Non-Cochrane · intervention · PM42130372
Esthetical and patient-reported outcomes after root coverage procedures for multiple gingival recessions: A systematic review and meta-analysis.
Stefanini Martina, Mounssif Ilham, Figuero Elena, et al. · Periodontology 2000 · 2025 · PubMed · doi:10.1111/prd.70050
Findings
84 findings
| Population | ||||
|---|---|---|---|---|
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Any surgical root coverage procedure | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Patient-reported esthetic satisfaction (VAS) Follow-up mostly 6-12 months | WME 8.59 [8.29, 8.89] GRADE not reported 16 studies |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Any surgical root coverage procedure | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Postoperative pain, VAS 0-10 7 days postsurgery | WME 2.67 [2.28, 3.06] GRADE not reported 9 studies |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Any surgical root coverage procedure | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Keratinized tissue change (mm) Follow-up mostly 6-12 months | WME (mm) 0.74 [0.59, 0.89] GRADE not reported 30 studies |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Any surgical root coverage procedure | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Baseline recession depth (mm) Baseline | WME (mm) 2.66 [2.49, 2.83] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Any surgical root coverage procedure | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Association between professional RES and patient esthetic VAS Follow-up mostly 6-12 months | Metaregression slope (fixed effect) -0.5 GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Any surgical root coverage procedure | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Association between mean root coverage (MRC) and professional RES Follow-up mostly 6-12 months | Metaregression slope (fixed effect) 0.037 GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Any surgical root coverage procedure | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Gingival thickness change (mm) Follow-up mostly 6-12 months | WME (mm) 0.56 [0.43, 0.68] GRADE not reported 19 studies |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Any surgical root coverage procedure | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Association between mean root coverage (MRC) and patient esthetic VAS Follow-up mostly 6-12 months | Metaregression slope (fixed effect) -0.018 GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Any surgical root coverage procedure | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Recession reduction (mm) Follow-up mostly 6-12 months | WME (mm) 2.22 [2.11, 2.32] GRADE not reported 30 studies |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Any surgical root coverage procedure | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Clinical attachment level change (mm) Follow-up mostly 6-12 months | WME (mm) 2.17 [1.97, 2.38] GRADE not reported 28 studies |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Any surgical root coverage procedure | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Professional esthetic outcome: Root Coverage Esthetic Score (RES) Follow-up mostly 6-12 months | WME 8.31 [8.11, 8.5] GRADE not reported 22 studies |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Any surgical root coverage procedure | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Postoperative pain, VAS 0-100 7 days postsurgery | WME 24.34 [16.46, 32.22] GRADE not reported 5 studies |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Any surgical root coverage procedure | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Complete root coverage (CRC) Follow-up mostly 6-12 months | Pooled proportion (%) 62.7 [57.0, 68.4] GRADE not reported 30 studies |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Any surgical root coverage procedure | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Mean root coverage (%) Follow-up mostly 6-12 months | WME (%) 82.59 [71.33, 93.86] GRADE not reported 26 studies |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap (any, with or without adjunctives) | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Clinical attachment level change (mm) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap (any, with or without adjunctives) | WME (mm) 2.39 [2.11, 2.67] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap (any, with or without adjunctives) | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Postoperative pain, VAS 0-10 7 days postsurgery · Technique subgroup: Coronally advanced flap (any, with or without adjunctives) | WME 3.75 [1.27, 6.24] GRADE not reported Studies not reported |
| Adults with multiple adjacent gingival recessions (RT1/RT2 or Miller class I-III) | Coronally advanced flap (CAF), with or without adjunctive | None (pooled single-arm outcome; each trial arm treated as an independent study) | Complete root coverage (CRC, prevalence %) 6 to 12 months (most studies) · Technique subgroup: Coronally advanced flap (CAF), with or without adjunctive | Pooled proportion (%) 65.2 [58.7, 71.7] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap (any, with or without adjunctives) | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Mean root coverage (%) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap (any, with or without adjunctives) | WME (%) 86.53 [83.31, 89.75] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap (any, with or without adjunctives) | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Baseline recession depth (mm) Baseline · Technique subgroup: Coronally advanced flap (any, with