国际口腔医学杂志

国际口腔医学杂志 ›› 2025, Vol. 52 ›› Issue (3): 333-340.doi: 10.7518/gjkq.2025049

• 牙周病例展示 • 上一篇    

Ⅲ期C级牙周炎正畸患者上前牙龈乳头缺陷伴牙龈退缩1例

赵美林(),赵依琼,黄姣()   

  1. 重庆医科大学附属口腔医院 口腔疾病与生物医学重庆市重点实验室重庆市高校市级口腔生物医学工程重点实验室 重庆 401147
  • 收稿日期:2024-03-19 修回日期:2025-01-22 出版日期:2025-05-01 发布日期:2025-04-30
  • 通讯作者: 黄姣
  • 作者简介:赵美林，副主任医师，硕士，Email：zhaomeilin@cqmu.edu.cn
  • 基金资助:
    重庆市科学技术局项目(CSTB2022BSXM-JCX0047)

Treatment of gingival papilla loss with gingival recession in orthodontic patients with stage Ⅲ grade C periodontitis: a case report

Meilin Zhao(),Yiqiong Zhao,Jiao Huang()   

  1. Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China
  • Received:2024-03-19 Revised:2025-01-22 Online:2025-05-01 Published:2025-04-30
  • Contact: Jiao Huang
  • Supported by:
    Chongqing Municipal Science and Technology Bureau Project(CSTB2022BSXM-JCX0047)

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摘要：

完善的牙周非手术治疗和正畸治疗可以改善牙周炎患者的口腔健康、功能和美观，对于重度牙周炎患者，在牙周系统治疗后可能出现牙龈退缩和龈乳头缺陷等美学问题，需要个性化多学科合作治疗。本案例报道1例Ⅲ期C级牙周炎患者在牙周非手术治疗、前牙区单纯翻瓣术及正畸治疗后出现上前牙唇侧牙龈退缩及龈乳头缺陷，通过术前X线测量及诊断饰面分析，评估可以降低接触点到牙槽嵴顶的距离到5 mm内，并获得较理想的牙冠美学效果。通过设计“T”型结缔组织瓣及唇侧冠向复位瓣重建龈乳头及改善唇侧牙龈退缩，通过复合树脂贴面修复降低接触点位置并进一步修复黑三角。术后2年获得邻面附着水平的明显改善，理想的唇侧根面覆盖效果，以及较好的龈乳头形态，改善了患牙的预后，并有利于美学效果的长期保持。长期的临床效果需要进一步的临床观察。

关键词: 黑三角, 牙周炎, 正畸, 翻瓣术, 牙龈退缩, 龈乳头重建, 根面覆盖, 贴面

Abstract:

Comprehensive periodontal nonsurgical treatment and orthodontic treatment can improve the oral health, function, and aesthetics of patients with periodontitis. For patients with severe periodontitis, aesthetic problems, such as gingival recession and gingival papillary defects, may occur after periodontal system treatment, requiring personalized multidisciplinary collaborative treatment. This article reports a case of a patient with stage Ⅲ grade C periodontitis who underwent periodontal nonsurgical, simple flap, and orthodontic treatments in the anterior tooth area and labial-gingival retraction and gingival papillary defect repair in the anterior teeth. Preoperative X-ray measurement and diagnostic mock-up analysis revealed that the distance from the contact point to the alveolar ridge crest could be reduced to less than or equal to 5 mm and an ideal aesthetic effect of the dental crown could be achieved. A T-shaped connective tissue flap and lip coronal-positioned flap were designed to reconstruct the gingival papilla and improve the lip gingival recession. Composite resin veneers were used to lower the contact point position and repair black triangles. Remarkable improvement in clinical attachment level, ideal root coverage effect, and good gingival papilla morphology were achieved two years after surgery. These changes improved the prognosis of the affected teeth and facilitated the long-term maintenance of aesthetic effects. Long-term cli-nical outcomes require further clinical observation.

Key words: black triangle, periodontitis, orthodontics, open flap debridement, gingival recession, interdental papilla reconstruction, root coverage, veneer

中图分类号: 

  • R781.4

图1

患者术前口内照A：正面照；B：右侧面照；C：左侧面照。"

图2

初诊牙周检查表"

图 3

术前检查及治疗设计A：唇侧观；B：术前测量；C：X线片；D：术前设计，21、22牙间沟内切口及靠腭侧分离唇侧龈乳头（绿色虚线示），唇侧瓣通过隧道技术冠向复位（绿色椭圆型区域），接触点下降的范围（橙色虚线示），牙冠通过贴面修复（绿色半月形示）。"

图4

术中口内照A：术前设计沟内切口及唇侧瓣隧道冠向复位瓣（绿色虚线及椭圆形示）；B：术前根面处理；C：21、22牙间牙槽骨明显吸收，牙槽骨嵴顶距离邻牙接触点下方7~8 mm；D：唇侧瓣隧道预备，无张力冠向复位；E：设计并获取左侧腭部游离龈瓣；F：去上皮形成结缔组织瓣；G：设计成“T”型结缔组织瓣并固定，“水平段”（绿色箭头示）放置在唇侧，“垂直段”（橙色箭头示）放置在腭侧及邻面；H：通过唇侧冠向复位瓣复位的位置固定“T”型瓣的水平段两端，垂直段固定在腭侧组织面内侧（绿色箭头示）；I：唇腭侧瓣无张力缝合固定。"

图 5

术后2周、2个月、3个月、12个月口内照A：术后2周唇侧照；B：术后2周腭侧照；C：术后2个月唇侧照；D：术后3个月唇侧照；E：术后12个月唇侧照； F：术后12个月腭侧照。"

图 6

术后12个月牙周检查表"

图 7

术后15个月口内照A：唇侧左侧面照；B：唇侧正面照；C：腭侧照。"

图 8

术后根尖片A：术后15个月；B：术后 18个月。"

图9

术后18个月口内照A：唇侧照；B：腭侧照。"

图10

术后24个月口内照A：唇侧照；B：腭侧照。"

表 1

21、22牙术前与术后24个月临床指标比较"

时间龈乳头缺陷牙龈退缩/mm黑三角大小/mm2邻面PD/mmCAL/mm
术前Ⅱ类36.33~45~6
术后24个月Ⅰ类10.62~33~4
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