According to Glossary of Periodontal terms (2001), gingival recession is defined as the apical displacement of gingival margin in relation to cement enamel junction. One of the common clinical findings in periodontal disease is gingival recession. The attachment loss is because of the collapse of gingival tissue and destruction of periodontal connective tissue.

Various factors like plaque induced inflammation, trauma, high frenum attachment, traumatic brushing, lack of alveolar bone due to lip and tongue piercing, dehiscence, orthodontic movement, ageing, abnormal tooth position in the dental arch, iatrogenic factors, biologic width violation, smoking and tobacco chewing habits have been suggested as etiological factors for gingival recession. Gingival recession carries with itself not only aesthetic discrepancies but also leads to exposure of root surface. The exposure of root surface is associated with root hypersensitivity, difficulties in achieving optimal plaque control and development of root caries. Therefore, procedures involved in the treatment of gingival recession improve aesthetics by restoring natural tissue blending. These procedures also increase the thickness of soft tissues that facilitate plaque control and prevent periodontal breakdown and development of root caries.

As one of the greatest aesthetic concerns associated with the periodontal tissues is gingival recession, research is going on to find treatment modalities to address all the biological and functional problems. This has led to the development of several new and modified surgical techniques. There are various surgical techniques and their modifications for the treatment of gingival recession. Surgical procedures used in the treatment of recession defects may be categorised as coronally advanced flap, pedicle soft tissue grafting procedures (lateral sliding flap, double papilla flap), coronally repositioned flap and free soft tissue grafting procedures such as epithelialized grafts or subepithelial connective tissue grafts.

SCTG helps in improved long-term stability of complete root coverage (CRC) and it is accepted as the gold standard in the treatment of gingival recessions. However, the requirement of a second surgical site, limited amount of graft, rather low patient tolerance and high complication rates in donor area are the major disadvantages of SCTG. To reduce these disadvantages, barrier membrane, platelet-rich plasma, platelet-rich fibrin, enamel matrix derivatives and graft substitute materials have been used as an alternative to SCTG.

Periodontal connective tissue predominantly consists of type 1 collagen fibres. Thus, researchers developed many different kinds of collagen membranes for using as grafting material using type 1 collagen as the major component. The additional benefits of collagen material is hemostasis, chemotaxis for periodontal fibroblasts, gingival fibroblasts, weak immunogenicity, easy manipulation and ability to augment tissue thickness. Hence, collagen appears as an ideal choice for use in guided tissue regeneration procedures and soft tissue grafting.

Recently, a new xenogeneic collagen membrane (XCM) has been used in periodontal regenerative procedures. It is highly biocompatible and contains purified intact collagen. It has high mechanical strength. Also, it is soft and very drapable, yet repositionable for precise adjustment and placement. It has an additional advantage that it does not stick to instruments. Hence, XCM seems to be a promising soft tissue graft substitute. It is not only less invasive and time saving but also provides unlimited off-the-shelf supply of graft material and has been cleared by U.S. Food and Drug Administration (FDA). Very few studies have been done on the use of XCM for root coverage procedures. Hence, the present research work aims to evaluate and compare SCTG and XCM in the treatment of gingival recession using the modern alteration of coronally advanced tunnel technique.

In our study, we aim to evaluate and compare the clinical efficacy of XCM to SCTG in the treatment of Miller’s class I / class II gingival recession.