角化龈形成机制及增量移植材料的研究进展

Research progress in formation mechanism of keratinized gingiva and incremental transplant material

角化龈对于维持牙周组织健康有重要意义,但其具体形成机制目前尚不十分明确。口腔上皮细胞的分化由基因决定,同时上皮下结缔组织和牙周膜也会影响上皮的类型,其中上皮下结缔组织中的弹性纤维对于维持上皮的表型起重要间接作用。由于形成机制不明,目前角化龈增量的主要治疗方法是膜龈手术,使用的移植材料包括自体组织(游离龈移植物、上皮下结缔组织移植物和自体血小板浓缩物等)、异体材料(脱细胞真皮基质、异种胶原基质和羊膜等)以及两者结合而成的组织工程制品(以层状壳聚糖或纳米纤维水凝胶复合材料为支架的组织工程制品)。现从牙龈角化过程、角化决定因素和现有的移植材料进行综述,总结目前在牙龈角化机制及角化龈增量材料方面的研究进展,为进一步的机制研究及新型材料的开发提供依据。

Keratinized gingiva plays an important role in maintaining the health of the periodontal tissue,however,the specific mechanism of its formation is not fully understood.The differentiation of oral epithelial cells is determined by genetics,but the type of epithelium is also influenced by the underlying connective tissue and periodontal ligament,and the elastic fibers in the connective tissue has an important indirect effect on maintaining the epithelial phenotype.Due to the unclear formation mechanism,the primary treatment method for augmenting keratinized gingiva is currently mucogingival surgery,and the employing graft materials included autogenous tissues(free gingival grafts,subepithelial connective tissue grafts,and autologous platelet concentrates,etc),allogeneic materials(acellular dermal matrix,xenogeneic collagen matrix,and amniotic membrane,etc.)and the combination of these in the form of tissue-engineered products(using layered chitosan or nanofiber hydrogel composite materials as scaffolds).This review covers the keratinization process of the gingiva,the factors determining keratinization,and the existing graft materials,summarizes the current research advancements in gingival keratinization mechanism and materials for gingival augmentation,and provides the basis for the further mechanism research and the development of new materials.