Influência da remoção da margem gengival e do posicionamento do enxerto gengival livre sobre o “creeping attachment”em pré-molares inferiores
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Data
2007-02-28
Autores
Ribeiro, Luciana Liarte Gasparini [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A recessão gengival (RG) consiste na migração da margem gengival (MG) em direção apical à junção cemento-esmalte (JCE), deixando a raiz do dente exposta. O recobrimento da RG com a técnica do enxerto gengival livre (EGL) pode ocorrer imediatamente por meio de “bridging,” ou tardiamente por meio de “creeping attachment” (CA). O objetivo do presente estudo é avaliar a influência da remoção da margem gengival e do posicionamento do enxerto gengival livre sobre o “creeping attachment” em recessões classe II de Miller em pré-molares inferiores. Os pacientes deveriam ter um ou os dois pré-molares inferiores com recessões classe II de Miller de um ou ambos os lados. Eles foram divididos aleatoriamente em um dos grupos de acordo com sua chegada: Grupo 1: Preparo do leito receptor e sutura do EGL apical a um colar de MG mantida ao redor do dente. Grupo 2: Preparo do leito receptor removendo-se toda a MG e posicionando o EGL sem recobrir a porção exposta da raiz. Grupo 3: Preparo do leito receptor semelhante ao do Grupo 2 e posicionamento do EGL no nível da JCE. Foram feitas medições pré e pós-operatórias aos 30, 90, 180 e 360 dias da altura da RG (HR), largura da RG (LR), quantidade de gengiva queratinizada (GQ), profundidade de sondagem (PS), gengiva inserida (GI) e nível de inserção clínica (NIC). O recobrimento inicial (RI) e o CA foram calculados com as medidas obtidas. Os dados foram submetidos à análise estatística. Aos 360 dias pósoperatórios, a porcentagem de recobrimento dos Grupos 1, 2 e 3 foi de 4,12%; 39,58% e 30,99% respectivamente. Não houve diferença estatística de RI entre os grupos. A quantidade de CA, aos 90, 180 e 360 dias pós-operatórios, não foi estatisticamente significante entre os grupos. Os Grupos 2 e 3 tiveram redução significativa no nível de inserção clínica aos 360 dias pós-operatórios.
Gingival recession is the result of the apical migration of the free gingival margin (FGM), resulting in root exposure. The direct root coverage (DRC) obtained by free gingival graft (FGG) technique is the result of bridging, while root coverage obtained later is the result of creeping attachment (CA). The purpose of this study was to assess the influence of free gingival margin excision and free gingival graft adaptation on creeping attachment on lower premolars. 48 patients with or without bilateral Miller class II defects on one or both lower premolars were selected and randomly assigned to one of the following groups: Group 1 - FGG was placed apically to the collar of residual gingiva left in place at the moment of preparing the recipient bed. Group 2 – FGG was placed at the coronal border of the recipient bed after excision of FGM without any attempt to cover the denuded root. Group 3 – a direct coverage of the recession was attempted by placing the FGG with its coronal border at the level of cemento-enamel junction (CEJ). Height of recession (HR), width of recession (WR), height of keratinized tissue (HKT) were assessed at baseline and at 30, 90, 180 and 360 days postoperatively. Probing depth (PD), attached gingiva (AG) and clinical attachment level (CAL) were assessed at 360 days postoperatively. DRC and CA were calculated with the obtained measurements. The mean percentage of root coverage in the Groups 1, 2 and 3 were 4,12%; 39,58% and 30,99% respectively at 360 days post-op. All groups exhibited statistically similar DRC and CA. Groups 2 and 3 presented significantly gain in attachment level.
Gingival recession is the result of the apical migration of the free gingival margin (FGM), resulting in root exposure. The direct root coverage (DRC) obtained by free gingival graft (FGG) technique is the result of bridging, while root coverage obtained later is the result of creeping attachment (CA). The purpose of this study was to assess the influence of free gingival margin excision and free gingival graft adaptation on creeping attachment on lower premolars. 48 patients with or without bilateral Miller class II defects on one or both lower premolars were selected and randomly assigned to one of the following groups: Group 1 - FGG was placed apically to the collar of residual gingiva left in place at the moment of preparing the recipient bed. Group 2 – FGG was placed at the coronal border of the recipient bed after excision of FGM without any attempt to cover the denuded root. Group 3 – a direct coverage of the recession was attempted by placing the FGG with its coronal border at the level of cemento-enamel junction (CEJ). Height of recession (HR), width of recession (WR), height of keratinized tissue (HKT) were assessed at baseline and at 30, 90, 180 and 360 days postoperatively. Probing depth (PD), attached gingiva (AG) and clinical attachment level (CAL) were assessed at 360 days postoperatively. DRC and CA were calculated with the obtained measurements. The mean percentage of root coverage in the Groups 1, 2 and 3 were 4,12%; 39,58% and 30,99% respectively at 360 days post-op. All groups exhibited statistically similar DRC and CA. Groups 2 and 3 presented significantly gain in attachment level.
Descrição
Palavras-chave
Retração gengival, Gengivas, Gengiva - Transplantes, Gingival recession, Gingiva - Transplants
Como citar
RIBEIRO, Luciana Liarte Gasparini. Influência da remoção da margem gengival e do posicionamento do enxerto gengival livre sobre o “creeping attachment”em pré-molares inferiores. 2007. 87 f. Tese (doutorado) - Universidade Estadual Paulista, Faculdade de Odontologia de Araçatuba, 2007.