Saida Hiroyuki, Fukuba Shunsuke, Shiba Takahiko, Komatsu Keiji, Iwata Takanori, Nitta Hiroshi
Private Practice, Saitama, Japan.
Department of General Dentistry, Graduate School of Medical and Dental Sciences, 13100Tokyo Medical and Dental University, Tokyo Medical and Dental University, Tokyo, Japan.
J Int Med Res. 2021 Sep;49(9):3000605211044595. doi: 10.1177/03000605211044595.
Periodontal regenerative treatment is useful for intrabony defects and furcation involvement, but is difficult when there is insufficient keratinized mucosa to cover and maintain the regenerative material, particularly in the mandibular molar region. We report the case of a 27-year-old woman who underwent a two-stage surgical approach for a class II furcation defect with gingival recession and insufficient keratinized mucosal width (KMW) and vestibular depth at the mandibular left first molar. We first improved the KMW and keratinized mucosal thickness using an epithelial embossed connective tissue graft with enamel matrix derivative, and then focused on periodontal regeneration at the furcation defect using an enamel matrix derivative and a bovine-derived xenograft. Probing depth reduction, clinical attachment gain, horizontal probing depth reduction, KMW gain, and gingival recession reduction were observed 3 years postoperatively. This case report suggests that this novel staged approach may be effective for treating furcation defects with insufficient keratinized mucosa, thus providing useful insights into periodontal regeneration therapy.
牙周再生治疗对骨内缺损和根分叉病变有效，但当角化黏膜不足以覆盖和维持再生材料时则较为困难，尤其是在下颌磨牙区。我们报告了一例27岁女性患者，该患者因下颌左侧第一磨牙Ⅱ度根分叉病变、牙龈退缩且角化黏膜宽度（KMW）和前庭深度不足，接受了两阶段手术治疗。我们首先使用带釉基质衍生物的上皮压纹结缔组织移植物改善KMW和角化黏膜厚度，然后使用釉基质衍生物和牛源异种移植物专注于根分叉缺损处的牙周再生。术后3年观察到探诊深度降低、临床附着获得、水平探诊深度降低、KMW增加和牙龈退缩减少。本病例报告表明，这种新的分期方法可能对治疗角化黏膜不足的根分叉缺损有效，从而为牙周再生治疗提供有用的见解。
