Schmitt Christian M, Moest Tobias, Lutz Rainer, Wehrhan Falk, Neukam Friedrich W, Schlegel Karl Andreas
Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
Clin Oral Implants Res. 2016 Nov;27(11):e125-e133. doi: 10.1111/clr.12575. Epub 2015 Feb 27.
Porcine collagen matrices are proclaimed being a sufficient alternative to autologous free gingival grafts (FGG) in terms of augmenting the keratinized mucosa. The collagen matrix Mucograft (CM) already showed a comparable clinical performance in the early healing phase, similar histological appearance, and even a more natural appearance of augmented regions. Predictability for long-term stability does not yet exist due to missing studies reporting of a follow-up >6 months.
The study included 48 patients with atrophic edentulous or partially edentulous lower jaw situations that had undergone an implant treatment. In the context of implant exposure, a vestibuloplasty was either performed with two FGGs from the palate (n = 21 patients) or with the CM (n = 27 patients). Surgery time was recorded from the first incision to the last suture. Follow-up examinations were performed at the following time points: 10, 30, 90, and 180 days and 1, 2, 3, 4, and 5 years after surgery. The width of keratinized mucosa was measured at the buccal aspect of each implant, and augmented sites were evaluated in terms of their clinical appearances (texture and color).
The groups showed similar healing with increased peri-implant keratinized mucosa after surgery (FGG: 13.06 mm ± 2.26 mm and CM: 12.96 mm ± 2.86 mm). The maximum follow-up was 5 years (5 patients per group). After 180 days, the width of keratinized mucosa had decreased to 67.08 ± 13.85% in the FGG group and 58.88 ± 14.62% in the CM group with no statistically significant difference. The total loss of the width of keratinized mucosa after 5 years was significant between the FGG (40.65%) and the CM group (52.89%). The CM group had significantly shorter operation times than the FGG group. Augmented soft tissues had a comparable clinical appearance to adjacent native gingiva in the CM group. FGGs could still be defined after 5 years.
The FGG and the CM are both suitable for the regeneration of the peri-implant keratinized mucosa with a sufficient long-term stability. With the CM, tissue harvesting procedures are invalid, surgery time can be reduced, and regenerated tissues have a more esthetic appearance.
在增加角化黏膜方面，猪胶原蛋白基质被宣称是自体游离龈瓣移植术（FGG）的一种充分替代物。胶原蛋白基质Mucograft（CM）在早期愈合阶段已显示出类似的临床表现、相似的组织学外观，甚至增生区域外观更自然。由于缺乏随访时间超过6个月的研究报告，目前尚无长期稳定性的可预测性。
本研究纳入48例萎缩性无牙或部分无牙下颌患者，这些患者均接受了种植治疗。在种植体暴露的情况下，21例患者采用取自腭部的两片FGG进行前庭成形术，27例患者采用CM进行前庭成形术。记录从第一个切口到最后一针缝合的手术时间。在以下时间点进行随访检查：术后10、30、90和180天以及1、2、3、4和5年。在每个种植体的颊侧测量角化黏膜的宽度，并根据其临床外观（质地和颜色）评估增生部位。
两组术后种植体周围角化黏膜均增加，愈合情况相似（FGG组：13.06 mm±2.26 mm，CM组：12.96 mm±2.86 mm）。最长随访时间为5年（每组5例患者）。180天后，FGG组角化黏膜宽度降至67.08±13.85%，CM组降至58.88±14.62%，差异无统计学意义。5年后，FGG组（40.65%）和CM组（52.89%）角化黏膜宽度的总损失有显著差异。CM组的手术时间明显短于FGG组。CM组增生的软组织与相邻天然牙龈的临床外观相似。5年后仍可识别FGG。
FGG和CM均适用于种植体周围角化黏膜的再生，具有足够的长期稳定性。使用CM时，无需组织采集程序，可缩短手术时间，再生组织外观更美观。
