Técnica de tunelização versus retalho coronal avançado: comparação entre as diferentes técnicas cirúrgicas usadas no tratamento da recessão gengival - Revisão de literatura

Abstract

Gingival recession (RG) is a clinical condition defined by the apical displacement of the gingival margin below the cementoenamel junction, which is associated with loss of attachment and single or multiple root exposure. The high incidence of this defect can be attributed to a complex pathophysiology divided into direct causes and predisposing factors. The treatment of RG is a challenge in mucogingival surgery and has a variable rate of predictability, therefore, several surgical techniques have been suggested over the years. The objective of this study was to carry out a literature review evaluating the effectiveness and predictability of two surgical approaches: tunneling technique (TUN) and the advanced coronal flap (CAF), alone or associated with connective tissue grafts (CTG). The search was carried out in the VHL and Pubmed databases, using the descriptors: “Tunnel technique”; “Coronally advanced flap”; “Gingival recession”. The search resulted in 99 results. As an inclusion criterion, complete articles were chosen, published in the last 6 years, in all languages, including clinical trials and meta-analyses. After evaluating the abstracts and excluding repeated themes and articles that were not related to the topic, nine articles were selected. Studies show that the results depend on the technique, the severity of the case, the extent of the recession, the etiological factor and the type of graft chosen. Regarding the predictability and root coverage rate of the two techniques, a small difference was identified when comparing TUN and CAF, with the advanced coronal flap technique associated with connective tissue graft obtaining better results in medium and complete root coverage. In the analysis of secondary outcomes, no significant differences were observed for the parameters of cynical insertion level, probing depth and sensitivity. On the other hand, TUN showed more favorable results in relation to aesthetics, gain and texture of keratinized tissue, and pain. Thus, both the advanced coronal flap and the tunneling technique, associated with connective tissue grafts or other biomaterials, can achieve good root coverage in the treatment of gingival recessions, proving to be predictable and effective. However, apparently the advanced coronal flap stands out in relation to complete root coverage and medium root coverage, while the tunneling technique has better performance in terms of aesthetics, texture of keratinized tissue, width of keratinized tissue and postoperative pain.