Evidence-based dentistry · 2026
Coronally advanced flap with platelet-rich fibrin or amniotic membrane for the treatment of gingival recession: a systematic review and meta-analysis with trial sequential analysis.
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Alkabazi Malik, Abou-Bakr Asmaa, Piattelli Adriano, Fernandes Gustavo Vicentis Oliveira, Hassanein Fatma E A
Аннотация
OBJECTIVES: Platelet-rich fibrin (PRF) and Amniotic membrane (AM) have become viable substitute biomaterials to improve coronally advanced flap (CAF) outcomes. The aim of this study was to evaluate the effectiveness of CAF + PRF versus CAF + AM in treating Miller's Class I/II gingival recession (GR).
METHODS: A comprehensive search of six electronic databases was carried out in accordance with PRISMA guidelines. percentage of root coverage (PRC), keratinized gingiva width (KGW), gain gingival thickness (GT), recession depth (RD) reduction, and recession width (RW) reduction were the primary outcomes. clinical attachment level (CAL), plaque index (PI), and probing depth (PD) were secondary outcomes. Random-effects models were used to pool mean differences (MDs) with 95% confidence intervals, and trial sequential analysis (TSA) was performed to examine evidence sufficiency and required information size (RIS).
RESULTS: The qualitative and quantitative synthesis comprised six randomized controlled trials (RCTs) from 2017 to 2025. At 3- and 6-month follow-ups, a meta-analysis showed no statistically significant differences between CAF + PRF and CAF + AM for PRC, CAL, RD, RW, PD, or PI. At three months, there was a statistically significant difference in KGW gain favoring AM (MD = -0.16 mm, 95% CI: -0.27 to -0.06, p = 0.0028). TSA for KGW at 3 months showed that the accumulated evidence has reached the RIS and crossed the trial sequential monitoring boundary for benefit.
CONCLUSION: Within the limitations of a small number of short-term randomized trials, outcome-level risk-of-bias concerns, and potential unit-of-analysis issues, current evidence suggests that CAF combined with PRF or AM yields comparable clinical outcomes for the treatment of gingival recession. Although a statistically significant advantage in KGW was observed for AM at 3 months, this difference is unlikely to be clinically meaningful and was not sustained over time.
METHODS: A comprehensive search of six electronic databases was carried out in accordance with PRISMA guidelines. percentage of root coverage (PRC), keratinized gingiva width (KGW), gain gingival thickness (GT), recession depth (RD) reduction, and recession width (RW) reduction were the primary outcomes. clinical attachment level (CAL), plaque index (PI), and probing depth (PD) were secondary outcomes. Random-effects models were used to pool mean differences (MDs) with 95% confidence intervals, and trial sequential analysis (TSA) was performed to examine evidence sufficiency and required information size (RIS).
RESULTS: The qualitative and quantitative synthesis comprised six randomized controlled trials (RCTs) from 2017 to 2025. At 3- and 6-month follow-ups, a meta-analysis showed no statistically significant differences between CAF + PRF and CAF + AM for PRC, CAL, RD, RW, PD, or PI. At three months, there was a statistically significant difference in KGW gain favoring AM (MD = -0.16 mm, 95% CI: -0.27 to -0.06, p = 0.0028). TSA for KGW at 3 months showed that the accumulated evidence has reached the RIS and crossed the trial sequential monitoring boundary for benefit.
CONCLUSION: Within the limitations of a small number of short-term randomized trials, outcome-level risk-of-bias concerns, and potential unit-of-analysis issues, current evidence suggests that CAF combined with PRF or AM yields comparable clinical outcomes for the treatment of gingival recession. Although a statistically significant advantage in KGW was observed for AM at 3 months, this difference is unlikely to be clinically meaningful and was not sustained over time.