Objective: To compare the therapeutic effects of tunnel minimally invasive technique plus subepithelial connective tissue graft (TUN+CTG) and coronally advanced flap plus subepithelial connective tissue graft (CAF+CTG) in patients with Miller Class III gingival recession. Methods: A total of 26 patients with Miller Class III gingival recession (January 2022 to January 2025) admitted to our hospital were randomly divided into two groups using a random number table: the TUN+CTG group (12 cases, 25 teeth) and the CAF+CTG group (14 cases, 25 teeth). The therapeutic efficacy, clinical parameter improvements before and after treatment, postoperative pain levels (VAS), and follow-up complication rates were compared between the two groups. Results: The efficacy comparison showed no statistically significant difference between the TUN+CTG group and the CAF+CTG group (P>0.05). Before treatment, there were no statistically significant differences in RD, KTW, PD, GT, and RES between the two groups (P>0.05). After 3 and 6 months of treatment, both groups showed improvement, with no statistically significant differences between the TUN+CTG and CAF+CTG groups at 3 months post-treatment (P>0.05). However, at 6 months post-treatment, the RES score in the TUN+CTG group was higher than that in the CAF+CTG group (P<0.05). At 1, 3, and 5 days post-treatment, the VAS scores in the TUN+CTG group were lower than those in the CAF+CTG group (P<0.05), while no statistically significant difference was observed between the two groups at 7 days post-treatment (P>0.05). No statistically significant difference was found in complication rates between the two groups (P>0.05). Conclusion: Both TUN+CTG and CAF+CTG demonstrated equivalent efficacy in root coverage and clinical improvement. However, TUN+CTG exhibited advantages in early postoperative pain control and aesthetics, with fewer complications compared to CAF+CTG.