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Matriz de colágeno estável em volume para o tratamento de recessões gengivais múltiplas – relato de caso

Estudo avalia resultados da técnica de retalho posicionado coronariamente modificado associada à nova matriz de colágeno para o tratamento dos defeitos múltiplos adjacentes.


AUTORES

Mauro Pedrine Santamaria
Professor livre-docente na disciplina de Periodontia e do programa de Biopatologia Bucal do Depto. de Diagnóstico e Cirurgia – ICT-Unesp; Professor na University of Kentucky, College of Dentistry, Center for Oral Health Research and Division of Periodontology, EUA.
Orcid: 0000-0001-9468-0729.

Manuela Maria Viana Miguel
Mestra e doutoranda do programa de pós-graduação em Biopatologia Bucal (área de concentração: Periodontia) – ICT-Unesp.
Orcid: 0000-0003-4828-3487.

Sergio Kahn
Professor assistente da disciplina 3 de Reabilitação Oral – Universidade Veiga de Almeida.
Orcid: 0000-0001-5173-4045.

Ingrid Fernandes Mathias-Santamaria
Professora na University of Maryland School of Dentistry, division of Operative Dentistry, Dept. of General Dentistry, EUA.
Orcid: 0000-0003-2518-0135.

Marcelo Pereira Nunes
Mestre e doutor em Periodontia; Coordenador do Grupo Império.
Orcid: 0000-0002-8285-5410.

RESUMO

A recessão gengival (RG) é uma condição clínica com alta prevalência na população e está associada à demanda estética e hipersensibilidade dentinária. Casos de recessões gengivais múltiplas adjacentes (RGM) são desafiadores para o clínico, dada a peculiaridade de cada sítio na área cirúrgica, o que pode impactar na abordagem terapêutica. O retalho posicionado coronariamente (CAF) associado ao enxerto de tecido conjuntivo subepitelial (CTG) é considerado o procedimento padrão-ouro para o tratamento dos defeitos múltiplos. Contudo, morbidade, desconforto pós-operatório e quantidade restrita de tecido na área doadora palatina são limitações no uso do enxerto autógeno. Deste modo, se faz necessário o desenvolvimento de substitutos do CTG. Uma nova matriz de colágeno de origem suína estável em volume (VCMX) foi recentemente disponibilizada no mercado nacional, porém escassas são as avaliações de sua aplicabilidade em defeitos de RG. O presente relato de caso descreve o tratamento de RGM RT1 nos elementos dentários 22, 23 e 24 em uma paciente com 27 anos de idade apresentando fenótipo periodontal fino. O objetivo foi avaliar, a partir de mensurações clínicas e parâmetros centrados na paciente, os resultados de seis meses pós-operatórios da técnica de CAF modificado (MCAF) associada à VCMX para o tratamento dos defeitos múltiplos adjacentes. Após seis meses, observou-se resultados satisfatórios, dada a alta porcentagem de recobrimento radicular (%RR) – 95,1% –, bem como redução da recessão gengival (RedRec) – média de 2,65 mm. Adicionalmente, um ganho de espessura de tecido queratinizado foi observado ao fim do acompanhamento. A hipersensibilidade dentinária (HD) relatada pela paciente foi cessada nos sítios tratados, e foi alcançada satisfação estética por parte da paciente. Dentro dos limites do presente relato de caso, pôde-se concluir que a execução do MCAF associado à VCMX apresentou resultados satisfatórios no tratamento de RGM RT1.

Palavras-chave – Relato de caso; Recessão gengival; Biomaterial; Xenoenxertos.

