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牙龈退缩还能救吗？治疗要多少钱？｜證據鏈

km 編輯部2026-08-13阅读约 59 分钟
#證據鏈#牙醫KM#台灣#矯正

本頁是〈牙龈退缩还能救吗？治疗要多少钱？〉的事實單元帳：每一條主張對應的來源、證據等級、地域與期間、原文引句與限制，逐條攤開。

牙龈退缩还能救吗？治疗要多少钱？｜證據鏈

F-Units（事实单元账）

  • F1｜本题选题依据＝14 个诊所站 GSC 全量对账；“牙龈退缩治疗费用ptt”“牙龈退缩治疗费用”“牙龈退缩恢复ptt”“水激光牙龈退缩”“老人牙龈退缩假牙”等 7 个词项合计曝光 121,175、跨 4 个站点｜来源＝内部底账（km-dental-backlog.md #27 附录）｜confidence=high｜basis=internal_dataset｜period=GSC 保留窗（自 2025-03-22 起）｜geo: TW｜caveat：曝光为属性级数字、非去重流量；本栏为内部数据、非医学宣称，发布转换时不输出。
  • F2［结构性整理］｜“控制继续退缩／覆盖已暴露牙根”两层分流、“原因与分类应分开问”的问法，以及与 KM-DENTAL-14 的分工声明，均为本站根据病人查询语与文献术语对应所作的编辑框架，非事实宣称、非任何机构的分类方式｜confidence=n/a｜basis=editorial｜geo: TW｜caveat：不得标为待验（避免制造假查证工作）。
  • F3｜黏膜牙龈缺损（包括牙龈退缩）在成年人中常见、有随年龄增加的倾向，且在口腔卫生标准高和低的人群都会出现；牙根表面暴露常伴美观受损、牙本质敏感、颈部龋性和非龋性病损｜来源 #1｜confidence=high｜basis=clinical_guideline（2017 世界工作坊分类共识的叙述性回顾）｜period=2018；2026-08-06 检索未见取代 2017 世界工作坊的新版分类共识｜geo: universal｜caveat：与 KM-DENTAL-14 卡共用锚点；关联性和趋势陈述，非发生率宣称。
  • F4｜无病灶时监测特定位点为适当做法；当病灶发生或进展风险升高，或为满足病人美观需求时，改变生物型和／或覆盖牙根的手术介入可能有适应证｜来源 #1｜confidence=high｜basis=clinical_guideline｜period=2018｜geo: universal｜caveat：与 KM-DENTAL-14 卡共用锚点；适应证原则，非个案判准；本卡不提供自我诊断方法。
  • F5｜口腔卫生不良、正畸治疗和颈部修复体可能增加牙龈退缩风险；薄型牙周生物型风险较高；多数病人的牙周健康可由良好居家清洁维持｜来源 #1｜confidence=moderate｜basis=clinical_guideline（回顾性文献汇整）｜period=2018｜geo: universal｜caveat：风险因素陈述，未量化相对风险。
  • F6｜2016 年未治疗颊侧牙龈退缩的系统性回顾与荟萃分析：纳入随访 ≥24 个月且未接受根面覆盖或牙龈增量手术的研究，检索至 2015 年 7 月；378 篇初筛；8 篇报告（6 项研究）纳入；1,647 处有基线与随访资料的退缩缺损中，78.1% 深度增加，其余减少或无变化；随访病人的退缩缺损数增加 79.3%；合并估计按病人数 OR 2.43（P = 0.03）、按位点数 OR 2.16（P = 0.0005）；作者结论为口腔卫生良好者未治疗退缩缺损长期随访有较高进展概率｜来源 #2｜confidence=high｜basis=peer_reviewed（SR＋MA）｜period=2016；2026-08-06 以 PubMed 检索同一临床问题（未治疗退缩的长期进展）的 2017 年后系统性回顾，未见更新版｜geo: universal｜caveat：人群为口腔卫生良好的成年人、仅 6 项研究；本条为人群层级概率，禁止外推成个别牙位预测；“其余减少或无变化”不得省略。
