Clinical efficacy of coronally advanced flap with or without connective tissue graft for the treatment of multiple adjacent gingival recessions in the aesthetic area: a randomized controlled clinical trial

Background: The aim of this study was to assess the clinical efficacy of coronally advanced flap (CAF) with or without connective tissue graft (CTG) for the treatment of multiple adjacent gingival recessions in the upper arch. Material and Methods: Thirty-two patients with a total of 74 gingival recessions were randomly allocated to the two groups. Outcome measures, collected by a blind examiner, included complete root coverage (CRC), recession reduction (RecRed), keratinized tissue (KT) gain, increase in gingival thickness (GT), patient satisfaction and root coverage esthetic score (RES). Results: An interaction between treatment and baseline GT was detected. At 1 year, CAF + CTG resulted in better outcomes in terms of CRC (p = 0.0016) and RecRed (p < 0.0001) than CAF alone at sites with thin gingiva (thickness <= 0.8 mm). No difference was found between CAF alone and CAF + CTG at sites with thick gingiva (> 0.8 mm). CAF resulted in higher aesthetic scores (RES) than CAF + CTG at sites with thick gingiva. CAF + CTG was associated with greater KT gain (p < 0.0001) and greater post-operative morbidity (p < 0.0001). Conclusion: Connective tissue graft under CAF results in increased probability of CRC only at sites with thin baseline gingiva. CAF alone is associated with similar clinical outcomes and better aesthetics at sites with thick baseline gingiva.