改良腭条带移植用于角化组织增量：技术报告

文献信息

中文摘要

背景： 既往报道的条带移植技术要么使用多个腭部条带，要么使用单个腭部条带联合胶原基质，并且主要被描述用于增加种植体周围角化黏膜宽度。然而，迄今尚未报道使用腭部条带移植物进行牙齿周围角化组织（KT）增量。本技术报告描述了一种不使用辅助生物材料的单个腭部条带来增加牙齿周围KT的改良方法。
方法： 改良腭条带移植（mPSG）技术遵循标准化手术方案，包括受区床准备（三个不同区域）、供区处理（获取3 mm宽的腭部条带并仅用缝线关闭）以及移植物稳定：在移植物两端使用侧向缝线，并通过压缩性水平褥式缝线将移植物冠侧（1区）和根侧（3区）的结缔组织区与置于受区2区的移植物接合。报告一例代表性病例，并辅以额外临床图示，以展示手术步骤和临床结果。
结果： 临床观察显示，治疗牙周围的附着角化牙龈和龈沟深度增加。此外，供区术后疼痛有限（严重程度和持续时间）、无延迟出血，并且愈合更快（2周内实现完全上皮化）。
结论： mPSG方法对于牙齿周围KT增量似乎是可预测、成本效益高且“对患者友好”的。尽管如此，建议开展比较性随机临床试验以证实此处呈现的观察结果。
要点： 改良腭条带移植（mPSG）技术提供了一种使用单个腭部条带移植物同时进行牙齿周围角化组织增量和前庭加深的实用方法。该技术无需辅助生物材料，并可能减少供区并发症和治疗相关费用，但需要仔细选择病例，利用显微外科原则和高级手术技能以取得成功结果。mPSG方法可能对腭部供区组织有限的患者特别有用，例如青少年和腭穹窿较浅者，在这些患者中获取传统游离龈移植物可能具有挑战性。
通俗语言摘要： 一些患者牙齿周围坚固牙龈组织量不足，使口腔卫生更加困难，并增加牙龈炎症和刷牙时不适的可能性。增加这种组织最常用的治疗是游离龈移植物，即从腭部获取组织。尽管有效，但该手术可能导致术后疼痛、愈合延迟和供区出血。本报告描述了一种改良腭条带移植（mPSG）技术，该技术使用从腭部获取的窄条组织来增加牙齿周围附着牙龈组织的宽度。与先前描述的条带移植方法不同，该技术不需要额外生物材料，并遵循针对手术不同步骤的标准化手术方案。窄移植物设计减小了腭部创口大小，并可能改善术后患者舒适度。临床示例显示成功获得附着牙龈组织并增加牙齿周围前庭深度。腭部供区愈合迅速，并且报告的术后不适轻微。mPSG技术可能为需要附着牙龈组织增量的患者提供一种实用且成本效益高的替代方案，同时减少通常与传统移植手术相关的并发症。

英文摘要

BACKGROUND: Previously reported techniques on strip grafting have utilized either multiple palatal strips or a single palatal strip in conjunction with a collagen matrix, and have primarily been described for increasing the peri-implant keratinized mucosa width. However, the application of a palatal strip graft for keratinized tissue (KT) augmentation around teeth has not been reported to date. This technical report describes a modified approach to augment KT around teeth using a single palatal strip without adjunctive use of biomaterials.
METHODS: The modified palatal strip graft (mPSG) technique follows a standardized surgical protocol for recipient bed preparation (three distinct zones), donor site management (harvesting of a 3 mm wide palatal strip and closure with sutures only) and graft stabilization using lateral sutures at extremities of graft and compressive horizontal mattress sutures by engaging the connective tissue zones coronal (zone 1) and apical (zone 3) to the graft placed in zone 2 of recipient site. A representative case, supplemented by additional clinical illustrations, is presented to demonstrate the surgical steps and clinical outcomes.
RESULTS: Clinical observations demonstrated an increase in attached keratinized gingiva and vestibular depth around treated teeth. In addition, limited postoperative pain (severity and duration), absence of delayed bleeding, and faster healing (complete epithelialization achieved within 2 weeks) at the donor site were observed.
CONCLUSION: The mPSG approach seems to be predictable, cost-effective, and "patient-friendly" for KT augmentation around teeth. Nevertheless, comparative randomized clinical trials are suggested to confirm the observations presented here.
KEY POINTS: The modified palatal strip graft (mPSG) technique provides a practical approach for simultaneous keratinized tissue augmentation and vestibular deepening around teeth using a single palatal strip graft. The technique eliminates the need for adjunctive biomaterials and may reduce donor-site morbidity and treatment-related costs, though it requires careful case selection, utilizing microsurgical principles and advanced surgical skills for successful outcomes. The mPSG approach may be particularly useful in patients with limited palatal donor tissue, such as adolescents and individuals with a shallow palatal vault, where harvesting a conventional free gingival graft may be challenging.
PLAIN LANGUAGE SUMMARY: Some patients have an insufficient amount of firm gum tissue around their teeth, making oral hygiene more difficult and increasing the likelihood of gum inflammation and discomfort during brushing. The most commonly used treatment to increase this tissue is a free gingival graft, which involves harvesting tissue from the palate. Although effective, this procedure can result in postoperative pain, delayed healing, and bleeding at the donor site. This report describes a modified palatal strip graft (mPSG) technique that uses a narrow strip of tissue harvested from the palate to increase the width of attached gum tissue around teeth. Unlike previously described strip graft approaches, the technique does not require additional biomaterials and follows a standardized surgical protocol for different steps of the surgery. The narrow graft design reduces the size of the palatal wound and may improve patient comfort after surgery. Clinical examples demonstrated successful gain of attached gum tissue and an increase in depth of vestibule around teeth. Palatal donor site healing was rapid, and minimal postoperative discomfort was reported. The mPSG technique may provide a practical and cost-effective alternative for patients requiring attached gum tissue augmentation while reducing the morbidity commonly associated with conventional grafting procedures.