{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T02:04:57Z","timestamp":1790301897171,"version":"4.1.0"},"reference-count":89,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background: Gingival recession (GR) is defined as the exposure of the root surface due to the gingival margin shifting apically from the cemento-enamel junction. Current effective management of defects related to GR relies on root coverage periodontal plastic surgery (RCPPS), using the Modified Coronally Advanced Flap (mCAF) with an envelope design. Recent literature also reported the association of different biomaterials to the mCAF procedure. In light of these considerations, a systematic review (SR) was conducted to determine and compare the efficacy of all mCAF adjunctive techniques for the treatment of multiple adjacent GR-type (MAGR) defects. Methods: An electronic search was conducted in 2025 on studies published between 2013 and 2025, using PubMed, Scopus, Web of Science, and Cinahl Complete, to address the focused question: \u201cwhich is the efficacy of different mCAF adjunctive techniques for the treatment of multiple adjacent GR-type defects, in terms of root coverage (RC), esthetic outcomes, and keratinized tissue (KT) augmentation?\u201d. Randomized controlled trials with a minimum follow-up of 6 months with \u2265 5 patients treated for coverage of MAGR were included. Risk of bias was assessed with RoB 2 Tool. A meta-analysis was performed using RevMan5.4 software and the level of evidence of included studies was analyzed with GRADEPro GDT. Results: A total of 17 studies were included in the SR, 9 of which evaluating mCAF + sCTG (subepithelial connective tissue graft) vs. mCAF adjunctive techniques [Collagen Matrix (CM), xenogeneic acellular dermal matrix (XADM), Platelet-Rich Fibrin (PRF), Enamel Matrix Derivatives (EMD), sCTG harvested double blade scalpel] were then included in the meta-analysis. The primary outcomes of complete root coverage (CRC) and keratinized tissue width variation (\u0394KTW) were statistically significant ([CRC: Odds Ratio (OR) 1.70; 95% CI (confidence interval) 1.18, 2.44; p = 0.004]; [\u0394KTW: SMD (standardized mean difference) 0.37; 95% CI 0.11, 0.63; p = 0.005]) in favor of mCAF + CTG. Meanwhile, no statistically significant difference was observed in terms of RES. The certainty assessment highlighted relevant results: despite the lack of evidence in the long-term, a high level of evidence showed that sCTG was more effective than XADM in terms of CRC (p = 0.002) and \u0394KTW (p = 0.0001). A low level of evidence revealed that sCTG achieved a greater \u0394KTW compared to CM (p = 0.0006). Although no significant differences were observed, a low level of evidence suggested that mCAF + EMD and mCAF + sCTG (DBS) may provide good results. To date, only one RCT showed long-term stable results of CTG in terms of RC. Conclusions: The association of sCTG to mCAF demonstrated better results in terms of RC and KTW augmentation in short- and medium-term follow-ups. Long-term studies are needed to confirm the efficacy of the other mCAF adjunctive techniques, considering limitations due to heterogeneity in follow-ups, distribution of techniques analyzed, and different study designs. Registration in PROSPERO (International prospective register of systematic reviews) was performed with ID CRD420251085823.<\/jats:p>","DOI":"10.3390\/dj13100477","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T11:39:34Z","timestamp":1760701174000},"page":"477","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Modified Coronally Advanced Flaps: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1313-4986","authenticated-orcid":false,"given":"Miriana","family":"Gualtieri","sequence":"first","affiliation":[{"name":"Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9761-4046","authenticated-orcid":false,"given":"Annarita","family":"Signoriello","sequence":"additional","affiliation":[{"name":"Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6466-9825","authenticated-orcid":false,"given":"Alessia","family":"Pardo","sequence":"additional","affiliation":[{"name":"Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana