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Efficacy of microsurgery and comparison to macrosurgery for gingival recession treatment: a systematic review with meta-analysis

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Abstract

Objectives

Microsurgical principles, techniques, and armamentarium have made significant contributions to the periodontal plastic surgery. The present meta-analysis aimed to investigate the overall efficacy of microsurgery on root coverage, and its clinical outcomes when compared to traditional macrosurgery.

Material and methods

Electronic searches on PubMed, Embase, and CINAHL were used to retrieve prospective clinical trials. Primary outcomes were the mean root coverage (mRC) and probability of achieving complete root coverage (cRC), with secondary outcomes as other periodontal parameters and patient-reported outcome measures (PROMs).

Results

Nineteen studies were included in the quantitative analysis. Microsurgery was estimated to achieve 83.3% mRC and 69.3% cRC. From a subgroup of 9 comparative studies, it was estimated microsurgery increased mRC by 6.6% (p<0.001) and cRC by 27.9% (p<0.01) compared to macrosurgical control treatments. Operating microscope (OM) yielded a significantly 6.7% higher mRC than the control group (p=0.002), while using loupes showed 6.16% increase in mRC with a borderline significance (p=0.09). OM and loupes-only had a 31.05% (p=0.001) and 25.54% (p=0.001) increases in achieving cRC compared to control, respectively. As for PROMs, microsurgery reduced postoperative pain (p<0.001) and enhanced esthetics (p= 0.05).

Conclusions

Microsurgery significantly improved mean root coverage, probability of achieving complete root coverage, esthetics, and post-surgical recovery. Microsurgery enhances not only subclinical healing but also clinical outcomes, possibly owing to its minimally invasive approach and surgical precision.

Clinical relevance

Periodontal plastic microsurgery is minimally invasive, inducing less surgical trauma and ultimately resulting in improved clinical outcomes, patient’s satisfaction, and quality of life.

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Acknowledgements

The authors would like to thank Mark MacEachern (markmac@umich.edu; Research & Informatics, Taubman Health Sciences Library, University of Michigan. Ann Arbor, MI, USA) for his supervision on the selection of the controlled vocabularies of the search strategy.

Funding

Drs. H-L Chan and D. Velasquez have received educational funds from Zeiss. No funding was actively pursued for conducting of this study.

Author information

Authors and Affiliations

  1. Department of Periodontics and Oral Medicine, University of Michigan - School of Dentistry, 1011 North University Avenue, Ann Arbor, MI, USA

    Riccardo Di Gianfilippo, I-Ching Wang, Larissa Steigmann, Diego Velasquez, Hom-Lay Wang & Hsun-Liang Chan

  2. Private Practice, 415 North Alloy Drive, Fenton, MI, 48430, USA

    Diego Velasquez

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Contributions

All the authors provided significant contribution to the study. RDG: study design, screening, data extraction, data interpretation, writing. IW: study design, data extraction, statistical analysis, writing. LS: screening, data extraction, writing. DV: study design, data interpretation, writing. HLW: study design, data interpretation, writing. HLC: study design, data interpretation, writing. All the authors approved the last version of the study before submission and agreed to be accountable for all aspects of the work.

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Correspondence to Hsun-Liang Chan.

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Supplementary Information

Supplementary Figure 1:

MeSH terms, key words and Boolean operators were used to conduct electronic searches on Pubmed, Embase and CINAHL databases. MeSH terms were selected based on the controlled vocabularies of the specific databases. Last update was May 10th, 2020. (PDF 62 kb)

Supplementary Figure 2:

Sensitivity test for the mean root coverage of trials comparing micro- and macrosurgery. (PNG 454 kb)

High resolution image (TIFF 2802 kb)

Supplementary Figure 3:

Sensitivity test for complete root coverage reported in trials comparing micro- and macrosurgery. (PNG 329 kb)

High resolution image (TIFF 2398 kb)

Supplementary Figure 4:

Meta-analysis results on keratinized tissue width increase for studies comparing micro- and macrosurgery. (PNG 387 kb)

High resolution image (TIFF 2773 kb)

Supplementary Figure 5:

Meta-analysis results on surgical time in minutes for a subgroup of the four studies comparing micro- and macrosurgery. (PNG 259 kb)

High resolution image (TIFF 1935 kb)

Supplementary Figure 6:

Meta-analysis results on the visual analogue scale for pain perception at 3 and 7 postoperative days, comparing micro- and macrosurgery. (PNG 325 kb)

High resolution image (TIFF 3236 kb)

Supplementary Figure 7:

Meta-analysis results on visual analogue scale for the esthetic outcomes, comparing micro- and macrosurgery. (PNG 205 kb)

High resolution image (TIFF 1696 kb)

Supplementary Table 1:

Assessment of quality and risk of bias for the studies comparing microsurgical vs. macrosurgical approach. Each domain was ranked based on high, low, or not assessable (N/A) risk of bias according to the Cochrane Collaboration's tool for assessing risk of bias. (DOCX 16 kb)

Supplementary Table 2:

Assessment of quality and risk of bias for the studies reporting on magnified/microsurgical procedures without non-magnified control patients. Each domain was satisfied (yes), not satisfied (no), or not assessable (N/A) according to the Joanna Briggs Institute Critical Appraisal tool. (DOCX 21 kb)

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Di Gianfilippo, R., Wang, IC., Steigmann, L. et al. Efficacy of microsurgery and comparison to macrosurgery for gingival recession treatment: a systematic review with meta-analysis. Clin Oral Invest 25, 4269–4280 (2021). https://doi.org/10.1007/s00784-021-03954-0

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