- 期刊
以隧道式皮瓣合併結締組織移植物治療單一或多處牙齦萎縮：病例系列
Tunneling Flap Procedures with Connective Tissue Grafts for Single or Multiple Gingival Recessions: Case Series
摘要
牙齦萎縮為牙齦邊緣往牙骨質牙釉質交接處根向位移，可能造成美觀問題，亦與牙本質敏感、齲齒、齒頸部磨耗、牙菌斑堆積相關。治療牙齦萎縮從過往游離牙齦移植物、帶蒂皮瓣、搭配結締組織移植物，發展至隧道式皮瓣，隧道式皮瓣因為免除切割牙齦乳頭以及垂直鬆弛線，提供較佳的血流供應、減少術後疤痕形成。由於隧道式皮瓣的優點，吸引很多醫師在進行牙根覆蓋時，選擇使用此項術式。但是它卻是一個技術要求較高的術式，施術者需有相當的訓練。這類術式可能常見的失敗原因有皮瓣張力、皮瓣設計、移植物尺寸、傷口穩定性等。所以本文提出三個案例分別針對上述常見的影響因子進行一系列的預防措施，包含皮瓣減張、合適的皮瓣設計、移植物的建議尺寸、和傷口穩定的注意事項，以及後續發生併發症時的處置，做為欲執行此類術式的醫師們在操作此術式時的參考。
並列摘要
Gingival recession was defined as the displacement of the marginal tissue apical to the cement-enamel junction (CEJ), which might cause esthetic problems, as well as dentinal hypersensitivity, caries, abrasion and plaque accumulation. The evolution of treatment of gingival recession was from free gingival graft, pedicle flap, along with connective tissue graft to tunnel flap. Tunneling flap technique avoids cutting the gingival papillae and vertical releasing incisions, providing better blood supply and reducing scar formation postsurgically. Due to the advantages of the tunneling flap, many clinicians have chosen to use this technique for root coverage procedures. However, it is a technique sensitive procedure, requiring significant training from the operator. Improper flap tension, flap design, graft dimension and unstable wound stability are common causes of failure. This article presents three cases that detail preventive measures for these common failure factors, including release of flap tension, proper flap design, recommended graft dimension, considerations of wound stability, as well as management of potential complications. This serves as a reference for clinicians whishing to perform tunneling flap procedures.