Bassetti Renzo G, Stähli Alexandra, Bassetti Mario A, Sculean Anton
Department of Oral and Maxillofacial Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland.
Department of Periodontology, University of Bern, Bern, Switzerland.
Clin Oral Investig. 2016 Sep;20(7):1369-87. doi: 10.1007/s00784-016-1815-2. Epub 2016 Apr 4.
The aim of this systematic review was to evaluate the efficacy of different soft tissue augmentation/correction methods in terms of increasing the peri-implant width of keratinized mucosa (KM) and/or gain of soft tissue volume during second-stage surgery.
Screening of two databases, MEDLINE (PubMed) and EMBASE (OVID), and hand search of related articles, were performed. Human studies reporting on soft tissue augmentation/correction methods around submucosally osseointegrated implants during second-stage surgery up to July 31, 2015 were considered. Quality assessment of the selected full-text articles was performed according to the Cochrane collaboration's tool to assess the risk of bias.
Overall, eight prospective studies (risk of bias: high) and two case series (risk of bias: high) were included. Depending on the surgical technique and graft material used, the enlargement of keratinized tissue (KT) ranged between -0.20 and 9.35 mm. An apically positioned partial-thickness flap/vestibuloplasty (APPTF/VP) in combination with a free gingival graft (FGG) or a xenogeneic graft material (XCM) was most effective. Applying a roll envelope flap (REF) or an APPTF in combination with a subepithelial connective tissue graft (SCTG), mean increases in soft tissue volumes of 2.41 and 3.10 mm, respectively, were achieved. Due to the heterogeneity of study designs, no meta-analysis could be performed.
Within the limitations of this review, regarding the enlargement of peri-implant KT, the APPTF in the maxilla and the APPTF/VP in combination with FGG or XCM in the lower and upper jaw seem to provide acceptable outcomes. To augment peri-implant soft tissue volume REF in the maxilla or APPTF + SCTG in the lower and upper jaw appear to be reliable treatment options.
The localization in the jaw and the clinical situation are crucial for the decision which second-stage procedure should be applied.
本系统评价旨在评估不同软组织增量/矫正方法在二期手术中增加种植体周围角化黏膜（KM）宽度和/或软组织体积增加方面的疗效。
对两个数据库MEDLINE（PubMed）和EMBASE（OVID）进行筛选，并手工检索相关文章。纳入截至2015年7月31日报道二期手术中黏膜下骨整合种植体周围软组织增量/矫正方法的人体研究。根据Cochrane协作网评估偏倚风险的工具对所选全文文章进行质量评估。
总体而言，纳入了八项前瞻性研究（偏倚风险：高）和两个病例系列（偏倚风险：高）。根据所使用的手术技术和移植材料，角化组织（KT）的增大范围在-0.20至9.35毫米之间。根尖定位的部分厚度瓣/前庭成形术（APPTF/VP）联合游离龈移植（FGG）或异种移植材料（XCM）最为有效。应用卷边信封瓣（REF）或APPTF联合上皮下结缔组织移植（SCTG），软组织体积平均分别增加2.41和3.10毫米。由于研究设计的异质性，无法进行荟萃分析。
在本综述的局限性内，关于种植体周围KT的增大，上颌的APPTF以及上下颌联合FGG或XCM的APPTF/VP似乎能提供可接受的结果。为增加种植体周围软组织体积，上颌的REF或上下颌的APPTF + SCTG似乎是可靠的治疗选择。
颌骨的位置和临床情况对于决定应采用哪种二期手术至关重要。