Andreea","family":"Muresan","sequence":"additional","affiliation":[{"name":"Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1582-6476","authenticated-orcid":false,"given":"Alessandro","family":"Zangani","sequence":"additional","affiliation":[{"name":"Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5043-8578","authenticated-orcid":false,"given":"Paolo","family":"Faccioni","sequence":"additional","affiliation":[{"name":"Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2068-0053","authenticated-orcid":false,"given":"Giovanni","family":"Corrocher","sequence":"additional","affiliation":[{"name":"Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3677-6831","authenticated-orcid":false,"given":"Giorgio","family":"Lombardo","sequence":"additional","affiliation":[{"name":"Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1034\/j.1600-0757.2001.027001072.x","article-title":"The use of free gingival grafts for aesthetic purposes","volume":"27","author":"Camargo","year":"2001","journal-title":"Periodontol. 2000"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1902\/annals.1996.1.1.671","article-title":"Mucogingival therapy","volume":"1","year":"1996","journal-title":"Ann. Periodontol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1111\/j.1600-051X.2008.01267.x","article-title":"Treatment of gingival recession with coronally advanced flap procedures: A systematic review","volume":"35","author":"Cairo","year":"2008","journal-title":"J. Clin. Periodontol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1111\/jcpe.12114","article-title":"Patient perceptions of buccal gingival recessions and requests for treatment","volume":"40","author":"Nieri","year":"2013","journal-title":"J. Clin. Periodontol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1902\/jop.1992.63.6.489","article-title":"The natural history of periodontal disease in man: Prevalence, severity, and extent of gingival recession","volume":"63","author":"Anerud","year":"1992","journal-title":"J. Periodontol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1097\/MBC.0000000000000928","article-title":"Periodontitis, coronary heart disease and myocardial infarction: Treat one, benefit all","volume":"31","author":"Nocini","year":"2020","journal-title":"Blood Coagul. Fibrinolysis"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"10","DOI":"10.21037\/jphe.2020.03.01","article-title":"Periodontal disease: The portrait of an epidemic","volume":"4","author":"Nocini","year":"2020","journal-title":"J. Public Health Emerg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1902\/jop.2002.73.1.110","article-title":"Viral etiology of gingival recession. A case report","volume":"73","author":"Prato","year":"2002","journal-title":"J. Periodontol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1902\/jop.1984.55.12.713","article-title":"The toothbrush and gingival traumatic injury","volume":"55","author":"Smukler","year":"1984","journal-title":"J. Periodontol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1111\/j.1601-5037.2008.00348.x","article-title":"Gingival recession: Epidemiology and risk indicators in a university dental hospital in Turkey","volume":"7","author":"Toker","year":"2009","journal-title":"Int. J. Dent. Hyg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1111\/j.1600-051X.1991.tb01124.x","article-title":"Periodontal characteristics in individuals with varying form of the upper central incisors","volume":"18","author":"Olsson","year":"1991","journal-title":"J. Clin. Periodontol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1902\/jop.1980.51.2.74","article-title":"Gingival recession in the lower incisor region of 15-year-old subjects","volume":"51","author":"Stoner","year":"1980","journal-title":"J. Periodontol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1111\/j.1600-051X.1984.tb00837.x","article-title":"Recession in sites with inadequate width of the keratinized gingiva. An experimental study in the dog","volume":"11","author":"Ericsson","year":"1984","journal-title":"J. Clin. Periodontol."