Surgical Microscope May Enhance Root Coverage With Subepithelial Connective Tissue Graft: A Randomized-Controlled Clinical Trial Sandro Bittencourt,* E ´ rica Del Peloso Ribeiro,* Enilson A. Sallum, † Francisco H. Nociti Jr., † and Ma ´ rcio Zaffalon Casati † Background: Minimally invasive techniques have broadened the horizons of periodontal plastic surgery to improve treatment outcomes. Thus, the purpose of this clinical trial was to compare root coverage, postoperative morbidity, and esthetic outcomes of subepithelial connective tissue graft (SCTG) technique with or without the use of a surgical microscope in the treatment of gingival recessions. Methods: In this split-mouth study, twenty-four patients with bilateral Miller’s Class I or II buccal gingival recessions ‡2.0 mm in canines or premo- lars were selected. Gingival recessions were randomly designated to receive treatment with SCTG with or without the assistance of the surgical micro- scope (test and control groups, respectively). Clinical parameters evaluated included the following: depth (RH) and width (RW) of the gingival defect, width (WKT) and thickness (TKT) of keratinized tissue, probing depth (PD), and clinical attachment level (CAL). Postoperative morbidity was evaluated by means of an analog visual scale and questionnaire. Patient sat- isfaction was also evaluated with a questionnaire. Descriptive statistics were expressed as mean – SD. Repeated-measures analysis of variance was used for examination of differences regarding PD, CAL, and TKT. The Wilcoxon test was used to detect differences between groups and the Friedman test to detect differences within group regarding WKT, RH, and RW. Results: The average percentages of root coverage for test and control treatments, after 12 months, were 98.0% and 88.3%, respectively (P <0.05). Complete root coverage was achieved in 87.5% and 58.3% of teeth treated in test and control groups, respectively. For all parameters except recession height, there was an improvement in the final examination but without differ- ence between treatments. For the RH, a lower value was found in the test group compared to the control group (P <0.05). In the test group, all patients were satisfied with the esthetics obtained, and 19 patients (79.1%) were sat- isfied in the control group. For postoperative morbidity, 14 patients in each of the two treatment groups did not use analgesics for pain control. Conclusion: Both approaches were capable of producing root coverage; however, use of the surgical microscope was associated with additional clin- ical benefits in the treatment of teeth with gingival recessions. J Periodontol 2012;83:721-730. KEY WORDS Clinical trial; connective tissue; gingival recession; microscopy; split-mouth design; surgical flap. O ne of the objectives of periodontal plas- tic surgery is to obtain root coverage with techniques that ensure good predictability and esthetics. There are several reasons for the indication of a root coverage procedure, such as elimination of biofilm retention areas, control of dentin hypersensitivity, pre- vention of root caries, and enhancing esthetics. 1,2 The knowledge that sub- epithelial connective tissue graft (SCTG) is capable of inducing tissue keratiniza- tion, causing gain in the weight of keratinized tissue (WKT), has encouraged au- thors to develop techniques combining the SCTG with different tissue flap designs. The SCTG can be used in as- sociation with the coronally positioned flap, 3 ‘‘envelope’’ flap, 4 or double papilla flap. 5 This group of techniques raised the predictability of root coverage with SCTG because it increased graft nutrition. Recent systematic reviews 2,6-10 demonstrated * Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil. † Department of Prosthodontics and Periodontics, Division of Periodontics, Piracicaba Dental School, University of Campinas, Piracicaba, Sa ˜o Paolo, Brazil. doi: 10.1902/jop.2011.110202 J Periodontol • June 2012 721