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Análise comparativa entre diferentes biomateriais e o enxerto de tecido conjuntivo para recobrimento radicular – revisão crítica da literatura

Artigo compara o grau de recobrimento radicular com o emprego do plasma rico em fibrina da MCX, da MDAH e dos DME, em comparação ao enxerto de tecido conjuntivo.

AUTORES

Vivian Nixson do Carmo
Graduanda em Odontologia – UFMG.
Orcid: 0000-0002-7490-1941.

Fabiano Araújo Cunha
Professor adjunto de Periodontia – FO-UFMG.
Orcid: 0000-0002-1141-8563.

Rafael Paschoal Esteves Lima
Professor adjunto de Periodontia – FO-UFMG.
Orcid: 0000-0003-4343-3845.

Maria Aparecida Gonçalves de Melo Cunha
Professora de Saúde Coletiva – Faculdade de Odontologia do Centro Universitário Newton Paiva.
Orcid: 0000-0002-6488-0516.

Ilson de Sousa Melo Neto
Especialista em Periodontia – São Leopoldo Mandic.
Orcid: 0000-0002-2498-0211.

RESUMO

Objetivo: comparar o grau de cobertura radicular com o emprego do plasma rico em fibrina (PRF) da matriz colágena xenógena suína (MCX), da matriz dérmica acelular humana (MDAH) e dos derivados da matriz de esmalte (DME), em comparação ao enxerto de tecido conjuntivo (ETC), no tratamento de recessões gengivais. Material e métodos: os bancos de dados Cochrane Oral Health Group’s Specialised Register, Central, MEDLINE e Embase foram pesquisados no período compreendido entre 2009 e 2019. Os critérios de seleção e análise dos resultados seguiram as diretrizes do Cochrane Oral Health Group (Cochrane Handbook for Systematic Reviews of Interventions 5.0.0). Foram selecionados estudos de delineamento experimental em humanos (ensaios clínicos randomizados), revisões sistemáticas e metanálises. Foram excluídos da avaliação estudos em animais e in vitro. Resultados: foram selecionados 13 ensaios clínicos e cinco revisões sistemáticas e metanálises. Os estudos científicos não demonstraram a efetividade do PRF como substituto do enxerto de tecido conjuntivo gengival no tratamento de recessões gengivais. Foi possível observar que a técnica do retalho posicionado coronalmente (RPC) associado ao DME obteve um resultado não significativo quando comparado com o RPC isoladamente. Quando associado à MCX e à MDAH, foi significantemente mais eficiente do que sozinho, mas não quando comparado ao ETC. Conclusão: o ETC continua sendo a melhor alternativa para recobrimento radicular. Apesar disso, a MCX e a MDAH associadas ao retalho posicionado coronalmente podem ser utilizadas como alternativas para recessões gengivais Classes I e II de Miller em determinados casos. Existe ainda a necessidade de padronização dos ensaios clínicos para melhor determinação dos resultados a longo prazo com o emprego desses biomateriais.

Palavras-chave – Recessão gengival; Biomateriais; Tecido conjuntivo.

ABSTRACT

Objective: to compare the clinical efficacy of platelet-rich fibrina (PRF), xenogeneic collagen matrix (XCM), acellular dermal matrix (ADM) and enamel matrix derivative (EMD) compared to the connective tissue graft (CTG) for the treatment of gingival recessions. Material and methods: in the search strategy, the Cochrane Oral Health Group’s Specialized Register, Central, MEDLINE and Embase databases were searched in the period from 2009 to 2019. The criteria for selecting and analyzing the results followed the guidelines of the Cochrane Oral Health Group (Cochrane Handbook for Systematic Reviews of Interventions 5.0.0). Randomized clinical trials, systematic reviews and meta-analyzes were selected. Results: 13 clinical trials and 5 systematic analyzes and meta-analyzes were included. Until now, scientific studies have not demonstrated the effectiveness of PRF as a substitute for the CTG, in the treatment of gingival recessions. It was possible to observe that the coronally advanced flap (CAF) associated with EMD had a non-significant result when compared with the CAF alone. XCM and ADM associated with CAF technique were significantly more efficient than the surgical technique used alone. Despite this, there is a need for standardization of clinical trials to better determine long-term results, with the use of these biomaterials. Conclusion: although CTG remains the best alternative for root coverings, XCM and ADM associated with the coronally advanced flap can be used as alternatives to Miller class I and II gingival recessions in certain cases.

Key words – Gingival recession; Biomaterials; Connective tissue.

Recebido em mai/2020
Aprovado em jun/2020

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