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Ann Periodontol
Surgical Therapies for the Treatment of Gingival Recession.

A Systematic Review
Thomas W. Oates,* Melanie Robinson,* and John C. Gunsolley
* Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
Department of Periodontics, Baltimore College of Dental Surgery, University of Maryland, Baltimore, Maryland.
Background: A variety of soft tissue augmentation procedures directed at root coverage have been documented in the literature utilizing autogenous or allogenic soft tissue grafting or guided tissue regeneration
(GTR).
Rationale: The purpose of this systematic review was to assess the literature regarding the efficacies of
various surgical gingival augmentation procedures relative to clinical and patient-oriented outcomes.
Focused Question: What is the effect of surgical therapy for root coverage in patients with gingival recession compared with other treatment modalities or baseline values?
Search Protocol: PubMed and the Cochrane Oral Health Group Trials Register were searched to identify
human studies in English investigating the therapeutic use of a soft tissue surgical procedure to treat gingival recession. Searches were performed for articles published by April 2002.
Selection Criteria: Initial screening of identified abstracts accepted all studies evaluating surgical intervention of gingival recession. Independent review by 2 reviewers evaluated full-text reports regarding study
characteristics. Only those studies determined to be randomized clinical trials (RCTs) were included in the
final analysis.
Data Analysis and Collection: Outcome measures included changes in root coverage, clinical attachment
levels (CAL), probing depth (PD), and width of keratinized tissue (KT). The only data suitable for metaanalysis were comparisons of the efficacy of connective tissue grafts with GTR.
Main Results
1. Thirty-two articles (total study population: 687) met the criteria for RCTs: 11 (population: 286) related to
various autogenous soft tissue augmentation procedures; 18 (population: 360) to GTR; and 3 (population: 41)
to allogenic soft tissue augmentation.
2. Meta-analysis identified greater gains in both root coverage and keratinized tissue width for connective
tissue graft procedures compared to GTR.
3. No other data were compatible with meta-analysis.
Reviewers Conclusions
1. Soft tissue augmentation procedures are effective means of obtaining root coverage.
2. Connective grafting techniques appear to have an advantage over GTR.
3. There is a need for further efficacy studies and for investigation of these procedures relative to patientoriented outcomes such as esthetics, root sensitivity, and postoperative morbidities.
Ann Periodontol 2003;8:303-320.
KEY WORDS
Grafts, soft tissue; guided tissue regeneration; tooth root/surgery; periodontal diseases/surgery;
review literature; meta-analysis.
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Surgical Treatment of Gingival Recession
BACKGROUND
Periodontal therapy has historically been directed primarily at the elimination of disease and the maintenance
of a functional, healthy dentition and supporting tissues.
However, more recently periodontal therapy, consistent
with dental therapy in general, is increasingly directed
at esthetic outcomes for patients, which extend beyond
tooth replacement and tooth color to include the soft
tissue component framing the dentition.
Probably one of the most common esthetic concerns associated with the periodontal tissues is gingival
recession. Gingival recession may be associated with
anatomic factors, inflammatory conditions, or trauma.
The progression of recession defects warrants both the
investigation of etiologic factors and the consideration
of therapeutic actions directed at minimizing the progression of the apical movement of the gingival margin.
In many cases, these therapies directed at stopping
the progression also enhance the esthetic appearance
of the tissues. Root surface exposure resulting from
gingival recession may also produce hypersensitivity;
that is, a region of heightened temperature or tactile
sensitivity along the exposed root surface. Covering
the exposed root surface may decrease these symptoms. Additionally, there may be circumstances where
recession defects create anatomic contours or a lack
of keratinized tissue limiting proper plaque removal.
Any of these indications, including esthetics, progression of the defect, hypersensitivity, or difficulties with
oral hygiene may support the use of periodontal plastic
surgical procedures.
Periodontal plastic surgery includes periodontal
surgical procedures performed to prevent, correct, or eliminate anatomical, developmental, traumatic, or plaqueinduced disease-related defects in the gingiva or alveolar
mucosa.1 The adoption of the plastic surgery terminology in itself suggests the increasing importance of
the supporting tissues in the esthetics of the dentition.
There are multiple periodontal plastic surgery approaches documented in the literature for the treatment
of gingival recession defects. These treatment approaches generally include the manipulation of the patients
tissues to augment the soft tissues and cover the
exposed root surface. Flap positioning allows for the
maintenance of a vascular blood supply to the tissue,
whereas a complete removal of autogenous graft tissue
from intact vascular support to a distinct location
requires the reformation of vascular supply to the grafted
tissue. These grafting procedures may also take advantage of tissues procured in an allogeneic manner. More
recently, the use of guided tissue regeneration (GTR)
techniques have been utilized in re-establishing soft
tissue dimensions over areas of recession. Each of these
treatment approaches has been documented in the
literature as having therapeutic benefit. There are multiple surgical techniques, materials, and root surface
304
Volume 8 Number 1 December 2003
modification variables that may be considered, which

