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Double lateral flap versus laterally closed tunnel no tratamento de recessões mandibulares isoladas: revisão sistemática
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| Projeto de pós-graduação_42306 | 5 MB | Adobe PDF |
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Objetivo: O objetivo desta revisão sistemática é avaliar a eficácia e comparar dois tipos de técnicas cirúrgicas no tratamento de recessões profundas isoladas na mandíbula: a técnica Laterally Closed Tunnel e a Double Lateral Sliding Bridge Flap. Foram avaliados diferentes parâmetros biológicos como o recobrimento radicular completo, o recobrimento radicular medio, a espessura do tecido queratinizado, a altura da recessão, a largura da recessão, o nível de inserção clínica e a espessura gengival, nos vários estudos para perceber qual técnica ira ter condições biológicas mais favoráveis.
Materiais e Métodos: A questão de investigação foi: “Será que a técnica LCT apresenta melhores resultados no tratamento cirúrgico regenerativo de recessões gengivas isoladas comparativamente à DLSBF?”; de forma a tentar responder à questão de investigação, foi desenhada a estratégia PICO (População: pacientes com recessões gengivais mandibulares isoladas; Intervenção: correção cirúrgica da recessão gengival; Comparação: comparação entre as técnicas LCT e DLSBF no tratamento cirúrgico de recessões gengivais mandibulares isoladas; Resultados (Outcome): avaliação dos resultados clínicos quanto ao sucesso de recobrimento radicular entre as duas técnicas cirúrgicas). A pesquisa foi conduzida de acordo com a estratégia PRISMA. Foram utilizadas as bases de dados PubMed, B-ON, Cochrane Library e ScienceDirect e as seguintes palavras de pesquisa: ((((laterally closed tunnel) OR (double lateral flap)) AND (deep isolated gingival recession)) OR (root coverage)) AND (connective tissue graft). Os critérios de inclusão abrangeram estudos retrospetivos, ensaios clínicos, ensaios clínicos randomizados, estudos comparativos, estudos clínicos randomizados controlados, estudos clínicos, estudos que analisam recessões gengivas isoladas, publicados nos últimos 10 anos e redigidos em língua inglesa. Foram excluídos estudos redigidos em outro idioma que não for a língua inglesa, estudos secundários, estudos com tempo de follow up menor de 3 meses, estudos com pacientes periodontais não controlados, estudos que analisam outras técnicas que não a LCT e a DLSBF.
Resultados: Foram identificados 1261 artigos na pesquisa inicial. Destes, apenas 6 cumpriram os critérios de inclusão e exclusão e os objetivos estabelecidos. Para a avaliação do risco de viés dos estudos selecionados, foram utilizadas a JBI Critical Appraisal Checklist for Case Reports, a JBI Critical Appraisal Checklist for Case Series, a JBI Critical Appraisal Checklist for Quasi-Experimental studies e a JBI Critical Appraisal Checklist for Randomized Controlled Trials.
Conclusão: Ambas as abordagens demonstraram ser eficazes na obtenção de recobrimento radicular significativo, com melhorias nos parâmetros estéticos e funcionais. Contudo, observou-se que a seleção da técnica mais adequada depende de fatores anatómicos locais, da experiência do profissional e das expectativas do paciente.
