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Clinical effectiveness of periosteal pedicle graft for the management of gingival recession defects—a systematic review and meta-analysis

Evidence-Based Dentistry volume 24, pages 93–94 (2023)Cite this article

Subjects

Abstract

Objective

The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of periosteal pedicle graft (PPG) in terms of root coverage and patient related outcomes. To the best of our knowledge this is the first systematic review with meta-analysis on PPG.

Material and methods

A comprehensive search was performed using electronic and hand searches upto January 2023. Primary outcomes were Recession depth Reduction (Rec Red), mean root coverage (mRC) and complete root coverage (CRC). Secondary outcomes were gain in width of keratinized gingiva (WKG) and patient reported outcome measures (PROMs). Meta-analysis was performed when possible. The risk bias assessment was done using RevMan5.4.1 and Joanna Briggs institute scale for the included RCTs and case series respectively.

Results

A total of 8 RCTs and 2 case series (538 recession sites) were included based upon the predefined inclusion and exclusion criteria. The follow up period ranged from 6 months to 18 months. Results demonstrated that mRC of PPG + Coronally advanced flap (CAF) was 87.7% for localized gingival recession defects (GRDs) and 84.83% for multiple GRDs. An overall gain in WKG (Weighted Mean =1.49 ± 0.27 mm) was observed among all the included studies in the PPG + CAF group with mean difference (−0.10 (95% CI [−0.52, 0.33], p = 0.66)). Sub-group meta-analysis comparing PPG + CAF with sub-epithelial connective tissue graft (SCTG) + CAF resulted in similar outcomes in terms of Rec Red (0.10 (95% CI [−0.56 to 0.77], p = 0.76)) and gain in WKG (−0.03 (95% CI [−0.25 to 0.18], p = 0.76)). In terms of PROMs systematic review revealed better patient satisfaction with PPG + CAF than SCTG + CAF.

Conclusion

PPG + CAF is a viable treatment modality for management of GRDs. The primary and secondary outcomes achieved utilizing PPG + CAF were found to be comparable to other conventional techniques including the gold standard i.e., SCTG.

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Fig. 1: Prisma Flowchart.
Fig. 2: Bias risk assessment of the included RCTs.
Fig. 3: Meta-analysis of PPG and other root coverage procedures for assessing primary outcome.
Fig. 4: Meta-analysis for assessing secondary outcomes.

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Authors and Affiliations

  1. Department of Periodontology, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India

    Ajay Mahajan, Kanwarjit Singh Asi, Monika Shekhar Walhe & Nidhi Chandel

  2. All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab, India

    Lata Goyal

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Contributions

AM: Conceived and designed the analysis, collected the data, contributed to data analysis, wrote and edited the manuscript. LG: Collected the data and corrected the manuscript. KSA: Collected the data and corrected the manuscript. MSW: Contributed to data analysis and wrote the manuscript. NC: Contributed to data analysis and wrote the manuscript.

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Correspondence to Ajay Mahajan.

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Mahajan, A., Goyal, L., Asi, K.S. et al. Clinical effectiveness of periosteal pedicle graft for the management of gingival recession defects—a systematic review and meta-analysis. Evid Based Dent 24, 93–94 (2023). https://doi.org/10.1038/s41432-023-00898-0

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