complicate investigations relating to the effectiveness of
these various approaches.
RATIONALE
The treatment options for soft tissue augmentation of
gingival recession defects have been documented in
numerous case reports and clinical investigations. A
recent comprehensive review of this literature initially
considered 590 articles related to this topic, selecting
216 for review.1 This review failed to identify any significant treatment advantages of one surgical approach
over the others. With the current trend toward evidencebased assessments of treatment, it becomes increasingly important for us to consider therapeutic outcomes
relative to currently accepted treatment approaches.
With the extensive literature available, it is difficult to
assimilate these various studies into a meaningful policy. One approach toward achieving this assimilation
of a large number of investigations is to perform a
prospective, systematic review of the literature using
well-defined criteria for inclusion of reports in the final
considerations.
FOCUSED QUESTION
The purpose of this prospective systematic review was
to assess the effectiveness of periodontal plastic
surgery procedures in treating patients with gingival
recession. Specifically, this assessment was to answer
the following question: What is the effect of surgical
therapy for root coverage in patients with gingival
recession compared with other treatment modalities
or baseline values?
SEARCH PROTOCOL
Data Sources and Search Strategies
Initially, all identified references collected from 2 databases (PubMed, NCBI, National Library of Medicine
and the Cochrane Oral Health Group) were screened
to include only those human studies written in the English language investigating the therapeutic use of a
soft tissue surgical procedure in the treatment of gingival recession.
Search Strategy
Database searches were conducted to identify studies
with or as the connector between the following terms:
gingival recession, gingival augmentation, mucogingival defect, mucogingival surgery, gingival graft, root
coverage, and connective tissue graft. Publication cutoff date was April 2002.
Inclusion criteria: Inclusion of articles was based on
a careful review of the study title and abstract as to meeting the following eligibility criteria: human study, English
language, and therapeutic study including the use of a
gingival surgical procedure to treat gingival recession.
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Exclusion criteria: Reports clearly not meeting inclusion criteria were excluded, otherwise articles were
considered in a secondary review.
Screening Procedures
Preliminary screening of identified studies included an
independent assessment by the primary reviewer (TWO).
Review of these references was based on title and abstract information.
Secondary review of all identified references, conducted in an independent manner by the primary
(TWO) and secondary (MR) reviewers, involved the
review of full text versions of the studies identified in
the initial screening. Each reviewer independently
assessed studies for qualitative characteristics using
a standardized assessment form (Fig. 1). All studies
excluded by both reviewers were excluded from further
consideration. Disagreements between examiners were
resolved following joint review and discussion by the
examiners. Only studies determined to be randomized
controlled clinical trials (RCTs) were considered in the
final analysis.
Oates, Robinson, Gunsolley
Study participants: Studies included subjects having identified gingival recession defects of the soft tissue margin exposing the root surface of a tooth.
Interventions. Surgical therapy interventions included
all surgical therapies aimed at treating gingival recession defects and specifically included the use of autogenous and allogeneic soft tissue grafts and guided
tissue regeneration procedures.
Outcomes: Primary outcome measures included
patient attitude toward defect, procedures, and results,
including changes in esthetics, root surface sensitivity,
and therapeutic morbidity. Additionally, surrogate measures included percentage of sites with complete root
coverage, changes in gingival recession, probing depth
(PD), clinical attachment levels (CAL), and amount of
keratinized tissue.
Data Collection and Analysis

Quality appraisal. Studies were evaluated for randomization, masking, inclusion of control comparisons, and
follow-up of subjects.
Analysis. Study summary statistics included therapeutic modality, follow-up
period, number of patients/
I. Study Design:
teeth, pretreatment defect
________ Randomized controlled clinical trial (RCT)
dimensions, changes in defect
________ Case-control (observational with control group)
dimensions and/or root cover________ Case series (observational-no control group)
age, residual PD, changes in
CAL and gingival margin posiII. Study Criteria: (need both of these: check if yes or not sure)
tions, and subject assessments
________ Human
of changes in esthetics or tooth
________ Therapeutic for gingival recession/root coverage
sensitivity.
III. If steps I and II above are met, proceed below:
Study groupings were based
on therapeutic modalities inves1. What was test treatment?
____________________
tigated, outcomes measured,
2. What was control treatment?
____________________
and quality of studies. Identifi3. Was it randomized?
________ Yes
________ no
________ unsure
cation of 3 or more randomized
4. Method of randomization listed?
________ Yes
________ no
________ unsure
controlled clinical studies com5. Patients masked?
________ Yes
________ no
________ unsure
paring the same therapeutic
6. Therapists masked?
________ Yes
________ no
________ unsure
7. Examiners masked?
________ Yes
________ no
________ unsure
modalities were considered for
8. Method of masking adequate?
________ Yes
________ no
________ unsure
meta-analysis based on com9. Prospective assessment?
________ Yes
________ no
________ unsure
mon outcome measures and
10. Retrospective assessment?
________ Yes
________ no
________ unsure
levels of study quality.
11. Sequential cases?
________ Yes
________ no
________ unsure
The only study information
12. All cases accounted for?
________ Yes
________ no
________ unsure
that was appropriate for meta13. Outcome Measures Included:
analysis was a comparison of
Defect types: _________________
________ Change in keratinized tissue
the efficacy of connective
______ Number of subjects
________ Number of sites
tissue (CT) grafts with guided
______ Follow-up period
________ Number of teeth/patient
tissue regeneration procedures
______ Pretreatment defect dimensions ________ Change in defect dimension
(GTR). The outcome variables
______ Changes in root coverage
________ Residual CAL/PD
______ Changes in CAL/PD:
________ Changes in gingival margin
assessed were amount of root
coverage gained and keraSubject assessments of: ________ esthetics ________ sensitivity ________ other
tinized tissue. Heterogeneity of
results between studies was
Figure 1.
also assessed. The data were
Form used for full article screening.
analyzed using a standardized
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Page 306
difference as described by Fleiss.2 The results were

checked with both a fixed effects model and a random effects model and the results were consistent. To
test for heterogeneity both Cohens d (unadjusted) and
Hedgess g (adjusted) were used.3,4 Both tests had to
be nonsignificant to support the lack of heterogeneity.
RESULTS
Initial application of described search strategies resulted
in the identification of 1,434 reports that were eligible for
screening. Initial screening by the primary reviewer identified 139 articles appropriate for full review by both
reviewers.5-143 Of these 139 articles, 32 were selected
based on the criteria above for inclusion in this systematic review, with all but 2 articles included without discussion between reviewers to reach agreement. Of the
32 articles under review, 1110,33,36,41,62,63,70,76,78,86,110
evaluated autogenous soft tissue grafting procedures,
including coronally advanced flap procedures with or
without free tissue augmentation, free gingival grafts,
and connective tissue grafts using several technical
approaches (Table 1). These studies were so
inconsistent on the basis of interventions for both the
experimental group and the control group that there
were virtually no 2 studies alike. For that reason there
was no quantitative analysis of the data. Eigh-
teen12,13,20,21,24,25,28,32,34,44,46,49,52,53,68,72,74,87 of the 32
articles evaluated GTR procedures aimed at soft tissue
augmentation. These studies evaluated both bioabsorbable and non-resorbable materials (Table 2, page
308). The 3 remaining studies9,14,18 evaluated the use
of allogeneic soft tissue grafting materials (Table 3, page
310). The studies evaluated the effects of these various
therapies from 3 months postsurgically to as long as 6
years. As may be expected, those studies with the
longest follow-up period also had the greatest ranges in
evaluation periods. The most consistent comparison
among the studies was a control group of a connective
tissue graft compared to a therapeutic group of GTR (9
studies9,12,13,14,34,44,49,52,53 evaluated). A meta-analysis of this comparison was done (Fig 2, page 312.)
Quality Assessment of Studies
Overall, evaluation of the quality of the studies was
very difficult due to the failure of many reports to
provide sufficient information allowing for accurate
assessment. Eleven of the 32 studies reported masked
examiners and 5 studies clearly utilized sequentially
enrolled subjects (see Tables 1, 2, and 3).
Only randomized studies were included for this analysis. Methods of randomization for these studies varied
from no mention of methods of randomization (but were
Table 1.
Autogenous Grafting Procedures*
Reference
Defect Type
Intervention
N
Subjects
N
Defects
Examiner
Blinded?
Sequential
Cases
Test
Controls
Borghetti & Louise76 1994
Miller I-III
15
30
CTG/double papillae
None
Bouchard et al.62 1997
Miller I-II
30
30
CTG/CPF + TET
CTG/CPF + CA
Kennedy et al.110 1985
Mean rec = 1.1

