The patient received 600 mg of ibuprofen (paracetamol 1 g in case of allergy) prior to surgery, and chlorhexidine mouthwash 0.2% was provided for 2 min. Patients received local anaesthesia at the donor and recession sites (articaine hydrochloride 7200 mg/1.8 ml, adrenalin 1800 mcg/1.8 ml). CTG harvesting was performed prior to the preparation of the reception site to avoid any bias. The graft dimension was calculated according to the recession dimensions; a minimum of 3 mm of the graft was submerged mesially, distally and apically. The CTG was harvested from the palate with single edge incision and sutured with 4.0 silk. The patient was subsequently assigned randomly to the control (CAF+CTG) or the test group (TUN+CTG).

The plaque accumulation is assessed at baseline, 6 months and 4 years follow-up visits using a 0-1 scoring system, 0 being the the highest value, 1 being the lowest result (0 =No detectible plaque ; 1 = Plaque can be seen by the naked eye)

The bleeding tendency is assessed at baseline, 6 months and 4 years follow-up visits as : 0 No bleeding when a periodontal probe is passed along the gingival margin adjacent to the implant; 1 Isolated bleeding spots visible ; 2 Blood forms a confluent red line on the margin; 3 Heavy or profuse bleeding.

The status of the recession width was recorded at baseline, 6 months and 4 years follow-up visits.

The scale is in mm. More large is it, worst it is Minest large it is, best it is

The gingival thickness was recorded at baseline, 6 months and 4 years follow-up visits.

The scale is in mm. More thick is it, best it is Minest thick it is, worst it is

The status of the keratinised mucosa height was recorded at baseline, 6 months and 4 years follow-up visits.

The scale is in mm. More large is it, best it is Minest large it is, worst it is

The status of the Mean Root Coverage was recorded at 6 months and 4 years follow-up visits.

The scale is in mm. More long it is, best it is Minest long it is, worst it is

(Fürhauser et al., 2005). Patient-related esthetic outcomes were also recorded in a questionnaire using a 0-14 graduated scale (0 being the worst and 14 the best value).