Root coverage procedures for the treatment of localised recession-type defects

Chambrone L, Sukekava F, Araújo MG, Pustiglioni FE, Chambrone LA, Lima LA

Published Online:

April 15, 2009

Gingival recession is a term that designates the oral exposure of the root surface due to a displacement of the gingival margin apical to the cemento-enamel junction and it is also regularly linked to the deterioration of dental aesthetics as well as buccal cervical dentine hypersensitivity. The results of this review have shown that the majority of periodontal plastic surgery (PPS) procedures led to statistical significant gains in gingival recession depth, clinical attachment level and in the width of keratinized tissue, 23/24 studies were however judged to be at high risk of bias. Also, we observed a great variability in the percentages of complete root coverage and mean coverage. Preferably, subepithelial connective tissue grafts, coronally advanced flaps alone or associated with other graft or biomaterial and guided tissue regeneration can be used as root coverage procedures for the treatment of recession-type defects. We recommend further research to adequately confirm and identify possible factors associated with the prognosis and indications of each PPS procedure.

Abstract (click to read)

Background:

Gingival recession is defined as the oral exposure of the root surface due to a displacement of the gingival margin apical to the cemento-enamel junction and it is regularly linked to the deterioration of dental aesthetics. Successful treatment of recession-type defects is based on the use of predictable periodontal plastic surgery (PPS) procedures.

Objectives:

To evaluate the effectiveness of different root coverage procedures in the treatment of recession-type defects.

Search strategy:

The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched up to October 2008. The main international periodontal journals were handsearched. There were no restrictions with regard to publication status or language of publication.

Selection criteria:

Only randomised controlled clinical trials (RCTs) of at least 6 months' duration evaluating recession areas (Miller's Class I or II > 3 mm) and that were treated by means of PPS procedures were included.

Data collection and analysis:

Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Authors were contacted for any missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals.

Main results:

Twenty-four RCTs provided data. Only one trial was considered to be at low risk of bias. The remaining trials were considered to be at high risk of bias.
The results indicated a significant greater reduction in gingival recession and gain in keratinized tissue for subepithelial connective tissue grafts (SCTG) compared to guided tissue regeneration with resorbable membranes (GTR rm).
A significant greater gain in the keratinized tissue was found for enamel matrix protein when compared to coronally advanced flap (0.40 mm) and for SCTG when compared to GTR rm plus bone substitutes.
Limited data exist on aesthetic condition change related to patients' opinion and patients' preference for a specific procedure.

Authors' conclusions:

Subepithelial connective tissue grafts, coronally advanced flap alone or associated with other biomaterial and guided tissue regeneration may be used as root coverage procedures for the treatment of localised recession-type defects. In cases where both root coverage and gain in the keratinized tissue are expected, the use of subepithelial connective tissue grafts seems to be more adequate.
Randomised controlled clinical trials are necessary to identify possible factors associated with the prognosis of each PPS procedure.
The potential impact of bias on these outcomes is unclear.

This record should be cited as:

Chambrone L, Sukekava F, Araújo MG, Pustiglioni FE, Chambrone LA, Lima LA. Root coverage procedures for the treatment of localised recession-type defects. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD007161. DOI: 10.1002/14651858.CD007161.pub2

Assessed as up to date:

January 26, 2009

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Primary Review Group:

Oral Health Group

Health topics:

Dentistry & oral health > Periodontal disease > Associated conditions

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Root coverage procedures for the treatment of localised recession-type defects

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