  • F7｜爬行附连（creeping attachment）＝牙龈边缘向冠方移动以取得额外根面覆盖，是各种黏膜牙龈手术愈合后可能发生的现象；覆盖不总是完整，也非完全可预测｜来源 #3｜confidence=moderate｜basis=peer_reviewed（文献回顾，纳入 82 篇文献）｜period=2020｜geo: universal｜caveat：为术后现象，非未治疗状态的自发恢复；该篇为叙述性文献回顾，未做荟萃分析。
  • F8｜2015 年回顾与荟萃分析：荟萃分析纳入 159 名受试者，手动牙刷使用者 12 个月后牙龈退缩多于电动牙刷使用者；13 篇横断面研究显示常关联因素为刷牙频率、水平往复刷法、刷毛硬度、刷牙时间与换刷频率；作者结论为支持或推翻刷牙与牙龈退缩及非龋性颈部缺损关联的资料总体仍不足以下定论｜来源 #4｜confidence=moderate｜basis=peer_reviewed（回顾＋荟萃分析，欧洲牙周病学工作坊委托文献）｜period=2015；2026-08-06 以 PubMed 检索 2016 年后同题系统性回顾／荟萃分析仅得来源 #5（刷毛专题），未见取代本篇的更新版｜geo: universal｜caveat：作者明确证据不足以下定论；本卡不得写成“刷牙造成退缩”的因果句。
  • F9｜2019 年系统性回顾：1,945 篇初筛、13 篇纳入；硬毛牙刷造成的牙龈病损多于中毛和软毛牙刷；作者结论为软毛和超软毛牙刷倾向较安全｜来源 #5｜confidence=moderate｜basis=peer_reviewed（系统性回顾，定性综合）｜period=2019｜geo: universal｜caveat：仅 4 篇以不良反应为主要结果指标；本卡不推荐任何品牌产品。
  • F10｜2023 年正畸后牙龈退缩风险因素系统性回顾：检索至 2023-04-20、纳入 48 篇文章；退缩患病率、严重度、范围分别有 10/15、4/10、2/2 篇在正畸病人发现显著较高；10/16 篇报告前牙唇侧倾斜移动者有更多退缩和较大临床牙冠高度；薄牙龈生物型、既有退缩、基线角化牙龈宽度、唇侧牙龈边缘厚度被 9 篇关联到风险升高，牙周袋深度则否；作者指出研究异质性高、结果常相互矛盾｜来源 #6｜confidence=moderate｜basis=peer_reviewed（系统性回顾，未做荟萃分析）｜period=2023（本题当前最新版：较早的 2018 年同题系统性回顾 PMID 29911278 仅纳入 2 项观察研究，本卡采用较新且纳入量较大者）｜geo: universal｜caveat：纳入非随机研究、偏倚风险中等；为关联性而非因果。
  • F11｜2023 年系统性回顾与荟萃分析（129 篇初筛、12 篇纳入、8 篇进入定量分析）：当前证据不足以断定隐形牙套在正畸期间比固定矫治器更能维持牙周健康｜来源 #7｜confidence=moderate｜basis=peer_reviewed（SR＋MA）｜period=2023｜geo: universal｜caveat：部分指标异质性极高（如菌斑指数 I²=99%）；本卡仅引用总结论，不引用个别合并值。
  • F12｜咬合应力与非龋性颈部缺损（abfraction）系统性回顾：纳入 69 篇文献（31 篇临床研究、38 篇实验室研究），56/69（81%）发现咬合应力与非龋性颈部缺损有关联；无临床研究证明该缺损由应力单独造成｜来源 #8｜confidence=moderate｜basis=peer_reviewed（系统性回顾）｜period=2017；2026-08-06 检索 2018 年后同题系统性回顾未见取代版（近年新出者为患病率与考古样本专题）｜geo: universal｜caveat：结果指标为颈部缺损，并非牙龈退缩本身；不得改写为“咬合造成牙龈退缩”。
