Melo Luiz Gustavo N, Almeida Ana Lúcia P F, Lopes José Fernando Scarelli, Rezende Maria Lúcia R, Neto José Sérgio M, Ciporkin Frederico, Nagata Maria José Hitomi
Division of Implantology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo (HRAC-USP), Bauru, Brazil.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Oct;106(4):e7-14. doi: 10.1016/j.tripleo.2008.05.029. Epub 2008 Jul 26.
Severely resorbed mandibles often present a short band of keratinized tissue associated with a shallow vestibule. As a result, prominent muscle insertions are present, especially in the mental region of the mandible. This case report describes the deepening of the vestibular sulcus in an atrophic mandible by combining free gingival grafts harvested from the palate and a postoperative acrylic resin stent screwed on osseointegrated implants placed at the anterior region of the mandible.
During the second-stage surgery, a split-thickness labial flap was reflected and apically sutured onto the periosteum. Two free gingival grafts were obtained and then sutured at this recipient site. A previously custom-made acrylic stent was then screwed onto the most distally positioned implants. To document the procedure's stability over time, a metal ball was placed in the most apical part of the vestibule and standardized cephalometric radiographs were taken before and 6 months after the procedure. Linear measurements of vestibular depths over the observation time were realized using specific software for radiographic analysis.
The proposed technique augmented the band of attached masticatory mucosa, deepened the vestibule and prevented the muscle reinsertion. The difference between the 2 measurements of vestibular depths was 9.39 mm (initial 20.88 mm, final 11.49 mm) after a 6-month postoperative period.
The technique, in combination with palatal mucosal graft and use of a postoperative stent, decreased the pull of mentalis muscle and provided a peri-implantally stable soft tissue around implants.
严重吸收的下颌骨通常伴有一条短的角化组织带，且前庭沟浅。因此，尤其是在下颌骨的颏部，会出现明显的肌肉附着。本病例报告描述了通过联合使用从腭部获取的游离龈瓣以及术后拧在置于下颌骨前部的骨整合种植体上的丙烯酸树脂支架，加深萎缩下颌骨的前庭沟。
在二期手术中，翻起厚唇瓣并向根尖方向缝合于骨膜上。获取两片游离龈瓣，然后缝合于该受植区。接着将一个预先定制的丙烯酸树脂支架拧在最远端的种植体上。为记录该手术随时间的稳定性，在术前及术后6个月，在前庭最根尖部放置一个金属球并拍摄标准化的头颅侧位片。使用特定的放射影像分析软件在前庭深度的观察期内进行线性测量。
所提出的技术增加了附着咀嚼黏膜带，加深了前庭沟并防止了肌肉重新附着。术后6个月，前庭深度的两次测量差值为9.39毫米（初始值20.88毫米，最终值11.49毫米）。
该技术联合腭黏膜移植及术后支架的使用，减少了颏肌的牵拉，并在种植体周围提供了稳定的软组织。