},{"key":"ref_14","first-page":"30","article-title":"The effect of restorative margins on the postsurgical development and nature of the periodontium. Part I","volume":"5","author":"Fugazzoto","year":"1985","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1111\/j.1600-051X.1987.tb00954.x","article-title":"Some periodontal tissue reactions to orthodontic tooth movement in monkeys","volume":"14","author":"Lindhe","year":"1987","journal-title":"J. Clin. Periodontol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"6.e1","DOI":"10.1016\/j.ajodo.2006.01.015","article-title":"Periodontal status of mandibular central incisors after orthodontic proclination in adults","volume":"130","author":"Yared","year":"2006","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_17","first-page":"505","article-title":"Gingival recessions caused by lip piercing: Case report","volume":"69","author":"Chambrone","year":"2003","journal-title":"J. Can. Dent. Assoc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S63","DOI":"10.1111\/jcpe.12172","article-title":"Efficacy of periodontal plastic procedures in the treatment of multiple gingival recessions","volume":"41","author":"Graziani","year":"2014","journal-title":"J. Clin. Periodontol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S44","DOI":"10.1111\/jcpe.12182","article-title":"Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review","volume":"41","author":"Cairo","year":"2014","journal-title":"J. Clin. Periodontol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.1002\/JPER.22-0075","article-title":"Efficacy of biologics in root coverage and gingival augmentation therapy: An American Academy of Periodontology best evidence systematic review and network meta-analysis","volume":"93","author":"Chambrone","year":"2022","journal-title":"J. Periodontol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1002\/JPER.18-0066","article-title":"Efficacy of tunnel technique in the treatment of localized and multiple gingival recessions: A systematic review and meta-analysis","volume":"89","author":"Tavelli","year":"2018","journal-title":"J. Periodontol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Toledano-Osorio, M., Mu\u00f1oz-Soto, E., Toledano, M., Vallecillo-Rivas, M., Vallecillo, C., Ramos-Garc\u00eda, P., and Osorio, R. (2022). Treating Gingival Recessions Using Coronally Advanced Flap or Tunnel Techniques with Autografts or Polymeric Substitutes: A Systematic Review and Meta-Analysis. Polymers, 14.","DOI":"10.3390\/polym14071453"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3395","DOI":"10.1007\/s00784-020-03547-3","article-title":"Effectiveness of connective tissue graft substitutes for the treatment of gingival recessions compared with coronally advanced flap: A network meta-analysis","volume":"24","author":"Moraschini","year":"2020","journal-title":"Clin. Oral Investig."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1002\/JPER.22-0167","article-title":"Does the subepithelial connective tissue graft in conjunction with a coronally advanced flap remain as the gold standard therapy for the treatment of single gingival recession defects? A systematic review and network meta-analysis","volume":"93","author":"Chambrone","year":"2022","journal-title":"J. Periodontol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1177\/0022034519867071","article-title":"The Effect of Time on Root Coverage Outcomes: A Network Meta-analysis","volume":"98","author":"Tavelli","year":"2019","journal-title":"J. Dent. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1080\/00016357.2021.1908594","article-title":"Efficacy of modified coronally advanced flap in the treatment of multiple adjacent gingival recessions: A systematic review and meta-analysis","volume":"79","author":"Bhatia","year":"2021","journal-title":"Acta Odontol. Scand."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1902\/jop.2000.71.9.1506","article-title":"Treatment of multiple recession-type defects in patients with esthetic demands","volume":"71","author":"Zucchelli","year":"2000","journal-title":"J. Periodontol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1034\/j.1600-051X.2003.00397.x","article-title":"Bilaminar techniques for the treatment of recession-type defects. A comparative clinical study","volume":"30","author":"Zucchelli","year":"2003","journal-title":"J. Clin. Periodontol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1901","DOI":"10.1902\/jop.2006.050450","article-title":"Modified coronally advanced flap associated with a subepithelial connective tissue graft for the treatment of adjacent multiple gingival recessions","volume":"77","author":"Carvalho","year":"2006","journal-title":"J. Periodontol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1111\/jcpe.13174","article-title":"Coronally advanced flap and envelope type of flap plus acellular dermal matrix graft for the treatment of thin phenotype multiple recession defects. A randomized clinical trial","volume":"46","author":"Ahmedbeyli","year":"2019","journal-title":"J. Clin. Periodontol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1002\/JPER.22-0516","article-title":"Multiple