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牙龈退缩(gingival recession, GR)是指牙龈冠方最顶端的边缘位于釉牙骨质界的根方,而正常的牙龈边缘应位于釉牙骨质界的冠方。可能的原因有刷牙方式不正确,牙周疾病,以及牙齿位置异常、牙槽骨开裂、咬合创伤、医源性因素等[1-2]。发生于前牙区域的GR会导致牙冠变长、黑三角等美学缺陷,以及牙齿敏感、根面龋坏甚至牙齿丧失等功能缺陷[1-2],因此,大量的病人要求美学纠正来满足他们的美学需求以及功能要求。
目前根面覆盖的手术方法较多,如游离龈移植术(FGG)[3]、冠向复位瓣(CAF)[4]、结缔组织移植术(CTG)[5]、引导组织再生术(GTR)[6]和富血小板纤维蛋白(PRF)[7]等。CAF是GR中最常用的手术方式,手术过程是将软组织冠向迁移至暴露的牙根表面,目前为止是治疗Miller Ⅰ、ⅡGR较为有效的手术方式,也是根面覆盖中有效的膜龈手术[8]。PRF是第二代血小板浓缩物,是一种源于自身的白细胞和血小板聚集的纤维蛋白生物材料,是由CHOUKRON等[9]首先提出的,PRF基质合并有血小板、白细胞、生长因子和循环干细胞,且具有特殊的3D纤维聚合网结构,这种纤维蛋白网可以使细胞更有效地迁移和增殖,保护生长因子不被蛋白水解,从而延长生长因子的释放,延长作用时间,促进组织愈合[10-11]。本文将PRF结合CAF应用于GR中进行临床研究,现作报道。
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2组间术前PD、KTH、VGR、GT差异均无统计学意义(P>0.05);术后3个月,观察组VGR低于对照组,GT高于对照组,差异有统计学意义(P < 0.05和P < 0.01);术后6个月,观察组GT高于对照组,差异有统计学意义(P < 0.05)。术后3、6个月,观察组与对照组的VGR、GT与术前相比,差异均有统计学意义(P < 0.01);PD、KTH术前术后相比差异无统计学意义(P>0.05)(见表 1)。
分组 n 术前 术后3个月 术后6个月 PD 观察组 25 1.43±0.35 1.30±0.27 1.35±0.26 对照组 24 1.39±0.28 1.35±0.29 1.32±0.28 t — 0.43 0.66 0.32 P — >0.05 >0.05 >0.05 VGR 观察组 25 4.01±0.54 0.33±0.21** 0.40±0.19** 对照组 24 4.05±0.47 0.47±0.25** 0.51±0.25** t — 0.24 2.02 1.66 P — >0.05 < 0.05 >0.05 KTH 观察组 25 3.21±0.64 3.48±0.71 3.48±0.59 对照组 24 3.27±0.56 3.49±0.63 3.50±0.69 t — 0.36 0.02 0.15 P — >0.05 >0.05 >0.05 GT 观察组 25 0.94±0.20 1.56±0.42** 1.65±0.46** 对照组 24 0.85±0.19 1.18±0.46** 1.28±0.52** t — 1.54 3.02 2.60 P — >0.05 < 0.01 < 0.05 组内比较:与术前比较**P < 0.01 表 1 2组PD、VGR、KTH、GT的比较(x ±s)
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病人满意度中,2组间术前PCS、HS、PES差异均无统计学意义(P >0.05);术后3个月时2组HS比较,差异有统计学意义(P < 0.01)。术后6个月时PCS、PES 2组间差异均无统计学意义(P>0.05),而HS在2组间差异有统计学意义(P < 0.01)。术后3、6个月时2组PCS、HS、PES与术前相比,差异均有统计学意义(P < 0.01);术后6个月时PES与术后3个月相比,差异有统计学意义(P < 0.01)(见表 2)。最后根据VAS量化后,算出病人总满意度,观察组病人总满意度高于对照组,差异有统计学意义(P < 0.05)(见表 3)。
分组 n 术前 术后3个月 术后6个月 PCS 观察组 25 5.07±0.38 6.29±0.57** 6.34±0.56** 对照组 24 5.14±0.57 6.14±0.46** 6.34±0.49** t — 0.51 1.01 0.02 P — >0.05 >0.05 >0.05 HS 观察组 25 6.14±0.81 3.22±1.03** 3.00±0.91** 对照组 24 6.32±0.51 4.70±0.68** 4.60±0.98** t — 0.91 5.91 5.90 P — >0.05 < 0.01 < 0.01 PES 观察组 25 5.01±0.14 6.16±1.06** 6.92±0.57**## 对照组 24 5.07±0.21 6.07±0.90** 6.74±0.49**## t — 1.33 0.30 1.17 P — >0.05 >0.05 >0.05 组内比较:与术前比较**P < 0.01;与术后3个月比较##P < 0.01 表 2 病人满意度的比较(x ±s)
分组 n 满意 不满意 满意率/% χ2 P 观察组 25 24 1 96.00 3.98 < 0.05 对照组 24 17 7 70.80 合计 49 41 8 83.67 表 3 2组总满意率比较
富血小板纤维蛋白结合冠向复位瓣在牙龈退缩中的应用
Application of platelet-rich fibrin combined with coronally advance flap in the treatment of gingival recession
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摘要:
目的 评价显微手术中用冠向复位瓣(coronally advanced flap, CAF)联合富血小板纤维蛋白(platelet-rich fibrin, PRF)与单纯使用冠向复位瓣在治疗牙龈退缩(GR)中的应用效果。 方法 36例GR病人中,随机选取18例25颗GR患牙进行PRF+CAF(观察组);余18例24颗GR患牙进行CAF(对照组);2组均采用显微手术方法,记录并比较2组病人基线和术后3、6个月的牙周探诊深度(PD)、牙龈垂直向退缩高度(VGR)、角化龈宽度(KTH)、牙龈厚度(GT)、病人舒适度(PCS)、敏感度(HS)、美学指数(PES)以及病人总满意度。 结果 2组术前、术后PD、KTH差异均无统计学意义(P>0.05);在根面覆盖上,2组术前、术后VGR比较差异有统计学意义(P < 0.01);观察组术前、术后GT比较差异均有统计学意义(P < 0.01);病人满意度(包括PCS、HS、PES)术前、术后差异均有统计学意义(P < 0.01),特别是HS,病人术后总体比较满意。 结论 PRF膜与CAF联合治疗GR可以达到很好的根面覆盖效果,且术后GT及病人满意度比单纯使用CAF具有更突出的优点。 