Evaluación clínica de los tejidos periodontales después del aumento de corona clínica / Clinical evaluation of periodontal tissue after crown lengthening surgery

INTRODUCCIÓN: La cirugía de aumento de corona clínica es un medio para facilitar los procedimientos de restauración con el objetivo de restablecer el ancho biológico periodontal. OBJETIVO: Registrar la evolución clínica de los tejidos periodontales de dientes sometidos a cirugía de aumento de corona clínica durante un período de cicatrización de 6 meses. Material y métodos: Se realizó un estudio observacional prospectivo, en el cual se evaluaron 25 pacientes; todos cumplieron con los criterios de inclusión y exclusión. Para evaluar la evolución de los dientes, se registró el índice gingival, índice de placa, índice PMA, recesión gingival, profundidad de sondaje y después de la cirugía, presencia de movilidad y lesión de área de furcación. Para medir la migración del margen gingival libre, se utilizó un dispositivo de acrílico. Se realizó el análisis estadístico de análisis de la varianza de un factor, margen de error del 5%, intervalo de confianza de 95%. RESULTADOS: El 84% de los pacientes fueron de género femenino, concentrándose el mayor porcentaje de pacientes entre los rangos de edad de 30 a 40 años (60%). Con respecto a los dientes intervenidos, el 76% fueron dientes posteriores, el diagnóstico más prevalente fue la categoría de diente con eliminación de caries subgingival (48%). A los 6 meses, existió ausencia total de inflamación gingival tanto en diente tratado como diente adyacente. Con respecto a la exposición coronal, medida a través de la distancia dispositivo-margen gingival libre, existió variación con la medición inicial de 4,26 mm en diente tratado y 3,90 mm en diente adyacente en relación con los 3 meses, 5,10 mm en diente tratado y 4,40 mm en diente adyacente, manteniéndose casi de forma similar a los 6 meses. CONCLUSIÓN: La evolución clínica de los tejidos periodontales posterior a la cirugía de aumento de corona clínica de nuestros pacientes demostró que a los 3 meses existe ausencia de inflamación gingival y en todos los casos se produjo retracción gingival de la encía comparada con los datos iniciales, consideración que debe tenerse presente en el momento de la rehabilitación final del diente

INTRODUCTION: Crown lengthening is a surgical procedure performed to re-establish the periodontal biological width of the tooth for its subsequent restoration. OBJECTIVE: To record the clinical outcomes of the periodontal tissues subjected to crown lengthening surgery, for a period of 6 months. Materials and methods: A prospective observational descriptive study was conducted on 25 patients who fulfilled the inclusion and exclusion criteria. The parameters evaluated were: gingival index, plaque index, Papillary-Marginal-Attachment (PMA) index, classification for gingival recessions probing depth and after surgery, classes of mobility and furcation classification. An acrylic device was used to measure the gingival margin migration. Statistical analysis was performed using one-way ANOVA, margin of error of 5%, and confidence level of 95%. RESULTS: Of the 25 patients, 84% were female, with the highest percentage of patients between the age ranges of 30 to 40 years (60%). As regards the teeth, 76% were back teeth, and the most prevalent diagnostic category was the removal of subgingival tooth decay (48%). At six months there was complete absence of gingival inflammation in the treated (TT) tooth, as well as in the adjacent (AD) tooth. With respect to the coronal exposure measured by the free gingival margin distance device, there was a difference between the initial measurement of 4.26 mm for the TT tooth and 3.90 mm for the AD tooth, and at three months, 5.10 mm for the TT tooth and 4.40 mm for the AD tooth, remaining almost the same at 6 months. CONCLUSION: The clinical outcome of periodontal tissues after crown lengthening surgery on our patients showed that there is absence of gingival inflammation after 3 months, and in all cases gingival gum recession, compared to the initial data. This should be taken into account when the final restoration of the tooth is considered

Steroidal and non-steroidal cyclooxygenase-2 inhibitor anti-inflammatory drugs as pre-emptive medication in patients undergoing periodontal surgery

The aim of the present study was to compare the pre-emptive use of a cyclooxygenase-2 (COX-2) inhibitor with a well established steroidal anti-inflammatory drug for pain and edema relief following periodontal surgery for crown lengthening. Thirty patients requiring periodontal surgery were randomly assigned to receive one of the following medications: selective COX-2 inhibitor or steroidal anti-inflammatory drug, 60 min before the surgical procedure. To examine patient anxiety, a Corah's dental anxiety scale was applied before surgery. Using a visual analog scale, the extent of pain/discomfort during the trans-operative period and immediately after the surgery was measured. Additionally, intensity of pain/discomfort and edema were examined 4, 8, 12 and 24 h postoperatively. With regard to anxiety, no statistical differences between the groups were observed (p>0.05). With respect to the extent of pain/discomfort during the trans-operative, immediate and late postoperative period, data demonstrated no significant differences (p>0.05) between the COX-2 inhibitor and steroidal groups. With regard to edema, intragroup analysis did not reveal any statistically significant difference (p>0.05) during the 24 h following surgery in either group. In conclusion, both anti-inflammatory drugs presented a similar potential for pain and edema relief following periodontal surgery.

O objetivo do presente estudo foi comparar a utilização pré-emptiva de medicamento inibidor da COX-2 (cicloxigenase-2) com uma droga antinflamatória esteroidal amplamente utilizada, para o controle da dor e edema após cirurgia periodontal para aumento de coroa. Trinta pacientes que necessitavam de cirurgia periodontal foram aleatoriamente designados a receber uma das seguintes medicações: inibidor seletivo da COX-2 ou a droga antinflamatória esteroidal, 60 min antes do procedimento cirúrgico. Para avaliar a ansiedade do paciente, a escala de ansiedade ao tratamento dental de Corah foi aplicada antes da cirurgia. Com a utilização de escala analógica visual a extensão de dor/desconforto durante o período trans-cirúrgico e imediatamente após a cirurgia foi mensurada. Adicionalmente, a intensidade de dor/desconforto e edema foram avaliados no periodo pós-operatório tardio 4, 8, 12 e 24 h após o procedimento cirúrgico. Com relação à ansiedade, não foi observada diferença estatística entre os grupos (p>0,05). Com relação à extensão de dor/desconforto durante os períodos trans-cirúrgico e pós operatório imediato e tardio, os dados não demonstraram diferenças entre o grupo que recebeu o inibidor seletivo da COX-2 e o aintinflamatório esteroidal (p>0,05). A avaliação do edema, intragrupo, não revelou diferença estatística durante as primeiras 24 h em nenhum dos grupos estudados (p>0,05). Em conclusão, ambas as drogas antiinflamatórias utilizadas apresentaram um potencial similar no controle da dor e edema após cirurgia periodontal.