Unit of Dentistry and Oral Surgery, Department of Surgical & Medical Pathology, University of Pisa, Pisa, Italy.
J Clin Periodontol. 2014 Apr;41 Suppl 15:S63-76. doi: 10.1111/jcpe.12172.
To systematically review the efficacy of periodontal plastic procedures (PPP) in the treatment of multiple gingival recessions (MGR).
Randomized clinical trials (RCT) on MGR treatment with at least 6 months duration were identified through electronic databases and hand-searched journals. Primary outcomes were complete root coverage (CRC) and percentage of root coverage (PRC). Weighted means and forest plots were calculated for all PPP. Subgroup analysis was performed according to the type of flap. A Bayesian network meta-analysis (NM) on secondary outcomes was also performed.
Nine trials including 208 subjects and 858 recessions were identified. CRC after PPP was 24-89%. Mean weighted PRC was 86.27% (95% CI 80.71-91.83; p < 0.01). Heterogeneity of the literature prevented inter-techniques comparison. Coronally advanced flap (CAF) shows the higher variability in terms of CRC. Modified CAF and tunnel approaches show higher level of CRC. The NM suggests that CAF plus graft showed the higher probability of being the best treatment.
Limited evidence is available for MGR coverage. PPP are associated with high level of efficacy, in terms of PRC, and high variability of CRC. Indirect evidence indicates that CAF may benefit from newer variations of the technique and by the additional use of grafting.
系统评价牙周整形术（PPP）治疗多发牙龈退缩（MGR）的疗效。
通过电子数据库和手工检索期刊，确定了至少 6 个月疗程的 MGR 治疗的随机临床试验（RCT）。主要结局是完全根覆盖（CRC）和根覆盖百分比（PRC）。所有 PPP 均计算加权均值和森林图。根据瓣的类型进行亚组分析。还对次要结局进行了贝叶斯网络荟萃分析（NM）。
确定了 9 项试验，共纳入 208 名受试者和 858 个退缩区。PPP 后的 CRC 为 24-89%。平均加权 PRC 为 86.27%（95%CI 80.71-91.83;p<0.01）。文献的异质性使得无法进行技术间比较。冠向推进瓣（CAF）在 CRC 方面显示出更高的变异性。改良 CAF 和隧道技术显示出更高的 CRC 水平。NM 表明 CAF 加移植物可能是最佳治疗方法。
MGR 覆盖的证据有限。PPP 在 PRC 方面具有高效性，CRC 的变异性较高。间接证据表明，CAF 可能受益于该技术的新变化以及额外使用移植物。
