January 2021

Objectives: To compare the outcomes of root coverage when the (1) donor site of connective tissue graft is the palate or tuberosity and (2) when connective tissue graft is harvested with intra- or extra-oral de-epithelization techniques. Methods: The primary outcome was patient satisfaction. Secondary outcomes included complete root coverage, percentage of root coverage and keratinized tissue width. Searches were conducted until December 2019 in PubMed, EMBASE, Scopus and CENTRAL. Results: 3275 studies were retrieved, but no randomized trials (randomized controlled trials) were found comparing tuberosity and palate. Data were extracted for one arm assessing any connective tissue graft technique from 56 randomized controlled trials to compare intra-oral de-epithelization and extra-oral de-epithelization outcomes. Among these studies, none have harvested connective tissue graft from tuberosity. Patient satisfaction for intra-oral de-epithelization and extra-oral de-epithelization ranged between 79% and 95%. Complete root coverage for intra-oral de-epithelization and extra-oral de-epithelization techniques was 55% (95%CI 46-65) and 70% (95%CI 63-77). Metaregression analyzes demonstrated that free gingival graft presented 4.41 higher chance of CRC [odds ratio (OR)=4.41, p=0.001] compared to single incision technique, followed by Bruno’s (OR=4.39) and double-blade (OR=3.85) techniques. There were no differences between de-epithelization techniques for percentage of root coverage and keratinized tissue width. Conclusions: No evidence was found to support the use of connective tissue grafts from the tuberosity. If complete root coverage is the major clinical goal, extra-oral de-epithelization may be preferred over intra-oral de-epithelization techniques.