Restoration of Non-Carious Cervical Lesions and Their Effect on Gingival Recession: A Systematic Review

Abstract

Non-carious cervical lesions (NCCLs) frequently coexist with gingival recession and may compromise 
esthetics, comfort, plaque control, and periodontal stability. The periodontal implications of restoring NCCLs, 
such as its influences on recession outcomes, remain uncertain. To evaluate whether restoring NCCLs influences 
gingival recession and gingival health, and to explore whether different restorative materials lead to different 
periodontal outcomes. This systematic review followed Preferred Reporting Items for Systematic Reviews 
and Meta-Analyses 2020 guidance. Randomized clinical trials assessing NCCL restoration (alone or combined 
with periodontal surgery) and reporting periodontal outcomes were included. Risk of bias was assessed using 
Risk of Bias 2. Eight randomized clinical trials (2008–2021; 241 patients) were included. Materials evaluated 
included resin composite/flowable resin, resin-modified glass ionomer cement, and giomer; several trials also 
used root-coverage procedures, such as coronary advance flap with or without connective tissue graft. Mean 
root coverage commonly ranged from 50% to 97% across groups. Across some of the studies, resin-based 
restorations showed a positive trend in gingival health parameters, suggesting improved marginal conditions 
and plaque control. However, changes in gingival recession itself were inconsistent, and material superiority 
for recession reduction could not be established due to heterogeneity and incomplete outcome reporting in 
some trials. Restoring NCCLs may support better local gingival health, but no restorative material consistently 
improves gingival recession outcomes.