Mean rec = 1.0
32
64
FGG
None
Jahnke et al.86 1993
Miller I-II
10
20
CGT/envelope
FGG (thick)
11
22
CPF-TET + fibrin glue
CPF/TET; no
fibrin glue
Trombelli
et al.70
1996
Paolantonio et al.63 1997
Miller I-II
70
70
CTG/CPF
FGG
Cordioli et al.10 2001
Miller I-II
31
62
CTG-envelope
CTG/CPF
Pini Prato et al.41 1970
Miller I-II >2 m
10
20
CPF + root polishing
CPF + root planing
Caffesse et al.33 2000
Miller I-II
36
36
CTG/CPF + citric acid CTG/CPF; no CA
Miller I >2 m
11
22
CPF + tension
CPF; no tension
Bouchard et al.78 1994
Miller I-II
30
30
CTG/CPF
CA; no EPI collar
No CA + EPI collar
CTG/CPF
* Only RCTs are included in this review; therefore, in accordance with previously reported classifications, all studies are ranked 1 (highest).144
Yes (Y) or no or unsure (N).
Abbreviations: CA = citric acid; CPF = coronally positioned flap; CTG = connective tissue graft; EPI = epithelial; FGG = free gingival graft; TET = tetracycline.
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included as a randomized study as long as suggestion

of randomization was made in article) to complete randomization methodology descriptions. Of the 32 studies
considered here, 17 failed to report some mechanism
of randomization, and only 9 presented appropriate randomization mechanisms.12-14,24,33,41,49,72,86
Subjective Evaluation of Therapies
Seven of the 32 articles considered a subjective evaluation of the results regarding esthetics, root sensitivity, or patient preferences for individual procedures
(Table 4, page 313).12-14,28,72,78,87 There was no standardization in the format of the results or in the methodology of these assessments. The findings ranged from
general preference queries to the patients in split-mouth
studies, to masked examiner assessments of procedures using a 4-point categorical assessment tool. The
variability of the methods of assessment for these
patient-oriented outcomes precluded our formal analysis of the results. However, evaluating the reported
outcomes for each of these reports, there appeared to
be consistent improvement of symptoms and esthetic
concerns following root coverage procedures.
Objective Evaluation of Therapies
The only therapeutic comparisons providing information appropriate for meta-analysis were efficacy studies comparing autogenous connective tissue grafting
with GTR or allogeneic graft procedures for the coverage of recession defects (Fig. 2). This comparison
lent it self to meta-analysis since there were a sufficient
number of studies (9) and the studies had 2 consistent
outcome measures, change in keratinized tissue and
change in recession.
In evaluating the gain in root coverage between connective tissue (CT) grafts with GTR or allogeneic grafts,
CT grafts had significantly (P = 0.012) greater gains in
root coverage than did these other procedures. CT grafts
had a mean (SD) gain of 2.90 mm (1.10) compared
with a mean (SD) gain of root coverage of 2.56 mm
(1.09) for the GTR with bioabsorbable membranes. A
comparison of 2 studies using non-resorbable membranes found a similar relationship, with CT grafts providing a greater gain in root coverage than the GTR
procedures.52,53 In these studies, CT grafts produced
4.20 mm (0.90) gain in root coverage, compared with
a mean gain of 3.80 mm (0.75) for GTR. The metaanalyses of these data are difficult to interpret. For the
combined group of studies with bioabsorbable membranes and allogeneic grafts, there was a statistically
significant (P = 0.041) difference between the 2 treatment groups. For the non-resorbable studies, the difference was not statistically significant (P = 0.309), but
since there were only 2 studies with small sample sizes,
there was not sufficient statistical power to find a difference. The test for heterogeneity was also significant,
thus the results of these studies were inconsistent and

