Histological Outcomes of Root Coverage Procedures: A Systematic Review With Meta-Analysis

Area of Science:

• Periodontology
• Regenerative Dentistry
• Oral Histology

Background:

• Gingival recession defects are common, necessitating effective root coverage procedures (RCPs).
• Understanding the histological outcomes of different RCPs is crucial for optimizing treatment strategies.
• This review focuses on preclinical and clinical evidence of RCPs' histological effects.

Purpose of the Study:

• To evaluate the histological outcomes of various root coverage procedures (RCPs) for gingival recession defects.
• To compare the efficacy of different RCPs in preclinical animal models and human clinical studies.
• To determine the role of biologicals as adjuncts in enhancing periodontal regeneration.

Main Methods:

• Systematic search of MEDLINE, EMBASE, and CENTRAL databases for studies on RCP histological outcomes.
• Inclusion of preclinical large-animal models and human clinical studies.
• Meta-analyses of histomorphometric data from animal studies using pooled means and effect sizes.

Main Results:

• Forty-one preclinical and 43 clinical studies were included, with coronally advanced flaps being common RCPs.
• Healing in humans primarily involved long junctional epithelium and connective tissue adhesion; periodontal regeneration was observed in half of studies.
• Animal studies showed enhanced new cementum with inserting fibers when using adjuncts like enamel matrix derivatives (EMD) or membranes.

Conclusions:

• Root coverage procedures (RCPs) generally lead to 'repair' characterized by long junctional epithelium and connective tissue adhesion.
• Adjunctive use of biologicals or membranes in RCPs may promote short-term periodontal regeneration, particularly evident in animal models.
• Further research may elucidate long-term regenerative potential and optimal application of biologicals in RCPs.