Background: The objective of this study was to compare the 24 month results of coronally advanced fl ap + enamel matrix derivates (EMD+CAF) and CAF+ connective tissue graft (CTG+CAF) in the treatment of Miller Class I recession defects.Methods: Twelve patients with bilateral gingival recessions were treated with EMD+CAF or CTG+CAF. Vertical recession depth (VRD), keratinized tissue width (KTW), clinical attachment level (CAL), and clinical probing depth (CPD) were measured preoperatively, 1 and 2 years post surgery. A paired t-test and independent t-test were used to compare differences for the measured characters within and between groups, respectively.Results: After 24 months a signifi cant decrease in VRD was observed in CAF + EMD (3.33±0.30 mm) and CAF + CTG (4.5 ± 0.28 mm) treated sites. There was also a signifi cant increase in KTW (0.83±0.23 mm versus 2.08±0.14 mm in EMD+CAF and CTG+CAF sites, respectively). The gain in CAL was 3.54 ± 0.38 mm and 4.45±0.30 mm in EMD+CAF and CTG+CAF group, respectively. There were signifi cant differences between the treatments for VRD, CAL, and KTW at the end of study.Conclusions: The CTG+CAF procedure seems to provide better long-term results than the EMD+CAF in obtaining root coverage, increasing the KTW and CAL gain.