Eficácia dos enxertos de tecido mole e substitutos teciduais em procedimentos de recobrimento radicular: revisão da literatura

Roberta Michels
Mestre e doutoranda em Implantodontia, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brasil. Pesquisadora assistente, Universidade de Berna, Suíça.
ORCID: 0000-0003-4882-0852

Giuliano Zorzo
Graduando em Odontologia, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brasil.
ORCID: 0009-0005-1227-3692

Ana Clara Kuerten Gil
Mestre e doutoranda em Implantodontia, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brasil.
ORCID: 0000-0001-5544-8310

Kelly Batista Maier
Mestranda em Implantodontia, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brasil.
ORCID: 0000-0002-1873-135X

Cesar Augusto Magalhães Benfatti
Professor de Periodontia e Implantodontia, Departamento de Odontologia, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brasil.
ORCID: 0000-0002-4209-0054

Ricardo de Souza Magini
Professor de Periodontia e Implantodontia, Departamento de Odontologia, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brasil.
ORCID: 0000-0003-3024-6338

Gabriel Leonardo Magrin
Professor de Periodontia e Implantodontia, Departamento de Odontologia, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brasil.
ORCID: 0000-0003-0724-0560

DOI: https://doi.org/10.71440/2675-5610.10.4.25.476-488.art

RESUMO

Objetivos: Analisar a eficácia do uso de enxertos e substitutos teciduais no tratamento da recessão gengival, avaliando ganhos quantitativos (em mm) e melhorias qualitativas na integração e na estética tecidual. Material e métodos: Foram pesquisados artigos científicos relacionados ao uso de enxertos de tecido mole e substitutos teciduais em procedimentos de recobrimento radicular nas bases de dados PubMed e Google Acadêmico, sem filtros adicionais. Resultados: A estratégia de busca identificou inicialmente 250 referências; após a triagem de títulos e resumos, 90 estudos foram avaliados na íntegra, dos quais 25 atenderam aos critérios de inclusão. Os enxertos teciduais autógenos destacaram-se como a principal opção terapêutica, apresentando ganho médio de recobrimento radicular entre 2,5 e 3,0 mm. Em contrapartida, os substitutos teciduais não autógenos demonstraram ganho médio de aproximadamente 2,0 mm, sendo especialmente indicados em casos de recessões múltiplas, nos quais o tecido doador autógeno é limitado. Conclusão: Embora o enxerto autógeno seja considerado o padrão-ouro para recessões unitárias, suas limitações em casos múltiplos evidenciam a necessidade de alternativas. Os substitutos de tecido mole apresentam resultados promissores, mas requerem investigações adicionais para confirmar sua eficácia.

Palavras-chave: enxerto gengival; recobrimento radicular; enxertos de tecido conjuntivo; matriz de colágeno; revisão da literatura.

Efficacy of soft tissue grafts and tissue substitutes for root coverage procedures: a literature review

ABSTRACT

Objectives: To analyze the efficacy of grafts and tissue substitutes in the treatment of gingival recession, evaluating quantitative gains (measured in mm) and qualitative improvements in tissue integration and aesthetics. Material and methods: Scientific articles related to the use of soft tissue grafts and tissue substitutes in root coverage procedures were searched in the PubMed and Google Scholar databases with no additional filters. Results: The search strategy initially retrieved 250 references. After screening titles and abstracts, 90 studies were fully analyzed, of which 25 met the inclusion criteria. Autogenous tissue grafts stood out as the primary therapeutic option, achieving an average root coverage gain between 2.5 and 3.0 mm. In contrast, non autogenous tissue substitutes demonstrated an average gain of approximately 2.0 mm and were particularly recommended for multiple recessions where autogenous donor tissue is limited. Conclusion: Although autogenous grafts are considered the gold standard for single recessions, their limitations in multiple cases highlight the need for alternatives. Soft tissue substitutes show promising results but require further research to confirm their efficacy.

Keywords: gingival graft; root coverage; connective tissue grafts; collagen matrix; literature review.

