改良游离龈移植术增宽种植体周角化黏膜的回顾性临床研究

doi:10.13701/j.cnki.kqyxyj.2026.03.008

摘要/Abstract

摘要： 目的:探讨角化黏膜宽度(keratinized mucosa width, KMW)对种植体周围软硬组织的影响,分析改良游离龈移植术(modified free gingival graft, MFGG)的临床疗效,验证通过颊侧黏膜瓣复位固定移植物的MFGG改善种植体周围健康的效果与优势。方法:对2017~2024年收治共计59例患者(79颗种植体),包括角化黏膜充足(A组,20例患者,24颗种植体)、角化黏膜不足(B组,22例患者,33颗种植体)、角化黏膜不足并行MFGG(C组,17例患者,22颗种植体)3组,C组包括预防性增宽(C1组,10例患者,14颗种植体),干预性增宽(C2组,7例患者,8颗种植体)。观察比较各组种植体周围组织临床指标的变化,包括KMW、探诊深度(probing depth,PD)、改良菌斑指数(modified plaque index,mPLI)、改良龈沟出血指数(modified sulcus bleeding index,mSBI)、种植体边缘骨吸收(marginal bone loss,MBL)、移植物收缩率、术后疼痛反应及黏膜瘢痕指数(mucosal scarring index, MSI)。结果:(1)种植体周围疾病(peri-implant diseases,PID)相关指标:①A、B两组间PD差异无统计学意义(P＞0.05),mPLI、mSBI、MBL均表现出B组高于A组,且差异具有统计学意义(P＜0.05)。②B组PIM与PID发病率显著高于A组(P＜0.05);B组PI发病率略高于A组,差异无统计学意义(P＞0.05)。(2)MFGG手术疗效相关指标:①C组所有移植物均成活,手术成功率100%。所有患者在术后7 d时疼痛基本消失,疼痛部位主要发生于硬腭供区。②术后3个月(T2)移植物收缩率为25.2%,术后6个月(T3)移植物收缩率为30.1%。③术后6个月,C组PD与B组比较无统计学差异(P＞0.05),C组mPLI_T3、mSBI_T3显著低于B组(P＜0.05);C1组MBL_T3数值显著低于B组(P＜0.05);C组PID_T3发病率与B组比较具有显著性差异(P＜0.05)。④C2组术后6个月(T3)与术前(T0)相比,PD_T3较PD_T0比较无统计学差异(P＞0.05);mPLI_T3、mSBI_T3较mPLI_T0、mSBI_T0显著降低(P＜0.05);MBL_T3较MBL_T0比较无统计学差异(P＞0.05)。⑤术后6个月,MSI_T3(2.12±0.60)较MSI_T2(2.41±0.94)略有降低,差异无统计学意义(P＞0.05)。结论:(1)角化黏膜宽度与种植体周围软硬组织健康相关,KMW充足的种植体周围疾病发病率较低。(2)改良游离龈移植术通过颊侧黏膜瓣复位,促进移植牙龈成活,操作简便,术后反应小,应用于种植体周角化黏膜增宽效果良好,可以有效预防种植体周围疾病的发生,改善软组织炎症,降低边缘骨吸收风险。

