Int J Periodontics Restorative Dent. 2023 Nov 3;43(6):753-761. doi: 10.11607/prd.6213.
Currently, the incision design for periodontal and implant surgeries is mainly based on the surgeon's personal preference. The primary aim of this study is to review the intricate periodontal microvascular system and to illustrate the potential impact of commonly applied flap designs on the integrity of this system. A complete literature electronic search resulted in 37 relevant articles. The maxillary, facial, and lingual arteries supply the microvasculature system, including the supraperiosteal, intraligamental, and intraosseous arterioles. These arterioles have their own territories yet are extensively interconnected. The impact of common papilla management techniques are discussed, including tunneling; papilla base, incision, and preservation; and flap-releasing incisions. Flap design can impact reperfusion and blood inflow in the early healing phase, which eventually influences wound closure probability, healing speed, surgical predictability, tissue volume change, and postoperative morbidity. Future studies on the three-dimensional distribution of microvasculature and clinical impact of various flap designs on tissue reperfusion can lead to evidence-based incision selection and improved wound-healing outcomes.
目前，牙周和种植手术的切口设计主要基于外科医生的个人偏好。本研究的主要目的是回顾复杂的牙周微血管系统，并说明常见的瓣设计对该系统完整性的潜在影响。通过全面的文献电子检索，共得到 37 篇相关文章。上颌、面部和舌动脉为包括骨膜上、韧带内和骨内小动脉在内的微血管系统提供血液。这些小动脉有各自的分布区域，但广泛相互连接。本文还讨论了常见的乳头管理技术，包括隧道式、乳头基底、切口和保留以及瓣松解切口。瓣设计可以影响早期愈合阶段的再灌注和血流，最终影响伤口闭合的可能性、愈合速度、手术的可预测性、组织体积变化和术后发病率。关于微血管三维分布以及各种瓣设计对组织再灌注的临床影响的未来研究，可以为基于证据的切口选择和改善伤口愈合结果提供依据。
