CTG or EMD in conjunction with CAF enhances the probability of obtaining CRC in Miller Class I and II single gingival recessions.

Conflict of interest:The authors certify that there is no conflict of interest concerning the contents of the study. This study has been self-supported by the authors.Key words: gingival recession, diagnosis, periodontal disease, classification, aesthetics, clinical attachment level, root coverage. Running title: Interproximal CAL for gingival recessions Clinical relevance Scientific rationale for the studyNo information concerning the reliability of classifications of gingival recessions is currently available and there is no general consensus on the use of a specific system. In addition, the prediction of the gingival margin position following root coverage is a controversial issue. Principal findingsUsing the level of interproximal clinical attachment as identification criterion the proposed classification of gingival recessions showed an ICC= 0.86 (almost perfect agreement) among different examiners. Furthermore, the proposed classification was predictive of the final root coverage outcomes at the 6-month follow-up. Practical implicationsA classification system of gingival recessions based on the interproximal CAL may aid clinicians for a reliable categorization of defects and an effective prediction of treatment outcomes.

Background The aim of this Systematic Review (SR) was to assess the clinical efficacy of periodontal plastic surgery procedures in the treatment of localized gingival recessions (Rec) with or without inter‐dental clinical attachment loss (iCAL). Material and Methods Electronic and hand searches were performed to identify randomized clinical trials (RCTs) on treatment of single gingival recessions with at least 6 months of follow‐up. Primary outcome variable was complete root coverage (CRC). Secondary outcome variables were recession reduction (RecRed) and keratinized tissue (KT) gain. To evaluate treatment effect, Odds Ratios were combined for dichotomous data and mean differences in continuous data using a random‐effect model. Results Fifty‐one RCTs (53 articles) with a total of 1574 treated patients (1744 recessions) were included in this SR. Finally, 30 groups of comparisons were identified and a total of 80 meta‐analyses were performed. Coronally Advanced Flap (CAF) was associated with higher probability of CRC and higher amount of RecRed than Semilunar Coronal Positioned Flap (SCPF). The combination CAF plus Connective Tissue Graft (CAF+CTG) or CAF plus Enamel Matrix Derivative (CAF+EMD) was more effective than CAF alone in terms of CRC and RecRed. The combination CAF plus Collagen Matrix (CAF+CM) achieved higher RecRed than CAF alone. In addition, CAF+CTG achieved CRC more frequently than CAF+EMD, SCPF, Free Gingival Graft (FGG) and Laterally Positioned Flap (LPS). CAF+CTG was also associated with higher RecRed than Barrier Membranes (CAF+GTR), CAF+EMD and CAF+CM. GTR was not able to improve the clinical efficacy of CAF. Studies adding Acellular Dermal Matrix (ADM) under CAF showed a large heterogeneity and not significant benefits compared with CAF alone. Multiple combinations, using more than a single graft/biomaterial under the flap, usually provide similar or less benefits than simpler, control procedures in term of root coverage outcomes. Conclusions CAF procedures alone or with CTG, EMD are supported by large evidence in modern periodontal plastic surgery. CAF+CTG achieved the best clinical outcomes in single gingival recessions with or without iCAL.