下顎前歯部単発性陥凹の治療におけるダブルラテラルスライディングブリッジフラップと側方クローズドトンネルの比較：疑似ランダム化臨床試験

Double Lateral Sliding Bridge Flap versus Laterally Closed Tunnel for the Treatment of Single Recessions in the Mandibular Anterior Teeth: A Pseudorandomized Clinical Trial.

抄録

(1) 背景本研究では、下顎前歯部のMiller II-III級単発性陥凹の治療において、上皮下結合組織移植（SCTG）を併用したダブルラテラルスライディングブリッジフラップ（DLSBF）法とラテラリー・クローズドトンネル（LCT）法の臨床結果と審美結果を比較した。(2) 方法この擬似ランダム化臨床試験では、14名の患者を評価した。そのうち7名はDLSBF＋SCTG群で、平均追跡期間は58.7±24.0ヶ月、7名はLCT＋SCTG群で、平均追跡期間は16.7±3.3ヶ月であった。臨床的および審美的な評価として、歯肉退縮の深さ、プロービングデプス、角化組織の幅、歯肉の厚さ、根面被覆率、根面被覆の審美的スコアについて、両群の結果を比較した。(3)結果追跡調査期間後、各手法は歯肉退縮深さと臨床的付着レベルの減少、角化組織幅と歯肉厚の増加を証明し、統計学的に有意な差が認められた（p < 0.05）。解析の結果、歯肉退縮の深さはDLSBF群（4.3±1.2mm→0.6±1.1mm）ではLCT群（4.9±1.1mm→0.1±0.4mm）よりも減少したが、両群間に有意差は認められなかった。同様に、臨床的アタッチメントレベルパラメーターの減少はLCT群でより大きく、歯肉厚の増加はDLSBF群でより大きく観察された。瘢痕の有無は、両群間で統計的に有意な差（p＜0.05）が認められた唯一のパラメータであった。(4）結論本研究の限界の範囲内において、LCT + SCTG法は、下顎前歯部の単発性歯肉退縮の治療において、歯肉退縮の深さの減少、完全な歯根被覆、審美的結果の点で最適な術式であると考えられる。

(1) Background: This study compared the clinical and esthetic results of the double lateral sliding bridge flap (DLSBF) and the laterally closed tunnel (LCT) techniques, with a subepithelial connective tissue graft (SCTG), for the treatment of single Miller class II-III recessions in the mandibular anterior teeth. (2) Methods: This pseudorandomized clinical trial evaluated 14 patients, 7 of whom were part of the DLSBF + SCTG group, with an average follow-up of 58.7 ± 24.0 months, and 7 of whom were in the LCT + SCTG group, with an average follow-up of 16.7 ± 3.3 months. Clinical and esthetic evaluations of the following parameters were performed and the results for the two groups were compared: gingival recession depth, probing depth, keratinized tissue width, gingival thickness, percentage of root coverage and root coverage esthetic score. (3) Results: After the follow-up period, each technique provided evidence of a reduction in recession depth and clinical attachment level, as well as increased keratinized tissue width and gingival thickness, with statistically significant differences (p < 0.05). The analysis showed that gingival recession depth decreased less in the DLSBF group (4.3 ± 1.2 mm to 0.6 ± 1.1 mm) than it did in the LCT group (4.9 ± 1.1 mm to 0.1 ± 0.4 mm), but no significant difference was found between the two groups. Similarly, a greater reduction in the clinical attachment level parameter was observed in the LCT group, while a greater increase in gingival thickness was observed in the DLSBF group. The presence of scars was the only parameter for which statistically significant differences (p < 0.05) between the two study groups were found. (4) Conclusions: Within the limitations of the study, it indicates that the LCT + SCTG technique may be considered an optimal technique in terms of reducing gingival recession depth, complete root coverage and esthetic results for the treatment of single gingival recessions in the mandibular anterior teeth.