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

Area of Science:

• Periodontology
• Restorative Dentistry
• Aesthetic Dentistry

Background:

• Gingival recession is a common condition affecting oral health and aesthetics.
• Periodontal plastic surgery (PPS) aims to treat gingival recessions and improve aesthetics.
• Assessing aesthetic outcomes at both patient and professional levels is crucial for evaluating treatment success.

Purpose of the Study:

• To systematically review randomized controlled trials (RCTs) on periodontal plastic surgery for gingival recessions.
• To explore the impact of these procedures on aesthetic outcomes from patient and professional perspectives.
• To conduct a Bayesian network meta-analysis (BNM) to combine evidence from various trials.

Main Methods:

• A systematic review of RCTs was performed, searching databases like PubMed, Cochrane, and EMBASE.
• Studies published up to January 2016 reporting aesthetic outcomes using standardized evaluations were included.
• A BNM was planned to integrate direct and indirect treatment comparisons.

Main Results:

• 16 RCTs were included in the systematic review.
• Coronally Advanced Flap plus Connective Tissue Graft (CAF + CTG) and CAF + Acellular Dermal Matrix (ADM) showed the best professional aesthetic scores (Root coverage Aesthetic Score - RES).
• CAF + CTG and CAF + CTG + Enamel matrix Derivatives (EMD) yielded the highest patient-reported aesthetic satisfaction (Visual Analogue Scale - VAS Est).

Conclusions:

• Periodontal plastic surgery techniques, particularly those involving grafts under Coronally Advanced Flap (CAF) with or without Enamel matrix Derivatives (EMD), enhance aesthetics.
• These improvements are supported by both patient self-perception and professional evaluations (RES).
• PPS procedures offer a viable solution for improving the aesthetic appearance of gingival recessions.