scholarly journals A associação do enxerto de tecido conjuntivo subepitelial e a matriz derivada do esmalte no recobrimento das recessões gengivais

2021 ◽  
Vol 10 (13) ◽  
Author(s):  
Vitor Dias Bizzaria ◽  
Gabriel Pessoa de Lima ◽  
Leonardo Bíscaro Pereira ◽  
Daniela Navarro Ribeiro Teixeira ◽  
Marcos Bilharinho de Mendonça ◽  
...  
Keyword(s):  
Connective Tissue ◽  
Enamel Matrix ◽  
Connective Tissue Graft ◽  
Tissue Graft ◽  
Subepithelial Connective Tissue Graft ◽  
Enamel Matrix Derivatives ◽  
Matrix Derivatives

A recessão gengival (RG) pode ser definida como uma condição, na qual ocorre a migração em sentido apical com consequente exposição da junção amelo-cementária e superfície radicular. As técnicas cirúrgicas plásticas periodontais objetivam a melhora do fenótipo gengival e a correção da morfologia, posição e dimensões do tecido gengival. Nos últimos anos, com o intuito de melhorar os resultados destes tratamentos, novos recursos relacionados com a otimização da regeneração periodontal, vem sendo associados aos enxertos gengivais. Sendo um coadjuvante ou não às técnicas cirúrgicas de recobrimento radicular, a matriz derivada do esmalte (Emdogain â), tem sido cada vez mais incorporada nesses tratamentos, na medida em que, tanto sua aplicabilidade clínica, como seus benefícios, já se encontra embasados em evidências científicas. O objetivo deste estudo é realizar uma revisão literária integrativa sobre a utilização da matriz derivada do esmalte (EMD) nos procedimentos cirúrgicos plásticos periodontais para o tratamento da recessão gengival. Para a elaboração do estudo foi utilizada a estratégia PICO e a busca nas bases de dados PubMed, MedLine e Scielo, a partir das seguintes palavras-chave: “enamel matrix derivatives”, “gingival retraction” e “subepithelial connective tissue graft”. A partir dessa busca 181 artigos publicados entre os anos de 2016 a 2021 foram selecionados, sendo que desse número, somente 12 foram utilizados para realizar a revisão da literatura. Com esta revisão foi possível concluir que a EMD associada aos enxertos de tecido conjuntivo subepitelial pode aumentar a previsibilidade da terapia de recobrimento, podendo favorecer uma nova inserção periodontal.

scholarly journals Modified coronally advanced tunnel technique with enamel matrix derivative in addition to subepithelial connective tissue graft compared with connective tissue graft alone for the treatment of multiple gingival recessions: prognostic parameters for clinical treatment outcomes

2021 ◽  
Author(s):  
Bartłomiej Górski ◽  
Renata Górska ◽  
Marcin Szerszeń ◽  
Tomasz Kaczyński
Keyword(s):  
Logistic Regression ◽  
Connective Tissue ◽  
Enamel Matrix Derivative ◽  
Enamel Matrix ◽  
Root Coverage ◽  
Gingival Thickness ◽  
Connective Tissue Graft ◽  
Tissue Graft ◽  
Subepithelial Connective Tissue Graft ◽  
Matrix Derivative

Abstract Objectives To investigate factors that influence 12-month outcomes after treatment of multiple gingival recessions (GR) with modified coronally advanced tunnel (MCAT) and subepithelial connective tissue graft (SCTG) with enamel matrix derivative (EMD) (tests) or without (controls). Materials and methods Twenty patients with 150 GR were treated. Logistic regression models were used to identify baseline parameters that could predict 12-month average root coverage (ARC), complete root coverage (CRC), root esthetic coverage score (RES), gain in keratinized tissue width (KTW), and gain in gingival thickness (GT). Results The likelihood of ARC > 85% increased sevenfold (odds ratio [OR] = 7.33; 95% confidence interval [CI] = 2.43–12.12), of achieving CRC: 21-fold (OR = 21.23; 95% CI = 10.21–45.32), and of gaining RES = 10: tenfold (OR = 10.23; 95% CI = 5.78–32.23) in favor of EMD-treated sites. With each 1-mm2 increase in baseline avascular exposed root surface area (AERSA), the odds of failure (ARC ≤ 85%, not achieving CRC and postoperative GT ≤ 2 mm) increased almost fourfold (OR = 3.56; 95% CI = 1.98–10.19), fourfold (OR = 4.23; 95% CI = 1.11–9.02), and nearly sixfold (OR = 5.76; 95% CI = 2.43–12.87), respectively. The greater the baseline GT, the more likely the chance of achieving CRC (OR = 10.23; 95% CI = 8.37–16.23) and RES = 10 (OR = 5.50; 95% CI = 3.34–16.43). All models exhibited fair to excellent discrimination and satisfactory calibration. Conclusions Based on logistic regression, EMD application improved postoperative ARC, CRC and RES; baseline AERSA predicted 12-month ARC, CRC, and GT gain, whereas baseline GT was a predictor of achieving CRC and perfect RES. Clinical relevance Additional use of EMD, lower baseline AERSA, and greater baseline GT significantly increase the odds of obtaining better outcomes 12 months after MCAT + SCTG technique.

scholarly journals Tunnel technique with enamel matrix derivative in addition to subepithelial connective tissue graft compared with connective tissue graft alone for the treatment of multiple gingival recessions: a randomized clinical trial

2020 ◽  
Vol 24 (12) ◽  
pp. 4475-4486
Author(s):  
Bartłomiej Górski ◽  
Renata Górska ◽  
Joanna Wysokińska-Miszczuk ◽  
Tomasz Kaczyński
Keyword(s):  
Connective Tissue ◽  
Enamel Matrix Derivative ◽  
Clinical Parameters ◽  
Enamel Matrix ◽  
Root Coverage ◽  
Connective Tissue Graft ◽  
Tissue Graft ◽  
Tunnel Technique ◽  
Subepithelial Connective Tissue Graft ◽  
Matrix Derivative

Abstract Objectives The aim of this study was to compare outcomes of the modified coronally advanced tunnel technique (MCAT) combined with subepithelial connective tissue graft (SCTG) with or without enamel matrix derivative (EMD), in the treatment of gingival recession types 1 and 2. Materials and methods A total of 20 patients with 150 multiple gingival recessions (GR) were included in the study. On one side, MCAT was combined with SCTG and EMD (tests), whereas MCAT with SCTG was applied on the contralateral side (controls). Clinical parameters were measured at baseline and 6 months after surgery. Visual analog scales (VAS) and questionnaires were used to assess patient-reported outcomes and the root coverage esthetic score (RES) for professional esthetic evaluation. Results MCAT+SCTG+EMD was not superior with regard to root coverage. At 6 months, average root coverage (ARC) was 87.4% for SCTG+EMD-treated and 90.9% for SCTG-treated defects (p = 0.4170). Complete root coverage (CRC) was observed in 86.7% (tests) and 85.3% (controls) of the cases (p = 0.9872). Significantly less pain was reported using VAS (p = 0.0342) post-operatively in the SCTG+EMD group. Professional assessment of esthetic outcomes using RES showed a significant difference (9.25 versus 8.71, p = 0.0103) in favor of the test group. Conclusions Both treatment modalities were equally effective in treatment of multiple GR and led to similar improvements in clinical parameters. However, the application of EMD as an adjunct resulted in less post-operative pain and better professionally assessed esthetic outcomes. Clinical relevance Patients’ early morbidity and 6-month esthetic outcomes following GR coverage with MCAT might be influenced by means of EMD utilization.

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