  • F13｜上颌中线系带系统性回顾（206 篇初筛、48 篇纳入）：关于上颌系带造成牙龈退缩的研究结论不一致；其对上颌前牙区退缩与种植体周围疾病的贡献颇有争议；激光手术优于传统手术尚未在文献中证明｜来源 #9｜confidence=low｜basis=peer_reviewed（系统性回顾）｜period=2013｜geo: universal｜caveat：年代较早（2013）；2026-08-06 检索 2014 年后同题文献多为术式比较（如 2026 年二极管激光对手术刀的荟萃分析），未见针对“系带与牙龈退缩因果”的取代性系统性回顾；本卡仅引用其“结论不一致”的保守陈述。
  • F14｜欧洲牙周病学联盟（European Federation of Periodontology）S3 级临床实践指南（I–III 期牙周炎）：采用预先设定的分阶段、逐步递增治疗路径；共识涵盖行为改变、龈上生物膜、牙龈炎症和风险因素控制，龈上与龈下器械治疗（有或没有辅助疗法），各类牙周手术介入，以及延续效益所需的支持性牙周护理｜来源 #10｜confidence=high｜basis=clinical_guideline（S3 级、GRADE 方法、15 篇委托系统性回顾）｜period=2020；2026-08-06 检索未见同范围（I–III 期）改版；2022 年 IV 期指南和 2023 年种植体周围疾病指南属于不同范围｜geo: universal｜caveat：指南是临床决策依据，非个案治疗处方；摘要以 (a)–(d) 列出共识介入，未逐项标注“第几步”，本卡仅按列出顺序转述，不自行分配步骤编号；台湾实务的给付与流程另依健保署公告。
  • F15｜RT1＝邻接面无附连丧失；RT2＝邻接面附连丧失小于或等于颊侧；RT3＝邻接面附连丧失大于颊侧。该分类可预测 6 个月时退缩减少量（109 处治疗位点，p<0.0001）｜来源 #11｜confidence=moderate｜basis=peer_reviewed（探索性与信度研究，25 名病人、116 处退缩）｜period=2011｜geo: universal｜caveat：与 KM-DENTAL-14 卡共用锚点；单中心探索性研究；分类须由临床测量执行，本卡不提供病人自我分类方法。
  • F16｜Cochrane 系统性回顾（2018 更新版，原始版 2009）纳入 48 篇随机试验；牙龈退缩定义＝牙龈边缘移位到釉牙骨质界根尖侧，使牙根表面暴露于口腔｜来源 #12｜confidence=high｜basis=peer_reviewed（Cochrane 系统性回顾）｜period=检索至 2018-01-15；2026-08-06 以 CD007161[pg] 检索版本链仅得 2009 原版和 2018 更新版两笔，2018 版为现行版｜geo: universal｜caveat：术式比较细节为 KM-DENTAL-14 的 canonical；本卡仅引用定义和纳入试验数。
  • F17｜2025 年多发性牙龈退缩系统性回顾与荟萃分析（检索至 2024-05；32 篇 RCT、1012 名病人、3589 处退缩）：平均根面覆盖 82.6%（95% CI 71.3–93.9），完全根面覆盖 62.7%（95% CI 57.0–68.4）｜来源 #13｜confidence=high｜basis=peer_reviewed（SR＋MA）｜period=2025（2026-08-06 检索未见更新版）｜geo: universal｜caveat：人群为多发性退缩，不得外推为所有退缩或单颗缺损的个人预测；本卡仅作一句摘要，完整脉络为 KM-DENTAL-14 的 canonical。
  • F18｜2018 年系统性回顾与荟萃分析（检索至 2017 年 8 月；7 篇 RCT、173 名病人、296 颗牙）：翻瓣移植加激光与单纯手术相比，在退缩深度（P = 0.21）、退缩宽度（P = 0.92）、根面美学评分（P = 0.21）、完全根面覆盖（P = 0.09）无统计学显著差异；在角化组织宽度（P < 0.0001）、1 年随访牙周袋深度（P = 0.03）、临床附连水平（P < 0.00001）有统计学显著差异；作者结论为加用激光未为根面覆盖和美观带来额外好处｜来源 #14｜confidence=moderate｜basis=peer_reviewed（SR＋MA）｜period=2018；2026-08-06 以“激光×根面覆盖×系统性回顾／荟萃分析×2019 年后”检索，命中 9 笔皆为不同临床问题（去上皮化取瓣、牙周内骨缺损、种植体周围炎、正畸期口腔健康等），未见取代本篇更新版｜geo: universal｜caveat：摘要未列各试验使用的激光种类，不得等同于水激光（Er,Cr:YSGG）；纳入试验数少、样本量小。
