国际口腔医学杂志

国际口腔医学杂志 ›› 2025, Vol. 52 ›› Issue (3): 323-332.doi: 10.7518/gjkq.2025039

• 牙周病例展示 • 上一篇    

腭侧带蒂结缔组织转瓣移植联合冠修复重建美学区龈乳头1例

周婕妤1(),赵蕾1,吴亚菲1,李勇2,赵寰1()   

  1. 1.口腔疾病防治全国重点实验室 国家口腔医学中心 国家口腔疾病临床医学研究中心;四川大学华西口腔医院牙周病科 成都 610041
    2.口腔疾病防治全国重点实验室 国家口腔医学中心 国家口腔疾病临床医学研究中心;四川大学华西口腔医院修复Ⅰ科 成都 610041
  • 收稿日期:2024-03-16 修回日期:2024-07-17 出版日期:2025-05-01 发布日期:2025-04-30
  • 通讯作者: 赵寰
  • 作者简介:周婕妤，主治医师，博士，Email：453499723@qq.com
  • 基金资助:
    国家自然科学基金(82301089);四川大学华西口腔医院探索与研发项目(RD-02-202407)

Vascularized interpositional periopel connective tissue flap combined with crown restoration for reconstruction of esthetic gingival papillae: a case report

Jieyu Zhou1(),Lei Zhao1,Yafei Wu1,Yong Li2,Huan Zhao1()   

  1. 1.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
    2.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Prosthodontics Ⅰ, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2024-03-16 Revised:2024-07-17 Online:2025-05-01 Published:2025-04-30
  • Contact: Huan Zhao
  • Supported by:
    National Natural Science Foundation of China(82301089);Research and Develop Program, West China Hospital of Stomatology, Sichuan University(RD-02-202407)

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摘要：

前牙美学区由于牙周炎、局部解剖因素、机械损伤或异常力等原因易出现牙龈退缩、牙齿移位形成的“黑三角”的现象，是目前口腔临床治疗的难点之一。血管化腭骨膜间结缔组织（VIP-CT）瓣是一种上腭前蒂结缔组织瓣，血供充足，可促进骨移植物成骨，改善邻间隙软组织缺损。本文报道了1例前牙区牙龈退缩伴牙齿移位、龈乳头缺失的病例，经过VIP-CT转瓣移植和骨增量手术后软硬组织状况显著改善，随后联合冠修复恢复邻面触点，最终有效重建了美学区龈乳头，获得了理想的美学结果。

关键词: 牙龈退缩, 龈乳头缺陷, 黑三角, 血管化腭骨膜间结缔组织瓣, 修复治疗

Abstract:

The “black triangle” formed by gingival recession and tooth displacement in the aesthetic area of anterior teeth due to periodontitis, local anatomical factors, mechanical injury, or abnormal occlusal force is a difficulty in oral clinical treatment. The vascularized interpositional periopel connective tissue (VIP-CT) flap is a connective tissue flap from the palate that has sufficient blood supply. It can promote bone graft osteogenesis and improve soft tissue defects in the labial and adjacent spaces. In this paper, we report a case of gingival recession in the aesthetic area with tooth displacement and absence of gingival papillae. The soft and hard tissue status was significantly improved after VIP-CT rotary flap transplantation and bone graft augmentation. This approach was combined with crown repair to restore the adjacent contact. The gingival papillae in the aesthetic area were effectively reconstructed, obtaining ideal aesthetic results.

Key words: gingival recession, papillary deficiency, black triangle, vascularized palatine periosteal connective tissue flap, prosthodontic treatment

中图分类号: 

  • R781.4

图 1

初诊口内照A：右上颌腭面；B：上前牙腭面；C：左上颌腭面；D：右侧后牙颊面；E：前牙区正面；F：左侧后牙颊面；G：右下颌舌面；H：下前牙舌面；I：左下颌舌面。"

图 2

初诊牙周检查表"

表 1

12、11、21、22牙初诊PES"

PES参数12牙11牙21牙22牙
总分2167
近中龈乳头0112
远中龈乳头2022
龈缘顶点高度0000
龈缘曲线曲度0011
软组织丰满度/颜色/质地0022

表 2

12、11、21、22牙初诊WES"

WES参数12牙11牙21牙22牙
总分3366
牙冠形态0022
轮廓大小0011
牙冠颜色1111
表面纹理1111
透明度1111

图 3

初诊X线片A：12、11牙；B：21、22牙。"

图 4

初诊CBCT影像A：12牙矢状面；B：11牙矢状面；C：21牙矢状面；D：22牙矢状面；E、F：12、11、21、22牙冠状面；G、H：12、11、21、22牙水平面。"

图 5

初诊牙周预后评估"

图 6

11、12牙骨增量术+VIP-CT转瓣移植过程A~C：术前测量，11、12牙唇侧角化龈宽度6 mm，11牙远中牙龈退缩为5 mm，12牙近中牙龈退缩为4 mm；D：唇侧保留龈乳头切口，13牙近中轴角处行垂直切口；E：唇侧制备冠向复位瓣；F：11—16牙腭侧制备VIP-CT瓣，蒂部位于11、12牙龈乳头腭侧根方，瓣长度为25 mm，宽度7 mm，厚度2 mm；G：11、12牙间Ⅱ壁骨下袋内植入Geistlich Bio-Oss?胶原骨材料；H~J：将VIP-CT瓣由腭侧转向唇侧固定于骨膜上，覆盖12牙暴露根面；K：受区唇侧半厚瓣冠向复位缝合；L：缝合关闭腭侧供区创口。"

图 7

11、12牙VIP-CT瓣移植术联合牙冠修复后口内照A：术后2周前牙区正面；B：术后2周前牙局部放大；C：术后2周前牙区腭面；D：术后1年前牙区正面；E：术后1年12、11、21、22牙腭面；F：术后1年11—14牙腭面；G：牙冠修复治疗后1年前牙区正面；H：牙冠修复治疗后1年前牙区正面张口状态；I：牙冠修复治疗后1年前牙区侧面观。"

图 8

11、12牙VIP-CT瓣移植术后1年牙周检查及风险评估A：牙周检查表；B：牙周风险评估表。"

图9

11、12牙VIP-CT瓣移植术后1年X线片"

图10

11、12牙术前和最终修复后1年对比A：治疗前口内照；B：治疗前X线片；C：治疗前牙周检查表；D：治疗后口内照；E：治疗后X线片；F：治疗后牙周检查表。"

表 3

12、11、21、22牙术前和最终修复后1年效果对比"

观察

时间

PES分值WES分值11、12牙间隙
12牙11牙21牙22牙12牙11牙21牙22牙PPIpCEJ-BC
治疗前2167336647 mm
治疗后10101010888813.7 mm
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