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Background: One of the most common esthetic concerns in dentistry is gingival recession (GR), and despite the various treatment strategies for root coverage, multiple recessions still present a great challenge, especially Miller Class III/RT2. Thus, this study aimed to compare the effect of platelet-rich fibrin (PRF) versus connective tissue graft (CTG) using vestibular incision subperiosteal tunnel access (VISTA) in patients with Miller class III/RT2 multiple recessions for root coverage. Methods: Twenty-eight patients with multiple Class III/RT2 gingival recessions were randomly allocated to two equal groups – group 1 (VISTA+PRF) and group 2 (VISTA+CTG). Recession depth (RD) and width (RW), probing depth (PD), clinical attachment level (CAL), gingival thickness, keratinized tissue width, and root coverage esthetic score (RES) were measured at 0, 3, and 6 months. Statistical analysis was performed using repeated measures analysis of variance (ANOVA). Bonferroni’s post-hoc test was used for pair-wise comparisons when ANOVA was significant. For non-parametric data, the Mann-Whitney U test was used to compare between the two groups. Results: Within each group, a significant difference from baseline to six months was found. However, between groups, the results for the VISTA+CTG group significantly surpassed the VISTA+PRF group in most clinical outcomes; gingival recession depth (0.5 [0.25-1.75] and 1.33 [0.75-2], respectively), and width (1 [0.38-3.75] and 2.33 [1.33-3], respectively), gingival thickness at three and six months (2.62±0.36 and 2.63±0.36, respectively) and (1.85±0.2 and 1.87±0.18, respectively), and keratinized tissue width (3.98±0.72 and 3.33±0.56, respectively). However, CAL and PD showed a statistically insignificant difference when comparing both groups. Conclusion: The use of CTG is superior to PRF in root coverage of Miller Class III/RT2 when the VISTA technique is used. Connective tissue grafts can be considered the gold standard for root coverage.
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