審美性を要求される患者における多発性後退型欠損の治療

Treatment of multiple recession-type defects in patients with esthetic demands.

抄録

背景:

口腔内の審美領域に隣接歯に影響を及ぼす複数の後退欠損が存在する場合、患者への配慮から、欠損自体に近い軟組織を用いてすべての歯肉欠損を同時に修正できる手術法を選択することが推奨される。本研究の目的は、審美的要求を有する患者の複数の退縮欠損の治療において、冠状進行フラップ法という新しい外科的アプローチの有効性を、歯根被覆率に関して評価することである。

BACKGROUND: When multiple recession defects affecting adjacent teeth in esthetic areas of the mouth are present, patient-related considerations suggest the selection of surgical techniques that allow all gingival defects to be simultaneously corrected with the soft tissue close to the defects themselves. The aim of the present study was to evaluate, with respect to root coverage, the effectiveness of a new surgical approach to the coronally advanced flap procedure for the treatment of multiple recession defects in patients with esthetic demands.

方法:

口腔内の審美部位に隣接歯に影響を及ぼす2箇所以上の後退型欠損を有する、全身的にも歯周的にも健康な22名の若年被験者を試験に登録した。すべての退縮はミラークラスIまたはIIであった。各患者は，冠状進行性フラップ法を改良して，存在するすべての退縮を同時に治療した．術後1年目に臨床的再評価を行った。

METHODS: Twenty-two young systemically and periodontally healthy subjects with at least 2 recession-type defects affecting adjacent teeth in esthetic areas of the mouth were enrolled in the study. All recessions were Miller Class I or II. In each patient, all present recessions were treated at the same time with a modification of the coronally advanced flap technique. The clinical re-evaluation was made 1 year after the surgery.

結果:

合計73の歯肉退縮（平均退縮深さ2.8mm）が治療され、各被験者の平均歯肉退縮数は3.4個であった。1年後の検査では，平均97％が軟組織で覆われ，64欠損（88％）が完全に歯根で覆われていた．22 例中 16 例（73%）ですべての歯根が完全に覆われ，歯根被覆率と治療した歯根欠損の数との間に統計的な有意差は認められなかった．1年後に角化組織の統計的に有意な増加（0.6mm）が認められ、この増加は術前の角化組織量と逆相関していた（P <0.001）。重回帰モデルにより，根面被覆率という最終結果は，初期後退深度と術前角化組織の量に有意に影響されることが示された．初期状態が悪く，退縮欠損の先端部の角化組織の量が少ない症例では，退縮深度がより小さくなることが確認された．

RESULTS: A total of 73 recessions (mean recession depth 2.8 mm) were treated; mean number of gingival recessions in each subject was 3.4. At the 1-year examination, on average, 97% of the root surface was covered with soft tissue and 64 defects (88%) showed complete root coverage. Complete root coverage in all recessions was achieved in 16 out of 22 patients (73%), and no statistically significant relationship was found between the root coverage results and the number of recession defects treated in each patient. A statistically significant increase of keratinized tissue (0.6 mm) was observed after 1 year; this increase was inversely correlated (P <0.001) with the amount of presurgical keratinized tissue. The multiple regression model showed that the final result, in terms of root coverage, was significantly affected by the initial recession depth and by the amount of presurgical keratinized tissue. Greater reductions in recession depth were observed in the cases with worse initial conditions and with lesser amount of keratinized tissue apical to the recession defect.

結論:

本研究の結果、提案した外科的手法は、口腔内の審美領域にある歯に影響を及ぼす複数の歯肉退縮の治療に非常に有効であり、外科的介入中に同時に治療した退縮の数および手術前に欠損部の先端に最小限の角化組織が存在するかにかかわらず、根管治療の成功結果を達成することができることが示された。

CONCLUSIONS: The results of the present study demonstrated that the proposed surgical technique was very effective for the treatment of multiple gingival recessions affecting teeth in esthetic areas of the mouth and that these successful root coverage results could be achieved irrespective to both the number of recessions simultaneously treated during the surgical intervention and the presence, before surgery, of a minimal amount of keratinized tissue apical to the defects.