歯肉退縮は改善できる？治療費は？｜證據鏈

歯肉退縮は改善できる？治療費は？｜證據鏈

F-Units（事実単位帳）

• F1｜本テーマの選定根拠＝14 診療所サイトの GSC 全量照合。「牙齦萎縮治療費用ptt」「牙齦萎縮治療費用」「牙齦萎縮恢復ptt」「水雷射牙齦萎縮」「老人牙齦萎縮假牙」など 7 語句の合計露出 121,175、4 サイト｜source＝内部元帳（km-dental-backlog.md #27 appendix）｜confidence=high｜basis=internal_dataset｜period=GSC retention window（2025-03-22 から）｜geo: TW｜caveat: 露出は属性水準の数値で重複除外済みトラフィックではない。内部データで医学的主張ではなく、公開変換時は出力しない。
• F2［構造的編集］｜「進行機会を減らす／露出歯根を覆う」の二層分岐、「原因と分類を分けて尋ねる」という問い、KM-DENTAL-14 との分担声明は、患者の検索語と文献用語の対応に基づく本サイトの編集枠組みであり、事実主張でも機関の分類方式でもない｜confidence=n/a｜basis=editorial｜geo: TW｜caveat: 検証待ちと表示してはならない（偽の検証作業を作らないため）。
• F3｜粘膜歯肉欠損（歯肉退縮を含む）は成人で頻繁に起こり、年齢とともに増える傾向があり、口腔衛生水準の高低を問わず起こる。歯根表面露出には審美性低下、象牙質知覚過敏、う蝕性・非う蝕性歯頸部病変が伴うことが多い｜source #1｜confidence=high｜basis=clinical_guideline（2017 年ワークショップ分類合意の叙述的レビュー）｜period=2018；2026-08-06 の検索で 2017 年ワークショップを置き換える新版分類合意は見当たらなかった｜geo: universal｜caveat: KM-DENTAL-14 と共有するアンカー。関連・傾向の記述であり、発生率の主張ではない。
• F4｜病変がない場合、特定部位をモニタリングすることは適切である。病変発生・進行のリスクが上がる場合、または患者の審美的要求を満たす場合、生物型を変更し、または歯根を覆う外科的介入が適応となりうる｜source #1｜confidence=high｜basis=clinical_guideline｜period=2018｜geo: universal｜caveat: KM-DENTAL-14 と共有するアンカー。適応の原則であり個別の判断基準ではない。本カードは自己診断法を示さない。
• F5｜不十分な口腔衛生、矯正治療、歯頸部修復物は歯肉退縮リスクを高めうる。薄い歯周生物型はリスクが高く、多くの患者の歯周健康は良好な自宅での清掃で維持できる｜source #1｜confidence=moderate｜basis=clinical_guideline（レビュー文献の整理）｜period=2018｜geo: universal｜caveat: リスク因子の記述であり、相対リスクは定量化していない。
• F6｜2016 年の未治療頬側歯肉退縮の系統的レビュー・メタ解析：追跡 ≥24 か月で根面被覆または歯肉増大手術を受けていない研究を採用し、2015 年 7 月まで検索。378 件を初期選別、8 報告（6 研究）を採用。ベースライン・追跡データのある退縮欠損 1,647 箇所の 78.1% は深さが増え、残りは減少または変化なし。追跡患者の退縮欠損数は 79.3% 増加。統合推定は患者数で OR 2.43（P = 0.03）、部位数で OR 2.16（P = 0.0005）。著者は、口腔衛生が良好な人の未治療退縮欠損は長期追跡で進行する確率が高いと結論した｜source #2｜confidence=high｜basis=peer_reviewed（SR＋MA）｜period=2016；2026-08-06 に PubMed で同じ臨床問題（未治療退縮の長期進行）の 2017 年以後の系統的レビューを検索し、更新版は見当たらなかった｜geo: universal｜caveat: 集団は口腔衛生が良好な成人、研究は 6 件のみ。集団水準の確率で、個別歯の予測へ外挿してはならない。「残りは減少または変化なし」を省略してはならない。
• F7｜クリーピング・アタッチメント（creeping attachment）＝追加の根面被覆を得るため歯肉縁が歯冠側へ移動すること。各種粘膜歯肉手術の治癒後に起こりうる現象と説明され、被覆は常に完全でも完全に予測可能でもない｜source #3｜confidence=moderate｜basis=peer_reviewed（82 文献を含む文献レビュー）｜period=2020｜geo: universal｜caveat: 術後の現象であり、未治療状態での自然回復ではない。叙述的文献レビューで、メタ解析は行っていない。
• F8｜2015 年のレビュー・メタ解析：メタ解析は 159 人を含み、手用歯ブラシ使用者の 12 か月後の歯肉退縮は電動歯ブラシ使用者より多かった。13 横断研究では、頻度、水平往復法、毛の硬さ、時間、交換頻度が最もよく関連した要因だった。著者は、歯磨きと歯肉退縮・非う蝕性歯頸部病変との関連を支持も否定もするデータは全体としてなお結論に不十分とした｜source #4｜confidence=moderate｜basis=peer_reviewed（レビュー＋メタ解析、欧州歯周病学ワークショップ委託文献）｜period=2015；2026-08-06 に PubMed で 2016 年以後の同テーマの系統的レビュー／メタ解析を検索した結果は source #5（毛の特集）のみで、本稿を置き換える更新版はなかった｜geo: universal｜caveat: 著者は根拠不足を明示している。本カードは「歯磨きが退縮を起こす」という因果文にしてはならない。
• F9｜2019 年の系統的レビュー：1,945 件を初期選別、13 件採用。硬い毛の歯ブラシは中程度・柔らかい毛より多い歯肉病変を生じ、著者は柔らかい毛と極柔らかい毛が安全な傾向と結論した｜source #5｜confidence=moderate｜basis=peer_reviewed（系統的レビュー、定性的統合）｜period=2019｜geo: universal｜caveat: 有害事象を主要結果とした研究は 4 件のみ。本カードはブランド製品を推薦しない。
• F10｜2023 年の矯正後歯肉退縮リスク因子の系統的レビュー：2023-04-20 まで検索、48 論文採用。退縮の有病率、重症度、範囲はそれぞれ 10/15、4/10、2/2 論文で矯正患者に有意に高かった。10/16 論文は前歯唇側傾斜移動でより多い退縮とより大きな臨床的歯冠高を報告。薄い歯肉生物型、既存退縮、ベースライン角化歯肉幅、唇側歯肉縁の厚さは 9 論文でリスク上昇と関連し、ポケット深さは関連しなかった。著者は高い異質性としばしば矛盾する結果を指摘した｜source #6｜confidence=moderate｜basis=peer_reviewed（系統的レビュー、メタ解析なし）｜period=2023（本テーマの現行最新版：より早い 2018 年の同テーマ系統的レビュー PMID 29911278 は観察研究 2 件のみであり、本カードはより新しく採用量の多いものを用いる）｜geo: universal｜caveat: 非無作為化研究を含み、バイアスリスクは中等度。関連であり因果ではない。
• F11｜2023 年の系統的レビュー・メタ解析（129 件を初期選別、12 件採用、8 件を定量解析）：現時点の根拠では、マウスピース矯正が矯正中に固定式装置より歯周健康を維持できるとは結論できない｜source #7｜confidence=moderate｜basis=peer_reviewed（SR＋MA）｜period=2023｜geo: universal｜caveat: 一部の指標は極めて高い異質性（例：プラーク指数 I²=99%）。本カードは総合結論のみを引用し、個別統合値は引用しない。
• F12｜咬合応力と非う蝕性歯頸部病変（abfraction）の系統的レビュー：69 文献（臨床 31、実験室 38）を採用し、56/69（81%）が関連を認めた。病変が応力単独で起こることを証明した臨床研究はない｜source #8｜confidence=moderate｜basis=peer_reviewed（系統的レビュー）｜period=2017；2026-08-06 の検索で 2018 年以後の同テーマの置換版系統的レビューは見当たらなかった（近年の新規文献は有病率と考古学標本の特集）｜geo: universal｜caveat: 結果指標は歯頸部病変であり、歯肉退縮そのものではない。「咬合が歯肉退縮を起こす」と書き換えてはならない。
• F13｜上顎正中小帯の系統的レビュー（206 件を初期選別、48 件採用）：上顎小帯が歯肉退縮を起こすことに関する結論は一致せず、上顎前歯部の退縮・インプラント周囲疾患への寄与は議論がある。レーザー手術の従来手術に対する優越性は文献で証明されていない｜source #9｜confidence=low｜basis=peer_reviewed（系統的レビュー）｜period=2013｜geo: universal｜caveat: 古い（2013）。2026-08-06 に検索した 2014 年以後の文献は術式比較（例：2026 年のダイオードレーザー対メスのメタ解析）が多く、「小帯と退縮の因果」を置き換える系統的レビューは見当たらなかった。本カードは保守的な「結論は一致しない」記述のみを引用する。
