Effectiveness of restorative materials on combined periodontal-restorative treatment of gingival recession with cervical lesion: A systematic review

Introduction: Gingival recession associated with non-carious cervical lesions (NCCL) is a common finding in the majority of the population. Sometimes, periodontal surgery using connective tissue graft (CTG), which is the gold standard in the treatment of gingival recession, needs to be combined with adhesive restoration to restore sufficient convergence profile. Thus, this systematic review aims to evaluate periodontal-restorative therapy using CTG combined restorative material to treat gingival recession with NCCL. Methods: This study, following PRISMA guidelines, involved a literature search across PubMed, Scopus, Embase, and Google Scholar for articles from 2014 to June 2023 using keywords related to connective tissue grafts, cervical lesions, and gingival recession combined using AND/OR as Boolean operator. It included randomized controlled trials (RCTs), prospective studies, case series, or reports involving adult subjects with gingival recession and non-carious cervical lesions treated with CTG and restorative care, with at least 6 months of follow-up. Data were independently extracted by two reviewers, with discrepancies resolved by consensus. Risk of bias was assessed using the Cochrane RoB 2.0 tool, ROBINS-I, and the JBI Critical Appraisal tool. Results: 8 out of 1175 publications were selected for final analysis. Selected publications consist of randomized clinical trials, prospective studies, case series, and a case report. The restorative materials used include resin composite, resin-modified glass ionomer (RMGI), and giomers. It has been reported that the restoration showed no negative effect on the surrounding gingival tissue after surgical treatment. Resin composites and RMGI showed similar clinical results as restorative materials whereas giomers was reported to be less effective for the combined treatment of gingival recession associated with NCCL. Conclusion: Therefore, the combination of surgical and restorative treatment provides stable clinical outcome and good emergence profile in gingival recession associated with NCCL. Root coverage with CTG is successful on teeth with cervical fillings.