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 handsearched 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.

The results from this investigation showed that after tooth extraction the buccal socket wall underwent bone resorption at both test and control sites. This resorption appeared to be more pronounced at the implant sites, although the limitations of the histological evaluation method utilized preclude a definite conclusion.

Minor vertical bone reduction in both the buccal and lingual socket walls were observed. A marked horizontal reduction of the buccal bone wall was observed mostly in its coronal aspect.

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