• F14｜欧州歯周病学連盟（European Federation of Periodontology）の Stage I–III 歯周炎 S3 臨床実践ガイドライン：あらかじめ定めた段階的・漸増的な治療経路で、行動変容、歯肉縁上バイオフィルム、歯肉炎症、リスク因子の管理、補助療法の有無を問わない歯肉縁上・縁下の器具的治療、各種歯周外科介入、利益を維持する支持的歯周ケアを含む｜source #10｜confidence=high｜basis=clinical_guideline（S3、GRADE 法、委託系統的レビュー 15）｜period=2020；2026-08-06 の検索で同じ範囲（Stage I–III）の改訂版は見当たらず、2022 年の Stage IV ガイドラインと 2023 年のインプラント周囲疾患ガイドラインは別範囲｜geo: universal｜caveat: ガイドラインは臨床判断の根拠であり、個別処方ではない。要約は合意された介入を (a)–(d) に挙げるのみで、それぞれに段階番号を付さない。本カードは列挙順を述べるだけで番号を割り当てない。台湾での給付・手順は別途健保署公告による。
• F15｜RT1＝隣接面付着喪失なし。RT2＝隣接面付着喪失が頬側以下。RT3＝隣接面付着喪失が頬側より大きい。この分類は 6 か月時点の退縮減少量を予測した（治療部位 109、p<0.0001）｜source #11｜confidence=moderate｜basis=peer_reviewed（探索的・信頼性研究、患者 25 人、退縮 116）｜period=2011｜geo: universal｜caveat: KM-DENTAL-14 と共有するアンカー。単施設の探索的研究で、分類には臨床測定が必要。本カードは自己分類法を示さない。
• F16｜Cochrane 系統的レビュー（2018 年更新、原版 2009）は無作為化試験 48 を採用。歯肉退縮＝歯肉縁がセメント‐エナメル境から根尖側へ移動して歯根表面が口腔へ露出すること｜source #12｜confidence=high｜basis=peer_reviewed（Cochrane 系統的レビュー）｜period=2018-01-15 まで検索；2026-08-06 に CD007161[pg] で版の連鎖を検索し、2009 年原版と 2018 年更新の 2 件だけを得た。2018 年版が現行版である｜geo: universal｜caveat: 術式比較の詳細は KM-DENTAL-14 の正典。本カードは定義と試験数のみを引用する。
• F17｜2025 年の複数歯肉退縮の系統的レビュー・メタ解析（2024-05 まで検索、RCT 32、患者 1012 人、退縮 3589）：平均根面被覆 82.6%（95% CI 71.3–93.9）、完全根面被覆 62.7%（95% CI 57.0–68.4）｜source #13｜confidence=high｜basis=peer_reviewed（SR＋MA）｜period=2025（2026-08-06 の検索で更新版なし）｜geo: universal｜caveat: 集団は複数退縮をもつ人。全ての退縮や単歯欠損の個人予測に外挿してはならない。本カードは一文の要約のみで、完全な文脈は KM-DENTAL-14 の正典にある。
• F18｜2018 年の系統的レビュー・メタ解析（2017 年 8 月まで検索、RCT 7、患者 173 人、歯 296 本）：フラップ移植＋レーザーと手術単独は、退縮深さ（P = 0.21）、退縮幅（P = 0.92）、根面審美スコア（P = 0.21）、完全根面被覆（P = 0.09）に統計学的有意差なし。角化組織幅（P < 0.0001）、1 年のポケット深さ（P = 0.03）、臨床的付着レベル（P < 0.00001）には有意差があった。著者はレーザーに根面被覆・審美性の追加利益なしと結論した｜source #14｜confidence=moderate｜basis=peer_reviewed（SR＋MA）｜period=2018；2026-08-06 に「レーザー×根面被覆×系統的レビュー／メタ解析×2019 年後」を検索し、9 件はすべて別の臨床問題（脱上皮化移植片採取、歯周骨内欠損、インプラント周囲炎、矯正期の口腔健康など）で、本レビューを置き換える更新版はなかった｜geo: universal｜caveat: 要約は各試験のレーザー種類を列挙せず、Er,Cr:YSGG 水レーザーと同一視してはならない。試験数が少なく標本も小さい。
• F19｜無作為化比較臨床試験（単独歯退縮欠損の参加者 24 人。3 群：メスで採取した脱上皮化歯肉移植片、水レーザー採取＋根面フォトバイオモジュレーション、メス採取＋水レーザー根面フォトバイオモジュレーション）：対照群・試験群の根面被覆に統計学的有意差なし。レーザー採取は口蓋側供給部位の術後罹患率低下と関連｜source #15｜confidence=low｜basis=peer_reviewed（単施設 RCT、n=24、単盲検）｜period=2021；2026-08-06 に歯肉退縮での水レーザーを検索し、2025／2026 年の採取術式 RCT も得たが、全て小標本で系統的レビュー水準の根拠なし｜geo: universal｜caveat: 小標本、単施設。著者は結論で「改善」と表現したが、同時に統計学的有意差なしと報告した。本カードは有意差なしを採用し、レーザーが歯肉を戻せるとは書かない。
• F20｜欧州 7 か国の横断観察研究：全身健康な成人 3551 人（平均年齢 44 ± 17.4）、歯肉退縮（≥1 mm）は参加者の 87.9%。退縮と酸蝕性歯牙磨耗は若年成人期後も増え続けた｜source #16｜confidence=moderate｜basis=peer_reviewed（多国横断観察研究）｜period=2024｜geo: universal（欧州 7 か国標本）｜caveat: 台湾集団ではなく、台湾の有病率としての使用は禁止。研究は業界（Haleon）の資金支援を受け、同社雇用の著者を開示した。2025 年の Erratum 記録があり、本カードの数値は 2024 年原著要約から取る。
• F21｜2025 年の知覚過敏剤長期有効性の系統的レビュー・メタ解析（2025 年 1 月まで検索、追跡 ≥6 か月の RCT、レビュー 22、メタ解析 15）：複数の知覚過敏剤は感覚刺激による痛みスコアを有意に下げ、グルタルアルデヒドと低出力レーザーは比較的大きい効果量、接着システムとリン酸カルシウム系は統計学的有意な利益なし｜source #17｜confidence=moderate｜basis=peer_reviewed（SR＋MA）｜period=2025｜geo: universal｜caveat: 低出力レーザーは象牙質知覚過敏用であり、根面被覆手術の水レーザーとは介入・結果が同一でない。本カードは製品推薦も薬剤使用指示もしない。
• F22｜台湾医療法第 21 条：「医療機関が収受する医療費の基準は、直轄市・県（市）の主管機関が承認する」｜source #18｜confidence=high｜basis=law｜period=現行条文（2026-08-06 curl による HTTP 200 実測＋逐語照合）｜geo: TW｜caveat: KM-DENTAL-03／14 と共有するアンカー。法文の要約であり、法律意見ではない。
• F23｜台湾医療法第 22 条：医療機関は料金項目と金額を記載した領収書を発行しなければならず、料金基準に反して過大請求または勝手な料金項目設定をしてはならない｜source #19｜confidence=high｜basis=law｜period=現行条文（2026-08-06 curl による HTTP 200 実測＋二つの文言を逐語照合）｜geo: TW｜caveat: KM-DENTAL-03／14 と共有するアンカー。法文の要約であり、法律意見ではない。
• F24｜台湾医療法第 63 条：手術前に医療機関は患者または列挙された関係者へ理由、成功率または起こりうる合併症・危険を説明し、同意を得て、手術・麻酔同意書への署名を得なければならない｜source #20｜confidence=high｜basis=law｜period=現行条文（2026-08-06 curl による HTTP 200 実測＋逐語照合）｜geo: TW｜caveat: KM-DENTAL-14／17 と共有するアンカー。本文では法の但書「緊急の場合はこの限りでない」を引用しない。
• F25｜台湾全民健康保険法第 51 条は給付対象外を列挙し、第 3 号は美容外科手術、第 11 号は義歯、義眼、眼鏡、補聴器、車椅子、松葉杖その他積極的治療性のない装具を含む｜source #22｜confidence=high｜basis=law｜period=現行条文（2026-08-06 curl による HTTP 200 実測＋第 3 号・第 11 号を逐語照合）｜geo: TW｜caveat: KM-DENTAL-09／14／17 と共有するアンカー。法の列挙は個別事例の結論ではなく、本カードは該当性判断をしない。
• F26｜台湾医療法第 87 条：医療業務を暗示または示唆する広告は医療広告である。医療業務の勧誘を含まない医学知識・研究報告の発表、患者の衛生教育、学術刊行物は医療広告ではない｜source #21｜confidence=high｜basis=law｜period=現行条文（2026-08-06 curl による HTTP 200 実測＋二つの文言を逐語照合）｜geo: TW｜caveat: 本カードの位置づけの根拠。
• F27｜自費料金項目は地方衛生主管機関が承認した料金基準で扱う。検証済み例＝台北市政府衛生局「臺北市醫療機構牙科收費標準表」（1090117 承認）および政府オープンデータ・データセット 121913「臺北市醫療收費標準」｜source #23 and #24｜confidence=high｜basis=official_statement｜period=1090117 承認。2026-08-06、衛生局ページを ego-browser で読み込み、タイトルを逐語照合。データセットタイトルは Open API が返し逐語照合｜geo: TW｜caveat: KM-DENTAL-03／11／14／26 と共有するアンカー。一市の例のみで、他県市は別途公告。本カードはそこから金額を引用しない。
