上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2022, Vol. 42 ›› Issue (11): 1550-1556.doi: 10.3969/j.issn.1674-8115.2022.11.005

• 论著 · 临床研究 • 上一篇    

3种治疗牙龈退缩术式的根面覆盖和美学效果比较

孙文韬(), 孙梦君, 谢玉峰(), 束蓉   

  1. 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:2022-07-06 接受日期:2022-10-17 出版日期:2022-11-28 发布日期:2023-01-04
  • 通讯作者: 谢玉峰 E-mail:swtswtwt@sina.com;yufengxie_123@163.com
  • 作者简介:孙文韬（1991—），男，主治医师，硕士；电子信箱：swtswtwt@sina.com。
  • 基金资助:
    国家自然科学基金重点项目(81991500);上海市自然科学基金(18ZR1422400);口腔医学重点核心口腔颌面组织再生与功能修复创新团队(SSMUZDCX20180900);九院临床研究助力计划(JYLJ201819)

Comparison of the root coverage and esthetic outcomes of 3 different techniques for gingival recession

SUN Wentao(), SUN Mengjun, XIE Yufeng(), SHU Rong   

  1. 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, China
  • Received:2022-07-06 Accepted:2022-10-17 Online:2022-11-28 Published:2023-01-04
  • Contact: XIE Yufeng E-mail:swtswtwt@sina.com;yufengxie_123@163.com
  • Supported by:
    National Natural Science Foundation of China(81991500);Natural Science Foundation of Shanghai(18ZR1422400);Innovative Research Team of High-level Local Universities in Shanghai(SSMUZDCX20180900);Clinical Research Program of Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine(JYLJ201819)

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摘要：

目的·观察使用结缔组织移植术（connective tissue graft，CTG）分别联合信封技术、隧道技术（tunne technique，TUN）和经前庭沟切口的骨膜下隧道技术（vestibular incision subperiosteal tunnel access，VISTA）治疗牙龈退缩（gingival recession，GR）的手术效果，分析这3种术式在根面覆盖和美学效果上的差异。方法·纳入2020年1月—2021年12月就诊于上海交通大学医学院附属第九人民医院牙周病科的患者87例，共324颗伴有GR的患牙，分别使用信封技术+CTG、TUN+CTG、VISTA+CTG进行根面覆盖。在基线和术后6个月时分别检查患者的相关牙周状况，并由2名牙周专科医师各自使用根面覆盖美学评分（root coverage esthetic score，RES）和黏膜瘢痕指数（mucosal scarring index，MSI）对术后美学效果评分。使用t检验比较基线和术后6个月时患者GR深度和角化牙龈（keratinized gingiva，KG）宽度的差异。使用方差分析比较不同术式GR深度和KG宽度改变量之间的差异。使用方差分析比较不同术式、同一术式在不同牙位以及各牙位使用不同术式的根面覆盖率（percentage of root coverage，PRC）、RES和MSI的差异。结果·术后6个月时，KG平均增加（1.49±1.36）mm，3种术式KG的改变量存在显著差异（P=0.002）。GR平均减少（2.37±1.37）mm，3种术式GR的改变量存在显著差异（P=0.000）。平均PRC为（87.7±27.1）%，3种术式之间存在显著差异（P=0.003）。完全根面覆盖率（percentage of complete root coverage，PCRC）为74.0%，在3种术式之间存在显著差异（P=0.000）。信封+CTG组和VISTA+CTG组的不同牙位的RES存在显著差异（Penvelope=0.003，PVISTA=0.000）。VISTA+CTG组的不同牙位MSI存在显著差异（P=0.000）。3种术式之间，PRC仅在下颌前牙区存在显著差异（P=0.011）；RES在下颌前牙区和下颌后牙区存在显著差异（PLA=0.001，PLP=0.034），下颌前牙区TUN+CTG组的评分较高，下颌后牙区TUN+CTG组和VISTA+CTG组的评分均较高；MSI在各个牙位分区均存在显著差异（PUA=0.011，PUP=0.000，PLA=0.003，PLA=0.001）。结论·3种术式均可以达到改善GR和增宽KG的效果。若不考虑术者经验因素，TUN+CTG的根面覆盖和角化牙龈增量效果优于信封技术+CTG和VISTA+CTG。

关键词: 牙龈退缩, 根面覆盖, 信封技术, 隧道技术, 经前庭沟切口的骨膜下隧道技术

Abstract:

Objective ·To evaluate the outcomes of connective tissue graft (CTG) combined with 3 different techniques for gingiva recession (GR) including envelope technique, tunnel technique (TUN) and vestibular incision subperiosteal tunnel access (VISTA), and analyze the differences of root coverage and esthetic outcomes of the 3 techniques. Methods ·A total of 87 patients who visited the Department of Periodontology, Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine from January 2020 to December 2021 with a total of 324 GRs were enrolled in this study. All GRs were treated with one of the 3 techniques. The patients′ periodontal conditions were examined at baseline and 6 months after surgery. The root coverage esthetic score (RES) and mucosal scarring index (MSI) were evaluated by 2 periodontists 6 months after surgery. The differences of keratinized gingiva (KG) and GR at baseline and 6 months after surgery were compared by using t-test. Analysis of variance was used to compare the differences of percentage of root coverage (PRC), RES and MSI of different techniques, the same technique in different regions, and different techniques in each region. Results ·In this study, KG increased by (1.49±1.36) mm, and there was a significant difference between each technique (P=0.002). GR decreased by (2.37±1.37) mm, and there was a significant difference between each technique (P=0.000). The mean PRC was (87.7±27.1)%, which was significantly different between each technique (P=0.003). The percentage of complete root coverage (PCRC) was 74.0%, and there was significant difference among the 3 techniques (P=0.000). There were significant differences in RES in different regions between envelope+CTG and VISTA+CTG (Penvelope=0.003, PVISTA=0.000). There was a significant difference in MSI of different regions in VISTA+CTG (P=0.000). Among the 3 techniques, only PRC had differences in the lower anterior teeth (P=0.011); there was a significant difference in RES between lower anterior teeth and lower posterior teeth (PLA=0.001,PLP=0.034), the RES of lower anterior teeth treated with TUN+CTG was higher, and the RES of lower posterior teeth treated with TUN+CTG and VISTA+CTG was higher; there were significant differences in MSI in each region (PUA=0.011, PUP=0.000, PLA=0.003, PLA=0.001). Conclusion ·All the 3 techniques are capable of reducing GR and widening KG. The root coverage and esthetic outcomes of TUN+CTG are superior to the other 2 techniques if the operator′s experience is not considered.

Key words: gingival recession, root coverage, envelope technique, tunnel technique (TUN), vestibular incision subperiosteal tunnel access (VISTA)

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