Root coverage procedures for the treatment of localised recession-type defects.
BACKGROUND
Gingival recession is defined as the oral exposure of the root surface due to a displacement of the gingival margin apical to the cemento-enamel junction and it is regularly linked to the deterioration of dental aesthetics. Successful treatment of recession-type defects is based on the use of predictable periodontal plastic surgery (PPS) procedures.


OBJECTIVE
To evaluate the effectiveness of different root coverage procedures in the treatment of recession-type defects.


METHODS
The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched up to October 2008. The main international periodontal journals were handsearched. There were no restrictions with regard to publication status or language of publication.


METHODS
Only randomised controlled clinical trials (RCTs) of at least 6 months' duration evaluating recession areas (Miller's Class I or II > 3 mm) and that were treated by means of PPS procedures were included.


METHODS
Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Authors were contacted for any missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals.


RESULTS
Twenty-four RCTs provided data. Only one trial was considered to be at low risk of bias. The remaining trials were considered to be at high risk of bias. The results indicated a significant greater reduction in gingival recession and gain in keratinized tissue for subepithelial connective tissue grafts (SCTG) compared to guided tissue regeneration with resorbable membranes (GTR rm). A significant greater gain in the keratinized tissue was found for enamel matrix protein when compared to coronally advanced flap (0.40 mm) and for SCTG when compared to GTR rm plus bone substitutes. Limited data exist on aesthetic condition change related to patients' opinion and patients' preference for a specific procedure.


CONCLUSIONS
Subepithelial connective tissue grafts, coronally advanced flap alone or associated with other biomaterial and guided tissue regeneration may be used as root coverage procedures for the treatment of localised recession-type defects. In cases where both root coverage and gain in the keratinized tissue are expected, the use of subepithelial connective tissue grafts seems to be more adequate. Randomised controlled clinical trials are necessary to identify possible factors associated with the prognosis of each PPS procedure. The potential impact of bias on these outcomes is unclear.
Department of Periodontology, University of São Paulo, Av. Prof. Lineu Prestes, 2227 Cidade Universitária, São Paulo, SP, Brazil, 05508-000. chambrone@usp.br
Leandro
L
Chambrone
Flávia
F
Sukekava
Maurício G
MG
Araújo
Francisco E
FE
Pustiglioni
Luiz Armando
LA
Chambrone
Luiz A
LA
Lima
D003746:Dental Enamel Proteins / Q000627:therapeutic use; D005889:Gingival Recession / Q000601:surgery*; D005893:Gingivoplasty / Q000379:methods*; D016557:Guided Tissue Regeneration, Periodontal / Q000379:methods; D006801:Humans; D016032:Randomized Controlled Trials as Topic
D003746:Dental Enamel Proteins; C109069:enamel matrix proteins