• F28｜台湾健保の給付側を確認する入口＝健保署公告ページ「全民健康保險醫療服務給付項目及支付標準」および政府オープンデータ・データセット 174450「醫療服務給付項目及支付標準(csv檔)」｜source #25 and #26｜confidence=high｜basis=official_statement｜period=2026-08-06：公告ページを ego-browser で読み込み（タイトルと 4 ファイル一覧を逐語読取）、データセットのタイトルと説明は Open API が返し逐語照合｜geo: TW｜caveat: 本カードは確認入口の存在と到達可能性だけを記録し、各処置の支払状態を個別にダウンロード・比較していない（給付判定は F30 で検証待ち）。
• F29｜台湾健保の「醫材比價網」は二つの検索経路のいずれにも歯科項目を含まず、歯科自費項目をそこで確認できない｜source＝カード横断の検証事実ファイル `km-compliance/VERIFIED-FACTS.md`（OP が 2026-08-05 にブラウザでテストし全分類を読取）｜confidence=high｜basis=official_statement（テスト記録）｜period=2026-08-05｜geo: TW｜caveat: 本カードはカード横断の検証済みアンカーを再利用し、テストを繰り返していない。後に歯科分類が追加された場合は再検証が必要。
• F30［検証待ち］｜本テーマの処置（歯周治療、知覚過敏治療、歯頸部病変修復、根面被覆手術）の台湾健保支払基準上の給付状態｜source type: 台湾健保「全民健康保險醫療服務給付項目及支付標準」公告ファイル（入口は F28 で検証、内容は項目別に比較していない）｜confidence=low｜basis=pending｜geo: TW｜caveat: 検証前に、本カードは「給付／非給付」と断言しない。
• F31［検証待ち］｜本テーマの処置を民間保険が補償するかは保険契約の条項による｜source type: 保険契約条項（公に引用できる保険契約見本は得ていない）｜confidence=low｜basis=pending｜geo: TW｜caveat: 本サイトは補償判断の見解を示さず（編集方針）、「保険契約の条項による」とだけ述べる。
• F32［構造的編集］｜「診断・検査／原因への対応／症状への対応／手術／補助機器の追加項目／追跡と再処置」という六分割と見積照合の助言は、本サイトの編集上の読解枠組みであり、事実主張でも機関の料金分類でもない｜confidence=n/a｜basis=editorial｜geo: TW｜caveat: 検証待ちと表示してはならない。

出典一覧

• S1 Cortellini P, Bissada NF. Mucogingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations. J Periodontol. 2018;89 Suppl 1:S204-S213. PMID 29926948. https://pubmed.ncbi.nlm.nih.gov/29926948/ (accessed 2026-08-06; abstract retrieved by efetch). Verbatim spans: “Mucogingival defects including gingival recession occur frequently in adults, have a tendency to increase with age, and occur in populations with both high and low standards of oral hygiene” “The root surface exposure is frequently associated with impaired esthetics, dentinal hypersensitivity and carious and non-carious cervical lesions” “periodontal health can be maintained in most patients with optimal home care” “inadequate oral hygiene, orthodontic treatment, and cervical restorations might increase the risk for the development of gingival recession” “thin periodontal biotypes are at greater risk for developing gingival recession” “in the absence of pathosis, monitoring specific sites seems to be the proper approach” “surgical intervention, either to change the biotype and/or to cover roots, might be indicated when the risk for the development or progression of pathosis and associated root damages is increased and to satisfy the esthetic requirements of the patients”｜span：「Mucogingival defects including gingival recession occur frequently in adults, have a tendency to increase with age, and occur in populations with both high and low standards of oral hygiene」「The root surface exposure is frequently associated with impaired esthetics, dentinal hypersensitivity and carious and non-carious cervical lesions」「periodontal health can be maintained in most patients with optimal home care」「inadequate oral hygiene, orthodontic treatment, and cervical restorations might increase the risk for the development of gingival recession」「thin periodontal biotypes are at greater risk for developing gingival recession」「in the absence of pathosis, monitoring specific sites seems to be the proper approach」「surgical intervention, either to change the biotype and/or to cover roots, might be indicated when the risk for the development or progression of pathosis and associated root damages is increased and to satisfy the esthetic requirements of the patients」
• S2 Chambrone L, Tatakis DN. Long-Term Outcomes of Untreated Buccal Gingival Recessions: A Systematic Review and Meta-Analysis. J Periodontol. 2016;87(7):796-808. PMID 26878749. https://pubmed.ncbi.nlm.nih.gov/26878749/ (accessed 2026-08-06; abstract retrieved by efetch). Verbatim spans: “Interventional and observational studies with duration of ≥24 months reporting outcomes from adult patients with localized or multiple GR defects not treated by root coverage or gingival augmentation procedures were considered eligible for inclusion” “MEDLINE and EMBASE databases were searched for articles published through July 2015” “Of 378 potentially eligible articles, eight (reporting six studies) met inclusion criteria” “Of 1,647 GR defects with baseline and follow-up information, 78.1% experienced GR depth increase during the follow-up period, whereas the remaining experienced decrease or no change” “there was a 79.3% increase in the number of GR defects among the patients followed” “Pooled estimates (data from four studies) showed significantly