Comparative Clinical Evaluation of Trapezoidal, Envelope, and Tunnel Type Coronally Advanced Flap in the Treatment of Gingival Recession: A Network Meta-Analysis of Randomized Clinical Trials

This study evaluated the efficacy of trapezoidal coronally advanced flap (tCAF), envelope coronally advanced flap (eCAF), and coronally advanced tunnel flap (TUN) in treating gingival recession (GR) through a network meta-analysis. Eligible articles from the PubMed, Embase, and Cochrane Library databases published up to September 2020 were selected to identify randomized controlled trials (RCTs) on tCAF, eCAF, and TUN treatments. Sample size, treatment time, and outcome measures including complete root coverage (CRC), root coverage esthetic score (RES), and other data were extracted from the article, and integrated analysis was conducted. In total, 10 RCTs met the inclusion criteria, involving 310 patients. Direct meta-analysis showed no significant differences in CRC among the three surgical methods; A significant difference was seen for RES, with TUN worse than tCAF (weighted mean difference: -0.73; 95% CI: -1.44, -0.02; P = .045). The network meta-analysis showed no statistical significance in the cross-comparison of tCAF, eCAF, and TUN. However, eCAF had the most significant effect on improving CRC (SUCRA = 69.2) and RES (SUCRA = 85.0). eCAF has the best prognosis in the treatment of GR, followed by tCAF and TUN. This may influence the surgeon's treatment choice, as eCAF may be more effective in root coverage procedures.