根向复位瓣治疗Ⅲ度根分叉病变的临床评价

Clinical evaluation of apically repositioned flap in the treatment of Class Ⅲ furcation involvements

目的:评价根向复位瓣治疗下颌第一磨牙Ⅲ度根分叉病变的近期临床疗效。方法:选择患有双侧下颌第一磨牙Ⅲ度根分叉病变的慢性牙周炎患者10例,经牙周基础治疗4周后对其中一侧的下颌第一磨牙进行根向复位瓣(ARF)手术治疗,对侧同名牙则继续行龈下刮治和根面平整(SRP)。测量术前和术后6个月各临床指标包括垂直探诊深度(VPD)、临床附着水平(CAL)、角化龈宽度(WKG)的变化,进行统计学分析。结果:术后6个月ARF组根分叉充分暴露,无探诊出血和根面龋,VPD为(2.25±0.54)mm,比术前减少(5.57±0.47)mm,与术前和对照组相比较,差异均有高度显著性(P<0.01);CAL增加(0.15±0.15)mm,与术前比较无显著性差异(P>0.05);WKG减少(0.32±0.11)mm,与对照组比较差异无显著性(P>0.05),但有平均(1.33±0.72)mm的附着龈形成。结论:根向复位瓣治疗下颌第一磨牙Ⅲ度根分叉病变的近期疗效满意。

Objective： To evaluate the clinical results of apically repositioned flap procedure in the treatment of class Ⅲ furcation involvement in mandibular first molars. Method： Twenty mandibular first molars with class Ⅲ furcation involvements from 10 systemically healthy patients with chronic periodontitis wer6 selected. Following 4-week periodontal initial therapy, in the experimental group, apically repositioned flap procedures were applied on the buccal aspects of furcation involvements, while internal bevel incisions were made on the lingual sides to expose the furcation regions. After thorough debridement and osseous recontouring, the elevated flaps were sutured in an apical position. In the control group, subgingival scaling and root planing were performed on the fureations. Clinical parameters including vertical probing depth （VPD）, clinical attachment level （CAL） and width of keratinized gingiva （WKG） were recorded at baseline and 6 months postoperatively. Result：At 6-month clinical examination,in ARF group, no BOP and root caries were observed, and the mean VPD was （2.25±0.54） mm. There was a statisticaly significant reduction of （5.57±0.47） mm and （4.08±0.67） mm, compared with at baseline and control group. （P 〈 0.01）. An increase of （0.15±0.15）mm in CAL was also observed in the experimental group, but there was no significant difference between at baseline and 6-month postoperatively. （P 〉 0.05）. Although WKG decreased in both groups, there was no significant difference between them. （P 〉 0.05）. Moreover, a new attached gingiva was formed in thee ARF group. The average height was （1.33±0.72）mm. Conclusion：These short-term results from the study showed the satisfactory effects of apically repositioned flap procedure in the treatment of degree Ⅲ furcation involvements in the mandibular first molars.