Preidl Raimund H M, Reichert Sky, Coronel Talisa V, Kesting Marco, Wehrhan Falk, Schmitt Christian M
Resident, Department of Oral and Maxillofacial Surgery, University of Erlangen- Nuremberg, Erlangen, Germany.
Doctoral Student, Department of Oral and Maxillofacial Surgery, University of Erlangen- Nuremberg, Erlangen, Germany.
J Oral Maxillofac Surg. 2021 May;79(5):1027-1037. doi: 10.1016/j.joms.2020.12.019. Epub 2021 Jan 13.
Vestibuloplasty with free gingival grafting is a frequently performed surgical procedure to generate sufficient keratinized mucosa (KM) around dental implants. Avascular porcine collagen matrices (CM) have been proclaimed to be sufficient substitutes as alternatives to free gingival grafts (FGGs). However, the process of graft integration and vascularization is still incompletely understood.
In 18 patients a vestibuloplasty in the lower edentulous jaw situation was performed during implant exposure, either with FGGs from the palate or a porcine CM (mucoderm). Tissue perfusion of the soft tissue grafts was measured using laser-doppler-spectrophotometer intraoperatively and on postoperative days 2, 5, 10, 30 and between days 60 and 90. With graft perfusion expressed by oxygen saturation [SO2%], the relative amount of hemoglobin [rHb], blood flow, and velocity [AU] was detected and compared between groups and the surrounding mucosa.
Healing was uneventful in both groups, with mature KM around dental implants after healing. Blood flow and velocity significantly increased until postoperative day 10, comparable to perfusion values of the surrounded mucosa. Intergroup comparisons revelated no significant differences concerning the flow between CM and FGGs. Oxygen saturation also significantly increased within the first 5 postoperative days in both groups. Hemoglobin content did not show any differences during the investigated period.
The perfusion mainly progresses within the first postoperative week with only minimal further detectable alterations until the final investigation, comparable in both groups. Although integration of FGGs (revascularized) and the CM (new tissue formation) is biologically different, both transplants show comparable perfusion patterns, leading to sufficient KM.
游离龈瓣移植进行前庭成形术是一种常见的外科手术，用于在牙种植体周围生成足够的角化黏膜（KM）。无血管猪胶原基质（CM）已被宣称可作为游离龈瓣移植（FGG）的充分替代品。然而，移植物整合和血管化的过程仍未完全了解。
对18例患者在种植体暴露时进行下颌无牙区的前庭成形术，采用腭部的FGG或猪CM（黏膜皮肤组织）。术中以及术后第2天、第5天、第10天、第30天和第60至90天之间，使用激光多普勒分光光度计测量软组织移植物的组织灌注。以氧饱和度[SO2%]表示移植物灌注，检测并比较两组之间以及与周围黏膜的血红蛋白相对含量[rHb]、血流量和流速[AU]。
两组愈合均顺利，愈合后牙种植体周围有成熟的KM。血流量和流速在术后第10天前显著增加，与周围黏膜的灌注值相当。组间比较显示，CM和FGG之间的血流无显著差异。两组术后前5天内氧饱和度也显著增加。在研究期间，血红蛋白含量没有任何差异。
灌注主要在术后第一周内进行，直到最终检查时仅有微小的进一步可检测变化，两组情况相当。尽管FGG（再血管化）和CM（新组织形成）的整合在生物学上有所不同，但两种移植物显示出相当的灌注模式，从而产生足够的KM。
