The prevalence of dentine hypersensitivity is estimated to be around 11.5% (Dental Elf – 23rd Jan 2019) and a wide range of treatments have been tested most of which demonstrate efficacy (Dental Elf – 24th Sep 2019). Gingival recession is a predisposing factor for dentine hypersensitivity (DH) and is estimated to be present in 50% of adults aged between 18-64 and 88% of those over 65. Surgical root coverage (RC) is used in the management of recession and may also reduce DH.
The aim of this review was to assess the effect of surgical root coverage (RC) on dentine hypersensitivity associated with gingival recession.
Methods
A protocol for the review was registered on PROSPERO. Searches were conducted in the Cochrane Library, Medline/PubMed, Embase, Web of Science, Dentistry & Oral Sciences Source (DOSS), ScienceDirect, and ClinicalTrials.gov databases with no language restrictions. This was supplemented by manual searches in the Journals, Journal of Clinical Periodontology, Journal of Periodontology, Journal of Periodontal Research, Journal of Dental Research, and Journal of Dentistry. Only Randomised controlled trials (RCTs) published between January 2000 and March 2022 were considered. Two reviewers independently selected studies, abstracted data and assessed risk of bias using the Cochrane RoB2 tool. Disagreements were resolved with a third reviewer if required. The primary outcome was the proportion of patients with a DH suppression (percentage of patients initially affected by DH and who were DH-free after surgical RC procedure) A random effects meta-analysis was conducted together with sub-group analyses of different types of surgical RC procedures.
Results
- 13 RCTs (11 parallel group, 2 split mouth) involving 701 patients and 1086 recessions were included.
- Follow up ranged from 6 to 12 months
- Maxillary recessions with no loss of inter-proximal attachment (Miller classes I and II, RT1) were the most common gingival recessions treated.
- 11 RCTs were considered to be at low risk of bias with some concerns for 2 studies.
- 459 patients reported DH at baseline
- Meta-analysis (13 studies) showed DH suppression = 70.8% (95%CI; 64.4% to 76.6%).
Conclusions
The authors concluded: –
Surgical root coverage (RC) techniques are associated with a dentine hypersensitivity (DH) suppression of 70.8 (95% CI [64.4–76.6]; I2 = 39.2% [3.5–61.8], Q-test = 0.02) and are therefore a relevant treatment for the management of DH associated with gingival recession and improvement of patients’ quality of life. However, clinicians should be aware that DH may persist in roughly one-third of cases after surgical RC procedures and should consider other treatment options, or possibly re-operation, if periodontal parameters can be improved.
Comments
The review protocol was pre-registered, and a good range of databases and other sources searched. 13 RCTs were included with the majority (8) having fewer than 40 patients although 11 of the studies were considered to be at low risk of bias. However, as the authors noted dentine hypersensitivity was only assessed as a secondary outcome in the included studies. Subgroup analyses were conducted for different surgical RC procedures, but the number of studies and patients included in these were small. A broad range of non-surgical treatments for dentine hypersensitivity have been tested and those involving active agents have all reduced hypersensitivity (Dental Elf – 24th Sep 2019).
Links
Primary Paper
Antezack A, Ohanessian R, Sadowski C, Faure-Brac M, Brincat A, Etchecopar-Etchart D, Monnet-Corti V. Effectiveness of surgical root coverage on dentine hypersensitivity: A systematic review and meta-analysis. J Clin Periodontol. 2022 May 30. doi: 10.1111/jcpe.13664. Epub ahead of print. PMID: 35634650.
Other references
Dental Elf – 23rd Jan 2019
Dental Elf – 24th Sep 2019
Dental Elf – Dental Hypersensitivity blogs
Picture Credits
By Bedrock Person – My teeth Previously published: n/a, CC BY-SA 4.0.
