title: Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review.
abstract: BACKGROUND
  The aim of this Systematic Review (SR) was to assess the clinical efficacy of periodontal plastic surgery procedures in the treatment of localized gingival recessions (Rec) with or without inter-dental clinical attachment loss (iCAL).
  
  
  METHODS
  Electronic and hand searches were performed to identify randomized clinical trials (RCTs) on treatment of single gingival recessions with at least 6 months of follow-up. Primary outcome variable was complete root coverage (CRC). Secondary outcome variables were recession reduction (RecRed) and keratinized tissue (KT) gain. To evaluate treatment effect, Odds Ratios were combined for dichotomous data and mean differences in continuous data using a random-effect model.
  
  
  RESULTS
  Fifty-one RCTs (53 articles) with a total of 1574 treated patients (1744 recessions) were included in this SR. Finally, 30 groups of comparisons were identified and a total of 80 meta-analyses were performed. Coronally Advanced Flap (CAF) was associated with higher probability of CRC and higher amount of RecRed than Semilunar Coronal Positioned Flap (SCPF). The combination CAF plus Connective Tissue Graft (CAF+CTG) or CAF plus Enamel Matrix Derivative (CAF+EMD) was more effective than CAF alone in terms of CRC and RecRed. The combination CAF plus Collagen Matrix (CAF+CM) achieved higher RecRed than CAF alone. In addition, CAF+CTG achieved CRC more frequently than CAF+EMD, SCPF, Free Gingival Graft (FGG) and Laterally Positioned Flap (LPS). CAF+CTG was also associated with higher RecRed than Barrier Membranes (CAF+GTR), CAF+EMD and CAF+CM. GTR was not able to improve the clinical efficacy of CAF. Studies adding Acellular Dermal Matrix (ADM) under CAF showed a large heterogeneity and not significant benefits compared with CAF alone. Multiple combinations, using more than a single graft/biomaterial under the flap, usually provide similar or less benefits than simpler, control procedures in term of root coverage outcomes.
  
  
  CONCLUSIONS
  CAF procedures alone or with CTG, EMD are supported by large evidence in modern periodontal plastic surgery. CAF+CTG achieved the best clinical outcomes in single gingival recessions with or without iCAL.
authors.affiliation: Department of Periodontology and Implant Dentistry, Tuscan School of Dental Medicine, University of Florence, Florence, Italy; Department of Periodontology and Implant Dentistry, Tuscan School of Dental Medicine, University of Siena, Siena, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cairo
authors.forename: Michele
authors.initials: M
authors.lastname: Nieri
authors.forename: Umberto
authors.initials: U
authors.lastname: Pagliaro
mesh_terms: D003238:Connective Tissue / Q000637:transplantation; D003746:Dental Enamel Proteins / Q000627:therapeutic use; D005881:Gingiva / Q000637:transplantation; D005889:Gingival Recession / Q000601:surgery*; D006801:Humans; D007633:Keratins; D017622:Periodontal Attachment Loss / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000601:surgery; D014092:Tooth Root / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D003746:Dental Enamel Proteins; C109069:enamel matrix proteins; D007633:Keratins
keywords: connective tissue graft; coronally advanced flap; gingival recession; periodontal plastic surgery; root coverage; systematic review