or without adjunctives) | WME (mm) 3.0 [2.84, 3.15] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap (any, with or without adjunctives) | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Recession reduction (mm) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap (any, with or without adjunctives) | WME (mm) 2.58 [2.49, 2.67] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap (any, with or without adjunctives) | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Keratinized tissue change (mm) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap (any, with or without adjunctives) | WME (mm) 0.58 [0.37, 0.79] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap (any, with or without adjunctives) | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Postoperative pain, VAS 0-100 7 days postsurgery · Technique subgroup: Coronally advanced flap (any, with or without adjunctives) | WME 45.75 [33.41, 58.08] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap (any, with or without adjunctives) | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Complete root coverage (CRC) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap (any, with or without adjunctives) | Pooled proportion (%) 65.2 [58.7, 71.7] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap (any, with or without adjunctives) | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Patient-reported esthetic satisfaction (VAS) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap (any, with or without adjunctives) | WME 8.52 [8.02, 9.02] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap (any, with or without adjunctives) | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Gingival thickness change (mm) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap (any, with or without adjunctives) | WME (mm) 0.4 [0.24, 0.57] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap (any, with or without adjunctives) | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Professional esthetic outcome: Root Coverage Esthetic Score (RES) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap (any, with or without adjunctives) | WME 8.02 [7.78, 8.27] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap with adjunctive | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Postoperative pain, VAS 0-100 7 days postsurgery · Technique subgroup: Coronally advanced flap with adjunctive | WME 51.21 [37.98, 65.44] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap with adjunctive | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Recession reduction (mm) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap with adjunctive | WME (mm) 2.57 [2.47, 2.67] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap with adjunctive | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Mean root coverage (%) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap with adjunctive | WME (%) 86.86 [83.18, 90.55] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap with adjunctive | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Professional esthetic outcome: Root Coverage Esthetic Score (RES) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap with adjunctive | WME 8.08 [7.82, 8.34] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap with adjunctive | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Complete root coverage (CRC) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap with adjunctive | Pooled proportion (%) 65.5 [58.1, 72.9] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap with adjunctive | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Gingival thickness change (mm) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap with adjunctive | WME (mm) 0.59 [0.5, 0.67] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap with adjunctive | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Postoperative pain, VAS 0-10 7 days postsurgery · Technique subgroup: Coronally advanced flap with adjunctive | WME 4.13 [1.39, 6.87] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap with adjunctive | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Keratinized tissue change (mm) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap with adjunctive | WME (mm) 0.68 [0.42, 0.94] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap with adjunctive | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Baseline recession depth (mm) Baseline · Technique subgroup: Coronally advanced flap with adjunctive | WME (mm) 2.96 [2.8, 3.13] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap with adjunctive | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Patient-reported esthetic satisfaction (VAS) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap with adjunctive | WME 8.58 [8.03, 9.13] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap with adjunctive | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Clinical attachment level change (mm) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap with adjunctive | WME (mm) 2.32 [1.97, 2.67] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap without adjunctive | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Postoperative pain, VAS 0-10 7 days postsurgery · Technique subgroup: Coronally advanced flap without adjunctive | WME 1.2 [-0.05, 2.45] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap without adjunctive | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Clinical attachment level change (mm) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap without adjunctive | WME (mm) 2.54 [2.05, 3.04] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap without adjunctive | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Baseline