  • F19｜随机对照临床试验（24 名单颗退缩缺损受试者；三组：刀片取得去上皮化牙龈移植物、水激光取瓣加根面生物调节、刀片取瓣加水激光根面生物调节）：对照组和试验组间根面覆盖未达统计学显著差异；激光取瓣组与腭侧供区术后不适降低有关｜来源 #15｜confidence=low｜basis=peer_reviewed（单中心 RCT，n=24，单盲）｜period=2021；2026-08-06 检索水激光用于牙龈退缩文献，另见 2025／2026 年取瓣术式 RCT，均为小样本、无系统性回顾层级证据｜geo: universal｜caveat：小样本、单中心；作者在结论句用“改善”措辞，但同时载明差异未达统计学显著；本卡以未达统计学显著为准；禁止写成激光可使牙龈恢复。
  • F20｜7 个欧洲国家横断面观察研究：3,551 名全身健康成年人（平均年龄 44 ± 17.4），牙龈退缩（≥1 mm）出现在 87.9% 受试者中；牙龈退缩和酸蚀性牙齿磨耗在年轻成年期后持续增加｜来源 #16｜confidence=moderate｜basis=peer_reviewed（多国横断面观察研究）｜period=2024｜geo: universal（欧洲 7 国样本）｜caveat：非台湾人群，禁止作为台湾患病率使用；研究由业界（Haleon）财务支持，并披露有作者受雇该公司；另有 2025 年勘误（Erratum）记录，本卡数字取自 2024 年原文摘要。
  • F21｜2025 年脱敏制剂长期疗效系统性回顾与荟萃分析（检索至 2025 年 1 月；随访 ≥6 个月 RCT；22 篇纳入回顾，15 篇进入荟萃分析）：多种脱敏制剂使感觉刺激疼痛评分显著下降；戊二醛和低能量激光效应量相对较大；粘接系统和钙磷酸盐类制剂未显示统计学显著获益｜来源 #17｜confidence=moderate｜basis=peer_reviewed（SR＋MA）｜period=2025｜geo: universal｜caveat：低能量激光用于牙本质敏感，与根面覆盖手术中的水激光不是同一介入、也不是同一结果指标；本卡不作产品推荐，不构成用药指示。
  • F22｜台湾《医疗法》第 21 条：“醫療機構收取醫療費用之標準，由直轄市、縣（市）主管機關核定之。”｜来源 #18｜confidence=high｜basis=law｜period=现行条文（2026-08-06 curl 实测 HTTP 200＋逐字核对）｜geo: TW｜caveat：与 KM-DENTAL-03／14 卡共用锚点；条文转述，非法律意见。
  • F23｜台湾《医疗法》第 22 条：“醫療機構收取醫療費用，應開給載明收費項目及金額之收據”；“醫療機構不得違反收費標準，超額或擅立收費項目收費。”｜来源 #19｜confidence=high｜basis=law｜period=现行条文（2026-08-06 curl 实测 HTTP 200＋两项逐字核对）｜geo: TW｜caveat：与 KM-DENTAL-03／14 卡共用锚点；条文转述，非法律意见。
  • F24｜台湾《医疗法》第 63 条：医疗机构实施手术，应向病人或其法定代理人、配偶、亲属或关系人说明手术原因、手术成功率或可能发生的并发症及危险，经同意并签署手术同意书及麻醉同意书后，始得为之｜来源 #20｜confidence=high｜basis=law｜period=现行条文（2026-08-06 curl 实测 HTTP 200＋逐字核对）｜geo: TW｜caveat：与 KM-DENTAL-14／17 卡共用锚点；条文但书“情况紧急者，不在此限”未在正文引用。