it can be argued that they should not have been combined. However, 5 of these studies do show a trend
favoring CT grafts, with 2 studies having a neutral effect,
and only one using allogeneic grafts9 favoring the alternative treatment.
In evaluating the gain in width of keratinized tissue
comparing connective tissue (CT) grafts with GTR or
allogeneic grafts, 7 of the previously mentioned studies had data which could be evaluated (Fig. 3, page
313).9,12,14,44,49,52,53 CT grafts had significantly greater
(P = 0.002) gains in keratinized tissue than did these
other procedures. This difference is evident in the metaanalysis as all the studies considered favored CT grafts
regarding gains in KT. CT grafts had a mean gain of
1.33 mm (1.19) compared to a mean gain of keratinized tissue of 0.48 mm (1.03) for the GTR using
bioabsorbable membranes. A similar comparison with
2 studies using non-resorbable membranes found a
similar relationship with CT grafts providing a greater
gain in keratinized tissue than the GTR procedures.52,53
In these studies, CT grafts produced 2.30 mm (0.90)
gain in KT, compared with a mean gain of 0.50 mm
(1.01) for GTR. However, this difference was not statistically significant (P = 0.158) due to the heterogeneity
and small number of studies under consideration. The
analysis of the data was similar to the previous analysis
with a significant (P <0.05) difference for the bioabsorbable membranes or allogeneic grafts providing less
keratinized tissue than the connective tissue groups.
The test for heterogeneity was again statistically significant. However, in this case the reason for the inconsistence was that the gains for the connective tissue grafts
varied in the degree by which the connective tissue
grafts outperformed the GTR approach. Since all of
the 7 studies favored the connective tissue grafts, the
studies were combined and the subsequent metaanalysis supported the superiority of the connective
tissue graft.
GTR Procedures
Overall, this review identified 18 studies in which GTR
procedures were assessed for treatment of gingival
recession defects. The GTR procedures in these studies
utilized either bioabsorbable or non-resorbable materials. The comparative treatments in these studies included either autogenous tissue grafting procedures
or alternative GTR membranes. In addition to metaanalysis, observations were made regarding clinical
attachment levels and probing depths for all studies
presenting appropriate data. Evaluation of mean root
coverage for 17 of these 18 studies utilizing GTR procedures found 76.4 (11.3)% root coverage, with 100%
root coverage at 33.1 (20.4)% of the sites. These findings compare with various autogenous grafting procedures which served as controls with mean root cov307
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Table 2.
GTR Procedures*
Reference
308
Defect Type
N Subjects
N Defects
Examiner
Masked?
Sequential Cases?
Tatakis & Trombelli34 2000
Miller I, II; 2 mm
12
24
Amarante et al.32 2000
Miller I, II; 3 mm
20
40
Borghetti et al.44 1999
Miller I; 2 mm
14
28
Romagna-Genon13 2001
Miller I, II
21
42
Dodge et al.21 2000
Miller I, II; 3 mm
12
24
Ito et al.20 2000
Miller I, II; 4 mm
Miller I, II; 3 mm
50
50
Jepsen et al.52 1998
MIller I, II
15
30
Zucchelli et al.53 1998
Miller I, II; 5 mm
54
54
Trombelli et al.49 1998
Miller I, II
12
24
Trombelli et al.74 1995
Miller I, II; 4 mm
16
Rosetti et al.28 2000
Miller I, II; (3-5 mm)
12
24
3 mm
50
50
Wang et al.12 2001
Miller I, II; 3 mm
16
32
Duval et al.25 2000
Miller I, II; 3 mm
14
17
Modica et al.24 2000
Miller I, II
12
14
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Table 2. (continued)
GTR Procedures*
Mean Results
Interventions
Test
Controls
GTR/Bioab (PLA)
Study
Root
Duration Coverage
(months)
mm
2.1
2.2
0
0.3
0.7
0
2.7
2.6
56
69
25
50
1.3
1.5
0.7
0.2
0.5
0.4
2.89
2.89
70
76
29
29
2.88
2.73
0
0.22
2.8
3.3
75
85
3.31
3.09
0.61
0.11
12
3.38
90
50
3.29
0.08
2.85
74
33
2.19
0.67
2.25
12
2.5
3.13
74
86
3.75
3.38
1.25
0.25
0.12
5.75
18
4.12
3.62
73
71
5.12
3.56
1
0.06
0.56
5.32
12
3.1
87
47
0.1
1.5
3.1
87
47
3.1
0.1
2.5
12
4.9
4.5
5.3
86
81
94
39
28
66
4.9
4.7
4.7
0.02
0.11
0.47
0.7
0.6
3.1
1.6
2.5
48
81
8
50
1.7
2.3
0.1
0.2
.8
1.8
67
13
3.6
0.6
1.1
2.6
60
13
2.6
0.1
0.9
2.63
84
1.41
1.5
3.96
96
0.84
3.5
48
4.2
3.8
73
72
5
3.9
0.8
0.05
1.8
5.2
2.5
2.8
73
84
2.8
2.3
0.3
0.4
0.7
1.1
2.75
82
0.88
90
0.88
3.36
2.7
91
81
GTR/Bioab (PLA)
GTR/Non-res (ePTFE)
FGG
GTR/Non-res (ePTFE)
FGG + CPF (2-step)
GTR/Non-res
(TR-ePTFE) + TET
CTG/envelope + TET
GTR/Bioab (Por coll)
GTR/Non-res (ePTFE)
CTG/CPF
GTR/Bioab (PLA/PGA)
CTG/CPF
GTR/Non-res (ePTFE) +
TET/FN/FBN
GTR/Non-res (ePTFE)
GTR/Bioab (coll) +
DFDBA
18
CTG/CPF
GTR/non-res (ePTFE)
FGG + CPF (2-step)
GTR/Bioab (coll)
CTG/CPF
GTR/Bioab (PLA) +
DFDBA
GTR/Bioab (PLA)
CPF + EMD
6
CPF
KT
58
83
CTG/CPF
GTR/Bioab (PLA) +
PLA910 + DFDBA
PD
81
96
CTG/CPF
GTR/Bioab (Por coll)
CAL
2
2.4
CPF (no membrane)

GTR/Bioab (PLA)
100%
6
CTG/CPF
GTR/Bioab (PLA)
Root
Coverage
%
44
44
64
44
3.57
2.79
0.21
0.07
0.43
2.03
0.22
0.07
(continued)
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GTR Procedures*
Defect Type
N Subjects
N Defects
Examiner
Masked?
Sequential Cases?
Roccuzzo et al.72 1996
Miller I, II; 4 mm
12
24
Matarasso et al.46 1998
Miller I, II; >3 mm
20
20
Reference
Abbreviations: Biob = bioabsorbable membrane; Coll = collagen; CPF = coronally positioned flap; CTG = connective tissue graft; DFDBA = demineralized
freeze-dried bone allograft; DPF = double pedicle flap; EMD = enamel matrix derivative; ePTFE = expanded polytetrafluoroetheylene; FGG = free gingival graft;
FBN = fibronectin; FN = fibrin; Non-res = non-resorbable membrane; PLA = polylactic acid; PLA/PGA = polylactic/polygycolic acid- PLA 910 = polyglactin
910- Por coll = porcine collagen; TET = tetracycline; TR = titanium-reinforced.
Table 3.
Allogeneic Soft Tissue Grafts*
Defect
Type
Reference
Novaes et al.9 2001
Miller I, II
N
Subjects
N
Defects
Examiner
Masked?
Sequential
Cases?
30
Interventions
Test
Controls
Allogeneic graft
CTG
Aichelmann-Reidy
2001
et al.14
Miller I, II
2 mm
22
44
Allogeneic graft
CTG against tooth
Henderson
et al.18
2001
Miller I, II
3 mm
10
20
Allogeneic graft +
CPF/basement
membrane
against tooth
Allogeneic graft + CPF/

CT side against tooth
Abbreviations: CPF = coronally positioned flap; CT = connective tissue; CTG = connective tissue graft.
erage of 81.9 (9.8)%, with 42.2 (23.6)% of the sites

having 100% root coverage. Using GTR procedures,
mean (SD) gains in clinical attachment levels were
3.20 (1.14) mm based on 16 of the 18 studies.
Changes in probing depths were minimal for all 18
studies (mean: 0.53 0.41 mm) and may be reflective
of the shallow probing depth identified at baseline
(mean: 1.54 mm).
Autogenous Tissue Grafts
In comparing the studies meeting the criteria set forth
in this analysis, 11 studies were identified in which
310
autogenous tissue grafting procedures were assessed

