自体血小板浓缩物在角化黏膜增量中的临床应用

doi:10.12337/zgkqzzxzz.2023.08.008

摘要/Abstract

摘要： 目的研究结合富血小板纤维蛋白（platelet-rich fibrin,PRF）的“开放式缝合”方式应用于角化黏膜增量的临床效果。方法选取牙列缺损同时伴有角化黏膜缺失的患者84例,对其进行适合种植手术方案确定后,应用PRF进行“开放式缝合”。术前及术后3个月拍摄CBCT,进行口腔扫描记录并测量角化黏膜宽度,同时对患者进行随访,记录术后并发症发生情况及患者的疼痛情况。结果术前与术后3个月相比较,角化黏膜宽度增加（2.81±1.12）mm（P<0.05）,牙龈指数和改良出血指数分别降低0.85±0.76（P<0.05）和0.58±0.28（P>0.05）,前庭沟深度在两个时间点之间差异不具有统计学显著性（P>0.05）。同时患者术后并发症的发生风险较低,患者自身疼痛感较轻,术后1周的VAS评分为1.58±0.43。结论结合PRF“开放式缝合”这一无皮瓣减张缝合技术,可维持骨-骨膜界面处的血液供应,保留了初始缺损周围硬组织和软组织的三维结构,实现了软硬组织的协调及稳定,减少了创口裂开及黏膜穿孔等并发症的发生风险。此外,无需骨膜分离或进行游离龈移植,通过微创干预促进了软硬组织的同时增量,降低了患者术后感染风险,并促进创口愈合,从而缩短了患者的治疗周期,提高了患者术后的舒适度,故其可成为一种可预测的创口缝合方式。

关键词: 富血小板纤维蛋白, 角化黏膜, 软组织增量, 牙种植, 开放式缝合

Abstract: Objective s To evaluate the clinical efficacy of the "open suture" combined with platelet-rich fibrin (PRF) in keratinized mucosal augmentation. Methods 84 patients with dentition defects accompanied by keratinized mucosal loss were enrolled in this study, receiving "open suture" combined with PRF after the implant surgery. CBCT was taken before and 3 months after surgery, and oral scanning was performed to record and measure the width of the keratinized mucosa. At the same time, patients were followed up to record the occurrence of postoperative complications and pain levels. Results Compared the preoperative period with 3 months postoperatively, the width of keratinized mucosa increased by（2.81±1.12）mm (P<0.05), while the gingival index (GI) and modified bleeding index (mBI) decreased by 0.85 ± 0.76 (P<0.05) and 0.58 ± 0.28 (P>0.05), respectively. There was no significant difference in the vestibular depth (VD) between these two-time points (P>0.05). Meanwhile, the risk of postoperative complications was low, and the patients' own pain was relatively mild. The VAS score for the first week after surgery is 1.58±0.43. Conclusion This flapless tension-releasing suture technique in combination with the PRF "open suture" could maintain blood supply at the bone-periosteum interface, and preserve the three-dimensional structure of the hard and soft tissues around the initial defect. Also, this suture method could achieve coordination and stability of soft and hard tissues and reduce the risk of complications such as wound dehiscence and mucosal perforation. In addition, without the need for periosteal elevation or free gingival grafts, minimally invasive intervention can promote the growth of soft and hard tissues, reduce the risk of postoperative infection in patients, and promote wound healing, thereby shortening the treatment cycle of patients and improving their postoperative comfort. This can become a predictable method of wound closure.

Key words: Platelet-rich fibrin, Keratinized mucosa, Soft tissue augmentation, Dental implant, Open suture

朱悦萌,贾克文,焦俊杰,等. 自体血小板浓缩物在角化黏膜增量中的临床应用[J]. 中国口腔种植学杂志, 2023, 28(4): 250-259. DOI: 10.12337/zgkqzzxzz.2023.08.008

Zhu Yuemeng, Jia Kewen, Jiao Junjie, Chen Siyu, Ren Sicong, Chen Sheng, Zhou Yanmin. Clinical applications of autologous platelet-rich concentrate in keratinized mucosal augmentation[J].Chinese Journal of Oral Implantology, 2023, 28(4): 250-259.DOI: 10.12337/zgkqzzxzz.2023.08.008.

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