Retzepi M, Tonetti M, Donos N
Periodontology Unit, Eastman Dental Institute, University College London, London, UK.
J Clin Periodontol. 2007 Oct;34(10):903-11. doi: 10.1111/j.1600-051X.2007.01119.x.
This prospective randomized-controlled clinical trial compared the gingival blood flow responses following simplified papilla preservation (test) versus modified Widman flap (control).
Twenty contra-lateral upper sites with pocket depth > or = 5 mm after initial treatment in 10 chronic periodontitis patients were randomly assigned to either test or control treatment, using a split-mouth design. Laser Doppler flowmetry recordings were performed pre-operatively, following anaesthesia, immediately post-operatively and on days 1, 2, 3, 4, 7, 15, 30 and 60, at nine selected sites per flap.
Significant ischaemia was observed at all sites following anaesthesia and immediately post-operatively. At the mucosal flap basis, a peak hyperaemic response was observed on day 1, which tended to resolve by day 4 at the test sites, but persisted until day 7 at the control sites. The buccal and palatal papillae blood perfusion presented the maximum increase on day 7 in both groups and returned to baseline by day 15. Both surgical modalities yielded significant pocket depth reduction, recession increase and clinical attachment gain.
Periodontal access flaps represent an ischaemia-reperfusion flap model. The simplified papilla preservation flap may be associated with faster recovery of the gingival blood flow post-operatively compared with the modified Widman flap.
本前瞻性随机对照临床试验比较了简化乳头保留术（试验组）与改良Widman翻瓣术（对照组）术后牙龈血流反应。
采用双侧设计，将10例慢性牙周炎患者初始治疗后20个袋深≥5mm的对侧上颌部位随机分为试验组或对照组。在术前、麻醉后、术后即刻以及术后第1、2、3、4、7、15、30和60天，对每个瓣的9个选定部位进行激光多普勒血流仪记录。
麻醉后及术后即刻所有部位均观察到明显缺血。在黏膜瓣基部，术后第1天观察到充血反应高峰，试验组在第4天趋于缓解，而对照组持续至第7天。两组颊侧和腭侧乳头的血流灌注在第7天均出现最大增加，并在第15天恢复至基线水平。两种手术方式均使袋深显著减小、退缩增加且临床附着获得改善。
牙周翻瓣术是一种缺血再灌注瓣模型。与改良Widman翻瓣术相比，简化乳头保留瓣术后牙龈血流恢复可能更快。
