背景:使用整个乳头保存(EPP)技术,可以在牙间乳头无切口的情况下进行再生治疗,并降低乳头破裂的风险。然而,EPP的一个限制是从颊侧的唯一通路。这里,我们介绍了使用双面(颊-腭)EPP(DEPP)技术的联合再生疗法治疗的牙周炎病例,这为EPP增加了腭垂直切口。
方法:一名1-2例壁骨内缺损的患者接受了使用重组人成纤维细胞生长因子(rhFGF)-2和碳酸盐磷灰石(CO3Ap)的再生治疗。使用DEPP技术,在颊部和腭部放置垂直切口,以充分进入11号和12号之间的1-2壁骨内缺损,而不在牙间乳头中切开。清创术后,将rhFGF-2和CO3Ap应用于缺损。在第一次就诊时评估牙周临床参数和X线图像,初始牙周治疗后(基线),术后6、9和12个月。
结果:伤口愈合顺利。切口线的疤痕很小。术后12个月,探测深度减少4毫米,临床附着增益为4毫米,和牙龈衰退没有观察到。在先前的骨缺损中观察到射线不透性的改善。
结论:DEPP是一种创新技术,可以从颊侧和腭侧接近,同时确保皮瓣的延展性,而不会损害牙间乳头。该报告表明,再生疗法与DEPP的组合在治疗骨内缺陷方面可能是有希望的。
结论:为什么这种情况是新信息?DEPP允许直接观察从颊侧延伸到腭侧的1-2壁骨内缺损,增加了皮瓣的延伸性,而不会损害乳头。成功处理这种情况的关键是什么?需要评估三维骨缺损的形态。计算机断层扫描图像非常有用。应使用小型挖掘机仔细进行牙间乳头下方的皮瓣抬高,以免损坏牙间乳头。在这种情况下成功的主要限制是什么?尽管增加了腭切口,不可能获得腭牙龈的完全柔韧性。在齿间乳头之间的距离狭窄的情况下,必须谨慎。即使在手术过程中牙间乳头破裂,通过继续手术并在结束时缝合破裂是可能的。
BACKGROUND: With the entire papilla preservation (EPP) technique, it is possible to perform regenerative therapy without incisions in the interdental papilla and to reduce the risk of papillary rupture. However, one limitation of the EPP is the sole access from the buccal side. Here, we present a
case of periodontitis treated by the combination regenerative therapy employing the Double-sided (buccal-palatal) EPP (DEPP) technique, which adds a palatal vertical incision to the EPP.
METHODS: A patient with 1-2 wall intrabony defects received the regenerative therapy using recombinant human fibroblast growth factor (rhFGF)-2 and carbonate apatite (CO3Ap). Using the DEPP technique, vertical incisions at buccal and palatal aspects were placed to gain adequate access to the 1-2 wall intrabony defects between #11 and #12 without incision in the interdental papilla. After debridement, rhFGF-2 and CO3Ap were applied to the defect. Periodontal clinical parameters and radiographic images were evaluated at the first visit, following initial periodontal therapy (baseline), 6, 9, and 12 months postoperatively.
RESULTS: Wound healing was uneventful. Scarring of the incision lines was minimal. At 12 months postoperatively, probing depth reduction was 4 mm, clinical attachment gain was 4 mm, and gingival recession was not observed. An improvement in radiopacity in the previous bone defect was observed.
CONCLUSIONS: The DEPP is an innovative technique that allows approaching from both the buccal and palatal sides while ensuring flap extensibility without compromising the interdental papilla. This report suggests that the combination of regenerative therapy with the DEPP may be promising in the treatment of intrabony defects.
CONCLUSIONS: Why is this
case new information? The DEPP allows a direct visual approach to a 1-2 wall intrabony defect extending from the buccal to palatal sides, and increases flap extensibility, without compromising the papilla. What are the keys to the successful management of this
case? Assessment of three-dimensional bone defect morphology is required. Computed tomography images are very useful. The flap elevation just under the interdental papilla should be carefully performed with a small excavator to avoid damage to the interdental papilla. What are the primary limitations to success in this
case? Despite the addition of a palatal incision, it was not possible to obtain complete flexibility of the palatal gingiva. Caution must be taken in a
case in which the distance between the interdental papilla is narrow. Even if the interdental papilla is ruptured during the operation, recovery is possible by continuing the operation and suturing the rupture at the end.