Esthetical and patient‐reported outcomes after root coverage procedures for multiple gingival recessions: A systematic review and meta‐analysis

Abstract Background Multiple gingival recessions can lead to esthetic impairments and may require surgical root coverage. Esthetic outcome measures can be assessed from both professional and patient perspectives. Several objective and subjective outcome measures have been applied for these evaluations. Aim To systematically review and conduct a meta‐analysis of the available literature on professional esthetic assessments and patient‐related outcome measures (PROMs) following surgical root coverage procedures for the treatment of multiple gingival recessions. Materials and Methods A computerized systematic search was conducted in the MEDLINE (via PubMed), EMBASE, and Cochrane Central Register of Controlled Trials databases up to May 2024 to identify eligible studies meeting the inclusion criteria. Results A total of 32 randomized controlled trials involving 1012 patients and 3589 multiple gingival recessions were included. No case‐series studies meeting the inclusion criteria were retrieved. Meta‐analyses demonstrated that root coverage procedures statistically significantly improved both professionally assessed and patient‐reported esthetic outcomes. The overall weighted mean Root Coverage Esthetic Score (RES) was 8.31 (95% CI: 8.11–8.50), with comparable results across coronally advanced flap (CAF) and tunnel (TUN) techniques, particularly when combined with autogenous connective tissue grafts or graft substitutes. Patient‐reported esthetic satisfaction, measured primarily by visual analog scales (VAS), showed a pooled mean of 8.59 (95% CI: 8.29–8.89). Mean root coverage (MRC) reached 82.6% (95% CI: 71.3–93.9), and complete root coverage (CRC) was 62.7% (95% CI: 57.0–68.4). Statistically significant reductions in recession depth (mean difference = 2.22 mm) and gains in keratinized tissue (0.74 mm), gingival thickness (0.56 mm), and clinical attachment level (2.17 mm) were observed. Postoperative pain was low across techniques (VAS 0–10 mean: 2.67; VAS 0–100 mean: 24.34). Metaregression revealed a positive association between MRC and RES ( R 2 = 0.345) but no significant correlation between MRC and patient esthetic perception ( R 2 = 0.091), underscoring the divergence between clinical and patient‐reported outcomes. Conclusions The results of this systematic review and meta‐analysis, focusing on multiple gingival recessions, suggest that (a) CAF and TUN with the adjunctive use of autogenous graft support esthetic improvement from both professional and patient perspectives and (b) CAF and TUN with the adjunctive use of autogenous graft or graft substitutes are effective in root coverage outcomes with a minimal postoperative morbidity.