Preidl Raimund H M, Wehrhan Falk, Weber Manuel, Neukam Friedrich W, Kesting Marco, Schmitt Christian M
Resident, Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
Specialist for Oral Surgery and Oral-Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
J Oral Maxillofac Surg. 2019 Sep;77(9):1797-1806. doi: 10.1016/j.joms.2019.03.010. Epub 2019 Mar 19.
Vestibuloplasty is a frequently performed surgical procedure to create or increase soft tissue mucosal sealing around dental restorations. Collagen matrices have exhibited comparable clinical results as free gingival grafts in the context of intraoral tissue augmentation. However, the process of matrix vascularization, the basic requirement for local healing, is incompletely understood. Therefore, this study investigated collagen matrix perfusion in a clinical intraoral setting.
In a prospective cohort study, vestibuloplasty was performed during implant exposure using prefabricated collagen matrices. Matric perfusion was determined intraoperatively and at days 2, 5, 7, 14, 30, and 90 using a laser Doppler spectrophotometer measuring oxygen saturation, relative amount of hemoglobin, blood flow, and blood velocity as primary outcome variables. These parameters were compared with perfusion of the oral mucosa surrounding the matrices. Statistical analysis was performed by applying variance and regression models.
In 10 patients (average age, 60.9 yr), vestibuloplasty was performed exclusively in the anterior mandible. Blood flow and tissue oxygen saturation in the augmented zones markedly increased until postoperative day 5 and approximated perfusion values of the adjacent mucosa at the following 2 time points. Likewise, matrix oxygen saturation markedly increased until day 7 and subsequently converged to perfusion parameters of the surrounding mucosa at the following time points.
Flow signals in incorporated collagen matrices occurred on day 2 after vestibuloplasty and further increased until days 5 to 7. Therefore, matrix perfusion mainly occurs within the first postoperative week, converging to perfusion levels of the surrounding mucosa with minimal alterations during the following course.
前庭成形术是一种常见的外科手术，用于在牙齿修复体周围创建或增加软组织黏膜封闭。在口腔内组织增量的情况下，胶原基质已显示出与游离龈瓣移植相当的临床效果。然而，基质血管化过程作为局部愈合的基本要求，目前尚未完全了解。因此，本研究在临床口腔环境中调查了胶原基质灌注情况。
在一项前瞻性队列研究中，在种植体暴露期间使用预制胶原基质进行前庭成形术。术中以及术后第2、5、7、14、30和90天使用激光多普勒分光光度计测定基质灌注，测量氧饱和度、血红蛋白相对量、血流和血流速度作为主要结局变量。将这些参数与基质周围口腔黏膜的灌注情况进行比较。采用方差和回归模型进行统计分析。
10例患者（平均年龄60.9岁）仅在下颌前部进行了前庭成形术。增厚区域的血流和组织氧饱和度在术后第5天之前显著增加，并在随后的两个时间点接近相邻黏膜的灌注值。同样，基质氧饱和度在第7天之前显著增加，随后在接下来的时间点趋于周围黏膜的灌注参数。
前庭成形术后第2天在植入的胶原基质中出现血流信号，并持续增加直至第5至7天。因此，基质灌注主要发生在术后第一周内，在随后的过程中趋于周围黏膜的灌注水平，变化最小。
