O impacto da distância biológica na saúde gengival: relato de caso

Abstract

The biological distance, more accepted as supracrestal attached tissues (TAS), is the dimension of soft tissue located between the sulcular epithelium and the alveolar bone crest, being composed of junctional epithelium and conjunctiva insertion, in addition to being essential for the adhesion of these tissues and, in case of violation, measures are necessary for their restoration. Patient, female, complained of constant gingival bleeding after performing porcelain veneers from element 14 to 24 and reported that the use of antibiotics stopped the bleeding. On clinical examination, evident inflammation, bleeding on probing, presence of bacterial plaque and unsatisfactory anatomy of the parts with steps were observed, indicating invasion of the biological space. Removal and exchange of prosthetic parts were indicated, however the patient refused. Amoxicillin 500mg was prescribed to reduce inflammation. The patient underwent surgical periodontal therapy with flap lifting and osteotomy, in addition to removing the prosthetic steps, making it possible to identify the end of the porcelain in the bone crest. After 7 days, the patient returned with no bleeding and, due to extreme prosthetic maladjustment, there was gingival recession. When the biological distance is invaded, an inflammatory process occurs, which leads to loss of alveolar bone. The biological limits and conditions of each individual must be evaluated before the indication and initiation of rehabilitation treatment. According to the literature, there is no specific technique, but there are inherent indications so that the dental surgeon must analyze and consider the physiology and health of the periodontium in the stability of aesthetic rehabilitation. It is concluded, therefore, that the preservation and integrity of the TAS must be a constant care in the restorative stage, since when there is invasion of the same, it is necessary to recover it through procedures aimed at reestablishing its biological functions, promoting gum health.