Predictor factors for long‐term outcomes stability of coronally advanced flap with or without connective tissue graft in the treatment of single maxillary gingival recessions: 9 years results of a randomized controlled clinical trial

Aim To assess the clinical outcomes 9 years after the surgical treatment of single maxillary gingival recessions and identify predictors for long‐term gingival margin stability. Materials and Methods Twenty‐five gingival recessions (Miller Class I and II ) were randomly treated with Coronally Advanced Flap ( CAF ) plus Connective Tissue Graft ( CTG ) or CAF alone. Outcomes included complete root coverage ( CRC ), recession reduction ( REC ), keratinized tissue ( KT ) gain and dentin hypersensitivity, and were evaluated at 6 months, 1 and 9 years. Multilevel analysis was performed to identify predictors for long‐term gingival margin stability. Results Baseline gingival recession was 2.4 ± 0.8 mm and 2.4 ± 1.0 mm in the CAF  +  CTG and in the CAF ‐treated sites, respectively ( p  =   0.693). The chance to gain and preserve CRC over time is equal to 70% in the CAF  +  CTG group (Relative Risk [ RR ] = 1.70, 95% CI [0.84–3.45]; adjusted RR  = 1.48, 95% CI [0.61–3.62]). Using the CTG , an increase in KT was recorded 9 years after the surgery ( p  =   0.019). An OR of 0.12 ( p  =   0.022) of not achieving CRC was observed in cases with non‐carious cervical lesions (NCCL) compared to cases without NCCL . Conclusion Both treatment modalities demonstrated stability over time. Additional use of CTG provided a greater increase in KT . The presence of NCCL negatively affected CRC and REC.