title: Efficacy of periodontal plastic procedures in the treatment of multiple gingival recessions.
abstract: OBJECTIVE
  To systematically review the efficacy of periodontal plastic procedures (PPP) in the treatment of multiple gingival recessions (MGR).
  
  
  METHODS
  Randomized clinical trials (RCT) on MGR treatment with at least 6 months duration were identified through electronic databases and hand-searched journals. Primary outcomes were complete root coverage (CRC) and percentage of root coverage (PRC). Weighted means and forest plots were calculated for all PPP. Subgroup analysis was performed according to the type of flap. A Bayesian network meta-analysis (NM) on secondary outcomes was also performed.
  
  
  RESULTS
  Nine trials including 208 subjects and 858 recessions were identified. CRC after PPP was 24-89%. Mean weighted PRC was 86.27% (95% CI 80.71-91.83; p < 0.01). Heterogeneity of the literature prevented inter-techniques comparison. Coronally advanced flap (CAF) shows the higher variability in terms of CRC. Modified CAF and tunnel approaches show higher level of CRC. The NM suggests that CAF plus graft showed the higher probability of being the best treatment.
  
  
  CONCLUSIONS
  Limited evidence is available for MGR coverage. PPP are associated with high level of efficacy, in terms of PRC, and high variability of CRC. Indirect evidence indicates that CAF may benefit from newer variations of the technique and by the additional use of grafting.
authors.affiliation: Unit of Dentistry and Oral Surgery, Department of Surgical & Medical Pathology, University of Pisa, Pisa, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Graziani
authors.forename: Stefano
authors.initials: S
authors.lastname: Gennai
authors.forename: Silvia
authors.initials: S
authors.lastname: Roldán
authors.forename: Nicola
authors.initials: N
authors.lastname: Discepoli
authors.forename: Jacpop
authors.initials: J
authors.lastname: Buti
authors.forename: Phoebus
authors.initials: P
authors.lastname: Madianos
authors.forename: David
authors.initials: D
authors.lastname: Herrera
mesh_terms: D015982:Bias; D003238:Connective Tissue / Q000637:transplantation; D005881:Gingiva / Q000637:transplantation; D005889:Gingival Recession / Q000601:surgery*; D006801:Humans; D015201:Meta-Analysis as Topic; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000601:surgery; D014092:Tooth Root / Q000601:surgery; D016896:Treatment Outcome
keywords: meta-analysis; muco-gingival surgery; multiple gingival recessions; systematic review