Aumento do fenótipo do tecido mole peri-implantar em área previamente acometida por peri-implantite: relato de caso com acompanhamento de três anos

Ana Carolina Ferreira Bonafé
Mestra e doutoranda em Periodontia – ICT-Unesp, Universidade Estadual Paulista, Instituto de Ciência e Tecnologia, São José dos Campos, São Paulo,
Brasil.
ORCID: 0000-0001-5685-0002

Amanda Rossato
Mestra, doutora, pós-doutoranda em Periodontia – ICT-Unesp, Universidade Estadual Paulista, Instituto de Ciência e Tecnologia, São José dos Campos, São
Paulo, Brasil.
ORCID: 0000-0001-9354-9446

Ingrid Fernandes Mathias-Santamaria
Mestra e doutora em Odontologia Restauradora – ICT-Unesp, Associate Professor in the Restorative Dentistry Division – University of Kentucky, University of Kentucky, College of Dentistry, Lexington, Kentucky, EUA.
ORCID: 0000-0003-2518-0135

Lucas Raineri Capeletti
Mestre em Implantodontia – UnB e doutorando em Periodontia – UFG, Faculdade de Odontologia, Universidade Federal de Goiás, Goiânia, Goiás,
Brasil.
ORCID: 0000-0003-1146-3257

Mauro Pedrine Santamaria
Mestre e doutor em Periodontia – Unicamp, Associate Professor in the Center for Oral Health Research and Division of Periodontology – University of Kentucky, University of Kentucky, College of Dentistry, Lexington, Kentucky, EUA.
ORCID: 0000-0001-9468-0729

Marcelo Pereira Nunes
Mestre em Implantodontia – SLMandic e doutor em Periodontia – UFPE, Coordenador do Grupo Proimperio, Instituto Proimperio, São Paulo, Brasil
ORCID: 0000-0002-8285-5410.

DOI: https://doi.org/10.71440/2675-5610.10.6.25.798-805.art

RESUMO

Paciente, sexo feminino, com 66 anos de idade, foi encaminhada com o objetivo de tratar a peri-implantite e melhorar a estabilidade dos tecidos ao redor dos implantes 25 e 26. A cirurgia com EGL foi conduzida após tratamento cirúrgico da peri-implantite e consistiu na realização do retalho posicionado apicalmente com EGL. A profundidade de sondagem (PS), índice da mucosa implantar (IMI), índice gengival modificado (IGm), índice de placa modificado (IPm), espessura da mucosa (EM), largura de TQ e recessão da mucosa peri-implantar (RMP). Alem disso, foi utilizado o escore estético rosa: papilas mesial (PM) e distal (PD), nível e contorno do tecido mole (NMT), deficiência do processo alveolar (DPA), e cor (CT) e textura (TT) do tecido foram avaliados inicialmente. Apos 3 anos, o implante #25 apresentou aumento de EM (1 mm para 2 mm) e TQ (0,5 mm para 2 mm), com redução da RMP (0,5 mm para 0 mm). Houve melhora na NMT (discrepância maior para ausência), CT (pouco natural para natural), cor e TT (diferença obvia para nenhuma diferença), enquanto PM e PD se mantiveram estáveis. A DPA mostrou melhora radiográfica. Para o implante 26, observou-se aumento de EM (1 mm para 2 mm) e TQ (0,5 mm para 2 mm), e redução da RMP (1,5 mm para 1 mm). Houve melhora em NMT (discrepância maior para menor), CT (pouco natural para natural), cor e TT (diferença obvia para nenhuma diferença), enquanto PM manteve-se ausente. A DPA também permaneceu leve. Os sítios atingiram PS ≤ 5 mm, IMI = 0, IGm = 1, IPm = 0 ao final do tratamento da peri-implantite e mantiveram estabilidade. O enxerto gengival livre (EGL) foi eficaz na modificação do fenótipo em sitio com histórico de peri-implantite, promovendo aumento de espessura e largura do tecido queratinizado, mantendo-se estável após três anos.

Palavras-chave: Implantes Dentarios, Estética, Peri-implantite, Terapia de Tecidos Moles, Tecido Conjuntivo.

Soft tissue phenotype augmentation in an area previously affected by periimplantitis: a case report with three-years of follow-up

ABSTRACT

A 66-years-old, female patient was referred for peri-implantitis treatment and soft tissue augmentation around implants #25 and #26. The FGG procedure was carried out following surgical management of peri-implantitis and involved the execution of an apically positioned flap combined with FGG. The following clinical parameters were assessed at baseline: probing depth (PD), modified plaque index (mPI), modified gingival index (mGI), implant mucosal index (IMI), mucosal thickness (MT), width of keratinized tissue (KT), and periimplant mucosal recession (PIMR). In addition, the Pink Esthetic Score (PES) was applied, including assessment of mesial (MP) and distal (DP) papillae, soft tissue level and contour (STLC), alveolar process deficiency (APD), as well as color (C ) and texture (T) of the periimplant soft tissues. After 3 years, implant #25 showed an increase in MT (1 mm to 2 mm) and KT (0.5 mm to 2 mm), with a reduction in PIMR (0.5 mm to 0 mm). STLC improved (major discrepancy to none), as did C and T (from obvious to no difference), while MP and DP remained stable. APD showed radiographic improvement. Implant #26 also showed increased MT (1 mm to 2 mm) and KT (0.5 mm to 2 mm), and PIMR reduction (1.5 mm to 1 mm). STLC improved (major to minor discrepancy), and both C and T improved (from obvious to no difference), while MP remained absent. APD also remained mild. Sites achieved PD ≤ 5 mm, IMI = 0, mGI = 1, and mPI = 0 at the end of peri-implantitis treatment and remained stable. The free gingival graft (FGG) was effective in modifying the peri-implant phenotype in a site with a history of peri-implantitis, promoting increased mucosal thickness and keratinized tissue width, with clinical and esthetic stability maintained over three years.

Keywords: Connective Tissue, Dental Implant, Esthetics, Peri-implantitis, Soft Tissue Therapy.

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