Patient-Reported Outcomes After Multiple Recession Coverage with Modified Coronally Advanced Tunnel Technique and Bilaminar Subepithelial Connective Tissue Graft: A Retrospective Analysis

Background: Patient-reported outcome measures (PROMs) complement clinician-assessed endpoints by capturing pain, swelling, functional limitations, and satisfaction from the patient perspective after periodontal plastic surgery. This study compared PROMs after coronally advanced tunnel (MCAT) with a subepithelial connective tissue graft (SCTG) combined with different adjunctive biomaterials. Methods: In this retrospective comparative cohort study, 64 consecutively treated patients (275 gingival recession defects) underwent MCAT + SCTG physiological saline with one of three adjuncts: 24% EDTA, enamel matrix derivative (EMD) or cross-linked hyaluronic acid (HA). PROMs included pain and swelling assessed on a 0–100 mm visual analogue scale (VAS) and binary symptom items on postoperative days 1, 2, 4, 7, and 14, as well as patient satisfaction and willingness to recommend the procedure. Clinical and professional esthetic outcomes (Root Coverage Esthetic Score, RES) were assessed at 12 months. Results: In 64 patients (275 recession defects), all treatments (EMD, EDTA, HA and SCTG + saline) produced significant reductions in recession height and width at 12 months (p < 0.0001), with no intergroup differences in mean or complete root coverage. CAL improved in all groups, with a significantly greater gain in the HA group (p = 0.0183). Early postoperative pain and edema differed between groups, while patient-reported satisfaction was high in all groups. Professional esthetic outcomes were generally favorable, with significant intergroup differences for several esthetic parameters and the overall esthetic score. Conclusions: MCAT + SCTG provided predictable root coverage across adjunctive approaches; however, PROMs identified clinically meaningful differences in short-term patient morbidity. Incorporating PROMs alongside clinician-reported outcomes enables a more comprehensive, patient-centered assessment of treatment success.