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Recobrimento radicular com enxerto de tecido conjuntivo com e sem proteínas derivadas da matriz de esmalte : um estudo clínico piloto
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Authors
Abstract(s)
Objetivos: O objetivo principal do estudo foi avaliar o impacto clínico e biomolecular das proteínas derivadas da matriz esmalte (PDME) na cicatrização das recessões gengivais de classificação 1 de Cairo (RT1), utilizando um enxerto de tecido conjuntivo com a técnica de retalho de avanço coronal ou a técnica de tunelização. Além disso, foram avaliados, quantificados e comparados três biomarcadores do fluido crevicular gengival; a interleucina 8 (IL-8), o fator de crescimento fibroblástico 2 (FGF-2) e o fator de crescimento endotelial vascular (VEGF), de modo a avaliar a cicatrização gengival aguda e os benefícios da utilização das proteínas derivadas do esmalte.
Materiais e Métodos: Entre setembro de 2022 e março 2023, foram realizadas 8 cirurgias de tratamento de recessões gengivais RT1. Foi feita uma seleção aleatória formando os seguintes grupos: grupo controlo 1 (CAF + STCG), grupo controlo 2 (TUN + SCTG), grupo teste 1 (CAF + SCTG + EMD) e grupo teste 2 (TUN + SCTG + EMD). Foram analisados parâmetros clínicos e biomoleculares antes das cirurgias e até 3 meses depois: redução de recessão gengival (RecRed), recobrimento radicular total (RCR), recobrimento radicular parcial (mRC). Através da recolha do fluído crevicular gengival (FCG), foi realizada a análise da interleucina 8 (IL-8), do fator de crescimento fibroblástico 2 (FGF-2) e do fator de crescimento endotelial vascular (VEGF). Foram ainda analisadas a escala visual analógica (VAS), a pontuação da estética radicular (RES)
e a satisfação dos doentes (PROMs).
Resultados: Foi verificado, relativamente aos grupos teste (com PDME), um recobrimento radicular médio e completo significativamente superior, bem como um aumento significativo na expressão de VEGF. Além disso, as variáveis adicionais revelaram que a técnica de tunelizaçāo apresentou uma aparência estética superior, uma menor morbilidade para o paciente e menor sintomatologia pós-operatória.
Conclusão : Foi possível concluir que a utilização das PDME demonstrou contribuir para o processo angiogénico e de cicatrização. Sāo necessários mais estudos, sendo fundamental aumentar o número de amostras para comparação de resultados estatísticos.
Objectives: The main objective of the study was to evaluate the clinical and biomolecular impact of enamel-derived proteins on the healing of Cairo classification 1 (RT1) gingival recessions using a connective tissue graft with the coronal advancement flap technique or the tunneling technique. In addition, three biomarkers of gingival crevicular fluid were evaluated, quantified and compared; interleukin 8 (IL-8), fibroblast growth factor 2 (FGF- 2) and vascular endothelial growth factor (VEGF), in order to assess acute gingival healing and the benefits of using enamel-derived proteins. Materials and Methods: Between September 2022 and March 2023, 8 surgeries were performed to treat RT1 gingival recessions. A random selection was made forming the following groups: control group 1 (CAF + STCG), control group 2 (TUN + SCTG), test group 1 (CAF + SCTG + EMD) and test group 2 (TUN + SCTG + EMD). Clinical and biomolecular parameters were analysed before the surgeries and up to 3 months afterwards: reduction in gingival recession (RecRed), complete root coverage (RCR), partial root coverage (mRC). Interleukin 8 (IL-8), fibroblast growth factor 2 (FGF-2) and vascular endothelial growth factor (VEGF) were analysed by collecting gingival crevicular fluid (FCG). The visual analogue scale (VAS), root aesthetic score (RES) and patient satisfaction (PROMs) were also analysed. Results: A significantly higher average and complete root coverage was found compared to the test groups (with PDME), as well as a significant increase in VEGF expression. In addition, the additional variables revealed that the tunnelling technique has a superior aesthetic appearance, less morbidity for the patient and less post-operative symptoms. Conclusion: It was possible to conclude that the use of PDME has been shown to contribute to the angiogenic and healing process. Further studies are needed, and it is essential to increase the number of samples in order to compare statistical results.
Objectives: The main objective of the study was to evaluate the clinical and biomolecular impact of enamel-derived proteins on the healing of Cairo classification 1 (RT1) gingival recessions using a connective tissue graft with the coronal advancement flap technique or the tunneling technique. In addition, three biomarkers of gingival crevicular fluid were evaluated, quantified and compared; interleukin 8 (IL-8), fibroblast growth factor 2 (FGF- 2) and vascular endothelial growth factor (VEGF), in order to assess acute gingival healing and the benefits of using enamel-derived proteins. Materials and Methods: Between September 2022 and March 2023, 8 surgeries were performed to treat RT1 gingival recessions. A random selection was made forming the following groups: control group 1 (CAF + STCG), control group 2 (TUN + SCTG), test group 1 (CAF + SCTG + EMD) and test group 2 (TUN + SCTG + EMD). Clinical and biomolecular parameters were analysed before the surgeries and up to 3 months afterwards: reduction in gingival recession (RecRed), complete root coverage (RCR), partial root coverage (mRC). Interleukin 8 (IL-8), fibroblast growth factor 2 (FGF-2) and vascular endothelial growth factor (VEGF) were analysed by collecting gingival crevicular fluid (FCG). The visual analogue scale (VAS), root aesthetic score (RES) and patient satisfaction (PROMs) were also analysed. Results: A significantly higher average and complete root coverage was found compared to the test groups (with PDME), as well as a significant increase in VEGF expression. In addition, the additional variables revealed that the tunnelling technique has a superior aesthetic appearance, less morbidity for the patient and less post-operative symptoms. Conclusion: It was possible to conclude that the use of PDME has been shown to contribute to the angiogenic and healing process. Further studies are needed, and it is essential to increase the number of samples in order to compare statistical results.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Recessão gengival Enxerto de tecido conjuntivo Emdogain Biomarcadores