title: Efficacy of root surface biomodification in root coverage: a systematic review.
abstract: BACKGROUND
  Although many Authors have reported the use of root surface biomodification (RSB), the clinical outcomes in terms of root coverage are still unclear, as a number of biomodifier agents have been used in combination with various periodontal plastic surgical techniques. In this review we aim to evaluate the efficacy of RSB in root coverage and its impact on the outcomes.
  
  
  METHODS
  A search of MEDLINE and Cochrane databases was carried out along with 2 manual searches. A combination of specific terms was used to identify relevant studies that met well-defined inclusion and exclusion criteria. Clinical attachment level, probing depth and percentage root coverage after treatment were among the results expected to be reported in the included articles.
  
  
  RESULTS
  A total of 10 articles were identified and data were extracted. Only 6 met the inclusion criteria. Among these 6 studies, citric acid, ethylenediaminetetraacetic acid and laser therapy were used as RSB agents and free gingival graft, subepithelial connective tissue graft plus coronally advanced flap and semilunar coronally respositioned flap were the surgical approaches to root coverage treatment. Baseline and outcome data were analyzed and compared.
  
  
  CONCLUSIONS
  RSB provided no additional benefit in terms of the evaluated clinical parameters. Within the limitations of this review, we found no evidence to support the use of RSB prior to root coverage treatment.
authors.affiliation: Periodontics Program, Division of Periodontics, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Bauru, São Paulo, Brazil.
authors.forename: Guilherme H C
authors.initials: GH
authors.lastname: Oliveira
authors.forename: Eduardo A G
authors.initials: EA
authors.lastname: Muncinelli
mesh_terms: D019343:Citric Acid / Q000627:therapeutic use; D004492:Edetic Acid / Q000627:therapeutic use; D005881:Gingiva / Q000637:transplantation; D005889:Gingival Recession / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy; D013524:Surgical Flaps / Q000145:classification; D014092:Tooth Root / Q000187:drug effects / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D019343:Citric Acid; D004492:Edetic Acid