McGuire Michael K, Nunn Martha E
Department of Periodontics, University of Texas Dental Branch, Houston, USA.
J Periodontol. 2005 Jun;76(6):867-80. doi: 10.1902/jop.2005.76.6.867.
Periodontists have found the gingival autograft to be an effective and predictable technique to increase the amount of attached gingiva around teeth, but this technique requires the surgeon to harvest donor tissue from a remote surgical site. The present study seeks to evaluate the safety and effectiveness of a tissue-engineered skin equivalent, a living human fibroblast-derived dermal substitute (HF-DDS), compared to a gingival autograft (GA) consisting of donor tissue harvested from the patient's palate in a procedure designed to increase the amount of keratinized tissue around teeth that do not require root coverage.
Twenty-five patients with insufficient attached gingiva associated with at least two teeth in contralateral quadrants of the same jaw were treated. One tooth in each patient was randomized to receive either a GA (control) or a HF-DDS graft (test). Clinical parameters measured at baseline and 3, 5, 7, 9, and 12 months included recession, clinical attachment level, keratinized tissue height, and plaque index. Probing depth was measured at 7, 9, and 12 months. Inflammation of each site was scored and texture and color of the grafted tissue were compared to the surrounding tissue. Resistance to muscle pull was evaluated and a questionnaire was used to determine patient preference. Surgical position of the graft and alveolar bone level were recorded at the surgical visit and patients were evaluated weekly for the first 4 weeks at which time recession and level of oral hygiene were measured. Biopsies and persistence studies were performed on a subset of the patients.
Results for both test and control groups were similar for all measured clinical parameters with the exception of amount of keratinized tissue and percent shrinkage of keratinized tissue. The control group exhibited an average of 1.0 to 1.2 mm more keratinized tissue over time than the test group (P <0.001) and the control group had about half as much shrinkage as the test group over time (P <0.001). Test sites demonstrated significantly better color match over time compared to control sites. Similarly, tissue texture for test sites was significantly better than control sites over time.
Based on the results of this investigation, the tissue engineered HF-DDS graft was safe and capable of generating keratinized tissue without the morbidity and potential clinical difficulties associated with donor site surgery. The GA generated more keratinized tissue and shrank less than the HF-DDS graft, but the test graft generated tissue that appeared more natural.
牙周病医生发现牙龈自体移植术是一种有效且可预测的技术，可增加牙齿周围附着龈的量，但该技术要求外科医生从远处的手术部位获取供体组织。本研究旨在评估一种组织工程皮肤替代物，即一种源自活人的成纤维细胞真皮替代物（HF-DDS），与牙龈自体移植术（GA）相比的安全性和有效性。GA是在旨在增加无需根面覆盖的牙齿周围角化组织量的手术中，从患者腭部获取供体组织。
对25例同一颌骨对侧象限中至少两颗牙齿附着龈不足的患者进行治疗。每位患者的一颗牙齿随机接受GA（对照组）或HF-DDS移植（试验组）。在基线以及3、5、7、9和12个月时测量的临床参数包括牙龈退缩、临床附着水平、角化组织高度和菌斑指数。在7、9和12个月时测量探诊深度。对每个部位的炎症进行评分，并将移植组织的质地和颜色与周围组织进行比较。评估对肌肉牵拉的抵抗力，并使用问卷确定患者的偏好。在手术时记录移植的手术位置和牙槽骨水平，并在最初4周每周对患者进行评估，此时测量牙龈退缩和口腔卫生水平。对部分患者进行活检和留存研究。
除角化组织量和角化组织收缩百分比外，试验组和对照组所有测量的临床参数结果相似。随着时间的推移，对照组的角化组织平均比试验组多1.0至1.2毫米（P<0.001），且随着时间的推移，对照组的收缩量约为试验组的一半（P<0.001）。随着时间的推移，试验部位的颜色匹配明显优于对照部位。同样，随着时间的推移，试验部位的组织质地明显优于对照部位。
基于本研究结果，组织工程HF-DDS移植是安全的，能够生成角化组织，且没有与供体部位手术相关的发病率和潜在临床困难。GA生成的角化组织比HF-DDS移植更多，收缩也更少，但试验移植生成的组织看起来更自然。