increased odds of recession development long term, regarding either number of patients (odds ratio 2.43; P = 0.03) or number of sites with GR (odds ratio 2.16; P = 0.0005)” “Untreated recession defects in individuals with good oral hygiene have a high probability of progressing during long-term follow-up”｜span：「Interventional and observational studies with duration of ≥24 months reporting outcomes from adult patients with localized or multiple GR defects not treated by root coverage or gingival augmentation procedures were considered eligible for inclusion」「MEDLINE and EMBASE databases were searched for articles published through July 2015」「Of 378 potentially eligible articles, eight (reporting six studies) met inclusion criteria」「Of 1,647 GR defects with baseline and follow-up information, 78.1% experienced GR depth increase during the follow-up period, whereas the remaining experienced decrease or no change」「there was a 79.3% increase in the number of GR defects among the patients followed」「Pooled estimates (data from four studies) showed significantly increased odds of recession development long term, regarding either number of patients (odds ratio 2.43; P = 0.03) or number of sites with GR (odds ratio 2.16; P = 0.0005)」「Untreated recession defects in individuals with good oral hygiene have a high probability of progressing during long-term follow-up」
• S3 Wan W, Zhong H, Wang J. Creeping attachment: A literature review. J Esthet Restor Dent. 2020;32(8):776-782. PMID 32896991. https://pubmed.ncbi.nlm.nih.gov/32896991/ (accessed 2026-08-06; abstract retrieved by efetch). Verbatim spans: “An interesting phenomenon after mucogingival surgery is the coronal migration of gingival margin” “A total of 82 relevant articles were included in the literature review” “Creeping attachment may occur to obtain additional root coverage after the healing of various mucogingival surgeries. However, this coverage is not always complete nor entirely predictable.”｜span：「An interesting phenomenon after mucogingival surgery is the coronal migration of gingival margin」「A total of 82 relevant articles were included in the literature review」「Creeping attachment may occur to obtain additional root coverage after the healing of various mucogingival surgeries. However, this coverage is not always complete nor entirely predictable.」
• S4 Heasman PA, Holliday R, Bryant A, Preshaw PM. Evidence for the occurrence of gingival recession and non-carious cervical lesions as a consequence of traumatic toothbrushing. J Clin Periodontol. 2015;42 Suppl 16:S237-S255. PMID 25495508. https://pubmed.ncbi.nlm.nih.gov/25495508/ (accessed 2026-08-06; abstract retrieved by efetch). Verbatim spans: “A meta-analysis included 159 subjects and showed that subjects who used MTBs (manual toothbrush) had greater gingival recession after 12 months when compared with those using PTBs (powered toothbrush)” “Thirteen cross-sectional studies identified the most frequent toothbrushing factors associated with gingival recession as being toothbrushing frequency, a horizontal or scrub toothbrushing method, bristle hardness, toothbrushing duration and the frequency of changing a toothbrush” “The data to support or refute the association between toothbrushing and gingival recession and NCCLs remain largely inconclusive”｜span：「A meta-analysis included 159 subjects and showed that subjects who used MTBs (manual toothbrush) had greater gingival recession after 12 months when compared with those using PTBs (powered toothbrush)」「Thirteen cross-sectional studies identified the most frequent toothbrushing factors associated with gingival recession as being toothbrushing frequency, a horizontal or scrub toothbrushing method, bristle hardness, toothbrushing duration and the frequency of changing a toothbrush」「The data to support or refute the association between toothbrushing and gingival recession and NCCLs remain largely inconclusive」
• S5 Ranzan N, Muniz FWMG, Rösing CK. Are bristle stiffness and bristle end-shape related to adverse effects on soft tissues during toothbrushing? A systematic review. Int Dent J. 2019;69(3):171-182. PMID 30152076. https://pubmed.ncbi.nlm.nih.gov/30152076/ (accessed 2026-08-06; abstract retrieved by efetch). Verbatim spans: “Thirteen studies were included from the 1,945 initially retrieved” “Hard-bristle toothbrushes produced more gingival lesions than medium- and soft-bristle brushes” “Soft and extra-soft toothbrushes tend to be safer” “Only four studies presented adverse effects as the primary outcome”｜span：「Thirteen studies were included from the 1,945 initially retrieved」「Hard-bristle toothbrushes produced more gingival lesions than medium- and soft-bristle brushes」「Soft and extra-soft toothbrushes tend to be safer」「Only four studies presented adverse effects as the primary outcome」
