Clinical and Aesthetic Evaluation of Minimally Invasive Surgical Therapy for the Treatment of Gingival Recession Defects - A Systematic Review of Randomized Clinical Trials

Abstract

Background: The concept of minimally invasive dentistry has seamlessly blended into the various fields of dentistry including periodontics. The past three decades have witnessed a paradigm shift from conventional surgical procedures to microsurgery in the field of periodontal plastic surgery. This entails the integration of microsurgical principles, refined surgical skills and magnification devices along with microsurgical instruments. This systematic review of the randomized clinical trials attempts to address the clinical question whether the application of minimally invasive surgical procedures for gingival augmentation and root coverage procedures for the treatment of gingival recession translate into superior clinical and patient oriented results as compared to conventional root coverage procedures. Materials and Methods: Science Direct and Ovid databases, PubMed, Scopus, and Product literature were accessed to review relevant literature evaluating minimally invasive surgery for treatment of gingival recession defects (GRDs). The search covered 13 studies published in medical and dental journals in English with a relevant impact factor and had a follow up of at least 6 months, up to and including June 2023. The results were based on parameters such as complete root coverage (CRC, expressed as percentage), mean root coverage (MRC, expressed as %) width of keratinized tissue (WKT), and variables such as esthetics and pain postsurgery. Results and Conclusion: The 13 studies pooled in 342 patients who underwent root coverage procedures for treatment of GRDs. The test group (microsurgical) and the control group (macrosurgical group) both resulted in overall improvement in parameters like MRC and CRC, WKT etc. at least 6 months postsurgery; however, statistical difference in between both the groups in these parameters was seen in only three studies. There was marked improvement found in the test group after surgery with respect to esthetics (root coverage aesthetic score) and pain scores (Visual Analog Scale score) as compared to the control group. This compels us to infer that although both conventional and microsurgical procedures are successful as root coverage procedures, microsurgical procedures are minimally invasive and produce superior esthetic and comfort parameters for the patient and are therefore highly recommended in surgical procedures.