Root coverage procedures improve patient aesthetics. A systematic review and Bayesian network meta‐analysis

Abstract

Background: The aim of this study was to perform a systematic review (SR) of randomized controlled trials (RCTs) to explore if periodontal plastic surgery procedures for the treatment of single and multiple gingival recessions (Rec) may improve aesthetics at patient and professional levels. Material and Methods:In order to combine evidence from direct and indirect comparisons by different trials a Bayesian network meta-analysis (BNM) was planned. A literature search on PubMed, Cochrane libraries, EMBASE, and hand-searched journals until January 2015 was conducted to identify RCTs presenting aesthetic outcomes after root coverage using standardized evaluations at patient and professional level.Results: A total of 16 RCTs were selected in the SR; 3 RTCs presenting professional aesthetic evaluation with Root coverage Aesthetic Score (RES) and 3 showing final self-perception using the Visual Analogue Scale (VAS Est) could be included in a BNM model. Coronally Advanced Flap plus Connective Tissue Graft (CAF+CTG) and CAF+Acellular Dermal Matrix (ADM) and Autologous Fibroblasts (AF) were associated with the best RES outcomes (best probability = 24% and 64%, respectively), while CAF+CTG and CAF+CTG+Enamel matrix Derivatives (EMD) obtained highest values of VAS Est score (best probability = 44% and 26%, respectively). Conclusions: Periodontal Plastic Surgery (PPS) techniques applying grafts underneath CAF with orwithout the adding of EMD are associated with improved aesthetics assessed by final patient perception and RES as professional evaluation system. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 To compare, using a Bayesian network meta-analysis, the efficacy of periodontal plastic surgery procedures to improve aesthetics as assessed by professional and patient scores. Principal findings:Coronally Advanced Flap plus Connective Tissue Graft (CAF+CTG) and CAF plus Acellular Dermal Matrix (ADM) and Autologous Fibroblasts (AF) were associated with the highest professional outcomes rated by means of Root Coverage Aesthetics Score (RES). CAF+CTG and CAF+CTG plus Enamel Matrix Derivatives (EMD) obtained highest values in term of patient satisfaction rated by Visual Analogue Scale (VAS est). Practical implications:Grafting underneath the Coronally Advanced Flap with or without the adding of Enamel Matrix Derivatives is associated with highest aesthetic outcomes at professional and patient level. Conflict of Interest:The authors certify that there is no conflict of interest concerning the contents of the study. Source of Funding:The study was self founded by authors. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 INTRODUCTIONAesthetic concern is a primary in...

Influence of tooth location on coronally advanced flap procedures for root coverage

“…It has been showed that increased marginal soft tissue thickness, which is typically observed when a graft is positioned below the flap, is positively related to higher mRC and to a tendency of the gingival margin to coronally migrate over time . In agreement with Cairo et al., the present study confirm the efficacy of CAF, especially when a CTG with or without EMD is added . However, care should be taken when interpreting the results because of the small number of patients in certain included groups (such as CTG + EMD) and the lack of information regarding the patient phenotype or gingiva thickness at the baseline.…”

“…Several surgical techniques, such as guided tissue regeneration (GTR); subepithelial connective tissue graft procedure (SCTG); coronally advanced flap (CAF); lateral positioned flap; double papilla technique; semilunar pedicle flap; oblique rotated flap; tunnel technique; and surgical techniques based on modifications of these protocols, have been proposed for the treatment of GR defects. Among these procedures, it has been demonstrated that CAF represents the most predictable technique for the correction of GR defects . Similarly, several connective tissue substitutes have been tested in attempt to eliminate the drawbacks related with a secondary surgical site, however, autogenous connective tissue graft (CTG) remains to be considered the gold standard providing with the most predictable and long‐term satisfactory results …”

Long‐Term Stability of Root Coverage by Coronally Advanced Flap Procedures

“…VAS scores for patient satisfaction in the present study compare favorably with the recently‐reported mean VAS values of 8.38 and 8.58, respectively, 12 months after RC with CAF + CMX and CAF 28 . VAS scores in the present study also compare favorably with mean VAS of 8.54 in a recently published Bayesian network meta‐analysis on improved esthetics after RC procedures 29 …”

Aesthetic assessment after root coverage of multiple adjacent recessions with coronally advanced flap with adjunctive collagen matrix or connective tissue graft: Randomized clinical trial

“…(Cairo et al., ) that compared CAF+CTG to CAF alone. A recent network meta‐analysis focused on aesthetic scores also reported similar total RES scores (Cairo, Pagliaro et al., ) although some studies included in the meta‐analysis, still on single tooth recessions, reported significantly better scores. The results of this study appear in line with higher estimates for CTG while for CMX results seemed to be less favourable than those reported for CAF alone.…”