游离角化龈移植在下颌后牙单颗及连续种植区的应用
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摘要
目的比较游离角化龈移植在增加下颌后牙单颗及连续缺失区种植体颊侧附着龈宽度的作用效果。方法 20例下颌后牙角化龈不足患者,分单颗牙缺失(第1组)及多颗牙缺失(第2组)两组,一期种植术后2个月行游离瓣移植术,术后2个月行二期种植术,戴牙当天和6个月后测量颊侧角化龈宽度、宽度收缩率、种植体周围探诊深度(PD)和牙龈出血(BOP)情况,并进行比较和统计学分析。结果戴牙当天单颗牙游离龈移植患者颊侧角化龈宽度和为(3.2±0.1)mm,6个月后平均宽度降为(3.1±0.1)mm,多颗牙游离龈移植患者戴牙当天颊侧角化龈宽度为(2.9±0.1)mm,6个月后平均宽度降为(2.5±0.1)mm;单颗牙角化龈移植收缩率(4.2±0.7)%,较多颗牙颊侧角化龈收缩率(13.6±2.4)%小,差异有统计学意义(P<0.05)。6个月后两组间探诊深度及探诊出血指数差异无统计学意义。结论单颗牙或多颗牙缺失种植术后行颊侧角化龈移植术,均能获得健康的种植体周围探诊深度和牙龈出血指数,是有效的软组织增量方法。然而较之多颗牙缺失区的角化龈移植术,单颗牙缺失角化龈移植术能获得更宽的角化龈宽度和更小的宽度收缩率。
Objective To compare the effect of free gingival grafting on increasing the width of the buccal keratinized gingiva at posterior mandibular single tooth loss sites and continuous teeth loss sites. Methods Twenty patients with inadequate buccal keratinized gingiva were subjected to gingiva grafting surgery two months after bone level implant placement. Two months after the soft tissue surgery, healing abutments were placed and crowns were connected to the abutment. The widths of the buccal keratinized gingiva around the implant were measured on the day of cementing the definite restorations as baseline, and 6-month later as follow-up. The probing depth(PD) and bleeding index of probing(BOP) were recorded at follow-up. Gingival grafting outcome on single implant were compared to that on several implants. Results The buccal keratinized gingiva width was(3.2±0.1)mm in the single implant group, and(2.9±0.1)mm in several-implant group; 6 months later the widths were reduced to(3.1±0.1)mm and(2.5±0.1)mm, respectively. The buccal keratinized gingival width shrinkage around the single implant group(4.2±0.7)% was significantly lower than several-implant group [(13.6±2.4)%, P<0.05]. PD and BOP were similar in both groups. Conclusion Sufficient increased keratinized gingiva widths, together with reduced keratinized gingival width shrinkage have been found around single tooth implant placement site. Though less keratinized gingival width and more keratinized gingival width shrinkage have been found in continuous implant placement sites, PD and BOP are comparable to single implant placement site. Free gingival grafting has been proven to be a successful technique for maintaining peri-implant health in the long term.
Objective To compare the effect of free gingival grafting on increasing the width of the buccal keratinized gingiva at posterior mandibular single tooth loss sites and continuous teeth loss sites. Methods Twenty patients with inadequate buccal keratinized gingiva were subjected to gingiva grafting surgery two months after bone level implant placement. Two months after the soft tissue surgery, healing abutments were placed and crowns were connected to the abutment. The widths of the buccal keratinized gingiva around the implant were measured on the day of cementing the definite restorations as baseline, and 6-month later as follow-up. The probing depth(PD) and bleeding index of probing(BOP) were recorded at follow-up. Gingival grafting outcome on single implant were compared to that on several implants. Results The buccal keratinized gingiva width was(3.2±0.1)mm in the single implant group, and(2.9±0.1)mm in several-implant group; 6 months later the widths were reduced to(3.1±0.1)mm and(2.5±0.1)mm, respectively. The buccal keratinized gingival width shrinkage around the single implant group(4.2±0.7)% was significantly lower than several-implant group [(13.6±2.4)%, P<0.05]. PD and BOP were similar in both groups. Conclusion Sufficient increased keratinized gingiva widths, together with reduced keratinized gingival width shrinkage have been found around single tooth implant placement site. Though less keratinized gingival width and more keratinized gingival width shrinkage have been found in continuous implant placement sites, PD and BOP are comparable to single implant placement site. Free gingival grafting has been proven to be a successful technique for maintaining peri-implant health in the long term.
引文
[1] Bassetti RG, St?hli A, Bassetti MA, et al. Soft tissue augmentation procedures at second-stage surgery: a systematic review[J]. Clin Oral Investig,2016,20(7):1369-1387.
[2] Berglundh T, Lindhe J.Dimension of the periimplant mucosa. Biological width revisited[J]. J Clin Periodontol, 1996, 23(10):971-973.
[3] Ladwein C, Schmelzeisen R, Nelson K, et al. Is the presence of keratinized mucosa associated with periimplant tissue health? A clinical cross-sectional analysis[J]. Int J Implant Dent,2015, 1(1):11.
[4] Schmitt CM, Tudor C, Kiener K, et al. Vestibuloplasty: porcine collagen matrix versus free gingival graft: a clinical and histologic study[J]. J Periodontol,2013, 84(7):914-923.
