Predictability of surgical techniques used for coverage of multiple adjacent gingival recessions - A systematic review

Objective: Predictable coverage of multiple adjacent gingival recessions (MAGRs) is a major challenge for clinicians. Although several surgical techniques have been proposed to treat MAGR, it is still unclear as to what extent the proposed approaches may lead to predictable root coverage. The aim of this article is to identify the predictability of the available surgical techniques used to achieve complete root coverage (CRC) of Miller Class I, II, and III MAGRs. Method and Materials: A search of the PubMed database was performed. Additional hand searching and a search for gray literature were also conducted. Due to the heterogeneity of the data, no meta-analysis could be performed. Results: The search resulted in the selection of 16 publications analyzed in this review. In Miller Class I and II MAGRs, the coronalIy advanced flap (CAF) and the modified coronally advanced flap (MCAF) yielded a CRC ranging from 74.6% to 89.3% and a mean root coverage (MRC) ranging from 91.5% to 97.27% at 6 to 12 months following surgery. In Miller Class I and II recessions, the results obtained with MCAF were maintained for up to 5 years (CRC ranging from 35% to 85.1%), as indicated by two studies. One study has indicated that MCAF + connective tissue grafting (CTG) may improve the long-term stability of CRC compared with MCAF (35% CRC without CTG vs 52% CRC with CTG). In Miller Class I and II MAGRs, the use of CTG in conjunction with CAF, MCAF, coronally positioned pedicle (CPP), double pedicle graft (DPG), or the supraperiosteal tunnel technique yielded higher CRC or MRC than with bioabsorbable membranes, acellular dermal matrix (ADM), or platelet-rich fibrin (PRF). In Miller Class III MAGRs, the modified coronally advanced tunnel (MCAT) and CTG with and without an enamel matrix derivative resulted in 38% CRC and in 82% to 83% MRC, respectively. Conclusion: The present findings indicate that in Miller Class I and II MAGRs, CAF or MCAF with or without CTG may lead to predictable CRC; the CRC obtained with MCAF were maintained over a period of 5 years; the use of CTG appears to improve the long-term stability of the MCAF; and the use of CTG in conjunction with CAF, MCAF, CPP, DPG, or the supraperiosteal tunnel technique appear to yield higher CRC or MRC than the use of bioabsorbable membranes, ADM, or PRF. Also, MCAT plus CTG appears to represent a valuable technique for the treatment of Miller Class III MAGRs. Keywords: coronally advanced flap, multiple adjacent gingival recessions, pedicle flap, root coverage, soft tissue grafts, tunnel