Batista E L, Batista F C, Novaes A B
Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
J Periodontol. 2001 Feb;72(2):265-73. doi: 10.1902/jop.2001.72.2.265.
Soft tissue ridge defects often hamper ideally shaped artificial crowns and are basically treated using autogenous soft tissue grafts or alloplastic materials. These approaches present disadvantages such as the necessity of creating additional surgical fields to harvest the graft and the requirement of primary closure, which may reduce ridge height. This investigation evaluated the use of acellular dermal matrix (ADM) in the treatment of soft tissue ridge defects.
Eight patients, non-smokers with non-contributory medical history, provided 18 sites corresponding to missing teeth in the anterior maxillary arch. The ideal horizontal gain (desired gain) was waxed up in study casts, which served as templates for construction of modified acrylic stents with orthodontic wires. These stents served as references for ideal horizontal gain and also as fixed reference points for further evaluation. The distance from the orthodontic wire to the buccal plate of the defect also represented its baseline horizontal component. Vertical variations were evaluated with another stent and, in this case, no desired gain was considered. After raising partial-thickness flaps, the ADM material was rehydrated and folded to fill the defect and reproduce the desired gain. Flaps were sutured with no tension, and part of the material was intentionally left exposed to avoid pressure on the incision line and prevent height loss. Patients used local and systemic antimicrobials, and the sutures were removed at 7 days.
Evaluations were carried out at 30 days, and 3 and 6 months, and all sites healed uneventfully. Neither infection nor significant pain was reported by the patients, and the material was covered by tissue at about 21 days. Mean horizontal gain of 1.72 +/- 0.59 mm (58.5%) at 6 months and mean shrinkage of 1.22 +/- 0.46 mm (41.4%) were observed. There was a mean improvement in vertical gain of only 0.61 +/- 0. 77 mm, although 66. 7% of the treated sites showed a 1 to 2 mm gain. Clinically, the total gain in the subjects was very effective and matched the receptor tissues nicely.
ADM may be a suitable material for the treatment of soft tissue ridge deformities due to its biocompatibility, color matching, and horizontal gain. Additional controlled, comparative trials are necessary to establish its advantages and potential compared to autogenous soft tissue techniques.
软组织嵴缺损常常妨碍理想形状的人工牙冠，基本上采用自体软组织移植或异体材料进行治疗。这些方法存在一些缺点，如需要开辟额外的手术区域来获取移植物以及需要一期缝合，这可能会降低嵴的高度。本研究评估了脱细胞真皮基质（ADM）在治疗软组织嵴缺损中的应用。
8例非吸烟且无相关病史的患者，提供了上颌前牙弓中对应缺失牙的18个部位。在研究模型上用蜡制作出理想的水平增量（期望增量），这些模型用作构建带有正畸钢丝的改良丙烯酸支架的模板。这些支架作为理想水平增量的参考，也作为进一步评估的固定参考点。正畸钢丝到缺损颊侧骨板的距离也代表其基线水平分量。用另一个支架评估垂直变化，在这种情况下，不考虑期望增量。掀起部分厚度的皮瓣后，将ADM材料复水并折叠以填充缺损并重现期望增量。皮瓣无张力缝合，部分材料有意暴露以避免对切口线施加压力并防止高度降低。患者使用局部和全身抗菌药物，7天后拆线。
在30天、3个月和6个月时进行评估，所有部位均愈合良好。患者均未报告感染或明显疼痛，材料在约21天时被组织覆盖。6个月时平均水平增量为1.72±0.59mm（58.5%），平均收缩量为1.22±0.46mm（41.4%）。垂直增量平均仅改善0.61±0.77mm，尽管66.7%的治疗部位有1至2mm的增量。临床上，受试者的总体增量非常有效，与受体组织匹配良好。
由于其生物相容性、颜色匹配和水平增量，ADM可能是治疗软组织嵴畸形的合适材料。与自体软组织技术相比，需要进行额外的对照、比较试验来确定其优势和潜力。