[5] Stimmelmayr M, Stangl M, Edelhoff D, et al. Clinicalprospective study of a modified technique to extend thekeratinized gingiva around implants in combination with ridgeaugmentation: one-year results[J]. Int J Oral Maxillofac Implants,2011, 26(5):1094-1101.
[6] Chiu YW, Lee SY, Lin YC, et al.Significance of the width of keratinized mucosa on peri-implant health[J]. J Chin Med Assoc, 2015, 78(7):389-394.
[7] Marin DOM, Leite ARP, Nícoli LG,et al. Free Gingival Graft to Increase Keratinized Mucosa after Placing of Mandibular Fixed Implant-Supported Prosthesis[J]. Case Rep Dent,2017, 2017:5796768.
[8] Schmitt CM, Moest T, Lutz R, et al. Long-term outcomes after vestibuloplasty with a porcine collagen matrix (Mucograft?) versus the free gingival graft: a comparative prospective clinical trial[J]. Clin Oral Implants Res,2016, 27(11):e125-e133.
[9] Hassani A, Sadrimanesh R, Vahdati SA,et al. Free gingival graft immobilization: a pilot study on a newly designed stent[J].J Oral Implantol,2010, 36(2):123-130.
[10] Thoma DS, Buranawat B, H?mmerle CH, et al. Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review[J].J Clin Periodontol,2014, Suppl 15:S77-S91.
[11] Roccuzzo M, Grasso G, Dalmasso P. Keratinized mucosa around implants in partially edentulous posterior mandible: 10-year results of a prospective comparative study[J]. Clin Oral Implants Res, 2016, 27(4):491-496.
[12] Poskevicius L, Sidlauskas A, Galindo-Moreno P, et al. Dimensional soft tissue changes following soft tissue grafting in conjunction with implant placement or around present dental implants: a systematic review[J]. Clin Oral Implants Res,2017, 28(1):1-8.
[13] Fickl S, Kauffmann F, Stappert CF, et al. Scar tissue formation following alveolar ridge preservation: A case control study[J]. Int J Periodontics Restorative Dent, 2018, 38(1):e1-e7.
[14] Gümü? P, Buduneli E. Graft stabilization with cyanoacrylate decreases shrinkage of free gingival grafts[J]. Aust Dent J, 2014, 59(1):57-64.
[2] Berglundh T, Lindhe J.Dimension of the periimplant mucosa. Biological width revisited[J]. J Clin Periodontol, 1996, 23(10):971-973.
[3] Ladwein C, Schmelzeisen R, Nelson K, et al. Is the presence of keratinized mucosa associated with periimplant tissue health? A clinical cross-sectional analysis[J]. Int J Implant Dent,2015, 1(1):11.
[4] Schmitt CM, Tudor C, Kiener K, et al. Vestibuloplasty: porcine collagen matrix versus free gingival graft: a clinical and histologic study[J]. J Periodontol,2013, 84(7):914-923.
[5] Stimmelmayr M, Stangl M, Edelhoff D, et al. Clinicalprospective study of a modified technique to extend thekeratinized gingiva around implants in combination with ridgeaugmentation: one-year results[J]. Int J Oral Maxillofac Implants,2011, 26(5):1094-1101.
[6] Chiu YW, Lee SY, Lin YC, et al.Significance of the width of keratinized mucosa on peri-implant health[J]. J Chin Med Assoc, 2015, 78(7):389-394.
[7] Marin DOM, Leite ARP, Nícoli LG,et al. Free Gingival Graft to Increase Keratinized Mucosa after Placing of Mandibular Fixed Implant-Supported Prosthesis[J]. Case Rep Dent,2017, 2017:5796768.
[8] Schmitt CM, Moest T, Lutz R, et al. Long-term outcomes after vestibuloplasty with a porcine collagen matrix (Mucograft?) versus the free gingival graft: a comparative prospective clinical trial[J]. Clin Oral Implants Res,2016, 27(11):e125-e133.
[9] Hassani A, Sadrimanesh R, Vahdati SA,et al. Free gingival graft immobilization: a pilot study on a newly designed stent[J].J Oral Implantol,2010, 36(2):123-130.
[10] Thoma DS, Buranawat B, H?mmerle CH, et al. Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review[J].J Clin Periodontol,2014, Suppl 15:S77-S91.
[11] Roccuzzo M, Grasso G, Dalmasso P. Keratinized mucosa around implants in partially edentulous posterior mandible: 10-year results of a prospective comparative study[J]. Clin Oral Implants Res, 2016, 27(4):491-496.
[12] Poskevicius L, Sidlauskas A, Galindo-Moreno P, et al. Dimensional soft tissue changes following soft tissue grafting in conjunction with implant placement or around present dental implants: a systematic review[J]. Clin Oral Implants Res,2017, 28(1):1-8.
[13] Fickl S, Kauffmann F, Stappert CF, et al. Scar tissue formation following alveolar ridge preservation: A case control study[J]. Int J Periodontics Restorative Dent, 2018, 38(1):e1-e7.
[14] Gümü? P, Buduneli E. Graft stabilization with cyanoacrylate decreases shrinkage of free gingival grafts[J]. Aust Dent J, 2014, 59(1):57-64.