Efficacy of combined periodontal-restorative treatment versus periodontal treatment alone for gingival recession associated with non-carious cervical lesions: a systematic review and meta-analysis

Abstract Objective Gingival recession (GR) is frequently associated with non-carious cervical lesions (NCCLs), necessitating a combined periodontal and restorative approach for optimal clinical management. This systematic review and meta-analysis compared integrated periodontal-restorative interventions with isolated periodontal treatment for managing GRs linked to NCCLs. Methods A comprehensive search of electronic databases, including PubMed, Cochrane Library, SciELO, Scopus, Web of Science, Embase, OpenAIRE, ProQuest, and Google Scholar, was performed up to December 2025 to identify randomized clinical trials (RCTs) with ≥ 1-year follow-up. We analyzed studies comparing integrated periodontal-restorative interventions against isolated periodontal therapy for NCCL-associated GRs. Risk of bias was assessed using RoB 2.0, while evidence certainty was graded using the GRADE framework. Results Out of 199 screened records, four RCTs were included. Pooled data showed no significant differences between the treatment groups regarding nine periodontal parameters, with the exception of a slight increase in probing depth in the combined therapy groups. Conclusion No statistically significant differences were observed between combined periodontal-restorative treatment and periodontal treatment alone for most clinical, esthetic, and root coverage outcomes in the management of gingival recessions associated with non-carious cervical lesions. The combined approach was associated with a significant reduction in dentin sensitivity and a statistically significant increase in probing depth, although the clinical relevance of the latter finding appears limited because it remained values within healthy periodontal ranges. These findings should be interpreted cautiously due to the low to very low certainty of evidence and the limited number of available randomized clinical trials. Further well-designed multicenter studies are needed to confirm the long-term effects of these interventions.