Efficacy of De‐Epithelialized vs. Subepithelial Grafts in Periodontal Plastic Surgery for Gingival Recession: A Systematic Review and Meta‐Analysis of Root Coverage Techniques

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Abstract
Objectives: To compare the efficacy of de‐epithelialized gingival graft (DGG) versus subepithelial connective tissue grafts (SCTG) for the treatment of RT1 gingival recessions. Materials and Methods: Five databases were searched with no restrictions for randomized clinical trials (RCTs) directly comparing DGG and SCTG for treating RT1 gingival recessions. Primary outcomes were mean recession coverage (mRC) and complete root coverage (CRC%). Secondary outcomes included keratinized tissue width (KTW) gain, clinical attachment level (CAL) gain, probing depth (PD) change, Root Coverage Esthetic Score (RES), and patient‐reported pain/discomfort (PROs). Random‐effects models (REML) with Hartung–Knapp adjustment were used to calculate mean differences (MDs) with 95% confidence intervals (CIs). Results: Six RCTs ( n = 221 patients) were included. No significant difference was observed in mRC (MD = −0.51 mm; 95% CI: −2.06 to 1.03; p = 0.368; I 2 = 95.9%). CRC significantly favored DGG (MD = 4.45%; 95% CI: 1.21–7.69; p = 0.027; I 2 = 0%). Small differences in KTW gain and PD reduction favored DGG, although heterogeneity was substantial for PD change. RES and PROs showed no consistent differences. Conclusions: Both DGG and SCTG are effective for correction of RT1 recessions. DGG showed modest advantages in CRC and PD reduction, while other outcomes were comparable. Clinical Significance: Both de‐epithelialized gingival grafts and subepithelial connective tissue grafts provide predictable root coverage for RT1 gingival recessions. De‐epithelialized grafts may offer a modest advantage in achieving complete root coverage without compromising esthetics or patient comfort, supporting their use as a viable alternative in periodontal plastic surgery.

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