Richardson Christopher R, Allen Edward P, Chambrone Leandro, Langer Burton, McGuire Michael K, Zabalegui Ion, Zadeh Homayoun H, Tatakis Dimitris N
Private practice, Richmond, VA.
Private practice, Dallas, TX.
Clin Adv Periodontics. 2015 Feb;5(1):2-10. doi: 10.1902/cap.2015.140059.
Focused Clinical Question: How should gingival recession (GR) defects be managed based on current evidence? Summary: The purpose of this practical application is to illustrate the management of GR defects with a primary outcome goal of complete root coverage. The consensus in dental literature and among expert clinicians is that root coverage may be attained through the application of different procedures and that outcomes are generally measured by reduced defect depth, gain in clinical attachment, and an increase in keratinized tissue (KT). These procedures may include the use of: 1) subepithelial connective tissue graft (SCTG); 2) coronally advanced flap; 3) free gingival graft; and 4) soft tissue graft substitutes (acellular dermal matrix and xenogeneic collagen matrix materials) and biologics (recombinant human platelet-derived growth factor and enamel matrix derivative). The variability in these techniques revolves around the inclusion or avoidance of a palatal donor graft. The decision as to how to approach a specific clinical GR-type defect should be a combination of considerations relative to the clinician's surgical goals and the patient's understanding of the anticipated outcome. The associated systematic review (Chambrone and Tatakis, J Periodontol 2015;86(Suppl.):S8-S51) provides clear evidence that SCTG-based procedures provide the best outcome for mean and complete root coverage, as well as an increase in KT. Patient-reported outcomes, a topic that needs additional research, should be considered in the decision-making process. Conclusion: Based on the available evidence and the illustrated cases included in this practical application, root coverage can be predictably achieved and a successful clinical outcome can be maintained long term.
根据现有证据，牙龈退缩（GR）缺损应如何处理？总结：本实际应用的目的是阐述以完全覆盖牙根为主要结局目标的GR缺损的处理方法。牙科文献和专家临床医生的共识是，通过应用不同的手术方法可以实现牙根覆盖，并且通常通过减少缺损深度、增加临床附着以及增加角化组织（KT）来衡量治疗效果。这些手术方法可能包括使用：1）上皮下结缔组织移植（SCTG）；2）冠向推进瓣；3）游离龈瓣移植；4）软组织移植替代物（无细胞真皮基质和异种胶原基质材料）以及生物制剂（重组人血小板衍生生长因子和釉基质衍生物）。这些技术的差异主要在于是否使用腭部供体移植物。对于如何处理特定临床类型的GR缺损的决策，应综合考虑临床医生的手术目标以及患者对预期结果的理解。相关的系统评价（Chambrone和Tatakis，《牙周病学杂志》2015年；86（增刊）：S8 - S51）提供了明确的证据，表明基于SCTG的手术方法在平均牙根覆盖和完全牙根覆盖以及KT增加方面效果最佳。患者报告的结局是一个需要进一步研究的主题，在决策过程中应予以考虑。结论：基于现有证据以及本实际应用中展示的病例，牙根覆盖可以可预测地实现，并且可以长期维持成功的临床效果。
