University of Zurich, Zurich, Switzerland.
J Clin Periodontol. 2014 Apr;41 Suppl 15:S1-5. doi: 10.1111/jcpe.12221.
The scope of this consensus was to review the biological processes of soft tissue wound healing in the oral cavity and to histologically evaluate soft tissue healing in clinical and pre-clinical models.
To review the current knowledge regarding the biological processes of soft tissue wound healing at teeth, implants and on the edentulous ridge. Furthermore, to review soft tissue wound healing at these sites, when using barrier membranes, growth and differentiation factors and soft tissue substitutes.
Searches of the literature with respect to recessions at teeth and soft tissue deficiencies at implants, augmentation of the area of keratinized tissue and soft tissue volume were conducted. The available evidence was collected, categorized and summarized.
Oral mucosal and skin wound healing follow a similar pattern of the four phases of haemostasis, inflammation, proliferation and maturation/matrix remodelling. The soft connective tissue determines the characteristics of the overlaying oral epithelium. Within 7-14 days, epithelial healing of surgical wounds at teeth is completed. Soft tissue healing following surgery at implants requires 6-8 weeks for maturation. The resulting tissue resembles scar tissue. Well-designed pre-clinical studies providing histological data have been reported describing soft tissue wound healing, when using barrier membranes, growth and differentiation factors and soft tissue substitutes. Few controlled clinical studies with low numbers of patients are available for some of the treatments reviewed at teeth. Whereas, histological new attachment has been demonstrated in pre-clinical studies resulting from some of the treatments reviewed, human histological data commonly report a lack of new attachment but rather long junctional epithelial attachment and connective tissue adhesion. Regarding soft tissue healing at implants human data are very scarce.
Oral soft tissue healing at teeth, implants and the edentulous ridge follows the same phases as skin wound healing. Histological studies in humans have not reported new attachment formation at teeth for the indications studied. Human histological data of soft tissue wound healing at implants are limited.
The use of barriers membranes, growth and differentiation factors and soft tissue substitutes for the treatment of localized gingival/mucosal recessions, insufficient amount of keratinized tissue and insufficient soft tissue volume is at a developing stage.
本共识的范围是回顾口腔软组织创伤愈合的生物学过程，并对临床和临床前模型中的软组织愈合进行组织学评估。
回顾牙齿、种植体和无牙颌嵴上软组织伤口愈合的生物学过程的现有知识。此外，回顾在这些部位使用屏障膜、生长和分化因子以及软组织替代物时的软组织伤口愈合情况。
对牙齿退缩和种植体软组织缺陷、角化组织和软组织体积增加进行了文献检索。收集、分类和总结了现有证据。
口腔黏膜和皮肤伤口愈合遵循相同的四个阶段模式，即止血、炎症、增殖和成熟/基质重塑。软结缔组织决定了覆盖的口腔上皮的特征。在 7-14 天内，牙齿手术伤口的上皮愈合完成。种植体手术后的软组织愈合需要 6-8 周才能成熟。所产生的组织类似于瘢痕组织。已有一些设计良好的临床前研究提供了组织学数据，描述了在使用屏障膜、生长和分化因子以及软组织替代物时的软组织伤口愈合情况。对于在牙齿上评估的一些治疗方法，只有少数对照临床试验，且纳入的患者数量较少。而在一些评估的治疗中，临床前研究已经证明了新附着的形成，但人类的组织学数据通常报告缺乏新附着，而是长的结合上皮附着和结缔组织粘连。关于种植体上的软组织愈合，人类数据非常有限。
牙齿、种植体和无牙颌嵴的口腔软组织愈合与皮肤伤口愈合遵循相同的阶段。在研究的适应证中，人类的组织学研究并未报告牙齿上形成新附着。关于种植体上软组织伤口愈合的人类组织学数据有限。
在治疗局部牙龈/黏膜退缩、角化组织量不足和软组织量不足时，使用屏障膜、生长和分化因子以及软组织替代品仍处于发展阶段。
