New methods in mucogingival surgery

Mukogingivalni problem je anatomsko – morfološki nesklad u mukogingivalnom kompleksu kojeg čine keratinizirana gingiva, alveolarna mukoza i mukogingivalna granica. Uzroci nesklada često su kombinacija genetskih i stečenih čimbenika, a to su dehiscencije i fenestracije, koronalno hvatište frenuluma, plitki vestibulum, loša oralna higijena i gruba tehnika četkanja zubi. Zbog narušene estetske i funkcionalne vrijednosti, mukogingivalni nesklad, odnosno gingivalna recesija najčešće se liječi kirurškim postupkom prekrivanja ogoljenog korijena zuba. Postoje brojne tehnike prekrivanja recesija, a to su tehnike peteljkastih transplantata mekih tkiva, tehnike vezivnih transplantata mekih tkiva, vođena tkivna regeneracija, primjena derivata proteina caklinskog matriksa i faktora rasta. Cilj tih terapijskih postupaka je potpuno prekrivanje ogoljenog korijena zuba i regeneracija svih izgubljenih parodontalnih tkiva zuba sa gingivalnom recesijom. Pošto je regeneracija parodontalnog tkiva najviše postignuta primjenom derivata caklinskog matriksa i faktora rasta, oni se u današnje vrijeme sve više istražuju i primjenjuju. Na tržištu postoji produkt Emdogain® koji sadrži derivate proteina matriksa cakline. Ti su proteini izdvojeni iz zubnih vrećica mladih zubi svinja. Oni ostvaruju regeneraciju parodontalnih tkiva imitirajući biološki slijed događaja za vrijeme razvoja parodonta. U terapiji gingivalnih recesija pokazala se i važnost rekombinantnog humanog trombocitnog čimbenika rasta (rhPDGF), koji stimulira proliferaciju i kemotaksiju stanica za razvoj parodontalnog tkiva.The mucogingival problem is anatomical – morphological discrepancy in the mucogingival complex formed by keratinized ginigiva, alveolar mucosa and mucogingival line. The causes of such discrepancy are often a combination of genetic and acquired factors, such as dehiscence and fenestration, high coronal attached frenulum, shallow vestibulum, poor oral hygiene and overly aggressive brushing. Due to impaired aesthetic and functional values, the mucogingival discrepancy, or gingival recession is most often treated by a surgical procedure of covering the root. There are many techniques which can be used to overcome the recession such as pedicle soft tissue grafts techniques, free soft tissue grafts techniques, guided tissue regeneration, enamel matrix derivatives and growth factors. The goal of these therapeutic procedures is to completely cover the exposed root and regenerate all the lost periodontal tissue teeth with gingival recession. As the regeneration of periodontal tissue is mostly achieved by applying the enamel matrix derivatives and growth factors, they are increasingly being explored and applied today. There is an Emdogain® product on the market containing the enamel matrix protein derivatives. These proteins are extracted from the toothpickets of young pig teeth. They make the regeneration of periodontal tissues by imitating the biological sequence of events during the periodontal development. In the therapy of gingival recessions there is a significant importance of recombinant human platelet-induced growth factor (rhPDGF), which stimulates proliferation and chemotaxis of cells for the development of periodontal tissue