Huang Z, Luan Q X
Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China.
Zhonghua Kou Qiang Yi Xue Za Zhi. 2025 Aug 9;60(8):846-856. doi: 10.3760/cma.j.cn112144-20250103-00003.
This article reviews the recent advancements in incision and flap design for periodontal regenerative surgery, with a particular focus on the application of minimally invasive surgical techniques and non-crestal approaches. When applied to periodontal regeneration, traditional flap designs, such as the modified Widman flap, present disadvantages including wound dehiscence and gingival recession, compromising regenerative outcomes. To address these issues, researchers have developed a series of novel techniques, including papilla preservation techniques, minimally invasive techniques, and single-flap techniques. However, these techniques usually involve horizontal or oblique incisions near the interdental papilla adjacent to the intrabony defect, which may still lead to wound dehiscence, limiting periodontal regeneration. Also they may cause gingival recession and reduction in papilla height, resulting in "black triangles". In recent years, a series of new techniques utilizing non-crestal approaches have emerged, altering incision placement to preserve the interdental papilla. Examples include the entire papilla preservation technique using a lateral incision approach, non-incised papilla surgical approaching by an apical incision, and apically incised coronally advanced surgical technique. By placing incisions away from the papilla, these methods achieve complete papilla preservation and provide greater space for regeneration, effectively promoting the regeneration of both intrabony and suprabony periodontal tissues. This article systematically analyzes the key surgical points, indications, and clinical efficacies of different incision designs in periodontal regenerative surgery. Detailed case presentations illustrate the step-by-step procedures of these techniques, demonstrating their favorable outcomes in treating intrabony defects. The aim is to encourage future clinical studies to validate the effectiveness and safety of these novel techniques.
本文综述了牙周再生手术中切口和瓣设计的最新进展，特别关注微创外科技术和非嵴顶入路的应用。当应用于牙周再生时，传统的瓣设计，如改良Widman瓣，存在包括伤口裂开和牙龈退缩等缺点，影响再生效果。为了解决这些问题，研究人员开发了一系列新技术，包括乳头保留技术、微创技术和单瓣技术。然而，这些技术通常涉及在骨内缺损相邻的牙间乳头附近进行水平或斜切口，这仍可能导致伤口裂开，限制牙周再生。它们还可能导致牙龈退缩和乳头高度降低，形成“黑三角”。近年来，出现了一系列利用非嵴顶入路的新技术，改变了切口位置以保留牙间乳头。例如，采用侧方切口入路的全乳头保留技术、通过根尖切口的无切口乳头手术入路以及根尖切开冠向推进手术技术。通过将切口远离乳头，这些方法实现了乳头的完全保留，并为再生提供了更大的空间，有效促进了骨内和骨上牙周组织的再生。本文系统分析了牙周再生手术中不同切口设计的关键手术要点、适应证和临床疗效。详细的病例展示说明了这些技术的逐步操作过程，展示了它们在治疗骨内缺损方面的良好效果。目的是鼓励未来的临床研究验证这些新技术的有效性和安全性。
