Title: Comparing surgical techniques for root coverage: Evidence and case selection
Abstract:
Background: Gingival recession can cause root sensitivity and esthetic concerns. Root coverage outcomes depend on defect anatomy, tissue characteristics, and surgical design.
Aim: To compare the clinical indications, expected benefits, and limitations of commonly used root coverage procedures and provide an evidence-informed framework for technique selection.
Overview: This review compares the coronally advanced flap (CAF), CAF with connective tissue graft (CTG), tunnel techniques with CTG, laterally positioned flaps, and graft substitutes, considering root coverage, tissue gain, esthetics, operative burden, and morbidity.
Comparative findings: For single defects without interproximal attachment loss, a network meta-analysis ranked CTG plus CAF among the most effective approaches for mean and complete root coverage and keratinized tissue gain. In multiple adjacent recessions, a multicenter randomized trial found similar six-month coverage with tunnel plus CTG and CAF plus CTG; tunnel surgery was shorter and morbidity lower. These results do not establish one technique as best for all cases because studies vary in defects, grafts, follow-up, and outcome measures. CTG can increase tissue thickness and keratinized tissue but requires a palatal donor site. Substitutes avoid harvesting, though gains may differ by indication. A laterally positioned flap suits a localized defect with adequate adjacent donor tissue.
Clinical relevance: Selection should consider recession type and interproximal attachment, number of defects, papillary integrity, tissue thickness, keratinized tissue, vestibular depth, tooth position, esthetic goals, and donor-site preference. Flap release, graft stabilization, and tension-free coronal positioning support predictable healing.
Conclusion: CAF with CTG is a strong option when predictability and tissue augmentation are priorities. Tunnel approaches offer comparable short-term coverage for multiple defects and may reduce morbidity. Technique selection should be anatomy-led and patient-specific; longer comparative trials are needed.
