Effectiveness of connective tissue graft substitutes for the treatment of gingival recessions compared with coronally advanced flap: a network meta-analysis.

OBJECTIVES This study aimed to conduct a network comparison of the clinical effect of connective tissue graft (CTG) substitutes on the treatment of gingival recessions using coronally advanced flap. MATERIALS AND METHODS An electronic search without language or dates restrictions was performed in five databases and in Grey literature for articles published until May, 2020. The eligibility criteria comprised randomized controlled trials (RCTs) that analyzed the clinical outcomes of CTG substitutes when compared with coronally advanced flap (CAF) for the treatment of Miller class I and II (Cairo RT I) gingival recessions. A pairwise and network meta-analysis were conducted for each periodontal parameters to assess and compare the outcomes among different treatment arms for the primary and secondary outcomes. This systematic review (SR) was registered in INPLASY under number INPLASY202060075. RESULTS Twenty-seven studies were included in the present SR. All analyzed CTG substitutes showed superior results when comparing with CAF alone for all periodontal parameters. However, when compared in a network, the acellular dermal matrix (ADM) demonstrated the best treatment ranking of probability results, followed by platelet-rich fibrin (PRF), enamel matrix derivative (EMD), and xenogeneic collagen matrix (XCM) for root coverage (RC). CONCLUSION This SR observed that the association of biomaterials increases the effectiveness of RC in comparison with CAF alone. Based on the treatment ranking, although all the biomaterials analyzed showed a positive effect for RC, the ADM demonstrated the best results. CLINICAL RELEVANCE To know the effectiveness of CTG substitutes for the treatment of gingival recessions