gingival recessions associated with non-carious cervical lesions treated by partial restoration and modified coronally advanced flap with either connective tissue graft or xenogeneic acellular dermal matrix: A randomized clinical trial","volume":"94","author":"Santamaria","year":"2023","journal-title":"J. Periodontol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"6919","DOI":"10.1007\/s00784-021-03982-w","article-title":"Comparison between a xenogeneic dermal matrix and connective tissue graft for the treatment of multiple adjacent gingival recessions: A randomized controlled clinical trial","volume":"25","author":"Duarte","year":"2021","journal-title":"Clin. Oral Investig."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1111\/jerd.12547","article-title":"Coronally advanced flap with connective tissue graft or xenogeneic acellular dermal matrix in the treatment of multiple gingival recessions: A split-mouth randomized clinical trial","volume":"32","author":"Nizam","year":"2020","journal-title":"J. Esthet. Restor. Dent."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"4077","DOI":"10.1007\/s00784-020-03280-x","article-title":"Root coverage using coronally advanced flap with porcine-derived acellular dermal matrix or subepithelial connective tissue graft: A randomized controlled clinical trial","volume":"24","author":"Suzuki","year":"2020","journal-title":"Clin. Oral Investig."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"265","DOI":"10.11607\/prd.2741","article-title":"The Use of Platelet-Rich Fibrin Versus Subepithelial Connective Tissue Graft in Treatment of Multiple Gingival Recessions: A Randomized Clinical Trial","volume":"37","year":"2017","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e123","DOI":"10.1590\/1807-3107bor-2019.vol33.0123","article-title":"Treatment of multiple recessions with collagen matrix versus connective tissue: A randomized clinical trial","volume":"33","author":"Nahas","year":"2020","journal-title":"Braz. Oral Res."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"De Santis, D., Luciano, U., Pancera, P., Castegnaro, G., Alberti, C., and Gelpi, F. (2022). A New Matrix for Soft Tissue Management. J. Clin. Med., 11.","DOI":"10.3390\/jcm11154486"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1902\/jop.2009.080253","article-title":"Clinical evaluation of a modified coronally advanced flap alone or in combination with a platelet-rich fibrin membrane for the treatment of adjacent multiple gingival recessions: A 6-month study","volume":"80","author":"Aroca","year":"2009","journal-title":"J. Periodontol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e12340","DOI":"10.1111\/jicd.12340","article-title":"Treatment of gingival recession using a coronally-advanced flap procedure with or without placental membrane","volume":"9","author":"George","year":"2018","journal-title":"J. Investig. Clin. Dent."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Rojas, M.A., Marini, L., Sahrmann, P., and Pilloni, A. (2022). Hyaluronic Acid as an Adjunct to Coronally Advanced Flap Procedures for Gingival Recessions: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J. Pers. Med., 12.","DOI":"10.3390\/jpm12091539"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1007\/s00784-018-2537-4","article-title":"Effectiveness of adjunctive hyaluronic acid application in coronally advanced flap in Miller class I single gingival recession sites: A randomized controlled clinical trial","volume":"23","author":"Pilloni","year":"2019","journal-title":"Clin. Oral Investig."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Pardo, A., Magnani, V., Montagna, P., Ala, A., Brancato, G., Melloni, F., Lombardo, G., and De Santis, D. (2025). Clinical, Microbiological, and Biochemical Outcomes of Hyaluronic Acid in Non-Surgical Periodontal Therapy: A Systematic Review and Meta-Analysis. Appl. Sci., 15.","DOI":"10.3390\/app15115975"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1111\/jerd.12418","article-title":"Comparison of minimally invasive coronally advanced flap and modified coronally advanced flap for the management of multiple adjacent gingival recession defects: A split mouth randomized control trial","volume":"30","author":"Rajendran","year":"2018","journal-title":"J. Esthet. Restor. Dent."