改良隧道技术联合树脂充填治疗伴非龋性牙颈部缺损的多牙位牙龈退缩的效果分析

doi:10.3969/j.issn.1674-8115.2022.11.018

上海交通大学学报（医学版） ›› 2022, Vol. 42 ›› Issue (11): 1638-1643.doi: 10.3969/j.issn.1674-8115.2022.11.018

• 短篇论著 • 上一篇

改良隧道技术联合树脂充填治疗伴非龋性牙颈部缺损的多牙位牙龈退缩的效果分析

廖悦(), 董家辰, 宋忠臣()

上海交通大学医学院附属第九人民医院牙周病科，上海交通大学口腔医学院，国家口腔医学中心，国家口腔疾病临床医学研究中心，上海市口腔医学重点实验室，上海 200011

收稿日期:2022-07-22 接受日期:2022-10-19 出版日期:2022-11-28 发布日期:2023-01-04
通讯作者: 宋忠臣 E-mail:vickyliao0911@163.com;szhongchen@sina.com
作者简介:廖　悦（1993—），女，住院医师，硕士；电子信箱：vickyliao0911@163.com。

Efficacy of modified coronally advanced tunnel technique combined with resin restoration for the treatment of multiple gingival recession with non-carious cervical lesions

LIAO Yue(), DONG Jiachen, SONG Zhongchen()

Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai 200011

Received:2022-07-22 Accepted:2022-10-19 Online:2022-11-28 Published:2023-01-04
Contact: SONG Zhongchen E-mail:vickyliao0911@163.com;szhongchen@sina.com

摘要/Abstract

摘要：

目的·观察改良隧道技术（modified coronally advanced tunnel technique，MCAT）结合树脂充填治疗伴非龋性牙颈部病变（non-carious cervical lesion，NCCL）的多牙位牙龈退缩临床效果。方法·纳入伴NCCL的多牙位牙龈退缩的患者，通过树脂充填结合MCAT+上皮下结缔组织移植物（subepithelial connective tissue graft，sCTG）技术修复患牙冠根部的软硬组织缺损。在术前及术后6个月随访时检查患牙的探诊深度（probing depth，PD）、出血指数（bleeding index，BI）、菌斑指数（plaque index，PLI）、牙龈退缩高度（recession height，RH）、角化龈宽度（keratinized tissue width，KTW）、牙龈厚度（gingival thickness，GT）、龈乳头高度，并行根面覆盖美学评分（root coverage esthetic score，RES）。结果·共纳入3名患者，9个牙位。术后6个月时，BI、PLI、RH较术前下降；而KTW、GT及龈乳头高度均较术前增加，龈乳头高度较术前增加了（0.67±0.75）mm，术后RES评分为（8.56±1.33）分。结论·MCAT结合树脂充填技术能有效改善伴NCCL的多牙位牙龈退缩，获得唇颊侧及邻面软组织增量，并取得良好的美学效果。

关键词: 改良隧道技术, 非龋性牙颈部病变, 牙龈退缩, 树脂充填

Abstract:

Objective ·To observe the clinical efficacy of modified coronally advanced tunnel technique (MCAT) combined with resin restoration in treating multiple gingival recession with non-carious cervical lesion (NCCL). Methods ·Subjects with multiple gingival recession and NCCL were enrolled in the trial. All the patients were treated with MCAT with subepithelial connective tissue graft (sCTG) and resin restoration to repair the soft and hard tissue defect. Probing depth (PD), bleeding index (BI), plaque index, (PLI), recession height (RH), keratinized tissue width (KTW), gingival thickness (GT), and interdental papilla height were measured at baseline and 6-month follow-up. Root coverage esthetic score (RES) was also evaluated 6 months postoperatively. Results ·Three patients were treated in this study, including 9 sites. The mean BI, PLI and RH were significantly decreased at 6 months after treatment compared with the baseline. The augment of KTW, GT and interdental papilla height was achieved at follow-up, and interdental papilla height increased by (0.67±0.75) mm compared with the baseline. The mean RES was 8.56±1.33, postoperatively. Conclusion ·The MCAT combined with resin restoration could be a promising treatment for multiple gingival recession, resulting in ideal esthetic effect by the augment of buccal and interdental soft tissue.

Key words: modified coronally advanced tunnel technique, non-carious cervical lesion, gingival recession, resin restoration

中图分类号:

R781.4

廖悦, 董家辰, 宋忠臣. 改良隧道技术联合树脂充填治疗伴非龋性牙颈部缺损的多牙位牙龈退缩的效果分析[J]. 上海交通大学学报（医学版）, 2022, 42(11): 1638-1643.

LIAO Yue, DONG Jiachen, SONG Zhongchen. Efficacy of modified coronally advanced tunnel technique combined with resin restoration for the treatment of multiple gingival recession with non-carious cervical lesions[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(11): 1638-1643.

图/表 4

表1 多牙位牙龈退缩伴NCCL患者的一般情况

Tab 1 General information of patients with multiple gingival recession associated with NCCL

No.	Gender	Age	Tooth position	Classification of gingival recession	Gingival biotype
1	Female	33	23，24	Miller Ⅱ	Thin
2	Male	30	12，11，21	Miller Ⅲ	Thin
2	Male	30	22	Miller Ⅲ	Thick
3	Male	31	22，23，24	Miller Ⅲ	Thin

图1 病例1手术过程及复查情况Note： A. Pre-surgery, frontal view. B. Pre-surgery, lateral view. C. The frontal view of 23, 24 after resin restoration. D. The lateral view of 23, 24 after resin restoration. E. Tension free suture. F. Three months post-surgery. G. Six months post-surgery.