(Table 1).10,33,35,41,62,63,70,76,78,86,110 These procedures
included connective tissue grafting using various techniques (e.g., coronally positioned, double papillae, or
envelope flap) and adjunctive materials (e.g., fibrin
glue, citric acid, or tetracycline). They also assessed
the levels of tension on the flap and the need for root
planing versus root polishing. None of these studies
allowed for consideration using meta-analysis.
However, observations were made regarding reduction
in recession, clinical attachment levels, probing depths,
and gains in keratinized tissues. Reductions in recession
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GTR Procedures*
Mean Results:
Interventions
Test
Controls
Study
Duration
(months)
Root
Coverage
mm
Root
Coverage
%
3.9
4
12
GTR/Bioab
ePTFE
GTR/Bioab (PLA)
DPF
GRT/Bioab (PLA) +
CPF
Allogeneic Soft Tissue Grafts*

Results
Study
Duration
(months)
6
6
12
Root Coverage
mm
100%
CAL
PD
KT
2.1
1.84
65
62
33
40
0.81
0.92
0.13
0.09
0.63
1.26
1.7
66
1.5
0.2
1.2
2.2
74
1.6
0.6
1.6
3.95
95
70
4.15
0.1
0.8
4.2
95
80
3.65
0.8
defects showed a mean gain of 2.46 (0.61) mm.

When excluding the one and only study110 using free
gingival grafts as a test intervention, with a mean
reduction of 0.3 mm, the mean gain in root coverage
for the remaining 10 studies was 2.68 (0.45) mm.
The mean percentage of root coverage for these 10
studies was 77.9 (10.0)% root coverage, with 100%
root coverage 37.4 (19.4)% for procedures utilizing
connective tissue grafting and/or coronally positioned
flaps. These findings appear favorable compared with
free gingival grafts in 2 studies.63,86 The mean root
coverage was 48.1 (7.2)%, with 9.3 (1.0)% of sites
having 100% root coverage. The mean gain in CAL
level was 2.33 (0.80) mm when considering all 11
100%
CAL
PD
KT
82
83
42
42
4.3
4.4
0.4
0.4
0
0.2
3.4
74
3.1
74
0.3
2.0
2.5
63
2.8
63
0.3
0.9
studies and 2.62 (0.68) mm when excluding the free

gingival graft data. Changes in mean PD were minimal
for all studies, 0.11 (0.32) mm, and may be reflective of the shallow probing depth identified at baseline, 1.33 (0.23) mm. Evaluating the mean gain in
keratinized tissue showed an increase of 1.85 (1.05)
mm, with the free gingival grafting study110 having the
greatest increase (4.9 mm). Excluding this study, the
mean gain in keratinized tissue was 1.52 (0.96) mm.
Allogeneic Tissue Grafts
In comparing the studies meeting the criteria set forth
in this systematic review, 3 studies9,14,18 were identified
in which allogeneic tissue grafting procedures were
assessed (see Table 3). The grafts utilized in each of
these studies were allogeneic dermal connective tissue
matrix grafts. These studies did not allow for consideration using meta-analysis. However, certain
observations were made using the 2 studies in which
autogenous CT grafting was compared,9,14 including
reduction in recession, clinical attachment levels, and
probing depths, and gains in keratinized tissue. Reductions in recession defects using allogeneic grafts
showed a mean gain of 1.90 (0.28) mm and mean
changes in clinical attachment levels of 1.15 (0.49)
mm. This change equaled 65.5 (0.71)% root coverage. This compared with autogenous connective tissue
grafting, in which reductions in recession defects showed
a mean gain of 2.05 (0.18) mm, or 67.3 (6.11)% root
coverage, and a mean change in clinical attachment
level of 1.34 (0.36) mm.9,14 Changes in probing depths
were minimal for all studies, mean increase of 0.19
(0.31) mm, and may be reflective of the shallow mean
probing depth identified at baseline, 1.20 (0.13) mm.
Evaluating the mean gain in keratinized tissue showed
an increase of 0.92 (0.40) mm with allogeneic tissue
311
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Figure 2.
Comprehensive meta-analysis of recession comparing autogenous connective tissue grafting with GTR procedures.
Abbreviations: Coll = collagen; ePTFE = expanded polytetrafluoroethylene; PLA = polylactic acid; PLA/PGA = polylactic/polyglycolic acid; Por coll = porcine
collagen.
grafting compared with 1.35 (0.22) mm in autogenous

connective tissue grafting.9,14
DISCUSSION
The results of the meta-analyses in this review identified
statistically greater reductions in gingival recession and
gains in keratinized tissue utilizing autogenous connective tissue grafts compared with guided tissue regeneration procedures. This result is interesting in that the
identified differences found in this meta-analysis were
based on a series of individual studies in which a significant difference was not detected. Unfortunately,
inconsistencies between studies did not permit similar
analyses of study comparisons between various aspects
of autogenous soft tissue grafting procedures nor
between procedures using allogeneic grafting procedures.
An additional shortcoming with the majority of the
reviewed studies was a general insufficiency in presenting study parameters. In evaluating the studies
meeting our inclusion criteria, there was a minority of
reports that had identified methods of randomization
that were viewed as adequate, such as randomization
lists or coin toss. The majority of the reports did not
identify the method of randomization, but merely noted
that randomization was performed as part of the study
design. Three studies listed as randomized utilized alternating patterns for randomization. These studies, and
those without any specific description of method of randomization, were included in these analyses. Similarly,
312
only 11 studies12,14,18,21,24,28,32,34,36,53,74 reported that

the examiners were masked as to the treatment provided. None of the studies reported any masking of the
patient or the individual providing the therapies. These
deficiencies may be viewed as a limitation of this current analysis of the literature.
The evaluated studies included 2 investigations comparing autogenous tissue grafting to no treatment.44,110
These 2 studies were consistent in demonstrating the
potential for either free gingival grafting or connective tissue grafting to successfully augment keratinized tissue;
however the control conditions demonstrated little change
over extended evaluations as long as 12 to 72 months.
These findings do support the potential for stability with
recession defects having little keratinized tissues.
Soft tissue augmentation procedures have multiple
indications including esthetics, prevention of the progression of the recession defect, hypersensitivity, and
anatomic deficiencies that may affect tissue health.
Treatment based on these indications may be addressed with the goals of obtaining an increased zone
of keratinized tissue and root coverage. It is clear that
these studies demonstrate a wide range of root coverage success. The mean levels of root coverage
obtained were between 73 to 80% for the 3 general
treatment groupings, but the ranges reported from individual studies varied from 48 to 91%, thus raising some
question as to the predictability of these procedures.
One of the most utilized methods in the reviewed studies to quantify this predictability was by measuring the
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Table 4.
Patient Centered Outcomes

