Reconstruction of Severe Hard and Soft Tissue Defects Combined with Gingival Recession of Adjacent Teeth Using Modified Vascularized Interpositional Periosteal Connective Tissue Technique

利用改良式血管化插入式骨膜－結締組織瓣重建嚴重軟硬組織缺陷合併鄰牙牙齦萎縮

蔣依婷(Yi-Ting Chiang) ； 潘惠玲(Whei-Lin Pan) ； 陳必綸(Pi-Lun Chen)

《臺灣口腔顎面外科學會雜誌》 24卷2期 (2013/06) Pp. 118-125

摘要

面對因牙齒缺失造成的嚴重軟硬組織缺陷，想要達到理想的美觀結果是相當困難的。若在以牙冠牙橋重建牙齒缺失的病例中，臨床上可以搭配軟組織增進手術來塑造自然的齒間乳頭的外型；然而軟組織很容易在癒合過程當中大量萎縮，而不足以重建理想中的軟組織外觀，因此我們可以考慮不同於傳統軟組織增進術的作法，利用保有蒂而有較好血液供應的血管化插入式骨膜一結締組織瓣來達到比較可預期的軟組織增進結果。本文提出一案例使用血管化插入式骨膜一結締組織瓣作軟組織增進術，同時完成鄰牙的牙根覆蓋術，完成左上第一小臼齒缺失造成之Seibert第三級分類齒槽骨嵴缺損，合併左上犬齒Miller第四級分類之牙齦萎縮之治療，最後再用牙橋將缺失的左上第一小臼齒重建，此術式有相當不錯的可預期性，最後達到患者滿意的結果及大幅的美觀改善。

關鍵字

改良式血管化插入式骨膜－結締組織瓣 ； 牙齦萎縮 ； 軟硬組織缺陷

並列摘要

Management of severe soft and hard tissue defects following tooth loss is critical to achieve optimal esthetic outcomes. In cases of crown and bridge fabrication, soft tissue ridge augmentation along with the use of ovate pontic for shaping the gingiva1 contour is usually sufficient to create the appearance of natural interdental papilla. However, a large volume of soft tissue graft usually contracts during the healing process and is insufficient to reestablish the soft tissue outline. Thus, vascularized interpositional periosteal connective tissue (VIP-CT) technique, an altemative to the traditional soft tissue augmentation, is recommended since the pediculated graft is rich in blood supply and provides comparatively predictable results. The purpose of this article was to present a case of Seibert class III ridge defect in the edentulous region of maxillary left first premolar in combination with Miller class IV gingival recession in the adjacent canine demonstrating significant increase in horizontal and vertical soft tissue volume following VIP-CT grafting and root coverage of adjacent tooth. Bridge for the maxillary left canine and second premolar to replace the missing first premolar was subsequently fabricated. A satisfactory outcome was obtained since the technique was relatively predictable with great improvement of esthetics.

並列關鍵字

modified vascularized interpositional periosteal connective tissue graft ； gingival recession ； soft and hard tissue deformities