歯肉退縮の治療における異なるデザインの冠状動脈フラップ。比較対照無作為化臨床試験

Coronally Advanced Flap with Different Designs in the Treatment of Gingival Recession: A Comparative Controlled Randomized Clinical Trial.

抄録

この並行二重盲検無作為化比較臨床試験の目的は、三角形のデザインを持つCoronally Advanced Flap（CAF）を用いた修正アプローチを説明し、台形タイプのCAFと根面被覆率と審美性の点でその有効性を比較することである。Miller Class IとIIに分類される歯肉退縮で，欠損部の先端側に少なくとも1mmの角化組織がある50例の孤立した歯肉退縮をCAFで治療した．これらの凹みのうち，25個を無作為に台形CAFで治療し（対照群），他の25個（試験群）を改良型三角形CAFで治療した．術後3ヵ月，6ヵ月，1年後に，患者と独立した歯周病専門医による臨床評価と審美評価が行われた．2つのCAFグループの間には，後退の減少，完全根面被覆，6ヵ月後および1年後の患者の審美的スコアに関して，統計的に有意な差は示されなかった．3ヶ月後の患者の審美的評価と歯周病専門医の歯根被覆率，カラーマッチ，コンティギュイティの評価は，三角形のCAFの方が良好であると報告された．台形CAFはケロイド形成の発生率と関連していた．シングルタイプの歯肉退縮は両タイプのCAFで良好にカバーできる．審美性を重視する患者には三角形CAFを選択することが望ましい．

The aim of this parallel double-blind randomized controlled clinical trial was to describe a modified approach using the coronally advanced flap (CAF) with triangular design and to compare its efficacy, in terms of root coverage and esthetics, with a trapezoidal type of CAF. A sample of 50 isolated Miller Class I and II gingival recessions with at least 1 mm of keratinized tissue apical to the defects were treated with CAF. Of these recessions, 25 were randomly treated with trapezoidal CAF (control group) while the other 25 (test group) were treated with a modified triangular CAF. The clinical and esthetic evaluations, made by the patient and an independent periodontist, were performed 3 months, 6 months, and 1 year after the surgery. No statistically significant difference was demonstrated between the two CAF groups in terms of recession reduction, complete root coverage, or 6-month and 1-year patient esthetic scores. Better 3-month patient esthetic evaluations and better periodontist root coverage, color match, and contiguity assessments were reported after triangular CAF. Trapezoidal CAF was associated with greater incidence of keloid formation. Single-type gingival recessions can be successfully covered with both types of CAF. The triangular CAF should be preferred for esthetically demanding patients.