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"544","DOI":"10.4103\/0976-237X.194121","article-title":"Modified coronally advanced flap with and without orthodontic button application in management of multiple proximate gingival recession defects: A randomized clinical trial","volume":"7","author":"Khobragade","year":"2016","journal-title":"Contemp. Clin. Dent."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"87","DOI":"10.4103\/1735-3327.359324","article-title":"Effect of microsurgical technique for root coverage using modified coronally advanced flap with connective tissue graft- Randomized controlled clinical trial","volume":"19","author":"Savithri","year":"2022","journal-title":"Dent. Res. J."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1016\/j.jclinepi.2009.06.005","article-title":"Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement","volume":"62","author":"Moher","year":"2009","journal-title":"J. Clin. Epidemiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"121","DOI":"10.3163\/1536-5050.100.2.010","article-title":"Comparing patient characteristics, type of intervention, control, and outcome (PICO) queries with unguided searching: A randomized controlled crossover trial","volume":"100","author":"Hoogendam","year":"2012","journal-title":"J. Med. Libr. Assoc."},{"key":"ref_48","first-page":"8","article-title":"A classification of marginal tissue recession","volume":"5","author":"Miller","year":"1985","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1111\/j.1600-051X.2011.01732.x","article-title":"The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: An explorative and reliability study","volume":"38","author":"Cairo","year":"2011","journal-title":"J. Clin. Periodontol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1111\/jerd.12986","article-title":"Splith mouth randomized control trial comparison of T-PRF and subepithelial connective tissue graft in the treatment of maxillar multiple gingival recessions","volume":"35","year":"2023","journal-title":"J. Esthet. Restor. Dent."},{"key":"ref_51","first-page":"1","article-title":"Use of Mucograft Collagen Matrix","volume":"17","author":"Rokn","year":"2020","journal-title":"Front. Dent."},{"key":"ref_52","first-page":"381","article-title":"Comparison of enamel matrix derivative (Emdogain) and subepithelial connective tissue graft for root coverage in patients with multiple gingival recession defects: A randomized controlled clinical study","volume":"48","author":"Alexiou","year":"2017","journal-title":"Quintessence Int."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Fern\u00e1ndez-Jim\u00e9nez, A., Garc\u00eda-De-La-Fuente, A.M., Estefan\u00eda-Fresco, R., Marichalar-Mendia, X., Aguirre-Urizar, J.M., and Aguirre-Zorzano, L.A. (2021). Complete root coverage in the treatment of Miller class III or RT2 gingival recessions: A systematic review and meta-analysis. BMC Oral Health, 21.","DOI":"10.1186\/s12903-021-01494-3"},{"key":"ref_54","first-page":"655","article-title":"Critical Evaluation of Complete Root Coverage as a Successful Endpoint of Treatment for Gingival Recessions","volume":"35","author":"Magnani","year":"2015","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1902\/jop.2009.080565","article-title":"Root coverage esthetic score: A system to evaluate the esthetic outcome of the treatment of gingival recession through evaluation of clinical cases","volume":"80","author":"Cairo","year":"2009","journal-title":"J. Periodontol."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"S\u00f8rdahl, A.J., and Verket, A. (2022). Patient and professional use of the root coverage esthetic score (RES) and how it relates to patient satisfaction following periodontal plastic surgery. BMC Oral Health, 22.","DOI":"10.1186\/s12903-022-02326-8"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1002\/JPER.17-0556","article-title":"The root coverage esthetic score: Intra-examiner reliability among dental students and dental faculty","volume":"89","author":"Isaia","year":"2018","journal-title":"J. Periodontol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e20190236","DOI":"10.1590\/1678-7757-2019-0236","article-title":"Gingival recession treatment with concentrated growth factor membrane: A comparative clinical trial","volume":"28","author":"Akcan","year":"2020","journal-title":"J. Appl. Oral Sci."