传统隧道技术与改良隧道技术治疗上前牙牙龈退缩临床疗效

Traditional and modified tunnel technique for the treatment of maxillary anterior teeth gingival recession

目的比较传统隧道技术(tunnel technique,TUN)与经前庭沟切口的骨膜下改良隧道技术(vestibu⁃lar incisionsubperiostealtunnelaccess,VISTA)联合上皮下结缔组织瓣(connective tissuegraft,CTG)移植进行根面覆盖治疗上前牙牙龈退缩的临床效果,为临床上治疗牙龈退缩提供参考。方法对1例13⁃14,22⁃23 Mill⁃er I类牙龈退缩患者采用自身左右对照的方法,22、23行TUN联合CTG移植,13、14行VISTA联合CTG移植治疗牙龈退缩。术后进行测量牙龈退缩高度(gingival recessionheight,GRH)、牙龈退缩宽度(gingival recession width,GRW)、角化龈宽度(keratinized gingivalwidth,KW),且进行根面覆盖美学评分(root coverageesthetic score,RES)与视觉模拟评分(visual analoguescale,VAS)。结果术后13、14、22、23取得完全的根面覆盖效果,两种术式的术后效果均稳定,GRH、GRW降低,KW增加;根面RES评分均为10分;术后VISTA+CTG患者VAS为6,较TUN+CTG的VAS高。结论TUN+CTG和VISTA+CTG术式均可以有效地治疗牙龈退缩,美学效果较好,患者满意,VISTA增加附加切口使临床操作更为简便,但舒适感较差。

Objective To compare the clinical effect of the tunnel technique(TUN)and vestibular incision subperi⁃osteal tunnel access(VISTA)combining connective tissue grafts(CTGs)on recovering the exposed root surface in a case of gingival recession over the upper anterior teeth and then to provide clinical evidence for gingival recession treatment.Methods A case of gingival recession(Miller I type)over teeth 13⁃14 and 22⁃23 was treated using different tech⁃niques bilaterally.22⁃23 were treated by a TUN combined CTG transplantation,while teeth 13⁃14 were treated by a VISTA technique combined with CTG transplantation.The gingival retraction height(GRH),gingival retraction width(GRW),keratinized gingival width(KW),root coverage aesthetic score(RES)and visual analog scale(VAS)were mea⁃sured after operation.Results The effect of post⁃operation were ideal and complete ginglval recovering were achieved,the postoperative effects of the two methods were stable,GRH and GRW decreased,and KW increased.RES was 10.The VAS score of VISTA combined with CTG transplantation was 6,which was higher than that of TUN+CTG.Conclu⁃sion Gingival recession can be treated by TUN+CTG or VISTA+CTG with ideal prognosis.VISTA with an additional incision facilitates the operative procedure but leads to less comfort.