Protocolos cirúrgico-restauradores para o tratamento de recessões gengivais associadas à lesões cervicais não-cariosas. Revisão de literatura
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Data
2022-04-12
Autores
De Sousa, Rafaela Mota
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Universidade Estadual Paulista (Unesp)
Resumo
Este levantamento e revisão bibliográfica tem como objetivo avaliar as alternativas cirúrgico-restauradoras no tratamento de Defeito Combinado, sendo este a associação de recessões gengivais e lesões cervicais não-cariosas. O defeito pode apresentar-se de forma generalizada - em múltiplos sítios - ou localizada, sendo fatores influentes na decisão da técnica cirúrgica. As abordagens multidisciplinares já avaliadas, foram propostas visando obter melhores resultados estéticos e funcionais. A técnica cirúrgica mais adequada depende da topografia das Lesões Cervicais Não-Cariosas. As abordagens cirúrgicas propostas com melhores resultados envolvem reposicionamento de retalho ou enxerto de tecido conjuntivo, separados ou associados; enquanto na fase restauradora, é proposta a restauração parcial - a 1 mm da JCE estimada - ou total da raiz. Outros materiais restauradores foram avaliados em estudos longitudinais e acompanhados, como o ionômero de vidro modificado por resina, que apresentou como problema a instabilidade de cor, gerando insucesso no aspecto estético, queixa frequente entre os pacientes. Ademais, a escolha da abordagem a ser adotada também deve levar em consideração fatores como recuperação do paciente e tempo de procedimento, visando reduzir a morbidade pós-operatória e o tempo de cadeira, além de buscar sanar a hipersensibilidade dentinária, devido aos túbulos expostos com a perda de estrutura.
This survey and literature review aims to evaluate the surgical-restorative alternatives in the treatment of Combined Defect, which is the association of gingival recessions and non-carious cervical lesions. The defect can be generalized - in multiple sites - or localized, being influential factors in the decision of the surgical technique. The multidisciplinary approaches already evaluated were proposed aiming to obtain better aesthetic and functional results. The most appropriate surgical technique depends on the topography of the Non-Carious Cervical Lesions. The surgical approaches proposed with better results involve repositioning a flap or connective tissue graft, either separately or in association; while in the restorative phase, partial restoration is proposed - at 1 mm from the estimated JCE - or total root restoration. Other restorative materials were evaluated in longitudinal and monitored studies, such as resin-modified glass ionomer, which presented color instability as a problem, causing failure in the aesthetic aspect, a frequent complaint among patients. Furthermore, the choice of approach to be adopted must also take into account factors such as patient recovery and procedure time, aiming to reduce postoperative morbidity and chair time, in addition to seeking to remedy dentin hypersensitivity, due to exposed tubules with the loss of structure.
This survey and literature review aims to evaluate the surgical-restorative alternatives in the treatment of Combined Defect, which is the association of gingival recessions and non-carious cervical lesions. The defect can be generalized - in multiple sites - or localized, being influential factors in the decision of the surgical technique. The multidisciplinary approaches already evaluated were proposed aiming to obtain better aesthetic and functional results. The most appropriate surgical technique depends on the topography of the Non-Carious Cervical Lesions. The surgical approaches proposed with better results involve repositioning a flap or connective tissue graft, either separately or in association; while in the restorative phase, partial restoration is proposed - at 1 mm from the estimated JCE - or total root restoration. Other restorative materials were evaluated in longitudinal and monitored studies, such as resin-modified glass ionomer, which presented color instability as a problem, causing failure in the aesthetic aspect, a frequent complaint among patients. Furthermore, the choice of approach to be adopted must also take into account factors such as patient recovery and procedure time, aiming to reduce postoperative morbidity and chair time, in addition to seeking to remedy dentin hypersensitivity, due to exposed tubules with the loss of structure.
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Recessão gengiva, tecido conjuntivo, retalhos cirúrgicos, junção cemento-esmalte (CEJ), sensibilidade da dentina, gingival recession, connective tissue, surgical flaps, cemento-enamel junction (CEJ), dentin sensitivity