title: The Effect of Suturing Protocols on Coronally Advanced Flap Root-Coverage Outcomes: A Meta-Analysis.
abstract: BACKGROUND
  The purpose of this systematic review and meta-analysis was to investigate whether suturing protocols (suture removal timing and/or type of suture material) influence root coverage outcomes in recession defects treated with a coronally advanced flap (CAF) procedure.
  
  
  METHODS
  Databases (MEDLINE, EMBASE) were searched for randomized clinical trials (RCTs) that assessed single-tooth, Miller Class I/II recession defects, surgically treated by CAF. Mixed-effects linear regression analysis evaluated differences on complete root coverage (CRC) between RCTs with early (<10 days postoperatively) and late (≥10 days) suture removal, as well as between RCTs using absorbable and non-absorbable sutures removed ≥10 days postoperatively.
  
  
  RESULTS
  Seventeen RCTs were eligible for inclusion. Overall, data from 325 single gingival recession defects revealed a statistically significant superior proportion of sites exhibiting CRC when sutures were removed ≥10 days postoperatively compared to those in which sutures were removed <10 days (P = 0.03). Conversely, there were no significant differences in CRC outcomes between absorbable and non-absorbable sutures when they were removed ≥10 days after surgery (P = 1.00). The majority of included RCTs (59%) reported use of non-absorbable suture materials.
  
  
  CONCLUSIONS
  Within the limitations of the available data, it can be concluded that early suture removal (<10 days) can negatively influence root-coverage outcomes in single-tooth defects treated by a CAF procedure. There is a strong need for studies designed specifically to investigate suturing protocols in root-coverage procedures.
authors.affiliation: Division of Periodontology, College of Dentistry, Ohio State University, Columbus, OH.
authors.forename: Dimitris N
authors.initials: DN
authors.lastname: Tatakis
authors.affiliation: Unit of Basic Oral Investigation (UIBO), School of Dentistry, El Bosque University, Bogota, Colombia.|MSc Program, School of Dentistry, Ibirapuera University (UNIB), São Paulo, SP, Brazil.
authors.forename: Leandro
authors.initials: L
authors.lastname: Chambrone
mesh_terms: D005881:Gingiva; D005889:Gingival Recession / Q000601:surgery; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013524:Surgical Flaps / Q000601:surgery; D013537:Sutures; D014092:Tooth Root / Q000601:surgery; D016896:Treatment Outcome
keywords: Clinical trial; gingival recession; review; surgical flaps; sutures; tooth root