TRATAMENTO DA RETRAÇÃO GENGIVAL: DO DIAGNÓSTICO AO ENXERTO DE TECIDO CONJUNTIVO SUBEPITELIAL
Palavras-chave:
Palavras-chave: Periodontia; Retração gengival; Tecido conjuntivo.Resumo
Introdução:A retração gengival (RG) é caracterizada pelo deslocamento da margem gengival em direção apical, expondo a raiz e podendo comprometer a estética, causar hipersensibilidade dentinária e aumentar o risco de lesões cervicais não cariosas (LCNC). O enxerto de tecido conjuntivo subepitelial (ETCS) associado ao descolamento coronal do retalho (DCR) é considerado padrão-ouro, devido à previsibilidade clínica, ganho de tecido queratinizado (TQ) e bons resultados estéticos, indicado em Classes I e II de Miller. Objetivo: Revisar a literatura sobre o uso do ETCS no recobrimento radicular (RR). Métodos: Busca nas plataformas SciELO e PubMed, incluindo artigos em português e inglês com descritores “Enxerto”, “Retração gengival”, “Tecido conjuntivo” e “Periodontia”. Resultados: A espessura do enxerto é determinante para o sucesso, sendo recomendados 1 a 2 mm para melhor integração tecidual e estabilidade do TQ. O palato duro foi a região doadora mais utilizada. A associação do ETCS com o DCR resultou em altas taxas de RR, melhora na estética e aumento da faixa de TQ. O uso de tesouras microcirúrgicas favorece melhor adaptação e menor morbidade pós-operatória. Considerações Finais: O ETCS associado ao DCR é a técnica mais previsível e eficaz para as Classes I e II de Miller. Apesar dos resultados consistentes, são necessárias mais pesquisas clínicas de longo prazo para avaliar a estabilidade dos resultados e compará-los com novas alternativas cirúrgicas e biomateriais.
Referências
REFERÊNCIAS
Tonetti MS, Jepsen S. Working Group 2 of the European Workshop on Periodontology. Clinical efficacy of periodontal plastic surgery procedures: Consensus report of Group 2 of the 10th European Workshop on Periodontology. J Clin Periodontol. 2019;46 Suppl 21:36–43.
Azaripour A, Kissinger M, Farina V, Noorden V, Gerhold‐Ay A, Willershausen B, et al. Root coverage with connective tissue graft associated with coronally advanced flap or tunnel technique: a randomized, double-blind, mono-centre clinical trial. Journal of Clinical Periodontology. 2016 Oct 25;43(12):1142–50.
Cortellini P, Bissada NF. Mucogingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations. Journal of Periodontology. 2018 Jun;89:S204–13.
Wagner TP, Costa RSA, Rios FS, Moura MS, Maltz M, Jardim JJ, et al. Gingival recession and oral health-related quality of life: a population-based cross-sectional study in Brazil. Community Dentistry and Oral Epidemiology. 2016 Mar 8;44(4):390–9.
Oliveira LML de, Souza CA, Cunha S, Siqueira R, Vajgel B de CF, Cimões R. Treatment efficacy of gingival recession defects associated with non-carious cervical lesions: a systematic review. Journal of Periodontal & Implant Science. 2021;51.
Rajapakse PS, McCracken GI, Gwynnett E, Steen ND, Guentsch A, Heasman PA. Does tooth brushing influence the development and progression of non-inflammatory gingival recession? A systematic review. Journal of Clinical Periodontology. 2007 Dec;34(12):1046–61.
Zucchelli G, Gori G, Mele M, Stefanini M, Mazzotti C, Marzadori M, et al. Non-Carious Cervical Lesions Associated With Gingival Recessions: A Decision-Making Process. Journal of Periodontology. 2011 Dec;82(12):1713–24.
West NX, Lussi A, Seong J, Hellwig E. Dentin hypersensitivity: pain mechanisms and aetiology of exposed cervical dentin. Clinical Oral Investigations. 2012 Dec 9;17(S1):9–19.
Chambrone L, Salinas Ortega MA, Sukekava F, Rotundo R, Kalemaj Z, Buti J, et al. Root coverage procedures for treating localised and multiple recession-type defects. The Cochrane database of systematic reviews. 2018;10(10):CD007161.
Chambrone L, Tatakis DN. Periodontal Soft Tissue Root Coverage Procedures: A Systematic Review From the AAP Regeneration Workshop. Journal of Periodontology. 2015 Feb;86(2-s):S8–51.
Lima VHS de, Sousa MJC de, Monteiro LKB, Araújo VMA, Ferreira Filho JL, Lopes MCM de S, et al. Enxerto subepitelial de tecido conjuntivo e enxerto gengival livre para recobrimento radicular – relato de dois casos clínicos. Revista Eletrônica Acervo Saúde. 2020 Mar 12;12(4):e2791.
