Clinician‐ and patient‐reported outcomes following the surgical treatment of single gingival recession defects: A systematic review

To analyze the effect of root coverage surgical therapy for the treatment of single gingival recession defects (GRD) in terms of clinician- and patient-reported outcomes (CROs and PROs), with an emphasis on esthetic perception. The protocol of this PRISMA 2020-compliant systematic review was registered in PROSPERO (CRD517050). Relevant articles reporting the outcomes of randomized controlled trials (RCTs) were identified through a literature search. After final article selection, according to specific eligibility criteria, data were extracted and categorized. Primary outcomes were clinician-reported root coverage esthetic scores (RES) and patient-reported esthetic perception and satisfaction using different assessment methods, such as standardized visual analog scales (VAS). Data were analyzed and the risk of bias in all included studies was assessed. Fifty-eight articles pertaining to 50 different RCTs were selected. A total of 1820 subjects presenting 2219 single GRDs were treated. Key findings derived from the pooled estimates indicated that root coverage and gingival phenotype modification therapy positively influenced both RES and patient-reported esthetic perception and satisfaction values. Compared to the use of a coronally advanced flap (CAF) alone (i.e., monolaminar technique), the use of a CAF in conjunction with a subepithelial connective tissue graft (i.e., bilaminar technique) had a positive impact on both RES and VAS values, whereas CAF in conjunction with soft tissue substitutes only had a beneficial effect on VAS values. Surgical approaches based on lateral flap displacement were associated with superior mean RES values compared to techniques involving coronal flap displacement. Meta-regression analyses revealed a statistically significant positive association between mean root coverage and RES (i.e., the greater the percentage of root coverage, the higher the RES). Conversely, the association between patient-reported esthetic perception and MRC was not statistically significant. In addition, it was observed that dentinal hypersensitivity can be substantially reduced with surgical root coverage therapy, regardless of the treatment modality. Surgical therapy for the correction of single GRDs had a positive effect on both clinician-reported esthetic scores and patient-reported esthetic perception and satisfaction. Bilaminar techniques are generally associated with superior results.