Objectives <p>The current literature about the effect of advanced platelet rich fibrin(A-PRF) with vestibular incision subperiosteal tunnel access (VISTA) technique in treating gingival recession is scarce. Therefore, the aim of the current randomized clinical trial is to evaluate the effect of A-PRF with VISTA technique in the treatment of Cairo class 1 gingival recession (RT1).</p> Methods <p>Twenty-four patients who met the eligibility criteria were randomly allocated into two groups. VISTA + A-PRF was the treatment of the study group, while VISTA + collagen matrix was performed for the control group. The clinical outcomes were assessed by a single-blind assessor at baseline, three months, and six months. They were divided into primary and secondary outcomes. The primary outcomes included recession depth (RD), recession width (RW), gingival thickness (GT), mean of root coverage % (MRC%), and width of attached gingiva (WAG) while the secondary outcome included clinical attachment level (CAL).</p> Results <p>The primary outcomes analysis demonstrated statistically significant improvements in RD, RW, MRC%, GT, and WAG after 3 and 6&#xa0;months in both groups (<i>p</i> &lt; 0.001). However, the study group demonstrated a significantly greater improvement than the control group in RD, RW, and MRC%. No significant differences were observed between the two groups regarding GT and WAG.</p> Conclusions <p>Both treatment approaches were effective in the treating of RT1 adjacent gingival recessions. A-PRF showed promising results compared to collagen matrix.</p> Trial registration <p>The current randomized clinical trial was registered at ClinicalTrials.gov (Registration number: NCT06357351) and it was released on 10/04/2024.</p>