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골유도재생술을 동반한 임플란트 식립 후 유리치은이식술/근단변위판막술을 이용한 각화치은 증대술: 증례 보고

Free gingiva graft/apically positioned flap for keratinized gingiva augmentation following horizontal ridge augmentation: case report

대한인공치아골유착학회지 2020년 12권 1호 p.32 ~ 41
서영욱, Hong In-Pyo, 전수희, 송영우, 차재국, 백정원, 정의원, 최성호,
소속 상세정보
서영욱 ( Seo Young-Wook ) - Yonsei University College of Dentistry Department of Periodontology
 ( Hong In-Pyo ) - Yonsei University College of Dentistry Department of Periodontology
전수희 ( Jeon Su-Hee ) - Yonsei University College of Dentistry Department of Periodontology
송영우 ( Song Young-Woo ) - Yonsei University College of Dentistry Department of Periodontology
차재국 ( Cha Jae-Kook ) - Yonsei University College of Dentistry Department of Periodontology
백정원 ( Paik Jeong-Won ) - Yonsei University College of Dentistry Department of Periodontology
정의원 ( Jung Ui-Won ) - Yonsei University College of Dentistry Department of Periodontology
최성호 ( Choi Seong-Ho ) - Yonsei University College of Dentistry Department of Periodontology

Abstract


Insufficient thickness of keratinized gingiva and shallow oral vestibule around dental implants may hamper hygienic control of patients. Lack of oral hygienic control can cause peri-implant disease. To secure sufficient keratinized gingiva around implant, apically positioning flap with or without free gingival graft can be choice of treatment. (Case 1) A 66 year-old female patient was planned to place implant on upper left first premolar and first molar area, and prosthetically reconstructed with i24 = 26. In clinical and radiographic analysis, 1 to 2 mm of narrow keratinized gingiva and insufficient alveolar bone dimension was found. Implant placement was done with guided bone regeneration(GBR). In second surgery, apically positioning flap with free gingival graft was done simultaneously. The width of keratinized gingiva was increased to 3 to 4 mm and well maintained, (Case 2) A 74 year-old female patient was planned to place implant on lower right second premolar and first molar area. In clinical and radiographic analysis, insufficient alveolar bone dimension and 1 to 2 mm of narrow keratinized gingiva was found. Implant placement was done with guided bone regeneration (GBR). In second surgery, apically positioning flap was done simultaneously without additional graft. The width of keratinized gingiva was increased to 3 to 4 mm and well maintained. Both apically positioning flap with and without free gingival graft showed stable and sufficient gaining of keratinized gingiva around implant fixture. Loss of keratinized tissue due to alveolar bone resorption and flap releasing in GBR procedure was recovered by apically positioning flap. Sufficient keratinized gingiva over 2 mm width was secured before final prosthesis. Both apically positioned flap with and without free gingiva graft can be adequate treatment for lack of keratinized gingiva. Using free gingival graft have advantage in predictability of outcome, and apically positioning flap without graft have advantage in patient morbidity. Considering clinical situation, both treatment can be adequate choice for securing keratinized gingiva.

키워드

Free gingiva graft/apically positioned flap; Keratinized gingiva augmentation; Guided bone regeneration

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