2种龈瓣复位方式对牙龈瘤切除术后效果的影响

doi:10.3969/j.issn.1674-8115.2025.05.011

上海交通大学学报（医学版） ›› 2025, Vol. 45 ›› Issue (5): 624-629.doi: 10.3969/j.issn.1674-8115.2025.05.011

• 论著 · 技术与方法 • 上一篇下一篇

2种龈瓣复位方式对牙龈瘤切除术后效果的影响

孙文韬, 董家辰, 孙梦君, 廖悦, 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，上海市口腔医学研究所，中国医学科学院口腔颌面再生医学创新单元，上海 200011

收稿日期:2024-11-20 接受日期:2025-01-23 出版日期:2025-05-28 发布日期:2025-05-28
通讯作者: 宋忠臣，主任医师，博士；电子信箱：szhongchen@sina.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:
中国医学科学院医学与健康科技创新工程项目(2019?I2M?5?037)

Effects of 2 different flap techniques on clinical outcomes after epulis excision

SUN Wentao, DONG Jiachen, SUN Mengjun, LIAO Yue, 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 Research Institute of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai 200011, China

Received:2024-11-20 Accepted:2025-01-23 Online:2025-05-28 Published:2025-05-28
Contact: SONG Zhongchen, E-mail: szhongchen@sina.com.
Supported by:
CAMS Innovation Fund for Medical Sciences (CIFMS)(2019?I2M?5?037)

摘要/Abstract

摘要：

目的·观察牙龈瘤切除术后分别使用原位复位瓣（normally positioned flap，NPF）和冠向复位瓣（coronally advanced flap，CAF）技术关闭创口对手术效果的影响。方法·纳入2022年8月—2023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牙龈瘤患者共55例，分为NPF组和CAF组，在手术彻底切除牙龈瘤后，分别使用NPF和CAF技术缝合创口。记录基线时牙龈瘤的宽度（epulis width，EW）和高度（epulis height，EH），术后6个月时龈乳头的宽度（papilla width，PW）和高度（papilla height，PH），基线和术后6个月时的探诊深度（probing depth，PD）、附着丧失（attachment loss，AL）、角化牙龈宽度（keratinized gingiva width，KGW）等，并由2名牙周专科医师使用视觉模拟评分法（visual analogue scale，VAS）评估术后美学效果。使用t检验比较基线和术后6个月时的差异。结果·术后6个月时，CAF组的PD为（1.68±0.79）mm，与基线相比差异有统计学意义（P<0.001），但与NPF组差异没有统计学意义（P=0.365）；术后6个月时，CAF组的AL为（1.26±1.18）mm，与基线相比差异没有统计学意义（P=0.746），但是显著低于NPF组（P<0.001）；术后6个月时，CAF组的PH为（3.74±0.62）mm，显著高于NPF组（P<0.001），且前者的VAS得分显著优于后者（P<0.001）。结论·相对于传统的NPF技术，CAF技术可以有效改善牙龈瘤切除术后术区KGW，避免术后AL增加，减轻术后的牙周软组织缺损，改善术后美学效果。

关键词: 牙龈瘤, 牙周软组织缺损, 原位复位瓣, 冠向复位瓣

Abstract:

Objective ·To evaluate the effects of normally positioned flap (NPF) and coronally advanced flap (CAF) techniques on clinical results after epulis excision. Methods ·A total of 55 patients with epulis who visited the Department of Periodontology, Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine from August 2022 to December 2023 were included. The patients were divided into the NPF group and the CAF group. After epulis excision, the surgical area was closed using NPF or CAF technique. The following parameters were recorded: baseline epulis width (EW) and epulis height (EH); papilla width (PW) and papilla height (PH) at 6 months post-surgery; probing depth (PD), attachment loss (AL), and keratinized gingiva width (KGW) at both baseline and 6 months post-surgery. The esthetic outcomes were evaluated using a visual analog scale (VAS) by 2 periodontal specialists. t test was used to compare the differences in periodontal indices between baseline and 6 months post-surgery, as well as between the 2 flap techniques. Results ·At 6 months post-surgery, PD of the CAF group was (1.68±0.79) mm, significantly lower than at baseline (P<0.001), but not significantly different from that in the NPF group (P=0.365); the AL in the CAF group was (1.26±1.18) mm, not significantly different from baseline (P=0.746), but significantly lower than in the NPF group (P<0.001). At 6 months post-surgery, PH of the CAF group was (3.74±0.62) mm, significantly higher than that in the NPF group (P<0.001), and the VAS score of the CAF group was significantly higher than that of the NPF group (P<0.001). Conclusion ·Compared with NPF, CAF could effectively improve post-surgical KGW and reduce AL, which could prevent periodontal soft tissue defects, and improve esthetic outcome after epulis excision.

