Influência da aplicação de laser de baixa intensidade no recobrimento radicular associado à técnica de enxerto de tecido conjuntivo: estudo clínico controlado randomizado com acompanhamento de dois anos
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Data
2016-12-08
Autores
Dias, Stephanie Botti Fernandes [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A terapia com laser de baixa intensidade (LBI) tem sido utilizada com sucesso para fotobioestimular e acelerar a cicatrização de feridas em seres humanos. Porém, a literatura carece de estudos controlados que avaliem o uso desta terapia no campo da cirurgia plástica periodontal. O presente estudo tem como objetivo avaliar os resultados de longo prazo (≥ 24 meses) da técnica de enxerto de tecido conjuntivo associado à aplicação do LBI no tratamento da recessão gengival. Além disso, o presente estudo também tem como objetivo avaliar a influência de fatores anatômicos no recobrimento radicular através de medidas clínicas, digitais e tomográficas. Foram incluídos quarenta pacientes com recessão gengival Classe I e II de Miller previamente tratados com: enxerto de tecido conjuntivo (grupo controle; n = 20) ou enxerto de tecido conjuntivo + LBI (grupo de teste; n = 20). Um laser de diodo (GaAlAs, 660 nm) foi aplicado no grupo teste imediatamente após a cirurgia e a cada dois dias durante 14 dias (8 aplicações). Após 2 anos de acompanhamento, avaliações clínicas, estéticas, digitais e tomográficas foram realizadas em trinta e seis pacientes. A porcentagem média de recobrimento radicular foi de 93,43% no grupo de teste e 92,32% no grupo controle (p = 0,55). O recobrimento radicular completo foi de 79% (n = 15) no grupo de teste e 76% (n = 13) no grupo controle (n = 13) (p = 0,8). Os dois grupos apresentaram manutenção da estética após 2 anos de acompanhamento. A análise de regressão linear múltipla demonstrou uma associação significativa e um forte coeficiente de correlação (R2 = 0,73) entre o recobrimento radicular e a recessão gengival, a largura papila, a espessura do tecido queratinizado e a altura da crista óssea. Dentro das limitações do presente estudo, nossos resultados indicam que a aplicação de LBI não mostrou benefícios adicionais, em longo prazo, quando associado com enxerto de tecido conjuntivo no tratamento de recessões gengivais Classe I e II de Miller.
Low-level laser therapy (LLLT) has been successfully used to photobiostimulate and to accelerate wound healing in humans. However, there is a lack of controlled studies evaluating the use of this therapy in the field of periodontal plastic surgery. The present study shows a 2-year result of connective tissue graft associated with LLLT in the treatment of gingival recession defects. Furthermore, this study also aims to evaluate the influence of anatomical factors in root coverage through clinical, digital and tomographic measurements. Forty patients presenting Miller Class I and II gingival recessions were previously treated by: Connective tissue graft (Control group; n = 20) or Connective tissue graft + LLLT (Test group; n = 20). A diode laser (GaAlAs, 660 nm) was applied to the test sites immediately after surgery and every other day for 14 days (8 applications). After a follow-up of 2 years, clinical and aesthetic evaluations were performed in thirty-six patients. The mean percentage of root coverage was 93.43% for the test group and 92.32% for control group (p = 0.55). Complete root coverage was 79% (n = 15) for test group and 76% (n = 13) for control group (n = 13) (p = 0.8). The two groups showed aesthetics maintenance after 2 years. The multiple linear regression analysis demonstrated that there was a significant association and a strong correlation coefficient (R2 = 0.73) between root coverage and gingival recession, papilla width, keratinized tissue thickness and alveolar crest height. Within the limitations of this study, the previous results indicated that LLLT showed no additional benefit in the long term when associated with connective tissue graft in the treatment of Miller Class I and II gingival recessions.
Low-level laser therapy (LLLT) has been successfully used to photobiostimulate and to accelerate wound healing in humans. However, there is a lack of controlled studies evaluating the use of this therapy in the field of periodontal plastic surgery. The present study shows a 2-year result of connective tissue graft associated with LLLT in the treatment of gingival recession defects. Furthermore, this study also aims to evaluate the influence of anatomical factors in root coverage through clinical, digital and tomographic measurements. Forty patients presenting Miller Class I and II gingival recessions were previously treated by: Connective tissue graft (Control group; n = 20) or Connective tissue graft + LLLT (Test group; n = 20). A diode laser (GaAlAs, 660 nm) was applied to the test sites immediately after surgery and every other day for 14 days (8 applications). After a follow-up of 2 years, clinical and aesthetic evaluations were performed in thirty-six patients. The mean percentage of root coverage was 93.43% for the test group and 92.32% for control group (p = 0.55). Complete root coverage was 79% (n = 15) for test group and 76% (n = 13) for control group (n = 13) (p = 0.8). The two groups showed aesthetics maintenance after 2 years. The multiple linear regression analysis demonstrated that there was a significant association and a strong correlation coefficient (R2 = 0.73) between root coverage and gingival recession, papilla width, keratinized tissue thickness and alveolar crest height. Within the limitations of this study, the previous results indicated that LLLT showed no additional benefit in the long term when associated with connective tissue graft in the treatment of Miller Class I and II gingival recessions.
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Palavras-chave
Estudo clínico, Lasers, Retração gengival, Clinical trial, Gingival recession