Treatment methods in lingual/palatal recessions
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Date
2022
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Abstrakts Vispārīgā informācija: informācija par ārstēšanas iespējām lingvālo un palatinālo recesiju gadījumā ir ierobežota. Šī zinātniski pētnieciskā darba mērķis ir veikt literatūras apskatu par lingvālo un palatinālo smaganu recesiju ārstēšanas iespējām. Šī literatūras apskata hipotēze ir tāda, ka, neraugoties uz tehniskajām grūtībām, lingvālās un palatinālās recesijas var tikt ārstētas, izmantojot tās pašas metodes, kas tiek pielietotas faciālo un bukālo recesiju slēgšanai. Metodes: Tika veikta sistemātiska publikāciju meklēšana datubāzēs Pubmed, EBSCO un Clinmed. Tika atlasītas publikācijas par lingvālo un palatinālo recesiju ārstēšanas metodēm, kas tika izdotas laika posmā no 2012. gada līdz 2022. gadam. Tika atlasīti klīniskie pētījumi, klīnisko gadījumu ziņojumi, novērošanas pētījumi un sistemātiskie pārskati angļu valodā. Rezultāti: Kopumā tika identificētas 44 publikācijas, no kurām 16 tika atlasītas pārskata veidošanai, tostarp klīnisko gadījumu ziņojumi un viena klīnisko gadījumu sērija. Vēl 10 papildus raksti tika iekļauti informācijas apkopošanai ievadā, literatūras apskatā un diskusijas sadaļā. No 16 apkopotajiem klīnisko gadījumu ziņojumiem 12 apskatīja lingvālo recesiju ārstēšanu, savukārt, 4 palatinālo recesiju ārstēšanu. Pacientiem ar lingvālajām smaganu recesijām ārstēšanai tika izmantoti: koronāli pārvietots lēveris, tunelēšanas metode, aplokšņveida lēveris, kā arī audu vadāmā reģenerācija, kombinācijā ar audu transplantātiem, kas varēja būt keratinizēti, daļēji keratinizēti vai saistaudu. Vienā gadījumā tika izmantots allografts. Rezultātu novērtēšanas un kontroles laiks bija no 21 dienas līdz 30 gadiem. 4 klīnisko gadījumu ziņojumos bija iekļauti pacienti ar lokalizētu palatinālu recesiju. Visi pacienti tika ārstēti ar autogēniem smaganu transplantātiem, tomēr, izmantotā transplantāta veids dažādās publikācijās bija atšķirīgs.Vienā klīniskajā gadījumā tika lietots daļēji deepitelizēts transplantāts, kas tika ņemts no aukslējām (18). Vienā klīniskajā gadījumā recesija tika slēgta izmantojot brīvo saistaudu transplantātu (22) un divos citos gadījumos - izmantojot reverso vai rotējošo transplantātu uz „kājiņas” (12, 24). Rezultātu novērtēšanas un kontroles laiks variēja no 2-18 mēnešiem. Secinājumi: Šī zinātniski pētnieciskā darba hipotēze, ka, neraugoties uz tehniskajām grūtībām, lingvālās un palatālās recesijas var ārstēt, izmantojot tās pašas metodes, kas tiek izmantotas faciālo un bukālo recesiju ārstēšanai, ir apstiprināta. Lai gan ir pieejama detalizēta informācija par smaganu recesiju ārstēšanas metodēm kopumā, ir 2 nepieciešams diferencēt ārstēšanu pacientiem ar lingvālajām/palatinālajām smaganu recesijām galvenokārt tāpēc, ka to lokalizācijas dēļ ir apgrūtinātāka operācijas lauka redzamība. Ķirurģiju apgrūtina arī svarīgu anatomisko struktūru tuvā atrašanās. Ir skaidrs, ka ir nepieciešams vairāk literatūras un klīnisko gadījumu ziņojumu, lai noteiktu optimālāko ārstēšanas metodi. Tomēr, nav iespējams uzlabot ārstēšana
Background: There is limited information related to the treatment options for lingual or palatal recession. The aim of this thesis is to review the literature related to the treatment of gingival recessions (GR) within the lingual or palatal gingival margin. The hypothesis of this review is that despite the technical difficulty, lingual and palatal recessions can be treated using the same methods as vestibular recessions. Methods: Databases Pubmed, EBSCO, and Clinmed Journals were systematically searched from 2012 to February 2022, for articles related to the treatment of lingual or palatal gingival recession. Clinical trials, case reports, observational studies, and systematic reviews in the English language were eligible. Result: In total, 44 articles were identified, of which 16 were selected for this review, and included case reports and one case series. Furthermore, 10 additional articles have been included as references in the introduction, literature review and discussion section. Of the 16 case reports retrieved, 12 addressed lingual recession while 4 were focused on palatal recession. Coronally advanced flap (CAF), tunneling techniques, envelope flap, and guided tissue regeneration were used in the case reports from patients with lingual GR, along with tissue grafts varying from keratinized, partially keratinized, or connective tissue grafts (CTG) and one allograft. Follow-up time ranged from 21 days to 30 years. 