Comparação dos diferentes tipos de Enxerto de Tecido Conjuntivo Subepitelial (ETCS) utilizados em procedimentos de recobrimento radicular de recessões gengivais classe I e II de Miller e análise para verificação da existência de uma previsibilidade para melhores resultados clínicos

Abstract

Since the first publications, through studies by Haggerty, Nabers and Sullivan & Atkins, grafts removed and used in the oral cavity have been studied and applied for various purposes, mainly in procedures on the alveolar ridge. Initially, such procedures focused almost exclusively on increasing the keratinized mucosa of dental elements, due to their characteristics of impermeability, immobility and protection of the periodontium. Currently, various types of grafts can be used to gain keratinized mucosa around teeth and implants and gain volume in the alveolar ridge. Furthermore, they have been used in root coverage procedures of elements affected by gingival recessions, through the bilaminar technique, in the aesthetic improvement of shaded or bluish areas associated with prostheses on teeth and implants, and in the phenotypic improvement around implants installed in atrophic areas, with or without exposure of their threads, or deficiency of keratinized tissue. However, even though SCTG is considered the gold standard procedure in Miller class I and II gingival recessions, in association with the coronally advanced flap (CAF), there has been no evolution towards a classification of these autogenous grafts that takes into account criteria such as the donor site, harvest technique of the graft, de-epithelization technique, and the presence or absence of a partial exposure of the graft after the procedure, among others. The aim of this study was to elucidate whether a specific type of SCTG shows greater predictability for better clinical outcomes in the root coverage of Miller class I and II gingival recessions, associated with the coronally advanced flap. Searches were performed in five databases, in addition to a manual search, and in the gray literature. Study selection, data extraction, and assessment of risk of bias were performed. Three meta-analyses were performed. Confidence intervals and mean differences were calculated. Sixteen studies were included, most of which used the lateral palate subepithelial connective tissue graft (LP-SCTG) in their comparisons. There was no difference in the efficacy of the different types of SCTG, regarding their modifying factors applied to the treatment of gingival recessions (p<0.05). There was no difference in the reduction of recession depth between fully covered or partially exposed LP-SCTGs (p<0.05); between LP-SCTGs with de epithelialization performed with a scalpel blade or laser device (p<0.05), or between LP-SCTGs in which the de-epithelialized surface was turned to the flaps or teeth (p<0.05). The risk of bias in the study was low. Despite the various histological, morphological, dimensional or geometric differences found in the SCTGs and determined by the modifying factors applied to each type, no differences were observed regarding the reduction in the recession depth or in the percentage of root coverage.