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A utilização da fibrina rica em plaquetas (PRF) e seus derivados para o tratamento cirúrgico das recessões gengivais – uma revisão da literatura

Artigo realiza revisão da literatura sobre as possibilidades cirúrgicas da utilização da fibrina rica em plaquetas e seus derivados para o tratamento da recessão gengival.


AUTORES

Bruno Jardim Fatureto Jeronimo
Graduando em Odontologia – Universidade de Brasília.

Roberto Machado Cruz
Professor adjunto de Implantodontia – Universidade de Brasília.

Antonio Carlos Quintão Medeiros
Mestre em Implantologia – Universidade Sagrado Coração.

RESUMO

Objetivo: realizar uma revisão da literatura sobre as possibilidades cirúrgicas da utilização da fibrina rica em plaquetas (PRF) e seus derivados para o tratamento da recessão gengival. Material e métodos: a pesquisa de trabalhos primários foi realizada nas bases científicas PubMed e Google Acadêmico com a seguinte estratégia de busca: (“gingival recession” OR “gingival graft”) AND (“platelet-rich fibrin” OR “PRF”). Apenas estudos em inglês e português foram considerados, publicados nos últimos 20 anos, e os desfechos analisados foram o recobrimento radicular (%) e a cicatrização tecidual da região doadora. Resultados: a busca inicial resultou em 248 estudos que passaram pelos critérios de inclusão. Ao final, 14 estudos (oito ensaios clínicos randomizados; quatro ensaios clínicos boca-dividida randomizados; um ensaio clínico boca-dividida; e uma série de casos) foram incluídos nesta revisão. Os ensaios clínicos randomizados e boca-dividida randomizados foram submetidos à ferramenta “Rob 2 Cochrane” e as séries de casos à ferramenta escala “JBI Case Series Critical Appraisal Tool” para avaliar o risco de viés. Nos estudos revisados, a fibrina foi associada a seis técnicas cirúrgicas de recobrimento gengival, mostrando-se muito versátil com a possibilidade de substituição dos enxertos de tecido conjuntivo, mantendo a porcentagem de recobrimento radicular. Quando utilizada de forma aliada, no entanto, não apresentou benefícios claros, com ganhos estatisticamente insignificantes. Conclusão: a fibrina rica em plaquetas mostra-se uma ferramenta biológica de alto benefício no auxílio do recobrimento gengival, quando aliado de forma correta às técnicas cirúrgicas tradicionais. Por se tratar de uma ferramenta nova na área da cirurgia periodontal, não foi possível estabelecer uma técnica que melhor se associe ao biomaterial. Novos estudos devem ser traçados para aprofundar o entendimento de suas vantagens clínicas a curto e longo prazo.

Palavras-chave – Recessão gengival; Gengiva; Cirurgia periodontal; Agregados plaquetários; Fibrina rica em plaquetas; PRF.

ABSTRACT

Objective: the aim of this study was to perform a literature review on the surgical possibilities of using platelet-rich fibrin (PRF), and its derivatives, for the treatment of gingival recession. Material and methods: the research of primary works was carried out in the scientific databases PubMed and Academic Google with the following search strategy: (“gingival recession” OR “gingival graft”) AND (“platelet-rich fibrin” OR “PRF”). Only studies in English and Portuguese were considered, published in the last 20 years, and the outcomes analyzed were root coverage (%) and tissue healing in the donor region. Results: the initial search resulted in 248 studies that were submitted to the inclusion and exclusion criteria. In the end, 14 studies (8 randomized controlled trials; 4 randomized split-mouth clinical trials; 1 split-mouth clinical trial; and 1 case series) were included in this review. Randomized and split-mouth randomized clinical trials were submitted to the “Rob 2 Cochrane” tool and the case series to the “JBI Case Series Critical Appraisal Tool” to assess the risk of bias. In the reviewed studies, fibrin was associated with 6 surgical techniques for gingival coverage, proving to be very versatile, with the possibility of replacing connective tissue graft s, maintaining the percentage of root coverage. When used as an ally, however, it did not show clear benefits, with statistically insignificant gains. Conclusion: PRF proves to be a biological tool that provides high benefits in the treatment of gingival recession if correctly combined with traditional surgical techniques. As this is a new tool in the field of periodontal surgery, it was not possible to establish a technique that better associates with the biomaterial. New studies should be designed to deepen the understanding of its short and long-term clinical advantages.

Key words – Gingival recession; Gingiva; Periodontal surgery; Platelet aggregates; Platelet-rich fibrin; PRF (fibrina rica em plaquetas).

Recebido em nov/2021
Aprovado em jan/2022

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