Enxerto gengival livre em paciente após radioterapia para câncer de cabeça e pescoço: relato de caso clínico

Abstract

Gingival recession is characterized by the apical displacement of the gingival margin, with exposure of the root surface. The inserted gingiva (IG), adjacent to the free marginal gingiva, plays an important role in oral health and has a keratinized surface that is firmly attached to the alveolar bone. Gingival recession is influenced by factors such as inadequate oral hygiene, trauma, periodontal phenotype, radiotherapy, and the association between these factors. Areas with less than 2 mm of keratinized gingiva or less than 1 mm of inserted gingiva have a significantly higher number of gingival inflammations; the smaller the amount of keratinized gingiva, the greater the chance of triggering inflammation. Radiotherapy can lead to periodontal changes due to the direct and indirect effects of radiation, as it increases metalloproteinase enzymes and the pro-inflammatory cytokine IL-6, which results in inflammatory reactions. Patients who have undergone radiotherapy for head and neck cancer may experience side effects such as radiation-related caries and hyposalivation. Radiation affects tooth structure, called delamination, and also atrophy of the salivary glands, which leads to oral discomfort, difficulties with oral hygiene and eating, as well as requiring preventive measures for caries and other radiation-related oral changes. Teeth with gingival recession are susceptible to more aggressive consequences of radiation treatment. Surgical treatment for recession aims to improve the periodontal phenotype, and aesthetics, reduce root surface hypersensitivity, provide conditions for the patient to control bacterial plaque, and prevent the progression of the periodontal defect. Free gingival graft surgery is a therapeutic option involving the transfer of epithelial tissue to increase the amount of keratinized gingiva in the region. The aim of this study is to report the diagnosis and treatment of gingival recession in a patient after radiotherapy for head and neck cancer, highlighting the importance of improving the periodontal phenotype and covering the recession so that the patient is able to control plaque properly. The existing literature gap justifies the publication of this article, which aims to improve the scientific basis in the area and provide guidelines for the treatment of recessions in cancer patients after radiotherapy.