Diferentes formas de proteção de áreas doadoras de enxerto gengival livre

Artigo descreve as diversas alternativas de proteção de áreas doadoras em procedimentos de enxerto gengival livre.

AUTORES

Ianca Batista
Acadêmica do curso de Odontologia – UFMG.
Orcid: 0000-0003-1152-4761.

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

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

RESUMO

Objetivo: descrever as diversas alternativas de proteção de áreas doadoras em procedimentos de enxerto gengival livre. Material e métodos: na estratégia de pesquisa, os bancos de dados Cochrane Oral Health Group’s Specialised Register, Central, MEDLINE e Embase foram pesquisados no período compreendido entre 1999 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 25 ensaios clínicos e cinco revisões sistemáticas e metanálises. Até o presente momento, poucos estudos científicos avaliaram a morbidade pós-operatória em procedimentos de enxerto gengival livre utilizando diferentes técnicas e materiais de proteção à área doadora palatina. As técnicas que apresentaram resultados satisfatórios foram o cimento cirúrgico convencional, fragmentos de tecido conjuntivo com epitélio, colágeno hemostático microfibrilar, plasma rico em plaquetas, plasma rico em fibrinas, laser de baixa potência, óleo de oliva ozonizado e alguns curativos à base de mel. Conclusão: apesar da evolução das técnicas cirúrgicas periodontais, com o objetivo de aumentar a faixa de mucosa ceratinizada inserida, pouca atenção vem sendo dada ao controle da dor pós-operatória em cirurgias de enxerto gengival livre. A literatura científica apresenta algumas opções de proteção à área doadora palatina, como o uso de cimento cirúrgico periodontal, placas de acrílicos protetoras do palato, adesivos teciduais, curativos, dentre outras. Porém, não existe um consenso sobre estes diferentes materiais e/ou técnicas para redução da dor, edema e complicações inerentes à área doadora nas cirurgias de enxerto gengival livre.

Palavras-chave – Enxerto gengival livre; Cirurgia plástica periodontal; Cirurgia mucogengival.

ABSTRACT

Objective: to describe the various alternatives for protecting the donor area, in free gingival graft procedures. Material and methods: in the search strategy, the Cochrane Oral Health Group’s Specialized Register, Central, MEDLINE and Embase databases were screened in the period from 1999 to 2019. The selection and analysis criteria of the results followed the guidelines of the Cochrane Oral Health Group (Cochrane Handbook for Systematic Reviews of Interventions 5.0.0). Human experimental design studies (randomized clinical trials), systematic reviews and meta-analyzes were selected. Animal and “in vitro” studies were excluded from the evaluation. Results: 25 clinical trials and 5 systematic reviews and meta-analyzes were selected. To date, few scientific studies have evaluated postoperative morbidity in free gingival graft procedures, using different techniques and protective materials for the palatal donor area. The techniques that showed satisfactory results were conventional surgical cement, fragments of connective tissue with epithelium, microfibrillary hemostatic collagen, platelet-rich plasma, fibrin-rich plasma, low-power laser, ozonized olive oil and some honey-based dressings. Conclusion: despite the evolution of periodontal surgical techniques, in order to increase the range of inserted keratinized mucosa, little attention has been given to the control of postoperative pain in free gingival graft surgeries. The scientific literature presents some options for protection of the palatal donor area, such as the use of periodontal surgical cement, acrylic devices that protect the palate, tissue adhesives, dressings, among others. However, there is no consensus on these different materials and/or techniques for reducing pain, edema and complications inherent to the donor area in free gingival graft surgeries.

Key words – Free gingival graft ; Periodontal plastic surgery; Mucogingival surgery.

Recebido em ago/2020
Aprovado em set/2020

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