  • F25｜台湾《全民健康保险法》第 51 条列举不列入给付范围项目，第 3 款含“美容外科手术”，第 11 款含“義齒、義眼、眼鏡、助聽器、輪椅、拐杖及其他非具積極治療性之裝具”｜来源 #22｜confidence=high｜basis=law｜period=现行条文（2026-08-06 curl 实测 HTTP 200＋逐字核对）｜geo: TW｜caveat：与 KM-DENTAL-09／14／17 卡共用锚点；条文列举不等于个案结论，本卡不作涵摄判断。
  • F26｜台湾《医疗法》第 87 条：广告内容暗示或影射医疗业务者视为医疗广告；医学新知或研究报告发表、病人卫生教育、学术性刊物，未涉及招揽医疗业务者，不视为医疗广告｜来源 #21｜confidence=high｜basis=law｜period=现行条文（2026-08-06 curl 实测 HTTP 200＋两项逐字核对）｜geo: TW｜caveat：本卡定位依据。
  • F27｜自费收费项目依地方卫生主管机关核定的收费标准办理；已验证例证＝台北市政府卫生局“臺北市醫療機構牙科收費標準表”（1090117 核定），及政府数据开放平台数据集 121913“臺北市醫療收費標準”｜来源 #23・#24｜confidence=high｜basis=official_statement｜period=1090117 核定；2026-08-06 卫生局页面以 ego-browser 实载、标题逐字核对；数据集以开放 API 取回 title 逐字核对｜geo: TW｜caveat：与 KM-DENTAL-03／11／14／26 卡共用锚点；仅一县市例证，其他县市各自公告；本卡不引用任何金额。
  • F28｜健保给付侧的核查入口＝卫生福利部中央健康保险署“全民健康保险医疗服务给付项目及支付标准”公告页，以及政府数据开放平台数据集 174450“医疗服务给付项目及支付标准(csv档)”｜来源 #25・#26｜confidence=high｜basis=official_statement｜period=2026-08-06 公告页面以 ego-browser 实载（标题和 4 笔文件清单逐字读取）、数据集以开放 API 取回 title 和描述逐字核对｜geo: TW｜caveat：本卡只记录核查入口存在和可及，未下载文件逐项比对本题各处置给付状态（给付判断见待验 F30）。
  • F29｜健保署“醫材比價網”两条查询路径均不含牙科品项，牙科自费项目无法由该网核查｜来源＝跨卡已验事实文件 `km-compliance/VERIFIED-FACTS.md`（2026-08-05 OP 以浏览器实测并逐类读取）｜confidence=high｜basis=official_statement（实测记录）｜period=2026-08-05｜geo: TW｜caveat：本卡沿用跨卡已验锚点，未重复实测；若该网日后新增牙科分类，本条需复验。
  • F30［待验］｜本题各项处置（牙周治疗、脱敏处置、颈部缺损修复、根面覆盖手术）在健保支付标准中的给付状态｜来源类别：健保署“医疗服务给付项目及支付标准”公告文件（入口已验＝F28，内容未逐项比对）｜confidence=low｜basis=待补｜geo: TW｜caveat：未验前，本卡不作“有给付／不给付”断言。
  • F31［待验］｜商业保险是否理赔本题各项处置，依保单条款而定｜来源类别：保单条款（未取得可公开引用的条款样本）｜confidence=low｜basis=待补｜geo: TW｜caveat：本站不提供理赔见解（编辑政策），仅陈述“依保单条款而定”。
  • F32［结构性整理］｜“诊断与检查／病因处理／症状处理／手术／辅助设备加价项目／随访与再处理”六段拆法及报价对账建议，为本站编辑定义的阅读框架，非事实宣称、非任何机构的收费分类｜confidence=n/a｜basis=editorial｜geo: TW｜caveat：不得标为待验。