Key words: epulis, periodontal soft tissue defect, normally positioned flap (NPF), coronally advanced flap (CAF)

中图分类号:

R781.4⁺5

孙文韬, 董家辰, 孙梦君, 廖悦, 宋忠臣. 2种龈瓣复位方式对牙龈瘤切除术后效果的影响[J]. 上海交通大学学报（医学版）, 2025, 45(5): 624-629.

SUN Wentao, DONG Jiachen, SUN Mengjun, LIAO Yue, SONG Zhongchen. Effects of 2 different flap techniques on clinical outcomes after epulis excision[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(5): 624-629.

图/表 6

图1 使用NPF技术缝合牙龈瘤切除术后的创口Note： A. Epulis between the right mandibular canine and first premolar. B. Excision of the epulis. C. The size of the epulis. D. The wound was sutured with NPF technique. E. Six months post-surgery. The dotted line marks the position of the muco-gingival junction.

Fig 1 Surgical site sutured using NPF technique after epulis excision

图2 使用CAF技术缝合牙龈瘤切除术后的创口Note： A. Epulis between the left maxillary central and lateral incisors. B. Excision of the epulis. C. The size of the epulis. D. The wound was sutured with CAF technique. E. Six months post-surgery. The dotted line marks the position of the muco-gingival junction.

Fig 2 Surgical site sutured using CAF technique after epulis excision

图3 临床指标的测量Note： A. The indicators at baseline. EW—the horizontal dimension of the epulis; EH—the vertical dimension of the epulis; KGW—the vertical distance from muco-gingival junction to the lower margin of the epulis. B. The indicators at 6 months post-surgery. PW—the horizontal dimension of the gingival papilla; PH—the vertical dimension of the gingival papilla; KGW—the vertical distance from muco-gingival junction to the base of the gingival papilla.

Fig 3 Measurement of clinical indicators

表1 患者基本信息

Tab 1 Patients′ essential information

Item	NPF group (n=32)	CAF group (n=23)	Total (n=55)
Gender/n (%)
Male	12 (37.5)	8 (34.8)	20 (36.4)
Female	20 (62.5)	15 (65.2)	35 (63.6)
Age/year	36.50±9.28	38.65±12.64	37.40±10.76

表2 基线时牙龈瘤的大小和术后6个月时龈乳头的大小

Tab 2 Epulis dimensions at baseline and the papilla dimensions at 6 months post-surgery

Item	NPF group (n=32)	CAF group (n=23)	P value
EW/mm	8.31±2.51	10.52±3.77	0.012
EH/mm	8.06±3.93	8.09±2.23	0.979
PW/mm	4.69±2.15	4.61±1.20	0.874
PH/mm	2.25±1.37	3.74±0.62	<0.001

表3 基线和术后6个月时的PD、AL、KGW和VAS

Tab 3 PD， Al， KGW， and VAS at baseline and 6 months post-surgery

Indicator	NPF group (n=32)	CAF group (n=23)	P value
PD/mm
Baseline	2.77±1.52	2.77±2.42	0.986
6 months post-surgery	1.73±0.64	1.68±0.79	0.365
P value	<0.001	<0.001
AL/mm
Baseline	1.86±1.49	1.23±1.18	<0.001
6 months post-surgery	2.27±1.56	1.26±1.18	<0.001
P value	<0.001	0.746
KGW/mm
Baseline	1.81±1.65	2.13±2.58	0.477
6 months post-surgery	2.94±1.74	4.83±1.07	<0.001
P value	0.010	<0.001
VAS	4.63±1.74	8.93±1.02	<0.001

