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Prognóstico de dentes reabilitados com alongamento coronário versus elevação da margem profunda: revisão sistemática
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Pretende-se com a presente revisão sistemática analisar a sobrevivência de restaurações dentárias realizadas por meio da técnica de elevação da margem profunda (Deep Margin Elevation; DME) comparativamente com os resultados obtidos após alongamento coronário cirúrgico (Surgical Crown Lengthening; SCL) em pacientes com margens subgengivais profundas. Realizou-se uma pesquisa bibliográfica em bases de dados eletrónicas (PubMed, B-ON e Cochrane Library) abrangendo publicações entre 2014 e 2024. Após aplicação dos critérios de inclusão e exclusão e da triagem segundo o método PRISMA, foram selecionados seis estudos para análise. A avaliação da qualidade metodológica e risco de viés foi realizada por meio de ROBINS-I (Risk Of Bias In Non randomized Studies - of Interventions), RoB 2 (Revised Cochrane Risk-of-Bias Tool for Randomized Trials) e CARE Guidelines (CAse REport Guidelines). Os resultados demonstraram que ambas as técnicas, quando corretamente executadas e com materiais adequados, garantem estabilidade periodontal, boa taxa de sucesso clínico e baixa incidência de cáries recorrentes. A DME destacou-se como uma abordagem minimamente invasiva, eficaz na preservação da estrutura dentária e na manutenção da estética gengival, sendo particularmente vantajosa em casos com biotipo gengival espesso. Contudo, a escolha entre DME e SCL deve ser individualizada, tendo em consideração o biotipo periodontal, o acesso ao campo operatório e os objetivos estéticos e funcionais do tratamento. Salienta-se a necessidade de realização estudos com períodos de seguimento mais longos para confirmação das conclusões.
The aim of the present systematic review is to analyse the survival of dental restorations performed using the Deep Margin Elevation (DME) technique, in comparison with the results obtained after Surgical Crown Lengthening (SCL) in patients with deep subgingival margins. A bibliographic search was conducted in electronic databases (PubMed, B-ON and Cochrane Library), covering publications from 2014 to 2024. After applying the inclusion and exclusion criteria and screening according to the PRISMA method, six studies were selected for analysis. The assessment of methodological quality and risk of bias was performed using ROBINS-I (Risk Of Bias In Non-randomized Studies - of Interventions), RoB 2 (Revised Cochrane Risk-of-Bias Tool for Randomized Trials) and the CARE Guidelines (CAse REport Guidelines). The results showed that both techniques, when correctly executed and with appropriate materials, ensure periodontal stability, a good rate of clinical success, and a low incidence of recurrent caries. DME stood out as a minimally invasive approach, effective in preserving tooth structure and maintaining gingival aesthetics, being particularly advantageous in cases with thick gingival biotype. However, the choice between DME and SCL should be individualised, taking into consideration the periodontal biotype, access to the operative field, and the aesthetic and functional objectives of the treatment. The need for studies with longer follow-up periods to confirm these conclusions is emphasised.
The aim of the present systematic review is to analyse the survival of dental restorations performed using the Deep Margin Elevation (DME) technique, in comparison with the results obtained after Surgical Crown Lengthening (SCL) in patients with deep subgingival margins. A bibliographic search was conducted in electronic databases (PubMed, B-ON and Cochrane Library), covering publications from 2014 to 2024. After applying the inclusion and exclusion criteria and screening according to the PRISMA method, six studies were selected for analysis. The assessment of methodological quality and risk of bias was performed using ROBINS-I (Risk Of Bias In Non-randomized Studies - of Interventions), RoB 2 (Revised Cochrane Risk-of-Bias Tool for Randomized Trials) and the CARE Guidelines (CAse REport Guidelines). The results showed that both techniques, when correctly executed and with appropriate materials, ensure periodontal stability, a good rate of clinical success, and a low incidence of recurrent caries. DME stood out as a minimally invasive approach, effective in preserving tooth structure and maintaining gingival aesthetics, being particularly advantageous in cases with thick gingival biotype. However, the choice between DME and SCL should be individualised, taking into consideration the periodontal biotype, access to the operative field, and the aesthetic and functional objectives of the treatment. The need for studies with longer follow-up periods to confirm these conclusions is emphasised.
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Palavras-chave
Alongamento coronário Elevação de margem profunda Prognóstico dentário Resultados a longo prazo Elevação de margem subgengival Restauração dentária Crown lengthening Deep margin elevation Tooth prognosis Long-term outcomes Subgingival margin elevation Dental restoration