[Vestibular incision subperiosteal tunnel access with connective tissue graft for the treatment of Miller classI and II gingival recession].

抄録

OBJECTIVE: To evaluate the clinical outcomes of vestibular incision subperiosteal tunnel access (VISTA) with connective tissue graft (CTG) in the treatment of Miller classes I and II localized gingival recession.

METHODS: Ten patients with 10 Miller classes I and II localized gingival recessions were enrolled in the study. All defects were equal to or above 2 mm in recession depth. All the patients received treatment with VISTA+CTG. Their clinical parameters, including recession depth (Rec), recession width (RW), keratinized tissue width (KT), clinical attachment loss (CAL), probing depth (PD) were recorded and compared before surgery and 6 months later. The mean root coverage (MRC) and complete root coverage (CRC) were calculated at the end of 6 months. A visual analogue scale (VAS) was used to estimate the patients' discomfort during the operation and during the 2 weeks post-operation. Patient-based aesthetic satisfaction 6 months after surgery was evaluated by a VAS.

RESULTS: The mean Rec was (2.65±0.82) mm at baseline, and (0.35±0.58) mm after 6 months. The VISTA+CTG treatment resulted in an improvement of (2.30±0.98) mm in recession depth (P<0.001). MRC was 86.67%±21.94% and CRC reached 70% at the end of 6 months. KT increased (0.90±1.22) mm (P<0.05). Aesthetic satisfaction on the patients' level was 8.30 based on VAS (0=unsatisfied, 10=extremely satisfied). The patients' discomfort during the operation and 2 weeks post operation were 2.40 and 4.30 (0=no pain, 10=extreme pain). Furthermore, clinical outcomes showed no statistically significant difference between the gingival biotypes, and between the teeth positioned in maxillary and in mandibular.

CONCLUSION: VISTA+CTG could be an effective treatment for Miller classes I and II localized gingival recession. Clinical outcomes indicated decrease in recession depth and width, and increase in width of keratinized tissue. Patients suffered little pain during the operation and 2 weeks post-operation of healing and accessed good aesthetic satisfaction. VISTA+CTG could be an option for the treatment of Miller classes I and II localized gingival recession.

目的: 拟评价经前庭沟切口的骨膜下隧道技术(vestibular incision subperiosteal tunnel access,VISTA)联合上皮下结缔组织移植术(connective tissue graft,CTG)治疗MillerⅠ、Ⅱ度单牙牙龈退缩的效果。

方法: 采用VISTA联合CTG技术治疗10颗单牙、退缩深度≥2 mm的MillerⅠ、Ⅱ度牙龈退缩,比较术前及术后6个月时的牙龈退缩深度、宽度、角化龈宽度、牙龈生物型、探诊深度和临床附着丧失水平,计算根面覆盖率,用视觉模拟评分法评价患者术中和术后2周内疼痛情况以及对术后6个月美观效果满意度。

结果: 牙龈退缩深度术前达(2.65±0.82) mm,术后6个月时减少了(2.30±0.98) mm(<0.001),平均根面覆盖率为86.67%±21.94%,完全根面覆盖率为70%;角化龈宽度增加了(0.90±1.22) mm(<0.05);患者对美观效果满意,评分为8.30分,患者术中及术后2周内疼痛感较轻,评分在2.40~4.30分。进一步分析发现牙龈退缩改善效果与患牙的牙龈生物型及上、下颌牙位分布无关。

结论: VISTA技术联合CTG可以有效地治疗单颗牙Miller Ⅰ、 Ⅱ 度牙龈退缩,增加角化龈宽度;患者的疼痛感较轻,患者对术后6个月时的美学效果较满意。该技术可作为临床上治疗单牙Miller Ⅰ、 Ⅱ 度牙龈退缩的方法之一。