参考文献 17

1	HOLMSTRUP P, PLEMONS J, MEYLE J. Non-plaque-induced gingival diseases[J]. J Periodontol, 2018, 89(Suppl 1): S28-S45.
2	NADERI N J, ESHGHYAR N, ESFEHANIAN H. Reactive lesions of the oral cavity: a retrospective study on 2 068 cases[J]. Dent Res J (Isfahan), 2012, 9(3): 251-255.
3	KUMAR S K S, RAM S, JORGENSEN M G, et al. Multicentric peripheral ossifying fibroma[J]. J Oral Sci, 2006, 48(4): 239-243.
4	LOMELI MARTINEZ S M, CARRILLO CONTRERAS N G, GÓMEZ SANDOVAL J R, et al. Oral pyogenic granuloma: a narrative review[J]. Int J Mol Sci, 2023, 24(23): 16885.
5	RATRE M S, CHAUDHARI P A, KHETARPAL S, et al. Effective management of focal reactive gingival overgrowths by diode laser: a review and report of two cases[J]. Laser Ther, 2019, 28(4): 291-297.
6	ANWAR S K, EDWARD S N, ELSAYED N M. Diode laser versus sclerotherapy: bloodless approaches in the treatment of oral pyogenic granuloma (randomised controlled clinical trial)[J]. Odontology, 2023, 111(2): 511-521.
7	XIE Y F, SHU R, QIAN J L, et al. Esthetic management of mucogingival defects after excision of epulis using laterally positioned flaps[J]. Cell Biochem Biophys, 2015, 71(2): 1005-1010.
8	BERNIMOULIN J P, LÜSCHER B, MÜHLEMANN H R. Coronally repositioned periodontal flap. Clinical evaluation after one year[J]. J Clin Periodontol, 1975, 2(1): 1-13.
9	RAETZKE P B. Covering localized areas of root exposure employing the “envelope” technique[J]. J Periodontol, 1985, 56(7): 397-402.
10	SABRI H, BAROOTCHI S, PADBURY A J, et al. Considerations for selecting root coverage techniques in the anterior mandible[J]. Int J Periodontics Restorative Dent, 2024, 44(2): 145-152.
11	ZHAO N, YESIBULATI Y, XIAYIZHATI P, et al. A large-cohort study of 2 971 cases of epulis: focusing on risk factors associated with recurrence[J]. BMC Oral Health, 2023, 23(1): 229.
12	CHRCANOVIC B R, GOMES C C, GOMEZ R S. Peripheral giant cell granuloma: an updated analysis of 2 824 cases reported in the literature[J]. J Oral Pathol Med, 2018, 47(5): 454-459.
13	刘明宏, 荆进, 韩晓虹. 牙龈瘤微创治疗2例[J]. 中华口腔医学杂志, 2022, 57(4): 415-417.
	LIU M H, JIN J, HAN X H. Minimally invasive treatment of epulis in 2 cases[J]. Chinese Journal of Stomatology, 2022, 57(4): 415-417.
14	石雪, 李新月. 牙龈瘤切除后不同术式治疗根面暴露的临床效果评价[J]. 中华口腔医学杂志, 2019, 54(1): 29-34.
	SHI X, LI X Y. Clinical evaluation and comparison of three surgical procedures for treatment of root surface exposure after epulis resection[J]. Chinese Journal of Stomatology, 2019, 54(1): 29-34.
15	ZUHR O, AKAKPO D L, HÜRZELER M. Wound closure and wound healing. Suture techniques in contemporary periodontal and implant surgery: interactions, requirements, and practical considerations[J]. Quintessence Int, 2017: 647-660.
16	ZUCCHELLI G, TAVELLI L, MCGUIRE M K, et al. Autogenous soft tissue grafting for periodontal and peri-implant plastic surgical reconstruction[J]. J Periodontol, 2020, 91(1): 9-16.
17	ZUCCHELLI G, DE SANCTIS M. Treatment of multiple recession-type defects in patients with esthetic demands[J]. J Periodontol, 2000, 71(9): 1506-1514.

2种龈瓣复位方式对牙龈瘤切除术后效果的影响

Effects of 2 different flap techniques on clinical outcomes after epulis excision

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 6

参考文献 17

相关文章 1

编辑推荐

Metrics