排龈技术的应用方案及热点聚焦

Gingival retraction:application profiles and hot spotlights

背景:种植义齿的周围组织与正常牙齿的牙周组织存在很大不同,所以对于排龈时机械化学刺激的反应必定也是不同的。目的:文章就各种排龈方法的临床效果、应用现状及在种植体周围排龈的研究前景做一综述,以帮助临床医师较好地选择排龈技术。方法:以中文检索词"排龈;排龈时间;排龈效果""种植体周围组织;粘接;临时冠;楔状缺损;激光"检索并进行匹配检索2007至2019年CNKI、万方数据库、VIP数据库;并以英文检索词"gingival retraction;gingival;implant;temporary crown"检索PubMed数据库相关文献。通过阅读文献题目、摘要及全文筛选,最后纳入60篇文献进行综述。结果与结论:①排龈技术是使牙龈组织回缩,发生水平、垂直向移位,使游离龈缘与牙面分离的一种技术,要求至少有0.2 mm的龈沟宽度,以创造一个清洁、干燥、视野清晰的工作环境,以便于预备肩台、制取印模、修补楔状缺损,提高修复体的边缘适合性及修复效果,减少并发症;②排龈过程本身就是对牙周组织的一种刺激,会对牙周组织造成一定程度的损伤,该损伤不会恢复至排龈前水平,会造成轻微的牙龈永久性退缩;③临床医师可根据牙龈的永久性退缩量来指导修复基牙肩台的位置,以防冠边缘暴露影响美观;④影响排龈效果的因素有很多,口腔医师需要针对患者的口腔及全身状况,结合排龈方法的优缺点为患者选择适合个体的排龈方法,以最大程度地减小对牙周组织的损伤;⑤目前排龈方法有很多,都能达到需要的龈沟宽度。

BACKGROUND:The peri-implant tissue is very different from the periodontal tissue of natural teeth,so the response to the mechanical and chemical stimulation during gingival retraction must be different.OBJECTIVE:To review the clinical effects and application status of all kinds of gingival retraction systems,and describe the study prospect of gingival retraction around implants,attempting to help clinicians choose a better gingival retraction method.METHODS:Based on Chinese search terms“gingival retraction;gingival retraction time;gingival displacement effect”and“peri-implant tissue;adhesive;temporary crown;wedge-shaped defect;laser,”the authors searched and matched relevant documents in CNKI,WanFang database,VIP database from 2007 to 2019.And with the English search terms“gingival retraction;gingival;implant;temporary crown,”the authors searched for relevant literature in PubMed database.After reading title,abstract and full-text selection of literature,60 articles were finally included for review.RESULTS AND CONCLUSION:Gingivlal retraction is a kind of technique that makes gingival tissue retract and produces both horizontal and vertical displacement,which separates free gingival margin from tooth surface.It has a requirement of at least 0.2 mm gingival sulcus width in order to create a clean,dry and clear-view working environment.It is convenient for clinicians to prepare the shoulder,make impression and repair wedge-shaped defect.The clinicians can also improve the edge suitability of restoration and restoration effect,reducing the complications.The gingival retraction process itself is a sort of stimulation to periodontal tissue and it causes a certain degree of damage to periodontal tissue.The damage will not recover to the pre-gingival level and cause slight permanent gingival recession.According to the amount of permanent gingival recession,clinicians can determine the position of abutment shoulder to prevent the exposure of crown edge from affecting the aesthetics.There are many factors that affect the effect of gingival retraction,the dentist needs to select the suitable gingival retraction method for the patient according to the patient’s oral and systemic conditions and in combination with the advantages and disadvantages of gingival retraction methods,in order to minimize the damage to the periodontal tissue.At present,there are many methods of gingival retraction,which can reach the required gingival sulcus width.