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Comparação clínica entre enxerto de matriz dérmica acelular e enxerto de tecido conjuntivo em procedimentos de recobrimento radicular
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Abstract(s)
Os enxertos gengivais, nomeadamente o enxerto gengival livre e o enxerto de tecido conjuntivo, apresentam resultados mais previsíveis e a sua utilização está fortemente indicada para o recobrimento radicular. Contudo, recentemente, foram introduzidos outras técnicas de enxertos alternativos e biomateriais, de forma a evitar morbilidade da zona dadora e superar a disponibilidade limitada de tecido autógeno. Um dos procedimentos alternativos são as matrizes dérmicas acelulares. O objectivo este trabalho foi, através da realização de uma revisão da literatura, verificar a aplicação da matriz dérmica acelular e de enxerto de tecido conjuntivo nas técnicas de cirurgia plástica periodontal para tratamento das recessões gengivais. E, avaliar qual o procedimento que proporcionaria maior recobrimento radicular, com os consequentes parâmetros clínicos e quantidade de tecido queratinizado. Efetuou-se uma pesquisa recorrendo a uma base de dados primária (PubMed), selecionando-se artigos publicadas entre 2000 e 2017, na língua inglesa e portuguesa, e publicações que avaliassem a comparação entre matrizes dérmicas e enxerto de tecido conjuntivo no recobrimento radicular. No total foram identificados 21 artigos. Em conclusão, as recessões gengivais representam um grande desafio estético e a possibilidade de recobrimento radicular com o emprego de técnicas cirúrgicas previsíveis e bem documentadas na literatura pode ser de grande utilidade na resolução de problemas estéticos. Nesse sentido, a técnica do Enxerto Subepitelial de tecido Conjuntivo, assim como, a utilização da Matriz Dérmica Acelular, a qual foi descrita e comentada neste trabalho, merecem ser consideradas como técnicas efetiva em alcançar satisfatórios do ponto de vista clínico.
Gingival grafts, in particular free gingival grafts and connective tissue grafts, present more predictable results and their use is strongly indicated in adherent gingivitis increases. However, other alternative grafting techniques and biomaterials have recently been introduced in order to avoid donor site morbidity and to overcome the limited availability of autogenous tissue. One of the alternative procedures is the acellular dermal matrices. The aim of this work is to verify the application of acellular dermal matrices and connective tissue graft in the techniques of periodontal plastic surgery to increase adherent gingiva. And to evaluate the procedure that would provide greater root coverage, with the consequent clinical parameters and quantity of keratinized tissue. A research was done using a primary database (PubMed), selecting publications published from 2000 to 2017, in the English and Portuguese language, and publications comparing the use of dermal matrices and connective tissue grafting for increased gum adherence. A total of 21 articles were identified. In conclusion, gingival retractions represent a great aesthetic challenge in some clinical situations. The possibility of root coverage with the use of predictable and well documented surgical techniques in the literature can be of great use in solving aesthetic problems in dental offices. In this sense, the technique of the Subepithelial Grafting of Connective Tissue , as well as the use of the Acellular Dermal Matrix, which has been described and commented in this work, deserve to be considered as effective techniques to achieve satisfactory from the clinical point of view.
Gingival grafts, in particular free gingival grafts and connective tissue grafts, present more predictable results and their use is strongly indicated in adherent gingivitis increases. However, other alternative grafting techniques and biomaterials have recently been introduced in order to avoid donor site morbidity and to overcome the limited availability of autogenous tissue. One of the alternative procedures is the acellular dermal matrices. The aim of this work is to verify the application of acellular dermal matrices and connective tissue graft in the techniques of periodontal plastic surgery to increase adherent gingiva. And to evaluate the procedure that would provide greater root coverage, with the consequent clinical parameters and quantity of keratinized tissue. A research was done using a primary database (PubMed), selecting publications published from 2000 to 2017, in the English and Portuguese language, and publications comparing the use of dermal matrices and connective tissue grafting for increased gum adherence. A total of 21 articles were identified. In conclusion, gingival retractions represent a great aesthetic challenge in some clinical situations. The possibility of root coverage with the use of predictable and well documented surgical techniques in the literature can be of great use in solving aesthetic problems in dental offices. In this sense, the technique of the Subepithelial Grafting of Connective Tissue , as well as the use of the Acellular Dermal Matrix, which has been described and commented in this work, deserve to be considered as effective techniques to achieve satisfactory from the clinical point of view.
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Keywords
Recessão gengival Enxerto gengival Matriz dérmica acelular Cirurgia plástica periodontal Aumento gengival Cirurgia mucogengival Gingival recession Gingival graft Acellular dermal matrix Periodontal plastic surgery Gingival augmentation Mucogingival surgery