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Publication
Recobrimento radicular por técnica de retalho de avanço coronal, com autoenxerto de tecido conjuntivo, com e sem proteínas derivadas da matriz de esmalte : ensaio clínico controlado randomizado
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Authors
Abstract(s)
Objetivos: O objetivo do estudo foi avaliar se no recobrimento radicular de recessões gengivais de
tipo I de Cairo, existem vantagens da adição de proteínas derivadas da matriz do esmalte (PDME)
com a técnica do retalho de avanço coronal (CAF) com autoenxerto de tecido conjuntivo (SCTG)
(CAF + SCTG + PDME), em comparação com o recobrimento radicular pela técnica do retalho de
avanço coronal, com autoenxerto de tecido conjuntivo isoladamente (CAF + SCTG). Como objetivo
primário temos a avaliação das variáveis clínicas: redução da recessão gengival (RecRed),
recobrimento radicular parcial/total (Rrp/Rrt) e satisfação do paciente (Paciente Reported Outcome
Mesure – PROMs) nos dois grupos. Como objetivo secundário da nossa investigação temos
avaliação dos benefícios a nível bioquímico da associação de PDME com o retalho de avanço
coronal, com autoenxerto de tecido conjuntivo.
Materiais e Métodos: Foram realizadas 11 cirurgias de recobrimento radicular envolvendo 25
recessões. Dessas 25 recessões, 10 foram selecionadas para compor os dois grupos de estudo que
serão apresentados, o grupo de teste (CAF + SCTG + PDME) e o grupo de controlo (CAF + SCTG).
Os parâmetros clínicos foram avaliados em cada consulta e a satisfação do doente através de
questionário oral. Quanto ao objetivo secundário, foram realizadas avaliações bioquímicas de três
biomarcadores da inflamação periodontal: interleucina 8 (IL-8), o fator de crescimento fibroblasto
2 (FGF-2) e o fator de crescimento vascular endotelial (VEGF).
Resultados: A RecRed e a Rrp/Rrt obtiveram melhores resultados no grupo teste em comparação
com o grupo de controlo. Três semanas após a intervenção cirúrgica, a RecRed era de 1,2 mm no
grupo teste que no grupo de controlo era de 0,8mm. A Rrp/Rrt foi de 50% no grupo teste e 33,2%
no grupo controlo. Contudo, as diferenças não foram estatisticamente significativas. Os PROMs
mostraram resultados globalmente semelhantes entre os dois grupos. Em relação à análise
biomolecular da interleucina 8, o uso de proteínas derivadas da matriz do esmalte parece manter
concentrações mais baixas ao longo do período de observação comparativamente com o grupo de
controlo. Para o VEGF e o FGF-2, foram observadas concentrações mais elevadas no grupo teste
em comparação com o grupo controlo, em todas as análises. Nesta avaliação as diferenças também
não foram estatisticamente significativas.
Conclusão: Parece haver uma tendência para as PDME terem um efeito positivo a nível
biomolecular, no recobrimento radicular de recessões de tipo RT1, pela técnica de retalho de avanço
coronal com enxerto autógeno de tecido conjuntivo palatino. Mais estudos são necessários para
avaliar o possível efeito benéfico das PDME neste tipo de cirurgias.
Objectives: The objective of this study is to evaluate whether there are advantages to adding enamel matrix derivative proteins (EMDP) to the coronally advanced flap technique with autogenous connective tissue graft (CAF + SCTG + EMDP) for the root coverage of Cairo type I gingival recessions, compared to root coverage using the coronally advanced flap technique with autogenous connective tissue graft alone (CAF + SCTG). The primary objective is to assess clinical variables: reduction of gingival recession (RecRed), partial/total root coverage, and patient satisfaction (Patient Reported Outcome Measure – PROMs) in both groups. The secondary objective of our investigation is to evaluate the biochemical benefits of the association of EMDP with the coronally advanced flap technique and autogenous connective tissue graft. Materials and Methods: To this end, 11 root coverage surgeries involving 25 recessions were performed. Of these, 10 were selected to compose our two study groups. The first group is the test group (CAF + SCTG + EMDP) and the second group is the control group (CAF + SCTG). Clinical parameters were assessed at each visit through an oral questionnaire. For the secondary objective, an evaluation of three periodontal inflammation biomarkers will be carried out: interleukin 8 (IL-8), fibroblast growth factor 2 (FGF-2), and vascular endothelial growth factor (VEGF). Results: RecRed and Rrp/Rrt achieved better results in the test group compared to the control group. Three weeks after the surgical intervention, RecRed measured 1.2 mm in the test group versus 0.8 mm in the control group, while Rrp/Rrt was 50% in the test group compared to 33.2% in the control group. The PROMs showed generally similar results between the two groups, with a slight favorable trend in the control group. Regarding the biomolecular analysis of interleukin 8, the use of EMDP seems to maintain lower concentrations over time compared to the control group. For VEGF and FGF-2, higher concentrations were observed in the test group compared to the control group in all our analyses. Conclusion: Although the results are not significant, the use of EMDP seems to improve root coverage with the coronal advancement flap technique combined with palatal connective tissue autograft.
Objectives: The objective of this study is to evaluate whether there are advantages to adding enamel matrix derivative proteins (EMDP) to the coronally advanced flap technique with autogenous connective tissue graft (CAF + SCTG + EMDP) for the root coverage of Cairo type I gingival recessions, compared to root coverage using the coronally advanced flap technique with autogenous connective tissue graft alone (CAF + SCTG). The primary objective is to assess clinical variables: reduction of gingival recession (RecRed), partial/total root coverage, and patient satisfaction (Patient Reported Outcome Measure – PROMs) in both groups. The secondary objective of our investigation is to evaluate the biochemical benefits of the association of EMDP with the coronally advanced flap technique and autogenous connective tissue graft. Materials and Methods: To this end, 11 root coverage surgeries involving 25 recessions were performed. Of these, 10 were selected to compose our two study groups. The first group is the test group (CAF + SCTG + EMDP) and the second group is the control group (CAF + SCTG). Clinical parameters were assessed at each visit through an oral questionnaire. For the secondary objective, an evaluation of three periodontal inflammation biomarkers will be carried out: interleukin 8 (IL-8), fibroblast growth factor 2 (FGF-2), and vascular endothelial growth factor (VEGF). Results: RecRed and Rrp/Rrt achieved better results in the test group compared to the control group. Three weeks after the surgical intervention, RecRed measured 1.2 mm in the test group versus 0.8 mm in the control group, while Rrp/Rrt was 50% in the test group compared to 33.2% in the control group. The PROMs showed generally similar results between the two groups, with a slight favorable trend in the control group. Regarding the biomolecular analysis of interleukin 8, the use of EMDP seems to maintain lower concentrations over time compared to the control group. For VEGF and FGF-2, higher concentrations were observed in the test group compared to the control group in all our analyses. Conclusion: Although the results are not significant, the use of EMDP seems to improve root coverage with the coronal advancement flap technique combined with palatal connective tissue autograft.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Recessão gengival CAF PDME Biomarcadores