Abstract
BackgroundThe primary objective of this systematic review and meta-analysis was to assess the evidence on complete root coverage (CRC) achieved by periodontal plastic techniques in the treatment of Miller class III/RT2 gingival recessions, comparing techniques developed along the twentieth century (pre-twenty-first) versus surgical approaches of the twenty-first century (21st).MethodsAn electronic bibliographic search was carried out in four databases up to December 2019, focusing on studies that reported CRC results in Miller class III or RT2 recessions treatment with at least a six-month follow-up. In addition, a random-effects models’ meta-analysis was performed for the CRC, comparing pre-twenty-first versus twenty-first century techniques at 6 months, 12 months and more than 12 months.ResultsThirty-seven publications were included. A total of 933 gingival recessions were treated, 298 with pre-twenty-first century surgical techniques and 635 with techniques from the twenty-first century. CRC was achieved at 6 months on half of the recessions (pre-twenty-first: 57.60% vs. 21st: 51.11%), but decreased markedly for twenty-first century techniques at 12 months (pre-twenty-first: 63.82% vs. 21st: 32.87%). Thereafter, this difference was the other way around (> 12 months: pre-twenty-first: 5.26% vs. 21st: 19.65%). The meta-analysis showed a high heterogeneity, with no significant differences amongst the techniques.ConclusionsAlthough CRC might be achievable by treating Miller class III or RT2 recessions with any of the described techniques, its long-term stability is not predictable. More randomized clinical trials with longer follow-ups and several visits, are needed. In addition, the patient’s satisfaction should also be assessed.
Highlights
Periodontitis is a very prevalent pathology that leads to tooth loss in adult population [1,2,3]
Eligibility criteria Articles were included in this systematic review if they met the following inclusion criteria: (1) clinical studies including randomized clinical trials, cohort studies, retrospective studies, cases series and case reports in humans; (2) treatment of Miller class III or RT2 gingival recessions (GRs) around teeth (3) complete root coverage (CRC) was reported or could be obtained from the results provided; (4) that the results reported had at least six-month follow-up; (5) studies written in English and Spanish
The titles and the abstracts of all reports identified were read separately by the two authors (AFJ and AMGF) to include the articles where Miller class III [4]/RT2 [5] were treated with periodontal plastic surgical procedures; the inter-examiner global agreement was of 95.68% (Kappa = 0.91)
Summary
Periodontitis is a very prevalent pathology that leads to tooth loss in adult population [1,2,3]. In order to treat these challenging Miller class III [4] or RT2 [5] recessions, several mucogingival approaches have been proposed such as tunnel techniques, coronally advanced flaps, free gingival grafts, rotated techniques and two-stage procedures. These techniques have been developed along the twentieth century (pre-twenty-first century techniques) and the twenty-first century as well. The primary objective of this systematic review and meta-analysis was to assess the evidence on complete root coverage (CRC) achieved by periodontal plastic techniques in the treatment of Miller class III/RT2 gingival recessions, comparing techniques developed along the twentieth century (pre-twenty-first) versus surgical approaches of the twenty-first century (21st)
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