Haghighat Kamran
Department of Periodontology, School of Dentistry, Oregon Health Sciences University, Portland, OR 97239-3097, USA.
J Periodontol. 2006 Jul;77(7):1274-9. doi: 10.1902/jop.2006.050426.
Correction of mucogingival recession deformities with a variety of periodontal plastic surgery procedures has been described, each demonstrating a variable degree of success. A modified semilunar coronally advanced flap is described for the treatment of recession defects on multiple adjacent teeth.
Semilunar incisions were made apical to the recession defects, starting within mucosa and extended mesio-distally, arching more coronally to terminate apical to the papillae mesial and distal to the teeth exhibiting the defects. The papilla between the teeth with recession was coronally advanced after a split-thickness dissection and sutured more coronally, over the deepithelialized portion of the original papilla. The flap design gave better mobility and stability to the repositioned pedicle than previously described semilunar coronally advanced flap procedures.
Seven cases treated with this approach healed without complication and remained stable throughout the 8 to 22 months of post-surgical observation.
This technique will be particularly valuable when previous attempts for root coverage with soft tissue autografts have resulted in residual recession defects on adjacent teeth and in a thicker-tissue biotype that would be amenable to partial-thickness dissection. An adequate thickness of tissue that will allow a partial-thickness flap dissection is required to avoid tooth or alveolar bone fenestrations. This technique provides better control over flap repositioning than previously described semilunar coronally advanced flaps.
已有多种牙周整形手术方法用于纠正牙龈黏膜退缩畸形，每种方法的成功率各不相同。本文介绍一种改良的半月形冠向推进瓣，用于治疗多个相邻牙齿的退缩缺损。
在退缩缺损根尖处做半月形切口，切口始于黏膜内并向近远中延伸，更向冠方弯曲，在有缺损牙齿近远中乳头根尖处终止。对有退缩的牙齿间乳头进行分层剥离后向冠方推进，并在原乳头去上皮部分上方更向冠方缝合。与先前描述的半月形冠向推进瓣手术相比，该瓣设计使重新定位的蒂部具有更好的移动性和稳定性。
采用该方法治疗的7例患者均愈合良好，无并发症，在术后8至22个月的观察期内保持稳定。
当先前采用软组织自体移植进行牙根覆盖的尝试导致相邻牙齿残留退缩缺损，且组织生物型较厚适合分层剥离时，该技术将特别有价值。需要有足够厚度的组织以允许进行分层瓣剥离，以避免牙齿或牙槽骨开窗。与先前描述的半月形冠向推进瓣相比，该技术能更好地控制瓣的重新定位。