• S6 Cadenas de Llano-Pérula M, Castro AB, Danneels M, Schelfhout A, Teughels W, Willems G. Risk factors for gingival recessions after orthodontic treatment: a systematic review. Eur J Orthod. 2023;45(5):528-544. PMID 37432131. https://pubmed.ncbi.nlm.nih.gov/37432131/ (accessed 2026-08-06; abstract retrieved by efetch). Verbatim spans: “systematically searching 3 data bases: Pubmed, EMBASE, and Web of Science until 20 April 2023” “Forty-eight articles were included” “Significantly higher prevalence, severity and extent of GR were found in orthodontic patients by 10/15, 4/10, and 2/2 articles respectively” “10/16 articles reported significantly more GR and increased CCH in patients where orthodontic incisor proclination was performed” “A thin gingival biotype, presence of previous GR, baseline width of keratinized gingiva and facial gingival margin thickness were correlated with increased risk of GR after OT by nine articles, while pocket depth was not” “they are very heterogeneous concerning design, studied factors, methodology and reporting, which often leads to contradictory results”｜span：「systematically searching 3 data bases: Pubmed, EMBASE, and Web of Science until 20 April 2023」「Forty-eight articles were included」「Significantly higher prevalence, severity and extent of GR were found in orthodontic patients by 10/15, 4/10, and 2/2 articles respectively」「10/16 articles reported significantly more GR and increased CCH in patients where orthodontic incisor proclination was performed」「A thin gingival biotype, presence of previous GR, baseline width of keratinized gingiva and facial gingival margin thickness were correlated with increased risk of GR after OT by nine articles, while pocket depth was not」「they are very heterogeneous concerning design, studied factors, methodology and reporting, which often leads to contradictory results」
• S7 Crego-Ruiz M, Jorba-García A. Assessment of the periodontal health status and gingival recession during orthodontic treatment with clear aligners and fixed appliances: A systematic review and meta-analysis. Med Oral Patol Oral Cir Bucal. 2023;28(4):e330-e340. PMID 36641738. https://pubmed.ncbi.nlm.nih.gov/36641738/ (accessed 2026-08-06; abstract retrieved by efetch). Verbatim spans: “From the 129 potential studies, finally 12 studies were included. Only 8 could be included in the quantitative analysis” “Up to the date there is not enough evidence to conclude that CA maintains better periodontal health during an orthodontic treatment than FA”｜span：「From the 129 potential studies, finally 12 studies were included. Only 8 could be included in the quantitative analysis」「Up to the date there is not enough evidence to conclude that CA maintains better periodontal health during an orthodontic treatment than FA」
• S8 Duangthip D, Man A, Poon PH, Lo ECM, Chu CH. Occlusal stress is involved in the formation of non-carious cervical lesions. A systematic review of abfraction. Am J Dent. 2017;30(4):212-220. PMID 29178704. https://pubmed.ncbi.nlm.nih.gov/29178704/ (accessed 2026-08-06; abstract retrieved by efetch). Verbatim spans: “69 publications (31 clinical studies and 38 laboratory studies) were included in this review and the majority (56/69, 81%) found an association between occlusal stress and NCCLs” “no clinical study demonstrated that NCCL was caused by stress alone”｜span：「69 publications (31 clinical studies and 38 laboratory studies) were included in this review and the majority (56/69, 81%) found an association between occlusal stress and NCCLs」「no clinical study demonstrated that NCCL was caused by stress alone」
