels in Miller Class IV gingival recession[J]. Int J Periodontics Restorative Dent, 2014, 34(5):601-609. pmid: 25171030
[51]	Trombelli L, Simonelli A, Minenna L, et al. Effect of a connective tissue graft in combination with a single flap approach in the regenerative treatment of intraosseous defects[J]. J Periodontol, 2017, 88(4):348-356. doi: 10.1902/jop.2016.160471 pmid: 27958767