title: Qualitative cosmetic evaluation after root-coverage procedures.
abstract: BACKGROUND
  The purpose of the present study was to evaluate the esthetic outcome using four categories of root-coverage procedures (pedicle soft tissue grafts, non-submerged grafts, submerged grafts, and envelope techniques) and to identify factors associated with esthetic assessment.
  
  
  METHODS
  A professional panel of three observers (two periodontists and one control) used a before-after panel scoring system to evaluate the esthetics of 162 root-coverage surgeries. A five-point ordinal scale was used to evaluate the overall esthetic improvement and seven variables that may be considered in the assessment.
  
  
  RESULTS
  The intraobserver agreement of the two trained periodontists for the overall cosmetic assessment was almost perfect (kappa = 0.83), and substantial agreement was found between them (kappa = 0.68). Good to excellent overall esthetic results were found by the professionals and control in >70% of the surgical procedures. Analysis of variance indicated a statistical difference between the non-submerged grafts category and the three other surgical categories (P <10(-3)). Multivariate analysis showed that the degree of root coverage was not a significant predictive factor, whereas soft tissue appearance variables and the follow-up were significantly associated with cosmetic assessment.
  
  
  CONCLUSIONS
  The present study demonstrated that non-submerged grafts are not recommended in cases of esthetic demand. Future root-coverage trials, basing their justification on esthetics, should include overall qualitative evaluation as the primary variable. The follow-up period should not be <12 months. The before-after panel scoring system is a tool that can be used to evaluate cosmetic outcomes.
authors.affiliation: Department of Periodontology, Service of Odontology, Hôtel-Dieu Hospital, AP-HP, Paris 7-Denis Diderot University, UFR of Odontology, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Kerner
authors.forename: Alexandre
authors.initials: A
authors.lastname: Sarfati
authors.forename: Sandrine
authors.initials: S
authors.lastname: Katsahian
authors.forename: Vincent
authors.initials: V
authors.lastname: Jaumet
authors.forename: Charles
authors.initials: C
authors.lastname: Micheau
authors.forename: Francis
authors.initials: F
authors.lastname: Mora
authors.forename: Virginie
authors.initials: V
authors.lastname: Monnet-Corti
authors.forename: Philippe
authors.initials: P
authors.lastname: Bouchard
mesh_terms: D000328:Adult; D017439:Cicatrix, Hypertrophic / Q000473:pathology; D003116:Color; D004955:Esthetics, Dental; D005260:Female; D005500:Follow-Up Studies; D005881:Gingiva / Q000473:pathology / Q000637:transplantation*; D005889:Gingival Recession / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007633:Keratins; D008297:Male; D015588:Observer Variation; D023861:Photography, Dental; D011237:Predictive Value of Tests; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000145:classification; D014092:Tooth Root / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D007633:Keratins