• S9 Delli K, Livas C, Sculean A, Katsaros C, Bornstein MM. Facts and myths regarding the maxillary midline frenum and its treatment: a systematic review of the literature. Quintessence Int. 2013;44(2):177-187. PMID 23444184. https://pubmed.ncbi.nlm.nih.gov/23444184/ (accessed 2026-08-06; abstract retrieved by efetch). Verbatim spans: “Of the 206 initially identified articles, 48 met the inclusion criteria” “Studies on the cause of gingival recession due to the maxillary frenum are inconclusive” “the contribution to gingival recession and peri-implant diseases in the region of the maxillary incisors is rather controversial” “The superiority of laser treatment in relation to conventional surgical methods has not yet been demonstrated in the literature”｜span：「Of the 206 initially identified articles, 48 met the inclusion criteria」「Studies on the cause of gingival recession due to the maxillary frenum are inconclusive」「the contribution to gingival recession and peri-implant diseases in the region of the maxillary incisors is rather controversial」「The superiority of laser treatment in relation to conventional surgical methods has not yet been demonstrated in the literature」
• S10 Sanz M, Herrera D, Kebschull M, Chapple I, Jepsen S, Berglundh T, Sculean A, Tonetti MS; EFP Workshop Participants and Methodological Consultants. Treatment of stage I-III periodontitis—The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020;47 Suppl 22:4-60. PMID 32383274. https://pubmed.ncbi.nlm.nih.gov/32383274/ (accessed 2026-08-06; abstract retrieved by efetch). Verbatim spans: “The S3 CPG approaches the treatment of periodontitis (stages I, II and III) using a pre-established stepwise approach to therapy that, depending on the disease stage, should be incremental, each including different interventions” “behavioural changes, supragingival biofilm, gingival inflammation and risk factor control” “the necessary supportive periodontal care to extend benefits over time”｜span：「The S3 CPG approaches the treatment of periodontitis (stages I, II and III) using a pre-established stepwise approach to therapy that, depending on the disease stage, should be incremental, each including different interventions」「behavioural changes, supragingival biofilm, gingival inflammation and risk factor control」「the necessary supportive periodontal care to extend benefits over time」
• S11 Cairo F, Nieri M, Cincinelli S, Mervelt J, Pagliaro U. The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol. 2011;38(7):661-666. PMID 21507033. https://pubmed.ncbi.nlm.nih.gov/21507033/ (accessed 2026-08-06; abstract retrieved by efetch). Verbatim spans: “class RT1 included gingival recession with no loss of interproximal attachment, class RT2 recession was associated with interproximal attachment loss less than or equal to the buccal site and class RT3 showed higher interproximal attachment loss than the buccal site” “The RT classification was predictive of the final Rec Red (p<0.0001) at the 6-month follow-up in 109 treated gingival recessions”｜span：「class RT1 included gingival recession with no loss of interproximal attachment, class RT2 recession was associated with interproximal attachment loss less than or equal to the buccal site and class RT3 showed higher interproximal attachment loss than the buccal site」「The RT classification was predictive of the final Rec Red (p<0.0001) at the 6-month follow-up in 109 treated gingival recessions」
• S12 Chambrone L, Salinas Ortega MA, Sukekava F, Rotundo R, Kalemaj Z, Buti J, Pini Prato GP. Root coverage procedures for treating localised and multiple recession-type defects. Cochrane Database Syst Rev. 2018;10(10):CD007161. PMID 30277568. https://pubmed.ncbi.nlm.nih.gov/30277568/ (accessed 2026-08-06; abstract retrieved by efetch). Verbatim spans: “Gingival recession is defined as the oral exposure of the root surface due to a displacement of the gingival margin apical to the cemento-enamel junction” “This review is an update of the original version that was published in 2009” “We included 48 RCTs in the review”｜span：「Gingival recession is defined as the oral exposure of the root surface due to a displacement of the gingival margin apical to the cemento-enamel junction」「This review is an update of the original version that was published in 2009」「We included 48 RCTs in the review」
