Department of Periodontics, Chang Gung Memorial Hospital, Taipei, Taiwan.
Chang Gung University, Taoyuan city, Taiwan.
Clin Oral Investig. 2023 Mar;27(3):1089-1100. doi: 10.1007/s00784-022-04697-2. Epub 2022 Sep 1.
Soft tissue phenotype modification (STPM) could be performed to maintain peri-implant health. Therefore, the aim of the study was to analyze tissue alteration around implants following soft tissue phenotype modification during implant uncovering surgery.
Patients who had STPM (either pouch roll or modified roll technique) during implant second-stage surgery with at least 12-month follow-up were included. Clinical and radiographic parameters including mucosal tissue thickness (MTT), recession (REC), keratinized mucosa width (KMW), probing pocket depth (PPD), marginal bone loss (MBL), emergence profile, and emergence angle were extracted from 2-week, 2-month, and 12-month visits after second-stage surgery.
Twenty-eight patients with 33 implants that fulfilled the inclusion criteria were included. After soft tissue phenotype modification, at 2 weeks, REC was negatively correlated to mean MTT at mid-buccal site (r = - 0.41, p = 0.018) and borderline correlated at mid-lingual site (r = - 0.343, p = 0.051). Stable KMW was maintained from 2 weeks to 12 months with minimal shrinkage rate (3 ~ 14%). MBL change was limited (0.24 ~ 0.47 mm) after STPM. All implants had shallow PPD (≤ 3 mm) with the absence of bleeding on probing. Emergence angle at the mesial side, however, was significantly correlated to surgical techniques, which indicated pouch roll technique would have 6.96 degrees more than modified roll technique (p = 0.024).
Soft tissue phenotype modification, either pouch roll or modified roll technique, during uncovering surgery resulted in favorable clinical outcomes. Thin mucosal tissue thickness and pouch roll technique are the factors related to more recession at 2 weeks. Pouch roll technique could influence the restorative design by having a wide emergence angle at the mesial side.
Modified and pouch roll techniques during uncovering surgery were viable methods to yield favorable peri-implant health, while the preciseness of pouch roll technique was required to avoid mucosal recession and inadequate restorative design.
软组织表型修饰（STPM）可用于维持种植体周围健康。因此，本研究旨在分析种植体二期手术中进行软组织表型修饰（袋状卷瓣术或改良卷瓣术）后种植体周围组织的改变。
本研究纳入了在种植体二期手术中接受 STPM（袋状卷瓣术或改良卷瓣术）并至少随访 12 个月的患者。从二期手术后 2 周、2 个月和 12 个月的随访中提取临床和影像学参数，包括黏膜组织厚度（MTT）、退缩（REC）、角化黏膜宽度（KMW）、探诊袋深（PPD）、边缘骨丧失（MBL）、暴露轮廓和暴露角度。
本研究共纳入 28 名患者的 33 个种植体，符合纳入标准。在进行软组织表型修饰后，2 周时，颊侧中位点的平均 MTT 与 REC 呈负相关（r= -0.41，p=0.018），与舌侧中位点的相关性为临界相关（r= -0.343，p=0.051）。在 2 周到 12 个月期间，KMW 保持稳定，仅有微小的收缩率（3%14%）。在 STPM 后，MBL 变化有限（0.240.47 mm）。所有种植体的 PPD 均较浅（≤3 mm），探诊无出血。然而，近中侧的暴露角度与手术技术显著相关，提示袋状卷瓣术比改良卷瓣术多 6.96 度（p=0.024）。
在二期手术中进行软组织表型修饰（袋状卷瓣术或改良卷瓣术）可获得良好的临床效果。较薄的黏膜组织厚度和袋状卷瓣术是导致术后 2 周时 REC 增加的相关因素。袋状卷瓣术会影响近中侧的修复设计，导致暴露角度较大。
袋状卷瓣术和改良卷瓣术是获得良好种植体周围健康的可行方法，而袋状卷瓣术的精确性对于避免黏膜退缩和不适当的修复设计至关重要。
