{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T13:11:35Z","timestamp":1787058695393,"version":"build-2736575974"},"reference-count":37,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Gingival recession (GR) is a recognized periodontal condition that can expose the tooth root, imposing aesthetic, functional, and hypersensitivity concerns. We conducted this study to investigate xenogenic soft tissue substitutes as potential alternatives to the gold standard connective tissue graft (CTG) for the treatment of multiple GR. Materials and Methods: This systematic review and meta-analysis adhered to PRISMA guidelines and was registered in PROSPERO. A comprehensive search of PubMed, Web of Science, Scopus, and the Cochrane Library was conducted until October 2025 for randomized controlled trials (RCTs) comparing connective tissue graft (CTG) to xenogeneic substitutes (XCM or P-XADM) for treating multiple gingival recessions. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using the RoB 2 tool, 2019 version. Data were pooled using a random-effects model to calculate mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI) for primary (mean root coverage, MRC; complete root coverage, CRC) and secondary outcomes (clinical attachment level, CAL; keratinized tissue width, KTW; gingival thickness, GT; probing depth, PD). Results: Sixteen RCTs (632 patients, 1878 recessions) were included. At 6 and 12 months, CTG demonstrated a significantly greater MRC than both XCM (MD \u221213.4% and \u221211.05%) and P-XADM (MD \u221211.63% at 12 months). CTG was also superior to XCM in achieving CRC at 6 months (RR = 0.71, 95% CI [0.62 to 0.82]). For secondary outcomes, CTG showed superior gains in CAL and KTW at 12 months compared with both xenogeneic materials. GT was significantly greater in the CTG than in the XCM group in 12 months. No significant differences were found in PD at all time points. Conclusions: CTG continues to have superior clinical outcomes in the treatment of multiple GR. However, xenogenic materials are a promising alternative, particularly when patient comfort and satisfaction are prioritized. Future well-designed trials with larger sample sizes and standardized outcomes are needed to validate their clinical benefits and long-term stability.<\/jats:p>","DOI":"10.3390\/medicina62020366","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T12:05:46Z","timestamp":1770897946000},"page":"366","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparative Effectiveness of Autogenous Connective Tissue Grafts and Xenogeneic Soft Tissue Substitutes for Multiple Gingival Recessions: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8226-6926","authenticated-orcid":false,"given":"Pradeep","family":"Koppolu","sequence":"first","affiliation":[{"name":"Dental School, University of Western Australia, Perth, WA 6009, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5473-9808","authenticated-orcid":false,"given":"Sally Abd-ElMeniem","family":"ElHaddad","sequence":"additional","affiliation":[{"name":"Periodontology and Oral Medicine, Preventive Dental Sciences Department, College of Dentistry, Dar Al Uloom University, Riyadh 13314, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0655-0404","authenticated-orcid":false,"given":"Azza A.","family":"Abushama","sequence":"additional","affiliation":[{"name":"Department of Preventive Dental Sciences (Periodontology), College of Dentistry, Dar Al Uloom University, Riyadh 13314, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Soliman","sequence":"additional","affiliation":[{"name":"Periodontology, Oral Medicine and Oral Diagnosis, Faculty of Dentistry, Qena University, Qena 83523, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8816-1119","authenticated-orcid":false,"given":"Abdelrahman","family":"Afsa","sequence":"additional","affiliation":[{"name":"Independent Researcher, Salmiya 20006, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abrar Hamed","family":"Almutairi","sequence":"additional","affiliation":[{"name":"College of Dentistry, Dar Al Uloom University, Riyadh 13314, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariem S. A.","family":"Youssef","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Cairo University, Cairo 4240310, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferdous","family":"Bukhary","sequence":"additional","affiliation":[{"name":"Preventive Dental Sciences Department, College of Dentistry, Dar Al Uloom University, Riyadh 13314, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0335-4733","authenticated-orcid":false,"given":"Maei Hesham Saleh","family":"Almoallim","sequence":"additional","affiliation":[{"name":"College of Dentistry, Dar Al Uloom University, Riyadh 13314, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Essa Fraih","family":"Alrashidi","sequence":"additional","affiliation":[{"name":"General Dentist, Al Safa Medical Complex, Hail 55425, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2549-3465","authenticated-orcid":false,"given":"Salah A.","family":"Yousief","sequence":"additional","affiliation":[{"name":"Department of Restorative and Prosthetic Dental Sciences, College of Dentistry, Dar Al Uloom University, Riyadh 13313, Saudi Arabia"},{"name":"Department of Crown and Bridge, Faculty of Oral and Dental Medicine, Al Azhar University, Assiut 71524, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"100008","DOI":"10.1016\/j.dentre.2021.100008","article-title":"Gingival Recession and Root Coverage Up to Date, A literature Review","volume":"2","author":"Mostafa","year":"2022","journal-title":"Dent. 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