【案例分享】集五大挑戰的根覆蓋術難症
【案例分享】集五大挑戰的根覆蓋術難症
本次案例要展示的是牙齦退縮的下顎門牙、伴隨牙周囊袋及高繫帶拉扯，並有排列不正和非常窄小的齦乳頭之根覆蓋挑戰。
被歸類在米勒三類/RT2類型的本案，整體而言要執行完全的根覆蓋並不容易，執行面上最大的挑戰就是「血液的供應」，患者主要目的是希望針對＃41這顆牙齒得到改善，但為了增加血液循環，所以我將＃31這顆也一併處理。
我使用隧道術同時將兩個正門牙一起做根覆蓋和增厚，在完成非手術改善牙周囊袋後，在＃41的齦緣置放結締組織，再鬆開＃31、＃ 41之間的齦乳頭，然後達到根覆蓋的效果。其實＃41在非手術時就已得到1mm牙齦退縮的改善，在根覆蓋手術完成後，共得到2mm的根覆蓋效果，且齦乳頭沒有受影響，皆維持在原來的位置。
整體而言，前面四顆門牙都被增厚，且沒有改變鄰牙齦緣的型態，後續追蹤的效果也維持得很好！
The 5 Challenges on a difficult Root Coverage Case
-Root Coverage on a crowded mandibular incisor
⚫️Case scenario: #41 with Miller Class III ( RT2 ) recession complicated by following 5 challenges:
1. 5mm probe depth
2. High frenulum pull
3. Lack of keratinized attached gingiva
4. Crowded by mesial rotation
5. Very narrow papilla
⚫️Goals:
Can one surgical procedure warrant optimal root coverage be achieved with gain of keratinized tissue, frenulum removal, attachment gain, thickened gingiva yet without compromising adjacent papilla and marginal gingiva?
⚫️Treatment:
Yes, tunneled flap with connective graft enough to cover #’s 31 & 41 will do following non-surgical scaling and root planing.
⚫️Discussion:
Partial thickness detachment seems to be able to release the frenulum tension while providing favorable bilaminar blood supply at the same time. Partially exposed graft will turn into future keratinized gingiva while thickening the marginal tissue. Suspensory suture appears to be helping counteract with gravity from the tunneled lower flap.