• S13 Stefanini M, Mounssif I, Figuero E, Zucchelli G, Sculean A, Cosgarea R. Esthetical and patient-reported outcomes after root coverage procedures for multiple gingival recessions: A systematic review and meta-analysis. Periodontol 2000. 2025;99(1):21-41. PMID 42130372. https://pubmed.ncbi.nlm.nih.gov/42130372/ (accessed 2026-08-06; abstract retrieved by efetch). Verbatim spans: “up to May 2024” “A total of 32 randomized controlled trials involving 1012 patients and 3589 multiple gingival recessions were included” “Mean root coverage (MRC) reached 82.6% (95% CI: 71.3-93.9), and complete root coverage (CRC) was 62.7% (95% CI: 57.0-68.4)”｜span：「up to May 2024」「A total of 32 randomized controlled trials involving 1012 patients and 3589 multiple gingival recessions were included」「Mean root coverage (MRC) reached 82.6% (95% CI: 71.3-93.9), and complete root coverage (CRC) was 62.7% (95% CI: 57.0-68.4)」
• S14 Yan J, Zhang J, Zhang Q, Zhang X, Ji K. Effectiveness of laser adjunctive therapy for surgical treatment of gingival recession with flap graft techniques: a systematic review and meta-analysis. Lasers Med Sci. 2018;33(4):899-908. PMID 29374364. https://pubmed.ncbi.nlm.nih.gov/29374364/ (accessed 2026-08-06; abstract retrieved by efetch). Verbatim spans: “The studies were searched from PubMed, Embase, Web of science, and the Cochrane Central Register of Controlled Trials by two reviewers up to August 2017” “Seven RCTs with 173 patients and 296 teeth were included in the meta-analysis” “We found no statistically significant differences between two groups in GRD (gingival recession depth) (P = 0.21), GRW (gingival recession width) (P = 0.92), RES (root esthetic score) (P = 0.21), and CRC (complete root coverage) (P = 0.09)” “Statistically significant differences were found between two groups in the WKT (width of keratinized tissue) (P < 0.0001) and 1-year follow-up of PD (probing depth) (P = 0.03) and CAL (clinical attachment level) (P < 0.00001)” “flap graft associated with laser did not offer additional benefit to root coverage and esthetics in treating gingival recession”｜span：「The studies were searched from PubMed, Embase, Web of science, and the Cochrane Central Register of Controlled Trials by two reviewers up to August 2017」「Seven RCTs with 173 patients and 296 teeth were included in the meta-analysis」「We found no statistically significant differences between two groups in GRD (gingival recession depth) (P = 0.21), GRW (gingival recession width) (P = 0.92), RES (root esthetic score) (P = 0.21), and CRC (complete root coverage) (P = 0.09)」「Statistically significant differences were found between two groups in the WKT (width of keratinized tissue) (P < 0.0001) and 1-year follow-up of PD (probing depth) (P = 0.03) and CAL (clinical attachment level) (P < 0.00001)」「flap graft associated with laser did not offer additional benefit to root coverage and esthetics in treating gingival recession」
• S15 Eltayeb TM, Ghali RM, Elashiry SG Jr, Eldemerdash FH, Shaker IS, Gamal AY, Romanos GE. Erbium, Chromium:Yttrium-Scandium-Gallium-Garnet Laser for Root Conditioning and Reduction of Postoperative Morbidity in the Treatment of Gingival Recession Defects: A Randomized Controlled Clinical Trial. Photobiomodul Photomed Laser Surg. 2021;39(10):665-673. PMID 34115953. https://pubmed.ncbi.nlm.nih.gov/34115953/ (accessed 2026-08-06; abstract retrieved by efetch). Verbatim spans: “This study is a randomized, single-blinded controlled trial, including 24 volunteers with isolated GR defects” “Root coverage did not show a statistically significant difference between control and test groups” “the L-DGG technique was associated with decreased postoperative morbidity in the palatal donor site”｜span：「This study is a randomized, single-blinded controlled trial, including 24 volunteers with isolated GR defects」「Root coverage did not show a statistically significant difference between control and test groups」「the L-DGG technique was associated with decreased postoperative morbidity in the palatal donor site」
• S16 West NX, Davies M, Sculean A, Jepsen S, Faria-Almeida R, Harding M, Graziani F, Newcombe RG, Creeth JE, Herrera D. Prevalence of dentine hypersensitivity, erosive tooth wear, gingival recession and periodontal health in seven European countries. J Dent. 2024;150:105364. PMID 39317300. https://pubmed.ncbi.nlm.nih.gov/39317300/ (accessed 2026-08-06; abstract retrieved by efetch). Verbatim spans: “3551 participants completed the study, mean age 44 ± 17.4” “GR (≥1 mm) in 87.9 %” “Thereafter, GR and ETW continued to increase”｜span：「3551 participants completed the study, mean age 44 ± 17.4」「GR (≥1 mm) in 87.9 %」「Thereafter, GR and ETW continued to increase」
