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Root coverage procedures improve patient aesthetics. A systematic review and Bayesian network meta‐analysis
Author(s) -
Cairo Francesco,
Pagliaro Umberto,
Buti Jacopo,
Baccini Michela,
Graziani Filippo,
Tonelli Paolo,
Pagavino Gabriella,
Tonetti Maurizio S.
Publication year - 2016
Publication title -
journal of clinical periodontology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.456
H-Index - 151
eISSN - 1600-051X
pISSN - 0303-6979
DOI - 10.1111/jcpe.12603
Subject(s) - randomized controlled trial , medicine , gingival recession , dentistry , visual analogue scale , meta analysis , medline , orthodontics , surgery , political science , law
Background The aim of this study was to perform a systematic review ( SR ) of randomized controlled trials ( RCT s) to explore if periodontal plastic surgery procedures for the treatment of single and multiple gingival recessions (Rec) may improve aesthetics at patient and professional levels. Material and Methods In order to combine evidence from direct and indirect comparisons by different trials a Bayesian network meta‐analysis ( BNM ) was planned. A literature search on PubMed, Cochrane libraries, EMBASE , and hand‐searched journals until January 2016 was conducted to identify RCT s presenting aesthetic outcomes after root coverage using standardized evaluations at patient and professional level. Results A total of 16 RCT s were selected in the SR ; three RTC s presenting professional aesthetic evaluation with Root coverage Aesthetic Score ( RES ) and three showing final self‐perception using the Visual Analogue Scale ( VAS Est) could be included in a BNM model. Coronally Advanced Flap plus Connective Tissue Graft ( CAF + CTG ) and CAF + Acellular Dermal Matrix ( ADM ) and Autologous Fibroblasts ( AF ) were associated with the best RES outcomes (best probability = 24% and 64%, respectively), while CAF + CTG and CAF + CTG + Enamel matrix Derivatives ( EMD ) obtained highest values of VAS Est score (best probability = 44% and 26%, respectively). Conclusions Periodontal Plastic Surgery ( PPS ) techniques applying grafts underneath CAF with or without the adding of EMD are associated with improved aesthetics assessed by final patient perception and RES as professional evaluation system.