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.

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