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1902\/jop.2011.110215","article-title":"Treatment of gingival recession defects using coronally advanced flap with a porcine collagen matrix compared to coronally advanced flap with connective tissue graft: A randomized controlled clinical trial","volume":"83","author":"Cardaropoli","year":"2012","journal-title":"J. Periodontol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"265","DOI":"10.5051\/jpis.2204100205","article-title":"Clinical evaluation of root coverage in Miller class III\/RT2 labial gingival recession treated with interdisciplinary periodontal-orthodontic therapy: A randomized controlled clinical trial","volume":"54","author":"Malhotra","year":"2024","journal-title":"J. Periodontal Implant. Sci."},{"key":"ref_61","first-page":"CD007161","article-title":"Root coverage procedures for treating localised and multiple recession-type defects","volume":"10","author":"Chambrone","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1902\/jop.2000.71.2.299","article-title":"Gingival recession treatment: Guided tissue regeneration with bioabsorbable membrane versus connective tissue graft","volume":"71","author":"Tatakis","year":"2000","journal-title":"J. Periodontol."},{"key":"ref_63","unstructured":"(2025, July 01). Chapter 8: Assessing Risk of Bias in a Randomized Trial. Available online: https:\/\/www.cochrane.org\/authors\/handbooks-and-manuals\/handbook\/current\/chapter-08."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1002\/jrsm.1411","article-title":"Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments","volume":"12","author":"McGuinness","year":"2021","journal-title":"Res. Synth. Methods"},{"key":"ref_65","unstructured":"RevMan Web (2025, July 01). The Cochrane Collaboration. Available online: https:\/\/revman.cochrane.org."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.cegh.2018.05.005","article-title":"Interpretation of subgroup analyses in systematic reviews: A tutorial","volume":"7","author":"Richardson","year":"2019","journal-title":"Clin. Epidemiol. Glob. Health"},{"key":"ref_67","unstructured":"(2025, July 01). McMaster University and Evidence Prime, GRADEpro GDT: GRADEpro Guideline Development Tool. Available online: https:\/\/gradepro.org."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1111\/jcpe.12590","article-title":"Clinical efficacy of coronally advanced flap with or without connective tissue graft for the treatment of multiple adjacent gingival recessions in the aesthetic area: A randomized controlled clinical trial","volume":"43","author":"Cairo","year":"2016","journal-title":"J. Clin. Periodontol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"e20170278","DOI":"10.1590\/1678-7757-2017-0278","article-title":"Evaluation of the effect of dose-dependent platelet-rich fibrin membrane on treatment of gingival recession: A randomized, controlled clinical trial","volume":"26","author":"Culhaoglu","year":"2018","journal-title":"J. Appl. Oral Sci."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"5765","DOI":"10.1007\/s00784-021-03879-8","article-title":"Root coverage of multiple gingival recessions treated with coronally advanced flap associated with xenogeneic acellular dermal matrix or connective tissue graft: A 6-month split-mouth controlled and randomized clinical trial","volume":"25","author":"Maluta","year":"2021","journal-title":"Clin. Oral Investig."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1111\/j.1600-051X.2011.01724.x","article-title":"Treatment of multiple gingival recessions using a coronally advanced flap procedure combined with button application","volume":"38","author":"Ozcelik","year":"2011","journal-title":"J. Clin. Periodontol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1002\/JPER.19-0646","article-title":"Clinical and patient-centered outcomes using two types of subepithelial connective tissue grafts: A split-mouth randomized clinical trial","volume":"92","author":"Zangrando","year":"2021","journal-title":"J. Periodontol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1111\/jcpe.13168","article-title":"Adjunctive benefit of a xenogenic collagen matrix associated with coronally advanced flap for the treatment of multiple gingival recessions: A superiority, assessor-blind, randomized clinical trial","volume":"46","author":"Rotundo","year":"2019","journal-title":"J. Clin. Periodontol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1111\/jcpe.12224","article-title":"Coronally advanced flap with and without connective tissue graft for the treatment of multiple gingival recessions: A comparative short- and long-term controlled randomized clinical trial","volume":"41","author":"Zucchelli","year":"2014","journal-title":"J. Clin. Periodontol."