血小板濃縮生長因子聯合冠向復位瓣修復對牙齦退縮患者根面覆蓋效果及美學評價的影響

于文鳳　于蘭　呂敏敏　紀坤　張志媛　路茜　崔鳳林

[摘要]目的：探究血小板濃縮生長因子（platelet Concentration Growth Factor， pCGF）聯合冠向復位瓣修復對牙齦退縮患者根面覆蓋效果及美學評價的影響。方法：選取2016年6月-2017年6月筆者醫院口腔科收治的32例牙齦退縮患者，觀察組：16例患者（28顆患牙），接受pCGF+冠向復位瓣修復手術治療;對照組：16例患者（26顆患牙），接受上皮下結締組織瓣+冠向復位瓣修復手術治療。測量對比兩組患者術前及術后6個月角化齦寬度（KTW）、探診深度（PD）、牙齦退縮深度（RD）、臨床附著水平（CAL）及牙齦厚度（GT），根面覆蓋情況以及美學評價指標。結果：術后6個月，兩組患者KTW、GT明顯大于術前，PD、RD及CAL明顯小于術前（P<0.05）;且觀察組患者GT值明顯大于對照組（P<0.05）;觀察組患者術后PES、VAS評分明顯高于對照組，就診滿意度總分明顯高于對照組（P<0.05）。結論：應用血小板濃縮生長因子聯合冠向復位瓣修復治療牙齦退縮與上皮下結締組織瓣聯合冠向復位瓣修復手術的臨床療效相當，但前者美觀度更高，患者就診體驗更好。

[關鍵詞]牙齦退縮;血小板濃縮生長因子;上皮下結締組織瓣;根面覆蓋

[中圖分類號]R783.4? ? [文獻標志碼]A? ? [文章編號]1008-6455（2019）10-0117-04

Abstract： Objective? To investigate the effect of platelet Concentration Growth Factor combined with coronary reduction flap on the root surface coverage and aesthetic evaluation of patients with gingival recession.? Methods? 32 patients with gingival recession admitted to our hospital from June 2016 to June 2017 were enrolled in this study. The observation group was 16 patients （28 teeth） who underwent pCGF+ coronary reduction flap surgery， and The control group consisted of 16 patients （26 teeth） who underwent subepithelial connective tissue flap+ coronary reduction flap surgery . The keratosis width （KTW）， depth of probing （PD）， depth of gingival recession （RD）， clinical attachment level （CAL）， and gingival thickness （GT），? and the root surface coverage and Aesthetic evaluation indicators were measured and compared before and after surgery in the two groups. Results? At 6 months after operation， the KTW and GT were significantly larger and the preoperative， PD， RD and CAL were significantly smaller than those before operation （P<0.05）. The GT value of the observation group was significantly higher than that of the control group （P<0.05）. The PES and VAS scores of the patients in the group were significantly higher than those in the control group， and the total score of satisfaction was significantly higher than that of the control group （P<0.05）. Conclusion? The application of platelet-concentrated growth factor can further improve the aesthetic score， the aesthetics are higher， and the patient's experience of visiting is better.

Key words： gingival recession; platelet concentration growth factor; subepithelial connective tissue flap; root cover

牙齦退縮是由于牙齦邊緣向頂端遷移造成牙根表面的暴露，其在人群中較為常見，臨床多根據Miller分型分為MillerⅠ～Ⅳ度，共4型[1]。牙齦退縮較輕者多無自覺癥狀，而退縮嚴重的患者可出現根面敏感、食物嵌塞、牙頸部齲及影響美觀等問題，也是患者尋求治療的主要原因[2]。目前，各種外科手術已被用于牙齦退縮的臨床治療，包括側臥皮瓣、游離齦移植、冠狀動脈瓣、上皮下結締組織移植以及引導組織再生膜等，其中上皮下結締組織移植聯合冠向復位瓣被臨床公認為治療牙齦退縮的金標準[3-4]。但上皮下結締組織瓣移植方案仍然存在一些問題，例如治療耗時過長，術后疼痛和出血，復發率較高，需要二次手術，以及供體組織有限等[5]。……