关键词: 种植体, 角化黏膜宽度, 种植体周围疾病, 游离龈移植术

Abstract: Objective: To investigate the influence of keratinized mucosa width (KMW) on peri-implant hard- and soft-tissue conditions and to evaluate the clinical efficacy of the modified free gingival graft (MFGG) with buccal flap repositioning for graft stabilization, thereby ascertaining its effectiveness and advantages in enhancing peri-implant health. Methods: A total of 79 implants in 59 patients treated between 2017 and 2024 were retrospectively enrolled and stratified into three groups: (1) group A: adequate KMW, 24 implants in 20 patients; (2) group B: insufficient KMW, 33 implants in 22 patients; and (3) group C: insufficient KMW subsequently managed with MFGG, 22 implants in 17 patients. Group C was further divided into a prophylactic augmentation subgroup (C1: 14 implants in 10 patients) and a therapeutic augmentation subgroup (C2: 8 implants in 7 patients). Peri-implant tissue parameters were systematically recorded and compared across groups, including KMW, probing depth (PD), modified plaque index (mPLI), modified sulcus bleeding index (mSBI), marginal bone loss (MBL), graft contraction rate, postoperative pain, and mucosal scarring index (MSI). Results: (1) Peri-implant disease (PID)-related indices: ① Inter-group comparison between groups A and B revealed no statistically significant difference in PD (P>0.05). mPLI, mSBI, and MBL were all significantly higher in group B than in group A (P<0.05). ② The prevalence of peri-implant mucositis (PIM) and peri-implantitis (PI) in group B was markedly higher than in group A (P<0.05), whereas the incidence of PI in group B was only slightly elevated relative to group A, a difference that did not reach statistical significance (P>0.05). (2) Efficacy indices of the MFGG procedure: ① All grafts in group C achieved complete survival, yielding a surgical success rate of 100 %. Pain had largely resolved by post-operative day 7; discomfort was predominantly localized to the hard-palate donor site. ② At 3 months (T2) post-surgery, the graft contraction rate was 25.2 %, increasing to 30.1 % at 6 months (T3). ③ At 6 months, no significant difference in PD was observed between groups C and B (P>0.05). Both mPLI_T3 and mSBI_T3 were significantly lower in group C than in group B (P<0.05). Subgroup C1 exhibited significantly less MBLT3 than group B (P<0.05). The incidence of PID_T3 in group C differed significantly from that in group B (P<0.05). ④ In subgroup C2, comparison of data at 6 months (T3) with baseline (T0) showed no significant change in PD (PD_T3 vs PD_T0, P>0.05), whereas both mPLI_T3 and mSBI_T3 were significantly reduced relative to mPLI_T0 and mSBI_T0 (P<0.05). MBL_T3 did not differ significantly from MBL_T0 (P>0.05). ⑤ At 6 months, the modified sulcus bleeding index (MSI_T3: 2.12±0.60) was slightly lower than at 3 months (MSI_T2: 2.41±0.94); this change was not statistically significant (P>0.05). Conclusion: KMW is positively correlated with the health of peri-implant hard and soft tissues; implants with adequate KMW demonstrate a significantly lower incidence of peri-implant diseases. MFGG technique, employing buccal flap repositioning, enhances graft survival, is technically straightforward, and elicits minimal postoperative morbidity. Clinical application of this surgical modality for peri-implant keratinized mucosa augmentation demonstrates favorable efficacy, conferring effective prevention of peri-implant diseases, amelioration of soft-tissue inflammation, and reduction in marginal bone resorption risk.

Key words: dental implant, keratinized mucosa width, peri-implant disease, free gingival graft

韩翠, 梁韩莹, 仲维剑. 改良游离龈移植术增宽种植体周角化黏膜的回顾性临床研究[J]. 口腔医学研究, 2026, 42(3): 219-224.

HAN Cui, LIANG Hanying, ZHONG Weijian. Retrospective Clinical Study on Modified Free Gingival Graft for Peri-implant Keratinized Mucosa Width Augmentation[J]. Journal of Oral Science Research, 2026, 42(3): 219-224.

