後牙區域以隧道穿通術合併結締組織移植進行牙根覆蓋術：18個月追蹤

Root Coverage of the Mandibular Posterior Teeth with a Connective Tissue Graft by the Tunneling Technique: An Eighteen-Month Follow-Up

文萬鈞(Wan-Chun Wen) ； 郭博仁(Po-Jan Kuo) ； 江正陽(Cheng-Yang Chiang) ； 戴得育(Te-Yu Tai)

《臺灣牙周病醫學會雜誌》 19卷3期 (2014/09) Pp. 271-279

https://doi.org/10.6121/TAP.2014.19.3.09

摘要

牙齦退縮於後牙區域雖不似前牙區對美觀有明顯影響，但可能會對病患之生活品質造成影響，例如牙根敏感或口腔衛生維持的困難。對於治療後牙區Miller's一至二級的牙齦退縮文獻上有跡可尋，但針對後牙Miller's第三級牙齦退縮之治療術式，並未有大規模的文獻報告，也未有相當穩定的治療方法，因此提出本病例報告與討論。本病例為病患曾矯正治療拔除左下一顆小臼齒，經過後續之牙周破壞與齒頸部磨耗，造成左下後牙區由小臼齒至第一大臼齒之第三級牙齦退縮。此區域牙根覆蓋術利用冠向移位皮瓣與隧道穿通術設計翻瓣，與結締組織移植體併用，以改善牙齦退縮與牙齦外型，經過18個月後追蹤，後牙牙根覆蓋比率為50%與70%。

關鍵字

牙根覆蓋術 ； 隧道穿通術 ； 結締組織移植 ； 冠向移位皮瓣

並列摘要

Gingival recession of the posterior teeth may not raise any esthetic concerns. Nevertheless, such recession may become an impact on the patient's quality of life as a result of either root sensitivity or difficulties in maintaining oral hygiene. Most studies of root coverage procedures to treat gingival recession have emphasized anterior dentition, while literature on the posterior teeth has remained limited. Based on literature that focuses on the esthetic area, the treatment outcomes for Miller's Class I and II recession is usually predictable and stable with a high percentage of coverage. However, when it comes to Miller's Class III and IV recession, unpredictable results have been found in terms of root coverage in a number of studies. The aim in this case report was to achieve a reasonable root coverage percentage in a patient with Miller's Class III gingival recession of posterior teeth. This was done by combining surgical techniques that have been shown to have good results. This patient suffered from periodontal breakdown around the lower left premolar and molar and this had resulted in Miller's Class III recession and cervical abrasion. To correct the gingival recession and achieve root coverage, a coronally advanced flap, combined with connective tissue grafting and tunneling access through interdental papilla, were performed. The root coverage percentage that resulted ranged from 50% to 70% and an obvious increase in gingival thickness was also achieved for the posterior teeth after eighteen months follow up.

並列關鍵字

root coverage ； tunneling technique ； connective tissue graft ； coronally advanced flap