目的:本临床指南项目的目的是确定最合适的手术技术,就功效而言,并发症,和病人的意见,用于治疗口腔单牙龈凹陷,而不损失邻间软组织和硬组织。
方法:文献检索(电子和手动)进行到2月28日的条目,2013年关于治疗牙龈凹陷的手术方法。包括随机对照试验(RCTs)的系统评价(SRs)和单个RCTs,这些RCTs报告了至少6个月的单牙龈凹陷手术治疗随访。根据苏格兰校际指南网络(SIGN)方法,使用清单对选定的SR和RCT的全文进行了定性评估。评估了以下变量:完全根部覆盖(CRC);减少衰退(RecRed);并发症;患者的功能和美学满意度;以及治疗费用。
结果:在30篇系统评价中,313项RCTs中的3项和16项被认为具有低偏倚风险(SIGN代码:1+)。在短期评估中,冠状推进皮瓣加结缔组织移植方法(CAFCTG)在CRC和/或Recred方面是最佳的治疗方法;在宫颈磨损和存在根部敏感性的情况下,CAFCTG修复引起的敏感性低于CAFCTG。CAF对患者产生的术后不适较少。关于患者术后牙齿过敏和美学满意度的信息有限。
结论:在存在美学需求或牙齿过敏的情况下,使用与CTG相关的CAF手术可实现手术治疗单个牙龈凹陷而不损失邻间组织的最佳方法。考虑到术后不适,CAF手术是痛苦较小的手术方法,而单独或与CTG一起进行CAF后,美学满意度水平更高。目前尚不清楚通过手术覆盖颊侧凹陷可以减少多少牙齿超敏反应。必须指出,本建议是基于短期数据(不到1年)。
背景:作者通过自筹资金使指南项目成为可能。
OBJECTIVE: The purpose of this clinical
guidelines project was to determine the most appropriate surgical techniques, in terms of efficacy, complications, and patient opinions, for the treatment of buccal single gingival recessions without loss of interproximal soft and hard tissues.
METHODS: Literature searches were performed (electronically and manually) for entries up to 28 February, 2013 concerning the surgical approaches for the treatment of gingival recessions. Systematic reviews (SRs) of randomised controlled trials (RCTs) and individual RCTs that reported at least 6 months of follow-up of surgical treatment of single gingival recessions were included. The full texts of the selected SRs and RCTs were analysed using checklists for qualitative evaluation according to the Scottish Intercollegiate
Guidelines Network (SIGN) method. The following variables were evaluated: Complete Root Coverage (CRC); Recession Reduction (RecRed); complications; functional and aesthetic satisfaction of the patients; and costs of therapies.
RESULTS: Out of 30 systematic reviews, 3 SRs and 16 out of 313 RCTs were judged to have a low risk for bias (SIGN code: 1+). At a short-term evaluation, the coronally advanced flap plus connective tissue graft method (CAF+CTG) resulted in the best treatment in terms of CRC and/or RecRed; in case of cervical abrasion and presence of root sensitivity CAF + CTG + Restoration caused less sensitivity than CAF+CTG. CAF produced less postoperative discomfort for patients. Limited information is available regarding postoperative dental hypersensitivity and aesthetic satisfaction of the patients.
CONCLUSIONS: In presence of aesthetic demands or tooth hypersensitivity, the best way to surgically treat single gingival recessions without loss of interproximal tissues is achieved using the CAF procedure associated with CTG. Considering postoperative discomfort, the CAF procedure is the less painful surgical approach, while the level of aesthetic satisfaction resulted higher after CAF either alone or with CTG. It is unclear how much tooth hypersensitivity is reduced by surgically covering buccal recessions. It is important to note that the present recommendations are based on short-term data (less than 1 year).
BACKGROUND: The
guidelines project was made possible through self-financing by the authors.