BACKGROUND This study clinically evaluates the 10-year results of connective tissue graft (CTG) and guided tissue regeneration (GTR) therapies using bioabsorbable barriers for root coverage (i.e., the reduction of recession depth). METHODS In 15 patients, 38 Miller Class I and II recessions were treated. Recession defects received a CTG or GTR by random assignment. At baseline (immediately prior to surgery) and 6 and 120 +/- 12 months after surgery, clinical parameters were obtained. RESULTS Nine patients, who contributed 24 recession defects, were available for re-examination at 120 +/- 12 months. Six and 120 +/- 12 months after receiving a CTG, statistically significant (P <0.05) root coverage was observed compared to baseline root coverage (6 months: 3.07 +/- 1.74 mm; 120 +/- 12 months: 2.07 +/- 1.89 mm). The GTR therapy resulted in statistically significant root coverage compared to baseline root coverage only after 6 months (2.28 +/- 1.77 mm; P <0.05). Both groups experienced a statistically significant loss of coverage from 6 to 120 +/- 12 months (CTG: -1.0 +/- 0.78 mm; GTR: -2.03 +/- 2.24 mm). At 120 +/- 12 months after CTG surgery, the stability of root coverage was statistically significantly better than 120 +/- 12 months after GTR surgery (P = 0.002). The CTG caused more post-surgical discomfort (P <0.05), but it resulted in a better treatment outcome (P <0.05) than GTR as perceived by patients. CONCLUSIONS The long-term stability of root coverage (i.e., the reduction of recession depth) and esthetic results perceived by patients were significantly better 10 years after CTG surgery, statistically, than after GTR surgery using bioabsorbable barriers.