Weak evidence shows no evidence of improved root surface coverage using root surface biomodification agents


It has been suggested that root surface biomodification (RSB) with chemical agents, improves outcomes of periodontal surgery and scaling and root planning. The aim of this review was to determine if RSB has any positive or negative effects when used before root coverage procedures?

Medline and the Cochrane Central Register of Controlled Trials together with a number of periodontal journals for randomised controlled trials conducted on humans. Reference lists of the studies identified in the online and manual searches were also checked. The search was limited to English.

  • Six studies (in total 98 patients, 166 recessions) were included only one od which was rated as good.
  • Citric acid, ethylenediaminetetraacetic acid and laser therapy were used as RSB agents
  • Free gingival graft, subepithelial connective tissue graft plus coronally advanced flap and semilunar coronally respositioned flap were the surgical approaches used.

The authors concluded

RSB provided no additional benefit in terms of the evaluated clinical parameters. Within the limitations of this review, we found no evidence to support the use of RSB prior to root coverage treatment


All of the studies included in this review were relatively small, the largest studies involving just 36 patients. Based on the number of recessions treated many of the patients will also have had more than one and it is not clear from the review whether randomisation of treatment approaches was conducted within the patient in the original studies.  The maximum follow-up period for the included studies was 6-months so while initial post-operative issues will have been identified long-term outcomes cannot be addressed.  A Cochrane review by Chambrone et al was published in 2009 looking at periodontal plastic surgery approaches and there have been other related reviews by the same author.


Oliveira GHC, Muncinelli EAG. Efficacy of Root Surface Biomodification in Root Coverage: A Systematic Review. J Can Dent Assoc 2012;78:c122

Chambrone L, Pannuti CM, Tu YK, Chambrone LA. Evidence-based periodontalplastic surgery. II. An individual data meta-analysis for evaluating factors in achieving complete root coverage. J Periodontol. 2012 Apr;83(4):477-90. doi:10.1902/jop.2011.110382. Epub 2011 Aug 22. Review. PubMed PMID: 21859324.

Chambrone L, Faggion CM Jr, Pannuti CM, Chambrone LA. Evidence-based periodontal plastic surgery: an assessment of quality of systematic reviews in the treatment of recession-type defects. J Clin Periodontol. 2010Dec;37(12):1110-8. doi: 10.1111/j.1600-051X.2010.01634.x. Review. PubMed PMID:21070325.

Chambrone L, Sukekava F, Araújo MG, Pustiglioni FE, Chambrone LA, Lima LA. Root coverage procedures for the treatment of localised recession-type defects. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD007161. doi: 10.1002/14651858.CD007161.pub2. Review. PubMed PMID: 19370675.


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