软组织移植用于治疗正畸后牙龈退缩的临床疗效分析

doi:10.13701/j.cnki.kqyxyj.2021.08.008

摘要/Abstract

摘要： 目的: 用软组织移植的方法治疗正畸后牙龈退缩,通过统计相关临床指标来评估软组织移植治疗正畸治疗后牙龈退缩的临床效果。方法: 收集正畸治疗后发生牙龈退缩的患者12例,均为Miller Ⅰ类、Miller Ⅱ类牙龈退缩,采用冠向复位瓣+结缔组织移植或游离龈移植的方法治疗牙龈退缩,在基线和术后1年随访时分别记录每颗牙牙龈退缩深度(RD)、角化龈宽度(KTW)、根面覆盖率(RC),探诊深度(PD),采用视觉模拟评分法(VAS)评估患者对手术的满意度,计算各项临床指标平均值变化。结果: 12例患者的平均基线RD为(3.7±0.9) mm,术后1年平均RD为(0.3±0.9) mm;术后1年患者的平均RC为(97.1±6.3)%,大部分牙齿得到完全根面覆盖;患者基线和术后1年平均KTW为(0. 8±0.3) mm和(3.8±0.6) mm,角化龈增加明显;PD从基线(1.5±0.5) mm减少到(1.2±0.5) mm;术后1年患者满意度评分为(9.6±0.6)分,大部分患者对术后效果感到满意且根面敏感情况好转。结论: 正畸治疗后牙龈退缩的患者采用冠向复位瓣+结缔组织移植或游离龈移植的方法均可取得良好临床效果,患者根面敏感情况得到明显改善且满意度高。

关键词: 正畸治疗, 牙龈退缩, 结缔组织移植, 游离龈移植

Abstract: Objective: To evaluate the clinical outcomes of treatment of gingival recession after orthodontic treatment with soft tissue graft. Methods: Twelve patients with gingival recession after orthodontic treatment were treated with coronal advanced flap combined with connective tissue graft (CAF+CTG) or free gingival graft (FGG). Recession depth (RD), keratinized tissue width (KTW), pocket depth (PD), and root coverage rate (RC) at baseline and follow-up-one-year after treatment were recorded and analyzed. The satisfaction degree of patients was evaluated by visual analogue scale (VAS). Results: The mean RDs and KTWs at baseline and follow-up were (3.7±0.9) mm, (0.8±0.3) mm, (0.3±0.9) mm, and (3.8±0.6) mm, respectively. The mean RC at follow-up was (97.1±6.3)%. PD was decreased from (1.5±0.5) mm to (1.2±0.5) mm. The VAS value was 9.6±0.6 at one-year-follow-up. Root sensitivity was significantly improved. Conclusion: The coronal advanced flap combined with connective tissue graft (CAF+CTG) or free gingival graft (FGG) has ideal clinical outcomes and satisfaction for the treatment of gingival recession after orthodontic treatment.

Key words: orthodontic treatment, gingival recession, connective tissue graft, free gingival graft

刘冬晓, 夏连松, 黄川. 软组织移植用于治疗正畸后牙龈退缩的临床疗效分析[J]. 口腔医学研究, 2021, 37(8): 708-711.

LIU Dongxiao, XIA Liansong, HUANG Chuan. Clinical Study on Effect of Soft Tissue Graft on Gingival Recession after Orthodontic Treatment[J]. Journal of Oral Science Research, 2021, 37(8): 708-711.

