冠向复位瓣联合结缔组织瓣治疗下前牙牙龈退缩

Coronally advanced flap combined with connective tissue grafts for the treatment of mandibular anterior teeth gingival recession

目的比较冠向复位瓣技术联合结缔组织瓣移植技术与膜引导组织再生技术进行根面覆盖治疗下前牙牙龈退缩的临床效果。方法对1例33～43 MillerⅢ类牙龈退缩伴右下牙敏感的患者采用自身左右对照的方法,42、43行冠向复位瓣技术联合结缔组织瓣移植、33～41行冠向复位瓣技术联合可吸收胶原蛋白膜引导组织再生术治疗牙龈退缩。结果术后3.5个月,42、43取得较理想的根面覆盖效果,敏感症状消失;33～41牙龈根面覆盖与术前相比没有发生明显变化;术后12个月,42、43根面覆盖效果稳定。结论利用冠向复位瓣技术联合结缔组织瓣治疗牙龈退缩是一种安全可行的手术方法,可以获得较好的根面覆盖;采用膜引导组织再生技术治疗邻面附着丧失的多牙MillerⅢ类牙龈退缩效果欠佳。

Objective To compare the effect of the combined coronally advanced flap and connective tissue flap techniques with that of a guided tissue regeneration （GTR） technique on recovering the exposed root surface in a ease of gingival retraction over the lower anterior teeth. Methods A ease of gingival recession （Miller Ⅲ type） over teeth 33-43 accompanied by hypersensitivity of the right lower teeth ,was treated using different techniques bilaterally. Teeth 42-43 were treated by a combined coronally advanced flap and connective tissue flap technique, while teeth 33-41 ,were treated by a GTR technique of a coronally advanced flap combined with an absorbable collagen membrane. Results Teeth 42-43 exhibited ideal gingival recovering of the exposed root surface, with the disappearance of the hypersensitivi-ty symptoms, during the follow-up visits at 3.5 months after surgery. However, the exposed root surface of teeth 33-41 exhibited no significant change in coverage at the same time points compared with the preoperative coverage. At 12 months after surgery, the recovered gingiva on the root surface of teeth 42-43 ,was stable. Conclusion The combined coronally advanced flap and connective tissue flap approach, which can achieve better coverage of the exposed root sur- face than the GTR technique, is a feasible and safe surgical method for treating cases with gingival recession. The GTR technique is not an effective method for treating cases with Miller Ⅲ type gingival recession over multiple teeth due to proximal attachment loss.