Terapia periodontal cirúrgica: técnica e manejo da dor pós-operatória

Abstract

A systematic review with meta-analysis was performed to evaluate and compare the pharmacological effect of different drugs on pain relief after periodontal surgery. Were included clinical trials (parallel or crossover), involving only periodontal procedures, presenting two distinct groups of a therapeutic regimen for post-procedure pain control. The risk of bias was assessed using RoB 2 Cochrane and GRADE. Meta-analyzes were performed using different comparisons of follow-up and medications. 2,398 articles were identified, of which 40 were included. The evaluation of dexamethasone or non-steroidal anti-inflammatory drugs (NSAIDs) versus placebo favored the use of both interventions at 1 to 8 hour follow-up. However, no statistical difference was found for the comparison between NSAIDs and dexamethasone for open flap surgery procedures. Were concluded that the patient can benefit from various pharmacological regimens for pain relief after periodontal surgery. However, due to the high heterogeneity between studies, no fixed pharmacological protocol can be proposed. Three case reports of clinical studies will be presented in this article. Clinical case 1. Aimed to perform root cover surgery using subepithelial connective tissue on tooth 41. To perform the gingival graft technique, micro-blades were used in the management of gingival tissue. The tunneling technique was used. After surgery, a Visual Analog Scale (VAS) was used to assess postoperative pain at 1, 2, 3, 4, 8 and 24 hours postoperatively. Even though it is a two sites surgical procedure, moderate pain was reported only 4 hours after the procedure. In other periods, only mild pain. The clinical case is followed up for one year. Clinical case 2 aimed to demonstrate a case of multiple root coverage at different surgical stages. The tunneling technique was also recommended for gingival graft surgery. In all procedures, the subepithelial connective tissue was used. All surgical stages are followed up for one year. VAS was also applied, corroborating the data of article 1, in which the patient noticed moderate pain only 4 hours after the surgical procedure. In this case, this scale was used only in the last procedure.