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Tratamento de recessão gengival profunda Classe III de Miller em canino inferior vestibularizado

Trabalho relata um caso clínico de tratamento de recessão gengival profunda em canino inferior vestibularizado, com queixa de hipersensibilidade e dificuldade de higienização na região do dente 43.


AUTORES

Laura Gantes Rodrigues Dias
Cirurgiã-dentista – Universidade Federal de Pelotas.
Orcid: 0000-0002-2804-4676.

Caroline Fernandes e Silva
Doutoranda do programa de pós-graduacão em Odontologia, área de concentração em Periodontia – Universidade Federal de Pelotas.
Orcid: 0000-0002-1209-7415.

Thiago Marchi Martins
Professor associado do Depto. de Semiologia e Clínica, disciplina de Periodontia – Universidade Federal de Pelotas.
Orcid: 0000-0002-5301-7282.


RESUMO

A recessão gengival (RG) é caracterizada pelo deslocamento da margem gengival para uma posição apical à junção amelocementária. O mau posicionamento dentário pode ser um fator que interfere tanto na severidade da RG quanto na previsibilidade de cobertura radicular. O objetivo deste trabalho foi relatar um caso clínico de tratamento de recessão gengival profunda em canino inferior vestibularizado. Paciente do sexo masculino com 25 anos de idade compareceu à clínica odontológica com queixa de hipersensibilidade dentinária e dificuldade de higienização na região do dente 43. Relatou já ter realizado tratamento ortodôntico e não tinha interesse em voltar a utilizar aparelho se fosse necessário. Ao exame clínico, notou-se que o paciente apresentava gengivite induzida por placa, patologia oclusal severa, RG profunda Classe III de Miller na vestibular do 43 (10 mm de altura e 5 mm de largura), com exacerbada vestibularização dentária e fenótipo periodontal delgado, além da presença de uma restauração em resina composta com sobrecontorno. Ao exame radiográfico, foi observada uma pequena perda óssea interproximal na mesial do 43. Diante dessa condição clínica, optou-se pela realização da terapia periodontal básica, motivação e orientações de higiene oral. Após um mês, observou-se saúde periodontal e procedeu-se com o aplainamento radicular do 43 e retalho posicionado lateralmente associado ao enxerto de tecido conjuntivo subepitelial (RPL + ETCS) de mesial para distal a partir do dente 41. Baseando-se nos resultados clínicos obtidos, concluiu-se que, apesar da persistência das alterações nos princípios de oclusão normal e RG Classe III de Miller profunda associada a dente mal posicionado no arco, obteve-se sucesso clínico decorrente dos procedimentos executados, superior ao prognóstico de recobrimento para essa classificação de Miller, mantendo a completa cobertura radicular ao longo dos 12 meses.

Palavras-chave – Recessão gengival; Cirurgia plástica periodontal; Recobrimento radicular.


ABSTRACT

Gingival recession (GR) is characterized by dislocation of the gingival margin to an apical position at the cementum-enamel junction. Dental positioning may be a factor that interferes with the severity of GR and the predictability of root coverage. The aim of this study was to report a clinical case of treatment of deep gingival recession in the vetibularized lower canine. The 25-year-old male CRPSML was the dental clinic with dental hypersensitivity and difficulty cleaning the dental region. 43 He reported having had orthodontic treatment and had no interest in using orthodontic again if necessary. On clinical examination, the patient has plaqueinduced gingivitis, severe occlusal pathology, Miller’s Class III deep vestibular RG (10 mm high and 5 mm wide), with exacerbation of the vestibularization and fine periodontal phenotype, in addition to the presence of an overcontoured composite resin restoration. At radiographic examination, a small interproximal bone loss was observed in the mesial 43. Given this clinical condition, we decided to perform basic periodontal therapy, motivation and oral hygiene. After one month, periodontal health was observed it was decided to do a regularization of tooth root 43 and use the laterally positioned flap (LPF) was associated with the subepithelial connective tissue graft (SCTG), starting at mesial to distal 41 was done. Based on clinical outcomes, despite persistent pathological occlusion, the outcome of the procedures performed was clinically successful, in the resulting from the procedures performed, with the prognosis superior for this Miller classification, maintaining complete root coverage over the 12 months.

Key words – Gingival recession; Periodontal plastic surgery; Root coverage.

Recebido em jun/2020
Aprovado em jun/2020

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