Eficácia da gengivectomia com laser de alta potência para correção do sorriso gengival decorrente de erupção passiva alterada: estudo piloto

Abstract

Gummy smile (GS) is a clinical condition, characterized by excessive gingival exposure above the upper anterior teeth, during the smile, which can have a negative impact on the aesthetics and self-esteem of individuals, making even social life difficult. For its correction, conventional gingivectomy with the use of a scapel is the most performed technique, but it causes bleeding during the surgical procedure, which makes it difficult to see the operative field cleanly, in addition to causing great trans and postoperative discomfort. High-power laser (HPL) gingivectomy is a promising technique for these cases, as, in oral cavity surgeries, it promotes minimal discomfort, absence of bleeding, in addition to reducing surgical time. However, there is a scarcity of studies that prove its efficacy. Therefore, the present study aimed to compare the efficacy between the surgical techniques of gingivectomy with HPL and conventional gingivectomy for correction of GS due to altered passive eruption. This was a pilot study of a controlled, non-randomized, split-mouth clinical trial, in which six subjects with GS were selected for convenience. Conventional gingivectomy was performed on the right side (teeth 11, 12 and 13), and diode laser gingivectomy (808 nm, 2 W, continuous mode) was performed on the left side (teeth 21, 22 and 23). Intraoperative bleeding was assessed according to the classification proposed by the World Health Organization (WHO). The level of postoperative pain was determined using the Visual Analogue Scale (VAS) at 48 hours, seven and 14 days after the procedures. The degree of tissue repair was assessed at seven, 14 and 30 days after the procedures. The analysis of inflammation, using infrared thermography, was performed in a single moment, 48 hours after surgical procedures. Initially, a descriptive statistical analysis was carried out in order to characterize the sample. The analysis of intraoperative bleeding, according to the presence or absence of bleeding, was performed using Fisher's exact test. Then, the Shapiro-Wilk test was performed to assess the assumption of normal distribution of quantitative data. Mann-Whitney test was used for intergroup evaluation and Friedman's ANOVA for intragroup evaluation for postoperative pain and tissue repair analysis. For intergroup analyses of tissue inflammation, Mann-Whitney and Student's t tests were used. The level of significance was set at p <0.05. There was no intraoperative bleeding in the experimental groups (p = 0.002). The control group showed significantly better tissue repair than the experimental group on the 14th postoperative day (p = 0.004). There were no statistically significant differences in the level of postoperative pain between the groups (p> 0.05). Regarding the thermographic analysis, there were also no statistically significant differences (p> 0.05). From the results obtained, it can be concluded that gingivectomy with HPL was more effective compared to conventional gingivectomy, with regard to the absence of intraoperative bleeding. On the other hand, the conventional technique promoted better tissue repair. As for postoperative pain and thermal pattern, no significant differences were observed, possibly due to the small sample and the minimal tissue damage that gingivectomy causes.