Review Root-Coverage Procedures for the Treatment of Localized Recession-Type Defects: A Cochrane Systematic Review Leandro Chambrone,* Fla ´via Sukekava,* † Maurı ´cio G. Arau ´jo, † Francisco E. Pustiglioni,* Luiz Armando Chambrone, ‡ and Luiz A. Lima* Background: The purpose of this review is to evaluate the effectiveness of different root-coverage procedures in the treatment of recession-type defects. Methods: The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched for entries up to October 2008. There were no restrictions regarding publication status or the language of publication. Only clinical randomized controlled trials (RCTs) with a duration ‡6 months that evaluated reces- sion areas (Miller Class I or II ‡3 mm) that were treated by means of periodontal plastic surgery procedures were included. Results: Twenty-four RCTs provided data. Only one trial was considered to be at low risk of bias. The remaining trials were considered to be at high risk of bias. The results indicated a sig- nificantly greater reduction in gingival recession and gain in keratinized tissue for subepithelial connective tissue grafts (SCTGs) compared to guided tissue regeneration (GTR) with bioabsorbable membranes (GTR bms). A significantly greater gain in keratinized tissue was found for enamel matrix protein compared to a coronally advanced flap (0.40 mm) and for SCTGs compared to GTR bms plus bone substitutes. Limited data exist on the changes of esthetic conditions as related to the opinions and preferences of patients for specific proce- dures. Conclusions: SCTGs, coronally advanced flaps alone or associated with other biomaterial, and GTR may be used as root-coverage procedures for the treatment of localized reces- sion-type defects. In cases where root coverage and gain in keratinized tissue are expected, the use of SCTGs seems to be more adequate. J Periodontol 2010;81:452-478. KEY WORDS Connective tissue; gingival recession; gingival recession/ surgery; gingival recession/therapy; systematic review; tooth root/surgery. G ingival recession (GR) is a term that designates the oral exposure of the root surface because of a displacement of the gingival margin apical to the cemento-enamel junc- tion. 1-3 Reports from diverse epidemio- logic surveys revealed that GR may affect most of the adult population. 4-6 Gingival anatomic factors, chronic trauma, periodontitis, and tooth align- ment are the main conditions leading to the development of these defects. 2,7-9 GR is also regularly linked to the de- terioration of dental esthetics and buccal cervical dentine hypersensitivity. 10 In such cases, the goal of periodontal therapy should be to address the needs and wishes of each patient, and treatment options should be made available to them. 11 Preferably, treatment options should be based on systematic, unbiased, and objective evaluations of the literature. 12 Moreover, the introduction of specific ob- jectives, inclusion criteria, and search strategies based on evidence and scien- tifically valid information may reduce the variation in clinical outcomes, estab- lish the application and predictability of a specific procedure, and improve the effectiveness of clinical practice. 12 Consequently, scientific evidence-based information should be achieved by well- delineated systematic reviews. 13 Successful treatment of recession- type defects is based on the use of This paper is based on a Cochrane Review 1 published in The Cochrane Library 2009, Issue 2 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library should be consulted for the most recent version of the review. * Division of Periodontics, Department of Stomatology, School of Dentistry, University of Sa ˜o Paulo, Sa ˜o Paulo, SP, Brazil. † Department of Dentistry, State University of Maringa ´ , Maringa ´ , PR, Brazil. ‡ Private practice, Sa ˜o Paulo, SP, Brazil. doi: 10.1902/jop.2010.090540 Volume 81 • Number 4 452