Intervention
Reference
Test
Control
Romagna-Genon13
2001
GTR/Bioab
(Por coll)
CTG/CPF
Width of recession defect was reduced more in control than

test defects, all control patients complained of soreness at
donor site
Rosetti et al.28 2000
GTR/Bioab
(coll) + DFDBA
CTG/CPF
Patients satisfied with result (good) for CT graft (80%) and

GTR (82%)
Wang et al.12 2001
GTR/Bioab (coll)
CTG/CPF
Examiner: 15/16 excellent color for GTR; 16/16 excellent or

good color for CT graft
Patient: 14/16 exellcent or good for both treatments
Roccuzzo et al.72
1996
GTR/Bioab
ePTFE
Postoperative pain, swelling, esthetics similar between groups

GTR/bioab preferred due to 1 sx-(No statistics shown)
AichelmannReidy et al.14 2001
Allogeneic
CTG
Both patient and clinician evaluations: significantly greater frequency of excellent appearance scores with allogeneic graft
Pini Prato et al.87

1992
GTR/non-res
(ePTFE)
FGG + CPF
(2 step)
4/25 patients in test group with baseline root hypersensitivity;

0/25 postoperatively
0/25 patients in control group with root hypersensitivity
at baseline and postoperatively
Bouchard et al.78
1994
CTG/CPF
No CA + EPI
collar
CTG/CPF
Examiner: 20/30 had good esthetic result and 10/30

moderate esthetic result
5/30 patients with baseline root hypersensitivity;
0/30 postoperatively
CA; no EPI collar
Results
Abbreviations: Bioab = bioabsorbable membrane; Coll = collagen; CPF = coronally positioned flap; CTG = connective tissue graft; DFDBA = demineralized
freeze-dried bone allograft; EPI = epithelial; ePTFE = expanded polytetrafluoroetheylene; FGG = free gingival graft; Non-res = non-resorbable membrane.
Figure 3.
Comprehensive meta-analysis of gains in keratinized tissue comparing autogenous connective tissue grafting with GTR procedures.
Abbreviations: Coll = collagen; ePTFE = expanded polytetrafluoroethylene; PLA = polylactic acid; PLA/PGA = polylactic/polyglycolic acid; Por coll =
porcine collagen.
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incidence of achieving 100% root coverage following

the tested treatment. The results for percentage of sites
with 100% root coverage varied widely for the 3 treatment groups, from 33 to 52%. The mean ranges
reported within the individual studies varied from 8 to
70%. These ranges suggest there are numerous factors that may influence treatment success using procedures directed at root coverage. Many of the technical and therapeutic factors have been evaluated through
the efforts of individual investigations. However, there is
no single factor or group of factors that have been identified to explain this variance.
Based on the limited assessments of the 7 reviewed
studies in which patient-oriented outcomes were
assessed,12-14,28,72,78,87 each of these surgical options
appears to have positive effects. Three studies
addressed esthetic results12,14,28 and showed definite
improvements with treatment. One study72 found that
there was difference in postoperative morbidities and
esthetics between bioabsorbable and non-resorbable
membranes. The findings of 2 additional studies support the use of these procedures to reduce root hypersensitivity.78,87 Although postoperative discomfort was
demonstrable in study surveys, at least in association
with palatal connective tissue donor sites, the level of
discomfort appears minimal.13,14
The evaluation of these reports in the present
analysis was based on the assessment of soft tissue
augmentation procedures aimed at root coverage.
These procedures were classified as using autogenous or allogeneic tissue graft materials with any of
several manipulative approaches or the use of GTR
procedures. The use of GTR represents an interesting shift in the treatment paradigm for GTR procedures typically associated with intrabony defects
rather than soft tissue defects. From our investigation it is clear that considerable research effort has
gone into investigating the efficacy of this treatment
approach. It is therefore significant that the present
study found the GTR approach did not provide the
same levels of root coverage and gains in keratinized
tissues that are associated with the more traditional
soft tissue augmentation approaches.
It is also of interest to note that this analysis included
a single study utilizing a non-barrier technique in the
GTR group.24 This classification was based on the proposed effects of the enamel matrix protein extract to
stimulate specific patterns of cellular proliferation and
differentiation. This non-barrier GTR study compared
coronally positioned flap surgery with or without enamel
matrix extract treatment and failed to find a significant
difference in percentages of root coverage obtained,
although mean values for percentage of root coverage
were greater with the addition of the extract.24 This finding is consistent with a recent report that compared the
use of the enamel protein extract application or con314
nective tissue grafts in conjunction with coronally positioned flap procedures.145 This study showed that there
was no difference in the amounts of root coverage
obtained between treatment approaches. In addition,
there was less keratinized tissue resulting from this nonbarrier GTR procedure, consistent with our meta-analysis
for GTR procedures using barrier techniques compared
with connective tissue grafting procedures.
In summary, the overall goal of this study to assess
both clinical and patient-oriented outcomes using a prospectively designed systematic analysis was only partially achieved. Wide variations in results obtained and
in techniques utilized impacted on our ability to accomplish this goal. However, this in itself may be a significant finding regarding our current state of knowledge
and the high level of difficulty in effectively synthesizing
reports into clinical decisions. Hopefully, analyses of the
literature such as this will provide guidance for future
studies directed at the evidence-based assessment of
therapy.
REVIEWERS CONCLUSIONS
1. The systematic review of the data demonstrates
there are several surgical procedures that successfully
cover exposed root surfaces. There is evidence that
these surgical procedures result in improved patientoriented outcomes including decreased root sensitivity and enhanced soft tissue esthetics.
2. Meta-analysis identified statistically significant
advantages for autogenous connective tissue grafts
when compared with GTR using bioabsorbable barriers in terms of root coverage and width of keratinized
tissue.
3. A limited number of recent randomized controlled
studies support the efficacy of coronally positioned
flaps with allogeneic soft tissue grafts for root coverage.
4. The studies identified in this systematic review
concerning patient-oriented outcomes lacked standardization of measures, precluding quantitative analysis.
FUTURE DIRECTIONS FOR PRACTICE
AND RESEARCH
1. Future studies designed primarily to investigate
patient-oriented outcomes such as esthetics, hypersensitivity, morbidities, and overall satisfaction are needed.
2. Most of the literature dealing with root coverage
procedures consists of case series and non-randomized
studies. Future well-designed investigations are needed
to further clarify the relative efficacy of different treatment options.
3. Based on the number of studies using autogenous
connective tissue grafts in conjunction with coronally
positioned flap surgery, it is surprising there are no
comparative randomized controlled clinical trials for
this treatment and coronally positioned flap surgery
alone. Future studies are needed to assess the effi-
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cacy of coronally positioned flap procedures in the