recession depth (mm) Baseline · Technique subgroup: Coronally advanced flap without adjunctive | WME (mm) 3.09 [2.73, 3.45] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap without adjunctive | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Complete root coverage (CRC) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap without adjunctive | Pooled proportion (%) 64.0 [49.9, 78.1] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap without adjunctive | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Patient-reported esthetic satisfaction (VAS) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap without adjunctive | WME 8.33 [7.24, 9.41] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap without adjunctive | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Keratinized tissue change (mm) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap without adjunctive | WME (mm) 0.33 [0.09, 0.57] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap without adjunctive | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Professional esthetic outcome: Root Coverage Esthetic Score (RES) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap without adjunctive | WME 7.62 [7.29, 7.96] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap without adjunctive | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Recession reduction (mm) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap without adjunctive | WME (mm) 2.63 [2.23, 3.03] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap without adjunctive | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Postoperative pain, VAS 0-100 7 days postsurgery · Technique subgroup: Coronally advanced flap without adjunctive | WME 28.9 [25.47, 32.33] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap without adjunctive | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Gingival thickness change (mm) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap without adjunctive | WME (mm) 0.03 [-0.026, 0.09] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Coronally advanced flap without adjunctive | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Mean root coverage (%) Follow-up mostly 6-12 months · Technique subgroup: Coronally advanced flap without adjunctive | WME (%) 85.12 [77.31, 92.94] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Tunnel technique (with or without adjunctives) | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Baseline recession depth (mm) Baseline · Technique subgroup: Tunnel technique (with or without adjunctives) | WME (mm) 2.33 [2.12, 2.53] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Tunnel technique (with or without adjunctives) | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Keratinized tissue change (mm) Follow-up mostly 6-12 months · Technique subgroup: Tunnel technique (with or without adjunctives) | WME (mm) 0.79 [0.55, 1.03] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Tunnel technique (with or without adjunctives) | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Professional esthetic outcome: Root Coverage Esthetic Score (RES) Follow-up mostly 6-12 months · Technique subgroup: Tunnel technique (with or without adjunctives) | WME 8.53 [8.23, 8.83] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Tunnel technique (with or without adjunctives) | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Clinical attachment level change (mm) Follow-up mostly 6-12 months · Technique subgroup: Tunnel technique (with or without adjunctives) | WME (mm) 2.01 [1.73, 2.29] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Tunnel technique (with or without adjunctives) | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Mean root coverage (%) Follow-up mostly 6-12 months · Technique subgroup: Tunnel technique (with or without adjunctives) | WME (%) 80.85 [64.5, 97.21] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Tunnel technique (with or without adjunctives) | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Complete root coverage (CRC) Follow-up mostly 6-12 months · Technique subgroup: Tunnel technique (with or without adjunctives) | Pooled proportion (%) 61.0 [50.0, 71.9] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Tunnel technique (with or without adjunctives) | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Patient-reported esthetic satisfaction (VAS) Follow-up mostly 6-12 months · Technique subgroup: Tunnel technique (with or without adjunctives) | WME 8.61 [8.35, 8.88] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Tunnel technique (with or without adjunctives) | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Gingival thickness change (mm) Follow-up mostly 6-12 months · Technique subgroup: Tunnel technique (with or without adjunctives) | WME (mm) 0.65 [0.54, 0.77] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Tunnel technique (with or without adjunctives) | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Postoperative pain, VAS 0-10 7 days postsurgery · Technique subgroup: Tunnel technique (with or without adjunctives) | WME 2.25 [1.8, 2.69] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Tunnel technique (with or without adjunctives) | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Postoperative pain, VAS 0-100 7 days postsurgery · Technique subgroup: Tunnel technique (with or without adjunctives) Unresolved: the two extractors disagree on this row. | WME 24.34 [16.46, 32.22] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Tunnel technique (with or without adjunctives) | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Recession reduction (mm) Follow-up mostly 6-12 months · Technique subgroup: Tunnel technique (with or without adjunctives) | WME (mm) 1.86 [1.66, 2.07] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Free gingival graft | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Mean root coverage (%) Follow-up mostly 6-12 months · Technique subgroup: Free gingival graft | WME (%) 63.54 [51.84, 75.24] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Free gingival graft | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Clinical attachment level change (mm) Follow-up mostly 6-12 months · Technique subgroup: Free gingival graft | WME (mm) 2.05 [1.54, 2.56] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Free gingival graft | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Baseline recession depth (mm) Baseline · Technique subgroup: Free gingival graft | WME (mm) 3.58 [3.26, 3.9] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Free gingival graft | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Complete root coverage (CRC) Follow-up mostly 6-12 months · Technique subgroup: Free gingival graft | Pooled proportion (%) 10.0 [0.7, 19.3] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Free gingival graft | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Gingival thickness change (mm) Follow-up mostly 6-12 months · Technique subgroup: Free gingival graft | WME (mm) 0.72 [0.62, 0.82] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Free gingival graft | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Keratinized tissue change (mm) Follow-up mostly 6-12 months · Technique subgroup: Free gingival graft | WME (mm) 4.43 [3.84, 5.02] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Free gingival graft | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Recession reduction (mm) Follow-up mostly 6-12 months · Technique subgroup: Free gingival graft | WME (mm) 2.29 [1.88, 2.7] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | VISTA technique | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Professional esthetic outcome: Root Coverage Esthetic Score (RES) Follow-up mostly 6-12 months · Technique subgroup: VISTA technique | WME 8.82 [8.29, 9.35] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | VISTA technique | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Gingival thickness change (mm) Follow-up mostly 6-12 months · Technique subgroup: VISTA technique | WME (mm) 0.41 [0.19, 0.63] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | VISTA technique | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Keratinized tissue change (mm) Follow-up mostly 6-12 months · Technique subgroup: VISTA technique | WME (mm) 0.74 [0.47, 1.0] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | VISTA technique | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Complete root coverage (CRC) Follow-up mostly 6-12 months · Technique subgroup: VISTA technique | Pooled proportion (%) 59.2 [35.9, 82.4] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | VISTA technique | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Clinical attachment level change (mm) Follow-up mostly 6-12 months · Technique subgroup: VISTA technique | WME (mm) 1.89 [0.93, 2.85] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | VISTA technique | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Recession reduction (mm) Follow-up mostly 6-12 months · Technique subgroup: VISTA technique Unresolved: the two extractors disagree on this row. | WME (mm) 2.37 [1.7, 2.69] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | VISTA technique | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Mean root coverage (%) Follow-up mostly 6-12 months · Technique subgroup: VISTA technique | WME (%) 83.5 [66.17, 100.0] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | VISTA technique | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Baseline recession depth (mm) Baseline · Technique subgroup: VISTA technique | WME (mm) 2.58 [2.05, 3.11] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | VISTA technique | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Postoperative pain, VAS 0-10 7 days postsurgery · Technique subgroup: VISTA technique | WME 3.17 [1.01, 5.33] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | VISTA technique | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Patient-reported esthetic satisfaction (VAS) Follow-up mostly 6-12 months · Technique subgroup: VISTA technique | WME 9.05 [8.69, 9.41] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Pinhole surgical technique | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Recession reduction (mm) Follow-up mostly 6-12 months · Technique subgroup: Pinhole surgical technique | WME (mm) 1.13 [0.83, 1.43] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Pinhole surgical technique | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Professional esthetic outcome: Root Coverage Esthetic Score (RES) Follow-up mostly 6-12 months · Technique subgroup: Pinhole surgical technique | WME 9.05 [8.38, 9.71] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Pinhole surgical technique | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Baseline recession depth (mm) Baseline · Technique subgroup: Pinhole surgical technique | WME (mm) 1.42 [1.29, 1.55] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Pinhole surgical technique | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Mean root coverage (%) Follow-up mostly 6-12 months · Technique subgroup: Pinhole surgical technique | WME (%) 79.67 [65.97, 93.37] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Pinhole surgical technique | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Clinical attachment level change (mm) Follow-up mostly 6-12 months · Technique subgroup: Pinhole surgical technique | WME (mm) 1.54 [1.08, 2.0] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Pinhole surgical technique | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Keratinized tissue change (mm) Follow-up mostly 6-12 months · Technique subgroup: Pinhole surgical technique | WME (mm) 1.14 [0.45, 1.82] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Pinhole surgical technique | None (single-arm pooled change/score; arms of RCTs analyzed as independent cohorts; no direct comparison between interventions) | Complete root coverage (CRC) Follow-up mostly 6-12 months · Technique subgroup: Pinhole surgical technique | Pooled proportion (%) 67.4 [51.9, 82.8] GRADE not reported Studies not reported |
