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Introdução: a periodontite é uma doença inflamatória crónica associada ao biofilme bacteriano, caracterizada pela perda dos tecidos de suporte dos dentes. Defeitos intraósseos são definidos pela localização apical da base da bolsa periodontal em relação à crista alveolar. Abordagens como enxertos ósseos, regeneração tecidual guiada e derivados da matriz do esmalte são usadas, frequentemente combinadas, para restaurar os tecidos de suporte de forma previsível.
Descrição do caso clínico: doente do sexo feminino, 58 anos, saudável, sem hábitos tabágicos ou necessidade de medicação habitual. No exame clínico constatou-se ausência de 13 dentes, mobilidade dentária grau 1 e 2 na maioria dos dentes presentes, profundidade de sondagem > 7 mm em 3 dentes (13,16 e 32) e lesões de furca grau II no dente 16. A perda de inserção clínica no dente 32 foi de 12 mm e a análise radiográfica revelou um defeito vertical. A doente foi submetida a tratamento periodontal não cirúrgico. Na consulta de reavaliação, o dente 32 apresentou profundidade de sondagem ≥ 6mm com hemorragia à sondagem. Foi proposta uma cirurgia regenerativa utilizando as proteínas derivadas da matriz do esmalte (Emdogain®) visando restaurar a estrutura periodontal perdida. A cirurgia consistiu na realização da técnica de preservação de papila modificada com abordagem de retalho único, alisamento radicular, condicionamento radicular com Prefgel®, utilização do Emdogain® e do biomaterial xenogénico, seguido de sutura. A doente foi acompanhada durante 7 meses após a cirurgia. Os resultados mostraram uma diminuição da profundidade de sondagem e ganho de inserção clínica. A radiografia periapical indicou preenchimento ósseo na área do defeito evidenciando cicatrização óssea e maturação do biomaterial xenogénico.
Conclusão: este estudo de caso sugere que o uso de Emdogain® com substituto ósseo é vantajoso para a regeneração de defeitos intraósseos, melhorando significativamente a inserção periodontal, através do ganho do nível de inserção clínico e redução da profundidade de sondagem.
Introdution: periodontitis is a chronic inflammatory disease associated with bacterial biofilm, characterized by the loss of tooth-supporting tissues. Intraosseous defects are defined by the apical location of the periodontal pocket base in relation to the alveolar crest. Approaches such as bone grafts, guided tissue regeneration, and enamel matrix derivatives are commonly used, often in combination, to predictably restore supporting tissues. Case report: a 58-year-old healthy female patient, with no smoking habits or regular medication needs, presented for clinical examination. Findings included the absence of 13 teeth, tooth mobility grades 1 and 2 in most present teeth, probing depths > 7 mm in three teeth (13, 16, and 32), and grade II furcation lesions in tooth 16. Clinical attachment loss in tooth 32 was 12 mm, and radiographic analysis revealed a vertical defect. The patient underwent non-surgical periodontal treatment. At the re-evaluation appointment, tooth 32 showed probing depth ≥ 6 mm with bleeding on probing. A regenerative surgery using enamel matrix proteins (Emdogain®) was proposed to restore the lost periodontal structure. The surgery involved a modified papilla preservation technique with a single flap approach, root planing, root conditioning with Prefgel®, application of Emdogain® and xenogenic biomaterial, followed by suturing. The patient was followed up for 7 months post-surgery. The results showed a decrease in probing depth and a gain in clinical attachment. The periapical radiograph indicated bone fill in the defect area, demonstrating bone healing and maturation of the xenogenic biomaterial. Conclusion: this case study suggests that the use of Emdogain® with bone substitute is advantageous for the regeneration of intraosseous defects, significantly improving periodontal attachment by gaining clinical attachment level and reducing probing depth.
Introdution: periodontitis is a chronic inflammatory disease associated with bacterial biofilm, characterized by the loss of tooth-supporting tissues. Intraosseous defects are defined by the apical location of the periodontal pocket base in relation to the alveolar crest. Approaches such as bone grafts, guided tissue regeneration, and enamel matrix derivatives are commonly used, often in combination, to predictably restore supporting tissues. Case report: a 58-year-old healthy female patient, with no smoking habits or regular medication needs, presented for clinical examination. Findings included the absence of 13 teeth, tooth mobility grades 1 and 2 in most present teeth, probing depths > 7 mm in three teeth (13, 16, and 32), and grade II furcation lesions in tooth 16. Clinical attachment loss in tooth 32 was 12 mm, and radiographic analysis revealed a vertical defect. The patient underwent non-surgical periodontal treatment. At the re-evaluation appointment, tooth 32 showed probing depth ≥ 6 mm with bleeding on probing. A regenerative surgery using enamel matrix proteins (Emdogain®) was proposed to restore the lost periodontal structure. The surgery involved a modified papilla preservation technique with a single flap approach, root planing, root conditioning with Prefgel®, application of Emdogain® and xenogenic biomaterial, followed by suturing. The patient was followed up for 7 months post-surgery. The results showed a decrease in probing depth and a gain in clinical attachment. The periapical radiograph indicated bone fill in the defect area, demonstrating bone healing and maturation of the xenogenic biomaterial. Conclusion: this case study suggests that the use of Emdogain® with bone substitute is advantageous for the regeneration of intraosseous defects, significantly improving periodontal attachment by gaining clinical attachment level and reducing probing depth.
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Teses de mestrado - 2024 Saúde Oral