Referências

Jepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P, Cortellini P et al. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018 Jun 1;89(Suppl 1):S237–48. https://doi.org/10.1002/jper.17-0733

Molnár B, Aroca S, Dobos A, Orbán K, Szabó J, Windisch P et al. Treatment of multiple adjacent RT 1 gingival recessions with the modified coronally advanced tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: 9-year results of a split-mouth randomized clinical trial. Clin Oral Investig. 2022 Dec 1;26(12):7135–42. https://doi.org/10.1007/s00784-022-04674-9

Cortellini P, Bissada NF. Mucogingival conditions in the natural dentition: narrative review, case definitions, and diagnostic considerations. J Periodontol. 2018;89(Suppl 1):S204–13. https://doi.org/10.1002/jper.16-0671

Miller Jr PD. A classification of marginal tissue recession. Int J Periodontics Restorative Dent 1985; 5(2):9-13.

Cairo F, Nieri M, Cincinelli S, Mervelt J, Pagliaro U. The inter- proximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol. 2011;38:661–6. https://doi.org/10.1111/j.1600-051x.2011.01732.x

McGuire MK, Scheyer ET. Xenogeneic collagen matrix with coronally advanced flap compared to connective tissue with coronally advanced flap for the treatment of dehiscence-type recession defects. J Periodontol. 2010 Aug;81(8):1108–17. https://doi.org/10.1902/jop.2010.090698

Cairo F, Nieri M, Pagliaro U. Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions: A systematic review. J Clin Periodontol. 2014;41(Suppl 15):S44–62. https://doi.org/10.1111/jcpe.12182

Thoma DS, Hämmerle CH, Cochran DL, Jones AA, Görlach C, Uebersax L et al. Soft tissue volume augmentation by the use of collagen-based matrices in the dog mandible – A histological analysis. J Clin Periodontol. 2011;38(11):1063–70. https://doi.org/10.1111/j.1600-051x.2011.01786.x

Thoma DS, Zeltner M, Hilbe M, Hämmerle CH, Hüsler J, Jung RE. Randomized controlled clinical study evaluating effectiveness and safety of a volume-stable collagen matrix compared to autogenous connective tissue grafts for soft tissue augmentation at implant sites. J Clin Periodontol. 2016;43(10):874–85. https://doi.org/10.1111/jcpe.12588

Fernández-Jiménez A, García-De-La-Fuente AM, Estefanía-Fresco R, Marichalar-Mendia X, Aguirre-Urizar JM, Aguirre-Zorzano LA. Complete root coverage in the treatment of Miller class III or RT2 gingival recessions: a systematic review and meta-analysis. BMC Oral Health. 2021 Mar 22;21(1):145. https://doi.org/10.1186/s12903-021-01494-3

Thoma DS, Naenni N, Figuero E, Hämmerle CHF, Schwarz F, Jung RE et al. Effects of soft tissue augmentation procedures on peri-implant health or disease: a systematic review and meta-analysis. Clin Oral Implants Res. 2018 Mar;29(Suppl 15):32–49. https://doi.org/10.1111/clr.13114

Zucchelli G, Mounssif I. Periodontal plastic surgery. Periodontol 2000. 2015 Jun;68(1):333-68. https://doi.org/10.1111/prd.12059

Lu W, Qi G, Ding Z, Li X, Qi W, He F. Clinical efficacy of acellular dermal matrix for plastic periodontal and implant surgery: a systematic review. Int J Oral Maxillofac Surg. 2020 Aug;49(8):1057-1066. https://doi.org/10.1016/j.ijom.2019.12.005

Chambrone L, Botelho J, Machado V, Mascarenhas P, Mendes JJ, Avila-Ortiz G. Does the subepithelial connective tissue graft in conjunction with a coronally advanced flap remain as the gold standard therapy for the treatment of single gingival recession defects? A systematic review and network meta-analysis. J Periodontol. 2022 Sep;93(9):1336–1352. https://doi.org/10.1002/jper.22-0167

Harris RJ. Clinical evaluation of 3 techniques to augment keratinized tissue without root coverage. J Periodontol. 2001;72(7):932–8. https://doi.org/10.1902/jop.2001.72.7.932

Zucchelli G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L et al. Patient morbidity and root coverage outcome after subepithelial connective tissue and de-epithelialized grafts: a comparative randomized-controlled clinical trial. J Clin Periodontol. 2010;37(8):728-38. https://doi.org/10.1111/j.1600-051x.2010.01550.x

