国际口腔医学杂志

国际口腔医学杂志 ›› 2020, Vol. 47 ›› Issue (3): 318-327.doi: 10.7518/gjkq.2020043

• 综述 • 上一篇    下一篇

膜龈手术在牙龈乳头保留与重建中的应用

柳佳美,吴燕岷()   

  1. 浙江大学医学院附属第二医院口腔内科 杭州 310009
  • 收稿日期:2019-08-06 修回日期:2020-02-06 出版日期:2020-05-01 发布日期:2020-05-08
  • 通讯作者: 吴燕岷
  • 作者简介:柳佳美,学士,Email：liu-jm@zju.edu.cn
  • 基金资助:
    浙江省科学技术厅公益研究计划(LGF18H140003)

Application of periodontal plastic surgery in the preservation and reconstruction of gingival papilla

Liu Jiamei,Wu Yanmin()   

  1. Dept. of Oral Medicine, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou 310009, China
  • Received:2019-08-06 Revised:2020-02-06 Online:2020-05-01 Published:2020-05-08
  • Contact: Yanmin Wu
  • Supported by:
    Public Welfare Research Program of Science and Technology Department of Zhejiang Province(LGF18H140003)

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摘要：

牙周组织丧失所导致的前牙牙龈乳头退缩是影响口腔美学的重要原因。牙龈乳头退缩还会引起食物嵌塞、牙龈乳头炎症,甚至影响发音。牙龈乳头退缩的治疗包括手术治疗与非手术治疗。膜龈手术中保留牙龈乳头的切口设计能避免龈乳头高度丧失,上皮下结缔组织移植术结合特殊的翻瓣术式是重建牙龈乳头的重要途径。牙龈乳头保留或重建成功的关键在于良好的血供。本文就膜龈手术方式在保留和重建牙龈乳头中的作用作一综述,以期为临床诊疗提供借鉴。

关键词: 牙龈乳头保留, 牙龈乳头重建, 上皮下结缔组织移植术

Abstract:

Papilla loss due to periodontal tissue defects could lead to aesthetic problems, food impaction, gingivitis, and pronunciation problems. Periodontal surgery and non-surgical treatment are the major solutions to preserve or reconstruct the gingival papilla. Relative periodontal surgery includes special surgical incisions to reduce papilla loss and application of soft tissue grafts or substitutes for papilla reconstruction. Sufficient blood supply is the key to successful periodontal mucogingival surgery. This article aims to review the specific role of periodontal surgery in the preservation and reconstruc-tion of gingival papilla.

Key words: gingival papilla preservation, gingival papilla reconstruction, subepithelial connective tissue graft

中图分类号: 

  • R781.4 +5

图 1

保留牙龈乳头切口示意图 A：保留牙龈乳头切口;B：改良的保留牙龈乳头切口;C：简化的保留牙龈乳头切口。虚线示沟内切口。"

表 1

膜龈手术的保留牙龈乳头切口设计"

手术术式 切口设计 操作步骤 主要适用手术
沟内 龈乳头 垂直
切口 切口 切口
保留牙龈乳 保留牙龈乳头切口 + - - 绕邻牙一周作沟内切口,在腭侧作弧形切 引导组织再生术（牙间隙
头切口 口,将完整保留的龈乳头连在唇瓣上 充分时）
改良的保留牙龈乳头切口 + - - 绕邻牙一周作沟内切口,在唇侧作弧形切
口连接邻牙近中轴角,将完整保留的龈乳
头连在腭瓣上
简化的保留牙龈乳头切口 + + - 绕邻牙一周作沟内切口,在牙间龈乳头上作 引导组织再生术（牙间隙
一牙颊侧近中轴角向邻牙邻面中点的切口 不充分时）
“鲸尾”技术 “鲸尾”技术 + - + 在骨缺损累及的2颗患牙的远缺损处,沿远 引导组织再生术（前牙区
中轴角各作一垂直切口,垂直切口延伸至 垂直骨缺损）
膜龈联合,其终点作水平切口相连,绕邻
牙一周作沟内切口,龈乳头保留在唇瓣上
改良 “鲸尾”技术 + - + 在骨缺损累及的2颗患牙的远缺损处,沿远
中轴角作2个半月形切口代替垂直切口和水
平切口至膜龈联合处
全牙龈乳头 + - + 在颊侧做沟内切口,然后在远离患牙骨缺 引导组织再生术（后牙区
保留技术 损处作一垂直切口,翻开全厚瓣,用显微 垂直骨缺损）
器械分离骨缺损处牙龈乳头,提升完整的
牙龈乳头
非牙龈乳头 - - - 仅作一颗患牙颊侧根方的水平切口,切口 引导组织再生术（颊侧骨
切口 尽可能远离骨缺损和龈缘,冠向翻起黏骨 壁吸收）
膜瓣
隧道技术 + - + 沿患牙颈部作沟内切口,然后在非直视下 根面覆盖
利用隧道专用显微器械分离颊侧半厚瓣至
膜龈联合处

图 2

“鲸尾”技术切口示意图 A：“鲸尾”技术;B：改良“鲸尾”技术。虚线示沟内切口。"

图 3

全牙龈乳头保留技术示意图 A：全牙龈乳头保留技术的切口设计;B：翻瓣后龈乳头仍保留。虚线示沟内切口,黄色箭头示窄深骨缺损处,黑色箭头示翻瓣方向。"

图 4

非牙龈乳头切口示意图"

图 5

隧道技术示意图 A：隧道技术唇侧示意图,线段状虚线示沟内切口,点状阴影示隧道;B：隧道技术矢状面示意图,虚线示隧道。"

图 6

种植二期保留牙龈乳头切口示意图 A：U形切口;B：H形切口;C：十字形切口;D：S形切口。虚线同心圆示种植体。"

图 7

Beagle术式示意图 A：Beagle术式腭侧示意图;B、C：Beagle术式矢状面示意图;D：改良Beagle术式唇侧示意图;E、F：改良Beagle术式矢状面示意图。虚线示沟内切口。"

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