To assess whether coverage of an untreated or restored carious root lesion with a subepithelial connective tissue graft would provide a predictable, esthetically acceptable result and prevent further caries progression.Twenty-seven teeth from 13 patients with root caries and gingival recessions of 3.4 +/- 0.2 mm (mean +/- SEM) were treated with subepithelial connective tissue grafts. Eighteen teeth had untreated caries, and the other nine had composite or glass-ionomer restorations. The carious dentin and the plastic restorations were removed prior to the surgical procedure. The exposed roots were thoroughly planed and covered by a subepithelial connective graft with no further root treatment or conditioning. The teeth were examined periodically from 1-6 years post-treatment for retention of root surface coverage and presence of carious lesions.The mean root coverage recession left after the treatment was 0.3 +/- 0.1 mm, with coverage of 92.4 +/- 2.4%. Significant differences (P< 0.05) were found between the coverage of roots with carious lesions that had not been restored and those that had restorations removed. However, since the number of teeth with restorations was limited, further study is required to confirm this difference. In 18 cases, complete coverage of the recession was achieved. The results were stable, and no further recessions or recurrent caries were detected.