Novaes AB Jr, Grisi DC, Molina GO, Souza SL, Taba M Jr, Grisi MF. Comparative 6-month clinical study of a subepithelial connective tissue graft and acellular dermal matrix graft for the treatment of gingival recession. J Periodontol. 2001;72(11):1477-84. https://doi.org/10.1902/jop.2001.72.11.1477

Sanz M, Lorenzo R, Aranda JJ, Martin C, Orsini M. Clinical evaluation of a new collagen matrix (Mucograft® prototype) to enhance the width of keratinized tissue in patients with fixed prosthetic restorations: A randomized prospective clinical trial. J Clin Periodontol. 2009 Oct;36(10):868–76. https://doi.org/10.1111/j.1600-051x.2009.01460.x

Wennström J, Lindhe J. Role of attached gingiva for maintenance of periodontal health and healing following excisional and grafting procedures in dogs. J Clin Periodontol. 1983 Mar;10(2):238–50. https://doi.org/10.1111/j.1600-051x.1983.tb02208.x

Bez LV, Magrin GL, Magini RS, Greghi SLA, Benfatti CAM. Histologic and histomorphometric analyses of free gingival grafts after mechanical expansion: a study in dogs. Int J Periodontics Restorative Dent. 2023 Mar/Apr;43(2):e89-e97. https://doi.org/10.11607/prd.5752

Janson WA, Ruben MP, Kramer GM, Bloom AA, Turner H. Development of the blood supply to split-thickness free gingival autografts. J Periodontol. 1969 Dec;40(12):707–16. https://doi.org/10.1902/jop.1969.40.12.707

Srivastava A, DeSagun EZ, Jennings LJ, Sethi S, Phuangsab A, Hanumadass M et al. Use of porcine acellular dermal matrix as a dermal substitute in rats. Ann Surg. 2001 Mar;233(3):400-8. https://doi.org/10.1097/00000658-200103000-00015

Schmitt CM, Matta RE, Moest T, Humann J, Gammel L, Neukam FW et al. Soft tissue volume alterations after connective tissue grafting at teeth: the subepithelial autologous connective tissue graft versus a porcine collagen matrix – a pre-clinical volumetric analysis. J Clin Periodontol. 2016 Jul;43(7):609-17. https://doi.org/10.1111/jcpe.12547

Kasaj A, Levin L, Stratul SI, Götz H, Schlee M, Rütters CB et al. The influence of various rehydration protocols on biomechanical properties of different acellular tissue matrices. Clin Oral Investig. 2016 Jul;20(6):1303–15. https://doi.org/10.1007/s00784-015-1614-1

Thoma DS, Villar CC, Cochran DL, Hämmerle CH, Jung RE. Tissue integration of collagen-based matrices: an experimental study in mice. Clin Oral Implants Res. 2012 Dec;23(12):1333–9. https://doi.org/10.1111/j.1600-0501.2011.02356.x

Dorfman HS, Kennedy JE, Bird WC. Longitudinal evaluation of free autogenous gingival grafts: a four-year report. J Periodontol. 1982 Jun;53(6):349-52. https://doi.org/10.1902/jop.1982.53.6.349

Zuhr O, Akakpo D, Eickholz P, Vach K, Hürzeler MB, Petsos H et al. Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage: 5-year results of an RCT using 3D digital measurement technology for volumetric comparison of soft tissue changes. J Clin Periodontol. 2021 Jul;48(7):949–61. https://doi.org/10.1111/jcpe.13470

Prato GPP, Franceschi D, Cortellini P, Chambrone L. Long-term evaluation (20 years) of the outcomes of subepithelial connective tissue graft plus coronally advanced flap in the treatment of maxillary single recession-type defects. J Periodontol. 2018 Nov;89(11):1290–1299. https://doi.org/10.1002/jper.17-0619

Harris RJ. A comparison of 2 root coverage techniques: guided tissue regeneration with a bioabsorbable matrix style membrane versus a connective tissue graft combined with a coronally positioned pedicle graft without vertical incisions. results of a series of consecutive cases. J Periodontol. 1998 Dec;69(12):1426-34. https://doi.org/10.1902/jop.1998.69.12.1426

Michels R, Magrin GL, Cruz A, Magini RS, Benfatti CAM. Functionalization of a volume-stable collagen matrix using liquid platelet-rich fibrin: a case report presenting a new approach for root coverage. Case Rep Dent. 2023 Mar 22:2023:3929269. https://doi.org/10.1155/2023/3929269