Hong Inpyo, Jeong Seungho, Shin Hae Jee, Thoma Daniel S, Strauss Franz J, Lee Jung-Seok
Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, South Korea.
Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland.
J Clin Periodontol. 2025 Sep;52(9):1362-1371. doi: 10.1111/jcpe.14188. Epub 2025 Jun 2.
To evaluate the efficacy of the apically positioned flap (APF) with periosteal fenestration in increasing the width of the masticatory mucosa (MM, including attached and keratinized mucosa) and to assess the histological properties of the MM gained through this technique.
Six mongrel dogs were treated using a split-mouth design, with APF alone (control) and APF with periosteal fenestration (test) applied from the first to the fourth maxillary premolars on both sides (total of 48 sites). Clinical MM width (cMW) and digitally scanned MM width (dMW) were measured at baseline, post-operatively, and after 8 weeks of healing. Histological observations included measuring the distance from the free gingival margin to the mucogingival junction (MGJ) and the width of non-keratinized attached mucosa (NKAM). A linear mixed model was employed to analyse changes in MM measurements.
The mean gain of cMW was 3.17 mm (SD 1.63) in the control group and 4.27 mm (SD 1.91) in the fenestration group with a significant difference in favour of the fenestration group. The estimated mean difference was 1.45 mm (95% CI: 0.57-2.33; p = 0.002). Histologically, the increased mucosal width observed in the fenestration group, compared to the control group, was primarily characterized by non-keratinized epithelium.
APF with periosteal fenestration enhances the attached mucosal width; however, this increase is predominantly composed of NKAM rather than orthokeratinized mucosa.
评估带骨膜开窗的根向复位瓣（APF）在增加咀嚼黏膜（MM，包括附着龈和角化龈）宽度方面的疗效，并评估通过该技术获得的MM的组织学特性。
采用双颌设计对6只杂种犬进行治疗，在两侧第一至第四上颌前磨牙处分别应用单纯APF（对照组）和带骨膜开窗的APF（试验组）（共48个位点）。在基线、术后及愈合8周后测量临床MM宽度（cMW）和数字化扫描MM宽度（dMW）。组织学观察包括测量从游离龈缘到膜龈联合（MGJ）的距离以及非角化附着龈（NKAM）的宽度。采用线性混合模型分析MM测量值的变化。
对照组cMW的平均增加量为3.17 mm（标准差1.63），开窗组为4.27 mm（标准差1.91），开窗组有显著差异，估计平均差异为1.45 mm（95%可信区间：0.57 - 2.33；p = 0.002）。组织学上，与对照组相比，开窗组观察到的黏膜宽度增加主要以非角化上皮为特征。
带骨膜开窗的APF可增加附着龈宽度；然而，这种增加主要由NKAM而非正角化黏膜组成。
