根面覆盖术之隧道技术的研究进展

Research progress on the tunnel technique for root coverage

牙龈退缩导致牙根敏感、根面龋、牙根暴露等问题,各类根面覆盖术是目前牙周病学研究的热点和难点之一,其中隧道技术因其微创、稳定、疗效好受到广大医师的青睐,但其存在局限性。本文拟从隧道技术的历史、疗效评价、局限性及技术改良等方面阐述隧道技术的研究进展,包括信封瓣技术演变为隧道技术的过程;隧道技术的疗效与冠向复位瓣联合结缔组织移植术之间的比较;结合本团队临床体会归纳了隧道技术的应用局限,如超过5 mm牙龈退缩,隧道技术的冠向复位程度可能无法完全覆盖结缔组织移植物,存在技术敏感性高等问题;讨论了隧道技术的手术入路,包括经前庭切口的隧道技术、W型瓣技术、针孔技术等;缝合固定包括水平褥式缝合、单个牙悬吊、连续多个牙的悬吊缝合等;隧道内移植物包括自体结缔组织、富含血小板血浆、同种异体移植物如脱细胞真皮基质、异种胶原膜等;根面处理方式包括机械法、化学法、生长因子等的处理;术后护理包括常规的消炎止痛,尤其是术区的保护;最后着重讨论了隧道技术与其他术式联合应用实现技术改良,包括隧道技术的冠向复位联合侧方关闭技术、隧道技术联合侧向转位瓣、隧道技术联合双乳头瓣、隧道技术联合系带修整等。微创、美观、长效及操作简单仍然是隧道技术研究的方向。

Gingival recessions(GRs)result in root hypersensitivity,root surface caries,and esthetic problems.Vari⁃ous root coverage surgeries are being developed for periodontal plastic therapy.The tunnel technique(TUN)is one of the most widely applied surgeries due to its features of being minimally invasive,practical,excellent outcomes and long⁃term stability;however,there are still some limitations of this technique.The history and evolution from the envelope flap to TUN,including its efficiency when compared with coronally advanced flaps with a connective tissue graft(CTG),are reviewed in this paper.The limitations of TUN are discussed in consideration of our clinical experience;for exam⁃ple,there is high technique sensitivity when TUN is applied in GR>5 mm because of the great difficulty in covering the grafts.The advantages of surgical access,including vertical incisions in the vestibule,“W”type and pinhole access,are discussed for different situations.Mattress sutures and sling sutures in a single tooth or multiple teeth are applied in TUN.The different types of grafts,such as CTG,platelet⁃rich plasma,articular dermal matrix and xenogeneic collagen matrix,are described.Mechanical,chemical and biological conditioning of the root surface are recommended during sur⁃gery.Protecting the surgical area and taking antibiotics postoperatively are also very important.Finally,the modifica⁃tions when TUN is applied with other kinds of techniques are discussed,including lateral closed TUN,laterally posi⁃tioned flaps,double papilla flaps and frenuloplasty.Minimally invasive,esthetic,long⁃term stability and simplified tech⁃niques are the development trends of TUN in the future.