Zazou N, El Nahass H, Ezz El-Arab A. A Technical Modified Method for Harvesting Palatal De-epithelialized Connective Tissue Graft for Root Coverage: A Case Report. Advanced Dental Journal. 2019 Oct 1;1(3):72–6.
Kumar A, Sood V, Masamatti SS, Triveni MG, Mehta D, Khatri M, et al. Modified single incision technique to harvest subepithelial connective tissue graft. Journal of Indian Society of Periodontology. 2013 Jan 1;17(5):676–6.
Kassab MM, Cohen RE. The etiology and prevalence of gingival recession. Journal of the American Dental Association (1939). 2003 Feb 1;134(2):220–5.
Yared KFG, Zenobio EG, Pacheco W. A etiologia multifatorial da recessão periodontal. Revista Dental Press de Ortodontia e Ortopedia Facial. 2006 Dec 1;11:45–51.
Subepithelial connective tissue graft for root coverage. Rev. Cir. Traumatol. Buco-Maxilo-fac., Camaragibe v.9, n.4, p. 31 - 38, out./dez.2009
Marschner F, Lechte C, Kanzow P, Hraský V, Pfister W. Systematic review and meta-analysis on prevalence and risk factors for gingival recession. Journal of Dentistry. 2025 Feb 21;155:105645.
Guttiganur N, Aspalli S, Sanikop MV, Desai A, Gaddale R, Devanoorkar A. Classification systems for gingival recession and suggestion of a new classification system. Indian Journal of Dental Research: Official Publication of Indian Society for Dental Research . 2018 Mar 1;29(2):233–7.
Miller PD Jr. Uma classificação da recessão tecidual marginal Int J. Periodontics Restorative Dent. 1985;5:8–13
Zucchelli G, Gori G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L, De Sanctis M. Non-carious cervical lesions associated with gingival recessions: a decision-making process. J Periodontol. 2011 Dec;82(12):1713-24. doi: 10.1902/jop.2011.110080.
Saade J, Bassani M. Cirurgia plástica periodontal – recobrimento radicular. In: Cardoso RJA, Gonçalves EAN, editors. 20º Congresso Internacional de Odontologia. São Paulo: Artes Médicas; 2002. p. 201-248.
Zucchelli G, Mounssif I. Periodontal plastic surgery. Periodontology 2000. 2015 Apr 13;68(1):333–68.
Zucchelli G, Tavelli L, McGuire MK, Rasperini G, Feinberg SE, Wang H, et al. Autogenous soft tissue grafting for periodontal and peri‐implant plastic surgical reconstruction. Journal of Periodontology. janeiro de 2020;91(1):9–16.
Langer B, Langer L. Subepithelial Connective Tissue Graft Technique for Root Coverage. Journal of Periodontology. 1985 Dec;56(12):715–20.
Pereira PH de S, Calaça GJB. Recobrimento radicular com enxerto conjuntivo e retalho modificado por tesoura de microcirurgia: relato de caso. Revista JRG de Estudos Acadêmicos. 2024 Nov 22;7(15):e151618.
Zucchelli G, De Sanctis M. Treatment of Multiple Recession-Type Defects in Patients With Esthetic Demands. Journal of Periodontology. 2000 Sep;71(9):1506–14.
Satto N. Periodontol surgery: a clinical atlas. Illinois: Quintessence Publishing Co, Inc.; 2000.
Moisa DH, Connolly JA, Cheng B, Lalla E. Impact of connective tissue graft thickness on surgical outcomes: A pilot randomized clinical trial. Journal of Periodontology. 2019 Apr 25;90(9):966–72.
Han SH, Song HJ, Kim NJ, Park WJ, Park JB. Long-Term Outcomes of Collagen Matrix versus Subepithelial Connective Tissue in Root Coverage for Multiple Teeth: A Systematic Review and Meta-Analysis. Applied Sciences. 2024 Sep 9;14(17):8049–9.
Reiser GM, Bruno JF, Mahan PE, Larkin LH. The subepithelial connective tissue graft palatal donor site: anatomic considerations for surgeons. Int J Periodontics Restorative Dent. 1996;16(2):130-137.
Cairo F, Pagliaro U, Nieri M. Treatment of gingival recession with coronally advanced flap procedures: a systematic review. Journal of Clinical Periodontology. 2008 Sep 1;35(8 Suppl):136–62.
Santamaria MP, Feitosa D da S, Casati MZ, Nociti FH, Sallum AW, Sallum EA. Randomized Controlled Clinical Trial Evaluating Connective Tissue Graft Plus Resin-Modified Glass Ionomer Restoration for the Treatment of Gingival Recession Associated With Non-Carious Cervical Lesion: 2-Year Follow-Up. Journal of Periodontology. 2013 Sep;84(9):e1–8.