| Adults with multiple gingival recessions (Miller class I-III or RT1/RT2) | Surgical root coverage procedures | Not applicable (case series with at least 10 patients) | Esthetic and patient-reported outcomes At least 6 months | no estimate extracted No studies found 0 studies |
Included primary studies 39
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Aroca 2013 Treatment of multiple adjacent Miller class I and II gingival recessions with a Modified Coronally Advanced Tunnel (MCAT) technique and a… PMID:23627374 | 2013 | 2 other reviews | not stated | not extracted yet |
| Meza-Mauricio 2021 Comparison between a xenogeneic dermal matrix and connective tissue graft for the treatment of multiple adjacent gingival recessions: a… PMID:34021404 | 2021 | 2 other reviews | not stated | not extracted yet |
| Pietruska 2019 Clinical evaluation of Miller class I and II recessions treatment with the use of modified coronally advanced tunnel technique with either… PMID:30362599 | 2019 | 2 other reviews | not stated | not extracted yet |
| Rakasevic 2020 The use of collagen porcine dermal matrix and connective tissue graft with modified coronally advanced tunnel technique in the treatment… PMID:32706184 | 2020 | 2 other reviews | not stated | not extracted yet |
| Ahmedbeyli 2014 Clinical evaluation of coronally advanced flap with or without acellular dermal matrix graft on complete defect coverage for the treatment… PMID:24304099 | 2014 | 1 other review | not stated | not extracted yet |
| Ahmedbeyli 2019 Coronally advanced flap and envelope type of flap plus acellular dermal matrix graft for the treatment of thin phenotype multiple… PMID:31350924 | 2019 | 1 other review | not stated | not extracted yet |
| Bakhishov 2021 De-epithelialized gingival graft versus subepithelial connective tissue graft in the treatment of multiple adjacent gingival recessions… PMID:33751615 | 2021 | 1 other review | not stated | not extracted yet |
| Cairo 2016 Clinical efficacy of coronally advanced flap with or without connective tissue graft for the treatment of multiple adjacent gingival… PMID:27329829 | 2016 | 1 other review | not stated | not extracted yet |
| Carrera 2023 Root coverage with platelet-rich fibrin or connective tissue graft: a split-mouth randomized trial. PMID:37672418 | 2023 | 1 other review | not stated | not extracted yet |
| Chen 2023 Does vestibular incision improve the outcomes of vestibular incision subperiosteal tunnel technique: A randomized clinical trial for… PMID:37078417 | 2023 | 1 other review | not stated | not extracted yet |
| Cieslik-Wegemund 2016 Tunnel Technique With Collagen Matrix Compared With Connective Tissue Graft for Treatment of Periodontal Recession: A Randomized Clinical… PMID:27424564 | 2016 | 1 other review | not stated | not extracted yet |
| Gorski 2022 Effect of 24% EDTA root conditioning on the outcome of modified coronally advanced tunnel technique with subepithelial connective tissue… PMID:34431001 | 2022 | 1 other review | not stated | not extracted yet |
| Kuka 2018 Clinical evaluation of coronally advanced flap with or without platelet-rich fibrin for the treatment of multiple gingival recessions. PMID:29058084 | 2018 | 1 other review | not stated | not extracted yet |
| Nahas 2020 Treatment of multiple recessions with collagen matrix versus connective tissue: a randomized clinical trial. PMID:31994596 | 2020 | 1 other review | not stated | not extracted yet |
| Rotundo 2019 Adjunctive benefit of a xenogenic collagen matrix associated with coronally advanced flap for the treatment of multiple gingival… PMID:31292987 | 2019 | 1 other review | not stated | not extracted yet |
| Tavelli 2022 Recombinant human platelet-derived growth factor improves root coverage of a collagen matrix for multiple adjacent gingival recessions: A… PMID:35871600 | 2022 | 1 other review | not stated | not extracted yet |
| Tonetti 2018 Xenogenic collagen matrix or autologous connective tissue graft as adjunct to coronally advanced flaps for coverage of multiple adjacent… PMID:29087001 | 2018 | 1 other review | not stated | not extracted yet |
| Tonetti 2021 Autologous connective tissue graft or xenogenic collagen matrix with coronally advanced flaps for coverage of multiple adjacent gingival… PMID:33817812 | 2021 | 1 other review | not stated | not extracted yet |
| Trivedi 2024 Comparative evaluation of pinhole surgical technique with and without A-PRF in the treatment of multiple adjacent recession defects: A… PMID:37466087 | 2024 | 1 other review | not stated | not extracted yet |
| Yilmaz 2022 Modified coronally advanced tunnel versus epithelialized free gingival graft technique in gingival phenotype modification: a comparative… PMID:35708779 | 2022 | 1 other review | not stated | not extracted yet |
