Periodontology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
Periodontology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil and Instituto Implanteperio, São Paulo, Brazil.
J Int Acad Periodontol. 2021 Jan 1;23(1):79-98.
To compare the outcomes of root coverage when the (1) donor site of connective tissue graft is the palate or tuberosity and (2) when connective tissue graft is harvested with intra- or extra-oral de-epithelization techniques.
The primary outcome was patient satisfaction. Secondary outcomes included complete root coverage, percentage of root coverage and keratinized tissue width. Searches were conducted until December 2019 in PubMed, EMBASE, Scopus and CENTRAL.
3275 studies were retrieved, but no randomized trials (randomized controlled trials) were found comparing tuberosity and palate. Data were extracted for one arm assessing any connective tissue graft technique from 56 randomized controlled trials to compare intra-oral de-epithelization and extra-oral de-epithelization outcomes. Among these studies, none have harvested connective tissue graft from tuberosity. Patient satisfaction for intra-oral de-epithelization and extra-oral de-epithelization ranged between 79% and 95%. Complete root coverage for intra-oral de-epithelization and extra-oral de-epithelization techniques was 55% (95%CI 46-65) and 70% (95%CI 63-77). Metaregression analyzes demonstrated that free gingival graft presented 4.41 higher chance of CRC [odds ratio (OR)=4.41, p=0.001] compared to single incision technique, followed by Bruno's (OR=4.39) and double-blade (OR=3.85) techniques. There were no differences between de-epithelization techniques for percentage of root coverage and keratinized tissue width.
No evidence was found to support the use of connective tissue grafts from the tuberosity. If complete root coverage is the major clinical goal, extra-oral deepithelization may be preferred over intra-oral de-epithelization techniques.
比较（1）结缔组织移植的供体部位为腭或结节和（2）当结缔组织移植采用口腔内或口腔外去上皮化技术采集时的根覆盖结果。
主要结果是患者满意度。次要结果包括完全根覆盖、根覆盖百分比和角化组织宽度。检索时间截至 2019 年 12 月，检索数据库包括 PubMed、EMBASE、Scopus 和 CENTRAL。
共检索到 3275 项研究，但未发现比较结节和腭的随机试验（随机对照试验）。从 56 项随机对照试验中提取了评估任何结缔组织移植技术的一个臂的数据，以比较口腔内去上皮化和口腔外去上皮化的结果。在这些研究中，均未从结节采集结缔组织移植。口腔内去上皮化和口腔外去上皮化的患者满意度在 79%至 95%之间。口腔内去上皮化和口腔外去上皮化技术的完全根覆盖率分别为 55%（95%CI 46-65）和 70%（95%CI 63-77）。Meta 回归分析表明，与单切口技术相比，游离龈移植术（OR=4.41，p=0.001）和 Brunno 技术（OR=4.39）和双刀片技术（OR=3.85）具有更高的 CRC 发生几率。口腔内去上皮化技术在根覆盖百分比和角化组织宽度方面无差异。
没有证据支持使用来自结节的结缔组织移植。如果完全根覆盖是主要的临床目标，那么口腔外去上皮化可能优于口腔内去上皮化技术。