Abstract:Objective To compare the application effects between the platelet-rich fibrin(PRF) combined with coronally advanced flap(CAF) and coronally advanced flap alone in the treatment of gingival recession(GR). Methods Thirty-six patients with GR were randomly divided into the observation group(18 cases, 25 teeth with GR) and control group(18 cases, 24 teeth with GR). The observation group and control group were treated with PRF combined with CAF and CAF, respectively. The microsurgery in two groups were used.The base line, and periodontal probing depth(PD), vertical gingival regression height(VGR), keratinized gingival width(KTH), gingival thickness(GT), patient comfort(PCS), sensitivity(HS), aesthetic index(PES) and total satisfaction after 3 and 6 months of operation in two groups were recorded and compared. Results The differences of the PD and KTH in two groups between before and after operation were not statistically significant(P>0.05). In terms of root surface coverage, the difference of the VGR in two groups between before and after operation was statistically significant(P < 0.01). The difference of the GT in the observation group between before and after operation was statistically significant(P < 0.01). The differences of the patients' satisfaction(including the PCS, HS and PES) in the observation group were statistically significant between before and after surgery(P < 0.01), especially for HS, the patients were generally satisfied after surgery. Conclusions The PRF membrane combined with CAF in the treatment of GR can achieve the good root surface coverage, and the postoperative GT and patient's satisfaction have more prominent advantages compared with the CAF alone. -
Key words:
- gingival recession /
- platelet-rich fibrin /
- coronally advanced flap
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表 1 2组PD、VGR、KTH、GT的比较(x ±s)
分组 n 术前 术后3个月 术后6个月 PD 观察组 25 1.43±0.35 1.30±0.27 1.35±0.26 对照组 24 1.39±0.28 1.35±0.29 1.32±0.28 t — 0.43 0.66 0.32 P — >0.05 >0.05 >0.05 VGR 观察组 25 4.01±0.54 0.33±0.21** 0.40±0.19** 对照组 24 4.05±0.47 0.47±0.25** 0.51±0.25** t — 0.24 2.02 1.66 P — >0.05 < 0.05 >0.05 KTH 观察组 25 3.21±0.64 3.48±0.71 3.48±0.59 对照组 24 3.27±0.56 3.49±0.63 3.50±0.69 t — 0.36 0.02 0.15 P — >0.05 >0.05 >0.05 GT 观察组 25 0.94±0.20 1.56±0.42** 1.65±0.46** 对照组 24 0.85±0.19 1.18±0.46** 1.28±0.52** t — 1.54 3.02 2.60 P — >0.05 < 0.01 < 0.05 组内比较:与术前比较**P < 0.01 表 2 病人满意度的比较(x ±s)
分组 n 术前 术后3个月 术后6个月 PCS 观察组 25 5.07±0.38 6.29±0.57** 6.34±0.56** 对照组 24 5.14±0.57 6.14±0.46** 6.34±0.49** t — 0.51 1.01 0.02 P — >0.05 >0.05 >0.05 HS 观察组 25 6.14±0.81 3.22±1.03** 3.00±0.91** 对照组 24 6.32±0.51 4.70±0.68** 4.60±0.98** t — 0.91 5.91 5.90 P — >0.05 < 0.01 < 0.01 PES 观察组 25 5.01±0.14 6.16±1.06** 6.92±0.57**## 对照组 24 5.07±0.21 6.07±0.90** 6.74±0.49**## t — 1.33 0.30 1.17 P — >0.05 >0.05 >0.05 组内比较:与术前比较**P < 0.01;与术后3个月比较##P < 0.01 表 3 2组总满意率比较
分组 n 满意 不满意 满意率/% χ2 P 观察组 25 24 1 96.00 3.98 < 0.05 对照组 24 17 7 70.80 合计 49 41 8 83.67 -
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