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@#With the increasing demand for beauty, the treatment of gingival recession has become a common request among patients. Clinically, gingival recession is mainly treated by surgery. The common surgical methods include free gingival grafting, pedicled flap technology and double flap technology (subepithelial connective tissue transplantation combined with coronally advanced flaps). If patients with indications are selected, satisfactory surgical results will be obtained. However, there are still some shortcomings in the above mentioned methods, such as the root coverage effect not being satisfactory. In recent years, researchers have put forward some improved schemes to minimize the shortcomings of the above methods to treat different degrees of gingival recession. A gingival unit graft containing gingival papilla and free gingiva can improve the blood supply of the recipient area and improve the effect of root coverage. It can obtain better root coverage for slight retraction, widening of the angular gingiva and deepening of the vestibular sulcus, but there may be issues with inconsistent color and shape of the gingiva after surgery, as well as poor aesthetic effects. Modified coronally advanced flaps, flaps prepared by the technique of half-thickness, full-thickness and half-thickness, and modified coronally advanced envelope flap technology are designed with the most serious retraction teeth as the center in the case of multiple gingival retractions, both of which can improve the effect of root covering. Tunnel technology and modified tunnel technology, without severing the gingival papilla and tunneling the gingival flap to accommodate the graft, can effectively reduce tissue damage and promote wound healing. This paper reviews the literature and summarizes the outcome of the modified surgery techniques in the treatment of gingival recession. These treatment options for gingival recession are proposed with the aim of improving clinical work, and some suggestions for the treatment of gingival recession to achieve a stable root coverage effect are put forward. In the future, the development direction of mucogingival surgery is to reduce trauma and have a stable curative effect.
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Abstract This case series reports a modified tunnel technique with connective tissue graft for the root coverage of multiple Miller Class I, II, and III gingival recessions. The modified approach presents an innovative suture technique to improve the stability and position of the graft. Ten patients with multiple gingival recessions (n=85 teeth) received surgical root coverage treatment. The gingival recession height and width were measured and presented as median, minimum, and maximum values. The percentage of the root coverage after at least 12 months expressed the treatment effectiveness. The Shapiro-Wilk test evaluated the normality; pared Wilcoxon test determined the exact P-value for the differences in the height of the gingival recession before and after surgical treatment (α = 0.05). An average of 97.9% (± 5.6%, p < 0.0001) root coverage after treatment occurred, and 73 out of 85 recessions presented complete root coverage after 12 months. Treatment of Miller class I and II gingival recessions resulted in root coverage higher than 99 and class III higher than 95% (p < 0.0001). The presented case series report the efficacy of a modified surgical technique promoting more than 95% of root coverage after 12 months in multiple Miller Class I, II, and III gingival recessions. Well-designed blind randomized controlled trials are needed to validate the proposed technique.
Resumo Esta série de casos relata uma técnica de túnel modificada com enxerto de tecido conjuntivo para o recobrimento radicular de múltiplas recessões gengivais Classe I, II e III de Miller. A abordagem modificada apresenta uma técnica de sutura inovadora para melhorar a estabilidade e a posição do enxerto. Dez pacientes com múltiplas recessões gengivais (n=85 dentes) receberam tratamento cirúrgico de recobrimento radicular. A altura e a largura da recessão gengival foram mensuradas e apresentadas como valores medianos, mínimos e máximos. A eficácia do tratamento foi expressa como uma porcentagem da cobertura radicular após pelo menos 12 meses. O teste de Shapiro-Wilk avaliou a normalidade; o teste de Wilcoxon pared determinou o valor P exato para as diferenças entre a altura da recessão gengival antes e após o tratamento cirúrgico (α = 0,05). Uma média de 97,9% (± 5,6%, p < 0,0001) de cobertura radicular após o tratamento ocorreu, e 73 das 85 recessões apresentaram cobertura radicular completa após 12 meses. O tratamento das recessões gengivais classe I e II de Miller resultou em recobrimento radicular superior a 99 e classe III superior a 95% (p < 0,0001). A série de casos apresentada relata a eficácia de uma técnica cirúrgica modificada promovendo mais de 95% de cobertura radicular após 12 meses em múltiplas recessões gengivais Classe I, II e III de Miller. Ensaios controlados randomizados cegos bem desenhados são necessários para validar a técnica proposta.
