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下顎骨の深い歯肉退縮に対する冠状動脈性フラップ＋結合組織移植術。無作為化対照臨床試験
Coronally advanced flap + connective tissue graft techniques for the treatment of deep gingival recession in the lower incisors. A controlled randomized clinical trial.
PMID: 24802283
抄録
目的:
本研究の目的は、下顎切歯に影響を及ぼす深い歯肉退縮の治療に対して、2つの異なる外科的アプローチの臨床的・審美的結果を比較することであった。
AIM: The aim of this study was to compare the clinical and aesthetic outcomes of two different surgical approaches for the treatment of deep gingival recession affecting the mandibular incisors.
方法:
下切歯のミラークラスIおよびII歯肉退縮（3mm以上）を有する50名の患者を登録した。25名をコントロール群に，残りの25名をテスト群に無作為に割り付けた．すべての欠損はcoronally advanced flap + connective tissue graft（CAF + CTG）で治療し，test群では唇側粘膜下組織（LST）を除去した．術後の病的状態は1週間後に評価された。1年後に臨床的、審美的評価を行った。
METHODS: Fifty patients with Miller class I and II gingival recessions (≥ 3 mm) in the lower incisors were enrolled. Twenty-five patients were randomly assigned to the control group and the other 25 patients to the test group. All defects were treated with the coronally advanced flap + connective tissue graft (CAF + CTG) and in the test group the labial submucosal tissue (LST) was removed. Post-operative morbidity was evaluated at 1 week. Clinical and aesthetic evaluations were made at 1 year.
結果:
テスト群では，より大きな後退の減少，CRCの確率（adjusted OR 7.94 95% CI = 1.88-33.50, p = 0.0024）およびGTの増加が統計的に観察された．コントロール群では、より大きなグラフト露出とKTHの増加が示された。テスト群では、より良い審美的な結果が観察された。患者の鎮痛想定、術後の不快感や出血については、群間で統計的に有意な差は認められなかった。
RESULTS: Statistically greater recession reduction, probability of CRC (adjusted OR 7.94 95% CI = 1.88-33.50, p = 0.0024) and greater increase in GT were observed in the test group. Greater graft exposure and increase in KTH were demonstrated in the control group. Better aesthetics outcomes were observed in the test group. No statistically significant between groups differences were demonstrated in patient analgesic assumption and post-operative discomfort and bleeding.
結論:
CAF + CTG手術におけるLST除去は，下切歯に影響を及ぼす歯肉退縮の治療において，より良い歯根被覆と審美的結果を提供することが示唆された．
CONCLUSIONS: LST removal during CAF + CTG surgery is indicated to provide better root coverage and aesthetic outcomes in the treatment of gingival recessions affecting the lower incisors.