种植体周游离带上皮结缔组织移植角化黏膜增宽术的操作技巧OA
Surgical techniques for peri-implant free epithelium-connective tissue grafting to augment keratinized mucosa
在口腔种植领域,种植体周角化黏膜宽度(KMW)不足是影响种植体长期稳定和周围组织健康的关键因素之一.而游离带上皮结缔组织移植作为一种有效的外科手段,对于解决这一问题具有重要意义.本文旨在分享笔者团队在实施该手术过程中的实践经验与操作技巧.在手术时机方面,建议在种植二期手术前或同期行角化黏膜增量,不仅便于手术操作,还有利于合理分配颊舌侧角化黏膜.在角化黏膜分配策略的选择上,对于上颌,可以通过转移腭侧软组织来增加唇/颊侧KMW.然而,对于下颌,由于其舌侧解剖结构的特殊性,需格外谨慎处理,避免因操作不当导致舌侧角化黏膜不足甚至缺如.在手术操作过程中,骨膜受植床的制备是整个手术的关键环节.制备过程中,应尽可能确保骨膜的完整性,其表面应尽量减少松软活动性软组织的残留,以保证后续移植物的血供和移植成功后的低活动度.同时,受植床的面积应略大于移植物的尺寸,便于移植物的缝合.此外,稍大的受植床面积还有助于移植物在早期获得充足的营养和氧气供应,从而促进其存活.在移植物的缝合固定方面,建议采用冠方间断缝合联合外褥式锚着缝合的方法,这种方法不仅能够有效地固定移植物,还能降低手术风险,提高手术成功率.此外,建议略去根向复位瓣的缝合,可以进一步简化操作流程,降低手术难度,缩短手术时间.期望本文的分享能够为对该术式感兴趣的医生提供有价值的参考和借鉴,从而推动该术式在临床实践中的广泛应用.
In addressing insufficient peri-implant keratinized mucosa width(KMW)—a critical determinant of long-term implant stability and peri-implant tissue health—the peri-implant free epithelium-connective tissue grafting(FECTG)emerges as an efficacious surgical solution.This article presents technical refinements for FECTG implementation,advocating keratinized mucosa augmentation either prior to or concomitant with second-stage implant surgery to optimize surgical access and buccolingual keratinized tissue distribution.Maxillary cases benefit from palatal soft tissue transfer for buccal width enhancement,whereas mandibular cases demand meticulous technique due to lingual anatomical constraints,where improper handling may risk keratinized mucosa deficiency.The pivotal periosteal recipient bed preparation requires preservation of periosteal integrity to ensure vascularization,elimination of mobile soft tissue to enhance graft stability,and creation of a recipient bed slightly larger than the graft to facilitate suturing and promote early nutrient/oxygen diffusion.Graft fixation employs a dual-suture approach—coronal interrupted sutures coupled with external horizontal mattress sutures.Crucially,omitting sutures for apically positioned flaps streamlines the procedure,reducing operative time while lowering technical complexity.These evidence-based protocols may facilitate the broader clinical adoption of FECTG for peri-implant soft tissue augmentation.
Zhao Lingzhou;Ma Chufan
Department of Stomatology,Air Force Medical Center of PLA,Beijing 100142,ChinaDepartment of Stomatology,Air Force Medical Center of PLA,Beijing 100142,China
游离带上皮结缔组织移植角化黏膜增量根向复位瓣
Free epithelium-connective tissue graftingKeratinized mucosa augmentationApically positioned flap
《中国口腔种植学杂志》 2025 (6)
519-524,6
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