Aim: Sup-epithelial connective tissue graft (SCTG) and de-epithelialized gingival graft (DGG) approaches have been investigated with a focus on post-operative morbidity but not from a clinical outcome standpoint. The aim of this systematic review was to systematically investigate the literature for coronally advanced flaps (CAFs) combined with SCTG or DGG. Material and Methods: Electronic and hand searches were performed to identified randomized controlled trials (RCTs) investigating the treatment of gingival recession (GRs) using CAF, with at least a 1-year of follow-up. The primary outcome was the mean root coverage (mRC), while the secondary outcomes included recession reduction (Rec Red), keratinized tissue (KT) gain, probing depth (PD) change, and clinical attachment level (CAL) gain. Results: Ten RCTs with a total of 408 gingival recessions were included. The meta-analysis demonstrated that CAF + DGG is associated with superior mRC, Rec Red, KT gain, PD reduction and CAL gain. The mRC for SCTG and DGG at 1-year was 89.3% and 94.0% respectively, while the mean difference of the other clinical parameters between the two approaches was within 1 mm in favor of the DGG group. Conclusions: Limited evidence is available when comparing the two techniques, however the usage of DGG may be considered as the preferred technique of choice for autologous CTG harvesting when incorporated with a CAF.
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