Periodontal plastic surgery: surgical technique and operator experience as determinants of successful outcomes – narrative review

Background: There are varied surgical techniques employed for root coverage of gingival recessions. Factors that may influence the outcome of root-coverage surgery include surgical/technical elements, such as the surgeon’s clinical experience, flap tension, and root surface preparation techniques. Objective: The aim of this study was thus to describe and analyze the influence of factors related to surgical technique and operator experience on the success of periodontal plastic surgery as reported in literature. Material and methods: the Pubmed and Google Scholar databases were searched using the keywords “periodontium” or “gingival recession” and “surgical flaps” or “plastic surgery”. Some references in selected studies were also included. Results: A total of 29,704 studies were found. The most relevant studies in English were selected after reading the title and the abstract. Forty-six studies were read in full and relevant articles referenced were also designated for full reading. Thirty studies were eventually included in the review. Conclusion: The surgical technic and the operator experience may influence the outcome of root-coverage surgery. All root-coverage surgery techniques significantly increase gingival recession-depth reduction and concomitant clinical attachment-level gain. A conjunctive tissue graft (CTG), adjunct to the flap, seems to have the greatest level of predictability regarding the root-coverage recessions.