4 case reports included patients with localized palatal recession. All patients were treated with autogenous gingival grafts. However, graft type varied between the case reports one with a partly de-epithelialized palatal graft (19). One with CTG (22) and two using reverse or rotational pedicle graft (12, 24). Follow-up time varied from 2-18 months. Conclusions: The hypothesis of this review is that despite the technical difficulty, lingual and palatal recessions can be treated using the same methods as vestibular recessions. The result did confirm the study hypothesis. While there is detailed information available on the treatment of GR in general, there is a need to differentiate treatment for patients with lingual or palatal GR, mainly due to greater difficulty with regard to visibility, anatomy, and location. Clearly, there is a need for more literature and case reports to define optimal treatment. However, one cannot improve treatment outcomes for patients with lingual or palatal GR without ensuring patient compliance, due to the vulnerable position in relation to the tongue. Therefore, a more “beyond treatment” holistic approach is needed to ensure optimal outcomes for patients with lingual or palatal GR.
Background: There is limited information related to the treatment options for lingual or palatal recession. The aim of this thesis is to review the literature related to the treatment of gingival recessions (GR) within the lingual or palatal gingival margin. The hypothesis of this review is that despite the technical difficulty, lingual and palatal recessions can be treated using the same methods as vestibular recessions. Methods: Databases Pubmed, EBSCO, and Clinmed Journals were systematically searched from 2012 to February 2022, for articles related to the treatment of lingual or palatal gingival recession. Clinical trials, case reports, observational studies, and systematic reviews in the English language were eligible. Result: In total, 44 articles were identified, of which 16 were selected for this review, and included case reports and one case series. Furthermore, 10 additional articles have been included as references in the introduction, literature review and discussion section. Of the 16 case reports retrieved, 12 addressed lingual recession while 4 were focused on palatal recession. Coronally advanced flap (CAF), tunneling techniques, envelope flap, and guided tissue regeneration were used in the case reports from patients with lingual GR, along with tissue grafts varying from keratinized, partially keratinized, or connective tissue grafts (CTG) and one allograft. Follow-up time ranged from 21 days to 30 years. 4 case reports included patients with localized palatal recession. All patients were treated with autogenous gingival grafts. However, graft type varied between the case reports one with a partly de-epithelialized palatal graft (19). One with CTG (22) and two using reverse or rotational pedicle graft (12, 24). Follow-up time varied from 2-18 months. Conclusions: The hypothesis of this review is that despite the technical difficulty, lingual and palatal recessions can be treated using the same methods as vestibular recessions. The result did confirm the study hypothesis. While there is detailed information available on the treatment of GR in general, there is a need to differentiate treatment for patients with lingual or palatal GR, mainly due to greater difficulty with regard to visibility, anatomy, and location. Clearly, there is a need for more literature and case reports to define optimal treatment. However, one cannot improve treatment outcomes for patients with lingual or palatal GR without ensuring patient compliance, due to the vulnerable position in relation to the tongue. Therefore, a more “beyond treatment” holistic approach is needed to ensure optimal outcomes for patients with lingual or palatal GR.
Description
Zobārstniecība
Dentistry
Veselības aprūpe
Health Care
Dentistry
Veselības aprūpe
Health Care
Keywords
"Gingivālā recesija UN", "palatālā", "lingvālā", "ārstēšana", "terapija". Turklāt "lingvālā/palatālā smaganu recesija UN", "ārstēšana", "terapija", "izplatība"., “Gingival recession AND”, “palatal”, “lingual”, “treatment”, “therapy”. Additionally, “lingual/palatal gingival recession AND”, “treatment”, “therapy”, “prevalence”.