应用异体脱细胞真皮基质重建种植体周围附着牙龈的临床研究

Clinical study of using acellular dermal matrix in the reconstruction of gingiva around dental implants

目的：探讨及评估应用异体脱细胞真皮基质重建种植体周围附着软组织结构的临床效果及组织学特点。方法：从2005-06-2006-01在北京大学口腔医院种植中心接受种植治疗伴附着牙龈缺失的患者9例,接受了异体脱细胞真皮基质的游离移植（共26颗种植体区域）,其中男性3例,女性6例,年龄为26-69岁（平均43.5岁）。9例患者均已完成修复1年以上（23-30个月）。临床追踪异体脱细胞真皮基质愈合情况。HE染色和Verhoeff法VG染色观察移植的异体脱细胞真皮基质的组织学特点。结果：9例患者中除1例在术后10d时异体脱细胞真皮基质发生坏死脱落,其余8例均顺利成活。8例在移植术后1年复查见种植体周围均有至少2mm宽的附着牙龈。术后1年时移植的异体脱细胞真皮基质收缩率为62.7%（51%-80%）。组织学观察提示异体脱细胞真皮基质作为软组织支架真正参与了组织愈合。至最后1次复查,26颗种植体未观察到松动或脱落。结论：异体脱细胞真皮基质可有效地重建种植体周围附着软组织,近期效果满意,但移植后收缩率较高是其缺点。

Objective：To evaluate the application of acellular dermal matrix in gingival reconstruction around dental implants. Methods： From June 2005 to January 2006, 9 patients with inadequate keratinized gingiva underwent implants treatment and acellular dermal matrix were also applied in the area. Among them 3 were men and 6 were women. The age ranged from 26 to 69 years old （ mean 43.5 ）. 26 implants were placed and restored. All cases were followed up at least 12 months （23 -30 months）. Clinical examination was conducted. Hematoxylin-eosin staining and Verhoeff＇s-van Giesen staining were used for histological evaluation. Results： Immuno-rejection was not found except necrosis occurred in 1 case 10 days after operation. At least 2 mm keratinized gingiva was observed in 8 cases. matrix shrinkage was 62.7% （51% -80% ） 12 months postoperation. The acellular dermal matrix did take and incorporated into the gingiva based on the histological evaluation. During the last recheck, no implant loss was observed. Conclusion： The attached soft tissue was reconstructed by using the acellular dermal matrix, and the shortterm clinical result was predictable. The disadvantage was the high shrinkage of the acellular dermal graft.