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Avaliação e tratamento das sequelas estéticas da periodontite
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A periodontite é uma infecção que afecta os tecidos de suporte dentário, sendo a periodontite crónica a sua forma de apresentação mais comum. Apesar de os casos graves se concentrarem num número reduzido de indivíduos, pensa-se ter uma expressão dramática na população adulta mundial. A placa bacteriana é condição sine qua non para o seu desenvolvimento, embora outros factores possam estar concomitantemente implicados. A doença caracteriza-se por uma série de alterações clínicas e radiográficas, algumas das quais não regridem com o tratamento convencional e se consideram, por isso, sequelas. A Estética dedica-se ao estudo da beleza e as evidências históricas fazem dela uma disciplina milenar. É, em carácter, filosófica e subjectiva, pelo que, no âmbito da Medicina Dentária, alguns autores têm procurado concretizá-la em parâmetros objectivos. Relativamente aos que definem a estética periodontal, algumas das sequelas da periodontite comprometem a sua verificação, constituindo sequelas estéticas da periodontite: recessão gengival (RG) e perda da papila interdentária. Para além destas, achou-se pertinente abordar a perda óssea e hipersensibilidade dentinária (HD). A avaliação destas sequelas orienta quanto às opções terapêuticas disponíveis para as solucionar. A RG de classe I e II de Miller pode trata-se com técnicas cirúrgicas de recobrimento radicular (RR). Pelo contrário, a de classe III e IV, sendo o RR imprevisível, está confinada a soluções protéticas. A perda da papila é tratável com técnicas cirúrgicas reconstrutivas, caso a distância crista óssea-ponto de contacto seja inferior a 5 mm, ou, caso contrário, com retalho de reposição apical e/ou soluções protéticas. A perda óssea vertical responde de forma previsível à terapia periodontal regenerativa. Já na horizontal verifica-se o inverso, o que remete novamente para soluções protéticas. A DH apresenta três grupos de alternativas terapêuticas, os dentífricos e materiais adesivos dessensibilizantes e o laser. Contudo, nenhuma se mostrou, para o efeito, completamente eficaz.
Periodontitis is an infection which affects the tooth’s supporting tissues, chronic periodontitis being its most common presentation. It is thought to carry a dramatic expression in the world’s adult population, although the most advanced forms of the disease represent a narrow percentage. Dental plaque is essencial to its development, however other etiologic factors might be simultaneously involved. Typically, the infection brings about a series of clinical and radiographic changes, some of which do not vanish after conventional treatment and are, as such, referred to as sequelae. Esthetics is devoted to the study of beauty and historical evidence makes it a millenary subject. It is, in essence, philosophic and subjective, which has motivated some authors in the field of Dentistry to translate it into objective parameters. Regarding those defining periodontal esthetics, some of the periodontitis’ sequelae prevent their establishment, which makes them periodontitis’ esthetic sequelae – gingival recession (GR) and loss of the interdental papilla. Aside from these, it was deemed pertinent to discuss bone loss and dentinal hypersensitivity (DH). The evaluation of these sequelae provides guidance as to the therapeutic options available to address them. Miller’s class I and II GR is treatable with surgical root coverage (RC) techniques. Conversely, RC of class III and IV GR is unpredictable, which leaves prosthetic solutions as an alternative. Loss of the interdental papilla may be managed with surgical reconstructive techniques if the alveolar bone crest-contact point distance is smaller than 5 mm or, if not, with apically positioned flap (APF) and/or prosthetic solutions. Vertical bone loss responds predictably to periodontal regenerative procedures. On the other hand, horizontal bone loss does not, once again referring to prosthetic solutions. Treatment options for DH can be divided into three groups: desensitizing dentifrices and adhesive materials and laser. However, none of them seems to be completely effective.
Periodontitis is an infection which affects the tooth’s supporting tissues, chronic periodontitis being its most common presentation. It is thought to carry a dramatic expression in the world’s adult population, although the most advanced forms of the disease represent a narrow percentage. Dental plaque is essencial to its development, however other etiologic factors might be simultaneously involved. Typically, the infection brings about a series of clinical and radiographic changes, some of which do not vanish after conventional treatment and are, as such, referred to as sequelae. Esthetics is devoted to the study of beauty and historical evidence makes it a millenary subject. It is, in essence, philosophic and subjective, which has motivated some authors in the field of Dentistry to translate it into objective parameters. Regarding those defining periodontal esthetics, some of the periodontitis’ sequelae prevent their establishment, which makes them periodontitis’ esthetic sequelae – gingival recession (GR) and loss of the interdental papilla. Aside from these, it was deemed pertinent to discuss bone loss and dentinal hypersensitivity (DH). The evaluation of these sequelae provides guidance as to the therapeutic options available to address them. Miller’s class I and II GR is treatable with surgical root coverage (RC) techniques. Conversely, RC of class III and IV GR is unpredictable, which leaves prosthetic solutions as an alternative. Loss of the interdental papilla may be managed with surgical reconstructive techniques if the alveolar bone crest-contact point distance is smaller than 5 mm or, if not, with apically positioned flap (APF) and/or prosthetic solutions. Vertical bone loss responds predictably to periodontal regenerative procedures. On the other hand, horizontal bone loss does not, once again referring to prosthetic solutions. Treatment options for DH can be divided into three groups: desensitizing dentifrices and adhesive materials and laser. However, none of them seems to be completely effective.
Descrição
Tese de mestrado, Medicina Dentária, Universidade de Lisboa, Faculdade de Medicina Dentária, 2012
Palavras-chave
Periodontologia Teses de mestrado - 2012