附着龈增宽临床研究现状

doi:10.13701/j.cnki.kqyxyj.2024.02.001

摘要/Abstract

摘要： 附着龈与游离龈相连续,均为角化上皮,两者合称为角化龈。附着龈紧紧附于牙槽骨,质地坚韧,抵抗力强,对于牙周健康具有重要意义。在临床上,附着龈不足或者缺失会造成一系列问题,如咀嚼过程中龈缘受到摩擦或肌肉牵引后与牙面分离,从而导致食物残渣等进入龈沟,造成牙周破坏;此外,在修复体、种植体边缘会导致患者咀嚼过程中出现疼痛;对于可摘局部义齿而言,还会影响义齿设计和患者佩戴,影响患者生活质量。可见,附着龈不足或缺失已成为牙周、修复、种植等多学科共同面临的问题。针对其治疗,目前涉及的方法主要有自体软组织移植和生物替代材料两大类。本综述旨在探讨各种附着龈增宽治疗方式的特点,为临床工作提供理论依据,为进一步研究提供参考。

关键词: 附着龈, 游离龈移植, 结缔组织瓣移植, 脱细胞真皮基质, 胶原基质膜

Abstract: Attached gingiva and free gingiva are continuous, both of which are keratinized epithelium, and they are collectively called keratinized gingiva. Attached gingival is tightly attached to alveolar bone, tough texture, strong resistance, and has important significance for periodontal health. Clinically, insufficient or missing attached gingival may cause a series of problems. For example, during chewing, the gingival margin is separated from the dental surface after being rubbed or pulled by muscles, which leads to food residues entering the gingival sulci and causing periodontal destruction. In addition, the edge of the prosthesis and implant will cause pain during mastication. For removable partial denture, it will also affect denture design and patient wearing, and affect the quality of patients life. It can be seen that the deficiency or absence of attached gingival has become a common problem faced by periodontal, prosthesis, implant and other disciplines. For its treatment, there are two main types of methods: autologous soft tissue transplantation and biological replacement materials. The purpose of this review is to explore the characteristics of various therapeutic modalities, provide theoretical basis for clinical work, and provide reference for further research.

Key words: attached gingival, free gingival transplantation, connective tissue flap transplantation, acellular dermal matrix, collagen matrix membrane

景雪琴, 苗辉. 附着龈增宽临床研究现状[J]. 口腔医学研究, 2024, 40(2): 97-102.

JING Xueqin, MIAO Hui. Clinical Research Status of Attached Gingival Widening[J]. Journal of Oral Science Research, 2024, 40(2): 97-102.

