Comparação de enxerto de tecido conjuntivo e membrana de fibrina rica em plaquetas (prf) no aumento de espessura de tecido mole peri-implantar: reanálise de dados de ensaios clínicos randomizados
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Data
2022-07-08
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Universidade Estadual Paulista (Unesp)
Resumo
O implante dentário é uma importante ferramenta para se obter resultados estéticos e funcionais em pacientes com ausências dentárias, porém é observado que a falta de tecido mole peri-implantar é frequente e pode levar a diversos problemas, como maior reabsorção de crista óssea e maior risco de recessão peri-implantar. Estudos anteriores demonstraram a eficácia de técnica como enxerto de tecido conjuntivo (CTG) que é considerado padrão ouro no aumento de tecido mole peri-implantar em região anterior de maxila. No entanto, a utilização de enxerto de tecido conjuntivo apresenta algumas limitações descrita na literatura, como maior desconforto pós-operatório e quantidade limitada de enxerto. Portanto, outras formas de enxerto de tecido mole para aumento de espessura do tecido periimplantar devem ser investigadas. Bons resultados foram obtidos quando utilizamos fibrina rica em plaquetas (PRF) para o tratamento de diversas condições periodontais e periimplantares. Sendo assim, o objetivo desse estudo é comparar a utilização de PRF com o CTG para aumento da espessura de tecido mole peri-implantar quando colocados simultaneamente a implantes unitários em área estética de maxila. Trinta pacientes advindos de dois estudos clínicos randomizados prévios do presente grupo de pesquisa foram reanalisados. Parâmetros clínicos foram mensurados por um avaliador cego e calibrado em baseline e 4 meses. As seguintes medidas foram avaliadas: espessura do tecido mole periimplantar em vestibular (ETQv) e na oclusal (ETQo) do implante instalado, defeito do rebordo (DR) e altura do tecido queratinizado (ATQ). Além disso, medidas transoperatórias foram reanalisadas. Frente aos resultados observados, o uso do CTG favoreceu melhores resultados em ETQv (3,09mm) e DR (0,27mm) após 4 meses, quando comparado ao PRF, ETQv (2,55mm) e DR (1,26mm). Em adição, avaliações frente à parâmetros centrados no paciente evidenciaram similaridade no desconforto pós-operatório e número de analgésicos utilizados. Conclui-se que os dois grupos apresentaram aumento de espessura do tecido periimplantar, porém o CTG demonstrou maior ganho relativo, até o período de acompanhamento preconizado.
The dental implant is an important tool to obtain aesthetic and functional results in patients with missing teeth, however, it is observed that the lack of peri-implant soft tissue is frequent and can lead to several problems, such as greater bone crest resorption and greater risk peri-implant recession. Previous studies have demonstrated the effectiveness of a technique such as connective tissue grafting (CTG), which is considered the gold standard in the increase of peri-implant soft tissue in the anterior region of the maxilla. However, the use of connective tissue graft has some limitations described in the literature, such as greater postoperative discomfort and limited amount of graft. Therefore, other forms of soft tissue grafting to increase peri-implant tissue thickness should be investigated. Good results were obtained when using platelet-rich fibrin (PRF) for the treatment of various periodontal and peri-implant conditions. Therefore, the aim of this study is to compare the use of PRF with CTG to increase peri-implant soft tissue thickness when placed simultaneously with single implants in the esthetic area of the maxilla. Thirty patients from two previous randomized clinical trials of the present research group were reanalyzed. Clinical parameters were measured by a blinded evaluator and calibrated at baseline and 4 months. The following measurements were evaluated: peri-implant soft tissue thickness in the labial (ETQv) and occlusal (ETQo) of the installed implant, ridge defect (RD) and height of the keratinized tissue (ATQ). In addition, intraoperative measurements were reanalyzed. In view of the observed results, the use of CTG favored better results in ETQv (3.09mm) and RD (0.27mm) after 4 months, when compared to PRF, ETQv (2.55mm) and RD (1.26mm). In addition, evaluations against patient-centered parameters showed similarity in postoperative discomfort and number of analgesics used. It was concluded that both groups showed an increase in periimplant tissue thickness, but the CTG showed a greater relative gain, until the recommended follow-up period.
The dental implant is an important tool to obtain aesthetic and functional results in patients with missing teeth, however, it is observed that the lack of peri-implant soft tissue is frequent and can lead to several problems, such as greater bone crest resorption and greater risk peri-implant recession. Previous studies have demonstrated the effectiveness of a technique such as connective tissue grafting (CTG), which is considered the gold standard in the increase of peri-implant soft tissue in the anterior region of the maxilla. However, the use of connective tissue graft has some limitations described in the literature, such as greater postoperative discomfort and limited amount of graft. Therefore, other forms of soft tissue grafting to increase peri-implant tissue thickness should be investigated. Good results were obtained when using platelet-rich fibrin (PRF) for the treatment of various periodontal and peri-implant conditions. Therefore, the aim of this study is to compare the use of PRF with CTG to increase peri-implant soft tissue thickness when placed simultaneously with single implants in the esthetic area of the maxilla. Thirty patients from two previous randomized clinical trials of the present research group were reanalyzed. Clinical parameters were measured by a blinded evaluator and calibrated at baseline and 4 months. The following measurements were evaluated: peri-implant soft tissue thickness in the labial (ETQv) and occlusal (ETQo) of the installed implant, ridge defect (RD) and height of the keratinized tissue (ATQ). In addition, intraoperative measurements were reanalyzed. In view of the observed results, the use of CTG favored better results in ETQv (3.09mm) and RD (0.27mm) after 4 months, when compared to PRF, ETQv (2.55mm) and RD (1.26mm). In addition, evaluations against patient-centered parameters showed similarity in postoperative discomfort and number of analgesics used. It was concluded that both groups showed an increase in periimplant tissue thickness, but the CTG showed a greater relative gain, until the recommended follow-up period.
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Palavras-chave
Implantes dentários, Enxerto de tecido conjuntivo, Fibrina rica em plaquetas, Recessão gengival, Dental implant, Connective tissue graft, Platelet-rich fibrin, Gingival recession