Date of Graduation


Document Type


Degree Type



School of Dentistry



Committee Chair

Gian Pietro Schincaglia

Committee Member

Arif Salman

Committee Member

Matthew S. Bryington


Introduction. Mandibular anterior teeth are most frequently affected by gingival recessions. However, data regarding mucogingival treatment aimed at root coverage in this specific location is limited.

Aim. To systematically review the literature addressing the focused question: “What is the effectiveness, efficacy and efficiency of different surgical approaches on clinical and patient-related outcomes in the treatment of buccal gingival recessions on mandibular anterior teeth?

Material methods. Electronic (Medline, Scopus, and Cochrane databases) and hand literature searches were performed for studies including at least one arm involving the use of pedicle flaps and/or free soft tissue grafts in the treatment of RT1 and RT2 gingival recessions located on the buccal aspects of mandibular centrals, laterals and canines. A Bayesian single-arm network meta-analysis was performed, and a treatment hierarchy of different surgical technique was based on a 3-12-month follow-up.

Results. Sixteen studies, with a total of 23 arms, were included in the quantitative analysis. The greatest mean root coverage is associated with LPF+CTG (91.2%) and TUN+CTG (89.4%), whereas LPF alone, CAF+CTG and FGG showed lower mRC (79.1%, 78.9% and 68.5% respectively). TUN+CTG provides significantly greater mean root coverage compared to CAF+CTG. No difference among the procedures could be observed in terms of keratinized tissue width gain.

Conclusions. Treatment hierarchy generated by an arm-based network meta-analysis model indicated in tunnel and laterally positioned flap, both in combination with connective tissue graft, the greatest results in the treatment of mandibular anterior recessions.