参考文献

[1] 《广东牙病防治》编辑部.附着龈增宽术的探讨[J].广东牙病防治,2012,20(11): 565-572.
[2] 毛俊木,刘潇,龙文,等.游离龈移植和根向复位瓣术增加下颌后牙种植区角化龈的临床效果观察[J].中国医药科学, 2020,10(10):229-234.
[3] 容明灯,黄雁红,卢海宾,等.显微牙周外科技术在种植体周附着龈增宽术中的应用[J].华西口腔医学杂志,2018,36(1):71-75.
[4] 陆杰,徐燕,邹晨阳.角化龈增量对维护牙周炎患者种植体稳定性的临床研究[J].口腔医学研究,2023,39(6):510-514.
[5] Naziker Y, Ertugrul AS. Aesthetic evaluation of free gingival graft applied by partial de-epithelialization and free gingival graft applied by conventional method: a randomized controlled clinical study [J]. Clin Oral Investig, 2023, 27(7): 4029-4038.
[6] Carcuac O, Trullenque-Eriksson A, Derks J. Modified free gingival graft technique for treatment of gingival recession defects at mandibular incisors: A randomized clinical trial [J]. J Periodontol, 2023, 94(6): 722-730.
[7] Barootchi S, Tavelli L. Tunneled coronally advanced flap for the treatment of isolated gingival recessions with deficient papilla [J]. Int J Esthet Dent, 2022, 17(1): 14-26.
[8] Gher ME Jr, Williams JE Jr, Vernino AR, et al. Evaluation of the immunogenicity of freeze-dried skin allografts in humans[J]. J Periodontol, 1980, 51(10):571-577.
[9] Gher ME Jr, Vernino AR, Maluish AE, et al. Evaluation of the immunogenicity of freeze-dried skin allografts in humans: cell-mediated response [J]. J Periodontol, 1982, 53(5): 325-327.
[10] Yukna RA, Tow HD, Caroll PB, et al. Comparative clinical evaluation of freeze-dried skin allografts and autogenous gingival grafts in humans [J]. J Clin Periodontol, 1977, 4(3): 191-199.
[11] Yukna RA, Tow HD, Carroll PB, et al. Evaluation of the use of freeze-dried skin allografts in the treatment of human mucogingival problems [J]. J Periodontol, 1977, 48(4): 187-193.
[12] Ouhayoun JP, Holzman S, Etienne D, et al. Freeze-dried skin allografts. A human clinical and histological study [J]. J Periodontol, 1983, 54(8):463-469.
[13] Cairo F, Nieri M, Pagliaro U. Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review [J]. J Clin Periodontol, 2014, 4 Suppl 15: S44-S62.
[14] Aichelmann-Reidy ME, Yukna RA, Evans GH, et al. Clinical evaluation of acellular allograft dermis for the treatment of human gingival recession [J]. J Periodontol, 2001, 72(8): 998-1005.
[15] Cevallos CAR, de Resende DRB, Damante CA, et al. Free gingival graft and acellular dermal matrix for gingival augmentation: a 15-year clinical study [J]. Clin Oral Investig, 2020, 24(3): 1197-1203.
[16] Wang Z, Zhai T. Efficacy of acellular dermal matrix versus connective tissue graft for root coverage in patients with gingival recession: A meta-analysis [J]. Int J Periodontics Restorative Dent, 2023.
[17] Park JB. Increasing the width of keratinized mucosa around endosseous implant using acellular dermal matrix allograft [J]. Implant Dent, 2006, 15(3): 275-281.
[18] Yan JJ, Tsai AY, Wong MY, et al. Comparison of acellular dermal graft and palatal autograft in the reconstruction of keratinized gingiva around dental implants: a case report [J]. Int J Periodontics Restorative Dent, 2006, 26(3): 287-292.
[19] 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): 145-152.
[20] Happe A, Schmidt A, Neugebauer J, et al. Peri-implant soft-tissue esthetic outcome after immediate implant placement in conjunction with xenogeneic acellular dermal matrix or connective tissue graft: A randomized controlled clinical study [J]. J Esthet Restor Dent, 2022, 34(1): 215-225.
[21] Anderson LE, Inglehart MR, El-Kholy K, et al. Implant associated soft tissue defects in the anterior maxilla: a randomized control trial comparing subepithelial connective tissue graft and acellular dermal matrix allograft [J]. Implant Dent, 2014, 23(4): 416-425.
[22] Hutton CG, Johnson GK, Barwacz CA, et al. Comparison of two different surgical approaches to increase peri-implant mucosal thickness: A randomized controlled clinical trial [J]. J Periodontol, 2018, 89(7): 807-814.
[23] Zang J, Su L, Luan Q, et al. Clinical and histological evaluation of the use of acellular dermal matrix (ADM) membrane in peri-implant vertical soft tissue augmentation: A controlled clinical trial [J]. Clin Oral Implants Res, 2022, 33(6): 586-597.
[24] Happe A, Debring L, Schmidt A, et al. Immediate implant placement in conjunction with acellular dermal matrix or connective tissue graft: A randomized controlled clinical volumetric study [J]. Int J Periodontics Restorative Dent, 2022, 42(3): 381-390.
[25] 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): 868-876.
[26] Rakasevic DL, Milinkovic IZ, Jankovic SM, et al. The use of collagen porcine dermal matrix and connective tissue graft with modified coronally advanced tunnel technique in the treatment of multiple adjacent type Ⅰ gingival recessions: A randomized, controlled clinical trial [J]. J Esthet Restor Dent, 2020, 32(7): 681-690.
