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Publicação
Biomateriais não autólogos na cirurgia plástica periodontal
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Resumo(s)
Os médicos dentistas têm, habitualmente, pacientes com queixas estéticas ao nível do
sorriso. A abordagem estética do sorriso envolve em parte o tratamento dos dentes, mas
também da gengiva. As cirurgias estéticas dos tecidos moles e da gengiva denominam-se cirurgias plásticas periodontais. Estas melhoram as condições estéticas dos pacientes e permitem obter outros resultados clínicos através do recobrimento de superfícies radiculares previamente expostas.
As cirurgias plásticas periodontais recorrem frequentemente ao uso de um enxerto;
recolhido na maioria das vezes da mucosa palatina. Contudo estes enxertos autólogos
podem apresentar limitações associadas à sua disponibilidade, qualidade e homogeneidade dos mesmos. Esta colheita necessita de um segundo local cirúrgico
aumentando a probabilidade de desenvolvimento de comorbilidades.
Para tentar ultrapassar estas limitações, vários biomateriais não autólogos têm sido
desenvolvidos como as membranas dérmicas acelulares, membranas de colagénio,
proteínas derivadas do esmalte e outros produtos.
Nesta monografia, o primeiro objetivo é explicar as principais técnicas cirúrgicas
aplicadas ao recobrimento radicular, aumento de gengiva queratinizada e correção de
colapsos. Este conjunto de procedimentos são as principais indicações das cirurgias
plásticas periodontais. O segundo e principal objetivo é descrever os diferentes
biomateriais não autólogos que estão atualmente disponíveis. Assim, para cada tipo de
biomaterial será abordado: o tipo, sua produção, funcionamento, indicações,
contraindicações, protocolo de utilização, vantagens e desvantagens. Por último,
pretendeu-se não só procurar a evidência científica do uso deste tipo de materiais, assim
como comparar com o gold standard – enxertos autólogos.
Para a realização desta monografia, foi efetuada uma pesquisa bibliográfica recorrendo
às plataformas informáticas de literatura científica Pubmed, Cochrane e Google Scholar,
assim como, a livros científicos em inglês, português ou francês. Foram efetuadas
também pesquisas de todos os folhetos disponibilizados pelas casas comerciais referentes aos materiais não autólogos analisados.
Dentists usually receive patients with aesthetic demands at smile level. The aesthetic approach to the smile involves the treatment of the teeth and of the gums. The aesthetic surgeries of the soft tissues and gums are called periodontal plastic surgeries. They improve the aesthetic conditions of the patients and allow other clinical results through the covering of previously exposed root surfaces. Periodontal plastic surgeries often resort to the use of a graft mostly collected from the palatal mucosa. However, these autologous grafts may present limitations associated with their availability, quality and homogeneity. Also, this harvest from a second surgical site increases the probability of developing comorbidities. To overcome these limitations, several non-autologous biomaterials have been developed such as acellular dermal membranes, collagen membranes, proteins from enamel derivatives and other products. In this monograph, the first objective is to explain the main surgical techniques applied to root covering, keratinized gum augmentation and collapse correction. This set of procedures is the main indications of periodontal plastic surgeries. The second and main objective is to describe the different non-autologos biomaterials that are currently available. Thus, for each type of biomaterial we will address: its type, its production, functioning, indications, contraindications, use protocol, advantages and disadvantages. Finally, it was intended not only to look for scientific evidence of the use of this type of materials, but also to compare with the gold standard - autologous grafts. For this monograph, a bibliographic search was made using the computer platforms of scientific literature Pubmed, Cochrane and Google Scholar, as well as scientific books in English, Portuguese or French. Researches were also made on all the leaflets made available by the commercial houses regarding the non-autologous materials analyzed.
Dentists usually receive patients with aesthetic demands at smile level. The aesthetic approach to the smile involves the treatment of the teeth and of the gums. The aesthetic surgeries of the soft tissues and gums are called periodontal plastic surgeries. They improve the aesthetic conditions of the patients and allow other clinical results through the covering of previously exposed root surfaces. Periodontal plastic surgeries often resort to the use of a graft mostly collected from the palatal mucosa. However, these autologous grafts may present limitations associated with their availability, quality and homogeneity. Also, this harvest from a second surgical site increases the probability of developing comorbidities. To overcome these limitations, several non-autologous biomaterials have been developed such as acellular dermal membranes, collagen membranes, proteins from enamel derivatives and other products. In this monograph, the first objective is to explain the main surgical techniques applied to root covering, keratinized gum augmentation and collapse correction. This set of procedures is the main indications of periodontal plastic surgeries. The second and main objective is to describe the different non-autologos biomaterials that are currently available. Thus, for each type of biomaterial we will address: its type, its production, functioning, indications, contraindications, use protocol, advantages and disadvantages. Finally, it was intended not only to look for scientific evidence of the use of this type of materials, but also to compare with the gold standard - autologous grafts. For this monograph, a bibliographic search was made using the computer platforms of scientific literature Pubmed, Cochrane and Google Scholar, as well as scientific books in English, Portuguese or French. Researches were also made on all the leaflets made available by the commercial houses regarding the non-autologous materials analyzed.
Descrição
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Palavras-chave
Periodontologia Cirurgias plásticas periodontais Enxertos não autólogos Biomateriais