中国实用口腔科杂志

中国实用口腔科杂志 ›› 2023, Vol. 16 ›› Issue (3): 296-301.DOI: 10.19538/j.kq.2023.03.008

• 牙周成形手术改善前牙美学缺陷专栏 • 上一篇    下一篇

经前庭沟切口的骨膜下隧道技术联合上皮下结缔组织移植术治疗缺牙间隙两侧邻牙Miller Ⅲ度牙龈退缩临床效果观察（附1例5年随访报告）

杨    刚，阳    婷，钟金晟，胡文杰   

  1. 北京大学口腔医学院·口腔医院牙周科；国家口腔医学中心；国家口腔疾病临床医学研究中心；口腔数字化医疗技术和材料国家工程实验室；国家卫生健康委员会口腔医学计算机应用工程技术研究中心，北京  100081
  • 出版日期:2023-05-30 发布日期:2023-07-03
  • 基金资助:
    国家科技基础资源调查专项（2018FY101003）；北京市卫健委住培质量提升探索及推广项目（住培-2022jy01203）；北京大学口腔医学院教改项目（2021-PT-04 ）

  • Online:2023-05-30 Published:2023-07-03

摘要： 牙龈退缩是牙周炎常见的伴发病变，可导致根面暴露影响美观，还会导致牙齿敏感、根面龋及牙体缺损等问题，影响患者的生活质量。膜龈手术是治疗牙龈退缩的有效方法。牙龈冠向复位瓣（coronally advanced flap，CAF）结合上皮下结缔组织移植术（subepithelial connective tissue graft，SCTG）可较好地覆盖裸露根面，改善牙龈退缩，是临床公认的“金标准”治疗手段。近年来，经前庭沟切口的骨膜下隧道技术（vestibular incision subperiosteal tunnel access，VISTA）逐渐受到医生与学者的关注，其与SCTG联合应用，不仅可实现微创有效地覆盖根面，还能增加软组织厚度及角化龈宽度，并减少术区范围及术后疼痛等并发症的发生。文章展示了1例下前牙区缺牙间隙两侧邻牙Miller Ⅲ度牙龈退缩的临床处置过程，详细介绍了VISTA联合SCTG的膜龈术式对裸露根面进行覆盖的技术要点及术后追踪随访5年的临床效果。

关键词: 经前庭沟切口的骨膜下隧道技术, 上皮下结缔组织移植术, 牙龈退缩, 根面覆盖

Abstract: Gingival recession is a common complication of periodontal disease，resulting in the exposure of root surfaces leading to tooth hypersensitivity and esthetic deficiencies，which impairs patients′oral health-related quality of life. Mucogingival surgery is an effective method for the treatment of gingival recession. It is well recognized that the subepithelial connective tissue graft（SCTG）combined with coronally advanced flap（CAF）are effective root coverage procedures，which are considered as the＇ gold standard＇ technique. In recent years，the combination of vestibular incision subperiosteal tunnel access（VISTA）and SCTG has been used，which can achieve satisfactory outcomes of root coverage，increase the soft tissue thickness and keratinized gingiva width，and decrease the incidence of post-surgical morbidities. This paper presents a case of Miller class Ⅲ gingival recession of the teeth near edentulous space in the lower anterior region，treated with the combination of VISTA with SCTG，the technical main points of which in covering the exposed root surface are introduced in detail，and the 5-year clinical results are followed up.

Key words: vestibular incision subperiosteal tunnel access, VISTA, subepithelial connective tissue graft, SCTG, gingival recession, root coverage