Comparação entre o uso de enxerto de tecido conjuntivo e matriz dérmica acelular xenógena associados ao retalho posicionado coronariamente para o tratamento de recessões gengivais unitárias: reanálise de dados de dois estudos randomizados
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Data
2021-07-30
Autores
Fonseca, Manuela Bafini
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
As recessões gengivais apresentam alta prevalência e estão relacionadas com a demanda estética e de hipersensibilidade dentinária. A técnica de retalho posicionado coronariamente (CAF) associada ao enxerto de tecido conjuntivo subepitelial (CTG) é considerada como terapia padrão-ouro para o tratamento de recessões gengivais unitárias. Contudo, o uso de enxerto autógenos está diretamente relacionado a desconforto e morbidade pós-operatória. Deste modo, biomateriais vêm sendo desenvolvidos com o objetivo de substituição do CTG, como por exemplo a matriz dérmica acelular xenógena (XDM). Tal matriz tridimensional possui características biológicas que favorecem o seu uso em cirurgias mucogengivais, apresentando um comportamento semelhante ao CTG. Apesar da literatura abordar o seu uso em mucosa peri-implantar e em recessões gengivais múltiplas, há poucas evidências a longo prazo do seu emprego em defeitos unitários e em comparação com o CTG. O objetivo do presente estudo foi de comparar o uso de XDM ao uso do CTG, associados ao CAF, no tratamento de RGU RT1. Ademais, analisar variáveis independentes influenciadoras no resultado clínico final da RGU. Cinquenta sítios com RGU foram avaliados em baseline, 3 e 6 meses a partir da redução da recessão gengival (RedRec), recobrimento radicular completo (RRC), porcentagem de recobrimento (%R), ganho em altura (ATQ) e em espessura tecidual (ETQ). Superioridade do CTG foi visto na RedRec, RRC e %R (p < 0,05) após 6 meses, bem como melhores ganhos teciduais. A partir da regressão dos dados em baseline com o desfecho de RRC, verificou-se que a ETQ se apresenta como um preditor significante [OR= 1,6473 (IC (1,134 – 2,3926)], bem como a altura da papila (AP) [OR= 8,2 (IC (1,31 – 51,2)]. Contudo, a interação XDM x ETQ revelou OR de 7,105-5 [IC (9,917-9 – 5,09-1)]. ETQ atuou como um preditor relevante para RedRec (B= 1,365, p = 0,03). AP e uso do XDM como preditores na %R (B=11,53, p = 0,001; B= -20,36; p = 0,0003, respectivamente). Aos 6 meses verificou-se uma influência negativa da variável independente XDM no RRC [OR= 4-3 (IC (2,64-5 – 0,6)] e RedRec quando comparado ao CTG. Conclui-se que CTG é superior ao XDM no tratamento de RGU RT1.
Gingival recessions are highly prevalent and are related to esthetic demand and dentin hypersensitivity (HD). The association between coronally advanced flap (CAF) and the subepithelial connective tissue graft (CTG) is considered the gold standard to treat single gingival recessions. However, the autogenous graft is directly associated with morbidity and patient discomfort after the surgical procedure. Therefore, biomaterials have been developed with the aim to substitute CTG, as, for example, a xenogeneic acellular dermal matrix (XDM). This tridimensional matrix presents features that favor its use in mucogingival surgeries due to CTG similar behavior. Although the literature shows XDM use in peri-implant mucosa and multiple gingival recessions, low evidence in long terms is present toward XDM use in single defects. Fifty single gingival recessions (RT1) were evaluated in the baseline and 6 months, by clinical parameters, as gingival recession reduction (RedRec), complete root coverage (RRC), root coverage percent (%RC), keratinized tissue width (KTW) keratinized tissue thickness (KTT). Superiority was seen by CTG in RecRed, CRC and, %RC (p < 0.05) after 6-month. Moreover, better KTT and KTW gains were obtained with CTG. Regarding the regression analysis with baseline data and CRC was observed KTT and papilla height (PH) acting as significant predictors [OR= 1,6473 (IC (1,134 – 2,3926 ); OR= 8,2 (IC (1,31 – 51,2), respectively. Despite those OR, the interaction between XDM*KTT showed an OR of 7,105-5 [IC (9,917-9 – 5,09-1 )]. KTT acted as a relevant predictor in RecRec (B= 1,365, p = 0,03); as well this, AP and XDM for %RC B=11,53, p = 0,001; B= -20,36; p = 0,0003, respectively). At the end of the follow-up, a negative influence was seen by XDM with CRC [OR= 4-3 (IC (2,64-5 – 0,6)] and RecRed comparing to CTG. It can be concluded that CTG is better than XDM to treat single gingival recessions (RT1).
Gingival recessions are highly prevalent and are related to esthetic demand and dentin hypersensitivity (HD). The association between coronally advanced flap (CAF) and the subepithelial connective tissue graft (CTG) is considered the gold standard to treat single gingival recessions. However, the autogenous graft is directly associated with morbidity and patient discomfort after the surgical procedure. Therefore, biomaterials have been developed with the aim to substitute CTG, as, for example, a xenogeneic acellular dermal matrix (XDM). This tridimensional matrix presents features that favor its use in mucogingival surgeries due to CTG similar behavior. Although the literature shows XDM use in peri-implant mucosa and multiple gingival recessions, low evidence in long terms is present toward XDM use in single defects. Fifty single gingival recessions (RT1) were evaluated in the baseline and 6 months, by clinical parameters, as gingival recession reduction (RedRec), complete root coverage (RRC), root coverage percent (%RC), keratinized tissue width (KTW) keratinized tissue thickness (KTT). Superiority was seen by CTG in RecRed, CRC and, %RC (p < 0.05) after 6-month. Moreover, better KTT and KTW gains were obtained with CTG. Regarding the regression analysis with baseline data and CRC was observed KTT and papilla height (PH) acting as significant predictors [OR= 1,6473 (IC (1,134 – 2,3926 ); OR= 8,2 (IC (1,31 – 51,2), respectively. Despite those OR, the interaction between XDM*KTT showed an OR of 7,105-5 [IC (9,917-9 – 5,09-1 )]. KTT acted as a relevant predictor in RecRec (B= 1,365, p = 0,03); as well this, AP and XDM for %RC B=11,53, p = 0,001; B= -20,36; p = 0,0003, respectively). At the end of the follow-up, a negative influence was seen by XDM with CRC [OR= 4-3 (IC (2,64-5 – 0,6)] and RecRed comparing to CTG. It can be concluded that CTG is better than XDM to treat single gingival recessions (RT1).
Descrição
Palavras-chave
Biomaterial, Recessão gengival, Xenoenxertos, Biomaterial, Gingival recession, Heterografts