Análise radiográfica do tratamento de defeitos infra-ósseos humanos por meio de retalho de espessura total reposto associado ou não à proteína da matriz do esmalte: resultados após dois anos / Radiographic analysis of the treatment of human infrabony defects using repositioned flap associated or not to enamel matrix protein: results after two years

RESUMO

O objetivo deste estudo clínico aleatório, boca dividida e duplo cego foi avaliar por meio de mensurações radiográficas lineares, o tratamento de defeitos infra-ósseos de 2 ou 3 paredes com retalho de espessura total reposto (RET) associado ou não à proteína derivada da matriz do esmalte (PME) após 24 meses. Foram avaliados 10 pacientes com periodontite crônica apresentando 2 ou mais defeitos infra-ósseos, totalizando 43 defeitos. As tomadas radiográficas foram realizadas antes do procedimento cirúrgico e após 24 meses. Foram confeccionados registros oclusais individualizados para padronização das radiografias. As películas radiográficas foram digitalizadas (500dpi/8bits) em um escaner (SprintScan 35 Plus scanner-Polaroid). O software AxioVision (version 3.0-Carl Zeiss) foi utilizado para mensurar as distâncias da junção esmalte-cemento (JEC) à crista óssea alveolar (CO), JEC ao fundo do defeito (FD) e o ângulo do defeito infra-ósseo. Uma escala milimétrica foi adquirida através da calibração de uma tela radiográfica de 1x1mm. Um examinador cego e calibrado realizou todas as mensurações radiográficas. A análise estatística utilizou nível de significância p=0,05...

ABSTRACT

The aim of this randomized, double-blind, split-mouth clinical trial was evaluate, using linear radiographic measurements, infra-bony defects treated with enamel matrix protein (EMP) or repositioned flap (RF), after 24 months. Ten healthy patients with chronic periodontitis presenting 2 or more defects were selected, totalizing 43 defects. Radiographic data were collected just before surgery and after 24 months. An individualized film holder was used to take standardized radiographs. Images were digitized (500dpi/8bits) with the SprintScan 35 Plus scanner (Polaroid). The AxioVision (version 3.0) software (Carl Zeiss) was used to measure the distances from the cemento-enamel junction (CEJ) to the alveolar crest (AC), CEJ to the bottom of the defect (BD) and infra-bony defect angle. A milimetric scale was achieved after calibration with a 1x1mm grid. A blind calibrated examiner performed all radiographic measurements. Statistical analysis used a level of significance of p=0,05. After 24 months, a significant crestal bone loss (CEJ-AC) was observed for EMP (1,01mm; p=0,049) but not for RF (0,14mm; p=0,622), however, no differences were detected between groups (p=0,37). Reduction of the bone defect depth (CEJBD) was significant for RF (0,70mm; p=0,005) but not for EMP (-0,04mm; p=0,86), while no differences were detected between them (p=0,87). Both EMP (0,69; p=0,82) and RF (5,71; p=0,24) showed an improvement in defect angle measurements but no significant differences were observed after 24 months or between them (p=0,35). In this sample, the linear radiographic analysis was not able to demonstrate the superiority of EMP treated infra-bony defects when compared to RF alone after 24 months.