ABSTRACT

Gingival recession (GR) is a clinical condition with high population prevalence associated with aesthetic demand and dentin hypersensitivity (DH). Multiple adjacent gingival recession (MGR) cases are challenging for the practitioner due to each site peculiarity on surgical area which affects the surgical technique selected. Coronally advanced flap (CAF) associated with connective tissue graft (CTG) have been considered the gold standard to treat MRG. However, high morbidity, patient discomfort, and limited amount of tissue have been reported when CTG-grafted procedures are performed. Thus, it is necessary to develop CTG substitutes. A new volume-stable collagen matrix volume (VCMX) has recently available on national market; however, literature lacks evaluation regarding VCMX applicability on MGR. The present case report describes MGRs RT1 at teeth #10, 11, and 12 of a 27-year-old patient with a thin periodontal phenotype. The aim was to evaluate the 6-month clinical and patient-centered outcomes of VCMX combined with modified CAF to treat MGR defects. At 6-month, a satisfactory outcome was shown due to a high root coverage percentage (95.1%), as well as recession reduction (on average, 2.65 mm). In addition, keratinized tissue thickness gain was observed at the end of the follow-up. DH reported by the patient at the study beginning was reduced and patient aesthetic satisfaction was achieved using the biomaterial. Within the present case report limits, it may be concluded that VCMX associated with MCAF showed satisfactory outcomes to treat MGR RT1.

Key words – Case report; Gingival recession; Biomaterials; Heterografts.

