牙周手術之美學探討

Esthetic Concerns in Periodontal Surgery-Review Article

林宗佑(Tsung-Yu Lin) ； 劉錦龍(Chin-Lung Liu) ； 王振穎(Chen-Ying Wang)

《中華民國家庭牙醫學雜誌》 3卷2期 (2008/09) Pp. 13-18

https://doi.org/10.6566/JFD/2008.3(2).13

摘要

牙周手術的手術區域若牽涉前牙美觀區時，術者在術前須對患者做基礎評估、微笑分析和笑線評估後，才有辦法評估是否能藉由哪種術式去達成美觀需求。牙冠增長術和牙根覆蓋術兩類手術是一體兩面，處理方向截然不同，但在美觀上的要求和評估的重點是類似的。需要做牙冠增長術的原因多為牙冠過短或牙齦露出過多，牙冠增長術施行時，尤須注意生物寬度(Biological width)的關係與牙周生物型態(Periodontal biotype)的條件。臨床上需要做牙根覆蓋術原因，多為牙齦萎縮(Gingival recession)，根據Miller氏分類，於第一、二級的牙齦萎縮病患，醫師有機會利用牙根覆蓋術的各項術式，達成100%牙根覆蓋的效果。牙根覆蓋術包括三大類，第一類為不利用皮下結締組織，單純利用翻瓣設計達成牙根覆蓋，第二類為利用游離軟組織移植(Free soft tissue grafts)來達成牙根覆蓋，如以角化牙齦移植(Free gingival graft)或皮下結締組織配合切線或翻瓣達成牙根覆蓋，第三類為利用其它方式如牙周再生手術(GTR, Emdogain(上標 ®) regeneration)，利用無細胞人造真皮(Alloderm(上標 ®)等去達成牙根覆蓋。術者善盡評估及分析的工作，才可能達成臨床美觀的要求。

關鍵字

牙冠增長術 ； 生物寬度 ； 牙齦萎縮 ； 牙根覆蓋術

並列摘要

Operators should evaluate the patient in smile analysis and basic examination to find out the best way for fulfilling patient's esthetic concern when performing periodontal surgery in the anterior teeth area. Crown lengthening procedure and root coverage procedure are like two sides to one coin. Both treatments have different clinical procedure, but the esthetic concern and the way of pre-surgical evaluation are similar.
The main reason to perform crown lengthening clinically is usually due to short clinical crown or gingiva hyperplasia. The evaluation of biological width of individual teeth and generalized periodontal biotype are important for this procedure .On the other hand, gingiva recession is the common indication for root coverage procedure. Operators have a great chance to achieve 100% root coverage in class Ⅰ and Ⅱ gingiva recession (Miller's classification). There are usually three kinds of techniques to perform root coverage. Pedicle grafts use soft tissue adjacent to the recession area to cover the defect. Free grafts use soft tissue harvested from donor site to cover the recession defect, such as free gingival graft or subepithelial connective tissue graft. The last one is regeneration treatment for root coverage, such as guided tissue regeneration or enamel matrix proteins (Emdogain(superscript ®) regeneration) regeneration. In order to achieve the best esthetic result, a comprehensive pre-surgical evaluation can not be overemphasized.

並列關鍵字

Crown lengthening ； Biological width ； Gingival recession ； Root coverage