},{"key":"ref_75","first-page":"545","article-title":"Predictability of surgical techniques used for coverage of multiple adjacent gingival recessions--A systematic review","volume":"43","author":"Alessandri","year":"2012","journal-title":"Quintessence Int."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1111\/odi.15203","article-title":"Collagen Matrix Versus Subepithelial Connective Tissue for Recession Coverage: A Systematic Review","volume":"31","author":"Zangani","year":"2024","journal-title":"Oral Dis."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1111\/jcpe.12256","article-title":"Does the dimension of the graft influence patient morbidity and root coverage outcomes? A randomized controlled clinical trial","volume":"41","author":"Zucchelli","year":"2014","journal-title":"J. Clin. Periodontol."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"D\u2019Ambrosio, F., Caggiano, M., Chiacchio, A., Acerra, A., and Giordano, F. (2024). Palatal Graft Harvesting Site Healing and Pain Management: What Is the Best Choice? An Umbrella Review. Appl. Sci., 14.","DOI":"10.3390\/app14135614"},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Xiang, C., Zhang, L., and Tao, E. (2025). Research progress of enamel matrix derivative on periodontal tissue regeneration: A narrative review. Front. Dent. Med., 6.","DOI":"10.3389\/fdmed.2025.1611402"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1111\/jcpe.13346","article-title":"Aesthetic-And patient-related outcomes following root coverage procedures: A systematic review and network meta-analysis","volume":"47","author":"Cairo","year":"2020","journal-title":"J. Clin. Periodontol."},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Hajibagheri, P., Basirat, M., Tabari-Khomeiran, Z., and Asadi-Aria, A. (2025). The efficacy of platelet-rich fibrin (PRF) in post-extraction hard and soft tissue healing and associated complications: A systematic review and meta-analysis of split-mouth randomized clinical trials. BMC Oral Health, 25.","DOI":"10.1186\/s12903-025-06238-1"},{"key":"ref_82","first-page":"521","article-title":"[The use of platelet concentrates: Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in bone reconstruction prior to dental implant surgery]","volume":"31","author":"Baeyens","year":"2010","journal-title":"Rev. Med. Brux."},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Valenzuela-Mencia, J., and Manzano-Moreno, F.J. (2025). Applications of Platelet-Rich Fibrin (PRF) Membranes Alone or in Combination with Biomimetic Materials in Oral Regeneration: A Narrative Review. Biomimetics, 10.","DOI":"10.3390\/biomimetics10030172"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1007\/s00784-024-06119-x","article-title":"Platelet-rich fibrin application after mandibular third molar extraction: An umbrella review","volume":"29","author":"Yang","year":"2024","journal-title":"Clin. Oral Investig."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1652032","DOI":"10.1155\/2021\/1652032","article-title":"Porcine Acellular Dermal Matrix: An Alternative to Connective Tissue Graft-A Narrative Review","volume":"2021","author":"Dadlani","year":"2021","journal-title":"Int. J. Dent."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1111\/jre.12115","article-title":"In vitro and in vivo characterization of porcine acellular dermal matrix for gingival augmentation procedures","volume":"49","author":"Pabst","year":"2014","journal-title":"J. Periodontal Res."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s10266-014-0186-x","article-title":"Influence of porcine-derived collagen matrix on endothelial progenitor cells: An in vitro study","volume":"104","author":"Pabst","year":"2016","journal-title":"Odontology"},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Papi, P., and Pompa, G. (2018). The Use of a Novel Porcine Derived Acellular Dermal Matrix (Mucoderm) in Peri-Implant Soft Tissue Augmentation: Preliminary Results of a Prospective Pilot Cohort Study. Biomed. Res. Int., 2018.","DOI":"10.1155\/2018\/6406051"},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Rotundo, R., Pancrazi, G.L., Grassi, A., Ceresoli, L., Di Domenico, G.L., and Bonafede, V. (2024). Soft Tissue Substitutes in Periodontal and Peri-Implant Soft Tissue Augmentation: A Systematic Review. 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