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@#Gingival recessions (GRs) result in root hypersensitivity, root surface caries, and esthetic problems. Various root coverage surgeries are being developed for periodontal plastic therapy. The tunnel technique (TUN) is one of the most widely applied surgeries due to its features of being minimally invasive, practical, excellent outcomes and long-term stability; however, there are still some limitations of this technique. The history and evolution from the envelope flap to TUN, including its efficiency when compared with coronally advanced flaps with a connective tissue graft (CTG), are reviewed in this paper. The limitations of TUN are discussed in consideration of our clinical experience; for example, there is high technique sensitivity when TUN is applied in GR>5 mm because of the great difficulty in covering the grafts. The advantages of surgical access, including vertical incisions in the vestibule, “W” type and pinhole access, are discussed for different situations. Mattress sutures and sling sutures in a single tooth or multiple teeth are applied in TUN. The different types of grafts, such as CTG, platelet-rich plasma, articular dermal matrix and xenogeneic collagen matrix, are described. Mechanical, chemical and biological conditioning of the root surface are recommended during surgery. Protecting the surgical area and taking antibiotics postoperatively are also very important. Finally, the modifications when TUN is applied with other kinds of techniques are discussed, including lateral closed TUN, laterally positioned flaps, double papilla flaps and frenuloplasty. Minimally invasive, esthetic, long-term stability and simplified techniques are the development trends of TUN in the future.
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Objective @#To compare the clinical effect of the tunnel technique (TUN) and vestibular incision subperiosteal tunnel access (VISTA) combining connective tissue grafts (CTGs) on recovering the exposed root surface in a case of gingival recession over the upper anterior teeth and then to provide clinical evidence for gingival recession treatment. @*Methods@# A case of gingival recession (Miller I type) over teeth 13-14 and 22-23 was treated using different techniques bilaterally. 22-23 were treated by a TUN combined CTG transplantation,while teeth 13-14 were treated by a VISTA technique combined with CTG transplantation. The gingival retraction height (GRH), gingival retraction width (GRW), keratinized gingival width (KW), root coverage aesthetic score (RES) and visual analog scale (VAS) were measured after operation. @*Results @#The effect of post-operation were ideal and complete ginglval recovering were achieved, the postoperative effects of the two methods were stable, GRH and GRW decreased, and KW increased. RES was 10. The VAS score of VISTA combined with CTG transplantation was 6, which was higher than that of TUN+CTG. @*Conclusion@#Gingival recession can be treated by TUN+CTG or VISTA+CTG with ideal prognosis. VISTA with an additional incision facilitates the operative procedure but leads to less comfort.
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Objective:To observe the clinical outcome of the modified laterally advanced flap combined with tunnel technique for the treatment of maxillary isolated soft tissue defects. Methods:Three of maxillary isolated soft tissue defects were selected, and the modified lateral advanced flap combined with tunnel technique and subepithelial connective tissue graft was performed to repair the soft tissue defects. Pocket depth (PD), clinical attachment loss (CAL), recession height (RD), recession weight (RW), gingiva thickness (GT), and keratinized tissue width (KTW) were measured at baseline and one-year follow-up after treatment and the root coverage rate (RC%) was calculated. Results:Totally three patients were treated, two Miller III and one Miller Ⅱ. The mean RC% at one-year follow-up was (78.89±18.36)%. The mean CALs at baseline and follow-up were (6.00±1.00) mm and (1.83±1.61) mm. The mean RHs at baseline and follow-up were (5.33±0.58) mm and (1.17±1.04) mm. The mean RWs at baseline and follow-up were (6.00±1.32) mm and (4.50±3.91) mm. The mean GTs at baseline and follow-up were (0.83±0.29) mm and (1.83±0.76) mm. The mean KTWs at baseline and follow-up were (0.83±0.76) mm and (5.50±0.50) mm. Conclusion:In the treatment of maxillary isolated soft tissue defect, the modified lateral advanced flap combined with tunnel technique has broad application and valid clinical outcome.
