title: Root surface modifiers and subepithelial connective tissue graft for treatment of gingival recessions: a systematic review.
abstract: OBJECTIVE
  Many techniques and flap designs have been used to treat gingival recession by root coverage, but subepithelial connective tissue graft (SCTG) seems to be the gold standard procedure. In an attempt to improve the healing process and increase the success rate of root coverage, some authors have used root modifiers, including different root conditioners, lasers, EMD, recombinant human growth factors and platelet-rich plasma (PRP). The aim of this systematic review was to evaluate the effects of root biomodification in clinical outcomes of gingival recessions treated with SCTG.
  
  
  METHODS
  Studies reporting SCTG associated with any form of root surface biomodification for root coverage of gingival recessions (Miller Class I and Class II) were considered as eligible for inclusion. Studies needed to have data of clinical outcomes in a follow up of at least 6 months. Screening of the articles, data extraction and quality assessment were conducted independently and in duplicate.
  
  
  RESULTS
  None of the products evaluated (citric acid, EDTA, PRP, lasers and EMD) showed evident benefits in clinical outcomes. Test and control groups presented similar outcomes related to root coverage and periodontal parameters, with no statistical differences between them. The exception was root biomodification with the neodymium-doped yttrium aluminium garnet (Nd:YAG) laser, which impaired root coverage and had a detrimental effect on clinical outcomes.
  
  
  CONCLUSIONS
  Based on the present clinical data, the use of root surface modifiers to improve clinical outcomes in gingival recessions treated with SCTG is not justified. More in vivo studies, and randomized clinical trials with larger sample sizes and extended follow up, are necessary.
authors.affiliation: Department of Prosthodontics, Discipline of Periodontology, Bauru Dental School, University of São Paulo, Bauru, Brazil.
authors.forename: P S B H
authors.initials: PS
authors.lastname: Karam
authors.affiliation: Department of Prosthodontics, Discipline of Periodontology, Bauru Dental School, University of São Paulo, Bauru, Brazil.
authors.forename: A C P
authors.initials: AC
authors.lastname: Sant'Ana
authors.affiliation: Department of Prosthodontics, Discipline of Periodontology, Bauru Dental School, University of São Paulo, Bauru, Brazil.
authors.forename: M L R
authors.initials: ML
authors.lastname: de Rezende
authors.affiliation: Department of Prosthodontics, Discipline of Periodontology, Bauru Dental School, University of São Paulo, Bauru, Brazil.
authors.forename: S L A
authors.initials: SL
authors.lastname: Greghi
authors.affiliation: Department of Prosthodontics, Discipline of Periodontology, Bauru Dental School, University of São Paulo, Bauru, Brazil.
authors.forename: C A
authors.initials: CA
authors.lastname: Damante
authors.affiliation: Department of Prosthodontics, Discipline of Periodontology, Bauru Dental School, University of São Paulo, Bauru, Brazil.
authors.forename: M S R
authors.initials: MS
authors.lastname: Zangrando
mesh_terms: D003238:Connective Tissue; D005500:Follow-Up Studies; D005881:Gingiva; D005889:Gingival Recession / Q000601:surgery; D006801:Humans; D013524:Surgical Flaps / Q000601:surgery; D014092:Tooth Root / Q000601:surgery; D016896:Treatment Outcome
keywords: gingival recessions; root conditioning; root coverage; subepithelial connective tissue graft