[27] McGuire MK, Scheyer ET. Randomized, controlled clinical trial to evaluate a xenogeneic collagen matrix as an alternative to free gingival grafting for oral soft tissue augmentation [J]. J Periodontol, 2014, 85(10):1333-1341.
[28] McGuire MK, Scheyer ET, Lipton DI, et al. Randomized, controlled, clinical trial to evaluate a xenogeneic collagen matrix as an alternative to free gingival grafting for oral soft tissue augmentation: A 6- to 8-year follow-up [J]. J Periodontol, 2021, 92(8): 1088-1095.
[29] McGuire MK, Janakievski J, Scheyer ET, et al. Efficacy of a harvest graft substitute for recession coverage and soft tissue volume augmentation: A randomized controlled trial [J]. J Periodontol, 2022, 93(3): 333-342.
[30] Aroca S, Molnár B, Windisch P, et al. Treatment of multiple adjacent Miller class Ⅰ and Ⅱ gingival recessions with a Modified Coronally Advanced Tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: a randomized, controlled clinical trial [J]. J Clin Periodontol, 2013, 40(7): 713-720.
[31] Tarasenko S, Ashurko I, Taschieri S, et al. Comparative analysis of methods to increase the amount of keratinized mucosa before stage-two surgery: a randomized controlled study [J]. Quintessence Int, 2020, 51(5): 374-387.
[32] Huang JP, Liu JM, Wu YM, et al. Clinical evaluation of xenogeneic collagen matrix versus free gingival grafts for keratinized mucosa augmentation around dental implants: A randomized controlled clinical trial [J]. J Clin Periodontol, 2021, 48(10): 1293-1301.
[33] Rinastiti M, Harijadi, Santoso AL, et al. Histological evaluation of rabbit gingival wound healing transplanted with human amniotic membrane [J]. Int J Oral Maxillofac Surg, 2006, 35(3): 247-251.
[34] Qi F, Yoshida T, Koike T, et al. Construction and characterization of human oral mucosa equivalent using hyper-dry amniotic membrane as a matrix [J]. Arch Oral Biol, 2016, 65: 26-34.
[35] Martelloni M, Boccaletto P, Montagner G, et al. Bilaminar technique with coronally advanced flap and cryopreserved human amniotic membrane in the treatment of gingival recessions [J]. Case Rep Dent, 2020, 2020: 7827092.
[36] Miron RJ, Moraschini V, Del Fabbro M, et al. Use of platelet-rich fibrin for the treatment of gingival recessions: a systematic review and meta-analysis [J]. Clin Oral Investig, 2020, 24(8): 2543-2557.
[37] Ozsagir ZB, Saglam E, Sen Yilmaz B, et al. Injectable platelet-rich fibrin and microneedling for gingival augmentation in thin periodontal phenotype: A randomized controlled clinical trial [J]. J Clin Periodontol, 2020, 47(4): 489-499.
[38] Han CY, Wang DZ, Bai JF, et al. Peri-implant keratinized gingiva augmentation using xenogeneic collagen matrix and platelet-rich fibrin: A case report [J]. World J Clin Cases, 2021, 9(34): 10738-10745.
[39] 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.
[40] Bozkurt Doğanş, Öngöz Dede F, Ballı U, et al. Concentrated growth factor in the treatment of adjacent multiple gingival recessions: a split-mouth randomized clinical trial [J]. J Clin Periodontol, 2015, 42(9): 868-875.
[41] Korkmaz B, Balli U. Clinical evaluation of the treatment of multiple gingival recessions with connective tissue graft or concentrated growth factor using tunnel technique: a randomized controlled clinical trial [J]. Clin Oral Investig, 2021, 25(11): 6347-6356.
[42] Tazegül K, Doğanş B, Ballı U, et al. Growth factor membranes in treatment of multiple gingival recessions: a randomized clinical trial [J]. Quintessence Int, 2022, 53(4): 288-297.
[43] Miron RJ, Sculean A, Cochran DL, et al. Twenty years of enamel matrix derivative: the past, the present and the future [J]. J Clin Periodontol, 2016, 43(8): 668-683.
[44] McGuire MK, Scheyer ET, Nunn M. Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue: comparison of clinical parameters at 10 years [J]. J Periodontol, 2012, 83(11): 1353-1362.
[45] Meza Mauricio J, Furquim CP, Bustillos-Torrez W, et al. Does enamel matrix derivative application provide additional clinical benefits in the treatment of maxillary Miller class Ⅰ and Ⅱ gingival recession? A systematic review and meta-analysis [J]. Clin Oral Investig, 2021, 25(4): 1613-1626.
[46] Dias AT, de Menezes CC, Kahn S, et al. Gingival recession treatment with enamel matrix derivative associated with coronally advanced flap and subepithelial connective tissue graft: a split-mouth randomized controlled clinical trial with molecular evaluation [J]. Clin Oral Investig, 2022, 26(2): 1453-1463.
[47] Chambrone L, Barootchi S, Avila-Ortiz G. Efficacy of biologics in root coverage and gingival augmentation therapy: An American Academy of Periodontology best evidence systematic review and network meta-analysis [J]. J Periodontol, 2022, 93(12): 1771-1802.