前牙牙周導引組織再生術：二病例報告

Guided Tissue Regeneration in Periodontal Surgery of Anterior Teeth：Report of Two Cases

背景：再生手術術後常見的牙齦萎縮併發症在前牙美觀區是一個很大的問題。本篇報告提出兩例在前牙區進行牙周導引再生術合併唇繫帶切斷法的病例，觀察術後三～六個月的臨床骨生成效果和牙齦的穩定性。方法：創新整合使用Cortellini 的 ''modified papilla preservation techipue''進行導引組織再生術和真空冷凍乾燥異質骨充填，並且合併唇側擊帶切斷術，治療兩例在上顎正中門牙美觀敏感區的骨內牙周缺損。治療前後均以牙週臨床指數，牙根尖放射檢查和彩色幻燈片作定期追蹤評估比較。結果：術後六個月，牙齦位置穩定，再生膜並無暴露。在臨床上並未發生明顯的牙齦萎縮，有明顯的牙周附連增加，X光片也可見到新生骨組織生成的影像，牙周附連較術前增加了3mm。結論：前牙美觀區之牙周骨內缺損之導引組織再生治療，經由仔細的牙周翻瓣設計，並去除可能造成傷口拉址力量而導致牙齦萎縮和導引組織膜暴露的因子，在上顎前牙區妥善的併用牙周整形手術，仍可達到臨床美觀上令人滿意的效果。

Background: gingival recession after periodontal regeneration procedure usually compromised the esthetics of upper anterior region. This paper reported two cases using guided tissue regeneration in conjunction with frenotomy in the maxillary anterior area in order to control the retraction of the flap by the frenum. Clinical stability of the gingival line and the osteogenesis effect was examined after the surgery in the three-to-six month time period. Methods: To resolve the periodontal intraosseous defect in the maxillary central incisor, an integrated surgical design using Cortellini's ''modified papillary preservation technique'', guided tissue regeneration combined with deminerealized freeze-dried bone allograft as well as labial side frenotomy were innovatively performed in two clinical cases. Records of the clinical periodontal parameters, peripiacal x-ray films and color slides were taken before the surgery and during the periodic follow-up visits. Results: Six months after the procedure, the gingival line was stable and there was no exposure of the membrane. No obvious gingival recession was noted. Clinically, an increase of 3 mm attachment gain was measured and obvious bone formation could be detected from the x-ray. Conclusion: Guided tissue regeneration can be combined with periodontal plastic surgery through using a delicate periodontal flap design, removing the factors that may cause gingival recession, and controlling the tension force that may cause the exposure of the membrane during wrund healing. A clinically satisfactory result can be achieved in the esthetic zone in cases with periodontal intraosseous defect.