Clinical Study Of An Improved Technique For Widening Keratinized Mucosa

Background:With the popularization of oral implant technology,while scholars are paying attention to osseointegration,the treatment of insufficient soft tissue around the implant has also become a research hotspot in implant treatment^[1].Adhesive gums with sufficient width at the implant site play a very important role in the health and stability of the implant^[2].When the keratinized gingival around the implant is less than 2mm,the mucosa to the crest forms a triangular frenulum,and the implant site is prone to plaque accumulation and local food impaction,which increases the risk of bone loss^[3].How to ensure sufficient attached gingival width has become a research hotspot in current planting.At present,the main methods for widening the insufficient width of attached gums at home and abroad are:free gingival transplantation,root reduction flap surgery,pedicled flap surgery（full or partial thick flap）,etc.^[4].These methods can widen the attached gingiva to a certain extent and solve the problems caused by insufficient attached gingival width.However,the operation is more difficult and traumatic,and it is not acceptable to most patients.This study aims to explore a simple and effective surgical method that effectively widens the attached gums and shortens the course of implant restoration.Objective:To explore the clinical effect of an improved appically repositioned flap surgery to widen the attached gingiva.For patients with clinical dentition defects who have undergone implantation surgery in the first stage,and the buccal attachment gingival width of the implant site before the second stage surgery is less than 2mm,the local modified attachment gingival widening surgery will be performed,and the short-term follow-up will observe the treatment effect to find a simple An effective and more acceptable way of widening attached gingiva provides new ideas for the treatment of patients with insufficient gingival width around clinical implants.Methods:The Department of Stomatology of the Third Affiliated Hospital of Nanchang University has performed the first-stage operation to implant Superline implants,and20 patients（20 implants）with the implant site attached to the gingival width less than 2mm were measured before the second-stage operation.All implant sites are in the posterior maxillary area.The first-stage operation adopts the submerged healing method,and it has reached the second-stage operation standard.Twenty patients were randomly divided into experimental group and control group with 10 cases each.Before the second stage of operation,20 patients were checked for gingival attachment on the buccal side of the implant site.The width of the attached gingiva was measured three times using an electronic vernier caliper and the average value was taken.Disinfect the inside and outside of the mouth,and inject lidocaine for local anesthesia.The experimental group designed a partial palatal horizontal incision at the implant site,and a mesiodistal vertical incision on the buccal side to form a trapezoidal incision.Make an incision along the designed incision.Note that the gums are not involved.The nipple does not cut through the periosteum.Separate the semi-thick flap sharply,preserving the periosteum and part of the connective tissue on the bone surface,peeling off part of the muscle fiber tissue,pushing the semi-thick flap toward the root of the buccal side,and suture the root to the transition groove below the membranous gingival joint to make the buccal soft tissue The flap is a keratinized gingival with a width≥2mm.Note that the root reduction needs to exceed 5mm,because the soft tissue will shrink by 30%-50%after healing.The sealing screw is exposed and the replacement screwed into the healing abutment.The control group routinely performed second-stage surgery on the healing abutment.Within 24 hours after operation,apply ice,gargle with normal saline,take antibiotics for 3-5 days to prevent infection,remove stitches 2 weeks after operation,and perform crown restoration one month later.Results:1.The width of attached gingiva（5.72±0.86）mm in the experimental group was higher than that in the control group（1.23±0.55）mm at 1 month after operation.The width of the experimental group was 4.81 mm wider than the preoperative average,P<0.05.2.The width of attached gingiva（5.65±0.85）mm in the experimental group was higher than that in the control group（1.16±0.53）mm at 6 months after surgery,and the difference between the groups was statistically significant（P<0.05）.3.When the sutures were removed at 2 weeks,the mucosa in the two groups healed well,and the comparison of the attachment point reconstruction was P<0.05,the difference was statistically significant.4.There was a statistically significant difference in the modified plaque index between the two groups at 6 months after the operation.Conclusion:1.In this study,a partial palatal incision was designed,and the palatal attached gingiva was restored and sutured to the buccal root.The research data showed that the width of the attached gingiva（5.72±0.86）mm in the experimental group was higher than that in the control group（1.23±0.55）mm,the width of attached gingiva（5.65±0.85）mm in the experimental group was higher than that in the control group（1.16±0.53）mm at 6 months after operation.The difference between the groups was statistically significant（P<0.05）,indicating the improved root reduction.The effect of flap surgery to widen the attached gingiva is ideal.Although the attached gingiva of the experimental group contracted slightly at 6 months compared with that at 1month,the difference was not statistically significant（P>0.05）,indicating that the effect of this type of attached gingival widening surgery is relatively stable,and there will be no obvious short-term absorb.2.Comparing the wound healing of the two groups of patients 2 weeks after operation,it is found that P>0.05,the difference is not statistically significant,indicating that the experimental group and the control group can achieve ideal healing of the gums.3.The oral health status of the operation area of the group was compared 6months after the operation.It was found that the oral health status of the experimental group was significantly better than that of the control group,which showed less plaque accumulation,P<0.05,the difference was statistically significant.4.This method can effectively widen the attached gingiva,which can be performed at the same time during the second stage of implantation surgery,shortening the course of implant restoration;there is no need to open a second operation area,and the trauma is small;it can improve oral hygiene,and is for the clinical implants with insufficient gingival width.Treatment provides new ideas.