切口设计及修复情况对上前牙美学区显微根尖手术术后牙龈退缩影响的回顾性研究

Retrospective study of the effect of incision design and restoration on gingival recession after endodontic microsurgery in anterior maxillary esthetic zone

目的:研究切口类型及修复体对上前牙美学区显微根管外科手术(endodontic microsurgery,EMS)后牙龈退缩的影响。方法:纳入53例上前牙美学区需行EMS患者,术后随访1年以上,分析性别、切口类型(沟内切口;龈乳头基部切口)、修复体情况(无修复体;有修复体)对上前牙美学区根尖手术后牙龈退缩的影响。结果:按纳入标准,共采集53例患牙临床冠及78例龈乳头数据,统计分析表明,术前及术后1年患牙临床冠高度(H1)、龈乳头高度(H2)及切缘龈乳头距离(H3)存在统计学差异(P <0.05)。性别和切口类型对术后牙龈退缩无显著影响。按修复体有无进行分析,临床冠高度变化(ΔH1)及切缘龈乳头距离变化(ΔH3)均有统计学意义(P <0.05)。结论:上前牙美学区患牙显微根尖手术术后存在一定程度牙龈退缩,修复体的存在会使牙龈退缩加重,影响前牙区美学效果。

Objective:To evaluate the effect of incision design and restorations on gingival recession after endodontic microsurgery(EMS)in anterior maxillary esthetic zone.Methods:Data from 53 EMS cases in the anterior esthetic zone(with a follow-up period of at least 1 year)were collected.The effects of gender,incision type(intrasulcular incision,ISI;papilla based incision,PBI),and the restorations status(no restoration,NR;crown margin,CM)on gingival recession in the anterior esthetic zone after EMS were analyzed.Results:According to the inclusion criteria,data of 53 clinical crowns and 78 gingival papillae were collected.There were statistical differences in the clinical crown height(H1),gingival nipple height(H2)and cut-margin gingival papilla distance(H3)before and 1 year after EMS(P<0.05).Gender and incision type had no significant effect on postoperative gingival recession.According to whether the restoration has contrast,the change of clinical crown height(ΔH1)and the change of cut-margin gingival papilla distance(ΔH3)had statistically significant difference(P<0.05).Conclusion:There is a certain degree of gingival retraction after EMS in anterior maxillary esthetic zone.The presence of restoration exacerbates gingival retraction,affecting the esthetic effect of anterior teeth.It is clinically significant to fully communicate with patients before surgery.