Burkhardt Rino, Lang Niklaus P
School of Dental Medicine, University of Berne, Berne, Switzerland.
J Clin Periodontol. 2005 Mar;32(3):287-93. doi: 10.1111/j.1600-051X.2005.00660.x.
In the presence of a thin and narrow zone of gingival tissue root recessions caused by trauma or inflammatory reactions seem to be a common feature of the buccal tissue morphology. The surgical coverage is mainly indicated for aesthetic reasons and may be accomplished with pedicled flaps in conjunction with or without the use of connective tissue grafts.
The purpose of the present study was to evaluate the degree of vascularization of connective tissue grafts by applying a microsurgical approach. In addition, the clinical outcome was followed for 1 year.
The study population consisted of 10 patients with bilateral Class I and II recessions at maxillary canines. In split-mouth design, the defects were randomly selected for recession coverage either by a microsurgical (test) or macrosurgical (control) approach. Immediately after the surgical procedures, and after 3 and 7 days of healing, fluorescent angiograms were performed to evaluate graft vascularization. In addition, the clinical parameters were assessed before the surgical intervention, and 1, 3, 6 and 12 months postoperatively.
The results of the angiographic evaluation at test sites revealed a vascularization of 8.9+/-1.9% immediately after the procedure. After 3 days and after 7 days, the vascularization rose to 53.3+/-10.5% and 84.8+/-13.5%, respectively. The corresponding vascularization at control sites were 7.95+/-1.8%/44.5+/-5.7% and 64.0+/-12.3%, respectively. All the differences between test and control sites were statistically significant. The clinical measurements revealed a mean recession coverage of 99.4+/-1.7% for the test and 90.8+/-12.1% for the control sites after the first month of healing. Again, this difference was statistically significant. The percentage of root coverage both test and control sites remained stable during the first year at 98% and 90%, respectively.
The present controlled clinical study has demonstrated that in root surface coverage, a microsurgical approach substantially improved the vascularization of the grafts and the percentages of root coverage compared with applying a conventional macroscopic approach.
在存在薄而窄的牙龈组织区域时，由创伤或炎症反应引起的牙根退缩似乎是颊侧组织形态的一个常见特征。手术覆盖主要出于美学原因，可通过带蒂瓣联合或不联合使用结缔组织移植来完成。
本研究的目的是通过应用显微外科方法评估结缔组织移植的血管化程度。此外，对临床结果进行了1年的随访。
研究人群包括10例双侧上颌尖牙I类和II类退缩患者。采用分口设计，随机选择缺损部位，通过显微外科（试验）或宏观外科（对照）方法进行退缩覆盖。手术操作后立即以及愈合3天和7天后，进行荧光血管造影以评估移植组织的血管化情况。此外，在手术干预前以及术后1、3、6和12个月评估临床参数。
试验部位血管造影评估结果显示，术后立即血管化率为8.9±1.9%。3天后和7天后，血管化率分别升至53.3±10.5%和84.8±13.5%。对照部位相应的血管化率分别为7.95±1.8%/44.5±5.7%和64.0±12.3%。试验部位和对照部位之间的所有差异均具有统计学意义。临床测量显示，愈合第一个月后，试验部位的平均退缩覆盖率为99.4±1.7%，对照部位为90.8±12.1%。同样，这种差异具有统计学意义。试验部位和对照部位的牙根覆盖百分比在第一年分别保持稳定在98%和90%。
本对照临床研究表明，在牙根表面覆盖方面，与传统的宏观方法相比，显微外科方法显著改善了移植组织的血管化和牙根覆盖百分比。
