A presença de uma faixa adequada de mucosa ceratinizada (MC) é essencial para manutenção da homeostasia periodontal. Existem várias técnicas cirúrgicas com a finalidade de corrigir alterações mucogengivais, criando uma faixa de MC adequada nos casos em que está ausente ou insuficiente. O enxerto gengival livre (EGL) é uma das técnicas indicadas para criação de gengiva em áreas não estéticas. Outra opção é o uso de substitutos teciduais dentre eles, a matriz dérmica acelular (MDA), considerada uma alternativa para a criação de gengiva. O objetivo desse estudo foi analisar longitudinalmente (após 13 anos) os resultados obtidos após procedimentos cirúrgicos de EGL e MDA para a criação da faixa de MC. Foram comparados os dados intra e inter-grupos. Os dados iniciais e de 6 meses foram obtidos de um estudo prévio realizado na Disciplina de Periodontia da FOB-USP, em 2004. Vinte e dois pacientes foram incluídos e avaliados originalmente, sendo que 12 aceitaram participar desta avaliação longitudinal. Os parâmetros clínicos avaliados foram: recessão gengival (RG), profundidade de sondagem (PS); nível clínico de inserção (NCI); largura da mucosa ceratinizada (LMC) e espessura da mucosa ceratinizada (EMC). Além desses parâmetros, também foi feita uma análise atual da percepção estética pelos pacientes e por um profissional calibrado das áreas tratadas. Após 13 anos, ambos os tratamentos resultaram em aumento significante LMC e EMC, porém com resultados superiores para o grupo que recebeu EGL (p<0,05). Não houve diferenças entre os grupos para os parâmetros PS e NCI, contudo no grupo MDA, a profundidade da RG foi significantemente maior comparado ao EGL em longo prazo. No entanto, o grupo MDA apresentou resultados superiores em relação à percepção estética do profissional. / The presence of an adequate width of keratinized tissue (KT) is essential for the maintenance of periodontal homeostasis. There are several surgical techniques with the purpose of correcting mucogingival changes, creating a suitable KT width in cases where it is absent or insufficient. Free gingival graft (FGG) is one of the techniques used to create gingiva in non-esthetic areas. Another option is the use of tissue substitutes, the acellular dermal matrix (ADM) that is considered an alternative for the gingiva augmentation. The aim of this study was to longitudinally analyze (after 13 years) the outcomes obtained after surgical procedures of FGG and ADM for the KT augmentation. Intra and intergroup data were compared. Initial and 6- month data were obtained from a previous study conducted at the Discipline of Periodontics of Bauru School of Dentistry-University of São Paulo in 2004. Twentytwo patients were originally included and evaluated, and 12 accepted to participate in this longitudinal evaluation. Clinical parameters evaluated were: gingival recession (GR), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), soft tissue thickness (TT). In addition, esthetic perception was evaluated by patients and by a calibrated periodontist. After 13 years, both treatments resulted in a significant increase in KWT and TT, but with superior results for the FGG group (p <0.05). There were no differences between groups for PD and CAL, however in the ADM group, the depth of GR was significantly higher compared to FGG in long-term. However, esthetics perception by professional evaluation demonstrated superior outcomes for ADM group.

