Application of the Coronally Positioned Palatal Sliding Flap to Thin Palatal Masticatory Mucosa, A Case Series Report

腭側冠向移位瓣用於較薄的腭側咀嚼黏膜之病例系列報告

徐世勳(Shih-Shiun Shyu) ； 傅鍔(Earl Fu) ； 沈一慶(E-Chin Shen)

《臺灣牙周病醫學會雜誌》 22卷1期 (2017/03) Pp. 74-83

https://doi.org/10.6121/TAP.2017.22.1.08

摘要

The use of a coronally positioned buccal flap during guided bone regeneration is a common technique for achieving primary and tension free closure in the maxilla. Various disadvantages, including deficiencies in keratinized tissue and reduced vestibular depth on the buccal side, can occur following the application of a coronally positioned buccal flap. A specific technique, the coronally positioned palatal sliding flap (CPPSF), was design to coronally position the palatal flap such that these drawbacks might be minimized. However, the designers of the CPPSF suggested that at least 4 mm of palatal masticatory mucosa (PMM) thickness was required. This would seem to limit the clinical application of CPPSFs because the average thickness of the human PMM in the literature is less than 4mm. This case series presents three clinical cases of implant placement combined with guided bone regeneration in the maxilla. CPPSF was utilized to achieve primary closure when the mean PMM thicknesses were 2.63, 3.03 and 3.06 mm before treatment. The resorbed ridges were successfully augmented in all three cases with sufficient keratinized tissue being present around the implant prostheses.

關鍵字

technique ； palatal flap ； GBR ； implant

並列摘要

傳統上在上顎區使用引導骨再生術時，常會使用到冠向移位之頰側定位瓣以利手術區之初級縫合。然而頰側之角質化上皮減少以及前庭變淺將會隨著頰側皮瓣往冠向移位而發生。一特殊之手術技術「腭側冠向移位瓣」可以將腭側咀嚼黏膜往冠向移位，進而減少上述情況。不過此技術設計者建議腭側咀嚼黏膜至少需要4公釐之厚度以施行此項技術，而此厚度大於了文獻回顧中腭側咀嚼黏膜之平均厚度。此病例系列報告中提出了三例於上顎區進行植牙合併引導式骨再生術之臺灣患者，且皆使用了腭側冠向移位瓣幫忙達到手術區之初級縫合。雖然此三例病例術前腭側咀嚼黏膜之平均厚度皆不到此技術設計者建議之厚度，不過手術區在術後皆獲得成功之骨再生，且植體贗復物周圍皆具有足夠之角質化上皮。

並列關鍵字

手術技術 ； 腭側皮瓣 ； 引導式骨再生 ； 植牙