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OBJECTIVE@#This study aimed to investigate the clinical effect of modified tunnel technique (MTUN) in the treatment of gingival recession with non-carious cervical lesion (NCCL).@*METHODS@#Forty-two teeth with Miller I degree gingival recession were divided into the NCCL group or control group depending on whether NCCL was present. Both groups were treated with MTUN plus subepithelial connective tissue. The periodontal probing depth (PD), gingival recession height (GRH), gingival recession width (GRW), attached gingival width (AGW), and clinical attachment loss (CAL) were recorded before and at 3 and 6 months after operation. The mean root coverage (MRC) at 6 months after operation was calculated and analyzed. A root coverage esthetic scoring system was used to record aesthetic scores.@*RESULTS@#GRH, GRW, and CAL of the two groups after surgery were significantly lower than those before surgery, and no significant changes in PD and AGW were observed. The MRC in the NCCL group was 63.40%±28.02%, whereas that in the control group was 67.00%±21.72%; no significant difference between the two groups was found. In terms of aesthetic outcomes, no significant difference between groups was reported.@*CONCLUSIONS@#MTUN can effectively improve gingival recession, and the presence of shallow NCCL (≤1 mm) will not affect the surgical effect of MTUN.
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Humans , Connective Tissue , Esthetics, Dental , Follow-Up Studies , Gingiva , Gingival Recession , Tooth Root , Treatment OutcomeABSTRACT
Abstract@#Medial meniscus root tear (MMRT) is uncommon and is often associated with osteoarthritis during presentation. Whether it is a cause or effect, it is still debatable at this point of time. However, when a combination of injuries occurs in a middle age group patient, a careful examination before offering a treatment is advised. We herein report a case of a middle-aged gentleman suffering from both arthritis and MMRT.
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Background: Currently, many problems are still controversial on performing out of digestive tract operation through endoscopic submucosal tunnel. Aims: To evaluate the feasibility and safety of endoscopic mediastinal exploration via esophageal submucosal tunnel. Methods: Endoscopic mediastinal exploration was performed via esophageal submucosal tunnel in two healthy swine. A 5 cm submucosal tunnel was created with blunt dissection. The mucosal incision was closed by hemostatic clips, and penicillin was used prophylactically. Two weeks later, after reexamined by gastroscopy, the animals were sacrificed and the esophagus was obtained for macropathology and histopathology. The survival rate, wound healing and complications were observed. Results: The mediastinal organs such as aorta, trachea, and pericardium were identified clearly during exploration. All the animals survived with no obvious complications. Gastroscopy and histopathology showed good wound healing two weeks after operation. Taking autopsy as standard, the anatomical structures were accurately identified under endoscopy. Conclusions: Animal experiment revealed that mediastinal exploration via transesophageal endoscopic submucosal tunnel is feasible and relatively safe.
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@#Gingival recession (GR) is characterized by exposure of the root surface into oral environment due to apical migration of the marginal gingiva to the cementoenamel junction (CEJ). A high prevalence of GR has been reported in several representative population samples. GR may result in a certain degree of functional and aesthetic alterations if left untreated for long periods. In severe cases, root-dentin hypersensitivity, abrasion, abfraction and root caries may also be involved in GR, which increases the challenge of plaque control. The etiology of GR is multifactorial, including periodontal disease, local anatomical variation, tooth malposition, improper tooth brushing, mechanical trauma and iatrogenic factors, of which periodontal disease is the most common cause. The treatments of GR consist of nonsurgical and surgical therapy, and the latter generally involves mucogingival surgery to restore the aesthetics and function of the local gingival recession. However, over the past 50 years, the periodontal plastic surgical technique has evolved from the traditional free gingival graft method into a more advanced, minimally invasive tunnel technique. For this technique, sulcular incisions instead of vertical relieving incisions are provided through each recession area, and full thickness mucoperiosteal flaps are created and extended beyond the mucogingival junction to facilitate coronal displacement. Each pedicle adjacent to the recession is gently undermined to create a tunnel at recipient site, where either autograft or allograft can be used. A minimally invasive tunnel technique is a better method for root coverage and reduced postoperative patient discomfort. This technique is characterized by both practical and aesthetic features.
