CTG or EMD in conjunction with CAF enhances the probability of obtaining CRC in Miller Class I and II single gingival recessions.

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). Material and 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.

Conflict of interest:The authors certify that there is no conflict of interest concerning the contents of the study. This study has been self-supported by the authors.Key words: gingival recession, diagnosis, periodontal disease, classification, aesthetics, clinical attachment level, root coverage. Running title: Interproximal CAL for gingival recessions Clinical relevance Scientific rationale for the studyNo information concerning the reliability of classifications of gingival recessions is currently available and there is no general consensus on the use of a specific system. In addition, the prediction of the gingival margin position following root coverage is a controversial issue. Principal findingsUsing the level of interproximal clinical attachment as identification criterion the proposed classification of gingival recessions showed an ICC= 0.86 (almost perfect agreement) among different examiners. Furthermore, the proposed classification was predictive of the final root coverage outcomes at the 6-month follow-up. Practical implicationsA classification system of gingival recessions based on the interproximal CAL may aid clinicians for a reliable categorization of defects and an effective prediction of treatment outcomes.

The RES system may be a useful tool to assess the esthetic outcome following root-coverage procedures.

Aim: To compare need for bone augmentation, surgical complications, periodontal, radiographic, aesthetic and patient reported outcomes in subjects receiving implant placement at the time of extraction (Immediate Implant) or 12 weeks thereafter. Methods: Subjects requiring single tooth extraction in the anterior and premolar areas were recruited in seven private practices. Implant position and choice of platform were restoratively driven. Measurements were performed by calibrated and masked examiners. Results: IMI was unfeasible in 7.5% of cases. One hundred and 24 subjects were randomized. One implant was lost in the IMI group. IMI required bone augmentation in 72% of cases compared with 43.9% for delayed (p = 0.01), while wound failure occurred in 26.1% and 5.3% of cases, respectively (p = 0.02). At 1 year, IMI had deeper probing depths (4.1 AE 1.2 mm versus 3.3 AE 1.1 mm, p < 0.01). A trend for greater radiographic bone loss was observed at IMI over the initial 3-year period (p-trend < 0.01). Inadequate pink aesthetic scores were obtained in 19% of delayed and in 42% of IMI implant cases (p = 0.03). No differences in patient reported outcomes were observed.

AimTo evaluate the non‐inferiority of the adjunct of a xenogeneic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions and compare superiority in patient‐reported outcomes (PROM).Material and methodsOne hundred and eighty‐seven subjects (92 CMX) with 485 recessions in 14 centres were randomized and followed up for 6 months. Patients filled daily diaries for 15 days to monitor patient‐reported experience. The primary outcome was changed in position of the gingival margin. Multilevel analysis used centre, subject and tooth as levels and baseline parameters as covariates.ResultsAverage baseline recession was 2.5 ± 1.0 mm. The surgery was 15.7 min shorter (95%CI from 11.9 to 19.6, p < .0001) and perceived lighter (11.9 VAS units, 95%CI from 4.6 to 19.1, p = .0014) in CMX subjects. Time to recovery was 1.8 days shorter in CMX. Six‐month root coverage was 1.7 ± 1.1 mm for CMX and 2.1 ± 1.0 mm for CTG (difference of 0.44 mm, 95%CI from 0.25 to 0.63 mm). The upper limit of the confidence interval was over the non‐inferiority margin of 0.25 mm. Odds of complete root coverage were significantly higher for CTG (OR = 4.0, 95% CI 1.8–8.8).ConclusionReplacing CTG with CMX shortens time to recovery and decreases morbidity, but the tested generation of devices is probably inferior to autologous CTG in terms of root coverage. Significant variability in PROMs was observed among centres.

CTG was more effective than XCM to increase buccal peri-implant soft tissue thickness.

Pini-Prato GP, Cairo F, Nieri M, Franceschi D, Rotundo R, Cortellini P. Coronally advanced flap versus connective tissue graft in the treatment of multiple gingival recessions: a split-mouth study with a 5-year follow-up. J Clin Periodontol 2010; 37: 644-650. doi: 10.1111/j.1600-051X.2010.01559.x Abstract Aim: The aim of this long-term study was to compare the clinical outcomes of coronally advanced flap (CAF) alone versus coronally advanced flap plus connective tissue graft (CAF1CTG) in the treatment of multiple gingival recessions using a splitmouth design over 5 years of follow-up. Materials and Methods: A total of 13 patients (mean age 31.4 years) showing multiple bilateral gingival recessions were treated. On one side, CAF1CTG was used, while in the contra-lateral side, a CAF alone was applied. Clinical outcomes were evaluated at the 6-month, 1-year and 5-year follow-ups. Results: A total of 93 Miller class I, II and III gingival recessions were treated. In the CAF1CTG-treated sites, the baseline gingival recession was 3.6 AE 1.3 mm, while in the CAF-treated sites, it was 2.9 AE 1.3 mm (p 5 0.0034). No difference in terms of the number of sites with complete root coverage (CRC) was reported (OR 5 0.49, p 5 0.1772) at the 6-month follow-up. At the 5-year follow-up, CAF1CTG-treated sites showed a higher percentage of sites with CRC (52%) than CAF-treated sites (35%) (OR 5 3.94; p 5 0.0239). An apical relapse of the gingival margin in CAFtreated sites was observed while a coronal improvement of the margin was noted in CAF1CTG-treated sites between the 6-month and the 5-year follow-ups. Conclusions: CAF1CTG provided better CRC than CAF alone in the treatment of multiple gingival recessions at the 5-year follow-up.