presence or absence of connective tissue grafting.
ACKNOWLEDGMENTS
The authors extend their appreciation to Ms. Madgeline
Cluck for her untiring assistance throughout the development of this report.
18.
19.
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report. J Periodontol 1982;53:349-352.
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123. Espinel MC, Caffesse RG. Comparison of the results
obtained with the laterally positioned pedicle sliding
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128. Dorfman HS, Kennedy JE, Bird WC. Longitudinal evaluation of free autogenous gingival grafts. J Clin Periodontol 1980;7:316-324.
129. Liu WJ-L, Solt CW. A surgical procedure for the treatment of localized gingival recession in conjunction with
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gingival graft effectiveness on the maintenance of periodontal health. J Periodontol 1980;51:274-278.
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1979;6:437-442.
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gingival recessions. Part II. Coronally repositioned flap
with a free gingival graft. J Periodontol 1978;49:
357-361.
134. Guinard EA, Caffesse RG. Treatment of localized gingival recessions. Part I. Lateral sliding flap. J Periodontol
1978;49:351-356.
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gingival grafts. J Periodontol 1976;47:574-579.
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repositioned periodontal flap. Clinical evaluation after
one year. J Clin Periodontol 1975;2:1-13.
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observation. J Periodontol 1974;45:274-278.
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Ann Periodontol
141. Ward VJ. A clinical assessment of the use of the free

gingival graft for correcting localized recession
associated with frenal pull. J Periodontol 1974;45:
78-83.
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gingival graft and partial thickness apically positioned
flap. J Periodontol 1974;45:3-8.
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grafts. III. Utilization of grafts in the treatment of gingival recession. Periodontics 1968;6:152-160.
144. Newman MG, Hujoel PP. Statement of purpose and
methods. J Evid Based Dent 2001;1:3A-5A.
145. McGuire MK, Nunn M. Evaluation of human recession
defects treated with coronally advanced flaps and either
enamel matrix derivative or connective tissue. Part 1:
Comparison of clinical parameters. J Periodontol 2003;
74:1110-1125.
Correspondence: Dr. Thomas Oates, Department of Periodontics, University of Texas Health Science Center at San
Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229-3900.
E-mail: oates@uthscsa.edu.
Accepted for publication August 17, 2003.
APPENDIX A
CONSENSUS REPORT
Members of the Section read and studied the review
titled Surgical Therapies for the Treatment of Gingival
Recession. A Systematic Review, by Thomas Oates,
Melanie Robinson, and John C. Gunsolley. The focused
PICO question addressed by this evidence-based systematic review is: What is the effect of surgical therapy
for root coverage in patients with gingival recession
compared with other treatment modalities or baseline
values?
INTRODUCTION
The Section participants declared there were no conflicts of interest regarding the topics to be discussed. The
generated discussions were centered around the evidence-based systematic review as well as 2 previously
published systematic reviews. The Sections extensive
personal clinical experience in the area of periodontal
plastic surgery brought insight, clarity, and clinical relevance to the deliberations. This allowed the participants to integrate individual clinical experience with the
best available evidence.
The deliberations were focused on the PICO question and the data provided by the systematic review.
Decisions were reached after consideration of the
strength of evidence for each of the 5 Consensus
Report questions.
It is important for readers to understand that treatment decisions based on recommendations from this
Section must take into account the expertise of the
clinician, type of lesion presented, and patient treatment needs and desires.
It was not within the scope of the systematic review
to assess elements important in case selection (e.g.,
patient factors, defect morphology, and site characteristics) and the critical aspects of the execution of these
procedures (e.g., flap design and suturing techniques)
in accomplishing optimal root surface coverage. However, these factors may influence specific procedure
selection, outcomes, or decision to treat.
1. Does the Section agree that the evidence-based
systematic review is complete and accurate?
The data review was complete and accurate within the
context of the question posed.
2. Has any new information been generated
or discovered since the evidence-based search
cut-off date?
New information including 2 systematic reviews and
3 RCTs directly relevant to the PICO question was evaluated by the Section.1-5 Two studies compared coronally positioned flaps with either soft tissue allografts
or autogenous connective tissue grafts.3,4 Another
study compared coronally positioned flaps with either
enamel matrix derivative or autogenous connective
tissue grafts.5 The results of these studies were consistent with those included in the systematic review.
3. Does the Section agree with the interpretations
and conclusions of the reviewers?
After assessment of the original evidence, the Section
agrees with the following conclusions:
The systematic review of the data demonstrates
there are several surgical procedures that successfully
cover exposed root surfaces. There is evidence that
these surgical procedures result in improved patientoriented outcomes including decreased root sensitivity
and enhanced soft tissue esthetics.
The studies identified in this systematic review
concerning patient-oriented outcomes lacked standardization of measures, precluding quantitative analysis.
Future studies designed primarily to investigate
patient-oriented outcomes such as esthetics, hypersensitivity, morbidities, and overall satisfaction are needed.
Meta-analysis identified statistically significant
advantages for autogenous connective tissue grafts when
compared with GTR using bioabsorbable barriers in
terms of root coverage and width of keratinized tissue.
A limited number of recent randomized controlled
studies support the efficacy of coronally positioned
flaps with allogeneic soft tissue grafts for root coverage.
Based on the number of efficacy studies using
autogenous connective tissue grafts in conjunction with
coronally positioned flap surgery, it is surprising that
there are no comparative randomized controlled trials
for this treatment and coronally positioned flap surgery
alone. Future studies are needed to assess the efficacy of coronally positioned flap procedures in the
presence or absence of connective tissue grafting.
319
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Page 320
Most of the literature dealing with root coverage

