遺伝性歯肉線維腫症に対する修正歯肉形成術：2症例報告

Modified gingivoplasty for hereditary gingival fibromatosis: two case reports.

抄録

背景:

遺伝性歯肉線維腫症（HGF）は、角化歯肉の線維性肥大をもたらす角化歯肉の上皮下線維腫症が特徴です。治療法としては歯肉切除術が選択され、従来は内反切開、外反切開で行われてきた。しかし、いずれの術式も歯肉の自然な状態を取り戻すことは難しく、特に付着歯肉の幅が狭い症例では一定の再発率を有する。

BACKGROUND: Hereditary gingival fibromatosis (HGF) is characterized by sub-epithelial fibromatosis of keratinized gingiva resulting in a fibrotic enlargement of keratinized gingiva. The treatment choice is gingivectomy, which can be performed with an internal or external bevel incision conventionally. However, both techniques can hardly resume the natural status of gingiva, and have a certain recurrence rate, especially in the cases which have limited width of attached gingiva.

症例解説:

咀嚼困難、発音困難、審美性の低下を主訴とするHGFの2症例を提示した。初回歯周治療後、Crevicular incisionで修正した新規歯肉形成術を適用した。粘膜接合部上部のフルタッチフラップと接合部下部のスプリットフラップが起立した。そして、線維性結合組織は完全に除去され、角化した歯肉上皮が保存された。線維化した歯槽骨は、ハンドピースとバーで整形した。最後に、フラップを先端方向に再配置し、縫合した。術後12ヶ月で、歯肉は正常な色、輪郭、硬さに回復した。

CASE DESCRIPTION: Two cases of HGF with the chief complaint of difficulty in mastication, pronunciation, and poor esthetics were presented. After the initial periodontal therapy, a novel gingivoplasty modified with a crevicular incision was applied. A full thickness flap above the mucogingival junction and a split flap below the junction were raised. Then, fibrotic connective tissue was completely eliminated and keratinized gingival epithelium was preserved. The fibrotic alveolar bone was shaped by handpiece and bur. Finally, the flap was apically repositioned and sutured. Twelve months after surgery, the gingiva recovered with normal color, contour and consistency.

結論:

従来の歯肉切除術と比較して、病的な線維性結合組織の除去に焦点を当てた修正歯肉形成術は、歯肉の自然な外観を完全に再開することができ、再発の傾向もないことを示す。

CONCLUSIONS: Compared to traditional gingivectomy, modified gingivoplasty which focuses on eliminating pathological fibrotic connective tissue can completely resume the natural appearance of gingiva and demonstrate no tendency of recurrence.