来源清单

  • 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/（取用 2026-08-06，efetch 取回摘要）。逐字 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/（取用 2026-08-06，efetch 取回摘要）。逐字 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/（取用 2026-08-06，efetch 取回摘要）。逐字 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/（取用 2026-08-06，efetch 取回摘要）。逐字 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/（取用 2026-08-06，efetch 取回摘要）。逐字 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/（取用 2026-08-06，efetch 取回摘要）。逐字 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/（取用 2026-08-06，efetch 取回摘要）。逐字 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/（取用 2026-08-06，efetch 取回摘要）。逐字 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/（取用 2026-08-06，efetch 取回摘要）。逐字 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/（取用 2026-08-06，efetch 取回摘要）。逐字 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/（取用 2026-08-06，efetch 取回摘要）。逐字 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/（取用 2026-08-06，efetch 取回摘要）。逐字 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/（取用 2026-08-06，efetch 取回摘要）。逐字 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/（取用 2026-08-06，efetch 取回摘要）。逐字 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/（取用 2026-08-06，efetch 取回摘要）。逐字 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/（取用 2026-08-06，efetch 取回摘要）。逐字 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/（取用 2026-08-06，efetch 取回摘要）。逐字 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 台湾《医疗法》第 21 条，国家法规资料库。https://law.moj.gov.tw/ENG/LawClass/LawAll.aspx?pcode=L0020021（取用 2026-08-06，curl 实测 HTTP 200，逐字核对条文）
  • S19 台湾《医疗法》第 22 条，国家法规资料库。https://law.moj.gov.tw/ENG/LawClass/LawAll.aspx?pcode=L0020021（取用 2026-08-06，curl 实测 HTTP 200，逐字核对两项）
  • S20 台湾《医疗法》第 63 条，国家法规资料库。https://law.moj.gov.tw/ENG/LawClass/LawAll.aspx?pcode=L0020021（取用 2026-08-06，curl 实测 HTTP 200，逐字核对条文）
  • S21 台湾《医疗法》第 87 条，国家法规资料库。https://law.moj.gov.tw/ENG/LawClass/LawAll.aspx?pcode=L0020021（取用 2026-08-06，curl 实测 HTTP 200，逐字核对两项）
  • S22 台湾《全民健康保险法》第 51 条，国家法规资料库。https://law.moj.gov.tw/LawClass/LawSingle.aspx?pcode=L0060001&flno=51（取用 2026-08-06，curl 实测 HTTP 200，逐字核对第 3 款和第 11 款）
  • S23 台北市政府卫生局—收费标准：“臺北市醫療機構牙科收費標準表”（1090117 核定）。health.gov.taipei 收费标准页（取用 2026-08-06，ego-browser 实载，逐字核对页面标题；本卡不引用任何金额）
  • S24 政府数据开放平台数据集 121913“臺北市醫療收費標準”，提供机关为台北市政府卫生局。https://data.gov.tw/dataset/121913（取用 2026-08-06，HTTP 200；开放 API 返回 title＝“臺北市醫療收費標準”，逐字核对）
  • S25 卫生福利部中央健康保险署“全民健康保险医疗服务给付项目及支付标准”公告页。https://www.nhi.gov.tw/ch/lp-3778-1.html（取用 2026-08-06，ego-browser 实载，逐字读取页面标题与 4 笔文件清单；本卡未下载文件逐项比对）
  • S26 政府数据开放平台数据集 174450“医疗服务给付项目及支付标准(csv档)”，提供机关为卫生福利部中央健康保险署。https://data.gov.tw/dataset/174450（取用 2026-08-06，HTTP 200；开放 API 返回 title 与描述“全民健康保险医疗服务给付项目及支付标准现行给付项目(csv档)”，逐字核对）
  • 另：健保署“醫材比價網”不含牙科的实测记录见 `km-compliance/VERIFIED-FACTS.md`（2026-08-05 OP 浏览器实测，本卡未重验）。