• S17 Corrêa THR, da Rosa WLO, Lund RG. Long-term clinical efficacy of dentin desensitizing agents: A systematic review and meta-analysis. J Dent. 2025;163:106186. PMID 41139001. https://pubmed.ncbi.nlm.nih.gov/41139001/ (accessed 2026-08-06; abstract retrieved by efetch). Verbatim spans: “last search date: January, 2025” “a total of 22 studies included in the systematic review, 15 of which were also included in the meta-analysis” “randomized clinical trials with a minimum follow-up of 6 months” “Meta-analyses of sensory stimuli demonstrated significant reductions in pain scores with several desensitizing agents. Glutaraldehyde and low-level laser therapies achieved the largest effect sizes. In contrast, adhesive systems and calcium phosphate-based agents did not show statistically significant benefits.”｜span：「last search date: January, 2025」「a total of 22 studies included in the systematic review, 15 of which were also included in the meta-analysis」「randomized clinical trials with a minimum follow-up of 6 months」「Meta-analyses of sensory stimuli demonstrated significant reductions in pain scores with several desensitizing agents. Glutaraldehyde and low-level laser therapies achieved the largest effect sizes. In contrast, adhesive systems and calcium phosphate-based agents did not show statistically significant benefits.」
• S18 Taiwan Medical Care Act, Article 21, Laws & Regulations Database of the Republic of China (Taiwan). Official English translation (accessed 2026-08-06; curl verified HTTP 200; statutory text verbatim checked).
• S19 Taiwan Medical Care Act, Article 22, Laws & Regulations Database of the Republic of China (Taiwan). Official English translation (accessed 2026-08-06; curl verified HTTP 200; both passages verbatim checked).
• S20 Taiwan Medical Care Act, Article 63, Laws & Regulations Database of the Republic of China (Taiwan). Official English translation (accessed 2026-08-06; curl verified HTTP 200; statutory text verbatim checked).
• S21 Taiwan Medical Care Act, Article 87, Laws & Regulations Database of the Republic of China (Taiwan). Official English translation (accessed 2026-08-06; curl verified HTTP 200; both passages verbatim checked).
• S22 Taiwan National Health Insurance Act, Article 51, Laws & Regulations Database of the Republic of China (Taiwan). https://law.moj.gov.tw/LawClass/LawSingle.aspx?pcode=L0060001&flno=51 (accessed 2026-08-06; curl verified HTTP 200; items 3 and 11 verbatim checked).
• S23 Taipei City Department of Health—fee standards: “Taipei City Dental Fee Standards for Medical Institutions” (approved 1090117). health.gov.taipei fee-standards page (accessed 2026-08-06; page loaded in ego-browser and title verbatim checked; this card cites no amount).
• S24 Government Open Data Platform dataset 121913, “Taipei City Medical Fee Standards,” supplied by Taipei City Department of Health. https://data.gov.tw/dataset/121913 (accessed 2026-08-06; HTTP 200; open API returned the title “Taipei City Medical Fee Standards,” verbatim checked).
• S25 Taiwan National Health Insurance Administration, “National Health Insurance Medical Service Payment Items and Payment Standards” notice page. https://www.nhi.gov.tw/ch/lp-3778-1.html (accessed 2026-08-06; page loaded in ego-browser; title and 4-file list read verbatim; this card did not download and compare individual files).
• S26 Government Open Data Platform dataset 174450, “Medical Service Payment Items and Payment Standards (csv),” supplied by Taiwan National Health Insurance Administration. https://data.gov.tw/dataset/174450 (accessed 2026-08-06; HTTP 200; open API returned the title and description “current payment items of National Health Insurance Medical Service Payment Items and Payment Standards (csv),” verbatim checked).
• For the test record that Taiwan NHI’s “Medical Materials Price Comparison Platform” excludes dentistry, see `km-compliance/VERIFIED-FACTS.md` (OP browser test on 2026-08-05; not re-tested in this card).

内部引用チェーン

• 術式、根面被覆率、回復期、供給部位合併症の正典：歯肉移植手術：費用、保険、回復期をまとめて解説（km-drafts/km-14-gum-graft.md。共有アンカー：PMID 29926948／21507033／30277568／42130372。本カードは術式・被覆率の節を繰り返さない）。
• 同じ歯周外科群で、同意書と費用の考え方を比較できるカード：歯冠長延長術とは？費用、保険、痛み（km-drafts/km-17-crown-lengthening.md。共有アンカー：台湾医療法第 63 条、台湾全民健康保険法第 51 条）。
• 費用の分解と見積照合の一般的な読み方：固定式義歯 1 本の費用（km-drafts/km-03-fixed-denture-cost.md。共有アンカー：台湾医療法第 21／22 条、台北市歯科料金基準表）。
• 硬組織側（歯槽骨が自然再生するか）：失われた歯槽骨は自然に再生するか（km-production-queue.html 第 39 問。制作完了までリンクを保持）。

公開ゲートの注意：本カードは draft です。F30、F31 の検証待ちが解消するまで published としてはならず、zh-Hans／en／ja がそろうまで km_entries に入れてはなりません。