Root coverage procedures for treating single and multiple recession‐type defects: An updated Cochrane systematic review

Abstract

Background This updated Cochrane systematic review (SR) evaluated the efficacy of different root coverage (RC) procedures in the treatment of single and multiple gingival recessions (GR). Methods We included randomized controlled trials (RCTs) only of at least 6 months’ duration evaluating Miller's Class I or II GR (≥3 mm) treated by means of RC procedures. Five databases were searched up to January 16, 2018. Random effects meta‐analyses were conducted thoroughly. Results We included 48 RCTs in the SR. The results indicated a greater GR reduction for subepithelial connective tissue grafts (SCTG) + coronally advanced flap (CAF) compared to guided tissue regeneration with resorbable membranes (GTR rm) + CAF (mean difference [MD]: −0.37 mm). There was insufficient evidence of a difference in GR reduction between acellular dermal matrix grafts (ADMG) + CAF and SCTG + CAF or between enamel matrix derivative (EMD) + CAF and SCTG + CAF. Greater gains in the keratinized tissue width (KTW) were found for SCTG + CAF when compared to EMD + CAF (MD: −1.06 mm), and SCTG + CAF when compared to GTR rm + CAF (MD: −1.77 mm). There was insufficient evidence of a difference in KTW gain between ADMG + CAF and SCTG + CAF. Conclusions SCTG, CAF alone or associated with another biomaterial may be used for treating single or multiple GR. There is also some evidence suggesting that ADMG appear as the soft tissue substitute that may provide the most similar outcomes to those achieved by SCTG.

Gingival phenotype modification therapies on natural teeth: A network meta‐analysis

“…Chambrone et al. had concluded that ADM is the graft substitute that can provide the most similar results to that of the gold standard CTG 88 . Nevertheless, it has to be mentioned that a recent NMA from our group addressing the effect of time on root coverage outcomes, demonstrated that ADM has a tendency to have an apical relapse of the gingival margin over time, while CTG is the only material that shows a trend toward stability 14 .…”

“…In agreement with our findings, several authors have reported a significant increase in GT following CTG and ADM. 12,72,81,82,87 Chambrone et al had concluded that ADM is the graft substitute that can provide the most similar results to that of the gold standard CTG. 88 Nevertheless, it has to be mentioned that a recent NMA from our group addressing the effect of time on root coverage outcomes, demonstrated that ADM has a tendency to have an apical relapse of the gingival margin over time, while CTG is the only material that shows a trend toward stability. 14 In addition, it has been found that when the obtained GT at 6 months is ≥1.2 mm, the mean root coverage with ADM is more likely to remain stable.…”

A Modified Bilaminar Technique with the Use of a Fibrin-Fibronectin System for a Single Gingival Recession: A Case Report with a Follow-Up of 3 Years

“…Coronally advanced flap with the addition of a subepithelial connective tissue graft has demonstrated to be effective in covering the root at the MRC, providing optimal clinical and aesthetic results [ 21 , 22 ].…”

Late complications after root coverage with two types of subepithelial connective tissue grafts, clinical and histopathological evaluation: A prospective cohort study

“…Connective tissue graft (CTG) associated with coronally advanced flap (CAF) is considered the “gold standard” procedure for complete root coverage (CRC) (Chambrone & Pini Prato, 2019). Although related to high success rates for single and multiple GRs (Chambrone et al, 2019), this procedure could be associated with late complications (LC).…”