Referências

  1. Susin C, Haas AN, Oppermann RV, Haugejorden O, Albandar JM. Gingival recession: epidemiology and risk indicators in a representative urban Brazilian population. J Periodontol 2004;75(10):1377-86.
  2. Sarfati A, Bourgeois D, Katsahian S, Mora F, Bouchard P. Risk assessment for buccal gingival recession defects in an adult population. J Periodontol 2010;81(10):1419-25.
  3. Chambrone L, Tatakis DN. Long-term outcomes of untreated buccal gingival recessions: a systematic review and meta-analysis. J Periodontol 2016;87(7):796-808.
  4. Graziani F, Gennai S, Roldán S, Discepoli N, Buti J, Madianos P et al. Efficacy of periodontal plastic procedures in the treatment of multiple gingival recessions. J Clin Periodontol 2014;41(suppl.15):63-76.
  5. Chambrone L, Ortega MAS, Sukekava F, Rotundo R, Kalemaj Z, Buti J et al. Root coverage procedures for treating single and multiple recession-type defects: an updated Cochrane systematic review. J Periodontol 2019;90(12):1399-422.
  6. Miguel MMV, Mathias-Santamaria IF, Rossato A, Ferraz LFF, Figueiredo-Neto AM, de Marco AC et al. Microcurrent electrotherapy improves palatal wound healing: randomized clinical trial. J Periodontol 2021;92(2):244-53.
  7. Wessel JR, Tatakis DN. Patient outcomes following subepithelial connective tissue graft and free gingival graft procedures. J Periodontol 2008;79(3):425-30.
  8. Mathes SH, Wohlwend L, Uebersax L, von Mentlen R, Thoma DS, Jung RE et al. A bioreactor test system to mimic the biological and mechanical environment of oral soft tissues and to evaluate substitutes for connective tissue grafts. Biotechnol Bioeng 2010;107(6):1029-39.
  9. Caballé-Serrano J, Zhang S, Ferrantino L, Simion M, Chappuis V, Bosshardt DD. Tissue response to a porous collagen matrix used for soft tissue augmentation. Materials (Basel) 2019;12(22):3721.
  10. Thoma DS, Naenni N, Benic GI, Hämmerle CH, Jung RE. Soft tissue volume augmentation at dental implant sites using a volume stable three-dimensional collagen matrix – histological outcomes of a preclinical study. J Clin Periodontol 2017;44(2):185-94.
  11. Thoma DS, Gasser TJW, Jung RE, Hämmerle CHF. Randomized controlled clinical trial comparing implant sites augmented with a volume-stable collagen matrix or an autogenous connective tissue graft: 3-year data after insertion of reconstructions. J Clin Periodontol 2020;47(5):630-9.
  12. Stefanini M, Mounssif I, Barootchi S, Tavelli L, Wang HL, Zucchelli G. An exploratory clinical study evaluating safety and performance of a volume-stable collagen matrix with coronally advanced flap for single gingival recession treatment. Clin Oral Investig 2020;24(9):3181-91.
  13. Santamaria MP, Miguel MMV, Rossato A, Bonafé ACF, Ferraz LFF, dos Santos LM et al. New volume-stable collagen matrix and modified coronally advanced flap to treat multiple gingival recessions associated with partially restored non-carious cervical lesions: a case report. Clin Adv Periodontics 2022;12(2):69-74.
  14. Cairo F, Nieri M, Cincinelli S, Mervelt J, Pagliaro U. The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol 2011;38(7):661-6.
  15. Pini-Prato G, Franceschi D, Cairo F, Nieri M, Rotundo R. Classification of dental surface defects in areas of gingival recession. J Periodontol 2010;81(6):885-90.
  16. Zucchelli G, De Sanctis M. Treatment of multiple recession-type defects in patients with esthetic demands. J Periodontol 2000;71(9):1506-14.
  17. Tavelli L, Barootchi S, Cairo F, Rasperini G, Shedden K, Wang HL. The effect of time on root coverage outcomes: a network meta-analysis. J Dent Res 2019;98(11):1195-203.
  18. Tavelli L, Barootchi S, Di Gianfilippo R, Modarressi M, Cairo F, Rasperini G et al. Acellular dermal matrix and coronally advanced flap or tunnel technique in the treatment of multiple adjacent gingival recessions. A 12-year follow-up from a randomized clinical trial. J Clin Periodontol 2019;46(9):937-48.
  19. 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 derivate 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;48(7):949-61.
  20. De Rouck T, Eghbali R, Collys K, De Bruyn H, Cosyn J. The gingival biotype revisited: transparency of the periodontal probe through the gingival margin as a method to discriminate thin from thick gingiva. J Clin Periodontol 2009;36(5):428-33.
  21. Pini Prato GP, Magnani C, Chambrone L. Long-term evaluation (20 years) of the outcomes of coronally advanced flap in the treatment of single recession-type defects. J Periodontol 2018;89(3):265-74.
  22. Tonetti MS, Cortellini P, Pellegrini G, Nieri M, Bonaccini D, Allegri M et al. Xenogenic collagen matrix or autologous connective tissue graft as adjunct to coronally advanced flaps for coverage of multiple adjacent gingival recession: randomized trial assessing non-inferiority in root coverage and superiority in oral health-related quality of life. J Clin Periodontol 2018;45(1):78-88.
  23. Santamaria MP, Neves FLDS, Silveira CA, Mathias IF, Fernandes-Dias SB, Jardini MAN et al. Connective tissue graft and tunnel or trapezoidal flap for the treatment of single maxillary gingival recessions: a randomized clinical trial. J Clin Periodontol 2017;44(5):540-7.
  24. Santamaria MP, Silveira CA, Mathias IF, Neves FLDS, dos Santos LM, Jardini MAN et al. Treatment of single maxillary gingival recession associated with non-carious cervical lesion: randomized clinical trial comparing connective tissue graft alone to graft plus partial restoration. J Clin Periodontol 2018;45(8):968-76.
  25. Rotundo R, Genzano L, Patel D, D’Aiuto F, Nieri M. Adjunctive benefit of a xenogenic collagen matrix associated with coronally advanced flap for the treatment of multiple gingival recessions: a superiority, assessor-blind, randomized clinical trial. J Clin Periodontol 2019;46(10):1013-23.
  26. Cairo F, Barootchi S, Tavelli L, Barbato L, Wang HL, Rasperini G et al. Aesthetic-and patient-related outcomes following root coverage procedures: a systematic review and network meta-analysis. J Clin Periodontol 2020;47(11):1403-15.
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