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

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.

Keywords: Connective tissue; Gingival recession; Microsurgery; Minimally invasive surgical procedures; Plastic surgery; Surgical flaps.