Rebele Stephan F, Zuhr Otto, Schneider David, Jung Ronny E, Hürzeler Markus B
Private Office Huerzeler/Zuhr, Munich, Germany; Department of Operative Dentistry and Periodontology, University School of Dentistry, Albert-Ludwigs-University, Freiburg, Germany.
J Clin Periodontol. 2014 Jun;41(6):593-603. doi: 10.1111/jcpe.12254.
The aim of this randomized clinical trial (RCT) was to compare the clinical performance of the tunnel technique with subepithelial connective tissue graft (TUN) versus a coronally advanced flap with enamel matrix derivative (CAF) in the treatment of gingival recession defects. The use of innovative 3D digital measuring methods allowed to study healing dynamics at connective tissue (CT)-grafted sites and to evaluate the influence of the thickness of the root covering soft tissues on the outcome of surgical root coverage.
MATERIAL & METHODS: Twenty-four patients contributed a total of 47 Miller class I or II recessions for scientific evaluation. Precise study models collected at baseline and follow-up examinations were optically scanned and virtually superimposed for digital evaluation of clinical outcome measures including mean marginal soft tissue thickness (THK). Healing dynamics were measured in a defined region of interest at CT-grafted sites where volume differences between time points were calculated.
At 12 months, recession reduction as well as mean root coverage were significantly better at CT-grafted sites treated in the TUN group (1.94 mm and 98.4% respectively) compared to the non-augmented sites of the CAF group (1.17 mm and 71.8% respectively) and statistical analysis revealed a positive correlation of THK (1.63 mm TUN versus 0.91 mm CAF, p < 0.0001) to both these variables. Soft tissue healing following surgical root coverage with CT-grafting was mainly accomplished after 6 months, with around two-thirds of the augmented volume being maintained after 12 months.
The TUN resulted in thicker gingiva and better clinical outcomes compared to CAF. Increased gingival thickness was associated with better surgical outcomes in terms of recession reduction and root coverage.
本随机临床试验（RCT）的目的是比较隧道技术联合上皮下结缔组织移植（TUN）与冠向推进瓣联合釉基质衍生物（CAF）治疗牙龈退缩缺损的临床效果。采用创新的三维数字测量方法，能够研究结缔组织（CT）移植部位的愈合动态，并评估覆盖牙根软组织的厚度对手术牙根覆盖效果的影响。
24例患者共提供了47处Miller I级或II级牙龈退缩供科学评估。在基线和随访检查时收集的精确研究模型进行光学扫描，并进行虚拟叠加，以对包括平均边缘软组织厚度（THK）在内的临床结局指标进行数字评估。在CT移植部位的特定感兴趣区域测量愈合动态，计算不同时间点之间的体积差异。
12个月时，TUN组CT移植部位的退缩减少以及平均牙根覆盖情况（分别为1.94 mm和98.4%）明显优于CAF组未植骨部位（分别为1.17 mm和71.8%），统计分析显示THK（TUN组为1.63 mm，CAF组为0.91 mm，p < 0.0001）与这两个变量均呈正相关。CT移植手术牙根覆盖后的软组织愈合主要在6个月后完成，12个月后约三分之二的增加体积得以维持。
与CAF相比，TUN可使牙龈更厚，临床效果更好。牙龈厚度增加与退缩减少和牙根覆盖方面更好的手术效果相关。
