Dişeti Çekilmelerinin Tedavisinde Tünel Tekniği ve Modifikasyonlarının Klinik Etkinliğinin Değerlendirilmesi

Year 2024, Volume: 13 Issue: 1, 228 - 237, 26.01.2024

Ilgın Manav Ahu Uraz Çörekci Deniz Çetiner

https://doi.org/10.54617/adoklinikbilimler.1332104

Abstract

Dişeti çekilmesi (DÇ), dişin gingival kenarının mine-sement sınırının apikalinde konumlanması sonucu kök yüzeyinin ağız ortamına açılması olarak tanımlanır. Dişeti çekilmesinin patolojik, fizyolojik, anatomik veya bunların kombinasyonları sebebiyle oluşabileceği ile ilgili farklı düşünceler vardır. Son yıllarda hastaların yüksek estetik beklentilerini karşılamak ve kanlanmayı artırmak gibi sebeplerle papillanın bütünlüğünü koruyan cerrahi prosedürler ön plana çıkmaktadır. Periodontal biyotipi geliştirmek için bir otogreft olan bağ dokusu grefti(BDG) altın standarttır. Tünel tekniği (TUN), konservatif özellikleri ve gelişmiş estetik sonuçları sayesinde sıkça gündeme gelmektedir. Bu yöntem teknik hassasiyeti oldukça yüksek olan olan Modifiye Koronale Pozisyone Tünel Tekniği (MKPTT), Vestibuler İnsizyon Subperiosteal Tünel Tekniği (VISTA), modifiye-Vestibuler İnsizyon Subperiosteal Tünel Tekniği (m-VISTA ) ve Lateral Tünel Tekniği (LTT) modifikasyonların ortaya çıkmasına aracı olmuştur. Son yıllarda çokça uygulanan BDG ve/veya greft benzeri materyallerin kullanımı hasta konforunu artırmaktadır. Bu greft benzeri materyaller sığır/domuz kaynaklı kolajen matriks(KM), hiyalüronik asit(HA), trombositten zengin fibrin(TZF) olabilmektedir. Bu materyaller ile kullanılan çalışmaların sonuçları umut verici görünmektedir. LTT, tekli dişeti çekilmelerinin tedavisinde oldukça başarılı bulunmuştur. MKPTT hem tekli hem de çoklu dişeti çekilmelerinin tedavisinde kök kapama yüzdesi ve keratinize dişeti genişliğinin artırılmasında en yüksek başarıya sahip yöntem olarak öne çıkmaktadır.

Keywords

Dişeti çekilmesi, Tünel tekniği, Tünel tekniği modifikasyonları, Kök kapama

Evaluation of the Clinical Efficiency of Tunnel Technique and Modifications in the Treatment of Gingival Recessions

Abstract

Gingival recession can be defined as the displacement of the gingival margin apical to the cemento-enamel junction(CEJ) with root surface exposure. There are different opinions about whether gingival recession may occur due to pathological,physiological,anatomical or combinations of these.In recent years, surgical procedures that preserve the integrity of the papilla have come to the fore, for reasons such as meeting the high aesthetic expectations of the patients and increasing the blood supply.Subepithelial connective tissue graft(SCTG) is the gold standard. Tunnel technique(TUN) is frequently on the agenda thanks to its conservative properties and improved aesthetic results.This method has led to the emergence of the Modified Coronally Advanced Tunnel Technique(MCAT), Vestibular Incision Subperiosteal Tunnel Technique(VISTA), modified-Vestibular Incision Subperiosteal Tunnel Technique(m-VISTA) and Lateral Tunnel Technique(LTT). The use of graft-like materials with or without BDG increases patient comfort.These graft-like materials can be bovine/swine-derived collagen matrix(CM), hyaluronic acid(HA), and platelet-rich fibrin(PRF).The results of the studies used with these materials seem promising.LTT has been found to be quite successful in the treatment of single gingival recessions.MCAT stands out as the method with the highest success in increasing the percentage of root surface coverage and keratinized gingival width in the treatment of both single and multiple gingival recessions.

Keywords

Gingival recessions, Tunnel technique, Tunnel technique modifications, Root surface coverage, keratinized gingiva

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