Contexte: L’anxiété alimente l’évitement des traitements dentaires et occasionne une négligence de la santé bucco-dentaire. Cet évitement est amplifié par des inquiétudes liées à la douleur et l’insatisfaction potentielles à la suite d’une rencontre chez le dentiste. L’anxiété, la douleur et l’insatisfaction ne sont donc pas mutuellement exclusives et peuvent être regroupée sous une mesure composite appelée le fardeau de soins. Une intervention d’écoute musicale pourrait s’avérer efficace pour réduire le fardeau de soins des patients tel qu’observé dans la littérature pour divers contextes chirurgicaux. Cependant, les évidences appuyant les bienfaits d’une intervention musicale sur le fardeau de soins au cours de chirurgies dentaires sont limitées et les résultats sont hétérogènes en raison d’un manque de consistance sur le plan méthodologique. Objectif: L’objectif de cette étude était d’explorer les effets d’une intervention d’écoute musicale personnalisée sur le fardeau de soins associé à une greffe gingivale en comparaison à l’écoute de livres audios (contrôle). Méthodologie: Deux groupes de patients ont reçu la greffe gingivale autogène accompagnée de l’intervention musicale personnalisée (n= 25) ou d’un livre audio (n= 22). Les patients ont été attribués aléatoirement aux groupes en double aveugle (le chirurgien ignorait la stimulation auditive et les participants ignoraient la condition contrôle). Des mesures auto-rapportées d’anxiété, de douleur, d’insatisfaction et d’état émotionnel ont été prises avant et après la chirurgie. Les mesures postopératoires d’anxiété, de douleur et d’insatisfaction ont été combinées en une mesure composite du fardeau de soins. Les participants ont également complété les jugements émotionnels de leur stimulation auditive respective après la chirurgie. Résultats: Aucune différence significative n’a été observée entre les stimulations auditives pour le fardeau de soins et ses composantes. Les résultats illustrent une fluctuation des niveaux d’anxiété et de douleur à travers les temps de mesures pour les deux groupes. La musique a été perçue comme plus relaxante que le livre audio (U = 144.00, p =.005, η2=.17). Les participants, ayant rapporté plus d’émotions négatives avant (r =0.44, p =.002, R2 =.19) et après (r =0.42, p =.004, R2 =.17) la chirurgie, ont illustré un fardeau de soins plus important. Il n’y avait pas de différences significatives entre les groupes pour l’état émotionnel des participants. Conclusion: Il est possible que les deux stimulations auditives (musique et livre audio) soient efficaces pour réduire le fardeau de soins (et ses composantes séparément). Des évidences additionnelles sont nécessaires afin de confirmer les bienfaits d’une intervention musicale durant une chirurgie de greffe gingivale. Les recherches futures devraient inclure un troisième groupe recevant le traitement habituel afin d’évaluer l’effet des deux stimulations auditives sur le fardeau de soins. / Background: Anxiety feeds the avoidance of dental treatments which leads to the neglect of general oral health. This avoidance is often amplified by the fear of potential pain and dissatisfaction. Anxiety, pain and dissatisfaction are not mutually exclusive and can be combined into a composite measure called burden of care. A musical intervention could be beneficial to reduce this burden of care as shown in many surgical settings in the literature. However, there is limited evidence of the benefits of music listening during dental surgeries and results are heterogenous due to a lack of consistency in the methodology. Objective: The aim of this study was to explore the effects of a personalized musical intervention on the burden of care during autogenous gingival grafts in adults while comparing it to an active control (audiobook). Method: Two groups of patients received the autogenous gingival graft along with the personalized musical intervention (n=25) or an audiobook of choice (n=22). Participants were distributed randomly between groups in a double-blind design (surgeons were unaware of the assigned auditory stimuli and participants were unaware of the control condition). Self-reported measures of anxiety, pain, dissatisfaction, and emotional state were taken preoperatively and postoperatively. Postoperative measures of anxiety, pain and dissatisfaction were combined into a burden of care composite measure. Emotional ratings of the auditory stimuli were evaluated after the surgery. Results: There were no significant differences between the auditory stimuli on the burden of care and its separated components. Results show a fluctuation of anxiety and pain levels through time for both groups. Music was perceived as more relaxing than the audiobook (U = 144.00, p =.005, η2=.17). Participants, who felt more negative emotions before (r =0.44, p =.002, R2 =.19) and after the surgery (r =0.42, p =.004, R2 =.17), had a larger burden of care. There were no significant differences in the emotional states of the participants between the two groups. Conclusion: It is possible that both auditory stimuli (music or audiobook) are effective in the reduction of the burden of care (and its components separately). Further evidence is needed to verify the benefits of a personalized musical intervention during autogenous gingival grafts. Future research should add a third group of standard care to facilitate the evaluation of both auditory stimuli’s effects on the burden of care.