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Objective: To observe the clinical efficacy of acellular dermal matrix combined with modified tunnel in the treatment of gingival recessions. Methods: 27 teeth with gingival recessions in 8 patients were treated by the means of acellular dermal matrix and modified tunnel technique and were followed up for 1 year. The clinical parameters of gingival recession depth,recession width,keratinized tissue height,probing depth and clinical attachment level were assessed. Percentage of root coverage(PRC),complete root coverage(CRC) and patient satisfactions were evaluated. Results: 1 years after treatment PRC reached to 76％,19 teeth got complete root coverage. Recession depth and recession width were significantly decreased(P ＜ 0. 05). Keratinized tissue height increased by(1. 25 ± 0. 24) mm. Clinical attachment level increased by(2. 75 ± 0. 59) mm. Conclusion: Acellular dermal matrix allograft combined with modified tunnel technique is effective in the treatment of gingival recessions.
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Objective To investigate the clinic effect of tunnel technique on endoscopic submucosal dissection(ESD)for massive colorectal laterally spreading tumor(LST). Methods A retrospective study was conducted on the data of patients with colorectal large area LST(the shortest diameter>4 cm) undergoing ESD by tunnel technique from January 2015 to June 2016 in Digestive Endoscopy Center of Jiangsu Province Hospital of Traditional Chinese Medicine. The size of resected specimens, operation time, complications, pathology results, the number of en bloc resection and curative resection were analyzed. Results A total of 14 cases were collected, including 7 males and 7 females. The longest diameters of resected specimens were from 4.0 to 7.0 cm with mean size of 5.18 ± 0.49 cm. The operation times were from 40 to 120 min with mean time of 63.57±12.95 min. Intraoperative perforation occurred in 2 cases but no delayed perforation and bleeding occurred. Postoperative pathology showed 1 patient with adenoma hyperplasia with crypt abscess,3 patients with low grade intraepithelial neoplasia,6 patients with high grade intraepithelial neophasia,1 patient with carcinoma in situ, 1 patient with carcinoma in M3, and 2 patients with carcinoma in SM1. The number of cases who received en bloc resection, complete resection, and curative resection were 13, 13, and 13, respectively. Conclusion ESD by tunnel technique is safe and effective in the treatment of colorectal large area LST,which is worth popularizing in clinics.
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ObjectiveTo investigate the clinical value of endoscopic esophageal submucosal tunnel resection of gastric fundus-cardiac tumors originating from muscularis propria.Methods Clinical date of 18 patients with gastric fundus-cardiac submucosal tumors originating from muscularis propria who underwent endoscopic esophageal submucosal tunnel resection from January 2011 to December 2011 were retrospectively collected and analyzed.ResultsAll lesions were successfully and completely resected in 18 patients,with sizes ranging from 0.7 cm to 7.2 cm,mean (2.43 ± 1.91 ) cm.Pneumoretroperitoneum,pneumomediastinum and pneumohypoderma occured during the procedure in 2 cases,but spontaneously resolved in 3 days.Fever with increased WBC within 24 h after the procedure occurred in one patient,and was cured in two days with antibiotics.There were no severe complications including bleeding,perforation or death.All patients could have liquid diet 3 days later after the operation.Follow-up endoscopy at 1 week after the operation showed a healing of esophageal incision.ConclusionEndoscopic esophageal submucosal tunnel resection is a safe and effective method for gastric fundus-cardiac submucosal tumors originating from the muscularis propria,lessening the difficulty of traditional endoscopic resection.
