游离龈移植时机对种植修复效果影响的对比研究

Comparative study on the effect of the timing of free gingival transplantation on the repair effect in implant repair

目的:通过前瞻性研究分析评价附着龈缺失的种植患者在埋入愈合、穿龈愈合取模前行游离龈移植术的临床效果。方法:选取18例下后牙种植区因角化龈不足而行游离龈移植术的患者。种植术后2月角化龈宽度≤2 mm的患者(A组,埋入愈合);种植术后2个月颊侧角化龈宽度≤0.1 mm的患者(B组,穿龈愈合)。比较游离龈移植术术后即刻,术后6周,戴牙当天和戴牙6个月颊侧角化龈垂直向宽度、宽度收缩率,及戴牙6个月种植体周围探诊深度(probing depth,PD)和牙龈探诊出血(bleeding on probing,BOP)。结果:18例经游离龈移植的患者,术区龈瓣均成活。A组术后即刻角化龈宽度为(8.1±0.5)mm,术后6周(6.5±0.2)mm,戴牙当天(3.5±0.2)mm,戴牙6个月后平均宽度降为(3.1±0.2)mm;B组术后即刻为(7.1±0.1)mm,术后6周(5.9±0.1)mm,戴牙当天(5.1±0.1)mm,戴牙6个月后降为(4.9±0.1)mm;A组术后6周收缩率为(19.8±2.4)%,与B组收缩率(16.3±0.8)%差异有统计学意义;戴牙6个月比戴牙当天游离龈瓣收缩(11.2±3.5)%,较B组游离龈瓣收缩率[(8.8±1.0)%]大,但无显著性差异。戴牙6个月后两组间PD及BOP差异无统计学意义。结论:角化龈移植可有效增加附着龈宽度,且较之埋入种植的游离龈移植,穿龈愈合的游离龈移植术能获得更宽的角化龈和更小的补偿性收缩,但手术时机视种植体稳定情况而异。此外,龈瓣收缩亦存在个体差异。

Objective:To evaluate the clinical effect of free gingival transplantation in patients with loss of attached gingiva before and after stage through a prospective study.Methods:Eighteen patients with keratogingival insufficiency in lower and posterior dental implant area were selected for free gingival transplantation.Patients with gingival keratosis≤2 mm at 2 months after primary implantation(group A,implantation healing).Patients with buccal keratinized gingiva≤0.1 mm at 2 months after simultaneous implantation(group B,gingival healing).The vertical width and width contraction rate of buccal keratinized gingiva,periimplant probing depth(PD)and bleeding on probing(BOP)were compared and statistically analyzed.Results:The gingival flap survived in 18 patients who underwent free gingival transplantation.The width of keratinized gingiva in group A was(8.1±0.5)mm immediately after operation,(6.5±0.2)mm 6 weeks after operation,(3.5±0.2)mm on the day of tooth wearing,and the average width decreased to(3.1±0.2)mm after 6 months of tooth wearing.In group B,it was(7.1±0.1)mm immediately after operation,(5.9±0.1)mm 6 weeks after operation,(5.1±0.1)mm on the day of tooth wearing,and decreased to(4.9±0.1)mm after 6 months of tooth wearing.The 6-week postoperative systolic rate in group A was(19.8±2.4)%,which had significant difference from that in group B,which was(16.3±0.8)%.The contraction rate of free gingival flap after 6 months of tooth wearing was(11.2±3.5)%,which had no significant difference from that in group B[(8.8±1.0)%].There was no significant difference in PD and BOP between the two groups after 6 months of tooth wearing.Conclusion:Keratinized gingival transplantation can effectively increase the width of the attached gingiva,and compared to free gingival transplantation with embedded healing,transplants with gingival healing can achieve wider keratinized gingiva and smaller compensatory contraction,but the operation time varies according to the stability of implant.In addition,there were individual differences in gingival flap contraction.