Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review

Background: The evidence for the efficacy of periodontal plastic surgery (PPS) in the treatment of recession defects has not yet been systematically evaluated. The objective of this review was to systematically review the efficacy of PPS in achieving root coverage in the treatment of localized gingival recession. The following surgical procedures have been considered in this review: guided tissue regeneration (GTR), free gingival graft (FGG), connective tissue graft (CTG), and coronally advanced flap (CAF). Methods: Randomized and controlled trials, as well as case series of at least 6 months' follow-up, were searched. Data sources included electronic databases and hand-searched journals. Screening, data abstraction and quality assessment were conducted independently and in duplicate. Results: Regarding recession reduction, a limited but statistically significant greater benefit was found for CTG compared with GTR (weighted mean difference: 0.43 mm, 95% CI: 0.62-0.23). No differences were found comparing either GTR with CAF or resorbable versus non-resorbable GTR barriers. Gain in attachment was also similar for each of the three comparisons. Analysis of single arms of trials and case series demonstrated that PPS can have a marked improvement on clinical parameters but heterogeneity was often high and only partly explained by initial defect depth. Conclusions: Overall, PPS was effective in reducing gingival recessions with a concomitant improvement in attachment levels. Even though no single treatment can be considered superior to all the others, CTG was statistically significantly more effective than GTR in recession reduction. Further research is needed to identify the factors most associated with successful outcomes.