目的:探讨不良修复体致前牙区残根残冠患者的相关牙周手术治疗及美学再修复,阐明牙周手术治疗配合美学再修复在上前牙区的治疗效果,为其临床治疗方案的制定提供指导.方法:患者上前牙修复后2年余,修复体松动,患牙咬物不适伴牙龈出血,上唇系带附着过高,左上侧切牙根尖区可见低密度影.经牙周、牙体牙髓病和修复等学科会诊,行根管再治疗,牙周基础治疗,并采用牙冠延长术联合系带修整术恢复生物学宽度,引导骨再生术(GBR)联合富血小板纤维蛋白(PRF)修复根尖骨质缺损.术后1个月行暂时冠修复,术后3个月行永久冠修复.结果:术区牙龈及龈乳头形态恢复理想,与邻牙的牙龈高度协调性佳,上唇系带附着正常,中切牙未见明显缝隙;上前牙区修复体形态美观,功能良好;术后跟踪随访X线片显示术区骨密度同邻近骨质相似,已无明显界限.结论:涉及前牙区薄龈型牙龈生物型的美学修复,特别是再治疗的复杂病例,适当的牙周手术治疗手段介入,不但易于获得明显的短期效果,对远期疗效的稳定也有积极的影响.%Objective:To discuss the therapeutic effect of related periodontal surgical treatment and aesthetic rerepair in the patient with residual root and crown of anterior teeth induced by unfitting prosthesis and to clarify the curative effect of periodontal surgical treatment and aesthetic re-repair in the anterior teeth area,and to provide guidance for making the program of clinical treatment.Methods:Two years after repair of the anterior teeth of a patient,the restorations loosed;on the one hand the patient had a toothache of chewing food accompanying gingival bleeding,on the other hand the upper labial frenum was too high,furthermore the upper left incisor apical area showed low density images.After the consultation of periodontics,endodontics,prosthodontics and other disciplines doctors,anterior teeth root canal re-treatment and periodontal basic treatment were adopt as well ascrown lengthening combined with labial freneetomy to restore the normal biological width,additionally apply not only guided bone regeneration (GBR) but also platelet rich fibrin (PRF) to repair the defects of apical bone.One month later,provisional restorations were put into use and then three months later permanent repairs were conducted.Results:The corresponding gingival and gingival papilla shape recoverd perfectly and the height of gingiva coordinated with that of adjacent teeth,in the meantime the upper labial frenum attached normally and there was not obvious space between upper incisors;the morphology and function examination of restoration in maxillary anterior region were both well.The follow-up X-ray showed that the bone density of the defect area was the same as that of the peripheral bone without obvious boundaries.Conclusion:The aesthetic repair of thin biotype referring to anterior area,especially in the complicated re-treatment cases,the intervention of the appropriate periodontal surgical treatment is not only beneficial to obtain the obvious short-term effect,but also positive to stabilize longterm effects.
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