The concepts of evidence-based periodontal plastic surgery: Application of the principles of evidence-based dentistry for the treatment of recession-type defects

The decision-making process for the treatment of recession-type defects is based on translation of the outcomes from randomized controlled trials and systematic reviews to clinical practice. Such an approach is capable of assisting researchers, clinicians, and patients to understand the mechanisms and effects of the treatment of different root-coverage procedures, as well as turning treatment options into usable and predictable tools to be applied in dental practice. This review explores: (a) the aspects related to the etiology of gingival recession; (b) the history of periodontal plastic surgery procedures used to achieve root coverage; (c) the main findings, implications of research, and practice of root-coverage procedures described from the current base of systematic reviews; (d) the role of the evidence produced in Latin American research centers; and (e) the outcomes of an individual patient data meta-analysis of randomized controlled trials evaluating the role of root coverage and restorative procedures in achieving complete root coverage of noncarious cervical lesions. The findings of the current base of evidence clearly indicate that all of the main periodontal plastic surgery procedures lead to improvements in initial clinical parameters, but subepithelial connective tissue grafts, either alone or associated with coronally advanced flaps, result in superior complete root coverage, long-term stability, and greater increase of keratinized tissue. Nonetheless, coronally advanced flaps, either associated with biomaterials (acellular dermal matrix grafts, enamel derivative proteins and xenogeneic collagen matrix) or used alone, provide satisfactory results and are suitable for use as secondary/alternative procedures to subepithelial connective tissue grafts.