Coronally Advanced Flap Alone or With Connective Tissue Graft in the Treatment of Single Gingival Recession Defects: A Long‐Term Randomized Clinical Trial

Background: Numerous surgical approaches for the treatment of single gingival recession (GR) defects are documented in the literature. The aim of this 5‐year, split mouth–design, randomized clinical trial was to evaluate the effectiveness of coronally advanced flap (CAF) alone versus CAF with connective tissue graft (CAF+CTG) in the treatment of single Miller Class I and II GR defects. Methods: Thirty‐seven patients with 114 bilateral, single Miller Class I and II GR defects were treated with CAF on one side of the mouth and CAF+CTG on the other side. Clinical measurements (GR length [REC], keratinized tissue width [KT], complete root coverage [CRC], and percentage of root coverage [PRC]) were evaluated before surgery and after 6, 12, 24, and 60 months. Results: There was a significant reduction of REC and increase of KT after surgery in both groups. CAF+CTG showed significantly better results for all evaluated clinical parameters in all observed follow‐up periods. Miller Class I defects showed better results in terms of REC, CRC, and PRC, whereas Miller Class II showed better results in KT, both in favor of CAF+CTG. Miller Class I defects showed better results than Miller Class II GR defects regardless of the surgical procedure used. Conclusions: Both surgical procedures were effective in the treatment of single Miller Class I and II GR defects. The CAF+CTG procedure provided better long‐term outcomes (60 months postoperatively) than CAF alone. Long‐term stability of the gingival margin is less predictable for Miller Class II GR defects compared to those of Class I.