Bayesian network meta-analysis of root coverage procedures: ranking efficacy and identification of best treatment.
OBJECTIVE
The aim of this work was to conduct a Bayesian network meta-analysis (NM) of randomized controlled trials (RCTs) to establish a ranking in efficacy and the best technique for coronally advanced flap (CAF)-based root coverage procedures.


METHODS
A literature search on PubMed, Cochrane libraries, EMBASE, and hand-searched journals until June 2012 was conducted to identify RCTs on treatments of Miller Class I and II gingival recessions with at least 6 months of follow-up. The treatment outcomes were recession reduction (RecRed), clinical attachment gain (CALgain), keratinized tissue gain (KTgain), and complete root coverage (CRC).


RESULTS
Twenty-nine studies met the inclusion criteria, 20 of which were classified as at high risk of bias. The CAF+connective tissue graft (CTG) combination ranked highest in effectiveness for RecRed (Probability of being the best = 40%) and CALgain (Pr = 33%); CAF+enamel matrix derivative (EMD) was slightly better for CRC; CAF+Collagen Matrix (CM) appeared effective for KTgain (Pr = 69%). Network inconsistency was low for all outcomes excluding CALgain.


CONCLUSIONS
CAF+CTG might be considered the gold standard in root coverage procedures. The low amount of inconsistency gives support to the reliability of the present findings.
Department of Public Health, University of Florence, Florence, Italy. ruijack@libero.it
Jacopo
J
Buti
Michela
M
Baccini
Michele
M
Nieri
Michele
M
La Marca
Giovan P
GP
Pini-Prato
D001499:Bayes Theorem; D003094:Collagen / Q000627:therapeutic use; D003238:Connective Tissue / Q000637:transplantation*; D003746:Dental Enamel Proteins / Q000627:therapeutic use; D005889:Gingival Recession / Q000601:surgery*; D006801:Humans; D016247:Information Storage and Retrieval / Q000379:methods; D009010:Monte Carlo Method; D017622:Periodontal Attachment Loss / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D013524:Surgical Flaps; D016896:Treatment Outcome
D003746:Dental Enamel Proteins; C109069:enamel matrix proteins; D003094:Collagen