Han Chun-Yu, Wang De-Zhou, Bai Jian-Fei, Zhao Lan-Lan, Song Wen-Zhi
Department of Stomatology, China-Japan Union Hospital, Jilin University, Changchun 130031, Jilin Province, China.
World J Clin Cases. 2021 Dec 6;9(34):10738-10745. doi: 10.12998/wjcc.v9.i34.10738.
Keratinized gingival insufficiency is a disease attributed to long-term tooth loss, can severely jeopardizes the long-term health of implants. A simple and effective augmentation surgery method should be urgently developed.
A healthy female patient, 45-year-old, requested implant restoration of the her left mandibular first molar and second molar. Before considering a stage II, as suggested from the probing depth measurements, the widths of the mesial, medial, and distal buccal keratinized gingiva of second molar (tooth #37) were measured and found to be 0.5 mm, 0.5 mm, and 0 mm, respectively. This suggested that the gingiva was insufficient to resist damage from bacterial and mechanical stimulation. Accordingly, modified apically repositioned flap (ARF) surgery combined with xenogeneic collagen matrix (XCM) and platelet-rich fibrin (PRF) was employed to increase the width of gingival tissue. After 1 mo of healing, the widths of mesial, medial, and distal buccal keratinized gingiva reached 4 mm, 4 mm, and 3 mm, respectively, and the thickness of the augmented mucosa was 4.5 mm. Subsequently, through the second-stage operation, the patient obtained an ideal soft tissue shape around the implant.
For cases with keratinized gingiva widths around implants less than 2mm，the soft tissue width and thickness could be increased by modified ARF surgery combined with XCM and PRF. Moreover, this surgery significantly alleviated patients' pain and ameliorated oral functional comfort.
角化龈不足是一种由长期牙齿缺失引起的疾病，会严重危及种植体的长期健康。迫切需要开发一种简单有效的增宽手术方法。
一名45岁健康女性患者，要求对其左下颌第一磨牙和第二磨牙进行种植修复。在考虑二期手术前，根据探诊深度测量结果，对第二磨牙（37号牙）近中、中央和远中颊侧角化龈的宽度进行测量，发现分别为0.5毫米、0.5毫米和0毫米。这表明牙龈不足以抵抗细菌和机械刺激造成的损伤。因此，采用改良根向复位瓣（ARF）手术联合异种胶原基质（XCM）和富血小板纤维蛋白（PRF）来增加牙龈组织宽度。愈合1个月后，近中、中央和远中颊侧角化龈宽度分别达到4毫米、4毫米和3毫米，增厚的黏膜厚度为4.5毫米。随后，通过二期手术，患者在种植体周围获得了理想的软组织形态。
对于种植体周围角化龈宽度小于2毫米的病例，改良ARF手术联合XCM和PRF可增加软组织宽度和厚度。此外，该手术显著减轻了患者的疼痛，改善了口腔功能舒适度。