Objective: The aim of this systematic review is to evaluate the effectiveness and compare two types of surgical techniques in the treatment of deep isolated mandibular recessions: the Laterally Closed Tunnel technique and the Double Lateral Sliding Bridge Flap. Different biological parameters were assessed, such as complete root coverage, mean root coverage, width of keratinized tissue, recession height, recession width, clinical attachment level, and gingival thickness, across the various studies to understand which technique may present more favorable biological conditions. Materials and Methods: The research question was: "Does the LCT technique present better results in the regenerative surgical treatment of isolated gingival recessions compared to DLSBF?"; in order to attempt to answer the research question, a PICO strategy was designed (Population: patients with isolated mandibular gingival recessions; Intervention: surgical correction of gingival recession; Comparison: comparison between LCT and DLSBF techniques in the surgical treatment of isolated mandibular gingival recessions; Outcome: evaluation of clinical outcomes regarding root coverage success between the two surgical techniques). The search was conducted according to the PRISMA strategy. The databases used were PubMed, B-ON, Cochrane Library, and ScienceDirect, with the following search terms: ((((laterally closed tunnel) OR (double lateral flap)) AND (deep isolated gingival recession)) OR (root coverage)) AND (connective tissue graft). The inclusion criteria comprised retrospective studies, clinical trials, randomized clinical trials, comparative studies, controlled randomized clinical studies, clinical studies, studies analyzing isolated gingival recessions, published within the last 10 years, and written in English. Excluded were studies written in languages other than English, secondary studies, studies with a follow-up period of less than 3 months, studies with uncontrolled periodontal patients, and studies analyzing techniques other than LCT and DLSBF. Results: A total of 1261 articles were identified in the initial search. Of these, only 6 met the established aim and inclusion and exclusion criteria. To assess the risk of bias in the selected studies, the following tools were used: JBI Critical Appraisal Checklist for Case Reports, JBI Critical Appraisal Checklist for Case Series, JBI Critical Appraisal Checklist for Quasi-Experimental Studies, and JBI Critical Appraisal Checklist for Randomized Controlled Trials. Conclusion: Both approaches proved to be effective in achieving significant root coverage, with improvements in aesthetic and functional parameters. However, it was observed that the choice of the most appropriate technique depends on local anatomical factors, the clinician's experience, and the patient's expectations.
Objective: The aim of this systematic review is to evaluate the effectiveness and compare two types of surgical techniques in the treatment of deep isolated mandibular recessions: the Laterally Closed Tunnel technique and the Double Lateral Sliding Bridge Flap. Different biological parameters were assessed, such as complete root coverage, mean root coverage, width of keratinized tissue, recession height, recession width, clinical attachment level, and gingival thickness, across the various studies to understand which technique may present more favorable biological conditions. Materials and Methods: The research question was: "Does the LCT technique present better results in the regenerative surgical treatment of isolated gingival recessions compared to DLSBF?"; in order to attempt to answer the research question, a PICO strategy was designed (Population: patients with isolated mandibular gingival recessions; Intervention: surgical correction of gingival recession; Comparison: comparison between LCT and DLSBF techniques in the surgical treatment of isolated mandibular gingival recessions; Outcome: evaluation of clinical outcomes regarding root coverage success between the two surgical techniques). The search was conducted according to the PRISMA strategy. The databases used were PubMed, B-ON, Cochrane Library, and ScienceDirect, with the following search terms: ((((laterally closed tunnel) OR (double lateral flap)) AND (deep isolated gingival recession)) OR (root coverage)) AND (connective tissue graft). The inclusion criteria comprised retrospective studies, clinical trials, randomized clinical trials, comparative studies, controlled randomized clinical studies, clinical studies, studies analyzing isolated gingival recessions, published within the last 10 years, and written in English. Excluded were studies written in languages other than English, secondary studies, studies with a follow-up period of less than 3 months, studies with uncontrolled periodontal patients, and studies analyzing techniques other than LCT and DLSBF. Results: A total of 1261 articles were identified in the initial search. Of these, only 6 met the established aim and inclusion and exclusion criteria. To assess the risk of bias in the selected studies, the following tools were used: JBI Critical Appraisal Checklist for Case Reports, JBI Critical Appraisal Checklist for Case Series, JBI Critical Appraisal Checklist for Quasi-Experimental Studies, and JBI Critical Appraisal Checklist for Randomized Controlled Trials. Conclusion: Both approaches proved to be effective in achieving significant root coverage, with improvements in aesthetic and functional parameters. However, it was observed that the choice of the most appropriate technique depends on local anatomical factors, the clinician's experience, and the patient's expectations.
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Palavras-chave
Recessão gengival isolada profunda Recobrimento radicular Enxerto de tecido conjuntivo Laterally closed tunnel Double lateral flap Deep isolated gingival recession Root coverage Connective tissue graft