内部引用链

发布闸门提醒：本卡为 draft。F30、F31 待验未清前不得标为 published；zh-Hans／en／ja 四语未齐前不得进入 km_entries。

FAQ

牙龈退缩会自己长回来吗？
在文献中不是可预期结果。牙龈边缘向牙冠方向移动的“爬行附连”，被描述为各种黏膜牙龈手术愈合后可能发生的现象，且覆盖不总是完整、也并非完全可预测。[F7·S3] 在未接受手术的退缩缺损中，一篇荟萃分析记录 1,647 处缺损有 78.1% 在随访期间深度增加，其余减少或无变化。[F6·S2]
歯肉退縮は自然に戻りますか。 — 文献上、予測できる結果ではありません。歯肉縁が歯冠側へ移動するクリーピング・アタッチメントは、各種粘膜歯肉手術の治癒後に起こりうる現象で、被覆は常に完全でも完全に予測可能でもありません。[F7·S3] 手術を受けていない退縮欠損では、メタ解析は 1,647 箇所の 78.1% で追跡中に深さが増し、残りは減少または変化なしと記録しました。[F6·S2]
Will receding gums grow back by themselves? — That is not an expected outcome in the literature. Creeping attachment—coronal migration of the gingival margin—is described as a possible phenomenon after healing from various mucogingival surgeries, and coverage is not always complete or entirely predictable.[F7·S3] Among recession defects without surgery, one meta-analysis recorded depth increase during follow-up in 78.1% of 1,647 defects; the remainder decreased or did not change.[F6·S2]
不处理会怎样？
同一篇作者结论为：口腔卫生良好者的未治疗退缩缺损长期随访有较高进展概率；该篇同时记录随访病人的退缩缺损数增加 79.3%，合并估计优势比为 2.43（按病人数）和 2.16（按位点数）。[F6·S2] 这是人群层级概率，不是个人预测；是否需要处置和随访间隔须由牙医师评估。[F4·S1]
処置しないとどうなりますか。 — 同じ論文の著者は、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ました。同論文は、追跡患者の退縮欠損数が 79.3% 増え、統合推定オッズ比が患者数で 2.43、部位数で 2.16 であったことも記録しています。[F6·S2] これは集団水準の確率であり、個人の予測ではありません。処置の必要性と追跡間隔は歯科医師が評価します。[F4·S1]
What happens if I do not address it? — The same review concluded that untreated recession defects in people with good oral hygiene have a high probability of progressing over long-term follow-up. It also recorded a 79.3% increase in the number of recession defects among followed patients and pooled odds ratios of 2.43 by patient count and 2.16 by site count.[F6·S2] Those are population-level probabilities, not individual predictions; need for treatment and follow-up interval require a dentist’s assessment.[F4·S1]
水激光能治疗牙龈退缩吗？
现有研究把激光放在手术中的辅助位置。纳入 7 篇随机试验的荟萃分析结论为，翻瓣移植加激光未为根面覆盖和美观带来额外好处；[F18·S14] 24 人水激光（Er,Cr:YSGG）随机对照试验也记录，两组根面覆盖未达统计学显著差异，但激光取瓣者腭侧供区术后不适较低。[F19·S15] 是否采用须由牙医师按个别条件评估。
水レーザーで歯肉退縮を治療できますか。 — 現在の研究ではレーザーは手術の補助です。無作為化試験 7 件を含むメタ解析は、フラップ移植＋レーザーに根面被覆・審美性の追加利益がないと結論しました。[F18·S14] 水レーザー（Er,Cr:YSGG）の 24 人の無作為化比較試験も、両群の根面被覆に統計学的有意差がなく、レーザー採取群の口蓋側供給部位の術後不快感が低いことを記録しました。[F19·S15] 採用するかは個別条件に応じ歯科医師が評価します。
Can water laser treat gingival recession? — Existing studies place laser as a surgical adjunct. A meta-analysis of 7 randomized trials concluded that flap graft with laser did not provide additional root-coverage or esthetic benefit;[F18·S14] a 24-person Er,Cr:YSGG water-laser randomized trial also recorded no statistically significant between-group difference in root coverage, although laser harvesting was associated with lower postoperative morbidity at the palatal donor site.[F19·S15] Whether to use it requires assessment of individual conditions by a dentist.

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km 編輯部・《牙龈退缩还能救吗？治疗要多少钱？｜證據鏈》・IDAEO 知識庫・2026-08-13・https://km.idaeo.ai/reports/dental-gum-recession-evidence

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更新 2026-08-13T14:17:18.038Z · server-rendered · four-language · IDAEO 知識庫