参考文献

[1] Tavelli L, Barootchi S, Avila-Ortiz G, et al. Peri-implant soft tissue phenotype modification and its impact on peri-implant health: A systematic review and network meta-analysis[J]. J Periodontol, 2021, 92(1):21-44.
[2] Lang NP, Loe H. The relationship between the width of keratinized gingiva and gingival health[J]. J Periodontol, 1972, 43(10):623-627.
[3] Berglundh T, Lindhe J. Dimension of the periimplant mucosa. Biological width revisited[J]. J Clin Periodontol, 1996, 23(10):971-973.
[4] Fons-Badal C, Agustin-Panadero R, Labaig-Rueda C, et al. The influence of keratinized mucosa on the nonsurgical therapeutic treatment of peri-implantitis[J]. J Clin Med, 2022, 11(14):4118.
[5] 沈妍欣,刘玮,吴亚菲,等.种植体周围软组织表型对种植体周围组织健康的影响[J].中华口腔医学杂志, 2024, 59(8):846-850.
[6] Lin G, Chan H, Wang H. The significance of keratinized mucosa on implant health: a systematic review[J]. J Periodontol, 2013, 84(12):1755-1767.
[7] 刘瑞敏,陈江,周勇,等.后牙区角化黏膜宽度小于2 mm时,角化黏膜移植是必要的吗?[J].口腔医学, 2019, 39(9):827-830.
[8] 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):1369-1387.
[9] 李德华.种植体周围角化黏膜增宽术的关键技术原则与手术方案决策[J].中华口腔医学杂志, 2023, 58(2):118-123.
[10] 李效宇,蔡青,龚浩,等.改良种植体周游离龈移植术增宽角化黏膜1例[J].口腔医学研究, 2023, 39(5):463-465.
[11] Caton JG, Armitage G, Berglundh T, et al. A new classification scheme for periodontal and peri-implant diseases and conditions-Introduction and key changes from the 1999 classification[J]. J Periodontol, 2018, 89 Suppl 1:S1-S8.
[12] Lim HC, Wiedemeier DB, Hämmerle 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.
[13] 杨萌,姚立敏,王娟,等.种植体周围的牙龈退缩及自体软组织移植治疗的研究进展[J].口腔医学,2021,41(9):856-860.
[14] 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):650-655.
[15] Mahardawi B, Jiaranuchart S, Damrongsirirat N, et al. The lack of keratinized mucosa as a risk factor for peri-implantitis: a systematic review and meta-analysis[J]. Sci Rep, 2023, 13(1):3778.
[16] Blasi G, Chierico F, Amerio E, et al. Influence of keratinized mucosa width on the resolution of peri-implant mucositis: A prospective cohort study[J]. Clin Implant Dent Relat Res, 2024, 26(3):581-591.
[17] Tastan Eroglu Z, Ozkan Sen D, Oncu E. Association of peri-implant keratinized mucosa width and mucosal thickness with early bone loss: a cross-sectional study[J]. J Clin Med, 2024, 13(7):1936.
[18] 徐明华,钱印杰,陈龙,等.种植体周炎诊断的研究进展[J].中华口腔医学杂志,2024,59(12):1262-1271.
[19] Sinjab K, Garaicoa-Pazmino C, Wang H. Decision making for management of periimplant diseases[J]. Implant Dent, 2018, 27(3):276-281.
[20] 王昊喆,李磊.种植体周围炎治疗中软组织封闭的再建立[J].口腔医学研究,2024,40(11):945-949.
[21] Monje A, Blasi G, Nart J, et al. Soft tissue conditioning for the surgical therapy of peri-implantitis: a prospective 12-month study[J]. Int J Periodontics Restorative Dent, 2020, 40(6):899-906.
[22] Oh S, Ji C, Azad S. Free gingival grafts for implants exhibiting a lack of keratinized mucosa: Extended follow-up of a randomized controlled trial[J]. J Clin Periodontol, 2020, 47(6):777-785.
[23] Sculean A, Gruber R, Bosshardt DD. Soft tissue wound healing around teeth and dental implants[J]. J Clin Periodontol, 2014, 41 Suppl 15:S6-S22.
[24] Schwarz F, Becker J.种植体周围感染病因、诊断和治疗[M].宿玉成译.北京:人民军医出版社,2011:250-258.
[25] Shakiliyeva S, Sahin D, Gunpinar S, et al. Comparison of conventional and modified sling suture techniques in free gingival graft operations-a randomized controlled clinical trial[J]. BMC Oral Health, 2025, 25(1):279.
[26] 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.