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PURPOSE: To compare the results of posterior cruciate ligament reconstructions by tibial inlay and tibial tunnel techniques. MATERIALS AND METHODS: Despite of conservative treatment, all patients (31 cases) had pain and grade 2 or more posterior instability. Posterior drawer test and posterior drawer stress radiography were performed. Clinically, Lysholm knee score and Tegner activity score were evaluated. RESULTS: In the tibial tunnel group, posterior drawer test demonstrated grade 1 instability in 7 cases, grade 2 in 4 cases, and grade 3 in 1 case at the last follow-up. In the tibial inlay group, there was grade 1 instability in 14 cases and grade 2 in 5 cases. On posterior drawer stress radiography, the mean side-to-side difference in measurement of the tibial tunnel group improved from 12.4 mm preoperatively to 4.0 mm at follow-up, and that of the tibial inlay group improved from 11.8 mm to 2.9 mm. Lysholm knee score and Tegner activity score improved to 86.8 points and 5.83 points, respectively, in the tibial tunnel group, and to 88.2 points and 5.84 points, in the tibial inlay group. CONCLUSION: PCL reconstruction with the tibial inlay technique tends to maintain better posterior stability, but there is no statistically significant difference between the two techniques. Further study may be required.
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Humans , Follow-Up Studies , Inlays , Knee , Posterior Cruciate Ligament , RadiographyABSTRACT
[Objective]To explore the "acute angle" of femur,and evaluate the bone tunnel technique in posterior cruciate ligament reconstruction.[Method]Using the porcine flexor digitorum tendon as graft,the author reconstructed posterior cruciate ligament.The bone tunnel was established with the angle of 80?,90?and 100?comparison the tunnel and intercondylar fossa of femur side wall,and press sensitive film was set between the edge of tunnel and graft.The pressure between was used to represent abrasion.The bigger the pressure was,the larger the abrasion was.The difference of pressure between bone tunnel technique group and the control group was compared.[Result]The pressure of angle 100?was lowest(3.55?0.21 MPa).And the pressure of burnishing group(3.29?0.19 MPa)was lower than that of the control group(3.55?0.21 MPa).[Conclusion]The bone tunnel technique can reduce the femoral;"acute angle" of femur in posterior cruciate ligament reconstruction.
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Authors analyzed the findings of nineteen cases of arthroscopic second-look operations after posterior cruciate ligament (PCL) reconstruction with autogenous bone-patellar tendon-bone (BPTB) and Trevira augmentation by two tunnel technique during the period from Nov, 1993 to Jan. l997 in fifty-one cases, along with the results of reconstruction in terms of clinica1 knee scoring, radiographichl and arthroscopic findings. The results were as follows; Age ranged fmm 20 to 53 years, the average being 32.3 years. Thirteen cases (68%) had associated knee injuries; five medial collateral ligament (MCL) injuries, four lateral collateral ligament (LCL) injuries, two associated injuries of MCL and medial meniscus, one both menisci and one associated injury of anterior cruciate ligament and MCL. The average period fmm PCL injury to reconstruction was 7 weeks (range, 1 to 52 wecks) and the mean period from PCL reconstruction to second-look operation was 20.3 months (range, 10 to 46 months). The average Miiller s knee score at the last follow-up was 86 paints. The radiographical results: The distance of posterior translation of the PCL reconstrueted knee compared with the normal sidc knee in posterior stress roentgenography was average 3.8mm (range, 0 to 1 1 mm). The position of the fernoral bone block on the plane of extended Blumansaats line, from the anterior end of the line, was average 32%. The level of proximal end of the tibial bone block according to the tibial tunnel orifice into the joint was mean negative 2.6 degrees position. The findings of arthroscopic second-look examination; In 9 cases (47%), the reconstructed ligamcnts were well covered with synovial tissue and looked like almost normal PCL. There were five cases (26%) of severe fragmentation, three cases (16%) of partial torn fibers of the grafted tendon. And one case showed the thinning of thc grafted tendon compared with the initial diameter at the time of reconstruction and one case showed overgrawth of the synovial membrane which suitounding the grafted tendon. All the Trevira which were augmented at the time of PCL reconstruction were ruptured. Twelve cases (63%) were stable, three cases (16%) were slightly lax and 4 cases (21%) showed laxity of the grafted tendon by the posterior drawer test and probing under arthroscopy, The isometricity which was checked at the time of PCL reconstruction was average 3.4mm. From the ahove results, PCL reconstruction with autogenous BPTB by the two tunnel technique seemed to be a valuable procedure, but there were some cases of unfavorable results. Authors think that a new graft fixation method is needed for resolving the problem mentioned above.