Journal of Periodontology

Background: The purpose of the present study was to evaluate the esthetic outcome using four categories of root-coverage procedures (pedicle soft tissue grafts, non-submerged grafts, submerged grafts, and envelope techniques) and to identify factors associated with esthetic assessment.

Methods: A professional panel of three observers (two periodontists and one control) used a before–after panel scoring system to evaluate the esthetics of 162 root-coverage surgeries. A five-point ordinal scale was used to evaluate the overall esthetic improvement and seven variables that may be considered in the assessment.

Results: The intraobserver agreement of the two trained periodontists for the overall cosmetic assessment was almost perfect (κ = 0.83), and substantial agreement was found between them (κ = 0.68). Good to excellent overall esthetic results were found by the professionals and control in >70% of the surgical procedures. Analysis of variance indicated a statistical difference between the non-submerged grafts category and the three other surgical categories (P <10−3). Multivariate analysis showed that the degree of root coverage was not a significant predictive factor, whereas soft tissue appearance variables and the follow-up were significantly associated with cosmetic assessment.

Conclusions: The present study demonstrated that non-submerged grafts are not recommended in cases of esthetic demand. Future root-coverage trials, basing their justification on esthetics, should include overall qualitative evaluation as the primary variable. The follow-up period should not be <12 months. The before–after panel scoring system is a tool that can be used to evaluate cosmetic outcomes.