title: Clinical efficacy of coronally advanced flap with or without connective tissue graft for the treatment of multiple adjacent gingival recessions in the aesthetic area: a randomized controlled clinical trial.
abstract: The aim of this study was to assess the clinical efficacy of coronally advanced flap (CAF) with or without connective tissue graft (CTG) for the treatment of multiple adjacent gingival recessions in the upper arch.
  
  
  
  Thirty-two patients with a total of 74 gingival recessions were randomly allocated to the two groups. Outcome measures, collected by a blind examiner, included complete root coverage (CRC), recession reduction (RecRed), keratinized tissue (KT) gain, increase in gingival thickness (GT), patient satisfaction and root coverage esthetic score (RES).
  
  
  
  An interaction between treatment and baseline GT was detected. At 1 year, CAF + CTG resulted in better outcomes in terms of CRC (p = 0.0016) and RecRed (p < 0.0001) than CAF alone at sites with thin gingiva (thickness ≤ 0.8 mm). No difference was found between CAF alone and CAF + CTG at sites with thick gingiva (>0.8 mm). CAF resulted in higher aesthetic scores (RES) than CAF + CTG at sites with thick gingiva. CAF + CTG was associated with greater KT gain (p < 0.0001) and greater post-operative morbidity (p < 0.0001).
  
  
  
  Connective tissue graft under CAF results in increased probability of CRC only at sites with thin baseline gingiva. CAF alone is associated with similar clinical outcomes and better aesthetics at sites with thick baseline gingiva.
authors.affiliation: Section of Periodontology, Department of Surgery and Translational Medicine, A.O.U. Careggi, University of Florence, Florence, Italy. cairofrancesco@virgilio.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cairo
authors.affiliation: Accademia Toscana di Ricerca Odontostomatologia (ATRO), Florence, Italy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Cortellini
authors.affiliation: Section of Periodontology, University "La Sapienza" of Rome, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Pilloni
authors.affiliation: Section of Periodontology, Department of Surgery and Translational Medicine, A.O.U. Careggi, University of Florence, Florence, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Nieri
authors.affiliation: Section of Periodontology, Department of Surgery and Translational Medicine, A.O.U. Careggi, University of Florence, Florence, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Cincinelli
authors.affiliation: Unit of Special Care Dentistry, A.O.U. Careggi, University of Florence, Florence, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Amunni
authors.affiliation: Section of Endodontics, Department of Surgery and Translational Medicine, A.O.U. Careggi, University of Florence, Florence, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Pagavino
authors.affiliation: European Research Group on Periodontology (ERGOPERIO), Berne, Switzerland.
authors.forename: Maurizio S
authors.initials: MS
authors.lastname: Tonetti
mesh_terms: D003238:Connective Tissue; D004955:Esthetics, Dental; D005500:Follow-Up Studies; D005881:Gingiva; D005889:Gingival Recession; D006801:Humans; D017622:Periodontal Attachment Loss; D014092:Tooth Root; D016896:Treatment Outcome
keywords: aesthetics; connective tissue graft; coronally advanced flap; gingival recession; multiple gingival recessions; root coverage