牙齦退縮的重建考量

臨床上常見病患有牙齦退縮的問題。造成牙齦退縮的原因包括使用不當的牙刷與刷牙方式、薄的邊緣軟組織、骨開裂、高位之繫帶、牙齒錯位、牙根較外突、牙周炎、矯正治療及牙周治療後之副作用。裸露的牙根會造成美觀、齒質敏感、齒頸部磨耗或牙根齲齒的問題。臨床上治療牙齦退縮的手術方法眾多，包括蒂狀瓣、皮下結締組織移植、游離牙齦移植、引導組織再生手術、牙釉基質衍生物、無細胞皮膚間質、富含血小板血漿與富含血小板纖維素等，其中以皮下結締組織移植術式能得到最佳的牙根覆蓋效果與角化牙齦增加。本文除了比較各種牙根覆蓋手術的臨床效果，更進一步探討影響牙根覆蓋的因子，包括病人、牙齒、缺損、術式相關因子；臨床上須考慮牙齦退縮的嚴重程度與影響牙根覆蓋的相關因子，選擇適當的治療方式。

關鍵字

牙齦退縮；牙根覆蓋；皮下結締組織移植

並列摘要

Gingival recession is a frequent clinical feature. An improper toothbrushing technique, thin marginal tissue, bone dehiscence, a high frenum attachment, tooth malpositioning, periodontitis, orthodontic treatment or periodontal treatment all can result in a predisposition towards gingival recession. An exposed root is associated with esthetic concerns, dental hypersensitivity, cervical abrasion and root caries. There are several surgical techniques available for the treatment of gingival recession including pedicle flap creation, subepithelial connective tissue grafting, free gingival grafting, guided tissue regeneration, the use of enamel matrix derivative, the use of acellular dermal matrix, treatment with platelet-rich plasma and treatment with platelet-rich fibrin. The subepithelial connective tissue grafting technique results in the best outcome in terms of root coverage and an increase in keratinized tissue. This paper compares the clinical efficacies of the different techniques used to treat gingival recession and discusses the factors that influence root coverage outcomes, such as patient-related factors, tooth-related factors, defect-related factors and technique-related factors. The choice of an appropriate surgical technique will depend on the severity of the gingival recession and the various factors influencing root coverage.

並列關鍵字

gingival recession ； root coverage ； subepithelial connective tissue graft

國際替代計量

牙齦退縮的重建考量

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