Fig 1 Surgical procedure and follow-up of case 1

图2 病例2手术过程及复查情况Note： A. Pre-surgery, frontal view. B. Pre-surgery, lateral view. C. The frontal view of 12, 11, 21, 22 after resin restoration. D. The crevicular incision in 12, 11, 21, 22. E. Tension free suture. F. Three months post-surgery. G. Six months post-surgery.

Fig 2 Surgical procedure and follow-up of case 2

图3 病例3手术过程及复查情况Note： A. Pre-surgery, frontal view. B. Pre-surgery, lateral view. C. The frontal view of 22, 23, 24 after resin restoration. D. The crevicular incision in 22, 23, 24. E. Tension free suture. F. Three months post-surgery. G. Six months post-surgery.

Fig 3 Surgical procedure and follow-up of case 3

参考文献 19

1	CORTELLINI P, BISSADA N F. Mucogingival conditions in the natural dentition: narrative review, case definitions, and diagnostic considerations[J]. J Periodontol, 2018, 89 :S204-S213.
2	TEIXEIRA D N R, THOMAS R Z, SOARES P V, et al. Prevalence of noncarious cervical lesions among adults: asystematic review[J]. J Dent, 2020, 95:103285.
3	JEPSEN S, CATON J G, ALBANDAR J M, et al. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions[J]. J Periodontol, 2018, 89 : S237-S248.
4	ZUCCHELLI G, GORI G, MELE M, et al. Non-carious cervical lesions associated with gingival recessions: a decision-making process[J]. J Periodontol, 2011, 82(12): 1713-1724.
5	ZUCCHELLI G, TESTORI T, DE SANCTIS M. Clinical and anatomical factors limiting treatment outcomes of gingival recession: a new method to predetermine the line of root coverage[J]. J Periodontol, 2006, 77(4): 714-721.
6	AROCA S, KEGLEVICH T, NIKOLIDAKIS D, et al. Treatment of class III multiple gingival recessions: a randomized-clinical trial[J]. J Clin Periodontol, 2010, 37(1): 88-97.
7	MILLER P D J. A classification of marginal tissue recession[J]. Int J Periodontics Restorative Dent, 1985, 5(2): 8-13.
8	GONÇALVES D F M, SHINOHARA M S, CARVALHO P R M A, et al. Three-year evaluation of different adhesion strategies in non-carious cervical lesion restorations: a randomized clinical trial[J]. J Appl Oral Sci, 2021, 29: e20210192.
9	FERNÁNDEZ-JIMÉNEZ A, GARCÍA-DE-LA-FUENTE A M, ESTEFANÍA-FRESCO R, et al. Complete root coverage in the treatment of Miller class Ⅲ or RT2 gingival recessions: a systematic review and meta-analysis[J]. BMC Oral Health, 2021, 21(1): 145.
10	OLIVEIRA L M L, SOUZA C A, CUNHA S, et al. Treatment efficacy of gingival recession defects associated with non-carious cervical lesions: a systematic review[J]. J Periodontal Implant Sci, 2022, 52(2): 91-115.
11	SILVEIRA C A, MATHIAS I F, DA SILVA NEVES F L, et al. Connective tissue graft and crown-resin composite restoration for the treatment of gingival recession associated with noncarious cervical lesions: case series. Int J Periodontics Restorative Dent[J]. 2017, 37(4):601-607.
12	CAIRO F, CORTELLINI P, NIERI M, et al. Coronally advanced flap and composite restoration of the enamel with or without connective tissue graft for the treatment of single maxillary gingival recession with non-carious cervical lesion. A randomized controlled clinical trial[J]. J Clin Periodontol, 2020, 47(3): 362-371.
13	范雅丹, 董家辰. 树脂充填结合多牙位冠向复位瓣技术治疗非龋性牙颈部病变合并牙龈退缩的临床疗效[J]. 口腔医学, 2021, 41(10): 893-899.
	FAN Y D, DONG J C. Long-term clinical outcome of the resin restoration plus multiple coronally advanced flap technique for the treatment of gingival recession associated with non-carious cervical lesion[J]. Stomatology, 2021, 41(10): 893-899.
14	STEFANINI M, MARZADORI M, AROCA S, et al. Decision making in root-coverage procedures for the esthetic outcome[J]. Periodontol 2000, 2018, 77(1): 54-64.
15	GÓRSKI B, SZERSZEŃ M. Effect of root surface biomodification on multiple recession coverage with modified coronally advanced tunnel technique and subepithelial connective tissue graft: a retrospective analysis[J]. Gels, 2022, 8(1): 31.
16	SCULEAN A, COSGAREA R, STÄHLI A, et al. Treatment of multiple adjacent maxillary Miller Class Ⅰ, Ⅱ, and Ⅲ gingival recessions with the modified coronally advanced tunnel, enamel matrix derivative, and subepithelial connective tissue graft: a report of 12 cases[J]. Quintessence Int, 2016, 47(8): 653-659.
17	SCULEAN A, COSGAREA R, KATSAROS C, et al. Treatment of single and multiple Miller Class Ⅰ and Ⅲ gingival recessions at crown-restored teeth in maxillary esthetic areas[J]. Quintessence Int, 2017, 48(10): 777-782.
18	KAHN S, ALMEIDA R A, DIAS A T, et al. Clinical considerations on the root coverage of gingival recessions in thin or thick biotype[J]. Int J Periodontics Restorative Dent, 2016, 36(3): 409-415.
19	HWANG D, WANG H L. Flap thickness as a predictor of root coverage: a systematic review[J]. J Periodontol, 2006, 77(10): 1625-1634.

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改良隧道技术联合树脂充填治疗伴非龋性牙颈部缺损的多牙位牙龈退缩的效果分析

Efficacy of modified coronally advanced tunnel technique combined with resin restoration for the treatment of multiple gingival recession with non-carious cervical lesions

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