Gingival Ünite Greftinin Periodontal Plastik Cerrahide Kullanımı
Synopsis
Diş eti çekilmesi, diş eti marjininin mine-sement birleşiminin apikaline yer değiştirmesiyle dişin bir veya daha fazla yüzeyinin açığa çıkması olarak tanımlanır. Diş eti çekilmesinin tedavisi ve kök yüzeyinin kapatılması için çok sayıda tedavi yöntemi uygulanabilir. Diş eti çekilmesine yetersiz yapışık diş eti genişliğinin eşlik ettiği durumlarda serbest diş eti grefti (SDG) bir tedavi seçeneğidir. Ancak bu teknik, avasküler kök yüzeyinde vaskülarizasyonun etkilenmesi ve ardından greftin nekroz olasılığı nedeniyle kök kapamada düşük seviyede öngörülebilir bir yöntemdir. SDG, vasküler desteğin zengin olduğu suprakrestal gingival bölgeden elde edilen greft ile vaskülarizasyonun desteklenmesi ve greft canlılığının korunması düşüncesi ile marjinal ve interdental diş etini içerecek şekilde modifiye edilmiş ve gingival ünite grefti (GÜG) olarak tanımlanmıştır. Alıcı sahanın damarsal konfigürasyonuna sayı ve boyut olarak daha yakın bir greft elde edilmesiyle greftin kan desteğinin artırılacağı ve dolayısıyla avasküler kök yüzeyinde greftin beslenmesinin sağlanabileceği düşünülmüştür. Böylece greftte parsiyel nekroz riskinin azalacağı ve başarılı kök kapanması sonuçları elde edilebileceği öngörülmüştür. GÜG, diş eti çekilmelerinin tedavisi amacıyla uygulanan klinik çalışmalarda SDG ile kıyaslanmış ve ortalama kök kapanma yüzdesi ve tam kök kapanma yüzdesi açısından SDG’ye göre avantajlı bulunmuştur. Bu teknik aynı zamanda greft alımında major palatin artere uzak olunması, postoperatif kanama riskinin azalması ve greft adaptasyonunun kolaylığı nedeniyle hasta konforu ve estetik memnuniyet açısından da SDG’ye göre önde yer almaktadır. Sınırlı sayıdaki çalışma sonuçlarına bakılacak olursa keratinize diş etinin yetersiz olduğu izole çekilme vakalarında kök kapama amacı ile GÜG’ün uygulanabileceği sonucu ortaya çıkmaktadır. Ancak kök kapama açısından altın standart olarak kabul edilen bağ dokusu grefti ile kıyaslayan randomize kontrollü çalışmalara ihtiyaç vardır. Ayrıca greft vaskülarizasyonu avantajı, ileri tekniklerin kullanıldığı çalışmalarla desteklenmelidir.
Gingival recession is defined as the displacement of gingival margin to the apical of cementoenamel junction. Many treatment methods can be applied to treat gingival recession. Free gingival graft (FGG) is a treatment option in cases where gingival recession is accompanied by insufficient attached gingiva width. However, this technique is a poorly predictable method for root coverage due to the impact of vascularization on the avascular root surface and the possibility of graft necrosis. FGG is modified to include marginal and interdental gingiva with the idea of supporting vascularization and preserving graft viability with the graft obtained from the supracrestal gingival region, where vascular support is rich, and is defined as a gingival unit graft (GUG). It is thought that by obtaining a graft closer in number and size to the vascular configuration of the recipient site, the blood supply of the graft will be increased. Thus, the nutrition of the graft on the avascular root surface, the reduction of partial necrosis risk, and successful root coverage results can be achieved. GUG was compared with FGG in clinical studies and was found to be advantageous over FGG in terms of average root coverage percentage and complete root coverage percentage. This technique is also ahead of FGG in terms of patient comfort and esthetic satisfaction due to the ease of graft adaptation and the distance from the major palatine artery during graft harvesting. Considering the limited number of study results, it is concluded that GUG can be applied for root coverage in isolated recession cases where keratinized gingiva is insufficient. However, there is a need for randomized controlled studies comparing it with connective tissue graft, which is considered the gold standard in terms of root coverage. Additionally, the advantage of graft vascularization should be supported by studies using advanced techniques.
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