摘要
上颌前牙区垂直向骨增量是相对复杂,技术敏感性高的手术,选择恰当的软组织管理策略不可或缺,以避免短期和长期并发症。本文主要论述两个方面:①垂直向骨增量手术中,根据不同软组织的质和量,进行切口和翻瓣设计。对于质量俱佳的黏膜,采用梯形瓣切口设计,应用骨膜延展技术进行减张;对于过浅的前庭沟,采用更大范围的梯形瓣,应用黏膜-口轮匝肌分离的减张方式,以及龈乳头错位缝合保证创面的一期关闭;对于黏膜菲薄或存在黏膜穿孔的情况,通过带蒂骨膜瓣进行修补。②二期手术选择恰当的软组织增量术式,改善美学效果,以期为临床医师提供治疗参考。对于水平向软组织缺损,采用结缔组织移植或腭侧带蒂翻转瓣进行处理;对于垂直向软组织缺损,采用冰山技术或蝴蝶结技术等进行垂直向增量;对于水平向联合垂直向缺损,采用结缔组织平台技术进行三维软组织重建。
Vertical bone augmentation(VBA)in the anterior maxilla is a technically and biologically challenging technique with high complication rates and unpredictable outcomes.Selecting appropriate soft tissue management strategies is crucial to avoid short-term and long-term complications.This article aims to assist clinicians in making treatment decisions based on different soft tissue conditions during VBA.It is divided into two parts.Incision and flap design based on the quality and quantity of different soft tissues during VBA.For mucosa of good quality and quantity,a trapezoidal flap incision design is adopted,and the periosteum extension technique is applied for tension reduction.For a shallow vestibular sulcus,a larger trapezoidal flap is used,and the tension reduction method of mucosa-oralis muscle separation is applied,along with papilla transposition suture to ensure primary wound closure.For thin mucosa or with perforating defects,a pedicled periosteal flap is used for repair.Selection of appropriate soft tissue augmentation techniques during the second-stage surgery based on the soft tissue status to improve esthetic outcomes.For horizontal soft tissue defects,free connective tissue graft(CTG)or palatal pedicled flap can be used for treatment;for vertical soft tissue defects,techniques such as the iceberg technique or customized CTG with bowtie-like shape can be used for vertical augmentation;for combined horizontal and vertical defects,the connective tissue platform technique can be used for three-dimensional soft tissue reconstruction.
作者
王妙贞
刘峰
陈江
赵伟
Wang Miaozhen;Liu Feng;Chen Jiang;Zhao Wei(First Clinical Division,Peking University School and Hospital of Stomatology&National Center for Stomatology&National Clinical Research Center for Oral Diseases&National Engineering Research Center of Oral Biomaterials and Digital Medical Devices&Beijing Key Laboratory of Digital Stomatology,Beijing 100034,China;Department of Implantology,School and Hospital of Stomatology,Fujian Medical University&Fujian Key Laboratory of Oral Diseases&Fujian Provincial Engineering Research Center of Oral Biomaterial&Stomatological Key Laboratory of Fujian College and University&Institute of Stomatology,Fujian Medical University&Research Center of Dental and Craniofacial Implants,Fujian Medical University,Fuzhou 350025,China)
出处
《中华口腔医学杂志》
北大核心
2025年第4期340-346,共7页
Chinese Journal of Stomatology
关键词
美学
牙科
牙种植
垂直骨增量
软组织移植
治疗决策
Esthetics,dental
Dental implantation
Vertical bone augmentation
Soft tissue augmentation
Decision tree
