Method: Seventy eight combined defect were treated with one of the following approaches, coronally positioned flap (CAF), CAF plus glass ionomer restoration (CAF+R); tissue graft alone (CTG) CTG plus a glass ionomer restoration (CTG + R). Per-operative and six months, 1 year, and 2 years final pictures of the cases were presented for two pre calibrated examiners that analyzed the esthetic result using RES scale and by Qualitative Cosmetic Evaluation (ACQ) . Age, gender, race, smoking, initial gingival index, and initial plaque index of the patients were tested using logistic and linear regression to evaluated possible association with the final esthetic outcome.
Result: When intra-group analyses were performed the differences were not statistically significant among periods for all the groups. When CAF was compared to CAF+R the differences were not statistically significant and CTG technique was statistically superior when compared to CTG+R. Regarding surgery technique (CAF vs CTG and CAF+R vs CTG+R) the differences between groups were not statistically significant. Using Qualitative Cosmetic Evaluation, the results showed that, after two year of treatment, 60% of the CTG, CAF and CAF+R cases showed excellent or good appearance, and just CTG+R group did not reached more than 50% of the cases showing satisfactory appearance. Regarding to the patient factors, it was observed that the initial plaque index and the full mouth gingival tissue inflammation, were statistically associated with poor esthetic results (P=0,008, R= -0,15 and P=0,04, R= 0,48 respectively)
Conclusion: Within the limits of the present study, all the procedures provide good esthetic outcome. The overall final esthetic outcome may negatively be influenced by the initial plaque index and by gingival index