| Elmahdi 2022 Evaluation of Subepithelial Connective Tissue Graft Versus Acellular Dermal Matrix with Modified Coronally Advanced Tunnel Technique in… PMID:36305926 | 2022 | this review only | not stated | not extracted yet |
| Fernandez-Jimenez 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Fernandez-Jimenez 2023 Comparative study of the modified VISTA technique (m-VISTA) versus the coronally advanced flap (CAF) in the treatment of multiple Miller… PMID:36264343 | 2023 | this review only | not stated | not extracted yet |
| Gonzalez-Febles 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Gonzalez-Febles 2023 Tunnel vs. coronally advanced flap in combination with a connective tissue graft for the treatment of multiple gingival recessions: a… PMID:36988824 | 2023 | this review only | not stated | not extracted yet |
| Gorski 2020 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Gorski 2020 Tunnel technique with enamel matrix derivative in addition to subepithelial connective tissue graft compared with connective tissue graft… PMID:32382922 | 2020 | this review only | not stated | not extracted yet |
| Gorski 2022 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Gorski 2023 Tunnel technique with cross-linked hyaluronic acid in addition to subepithelial connective tissue graft, compared with connective tissue… PMID:36735090 | 2023 | this review only | not stated | not extracted yet |
| Lakshmi 2023 Clinical outcomes of root coverage using porcine-derived collagen matrix with modified coronally advanced tunnel technique (MCAT) in… PMID:36057652 | 2023 | this review only | not stated | not extracted yet |
| Ozcelik 2011 Treatment of multiple gingival recessions using a coronally advanced flap procedure combined with button application. PMID:21443557 | 2011 | this review only | not stated | not extracted yet |
| Pelekos 2019 Aesthetic assessment after root coverage of multiple adjacent recessions with coronally advanced flap with adjunctive collagen matrix or… PMID:30868622 | 2019 | this review only | not stated | not extracted yet |
| Potey 2019 Coronally advanced flap with and without platelet-rich fibrin in the treatment of multiple adjacent recession defects: A randomized… PMID:31543617 | 2019 | this review only | not stated | not extracted yet |
| Rajeswari 2021 Patient-centered comparative outcome analysis of platelet-rich fibrin-reinforced vestibular incision subperiosteal tunnel access technique… PMID:34393403 | 2021 | this review only | not stated | not extracted yet |
| Rotundo 2021 Smile esthetic evaluation of mucogingival reconstructive surgery. PMID:32772215 | 2021 | this review only | not stated | not extracted yet |
| Santamaria 2023 Multiple gingival recessions associated with non-carious cervical lesions treated by partial restoration and modified coronally advanced… PMID:36636760 | 2023 | this review only | not stated | not extracted yet |
| Zangrando 2021 Clinical and patient-centered outcomes using two types of subepithelial connective tissue grafts: A split-mouth randomized clinical trial. PMID:32997816 | 2021 | this review only | not stated | not extracted yet |
| Zucchelli 2009 Coronally advanced flap with and without vertical releasing incisions for the treatment of multiple gingival recessions: a comparative… PMID:19563288 | 2009 | this review only | not stated | not extracted yet |
| Zucchelli 2014 Coronally advanced flap with and without connective tissue graft for the treatment of multiple gingival recessions: a comparative short-… PMID:24382170 | 2014 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Systemically healthy adults (>=18 years) with two or more adjacent gingival recessions (Miller I-III or RT1/RT2); single and multiple recessions combined analyses excluded | Patients with multiple gingival recessions (1012 patients, 3589 defects; 32 RCTs) |
| Intervention | Any surgical root coverage procedure: coronally advanced flap (CAF), tunnel (TUN), free gingival graft (FGG), VISTA, pinhole surgical technique (PST), with adjunctives (autogenous grafts, graft substitutes, collagen matrices, acellular dermal matrices, biologic agents) | CAF (18 studies), TUN (about 20 studies), VISTA (3), PST (1), FGG (1), each with or without ATG, graft substitute, biologic agent or other adjunctives |
| Comparison | Any possible comparison between surgical interventions for root coverage | No pooled head-to-head comparison; between-technique contrasts restricted to subgroup analyses of single-arm pooled estimates |
| Outcomes | Primary: professionally determined esthetic scores and patient esthetic perception and satisfaction (PROMs). Secondary: root sensitivity, postoperative morbidity and complications, mean and complete root coverage, residual recession, keratinized tissue gain, gingival thickness, clinical attachment level | RES (22 studies, 43 arms); patient esthetic VAS (16 studies, 32 arms); MRC (26 studies); CRC (30 studies); recession reduction (30); KT change (30); GT change (19); CAL change (28); postoperative pain VAS 0-10 (9) and 0-100 (5) |
| Study designs | Randomized controlled trials and case series with at least 10 patients per arm; English language | 32 RCTs (24 parallel, 11 split-mouth by the review count); no case series retrieved |
| Timing | Minimum follow-up of 6 months | 6 to 12 months for most; longer follow-up 16 months, 18 months, 3 years and 5 years in four reports |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | NRSI: N/A · RCT: Yes | RCT: Yes | no |
| 10Funding of included studies reported | Yes | Yes | yes |
| 11Appropriate meta-analysis methodscritical | NRSI: N/A · RCT: No | RCT: No | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |