非う蝕性歯頸部欠損を有する上顎隣在歯の歯肉退縮に対するトンネルテクニックの有効性

[Efficacy of tunnel technique for treatment of gingival recession of upper adjacent teeth with noncarious cervical defect].

抄録

目的:

非う蝕性歯頸部病変（NCCL）を併発した隣接歯の歯肉退縮（GR）に対するトンネルテクニック（TUN）の有効性を評価すること。

OBJECTIVE: To evaluate the efficacy of tunnel technique (TUN) in treatment of teeth with adjacent gingival regression (GR) combined with noncarious cervical lesions (NCCL).

方法:

NCCLを合併したGRに対してTUN術を施行した21例（79歯）のデータを収集した。GRの深さ（GRD）とNCCLの病変深さ（LD）により，GRD≦3 mm，LD≦1 mmの第1群，GRD≦3 mm，LD＞1 mmの第2群，GRD＞3 mm，LD≦1 mmの第3群，GRD＞3 mm，LD＞1 mmの第4群に分類され，GRDとLDの平均根面被覆率（MRC）は3.5％，LDは1.5％，GRD≦3 mm，LD＜1 mmの第4群とした．TUN術後の平均歯根被覆率（MRC），完全歯根被覆率（CRC），角化歯肉幅，角化歯肉厚を4群間で比較検討した．

METHODS: We collected data from 21 patients (79 teeth) undergoing TUN surgery for GR combined with NCCL. According to GR depth (GRD) and lesion depth (LD) of NCCL, the teeth were divided into group 1 with GRD≤3 mm and LD≤1 mm; group 2 with GRD≤3 mm and LD>1mm; group 3 with GRD>3 mm and LD≤1 mm; and group 4 with GRD>3 mm and LD>1 mm. The mean root coverage (MRC) rate, complete root coverage (CRC) rate, keratinized gingival width, and keratinized gingival thickness were compared among the 4 groups after TUN surgery.

結果:

角化歯肉幅と厚さは，4群とも術後に有意に改善された．GRDが3mm以下の場合，MRCは1群と2群で有意差はなかった（8.55％ 95.45％＞0.05）; GRDが3mm以上の場合，3群と4群でMRC，CRCともに減少し，特に4群ではCRC率（25％）が他の3群に比べ有意に低かった（＜ 0.01 ）．

RESULTS: The keratinized gingival width and thickness were significantly improved after the surgery in the 4 groups. When the GRD was below 3 mm, the MRC was not significantly different between group 1 and group 2 (8.55% 95.45%, >0.05); When the GRD was beyond 3 mm, the MRC and CRC rates were both decreased in group 3 and group 4, especially in group 4, where the CRC rate (25%) was significantly lower than those in the other 3 groups ( < 0.01).

結論:

GRにNCCLを合併した患者において、TUN手術は明らかに角化歯肉の幅と厚さを改善することができる。GRDはLDよりも根管治療成績に大きな影響を与えることから，TUN術前にNCCLを修復する必要はない可能性が示唆された．TUN手術の臨床的有効性を評価する際には，GRDとLDの両方を考慮する必要がある．

CONCLUSION: In patients with GR combined with NCCL, TUN surgery can obviously improve keratinized gingival width and thickness. GRD has a greater effect on the outcome of root coverage than LD, suggesting that NCCL restoration before TUN surgery may not be necessary. Both GRD and LD should be considered in the evaluation of the clinical efficacy of TUN surgery.