Comparison of volume-stable collagen matrix, platelet-rich fibrin, and subepithelial connective tissue graft in the treatment of multiple adjacent gingival recessions: A parallel-group, randomized, controlled clinical trial

Objective: This study aimed to evaluate the clinical effects of volume-stable collagen matrix (VCMX) combined with a coronally advanced flap (CAF) in the treatment of multiple gingival recessions, comparing it with subepithelial connective tissue graft (SCTG) and platelet-rich fibrin (PRF), both combined with CAF. Materials and Methods: The study was conducted on 60 systemically healthy individuals with Miller Class I and II multiple adjacent gingival recession defects in the maxilla, totaling 174 recession sites. Participants were randomized into three parallel groups of 20 patients each. The test group received CAF+VCMX, while the control groups received CAF+SCTG or CAF+PRF. Clinical parameters, including plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), recession depth (RD), recession width (RW), gingival thickness (GT) and keratinized tissue width (KTW) were recorded at baseline, 6 months, and 12 months postoperatively. Aesthetic satisfaction and hypersensitivity scores were assessed at 6 and 12 months. Postoperative pain levels and analgesic use were recorded for the day of surgery and the first 10 days postoperatively. Results: Complete root coverage (CRC) and partial root coverage (PRC) percentages were significantly higher in the SCTG group compared to both the VCMX (p<0.001) and PRF (p=0.002) groups at 6 and 12 months. All three groups showed significant CAL gain (p<0.001), reductions in RD (p<0.001) and RW (p<0.001) at both 6 and 12 months compared to baseline. An increase in KTW was observed only in the SCTG group (p=0.005). The SCTG group was significantly superior to the VCMX group in terms of CAL gain (p<0.001), KTW increase (p=0.001) and RW reduction (p=0.001). Additionally, SCTG outperformed both VCMX and PRF in RD reduction (VCMX: p<0.001; PRF: p=0.001) and GT improvement (VCMX: p<0.001; PRF: p=0.001). The PRF group showed a significant advantage over the VCMX group in RW reduction (p=0.002). No statistically significant differences were found among the groups in terms of patient-reported aesthetic outcomes, hypersensitivity scores, procedure duration, or postoperative pain levels (p>0,05). Conclusion: Although SCTG provided significantly better root coverage compared to the other two groups, the lack of significant clinical differences between PRF and VCMX, combined with the known disadvantages of SCTG, suggests that VCMX is a viable alternative for treating multiple adjacent gingival recessions.