参考文献

[1] 孟焕新.牙周病学[M].第5版.北京:人民卫生出版社.
[2] Kassab MM, Cohen RE. The etiology and prevalence of gingival recession [J]. J Am Dent Assoc, 2003, 134(2):220-225.
[3] Slutzkey S, Levin L. Gingival recession in young adults: occurrence, severity, and relationship to past orthodontic treatment and oral piercing [J]. Am J Orthod Dentofacial Orthop, 2008, 134(5):652-656.
[4] Jati AS, Furquim LZ, Consolaro A. Gingival recession: its causes and types, and the importance of orthodontic treatment [J]. Dental Press J Orthod, 2016, 21(3):18-29.
[5] Richman C. Is gingival recession a consequence of an orthodontic tooth size and/or tooth position discrepancy? “A paradigm shift” [J]. Compend Contin Educ Dent, 2011, 32(1):62-69.
[6] Ko-Kimura N, Kimura-Hayashi M, Yamaguchi M, et al. Some factors associated with open gingival embrasures following orthodontic treatment [J]. Aust Orthod J, 2003, 19(1):19-24.
[7] 施优灵,韩光丽.正畸治疗中的牙龈退缩[J].国际口腔医学杂志,2014,41( 1) : 57-62.
[8] Cairo F, Pagliaro U, Nieri M. Treatment of gingival recession with coronally advanced flap procedures: systematic review [J]. J Clin Periodontol, 2008, 35(8 Suppl) : 136-162.
[9] Zucchelli G,De Sanctis M. Treatment of multiple recession-type defects in patients with esthetic demands [J]. J Periodontol,2000,71( 9) : 1506-1514.
[10] Menceva Z, Dimitrovski O, Popovska M, et al. Free gingival graft versus mucograft: histological evaluation [J]. Open Access Maced J Med Sci, 2018, 6(4): 675-679.
[11] O'Leary TJ, Drake RB, Naylor JE. The plaque control record [J]. J Periodontol, 1972,43(1): 38.
[12] Ainamo J, Bay I. Problems and proposalsfor recording gingivitis and plaque [J]. Int Dent J, 1975, 25(4): 229-235.
[13] Zucchelli G, Marzadori M, Mounssif I, et al. Coronally advanced flap⁺ connective tissue graft techniques for the treatment of deep gingival recession in the lower incisors. A controlled randomized clinical trial [J]. J Clin Periodontol, 2014, 41(8): 806-813.
[14] Rosetti EP, Marcantonio E Jr, Zuza EP, et al. Root coverage stability of the subepithelial connective tissue graft and guided tissue regeneration: A 30-month follow-up clinical trial [J]. J Dent, 2013, 41(2):114-120.
[15] Sedon CL, Breault LG, Covington LL, et al. The subepithelial connective tissue graft: part Ⅱ. Histologic healing and clinical root coverage [J]. J Contemp Dent Pract, 2005, 6(2):139-150.
[16] Polson AM, Proye MP. Effect of root surface alterations on periodontal healing. Ⅱ. Citric acid treatment of the denuded root [J]. J Clin Periodontol, 1982, 9(6):441-454.
[17] Pini-Prato G, Baldi C, Pagliaro U, et al. Coronally advanced flap procedure for root coverage. Treatment of root surface: root planning versus polishing [J]. J Periodontol, 1999, 70(9):1064-1076.
[18] 柴红波,廖海清,曹正国.上皮下结缔组织移植术对牙龈退缩治疗效果的Meta分析[J].口腔医学研究,2014,30(9),897-901.
[19] 张慧慧,李明丽,李成章.侧向转位瓣结合上皮下结缔组织移植治疗重度Miller Ⅲ°牙龈退缩1例[J].口腔医学研究,2018,34(5):572-574.
[20] Geiger AM. Mucogingival problems and the movement of mandibular incisors: A clinic review [J]. Am J Orthod, 1980, 78(5):511-527.
[21] Trossello VK, Gianelly AA. Orthodontic treatment and periodontal status [J]. J Periodon, 1979, 50(12):665-671.
[22] Pikdoken L, Erkan M, Usumez S. Gingival response to mandibular incisor extrusion [J]. Am J Orthod Dentofacial Orthop, 2009, 135(4):432-433.
[23] Erkan M, Pikdoken L, Usumez S. Gingival response to mandibular incisor intrusion [J]. Am J Orthod Dentofacial Orthop, 2007, 132(2): 143.e9-13.