procedures are case series and non-randomized studies.
Future well-designed investigations are needed to further
clarify the relative efficacy of different treatment options.
4. What further research needs to be done relative
to the focused questions of the evidence-based
review?
The Section members observed that the majority of
published research is focused on clinical measures of
single-tooth gingival recession involving intact root
surfaces. Such research was critical in providing the
evidence of efficacy. The Section identified several
areas of future research needs:
1. More data are needed with relation to the benefit
of root coverage in terms of root abrasion, root sensitivity, root caries prevention, ease of maintenance,
patient comfort, tooth survival, improved function, and
esthetics.
2. More information is also needed to assist in selection of the appropriate treatment options for specific
site characteristics and clinical situations.
3. The Section felt that future research should include
application of cell transplantation, biological mediators,
and appropriate bioactive scaffolds to improve the extent
and predictability of root coverage. Such research should
proceed in parallel with efforts to further refine and evaluate existing techniques and understand the sources of
their variability. As part of these investigations the
histologic nature of the wound healing process should
be identified.
5. How can the information from the evidencebased review be applied to patient management?
A. There is evidence to indicate that several surgical
procedures are effective in the coverage of an exposed
root.
Level of Evidence:6 Strong.
Rationale: Assignment of this level of evidence is
based on the current systematic review (31 independent
RCTs) and 2 independent systematic reviews reaching
similar conclusions.
B. There is evidence to indicate that coronally positioned flaps with autogenous connective tissue grafts
result in greater root coverage and increase keratinized
tissue compared to GTR procedures using bioresorbable
membranes.
Level of Evidence: Strong.
based on a meta-analysis of 6 RCTs in the current systematic review and was consistent with a second systematic review.
C. There is evidence to indicate that root coverage
procedures result in decreased root sensitivity and
improved esthetics.
320
Level of Evidence: Moderate.

based on the current systematic review (7 RCTs) and
a recent RCT.5
D. There is evidence to indicate that coronally positioned flaps with allogeneic soft tissue grafts result in
similar root coverage as coronally positioned flaps with
autogenous connective tissue.
Level of Evidence: Moderate.
based on the current systematic review (2 RCTs) and
2 recent RCTs.3,4
E. There is limited evidence that coronally positioned flaps plus enamel matrix derivative (EMD) provides similar root coverage as coronally positioned
flaps with autogenous connective tissue.
Level of Evidence: Limited.
based on a single-center recent RCT.5
REFERENCES
1. Roccuzzo M, Bunino M, Needleman I, Sanz M. Periodontal plastic surgery for treatment of localized gingival recessions: A systematic review. J Clin Periodontol
2002;29(Suppl. 3):178-194.
2. Clauser C, Nieri M, Franceschi D, Pagliaro U, Pini Prato
G. Evidence-based mucogingival therapy. Part 2: Ordinary
and individual patient data meta-analyses of surgical treatment of recession using complete root coverage as the
outcome variable. J Periodontol 2003;74:741-756.
3. Tal H, Moses O, Zohar R, Meir H, Nemcovsky C. Root coverage of advanced gingival recession: A comparative study
between acellular dermal matrix allograft and subepithelial
connective tissue grafts. J Periodontol 2002;73:1405-1411.
4. Paolantonio M. Treatment of gingival recessions by combined periodontal regenerative technique, guided tissue
regeneration, and subpedicle connective tissue graft. A
comparative clinical study. J Periodontol 2002;73:53-62.
5. McGuire MK, Nunn ME. Evaluation of human recession
defects treated with coronally advanced flaps and either
enamel matrix derivative or connective tissue. Part I:
Comparison of clinical parameters. J Periodontol 2003;
74:1110-1125.
6. Newman MG, Caton J, Gunsolley JC. The use of the evidence-based approach in a periodontal therapy contemporary science workshop. Ann Periodontol 2003;8:1-11.
SECTION MEMBERS
James T. Mellonig,
Pierpaolo S. Cortellini
Group Leader
J. Gary Maynard
Maurizio Tonetti, Chair
Michael MacNeil
Donald S. Clem, III,
Michael K. McGuire
Secretary
Kevin G. Murphy
Thomas Oates, Reviewer
Robert G. Schallhorn
Edward P. Allen
Henry H. Takei
Kenneth W. Bueltmann
Raymond A. Yukna

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8012.

Surgical Therapies for the Treatment of Gingival Recession.

Surgical Treatment of Gingival Recession

Volume 8 Number 1 December 2003

modification variables that may be considered, which

Oates, Robinson, Gunsolley

Data Collection and Analysis

Surgical Treatment of Gingival Recession

Volume 8 Number 1 December 2003

difference as described by Fleiss.2 The results were

Autogenous Grafting Procedures*

Borghetti & Louise76 1994

Bouchard et al.62 1997

Kennedy et al.110 1985

Mean rec = 1.1

Jahnke et al.86 1993

CPF-TET + fibrin glue

Paolantonio et al.63 1997

Cordioli et al.10 2001

Pini Prato et al.41 1970

Miller I-II >2 m

CPF + root polishing

CPF + root planing

Caffesse et al.33 2000

CTG/CPF + citric acid CTG/CPF; no CA

Pini Prato et al.36 2000

Bouchard et al.78 1994

included as a randomized study as long as suggestion

Oates, Robinson, Gunsolley

thus the results of these studies were inconsistent and

Surgical Treatment of Gingival Recession

Volume 8 Number 1 December 2003

Tatakis & Trombelli34 2000

Amarante et al.32 2000

Borghetti et al.44 1999

Dodge et al.21 2000

Ito et al.20 2000

Pini Prato et al.87 1992

Jepsen et al.52 1998

Zucchelli et al.53 1998

Trombelli et al.49 1998

Trombelli et al.74 1995

Rosetti et al.28 2000

Miller I, II; (3-5 mm)

Pini Prato et al.68 1996

Wang et al.12 2001

Duval et al.25 2000

Modica et al.24 2000

Oates, Robinson, Gunsolley

CPF (no membrane)

Surgical Treatment of Gingival Recession

Volume 8 Number 1 December 2003

Roccuzzo et al.72 1996

Matarasso et al.46 1998

Miller I, II; >3 mm

Allogeneic Soft Tissue Grafts*

Allogeneic graft + CPF/

erage of 81.9 (9.8)%, with 42.2 (23.6)% of the sites

autogenous tissue grafting procedures were assessed

Oates, Robinson, Gunsolley

Allogeneic Soft Tissue Grafts*

defects showed a mean gain of 2.46 (0.61) mm.

studies and 2.62 (0.68) mm when excluding the free